1.2: Ethical and Legal Responsibilities of the Nurse

Torts and Legal Liabilities in Nursing

Nurses are legally accountable for their actions and omissions in the clinical setting. A clear understanding of legal liabilities, particularly torts, is essential to ensure safe practice and avoid litigation. A tort is a civil wrong committed against a person or their property, which can be broadly classified into unintentional and intentional torts.

Unintentional Torts: Negligence and Malpractice

Negligence is a general term denoting conduct lacking in due care. It is the failure to exercise the degree of care that a person of ordinary prudence would exercise under the same circumstances. Anyone, including non-professionals, can be liable for negligence.

Malpractice, on the other hand, is a specific type of professional negligence. It occurs when a professional (like a registered nurse) fails to act in accordance with the standard of care expected in their profession, resulting in harm to the patient. For a nurse to be held liable for malpractice, six elements must be proven in a court of law:

1. Duty: The nurse had a legal relationship with the patient and owed a duty of care (e.g., the nurse was assigned to the patient).
2. Breach of Duty: The nurse failed to meet the standard of care (e.g., failing to administer a scheduled medication or ignoring an allergy alert).
3. Foreseeability: A reasonable nurse should have known that failing to meet the standard of care could result in harm.
4. Causation: The nurse's breach of duty directly caused the injury. It must be shown that the harm would not have occurred without the nurse's specific action or omission.
5. Injury/Harm: The patient suffered actual physical, financial, or emotional harm.
6. Damages: The patient is entitled to compensation for the injury.

Important Legal Doctrines:

• Res Ipsa Loquitur: "The thing speaks for itself." This doctrine applies when the injury could not have happened without negligence, the cause was exclusively in the defendant's control, and the plaintiff did not contribute to the injury (e.g., a surgical sponge left inside a patient's abdomen).
• Respondeat Superior: "Let the master answer." An employer can be held liable for the negligent acts of their employees if the act occurred within the scope of employment. However, this does not absolve the nurse of personal liability.
• Force Majeure: An unforeseeable, irresistible act of nature (e.g., typhoon, earthquake) that excuses a party from liability if it prevents them from fulfilling a duty.

Intentional Torts

Intentional torts involve deliberate acts that violate another person's rights. Key examples include:

• Assault: An intentional threat or attempt to cause bodily harm, creating a reasonable apprehension of imminent harm in the victim. (e.g., Threatening to restrain a patient if they do not eat).
• Battery: The unauthorized, intentional, and non-consensual physical contact with a person. (e.g., Administering an injection after the patient has explicitly refused).
• False Imprisonment: The unjustified, intentional restraint or detention of a person without their consent and without legal justification. (e.g., Using physical restraints on a competent patient simply because the nurse is understaffed).
• Invasion of Privacy: Intrusion into a patient's private affairs or unauthorized disclosure of confidential medical information.
• Defamation: False communication that injures a person's reputation. It is classified as Libel (written) or Slander (spoken).

Informed Consent

Informed consent is an ethical and legal mandate that respects a patient's autonomy. It is the patient's agreement to allow a medical procedure to happen, based on a full disclosure of risks, benefits, alternatives, and consequences of refusal.

For consent to be valid, three conditions must be met:

1. Voluntary: It must be given freely without coercion, undue influence, or fraud.
2. Competence: The patient must be of legal age (18 years or older in the Philippines) and possess the mental capacity to understand the information and make a decision. Minors or unconscious patients require consent from a legal guardian or next of kin.
3. Informed: The patient must receive enough information to make an educated decision.

The Nurse's Role: It is the duty of the physician or the practitioner performing the procedure to explain the procedure and obtain consent. The nurse's primary role is to act as a patient advocate and a witness to the patient's signature. The nurse confirms that the patient is the person who signed the form, that they did so voluntarily, and that they appear competent. If the patient asks medical questions about the procedure while signing, the nurse must halt the process and call the physician back to further explain.

Code of Ethics and Patient Rights

The Code of Ethics for Registered Nurses in the Philippines (promulgated by the Board of Nursing Resolution No. 220, series of 2004) dictates that the fundamental responsibility of the nurse is fourfold: to promote health, to prevent illness, to restore health, and to alleviate suffering.

Nurses must respect the Patient's Bill of Rights, which ensures patients receive considerate and respectful care, have the right to obtain complete current information concerning their diagnosis, the right to refuse treatment to the extent permitted by law, and the right to expect that all communications and records pertaining to their care be treated as confidential.