Some parts of this note are copied word-for-word given the nature of legal jargon and phrasing (especially the Preamble). I’ve tried to provide key phrases or words for each section to allow them to be more memorable. Just read the references anyway, it’s not that long.
References
The basis for the code of ethics for nurses was created by the Board of Nursing (BON) in coordination and consultation with the Philippine Nurses Association (PNA) based on the Code of Good Governance for the Professions in the Philippines, and approved by the Professional Regulation Commission (PRC) on July 14, 2004.
Code of Ethics for Nurses
Board Resolution No. 220, Series of 2004 approved last 14th day of July, 2004: the promulgation of the code of ethics for registered nurses.
Article I: Preamble
Section 01 (What?): Health is a fundamental right of every individual. The Filipino registered nurse, believing in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all cost. This responsibility encompasses promotion of health, prevention of illness, alleviation of suffering, and restoration of health. However, when the foregoing are not possible, assistance towards a peaceful death shall be his/her obligation.
Section 02 (How?): To assume this responsibility, registered nurses have to gain knowledge and understanding of man’s cultural, social, spiritual, physiological, and ecological aspects of illness, utilizing the therapeutic process. Cultural diversity and political and socio-economic status are inherent factors to effective nursing care.
Section 03 (Why?): The desire for the respect and confidence of clientele, colleagues, co-workers, and the members of the community provide the incentive to attain and maintain the highest possible degree of ethical conduct.
Article II: Registered Nurses and People
Section 04: Ethical Principles (for people)
- Respect individual beliefs. This includes values, customs, and spirituality.
- Respect autonomy and self-determination. Individuals are free to make rational and unconstrained decisions.
- Respect confidentiality. Any personal information acquired during care is held in strict confidence.
Section 05: Guidelines to be observed (for care of people)
- Be holistic. Both the individuality and totality of patients are considered when administering care.
- Respect spirituality, culture, and values (again?). Beliefs and practices are respected in regards to diet and treatment. However, in the event of conflicts, their welfare and safety must take precedence.
- Uphold the rights of the individuals.
Article III: Registered Nurses and Practice
Section 06: Ethical Principles (in practice)
- Human life is inviolable.
- Quality and excellence are the goals of practice.
- Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability.
Section 07: Guidelines to be observed (in the practice of nursing)
- Follow the scope of nursing practice as defined by R.A. 9173 (The Philippine Nursing Act of 2002) and Board Res. No. 425, Series of 2003, the Rules and Regulations Implementing the Philippine Nursing Act of 2002 (IRR).
- Be aware of the duties and responsibilities defined in the aforementioned legal bases.
- Become competent in knowledge, skills, and attitude through various learning situations.
- For administrators, provide a favorable environment for growth and development, and minimize ineffective and unlawful practice of registered nurses in their charge.
- Know that specialization programs are accredited through the Nursing Specialty Certification Council (NSCC).
- Strive for the optimum standard of safe nursing practice, and any modifications from the standard should follow the principles of safe nursing practice.
- Maintain confidentiality for the patient, allowing only those professionally and directly involved in their care to view records or when required by law.
Section 08: Ethical Principles (for patients’ rights)
- Nurses are advocates. They safeguard patient rights and privileges.
Section 09: Guidelines to be observed (in upholding rights):
- Respect the Patients’ Bill of Rights. In particular, provide the patient or their families information (4th in the patients’ bill of rights). All pertinent information except those deemed harmful is provided. If conflicts arise, the patients’ rights area upheld.
Section 10: Registered nurses should be aware that there are professional, ethical, moral, and legal dimensions in their actions. They strive to perform their work in the best interest of all concerned.
Section 11: Prohibitions and Regulations
- Follow existing laws, rules, regulations, measures, and generally accepted principles of moral conduct and proper decorum in professional duties.
- Do not demean the image of the profession in advertisements, such as in indecent exposure, dress code violations, seductive behavior, etc.
- No gifts, favors, or hospitality that can be interpreted as capitalizing on patients should be declined.
- Referrals should not be capitalized upon. Any demands or reception of any commission, fee, or emolument for recommending or referring a patient to other healthcare professionals is prohibited.
- No abuse of the privileged nurse-patient relationship should take place, such as access to property, resident, or workplace.
Article IV: Registered Nurses and Co-workers
Section 12: Ethical Principles (in working with others)
- Maintain solidarity with other members for the patient’s best interest.
