Chapter 10 focuses on the nurse through a discussion of issues of professional self-respect, with a special focus on reporting mistakes and clinical incidents, but also in a consideration of the place of self-forgiveness after making a mistake. It looks at factors that influence nurses’ decisions about reporting, and explains the importance of dealing effectively and ethically with clinical errors and incidents – for the sake of both patients and nurses. Admitting to mistakes has a number of important moral and practical effects for nurses, including restoring their self-respect and putting the patient back at the centre of care. The chapter also explains the open disclosure process for dealing with mistakes in a way that restores trust and justice to the clinical relationship.Finding the courage and the words to admit mistakes can be facilitated in the workplace by employing specific approaches. This chapter discusses an approach developed in the United States, and adopted worldwide, known as ‘Giving Voice to Values’. This is a structured practical approach that helps individuals to develop the skills they need to speak out when they know they should.

Chapter 6 takes a detailed look at the concept of negligence as it applies to health care, and how it is tied to the nurse’s duty of care towards their patients. It explains how a failure to meet that duty of care can lead to a legal finding of negligence against a nurse. It describes how a nurse’s required standard of care is determined in law, and how negligence is proven (or defended). It also explains a nurse’s legal liability and professional indemnity, as well as the employer’s vicarious liability for the actions of nurses. Finally, it discusses the role of apology and when an apology to a patient is appropriate. It also introduces the related concept of a ‘statutory duty of candour’, recently introduced into law in Victoria.

Chapter 7 looks at the cultural and ethical considerations that are relevant to nursing people from diverse cultures, with a focus on nursing Aboriginal and Torres Strait Islander people, and describes nursing practice that is culturally safe. It is important to remember that Aboriginal and Torres Strait Islander peoples are diverse groups who live a variety of lifestyles, from highly traditional to highly modern, on tropical islands, in remote deserts and in cities. Indigenous culture encompasses elements from ancient practices to contemporary technology. Appreciating the complexity of Indigenous Australian culture and its historical context is fundamental to providing ethical and therapeutic care.

Chapter 9 takes up the issues of trust and hope in the care provided by nurses – including trust in machines and colleagues – and revisits themes of power, autonomy and advocacy in decision-making about care. Trust is central to negotiating treatment in the nurse–patient relationship because the patient does not choose to enter into a relationship with the nurse. In considering the nature and scope of trust, and the extent to which nurses can be expected to accommodate patients’ wishes, the chapter also discusses the importance of hope and of avoiding both unrealistic hope and hopelessness.

Chapter 11 looks at some of the legal and ethical dimensions of two high-profile situations: abortion and voluntary assisted dying. These situations are often discussed together because they concern the limit of human vulnerability (in death) and the limit of human freedom and autonomy (in determining who can legitimately kill). This chapter considers some of the main ethical arguments for and against abortion and voluntary assisted dying, and sets out the relevant legal frameworks for nurses. In recent years, voluntary assisted dying laws have been introduced in all Australian states and the Australian Capital Territory, but not yet the Northern Territory, although legislation is being prepared. While nurses often have a special interest in the morality of abortion and voluntary assisted dying, the nurse’s role is clearly prescribed by law, and failure to act within the law can result in criminal charges of assault or even manslaughter.

Chapter 4 addresses the legal framework for valid consent to treatment and refusal of treatment, which is based on the right to autonomy (as discussed in Chapter 3). It considers situations where a person cannot give valid consent – for example, where the person is a young child or is unconscious – as well as situations where consent is not needed, such as in a medical emergency, where there is serious mental illness or where a patient needs to be restrained for their own safety. The chapter also explains the place of guardianship and advocacy, and the use of advance care directives in protecting a person’s autonomous decision-making.

Chapter 5 examines ‘restrictive practices’ and their legal and ethical implications for nurses. Restrictive practices are actions that restrict a person’s freedom of movement, such as locking the person in a room, secluding them by confining them to a physical space, putting them in manacles or straps, medicating them or directly holding them to restrict their movement. These practices can only be carried out as a last resort to protect the patient or another person, and must be authorised by a medical practitioner. A patient subject to restrictive practices must be observed closely at all times. In years past, the use of physical restraints in a clinical setting was not uncommon and included tying a person to a chair with a sheet, or tying the hands of a bed-bound person to the side of the bed. Besides any obvious cruelty, these practices were known to result in death by strangulation, falls, head injuries, lacerations and tissue necrosis. Nurses who use unauthorised restrictive practices may be liable for charges of kidnapping, assault and battery and, in the worst case, manslaughter.

