Good Morning

LEGAL & ETHICAL ISSUES

IN MIDWIFERY PRACTICE
AND STANDING ORDERS
 INTRODUCTION
• Legal: “legal” is an adjective and a noun used
to describe anything that concerns the law or
its workings.
• Ethical: Ethics seeks to resolve questions of
human morality by defining concepts such as
good and evil, right and wrong, virtue and
vice, justice and crime.
• Midwife: A midwife is a person who has
successfully completed a midwifery education
programme that is duly recognized in the country
where it is located and that is based on the ICM
Global Standards of Midwifery Education, who
has acquired the requisite qualifications to be
registered and/or legally licensed to practice
midwifery and the title ‘midwife’, and who
demonstrates competency in the practice of
midwifery.
• Midwifery is a professional discipline which
combines science, art and strong ethical values.
(Nursing and Midwives Studies)
 Principles of Ethics
• 1. Beneficence: beneficence is to act in the
best interests of the patient, and to balance
benefits against risks. The benefits that
medicine is competent to seek for patients are
the prevention and management of disease,
injury, handicap and unnecessary pain and
suffering and the prevention of premature or
unnecessary death.
• 2. Autonomy: means to respect the right of the
individual. Respect for autonomy enters the
clinical practice by the informed consent. It is
respect for the women’s autonomy that
underpins the requirement for informed
consent (Evidence based midwifery). This
process usually understood to have 3 elements,
disclosure by the physician to the patient’s
condition and its management, understanding
of that information by the patient and a
voluntary decision by the patient to authorize
or refuse treatment.
• 3. Non-malfeasance: it means that health
personnel should prevent causing harm
and is best understood as expressing the
limits of beneficence. This is commonly
known as ‘primum non nocere’ or first to
do no harm.
• 4. Justice: justice signifies to treat patients
fairly and without unfair discrimination,
there should be fairness in the distribution
of benefits and risks. Medical needs, and
benefits should be properly weighed.
• 5. Confidentiality: confidentiality is
the basis of trust between health
personnel and patient. By acting
against this principle one destroys the
patient trust.
 Patients’ Rights
• 1. The right to freedom from coercion in
decision making.
• 2. The right to use informed choice is care, by
having access to relevant information upon
which decisions are based.
• 3. The right to be treated with respect and
dignity without reference age, marital,
socio-economic, ethnic, national,
political, mental, physical or religious
status.
• 4. The right to know who will participate
in her care and obtain additional
consultation.
• 5. The right to full disclosure of financial
factors involved in her care.
• 5. The right to full disclosure of financial
factors involved in her care.
• 6. The right to accept or to refuse treatment of
her choice.
• 7. The right to absolute privacy except where
this right is pre-empted by law.
• 8. The right not to be abandoned
neglected or discharged room care
without an opportunity to find other
health provider.
• 9. Patients or individuals who require
health care services have right to make
their own decision about the opinions for
treatment or other related issues. The
process of obtaining permission is called
informed consent.
 Code of Ethical Midwifery Practice

Midwives rights
• 1. The right to receive reasonable
compensation for services rendered.
• 2. The right to receive honest,
relevant information from patients
upon which caring is based.
• 3. The right to discharge patients from
her care, provided adequate
information from patients upon which
caring is based.
• 4. The right to refuse care to patients
with whom no midwife-patient
relationship has been established.
 Midwives responsibilities
• 1. The obligation to honor the
confidence of those encountered in
the course of midwifery practice and
to regard everything seen and heard
as inviolable, remembering always
that a midwife’s highest loyalty is
owed to her patient and not to her
health care providers.
• 2. The obligation to serve as the
guardian of normal birth, alert to
possible complications, but always
on guard arbitrary interference in
birthing process for the sake of
convenience or the desire to use
human beings in scientific studies
and training.
• 3. The obligation, when referring a
patient to another health care provider, is
to remain responsible for the patient until
she is either she is discharged or formally
transferred.
• 4. The obligation to provide complete,
accurate and relevant information to
patients so that they can make informed
choices regarding their health care.
• 5. The responsibility to developed
and utilize a safe and efficient
mechanism for medical consultation,
collaboration and referral.
• 6. The obligation never to comment
on another midwife’s or other health
provider’s cares without first
contraction that practitioner
personally.
• 7. The responsibility to assist
others who wish to become
midwives by honestly and
accurately evaluating their
potential and competence and
sharing midwifery knowledge and
skill to extent possible without
violating another section in this
code.
• 8. The obligation to pursue professional
development through on going evaluation
of knowledge and skill and continuing
education including diligent study of all
subjects relevant to midwifery.
• 9. The obligation to accurately document
the patient’s history, condition, physical
progress and other vital information
obtained during patient care.
• 10. The responsibility to maintain
accountability for all midwifery
care delivered under her
supervision. Assignment and
delegation of duties to other
midwives or apprentices should
be proportionate to their
educational preparation and
demonstrated proficiency.
• 11. The midwife primary
responsibility is to promote the well-
being of the childbearing women
(The journal of parental education).
The obligation to know and comply
with all legal requirements related to
midwifery practice without the law
provide for the unobstrured practice
of midwifery within the state
 Legal and Ethical Principle in the
Provision of Heath Services

