Institute of Nursing

A.Y 2020 – 2021 1st Semester

Concept: Nursing Jurisprudence

(Part 2)

I. LEGAL LIABILITIES IN NURSING

a. Elements of legal liabilities

M: alpractice
 It occurs when a nurse fails to competently perform his or her medical duties
and that failure harms the patient. There are a variety of ways that a nurse
can harm a patient -- from administering the wrong drug to failing to notify a
doctor when something is really wrong.
 It is the idea of improper or unskillful care of a patient by a nurse.
 Failure to meet the standard of care which resulted to harm.
I: ncompetence
 It is the lack of ability, legal qualifications or fitness to discharge the required
duty.
 It means the display of lack of knowledge, skill or judgment in the
respondent's care of a client or delivery of nursing services that, having
regard to all the circumstances, rendered the respondent unsafe to practice
at the time of such care of the client or delivery of nursing services or that
renders the respondent unsafe to continue in practice without remedial
assistance.
N: egligence
 Carelessness; failure to act as an ordinary prudent person, or action contrary
to what a reasonable person would have done.
 It can be defined as a failure to take reasonable care or steps to prevent loss
or injury to another person. Nursing negligence is when a nurse who is fully
capable of caring does not care in the way a reasonably prudent nurse would,
and as a result the patient suffers unnecessarily.
D: eceit
 It is any act, declaration or practice which misleads a person or which causes
him to believe what is false.
F: raud
  It is a wrong doing or misconduct, an act resulting from a willful act to
deceive; deceitful practice, rules of common honesty.

b. Negligence

1. Elements of Professional Negligence

O: n duty
F: ailure to meet the standards of due care
F: oreseeability of harm

2. Doctrines of Professional Negligence

C: aptain of the Ship Doctrine
 It is a legal doctrine which holds that, during an operation in an operating
room, a surgeon of record is liable for all actions conducted in the course
of the operation.
 The leader of the team is responsible for the act of his members.
 Applicable in the Operating Room.
D: octrine of Respondeat Superior
 “Let the master answer for the acts of the subordinate.”
 An employer will be liable for an employee’s negligent actions or
omissions that occur during the course and scope of the employee’s
employment.
 This means that the employee must be performing duties for the
employer at the time of the negligence for the employer to be held liable
under respondeat superior.
D: octrine of Corporate Liabilities
 The liability of the hospital in cases of defective equipment/facilities w/c
caused harm/injury to a patient.
 It determines the extent to which a corporation as a legal person can be
liable for the acts and omissions of the natural persons it employs.
D: octrine of Force Majeure
 It means an irresistible force, one that is unforeseen or inevitable.
 No person shall be responsible for those events which cannot be foreseen
and are inevitable, such as floods, fire earthquakes, and accidents.
However habitual tardiness due to heavy traffic is not considered an
excuse for force majeure.
R: es Ipsa Loquitor
 Three conditions are required to establish a defendant’s negligence
without proving specific conduct.
 It is presumed to be negligent if he/she/it had exclusive control of
whatever caused the injury even though there is no specific evidence of
an act of negligence, and without negligence the accident would not have
happened.

c. Tort
1. Definition
Tort
 It is a legal wrong, committed against a person or property independent of a
contract which renders the person who commits it liable for damages in a
civil action.
 It is an act or omission that gives rise to injury or harm to another and
amounts to a civil wrong for which courts impose liability.

2. Types of Tort
B: attery
 It is an intentional, unconsented touching of another person.
 It is an intentional and wrongful physical contact with another person
without that person's consent that includes some injury or offensive
touching.
A: ssault
 It is the imminent threat of harmful or offensive bodily contact.
 It includes physical or verbal intimidation. A gesture that the client may
perceive as a threat is an assault if the client believes that force or injury
may follow. Telling the client that you are going to restrain him in bed if
he tries to get out of bed without assistance is an assault.
D: efamation
 It is a false and unprivileged statement of fact that is harmful to
someone's reputation, and published "with fault," meaning as a result of
negligence or malice.
 Types:
1. Slander
 It is oral defamation of a person by speaking unprivileged or false
words by which his reputation is damaged.
2. Libel
 It is defamation by written words, cartoons or such
representations that cause a person to be avoided, ridiculed or
held in contempt or tend to injure him in his work.

