Principle 1: respect for the dignity of the person
This principle is drawn from the Universal Declaration of Human Rights (United Nations, 1948) which proclaims that the basis for freedom, justice and peace is founded on the recognition of the inherent dignity and equality of human beings.
The European Convention for the Protection of Human Rights and Fundamental Freedoms (Council of Europe, 1950), the Irish Constitution (Government of Ireland, 1937) and the Equal Status Acts (Government of Ireland, 2000 - 2011) also serve as references for the values and standards established for respecting the dignity of the person.
- Nurses and midwives respect each person as a unique individual.
- Nurses and midwives respect and defend the dignity of every stage of human life.
- Nurses and midwives respect and maintain their own dignity and that of patients in their professional practice. They believe that this respect is mutual with patients.
- Nurses and midwives respect each person's right to self-determination as a basic human right. In respecting the right to self-determination, the requirement of informed consent is key. Except in exceptional circumstances, it is a violation of patients' rights to treat them without their consent. It is presumed that all adults have capacity to make health care decisions. Capacity is understood as the ability to understand, deliberate and communicate a choice in relation to a particular health care decision at a particular time.
- Nurses and midwives respect all people equally without discriminating on the grounds of age, gender, race, religion, civil status, family status, sexual orientation, disability (physical, mental or intellectual) or membership of the Traveller community.
Standards of conduct
- You must respect each person as a unique individual.
- You must respect and maintain the dignity of every stage of human life.
- You have a responsibility to make every valid or reasonable effort to protect the life and health of pregnant women and their unborn babies.
- In end-of-life care, you should support the person to die with dignity and comfort. This extends to ensuring respect for the patient in the period after their death, taking into consideration the cultural norms and values of the patient and their family.
- You should respect an individual's advance health care directive, if you know they have one.
- You must strive to communicate with patients about their care and give them information in a manner they can understand.
- If patients have communication or language needs, you should try to ensure that services are put in place so that you can communicate effectively with each other.
- You should protect and promote the autonomy of patients: respect their choices, priorities, beliefs and values. Decisions to refuse care or treatment should trigger further discussion and be respected in the context of the person's capacity.
- You are responsible for seeking the patient's consent to nursing and midwifery treatment and care. Never presume a patient's consent. The consent is valid if: information is communicated in a clear manner about the nature, purpose, benefits and risks of treatment and care in a way the patient can understand; the patient has the capacity to make a decision about a particular procedure; the patient gives their agreement freely.
- If a patient seems to lack understanding or capacity and is unable to communicate a choice about a treatment or procedure, you should give them the time and support they need to maximise their ability to make decisions for themselves. If you are still unsure about a patient's capacity to make health care decisions, that patient's capacity should be assessed by their doctor and other members of the health care team. If it is determined that a patient lacks capacity you should: take into account the person's previous directions and wishes, if known; discuss the case with appropriate family members, carers or guardian; discuss the case with other members of the health care team; take into account (if possible) the expressed views of the person who lacks capacity in making a treatment or care decision. (Standards of conduct 4 and 5 in Principle 4 - Trust and Confidentiality - discussing personal information - are linked with this standard).
- In exceptional circumstances - such as emergencies where a patient lacks capacity - consent to treatment or care is not necessary. A nurse or midwife may treat the person when it is immediately necessary to save their life or to prevent a serious deterioration in their condition and there is no advance refusal of treatment.
- You must respect diversity among patients and colleagues in your professional practice.
- You must respect all people equally and not discriminate on grounds of age, gender, race, religion, civil status, family status, sexual orientation, disability (physical, mental or intellectual) or membership of the Traveller community.
Advance healthcare directives
Advance healthcare directives have been recognised by the courts in Ireland. The Irish courts have established that a person with capacity has the right to refuse treatment.
Guidance from health care regulators and other agencies may help to inform you about best practice regarding the ethical and professional issues associated with advance health care directives.
An advance health care directive should be respected on condition that:
- The person made an informed choice regarding their decisions at the time of making the plan
- The decision in the directive covers the situation that has now arisen
- There is no indication that the person has changed their mind since the advance care directive or plan was made.
Further information about advance healthcare directives can be found on the Department of Health website.
Communication and information sharing by the nurse or midwife is key to the patient understanding and consenting to nursing or midwifery care. The need for consent extends to all nursing or midwifery intervention with patients in all settings. How the key elements of consent are applied, such as listening to and supporting the patient to ensure that their consent is freely given and considered, will vary with the particular situation. The amount of information that the nurse or midwife should provide about an intervention will depend on the urgency, complexity, nature and risks associated with the intervention.
The verbal or implied (for example, by a gesture) consent of patients to normally risk-free nursing or midwifery care is a sufficient indication that the consent is valid. As with medical interventions, the consent of patients to more serious and riskier procedures should be informed, written consent. There must be no doubt that informed consent was given and it is documented in the nursing or midwifery notes and the patient consent form.
There may be occasions when a patient's state of health status may prevent them taking part in the consent process. Health legislation, such as the Assisted Decision-Making Capacity Bill of 2013 (once enacted); Mental Health Act, 2001; supporting guidance from the Mental Health Commission and employer policy also direct best practice.
Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives
(PDF, 0.32 MB)