Legal, Ethical, Confidentiality, Consent, and Advocacy Foundations

1. Ethics and the ANA Code of Ethics

Nursing ethics is the study of right action in nursing. Six principles anchor it: autonomy (respecting a person's right to make their own decisions), beneficence (acting for the person's good), nonmaleficence (avoiding harm — "first, do no harm"), justice (fairness in care and resources), fidelity (keeping promises and commitments), and veracity (telling the truth). These are gathered in the ANA Code of Ethics, the profession's authoritative statement of its ethical obligations and ideals. The Code does not replace the law; it sets the standard to which nurses hold themselves, always within scope of practice — the legal boundary of what a nurse may do.

2. Legal wrongs: torts, negligence, and malpractice

A tort is a civil wrong — an injury to a person or their rights that can lead to a lawsuit, distinct from a crime against society. Negligence is unintentional harm from failing to act as a reasonably careful nurse would in the same situation (forgetting to raise a bed rail for an at-risk person). Malpractice is negligence by a professional — harm from failing to meet the accepted standard of care. Some torts are intentional: assault is the threat or attempt to touch someone without consent, creating fear of harm; battery is the actual harmful or offensive touching without consent; and false imprisonment is confining a person against their will without legal justification. The boundaries of each are defined by law and institutional policy, which vary by jurisdiction.

3. Consent, confidentiality, and advocacy

Informed consent is the process by which a person freely agrees to a treatment after receiving understandable information about its purpose, benefits, risks, and alternatives. Consent is valid only if the person has client capacity — the ability to understand the information and make a reasoned decision. The provider obtains consent; the nurse often witnesses the signature, verifies understanding, and as advocate speaks up if the person seems confused or coerced. Advance directives state a person's wishes for future care if they cannot speak for themselves: a living will states which treatments a person wants or refuses, and a durable power of attorney for healthcare names a trusted person to decide on their behalf. HIPAA (the Health Insurance Portability and Accountability Act) is the federal law protecting health information. Confidentiality is the ethical duty to keep information private; privacy is the person's right to control their own information and body. Mandatory reporting requires nurses to report suspected abuse (intentional harm) or neglect (failure to provide necessary care) of children, older adults, and other vulnerable people, and to report certain communicable diseases to public health, as required by law in their jurisdiction. Advocacy is the nurse's duty to protect the person's rights, and documentation is the accurate, timely record that makes care legally defensible and safe.

How it works

How informed consent protects autonomy:

1. The provider explains the treatment's purpose, benefits, risks, and alternatives in plain language.
2. The person demonstrates capacity — understanding the information and making a reasoned choice.
3. The person agrees freely, without coercion.
4. The nurse verifies understanding and may witness the signature; if the person seems confused or pressured, the nurse advocates by pausing and alerting the provider.
5. Consent and the person's choice are documented in the record.

Common confusions

Memory aids

For the six principles: "A Better Nurse Justly Follows Veracity" — Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, Veracity.

Quick review

Topic Recap

• Nursing ethics rests on autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity, articulated in the ANA Code of Ethics and bounded by scope of practice.
• Torts include negligence and malpractice (unintentional) and assault, battery, and false imprisonment (intentional).
• Informed consent requires capacity, information, and freedom from coercion; advance directives (living will, durable power of attorney) extend autonomy into the future.
• HIPAA protects health information; confidentiality is the duty, privacy is the right.
• Mandatory reporting (abuse, neglect, communicable disease) plus advocacy and documentation duties protect individuals and the public — always per local law.

Knowledge Check

1. What are the six principles of nursing ethics?
2. What is the difference between assault and battery?
3. What three conditions make consent valid?
4. What is the difference between a living will and a durable power of attorney for healthcare?
5. What kinds of situations generally require mandatory reporting?

Answers and Rationales

1. Answer: Autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity. Why: These six anchor ethical reasoning across nearly every nursing dilemma.
2. Answer: Assault is the threat or attempt of unwanted contact that creates fear; battery is the actual unwanted contact. Why: One is the threat, the other is the touch.
3. Answer: Capacity, understandable information, and freedom from coercion. Why: All three must be present for consent to be valid.
4. Answer: A living will states which treatments a person wants or refuses; a durable power of attorney for healthcare names a decision-maker. Why: One records wishes, the other appoints a person.
5. Answer: Suspected abuse or neglect of vulnerable people and certain communicable diseases. Why: These protect the person and public health, as defined by each jurisdiction's law.