F: alse Imprisonment or Illegal Detention

 It is the unjustifiable detention of a person without a legal warrant within
boundaries fixed by the defendant by an act or violation of duty intended
to result in such confinement.
I: nvasion of Right to Privacy
 The right to be left alone, to be free from unwarranted publicity and
exposure to public view
 It is a tort based in common law allowing an aggrieved party to bring a
lawsuit against an individual who unlawfully intrudes into his or her
private affairs, discloses his or her private information, publicizes him or
her in a false light, or appropriates his or her name for personal gain.
B: reach of Confidentiality
  The right not to divulge information from a patient’s chart to improper
sources or unauthorized persons.
 It occurs when data or information provided in confidence to you by a
client is disclosed to a third party without your client's consent.

II. ADVANCE DIRECTIVES

a. Definition

Advance Directives
 It is a written statement of a person’s wishes regarding medical treatment, often
including a living will, made to ensure those wishes are carried out should the
person be unable to communicate them to a doctor.
 It is a document by which a person makes provision for health care decisions in
the event that, in the future, he/she becomes unable to make those decisions.
 These are decisions that can be written down prior to medical treatment, so the
family can carry out a person's wishes for health care if this person is unable to
communicate them.

b. Philippine Setting

 Senate Bill No. 3195 – known as “Advance Directives Education Act” by Miriam
Defensor-Santiago
 Senate Bill No. 812 – known as “Magna Carta of Patient’s Rights and Obligations”
by Bong Revilla Jr.

c. Types of Advance Directives

1. Living Will
 It is the oldest type of health care advance directive.
 It delineates the patients’ specific wishes.
 It is a document that provides direction to your loved ones, family members
and physicians regarding your preferences for end-of-life care should you
become incapacitated, though it does not appoint anyone to make your
health care decisions.
 It can specifically address medical possibilities such as whether you want
artificial respiration, nutrition or hydration withheld, as well as what types of
pain medications to allow and whether you prefer to live your last days at
home or in the hospital. If you become incapacitated, your physicians and
loved ones will look to your living will for guidance.
 This written document sets out how a person should be cared for in an
emergency or if the person is otherwise incapacitated.
 A person’s living will sets forth their wishes on topics such as resuscitation,
desired quality of life and end of life treatments including treatments they
don't want to receive.
  This document is primarily between the patient and their doctors, and it
advises them how to approach their treatment.

2. Durable Power of Attorney for Healthcare

 It allows someone else -- an agent -- to make health care decisions for the
patient. The patient’s health care agent must act consistently with his/her
wishes, if the agent knows what the patient’s wishes are. If not, the agent
must act in the patient’s best interests.
 It remains valid even if the patient becomes incapacitated.
 It is given to the person whom the patient wants to make medical decisions
for them in an emergency. Even though the patient sets out his/her wishes in
his/her living will, such documents can never cover every circumstance, and
the person who has a durable power of attorney for healthcare can make
decisions not covered by the patient’s living will.
 Keep in mind that the person with a durable power of attorney for healthcare
can never contradict the terms of the patient’s living will. Rather, that person
is there to fill in gaps, for situations not covered by the patient’s living will, or
in case the patient’s living will is invalidated for any reason.
 Depending on the patient’s state, the person on whom the patient grants a
durable power of attorney for healthcare will typically be called as "agent,"
"proxy," "attorney-in-fact", "patient advocate" or "surrogate". The typical
rights for this person includes:
 Providing medical decisions that aren't covered in the patient’s
healthcare declaration
 Enforcing the patient’s healthcare wishes in court if necessary
 Hiring and firing doctors and medical workers seeing to the patient’s
treatment
 Having access to medical records
 Having visitation rights
 It is a document in which the patient name someone he/she trust (a family
member or a close friend) to make health care decisions for his/her behalf if
the patient is ever permanently or temporarily unable to make such
decisions for him/herself.

