ETHICAL PRINCIPLES

PREPARED BY:
MARIA FATIMA ORBECIDO-TAN,RN,MN,LLB
Informed consent is a process that’s required for most medical procedures.

In a healthcare
participate setting,
in your informedcare.
own medical consent allows you to
It enables
want you to decide which treatments you do or do not
to receive.
It allows you to make decisions with your healthcare
provider.
This
legal collaborative decision-making
obligation of healthcare process is an ethical and
providers.
 In a healthcare setting, the process of informed consent includes:
1. your ability to make a decisione
2.xplanation of information needed to make the decision
3.your understanding of the medical information
4your voluntary decision to get treatment

What types of procedures need informed consent? The following scenarios require informed consent:
 most surgeries
 blood transfusions
 anesthesia
 radiation
 chemotherapy
 some advanced medical tests, like a biopsy
 most vaccinations
An informed consent agreement should include the following information:
1.diagnosis of your condition
2.name and purpose of treatment
3.benefits, risks, and alternative procedures
4.benefits and risks of each alternative
5.With this information, you can make an educated choice about the procedures you receive.

Can others sign a consent form on your behalf? In some cases, another person can sign a consent form for you. This is

appropriate in the following scenarios:

 You aren’t of legal age.  if you’re younger than 18, a parent or guardian will need to give consent on your behalf. You want
someone else to make the decisions. 
 If you’d like to let another person make your future medical decisions, you can fill out a form called an advance directive. This
allows someone else to give consent on your behalf if you’re unable to.
 You can’t give consent. Another person can make your medical decisions if you can’t provide consent. This may happen if
you’re in a coma, or have a condition like advanced Alzheimer’s disease.
Obtaining informed consent in medicine is process that should include:
(1) describing the proposed intervention,
(2) emphasizing the patient's role in decision-making,
(3) discussing alternatives to the proposed intervention,
(4) discussing the risks of the proposed intervention and
(5) eliciting the patient's preference (usually by signature).

The Doctrine of Informed Consent

Informed consent is a client’s right to know and understand before agreeing to a procedure.
It is the physician’s sole responsibility to obtain consent from the client, even if other staff
assist in the process.

Consent should be obtained in writing because written consent implies an intentional and deliberate
decision
Consider the following examples:
1. A client calls complaining of a persistent, productive cough. When the receptionist makes
the appointment with the physician, the client has given consent for examination, which
may include throat examination and culture.
 
2. When a physician requires a blood test for diagnosis and the client comes to the labora-
tory with a rolled-up sleeve, implied consent is being given.
 
3. A client is scheduled for an office surgical procedure and signs an appropriate consent
form. This action constitutes a medical contract between the client and the physician.
Written consent has been obtained.
 
PROXY CONSENT
Proxy consent is the process by which people with the legal right to consent to medical treatment for themselves or for a minor or a ward delegate that right to another person. There are three fundamental constraints on this
delegation:
1.The person making the delegation must have the right to consent.

2.The person must be legally and medically competent to delegate the right to consent.

3.The right to consent must be delegated to a legally and medically competent adult.

There are two types of proxy consent for adults:

1.The first, the power of attorney to consent to medical care, is usually used by patients who want medical care but are concerned about who will consent if they are rendered temporarily incompetent by the medical care. A
power of attorney to consent to medical care delegates the right to consent to a specific person.

2.The second type is the living will.

 
EXERCISES :

1. In emergency situations, what type of consent exists? Explain and give an example.

2.The parents of a 6-year-old child consented to allow her to undergo “routine cardiac
tests.” One of the tests performed was a catheter arteriogram in which complications
occurred. Questioning of the parents revealed that they did not fully understand the
risks involved. What are the legal implications of this consent? Identify potential
problems in this situation.

3. A 15-year-old enters your office requesting treatment for scalds received on his hand
while emptying the dishwasher at his place of employment. Although his family receives
medical treatment at your office, you are uncertain about seeing him without his parents’
knowledge. Can he consent to treatment? What are the legal ramifications?
Privacy and confidentiality are basic rights in our society. Safeguarding those rights, with respect to an
individual’s personal health information, is our ethical and legal obligation as health care providers.
Doing so in today’s health care environment is increasingly challenging.

Every nurse understands and respects the need for patient confidentiality. As professionals, our
connection to our patients and our colleagues depends on it. But, the truth is, advanced technology,
new demands in health care, and developments in the world-at-large, make it more and more difficult
to keep this promise. But keep it we must!
Knowing the difference between privacy and confidentiality can be confusing.

