NCM 108 Healthcare Ethics PDF

NCM 108: Healthcare ethics Course description ▸ The application of ethical, moral, and legal principles to the practice of nursing is the focus of this course. It also addresses how to apply general bioethical concepts to problems that have an impact on nursing practice in healthcare...

NCM 108: Healthcare ethics Course description ▸ The application of ethical, moral, and legal principles to the practice of nursing is the focus of this course. It also addresses how to apply general bioethical concepts to problems that have an impact on nursing practice in healthcare settings. In order to equip the learner to deliver effective, efficient, and safe nursing care, these will serve as the foundation for good decision-making in a variety of settings. 2 Learning outcomes 1. Adheres to ethico-moral and legal considerations when providing safe, quality and professional nursing care 2. Ensuresthatallnursingpersonneladheretostandardsofsafety,bioethicalpri nciplesandevidence- based nursing practice 3. Formulate strategies to enhance the capability of the client and the healthcare providers to participate in ethical decision making. 4. Applies ethical reasoning and decision-making processes to address situations of ethical conflicts and moral dilemma. 5. Collaborates with other members nursing care. Hello! Maurice R. Villafranca, RN, CNN, MAN MSEUF – BSN 2012 UST – MAN (cum laude) 2015 SPUM – PhD (dissertation ongoing) Assoc. Prof 2b ER Nurse/Dialysis Nurse 4 5 Introduction to Bioethics; The Being we call MAN; MAN as a Unified Whole ▸ BIOETHICS- is a field of study concerned with the ETHICS and philosophical implications of certain biological and medical procedures, technologies, and treatments, as organ transplants, genetic engineering, and care of the terminally ill. ▹ a science that deals with the study of the morality of human conduct concerning human life in all its aspects from the moment of its conception to its natural end. 6 WHY study ethics? 7 ETHICS Nursing Ethics Bioethics ▸ defined broadly as the ▸ a relatively new field of examination of all kinds of inquiry and can be defined as ethical and bioethical issues ‘the systematic study from the perspective of of the moral dimensions — nursing theory and practice including moral vision, which, in turn, rest on the decisions, conduct and agreed core concepts of policies — of the life sciences nursing, namely: person, and health care culture, care, health, healing, environment and nursing itself 8 Morality of human conduct What makes good, What makes evil, What makes reason good? evil? right? ▸ An act is good ▸ When it is not in ▸ When it is in when it is in agreement or conformity with agreement or conformity with the truth- which conformity with and is in must be objective the dictates of transgression of in its sense. right reason the dictates of right reason. 9 ▸ CONFIDENTIALITY OF RECORDS ▸ RIGHT TO PRIVACY ▸ RIGHT TO INFORMATION ▸ COMPETENT CONSENT TO TREATMENT Ethical Concerns in ▸ RIGHT TO REFUSE healthcare TREATMENT ▸ TERMINATION OF TREATMENT ▸ QUALITY OF SERVICE PROVIDED FOR DISABLED OR TERMINAL PATIENTS 10 MAN ▸ From Latin “Humanitas”, the concept of Man means human nature, general culture of the mind. Most philosophers defined MAN as any human being endowed with reason. ▸ Origin of MAN ▹ Secular approach ▹ Theological approach 11 Three major views on man’s origin ▸ Evolution ▹ Evolution is a theory based on naturalism and precludes any supernatural intervention by God. ▹ “survival of the fittest.” ▸ Theistic ▹ Theistic Evolution is a theory based on naturalism and limited supernatural intervention by God. ▸ Creationism ▹ Creationism is a theory based on biblical revelation and the sole supernatural creation of God. 12 Personalism ▸ Personalism is any philosophy that considers personality the supreme value and the key to the measuring of reality. ▸ Personalists claim that the person is the key in the search for self-knowledge, for correct insight into reality, and for the place of persons in it. ▸ Persons have unique value, and only persons have free will. 13  ? What act is governed by the norm morality ▸ Morality – is the measure of relation between the human act performed and its norm according to the dictates of right reason, human nature, and ultimately, God’s eternal law. a. Good act- agreement with right reason, human rational nature, and God.eg. Assist in delivery of a baby. b. Evil act- disagreement or in opposition to the said norms.eg. Assist in abortion of a baby. Human Act ▸ Human act is a deed that proceeds from a conscious mind and deliberate free will of a person. It is an act or activity that is knowingly, voluntarily, and intentionally performed. 