Professional Role, Ethics, and Legal Issues
Ethical Principles
- Autonomy: respect patient’s right to decide.
- Beneficence: do good.
- Nonmaleficence: do no harm.
- Justice: fairness.
- Veracity: truthfulness.
- Fidelity: keep promises.
Legal Issues
- Confidentiality: HIPAA; exceptions: duty to warn/protect (Tarasoff), mandated reporting of abuse, communicable diseases, court order.
- Informed consent: capacity, voluntariness, information; emergency exception.
- Involuntary commitment: criteria vary by state; imminent danger to self/others or grave disability; least restrictive alternative.
- Patient rights: right to treatment, refuse treatment (unless emergency/committed), habeas corpus, privacy, dignity.
- Restraints/seclusion: legal and ethical standards; documentation.
Professional Boundaries
- Avoid dual relationships, self-disclosure, gifts, social media contact.
- Report impaired colleagues.
Traps in Questions
- Confusing confidentiality with absolute secrecy-exceptions exist.
- Overlooking patient’s right to refuse medication unless emergency.
- Misapplying duty to warn (must be specific threat to identifiable victim).
- Forgetting mandatory reporting for child/elder abuse.
Worked Example
A patient threatens to kill his ex-wife. What is the nurse’s priority? Answer: Notify the treatment team and take steps to protect the identified victim-duty to warn/protect. Rule of thumb: specific threat + identifiable victim = duty to warn.