Privacy is the right of individuals to keep information about themselves from being disclosed; that is, people (our patients) are
in control of others access to themselves or information about themselves. Patients decide who, when, and where to share their
health information.

On the other hand, confidentiality is how we, as nurses, treat private information once it has been disclosed to others or
ourselves. This disclosure of information usually results from a relationship of trust; it assumes that health information is given
with the expectation that it will not be divulged except in ways that have been previously agreed upon, e.g., for treatment, for
payment of services, or for use in monitoring the quality of care that is being delivered.

N.B. With the increasing use of technology for the provision of care in our fast-paced clinical environments, maintaining
privacy and confidentiality can be a daunting task.
The Impact of Technology

Electronic messaging and new computer technology, though quick and efficient, might not be as secure as we would want it to be. This is
an unfortunate reality, but one we must consider. If it is not absolutely necessary to include patients’ names in electronic correspondences, then
we should refrain from doing so. We must be smart and sensitive when communicating patient information, be it by fax, telephone, email, or
other technologies yet to be developed (Ives Erickson, 1999).

When communicating with another clinician, remember this:

1.Others besides the addressee may process messages during addressee’s usual business hours or during addressee’s vacation or illness
2.Electronic messages can occasionally go to the wrong party
3.Electronic communication can be accessed from various locations
4.Information written by one clinician may be sent electronically to other care providers
5.The Internet does not typically provide a secure media for transporting confidential information unless both parties are using encryption
technologies.
The following are other strategies to address confidentiality challenges facing nurses.

 Communication with family members – always keep the patient’s best interest in mind. This may translate into adequately informing long-distance family

members so they are able to properly respond and support elderly or demented parent’s needs. Verify identity as legal guardian or executor, if necessary.

 Never assume you have the right to look at any type of health information unless you need it in order to do your job.. For example, co-workers’ phone

numbers for personal reasons may be looked up by the interested party on the Internet or the phone book. Phone numbers needed for work-related reasons

may be obtained from the supervisor or the employee database if you have been authorized for access. Always ask yourself, "Do I need-to-know this

information?" Need-to-Know is defined as that which is necessary for one to adequately perform one's specific job responsibilities.

 Hold your colleagues as accountable as you hold yourself when it comes to respecting patient privacy. When you see a nurse or physician carrying

progress notes on their tray in the cafeteria for others to see, gently and politely remind them to turn them over in the name of confidentiality. When you

are hearing a conversation between two care providers in the elevator or the hospital shuttle, politely ask them to please continue their discussion in a

private area.
Be a privacy mentor to nursing students just starting out in the profession. For example, keep medical records closed on
desktops, close out results on computer screens, send out text paging with minimum necessary information (last name first
initial), restrict excessive printing of health information from computers, restrict the removal of all copies of health information
from the hospital, even if reports have been de-identified.
Stand up to peer pressure when friends or neighbors ask you to do a favor by obtaining for them copies of their records or
copies of a family member’s records. Always get written authorization and follow proper procedure. In many organizations,
failure to follow proper procedures regarding release of information may result in disciplinary action, up to and including
termination of employment or suspension of privileges.
If in doubt when releasing health information to patients, confer with your health information services department or privacy
office for advice and assistance.
Privacy

The nurse safeguards the patient's right to privacy. The need for health care does not justify
unwanted intrusion into the patient's life. The nurse advocates for an environment that
provides for sufficient physical privacy, including auditory privacy for discussions of a
personal nature and policies and practices that protect the confidentiality of information
Confidentiality
Associated with the right to privacy, the nurse has a duty to maintain confidentiality of all patient information.
The patient's well being could be jeopardized and the fundamental trust between patient and nurse destroyed by
unnecessary access to data or by the inappropriate disclosure of identifiable patient information.

The rights, well being, and safety of the individual patient should be the primary factors in arriving at any
professional judgment concerning the disposition of confidential information received from or about the patient,
whether oral, written or electronic.

The standard of nursing practice and the nurse's responsibility to provide quality care require that relevant data be
shared with those members of the health care team who have a need to know
II. EXERCISES:

1.Robert is the pastor of your church. He comes to you as you are leaving the Sunday service and
tells you about a parishioner who is now an inpatient at your hospital. You are very goods friends
with the pastor and he asks you to find out what her diagnosis and prognosis is. Because of your
position you have access to this information. Can you look this up because your pastor asked you
to?

2. One of your nurse colleagues is expecting and it’s been decided that you will organize the baby
shower. Not having access to co-workers addresses, you only look in the demographics portion of
the electronic medical record to obtain this information. You do not look at any clinical information.
Would this be OK?