3 Essential elements required for an act to be a human act, namely: Ø Knowledge Ø Freedom Ø Voluntariness 15 Human Act A norm is a standard, a pattern, a measure, or a rule, which serves as basis or guide for human acts to be morally good. There are two (2) basic norms of human acts , namely: 1. Law- is a body of rules of action or conduct prescribed by controlling authority, and having binding legal force. 2. Conscience- may be constructed as an act of the practical judgment of reason that decides upon an individual action as good and to be performed, or as evil to be avoided. 16 Double Effect: ▸ Human acts with good and bad effect/consequences or wanted and unwanted effects. ▸ Principle of Double effect or twofold effect: - To be judged as morally good, an action with double effect must meet the following criteria: - a. The action must be morally good and must not be evil in itself (stealing,lying). Principle of Double effect - b. The good effect must be willed and the bad effect merely allowed. - The person intends only the good effect. The evil effect though foreseen and permitted, is not wanted. - c. The good effect must not come from an evil action but must come from the initial action itself directly. - The good effect must immediately occur after the action is performed or at least occur simultaneously with the evil effect. Principle of double effect ▸ “The good effect must have a greater effect than the bad effect. There should be a proportionately grave reason to justify the evil effect.” ▸ Eg. Myomectomy, Ectopic pregnancy, Act of man 1. There is no element of knowledge - The agent is not aware and conscious of what he is doing and what it means. - Eg. Somnambulism( sleep walking) ▸ 2. There is no element of freedom - Act of man is not freely done. - Eg. All acts of human infant. Act of man ▸ 3. There is no element of voluntariness. - Does not proceed from both knowledge and freedom. - Requiring no decision of the will to make the agent intend and willfully do such an act. - Eg. The act of digesting- involuntary act. - Eg. An insane person who attacks a nurse cannot be held liable for his actions. Thanks! Any questions? 22 Course task ▸ The Commission on Higher Education (CHED) technical committee on nursing integrated the course Bioethics/Healthcare ethics to the nursing curriculum as it is an essential component in delivering safe and quality nursing care. To what extent do you agree or disagree? 23 Code of Ethics for Nursing; Multiple Ethical Obligations; Nurse- Doctors Relations Learning outcomes 1. Understand the History and Code of Ethics for Nurses of the Philippines 2. Describe the Code of Ethics of International Council of Nurses. 3. Describe the Multiple Ethical Obligations of Nurses. 4. Discuss the Nurse-Physician Relationship. THE ICN CODE OF ETHICS FOR NURSES An international code of ethics for nurses was first adopted by the International Council of Nurses(ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2012. 26 Introduction ▸ Nurses have four fundamental responsibilities: 1. To promote health 2. To prevent illness 3. To restore health 4. To alleviate suffering The need for nursing applies to all of these. 27 What exists in nursing? è Is a respect for human rights ▸ These includes: - Cultural rights - The right to having a life and choice - To have dignity - To be treated with respect Nursing care is respectful of and unrestricted by considerations of: ▸ Gender and Age ▸ Color and Race ▸ Creed – set of beliefs ▸ Culture ▸ Disability or illness ▸ Social status ▸ Sexual orientation ▸ Nationality ▸ Politics THE ICN CODE ▸ The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct. 1. Nurses and people -Nurse’s primary professional responsibility is to people requiring è nursing care. 2. Nurses and practice - Nurses carries personal responsibility and accountability for è nursing practice - And for maintaining competence by è continual learning. THE ICN CODE 3. Nurses and the profession - The nurse assumes the major role in: è determining and implementing acceptable standards of clinical nursing practice, management, research and education. - The nurse is active in: 1. Developing a core of research-based professional knowledge. 