- Maintain a collegial and collaborative working relationship.
Section 13: Guidelines to be observed (in working with others)
- Nurses must maintain their professional role/identity when working with others.
- Nurses must conform with group activities based on acceptable, ethicolegal standards.
- Nurses must contribute to professional growth and development of other members of the health team.
- Nurses must actively participate in professional organizations.
- Nurses must not act in any manner prejudicial to other professions.
- Nurses must honor and safeguard the reputation and dignity of nurses and other professions. Avoid unfair and unwarranted comments or criticisms on competence, conduct, and procedures.
- Nurses must respect the rights of their co-workers.
Article V: Registered Nurses, Society, and Environment
Section 14: Ethical principles
- The preservation of life, respect for human rights, and promotion of health environment shall be a commitment of the Registered Nurse.
- The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse.
Section 15: Guidelines to be observed
- Nurses must be conscious of their obligations as citizens, i.e. be involved in community concerns.
- Nurses must be equipped with knowledge of health resources within the community, and take an active role in primary health care.
- Nurses must actively participate in programs, projects, and activities that respond to the problems of society.
- Nurses must lead their lives in conformity with the principles of right conduct and proper decorum.
- Nurses must uplift the nursing profession at all times with their image.
Article VI: Registered Nurses and the Profession
Section 16: Ethical Principles (in the nursing profession)
- Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal.
- Compliance with the by-laws of the accredited professional organization (PNA), and other professional organizations of which the Registered Nurse is a member is a lofty duty.
- Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations.
- Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and a visionary mission.
Section 17: Guidelines to be observed (in the nursing profession)
- Be members of the PNA (the accredited professional organization)
- Strictly adhere to nursing standards
- Participate actively in the growth and development.
- Strive to secure equitable socio-economic and work conditions in nursing through appropriate legislation and other means.
- Assert for the implementation of labor and work standards.
Article VII: Administrative Penalties, Repealing Clause, and Effectivity
The Certificate of Registration of Registered Nurse shall either be revoked or suspended for violation of any provisions of this Code pursuant to Sec. 23 (f), Art. IV of R. A. No. 9173 and Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR.
Also read: Nursing Accountability by Luansing
International Code of Ethics for Nurses
With its latest revision being in 2012, the International Council of Nurses (ICN) has also adopted an international code of ethics:
- Nurses and the People: the main professional responsibility of nurses is to people requiring nursing care.
- Nurses and Practice: the nurse carries personal responsibility and accountability for nursing practice, and maintains competence by continual learning
- Nurses and the Profession: the nurses have major roles in determining and implementing acceptable standards of clinical nursing practice, management, research, and education. They are also active in developing a core of research-based professional knowledge, and of professional values.
- Nurses and Co-workers: the nurse sustains a collaborative and respectful relationship with co-workers in all fields. They take appropriate action to protect individuals, families, and communities if their health is endangered by a co-worker or any other person. Similarly, the nurse supports and guides co-workers to advance in ethical conduct.
Contracts
A contract is a meeting of minds between two persons where each party binds themselves to the other, to give something or to render some service. It is a promise or a set of promises which the law recognizes as a duty which, if unfulfilled, the law remedies. In nursing, when a nurse enters into a contract with an employer, it often entails a salary and a set of benefits in exchange for their services as a nurse. Contracts can take various forms:
| Contract | Definition |
|---|---|
| Formal Contract | A contract put into writing by some special laws. This includes marriage contracts, mortgages, deeds of sale, work contracts, etc. |
| Informal Contract | A contract put into writing without an involvement of the law, or those produced by oral or spoken discussion with evidence and intention to form a contract. |
| Voidable Contract | A contract that can be retracted if fraud or misrepresentation has been involved in its formulation, especially in the absence of free consent from one or more involved parties. This contract is non-binding. |
| Void Contract | A contract that has ceased to be enforceable, either from its conception or from a change in events or circumstances. The name “void contract” is a misnomer; a contract does not exist if it is void. In this case, it should be referred to as a “void agreement”. |
| Unenforceable Contract | A contract that the law cannot enforce, such as void contracts, unconscionable contracts, impossible contracts, and contracts against public policy. It may be valid between the parties, but will not be enforced by the law. |
| Executed Contract | A contract where both parties have performed their obligation. |
