“Despite the esteem in which they are held, nurses can be sued” Stabler-Haas, 2012. P 170
“Ethics in nursing integrates knowledge with human caring and compassion, while respecting the dignity, self-determination, and worth of all persons (NLN 2010, p.13).
In this chapter, students will be introduced to:
- Legal considerations that impact nursing practice
- Various laws impact the practice of nursing
- Ethical principles that guide nursing practice
Legal Considerations
Laws are created to regulate behaviors, manage crime, and establish business agreements (Hessler, 2021). Healthcare law is a type of law that deals with healthcare and impacts health practitioners' ability to practice, patient rights, quality of care, payment for care, licensure, and malpractice issues (Hessler, 2021). Healthcare law directly impacts nursing practice by guiding actions, regulating behaviors, and controlling licensure. As a new nurse, healthcare law can serve as an invaluable resource to safely guide practice.
Health care law impacts the daily practice of the nurse by regulating actions, providing guidance, and limiting scope of practice. This section introduces various laws that impact nursing practice and ways to protect the nursing license.
Definition and scope
Laws establish rules or principles and either require or prohibit an action (Hessler, 2021). Healthcare law can be defined as “…. specialization in the field of law, which deals with a myriad of aspects of health care, including, but not limited to, the practices of healthcare practitioners and provider entities, the rights of patients, quality of care issues, and requirements of payment for medical and healthcare services (Hessler, 2021, p. 522). Healthcare law also encompasses licensure, certification, and state malpractice issues (Hessler, 2021). The executive, legislative, and judicial branches of the state and federal government are responsible for enforcing healthcare law (Hessler, 2021).
The increasing complexity and technology of today’s healthcare environment, the focus on quality care, and the rise in medical malpractice cases have resulted in an increased focus on healthcare law and evidence-based practice (Hessler, 2021). Nurses who understand legal parameters and standards of care promote safe, evidence-based practice (Potter et al., 2023). As you begin this nursing journey, a solid foundation of evidence-based best practice will prevent encounters with malpractice.
The World Health Organization provides substantial resources for healthcare lawhttps://www.who.int/westernpacific/about/how-we-work/programmes/health-law-and-ethics. In the U.S., laws are created and upheld by the executive, legislative and judicial branches of federal and state governments (Hessler, 2021). The authority to uphold laws is given to agencies that draft more specific rules to support the law, such as the state board of nursing (Hessler, 2021). Several types of law are discussed next.
Constitutional law is derived from federal and state constitutions. These laws include liberty rights and the rights afforded to every citizen (Hessler, 2021; Potter et al., 2023). Examples of constitutional law include a patient's right to refuse treatment (Potter et al., 2023). As a practicing nurse, the involvement of the patient in developing the plan of care will assist in ensuring the patient’s rights and wishes are upheld.
Statutory law is created by federal and state legislatures and includes criminal and civil law (Hessler, 2021; Potter et al., 2023). Criminal law prevents harm to individuals in a society and provides punishment for crimes with two classifications based on severity (Hessler, 2021; Potter et al., 2023). A felony, the first classification, is a more serious crime than a misdemeanor, the second classification (Hessler, 2021). For example, a nurse who parks in a no-parking zone commits a misdemeanor. Civil law protects the rights of individuals within a society and usually involves harm to a person or property. The Nurse Practice Act, which guides the practice of nursing, is an example of a state Civil Law (Potter et al., 202).
Nurse Practice Acts are included within statutory laws. In the U.S., each of the fifty states and territories determines rules and regulations for nursing practice within a Nurse Practice Act written by the state legislature (NCSBN, 2022). The agencies responsible for overseeing the law are the nursing regulatory bodies (NRB) or state boards of nursing (BON) (NCSBN, 2022).
Administrative and Regulatory law grants authority to an agency that enforces statutory rules and regulations. The state boards of nursing (BON) set the educational and licensing requirements for nurses for each state and have the authority to grant, suspend, or revoke licenses (Russell, 2017) The BON holds investigations and hearings regarding disciplinary actions (Potter et al., 2023). Chapter Eight contains more information on the granting and renewing of nursing licenses.
Torts are wrongful acts or omissions that harm another and can lead to civil liability (Hessler, 2021). These acts or omissions can be intentional (on purpose), unintentional (by accident or neglect), or quasi-intentional (gossip or invasion of privacy) (Potter et al., 2023). Assault and battery are two forms of intentional tort. Threatening to restrain, harm, or force compliance are forms of assault. Battery is intentional touching without consent which is offensive or harmful and always includes assault. For example, in assault, the nurse threatens to give an injection that the patient refused, while in battery, the nurse gives the injection (Potter et al., 2023).