2. Developing and sustaining a core of professional values. THE ICN CODE 4. Nurses and co-workers - The nurse sustains a collaborative and respectful relationship with co-workers in nursing and other fields. - The nurse takes appropriate action to safeguard individuals, families, and communities when their health is endangered by a co-worker or any other person. - The nurse takes appropriate action to support and guide co- workers to advance ethical conduct. SUGGESTIONS FOR USE of the ICN Code of Ethics for Nurses ▸ The ICN Code of ethics for Nurses is a guide for action based on social values and needs. It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society. ▸ To achieve its purpose the Code must be understood, internalized and used by nurses in all aspects of their work. It must be available to students and nurses throughout their study and work lives. APPLYING THE ELEMENTS of the ICN Code of Ethics for Nurses ▸ The following chart will assists nurses to translate the standards into action. Nurses and nursing students can therefore: ▸ Study the standards under each element of the Code. ▸ Reflect on what each standard means to you. Think about how you can apply ethics in your nursing domain. ▸ Discuss the Code with co-workers and others. APPLYING THE ELEMENTS of the ICN Code of Ethics for Nurses ▸ Use a specific example from experience to identify ethical dilemmas and standards of conduct as outlined in the Code. è Identify how you would resolve the dilemmas. ▸ Work in groups to clarify ethical decision making. ▸ Collaborate with your National Nurse Association, co-workers, and other in the continuous application of ethical standards in nursing practice, education, management and research. Preamble Health is a fundamental right of every individual. The Filipino registered nurse, believing in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all cost. This responsibility encompasses promotion of health, prevention of illness, alleviation of suffering, and restoration of health. However, when the foregoing are not possible, assistance towards a peaceful death shall be his/her obligation Registered Nurses and People SECTION 4. Ethical Principles 1. Values, customs, and spiritual beliefs held by individuals shall be respected. 2. Individual freedom to make rational and unconstrained decisions shall be respected. 3. Personal information acquired in the process of giving nursing care shall be held in strict confidence. SECTION 5. Guidelines to be observed: REGISTERED Nurses must 1. consider the individuality and totality of patients when they administer care. 2. respect the spiritual beliefs and practices of patients regarding diet and treatment. 3. uphold the rights of individuals. 4. take into consideration the culture and values of patients in providing nursing care. However, in the event of conflicts, their welfare and safety must take precedence. Registered Nurses and Practice SECTION 6. Ethical Principles 1. Human life is inviolable. 2. Quality and excellence in the care of the patients are the goals of nursing practice. 3. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability. SECTION 7. Guidelines to be observed: REGISTERED Nurses must 1. know the definition and scope of nursing practice which are in the provisions of R. A. No. 9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act. of 2002”, (the IRR). 2. be aware of their duties and responsibilities in the practice of their profession as defined in the “Philippine Nursing Act of 2002” and the IRR. 3. acquire and develop the necessary competence in knowledge, skills, and attitudes to effectively render appropriate nursing services through varied learning situations. 4. if they are administrators, be responsible in providing favorable environment for the growth and developments of Registered Nurses in their charge. Registered Nurses and Practice SECTION 7. Guidelines to be observed: REGISTERED Nurses must 1. be cognizant that professional programs for specialty certification by the BON are accredited through the Nursing Specialty Certification Council (NSCC). 2. see to it that quality nursing care and practice meet the optimum standard of safe nursing practice. 3. insure that modification of practice shall consider the principles of safe nursing practice. 4. if in position of authority in a work environment, be normally and legally responsible for devising a system of minimizing occurrences of ineffective and unlawful nursing practice. 5. ensure that patients’ records shall be available only if they are to be issued to those who are professionally and directly involved in their care and when they are required by law. Registered Nurses and Practice SECTION 8. Ethical Principle 1. Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and privileges. Guidelines to be observed: REGISTERED Nurses must 1. respect the “Patients’ Bill of Rights” in the delivery of nursing care 2. provide the patients or their families with all pertinent information except those which may be deemed harmful to their well-being. 