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ETHICAL AND LEGAL NORMS REGULATING THE RIGHT TO INFORMATION AND INFORMED CONSENT OF THE PATIENTS RELATED TO THE NURSE'S ACTIVITIES
Georgieva Anna Petrova, Mavrodinova Stanislava Milcheva, Medical University, Varna, Bulgaria
E-mail: anngebg@gmail.com
Аbstract. Nowadays, the nursing profession has a key role and it covers a large perimeter of the general medical activities. As a result, this increases the responsibility in professional decision making. This requires an increase of the professional behavior standards, as well as it demands for a good knowledge and observation of the ethical and legal norms regarding the patients' rights.
The aim of the present research is to analyze the link between the ethical and legal norms regulating the patients' rights, and more specifically to analyze the link between the rules that regulate the right to information and the informed consent related to the nurse's activities. As a result, the analysis found that the ethical norms in the Code of Ethics for nurses, midwives, and associated healthcare professionals in the Republic of Bulgaria acquire a burden of legal standards, the binding force of which is strengthened by the demand for administrative and criminal responsibility in the Law on the professional organization for nurses, midwives, and associated medical professionals. In conclusion, knowledge and compliance with the ethical and legal norms governing the right to information and informed consent of patients are a guarantee for the ethical and lawful exercise of the nursing profession and high quality of healthcare.
Key words: ethical norms, legal norms, informed consent, nurses, patients
Introduction
In the current health situation, the nursing profession in Bulgaria is undergoing a process of intellectual advance, social transformation and moral reassessment.
Nowadays, the nursing profession has a key role and it covers a large perimeter of the general medical activities. As a result, this increases the responsibility in professional decision making. This requires an increase of the professional behaviour standards, as well as it demands for a good knowledge and observation of the ethical and legal norms regarding the patients' rights.
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The aim of the present research is to analyse the link between the ethical and legal norms regulating the patients' rights, and more specifically to analyse the link between the rules that regulate the right to information and the informed consent related to the nurse's activities.
Materials and Methods
An analysis of literature sources was performed using documentary methods. A comparative analysis was made regarding the ethical and legal norms regulating the right to information and informed consent of the patients related to the nurse's activities. The research was conducted in the period from January 2018 to February 2020.
Results and Discussion
Patient-centered care and patient rights issues are becoming increasingly popular today. Informing and obtaining patient consent are important conditions for effective patient-centered care and making patients active participants in the treatment and care process [7; 8; 10; 11; 14].
Some authors consider the process of information provision and obtaining an informed consent as an essential part of the nurses' activities in providing a legal and ethical defense of the right for patient autonomy [3; 5; 6; 11; 12; 13].
To achieve this, it is necessary to know the ethical and legal norms governing the patient's right to informed consent. A number of authors study the distinctive features and at the same time the relationship between ethical and legal norms governing patients' rights [3; 6; 9].
As G. Grancharova et al. (2001) point out, "the problems of medical ethics are located on the border between the professional competence of the medical specialist and his legal responsibility. In this sense, there is a certain similarity and difference between ethical and legal norms. Both types of norms are aimed at regulating the behaviour of the people, respectively in health care, but they differ significantly in the way in which this regulation is carried out. Ethical norms operate through the moral consciousness of the individual and their violation is subject to class and social control, while compliance with legal norms is ensured by state coercion. Therefore, in case of violation of ethical norms, the medical specialist bears only moral responsibility, and for deontological errors related to violation of his / her professional duties, he / she may also bear legal responsibility " [3].
According to P. Lisaev (2014) "ethical rules can also be differentiated into mandatory (imperative) and non-formally binding ones. An example of the former are the legally supported requirements. Their observance is not subject to discussion, despite the personal opinion of the doctor, because their violation is a formal reason to seek responsibility. Hence the ethical commitment of medical professionals and their organizations in updating outdated norms and rules " [6].
According to M. Radeva (2011) "The main acts of domestic legislation regulating the ethical aspects of the medical professions are the Health Act, the structural laws of the respective professional organizations, the codes of professional ethics" [9].
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According to ICN Code of Ethics 2012: "The nurse insures that the individual receives accurate, sufficient and timely information in a culturally appropriate manner on which to base consent for care and related treatment [4].
Under Article 14 of the Code of Ethics for nurses, midwives and associated healthcare professionals in the Republic of Bulgaria, the healthcare professional provides the patient and his relatives with information within the scope of his competence, concerning the prognosis, diagnosis, medical treatment and the possible risks and priorities before taking any sort of medical actions [2].
A number of authors believe that codes of ethics are intended to determine the norms of conduct, they represent the leadership of members of a class, they are accepted by agreement, they are mandatory for all and impose sanction to noncompliance, but do not have the character of law [3; 6; 9].
According to M. Radeva (2011), however, the codes of ethics "only at first glance contain ethical norms". According to the author, "The codes of ethics of doctors and dentists are normative acts containing legal norms, the binding force of which is strengthened by the search for administrative and criminal liability." In support of her claim, M. Radeva (2011) cites Article 37 of the Law on Professional Organizations of Physicians and Dentists, according to which, "each member of the class bears legal responsibility for non-compliance with the rules provided for in the codes of professional ethics [9].
