NCM 108 (First Trinal)

CI: Paulo News Bioethics

Ethics - Study of the morality of human conduct

concerning human life in all its aspects from
- Science of the morality of human conduct or the moment of its conception to the natural
human act. end.
- Goodness or badness or the rightness or - Or the philosophical discipline that deals
wrongness of the human act. with the morality of human conduct.
What makes good, good? - Bio = “life”
- Ethos =“ethics”
- An act is good when it is in the agreement or
in conformity with the dictates of right Health Ethics
reason.
- Study of the morality of human conduct
What makes reason, right? concerning health and health care.
- Regulate human conduct in the practice of
- Reason is considered right when it is in health care so that good may be done and
conformity with the truth. evil may be avoided.
Truth

- Universally acceptable to all human persons, FILIPINO PRIMARY PRINCIPLES OF

regardless of time, and space. BIOETHICS

Grouped into 3 main divisions:

ETHICS VS. MORALITY 1. Goodness
2. Beneficence
Ethics
3. Family
- Formal, systematic study of moral beliefs
Goodness
Morality
- Justice, respect for autonomy, compassion,
- Adherence to informal personal values veracity, fidelity, and confidentiality.
- Filipinos practice delicate and generous
RELATION hospitality.
- Lending of money, materials, equipment,
morality ethics
and even human resources (bayanihan)
Both deal with human act or human conduct - Kababayan (compatriots)
- Utang na loob (indebtedness or gratitude)
Ethics studies about morality - Keeping secrets even if it would have been
more charitable to reveal the secret
Morality gives ethics a perspective of what to study about (confrontive dialogue)
that is the rectitude of whether an act is good or bad.
- Guise of being good and not hurting the
feeling of others.
Morality provides ethics with quality that determines and - Telling the truth should be done with
distinguishes right conduct form wrong conduct. compassion and full of respect (appropriate
timing and suitable occasion)
- Filipinos’ gift of pakiramdam (sensitivity)
- Motivating guideline in caring the patients

DISTINCTION Beneficence
Morality ethics
- No harm should be done to anyone
Morality pertains to the Ethics pertains to the
application of this knowledge knowledge of what to study - Contribute to welfare and growth
in the performance of human about that is the goodness or - Connotes blessings, act of mercy, kindness,
act. evil of a human act. charity, altruism, love, humanity
- Moral obligation to act for benefit of others
Morality provides ways in Ethics provides learning about
Family
practicing what is learned. morality of a human conduct.
- Important constitution in Filipino culture
- Solid bank one can rely on where
The “flesh” The “word” withdrawal of help and support is endless
Indicates the “practice” Indicates that “theory” and the resources is never exhausted.
- Parents are looked up to as mature,
respectable, responsible adults.
- The kind of our personhood often depends
on the nurturance, rearing and breeding we
have from the family.
 - Based on the notion of pleasure

ETHICAL THEORIES

Each theories emphasizes different points , a Act Utilitarianism

different decision making styles, or a decision rule
such as predicting the outcomes and following one’s - A person acts that benefit the most people
duties to others. They are considered in making regardless of personal feeling or societal
ethically correct decisions. In the absences of ethical constraints such as laws.
theories is one’s is a loss in determining in morality - Disadvantages: one individual’s right may
in human acts are determining a sound in moral be infringed upon in order to benefit a
assessment in relation of an action. greater number of people.

