APPLICATION OF

BIOETHICAL
PRINCIPLES TO THE
CARE OF THE SICK
 INFORMED CONSENT

INFORMATION

❑includes disclosure and understanding of the

essential information
- nature of the health concern and prognosis
if nothing is done
- description of ALL treatment options
- benefits, risks, consequences of the
various treatment alternatives
CONSENT

❑implies the freedom to accept or reject

❑must be voluntary, without coercion, force, or

manipulation
 INFORMED CONSENT

❑gives patients the opportunity to autonomously

choose a course of action in regard to plans for
health care
❑provides legal protection of a patient’s right to
personal autonomy
❑discussed in:
- surgeries
- complex procedures
- common interventions with undesirable
effects
❑exceptions include:
- emergency cases
- waivers by patients who do not want to
know their prognosis or risks of treatment
COMPONENTS

1. Patient must have the capacity to make the

decision.
2. The medical provider must disclose the information
on the treatment, tests, or procedure in question,
including the expected benefits, risks, and the
likelihood that the benefits and risks will occur.
3. The patient must be able to comprehend the
relevant information.
4. The patient must voluntarily grant consent, without
coercion or duress.
NURSING ROLES AND RESPONSIBILITIES

1. Ensuring that all criteria for autonomous

decision making are met.
2. Notifying the physician and requesting for
further information for the patient or stopping
the process until it is ensured that the decision
can be made autonomously.
3. Obtaining the patient’s signature on a consent
form.
4. Witnessing a patient’s signature on a consent
form.
5. Nurses in advanced practice roles are
accountable for providing information and
obtaining informed consent for interventions that
they initiate under their scope of practice.
 ADVANCE DIRECTIVES

❑instructions that indicate health care

interventions to initiate or withhold, or that
designate someone who will act as a surrogate
in making such decisions

❑help ensure that patients have the kind of end-

of-life care they want
LIVING WILL

❑a legal document giving directions to health care

providers related to withholding or withdrawing
life support if certain conditions exist

❑guides decisions by indicating a person’s

desires regarding life-sustaining interventions
DURABLE POWER OF ATTORNEY

❑allows a competent person to designate another

as a surrogate or proxy to act on her or his
behalf in making health care decisions in the
event of the loss of decision-making capacity

❑must be in writing and must be signed and dated

by the person making the designation and two
witnesses other than the designated surrogate
NURSING ROLES AND RESPONSIBILITIES:

1. Be aware with the state’s statutes and

institutional policies and procedures.
2. Explore patient and family understanding of
advance directives.
3. Be familiar with the patients’ directives for care
and ensure that care is consistent with the
patient’s wishes as expressed in the advance
directives.
4. Inform other members of the health care team of
the presence and content of advance
directives.
5. Intervene in behalf of the patient when wishes
expressed in advance directives are not being
followed.
6. Increase public awareness about advance
directives through patient and community
education, research and education of nurses
and other health care providers.
DO NOT RESUSCITATE ORDERS

❑not to initiate CPR in the event of a cardiac or

pulmonary arrest

❑written directives placed in a patient’s medical

record indicating that the use of CPR is to be
avoided

❑DNR decisions require open communication

among the patient/surrogate, the family, and the
health care team
❑apply only to resuscitation

❑require nurses to become more focused on

providing supportive and comfort interventions
and to ensure that there is no reduction in the
level of care
NURSING CONSIDERATIONS

1. Nurses need to know which patients under their

care have DNR orders, and these orders need
to be documented clearly in a patient’s chart.
2. The nurse should document the request in the
patient’s chart and bring this to the immediate
attention of the physician if a patient or
surrogate indicates to the nurse they desire not
to be resuscitated and there is no order in the
chart.