Finals – Bioethics

Introduction to Bioethics

Ethics

 It is a practical and normative science based on reason which studies human acts and provides
NORMS for its GOODNESS and BADNESS.
 It is a series of beliefs and principles held by a person or group about how to determine which
human interactions are believed to be right or wrong.
 As a practical science, ethics is a systematized body of knowledge that can be used, practiced,
and applied to human action.

Health Ethics

 It is a science that deals with the study of the morality of human conduct concerning health and
health and health care.

Biology

 The Greek word: bios means “life” and logy means “study of”
 It is a science that employs the scientific method to study living things.

Bioethics

 It is the application of ethics to the field of medicine and healthcare.

 Bios- comes from the Greek word which means life
 Ethics of life; ethics of medical
 It is “the division of Ethics that relates to the human life sciences and health care, both delivery
and research.”

Stages of human issues and queries:

1. The beginning of life

2. The middle of life
3. The end of life

Evolution of Bioethics

1. Medical Ethics
- Oldest phase of bioethical exploration.
- The formulation of ethical norms for the conduct of health care professionals in the
treatment of patients.
A. Hippocratic Oath (Hippocrates, the Father of medicine, Greece 460-357 BC)
 Underscores the physician’s all-out concern for the patient to be
kept from harm and injustice.
 No prescription on fatal drugs.
 Rule out any form of abortificient.
  No sexual relations between doctors and patients.
 Moral significance of confidentiality or medical secrecy.
B. Percival’s Medical Ethics (England, 1803)
C. American Medical Association’s Code of Ethics (1847)
D. Followed by a supplement of similar code of ethics for many groups such as:
dentist’s code of ethics, the teacher’s code of conduct, nursing code of
ethics.
E. Other nonmedical professions contribute to the articulation of ethical issues
such as: secretarial ethics, business ethics, and journalist’s ethics.
2. Research Ethics
- Govern the standards of conduct for scientific researchers.
- It is important to adhere to ethical principles in order to protect the dignity, rights
and welfare of research participants.
3. Public Policy
- Can be generally defined as:
o A system of laws;
o Regulatory measures;
o Courses of action; and
o Funding priorities concerning a given topic promulgated by a governmental
entity or its representatives.

Professional Ethics

 Human Person
- A living being that contains a real and existing power to direct its own development
toward fulfilment through perfect, unconditional, and infinite Truth, Love, Goodness,
Beauty, and Unity, and will to do so if all the proper conditions are met.
 Moral Person
- “A moral person is one who constantly exercises, and acts on, his best rational
judgement.” – Barbara Branden

How do you become a MORAL person?

 Always tell the truth.

 Do not destroy property.
 Have courage.
 Keep your promises.
 Do not cheat.
 Treat others as you want to be treated.
 Do not judge.
 Be dependable.
 Non Moral
- The immoral person knowingly violates human oral standards, the amoral person may
also violate moral standards because he or she has no moral sense.
 Human Act
- An act that proceeds from the deliberate free will of man.
 - In ethics, being deliberate or deliberation means merely advertence or knowledge in the
intellect of what one is about and what it means.
- The act, then, has to be advertently or knowingly done by the agent so as to be called a
human act.
- Human act requires the use of both the rational faculties of knowing and willing.
 Acts of Man
- An act that does not proceed from the deliberate free will of man.
- In contrast with human act, act of man does not require the employment of rational
faculties of intellect and free will.
- Acts shared in common by man and other animal.

Conscience

 Latin word: conscientia – “trial of oneself”

 It is an act of the practical judgement of reason deciding upon an individual’s action as good and
to be performed or as evil and to be avoided. By informing us of our values and principles. It
becomes the standard we use to judge whether or not our actions are ethical.
 Conscience is our lived knowledge of good and evil, our judgement about how we should act,
and commitment to do so.
 A moral faculty or feeling prompting us to see that certain actions are morally right or wrong.

Levels of Conscience

1. Antecedent Actual Conscience

- The whole process of making a judgement in conscience before performing moral acts.
- The judgement of a person deciding on a moral matter prior to acting to it.
2. Concomitant Actual Conscience
- Refers to our actual awareness of being morally responsible, for the goodness or the
badness of a particular act while one is doing it.
3. Consequent Actual Conscience
- It involves the process of reflection on one’s moral responsibility relative to the past
action.
- It approves, excuses, reproves, or accuses.

