Ethics and legal framework
The Ethics and legal framework domain tests whether you can justify a decision using ethical principles and legal duties, and whether you know when the patient, not the family or the team, holds the decision. Expect scenarios on consent, capacity, confidentiality, restraint and negligence.
Principles and their use
- Autonomy (the competent patient decides), beneficence (act in the patient's interest), nonmaleficence (avoid harm), justice (fair use of scarce resources). Dignity and vulnerability are explicit values in European nursing codes.
- Valid informed consent needs capacity, adequate information including material risks and alternatives, and voluntariness. Consent is a process, documented, and can be withdrawn at any time.
- Confidentiality is a duty with legal exceptions: statutory reporting, serious risk to a identifiable third party, court order, and care-team need-to-know under data-protection rules.
Capacity, minors and restraint
- Capacity is decision-specific and time-specific. A patient who refuses treatment while capacitous is not automatically depressed or incompetent; assess and document.
- For minors, parental or guardian consent is generally required, with the child's assent sought according to age and understanding; emergency treatment proceeds under the doctrine of necessity.
- Restraint is a last resort, least restrictive, time-limited, prescribed, monitored (circulation, respiration, dignity) and documented. Convenience is never an indication.
Worked example
A capacitous adult Jehovah's Witness refuses blood before elective surgery. Reasoning: autonomy prevails, the refusal is documented on the consent form, the team is informed in advance, and no transfusion is given even if the family later requests it. The nurse's duty is to ensure the patient understood the consequences and that the refusal was voluntary.
Traps that cost marks
Accepting a relative's consent for a competent adult; breaching confidentiality without a legal basis; treating a signed form as proof of valid consent.
Negligence in one line
Duty of care, breach of the standard of a reasonably competent nurse, causation, and damage, all four must be shown.