d. Criteria for Advance Directives

1. It must be in writing. Advance Directives can be written by the patient or by

someone else, and it also be can be written in the patient’s healthcare notes.
2. It must be signed by the patient or by someone else who is described as acting
on the patient’s behalf and who signed in the patient’s presence.
3. It must also be witnessed by someone who is present when the patient make
his/her signature or when a signature is made on the patient’s behalf.
4. It must detail the exact treatment the patient wants to refuse. It is not enough to
just generally say that the patient do not want to be treated.
 5. It must detail the situations where refusing treatment should apply. A clear
statement that the decision to refuse a specific treatment applies even if the
patient’s life is at risk.

e. Inclusions of written Advance Directives

1. The patient’s personal details, including his/her name, date of birth, home
address and anything that helps to identify the patient. This is because
healthcare professionals might need to identify the patient if he/she is not able
to wake up.
2. The name and address of attending physician and whether they have a copy of
the patient’s Advance Directive. Talk to the patient’s attending physician to make
sure it says in the patient’s medical notes that he/she has written an Advance
Directive.
3. A statement that says the document should be used if the patient is unable to
make decisions about his/her treatment.
4. The date the document was written or the date it was reviewed or updated.

f. Validity of Advance Directives

 To decide it is legal and applicable, the doctors or healthcare professionals must

try to find out if the person:
1. Has cancelled or 'revoked' their Advance Directives.
2. Has done anything that goes against their Advance Directives. For example, if
they have clearly said they would like to have a specific treatment that is
listed for refusal in their Advance Directive.
3. Has withdrawn the Advance Directive by preparing and registering a Lasting
Power of Attorney (LPA) for Health and Welfare.
 Once an Advance Decision is validly made, it remains legal unless the patients
decide to change some or all of it, or 'revoke' (meaning cancel) it.
 To make sure that the patient’s Advance Directive is up to date and valid, the
patient should review his/her decisions regularly. For example, every 3 to 5
years if the patient’s condition is relatively stable.

g. Termination of Advance Directives

 Living wills are only applicable during the patient’s life. The document
terminates at death because it can only address issues that occur during a
patient’s life, similar to durable powers of attorney for health care. Durable
powers of attorney designate a health care agent to make medical decisions on
the patient’s behalf and are often created to work together with the patient’s
living will. Because no medical decisions are left to be made once the patient
dies, neither document serves any purpose after death.

Note:
Last Will and Testament
  It is a completely different document than a living will, but the two are often
confused. A last will takes effect only after a person dies and directs
distribution of the deceased person’s estate rather than his medical care
during his life. A will can also nominate a guardian for the deceased person’s
children and a person to manage his estate prior to distribution, called an
executor or personal representative.

III. CRIMES

a. Definition of terms:

1. Crimes
 It is an act committed or omitted in violation of the law.
 An action or omission that constitutes an offense that may be prosecuted
by the state and is punishable by law.

2. Plaintiff
 Complainant, litigant, accuser
 The person who is accusing someone of violating the law.
 Someone who makes a legal complaint against someone else in court.
3. Defendant
 Perpetrator, offender
 The person who is accused of violating the law.
 An individual, company, or institution sued or accused in a court of law.
4. Witness
 The person who have the knowledge, idea, approval or participation in
the violation of the law.
 A person who sees an event, typically a crime or accident, take place.

b. Court Orders

1. Subpoena
 A legal order issued by the court to ask the witness to present evidences or
give testimonies that can be used in solving an issue.
1.1 Ad Testificandum
 The witness is required to appear in the court to give his testimonies
or statements that may help clarify the issue.
1.2 Duces Tecum
 The witness is required to bring records, papers or documents under
his possession which may help clarify the issue.
2. Summon
 A legal order issued by the court to inform the defendant that a case is
being filed against him/her.
3. Writ
  A legal order issued by the court asking someone or a party to do or cease
doing something.

c. Elements of a Crime

1. Criminal Intent
 It is the state of mind of a person at the time the criminal act is committed
that is, he/she knows that an act is not lawful and still decided to do it
anyway.
 To be criminal, an act must be defined as a crime.