Qualities of Conscience

A. Correct or True Conscience

- It judges what is good as good and what is evil is evil.
B. Erroneous or False Conscience
- It judges incorrectly that what is good is evil and what is evil is good.
C. Certain Conscience
- It is a subjective assurance of the lawfulness of an act.
D. Doubtful Conscience
- It is a rigorous conscience, unable to form a definite judgement of a certain action.
 E. Scrupulous Conscience
- It is a vacillating conscience, unable to form a definite judgement of an action.
F. Lax Action
- It is one which refuses to be bothered about the distinction of what is good and evil.

Erroneous Conscience

In good faith – you honestly and sincerely believe that a certain act is good but is actually bad,
and you do it.
In bad faith – you honestly and sincerely believe that the act is bad and you still do it.

Deep within or conscience we discover a law which we have not laid ourselves, but which we
must obey.
 We are not the source of our own conscience.
 We cannot manipulate or silence our conscience.
 It will never leave us in peace unless it is obeyed.

Philosophical Basis of Ethical Theories

Ethical Theories

 It refers to philosophical reflection or when we speak of morality’s nature and function.

 Purpose: To enhance clarity, systematic order, and precision of argument in our thinking about
morality.

Philosophical Basis of Ethical Theories

Deontological Ethics
Justice
Good Actions Whatever Happens
Teleological Ethics
Justice
Whatever is Done Good Results
Christian Ethics A. Deo
Aligns with ntol
Good Actions Good Results
ogic
al Ethics
- Greek “deon”, meaning duty or obligation.
- Duty as the norm of moral action.
- Also called duty ethics.
- An ethical theory that uses rules to distinguish right from wrong.
- Immanuel Kant – German Philosopher
B. Teleological Ethics
- Greek “telos”, End or Purpose.
 - It stresses the end-result, goal or consequences of an act as the determining factor of its
rightness and wrongness.
- It is also called Consequential Ethics.
C. Utilitarianism
- An action or practice is right if it leads to the greatest possible balance of good
consequences in the world as a whole.
- “Greatest good for the greatest amount of people.”

Four conditions of Utilitarianism:

1. The Principle of Utility: Maximize the good

2. Theory of Value: Standard of Goodness
3. Consequentialism: Whatever its precise value theory
4. Impartiality (Universalism)
D. Kantianism (Immanuel Kant)
Deontologism – it emphasizes duty obligation.
Intuitionism – what is morally right or wrong is a matter of intent, motive and will.

Act done in accord with duty

 An act to perform merely out of desire to do so or out of fear of being accused
of negligence.

Act done from a sense of duty

 An act to perform from a sense of obligation.

Categorical Imperative

An action without any conditions whatsoever, and without regard to the

consequences that such an action may yield.

Two Types of Duties

1. Perfect – one which we must always observe, irrespective of time and place or
circumstances. Veracity.
2. Imperfect Duty – one we must observe only on some occasions or based on one’s
choice.

Kant’s distinction between perfect and imperfect duties suggests:

That some rights should be recognized.

In a doctor-patient relationship, the physician has the imperfect duty to accept the
patient.

That is, how he discharges his duty is his own decision, his prerogative, his own
right.

KANTIANISM versus UTILITARIANISM

KANTIANISM UTILITARIANISM
 A moral philosophy introduced by A moral philosophy introduced by Jeremy
Immanuel Kant that emphasizes that Bentham, John Stuart Mill, Henry Sidgwick,
morality of an action/decision is not etc. that emphasizes that morality of an
determined by its consequences but the action/decision as determined by its
motivation of the doer. consequences.
Postulated by Jeremy Bentham, John Stuart
Postulated by Immanuel Kant.
Mill, Henry Sidgwick, et al.
A deontological theory. A teleological theory.
Action should be motivated by goodwill An action is considered moral and good if it
and duty and the morality of an action is results in providing greater happiness for
not measured by its consequences. others, regardless of its intention.

