2.

Teleological - goals and consequences

BIOETHICS 3. Consequentialism – theory whether something
is good or bad depends on its outcomes
First Examination 4. Utilitarianism
- theory of morality that advocates actions
1.1 Definition of Terms that foster happiness and oppose actions that
 Ethics - investigates moral duties, values, and cause unhappiness
ideal human character - promoting pleasure and avoiding pain
 Morals/Duty - actions that have to be done and
should be done
 Morality - rules of conduct 1.4 Virtue Ethics in Nursing
 Philosophy - intense and critical examination  A person of good character will tend to
of beliefs and assumptions behave in ways that are consistent with their
 Values - one's judgment of what is important in character
life
 Beliefs - acceptance that a statement is true or
that something exists 1.5 Qualities and Characteristics of Caring
 Virtues - high moral standards  compassion
 Conscience - being innate and instinctive.  competence
 confidence
 conscience
1.2 Ethical Theories  commitment
1. Deontological
a. duties and rights
b. duties are actions that we feel we ought
to do or should do
1.6 Core Values of Professional Nurse 1.8 Personal and Professional Values
PROFFESION - calling requiring specialized Personal values
knowledge
 concepts and ideals that provide meaning to a
PROFESSIONAL - conforming to the technical person’s life.
or ethical standards  come from the family, school, religion and the
norms of community and society.
 According to Chitty (2001), nursing is a
 Examples are honesty, integrity, and respect for
service profession
others.
Professional values
1.7 American Nurses Association (ANA) Code of
 espoused by a profession.
Ethics
 two basic values:
 adopted in 1950, and the latest revision o Competency - integration of the
of the Code occurred in 2001 attitudes, knowledge, skills
 a framework for ethical decision-making by o Compassion - sympathetic pity and
members of the profession. concern for other
 respect for human dignity, confidentiality,
incompetent and unethical practice of peers, Professional incompetence
accountability for personal nursing judgments  gross negligence,
and decisions, and maintenance of personal  failure to adhere to the applicable standard of
competence.  care
 stresses the nurse’s obligation to the patient,  incapacity or incompetence to practice nursing
and the responsibility to be accountable to self
and to the profession.
1.9 ETHICAL PRINCIPLES 9. Right to safety and quality care according to
standards - hygienic and sanitized
1. Autonomy
environment
2. Confidentiality
10.Right to choose alternative treatment options
3. Veracity
if available - consider treatment alternatives
4. Fidelity
and even refuse treatment.
5. Justice
11.Right to choose source for obtaining
6. Beneficence
medicines or tests - provide patients with
7. Nonmaleficence
goods and services they require.
12.Right to proper referral and transfer - free
1.10 17 PATIENTS RIGHTS from perverse commercial influences.
13.Right to protection for patients involved in
1. Right to information - what is the illness clinical - comply with Directorate General of
2. Right to records and reports access his/her Health Services.
medical records and investigation 14.Right to protection of participants involved
3. Right to emergency care - emergency medical in biomedical and health research - should
care follow the National Ethical Guidelines for
4. Right to informed consent - right to be asked Biomedical and Health Research Involving
for their informed consent. Physician explains. Human Participants.
5. Right to confidentiality, human dignity and 15.Right to take discharge of patient, or receive
privacy - strict confidentiality body of deceased from hospital - may not be
6. Right to second opinion detained
7. Right to transparency in rates, and care 16.Right to Patient Education - know about
according to prescribed rates - display the public health services such as insurance
rates schemes and charitable hospitals.
8. Right to non-discrimination - don’t deny 17.Right to be heard and seek redressal:
treatment feedback and comments to their health service
1.11Informed Consent
1.12 OTHER RELEVANT ETHICAL
 agreement or permission for care, treatment, or
PRINCIPLES
services.
 Proxy Consent / Legally Acceptable
Representative Principles of Double Effect
o lacks capacity to make decisions;
continue to treat that person  a good effect and an evil effect will result from
o incapacitated and over 16 years of age good cause
can appoint a person to make decisions  Issues and Concerns:
for them o act itself must be morally good
 Keeping privileged information private o bad effect is sometimes said to be
o state of being free from public scrutiny indirectly voluntary
o Justify Violation of Confidentiality: o good effect must follow
 detrimental to the common good; o good effect should compensate for the
 intends to inflict grave injury bad effect.
 avert grave injury
Principles of Legitimate Cooperation