As a result of our own research, we came to the conclusion that the obligations of the nurses and other health care professionals, members of the Bulgarian Association of Healthcare Professionals, are settled in an identical way. According to Art. 39 of the Law on the Professional Organization of Nurses, Midwives and Associated Medical Specialists "The members of the Bulgarian Association of Healthcare Professionals are obliged to: practice their profession in accordance with the Code of Professional Ethics and within their competencies and apply the rules of good medical practice [1].
In the provisions of Art. 40 of the cited law explicitly states that: "The members of the Bulgarian Association of Healthcare Professionals are responsible for the following violations committed in the performance of their professional duties: non-compliance with the rules provided for in the Code of Professional Ethics and non-compliance with the rules of good medical practice". According to Article 41: "Healthcare professionals may be subject to administrative penalties - reprimand, fine, deletion from the register of the college. At the same time, the provisions of Article 45, paragraph 1 of the Act explicitly state that" The imposition of penalties under Article 41 does not preclude the pursuit of criminal or civil liability or of disciplinary liability under the Labour Code [1].
Based on the comparative analysis of ethical and legal norms that regulate the patients' rights and more specifically the right to information along with the informed consent of patients related to the nurse's activities, we make the following conclusions:
- the similarity between ethical and legal norms is based on the common subject of regulation which is the medical professionals' behaviour;
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- the difference between ethical and legal norms stems from the fact that the ethical norms act through the individual's moral consciousness and norm breaking is a subject to professional and public control while the observance of legal norms is ensured by the public enforcement;
- the ethical norms guarantee that the medical professional shall respect the right of others. The legal norms thoroughly regulate probably the widest circle of social relations associated with providing and receiving a medical assistance;
- the nurses must practice their profession in accordance with the ethical norms specified in the Code of Ethics for nurses, midwives and associated healthcare professionals in the Republic of Bulgaria;
- the ethical norms specified in the Code of Ethics for nurses, midwives and associated healthcare professionals in the Republic of Bulgaria attain a significance of legal regulations with binding force which is affixed by claiming an administrative criminal liability under the Professional Organizations of Nurses, Midwives and Associated Medical Professionals Act 1;
- by observing the right to information and the informed consent, the nurses in Bulgaria do their moral duties and at the same time they bear a legal liability.
Conclusions
The knowledge and observation of the ethical and legal norms that regulate the right to information and the informed consent of patients, guarantee the ethical and legal practice of the nursing profession, as well as the high quality of the healthcare.
References:
1. Act on the Professional Organizations of nurses, midwives and associated medical specialists, dental technicians and assistant pharmacists Announced, SG. 46 of 2005, Title. Amend. SG. 91 of 2018 [Electronic resource]. - Access mode: https:// www.mh.government.bg/media/filer_public/2019/07/24/zakon-za-syslovnite-organiza cii.pdf
2. Code of Ethics for Nurses, Midwives and Associated Medical Specialists in Health Care in the Republic of Bulgaria, [Electronic resource]. - Access mode: https:// www.lex.bg/bg/laws/ldoc/2136548777
3. Grancharova G., Alexandrova S., Velkova A. Medical Ethics: Textbook 1st ed. P.: Ed. Center of the Medical University Pleven; 2001. - 284 p.
4. International Council of Nurses, The ICN Code of Ethics, Revised 2012, [Electronic resource]. - Access mode: http://www.icn.ch/about icn/code of ethics for nurses
5. León F.J., et al. El consentimento informado y el professional de enfermería: estudio cualitativo en hospital publico de Chile // Rev. Eleuthera. - 2009. - № 3. - P. 221-237. [Electronic resource]. - Access mode: https://www.redalyc.org/pdf/5859/58596183201 1.pdf
6. Lisaev P. Medical deontology and medical law for nurses, midwives and associates specialists: Textbook 1st ed. S.: Medicine and physical culture, 2014. - 192 p.
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7. Markova Y., J. Pavlovska. Analysis of the needs for care of the elderly in Bulgaria // Proceedings of the XII National Forum of Health Care Specialists "Continuous Health Care - a condition for a high quality of life" 11-12.11.2016, Shumen, Ed. of S. Toncheva. - 2016. - № 1. - P. 101-105.
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9. Radeva M., Ethical and legal norms in medicine // Scientific works of the University of Ruse. - 2011. - № 50 (8.1). - P. 14-18. - Access mode: http://conf.uni-ruse.bg/bg/docs/cp11/8.1/8.1-2.pdf
10. Stamova Kr., St. Staykova R. Dimitrova. Study of the need to provide help and support to patients on hemodialysis treatment from the dialysis clinic at the Multiprofile Hospital for Active Treatment "St. Marina". - Varna // Varna Medical Forum. -2014. - № 3 (2). - P. 308-311.
11. Toncheva S., Velkova R. The role of the nurse in receiving informed agreement from patients with large intestine operations // Military medicine. - 2004. - № 54 (1). - P. 32 37.
12. Valkanova M. Medical Law: Book 1st ed. - V.: STENO, 2014. - 316 p.
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