Informed Decision Making

• Individual requires health services
have right to make their own decision
about the options for treatment or
other related issues. The process of
obtaining permission is called
informed consent.
The Health care Provider Should Disclosed
the following details
• The individual currently assessed health status
regarding the general or reproductive health.
• Reasonable accessible medical, social and
other means of response to the individual’s
condition including predictable success rate,
side-effects and risk.
• In implication for the individual, general,
sexual and reproductive health and life style
decline any of the options or suggestions.
 Competent delivery services

• Every individual has the rights

to receive treatment by
competent heath care provider
who knows to handle just
situation quite well.
Legal Issues in Maternal and Infant Nursing
 International Codes of Ethics for
Midwives
The aim of the International
Confederation of Midwives (ICM) is:

• To improve the standard of care provided

to woman, babies and families throughout
the world through the development,
education and appropriate utilization of
the professional midwife.
• In keeping with this aim, the ICM sets
forth the following code to guide the
education, practice and research of
midwife.
• This code acknowledges women as
persons with human rights, seeks justice
for all people and equity in access to
health care, and is based on mutual
relationships of respects, trust and the
dignity of all members of society.
• The code addresses the midwife’s
ethical mandates in keeping with
the mission, the International
definition of Midwife, and
standards of ICM to promote the
health and well-being of women
and newborns within their
families and communities.
• Such care may encompass the
reproductive life cycle of the woman
from the pre-pregnancy state right to
the menopause and to the end of life.
These mandates include how midwives
relate to others; how they practice
midwifery; how they uphold
professional responsibilities and duties;
and how they are to assure the integrity
of the profession of midwifery.
 The Code
Midwifery Relationships
• 1. Midwives develop a partnership
with individual women in which they
share relevant information that leads
to informed decision-making,
consent to an evolving plan of care,
and acceptance of responsibility for
the outcomes of their choices.
• 2. Midwives support the right of
women/families to participate
actively in decisions about their
care.
• 3.Midwives empower
women/families to speak for
themselves on issues affecting the
health of women and families
within their culture/society.
• 4. Midwives, together with
women, work with policy and
funding agencies to define
women’s needs for health
services and to ensure that
resources are fairly allocated
considering priorities and
availability.
• 5. Midwives support and sustain each
other in their professional roles, and
actively nurture their own and others’
sense of self-worth.
• 6. Midwives respectfully work with
other health professionals, consulting
and referring as necessary when the
women’s need for care exceeds the
competencies of the midwife.
• 7. Midwives recognize the human
interdependence within their field
of practice and actively seek to
resolve inherent conflicts.
• 8. Midwives have responsibilities
to themselves as persons of moral
worth, including duties of moral
self-respect and the preservation
of integrity.
 Practice of midwifery
• 1. Midwives provide care for
women and child bearing families
with respect for cultural diversity
while also working to eliminate
harmful practices within those
same cultures.
• 2. Midwives encourage the minimum
expectation that no woman or girl
should be harmed by conception or
child bearing.
• 3. Midwives use up-to-date,
evidence-based professional
knowledge to maintain competence
in safe midwifery practices in all
environments and cultures.
• 4. Midwives respond to the
psychological, physical, emotional
and spiritual needs of women seeking
health care, whatever their
circumstances (nondiscrimination).
• 5. Midwives act as effective role
models of health promotion for
women throughout their life cycle,
for families and for other health
professionals.
• 6. Midwives actively seek
personal, intellectual and
professional growth throughout
their midwifery career, integrating
this growth into their practice.
 The professional responsibilities of
midwives
• 1. Midwives hold in confidence client
information in order to protect the right to
privacy, and use judgment in sharing this
information except when mandated by
law.
• 2. Midwives are responsible for their
decisions and actions, and are
accountable for the related outcomes in
their care of women.
• 3. Midwives may decide not to
participate in activities for which they
hold deep moral opposition; however,
the emphasis on individual conscience
should not deprive women of essential
health services.
• 4. Midwives with conscientious
objection to a given service request
will refer the woman to another where
such a service can be provided.
• 5. Midwives understand the adverse
consequences that ethical and human
rights violations have on the health of
women and infants, and will work to
eliminate these violations.
• 6. Midwives participate in the
development and implementation of
health policies that promote the health
of all women and childbearing
families.
 Advancement of midwifery knowledge
and practice

