LEGAL-AND-ETHICAL-ASPECTS-OF-MIDWIFERY.pdf

Anjulata singh Raipur

1. M.Sc. DEGREE COURSE IN NURSING
Obstetrics And GynaecologicalNursing
UNIT-I-INTRODUCTION
ETHICAL AND LEGAL ASPECTS
PREPARED BY :
Mrs.MohanaM.Sc(N)
PROFESSOR
KVCN

2. COURSE : M.ScNursing I year
SUBJECT : Obstetrics & gynaecology
UNIT : ‘I’-Nursing practice
TOPIC : ETHICAL AND LEGAL ASPECTS
PREPARED BY : Mrs.MohanaM.Sc(N)
DESIGNATION :Professor

3. OBJECTIVES
The students will be able to :-
•understand the laws and ethics in midwifery practices
•Explains the common issues faced by the midwives.
•Identifies the various practice standards in midwives
maternal and new born care

4. INTRODUCTION
Laws and ethics are often seen as complimentary to
each other, but at the same time they are also seen as
opposite side of a coin. Midwives must follow standard and
regulations that range from the national level to the individual
areas of practice, such as Hospital, Labor and delivery unit.

5. TERMINOLOGY
LAW
Law is based primary on a right model that establish rules of
conduct to define relationship among individuals. It also define relationship
to impersonal entities like formal organizations, agencies or hospitals
ETHICS
It based on responsibility or duty model that consider a wider
range of factors than the right model of law. Ethics incorporators factors
such as risks, benefits other relationship, concerns and the needs and
abilities of the person affected by and affecting decisions.

6. ETHICS IN MIDWIFERY PRACTICE
Ethical requires an understanding of ethics, values,
moral reasoning and ethical decision making.
The goal of ethical midwifery is to do the right thing
for the right reasons. Knowing how to make good decisions
as well as why these decisions were made, constitutes of
ethical midwifery practice

7. ETHICAL CODES

8. ETHICAL PRINCIPLES
ETHICAL PRINCIPLE OF BENEFICIENCE
The ethical principle of beneficence requires one to act in a
way that is expected reliably to produce the greater balance of benefits
over harms in the life of others.
NON-MALEFICENCE
It means that health professionals should prevent causing harm
and is understood as expressing the limits of beneficence

9. ETHICAL PRINCIPLES
Respect for Autonomy
This principle requires one always acknowledge and carry out
the value based preference to adult, competent patent.
Empowerment and Advocacy
One of the important role of the midwife is to support and help
woman to exercise their autonomy, is called empowerment. Educating
and supporting is one of the major role of midwife, as well as laying
emphasis on the public health and health promotion.

10. ETHICAL PRINCIPLES
Health as a basic rights for all
Women often lacked basic human rights
because they were viewed as less than human,
maternal deaths and disabilities are the tragic
examples. In order for the women to be healthy and
valued for themselves they must be given the same
status as men in society women must also demand
equal treatment and equal right to health and well
being.

11. CONTINUE….
D) Justice–All people should be treated equally
and fairly regardless of disease or social or
economic status.
E) Veracity–truthfulness.
F) Fidelity –keeping promises.
ETHICAL PRINCIPLES

12. ETHICALISSUES
1) IN REPRODUCTION:-
Reproductive issues conflicting which a
women behaves in a way that may cause
harm to her fetus or is disapproved of by
some or most members of society.
Conflicts between a mother and fetus
occur when the mothers needs behaviouror
wishes may injure the fetus.

13. 2) ELECTIVE ABORTION:-
A) Abortion was a volatile, legal, social and political
issue. This decision stipulated that,
*Woman could obtain an abortion at any time
during 1
st
trimester.
*State could regulate abortion during the 2
nd
trimester only to protect women health.
*State could regulate or prohibit abortion during
the 3rd trimester except when the mothers life
might be jeopardized by continuing the
pregnancy.

14. CONFLICTING BELEIFS ABOUT ABORTION
1)Belief that abortion is a private choice.
1)Belief that abortion is taking a life.

15. IMPLICATIONS FOR NURSES
•Personal values.
•Professional obligation.

16. 3) MANDATED CONTRACEPTION
People believe that it is a reasonable way to
prevent additional births to woman. Who is
considered unsuitable parents and decrease
government expenses for dependant children.

17. 4) INTRAUTERINE FETAL SURGERY
The parents must be informed of the experimental nature of
the treatment, the risks of the surgery, the commitment to
cesarean birth and alternatives to the treatment.
As in the other aspects of maternity care, caregivers
must respect the pregnant woman’s autonomy. The procedure
involves health risks to the woman and she retains the right to
refuse any surgical procedures.