Deontology or Formalist Theory Rule Utilitarianism

- Deon = obligation or duty - Take into account the law

- Logos = inquiry or study - Concerned with fairness
- Coined by Charlie Dunbar Broad (1857- - Seeks to benefit the most people but through
1971) fairest and most just means available
- Means ethical study or ethical inquiry - Values justice
regarding duty - Includes beneficence
- States that people should adhere to their - Disadvantages: use life experiences to
obligations and duties when engaged in attempt to predict outcomes but sometimes
decision making when ethics are in play. no one can be certain that one’s predict will
be accurate.
Flaw of Deontology
Virtue Ethics
- No rationale or logical basis for deciding
and individual’s duties - Puts much weight on the moral character of
- Puts focus on the rightness and wrongness the person rather that what he/she has done.
of action - Character rather than the consequences of
- Moral standard or principle exist action is the focal point in drawing moral
independently of the ends or consequences decisions
- In nursing: The nurse has duty to act based - Judges the person through his character by
on one relevant principle or most relevant of what he does.
several principles. - Judges a person by his/her character rather
than by an action that may be deviate from
Teleological Ethics his normal behavior
- Takes the person’s moral reputation and
- Telos = end or purpose
motivation into account when rating an
- Logos = science
unusual and irregular behavior that is
- Derives moral obligation from what is
considered unethical.
considered good or bad desirable as an end
- Virtue is usually construed as an act fitting
or purpose to be achieved
to a man.
- The rightness and wrongness of decisions
- Disadvantages: it does not make into
based on the outcomes
considerations a person’s change in moral
- “consequence-oriented theory”
character.
- Utilitarianism
- The focus in on the consequences of the act Beauchamp & Walters
that is executed by the agent premised on the
purpose or reason why the agent performs - A virtuous person is one whose inner self or
the act. character is always trained toward choosing
and doing what is good.
Utilitarianism - A morally good person will more likely:
a) Understand what should be done
- “The greatest good for the greatest
b) Perform required acts
number”
c) Form an act on moral ideals
- Choice that yields the greatest benefit to the
most people is the one that is ethically Ted Chambers
correct.
- Primary motive happiness and/or pleasure in - A virtuous professional is:
their highest degree to its greatest number of a) One who can discern the right
recipients. course of action in the situation
without relying on principle &
rules.
b) One who desires to do what is right
TWO TYPES OF UTILITARIANISM and avoid what is wrong
Act utilitarianism (eudaimonistic) Plato’s 4 Basic Virtues
- Based on the notion of happiness a) Wisdom – arises in the rational soul
Rule utilitarianism (hedonistic) b) Courage – in the spiritual soul
c) Temperance – in the appetitive soul
 d) Justice – comes when there is an - Signifies bravery and fearlessness
equilibrium among wisdom, courage, and
temperance.

Aristotle’s 2 Kinds of Virtues Bravery

a) Intellectual Virtues – arise from teaching - Applies to a kind of courage that is shown
and through the reflection of theoretical by the bold, fearless, and daring action in the
moral truths and the discovery of rational presence of danger.
principles that ought to control actions.
b) Moral Virtues – arises as a consequence
habit or one’s habitual choice of action in VICES OF HEALTHCARE PROVIDERS
consonance with rational principles.
An evil fault, an imperfection, an immoral
conduct, tendency, and practice or habit.

VIRTUES OF HEALTHCARE PROVIDERS Fraud

Nurses spontaneously and consistently show - Taking advantage over another by

in their personal and professional life their misrepresentation, false suggestions, or by
wholehearted support in upholding applicable laws, suppression of truth.
code of ethics, policies, and promise entered into - It can be actual or constructive
with clients/patients.
Actual Fraud
Clinical Virtues
- Consists in deceit, artifice, trick, design and
- Character traits that dispose nurses to some direct and active operation
provide good care to patients, families, and
communities. Constructive Fraud

Fidelity - Consists of act of commission or omission

contrary to legal or ethical duty, trust or
- Steadfast faithfulness associated with pledge confidence reposed.
of loyalty or the practice of keeping
promises. Pride

Honesty - High opinion of oneself that suggests neither

proper self-respect nor personal dignity;
- Quality of being honorable an upright in suggests an unpleasantly assertive manner.
character and actions.
Greed
Integrity
- Quality of wanting more than one’s share;
- Implies more directly to character than to synonymous to avidity, avarice, cupidity,
actions, and it is the soundness of character covetousness.
and possession of very high standards of
right and wrong.

Humility CORE VALUES OF PROFESSIONAL NURSES

- Meekness of heart; calls for submission, The 6 C’s of Caring in Nursing

docility, and courtesy Compassion
Respect
- Awareness of one’s relationship to others,
- Esteem or honor by which a person shows sharing their joys, sorrows, pain and
recognition or high regard to self-worth, accomplishments.
self-respect with dignity, respect for Competence
authority, and respect for others with
tolerance. - Having the knowledge, judgment, skills,
energy, experience and motivation to
Compassion
respond adequately to others with in the
- Signifies sympathy; implies feeling for demands of professional responsibilities.
another’s sorrow or hardship that leads to Confidence
help or pity.
- The quality that fosters trusting relationship
Prudence
comfort with self, client, and family
- Signifies carefulness, precaution, Conscience
attentiveness, and good judgment as applied
to action or conduct. - Morals, ethics, and an informed sense of
right and wrong; Awareness of personal
Courage
responsibility
Commitment Right to informed decision

