It is important to distinguish between health information use (internal to an organisation) and disclosure (external dissemination)19 (see also responsible practices in Ethics in research section later in this chapter). The best interests principle is a guiding principle for decision making in health care, and is defined as acting in a way that best promotes the good of the individual. Nurses hold in confidence any information obtained in a professional capacity, use professional judgement where there is a need to share information for the therapeutic benefit and safety of a person, and ensure that privacy is safeguarded. Some doctors do not communicate with patients or families or document decisions because of the lack of clear laws for end-of-life practices and the fear of litigation. In critical care nursing, there are ethical issues that come up all of the time. Mass critical care planning has occurred at the regional (2), state/provincial (3, 4), national (5–7), and international (8) levels. Directors and managers of ICU units have several ethics teaching options. With the introduction in the UK of the Human Rights Act21 there is increasing public awareness of individual rights, and in the medical setting people are encouraged to participate actively in decisions regarding their care. University of Barcelona, Spain See all articles by this author. People may also have a combination of both. Managing the critically ill patient in many cases represents a provision of supportive, rather than curative, therapies.29, A common ethical dilemma found in critical care is related to the opposing positions of ‘maintaining life at all costs’ and ‘relieving suffering associated with prolonging life ineffectively’. This principle is referred to when one person makes a decision on behalf of another person (e.g. These are useful records to provide clarity when treatment options require full and frank discussion and consideration, particularly regarding complex, critically ill patients (see Palliative care below). Managing a critical care unit can present many challenges for those whose roles have been only as clinicians. In Australia, when active treatment is withdrawn or withheld, legally the same principles apply. Advance directives were created in response to increasing medical technology.53,54. However, it is usually recognised that justice does not always require equal sharing of all possible social benefits. and Sibbald, W.J. (1995) ‘Ethical practice in a technological age’. Less than 10% of doctors and nurses would like their life prolonged by all available means, compared to 40% of patients and 32% of families. The thrust of this chapter is to explore research findings about issues that cause ethical concern for critical care nurses in Europe. Decision making in the critical care setting is conducted within, and is shaped by, a particular sociological context. Examples of statute law in Australia include: • Consent to Medical Treatment and Palliative Care Act 1995 (SA); Further details of these Australian Acts can be found in the Relevant legislation section at the end of the chapter. An understanding of the principle of consent is necessary for nurses practising in critical care. Because of the vulnerable nature of the critically ill individual, direct informed consent is often difficult, and surrogate consent may be the only option, particularly in an emergency. In principle, any procedure that involves intentional contact by a healthcare practitioner with the body of a patient is considered an invasion of the patient’s bodily integrity, and as such requires the patient’s consent. In the Ethicus study of 4248 patients who died or had limitations of treatments in 37 ICUs in 17 European countries, life support was limited in 73% of patients. 1990 Mar;2(1):1-13. Abstract. In order to provide safe patient care, clear internal systems and processes are required within critical care areas, as with any other healthcare service provision. Consent in human research is guided by a variety of different documents. Ethics involve principles and rules that guide and justify conduct. Inconsistency exists in decision making about when and how to withdraw life-sustaining treatment, and the level of communication among staff and family. This right is enshrined in common law in Australia (with state to state differences), and in the Code of Health and Disability Consumers’ Rights in New Zealand (1996). In Australia, when active treatment is withdrawn or withheld, legally the same principles apply. Chapter 3: Ethical and Legal Issues in Critical Care Nursing Test Bank MULTIPLE CHOICE 1. The integration of ethical principles in everyday work practice requires concordance with care delivery and ethical principles. a living will) or proxy (the appointment of a person(s) with enduring power of attorney to act as surrogate decision maker), or some combination of both. Nurses are autonomous moral agents, and at times may adopt a personal moral stance that makes participation in certain interventions or procedures morally unacceptable (see the. The principle of beneficence requires that nurses act in ways that promote the wellbeing of another person; this incorporates the two actions of doing no harm, and maximising possible benefits while minimising possible harms (non-maleficence).8 It also encompasses acts of kindness that go beyond obligation. However, it is incumbent on all critical care nurses, as patient advocates within the critical care areas of ICU, CCU and the emergency department (ED), to be aware of the potential impact and possible outcomes of therapies delivered in the critical care environment. Conditions of scarcity and competition result in the predominant problems associated with distributive justice. Some international literature reflects the different ethical reasoning and decision-making frameworks extant between medical staff and nurses. In addition, the Nursing Council of New Zealand has published a Code of Conduct for Nursing that incorporates ethical principles (2004) (Box 5.2).15 These codes outline the generic obligation of nurses to accept the rights of individuals, and to respect individuals’ needs, values, culture and vulnerability in the provision of nursing care. in relation to individual autonomy and informed consent, needs to take account of cultural values, while respecting absolutely the ethical standards. Nurses accept the rights of individuals to make informed choices in relation to their care. legal and ethical issues in nursing, patient care technicians, social workers, and office personal. However, even for formally-appointed guardians, certain procedures are not allowed and the consent of a guardianship authority is required. A general distinction can be made between civil law jurisdictions, which codify their laws, and common law systems, where judge-made law is not consolidated. 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