Ethical Issues in Health Care Practice - Desklib

This article discusses the ethical issues faced by nurses in health care practice, including confidentiality, informed consent, professional boundaries, and more. It also covers the codes of ethics and conduct, justice, continuing education, and discrimination. The article also explores the legislation governing health care practice, including the Privacy Act, Disability Discrimination Act, and more.

Tittle: Ethical Issues in Health Care Practice
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Qn1. Most nurses all over the world are struggling with ethical issues such as
confidentiality and the ability to meet the patients’ needs. Nurses are obliged to uphold strict
moral principles, virtues and duties in their profession. It is increasingly becoming difficulty
for the nurses to uphold integrity in their professional practice due to increasing pressure and
complex moral choices the nurses have to make (Ulrich et al. 2010). Ethical issues arise in
the health care setting where moral questions on rightness and wrongness of health care
practices underlie decisions making in the hospital concerning the patient. According to a
research carried out by Ulrich and Grady (2009), most nurses claim that staffing inadequacies
and protecting patients’ rights are the most stressful issues in the health care setting.
Insufficient stuffing, systematic and organizational shortcomings make it difficult for nurses
to meet the professional and ethical standards in their practice.
On daily bases, nurses make decisions on care delivery. In a correlational health care
settings, different ethical principles arise. These include veracity, non-maleficence,
beneficence, justice, fidelity and respect for others (NCCHC, 2011).
 Code of ethics and code of professional conduct- These codes guide the nurses
in making ethical decisions as nurses occasionally refer to these principles in
as they make decisions. According to the NCCHC, a common ethical concern
for the nurses is finding a balance between their attitudes of care, compassion
and keeping safe boundaries (McElroy, 2012).
Nurses and midwives registered by the NMBA must adhere to the professional code
of conduct. This code ensures that nurses respect, uphold and protect the fundamental rights
of the Australians.
 Justice is an ethical principle that involves the equitable allocation of health
care services and fair treatment of patients

 Rights- health officers have the right to practice nursing in accordance to their
code of conduct. Patients have the right to make decisions in accordance to
their treatment.
 Continuing professional education opportunities- this is education made
maintain knowledge, experience and skills gained as a nurse is working.
 Beneficence- is an ethical practice whereby nurses do good to their clients as a
moral obligation.
 Nonmaleficence- this must be in balance with beneficence. Nurses should not
inflict any harm so as to attain a good result
 Code of practice- The code of ethics together with the code of practice offer a
framework for responsibility and accountability in health care practices
(Waubra foundation, 2015).
 Children in work place- According to Scott (2010), a professor at the
University of South Australia, there has been an urgent need standards for
child protection in Australia due to the increased child abuse and neglect. She
claims that child maltreatment is on the increase and has serious consequences
on the child and long term effects on their mental and adult health. The health
sector in partnership with the universities came up with a project aimed at
equipping nurses and midwives with skills and knowledge to identify, respond
and also prevent child neglect and abuse and even promote and enhance child
wellbeing (Scott, 2010).
 Discrimination- According to Lampert (2016), 561 cases were reported on
racial discrimination, 740 on disability discrimination and 453 on sex
discrimination between 2014 and 2015. This indicates the increased rates of
discrimination in the health sector.

 Stonewall Scotland (2018) describes direct discrimination as a situation
whereby a person is treated unfavourably due to their gender, their sexual
orientation or of their family member or any other person they are close with.
 Indirect discrimination is a situation whereby the health care policies group
people into a given gender or sexual orientation whereby they are
disadvantaged as compared to another gender or sexual orientation (Royal
College of Nursing, 2018). It is unlawful according to the Equity Act 2010 for
any one including patients and health practitioners to be discriminated, be it
direct or indirect.
 Duty of care- Dowie (2017) thinks that nurses consider duty of care as a
fundamental aspect in their nursing practice. It is a legal obligation that the
nurses take to act within their competence and to the best interest of their
patients (and everyone else) and avoid endangering their health and wellbeing
(Young, 2009).
 Equal employment opportunities- The WSLHD is working hard to come up
with an environment which is a real reflection of the diversity in the society.
This would be achieved through ensuring there is equity in employment as
Australia in one of the socially, and culturally diverse nation. This would
make the nurses and patients feel accepted and supported regardless of their
culture, religion, gender, race, sexual orientation and physical abilities (NSW
Government, 2018).
 Informed consent- Legally, informed consent is the right of the patient or the
surrogate to know the risks, advantages and alternatives to the health care
practice. Ethically, informed consent is the patients’ autonomy; the patients
should be informed of their treatment details and freely agree to them. Health