Unintentional torts include negligence and malpractice. Negligence occurs when a nurse fails to provide care that a reasonable nurse would give in a similar situation. In other words, the nurse failed to act within the standards of nursing practice, which resulted in patient harm. Malpractice is professional negligence (Potter et al., 202). Malpractice occurs when a patient is injured because the nurse owed a duty but did not carry out the duty, and this failure caused an injury (Potter et al., 2023). In the eyes of the law, damages and remedies are allowed to correct the injury (Potter et al., 2023). Common malpractice causes are failure to follow a standard, failure to communicate, failure to assess, failure to document, and inappropriate delegation (Potter et al., 2023). Examples of malpractice include medication errors, intravenous infiltrations, burns, falls, and failure to use aseptic technique, monitor a condition or notify a provider regarding a change in condition (Potter et al., 2023).
Quasi-intentional torts include invasion of privacy and defamation of character. The right to privacy is a basic right (Potter et al., 2023). All information regarding a patient and his/her healthcare belongs to that patient. Nurses have a legal and ethical responsibility to provide privacy and protect the information. Defamation of character is the spreading of information that damages a person’s reputation. Slander is an oral statement, whereas libel is a written statement that negatively affects a reputation (Potter et al., 2023). For example, a nurse could be charged with slander for spreading a rumor that a patient has a sexually transmitted disease, and this information negatively impacted the patient’s business (Potter et al., 2023).
Attributes, criteria, and context in healthcare
Laws that govern healthcare can be discussed under two major headings: Patient rights and professional nursing responsibilities. For a list of various patient rights, go to https://medlineplus.gov/patientrights.html#cat_51.
Patient rights
Patient rights come in several forms and cover a variety of healthcare issues. Some rights are mandated by federal laws, while other rights are determined by state law (MedlinePlus, 2016). This text combines several sources to discuss commonly recognized patient rights: informed consent, advance directives, right to refuse, confidentiality, access to care, safe environment, and healthcare education.
Informed consent. Laws, policies, and procedures that regulate informed consent mandate that patients must agree to allow something to happen based on full knowledge of benefits, risks, alternatives, and consequences of refusal. Nurses usually work within facilities where patients sign consent forms upon admission that covers standard nursing care. However, physicians and advanced practice nurses are responsible for obtaining separate consents for treatment such as invasive procedures, surgery, and diagnostic procedures. These providers must provide education and specific information about the procedure before a patient signs the consent. The nurse will sometimes witness a patient’s signature on these documents, but nurses are not responsible for obtaining informed consent. If the patient does not understand or is questioning whether to proceed, the nurse must report this concern to the provider responsible for the procedure (Potter et al., 2023).
Age can make a difference, and nurses must know the law. Minors are children considered by state law under the direct care of a parent or guardian. An emancipated minor is freed from control by parents or guardians in a court of law. An example of possible confusion would be a 16-year-old mother who can sign for her infant son’s circumcision but is not allowed to sign for her blood transfusion. As a result, the nurse must know the state laws regarding this situation and the ability to sign a consent (Potter et al., 2023).
Vulnerable persons with disabilities, dementia, or other forms of mental deficit might require another person’s signature on informed consent. Competency is a legal term (not a medical diagnosis) that indicates a person is mentally sound and can safely determine self-care. For example, an older adult with dementia would need a legal declaration of incompetence so that a guardian could sign informed consent for healthcare. Guardians or someone with a “power of attorney for healthcare” are usually selected from family members, but if necessary, a trained volunteer could be appointed by the court (Halter, 2022; Potter et al., 2023).
Advance directives. The Patient Self-Determination Act of 1991 requires facilities to provide written information on the patient's right to make decisions about future healthcare. However, for nurses and other healthcare providers to honor those decisions, a written copy of the advance directives must be in the current medical record. This law also requires healthcare organizations to provide education to staff and the public regarding this right. Advance directives may establish the durable power of attorney for healthcare or be developed as a living will (Hessler, 2021; Potter et al., 2023). Both documents provide details of the patient's wishes if a cardiac or respiratory arrest were to occur, end-of-life care, and may establish the durable power of attorney for healthcare (Potter et al., 2023).
