Chapter 01: An Introduction to the Ethics and the Law: A Perspective for Nurses
Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition

MULTIPLE CHOICE

	1.	Which of the following mandates that nurses have a basic understanding of the Canadian legal system?
a.	Provincial and federal nursing bodies	
b.	The Supreme Court of Canada	
c.	Provincial nursing labor unions	
d.	The Drug and Pharmacies Regulation Act, 1990	

ANS:	A

	Feedback	
A	Correct! Provincial and territorial regulatory bodies, have certain requirements related to nurses’ knowledge/skill, which includes knowledge of the legal system.	
B	Incorrect—The Supreme Court, which is the final court of appeal in Canada, is not involved in the regulation of health care professionals.	
C	Incorrect—Labour unions do not focus on nursing standards and knowledge; rather, they represent the collective bargaining rights of nurses.	
D	Incorrect—This Act is relevant to nursing in that it regulates the prescribing, dispensing, and handling of drugs. It does not mandate the knowledge nurses require about the legal system.	

DIF:	Cognitive level: Comprehension

	2.	Identify one of the reasons why nurses need to have an understanding of ethics.
a.	Nurses do not share the same perspectives regarding health care with other health care professionals.	
b.	Morality and care are at the heart of nursing practice.	
c.	Ethics provides a clear answer to nurses regarding the correct course of action.	
d.	Convincing family members of compassionate courses of action is best done by nurses.	

ANS:	B

	Feedback	
A	Incorrect—Professional values may be shared across multiple professions, and perspectives on issues may be similar. When views on an issue differ, then knowledge of ethics assists in clarifying and defending one’s position to others.	
B	Correct! One reason for nurses studying ethics is that morality and care are at the heart of nursing practice.	
C	Incorrect—Ethical theories can provide a framework for the exploration of the ethical questions and moral issues faced in health care. These theories guide how morality is understood within the sphere of nursing practice and the nurse–patient or nurse–client relationship. Ethical theories and frameworks can assist/guide nurses as they consider multiple options to choose the best or the least wrong course of action.	
D	Incorrect—Nurses as members of the health care team are in a strong position to support families. They respect the values and beliefs of clients and families and support them in decision making regarding the right course of action.	

DIF:	Cognitive level: Synthesis

	3.	Why is it advantageous for nurses to have knowledge of ethical theories and principles?
a.	Ethical theories encourage nurses to critique others’ points of view.	
b.	Nurses are able to justify and defend their positions on a situation.	
c.	Ethical theories help nurses explain to the rest of the team why nurses have a greater understanding of the patient’s perspective.	
d.	This knowledge allows nurses to convince patients to choose comfort measures only.	

ANS:	B

	Feedback	
A	Incorrect—Ethics encourages nurses to respect the values of others and assists in understanding opposing points of view. Ethics offers tools to nurses to respectfully argue in favour of their positions while respecting the perspectives of others.	
B	Correct! When views differ, ethical theories help clarify one’s position and make arguments in support of it. Nurses ensure that all relevant information is shared with the team and the client.	
C	Incorrect—The perspective of all team members is important and is based on the unique relationships each nurse has with the patient or client.	
D	Incorrect—This approach is paternalistic. Nurses and the health care team, while respecting a person’s autonomy, support him or her in making decisions about what is best in a particular context. This includes ensuring that patients are aware of all the options available to them.	

DIF:	Cognitive level: Comprehension

	4.	Why must nurses be familiar with the legal system?
a.	Some nursing actions are governed by the law.	
b.	Nurses’ decisions may not be supported by the law.	
c.	Nurses are sometimes at risk for litigation.	
d.	All are correct.	

ANS:	D

	Feedback	
A	Incorrect—Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have untoward consequences, and errors or omissions may lead to negligence claims.	
B	Incorrect—Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have untoward consequences, and errors or omissions may lead to negligence claims.	
C	Incorrect—Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have untoward consequences, and errors or omissions may lead to negligence claims.	
D	Correct! Reserved or controlled acts and the administration of narcotics are two examples of nursing actions governed by the law. A nurse may think an action is “ethical,” but it may not be legal. Nurses’ decisions sometimes have untoward consequences, and errors or omissions may lead to negligence claims.	

