Ethical Foundations and Legal Aspects of Nursing Practice

Posted on Dec 14, 2024 in Philosophy and ethics

Unit 2: Model of Alterity

What Ethical Foundation Can Contribute to the Dynamics of Health Care?

We propose an ethical foundation of care in Otherness. The first ethical experience in healthcare is the otherness of the “other me” in need of health.

a) Constitutively in “Version”:

Human beings are constitutively referred to the other. This is primarily a matter of fact, a real and physical “version”, not merely existential or intentional. (For example, a child is connected to their mother or caregiver, who will provide nutrition. This is a radical way of being oneself and was originally part of the encounter with others).

Man cannot be a person without personalizing, and he should make his life with things, with other men, and with himself. His relationship with his surroundings is essential, constitutively intrinsic, both as a person and to their personality. He will only fulfill himself by interacting with others. The person is also precisely for this task, and openness can be easily hurt.

b) In Assistance:

The relationship between “nutritional needs of children” on the one hand, and “providing relief” on the other, is called “help“. But when the child shows intelligence and is responsible for the fact, his tendency to seek help becomes “assistance“. The need that the body has for others is a need for relief, assistance. Assistance is reflected in the state, as it is, for example, in illness or the needs of the sick.

c) The Other:

When a man, the other by his constitutive “version” and his health problem, is before us health professionals, as being needy, it is a calling. A call from the real otherness that is his neediness. It is called the “other me” which is the vocation of the therapist or caregiver. This gives reason and determines healthcare. Above all, it is what provokes the “way of being,” the “character,” the “ethos” of the doctor, nurse, or helper. Health professionals sense in our daily work the limits of human existence, the ontological and extreme fragility of being human.

Therefore, the nurse accesses the reality of another personal being in need of health, ruling out any speculative or uncompromising analysis. They must assume a unique ethical relationality.

Consequently, healthcare (professional behavior of nurses), both by constitutive “release to” the sick man to his keeper, as the constitutive “version” of the caregiver, has its ethical foundation in the experience of otherness, felt in the responsibility to the needy in human health. The ethics of alterity requires me to care for him above all else.

The ethical foundation of care is on the other, which is why it is home as long as you are in need, assistance, or disease. The vocation is the nurse, but the needy is the pro-vocation, calling from the need, from the neediness. All care must be detached from the other, from the needy.

Judgment as an Element of Human Behavior

Our moral personality (our conscience) builds up over time and evolves through stages of maturity. It takes shape through a learning process involving socio-cultural, educational, and emotional factors. Above all, it affects the evolution in the way of reasoning and judgments about ethics, that is, in the way of judging. Prescriptive moral judgments aim to guide actions and behavior. The nurse must develop and issue their own opinion.

There are different types or levels of judgment according to Kohlberg:

1. Pre-conventional level: This is the least mature moral reasoning. The person understands just what is selfish. At this level, rules are followed. It is an individualistic, selfish judgment, like that of a child.
2. Conventional level: One focuses on ethical issues in accordance with the rules. This means accepting what society deems as good; one adapts to what society wants. People identify with their moral or social role.
3. Post-conventional level: The person distinguishes between universal ethical principles and the forms of behavior that exist in society. They can build on these principles to develop justice or goodness in their behavior and commit their life according to that judgment. Applied to nursing, this is the most mature level for decision-making and problem-solving.

Unit 3: Nursing Ethics

A. The Human Being is by Nature an Ethical Subject:

The ethical, or moral, constitution that defines the human being is explained in two ways:

• First, human beings have an ethical structure common to every person. It lies in their ability to account for their conduct, behavior, or acts, thanks to their intelligence and freedom.
• Moreover, with this ability to “give a reason” for their actions and behavior, both are filled with content that seeks or intends the good of the people. This is the effective recognition of human dignity through our behavior. Our actions are ethically good or bad depending on whether they seek the good of people.

B. Human Dignity:

The person is not equivalent to anything, is not interchangeable with anything, is not convertible into any commodity. The person has value, not price, and not just any value, not relative value. People are not worth “in relation to…” but are valuable in themselves. This is what gives them dignity.