| Executory Contract | A contract yet to be executed; a contract where neither party has fulfilled their obligation. For example, a contract for a medical procedure is executory if the procedure nor the payment has been carried out. |
| Express Contract | When a contract’s terms are reduced in writing or are agreed upon by spoken words at the time of its formation. “Express” in this case refers to the shortening of the process. |
| Implied Contract | The terms of a contract which are implied based on the conduct or dealing between the parties. For example, the patient consenting to the administration of medications also consent to the method (even if invasive) by which those medications are given. |
| Quasi-Contract | A legal obligation decided by a judge for one party to compensate the other, such as in the case of a medical procedure being carried out by party A, but not being paid for by party B. In this case, a quasi-contract for party B to fulfill their obligation through their property is produced by a judge. |
| Contingent Contract | A contract set in place as a contingency. For example, a payment will be made to a worker in the event that the worker suffers an injury at a workplace. |
| Inexistent Contract | Contracts that are void or inexistent from the beginning, either due to unlawful terms, with invalid causes, whose object is outside the commerce of man, whose service is impossible, where the intention in relation to the principal object cannot be certain, those who are declared void by law, or those who are fictitious or simulated. |
| Voidable Contract | Contracts wherein one of the parties are incapable of giving consent, and those whose content is vitiated by mistake, violence, intimidation, or undue influence or fraud. |
| Illegal Contract | Contracts fraudulently, unlawfully, or prohibitively produced. |
A contract, being bound by the law, has various requisites before its validation:
- The presence of two or more consenting parties.
- Consent requires legal capacity dictated by age and sound mind (freedom from intoxication, duress, or mental disability).
- Married couples may need to enter into contracts with both parties involved; some contracts require both husband and wife to sign into a contract, such as in a mortgage.
- The object which is the subject matter of the contract is specified. Said object must not be outside the commerce of man, not untransmissible, future inheritance only within the authority of law, and do not contradict the law, morals, good customs, public order, and public policy.
- The cause for obligation should be established. Time, price, and subject are expressed.
- Generally, the duration of the contract is at least as long as the shortest fulfillable obligation, such as in salaries— a yearly salary will entail a contract valid for at least one year.’
Written contracts are often feared by personnel, and prefer oral contracts instead. However, a written contract includes many advantages:
- Certainty. Written contracts are certain and avoid issues with human memory.
- Time Frame. Written contracts contain a set time frame of validity as to protect both sides against sudden changes without notice.
- Setting Standards. An individual no longer needs to haggle for the amount of compensation to receive or to give, as all details is outlined within the contract. This also sets definite standards between contracts between different parties, to avoid favoritism.
- Procedure Setting. A written contract can outline the definite procedure to follow, especially for cases of complains of substandard work. The employer provides a clear course of action and the professional nurse has protection against arbitrary action. A nurse’s accountability for a negative outcome is reduced if such actions that resulted to the outcome has been outlined within a contract.
- Commitments are defined in a written contract, such as hours of work, salary, time of validity, days off duty, and reprimands in the case of unfulfillment of the terms of the contract.
Breach of Contract
A breach of contract occurs when there is a failure to perform the obligations set within an agreement, whether expressed or implied, without cause. The following are what constitute breaches of contract in nursing services:
- Prevention of performance
- Failure to perform because of inconvenience or difficulty; failure of cooperation in performance;
- Abandonment of duty (e.g., leaving unconscious patients, going off-duty without endorsement, loafing while on-duty)
- Substitution of Performance
- Failure to use due care
However, there are instances where refusing, neglecting, or failing to perform a contract is legally excused:
- Discovery of material misrepresentation made and relied upon;
- Where performance would be illegal, impossible (e.g. by reason of illness, death of patient or nurse, etc.), and where the contract is insufficient (lacking one or more elements to make it valid).
Wills
A will is a legal declaration of a person’s intentions upon death. It is called a testamentary document, as it occurs after the death of its maker. It is an act where a person is permitted by the law to control the deposition of their estate to take effect after death.
- Holographic Will: a will that is written, dated, and signed by the hand of the testator themself. In this type of will, at least one witness who knows the handwriting and signature of the testator explicitly declares that the will and the signature are in the handwriting of the testator.
- Oral Wills, Nuncupative Wills, Deathbed Wills: wills not put into writing, usually made in the presence of witnesses. The testator will say out loud to someone else how they wish for their property and assets to be distributed after their death.
- At least two witnesses are required for a nuncupative will.
