Ethico-Legal Issues in Disaster Nursing

Ethico-Legal Issues Affecting Disaster Nursing Management

Learning Objectives

• Learners should understand and apply ethico-legal bases, guidelines, laws, and codes of ethics in disaster nursing planning and management.

Ethics

• Ethics is based on standards of right and wrong, prescribing what humans ought to do.
• Guidelines are usually in terms of rights, obligations, benefits to society, fairness, or specific virtues.
• Ethics involves the study of values in human conduct or right conduct.
• Ethics offers a critical, rational, defensible, systematic, and intellectual approach to determining what is right or best in a difficult situation.
• It deals with the "rightness" or "wrongness" of human behavior.
• Applies principles to life-and-death issues.
• Ethical obligations of nurses are nonnegotiable and express the profession's commitment to society (ANA, 2001).

Ethical Principles and Ethical Thought

• Deontology (Duty): Requires both the means and the end goal to be moral and ethical.
• Utilitarianism: The end goal justifies the means, even when the means are not moral.

Ethical Principles

• Autonomy
• Nonmaleficence
• Beneficence
• Justice
• Fidelity
• Confidentiality
• Veracity
• Accountability

Autonomy

• The freedom to make decisions about oneself.
• The right to self-determination.
• Healthcare providers must respect client/patient rights to make choices about healthcare.
• This holds even if the healthcare providers disagree with the patient's decision.

Limits to Patient Autonomy

• Autonomy is limited when its exercise causes harm to someone else or may harm the patient.
• Harm to others overrides the principle of autonomy if sufficiently grave.

Nonmaleficence

• Requires that no harm be caused to an individual, either unintentionally or deliberately.
• Nurses must protect individuals who are unable to protect themselves.

Ethics, Law, and Nurse's Duty in a Disaster

• Nurses are needed when disaster strikes.
• It poses questions whether registered nurses have a contractual "duty" to help in disaster situations.
• It questions if they have an ethical obligation to respond, and whether the law can require them to respond.

ANA Code of Ethics for Nurses

• A nurse's duty to care is an ethical component of the nurse-patient relationship.
• It can be inferred from Provision 2 of the ANA Code of Ethics for Nurses with Interpretive Statements.
• "The nurse's primary commitment is to the patient."
• Nurses have an ethical obligation to care for others but also to care for themselves.
• Provision 5 states that the nurse owes the same duty to self as to others.
• During pandemics or natural catastrophes, nurses and other health care providers must decide how much high-quality care they can provide to others while caring for themselves.

Beneficence

• This principle means "doing good" for others (The Good Samaritan Law).
• Nurses need to assist clients in meeting all their needs: biological, psychological, and social.

Crisis Standards of Care in Disaster Situations

• A protocol designed to protect medical professionals operating in extreme conditions and resource scarcity (ANA, 2017).
• Ensures that the public receives the most adequate medical services possible.

Article 25 of Human Rights

• Everyone has the right to a standard of living adequate for health and well-being.
• This includes food, clothing, housing, medical care, and necessary social services.
• Encompasses the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood beyond one's control.

Justice

• Every individual must be treated equally.
• Nurses must be nonjudgmental.
• Article 7 of the HUMAN RIGHTS declares all equal before the law and entitled to equal protection without discrimination.
• Article 21 of HUMAN RIGHTS declares everyone has the right of equal access to public service in his country.

Fidelity

• Loyalty
• The promise to fulfill all commitments.
• The basis of accountability.
• Includes the professionals faithfulness or loyalty to agreements & responsibilities accepted as part of the practice of the profession.
• This is the foundation of the nurse-patient relationship.
• Fidelity is relevant to upholding our commitment to adequate pain control, quality care, comfort, and support; representing client interests, and truthfulness.

Confidentiality

• Anything stated to nurses or healthcare providers by patients must remain confidential.
• The only times this principle may be violated are if patients indicate harm to themselves or others, or if the patient gives permission for the information to be shared.

Veracity

• This principle implies "truthfulness".
• Nurses need to be truthful to their clients
• Veracity is an important component of building trusting relationships

Accountability

• Individuals need to be responsible for their own actions.
• Nurses are accountable to themselves and to their colleagues.

Ethical Dilemmas

• Occur when a problem exists between ethical principles.
• Deciding in favor of one principle usually violates another.
• Both sides have "goodness" and "badness" associated with them.

Ethical Decision-Making Process

• Describe the problem.
• Gather the facts.
• Clarify values.
• Note reactions.
• Identify ethical principles.
• Clarify legal rules.
• Decide on a recommendation.
• Develop an action plan.
• Evaluate the plan.

Philippine Laws on Disaster Management and Risk Reduction

• The Philippines is a disaster-prone country.
• It is among the top 4 most disaster-prone countries according to the World Risk Index 2014.
• The Philippines lies along the typhoon belt and the Ring of Fire.
• Reasons why the Philippines is disaster-prone include coastal homes (longest coastal lines in the world), deforestation, and poverty and underdevelopment.

