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Every day, registered nurses are required to act and make decisions based on their moral and legal obligations. They must build professional, culturally safe relationships with patients, understand patient rights and the requirements of consent, and prevent and manage clinical mistakes in order to avoid negligence and abuse of power. Now in its fifth edition, Ethics and Law for Australian Nurses guides students through foundational concepts such as personhood, autonomy, trust, consent and vulnerability, and considers a nurse's responsibilities in relation to voluntary assisted dying, abortions and advanced care directives. It explains the Australian legal system and how it relates to nursing practice. This edition discusses the impact of the COVID-19 pandemic, especially on elderly Australians, as well as on injury and negligence claims. It includes updated discussions on guardianship, assisted dying, abortion and 'not for resuscitation' orders.

LEARNING OBJECTIVES In this chapter, you will: ➔ Gain an understanding of the concepts of privacy and confidentiality, and be able to differentiate them ➔ Gain an understanding of the nurse's legal and moral responsibilities in relation to privacy and confidentiality ➔ Gain an understanding of the safe use of digital and social media to maintain patient confidentiality ➔ Learn about the legal requirements of mandatory reporting Ross was admitted through emergency services with chest pain, and was found to have had a myocardial infarction. He was admitted to the cardiac unit and placed on bed rest with cardiac monitoring. On admission, Kate, his nurse, gathered information from him about his condition and lifestyle to help plan his recovery and rehabilitation. When collecting this information, Ross told her that he was married and had three teenage sons. He added that he also had a long-term and loving relationship with Gill, and together they had a daughter who was seven years old. His wife did not know about his relationship with Gill or about his daughter, and he asked Kate to promise that this would not be disclosed to her. He said, ‘I know I can trust you with this information.’ He was most concerned that Kate arrange for Gill and his daughter to visit as well as notify his wife what had happened to him. Kate briefly described this unusual family situation in his notes, and suggested that discreet management of visitors was required as part of his nursing care. The next day, as she entered the unit, she noticed several nurses – one of them from the neighbouring renal unit – huddled around Ross’ case notes. They were whispering and giggling, apparently about her notation regarding his family situation. This chapter introduces the concepts of privacy and confidentiality in relation to the management of patient information, and outlines legal requirements for reporting harmful conduct of health professionals and others. The above case demonstrates how easily private and sensitive information recorded about a patient can result in a breach of confidentiality and unprofessional conduct. Kate appropriately recorded very personal information Ross had disclosed to her because she judged that it was relevant to his care. Yet other nurses perceived this to be a source of curiosity and gossip, and in sharing this with a nurse not involved in his care, had breached Ross’ confidentiality.

In April 2004, the Family Court was called upon to determine whether gender reassignment treatment was in the best interests of a child named Alex. In determining any person's interests, it is necessary to know who that person is and whose interests are at stake. This is even more difficult where the interest at stake concerns a person's identity. In order to determine whether gender reassignment was in Alex's interests, the court was required to determine how the question of gender related to who Alex was. In short, the court had to deploy a theory of identity. This article will argue that the process and the reasoning behind the judgement demonstrate the deployment of a practical and discursive conception of identity (specifically, a narrative self constitution view), rather than an essentialist view according to which gender identity is regarded as a direct expression of bodily sex. In coming to his judgement, the Chief Justice demonstrated a critical sensitivity and responsivity to the discursive nature and social context of identity by facilitating a dialogical account of Alex's situation and, ultimately, gender identity.

The narrative approach to identity has developed as a sophisticated philosophical response to the complexities and ambiguities of the human, lived situation, and is not – as has been naively suggested elsewhere – the imposition of a generic form of life or the attempt to imitate a fictional character. I argue that the narrative model of identity provides a more inclusive and exhaustive account of identity than the causal models employed by mainstream theorists of personal identity. Importantly for ethical subjectivity, the narrative model gives a central and irreducible role to the first-person perspective. I will draw the connection between narrative identity and ethical subjectivity by way of an exposition of work by Paul Ricoeur and Marya Schechtman, and a brief consideration of Korsgaard’s work on practical identity and normative ethics. I argue that the first-person perspective – the reflective structure of human consciousness – arises from human embodiment, and therefore the model of identity required of embodied consciousness is more complex and irreducibly first-personal than that provided in a causal account. What is required is a self-constitution model of identity: a narrative model of identity.

