Leuter C, Petrucci C, Mattei A, Tabassi G, Lancia L. Ethical problems in nursing, educational needs and attitudes towards the use of ethical resources. Ethics of nurses. 2013;20(3):348–58. doi.org/10.1177/0969733012455565. One of the most controversial issues that has been raised in the context of communication is whether, how and when providers should disclose medical errors to patients. Disclosure of medical errors creates a potential conflict between clinical ethics, law and risk management. Despite a professional ethical commitment to honest communication, suppliers cite fear of litigation as a reason for non-disclosure. In particular, there is concern that these statements could lead to a malpractice lawsuit or be used to support a claim against the supplier. An increase in malpractice claims could then negatively impact the provider`s claims history and malpractice insurance coverage. The four principles mentioned here are not hierarchical, meaning that no one principle systematically “trumps” another. It could be argued that we must consider all of the above principles when applicable to the clinical case under consideration. However, if two or more principles are true, we can see that they are in conflict.

Take, for example, a patient who has been diagnosed with a severely infected appendix. Our medical goal should be to provide the patient with the greatest possible benefit, an indication for immediate surgery. On the other hand, surgery and general anesthesia pose little risk to an otherwise healthy patient, and we are obliged not to “harm” the patient. Our rational calculation is that the patient is much more at risk of damage caused by a rupture of the appendix if we do not act than by surgery and anesthesia if we move quickly to surgery. Moreover, we are willing to put this working hypothesis to the test of rational discourse, because we believe that other people who act on a rational basis will agree. Therefore, balancing and balancing potential risks and benefits becomes an essential part of the reasoning process in applying the principles. Clinical ethics and law are disciplines with overlapping concepts, but each discipline has unique parameters and its own focus. For example, the ethical concept of respect for autonomy is expressed in law as individual freedom. Each of these disciplines has its forums and authority; However, the law can ultimately “solve” a clinical-ethical dilemma with a court order.

For EFA, factors with eigenvalues greater than 1 were selected according to the Kaiser criterion. A value greater than 0.4 was set for the inclusion of items below a certain factor. The Bartlett test and the Kaiser-Meyer-Olkin test evaluated the relevance of our data for factor analysis. At the univariate analysis level, independent sample T-tests and ANOVA investigated the relationships between sociodemographic variables and questionnaire means. The homogeneity of variance between groups was tested by the Levene test for equality of variances before the ANOVA. While the patient`s husband remains her surrogate legal decision-maker, his decisions on behalf of the patient are limited by clinical ethics and legal norms. First, a surrogate mother is required by law to make a “substitute judgment” on behalf of the patient. This means that the surrogate must act according to the patient`s wishes. If substitute judgment is not possible (i.e., it is not clear what the patient would want in the current medical circumstances), the law requires the surrogate to act in the patient`s “best interests.” Since the medical team has a significant influence on what would be medically in the best interests of the patient, a surrogate mother`s decision that does not meet this standard should not be automatically followed and may need to be reviewed by a clinical, risk management or legal ethics advisor or board.

The health profession has a set of ethics that are applicable to different groups of health professionals and health facilities. Ethics is not static, but applies to all times. What was considered good ethics a hundred years ago can no longer be considered good today. The hospital administrator is required to understand his or her legal and ethical responsibilities. [1] Reference librarians in law schools, especially public institutions, can be helpful in finding specific materials or indicating entitlement to an interested person. Specific laws, ordinances or jurisdictions may also be available on official government websites. In addition, medical journals (available on the Internet or in medical school libraries) often contain articles on clinical ethics or health policy issues, often addressed to the relevant legal authorities. In Washington State, a statute establishes the order of precedence of authorized decision-makers as follows: guardian, holder of a continuing power of attorney; spouse or partner registered by the State; adult children; Parents; and adult siblings. If the patient is a minor, other consent provisions may apply, such as: judicial authorization for a person with whom the child is in a home; the person(s) signed by the child`s parents to give their consent; or a competent adult who declares that he or she is a parent responsible for the child`s care and signs an affidavit attesting to this.11 Health care providers are required to make reasonable efforts to place a person in the highest possible category in order to give informed consent. If there are two or more people in the same category, e.g., adult children, the decision about medical treatment must be made unanimously between these individuals.12 A substitute decision-maker must make the choice he or she believes the patient would have wanted, which may not be the choice the decision-maker would have chosen for himself or herself in the same circumstances. This standard of decision is called a substitute judgment. 13 If the surrogate cannot determine what the patient would have wanted, the surrogate may accept medical treatment or non-treatment that is in the patient`s best interests.

14 comments. The term “futility” is open to various definitions [31] and often controversial, which is why some experts suggest the alternative term “clinically non-beneficial interventions” [32]. In this case, however, the term futility is appropriate to indicate that there is evidence of physiological futility (multisystem organ failure in pre-existing terminal COPD, and medical interventions would not reverse the decline).