Living will. This document specifies treatment and omission of treatment for selected healthcare issues according to patient wishes. For example, a patient might want to be placed on a ventilator after a car crash, but not at the end of life after chronic illness. Sometimes family members are not in agreement with these wishes, which presents ethical and legal dilemmas. Nurses work through these issues with other healthcare providers, and sometimes courts of law make determinations (Potter et al., 2023).
Durable power of attorney for healthcare. This document identifies someone other than the patient who has the legal authority to make healthcare decisions when the patient is no longer able to choose. Either the patient selects this person before incapacitation, or a court of law determines who serves in this capacity (Potter et al., 2023). For example, a person with a severe, chronic illness might choose one son or daughter as the durable power of attorney for healthcare and a different child as the power of attorney for financial decisions.
Additionally, persons with severe mental illness can prepare an advance directive for mental health care when incapacitated. This written document specifies in detail how the patient prefers to be treated during an episode. These directives usually cover preferred providers, treatment facilities, medications, and designated visitors.
In some states, patients have the right to determine end-of-life care that includes lethal doses of medication. These laws are called “death with dignity” and allow a physician to prescribe medication to hasten death for a terminally ill patient who has less than six months to live. Each state with this law has written safeguards and protocols to protect patients and physician licenses. Oregon was the first state to enact such a law in 1997 (Hessler, 2021).
Right to refuse. The Patient Self-Determination Act of 1991 requires facilities to provide written information concerning rights under state law regarding treatment refusal. Patients who have given prior consent and change their minds have the right to stop any treatment, at any time, and for any reason (Potter et al., 2023). The refusal can be given verbally and/or in writing. The only time a healthcare provider can override a refusal for healthcare is when the patient is in serious and imminent danger of harming themselves or someone else (Halter, 2018). For example, a patient who threatens suicide would be placed on a “suicide watch,” which takes away the right to privacy until the person is no longer a danger to him/herself.
Restraints and seclusion. The right to refuse treatment also relates to the restriction of freedom (Potter et al., 2023). Restraints and seclusion regulations can be traced back to The Omnibus Budget Reconciliation Act (1987) (Potter et al., 2023). Legislation provides strict guidelines for overriding a patient’s right to freedom of movement. Nurses must protect patients and their nursing license by following policies and procedures to protect patients from unnecessary treatment. In addition, nurses must understand the regulations and policies associated with restraint usage (Potter et al., 2023).
Confidentiality. Private patient information must always be protected and is a sacred trust. In 1996, the Health Information Portability and Accountability Act (HIPAA) set clear guidelines for patients and healthcare workers. The law is complex, but a nurse can determine whether information should be disclosed by asking this question: Is there a need to know, a right to know, or a want to know (Hessler, 2021; Potter et al., 2023; Yoder et al., 2019). For example, is the information needed to provide safe care (need)? Is the data something the patient or family has a right to know (right)? Or is the information something a person wants to know but is not needed to provide safe care (want)? Breaches in confidentiality include looking up a neighbor’s health record when the nurse is not caring for that person (want) or placing health information on social media about a patient without consent (right). Nurses must also be careful that computer screens and paper records are out of view of the public and non-clinical staff (Hessler, 2021; Potter et al., 2023; Yoder et al., 2019). When transferring healthcare information through fax or the internet, nurses must follow policies and procedures set by facilities that hold the patient data. Nurses must be aware of the regulations regarding sharing of patient information (Hessler, 2021; Potter et al., 2023; Yoder et al., 2019).
Duty to warn third parties. An exception to confidentiality laws includes the responsibility to warn other persons of potential harm (Halter, 2022). For example, if a patient reports a plan to harm another person, the nurse must report this intention so that the potential victim can be protected. The procedure for reporting varies in each state, so the nurse should know the law and follow facility policies and procedures to report the danger.
Reporting abuse and neglect. Any suspected abuse or neglect of vulnerable persons such as children, disabled persons, or the elderly must be reported through facility channels regardless of confidentiality laws. The nurse has a legal responsibility and must document facts to support the findings. Since state laws vary, nurses should be aware of regulations that mandate reporting.
Access to care. The Patient Protection and Affordable Care Act of 2010 is also known as the Affordable Care Act (ACA). This law expanded access to healthcare for millions of Americans to include mental health in parity with physical care (Halter, 2022; Potter et al., 2023). The law is complex; however, four themes impact nursing care: Consumer rights and protections, affordable healthcare coverage, increased access to care, and stronger Medicare for vulnerable populations. Consumer rights now include a provision that patients cannot be turned away from health insurance due to a pre-existing condition.