CONTEXT: Family planning providers can play an important role in helping women to identify their risk of HIV and other sexually transmitted diseases (STDs) and to adopt preventive measures. In-depth investigation of providers’ attitudes about approaches to STD risk assessment, contraceptive counseling and dual protection—concurrent protection from STDs and unintended pregnancy—has been limited. METHODS: In semistructured interviews conducted in 1998, 22 health care providers from a large New York City agency offering contraceptive and STD services described how they balanced STD and pregnancy concerns, viewed risk assessment and assessed various contraceptive methods. RESULTS: STD prevention was seen as an integral part of family planning counseling, and most providers believed that risk assessment should be conducted universally. Providers viewed dual protection as use of condoms along with an effective contraceptive; few advocated use of the male or female condom alone. The female condom was believed to be a disease prevention method of last resort and was considered appropriate only for specific groups of women. Although providers lacked understanding about the effectiveness of the female condom and how to counsel clients concerning its use, they expressed interest in learning more. CONCLUSIONS: Training is needed to reduce providers’ negative perceptions of the female condom and to reinforce the importance of individualized counseling tailored to women’s specific circumstances. Studies are needed on how to encourage family planning providers to promote male and female condoms as effective contraceptive methods. Perspectives on Sexual and Reproductive Health, 2003, 35(2):71‐78

Friendship, trust and forgiveness In this paper I will argue for a conception of forgiveness as the outcome of a process of mutuality rather than something brought about solely by the action of an individual. On the traditional view, forgiveness is conceived in terms of the emotional, cognitive or moral state of a harmed party who endows forgiveness upon the agent of the harm. On my account, unlike other, more traditional accounts,' the forgiven person plays a key role in bringing about forgiveness; the forgiven party is an active party in the process of forgiveness. I propose an intersubjective model that aims to overcome shortcomings arising from the individualistic orientation of the philosophical accounts of forgiveness that I have examined. The individualistic assumptions of these accounts leads them to collapse into what is called the 'paradox of forgiveness', 2 where forgiveness becomes either redundant or impossible. The paradox arises from the problem of retaining a sense of the moral quality of the agent of the harm, without either condoning a moral wrong or eliminating the moral quality of the harm. My account proposes a solution to the paradox by shifting the focus from the level of the individual to the level of the relationship. It is here, in the context of the mutuality of a relationship, that the moral agency of the one who harmed can be reconciled with forgiveness. My focus will be solely on the case of close friendship between two persons. While this focus is limited, I believe that the basic principles of nay account are applicable to other cases of moral harm between persons. One implication of my view is that it does not seem possible to forgive

Ricoeur distinguishes himself from many figures writing in hermeneutics and the natural sciences in that he does not strictly grant the hierarchical orientations proposed by Robert Crease:2 1. The priority of meaning over technique 2. The primacy of practical over theoretical 3. The primacy of situation over abstract formalisation However, neither does Ricoeur endorse the reverse order. Instead he sees each term as equiprimordial. It is on this point that Ricoeur's philosophy comes closer to the natural sciences than phenomenology would traditionally tolerate. However, Ricoeur's notion of objective reality is far removed from transcendental realism. He argues for a dialectical "middle way" that undercuts the dualism of subjectivity and objectivity by showing their mutual implication and logical dependence.3 The effect is to grant legitimacy to the methods of the natural sciences without falling victim to the estrangements of either transcendental realism or transcendental egoism. Ricoeur's "middle way" can be distinguished from the mainstream Heideggerian form of hermeneutics if we consider how he would respond to the following proposition from Patrick Heelan: What kind of entity then is a hammer...? It is a public cultural reality, a physical reality constituted by socio-cultural meaning."4 I suggest that Ricoeur would demure that the hammer, or any physical object, is not merely constituted by a socio-cultural meaning since meanings cannot constitute anything but other meanings. We do not resolve the problem of realism by appeal to the "as" structure of language, since this does not engage directly with the physicality of a physical object. As Ricoeur has argued in a different context, the reality of enduring physical objects exceeds the conceptual resources of phenomenology and, in doing so, implies an order of objective reality.5 The purpose of this essay is to examine the ways in which Ricoeur has articulated his particular form of phenomenology and its notion of objectivity in three different philosophical contexts.6 Ricoeur's arguments for objectivity appear variously as arguments concerning the nature of explanation and understanding, extra-linguistic reality, cosmological time, historical causality and, most recently, the neuronal basis of mental life.7 will be considering only three: explanation and understanding, cosmological time, and the neuronal basis of mental life. While the arguments for ontological reference that appear in the Rule of Metaphor would be entirely appropriate here, they have received considerable attention elsewhere,8 so for reasons of economy I have omitted that discussion.

