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Legal Speak

Code of Ethics

Published April 15, 2008 10:29 AM by Tony DeWitt
One recent trend among trial lawyers is to cross-examine witnesses on the stand with their association's code of ethics. The ANA has a very complete code of ethics, and it is doubtful that many nurses know it as well as they should. The problem with not knowing the code of ethics is that at some point every nurse has to make tough choices, and without a good basis in the ethics of the profession, that's hard to do.

Provision one of the ANA code says:

"The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems."

As a trial attorney, that lofty sounding position gives me a lot to work with where there has been a suggestion that a nurse has been less than compassionate, less than respectfull, or was restricted by considerations of a person's economic status or personal hygiene. The following excerpt is from a deposition of a nurse in a nursing home case. The nursing home was eventually sold and the company that owned it put out of business. The CEO and the Chairman of the Board were both sent to federal prison. So what follows is awful. But it illustrates how the code of ethics can be used to illustrate just how bad a nurse's failure was.

The nurse being deposed is the director of nurses. We will not use her name because she was honest, because she was in a horrible situation, and because she should not be held up to ridicule.  For the same reason, I won't identify the facility.  The violations occurred ten years ago, and the facility has changed hands.  Hopefully the nurse has found other employment.

      12    Q.   (By Mr. ___) I want to recite for you a

      13    portion of the American Nurses Association code of

      14    ethics and ask you whether you agree with it, okay?

      15    A.   Certainly.

      16    Q.  "The nurse's primary commitment is to the

      17    patient, whether an individual, family, group or

      18    community."  Would you agree with that statement?

      19    A.   Repeat it for me.

      20    Q.  "The nurse's primary commitment is to the

      21    patient, whether an individual, family, group or

      22    community."  Would you agree with that statement?

      23    A.   I agree that the nurse's primary

      24    responsibility is to the patient.  I don't know how the

      25    second part of the sentence applies, but --

       1     Q.   Fair enough.  You would agree then that the

       2    nurse's primary commitment is to the patient, fair?

       3    A.   Yes.

       4    Q.   Let me ask you about this ethical statement.

       5    "A fundamental principle that underlies all nursing

       6    practice is respect for the inherent worth, dignity and

       7    human rights of every individual.  Nurses take into

       8    account the individual needs and values of all persons

       9    in all professional relationships."  Do you agree with

      10    that ethical statement?

      11    A.   Yeah.

***

      18    Q.   And do you agree with it?

      19    A.   I think so, yeah.

      20    Q.   Okay.  You said you think so.  I just want to

      21    give you an opportunity --

      22    A.   Read it again.  Let me listen.

      23    Q.   Let me just read the first portion of it, and

      24    see if you agree with that statement.  "A fundamental

      25    principle that underlies all nursing practice is respect

       1    or the inherent worth, dignity and human rights of every

       2    individual."  Do you agree with that statement?

       3    A.   Yes.

                                                ***

      18   Q.   And that there is a recognition in the code

      19    of state regulations and in the code of federal

      20    regulations that governs your contact, that each person

      21    is entitled to that dignity and respect and the highest

      22    degree of care practicable.  Do you agree with that?

      23    A.   Yes.

      24    Q.   And that's the obligation that you have as a

      25    nurse with charge over those residents to make sure that

       1    that is carried out; isn't that true?

       2    A.   Yes.

       3    Q.   Let me ask you this question.  Does

       4    permitting a patient to lie in their own urine for up to

       5    eight hours in any way show respect for the inherent

       6    worth, dignity and human rights of an individual?

       7     A.   No.

       8     Q.   Does permitting a patient to lie in their own

       9    *** and letting them get the *** on their hands and

      10    in their hair in any way show respect for the inherent

      11    worth, dignity and human rights of that individual?

      12    A.   Repeat that for me.

      13    Q.   Does permitting a patient to lie in their own

      14    *** and permitting them get the *** on their hands

      15    and in their hair in any way show respect for the

      16    inherent worth, dignity and human rights of an

      17    individual?

      18    A.   Within the confines of a nursing home, it

      19    can't always be prevented.

      20    Q.   Does permitting a patient to lie in their

      21    *** for hours at a time in any way show respect for

      22    that person's dignity?

      23    A.   No.  I think we discussed that already.

      24    Q.   Well, we discussed it in the context of

      25    someone laying in their own urine for hours, and now I'm

        1    asking you if you permit a patient to lie in their own

       2    *** for hours at a time, that would not show respect

       3    for their dignity or worth; would it?

       4    A.   No, it is not.

       5    Q.   And that is something that is preventable; is

       6    it not?

       7    A.   Yes, to lay there for hours is preventable.

 

There were numerous other awful examples of patient neglect that were recited. The nurse testified honestly that the facility and its nurses did not live up to the ethical codes of nursing.

The impact of such testimony on a jury is difficult to understate. The nurse admits that she agrees that human dignity is important, but that it can't always be maintained. Her attempt to separate out skilled nursing facilities by saying "it can't always be prevented" merely opened the door for the lawyer who pointed out the things that could be prevented.

Most nursing home cases are not as serious and the conditions are not as hellish. But imagine how these questions could be used in a deposition where the allegation is a failure to monitor the patient for falls?  "Would failing to answer a call light for thirty minutes for a patient with a history of falls in any way show respect for the inherent human dignity...." 

If it's been a while since you've looked at your professional code of ethics and responsibilities imposed by your state's statutes, it is a good idea to take a look at that today and do so. If it has been a while since there was an inservice on ethics, there is no time like the present to hold that inservice. Ethical questions are interesting, stimulate discussion, and often lead to quality improvement in well-run organizations. Those pay dividends in the long term.

 

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About this Blog


    A.L. "Tony" DeWitt, RRT, CRT, JD, FAARC
    Occupation: Attorney
    Setting: Jefferson City, Mo.
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