3. uphold the patients’ rights when conflict arises regarding management of their care. Registered Nurses and Practice SECTION 9. Ethical Principle 1. Registered Nurses are aware that their actions have professional, ethical, moral, and legal dimensions. They strive to perform their work in the best interest of all concerned. SECTION 10. Guidelines to be observed: REGISTERED Nurses must 1. perform their professional duties in conformity with existing laws, rules regulations, measures, and generally accepted principles of moral conduct and proper decorum. 2. not allow themselves to be used in advertisement that should demean the image of the profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.). Registered Nurses and Practice SECTION 10. Guidelines to be observed: REGISTERED Nurses must 1. decline any gift, favor, or hospitality which might be interpreted as capitalizing on patinets 2. not demand and receive any commission, fee or emolument for recommending or referring a patient to a physician, a co-nurse or another health care worker; not to pay any commission, fee or other compensations to the one referring or recommending a patient to them for nursing care. 3. avoid any abuse of the privilege relationship which exists with patients and of the privilege access allowed to their property, residence, or workplace. Registered Nurses and Co-Workers SECTION 11. Ethical Principles 1. The Registered Nurse is in solidarity with other members of the healthcare team in working for the patient’s best interest. 2. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care providers. SECTION 12. Guidelines to be observed: REGISTERED Nurses must 1. maintain their professional role/identity while working with other members of the health team. 2. conform with group activities as those of a health team should be based on acceptable, ethico-legal statndards. 3. contribute to the professional growth and development of other members of the health team. SECTION 12. Guidelines to be observed: REGISTERED Nurses must 4. actively participate in professional organizations. 5. not act in any manner prejudicial to other professions. 6. honor and safeguard the reputation and dignity of the members of nursing and other professions; refrain from making unfair and unwarranted comments or criticisms on their competence, conduct, and procedures; or not do anything that will bring discredit to a colleague and to any member of other professions. PRC-BN 7. respect the rights of their co-workers. Registered Nurse, Society, and Environment SECTION 13. Ethical Principles 1. The preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment of a Registered Nurse. 2. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse. SECTION 14. Guidelines to be observed: REGISTERED Nurses must 1. be conscious of their obligations as citizens and, as such, be involved in community concerns. 2. be equipped with knowledge of health resources within the community, and take roles in primary health care. 3. actively participate in programs, projects, and activities that respond to the problems of society. 4. lead their lives in conformity with the principles of right conduct and proper decorum. 5. project an image that will uplift the nursing profession at all times. Registered Nurses and the Profession SECTION 15. Ethical Principles: 1. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal. 2. Compliance with the by-laws of the accredited professional organization (PNA), and other professional organizations of which the Registered Nurse is a member is a lofty duty. 3. Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations. 4. Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and a visionary mission. SECTION 16. Guidelines to be observed: REGISTERED Nurses must 1. be members of the Accredited Professional Organization (PNA). 2. strictly adhere to the nursing standards. PRC-BN 3. participate actively in the growth and development of the nursing profession. 4. strive to secure equitable socio-economic and work conditions in nursing through appropriate legislation and other means. 5. assert for the implementation of labor and work standards. “ Ten Steps to Improving Physician-Nurse Relationships Tips for Nurses 1. Always have the chart in hand when calling a physician. 2. Adopt the SBAR tool as a standard of communication especially telephone conversations. 3. Don’t begin telephone conversations with “I’m sorry to bother you....” 4.Be prepared for rounds. Anticipate late night problems ahead of time. 5.Use the progress notes to briefly communicate your key concerns/interventions. 