E. Rawls’ Ethics (John Rawl)

- A Harvard philosopher
- Theory of Justice
- EQUALITY is not equal to EQUITY

Rawls’ Theory of Justice

1. Every individual is inviolable.

- This inviolability, which is founded on justice, is so sacrosanct that not
even the general welfare of the society can override and supersede it.
2. An erroneous theory is tolerable in the absence of a good one.
3. Principle of Justice
a. Equal access to the basic human rights and liberties.
b. Equality of opportunity and equal distribution of economic resources.
4. Justice in Human Relations
- Aware of the need for principles that bind and guide individuals in
making moral decisions.

Four Types of Duties

1. Fairness in our dealings with others

2. Fidelity
3. Respect for persons
4. Beneficence
F. Thomistic Ethics
- St. Thomas Aquinas (1225-1274)
- Christian/Roman Catholic Ethics
- Natural Law Ethics
- Scholastic Ethics

Synderesis Principle – Scholastic Philosophy

- Inherent capacity of every individual, lettered or unlettered, to distinguish the good

from bad.
 - Voice of right reason or voice of conscience

Man’s threefold natural inclination:

1. Self-preservation
2. Just dealings with others
3. Propagation of our species

Three determinants of moral action:

1. The Object
- Determines the objective morality of an action.
- Could be a thing or a procedure.
2. The Circumstance
- There are conditions which, when super added to the nature of the moral
act, will affect its morality.
- Mitigating or aggravating circumstance.

Who?

This circumstance has something to do with the special quality, prestige,

rank, or excellence of the person involved in the moral act.

What?

This circumstance refers to the quantity or quality of the moral object.

Where?

This circumstance denotes the place where the act occurs.

By what means?

This refers to the means used in carrying out the act.

Why?

The end or purpose is considered as a circumstance affecting the goodness

or badness of the action.

How?

This circumstance indicates the manner in which the action is done.

When?

This circumstance refers to the time element involved in the performance of

an action, not only with regard to quantity but to quality as well.
3. The End of Purpose
- End or purpose of the doer or agent
- It also affects the goodness or badness of an action or decision in a number
of important ways.
 THE DETERMINANTS OF MORALITY
A. The object Chosen
(What I choose to do.)
B. The Intention
(Why I choose to do something.)
C. The Circumstances
(The what, where, when, how of my actions.)

To be morally good, a human act must agree with the norm of morality on all three
counts: in its nature, its motive, and its circumstances. Departure from any of these makes
the action morally wrong.
G. Ross Ethics
- William David Ross was a Scottish philosopher who is known for his work in ethics. His
best known work is The Right and the Good (1930).
- An action is validated as right by its consequences.
- Rules should not be absolute.
- Actual duty and prima facie duty.

Actual Duty

- Concrete duty, the duty we should perform in the particular situation of choice.
- One’s real duty in a given situation.
- It is the action one ought to choose from among many other actions.

E.g. RT giving nebulization to an asthmatic patient to relieve symptoms.

Prima Facie Duty

- Latin means “at first view,” or “based on the first impression.”

- A duty that is binding or obligatory, other things being equal.
- One that directs or commands what one ought to perform when than not,
relevant factors are not taken into account.
- An example of prima facie is when a wife walks in on her husband with another
woman; at first glance, it looks as if he is guilty of something just because of the
circumstances.
- Prima facie is defined as something that has been proven or assumed to be true
unless there is evidence presented to the contrary.

7 types of Prima Facie Duties

(1) Duty of fidelity

- We should be faithful to our duties, obligations, vows, or pledges.
- Telling the truth as the situation demands it.
- Keeping actual and implicit promises, and not representing fictions
as truth.
 (2) The duty of reparation
- “Kung nakagawa ka ng masama, gumawa ka naman ng mabuti.”
- We have a duty to make amends for injury that ewe have inflicted
on others.
(3) The duty of gratitude
- We have a duty to appreciate and recognize the services others
have done to us, which may be a favour, kindness, good fortune,
great help, or saving one’s life.
(4) The duty of justice
- Stresses the proper distribution of social benefits and burdens.
- The duty of justice demands fairness for everyone.
(5) The duty of beneficence
- This type of duty enjoins us not only to bring what good for others
but also help them better their conditions with respect to virtue,
intelligence, or comfort.
(6) The duty of self-improvement
- As we have a duty to help others better themselves, we also have a
duty to improve and develop ourselves with respect to virtue,
intelligence, and happiness.
(7) The duty of nonmaleficence

Universal Bioethical Principles

A. Autonomy
- This principle marks the significance of individual autonomy which mandates a strong
sense of personal responsibility for one’s own life.
- The word autonomy comes from the Greek autos-nomos meaning “self-rule” or “self-
determination.”