18. 5) REPRODUCTIVE ASSISTANCE
ASSISTED REPRODUCTIVE TECHNOLOGY(ART)
A)Multiple pregnancy.
B)Limiting the number of embryos transferred.
C)Surrogate child bearing.
These methods of resolving infertility raise ethical
issues about candidate selection, responsibility for a child
born with a congenital defect and religious objection to
artificial conception.

19. CONTINUES…..
Other ethical questions include the following:
A) What should be done with surplus
fertilized oocytes?
B) To whom do frozen embryos belong?
C) Who is liable if a woman or her
offspring contracts HIV from donated
sperm?
D) Should children be told about their
conception?

20. 6)EMBRYONIC STEM CELL RESEARCH
Theethicalquestionsanddilemmasassociatedwith
embryonicstemcellresearcharestaggeringandcomplex.
Thefollowingaretwoofthemostpressingissuestobe
considered.
Whatmoralstatusshouldbeattachedtothehuman
embryo?Howshouldbeaembryoviewed?Withfullstatus
asaperson?Asaclusterofundifferentiatedcellswithno
moralstatus?

21. Continues….
Ashavingstatussomewhereinbetweenthatis,
beyondmerecellsanddeservingofspecialrespect?
Whatsourcesofembryonictissueareacceptablefor
research?Isiteverethicaltocreateembryossolely
forstemcellresearch?Istherejustificationforusing
embryosremainingafterfertilitytreatments?

22. 7)CORD BLOOD BANKING
Ethicalissuesassociatedwithcordbloodbankinginclude
thefollowing(Smith&Thomson,2000)
Whoownstheblood?Thedonor?Theparents?Private
bloodbanks?Society?
Howwillinformedconsentwillbeobtainedandby
whom?
Howwillconfidentialitybeensured?Thefamilymust
understandthat,iftheychoosetodonate,themother
willbeaskedtoprovidebloodsamples

23. CONTINUE….
Anddetailedhistoryaboutherhealthandinfectious
diseasestatus.
Howwillobligationstonotifyandthefamilyand
donorbeaddressediftestingofthebloodreveals
infectiousdiseaseorgeneticdisorders.
Howwilltheharvestedbloodbeallocatedtoensure
fairnessandavailabilitytoindividualsfromallraces,
ethnicgroupsandincomelevels.

24. CRIMINAL LAW:
•It addresses public concerns and punishes the
wrong that threaten a group or society.
CIVIL LAW:
•Its concerned with and punishes wrongs
against the individual.

25. concepts
•TORT –It is a civil wrong that may be caused
either intentionally or unintentionally.
•NEGLIGENCE –It occurs when there is an
unintentional wrong caused by the failure to
act as a reasonable person would under
similar circumstances.

26. ELEMENTS OF NEGLIGENCE-
•DUTY –
–The nurse must have a duty to act or give care to
the client. It must be part of the nurse’s
responsibility.
•BREACH OF DUTY –
–A violation of that duty must occur. The nurse fails
to conform to established standards frperforming
that duty.

27. Contd……..
•DAMAGE –There must be actual injury or harm
to the client as result of the nurses breach of
duty.
•PROXMATE DUTY –The nurses breach of duty
must be proved to be the cause of harm to the
client
•LIABILITY
The concept of liability means that each person is
accountable for his or her acts that fail to meet the
standards of the profession

28. SAFEGUARDS FOR HEALTH CARE
•Three categories of safeguards determine how
the law views nursing practice:
•*State nurse practice acts,
•*Standards of care set by professional
organizations and
•*Rules and policies set by the institution
employing the nurse.

29. NURSE PRACTICE ACT
•Every state has nurse practice act that
determines the scope of practice for registered
nurses in that state. Nurse practice acts define
what the nurse is and is not allowed to do in
caring for clients.
• Laws relating to nursing practice also
delineate methods, called standard procedures
or protocols,by which nurses may assume
certain duties commonly considered part of
health care practice

30. STANDARDS OF CARE
•Standards of care are set by professional
associations and describe the level of care
that can be expected from practitioners. For
ex: Perinatal nurses are held to the specialty
standards published by the Association of the
Women's Health, Obstetric and Neonatal
nurses (AWHONN, www.awhonn.org).
•

31. AGENCY POLICIES
•Each health care facility sets specific policies,
procedures and protocols that govern nursing
care. All nurses should be familiar with those
that apply in the facilities they work. Nurses
are involved in writing nursing policies and
procedures that apply in their practice and
reviewing or revising them regularly.

