Professional Practice, Ethics and Health Law
Ethics and health law tests the nurse’s legal and ethical obligations: informed consent, capacity, confidentiality, advocacy, end-of-life care, negligence, and documentation. Questions often ask who can consent, when confidentiality may be breached, or what to do when a patient refuses care.
Core rules
- Valid informed consent requires capacity, adequate information (diagnosis, proposed treatment, risks, benefits, alternatives, consequences of refusal), voluntariness, and authorization. A competent adult can refuse treatment, even life-saving treatment; document the refusal and escalate.
- Capacity is decision-specific and clinical, not the same as a psychiatric diagnosis or odd choice. If capacity is uncertain, follow policy for assessment and substitute decision-making.
- Minors generally require a parent/guardian consent, but laws and policies may allow consent for specific services; know your local rules.
- Confidentiality may be breached only with consent or a legal/ethical exception, such as mandatory reporting of communicable disease, suspected abuse, or serious imminent harm. Share only the minimum necessary.
- Negligence requires duty, breach, causation, and damages. Documentation should be factual, timed, and complete; late entries are identified as late.
- Restraints require a valid order, least restrictive option, monitoring, and documentation; they are not punishment or staffing convenience.
Worked example
A competent adult with severe anemia refuses blood transfusion for religious reasons. Reasoning: the patient has capacity and the right to refuse. The nurse should confirm understanding, explore concerns, notify the treating team, document the discussion and refusal, and continue alternative care. Do not obtain family consent to override the patient; family cannot consent for a competent adult.
Traps
Do not assume an older adult lacks capacity. Do not disclose information to relatives without the patient’s permission. Do not document retrospectively as if written at the time. Do not accept a consent signed by someone who does not have authority.