Elements of Autonomy

a. Person should be respected.

b. He should be able to determine his personal goals.
c. He should have the ability to decide on plans of actions.
d. He should have the freedom to act upon his choice.
B. Beneficence
- The practice of doing acts of goodness, kindness and charity.
- The beneficence principle states “do not harm and produce the good” or “do good and
do no harm.”
C. Nonmaleficence
- Hippocratic Oath: “I will never use treatment to injure or wrong the sick.”
 - This seems to be similar to the duty of beneficence, where the practitioner work to
maximize the good for the patient and to minimize the harm.

Examples of Non-maleficence (by Gert, a bioethicist)

1. Do not kill.
2. Do not cause pain or suffering to others.
3. Do not cause offense to others.
4. Do not incapacitate others.
5. Do not deprive others of the goods of life.
D. Veracity
- Relates to the practice of telling the truth.
- Being honest and telling the truth and is related to the principle of autonomy. it is the
basis of the trust relationship established between a patient and a health care provider.

Justification of Truth Telling

1. It is argued that our human and moral quality as persons is taken away from us if we
are denied whatever knowledge is available about our condition as a patient.
2. As a patient, we have entrusted to the physician any knowledge he has about
ourselves, so the facts (findings) are ours and not his, hence to deny them to us is to
steal it from us.
3. The highest conception of the physician-patient relationship is a personalistic one
which is based on the mutual confidence and respect for each other’s rights.
4. To deny a patient pertinent knowledge about himself, especially in a life and death
situation, is to deprive him the ample time to prepare for his own death or to carry
out responsibilities that are based solely on his decisions or actions.

Practitioner is allowed to intentionally withhold information based on his/her

“sound medical judgement” that to divulge information might potentially harm the
depressed and unstable patient for an unpleasant fact…

Benevolent Deception
In medicine, benevolent deception is the process by which patients are misled
by doctors in an effort to prevent possible negative effects from the disclosure of
their dangers.

Two Approaches of Truth Telling

 Person-centered – considers patient as a person with problem.
 Problem-centered – considers the patient’s condition, illness or disease.
E. Confidentiality
- Is an important aspect of trust that patients place in health care professionals.

Confidentiality vs. Privacy

 Privacy – refers to the right of an individual to control the personal information or

secrets that are disclose to others.
  Confidentiality – demands nondisclosure of private or secret information about
another person with which one is entrusted.

Justifications of Violation of Confidentiality

a. When keeping the secret would be detrimental to the common good.

b. When the subject of the secret intends to inflict grave injury upon an innocent third
party.
c. When it is necessary for the subject of the secret to avert grave injury.
d. When it is necessary for one keeping the secret to avoid grave injury.
F. Fidelity
- Loyalty, trustworthiness, reliability, faithfulness.
- It requires that health care practitioner should practice faithfully within the constraints
of the role.
G. Justice
- Rendering of what is due or merited.
- Fairness in all medical decisions.
- The principle of justice states that there should be an element of fairness in all medical
decisions: fairness in decisions that burden and benefit, as well as equal distribution of
scarce resources and new treatments.

Two Types of Justice

1. Comparable Justice
- What a particular patient receives is determined by the gravity of the
condition or need.
2. Non Comparable Justice
- Concerned with making sure people gets what they are entitled to.

Criteria of Distribution

Non-comparative justice states that distribution of goods/resources is

determined by a certain standard as follows:

1. Criteria of Inclusion – selection of candidates

a. Constituency – Is the person a member of the community?
b. Progress of Science – Can new knowledge be gained from the case?
c. Success – Is the treatment effective?
2. Criteria of Comparison
a. The likelihood of successful treatment compared with others in the
group.
b. Life expectancy of the person.
c. The person’s family role.
d. The potential of the person in making future contribution.
e. The person’s record of services or contribution.
3. Random Selection (James Childress)
 A philosopher and theologian whose scholarship addresses ethics,
particularly biomedical ethics.
a. First come first serve basis.
b. Lottery
In an article titled “Who Shall Live When Not All Can?”, James Childress
proposes a system for allocating scarce lifesaving medical resources
based on random selection procedures.

