LEGAL AND ETHICAL ASPECTS OF ICU

Informed consent

• Informed consent is an agreement by a client to accept a course of treatment or a procedure after providing complete information includes the benefits and risks of treatment alternatives to the treatments and prognosis, if not treated by a health care provider. For the consent, usually the client sign a form provided by the agency, that form is the record of the informed consent.

Delegation

• "The delegation is defined as transferring to a competent individual the authority to perform a selected nursing task in a selected situation."
• "Delegation is defined as transferring responsibility for the performance of an activity or task while retaining accountability for the outcomes."
• "five right of delegation"
  • Right task – the task is delegate for a specific client such as tasks that are repetitive, require little supervision and are relatively noninvasive.
  • Right circumstances – appropriate client setting, available resources and other relevant factors are considered.
  • Right person – the right person is delegating the right task to the right person to be performed by the right person.
  • Right direction/communication – A clear, concise description of the task including its objective limits and expectation is given.
  • Right supervision – appropriate monitoring, evaluation, intervention as needed and feedback are provided.

Death and death related issue

• Advance directive
• DNR – Do-not-resuscitate order
• Euthanasia
• Certification of death
• Autopsy
• Inquest
• Organ-transplantation

Advance directive

• Advance directive is also known as advance health care directive or advance decision. Advance directive are instruction give to individuals by doctor to specify what kind of care you would like to have If you become unable to make the medical decision, such as if you are in unconscious or in coma.
• In advance directive, a form is filling by the patients that have complete instructions for the further care of patient. The living will and power of authority for health care.

(Do Not Resuscitate) DNR order

• DNR is another kind of advance directive. DNR is a request not to have CPR, if patient heart stops or if you stop breathing.
• For that as DNR form is used or to tell the doctor that you don't want to resuscitated. DNR order is written to indicate that the goal of treatment is comfortable, dignified death and that further life- sustaining measures are not indicated.

Euthanasia

• Euthanasia is also known as "mercy killing" or PAS (Physician assisted suicide). It is the act of painlessly putting the death to a person who is suffering from incurable or distressing disease (chronic or incurable disease).
• Netherland was the one of the first country to legalize the euthanasia. In India euthanasia is not legalized.

Death certification

• It is a medical certificate of the cause of death (MCCD) that is provided by the hospital, which include all the information regarding death.
• Death certificate must be made out when the person is die and this certificate is signed by the attending physician. This certificate is used as for the legal matter, such as insurance claim.

Autopsy

• The autopsy is also known as pots-mortem examination.
• Autopsy is a medical procedure performed for legal or medical purpose that consists of a thorough examination of a corpse (dead body) to determine the cause and manner of the death and to evaluate any disease or injury that may be present. It is usually performed by a specialized pathologist.
• It is the responsibility of the physician or in the some instance of the designated person in the hospital to obtain consent for an autopsy.
• Consent must be given by the decedent (before death) or by the next to kin. After autopsy, hospital cannot remain any tissue or organs without the permission of the person who consent to autopsy.

Inquest

• Inquest is the legal inquiry of the cause or the manner of the death, when the death is a result of an accident.
• The inquest is conducted under the jurisdictions of a coroner or a medical officer.
• Coroner is a public official, not necessary a physician, appointed or the elected for the inquiry of the cause of death.
• Medical examiner is a physician and usually has advanced education in pathology or forensic medicine.

Organ donation

• Under the uniform anatomical gifts Act's and the National organ transplant Act's or the human tissue Act's, person who is 18 year or older in age and heaving a sound mind may make a gifts of all or any part of their own body.
• In India, THO Act's (transplantation of human organ Act's- 1994) was passed in 1994 by parliament. The main aim is "to provide for the regulation of removal storage and transplantation of the human organs in therapeutic purpose.

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