officers must respect an informed consent on a person’s care, provided the
person is in a capacity to consent (Menendez, 2013).
 Insurance requirement for enrolled nurses- It is a recommendation for every
nurse to have Professional indemnity insurance so as to practice nursing. This
insurance would help in paying for any damages and legal fees in case of any
claim raised against them due to negligence of duty. (Express insurance,
2018). According to the Nurse Buff (2016), the steps to get a malpractice
insurance are: get a carrier, get a quote then apply.
 Health Practitioner Regulation National Law Act- this is a legislation in
accordance to the nurse code of conduct and nurse principle code of conduct
to regulate the nurse practice.
 Death and life issues- In most cases, nurses are faced with ethical issues
concerning legal mandates as thy care for dying patients. In cases of ethical
dilemmas, the nurse could be knowing the right action to take but cannot
approach it or the nurse is uncertain about the outcome. Research shows that
end of life care ethical dilemmas are as a result of lack of right channels to
discuss the family preferences concerning the person’s death (Hold, 2015).
Family members’ interference and how to preserve the quality of life during
the process of dying causes a unique headache to nurses.
 Power of attorney- is a legal document that gives authority to a second party to
make decisions on one’s behalf in case the first person is unable to do so due
to illness or absence (Queensland Government, 2017).
 Mandatory reporting- is a legislative duty given to certain people in the society
to report to the government authorities any cases of child neglect and abuse
(Matthews, Walsh and Fraser, 2006).

 NMBA nursing practice guidelines- Enrolled nurse standards for practice are
standards set to give a framework to assess registered nurses. The help the
public know what they should expect from enrolled nurses. The NMBA and
the courts use these standards to assess professional conduct of nurses
(NMBA, 2017)
 Professional boundaries- are borders are the minimum standards as dictated in
the nurses profession code of standards that the health professions must
uphold in their practice. These boundaries give a limit to patients’
vulnerability and clinicians’ powers. Crossing these boundaries could have
consequences like termination of employment or disciplinary measures as it is
a violation to the nurse practice.
 Professional practice guidelines- Clinical practice guidelines are statements
and principles set to health practitioners in decision making in given clinical
circumstances. Nurses have a growing interest in using the guidelines as they
help the nurses facilitate quality and evidence based health care practice
Australian Nursing and Midwifery Federation, 2018).
 Decision making framework -is set for nurses and clinical stakeholders to
intervene if given roles and activities are acceptable as the competence and
level of education of a nurse and if they meet the required standards for health
care practice (Minnesota Board of Nursing, 2018).
 Re-entry to practice- According to the NMBA (2018), there is a set of
mandatory requirement for any nurse requiring to return to nurse practice.
These requirements are based on nature, period, recency and extend of the
previous health care practice and the nurse should meet then all. The re-entry
to practice police holds to anyone seeking for registration after five or more

