Legal and ethical issues: questions and answers.

This article, in Question and Answer (Q&A) format, focuses on legal concerns raised by practicing school nurses across the country. In this Q & A edition, four questions submitted to the Section Editors by JOSN readers are included, with responses to each. The main topics of the questions are (a) the rights of emancipated and mature minors; (b) the "rights" of nonnurse supervisors to direct or assume the practice of school nursing; (c) the right of a school district to exclude a student from a fieldtrip (versus the right of the student to participate); and (d) the right of a school district to change the level of nursing care provided to a special education student.     

Legal and ethical issues confronting oncology nursing

OBJECTIVES: To identify and summarize the legal and ethical issues found in the multiple settings in which oncology nurses practice. DATA SOURCES: Lexis, Medline, Westlaw, federal and state laws, government documents, and nursing and medical textbooks. CONCLUSIONS: Oncology nurses face many legal and ethical dilemmas when delivering care. The best defense against litigation is to be knowledgeable about the specific issues found in each setting, the impact these issues have on practice, and requisite risk reduction practices. IMPLICATIONS FOR NURSING PRACTICE: With the advent of new technology, changing state and federal laws, and new court decisions, the ethical and legal issues nurses will encounter when taking care of cancer patients will not remain the same. Continuing education will be essential if nurses are to remain current, lower their legal liability, and deliver quality care.     

Legal and ethical issues in end-of-life care

Advances in medical technology during the past 3 decades altered the scenarios of our dying. It is now possible to prolong life, with the frightening reality that we also can extend death. This paper examines challenges to dying well in America, defines key end-of-life dilemmas faced by critical care nurses, and examines legal and ethical issues related to dying persons' care. These issues include patients' decision-making capacity and right to refuse treatment; withholding and withdrawing life-sustaining treatment, including nutrition and hydration; "no code" decisions; medical futility; and assisted suicide. Implications for critical care practice, education, research and public policy are identified.     

Legal issues relevant to clinical laboratory education program admissions.

OBJECTIVE: To address the basic legal requirements for admissions, admissions standards, student and applicant records, and discrimination in admissions for clinical laboratory science (CLS) and clinical laboratory technician (CLT) educational programs. DATA SOURCES: Recent academic literature and legal precedents. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: CLS and CLT educational programs typically practice selective admissions. Program directors and faculty need to be aware of the issues relating to student selection that may have legal implications. Admissions practices should be guided by three basic legal requirements: that the selection process not be arbitrary or capricious, that the program adhere to its published admissions standards and honor admissions decisions, and that the program not have admissions policies that discriminate on the basis of race, gender, age, disability, or citizenship. Specific guidelines are offered for applying these legal requirements to the admissions practices typically used by CLS and CLT programs, including published admission policies and standards, application forms, interviews, rating of noncognitive attributes, and communication with applicants. CONCLUSION: Admissions practices in CLS and CLT programs need to be guided by the three basic legal requirements.     

Legal and ethical issues related to nonheart beating organ donation

Major breakthroughs in immunosuppressant medication and advances in surgical techniques have increased the number of successful transplantations, but the demand for organs far outweighs the supply. People continue to die while waiting for donor organs to become available. Nonheart beating organ donation is a means of increasing the supply of organs to be transplanted. It is based on cardiac cessation criteria. This article explores the ethical and legal considerations, as well as implications for perioperative nurses. AORN J 77 (May 2003) 973-976.     

Legal and ethical issues in cancer genetics nursing

OBJECTIVES: This article will set forth major interests at stake for patients considering predictive genetic testing, some legal bases for protecting patients, and general ethical principles that can guide cancer genetic nurses in their practice. DATA SOURCES: Review of health, ethical, and legal literature CONCLUSION: There are many potential interests at stake for patients considering genetic testing for susceptibility to cancer and a number of legal protections for patients against genetic discrimination. Nurses and physicians who offer genetic testing should be aware of applicable laws in their states, and remain cognizant of evolving ethical principles that can guide the practice IMPLICATIONS FOR NURSING PRACTICE: Ethical and legal questions surrounding genetic testing linger--particularly for nurses and physicians whose primary concern is the best interests of the patient.     

Legal and ethical issues in HIV testing, Part 1.

HIV antibody testing presents multiple and complex legal and ethical issues. Nurse executives must be knowledgeable about these issues and their potential impact on administrative practice. In this two-part series, the author presents legal and ethical issues related to testing. Part 1 focuses on the AIDS epidemic, the ELISA test, informed consent, confidentiality, and mandatory vs. voluntary testing.     

Legal and ethical issues in HIV testing, Part 2.

In part 1 of this two-part series, legal and ethical issues in HIV testing were examined, such as the ELISA test, informed consent, confidentiality, and mandatory vs. voluntary testing. In this article, the author presents the most important legal and ethical concerns related to legislation for testing, testing in the workplace, Centers for Disease Control guidelines and recommendations, ethical analysis, and implications for nurse executives.     

Clinical research 2: Legal and ethical issues in research

This research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process.     

Legal issues related to drug testing in the clinical laboratory

As has been reported many times by the lay press, urine drug testing may pose some unique challenges. The clinical laboratory interested in industrial drug testing (typically known as employee drug testing) should be aware of the many challenges that may be brought on by the fact that the result may be contested in an adversarial proceeding. This is what makes the urine drug test a forensic test. It may be one piece of evidence or the only piece of evidence used in an adversarial proceeding that may decide on punitive or rehabilitative action against an employee. As a result, unique standards for governmental contract laboratories have been proposed from the National Institute on Drug Abuse, and special proficiency testing and accreditation procedures have been promoted by professional societies. These standards illustrate the sensitive nature of the results. Because the results are subject to adversarial proceedings, all parties concerned in the testing process should be aware of the legal issues surrounding urine drug testing. There are constitutional and statutory issues as well as tort issues such as negligence, defamation, invasion of privacy, battery, infliction of emotional distress, and others. Laboratories should be especially aware of these issues, since they may be brought in as a third-party defendant to a suit or brought in as a participant in gathering the evidence. The laboratory should also be aware of other legal ramifications such as chain of custody, expert testimony, and the acceptability of scientific evidence.     

Ethical issues and access to healthcare.

Access to healthcare services is far from equitable and legitimately raises the question of justice. Healthcare insurance provides access for most Americans, but for the 15% without coverage, access to healthcare services is difficult at best. As limits are put upon the healthcare dollar at the same time that technology is advancing rapidly, the population is aging, and resources are shrinking, we must determine a just and fair process for allocating limited healthcare resources.