ETHICAL PRINCIPLES

Sources of Ethical Principles

Key Laws

● Eternal Law: God's universal plan for moral order.

● Natural Law: Human understanding of eternal law through reason.

Conscience Formation

● Learn moral laws, seek expert advice, pray for guidance, and practice self-reflection.
● Characteristics: Free, clear, correct, and responsible judgment.

Principle of Well-Formed Conscience

● Act responsibly with informed, morally certain decisions.

Universal Ethical Principles

1. Autonomy
○ Patients have the right to make informed decisions about their care.
○ Includes informed consent, where patients voluntarily agree to treatment
with full knowledge of risks and benefits.
2. Beneficence
○ Act in the patient’s best interest to promote well-being.
3. Non-Maleficence
○ "Do no harm." Avoid actions that worsen a patient’s condition.
4. Justice
○ Ensure fairness in resource allocation and treatment.
5. Veracity
○ Truth-telling and respecting the patient’s right to accurate information.
6. Fidelity
○ Faithfulness to commitments and maintaining trust in patient relationships.

Patient’s Rights and Bill of Rights

Patient’s Rights

● Respect and dignity.

● Access to medical records and privacy.
● Freedom to make treatment decisions, including refusal of treatment.
● Informed end-of-life care choices.

Patient’s Bill of Rights in the Philippines

 ● A framework ensuring ethical treatment of patients during healthcare delivery.

Informed Consent

1. Principles
○ Protects patient autonomy.
○ Ensures decisions are voluntary and well-informed.
2. Four Requirements
○ Decision-making capacity.
○ Documentation of consent.
○ Disclosure of relevant information.
○ Comprehension of the provided information.
3. Conditions Fulfilled
○ Voluntary decision-making.
○ Understanding of risks, benefits, and alternatives.
○ Deliberate and careful consideration.

Proxy Consent

● Legal delegation of medical decision-making authority.

Confidentiality and Privacy

● Confidentiality: Obligation to protect patient information from unauthorized access

or disclosure.
● Privacy: The right of individuals to control their personal and medical information.

Additional Ethical Principles in Practice

Principle of the Inviolability of Human Life

● Respect and defend human dignity. Avoid harm to human life.

Principle of Freedom and Responsibility

● Recognize personal accountability and autonomy in healthcare decisions.

Principle of Totality and Bodily Integrity

● Preserve and care for all aspects of a patient’s physical and mental health.

Principle of Subsidiarity and Sociality

 ● Promote community involvement in achieving the common good, empowering
individuals to meet their own needs.

Application in Nursing Settings

1. Informed Consent
○ Ensure patients understand and voluntarily agree to treatments.
2. Confidentiality
○ Protect sensitive information in patient records and communication.
3. Justice in Care
○ Allocate resources fairly, especially in underserved communities.
4. Veracity and Fidelity
○ Communicate honestly and honor commitments to build trust.
5. Beneficence and Non-Maleficence
○ Balance actions to promote good and minimize harm during patient care.

Summary

Nursing ethics revolves around respecting human dignity, patient autonomy, and the
principles of beneficence, non-maleficence, justice, and fidelity. Understanding and applying
these principles in clinical practice ensures compassionate, fair, and ethical patient care.

D. Other Relevant Ethical Principles

1. Principle of Double Effect

This principle applies when an action has two effects: one intended and morally
good, and another unintended but foreseen and potentially harmful. It is used in
clinical scenarios such as administering pain relief that may hasten death (e.g.,
palliative care). The principle requires the following conditions to be met:
○ The action itself is morally neutral or good.
○ The intended outcome is good.
○ The harmful effect is not the means to the good effect.
○ There is a proportionate reason for permitting the harmful effect.
2. Principle of Legitimate Cooperation
This principle addresses ethical concerns when a person or group cooperates with
others in acts that may be morally wrong. It distinguishes between:
○ Formal cooperation (active agreement, morally impermissible).
○ Material cooperation (indirect involvement, which may sometimes be
permissible depending on the degree and necessity). Nurses must discern
their level of involvement in ethically questionable procedures.
3. Principle of Common Good and Subsidiarity
 ○ Common Good: Promotes actions that benefit the well-being of all members
of society, respecting human dignity and solidarity.
○ Subsidiarity: Emphasizes empowering individuals and smaller communities
to make decisions rather than imposing control from higher authorities.
Nurses advocate for patient autonomy and holistic care in this framework.