- Convergence between one’s desires and - Information and Understanding are

obligations and the deliberate choice to act necessary for genuine deliberation.
in accordance with them - The patient can’t make moral decisions
unless this two elements are present.
Comportment
- Refers to the necessary information of and
- Appropriate bearing, demeanor, dress, and decision on a medical treatment before the
language, that are in harmony with caring latter is carried out.
presence. -

FOUR MAJOR ELEMENT OF INFORMED

ETHICAL PRINCIPLES CONSENT

1. Respect for autonomy 1. Competence

- Autos = self - Refers to the capacity of patient for decision
- Nomos = rule or law making.
- Refers to self-rule - One if competent if:
- Ability to make a choice free from external a) One has made a decision (can
constraints choose between alternatives)
- Implies independence and firmness in one’s b) One has a capacity to justify one’s
conviction, perspective, or personal stance. choice (give reason why that us the
- Healthcare providers are duty bound to: choice) and choice made done in
reasonable manner.
a) Acknowledge the autonomy of their
patients
2. Disclosure
b) Recognize and appreciate the views,
decisions, choices, beliefs, and values - Refers to the content of what a patient is told
of their patients. or informed about during the consent
negotiation.
Patients’ rights
3. Comprehension
- Moral and inviolable power vested in him as - Refers to whether the information given has
person to do, hold, or demand something as been understood.
his own.
- Every tight involves corresponding duty in 4. Voluntariness
others to respect this right and not violate it. - Means the consent must be voluntary; agree
Types of Patient’s Right on his own volition; patient owns the
decision, it is patient’s decision alone, had
- The patient as an individual person has the chosen the decision or option based on the
moral right to determine what is good for information disclosed to him.
himself.
Right to refusal of treatment
Beauchamp and Walter (1979)4 patient’s rights:
- The patient has the right to refuse treatment
a) Right to informed consent to the extent permitted by the law and to be
b) Right to informed decision informed of the medical consequences of his
c) Right to informed choice action.
d) Right to refusal of treatment

Right to informed consent

LIMITATIONS OF A PATIENTS’ RIGHTS
- Refers to the knowledge of necessary
information a patient should know about in 1. Patient’s rights do not include the right to be
order to be able to give consent based on allowed to die.
his/her value system. 2. A patient in a moribund (dying) condition
- The patient have a right to know the does not possess the necessary mental or
necessary information concerning the emotional stability to make an informed
treatment and diagnosis in order to be able choice
to give consent based on her/his value 3. Patient’s rights are not absolute.
system.
- The patient have a right to inform about the
possible alternative course of the action TWO TYPES OF INFORMED CONSENT
taken together with the possible
Written Consent
consequences.
- Signed during admission
Right to informed choice
Verbal Consent
- A patient should know about the necessary
information about a medical treatment or - Verbally signifies willingness to undergo
experiment before it is administered so that medical treatment
moral choice can be made.
Informed Consent
 - Emergency cases – do not need IC seriously ill unable to make or communicate
a) Comatose or obtunded patients a decision of their choice.
b) Blind or illiterate patients - Legal instructions regarding preferences for
c) Under aged patients or those unable to medical care if one is unable to make
understand the circumstances decisions for themselves.
d) Language barrier
PATIENT’S BILL OF RIGHTS
2. Privacy
The patient has the right: - Refers to the right to be free from
1. To considerate and respectful care interference.
2. To obtain form his physician complete - Enables individuals to exert control over
current information concerning his their own lives which includes:
diagnosis, treatment, and prognosis in terms - Deciding who should have access to
that the patient can be reasonably expected personal information
to understand. - When and how this information will be
3. To receive form his physician information disclosed
necessary to give informed consent prior to 3. Confidentiality
start of procedure or treatment. - Refers to the duty to protect privileged
4. To refuse treatment to the extent permitted information and to share entrusted
by the law and be informed of the medical information responsibility.
consequences of his action. - Personal information should be treated with
5. To every consideration of his privacy respect.
concerning his own medical care program - It relates in the concept of privacy.
( the issue here is one of privacy and simple 4. Veracity
courtesy) - Obligation to tell the truth and not to be lie
6. To expect that all communication and or deceive others.
records pertaining to his care should be - It is difficult to achieve; it is not difficult to
treated as confidential. tell the truth but it quite hard to decide how
7. To expect that within its capacity, the much truth to tell.
hospital must provide a reasonable response - Telling the truth is communication to the
to his/her request for services. patient.
8. To obtain information regarding any - Deception can take many forms:
relationship of his hospital to other health a) Intentionally lying, non-disclosure of
care and educational institutions in so far as information, or partial disclosure of
his care is concerned. information.
9. To be advised if the hospital proposed to 5. Fidelity
engage in or perform human - Means faithfulness and keeping promises
experimentation affecting his care or - Ethical foundation of nurse-client
treatment.
relationship
10. To expect reasonable continuity of care
- Clients have an ethical right to expect nurses
11. To examine and receive an explanation of
to act in their best interest.
his bill, regardless of source of payment.
6. Justice
12. To know what hospital rules and regulations
- Jus = right
apply to his conduct as a patient.
- Right entails a context of relation since it is
Proxy Consent/Legally Acceptable Representative a correlative duty
- The true meaning of justice can only be
- The process by which people with legal achieved in the ambiance of relation
right to consent to medical treatment for - One can give each human person his/her due
themselves or for a minor or a ward delegate only in the context of a relation.
that right to another person.