- The following restrictions apply: the transcription of an oral will into writing is done at the time of their last illness at the place in which they died, within a given number of days and that it be offered to probate (the legal process of validation and administration of wills) within a specified time.
The creation of a will follows several legal requirements:
- The testator must have the expressed intention of making a will, be of the right age (18+) and of sound mind, and be free from undue influence.
- The testator shall name the person in charge of carrying out the provisions of the will.
- Properties, if disposed, should follow their respective legal requirements.
- The will must be signed by the testator, and attested and signed by at least three witnesses in his presence and of one another. Every witness shall be of sound mind, 18 years of age or more, not blind, deaf or dumb, and able to read and write.
- Every will must be acknowledged before a notary public by the testator and witnesses.
- A married woman may make a will without the consent of her husband and without the authority of the court.
Nursing Obligations in a Will
A nurse verifies the client as being of age, of sound of mind and free from fraud or undue influence. The nurse notes that the will was signed by the testator, and that all witnesses were present simultaneously and signed the will in the presence of the testator.
Gifts
Gifts are a form of property disposal besides the creation of a will. These consist of personal property, with the indication of the transfer of control over such property, and with the acceptance of the recipient. These gifts, when made in the anticipation of death, are called Gifts Causa Morta or Donation Causa Mortis.
Legal Procedure and Trial
The following is a summary of legal procedures a nurse may become involved in. A trial works to ascertain facts by hearing relevant evidence, applying the appropriate principle of law, and passing judgment:
- Commencement of the Action: the first step to take is to determine the type of legal action to take, such as negligence for negligence, and breach of contract for a failure to fulfill contractual obligations.
- Statutes of Limitation: complaints must be made within a specific time or the right to complain may be lost forever. There is a time limit in filing cases because witnesses become less reliable after the passage of time. In claims for negligence or malpractice, the limit may vary from 2 to 3 years. In criminal cases, the limit may vary from 2 to 6 years, except in the case of murder, in which there is no time limit.
- Pleading: also known as indictments, each party produces statements of facts, or “pleads” to the court. The First Pleading is generally known as the complaint or petition. In less serious crimes, these are misdemeanors. In more serious crimes, they are felonies.
- Pre-Trial Procedures: an informal discussion between the judge and attorneys to eliminate matters not in dispute, agree on issues, and settle procedural matters relating to the trial. Cases often become settled at this point without reaching trial.
- Trial: the facts of the case are determined, the principles of law are applied, and a conclusion as to liability is reached, as determined by the judge.
- Witnesses: the necessity of testimony by a person in a legal proceeding as determined by the attorneys for the parties involved.
- Subpoena: a court summons, directing a witness to appear and give testimony on the date and time ordered.
- Subpoena duces tecum: a subpoena requiring the addition of records, papers, and the like which may be in their possession and will be pertinent to the issue.
- Testimony of opinion: the opinion of expert witnesses qualified to testify based on special knowledge, skill, experience, and training.
- Ante-mortem statements or dying declarations are considered hearsay, except when stated by a victim of a crime.
- Appeals: if an appeal against a complaint is desired, an appellate court reviews the case and forms a final judgement, and the matter is ended.
- Execution of Judgement: generally, lawsuits against hospitals or healthcare workers involve monetary reimbursement for damages. The defendant is compelled to execute the judgement, or is held in contempt of court if they are not to comply. In such a case, a fine or imprisonment may be imposed.
Telephone Orders
Telephone orders are only to be used in extreme emergency when there is no alternative. The use of telephones for orders can lead to serious errors and border on malpractice. Confirmation and double-checking if a received order is correct is done and written on the patient’s chart, with the nurse’s signature and the physician’s name to be countersigned by the physician at the next visit within 24 hours.
Consent in Health Care
Consent is defined as a free and rational act that presupposes knowledge of the thing to which consent is being given by a person who is legally capable of giving consent. Specifically, informed consent is an established principle of law that every human being of adult years and sound mind has the right to determine what shall be done with their own body (Haytand). The consent signed by the patient or his authorized representative/legal guardian upon admission is for the diagnosis and treatment. There are six essential elements in a valid consent:
- The diagnosis and explanation of the condition.
- A fair explanation of the procedures to be done and used, benefits and their potential and foreseeable consequences.
- A description of alternative treatments or procedures.
- Material rights (rights received from signing the consent), if any.
- Prognosis if ever the procedure is refused.
