Legal Aspects of Nursing PDF - Philippine Nursing Act of 2002

Legal Aspects of Nursing Legal Aspects of Nursing RA 9173 - Philippine Nursing Act of 2002 - An Act providing for a more responsive nursing profession - Repealing for the purpose of RA 7164, known as the “Philippine Nursin...

Legal Aspects of Nursing Legal Aspects of Nursing RA 9173 - Philippine Nursing Act of 2002 - An Act providing for a more responsive nursing profession - Repealing for the purpose of RA 7164, known as the “Philippine Nursing Act of 1991”, and for other purposes. Important Dates in the Enactment of RA 9173 Enactment On October 8, 2002, RA 9173 was approved by the House of Senate as Senate Bill no. 2292 On October 15, 2002,it was approved by the House of Representative as House Bill no.1084 On October 21, 2002, it was signed into law by Pres. Gloria Macapagal Arroyo as Republic RA 9173 is divided into 9 articles and 41 sections Composition of the Board - Chairperson - Six (6) members - Nursing education: academe - Nursing service: hospitals - Community health nursing: public health Qualifications of BON - Natural-born Filipino citizen - Member of PNA/APO - RN - Provided: Master’s Degree - Provided further: majority of BON (MAN) - Provided finally: chairperson (MAN) - Continuous practice of nursing: 10 years - Provided the last 5 years shall be in the Philippines - Not convicted of any crime Term of Office Can be appointed for 1 term (1 term = 3 years) :  Can be reappointed for another term No reappointment more than 2 terms Removal / Suspension of BON Vested : President of the Philippines Continued neglect of duty Commission or toleration of irregularities in the board exam Unethical, immoral, and dishonorable conduct Powers and Duties of BON Supervision and regulation of nursing practice in the Philippines Conducts hearings and investigations Ensure quality nursing education Accrediting body: specialty program Maintain efficient ethical, moral, technical, and professional standards in nursing Issue, suspend and revoke license and CoR Conduct licensure exam Code of Ethics NLE Written exam (500 items) Qualifications: - Citizen of the Philippines - Citizen of other country: RECIPROCITY AGREEMENT - Good moral character - BSN degree holder Ratings: - Average: 75% - Rating not below 60% in any subject OATH-TAKING - Panunumpa - Priority thing to do after passing the board exam - Done: any public officials - When: within 15 days after the release of result CoR/ Certificate of Registration True license - Name of registrant - Serial number - Seal of commission - Signature (8) - 1 BON Chairperson :  - 6 members - 1 PRC Chairperson License Legal document given by the government that permits a person to practice his profession in a specific jurisdiction Most important tool for legal control and enforcement of nursing practice Temporary: privilege; public property License number Date of registration Date of issuance & expiration Signature (2) ○ PRC Chairperson ○ Nurse Legal Aspects of Nursing Other Laws That Affect Nursing Republic Act 7305 THE MAGNA CARTA OF PUBLIC HEALTH WORKERS SECTION 1. Title. - This Act shall be known as the "Magna Carta of Public Health Workers." SECTION. 2. Declaration of the Policy. - The State shall instill health consciousness among our people to effectively carry out the health programs and projects to the government essential for the growth and health of the nation. Towards this end, this Act aims: (a) to promote and improve the social and economic well-being of the health workers, their living and working conditions and terms of employment; (b) to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs; and (c) to encourage those with proper qualifications and excellent abilities to join and remain in government service. R.A. 7600 - The rooming-in & Breastfeeding Act of 1992 - E.O. 51 of 1996 Milk Code R.A. 10028 - An act expanding the promotion of breastfeeding, amending for the purpose RA 7600 , otherwise known as “ AN ACT PROVIDING INCENTIVES TO ALL GOVERNMENT & :  PRIVATE HEALTH INSTITUTIONS w/ rooming-in and breastfeeding practices and for other purposes.” SECTION 1. Short Title. - This Act shall be known as the "Expanded Breastfeeding Promotion Act of 2009” Section 2 of Republic Act No. 7600 is hereby amended to read as follows: SECTION 2. Declaration of Policy. - The State adopts rooming-in as a national policy to encourage, protect and support the practice of breastfeeding. It shall create an environment where basic physical, emotional, and psychological needs of mothers and infants are fulfilled through the practice of rooming-in and breastfeeding. Support for breastfeeding mothers in the workplace Last March 16, President Gloria Macapagal Arroyo signed Republic Act 10028 or the “Expanded Breastfeeding Promotion Act of 2009” which builds on RA 7600 (or the “Rooming-in and Breastfeeding Act of 1992”). Private enterprises as well as government agencies, including government-owned and controlled