49 Tips for Nurses 6.Confront physicians whose behaviors are degrading by speaking to them in private. State the behavior and its effect. Ask manager for support if needed. 7.Take the time to thank and acknowledge those physicians with whom you have a good working relationship. 8.Don’t complain about a doctor to other staff. If you have a problem, speak to the physician in private. 9.Raise your awareness. Identify those physician behaviors which belittle or diminish you (one-word answers, no eye contact, interrupting, raised voice, etc.) 10.Further your education by pursuing a BSN or MSN degree 50 Course task ▸ The general public often labels nurses as assistants of physician (or in some instances as “utusan ng doctor”). To what extent do you agree or disagree? 51 Sources of Ethics and Morality Sources of Ethics and Morality A. Human reason- primary source, acquisition and application of the knowledge of ethics. B. Contemporary and a. personal experience historical experiences b. experience of others 53 Theory of Ethics 1. Virtue Ethics- refers to the Eg. Prudence, justice, temperance and fortitude. (habit) moral practice or action in conformity to a standard of right - the goodness of an act is determined by the individual’s (as divine law or the highest posession of moral characters or good).Good character traits. virtues. 2. Divine command ethics- the religious idea that there is a divine being (God, Allah), a series of rules or commandments that believers claim can provide moral guidance to all. 54 Ethics Theories 4. Realism – opposite 427 BC of idealism.(Arestotle- 3. Idealism (Plato- 347 322 - The truth can be known by - Material objects exist in themselves, apart from the reasoning alone. (Deontology) mind’s or consciousness. Rene Descartes- “I think, (Utilitarianism) therefore I am”, “ if no one -” I am, therefore I think” (sarte hears, it does not exist”, prove and disprove the existence of and camus) God. 384 BC 55 Normative Ethics Study of morals on how one To establish what is morally right should ought to act, not one and what is morally wrong in thinks one should act. regard to human action. 56 Theories of Normative Ethics ▸ 1. Virtue theories- “are acquired good habits that are used to regulate emotions”.(Aristotle) ▹ Eg. Courage in facing fear of danger. ▸ 2. Duty/Deontological/Nonconsequential Theories (Immanuel Kant) ▹ - base morality on principles of obligation/duty arising from his profession regardless of the consequences. ▹ Duties: ▹ a. Fidelity- the duty to keep promises. ▹ b. Reparation- the duty to compensate others when we harm them. 57 Normative Theories ▹ c. Gratitude- the duty to thank those who help us. ▹ d. Justice- the duty to recognize merit. ▹ e. Beneficence- The duty to improve the conditions of others. To do good. ▹ f. Self – improvement- The duty to improve our virtue and intelligence. ▹ h. Nonmaleficence- the duty to not injure others. Justice 59 OR OR Normative Theories ▸ 3. Consequentialist/Teleological/Utilitarianism Theories ▹ -Based morality on the consequences of human action. ▹ An action is morally right if the consequences of such action are more favorable than unfavorable. ▹ End result of the action than the means or nature of the action. “ the end justifies the means”. (End or telos) 62 Utilitarianism (Jeremy Bentham) ▸ “We judge morality of each action by first determining the good and the bad consequences of it”. ▸ “The pleasure that results from a person’s action should outweigh the pain for it to be morally right.” ▸ Ethical Egoism/ social contract theory (Thomas Hobes) ▸ -”Persons being selfish individuals are at risk of suffering the consequences of each other selfish interests”. ▸ “Selfishness motivates individuals to adopt moral rules to protect themselves from selfish whims of one another”. 63 LEGAL RIGHTS Legal Rights ▸ These are rights derived from the state which are not only asserted as moral prerogatives, but they also afforded governmental and protection. 3 Types of Legal Rights ▸ Civil Rights - those rights which provide opportunity to each person to lead a civilized social life. 66 Political Rights those rights by virtue of which citizens get a share in the political process. These enable them to take an active part in the political process. available to the people in a democratic state. 