Consent as Proof
Consent is a written proof of the procedure that one consented to a procedure, signifying their understanding of the procedure, its benefits, risks, and possible consequences.
Ordinarily, the patient is the one to give consent on their own behalf. however, if the patient is incompetent (not of age, mentally ill) or physically unable, and there is no emergency, consent must be taken from another who is authorized to give it in his behalf.
- Minors: consent is obtained from parents or someone standing in their (the parents’) behalf. Not necessary in cases of emancipated or married minors.
- Mentally Ill: consent is obtained from parents or legal guardians.
- Emergency Situations: no consent may be obtainable in some emergencies. In these cases, no consent is necessary. The healthcare providers provide life-saving treatment as necessary.
- Refusal: a competent individual who refuses a procedure must sign a waiver of refusal against medical advice (AMA).
- Consent for Sterilization requires both the husband and wife’s permission.
Criminal Liabilities and Legal Responsibilities
Once nurses begin their practice, they become liable for their assumed authority, responsibility, and accountability in professional practice. They can be subject to scrutiny by the law and the board of nursing to ensure public welfare. Additionally, nurses can serve as expert witnesses for both plaintiffs and practitioner in a medicolegal case. For these reasons, it is necessary for professional nurses to obtain a basic understanding of the legal aspects of nursing.
A standard is the level of performance or quality against which actual practice is compared. It is the benchmark against which care is planned and implemented. Failure to deliver care up to standards can take various forms:
- Torts: intentional wrongdoing; a legal wrong that a nurse may be held accountable for in civil action. Some common examples of torts include:
- Assault: imminent threat of a harmful or offensive bodily contact, even if only verbal.
- Battery: intentional, unconsented touching of another person.
- False Imprisonment or Illegal Detection: unjustifiable detention of a person without a legal warrant or medical reason.
- Invasion of Right to Privacy and Breach of Confidentiality: the right to be left alone, free of unwanted publicity and exposure. Specifically, privacy refers to the person or identity, while confidentiality refers to data or information about an individual.
- Defamation: “character assassination”, be it written or spoken. Specifically, slander is oral defamation, and libel is written defamation.
- Negligence: the failure to fulfill (omission) a part of one’s due responsibilities in a situation where a reasonable prudent person would be able to fulfill, which results in an injury to another person or their property.
- Malpractice: the improper or unskillful care of a patient, or stepping beyond one’s authority with serious consequences.
- Incompetence: a lack of ability or legal qualification to be fit to discharge required duties. This is a ground for revocation and suspension of the certificate of registration. The nature of crime is further discussed later in this page.
Nurses, nurse trainees, and nurse volunteers are expected to be accountable for their practice, and should exercise utmost caution, critical thinking, and independent judgement to prevent incurring liabilities. Nursing aides must be supervised and limited in scope of responsibility as delegated by the nurse.
Nursing students are not permitted to perform professional nursing duties. They must be supervised, and are only given assignments at their level of training experience and competency. Guidance, orientation, and assessment is required to minimize errors.
Negligence
The failure to fulfill (omission) a part of one’s due responsibilities in a situation where a reasonable prudent person would be able to fulfill, which results in an injury to another person or their property. In a case of negligence, the actions of the person being charged is compared with set standards for care to determine whether or not negligence was present.
- Professional negligence must involve the existence of a duty, failure to meet the standard of due care, the foreseeable nature of the harm done, and injury to the plaintiff.
Legal Bases
- Civil Code, Article 19: one shall act with justice, give every man his due, observe honesty and good faith.
- Civil Code, Article 20: those who, in the performance of their obligations through negligence cause any injury to another, are liable for damages.
Negligence requires three conditions before being charged against a practitioner:
- The injury was of such nature that it would not normally occur unless negligence was present.
- The injury was caused by an agency within control of the practitioner.
- The plaintiff themself did not engage in any manner that would tend to bring about the injury (this would be a different charge).
One may defend themselves from negligence through proper documentation of care that attains the standard of care, and if the patient is a causative factor in their injury.
Doctrines in Legal Proceedings
- Doctrine of Res Ipsa Loquitur: meaning “the thing speaks for itself”, it is an action that implicitly details its consequence; no further proof is required. For example, an incident where forceps are left within the abdominal cavity after a surgical procedure speaks for itself. The forceps would not have gotten there without negligence.
- Doctrine of Force Majeure: a “superior force” that is unforeseen or inevitable. No person is responsible for these events. For example, floods, fires, earthquakes, and accidents fall under this doctrine; nurses who fail to render service during these periods are not considered negligent.