corporations, are required to put up lactation stations. R.A. No. 953 AN ACT TO PROVIDE FOR THE REGISTRATION OF, WITH THE COLLECTOR OF INTERNAL REVENUE, AND THE IMPOSITION OF FIXED AND SPECIAL TAXES UPON ALL PERSONS WHO PRODUCE, IMPORT, MANUFACTURE, COMPOUND, DEAL IN, DISPENSE, SELL, DISTRIBUTE, OR GIVE AWAY OPIUM, MARIJUANA, OPIUM POPPIES, OR COCA LEAVES, OR ANY SYNTHETIC DRUGS WHICH MAY HEREAFTER BE DECLARED HABIT FORMING BY THE PRESIDENT OF THE PHILIPPINES, THEIR SALTS, DERIVATIVES OR PREPARATIONS, AND FOR OTHER PURPOSES Section 1. This Act shall be known as the Narcotic Drugs Law. Drugs made from the opium poppy are called “opiates”. Some common opiates include: opium, heroin, morphine, oxycodone, hydrocodone (aka Vicodin), codeine, hydromorphone, Percocet, Fentanyl, etc. Coca leaf is the raw material for the manufacture of the drug cocaine, a powerful stimulant and anaesthetic extracted chemically from large quantities of coca leaves. R.A. 9257 An ACT GRANTING ADDITIONAL BENEFITS AND PRIVILEGES TO SENIOR CITIZENS AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7432, OTHERWISE KNOWN AS "AN ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES“ :  Promulgated on 26 February 2004, otherwise known as the "Expanded Senior Citizens Act of 2003," was signed into law and became effective on 21 March 2004. Expanded Senior Citizens Act of 2020 (R.A. 9994) Republic Act No. 7432, as amended by Republic Act No. 9257, otherwise known as the "Expanded Senior Citizens Act of 2003", is hereby further amended R.A. 7877 AN ACT DECLARING SEXUAL HARASSMENT IS UNLAWFUL IN THE EMPLOYMENT, EDUCATION OR TRAINING ENVIRONMENT, AND FOR OTHER PURPOSES. SECTION 1. Title. - This Act shall be known as the "Anti-Sexual Harassment Act of 1995." SECTION 2. Declaration of Policy. - The State shall value the dignity of every individual, enhance the development of its human resources, guarantee full respect for human rights, and uphold the dignity of workers, employees, applicants for employment, students or those undergoing training, instruction or education. Towards this end, all forms of sexual harassment in the employment, education or training environment are hereby declared unlawful. Sexual harassment occurs when a person is subject to unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature to such an extent that it alters the conditions of the person's employment and creates an abusive working environment. Sexual harassment may include touching, feeling, repeated unpleasant degrading and/or sexist remarks directed toward an employee, implying that employment status, promotion or favorable treatment depends upon the employee's assent. Pornography displayed in the workplace or emailed to coworkers may also constitute sexual harassment. R.A. 8749 June 23, 1999, Philippine Clean Air Act of 1999. An Act Providing for a Comprehensive Air Pollution Control Policy The focus is primarily on pollution prevention rather than on control and provide for a management program for air pollution. R.A. 6425 - Dangerous Drug Act of 1972 SECTION 1. Short Title. This Act shall be known and cited as "The Dangerous Drugs Act of 1972.“ SECTION 2. Definitions. As used in this Act, the term: "Dangerous drugs" refers to either: :  (1) "Prohibited drug," which includes opium and its active components and derivatives, such as heroin and morphine; coca leaf and its derivatives, principally cocaine; alpha and beta eucaine; hallucinogenic drugs, such as mescaline, lysergic acid diethylamide (LSD) and other substances producing similar effects; Indian hemp and its derivates; all preparations made from any of the foregoing; and other drugs, whether natural or synthetic, with the physiological effects of a narcotic drug; or (2) "Regulated drug," which includes self-inducing sedatives, such as secobarbital, phenobarbital, pentobarbital, barbital, amobarbital and any other drug which contains a salt or a derivative of a salt of barbituric acid; any salt, isomer or salt of an isomer, of amphetamine, such as benzedrine or dexedrine, or any drug which produces a physiological action similar to amphetamine; and hypnotic drugs, such as methaqualone or any other compound producing similar physiological effects; R.A. 5901 An act prescribing forty hours a week of labor for government & private hospitals or clinic personnel. R.A. 6675 AN ACT TO PROMOTE, REQUIRE AND ENSURE THE PRODUCTION OF AN ADEQUATE SUPPLY, DISTRIBUTION, USE AND ACCEPTANCE OF DRUGS AND MEDICINES IDENTIFIED BY THEIR GENERIC NAMES SECTION 1. Title – This Act shall be known as the "Generics Act of 1988.