PVR Legal and Ethical Issues

- any institution that receives federal funds must inform clients of the availability of Advance Directives and determine if the client has such directives

Can lead to criminal prosecution
ex: DNR and force upon them can lead to criminal prosecution

Are immune to liability
do what you really believe they meant
ex: DNR- no wrist bands

- what is in one state may not be valid in another state
- once admitted into an institution, Advance Directives must be implemented by the physician (written as an order)
- DNR order cannot be a verbal order
- A phone order can be taken if 2 nurses witness it, the physician must sign the order ASAP
- In PA, client has the legal right to refuse/avoid medical treatment, including artificial nutrition/hydration
- must be clear and convincing evidence of the client's intent to refuse

- should be written & signed by the client and witness
- should list specific treatments not wanted
- many have the inherent flaw of speaking only of terminal illnes, not addressing the issue of persisitent vegetative state
- many have the inherent flaw of speaking only of initiating treatment, not addressing withdrawl of ongoing treatment
- should address artificial nutrition/hydration

- does not survive competence

- survives competence (necessary for health care decisions) aka health care proxy
- durable power of attorney authorizes a specified agent to do things which a Living Will does not (can authorize release of institution from liability, waiver of doctor/patient privilege)

- many institutions have regulations and policies about witnessing wills
- may be written or oral
- person must be a sound mind/competent
- PA requires two witnesses
- witness need not know the contents
- witness signature is attesting to the competence of the person and to the signature

- standards devised for a profession, addressing a code of behaviors for its members
- involves rules of good conduct which reflect the highest ideals of the group
- a nurse's actions are guided by a code of ethcs and by laws addressing patient care issues

- laws enacted by legislative bodies such as county, city council, state legislature, federal legislature
ex: nurse practice act passed by state legislature
- rules and regulations established by governmental agencies such as licensing boards and regulatory boards
ex: state board of nursing (function as administrators of laws governing nursing)

-derived from judicial decision and court rulings
ex: contracts (implied, written, oral)
- law of torts (negligence, false imprisonment, consent, defamation of character, fraud, assault and battery)

- can be subdivided into civil and criminal components, both with legal implications

Laws that affect the public welfare as a whole.
- a violation is called a crime (crime against society)

Laws that regulateconduct between private individuals or businesses
- a violation is called a tort. can be intentional/unintentional (crimes against an individual)

- unintentional tort
- results when a person fails to conduct him/herself in a reasonable and prudent manner
- not synonymous with carelessness
- it is failure to exercise the degree of care that a person of reasonable intelligence and prudence would exercise under similar circumstances