This article seeks to fill the gap in female condom acceptability research by examining family planning (FP) providers' attitudes and experiences regarding the female condom in three countries (South Africa, the US, and Nigeria) to highlight providers' potential integral role in the introduction of the female condom. The case studies used data drawn from three independent projects, each of which was designed to study or to change FP providers' attitudes and practices in relation to the female condom. The case study for New York City used data from semistructured interviews with providers in one FP consortium in which no special female condom training had been undertaken. The data from South Africa were drawn from transcripts and observations of a female condom training program and from interviews conducted in preparation for the training. The Nigerian study used observations of client visits before and after providers were trained concerning the female condom. In New York City, providers were skeptical about the contraceptive efficacy of the female condom, with only 8 of 22 providers (36%) reporting they would recommend it as a primary contraceptive. In South Africa, providers who had practiced insertion of the female condom as part of their training expressed concern about its physical appearance and effects on sexual pleasure. However, they also saw the female condom as a tool to empower clients to increase their capacity for self-protection. Structured observations of providers' counseling interactions with clients following training indicated that Nigerian providers discussed the female condom with clients in 80% of the visits observed. Despite the lack of a uniform methodology, the three case studies illuminate various dimensions of FP providers' perceptions of the acceptability of the female condom. FP providers must be viewed as a critical factor in female condom acceptability, uptake, and continued use. Designing training programs and other interventions that address sources of provider resistance and enhance providers' skills in teaching female condom negotiation strategies may help to increase clients' use of the female condom.

In this essay I explicate Heidegger's conception of time to show that the account of self understanding and interpretation built upon that conception fails to provide the closure necessary for determinacy in self understanding. The flaw lies in a discontinuity between the two levels of time within Heidegger's concept of"Being-toward-death." This discontinuity prevents the formation of a requisite temporal unity and a concommitant conceptual unity. I go on to explain how Paul Ricoeur's account of "human time" responds to this problem by drawing on the strategies of poetics (specifically narrative) to articulate both temporal and conceptual unity. Ricoeur identifies the processes by which two levels of time interweave to achieve a tentative, unstable closure through the "inscription of phenomenological time on objective time."1 The strategies which fix meaning by connecting together the diverse aspects of human acting can also disconnect and reconnect those elements in ongoing processes of re-interpretation across chronological time. Dasein: The Ontological Temporality of Subjectivity Heidegger attempts to expose the ontological structures of human being through an analysis of the implicit structures of self awareness and experience. This analysis reveals that, as a subject, one always already finds oneself encountering a world wherein one is aware of one's existence in that world as self aware, i.e., as having an orientation to, and concern for, one's existence. This mode of existence Heidegger calls "Dasein."2 As self consciousness, or subjectivity, only Dasein can enquire into its own existence as an enquirer. This existence as enquiry into its own existence is ontological: it refers to Dasein's being "an entity for which, intimately involved in its being-in-the world, this very being is at issue."3 Dasein is not an entity, but is a mode of existence characteristic, indeed, constitutive, of being a human subject. That is to say, to exist as a self is to live this self concernfulness; there is no other essence, no soul or substantiality behind self consciousness, no telos determining what we are to be. The single defining feature of a self is concern with one's existence: one's existence is always an issue. For this reason Heidegger says that the essence of Dasein is its potentiality: "in each case possible ways for it to be."4 Because human being lacks predetermination, it can be characterized only by potentiality-the potentiality to become various kinds of lives. Aware of life's potential, it is up to each subject to carve out an existence for himself or herself, to create the meaning of one's own life. This is the task of self determination. Self determination is necessary if one is to acquire an identity, i.e., to become some-one. This is why Heidegger says that "Dasein has in each case mineness," and that "Dasein is mine to be in one way or another."5 The peculiar feature of human existence is that we are required to, as it were, appropriate our lives from the many possibilities and situations before us. The meaning of one's experiences is not a function of either nature or God, but of our own self activity. Our capacity for self determination is the response to the closure necessary for potentiality to become actuality. As potentiality-to-be, Dasein's being is fundamentally temporal-we are "in-the world" oriented to what we are to be; that is, we have a basic orientation to our own existence in terms of our future.6 If the essence of being a subject is to be self concerned, then it is to be concerned with oneself in a fundamentally temporal, and primarily futural, way. Because of the futural orientation of self concern, Dasein's existence is primordially practical. Heidegger argues that my understanding of the world is, firstly, in terms of tasks rather than objects, and it is the tasks that I find myself amongst that give definition and purpose to objects around me.7 Finding oneself always already among tasks, Dasein is said to be "thrown. …