Ethical Consideration

a. Good effect must be directly intended.

b. Good effect or bad effect must occur simultaneously or bad effect must follow the
good effect.
c. Bad effect may be permitted to occur after the intention of good effect.
H. Principle of Double Effect
Governs situation in which one action is followed by two effects, one good (and
intended), and the other evil (foreseen but not intended).

E.g. A pregnant mother having cancer of uterus and underwent hysterectomy thus
abortion of the baby happened to save the mother.
I. Principle of Stewardship
- Refers to the expression of one’s responsibility to take care of, nurture and cultivate
what has been entrusted to him.
- “Kaitiakitanga,” a New Zealand Māori term used for the concept of guardianship, for the
sky, the sea, and the land.
J. Principle of Totality
- The whole implies the existence of its part.
- The existence of parts indicates the existence of the whole.
- The principle of totality states that all decisions in medical ethics must prioritize the
good of the entire person, including physical, psychological and spiritual factors.
K. Principle of Solidarity
- Professionals must nurture and support the principle of one organization for all the
members.
- Professionals are obliged to put a broader interest of the profession above one’s
personal ambition and preference.
L. Principle of Cooperation
- Cooperation comes from the Latin word cum which means “with,” and operari which
means “to work.”
- Cooperation is working with another in the performance of an action.

Professional Ethics

“How ethical are you?”

  Experts agree that professional success depends on not only on the quality of your work but also
on your relationships with others.
 These relationships begin the minute you make a contact with an employer, a colleague, or a
prospective client (Ferrara et.al).

Professionalism

 The concept professionalism refers first to all to whatever counts as proper conduct oon the
part of members of a profession.
 “Professionalism is someone’s inherent ability to do what is expected of them and deliver
quality work because they are driven to do so.” (Brooks 2019)

Why is Professionalism important?

Attributes of a Professional

 Self-respect
 Self-transcendence
 Service-oriented
 Simplicity
 Sense of personal responsibility and accountability
 Risk taking personality
 Patience

Calling of the Health Care Provider

 The Health Care Profession

- An occupation requiring advanced, specialized, and systematic study and training in the
knowledge of health care designed.
- To provide service to society in that particular field.
 The Client – Patient
 The Health Care Provider
- The person who is authorized to practice the profession.
 The Health Care Provider-Client Relationship
- As a social being, the human person tends to relate with others.
- In establishing relationships, he or she uses language which may take variety of forms
such as spoken or written words, gestures, signs and others.

Major Components of the Therapeutic Interaction

1. The health care practitioners

2. The client/patient
3. Health care and the contents of the interaction
4. Environment
5. The outcome

Health Care Provider-Client Relationship

 Privacy
  Veracity
 Confidentiality
 Unavoidable Trust
 Personal Dignity
 Patient Advocacy

Qualities of a Good Health Care Provider

1. Goodwill
2. A recognition of acceptance of their personal power
3. The knowledge that they have found their own way
4. Self-respect and appreciation
5. A willingness to serve as models for their patients
6. A willingness to risk making mistakes and to admit having made them.
7. Virtues, Vices, ad Habits of a Health Care Profession

Focal Virtues

a. Compassion
b. Discernment
c. Trustworthiness
d. Integrity

Intellectual Virtues (Mind over Matter)

a. Understanding the First Principe

b. Science
c. Wisdom
d. Art
e. Prudence

Moral Virtues

a. Justice
b. Fortitude
- It’s both a gift of the Holy Spirit and cardinal virtue.
- It gives us strength to follow through.
- Also referred to as courage.
c. Temperance
- Temperance is moderation in the things that are good and total abstinence from the
things that are foul.

Other Virtues

a. Fidelity
b. Honesty
c. Humility
d. Respect
Undesired Virtues

a. Fraud
b. Pride
c. Greed
“Fraud is the daughter of greed”

Good Habits

 Be proactive
 Put first things first
 Think win-win solution
 Seek first to understand then to be understood
 Sharpen one’s saw
 Begin with an end in mind
 Synergize

“The only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t
settle. As with all matters of the heart, you’ll know when you find it.”

- Steve Jobs

Informed Consent

As an ethical doctrine, informed consent is a process of communication whereby a patient is enabled to

make informed and voluntary decision about accepting or declining medical care.