“ SECTION 2. Statement of Policy – It is hereby declared the policy of the State: To promote, encourage and require the use of generic terminology in the importation, manufacture, distribution, marketing, advertising and promotion, prescription and dispensing of drugs; To ensure the adequate supply of drugs with generic names at the lowest possible cost and endeavor to make them available for free to indigent patients; To encourage the extensive use of drugs with generic names through a rational system of procurement and distribution; To emphasize the scientific basis for the use of drugs, in order that health professionals may become more aware and cognizant of their therapeutic effectiveness; and To promote drug safety by minimizing duplication in medications and/or use of drugs with potentially adverse drug interactions. Only registered medical, dental or veterinary doctors are authorized to prescribe drugs. :  R.A. 8344 AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES" SECTION 1. Section 1 of Batas Pambansa Bilang 702 is hereby amended to read as follows: "SECTION 1. In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer, and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided, however, That when the patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent: Provided, further, That such transfer shall be done only after necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient's continued confinement: Provided, furthermore, That no hospital or clinic, after being informed of the medical indications for such transfer, shall refuse to receive the patient nor demand from the patient or his next of kin any deposit or advance payment: Provided, finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a refusal made punishable by this Act." Section 2. Section 2 of Batas Pambansa Bilang 702 is hereby deleted and in place thereof, new sections 2, 3 and 4 are added, to read as follows: SECTION 2. For purposes of this Act, the following definitions shall govern: "(a) 'Emergency' - a condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient. "(b) 'Serious case' - refers to a condition of a patient characterized by gravity or danger wherein based on the objective findings of a prudent medical officer on duty for the day when left unattended to, may cause loss of life or cause permanent disability to the patient. "(c) 'Confinement' - a state of being admitted in a hospital or medical clinic for medical observation, diagnosis, testing, and treatment consistent with the capability and available facilities of the hospital or clinic. :  "(d) 'Hospital' - a facility devoted primarily to the diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity, or in need of obstetrical or other medical and nursing care. It shall also be construed as any institution, building or place where there are facilities and personnel for the continued and prolonged care of patients. "(e) 'Emergency treatment and support' - any medical or surgical measure within the capability of the hospital or medical clinic that is administered by qualified health care professionals to prevent the death or permanent disability of a patient. "(f) 'Medical clinic' - a place in which patients can avail of medical consultation or treatment on an outpatient basis. "(g) 'Permanent disability' - a condition of physical disability as defined under Article 192-C and Article 193-B and C of Presidential Decree No 442; as amended, otherwise known as the Labor Code of the Philippines. "(h) 'Stabilize' - the provision of necessary care until such time that the patient may be discharged or transferred to another hospital or clinic with a reasonable probability that no physical deterioration would result from or occur during such discharge or transfer. Professional Adjustment or Negligence Refers to the commission or omission of an act, pursuant to a duty, that a reasonably person in the same or similar circumstance would or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property Elements of Professional Negligence Existence of a duty on the part of the person charged to use due care under circumstances Failure to meet the standard of due care The foreseeability of harm resulting from failure to meet standard The fact that the breach of this standard resulted in an injury to the plaintiff Specific Examples of Negligence - Failure to report observations to attending physicians. - Failure to exercise the degree of diligence which the circumstances of the particular case demands. - Mistaken identity. - Wrong medicine, wrong concentration, wrong route, and wrong dose. - Defects in equipment that may result in injuring the patients. - Errors due to family assistance. - Administration of medicine without a doctor prescription. The Doctrine of RES IPSA LOQUITUR :  “The thing speaks for itself.” It means that the nature of the wrongful act or injury is suggestive of negligence Three conditions are required to establish a defendant’s negligence without proving specific conduct. - That the injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone. - That the injury was caused by an agency within the control of the defendant - That the plaintiff himself did not engage in any manner that would tend to bring about the injury. Malpractice “you do things beyond your scope of practice” Also denotes stepping beyond one’s authority with serious consequences. Doctrine