Safe environment. Patients have a right to receive care in safe environments. This right includes adequate staffing, infection prevention, reduction of risks, and employees who work within their scope of practice and competencies. Breaches of this right include inadequate staffing which places a patient at risk of abandonment and decreased quality of care; lack of sanitation or aseptic technique which might cause an infection; and equipment failures which result in injury. Additional factors include mandatory overtime, assignments to specialties without adequate training, student employees who practice outside job descriptions, and failure to verify prescriptions that prevent medical errors (Potter et al., 2023).
Professional nursing responsibilities and patient advocacy
Professional malpractice insurance can protect a nurse’s professional well-being and personal finances. Even though most employers provide malpractice insurance, the agency lawyers will represent the facility first and foremost (Potter et al., 2023). It is recommended that registered nurses have a private malpractice policy to pay for costs regarding incidents that occur during work hours and for breaches of the nurse practice act when not working (Potter et al., 2023). Most nursing schools require students to purchase liability insurance as well and will often provide insurance for clinical rotations as part of the student fees.
Good Samaritan Laws. All fifty states and Washington, D.C., have a “good Samaritan” law that protects healthcare professionals or volunteers who assist in emergencies outside of work. However, the details of the law will vary by state or jurisdiction (West & Varacallo, 2022). If the nurse acts within his/her scope of practice and accepted standards, the nurse may be immune from liability. The aid must be given during an emergency as an unpaid volunteer. If a person is conscious, the nurse should ask permission to assist; however, if the person is unconscious, implied consent rules apply (US Legal.com, n.d.). It is important to know what the Good Samaritan Law covers in the state in which the emergency occurs (LawInfo.com, n.d.). In some states, once committed to providing emergency care, the nurse must remain with the person until care is transferred to professionals who can continue care, such as emergency medical personnel. Any nurse who leaves without transferring care could be liable for patient abandonment and injuries that occur after leaving.
Exemplars
The following examples highlight the nurse’s responsibility for adhering to professional standards, healthcare laws, and the code of ethics.
Negligence and malpractice
John Smith an RN with ten years of experience on the medical/surgical unit returned to work after only six hours of sleep and a 16-hour shift the day before. He entered a patient’s room to administer an IV antibiotic without checking the patient’s armband or medical record for allergies. After starting the medication, he did not return to the room for over an hour. The patient was severely allergic to the medication which was listed on the armband and in the medical record. The patient suffered anaphylaxis, a life-threatening reaction that was not discovered in a timely manner. The patient went into cardiac arrest and was placed on life support from which she did not recover.
The nurse omitted standard safety practices, including two of the seven rights of medication administration (right patient, medication, dose, route, time, documentation, reason, and response). The nurse failed to scan the IV bag and patient armband, which would have flagged the allergy. The nurse also did not monitor the patient’s response to the medication. The nurse was terminated from the hospital. The family filed a civil lawsuit and won a settlement of $1,000,000. The state board of nursing suspended the nurse’s license for nine months followed by practice restrictions for two years. The nurse was required to make continuing education presentations to nurses and students on the prevention of medication errors. Later, a criminal complaint charged the nurse with patient abuse and neglect which caused death. A jury found the nurse guilty and sentenced them to two years imprisonment with permanent revocation of their nursing license.
Standards of care (tort)
An intensive care unit nurse was caring for a patient after cardiac catheterization. The nurse failed to monitor pedal pulses and the insertion site which is standard nursing practice after this procedure. The patient developed a hematoma (collection of blood under the skin) at the site, which occluded blood flow to the leg. Normally, nurses are required to check the site and pulses every thirty minutes. However, the nurse made only two rounds in two hours and only checked the pedal pulses. On the last check, the right pulse was absent, and the nurse discovered the large hematoma, so the physician was notified. The patient was rushed to surgery, where the hematoma was evacuated, and blood flow was re-established. Additional information was discovered by the doctor, who reported the nurse to their supervisor. This information included: The patient had complained of pressure at the site for two hours, but this complaint was ignored. The nurse had also documented decreased pedal pulses every thirty minutes but had made rounds only twice and did not inform the physician. The nurse was suspended from work and was required to attend continuing education sessions regarding the critical assessment of patients after cardiac catheterizations and proper legal documentation. This patient could have hemorrhaged and died or lost a leg due to lack of blood flow. Later, the nurse was investigated by the state board of nursing for falsifying medical records. The nurse’s license was suspended for two years so resulting in a loss of income and job placement.