• 1. Midwives ensure that the

advancement of midwifery
knowledge is based on activities
that protect the rights of women
as persons.
• 2. Midwives develop and share
midwifery knowledge through a
variety of processes, such as peer
review and research.
• 3. Midwives contribute to the
formal education of midwifery
students and ongoing education of
midwives.
Standards for the Practice of Midwifery

• Midwifery practice as conducted by

certified nurse-midwives (CNMs) and
certified midwives (CMs) is the
independent management of women’s
health care, focusing particularly on
pregnancy, childbirth, the postpartum
period, care of the newborn, and the
family planning and gynecologic needs of
women.
• The CNM and CM practice within a health
care system that provides for consultation,
collaborative management, or referral, as
indicated by the health status of the client.
CNMs and CMs practice in accord with the
Standards for the Practice of Midwifery, as
defined by the American College of Nurse-
Midwives (ACNM). Nurses should be
updated with the legal and ethical issues in
midwifery nursing in order to protect
themselves from lawsuits. (Journal of
Science)
Standards
 STANDING ORDERS
• A standing order is a document
containing orders for the conduct of
routine therapies, monitoring guidelines,
and/or diagnostic procedure for specific
client with identified clinical problem.
Standing orders are approved and signed
by the physician in charge of care before
their implementation.
• They are commonly found in critical
care setting and other specialized
practice setting where client's needs
can change rapidly and require
immediate attention. Standing orders
are also common in the community
health setting, in which the nurse
encounters situations that do not
permit immediate contact with a
physician.
 DEFINITION
• Standing Orders are orders in which
the nurse may act to carry out
specific orders for a patient who
presents with symptoms or needs
addressed in the standing orders.
They must be in written form and
signed and dated by the Licensed
Independent Practitioner.
 Examples of situations in which standing
orders may be utilized can include,
• Administration of immunizations (e.g. influenza,
pneumococcal, and other vaccines)
• Nursing treatment of common health problems
• Health screening activities
• Occupational health services
• Public health clinical services
• Telephone triage and advice services
• Orders for lab tests.
• School health
• During labor.
 OBJECTIVES
• To maintain the continuity of the
treatment of the patient.
• To protect the life of the patient.
• To create feeling of responsibility
In the members of health team.
 USES

• Providing treatment during emergency

• Enhance the quality and activity of health
service.
• Developing the feeling of confidence and
responsibility in nurses and other health
workers.
• Protecting the general public from
troubles.
• Enhancing the faith of general public in
medical institution.
 CONCLUSION
• Legal issues can occur anytime during
the service period of the nurses in the
working field because of any negligence,
malpractices or any violation of the code
of the ethics. Standardized care is very
important and also all the nurses should
follow all the standards of care in order
to provide competent care and avoid any
kind of problems during their work
period.
 REFERENCES
• Dc Duttas’s “Textbook of Obstetrics”, 8th Edition,
Jaypee Brothers medical publishers (P) ltd.
• Dc Duttas’s “Textbook of Gynaecology”, 8th
Edition, Jaypee Brothers medical publishers (P) ltd.
• Annama Jaccob “A Comprehensive Textbook of
Midwifery and Gynaecology Nursing” 4th Edition
Jaypee Brothers medical publishers (P) ltd.
• AV Raman, “Reader’s Maternity Nursing”, 20th
Edition, Published by Wolters Kluwer (India) Pvt.
Ltd. New Delhi.
• Niksy Abraham “ Textbook of Midwifery &
Obstetrical Nursing”, Frontline Publications.
THANK
YOU