of Force Majeure It means an irresistible force, one that is unforeseen or inevitable. “you cannot stop it from happening” Circumstances such as floods, fire, earthquakes and accidents fall under this doctrine. Doctrine of Respondeat Superior “let the master answer for the acts of the subordinate” the liability is expanded to include the master as well as the employee and not a shift of liability from the subordinate to the master this doctrine applies only to those actions performed by the employee within the scope of his employment Incompetence Is the lack of ability, legal qualifications or fitness to discharge the required duty. Although a nurse is registered, if in the performance of her duty she manifests incompetency, there is ground for revocation or suspension of her certificates of registration. Liability of Nurses for the Work of Nursing Aides Nursing aides perform selected nursing activities under the direct supervision of nurses. :  Nurses should not delegate their functions to nursing aides since the Philippine Nursing Act specifies the scope of nursing practice of professional nurses. If a nurse delegates, he /she is responsible. Liability for the Work of Nursing Students Under the Philippine Nursing Act of 2002, nursing students do not perform professional nursing duties. They are to be supervised by their Clinical Instructors. Assumption of risk A nurse cannot bring suit against the patient if she gets hurt or contacts the disease since upon accepting the case, the nurse agreed to assume the risk of harm or infection. Consent Is defined as a “free and rational act that presupposes knowledge of the thing in which consent is being given by a person who is legally capable to give consent.” It is the NURSE who actually secures the consent of the patient upon admission. Informed Consent “it is established principle of law that every human being of adult years and sound mind has the right to determine what shall be done with his own body” Essential elements of Informed Consent :  - Diagnosis and explanation of the condition - A fair explanation of the procedures to be done and used and the consequences - A description of alternative treatment or procedures - A description of benefits to be expected - Material rights if any - The prognosis, if the recommended care, procedure, is refused. Proof of Consent A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of procedure A signed special consent is necessary before any medical or surgical treatment is done such as X- rays etc. Who Must Consent Normally the patient himself is the one who gives the consent If he is incompetent (minors or mentally ill) or physically unable, consent must be taken from another who is authorized to give it in his behalf. Consent of Minors Parents, or someone standing in their behalf If emancipated minor consent is signed by them. Consent of Mentally ill They cannot legally give consent. Parents or guardians. Emergency Situations If possible, a physician must obtain consent from a patient before providing treatment even in an emergency situation. The Act states "there is an emergency if the person for whom the treatment is proposed is apparently experiencing severe suffering or is at risk, if the treatment is not administered promptly, of sustaining serious bodily harm." Emergency treatment without consent: Capable person A treatment may be given without consent to an apparently capable person in an emergency, if, in the opinion of the physician: :  it is not possible to communicate the relevant information to the patient because of a language barrier or because the person has a disability that prevents the communication from taking place; steps have been taken to find a means of communicating but no such means has been found; the delay required to finding a means to communicate will prolong the patient’s suffering or will put the patient at risk of sustaining serious bodily harm; and there is no reason to believe that the person does not want the treatment. Emergency treatment without consent: Incapable person A treatment may be given without consent to an incapable person, if, in the opinion of a physician, there is an emergency and the delay required to obtain a consent or refusal on the person’s behalf will prolong the person’s suffering or will put the person at risk of sustaining serious bodily harm. ~ When an emergency situation exists, no consent is necessary because inaction at such time may cause greater injury. ~ Contract There is an assumption that everyone who needs help wants it. That is not always true. In order to care for someone in need, you must have permission. In the medical field, permission is called consent. Medical consent comes in two forms: expressed or implied. Types of Contracts Expressed - may be written or oral - all terms of the contract are explicitly stated Implied - not written - implied by the conduct of the parties Expressed consent Expressed consent is communicated to you either verbally or in written form. The victim tells you it is ok to provide assistance. The victim must be able to clearly communicate his or her wishes for expressed consent to count. Implied Consent :  Assent to a clinical procedure that is recognized as an informed agreement by the patient, even if verbal or written consent is not explicitly given. (during emergency situation) Synonym(s): emergency doctrine Implied consent happens when you are unable to communicate with the victim. Most commonly, this is because the victim is unconscious. When a victim cannot express his or her wishes, there is an assumption that they would ask for help if they could.