In this essay I take issue with Derek Parfit's reductionist account of personal identity.Parfit is concerned to respond to what he sees as flaws in the conception of the role of 'person' in self-interest theories. He attempts to show that the notion of a person as something over and above a totality of mental and physical states and events (in his words, a 'further fact'), is empty, and so, our ethical concerns must be based on something other than this. My objections centre around the claim that Parfit employs an impoverished conception of 'life'. Parfit misconceives the connection between 'I' and one's body, and, so, despite his rejection of a metaphysical conception of 'self', remains within the logic of Cartesianism. What Parfit and other reductionists call an 'impersonal' perspective, I shall call the third-person perspective: a perspective which one in general may take. Against Parfit I shall offer a more complex conception of 'self' through the concept of 'bodily perspective'. I emphasize the irred...

LEARNING OBJECTIVES In this chapter, you will: ➔ Distinguish between the two sources of law in Australia: statutory law and common law ➔ Gain an understanding of the hierarchy of the courts in Australia's legal system ➔ Gain an understanding of the difference between criminal and civil law and how each relates to nursing practice ➔ Gain an understanding of the importance for nurses of gaining knowledge of the law and the legal system The Australian legal system is complex. An illustration of its complexity can be seen in the protracted and controversial case of Dr Jayant Patel, a surgeon who had been working at the Bundaberg Base Hospital in Queensland. In 2010, following a commission of inquiry by the Queensland Government, and after being extradited from the United States, an action of criminal negligence was brought against Dr Patel under the Criminal Code 1899 (Qld). Although the legal action was initially successful, and Patel was found guilty on three counts of manslaughter and one count of grievous bodily harm, the case for the prosecution was not straightforward. Section 288 of the Criminal Code 1899 states that: ‘It is the duty of every person who … undertakes to administer surgical … treatment to any other person, or to do any other lawful act which is or may be dangerous to human life or health, to have reasonable skill and to use reasonable care in doing such act.’ Patel was found to have operated with appropriate skill and care. Jurors, therefore, were required to find that Patel's decision to operate showed ‘such a great falling short of the standard to have been expected of a surgeon, and showing such serious disregard for the patient's welfare … was so thoroughly reprehensible, involving such grave moral guilt, that it should be treated as a crime deserving of punishment’ (R v Patel [2010] QSC 233 [69]). Patel's convictions depended upon an interpretation of section 288 by Justice Byrne: Take a surgeon who performs a minor surgical procedure with consent. During the operation, in circumstances bespeaking criminal negligence, the surgeon lets the knife slip, wounding the patient. The surgeon will have breached the s 288 duty and be guilty of unlawful wounding.

LEARNING OBJECTIVES In this chapter, you will: Develop an understanding of the concepts of ‘duty of care’ and ‘standard of care’ Learn how a nurse's ‘scope of practice’ is determined Learn how a nurse's actions or omissions may be determined to be negligent Learn how to avoid acting negligently Gain an understanding of vicarious liability and professional indemnity Two ambulance officers attended a collapsed, unconscious person. Following ambulance protocol, a dose of intravenous adrenaline was administered. The person remained unresponsive. A second dose of adrenaline was administered, as per the ambulance protocol. Consequently, the person suffered a cerebral bleed as a result of high blood pressure induced by the adrenaline. The ambulance officer was initially found to be negligent, but the finding was overturned on appeal. The appeal judge determined that, by following ambulance protocol, the ambulance officer did provide a reasonable standard of care, and that the harm suffered by the person was not the result of a breach of duty of care. (Eburn 2007) DUTY OF CARE Chapter 4 noted that nurses have a duty of care towards their patients. Duty of care refers to the legal obligation on a professional to exercise reasonable care and skill in the provision of professional treatment: a person comes under a duty of care in relation to the provision of advice or information if he carries on a business or profession and in the course of it provides advice or information of a kind which calls for skill and competence or otherwise professes to possess skill and competence and he provides advice or information when he knows or ought to know that the recipient intends to act or rely on it. (Mason J in Shaddock & Associates v Parramatta City Council (1981) 150 CLR 225 at 248–9)