C. Content of Human Dignity, Fundamental Human Rights:

Human dignity, and thus its effective recognition, is explicit in several qualities (such as health, freedom, peace) that are proper and define human beings as such, as they are universal. These qualities, in which human dignity is explicitly recognized, are what we recognize as fundamental human rights. They are legislative in nature because the right is inherent and universal. These qualities are not given by the government or the state, but the government has the function to manage and protect them. The right does not legally belong to me in any way; the right was given to me before the state or government appeared. Now, if we choose the right to quality or health, the government will protect us by creating the Health Act of 1986.

Human dignity is the foundation of “human rights” and is explained from two angles corresponding to two different but convergent world views:

• Christian thinking understands that human dignity derives from the creation of man by God, who created man in His image and likeness.
• The thought that derives human dignity from rational capacity and freedom.

Both lines of reasoning are perfectly valid. Accepting human rights as ethical means taking action. Parallel to human rights is a duty (for example, I have the right to work and, simultaneously, I have the duty to work).

D. Civil Ethics:

The term “civil ethics” or “rational ethics” seeks to develop moral principles that guide rational human behavior, without religious or theological references.

Civil ethics is the ethos of a democratic society itself, which requires citizens and the powers that be to agree on certain common values (justice, freedom, equality) to guide the rules of coexistence.

E. Civil Ethics as “Minimal Ethics”

Civil ethics is the minimum required of all common morality in a pluralistic society, and its content is identified, more or less, with fundamental human rights. Therefore, the effective recognition of fundamental human rights is the minimum level of ethics required. We must respect the minimum human rights of another. This would be the minimum scale, and below it would be inhuman, and therefore, indignity. The ethics of minimums is required for the entire society.

F. The “Ethics of Maxima”

This means an ideal of life; happiness is a personal or group life plan. This ethic is for one person or group but is not required for the rest of society.

G. Nursing Care in the Context of Civil Ethics:

Nursing care is an effective recognition of the human right to health of every individual. Therefore, nurses are bound by nature to safeguard human rights simply because they are human. Our work means more than an embodiment of dignity and freedom.

Unit 4: Characteristics of a Human Activity to be Considered a Business Activity

Concept

Max Weber said that the word profession has a religious background because it means making a profession of personal life for others. He used the English word “calling” and explained that the one who calls you, the pro-vocation, is the other, and you can respond or not. (For example, Haiti is the one who calls you, and you can respond or not.) To the extent that I respond to the other, I answer to God; if I do not answer, I do not answer to God. The patient calls me to something, and I, as I have training and knowledge, come to fulfill my mission to help him (assistance).

Features

• Nursing is a specific human activity, established by society and demand.
• Professional activities are expected to be delivered within a minimalist ethic.
• Professionals develop it, that is, those who live and charge for it. If they did not charge, they would not be professionals.
• All professionals together form the group that is to be in control of themselves, the professional activity. They work to control the exercise of it. I will take control and set the protocol, and I do not have to send anyone (for example, the doctor does not tell me how I have to heal).
• Must have a Bachelor’s degree and be fully accredited.
• Autonomy of the professionals themselves.
• Never in the course of work will you be liable for anything where you have not taken part in the decision-making. For this change to occur, a decision must be made, and the person who made it assumes responsibility. Decision-making = Responsibility.
• Being a human activity that transcends self-interest and requires a certain altruism, because its orientation is mainly aimed at the good of society, it is expected that professionals do not practice for profit alone.

Unit 6: Sources of Law

Usually taken as sources of law are: law, custom, and general principles of law:

1. The Law:

The law is defined as the legal standard developed, delivered, and published by competent state bodies. Its requirements are:

• Disclaimer: It must be established by the government and with the legal requirements required to legislate.
• Advertising: It must be advertised, and legal certainty requires publicity of the law, as it requires the very purpose of it, which is to sort social coexistence.

2. The Practice:

Effective practice is repeated in a particular manner. It is the standard created by use and social will. Custom, as a source of law, requires:

• Continued use: It is a material element, the product of the realization of uniform external events, general, durable, and steady.
• The conception of law or necessity: Consistent with the general will of juridical regulation, as aforesaid, the point in question.

In the absence of legal regulation, customs that contain only an act of benevolence, tolerance, and courtesy, do not create law (by tradition, habit), i.e., tipping, giving up a seat on the bus.

3. General Principles of Law:

They are the fundamental ideas that inform positive law contained in laws and customs. They are, in essence, the guidelines derived from justice as understood by our legal system, enshrined in doctrine and jurisprudence.