Major Legal Elements of Informed Consent

1. Information
- What is being offered, the alternatives and their risks, benefits, and consequences
2. Consent
- Must be voluntary, without coercion, force, or manipulation from health care providers
or family

Key Aspects of informed Consent

 Nature of Treatment
 Alternatives
 Risks
 Benefits
 Opportunity for Questions

Content of Informed Consent

When educating clients about informed consent, the following information should be provided
in writing and discussed:
 The therapeutic process
  Background of therapist
 Costs involved in therapy
 The length of therapy and termination
 Consultation with colleagues
 Interruptions in therapy

Basic Elements of Informed Consent

 Description of Clinical Investigation/ Medical Procedure

 Risks and Discomforts
 Benefits
 Alternative Procedures or Treatments
 Confidentiality
 Compensation and Medical Treatment in Event of Injury
 Contacts
 Voluntary Participation

Patient’s Rights

 A patient’s bill of rights is a list of guarantees for those receiving medical care.
 It may take the form of a law or a non-binding declaration
 Typically a patient’s bill of rights guarantees patient’s information, fair treatment, and
autonomy over medical decisions, among other rights.

Proposed Magna Carta of Patient’s Rights

Explanatory Note
It is a declared policy of the State to ensure and protect the rights of patients to decent,
humane and quality health care. Further, the State shall adopt an integrated and
 comprehensive approach to health and development which shall endeavor to make
essential goods, health and other social services available to the people at affordable
costs. The State shall likewise endeavor to provide free medical care to pauper.
http://legacy.sente.gov.ph/lisdata/50404429!.pdf

1. Rights to informed consent

- Relates to a process by which patients are informed of the possible outcomes.
- Alternatives, risks of treatments, and patients are required to give their consent freely.
- Information, decision, and choice.
Types of Consent
 Admission Agreement
 Blood Transfusion Consent
 Surgical Consent
 Research Consent
 Special Consent
Functions of Informed Consent
 To avoid fraud and duress
 To encourage self-scrutiny by professionals
 To foster rational decision making
 To involve the larger society in the debate
Elements of Informed Consent
1. Competence
A competent individual is a person who:
 Can make decisions
 Able to justify the decision
 Able to justify decision in a reasonable manner
2. Disclosure
3. Comprehension
4. Voluntariness
2. Rights to informed decision
- Refers to the necessary information of and understanding so a genuine deliberation is
carried out before making a moral decision on a medical treatment.
3. Right to informed choice
- The patient has the right to be inform all possible alternative courses of action to be
taken, together with the possible consequences.
- = Moral Choice
4. Right to refuse treatment
- The patient has the right to refuse treatment to the extent permitted by law and to be
informed of the medical consequences of his action.
5. Right to self-determination
- The patient as an autonomous individual has the moral right to determine what is good
for himself, usually upon the advice of a health care provider.
Limitations of Patient’s Rights

 Patient’s rights do not include patient’s rights to be allowed to die.

 Patients in a moribund condition does not possess the necessary mental, physical, or emotional
stability to make decision.
 Patient’s right are not absolute.

Patient’s Bill of Rights from the Department of Health

1. Right to appropriate Medical care and Humane treatment

2. Right to informed consent
3. Right of privacy and confidentiality
4. Right to information
5. Righto choose health care provider and facility
6. Right of self-determination
7. Right to religious belief
8. Right to medical records
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence and to receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligations as a patient

Right to Health Care

 Health as a human right creates a legal obligation on states/countries to ensure access to

timely. Acceptable, and affordable health care of appropriate quality.
 To provide for the underlying determinants of health, such as safe and potable water,
sanitation, food, housing, health-related information.

Health Care Claim

 An insurance claim is a formal request by a policyholder to an insurance company for coverage

or compensation for a covered loos or policy event.

Health Care Resources

 Are defined as all materials. Personnel, facilities, funds, and anything else that can be used for
providing health care services.
Types:
Public
Private

Health Care System

 Primary
- Are the rural health units, their sub-centers, chest clinics, malaria eradication units, and
schistosomiasis control units operated by DOH
 Secondary
 - Are the smaller, non-departmentalized including emergency and regional hospitals
- Services offered to patients with symptomatic stages of disease, which require
moderately specialized knowledge and technical resources for adequate treatment
 Tertiary
- Are the highly technological and sophisticated services offered by medical centers and
large hospitals
- These are specialized national hospitals.