( emergency situation, between life and death ) Emancipation of a minor Generally refers to the process of freeing a minor (person under age 18) from parental control. It means that the parent is no longer legally responsible for the acts of the child. Emancipated minor Marriage - to earn emancipated minor status is to become legally married. Military Service - to enlist in the military - After a minor is officially inducted into military service, he or she is typically automatically granted emancipated minor status. Teenage Mom Refusal to Consent Patients other than those who are incompetent to give consent can refuse consent. If refuses to sign, this should be noted in his chart Medical Records As a record of illness and treatment, it saves duplication in future cases and aids in prompt treatment It serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or condition of patient and its management. “If it was not charted, it was not observed or done.” Nurses have the responsibility of keeping the patient’s right to confidentiality. :  Permission has to be taken from the Medical Records Division of the Hospital. Tort A civil wrong committed against a person or property, excluding breach of contract Is a legal wrong, committed against a person or property, independent of a contract which renders the person who commits it liable for damages in a civil action. The person who has been wronged seeks compensation for injury or wrong he has suffered Torts can be - intentional - unintentional Tortfeasor - Person guilty of committing a tort Liability - Responsibility for acts of commission and omission Tort Law: Malpractice and Negligence Malpractice refers to a professional’s wrongful conduct in discharge of professional duties or failure to meet standards of care for the profession which results in harm to another individual entrusted to the professional’s care. Negligence is the failure to provide the care a reasonable person would ordinarily provide in a similar situation. Examples of Torts are: Assault and Battery - Assault is the imminent threat of harmful or offensive bodily contact; “banta” - Battery is an intentional, unconsented touching of another person. Legal Issues That May Affect the Nurse Assault - Example: Treatment administered without patient’s consent False Imprisonment or Illegal Detention Unjustifiable detention of a person without legal warrant within the boundaries fixed by the defendant by an act or violation of duty intended to result in such confinement :  e.g. use of physical and/or chemical restraints Invasion of Right to Privacy and Breach of Confidentiality The right to privacy is the right to be left alone, the right to be free from unwarranted publicity and exposure to public view e.g. revealing confidential patient information Defamation Example: communicating false information about a patient (Note: several courts have ruled that charting information in a medical record, whether accurate or not, does not constitute publication as required for a charge of defamation.) Character assassination, be in written or spoken Slander is oral defamation of a person by speaking unprivileged or false words by which his reputation is damaged. Libel is defamation by written words, cartoons or such representations that cause a person to be avoided, ridiculed or held in contempt or tend to injure him in his work. Good Samaritan Laws Good samaritan laws are laws that have been enacted to protect the health care professional from legal liability for actions rendered in an emergency when the professional is giving service without pay. For actions to fall under the good samaritan laws, all these conditions must be met: The care is rendered in an emergency situation. The health care worker rendered the care without pay. The care provided did not, recklessly or intentionally, cause injury or harm to the injured party. Law that protects rescuers from prosecution or civil law suits, unless their actions constitute willful misconduct and negligence. The Rescuer MUST comply with proper emergency first aid and CPR guidelines; acting in good faith by being prudent and responsible in their rescue efforts. Advance Directives A written statement of a person’s wishes about their medical treatment :  An instrument in writing whereby the person signing the instrument, the