Unit 7: Legal Concept of Person

Civil law is the framework that provides for the protection and defense of the people. All civil institutions are aimed at protecting and defending people in the organization of social life. Example: family as a civil institution, if my father left everything to my brother and did not leave me anything, the civil law protects me, and my father is obliged to leave me the legitimate, and my brother can leave an improvement.

What do we mean by individual? A man or woman with a nature in which intelligence and freedom are fundamental for human society to be well-organized and fruitful. The concept of a person also extends to a legal entity (e.g., a neighborhood community, social institutions) that can be attributed rights and obligations.

1. The Person as a Subject of Rights

The capacity that a person has to be the subject of rights and obligations is called Legal Capacity. If, in addition, it is possible to perform legal acts, we call it the capacity to act.

• Legal Capacity: Competence and suitability of a person to have rights and obligations in general, legal relations. Therefore, any person, by virtue of being, has legal capacity.
• Capacity to Act: The possibility or ability to perform legal acts. The capacity to act supports graduations or variations. A person has a limited capacity to act when they have a total or partial absence of the natural ability to understand and to love.

2. Limits on the Capacity to Act

• Full capacity is usually obtained at age 18. There are certain cases in which more age is required, such as adoptions, where it is 25 years.
• Limited capacity to act is when the subject acts on their own but needs the cooperation of another person for the full validity of the act. Example: an emancipated minor cannot borrow without the consent of their parents or guardians.

3. Legal Incapacity

Civil disability is declared by the court when a person meets some of the grounds specified in Article 200 of the Civil Code.

From nursing, we must control the protection of the person, as they can take their hand and make the patient sign, for example, a script. Therefore, we can cite the judge to ask for that day. Legal capacity is never lost because you are a person; what is lost is the ability to work as long as there is legal incapacity by a court. If there is no legal disability, the person, even if they have problems, has legal capacity.

Hospital Patient Rights: Background and Development

Background

If every human being, by being a person, is entitled to healthcare and, therefore, social solidarity, they deserve it even more when in a situation of greater vulnerability, such as inpatients.

Formulation of Main Duties

1. Receive healthcare that puts at the service of the person every technical and human resource according to their disease and the possibilities of the center, without discrimination based on age, sex, race, ideology, or socio-economic status.
2. Be addressed swiftly so that paperwork does not delay patient care or entry.
3. Be treated by all staff with respect for their dignity.
4. Be treated with respect regarding their personal privacy.
5. Be treated with respect and recognition of their religious and philosophical convictions.
6. Continue to maintain relationships with family and friends and communication with the outside.
7. Receive understandable, adequate, and continuous information about the center, including their physician.
8. Have a medical history and have access to it.
9. Maintain secrecy about their illness and medical history data.
10. Choose to leave the hospital at any time.
11. Die with dignity.
12. Know their rights, have them widely disseminated among patients and hospital staff, and have them respected.
13. Make suggestions and complaints about the operation of the hospital and have them studied and answered.

Unit 8: Right of the Sick to Information

• It is necessary to reconstruct communication within the clinical relationship.
• It is a therapeutic and healthy element.
• It is our responsibility and moral obligation to consider the patient as a person, to understand that they can choose among alternative courses of action related to the therapeutic process in terms of their own value system.

Patient information is a necessity and a right.

Informed Consent

“Understanding by a patient, attentive and mentally competent, of the nature of his illness, the weight and balance between the effects of it and the risks and benefits of diagnostic and therapeutic procedures recommended, in order to request approval for being subjected to such procedures. The patient’s cooperation must be achieved without coercion, and doctors and nurses should not take advantage of their potential psychological power with respect to the sick.”

Items that give validity to informed consent are:

• That the subject is competent.
• That they have free will (if the patient does not act voluntarily, consent is not ethically or legally acceptable).
• That the information is on the diagnosis, prognosis, treatment, and alternative therapies.
• That the information is understood by the patient.

What Information to Give?

Information should be given about the diagnosis, prognosis, treatment, alternatives, and impacts.

The Truth About Information: Is There a Duty to Tell the Truth to the Sick?

The content of the information must relate to the nature of the disease. Therefore, I have to communicate the truth of the diagnosis, prognosis, and all that it entails. However, as the information is given depending on the sick person, subjects may have a neurotic or hypochondriac profile. They may be labile and capable of committing any act worse than the disease itself. From this, we can inform the family. In these cases, we give the truth in a nuanced and compassionate way, letting them see that things can go well. If, for example, the word “cancer” does not sound right, we can say they have a “lump”.