68 Economic Rights ▸ those rights which provide economic security to the people. PATIENT’S BILL OF RIGHTS ▸ Adopted by the American Hospital Association (AHA) or American Physician Association (APA) ▸ Senate Bill No. 588 , “Magna Carta of Patient’s Rights” -to recognize and promote patient’s rights 73 1. Right to Medical Care and Humane Treatment ▸ Corresponding to his state of health, without any discrimination and within the limits of the resources available ▸ Medical care of good quality. Patient’s individual needs and culture shall be likewise respected 74 ▸ Be directed to wait for care, or be referred of sent for treatment elsewhere ▸ Patient’s in Emergency shall be extended immediate medical care and treatment without any deposit, or any form of advance payment  2. Right to informed consent ▸ Clear explanation, in lay person’s term of all proposed procedure -In emergency cases, when px is unconscious or incapable of giving consent, then the physician can perform diagnostic or treatment  3. The right of Privacy ▸ To be left alone ▸ Right to be free from unwarranted publicity, except in the ff cases: a. When his mental or physical condition is in controversy and the appropriate court in its discretion orders him to submit a physical or mental examination by a physician b. When the public health and safety so demand c. When the patient waived his right  4. Right to Information ▸ Right to clear, complete, and accurate evaluation of the nature and extent of the disease ▸ The contemplated medical treatment and surgical procedure ▸ Economic costs, impact on lifestyle and work including side effects ▸ If the information will cause mental suffering, disclosure may be withheld ▸ Right to know the name and credentials of the physician responsible for his care ▸ Right to examine and be given an itemized bill for services rendered in the facility, regardless of the manner and source of payment  5. Right of Privileged Communication ▸ Right to demand that all information, communication and records pertaining to his care be treated as confidential ▸ A physician is not authorized to divulge any information, except: a. When such disclosure will benefit public health and safety; b. When it is in the interest of justice; and c. When the patients waives the confidential nature of such information  6. Right to Choose Physician ▸ Free to choose the physician to serve him except when; a. He is confined in a charity ward; b. He has entered into a contract with a health maintenance organization which stipulates that the patient can only be served by a physician affiliated with the organization  7. Right to Self-Determination ▸ Right to refuse diagnostic and treatment procedure a. He is of age and sound mind b. He is informed of the medical consequences of his refusal;  c. He releases those involved in his care from any obligation relative to the consequences of his decision d. Refusal will not jeopardize public health and safety  8. The Right to Religious Belief ▸ Right to refuse medical treatment which may be contrary to his religious beliefs  9. Right to Medical Records ▸ Entitled to a summary of his medical history condition ▸ Right to view the content of his medical records with the attending physician explaining contents; amendments can be made if there are corrections ▸ The health care institution shall issue medical certificate free of charge ▸ Upon discharge of patient, may obtain a reproduction of the same record, whether or not he has fully settled his financial obligations ▸ The health care institution shall ensure and safeguard the integrity and authenticity of then medical records  10. Right to Leave ▸ Right to leave the hospital regardless of his physical condition, ▸ No patient shall be detained against his will in any health care institution of his failure to fully settle his financial obligations 11. Right to Refuse Participation in Medical Research ▸ Right to be advised if the health care provider plans to involve him in medical research but not limited to human experimentation ▸ Such human experimentation may be performed only with the written informed consent of the patient  12. Right to Correspondence and Receive Visitor ▸ Right to communicate with relatives and other persons ▸ To receive visitors subject to reasonable limits prescribed the rules regulations of the health care institution  13. Right to Express Grievances ▸ Right to express the grievances about the care and service received without fear of discrimination. 