2. Criminal Action
 It deals with acts or offenses against public welfare.
 An action instituted by the government to punish offenses against the public.

d. Criminal Action

1. Types of Criminal Action

a. Misdemeanor
 It is a general name for a criminal offense which does not in law amount
to felony.
 Punishment is usually a fine or imprisonment for a term of less than one
year.
b. Felony
 It is a public offense for which a convicted person is liable to be sentenced
to death or to be imprisoned in a penitentiary or prison.
 It is committed with deceit and fault.

2. Felony
2.1 Types of Felony
a. Acts of Execution
1. Consummated
 It is when all the elements necessary for its execution and
accomplishment are present.
2. Frustrated
 It is when the offender performs all the acts or execution but do
not produce felony by reason of causes independent of the will of
the perpetrator.
3. Attempt
 It is when the offender commences the commission of the same
directly by overt (open or manifest) acts, and does not perform all
the acts or execution which shall produce the felony.
b. Degree of Punishment

FELONY IMPRISONMENT FINE

Grave Felonies 6 years and 1 day to life Not exceeding P6, 000.00.
imprisonment
Less Grave One month and one day to six Not exceeding P6, 000.00 but not less
Felonies years than P 200.00.
Light Felonies 1 day to 30 days Not exceeding P200.00

3. Conspiracy in Crime
 Exists when 2 or more persons agree to commit a felony and
decide to do it.
a. Principals
 Types:
1. Principal by Direct Participation
 This refers to those who actually and directly take part in the execution of the act.
 This requires that the principal by direct participation must be at the crime scene.
1.1 Unity of Intention. The person participated, agreed, or
concurred in the criminal design, intent or purposes or
resolution.
1.2 Unity of Action. All participated in the execution or carrying
out of the common intent, design, purpose or objective by
acts intended to bring about the common objective.
1.3 Participation in both ( Intention and Action)
2. Principal by Indespensable Cooperation
 It refers to those who cooperate in the commission of the
offense by another act without which it would not have been
accomplished.
 There must be a community of design or common purpose
between the PIC and the PDP, but not a conspiracy.
 The PIC knows or is aware of the intention or purpose of the
PDP and he cooperates or concurs in its realization by
performing an act without which the offense would not have
been accomplished.
3. Principal by Inducement
 Those who induce (PDP) to commit a crime either by: (a) force (b). inducement
3.1 By the giving of a price, promise or reward. This must be
made with the intention of procuring the commission of the
crime and not as an expression of appreciation. The same
must be the sole reason for the commission of the crime
3.2 By giving Words of Command.
3.3 By the use of Inciting Words. These are words uttered
while a crime is going on by one who is present and are
directed to a participant in the crime, such as the words “
sige pa, kick him, kill him, bugbugin mo”.

b. Accomplices
  They are those person who cooperate in the execution of the offense
by previous or simultaneous act; accessory before the fact.

c. Accessories
 They are those who take part subsequent to its commission by
profiting themselves or assisting the offender to profit from the effects
of the crime by concealing or destroying the body of the crime;
accessory after the crime.

4. Criminal Circumstances
J: ustifying Circumstances
 Free from criminal and civil liability
 Self – defense:
 Unlawful aggression
 Reasonable necessity of the action
 Means employed prevent/repel it
 Lack of sufficient provocation
 On the person defending himself
 Defense of relatives - up to 4th degree by consanguinity; that in the
case of provocation was given by the attacked, that the one making
defense had no part therein.
 Defense of a stranger - defending not induced by resentment, revenge
or other evil motive
 Who acts in fulfillment of a duty or in a lawful exercise of a right or
office
 Who acts in obedience to an order by a superior for some lawful
purpose