Who Reports?

The physician usually reports. It may happen that, in addition to the physician, there is a person within the group who has a special relationship with the patient, either because they are a civilian, because there is empathy, or because the patient trusts that person. However, the doctor is still responsible.

The nurse is responsible for all information regarding nursing intervention. Therefore, beds or rooms are always distributed to give you charge of patients assigned to you.

How to Report?

The information must be dispensed through a process because attention and the process are dosed.

When to Report?

Information must be given diachronically, that is, over time as the process unfolds. We must not do so anachronistically (not in time). Example: when you are called to the Polyclinic for an appointment and have to tell them your husband died a month ago, or when you have cataract surgery at a private clinic and the Polyclinic calls you to do the surgery next week, and you are already two months post-op from the private sector. (These are outdated information)

What to Report? Purpose

First, you have to report to alleviate and reduce the anxiety of the person and the family. Secondly, to alleviate the disability of a person when they know what is happening. Another point is to reduce dependence on others and also to the situation of dependence, or contribute to helping those around you (e.g., leaving is bad, still more dependent). With information, mistrust and fear also decrease.

Moreover, an informed person is helped to increase their level of collaboration; women are more cooperative and thus die less. It also helps to increase accountability and to be realistic with life itself.

Unit 10: Law. Features of the Law

The Law is a rule of conduct that may be physical, moral, social, or legal. Law or rule of law is a prescriptive statement ordering something that has been promulgated by those who have the power to do so and, moreover, can be applied coercively if not voluntarily complied with.

Features of the Law

a. Extrinsic Conditions:

• Generality: Laws need not be referred to every single individual, but they should be respected by all.
• Tender for the common good: To promote the harmonious and integral development of those individuals residing in the place of enforcement.
• Established by the government: That is truly entitled to carry out the legislative function. For example, in the territory and the Spanish state, the public authority that exercises the legislative function is the Parliament.

b. Intrinsic Conditions:

• Fairness: That is the reason for the law. A fair sentence would be one that applies the law correctly.
• Have a permanent basis: This does not mean it is forever the same, but it remains as a rule pending repeal or loss of its base of validity.
• Published and advertised accordingly: That is, published in that body. If they are autonomous regions, they must be signed by the President of the Community. It must be advertised in the mass media (TV, radio).

Unit 11 and 13: Purpose of the Law and Basic Principles of Law

Purpose of the Law

This law aims to regulate the rights and obligations of patients, users, and professionals, as well as schools and health services, public and private, regarding patient autonomy and clinical information and documentation.

Basic Principles

1. The dignity of the human person, respect for the autonomy of their will and privacy, guides all activity designed to obtain, use, store, preserve, and transmit information and clinical documentation (a nurse who advises and the family will always triumph, going to save or excuse).
2. Any action in the field of health requires the prior consent of patients or users. Consent must be obtained after the patient receives adequate information and shall be in writing in the cases provided by law.
3. The patient or user is entitled to freely decide, after receiving adequate information, from the clinical options available.
4. Any patient or user has the right to refuse treatment, except in cases specified by law. Refusal of treatment shall be in writing. It is like going back to number 3, i.e., in a specific case, the best treatment is A, and the patient can refuse. The law sets out that if you have been well informed, you may decline even when effective treatment is known to be 70%.
5. Patients or users have the duty to provide data on their physical condition or health fairly and truthfully and to assist in obtaining it when necessary for reasons of public interest or healthcare. Example: AIDS, tuberculosis.
6. The professional is obligated not only to the proper provision of techniques but also to the execution of the duties of information and clinical documentation and compliance with the decisions taken freely and voluntarily by the patient.
7. The person who prepares or has access to information and clinical documentation is required to keep the reservation and not to disclose it improperly.

Unit 12: Purpose of the Law and Inspiring Principles of the Law (Law of Andalusia Health)

Purpose of the Law

1. Health protection of citizens in Spain.
2. Definition and implementation scheme of rights and duties of citizens to health services in the region.
3. General management of health activities.