Principles of Bioethics

1. Principle of Stewardship and Role of Nurses as Stewards

Nurses act as stewards of care by ensuring resources and actions promote patient
welfare across several dimensions:
○ Personal: Responsibility for individual patient health.
○ Social: Advocacy for public health and equity.
○ Ecological: Awareness of environmental impacts of healthcare practices.
○ Biomedical: Ethical use of technology and treatments in patient care.
2. Principle of Totality and Its Integrity
○ Nurses have an ethico-moral responsibility to ensure surgical interventions
preserve the overall integrity of the patient.
○ Decisions involving sterilization, mutilation, or bodily alteration require careful
consideration of medical necessity and respect for the patient's dignity.
○ Organ donation issues should balance altruism, informed consent, and the
preservation of functional bodily integrity.
3. Principle of Ordinary and Extraordinary Means
This principle differentiates between morally obligatory (ordinary) treatments that
offer significant benefit without excessive burden and non-obligatory (extraordinary)
treatments that may be disproportionately burdensome. Nurses help guide patients
and families through these distinctions during end-of-life care or complex medical
decisions.
4. Principle of Personalized Sexuality
Recognizes sexuality as integral to human dignity and individuality, requiring
healthcare professionals to approach sexuality-related issues (e.g., reproductive
health) with respect for personal values, autonomy, and ethical standards.

Ethical Decision-Making in Bioethical Issues

The application of these principles helps guide ethical decision-making in healthcare by

emphasizing a balance between professional responsibilities, patient rights, and moral
values. Nurses, as frontline caregivers, play a crucial role in navigating these principles
through advocacy, education, and compassionate care.

A. Sexuality and Human Reproduction

1. Human Sexuality and Its Moral Evaluation

● Human Sexuality: An essential aspect of personhood, integrating physical,

emotional, and spiritual dimensions.
● Moral Evaluation:
○ Respects human dignity and the procreative and unitive purposes of sexuality.
○ Sexual acts must align with ethical principles promoting love, fidelity, and
openness to life.

2. Marriage

● Fundamentals of Marriage:
○ A lifelong union founded on mutual love, fidelity, and openness to procreation.
○ Serves both the well-being of spouses and the nurturing of family life.
○ Recognized as a sacred institution with moral obligations for both partners.
● Issues on Sex Outside Marriage and Homosexuality:
○ Sex Outside Marriage:
■ Includes premarital and extramarital sexual relations.
■ Considered morally wrong due to lack of commitment and violation of
marriage's sacred nature.
○ Homosexuality:
■ Respect for the dignity of individuals regardless of sexual orientation.
■ Moral teachings may uphold the view that sexual acts are ordered
toward procreation and unity within marriage.
■ Nurses are called to provide compassionate care without
discrimination while respecting patient values.
● Issues on Contraception:
○ Contraception is morally debated based on its impact on the procreative
purpose of sexual acts.
○ Ethico-moral responsibility of nurses includes:
■ Educating patients on family planning aligned with personal and moral
beliefs.
■ Respecting patient autonomy while providing ethical guidance.

3. Issues on Artificial Reproduction

Artificial reproduction introduces ethical concerns related to human dignity, natural

conception, and the sanctity of life.

● Artificial Insemination (AI):

○ Morality depends on whether it respects the dignity of marital intimacy and the
unitive-procreative purpose of marriage.
○ Nurses must educate patients and ensure ethical implications are considered.
● In-vitro Fertilization (IVF):
 ○ Raises issues of embryo destruction, commodification of life, and separation
of conception from the marital act.
○ Ethico-moral responsibility includes counseling on alternatives aligned with
moral principles.
● Surrogate Motherhood:
○ Ethical concerns include exploitation, commodification of women’s bodies,
and detachment from natural parenthood.
○ Nurses advocate for ethical alternatives while respecting patient choices.

4. Morality of Abortion, Rape, and Related Problems

● Abortion:
○ Considered the intentional termination of pregnancy, violating the principle of
the sanctity of life.
○ Nurses' responsibilities include:
■ Advocacy for the unborn while providing compassionate care to
mothers.
■ Educating about alternatives like adoption and support resources.
● Rape and Related Problems:
○ Requires sensitive care for survivors, emphasizing their dignity and autonomy.
○ Ethical responses to pregnancies resulting from rape include:
■ Supportive counseling.
■ Respect for patient choices within the moral framework.
● Destruction of Life:
○ Includes acts such as embryonic destruction in reproductive technologies and
late-term abortions.
○ Nurses must uphold life-affirming practices and provide education on ethical
considerations.