years lapse in nursing practice, anyone who has not been practicing nursing
for five or more years and is willing to start the practice again and anyone who
has qualifications on mental health, disability and paediatric nursing but does
not hold registration for the practice (NMBA, 2013).
 Recency for practice according to the NMBA (2018) shows that a nurse or a
midwife has observed and maintained what is required of them in their health
care practice since registration.
 Confidentiality is a professional obligation that ensures that patients’ records
are held in confidence by any stakeholder with access to them. The law
recognizes confidentiality as a communication between two parties (Prater,
2014).
 Privacy, confidentiality and disclosure- Privacy in the health care setting
requires that any information about the patient is held private. The patient has
a legal right to privacy. Laws have been set to guide health officers in
collecting and recording information on the patient’s health, how and when to
share it (Victoria State Government, 2015). Health care practitioners are
facing a big dilemma on the issue of disclosure. On exceptional circumstances
like in cases where it is to protect the best interest of the patient, a health
professional could overlook the principle of confidentiality to patients (Royal
College of Nursing, 2018). The issues of confidentiality and disclosure could
be unclear in most cases and the nurse should seek advice from the manager or
senior colleague.
 Social media policy- The Nursing Council of New Zealand in 2012 came up
with guidelines on how nurses and midwives should use the social media in
relation to the nurse and midwives code of professional conduct. These

guidelines explain the benefits and consequences of the social media in
accordance to the standards and code of conduct for nurses (Nursing Council
of New Zealand, 2013). Hughes (2017) thinks that use of social media is more
on the personal purposes than professional, though it could be helpful in
education and peer support.
 human rights including access to healthcare- this is a legal obligation that
ensures that every citizen can access affordable, timely and acceptable health
care
 Nursing and Midwifery Board of Australia nursing practice guidelines,
standards- these are principles and guidelines set by NMBA to govern
registered nurses and protect the health of the public
 registration guidelines- these are standards set by the bodies governing nurses
and health practitioners so that every health officer meets them before staring
the health care practice
 National safety and quality health service standards- The NSQHS standards
are rules set such that hospitals and other health care facilities set up maintain
a system whereby they minimize cases of patient harm and promote quality of
health care delivery (Victoria State Government, 2018; Twigg et al. 2013).
 Health legislation- Victoria State Government (2018) claim that drugs and
poisons are beneficial to the society when used appropriately but cause harm
to people when mishandled. It is for this reason the government has set laws to
con control the manufacture, supply and use of these substances. Medicine and
poison permits and licences guidelines are stated in the Drug, Poison and
Controlled Substances Act 1981 and the Drugs, Poisons and Controlled
Substances Regulations 2017.

 The mental health legislation- aims at providing a quality care, treatment and
control to people with mental illness, people with mental disorders and any
other related infections (NSW Government, 2018).
 The Privacy Act 1988 -gives guidelines on how personal information should
be handled. This covers even collection, storing, use and disclosing the
personal information. The Health Record Act 2012- contains a system of
records with summaries of people’s health information. The record allows
health care professionals to access health information of patients and also the
patients are able to access their records (Australian Government, 2018). The
Aged Care Act 1997- is a legislation that provided care for the elderly people
in the nation. This Act was amended as part of the government’s strategy to
improve care for the aging people (Australian Government, 2017).
 The Carers Recognition Legislation- explains the role of carers in the society.
It also discusses the principles and relationship of carers with the community
and the obligation of government authorities in the care for its citizens
(Australian Government, 2011).
 working with children legislation- this legislation protects children from any
kind of abuse by ensuring that people working with them are caring
 ethical decision making model-this are models use to evaluate and choose the
best alternative according to the nurse code of conduct
 role of the Nursing and Midwifery Board of Australia in regulating the nursing
profession- the NMBA supports nurses and midwives by providing professional
advice and policies helpful in the nurse and midwifery practice
 The Disability Discrimination Act 1992- protects the disabled from any kind
of discrimination based on their physical status (Australian Human Rights
Commission, 2018). Children and young people legislation- The

