Under supervision

Assist. Prof. DR/Hemat Amer

Prepared by

Miss:Walaa gamal Elshapshery

Outlines:
 Introduction
 Definition of ethics, law, public health and public health
ethics
 Ethical Decision Making
 Sources of law
 Types of law
 Comparison between ethics and laws
 The basic client rights
 Ethical principles
 Nursing responsibilities
 Principles of the Ethical Practice of Public Health
 References

Introduction
The public health nurse experiences many ethical conflicts which are existing in
health care delivery system. As we began professional practice, it is essential to
understand the law that defines the nurse’s responsibility and duties. Nurses have a
responsibility to deliver safe care to their clients. This expectation requires that
nurses have professional knowledge at them expected level of practice and be
proficient in technological skills This code of ethics states key principles of the
ethical practice of public health. An accompanying statement lists the key values
and beliefs inherent to a public health perspective upon which the Ethical
Principles are based.

Ethics
The term ‘ethics’ is derived from the Greek word ‘ethos’ that can mean
custom, tradition, personality or disposition Is a system of moral principles or a set
of rules that govern our expectations of our own and others’ behavior.

Ethics: is a branch of philosophy dealing with values related to human conduct

with respect to the rightness and wrongness of certain actions and to the goodness
and badness of the motives and ends of such actions

Ethics covers the following dimensions:

 Our moralities and accountabilities.
 The language of right and wrong.
 Ethical decisions – what is good and bad?
 How to live a good life?

Public health: Activities or actions that society undertakes to assure the

conditions in which people can be healthy.

Public health ethics: simplify address principles and values, which guide
public health actions. Principles and values offer an agenda for decision making
and a
means of justifying decisions.
 Public health actions are often commenced by governments and are
focused at the population level
Ethical Decision Making
Ethical decision making is the process in which you aim to make your
decisions in line with a code of ethics. To do so, you must seek out
resources such as professional guidelines and organizational policies, and
rule out any unethical solutions to your problem.

Decision Making Model

PLUS Model:
P = Policies and Procedures (Does this decision align with organization
Policies)
L = Legal (Does this decision violate any laws or regulations)
U = Universal (Is this decision in line with core values and organization
culture
S = Self (Does it meet my standards of fairness and honesty)
Law
It is a standard or rules of conduct established and enforced by the
Government, which governs the whole society which intended to protect
the public.

Sources of law
1. The constitution: it is a system of fundamental laws or principles
that governs a nation or society. And is the basis for protection of
individual rights. These laws define and limit the power of the
government and protect citizens’ freedom.
2. Statutes: laws that govern. It is enacted by the legislative body or
legislative law. Laws passed by council or parliament.
For example, Laws that govern nursing practice.
3. Administrative agencies: Administrative agencies are staffed with
professionals who develop the specific rules and regulations that direct
the implementation of statutory law. These rules must be reasonable and consistent
with existing statutory law. Usually, the rules go into effect
only after review and comment by affected persons or groups.
Types of law
1. Criminal law:
Criminal laws were developed to protect society from actions that
threaten its existence. Criminal acts, although directed toward
individuals, are considered offenses against the state.
There are three categories of criminal law:
 Felony: the most serious category, including such acts as
homicide.
 Misdemeanor: includes lesser offenses such as traffic violations.
 Juvenile: crimes carried out by individuals younger than 18 years;
specific age varies by state and crime.
A nurse who distributes controlled substances illegally, either for personal
use or for the use of others, is violating the law.
2. Civil law:
Civil laws usually involve the violation of one person’s rights by another
person. Areas of civil law that particularly affect nurses are tort law,
contract law.
A tort is a legal or civil wrong carried out by one person against the person
or property of another.
For example:
- Drivers of automobiles, everyone has a duty to drive safely so that
others will not be harmed
-Nurses have a duty to deliver care in such a manner that the
consumers of care are not harmed. (Malpractice cases can be tried in civil
courts)
These legal duties of care may be violated intentionally or unintentionally.
3. Administrative law:
A subset of civil law which governs bodies such as nursing boards
4. Military law:
Which obviously affects those in the armed services of our country
The basic client rights
1. Receive Considerable and respectful care.
2. Obtain complete medical information.
3. Receive information necessary for giving informed consent.
4. Refine treatment.
5. Consideration of privacy.
6. Confidential treatment of personal information and medical records.
7. Request services
8. Information about other institution and individuals related to care and treatment
9. Refuse participation in research projects
10.Expect reasonable continuity of care
11.Examination and explanation of financial changes
12.Know institutional regulations.
Ethical principles
Ethical principles that nurses must adhere to are the principles of justice,
beneficence, non-maleficence, accountability, fidelity, autonomy, and veracity.