32. LEGAL ISSUES

33. INFORMED CONSENT
•-It’s a legal concept that protects a
person’s right to autonomy and self
determination by specifying that no action
may be taken without that individuals prior
understanding and freely given consent.

34. Contd..
•Children under 18 to 21 years of age, depending
on state law, can legally give informed consent in
the following circumstances:
•When they are minor parents of the child client.
•When they are emancipated minors (self-
supporting adolescents under 18 years of age,
not subject to parental control). In most states, a
pregnant teen is considered emancipated.

35. Contd..
•When they are adolescents between 16 to 18 years of
age seeking birth control, mental health counseling or
substance abuse treatment (Dickey & Deatrick2009)
•Mature minors (14-and 15-years-old adolescents
who are able to understand treatment risks) can give
consent for treatment or refuse treatment in some
states.
•Refusal of treatment, medication or procedure after
appropriate information is provided also requires that
the individual sign a form releasing the doctor and
clinical facility from liability resulting from the effects
of such a refusal. Jehovah's witnesses’ refusal of blood
transfusions is an example of such refusal.

36. RIGHT TO PRIVACY
•The right to privacyis the right of a person to keep
his or her person and property free from public
scrutiny.
•Laws, Standards and Policies about privacy
specify that information about client’s treatment,
condition and prognosis can be shared by health
professionals responsible for their care.
Information considered vital statistics (name, age,
occupation and so on) may be revealed legally,
but is often withheld because of ethical
considerations. The client should be consulted as
to what information may be released and to whom.

37. PATIENT SELF-DETEREMINATION ACT
•Advance directives ( writing a living will or
authorizing a durable power of attorney for
healthcare decisions on the individual’s
behalf).
•Do not resuscitate (DNR) orders have become
more common for children with terminal
illnesses in which no further treatments are
possible or desired.
•

38. Other Ethical Issues
•Conceptusissues related to IVF, Cloning,
surrogate mother
•Abortion, foetalrights versus right to mother.
•Use of fetal tissue for research
•Resuscitation continuation
•Number of procedures as child

39. COMMON ISSUES FACED BY MIDWIFE
Administering
wrong
medications
Gender
discrimination
Sleeping off during night shift

40. COMMON ISSUES FACED BY MIDWIFE
Untrained midwifes
Telephonic
orders
Babies getting
suffocated

41. Nursing practice standards related to maternal
and new born care
Standard 1 -Quality of care: The nurse systematically
evaluates the quality and effectiveness of nursing practice
Standard 2 -Performance Appraisal: The nurse evaluates
his/her own nursing practice in relation to professional
practice standards and relevant statutes and regulations
Standard 3 -Education: The nurse acquires and maintains
current knowledge in Nursing practice
Standing 4 -Collegiality: The nurse contributes to the
professional development of peers, colleagues and others.

42. Nursing practice standards related to
maternal and new born care
•Standard 5 -Ethics; The nurse’s decisions and actions on
behalf of patients are determined in an ethical manner.
•Standard 6 -Collaboration; The nurse collaborates with
the patient, significant others, and health care providers in
providing patient care.
•Standard 7 -Research: The nurse uses research finding in
practice.
•Standard 8 -Resource Utilization; The nurses considers
factors related to safety, effectiveness, and cost in planning
and delivering patient care.

43. Nursing practice standards related to
maternal and new born care
•Standard 9 -Practice Environment: The nurse
contributes to the environment of delivery care within the
practice setting.
•Standard 10 -Accountability; The Nurse is
professionally and legally accountable for her or his
practice. The professional registered nurse may
delegate to and supervise qualified personnel who
provide patient care

44. REFERENCE
•1.Annamma Jacob, “ A comprehensive textbook of
midwifery & GynacologicalNursing”, 4
th
Edition, Jaypee
Publications, New Delhi.
•.
2.Diane M Fraser, MargetA Cooper 2009, “Myles
Textbook for midwives” 15
th
edition, churchill
Livingstone Elsevier Publications
3.http://link.springer.com
http://www.researchgate.net
http://ishbr.com/go/dops777/pdf

45. Evaluation
1)defineethics
2)Mentionaboutethicaldilemmas
3)Listouttheprinciplesofethics
4)Listouttheareasofethicalissues
5)Writeanytwolegalissues