Inspiring Principles of Law

Action on health protection is guided by the following principles:

1. Globalization and equity in health standards and effective equality in the conditions of access to the Andalusian Public Health System.
2. Achieving social equity and regional balance in the provision of health services. Example: A wife who will give birth at Guadalcanal will have the same rights as one who will give birth in Eduardo Dato, that is, since they pay the same.
3. Integrated concept of health promotion activities, including health education, prevention, care, and rehabilitation.
4. Functional integration of all public health resources: Rights must be developed in terms of resources.
5. Planning, effectiveness, and efficiency of healthcare organization: It is not acceptable for the director of the hospital to have a carpet worth 500 euros while a health center does not have bandages.
6. Decentralization, autonomy, and accountability in the management of services: This refers to the nurse case manager.
7. Citizen participation: This is why there are posters in hospitals and health centers to engage citizens.
8. Participation of workers in the health system.
9. Promoting teaching and research in health sciences: During the crisis, there is very little money, but in times of boom, it is sufficient for well-rewarded research.

Collaboration with the Private Sector

The public system is in crisis, and politically, arrangements are made with private institutions because the occupancy rate per day is cheaper. They also lessen the waiting list, and therefore, within the law, this issue of collaboration is addressed, and it responds to public law.

This collaboration is done through agreements, notably with an institution. Example: Managing with Santa Isabel Clinic for gallbladder interventions and San Juan de Dios. I can do a consortium (here I refer to a specific activity, but they are going to take care of all emergency department Aljarafe and act as the emergency department of Macarena Hospital). The nurse working in a consortial center gets the same points for the job bank.

All agreements and all concerts must meet the following minimum requirements:

• The central object of an agreement or conspiracy is approved.
• The convention center or service or concert has been established above.
• To comply with current regulations on taxation, labor, and social security.
• Adapt to the provisions and all activities covered by the agreement or concert.

Unit 14: Ethical and Legal Standards Regarding Reproduction and Abortion

Concept

We understand abortion as the termination of pregnancy if the fetus is not viable, i.e., when it cannot survive outside the womb.

Types

1. Depending on the cause that originates it, abortion can be:

a. Spontaneous abortion: When the abortion occurs from natural causes, i.e., without free human intervention. This is a miscarriage of a physiological nature.

b. Induced abortion: It is due to free human intervention. This is the abortion that we consider in the field of ethics and law since it involves human freedom.

In the medical world, we take into account both spontaneous and induced abortion (in this case, to prevent it, understand its causes).

From the legal point of view, abortion can be considered “criminal” if not permitted by law or may be considered non-criminal or “legal” if permitted by law. From the ethical point of view, abortion must be considered in reference to personal responsibility and moral value.

2. Depending on the causes or reasons behind the termination of pregnancy, induced abortion, both from the health and ethical and legal points of view, can be of 4 types:

a. Therapeutic abortion: When the continuation of pregnancy endangers the life of the pregnant woman. Today, this situation is often unique (e.g., ectopic pregnancy). It therefore has no real significance; it is not a medical, legal, or ethical problem.

b. Eugenic abortion: When there is a likelihood, or certainty, that the new being will be born with abnormalities or birth defects. Malformations are known by prenatal diagnosis, either by amniocentesis or by ultrasound. Eugenic abortion reveals a dramatic situation in which the decision to be made (either to terminate or continue the pregnancy) presents us with a “conflict of values.”

c. Humanitarian or ethical abortion: Induced abortion when the pregnancy was the result of rape. This is a dramatic situation in which the pregnancy is the result not of love but of violence, although there are humane alternatives such as adoption.

d. Psychosocial abortion: Induced abortion when the pregnancy is not desired for social or psychological reasons, economic problems, housing, single women. This type of abortion is often used effectively as a “method of birth control.” Unfortunately, the majority of abortions are due to psychosocial reasons because the relative unimportance of these reasons puts more emphasis on the darkening of the value of human life or intrauterine pregnancy.

General Conditions for the Practice of Legalized Abortion

1. On Women:

The law requires the express consent of the pregnant woman, which should be done in writing.

What happens when the woman is under age? If a minor under 18 years old wants to terminate her pregnancy under the Act, the following considerations will be taken:

a. If we apply Civil Law, the consent of a minor under 18 years is irrelevant; she is incapacitated, and it will be her parents or guardians who provide it. But if we apply Criminal Law, it must be remembered that this right is responsible from the age of 16, so any consent given by women over 16 years will be relevant to the doctor.

b. It may be that parents refuse to have the minor daughter have an abortion, and the doctor thinks that it is essential to save her life. In this case, the physician must consult with the minor, and if she agrees to the interruption, the judge will decide if the termination of pregnancy is to be carried out.