E: xempting Circumstances
 No criminal liability only civil liability
 Mistake of fact - (ignorantia facti excusat) must be committed in good
faith or under an honest belief
 An insane or imbecile unless acted during lucid interval
 Under 9 years of age
 Over 9 under 15, unless acted with discernment
 While performing a lawful act with due care causes an injury by mere
accident without fault or intention of doing it
 Who acted under the compulsion of an irresistible force from a third
person
 Impulse of uncontrollable fear of an equal or greater injury
 Insuperable or lawful cause

M: itigating Circumstances
 Decreasing the moral culpability of the offender
 Under 18 or over 70
 No intention to commit so grave a wrong
  Sufficient provocation or threat on the part of the offended party
immediately preceded the act
 Voluntary surrender
 Deaf, dumb or blind or suffering from physical defect
 Such illness that would diminish the exercise of his will power
 Committed in the immediate vindication of a grave offense to the one
committing the felony, his/her spouse, ascendants, descendants,
legitimate, natural or adopted brothers or sisters, relative by affinity
within the same degree
 Acted upon an impulse so powerful as naturally to have produced an
obfuscation

A: ggravating Circumstances
 Increasing the moral liability of the offender
 Advantage of public position
 In contempt or insult to public authorities
 Crime committed in the place of worship
 Abuse of confidence or obvious ungratefulness
 Committed on occasion of epidemic, conflagration, shipwreck or other
calamity or misfortune
 In consideration of a price or reward or promise
 Committed by means of fire, explosion, stranded of a vessel
 With evident premeditation
 Craft, fraud or disguise

5. Crimes involving Nurses

5.1 Parricide
 It is a crime committed by one who kills his/her father, mother, or child
whether legitimate or illegitimate, or any of his/her ascendants or
descendants or his/her spouse.
5.2 Murder
 It is the unlawful killing of a human being with intent to kill.
5.3 Homicide
 It is the killing of a human being by another.
5.4 Infanticide
 It is the killing of a child less than three (3) days of age.
1.5. Abortion
 It is the expulsion of the product of conception before the age of viability.
5.5 Giving assistance to suicide
 It is helping a person to take their own lives.
5.6 Illegal Detention
 It is unlawful taking of a person or property as in the case of forcible
entry or detention.
5.7 Simulation of birth, substitution of one child for another, or abandonment of a
legitimate child
IV. OTHER LAWS RELATED TO THE NURSING PROFESSION

a. Republic Acts (R.A)

RA 7164: Philippine Nursing Act of 1991

RA 9173: Philippine Nursing Act of 2002
RA No. 8981: PRC Modernization Act of 2000
RA 8344: “No Deposit Policy” during Emergency cases.
RA 6675: Generics Act of 1988
RA 7877: Anti-Sexual Harassment Act
RA 1080: Civil Service Eligibility
RA 6425 (9165): Dangerous Drugs Act
RA 7600: Mother Baby Friendly Hospital Act
RA 4226: Hospital Licensure Act
RA 3573: Reporting of Communicable Disease
RA 7170: Organ Donation Act
RA 9994 (7432): Expanded Senior Citizens Act of 2003
RA 953: Narcotic Drug Act
RA 2644: Philippine Midwifery Act
RA 8423: Traditional and Alternative Medicine Act of 1997
RA 7719: National Blood Service Act of 1994
RA 2328: Philippine Medical Act
RA 1612: Privilege Tax Law – professional tax payment
RA 5181: Permanent residence and Reciprocity
RA 1082: Rural Health Units all over the Philippines
RA 4073: Liberalizes Leprosy Treatment
RA 1054: Free Emergency Medical Treatments to Employees and
Laborers
RA 5901: 40 hours/week for nurses in with 100-bed capacity
RA6111: Medicare Act
RA 6713: Code of Conduct and Ethical Standards for Public
Officials/Employees
RA 6758: Salary Standardization Law
RA 7305: Magna Carta for Public Health Workers
RA 7277: Magna Carta of Disabled Persons
RA 7624: Drug Education Law
RA 6972: Day Care Center for every barangay
RA 7160: Local Autonomy Code
RA 349: Legalized Use of Human Organs for Scientific Purposes
RA 6809: Amended Article 34 of Family Code, 18 years is majority age
RA 10069: Health worker’s Day
RA 8504: Philippine AIDS Prevention and Control Act of 1998
RA 9262: Domestic Violence Act
RA 76875: National Health Insurance Act of 1995

b. Presidential Decrees (P.D)

