Chapter 6: Advocacy, Ethical & Legal Issues in Practice

Advocacy, Ethical & Legal Issues in Practice begins by grounding nursing actions in the core values established by the Canadian Nurses Association, which include providing safe and compassionate care, promoting health and well-being, respecting informed decision-making, and upholding principles of social justice. Social justice is presented as a fundamental framework for community health, emphasizing the need to address the root causes of disparities such as racism, classism, and sexism. The text explores ten attributes of social justice, including equity, human rights, and capacity building, and contrasts traditional bioethics with public health ethics by focusing on population health and the social determinants of health. Within the realm of health promotion and prevention, the chapter navigates the complexities of social control and medicalization, urging nurses to reflect on how sociopolitical factors influence client choices through the lens of relational autonomy. When public health interventions necessitate the restriction of individual liberties—such as in communicable disease surveillance—the discussion provides ethical justifications including the harm principle, paternalism, and collective efficiency. Legal and ethical challenges are further explored in diverse community settings, particularly the home, where technology and the environment influence moral agency. Significant attention is given to the process of informed consent, the use of advance directives, and the complexities of substitute decision-making. The chapter also addresses the gendered and often strained nature of informal family caregiving, highlighting the nurse's responsibility to support both the client and their support network. In the context of end-of-life care, it provides a comprehensive overview of palliative care philosophies and the legal criteria for Medical Assistance in Dying (MAID) in Canada, weighing the sanctity of life against the quality of life and the right to conscientious objection. Professional integrity is maintained through the management of therapeutic boundaries and the fulfillment of privacy and confidentiality requirements, including the mandatory duty to report child abuse or significant public health threats. Finally, the chapter outlines the legal elements of negligence—duty of care, breach of standard, harm, and causation—and advocates for environmental justice, particularly concerning the right to clean water in Indigenous communities.