Key Role of Nurses in Bioethical Issues

● Advocacy: Promote patient rights, dignity, and informed decision-making.

● Education: Provide accurate, nonjudgmental information about reproductive health
and ethical considerations.
● Compassionate Care: Support patients while balancing personal, professional, and
ethical responsibilities.

B. Dignity in Death and Dying

1. Euthanasia and Prolongation of Life

● Euthanasia: The intentional act of ending a life to alleviate suffering.

○ Voluntary: Requested by the patient.
 ○ Non-voluntary: Without the explicit consent of the patient.
○ Moral Debate: Contrasts the alleviation of suffering with the sanctity of life.
● Prolongation of Life: Using medical interventions to extend life, even when they
may be burdensome.
○ Ethically requires discernment to determine when treatment shifts from being
beneficial to causing undue suffering.

2. Inviolability of Human Life

● The principle asserts that life is sacred and must be protected from conception to
natural death.
● It opposes euthanasia, suicide, and any action intending to harm life.
● Nurses' responsibilities include advocating for holistic care and providing emotional
and spiritual support.

3. Euthanasia and Suicide

● Euthanasia: Morally debated due to its conflict with the natural process of dying and
the principle of non-maleficence.
● Suicide: Requires a compassionate response, focusing on mental health care,
prevention strategies, and respect for patient dignity.
● Nurses are tasked with recognizing signs of distress and facilitating appropriate
interventions.

4. Dysthanasia

● Refers to prolonging life artificially, causing unnecessary suffering and delaying the
natural process of death.
● Ethical care involves recognizing when interventions become futile and prioritizing
patient comfort.

5. Orthothanasia

● Allowing death to occur naturally, without unnecessary medical interventions.

● Promotes comfort, dignity, and respect for the natural dying process.
● Nurses focus on palliative care, emphasizing symptom management and emotional
support.

6. Administration of Drugs to the Dying

● Medications are administered to relieve pain and suffering, even if they may hasten
death as a secondary effect (principle of double effect).
● Nurses must ensure drugs are given ethically, considering dosage, intent, and patient
needs.

7. Advance Directives

● Legal documents outlining a patient’s preferences for medical treatment at the end of
life.
○ Includes living wills and durable power of attorney for healthcare.
 ● Nurses play a critical role in educating patients and families about advance directives
and ensuring they are respected.

8. Do-Not-Resuscitate (DNR) or End-of-Life Care Plan

● DNR Orders: A decision to withhold resuscitative measures, respecting the patient’s

wishes and condition.
● End-of-Life Care Plan: Involves palliative care, addressing physical, emotional,
spiritual, and social needs.
● Nurses must provide compassionate, patient-centered care while supporting family
members.

C. Nursing Roles and Responsibilities

● Advocate: Ensure patients' values and wishes are honored in end-of-life care.
● Educator: Provide clear information to patients and families about care options,
advance directives, and the dying process.
● Caregiver: Offer physical, emotional, and spiritual support to alleviate suffering.
● Ethical Decision-Maker: Participate in interdisciplinary discussions to address
ethical dilemmas related to end-of-life care.

D. Ethical Decision-Making Process

1. Identify the Ethical Issue: Clearly define the dilemma.

2. Gather Information: Collect facts about the patient’s condition, values, and
preferences.
3. Consider Ethical Principles: Balance autonomy, beneficence, non-maleficence, and
justice.
4. Evaluate Options: Analyze possible actions and their consequences.
5. Consult Stakeholders: Collaborate with patients, families, and healthcare teams.
6. Make a Decision: Choose the most ethically justifiable course of action.
7. Implement and Reflect: Take action and review the decision’s impact for future
learning.

Bioethics Reviewer: Use of Evidence-Based Practice in Health Care

Ethics

I. Use of Evidence-Based Practice in Health Care Ethics

 ● Evidence-Based Practice (EBP) integrates clinical expertise, patient values, and the
best available research to improve patient outcomes.
● Ethical Considerations:
○ Ensures that practices are both effective and aligned with ethical principles
such as autonomy, beneficence, and justice.
○ Requires transparency, informed consent, and respect for individual
preferences in care decisions.