principal, provided direction in the document for future health care decisions should that person become unable to make their own health care decisions. Black’s Law Dictionary Sixth Edition Basically, you are putting into writing how you want your health care decisions to be handled in case you cannot make decisions for yourself. There are two basic types of advance directives, the Living Will and the Power of Attorney for Health Care. Living Will A document which governs the withholding or withdrawal of life-sustaining treatment from an individual in the event of an incurable or irreversible condition that will cause death within a relatively short time, and when such person is no longer able to make decisions regarding his or her medical treatment. Living wills are permitted by statute in most states. Black’s Law Dictionary Sixth Edition The second type of an advance directive is the Health Care Power of Attorney. Legal and Ethical Issues Affecting End-of-life Care The Issues The outcomes related to their care should be their own wishes. The decisions may involve the choice for: ○ Organ and tissue donations ○ Advance directives Advance Directives A general term used to describe the documents that give instructions about future medical care and treatments Advance Directives include: ○ Living Will ○ Do Not Resuscitate Order ○ Withholding or Withdrawing Treatments Living Will Was the first advance directive The lay term used frequently to describe any number of documents that give instructions about future medical care and treatments or the wish to be allowed to die without heroic or extraordinary measures should the patient be unable to communicate for self :  Directive to physicians A written document specifying the patient's wish to be allowed to die without heroic or extraordinary measures Durable power of attorney for health care A term used to describe a document used for listing the person or persons to make health care decision should a patient become unable to make informed decisions for self. Medical power of attorney Same as durable power of attorney for health Person appointed may be called a health care agent, surrogate, attorney-in-fact, or proxy Health Care Power of Attorney An instrument in writing whereby one person, as principal, appoints another as his agent and confers authority to perform certain specified acts or kinds of acts on behalf of the principal regarding his health care only. Black’s Law Dictionary Sixth Edition Do Not Resuscitate A written physician's order instructing health care providers not to attempt CPR Often requested by family Must be signed my a physician to be valid Do Not Resuscitate A written physician's order instructing health care providers not to attempt CPR Often requested by family Must be signed my a physician to be valid Several types of CPR decisions can be made, including: ○ Full code ○ Chemical code ○ DNR or "no code" ○ Out-of-hospital DNR Full code Complete and total heroic measures, which may include CPR, drugs, and mechanical ventilation Chemical code The use of drugs for resuscitation without the use of CPR DNR or "no code" :  Allows the person to die with comfort measures only and without the interference of technology Becoming known as allow natural death (AND) or comfort code Out-of-hospital DNR For use by terminally ill patients who wish to have no heroic measures used to prolong life after they leave an acute care facility Withholding or withdrawing treatments What is to be done and what is not to be done must be included in clear terms Honoring the refusal of treatments that a patient does not desire, are disproportionately burdensome to the patient, or will not benefit the patient can be ethically and legally permissible The Nurse's Responsibilities Be aware of legal issues and the wishes of the patient Nursing care of dying patients is holistic and encompasses all aspects of psychosocial (grieving process) and physical needs (physical changes that are associated with dying) Focus on patient and family: respect, dignity, and comfort Recognize own needs when dealing with grief and dying. Euthanasia / mercy killing The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma. The act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy The practice is illegal in most countries. Ethical Dilemma A situation in which there is a difficult choice to be made between two or more options An ethical dilemma is a type of ethical issue that arises when the available choices and obligations in a specific situation do not allow for an ethical outcome. In such instances, a choice or an action is required and all of the available alternatives violate an explicit ethical principle or guideline. A person is in an ethical dilemma if they stand under several conflicting moral obligations and no obligation overrides the others. Two ethical requirements are conflicting if the agent can do one or the other but not both: the agent has to choose one over the other. :