LEARNING OBJECTIVES In this chapter, you will: Understand the nature of professional self-respect and its connection to trustworthiness Understand the nature of trust and its role in the clinical relationship Understand the factors that lead to clinical errors and incidents Understand some factors that influence nurses’ decisions about reporting errors Understand Open Disclosure policy Apari had been caring for a diabetic man, Jack, whose blood glucose levels had been difficult to regulate. One day they would be high, the next day they would be low. By chance one day Apari saw that a new nurse, Louise, was using the glucometer incorrectly to test Jack's blood glucose. Apari checked Jack's notes and realised that Louise had been recording incorrect blood glucose levels for several days. Just like everyone else, nurses sometimes make mistakes that can result in harm to others. The ANMC Code of Professional Conduct (2008b) makes a number of statements regarding safe conduct – for example: Conduct Statement 1: Nurses practise in a safe and competent manner. Conduct Statement 2: Nurses practise in accordance with the standards of the profession and broader health system. Conduct Statement 3: Nurses practise and conduct themselves in accordance with laws relevant to the profession and practice of nursing. The ANMC Code of Ethics (2008a) also refers to safe conduct: Value Statement 1: Nurses value quality nursing care for all people. Value Statement 6: Nurses value a culture of safety in nursing and health care.

LEARNING OBJECTIVES In this chapter, you will: ➔ Develop your appreciation of the complexity of the concept of ‘person’ ➔ Develop your understanding of ‘personhood’ as a relation between biological, interpersonal and social aspects of a human being ➔ Develop an understanding of human vulnerability, and how this makes possible the capacity to care for each other ➔ Gain a sense of the ways in which your beliefs about yourself affect your capacity to care for yourself and others In 2004, the Chief Justice of the Family Court of Australia, Alistair Nicholson, made a determination that a 13-year-old child (known as Alex) could proceed with medical treatment that would permanently change that child's gender from female to male. Justice Nicholson noted that Alex had the physical appearance of a girl and normal female chromosomes, but had a ‘longstanding, unwavering and present identification as male’ (Re Alex 2004, para. 80; see also Atkins 2005). In coming to a coherent determination of what was in Alex's best interests, Justice Nicholson gave due consideration to Alex's personal and family history; Alex's subjective perception of his situation; the nature of Alex's relationships with family and friends; and the relevant scientific and medical information pertaining to Alex's mental, physical and sexual health. Experiences such as Alex's raise questions about the nature of human identity: ➔ What is the connection between the physical body and a person's psychological outlook? ➔ What part do early life experiences play in shaping a personality? ➔ What part do social influences play in shaping a personality? ➔ Is there an essential defining quality that all persons share? ➔ Is there a proper or an improper way to be a male or female? ➔ Where do we get our ideas about persons and gender, as well as what is proper or improper? As a nurse, you will be called upon to support, care for and protect people who are vastly different from yourself. How you respond to the diversity of human beings will be a measure of your own humanity as well as your professionalism. Certainly, caring does not come as easily to some nurses as it does to others. After all, it is not always pleasant being around incapacitated, sick or grieving people.

Mrs Smith, a 28-year-old married woman with two children, had suffered from repeated sore throats with varying degrees of dysphagia and voice loss. She occasionally worked as a club hostess and complained of hoarseness and sore throats after an evening's work. Because of the ongoing number of attacks she visited her GP who tried to find out when she would be admitted for her long-awaited tonsillectomy. There had been a delay in admission because Mrs Smith had not informed the hospital about a change of address. This now being known, it was arranged for her to be admitted within a month. She was admitted to the ear, nose and throat (ENT) ward 24 hours before her planned surgery. Previous hospital admissions had been for the birth of her two children who were staying with their grandmother while Mrs Smith was in hospital.