Philippine Laws

• Philippine Disaster Risk Reduction and Management Act of 2010 (R.A. No. 10121)
• Risk Reduction and Preparedness Equipment Protection Act (R.A. No. 10344)
• Children's Emergency Relief and Protection Act (R.A. No. 10821)
• Philippine Environmental Laws

Philippine Environmental Laws

• Philippine Clean Air Act (R.A. No. 8749)
• Tobacco Regulation Act of 2003 (R.A. No. 9211)
• Toxic Substances and the Hazardous and Nuclear Wastes Control Act of 1990 (R.A. 6969)
• Ecological Solid Waste Management Act of 2000 (R.A. No. 9003)
• Wildlife Resources and Conservation and Protection Act (R.A. 9147)
• National Integrated Protected Areas (R.A. 1586)

RA 10121: Philippine Disaster Risk Reduction and Management (DRRM) Act of 2010

• Strengthens the Philippine disaster risk reduction and management system.
• Provides for the National Disaster Risk Reduction and Management Framework.
• Institutionalizes the National Disaster Risk Reduction Management Plan and appropriates funds.
• The Act shifted the policy environment from response to preparedness.
• Provides a comprehensive, all-hazard, multi-sectoral, inter-agency, and community-based approach via the National Disaster Risk Management Framework.
• Requires the government and its citizens to be prepared for disaster.

Republic Act No. 10344: Risk Reduction and Preparedness Equipment Protection Act

• Penalizes the unauthorized taking, stealing, keeping, or tampering of government risk reduction and preparedness equipment, accessories and similar facilities

Republic Act No. 10821: Children's Emergency Relief and Protection Act

• Mandates the provision of emergency relief and protection for children before, during, and after disasters and other emergency situations.

Other Laws

• United Nations' (UN's) Declaration of Human Rights in 1948.
  • Human rights in the Philippines are protected by its Constitution.
  • This ensures Filipinos can live peacefully and with dignity, safe from abuse by individuals or institutions.
  • Human rights are defined by Article III of the Philippine Constitution and the UN's International Bill of Human Rights, of which the Philippines is a signatory.
• RA 9372: Human Security Act of 2007.
  • Secures the State and protects people from "Terrorism".
  • Condemns terrorism as inimical and dangerous to national security and the welfare of the people.
  • Makes terrorism a crime against the Filipino people, Humanity and the Law of the nations.
• RA10168: Terrorism Financing Prevention and Suppression Act of 2012.
  • Otherwise known as "The Terrorism Financing Prevention and Suppression Act of 2012", hereafter referred to as the "TF Suppression Act."
  • The policy of the State to protect life, liberty, and property from acts of terrorism
  • Condemns terrorism and those who support and finance it.
  • Recognizes it as inimical and dangerous to national security and the welfare of the people.
  • to make the financing of terrorism a crime against the Filipino people, against humanity, and against the law of nations.
• RA 10871: BLS Training in Schools Act.
  • Requires basic education students to undergo age-appropriate basic life support training.
  • Pursuant to Section 15, Article II of the 1987 Philippine Constitution, policy of the State to protect and promote right to health and instill health consciousness.
  • The State shall ensure that able-bodied citizens are equipped with the necessary knowledge and basic skills to respond to certain health emergencies.
  • Duty of all public and private basic education schools to provide their students with basic life support training through psychomotor training.
  • Instruction shall include programs developed by the Philippine Heart Association (PHA) or Philippine National Red Cross (PNRC) using nationally-recognized, evidence-based guidelines for emergency cardiovascular care and psychomotor training.
  • Psychomotor training refers to hands-on practice to support cognitive learning.
• Standards of Care During Disaster
  • This refers to to the level of attentiveness and care owed under the circumstances.
  • Generally refers to professionals like doctors, paramedics, lawyers.
  • A professional standard of care applies to anyone in a professional role offering services to a client, patient, or customer.
  • Professionals are governed by a professional standard of care that, if violated, can subject to lawsuits for malpractice
• Code of Conduct for International Red Cross and Red Crescent Movement and NGOs
  • In Disaster Relief in 1992 (Steering Committee for Humanitarian Response agreed upon by 7 International Humanitarian Agencies: IFRC, ICRC, Caritas International, International Save the Children, Lutheran World Federation, Oxfam and World Council of Churches.
  • Seeks to guard the standards of behavior of International Humanitarian Agency and Humanitarian Aid workers.
  • To maintain high standards of independence, effectiveness and impact to humanitarian activities; Adopted by Federation through General Assembly and The Council of Delegates (Birmingham, 1993) and International Conference (Geneva, 1995
• IATF Guidelines (Inter-Agency Task Force for the Management of Emerging Infectious Disease)
  • RESOLUTION NO. 134, Series of 2021, August 19, 2021
  • Section 15 Article II of the 1987 Constitution states that the State shall protect and promote the right to health of the people and instill health consciousness among them;
  • Section 2(b) of Executive Order No. 168 (s.2014) mandates the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) to prevent and/or minimize the entry of suspected or confirmed patients with emerging infectious diseases into the country;
  • Continued implementation of proactive measures and restrictions must be put in place to slow down the surge in COVID-19 cases, stop further spread of variants, buy time for the health system to cope, and to protect more lives;