DIF:	Cognitive level: Analysis

	5.	What existing legislation has been influenced by the shifting of Canadian values over time?
a.	The abolition of capital punishment	
b.	Privacy	
c.	Medical Assistance in Dying	
d.	All are correct	

ANS:	D

	Feedback	
A	Incorrect—One reason for the abolition of capital punishment is based on the belief in the sanctity of life and the concern that an innocent person may be executed.	
B	Incorrect—Respect for autonomy and privacy led to legislation in provinces across Canada.	
C	Incorrect—Shifting views regarding euthanasia for the terminally ill led the Supreme Court to create a law regarding assistance in dying. This resulted in the legislation “Medical Assistance in Dying,” which was introduced in 2016.	
D	Correct! All of these are examples of how shifting Canadian values have influenced legislation.	

DIF:	Cognitive level: Comprehension

TRUE/FALSE

	1.	In addition to having obligations to clients, nurses also have rights regarding what they can expect as professionals.

ANS:	T

	Feedback	
Correct	Like all Canadians, nurses have rights under the Charter of Rights and Freedoms. Nurses consider these rights in the context of their responsibilities and obligations to clients.	
Incorrect	Like all Canadians, nurses have rights under the Charter of Rights and Freedoms. Nurses must consider these rights in the context of their responsibilities and obligations to clients.	

DIF:	Cognitive level: Comprehension

	2.	Through the Canada Health Act, the federal government is given authority over health care in Canada.

ANS:	F

	Feedback	
Correct	Health Care is a provincial responsibility. Only the conditions under which the federal government funds health care is specified in the Act.	
Incorrect	Health Care is a provincial responsibility. Only the conditions under which the federal government funds health care is specified in the Act.	

DIF:	Cognitive level: Knowledge

	3.	The field of ethics is gaining greater prominence, in part, because of the growing sophistication of science and technology.

ANS:	T

	Feedback	
Correct	Recent advances in genetics, transplantation, and reproductive biotechnology, have opened up an entirely new array of ethical dilemmas, not previously known. This raises the question “Just because you can do something, should you?”	
Incorrect	Recent advances in genetics, transplantation, and reproductive biotechnology, have opened up an entirely new array of ethical dilemmas, not previously known. This raises the question “Just because you can do something, should you?”	

DIF:	Cognitive level: Comprehension

	4.	A nurse is justified in accessing the chart of a friend who is a patient on another unit because she is aware of her friend’s serious allergy to antibiotics and wants to make sure this is documented.

ANS:	F

	Feedback	
Correct	It is inappropriate for a nurse to access the record of a patient who is outside of his or her “circle of care.” If the friend is not capable of disclosing this information, then to prevent serious harm, the nurse should disclose this information to the team if the friend’s family or substitute decision maker is not available to do so.	
Incorrect	It is inappropriate for a nurse to access the record of a patient who is outside of his or her “circle of care.” If the friend is not capable of disclosing this information, then to prevent serious harm, the nurse should disclose this information to the team if the friend’s family or substitute decision maker is not available to do so.	

DIF:	Cognitive level: Comprehension

	5.	A resident in long-term has been deteriorating for a number of days. His daughter has been with him most of the time and is exhausted. The nurse encourages her to go home to get some rest. A few hours later, it becomes clear to the staff that death is imminent. Appreciating how exhausted the daughter is, the nurse is justified in not disturbing her.

ANS:	F

	Feedback	
Correct	The nurse is denying the daughter the opportunity to be present with her father so that he does not die alone. It is the daughter’s, not the nurse’s, choice to make. This may also have implications for the grieving process.	
Incorrect	The nurse is denying the daughter the opportunity to be present with her father so that he does not die alone. It is the daughter’s, not the nurse’s, choice to make. This may also have implications for the grieving process.	

DIF:	Cognitive level: Comprehension