2. Relating to the Physician:

The physician or under their direction will legally perform the termination. There would be two: one who directs or supervises and one who materially practices it. If a harmful outcome for the woman were to occur due to fault or negligence, both are responsible.

3. Relative to the Center or Health Facility:

Centers or private establishments with at least the following human and material resources may be accredited to perform abortions that do not involve high risk to pregnant women and do not exceed twelve weeks of pregnancy:

• A doctor specializing in obstetrics and gynecology, a midwife, a paramedic, and a social worker.
• Local facilities and adequate medical supplies.
• The site must meet the living conditions and hygiene required for any hospital.
• You will have at least a physical space that includes:
  • A reception area.
  • An office for information and advice.
  • A room suitable for carrying out the abortion.
  • A recovery room following the procedure.
• There will be at least the following basic tools, in addition to those found in a consultation:
  • Equipment needed for gynecological examinations.
  • Equipment needed for abortion practice.
  • Computer equipment and training.
  • A reference hospital for referrals.

To perform abortions in high-risk pregnancies or those exceeding twelve weeks, the following must be available:

• Units of obstetrics and gynecology.
• Laboratory analysis, anesthesia, and resuscitation.
• Units and facilities for nursing and hospitalization.

Principles of Child Rights

1. The child shall enjoy all rights, and they will be granted to all without exception whatsoever and without distinction or discrimination based on race, color, sex, language, religion, political or other opinion, national or social origin, economic status.
2. The child shall enjoy special protection and be given opportunities and facilities, all by law and by other means. So they can develop physically, mentally, spiritually, and socially in a healthy and normal manner and in conditions of freedom and dignity.
3. The child is entitled from birth to a name and a nationality.
4. The child shall enjoy the benefits of social security. They are entitled to grow and develop in good health. The child has the right to adequate nutrition, housing, recreation, and medical services.
5. The child who is physically or mentally disabled or suffering from some social impairment should receive the treatment, education, and care required by their particular case.
6. The child, for the full and harmonious development of their personality, needs love and understanding. Whenever possible, they should grow up under the responsibility of their parents and, in any case, in an atmosphere of affection and moral and material security. Except in exceptional circumstances, a young child should not be separated from their mother. Society and public authorities have a duty of care specifically for children without families or those without means of subsistence. For the maintenance of children from large families, government subsidies and other measures should be given.
7. The child is entitled to receive education, which should be free and compulsory, at least in the elementary stages. They should be given an education that will promote their general culture and enable them, on the basis of equal opportunities, to develop their abilities, their individual judgment, their sense of moral and social responsibility, and become a useful member of society. The interest of the child must be the guiding principle of those responsible for their education and guidance; that responsibility lies primarily with their parents.
8. The child shall, in all circumstances, be among the first to receive protection and relief.
9. The child must be protected against all forms of neglect, cruelty, and exploitation. They should not be covered by any type of question. No child should be allowed to work before an appropriate minimum age, and in no case will they be allocated or permitted to engage in any occupation or employment which would prejudice their health or education or interfere with their physical, mental, or moral development.
10. The child must be protected from practices which may foster racial, religious, or other discrimination. They must be educated in a spirit of understanding, tolerance, friendship among peoples, peace, and universal brotherhood, and in full awareness that they must devote their energy and talents to the service of their fellow men.

Unit 15: Ethical and Legal Framework of Nursing Care for Elder Abuse. The Elderly in Abuse: Criminal and Civil Law

Legal: Several Points:

Rights and fundamental freedoms: Nurses should give due care. The alternative to abuse in nursing is proper care and good care.

• Full equality before the law.
• Right to life: Lack of attention because someone is older makes the nurse complicit and responsible because they are “passing the buck.”
• Right to freedom, honor, privacy, image.
• Right to freedom of residence; for an older person, their home is their health. In residences, much misery arises with respect to the elderly toward each other. Example: If you are here, it is because you are not wanted.
• The right to receive truthful information.