TWO KINDS OF JUSTICE

TWO TYPES OF PROXY CONSENT FOR
ADULTS 1. General Legal Justice
- Classified into equity and common legal
a) Power of attorney to consent to medical justice
care
- Refers to human person’s wishes and proper
- Usually used by the patients who wand
actions in consonance with the common
medical care but are concerned about who good
will consent if they rendered temporarily
- Has affinity with laws since laws are made
incompetent by the medical care.
not only for the good of certain individual
- Delegates the right to consent to a specific
but for the good of the whole community.
person
Equity
b) Living will
- A document that indicates a patient’s - Human person judges, wills, and does what
wishes regarding their health care and how is right to others not necessarily from the
they want to be treated should they become
 injunction of the moral law but from civil - One must inculcate the right thought (one of
law the 8th fold paths in Buddhism) which
requires the mind to be free form impurities
Common Legal Justice
like harm, ill-will, cruelty, and lust.)
- Human response shows proclivity to will Hindus
and do something for the good of others in
accordance with the moral law or with the - “ahimsa” which means non hurting of all
prescription of civil law. forms of life
- - It is clear that the mandate on preventing
2. Particular Justice harm or evil to self and others as well as
- Classified into commutative justice and mandate on the promotion of good is a
distributive justice universal phenomenon.
- Pertains to wishing and doing what is right
in relation to another person who is
accounted as an individual with an inherent 8. Nonmaleficence
right to his/her own private good. - Understood as the overriding principle
through which everyone is required to
Commutative Justice undertake the caring of the patient
- Deals with fairness of exchange - Capsulized in the phrase “do not harm”
- Exist in the relationship between individuals - Injunct one’s avoidance of inflicting injury,
or between entities like nations or harm, or pain to others.
corporations

Distributive Justice

- Refers to a person’s will to share the goods

which belong to a community or to
individual who are part of his her/his
community.
- Sharing of nation’s wealth

7. Beneficence
- Duty to do good and active promotion of
benevolent acts (goodness, kindness,
charity)
- Guides the decision maker to do “what is
good and right”
- Stipulates that one should strive to achieve
the greatest amount of good because people
benefit from the most good
- Requires nurses to abstain from injuring
patients
- Taking care of the patient is a beneficent act.

William Frankena’s 4 Elements of Beneficence

a. One ought not to inflict evil or harm

b. One ought to prevent evil or harm
c. One ought to remove evil or harm
d. One ought to do or promote good

Chinese

- Believes that everyone shares the same

nature hence, they assert that others are as
human as they are
- Leads Kong Zi preach his signature “golden
rule”
- “Do unto others what you want others do
unto you”
- “Do not do unto others what you do not
others do unto you.”

Buddhist