II. Bioethics and Research

A. Principles of Ethics in Research

1. Nuremberg Code (1947)

○ Established in response to unethical human experimentation during World
War II.
○ Key Principles:
■ Voluntary consent is essential.
■ Research must benefit society and avoid unnecessary harm.
■ Participants have the right to withdraw at any time.
2. Declaration of Helsinki (1964, updated periodically)
○ Issued by the World Medical Association to guide ethical research involving
human subjects.
○ Key Points:
■ Emphasizes informed consent and patient welfare.
■ Research must be scientifically valid and ethically reviewed.
■ Vulnerable populations require special protection.
3. Belmont Report (1979)
○ A foundational document for ethical research in the U.S., emphasizing three
core principles:
■ Respect for Persons: Autonomy and protection of vulnerable
individuals.
■ Beneficence: Maximize benefits and minimize harm.
■ Justice: Fair distribution of research risks and benefits.

B. Ethical Issues in Evidence-Based Practice (EBP)

● Consent and Autonomy: Ensuring patient understanding and voluntary participation

in EBP-based interventions.
● Justice and Equity: Addressing disparities in access to evidence-based treatments.
● Integrity and Transparency: Ensuring the use of reliable and valid evidence, free
from conflicts of interest.
● Cultural Sensitivity: Tailoring evidence-based interventions to respect diverse
patient values and beliefs.
C. Ethico-Moral Obligations of the Nurse in Evidence-Based Practice

1. Introduction to Good Clinical Practice (GCP) Guidelines

○ International standards for conducting ethical and scientifically sound clinical
research.
○ Nurses' Role:
■ Protecting participant rights and ensuring informed consent.
■ Monitoring for adverse effects and maintaining study integrity.
2. Guidelines and Protocol in Documentation and Health Care Records
○ Accuracy: Ensuring precise, thorough, and timely documentation.
○ Confidentiality: Protecting patient information in compliance with legal and
ethical standards.
○ Accountability: Upholding professional responsibility in reporting findings
and ensuring transparency.

Nurses' Responsibilities in EBP and Research

1. Advocate for Patient Rights:

○ Safeguard patient autonomy, dignity, and informed decision-making.
2. Ensure Ethical Research:
○ Verify that research protocols align with ethical standards and prioritize
participant welfare.
3. Promote Evidence-Based Care:
○ Stay informed about current research and apply evidence judiciously in
practice.
4. Collaborate with Multidisciplinary Teams:
○ Foster open communication to address ethical dilemmas in EBP and
research.
5. Foster Professional Growth:
○ Engage in continuing education to enhance competence in ethical and
evidence-based care.

Bioethics Reviewer: Ethical Considerations in Leadership and

Management

A. Moral Decision-Making

1. Principle of Moral Discernment

● Definition: The ability to distinguish between right and wrong in complex situations
by analyzing moral values and ethical principles.
● Application:
 ○ Leadership decisions in healthcare must balance the needs of individuals,
organizations, and the community.
○ Ensures that decisions prioritize patient well-being, equity, and fairness.

2. Principle of a Well-Formed Conscience

● Definition: A well-formed conscience is shaped by ethical principles, professional

standards, and moral reasoning.
● Key Elements:
○ Knowledge of ethical frameworks and the capacity to apply them.
○ Willingness to reflect on personal biases and prioritize the greater good.

3. Strategies for Moral Decision-Making Process

● Steps to Navigate Ethical Dilemmas:

○ Identify the ethical issue or dilemma.
○ Gather relevant facts and consider all stakeholders.
○ Evaluate options using ethical principles (e.g., autonomy, beneficence,
non-maleficence, and justice).
○ Consult interdisciplinary teams for diverse perspectives.
○ Make and implement the decision while ensuring transparency and
accountability.
○ Reflect on outcomes for future learning.
● Ethical Dilemmas in Leadership:
○ Balancing organizational goals with patient-centered care.
○ Addressing conflicts between resource allocation and staff or patient needs.

B. Meaning and Service Value of Medical Care

1. Allocation of Health Resources

● Ethical Principles:
○ Justice: Fair distribution of resources, ensuring equity among patients and
populations.
○ Efficiency: Optimizing resource use to maximize benefits and minimize
waste.
○ Priority Setting: Balancing individual needs with community health goals.
● Challenges for Leaders:
○ Scarcity of resources (e.g., ICU beds, medications).
○ Decisions about prioritizing care during emergencies or pandemics.
○ Addressing inequalities in resource distribution, especially in underserved
areas.

2. Issues Involving Access to Care

● Barriers to Access:
○ Socioeconomic disparities, geographic location, and systemic inequities.
 ○ Lack of insurance coverage or affordable healthcare services.
● Ethical Leadership Responses:
○ Advocate for policies promoting universal access to care.
○ Develop community outreach programs to serve vulnerable populations.
○ Foster an organizational culture that values inclusivity and health equity.