 PD 651: Birth Registration Act
PD 223: Professional Regulation Commission
P.D. 856: Sanitation Code
P.D. 996: Expanded Program for Immunization
P.D. 965: Family Planning and Responsible Parenthood
PD 603: Child and Youth Welfare
PD 541: Practice of profession in the Philippines by former
professionals
PD 491: Nutrition Program Law
PD 825: Penalty for Improper Garbage Disposal
PD 143: Woman and Child Labor Law (no child below 14 shall be employed)
PD 442: New Labor Code of the Philippines
PD 851: 13th Month Pay

c. Executive Orders (E.O)

E.O 51: Milk Code

EO 209: Family Code
EO 180: Government worker’s CBA
EO 857: Compulsory Dollar Remittance Law
EO 174: National Drug Policy (availability, affordability or safe,
effective, quality drugs)

d. Board of Nursing Resolutions

BON Res. No. 633 s. of 1984: International Council for Nurses (ICN) Code of
Ethics
BON Res. No. 1955 s. 1989: PNA Code of Ethics
BON Res. No. 1930 s. 1985: CPE for Nurses
BON Res. No. 187 s. 1991: Renewal of Professional license
BON Res. No. 217 s. 1992: Delisting of Delinquent Professionals
BON Res. No. 100 s. 1993: Implementing Rules and Regulations of RA 7392
BON Res. No. 557 s. 1988: Code of Ethics
BON Res. No. 8 s. 1994: Special Training on Intravenous Injections for the RN
BON Res. No. 20 s. 1994: Implementing Rules and Regulations of RA 7164
BON Res. No. 110 s. 1994: Guide to Evaluate Compliance with Standards for Safe
Nursing Practice

e. Letter of Instructions (LOI)

LOI 949: Legal Basis of Primary Health Care

LOI 100: Preference given to members of accredited professional
organization for employment and seminars
ILO Convention #149: Improvement of life and work conditions of nursing
personnel (ILO Recommendation #157)
 f. Proclamations

Proclamation No. 539, s. 1958: Nurses Week – Every last week of October
Proclamation No. 1348, s. 1974: National Cancer Consciousness Week – third
week of January
Proclamation No. 224, s. 1988: Women’s Week first week of March and March 8
as Women’s Rights and International Peace Day;
Proclamation No. 18, s. 1962: World Health Day – April 7
Proclamation No. 1481, s. 2008: Philippine’s Earth Day – April 22 of every year
Proclamation No. 4, s. 1998: Philippine Measles Elimination Campaign –
Declaring the period of September 16 – October
14, 1998 as the “Ligtas Tigdas Month”
Proclamation No. 6, s. 1986: United Nations – Universal Goal on Child Immunization
by 1990
Proclamation No. 46, s. 1992: Re-affirming the commitment of the Philippines
to the Universal Child and Mother Immunization
Goal of the World Health Assembly
Proclamation No. 118: Professional Regulation Week – June 16-22
Proclamation No. 1275: Midwifery Week – Every Third Week of October
Proclamation No. 147, s. 1993: Declares April 21 and May 19, 1993 and every 3rd
Wednesday of January and February and
thereafter for 2 years as National Immunization
Days
Proclamation No. 773, s. 1996: Every 3rd Wednesday of April and May as
the “Knock-Out Polio Day”
Proclamation No. 1064, s. 1997: Enjoining all sectors of society to participate in
the Acute Flaccid Paralysis (AFP) surveillance
component of polio eradication campaign
Proclamation No. 1066: Declaring a National Neonatal Tetanus
Elimination Campaign starting 1997

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