Chapter 2 provides an overview of the Australian legal system, its structure, function and philosophical underpinnings. It explains what counts as law in Australia and who can set the rules, and it sets out the differences between legislation, common law, criminal law and civil law. It illustrates how the law is relevant to nurses and the profession, especially the concept of ‘scope of practice’. This edition of the book also raises some new concepts, such as the ‘stabilising’ and ‘disburdening’ effects of law, both of which smooth the way for people who are essentially strangers to each other to interact in everyday life.

Chapter 8 continues the focus on the nurse–patient relationship by examining legal and moral requirements around patient privacy and confidentiality, and mandatory reporting. It explains requirements in relation to the management of patient information, including reporting of child abuse, family violence and professional misconduct.

Chapter 3 focuses on of the nurse–patient relationship. This relationship is called a therapeutic relationship because its function is to have a beneficial effect on the patient. This chapter has a focus on power within the therapeutic relationship: what it is, how it is related to vulnerability and how the Nursing and Midwifery Board of Australia’s Code of Conduct for Nurses places constraints on nurses’ use of their power. The chapter explores different models of professional relationship, and explains how nursing fits into a model of the fiduciary relationship. It then discusses how the therapeutic relationship embodies the moral principles of non-maleficence, beneficence, autonomy and justice. It also describes the regulation of nursing practice in Australia and explains why this is a necessary part of ensuring the safety and quality of clinical care. It sets out the roles of the Australian Health Practitioner Regulation Agency (AHPRA) and the Nursing and Midwifery Board of Australia (NMBA) in setting the training and practice standards for nurses and midwives, and handling complaints, investigations and disciplinary hearings.

Chapter 12 discusses ethics and aged care, with a special focus on how nurses can support the autonomy of elderly people. Although it is often believed that an older person’s autonomy begins to deteriorate as the processes of biological decline affects their mobility and mental acuity, it is more often the negative attitudes of other people that show up early and that initially constrain an older person’s freedom. This chapter begins with an alarmingly commonly reported experience of being treated as senile or invisible simply by virtue of looking older. It is usually much later that physical and/or mental decline manifests. While ethical issues such as assisted dying (previously called ‘euthanasia’) tend to capture the public imagination, it is at the level of everyday living that nurses can often have the most profound impact on the lives of older people experiencing physical and/or mental decline. It is at this level too that the dangers (and complexities) of elder abuse typically manifest. The role of artificial intelligence (AI) in providing companionship, engagement and even care for people living in aged care facilities is also touched upon.

China’s relationship with Australia is arguably one of its most challenging. While not an obvious strategic threat to China, Australia’s very close military ties with the United States, its hosting of American military assets, and its role as a significant regional power mean that Australia cannot be ignored or bullied into changing its ways. On the contrary, the task for China is to try and change the nature of the debate within Australia about the latter’s foreign and security policies in particular, as well the roles of China and the US in the region more generally. This chapter argues that this remains a formidable challenge, and one China has often not handled well, despite the importance of the bilateral economic relationship for both countries. There are, however, unambiguous signs of improvement in the relationship, albeit from a low base. Whether this can be successfully built upon by both sides given their respective historical concerns remains uncertain.

This chapter takes up the question of the mixed blessings of relationships of security assistance in the Indo-Pacific region. Network snapshots and qualitative analysis exhibit how the politics in the region have and will continue to shift: China's rise has impacted the support network, and a denser support network in the region has contributed to stability. Stark challenges remain, however, as Australia and the states it supports are decreasingly able to enjoy the relative security that they have. In response to such challenges, an overextension of support as part of a US-led containment strategy against China is tempting but risky. The US should pair unwavering support for closely aligned states with proactive investments in a dense network of security ties that allow less aligned states to thrive outside of dependencies on either the US or China.