APPLICATION OF ETHICAL PRINCIPLES TO PATIENT TEACHING

Six major ethical principles are woven through the ANA’s Code of Ethics for Nurses
and the AHA’s Patient’s Bill of Rights. These principles support the federal
government’s concern for ethical behavior practices. They are autonomy, veracity,
nonmalfeasance, confidentiality, beneficiance, and justice.

Autonomy

Autonomy refers to an individual’s right to make his or her own decisions regarding
medical treatment and health care services. Laws have been passed at the federal
level to protect the patient’s right to personal decision making based on the
principle of informed consent. This means that the patient must be fully informed
about his or her condition and be fully aware of what to expect as a result of
medical treatment. The Patient Self-Determination Act (PSDA) passed by the U.S.
congress on December 1, 1991, is a good expamle of a law mandating autonomy.
Any healthcare facility such as a hospital or nursing home, HMO, hospice, or home
care agency, receiving medical and/or medical funds must adhere to regulations
spelled out in the PSDA. The law requires, either at the time of hospital admission or
before the initiation of treatment, “that every individual receiving health care be
informed in writing of the right under state law to make decisions about his pr her
health care, including the right to refuse medical and surgical care and the right to
initiate advance directives”. It is the nurse’s responsibility to guarantee informed
decision making by patients, which includes living wills and health care proxies.
Documentation of such instruction must be noted in the patient record, which is the
legal document guaranteeing that informed consent took place.

Although heath teaching is not directly mentioned in the principle of autonomy, it is

an important part of the ethical concept of assisting people to gain more
independence, to avoid illness, and to keep themselves well. In fact, all nurse
practice acts address patient teaching as a legal responsibility of the registered
nurse.

Veracity

Veracity, or truth telling, is closely connected to informed decision making and

informed consent. The Cardozo decision legally protects and individual’s basic right
to make decision about his or her own body. It provides a basis in law for patient
teaching regarding invasive medical procedure requiring surgery, insertion of
needles, or insertion of an instrument into a body cavity, such as the throat or
colon. This includes being truthful about risks or benefits involved in these
procedures.

Nurses are often faced with ethical dilemmas related to truth telling. Truth telling
also pertains to the role of the nurse as an expert witness. Professional nurses who
are recognized for their skill or expertise in a particular area of nursing practice may
be allowed to testify in court on behalf of either the plaintiff or the defendant. The
concept of truth telling in expert testimony speaks for itself – the requirement under
oath to tell the truth.

Nonmalfeasance

Nonmalfeasance means “do no harm.” This principle is at the heart of legal

decisions concerning malpractice or negligence. Lesnik and Anderson (1962) stated,
“The term negligence refers to the doing or non – doing of an act, pursuant to a
duty, that a reasonable person in the same circumstances would or would not do
and the acting or non-acting is the proximate cause of injury to another person or
his property”. Brent (2001) explains negligence as ”conduct which falls below the
standard established by law for the protection of others against unreasonable risk of
harm”.

The term malpractice, on the other hand, “refers to a limited class of negligent
activities committed within the scope of performance by those pursuing a particular
profession involving highly skilled and technical services” (Lesnik and Anderson
1962). This means that malpractice is limited to those whose profession requires
special education and training, whereas negligence involves all improper or
wrongful behavior by anyone resulting from any activity.

The concept of duty is closely related to the meaning of malpractice and

negligence. Nurse’s duties are spelled out in job descriptions at places of
employment. Policy and procedure manuals exist to protect the patient, but they
also exist to protect the employee and the facility against lawsuits. Policies are
more than guidelines. They contain standards and behavior expected of employees
of a particular institution.

Confidentiality

Confidentiality means protection of privileged information. In legal terms,

confidentiality refers to a social contract or a covenant between the nurse and the
patient. The nurse – patient relationship is considered privileged in most states. This
means that the nurse may not reveal personal information gained in professional
capacity from a patient without the consent of the patient “... unless the patient has
been the victim pr subject of crime, the commission of which is the subject of legal
proceedings in which the nurse is a witness” (Lesnik and Anderson 1962).

Beneficence

Beneficence, which means “do good,” is the requirement to perform critical tasks
and duties in care of patients specified in job descriptions, policies and procedures
published and distributed by the healthcare facility, and the standards and codes of
ethics published and distributed by professional nursing organizations. These
various performance standards include providing adequate and up-to-date patient
teaching. The act of beneficence validates the nurse’s commitment to do what is
the best interest of the patient, emphasizing patient safety and providing sufficient
information to allow for optimal independence in self-care.

Justice

Justice refers to fairness and equality when distributing goods and services. Justice
is intended to provide equal treatment for all in legal matters. Laws are intended to
protect society. The focus of health law is the protection of the patient. The
Patient’s Bill of Rights is enforced as law in most states. That is, the nurse or any
health professional can be fined or sued for discrimination in the provision of care.

When a nurse is employed by a health care facility, that nurse enters into contract,
either written or understood, to provide nursing services in accordance with the
policies of that facility. Failure to provide nursing care or providing less than quality
care based on patient diagnosis or discriminating on the basis of someone’s culture,
nation origin, sexual orientation, and the like can result in being liable for breaking
a contract with the employing institution.