- Doctrine of Respondeat Superior: “the master must answer”. It is a doctrine dictating that the employer is responsible for the actions of their employee during their employment. For example, the hospital will be held liable if, in an effort to reduce costs, the hospital hires underboard nurses (those who have not passed the board exam) resulting in negligence from incompetence.
Other Bases for Legal Responsibilities
- The Ethical Principle of Advocacy is to participate in helping others grow and self-actualize by informing them of their rights and ascertaining that they have the right information on which to base their decisions.
- R.A. 6675, the Generics Act of 1988 specifies the requirements for valid prescriptions:
- Drugs must be written with their generic names, then brand name, or just the generic name, but never brand name alone.
- Orders are legal if they are in writing and bears the doctor’s signature. Valid orders impose a legal obligation for the nurse to follow them.
- Nurses must withhold an order if they are reasonably certain it will result in harm to the patient. In such a case, clarification with the prescribing physician is required.
- R.A. 5921, the Philippine Pharmacy Act issues provisions for pharmaceutical products, such as in pharmacist education and qualification, pharmaceutical practice, etc. Most importantly, it outlines the necessitated contents of a prescription:
- Name of the prescriber, date of prescription, their office address, professional registration number, and professional tax receipt number.
- Patient’s name, age, and sex
- Philippine Nursing Act of 1991, Section 28: IV injections require special training according to protocol established; the administration of IV injections without special training may be held liable, criminally and/or administratively. The scope of nursing duties in IV therapy include:
- Interpreting the doctor’s orders for IV therapy.
- Performance of venipuncture, insertion of needles, and cannulas except for TPN and cut down procedures.
- Preparation, administration, monitoring, and termination of intravenous solutions such as additives, intravenous medications, and intravenous push.
- Administration of blood or blood products as ordered.
- Recognition of solution and medicine incompatibilities.
- Maintenance and replacement of sites, tubing, and dressings in accordance with procedure.
- Establishment of the flowrate of solutions, medicines, blood and blood components.
- Utilization of competency in the use, care, maintenance, and evaluation of intravenous equipment.
- Nursing management of TPN and outpatient intravenous care.
- Maintenance of established infection control and aseptic nursing interventions.
- Maintenance of appropriate documentation.
- Medical Records are expected to contain full, accurate, legible, and prompt observations by nurses from the time of admission to discharge. A core principle for medical records is privacy and confidentiality.
- In times necessary, medical records can serve as legal protection for the practitioner by reflecting the disease or condition of the patient and the applied management. A common saying goes: “If it was not charted, it was not done.”
Criminal Liability
Criminal Liability is incurred if a nurse commits a felony or performs an act which would be an offense against person or property. Ignorance of the law is not an excuse for failure to comply therewith.
Crime is an act committed or omitted in violation of the law, consisting of (a) the criminal act itself and (b) evil or criminal intent. A conspiracy to commit a crime occurs when two or more persons agree to commit a crime and decide to do it. These people can be classified as:
- Principal: the “mastermind”; a member directly partaking in the crime and inducing or forcing others to aid in committing the crime.
- Accomplices: those who cooperate and are directly involved in the crime with knowledge of the malicious intentions of the act.
- Accessories: those taking part in the subsequent outcomes of the crime, e.g., profiting from stolen goods or assisting the offenders in profiting from the effects of the crime.
The Criminal Act can also be classified according to their nature and severity. Generally, there are:
- Misdemeanors: criminal offenses which do not, in law, amount to a felony. Punishment often results in fines or imprisonment in terms of less than one year.
- Felonies: a public offense for which a convicted person is liable to be sentenced to death or to be imprisoned in a penitentiary or prison. These involve deceit (deliberate intent) and fault (wrongful acts).
- Grave Felonies: those felonies to which the law attaches capital punishment (death) or penalties which in any of their periods are afflictive of imprisonment ranging from 6 years and 1 day to life imprisonment or a fine exceeding ₱6,000.00.
- Less Grave Felonies: those felonies to which the law attaches penalties of imprisonment with a maximum period of 1 month and 1 day to 6 years, or a fine not exceeding ₱6,000.00.
- Light Felonies: those infractions of law for the commission of which the penalty of arresto menor (one day to thirty days) or a fine not exceeding ₱200.00. Furthermore, these felonies are only punishable only when they have been consummated, with the exception of those felonies committed against a person or property.