commonwealth, states and territories in Australia altogether in 2009 agreed
that children and the young people were important and therefore the need to
protect them. This was stated in the Children and Young People Legislation.
 The Workplace health and safety legislation- is a national policy set to ensure
and uphold health and safety of workers in the workplace. It also aims to
improve workers’ compensation (Australian Government, 2018).
 Autonomy in the health care setting is a right of an individual (mostly adults)
to make decisions relating their medical care. Autonomy underlies the need to
seek for consent before the patient is treated.
 Veracity is related to autonomy and is based on a trust between the patient and
health professional. It requires that every party be honest and tell the truth
(Hill, 2003).
Qn2.
Ethical principles- Borhani et al. (2010) claim that the importance of ethics is not just
to teach nurses mental skills but also to promote spiritual, moral and good communication
among the stakeholders.
 Ethics help nurses to show commitment, responsibility and offer a high quality health
care. Moral theorists claim that ethical principles install in nurses the ability to handle
ethical issues in their working environment. In the health care setting, ethics is a set of
moral standards and principles that call for application of values in the health care
practice. Bioethics- explains on matters concerning human values such as right to live
and the right to health (Gabel, 2010).
 Ethical issues in abortion: abortion is among the controversial issues in medical
ethics. Many nations have accepted abortion in cases when the mother’s life is at

stake though other nations still hold abortion as unethical (Patil et al. 2014). Those
against abortion think that a foetus is alive and killing it would just be like killing a
human being.
 Tissue transplant- is among the medical advancements in the recent centuries and is
perceived as a means of giving a gift of life to a patient with vital organ failure.
 Organ donation- Donation of organs must involve the participation of the donating
individual, the one to which the organ is being donated and also the society (Tonti-
Filippini, 2012).
 Reproductive technology- Different governments have enacted laws to limit and
regulate the use of reproductive technologies though they have left some issues
unsolved. Issues like the disposal of embryo after conclusion of the medical process,
pregnancy and multiple implantation have not been tackled exhaustively (OBOS
infertility contributors, 2011).
 Mandatory reporting- is the act of reporting to the government agencies any suspected
case of child abuse. Mandatory reporting in the US is not new and they have
developed model acts for the concerned authorities to use in enacting the policy
(Brashler et al. 2016). Conscientious objection- though in the rise in health care
setting mostly due to the controversy arising in abortion and emergency
contraception, it is believed to be ubiquitous in women care and reproductive
medicine. According to Savulescu (2006) conscientious objection leads to
inefficiency, inequality and inconsistency.
 Artificially prolonging life- requires the consent of the patient or the family. Though
many nurses are aware of the consequences of using life sustaining intervention on
patients, they claim that it is safer provide the treatment (Welie and ten Have, 2014).

 Refusal and withdrawal of treatment- It is legally and ethically justified that
withdrawing treatment overweighs the benefits to the patient.
 Stem cell research- it offers hope to treatment of diseases like spinal cord injury and
diabetes. However, human stem cell research has faces ethical controversies as it
deprives embryos and oocytes pluripotent stem cell lines. Other ethical dilemmas
arise on the consent to donate stem cells required for the research (Lo and Parham,
2009).
 Euthanasia- this is an intentional act to cause dealth.
Qn3. Contemporary ethical issues are situations that needs one to choose between
what is right and what is unethical.
Qn4. According to the Australian department of health (2005), restraint should not be
used on a patient unless it is within the approved procedure of mental health and it is the only
way to protect the patient from harm. Instances of patient restraint must be recorded in the
patient’s medical record. A restrained patient should be kept under close and regular care and
supervision of qualified health care professionals. The use of restraint has been related to
adverse events like dehydration, loss of strength in the muscles, mobility, skin problems,
chocking, mechanical and physical restraint, pressure sores and circulatory complications. It
is also associated with other problems such as lack of good clinical practice, inappropriate
use of intervention, poor skills and knowledge on safer use of restraint or alternative ways
and violence triggered by using restraint (NSW Government, 2018).
Qn5. According to Marshal (2015), medical profession discourages disclosure of
medical errors or atoning for their actions. In the recent years this has changed, doing away
with the culture of secrecy and upholding transparency which is of benefit to health care
providers and the patients. Marshal (2015) thinks that disclosure is the right thing to do as the

patient and his family have the right to know what happened and also know what the causes
of the mistake were. He also thinks that disclosure is ethical for nurses to disclose their errors
to the patient. Mental Health Act 2014 requires only in specific conditions that health
information should be disclosed for patients with mental illness to get quality care and
treatment. Patient’s health information should be disclosed during when there is a threat on
the safety, health or even life of the patient and the public (Victoria State Government, 2018).

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