14. Right to be Informed of His Rights and Obligations as a Patient ▸ Right to be informed of his rights and obligations as a patient ▸ DOH and other health care providers, shall launch and sustain nation wide information and education campaign to make to people the rights as patient, as declared in this Act. Nurses Bill of Rights ▸ June 26, 2001 ANA Nurses Bill of Rights 1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care. 2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scoped of practice. Nurses bill of rights ▸ 3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for nurses and its interpretive statements. ▸ 4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution. Nurses bill of rights ▸ 5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities. ▸ 6. Nurses have the right to a work environment that is safe for themselves and their patients. ▸ 7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings. Nurses bill of rights ▸ 8. Nurses have the right not to be abused in any form by physician, pharmacists, administrators or nursing directors. Any abuse that occurs should be dealt with in a professional and in partial manner by the nurse’s employer. ▸ 9. Nurses have the right not to be exploited and abused by being floated to areas of practice that they are not familiar with. Nurses bill of rights ▸ 10. Nurses have the right to refuse any assignment that they feel is unsafe. Such as: ▹ -When a nurse is assigned a patient load he/she feels is unsafe. ▹ -A nurse is assigned to work in an area of nursing in which he/she is not familiar. ▹ -A nurse knows that equipment/ supplies are inadequate or not available. The problems of rights 1. The right to receive health care services ( article 27.1 a ) ▸ Due to an acknowledged scarcity of resources and the fact that it takes time to build an infra- structure, a person cannot claim an absolute and immediate right to receive health care. 2. Underlying conditions needed for health ▸ 2.1 The right to an environment that is not harmful to health or well-being (Article 24) -The health care industry generates potentially hazardous biological waste; and, unless health professionals and institutions manage such waste with care, the population is exposed to potential health risks ▸ 2.2 The right to freedom and security of person, including freedom from all forms of violence from either public or private sources (Article 12) -Health services should neither be a source of violence towards patients, nor permit violence to interfere with patient care. ▸ 2.3 Freedom of religion, belief and opinion (Article 15) _health care providers must respect differing beliefs in their practice. ▸ 2.4 Children have the right to basic nutrition, shelter, basic health care services and social services (Article 28) -This was the basis for the legal decision in Grootboom v. Oostenberg Municipality 2000 (3) BCLR 277 (Pillay 2000b; 2000c) to prevent the forced removal of residents from an informal settlement, without making adequate provision for the shelter of the residents’ children. ▸ 2.5 Other rights relating to health in the Constitution include Ø a prohibition on forcible medical experimentation without informed consent (Article 12.2 c) Ø prisoners’ rights to conditions of detention that are consistent with human dignity, including the provision, at state expense, of nutrition and medical treatment (Article 35) Ø rights to social claims for the underlying determinants of health - such as housing, education, water and social security (Articles 26,27.1 b and 29 c). 3. Foundational human rights that impact health ▸ 3.1 The right to life (Article 11) - It plays a key role in the on-going debates over Top and is integral to proposed legislation dealing with end- of-life decision making, the so-called euthanasia legislation. ▸ 3.2 The right to dignity (Article 10) - Health care workers have clear obligations to respect the dignity of service users, irrespective of resource constraints or conditions under which health care takes place. - The notion of respecting human dignity is at the heart of ethical codes for all health professionals ▸ 3.3 Non-discrimination (Article 9) -This means that health professionals may not unfairly discriminate against users of services on the basis of gender, race, age, disability, sexual orientation and a range of other listed factors. ▸ 3.4 Another foundational tenet relates to accessing information (Article 32). -The Promotion of Access to Information Act (Government Gazette 2000) makes a person’s right to information about themselves held by the State almost unqualified, while a person’s right to information about themselves held by a private body is constrained only in so far as the information must be shown to be needed in order for the person to exercise or protect another righ ▸ 3.5 The last generic area in the Bill of Rights important to health is the provision for lawful, reasonable and procedurally fair administrative actions (Article 33). - In the health sphere, this has translated into provisions within the Patients’ Rights Charter for a complaints procedure to ensure adequate redress of poor treatment.