1.12  working with another

 Formal Cooperation – person formally
 Veracity – Truthfulness cooperating to an act
 Fidelity - keep vows and promises  Material Cooperation – involvement to the
 Justice – fairness intention of an act
 Beneficence – produce good  Direct and Indirect Cooperation
 Non – maleficence – do no harm  Proximate and Remote Cooperation
  Voluntary sterilization - person wills
and requests that the procedure be done
Principle of Common Good and Subsidiarity
on himself or herself.
 individuals have right to participate in decisions  Involuntary/ Compulsory - order of the
that directly affect them public authority of state
 should be made at the most appropriate level  Purpose:
 not withdraw those decisions or choices o Therapeutic Sterilization - removal of a
reproductive organ to save one’s life
o Eugenic/social sterilization – hindering
Principle of Stewardship and Roles of Nursing as the conception of undesirable and
Stewards physical or mentally infit offspring
 stewards or caretaker o Punitive Sterilization - punishment for
 human life comes from God, and no individual crime or antisocial behavior, particularly
is the master of his/ her own body rape and other sex related offenses
 Justification:
o serious illness
Principle of Totality and Integrity o probability of genetic abnormality
 well -being of the whole person must be taken o severe financial burden
into account o child bearing puts one’s health in danger
 whole is greater than any of its parts.  Preservation of Bodily Functional Integrity
 Contraception - voluntary prevention of o constrain what we should be allowed to
conception by the positive use of artificial do to human bodies or their constituent
means parts
 Sterilization / Mutilation - cutting off the o body whole and intact and free from
sexual capacity in a man or a woman physical interference
 Organ Donation
 o Living organ donation o fill in the role of an educator, facilitator
o Deceased organ donation of care, administrator, counselor and
advocate
 Role of nurses as stewards:
Principle of Ordinary & Extraordinary Means o Personal
 Ordinary means – has benefit/success; does o Social
not present an excessive risk and are financially o Ecological
manageable o Biomedical
 Extraordinary means - no benefit/success;
excessive risk and are not financially
manageable Lesson 2: Bioethics and its Application in Various
Health Care Situations
2.1Definition of Terms
Principle of Personalized Sexuality
 Viability - child’s capability to live
 understanding of sexuality as one of the basic independently
traits of a person and must be developed in  Abortion - expulsion of a living fetus before it
ways consistent with enhancing human is viable
dignity.  Natural abortion - expulsion of the fetus
through natural or accidental causes
Principle of Bioethics  Intentional abortion - induced expulsion of a
living fetus
 Ethical Stewardship  Therapeutic abortion- induced expulsion of a
o encourages fair, just and equal treatment living fetus in order to save the mother
that works for the good of the  Marriage - permanent union between a man
organization as a whole and a woman
 Euthanasia - death, in an easy,
  painless way, of an individual suffering from an o someone other than their marriage
incurable condition or disease. partner
 Dysthanasia - means slow and painful death o Contraception - rightness or wrongness
without quality of life. of the use of various methods
 Orthonasia – a normal or natural manner of
Artificial Insemination
death and dying
 Advanced directives –spell out decisions  depositing a man’s semen in the vagina,
about end-of-life care cervical canal
 Assisted Suicide – sick person wishes to  types:
terminate their own life but needs help to carry o Homologous Insemination – semen is
out such act from the husband
 DNR – Do Not Resuscitate order o Heterologous Insemination – semen is
from a donor
 Methods of Homologous:
Sexuality and Human Reproduction o Homologous AI – transfer into a
 experience and express ourselves as sexual woman’s vagina of the sperm previously
beings extracted from her husband
 procreation as the natural purpose of sexuality, o Homologous IVF/ET – facilitate a
and thus sexual activity not aimed toward human conception through in vitro
procreation is prohibited. fertilization
 Issues:  Methods of Heterologous:
o Premarital sex- two people who are not o Heterologous AI - transfer into the
married to genital tracts of the wife of the sperm
o Extramarital sex -is when a married previously extracted from a donor other
person engages in sexual activity with than the husband
 o Heterologous IVF/ET – vitro  Indirect abortion –the removal of the fetus
fertilization of the generative cells taken occurs as a secondary effect of legitimate or
from at least one donor other than the licit action. Double effect principle.
two spouses in marriage