 Justice is fairness. Nurses must be fair when they distribute care, for
example, among the patients in the group of patients that they are taking
care of. Care must be fairly, justly, and equitably distributed among a
group of patients.
 Beneficence is doing good and the right thing for the patient.
 Non-maleficence is doing no harm. Harm can be intentional or unintentional.
 Accountability is accepting responsibility for one's own actions. Nurses are
accountable for their nursing care and other actions. They must accept all of the
professional and personal consequences that can occur as the result of their actions.
 Fidelity is keeping one's promises. The nurse must be faithful and true to their
professional promises and responsibilities by providing high quality, safe care in a
competent manner.
 Autonomy and patient self-determination are upheld when the nurse accepts the
client as a unique person who has the innate right to have their own opinions,
perspectives, values and beliefs. Nurses encourage patients to make their own
decision without any judgments or coercion from the nurse. The patient has the
right to reject or accept all
treatments.
 Veracity is being completely truthful with patients; nurses must not withhold the
whole truth from clients even when it may lead to patient distress.

Nursing responsibilities
o Observe agency policies and procedures.
o Establish standards by using evidence-based practice.
o Always prefers patient’s welfare.
o Be aware of relevant law and understand limits.
o Practice within the area or individual competence.
o Upgrade technical skills by attending continuing nursing education.
o Following the standards of care and referral services.
o Ensure patient safety
o Proper action for needs and problems and appropriate treatment.
o Verify the medication errors and reactions.
o Educate client/staff on legal issues.

Principles of the Ethical Practice of Public Health

1. Public health should address principally the fundamental causes of
disease and requirements for health, aiming to prevent adverse health
outcomes.
2. Public health should achieve community health in a way that respects
the rights of individuals in the community.
3. Public health policies, programs, and priorities should be developed
and evaluated through processes that ensure an opportunity for input
from community members.
4. Public health should advocate and work for the empowerment of
disenfranchised community members, aiming to ensure that the basic
resources and conditions necessary for health are accessible to all.
5. Public health should seek the information needed to implement
effective policies and programs that protect and promote health.
6. Public health institutions should provide communities with the
information they have that is needed for decisions on policies or
programs and should obtain the community’s consent for them
implementation.
7. Public health institutions should act in a timely manner on the
information they have within the resources and the mandate given to
them by the public.
8. Public health programs and policies should incorporate a variety of
approaches that anticipate and respect diverse values, beliefs, and
cultures in the community.
9. Public health programs and policies should be implemented in a
manner that most enhances the physical and social environment.
10. Public health institutions should protect the confidentiality of
information that can bring harm to an individual or community if
made public. Exceptions must be justified on the basis of the high
likelihood of significant harm to the individual or others.
11. Public health institutions should ensure the professional competence
of their employees.
12. Public health institutions and their employees should engage in
collaborations and affiliations in ways that build the public’s trust and
the institution’s effectiveness.

Legal safe guards of nurses

Informed consent: granted freedom, written or oral form (procedures,
expected outcome, complication, side effects, and alternative treatment.
■ A mentally competent adult has voluntarily given the consent
■ The client understands exactly to what he or she is consenting
■ The consent includes the risks involved in the procedure, alternative
treatments that may be available, and the possible result if the treatment is refused.
■ The consent is written.
■ A minor’s parent or guardian usually gives consent for treatment
Contracts: exchange of promises between two parties. Agreement may
be written or oral (e.g. patient and his family and health care team)
Documentation: actual, accurate, complete and essential.
Incident and Variance program: incident program for quality
improvement for our safety.
Sentinel events: expected to play in a critical role in sentinel event
(death or any other incident).
Groups at Special Risk
Women
Children
Civilians in war and terror situations
Disaster victims
Native peoples
Minority groups
Prisoners
Military
Refugees and internal migrants
Mentally ill

References
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