Breach of duty and abandonment
An RN working for a home health agency, had a caseload of 45 patients when only 30-35 patients are the standard for home care nurses. Most of the patients were high acuity which meant that they needed more visits each week to provide adequate nursing care. To cover the heavy assignment, the nurse reduced the number of visits to selected patients – less than their condition required. Due to this negligence, one of the patients missed several doses of medication. The patient was found by a neighbor two weeks after the last nurse visit, who called 911. The patient was semiconscious with a blood pressure of 240/130. After stabilization in the intensive care unit, the patient reported that they had called the home health nurse’s cell phone every day for seven days to come to fill her medication box. The nurse reportedly told the patient that they would be there the next day or the next but did not arrive. The hospital nurse practitioner called the home care agency to find out what had happened before writing discharge orders. The agency supervisor was unaware of the problem and agreed to investigate the situation. The supervisor assigned a different nurse to the case and reported the home health nurse to the corporate office. Meetings were held regarding the consequences of inadequate staffing, and a new policy was initiated. No longer would home care nurses at this agency be assigned more than 35 patients and the acuity levels would be adjusted to insure each nurse could provide safe and high-quality nursing care. The nurse’s caseload was closely supervised for twelve months, and during this probationary period, the nurse was empowered to advocate for high-quality patient care.
Ethical Considerations
Ethics explains ideals that people strive for within the standards of professional practice. When ethics are violated, a nurse can be sanctioned by a professional organization and possibly fired. This section addresses the ethical responsibilities of professional nurses.
Definitions and scope
Ethics deals specifically with elements of right and wrong (Potter et al., 2023). While legal situations are often handled by the law, ethical situations relate to doing the right thing with consideration of individual values, beliefs, and perceptions (Potter et al., 2023). Morals are a judgment about a behavior (Potter et al., 2023). These components work together to form the ethical foundation for decision-making.
The National League for Nursing (NLN) defines ethics as a core value that reflects “consideration of personal, societal, and professional values, principles, and codes that shape nursing practice” (NLN, 2010, p. 13). Nurses who practice ethically act as moral agents when caring for patients, families, and communities and blend nursing knowledge with caring, compassion, dignity, and respect for everyone (NLN, 2010).
The ANA standards of practice state that registered nurses practice ethically (ANA, 2015a). An entire book is dedicated to understanding the Code of Ethics set forth by the ANA (ANA, 2015b). These standards are written to guarantee the public that nurses are expected to exhibit exceptional professional behaviors. Additionally, when nurses find themselves in uncomfortable practice situations, the ANA’s Code of Ethics supports adherence to professional standards. The nine provisions are listed below (ANA, 2015b).
The scope of ethics is broad and encompasses several dimensions of human life. Nurses must fully understand how these dimensions form the ethical foundation for professional practice (Bennett-Woods, 2021). The following dimensions guide nursing practice:
Attributes, criteria, and context in healthcare
The NLN states that registered nurses should act as moral agents when caring for patients, families, communities, and organizations and respect the dignity, self-determination, and worth of all persons (NLN, 2010, p.13). Integrity is another core value of the nursing profession which provides a foundation for acting ethically and is demonstrated through open communication, humility, honesty, and doing the right thing (NLN, 2010).
The beliefs, values, and methods that define ethical practice are influenced by a variety of sources. Those sources include culture, peer response to situations, professional education, and, most importantly, family (Bennett-Woods, 2021). Ethical problems and dilemmas occur daily in the nursing profession. The ability to manage these situations requires critical thinking. As a registered nurse, recognizing the influence personal values and personal ethics have on ethical issues is a critical first step. An ethical problem is usually just a simple concern that has an ethical component. Most ethical problems have a clear solution, but on occasion, complexities can cloud decision-making. An ethical dilemma involves a problem with a “no-win” solution. To do what is right, the nurse must first do something wrong (Bennett-Woods, 2021).
Moral distress occurs when nurses are unable to act on ethical principles or have conflicts between personal and professional ethics, or act outside of either code. With moral distress, the nurse knows the right thing to do but fails to act due to some external or internal influence (Bennett-Woods, 2021). The impact of moral distress occurs in two phases. First, the nurse becomes angry, frustrated, guilt-ridden, anxious, and withdrawn. The second stage is called “reactive distress” and is characterized by lingering feelings that accumulate over time. This moral residue leads to conflicted feelings and behaviors (Bennett-Woods, 2021). Next, the nurse may consciously object to a plan of care or fail to follow orders. Later, the nurse becomes desensitized and actively withdraws from situations with potential ethical issues. Finally, as feelings continue without resolution, the nurse becomes physically and emotionally stressed, experiences burnout, and/or leaves the profession (Bennett-Woods, 2021).