Criminal Code:

Definition of abuse, usually actions or omissions constitute an offense or offenses that have the elderly person as a victim, which is exercised consistently and based on the relational fact, either by the family or the clinical-care.
– Crimes against life and freedom
– Torture, moral integrity
– Privacy, self-image, home, property or injury
A person who causes injury, arrest of 3-6 weekends or a fine of 1 or 2 months. Fine of 10 to 20 days for not paying attention or assistance.
CIVIL CODE:
Community of life among relatives
“Right to Food”
Sustenance (food)
Room (ceiling)
Dresses
Medical
Those responsible for the dependent elderly or disabled relatives are declared. The minimum that a person can have is a house (roof) and lunch.
To the ceiling, in nursing can not be more than 2 people in a room.
With regard to medical care, if the person is of Cordoba and is in a residence in Seville, the health center and the hospital is the internal reference.
“Right to food of our ancestors” Its foundation is that everyone, from the mere fact of being entitled to live in dignity. There is a debate on this right. Dependency Act attempted to provide legal for these people, so there is no debate, it is legislated.
Example: My father has the right to food, if it by itself can not, for I the son I have a duty to protect, but if I can not either, as it passes the City Council, and unless the council, and if not the Ministry of Social Affairs and it is by law
ITEM 16. STATEMENT Living Will
CONCEPT
The Living Will Declaration is the right that a person has to decide on health policies for which he may be in the future, on the assumption that when the time is not capable of deciding for itself.
The right to make the declaration of Living Will every person can exercise adult, emancipated minor or minor whose maturity allowed to make such a statement and is in a position to decide according to their convictions and preferences. Must be done personally.
The contents of the declaration may be consulted by the doctor treating the patient and if it can not express himself.
METHOD FOR MAKING THE DECLARATION
It takes the forms are available at Inters @ s, in the Provincial Health and all public health centers in Spain.
You can complete the forms on paper or directly through Inters @ s, in both cases these documents are considered draft.
To formalize the registration, you must appear personally before the Registrar, in the Provincial Health. It is advisable to fill the forms and prove their identity using a document such as passport.
The process is very simple: you simply make an appointment at your Health Responds (902,505,060). You can cancel or change the date and time of the appointment, change the contents of the draft, namely the status of proceedings concerning its application for registration or please check your own statement.
If the documentation is complete and meets all requirements are included in the Register of Wills, under the Ministry of Health of the Government of Andalusia and the National Registry of Advance Directives, the Ministry of Health, to be effective statement from the time of registration in the records.
The statement may be amended or revoked at any time you like by the same procedure by which the term was the first time.
Special Situations:
If you decide to appoint a representative to decide for you if you can not express their will by itself, requires that this representative consents in writing in a document of acceptance, which is available at Inters @ s, at the Provincial Offices Health and all public health centers in Spain. It may also appoint a substitute representative who also must accept that responsibility with the same procedure as for the representative.
ITEM 17. WHAT ARE THE CRITERIA OF DEATH WITH DIGNITY?
Good health often eliminating the request for euthanasia or assisted suicide. But there are patients seeking to die for:
– Loss of control of bodily functions
– Reduction of autonomy
– Fear of being a burden
– Dependence on others
These are the most common reasons, and here what is at stake is the autonomy of the patient.
RIGHT TO DIE WITH DIGNITY
The “death with dignity” is related to the rejection of therapeutic cruelty, because that’s when the dying lost human quality and, therefore, would be outraged. It is therefore a reaction to the prolongation of life in appalling conditions caused by the introduction of technologies in health care, medicine and nursing.
The basic contents of a dignified death in our world near and they are content where they can agree both those who defend the moral and legal legitimacy of euthanasia and assisted suicide as those who oppose these two behaviors, such content would be:
– No artificial prolongation of life as it is meaningless or rejection of therapeutic cruelty.
– The use of pain therapy and treatment for troublesome symptoms. All this affects the quality of life of sick, in their relationships, and may be included in some form as a requirement of dignity. In this area, the contribution of health professionals is very important.
– Relief of suffering whose origins can be quite varied.
– A moral imperative of accompaniment, presence near the patient, tenderness, affection, so do not feel abandoned.
– Since the death an important event in the lives of people, we have to treat that patient is aware he will die.
– Helping the key that has given meaning to his life such as religious.
EUTHANASIA
The term be reserved exclusively to mean those acts that are intended to deliberately end the life of a patient with a terminal or irreversible illness, suffering suffering he sees as intolerable, and his express request.
The term euthanasia are a number of characteristic elements:
– A specific biological state, or terminals, either incurable, without requiring that the two elements are given at the same time.
– An autonomous, ie capable of making decisions and competent to do so, he lives his situation as unbearable, making their own view of quality of life, and therefore made specific requests, repeated and maintained to end.
– An action or sufficient cooperation from a third party who causes the death of the patient, is what is called causality.
ASSISTED SUICIDE
Not involve the health professional. Ramona’s what he did with Ramon Sampedro.
IS IT ETHICAL TO RESPOND POSITIVELY TO WHOM YOU WANT TO DIE AND ASK FOR HELP?
We, in our professional work and health in the process of human dying, we must look directly the effect good, not bad. The principle of double effect or indirect voluntary principle is what should guide our behavior in these critical situations involved in the process of dying. But that principle can be developed in the process of death that may be experiencing a person, you must fulfill the following requirements:
– Do not look directly to death, but the resolution of the suffering of that person. It therefore aims to relieve pain and not to end life.
– Criterion of proportionality: there must be a ratio between the effect and the means used. Example: if you give 10 g of morphine, of course that the pain relief it is that killed him. If you are given 0.5 g as the worst pain relief will not kill him.
– Overuse of invasive procedures. It can be done when there is no other alternative, ie it is true that the use of morphine is harmful and mutilates the CNS but it is necessary to control the symptoms of pain, but should be used to shorten the life and precipitate death.
– The situation of quadriplegics are situations of great destitution, loneliness, etc. in these cases, it is logical to use the principle of double effect to end the pain and suffering of these people through euthanasia, without seeking redress before the situation in other ways that seem more human.
In conclusion: when they met all the conditions required by the principle of double effect is difficult to deny the legitimacy of direct intervention in the body of another person, even though such action may lead his death. This action can not be described as euthanasia because there is no direct intention of ending life. This applies in all situations irreversible and terminal, and perhaps also for those others in which no treatment is possible, as in the case of quadriplegia. In these situations it seems difficult to deny the legitimacy of the acts which directly cause death. What should not speak in these cases is euthanasia. Euthanasia should still be considered as a crime. But it is hard to deny the legitimacy of such actions are always on humanitarian grounds.
If someone asks us to do with it what did Ramona Ramon Sampedro, we must choose the principle of nonmaleficence (I can never do harm to anyone but you ask me), and if I do, I will be punished and punished by law
ITEM 9. INHERENT VALUE OF PRIVACY AS THE RELATIONSHIP CLINIC
Confidential intimacy is inherent in the clinical relationship as a moral budget. These reasons warrant:
– The clinical relationship develops in a vulnerable situation. The patient, to tell me what happens, highlights their vulnerability to me because it is me, being a nurse, who tells him his problem. The so-called power of the white coat (“initial vulnerability”).
– The area in which it develops that confidentiality is the Consultation and that involves binding obligations on both parties, since the relationship is based on accepting the authority of a person to guide unusual acts such as undressing. (“Auto” voluntary disclosure “).
– Share trust tells me because he knows I’m going to keep the secret. (“Share Trust on the activity of intimate information).
UNIT 10 .- LEGAL RESPONSIBILITY
The Spanish legal system does not contain a uniform regulation of liability in general, but it is set according to different classes or species. Therefore, we consider the following types of liability: civil, criminal and administrative.
– Civil Liability:
“Whoever by act or omission causes damage to another intervening fault or negligence, is obliged to repair the damage caused.”
– Liability of health professionals:
1. Obligation requires the ability to practice as a nurse or doctor.
2. It requires the obligation to use technical means available in the circumstances of time and place.
3. Proceed according to good clinical practice as the “lex artis” the nurse, for example, the practical steps of care.
– Elements to be present to impute a liability:
1. There is a voluntary act or omission.
2. That action may cause harm and therefore, the result is unfair. In the case of the nurse, who at the time to intervene has to click or to hurt the harmful result can be justified with the “consent of the offended.”
3. That it is a wrongful action, that is voluntary.
4. That the action from injury, harm, so the person will be compensated according to the damage: material, physical, moral or profits.
5. What has causal relationship between health worker performance and the harmful outcome.
– Duties which may lead to infringement liability:
1. Get the patient’s informed consent for any intervention.
2. Professional secrecy.
3. The duty to report, because it is a necessity and a right of the individual.
4. The task of using all possible means at hand to get the best possible results.
– Insurance:
1. Civil liability is insurable.
2. Can be accepted financial compensation that may be caused by the malfunction of a public or private institution and irresponsibility in expenses incurred by the healthcare professional.