Justifications for the expulsion of the fetus:

Surrogate Motherhood/Surrogacy  Personal - freedom of choice, giving centrality
 a fertilized ovum is implanted into the uterus of to the sovereignity of the individual’s
another woman who will carry the baby to term conscience
 Surrogate means substitute, from the Latin  Social reasons
surrogatus “in place of another”  Fetal reasons - preventing the births of
malformed or defective children

Morality of Abortion and Problems Related to

Destruction of Life Dignity in Death and Dying
Types of Abortion:  Dignity - worthiness and nobility. offering
options to terminally ill patients other than
 Natural abortion/ Spontaneous/ Miscarriage
just waiting for the illness to kill them slowly
- unintentional and involuntary
 Death
 Direct /intentional abortion
o Physiological definition - heart has
 Therapeutic abortion - end a pregnancy when
stopped beating
the mother's life is in danger or if the baby has
o Religious or philosophical definition -
abnormalities
 Eugenic abortion – certain defects are separation of body and soul
discovered in the developing fetus. o Brain death - brain is completely
destroyed
 o Cellular definition - disintegration and Orthonasia
breakdown of the metabolic processes of  normal or natural manner of death and dying
the body’s substance

Advanced Directives
Euthanasia
 The living will
 “easy death” (from the Greek eu-easy thanatos- • Durable power of attorney for health
death) care/Medical power of attorney
 Painless, peaceful death • POLST (Physician Orders for Life-
 Active (Positive) Euthanasia - act of Sustaining Treatment)
commission insofar as it is voluntary. Lethal • Do not resuscitate (DNR) orders
substances • Organ and tissue donation
 Passive (Negative) Euthanasia - act of
omission insofar as one simply refuses to take
anything to sustain life DNR or End of Life Care Plan
 Assisted suicide - sick person wishes to
terminate their own life but needs help to carry  instructs health care providers not to do
out this act cardiopulmonary resuscitation (CPR)

Dysthanasia ETHICAL DECISION-MAKING PROCESS:

 extending the life of terminal patients, but Death and Dying

subjects them to much suffering  ethical dilemmas:
 bitterness or aggressive therapy • Taking credit for others' work
 • Offering a client a worse product for 2. Data Collection - review of ethical codes,
your own profit published evidence-based practices, declaratory
• Utilizing inside knowledge for your own statements, professional position papers and the
profit professional literature.
 ethical dilemmas in healthcare 3. Data Analysis - all possible solutions and
• Advance directives alternatives to resolve the ethical dilemma are
• Surrogate decision making explored and evaluated.
• Refusal of treatment 4. Selecting the Best Possible Solution -
• Conflicts with caregivers potential solutions and alternatives are
• Foregoing life-sustaining treatment considered
• Do Not Attempt Resuscitation (DNAR) 5. Performing the Selected Desired Course of
orders Action to Resolve the Ethical Dilemma –
 ethical issues faced by nurses intervention and acting
• Protecting patients' rights and human 6. Evaluating the Results of the Action - actions
dignity, to resolve ethical issues are evaluated and
• Providing care with possible risk to their measured in terms of their effectiveness
own health,
• Informed consent,
• Staffing patterns that limited patient
access to nursing care

Ethical Decision-Making Process

1. Problem Definition - clear description of the
ethical dilemma and the circumstances