Ethical/Legal Principles

and Issues
• Ethics of care in the geriatric population is complex and
challenging Nursing Practice requires mindfulness of a
person’s autonomy within changing capacity.
• Ethical/Moral Principles are: Advocacy; Autonomy
Beneficence /nonmaleficence; Confidentiality ; Fidelity;
Fiduciary responsibility; Justice ; Quality of life; Reciprocity;
Sanctity of life and Veracity
Conflict and Dilemma
Ethical conflict occurs when a choice must be made between
2 equal possibilities.
 3 types of moral conflict: moral distress, moral
uncertainty, and moral dilemma
Moral distress-when someone wants to do the right thing
but is limited by constraints of organization or society.
•Moral uncertainty -confusion in situations when a person is
uncertain what the moral problem is or which moral principles
or values apply to it.

•Moral dilemma-when two or more moral principles apply

that support mutually inconsistent actions.
Moral Principles Incorporated into
professional code of ethics
Advocacy: Loyalty and a championing of the needs and
interests of others. Nurses advocate for patients by
supporting them in their efforts to retain as much autonomy
as their abilities allow.

Protecting the health and safety of clients by

communicating needs, promoting safe environments, and
helping with assertion of legal rights.
Autonomy: Beneficence: Nonmaleficence
Autonomy: Person’s right to make independent decisions
Respect for personal liberty, values, beliefs, and choices.
This respects the right of each person to make decisions
regarding their own body and course of life.
 Beneficence: To do good. To prevent or remove harm.
More proactive than nonmaleficence.
Nonmaleficence -Not to inflict harm or evil
Confidentiality and Fidelity
Confidentiality- Duty not to disclose information shared in a
trusted manner or relationship
Privacy: duty to respect limited access to a person
Fidelity: Duty to honor commitments. Keeping promises or
being true to another. Trust is earned, and fidelity is
demonstrated in daily work.
Fiduciary and Responsibility
• Fiduciary-Health care professionals have an ethical
obligation to good stewardship of both the patient’s and the
organization’s fund
• Justice-Treat equals equally and treat those who are
unequal according to their needs. Fairness of an act or
situation.
• Veracity- Truthfulness. Not misleading patients or their
families. Duty to be honest, tell the truth, not deceive others
Patient Rights
Patient rights- direct actions on ethical issues in the care
of geriatric populations

The Patient Self-Determination Act of 1990: patients are

provided the opportunity to express their preferences
regarding life-saving or life-sustaining care on entering any
healthcare service, including hospitals, long term care
centers, and home care agencies.
Patient Rights Competence Assisted suicide
• Mental clarity and appropriateness for decision making
based on a mental status exam
• Required for persons to exercise autonomy and right to
decide
• Assisted suicide-Violation of the Code of Ethics for Nurses
Oregon: Death with Dignity Act (1997)
Ethics in Practice Medical errors

Considerable effort has been put into reducing

mistakes and improving patient safety.

Average hospital patient can expect to be subjected to

at least one medication error per day