Resource allocation is the distribution of resources – usually financial – among competing groups of
people or programs.

Level 1: Allocating resources to health care versus other social needs.

Level 2: Allocating resources within the health care sector.
Level 3: Allocating resources among individual patients.

Levels of Allocation

Macro Level
 Health systems policy level
 National Health Authorities
Meso Level
 Health services (hospital, facility managers
Micro Level
 Clinical management (health care providers involved in direct provision of clinical care)

Palliative Care
Case Analysis

Javier quit smoking after he was diagnosed with Chronic Obstructive Pulmonary Disease (COPD)
8 years ago. He lives at home with his wife Selena, and their son and two grandchildren live nearby.
Javier had loved to play cards with friends and attend his grandchildren’s football games, but as his
COPD worsened he has become more and more fatigued. After several hospitalizations – including one
on which he was placed on a ventilator – Javier is now afraid to leave the house for fear that his dyspnea
will be triggered by the exertion. He sleeps fitfully, is losing weight, and has withdrawn even from
Selena, who is herself exhausted with the task of caring for Javier and anxious over their future.

Palliative Care

- An active intervention with the goal of achieving the maximum effort and function of the total
patient.
- It should be an integral part of the entire spectrum of patient care.
- Palliate and Pallium – cloak and conceal.
- Maximizing comfort of the patient who is terminally ill is a goal of home care.
- Palliative care involves control of the symptoms such as pain and dyspnea in the terminally ill
patient while maximizing the psychological and spiritual well-being of the patient.
- Respiratory therapists may play a key role when lung disease is present on the terminally ill
patient.

WHO

- An approach that improves the quality of life of patients and their families facing problems
associated with life-threatening illness.

GOAL

1. Provides relief from pain and other distressing symptoms.

2. Affirms life and regards dying as a normal process.
3. Intends neither to hasten nor postpone death.
4. Integrates the psychological and spiritual aspects of patient care.
5. Offers support system to help patient live as actively as possible until death.
6. Offers support system to family to cope during the patient’s illness and in their own
bereavement.
7. Uses team approach to address the needs of patients and their families.
8. Will enhance quality of life and ay positively influence the course of illness.

Substantive Criteria

1. Patients who determine that the small probability of cure or reversal, or the brief period of
remission offered by indicated curative interventions are outweighed by the burdens of pain and
suffering caused by the interventions.
2. Patients for whom the benefits of prolonged life, as defined by the patient or the surrogate, are
outweighed by the burdens of an unrelievable pain and suffering caused by the disease process.
 3. Patients whom the benefits of prolonged life, as defined previously by the patient in advance
directive or contemporaneously by the surrogate are unexperienced because the patient is
cognitively unaware or unresponsive to his surroundings.
4. Patients for whom all indicated medical, surgical, radiological, and chemotherapeutic options
have been attempted and found ineffective in curing or reversing the disease process.
5. Patients for whom diagnostic evaluation reveals that no medical, surgical, radiological, or
therapeutic options offer any likelihood of curing or reversing the disease process.
6. Patients for whom no cure is possible, but for whom there is the certainty of substantial
likelihood that therapeutic intervention will produce short-term benefit in improved comfort or
function.

Palliative Care Principle and Guidelines

1. Philosophy
Promoting the patient’s physical and emotional comfort is always a therapeutic GOAL.
A multidisciplinary undertaking involving the patient and family.
2. Assessment
An accurate determination and assessment of patient’s diagnosis sand prognosis forms the basis
of a care plan that adequately reflects the patient’s care needs.
3. Communication
Health care provider have the responsibility to facilitate communication with patient and family
in providing information.
4. Skills and Knowledge
Skilled health workers in identifying the physical and emotional symptoms exhibited by the
patients at the end of life and the various available treatment.
5. Education
Health care givers and researchers have the responsibility to study the effectiveness of palliative
care protocols and interventions.
6. Pain Management
Health care providers must be skilled in pain assessment.

Ethics in Palliative Care

1. Autonomy
2. Beneficence
3. Non Maleficence
4. Justice