This essay will address a general philosophical concern about autonomy, namely, that a conception of autonomy focused on freedom of the will alone is inadequate, once we consider the effects of oppressive forms of socialization on individuals' formation of choices. In response to this problem, I will present a brief overview of Diana Meyers's account of autonomy as relational and practical. On this view, autonomy consists in a set of socially acquired practical competencies in self-discovery, self-definition, self-knowledge, and self-direction. This account provides a distinction between choices that express unreflectively internalized social norms and those that are the result of a critical 'self-reading'. I conclude that this practical conception of autonomy makes much higher demands upon nurses (and patients) than has previously been thought. In fact, if nurses are to be expected to genuinely promote autonomy, they are going to need specific training in counselling-type communication skills.

Acknowledgements.Introduction..Part I: Early Modern Philosophy.1. Commentary on Descartes (Rene Descartes: "Meditation II").2. Commentary on Locke (John Locke: "Of Identity and Diversity".3. Commentary on Hume.David Hume: "Of Personal Identity"..Part II: Later Modern Philosophy.4. Commentary on Kant.Immanuel Kant: Critique of Pure Reason, "Paralogisms of Pure Reasons (A)" (first, second, and third paralogisms).5. Commentary on Hegel.G.W.F.Hegel: Phenomenology of Spirit, "Self-consciousness: Lordship and Bondage".6. Commentary on Nietzsche.Friedrich Nietzsche: "The Genealogy of Morals"..Part III: Phenomenology and Existentialism.7. Commentary on Sartre.Jean-Paul Sartre: "The Look".8. Commentary on Merleau-Ponty.Maurice Merleau-Ponty: "The Spatiality of One's Own Body and Motility".9. Commentary on Heidegger.Martin Heidegger: "Exposition of the Task of a Preparatory Analysis of Dasein"..Part IV: Analytic Philosophy.10. Commentary on Strawson.P. F. Strawson: "Persons".11. Commentary on Frankfurt.Harry Frankfurt: "Freedom of the Will and the Concept of a Person".12. Commentary on Shoemaker.Sydney Shoemaker: "Personal Identity: A Materialists's Account".13. Commentary on Williams (Bernard Williams: "Bodily Continuity and Personal Identity".14. Commentary of Parfit.Derek Parfit: Reasons and Persons, "What We Believe Ourselves To Be"..Part V: Post-structuralism.15. Commentary on Freud.Sigmund Freud: "The Ego and the Id".16. Commentary on Foucault.Michel Foucault: "About the Beginnings of ten Hermeneutics of the Self: two Lectures at Dartmouth".17. Commentary on Ricoeur.Paul Ricoeur: "Personal Identity and Narrative Identity"..Part VI: Feminist Philosophy.18. Commentary on de Beauvoir.Simone de Beauvooir: "Introduction" to The Second Sex.19. Commentary on Butler.Judith Butler: "Gender Trouble: Feminism and the Subversion of Identity".20. Commentary on Irigaray.Luce Irgaray: "Any Theory of the 'Subject' Has Always Been Appropriated by the 'Masculine'".21. Commentary on Mackenzie.Catriona Mackenzie: "Imaging Oneself Otherwise".Bibliography.Index.

In his famous paper, What Is It Like To Be a Bat?, Thomas Nagel argues against a reductive physicalist account of consciousness by highlighting what he calls "the subjective character of experience." In this paper I will argue that Nagel's insight is important for understanding the value placed on patient autonomy in medical ethics. Appreciation of the subjective character experience brings with it the necessity for an epistemological humility with respect to the lives of others and what can be said to be "right" for them. Appreciation of the subjective character of experience lies at the heart of empathy and our capacity to make decisions that genuinely reflect respect for the patient's autonomy. Through the example of a case involving extreme medical intervention, I identify some impediments to the proper recognition of autonomy. These kind of cases highlight the significance of affective responses with respect to the subjective character of experience, and, by extension, to our capacity to imagine and act in accordance with another's perspective. I argue that affective responses are appropriate and needed considerations in the case where one must attempt to assume another's perspective in order to respect autonomy. I conclude that understanding that experience has an irreducibly subjective character is essential to respecting patient autonomy.