- Reckless Imprudence: a type of criminal negligence where the material damage immediately results from the commission or omission of an act by the person.
- Simple Imprudence: a type of criminal negligence where the material damage is not immediately manifested or evident after the failure of a person to exercise caution and diligence in carrying out care.
The criminal act may also be classified based on the degree of execution:
- Consummated: all the necessary elements for execution and accomplishment are present.
- Frustrated: all acts to produce the felony has been performed, yet the intended result did not come about due to reasons independent of the will of the perpetrator.
- Attempted: the offender commences the criminal act, but due to unforeseen circumstances there was no complete execution to produce the desired felony.
Criminal Intent is the state of mind of a person at the time of the criminal act. It involves both freedom and intelligence, without which the act would not be a crime. In the evidence of insanity, necessity, compulsion, accident, or infancy (minors), the court decides guilt of the criminal offense.
There are, however, circumstances which can increase, reduce or completely exempt an individual from criminal liability. These are:
| Circumstances | Examples |
|---|---|
| Justifying Circumstances | Self-defense, defense for relatives, defense for strangers, defense from foreseeable threat, or the fulfillment of a duty or lawful exercise of right or office (e.g., a police officer shooting an armed drug addict |
| Exempting Circumstances | Imbeciles, insane persons (except when lucid), minors (<9), minors (>9, <15) acting without discernment, accidents, force majeure, acting from fear, or those prevented by some lawful or insuperable cau |
| Mitigating Circumstances | These do not remove liability, but rather lessens it. When the severity of wrongdoing was unforeseeable, but the initial action was intentional; <18 and >70 years of age; with sufficient threat or provocation from the offended party; in defense of relatives; if surrendered voluntarily; if with social impairment (deaf, dumb, blind, etc.) or illness that diminishes the exercise of willpower. |
| Aggravating Circumstances | These increase liability. Taking advantage of public positions, crimes committed in places of worship, crimes with evident premeditation or after an unlawful entry, crimes of abuse or confidence or obvious ungratefulness, crimes incentivized by a reward, crime committed during calamities or misfortune (theft during an epidemic), crimes involving misrepresentation (craft, fraud, disguise), and crimes supplemented by other wrongs not necessary for its commission. |
| Alternative Circumstances | Those circumstances which can be mitigating or aggravating depending on the case scenario. For example, intoxication can be mitigating if the crime was done while intoxicated; habitual intoxication, however, can be an aggravating circumstance. |
Other Crimes in Healthcare
- Moral Turpitude: act of baseness, vileness, or depravity in social or public duties, contrary to accepted and customary rights and duties between individuals.
- Murder: the unlawful killing of a human being with the intent to kill, such as in euthanasia and abortion.
- Homicide: the unlawful killing of a human being by another, given the victim is a person other than their father, mother, child, ascendants, descendants, or spouse.
- Abortion: the expulsion of products of conception before the age of viability. Procuring abortion is the charge against any individual who knowingly aids in this process.
- Infanticide: killing of a child less than three days of age. Imprisonment ranges from 2 years 4 months and 1 day, to 6 years.
- Parricide: the homicide or murder of family members whether legitimate or illegitimate. Imprisonment is for life (reclusión perpetua) to death.
- Simulation of Birth: one who enters in a birth certificate a birth that did not occur. This is a crime against the civil status of a person.
- Substitution of One Child for Another: substituting, concealing, or abandoning any legitimate child. Punishable by birth, prison mayor, and a fine not exceeding ₱1,000.00.
Avoiding Criminal Liability
(Just directly copied this one, it’s a good list.)
- Be very familiar with the Philippine nursing law.
- Beware of laws that affecting nursing practice.
- At the start of employment, get a copy of your job description, the agency’s rules, regulations and policies.
- Upgrade your skills and competence
- Accept only such responsibility that is within the scope of your employment and your job description.
- Do not delegate your responsibilities to others.
- Determine whether your subordinates are competent in the work you are assigning them.
- Develop good interpersonal relationships with your co-workers, whether they be your supervisors, peers or subordinates.
- Consult your superior for problems that may be too big for you to handle.
- Verify orders that are not clear to you or those that seem to be erroneous.
- The doctors should be informed about the patient’s conditions.
- Keep in mind the values and necessity of keeping accurate and adequate records.
- Patients are entitled to an informed consent.