Group No: 02
ETHICAL AND LEGAL Muhammad Junaid Khan
Muhammad Zaman
ISSUES IN ICU Zoya Nasab
Samreen Aman
OBJECTIVES:
Define ethical and legal standards.
Discuss ethical and legal issues in ICU.
Demonstrate the ethical principles.
Discuss some ethical decision making in ICU
Discuss common ethical dilemmas.
Elements of good ethical practice in ICU.
Discuss the common legal decision in ICU.
ETHICAL AND LEGAL STANDARDS:
Ethical standards Legal standards
Ethical standards are based on human Legal standards are based on written in
principles rights or wrong. governmental laws.
ETHICAL AND LEGAL ISSUES IN ICU:
Critical care nurses are often confronted with ethical and legal dilemmas related to informed
consent, withholding or withdrawing life-sustaining treatment, organ and tissue
transplantation, confidentiality, and increasingly, justice in the distribution of healthcare
resources.
A case with insufficient communication among ICU care givers, such as failure to share
medical information about patients or medical decisions. A case in which a patient's family or
surrogates do not communicate responsibly with health care professionals to support patient's
autonomy.
ETHICAL PRINCIPLES:
Nonmaleficence:
An obligation to never deliberately harm another.
Beneficence:
An obligation to promote the welfare of others, to maximize benefits and minimize harms.
Respect for autonomy:
An obligation to respect, and not to interfere with the choices and actions of an individual.
Justice:
Innursing, the ethical principle of justice means to treat fairly, and equally distribution of
healthcare services and resources.
CONT.:
Veracity:
An obligation to tell the truth, and it is an important ethical principle that strengthens the
nurse-patient relationship.
Fidelity:
An obligation to keep promises and fulfill commitments.
Confidentiality:
Confidentiality refers to the right of patients to keep their records private and represents the
record to physicians' and medical professionals’ only when it is required.
ETHICAL DECISIONS:
End-of-life issues
Palliative care.
CPR decisions
Withdrawing treatment
Futile care
ETHICAL DILEMMA:
In general, ethical cases are not always clear-cut. An ethical dilemma exists if there are two (or more)
morally correct actions that cannot be followed. The result is that both something right and something
wrong occur. In these situations, there are both ethical conflict and ethical conduct issues. The most
common ethical dilemmas encountered in critical care are forgoing treatment and allocating the scarce
resource of critical care, but how does the health care worker know that a true ethical dilemma exists?
Early Indicators For Ethical Dilemmas
• Signs of conflict among health care (HC) team members, family members, and HC team and family
• Signs of patient suffering
• Signs of nurse distress
• Signs of ethics violation
• Signs of unrealistic expectations
• Signs of poor communication
ELEMENTS OF GOOD ETHICAL PRACTICE IN MEDICAL
DECISIONS IN ICU
• Careful assessment of the patient’s condition.
• Evaluation of the risks and benefits of therapeutic options.
• Clear communication with the patient or proxy to inform about options and identify plan of
care.
• Identification and respect for a competent patient’s or proxy’s preferences
• Plan of care based on clinical assessment and mutually identified goals
• Toleration of uncertainty when making decisions
• Toleration of disagreement between parties
•Ongoing dialogue to resolve difficult situations.
LEGAL DECISION IN ICU:
Medical documentation
•Informed consent
•Incident report
Declaring brain death
Organ donation
Autopsy
OTHER IMPORTANT LEGAL DOCUMENT:
Consultation and referral slips
Nurses record
Treatment and investigation record
TPR chart, BP monitoring chart and IO chart.
Operative notes
Discharge summary
Death certificate
CONCLUSION:
Nursing ethics are truly essential in making the right, responsible and literate decisions, and
professional development. Ethical practice is a foundation for nurses, who deal with ethical
issues daily. Ethical dilemmas arise as nurses care for patients. These dilemmas may, at
times, conflict with the Code of Ethics or with the nurse's ethical values. Nurses are
advocates for patients and must find a balance while delivering patient care. Many complex
dilemmas in critical care nursing concern informed consent. Consent problems arise because
patients are experiencing acute, life- threatening illnesses that interfere with their ability to
make decisions about treatment or participation in a clinical research study.
REFERENCES:
Park DW, Moon JY, Ku EY, Kim SJ, Koo YM, Kim OJ, et al. Ethical issues recognized by
critical care nurses in the intensive care units of a tertiary hospital during two separate
periods. J Korean Med Sci. 2015;30:495–501.
Hawley G. Ethics in clinical practice: an interprofessional approach. Edinburgh: Pearson
Education; 2007. pp. 45-49.
Park SH, Koh YS. Attitudes toward medical ethics among resident physicians in one Korean
University Hospital. Korean J Med Ethics. 2007;10:109–116.
ANY QUESTION