To address ethical issues, nurses can develop moral resilience where the ability to ethically recognize problems and solve problems ethically is developed (Bennett-Woods, 2021). Nurses faced with an ethical issue should ask four questions to analyze the dilemma (Bennett-Woods, 2021):
These considerations reflect ethical principles such as beneficence, nonmaleficence, autonomy, and justice.
Ethical principles
An ethical principle is very similar to a camera lens, where multiple solutions can be chosen depending on which angle is used to approach the problem. Nurses must abide by these ethical principles: Beneficence, fidelity, justice, and nonmaleficence (Bennet-Woods, 2021; Potter et. al 2023). Bennett-Woods (2021) adds respect and Potter et al. (2023) adds autonomy. Additional principles are explained in the ANA Code of Ethics for Nurses: Accountability, advocacy, confidentiality, and responsibility (ANA, 2015b).
Many times ethical dilemmas arise when there are conflicting values. The nurse may experience a conflict with all of the above ethical principles in a single work shift. These challenges make it essential that the nurse understand ethical principles and the proper way to address these principles.
Novice and expert nurses can use the concept map below to incorporate ethics into daily practice.
Ethical Theory
Ethical theories are systems of thought that attempt to explain how and why humans should live. These frameworks can be categorized as action-based theories that ask, “What should I do?” (Taylor et. al, 2019, p. 103). A multitude of ethical theories guide professional practice. Nurses gravitate toward theories based on personal preferences. Some nurses will use a flexible theory whereas others prefer rule-based theories. Each theory approaches situations in a somewhat different manner which may or may not lead to similar decisions. Four types of theories are explained below:
Ethical Issues
Common ethical issues encountered by nurses include protecting patient rights, informed consent, the use of restraints, caring for a patient with risk to self, and end-of-life issues (Bennett-Woods, 2021).
Clinical decisions are not the sole responsibility of the nurse, especially when it involves an ethical issue. Most healthcare facilities encourage nurses to report unethical behavior or concerns. Organizational ethic teams step in when the ethical decision-making creates a conflict between the team, the patient, and/or the patient’s family.
Resources are available to assist nurses to make decisions. These resources include nursing organizations, nursing colleagues, ethics committees, and the boards of nursing (Bennett-Woods, 2021).
Exemplars
These scenarios reflect ethical behavior in nursing practice.
Confidentiality
A student nurse provided nursing care to her neighbor who was admitted for cancer treatment. The patient did not want other neighbors or her sister to know that she was in the hospital again but did not mention this to the student nurse. After the clinical that day, the student posted a note on social media about her wonderful interaction with a favorite neighbor. She posted the neighbor’s name and hospital room so others could go visit to support this precious person. The patient complained to the hospital and asked that the student not return the next day. The hospital administrator contacted the director of the nursing program regarding this breach of confidentiality and refused to allow any further clinical experiences for all students. The student was called into the office and dismissed from the nursing program with no possibility for re-entry. This student was in her last semester of school and would not be able to graduate or sit for the state license exam, but the HIPPA law was broken, and a breach of professional confidentiality occurred.
Advanced Directives
A 67-year-old man with one son and no other significant other was admitted for congestive heart failure, renal failure, ascites, and end-stage respiratory disease. He had no advance directive regarding his wishes for end-of-life care. His condition required mechanical ventilation which was ineffective in maintaining his oxygen levels. He was unconscious and unable to make his wishes known. The son was distraught and did not know what to do. He asked the nurse to help him make a life-and-death decision for his father. The physician explained that an advance directive would have given the healthcare team specific directions about healthcare preferences. The son, as the next of kin, could make decisions but was conflicted about turning off the ventilator without knowing his father’s preferences. The nurse explained that ethical decisions could be supported by consulting with the ethics committee. After much discussion, examination of the patient’s condition, and consideration of his potential quality of life, the son gave permission to the physician for removal of all life support measures. The patient died peacefully with his son and grandson beside him. An advance directive or power of attorney for healthcare would have made it easier for the son and healthcare team.
Summary
In this chapter, students learned about:
Key Terms