Key Responsibilities of Leaders in Ethical Healthcare Management

1. Foster Ethical Culture:

○ Promote transparency, accountability, and respect for ethical principles within
the organization.
2. Advocate for Fair Practices:
○ Ensure equitable access to healthcare and ethical allocation of resources.
3. Support Staff in Moral Decision-Making:
○ Provide training and resources to empower staff in resolving ethical
dilemmas.
4. Collaborate with Stakeholders:
○ Engage patients, families, and the community to align healthcare services
with shared values.
5. Monitor and Evaluate:
○ Continuously assess decisions and policies to uphold ethical standards and
improve outcomes.

Bioethics Reviewer: Ethical Issues Related to Technology in the Delivery

of Health Care

A. Data Protection and Security

1. Data Privacy Act of 2012 (RA 10173)

● Purpose: Protects the privacy of personal data while ensuring free flow of
information for legitimate purposes.
● Key Provisions:
○ Protects personal health information from unauthorized access, misuse, or
disclosure.
○ Requires healthcare providers to obtain informed consent before collecting,
processing, or sharing data.
○ Imposes accountability for data breaches through penalties and sanctions.
● Implications for Healthcare:
○ Healthcare institutions must implement strict security measures, such as
encryption and secure storage systems.
 ○ Nurses and healthcare workers are ethically obliged to uphold patient
confidentiality and report breaches.

B. Benefits and Challenges of Technology

Benefits of Technology in Health Care

● Improved Efficiency: Streamlines clinical workflows, such as electronic health

records (EHRs) and telemedicine platforms.
● Enhanced Patient Care: Allows for precision medicine, real-time monitoring, and
faster diagnostics.
● Accessibility: Expands access to care, especially in remote areas, through
telehealth and mobile health applications.

Challenges of Technology

1. Data Security:
○ Risk of breaches and unauthorized access to sensitive patient data.
○ Ethical obligation to safeguard privacy and maintain trust.
2. Equity and Accessibility:
○ Digital divides may limit access to technology for underserved populations.
○ Ethical imperative to ensure equitable distribution and accessibility.
3. Reliability and Errors:
○ Dependence on technology may lead to errors due to software bugs or user
inexperience.
○ Ensures validation and testing of new technologies before deployment.
4. Dehumanization of Care:
○ Over-reliance on technology risks reducing personal interaction and empathy
in patient care.

C. Current Technology: Issues and Dilemmas

Key Issues and Ethical Dilemmas

1. Artificial Intelligence (AI) in Health Care:

○ Benefits: Enhances diagnostics, predictive analytics, and personalized
treatment.
○ Ethical Dilemmas:
■ Accountability for AI-driven decisions.
■ Bias in algorithms affecting marginalized groups.
2. Telemedicine:
○ Benefits: Increases access to care, especially for remote or immobile
patients.
○ Ethical Dilemmas:
■ Privacy concerns during virtual consultations.
 ■ Maintaining care quality and rapport without face-to-face interaction.
3. Electronic Health Records (EHRs):
○ Benefits: Improves record-keeping, care coordination, and data analytics.
○ Challenges: Risk of breaches, user fatigue, and issues with interoperability.
4. Wearable Technology and Remote Monitoring:
○ Benefits: Empowers patients to manage their health and provides real-time
data for clinicians.
○ Ethical Dilemmas:
■ Ownership of data collected by devices.
■ Consent for continuous monitoring and secondary use of data.
5. Genomics and Biotechnologies:
○ Ethical concerns about genetic privacy, potential discrimination, and the
accessibility of life-altering therapies like CRISPR.

Key Ethical Principles in Health Technology

1. Autonomy:
○ Patients must give informed consent for the use of technology in their care.
○ Transparency in how data and AI decisions are used is essential.
2. Beneficence and Non-Maleficence:
○ Ensure technology enhances patient welfare without causing harm.
○ Address errors, biases, or risks associated with technological tools.
3. Justice:
○ Promote equitable access to health technologies for all populations.
○ Bridge the digital divide to avoid exacerbating health disparities.
4. Confidentiality:
○ Prioritize data protection to maintain trust in health systems.

D. Role of Nurses in Ethical Technology Use

1. Advocacy:
○ Protect patient rights in the use of technology.
○ Advocate for equitable access and transparency in data use.
2. Education:
○ Stay updated on emerging technologies and their ethical implications.
○ Educate patients on the benefits, risks, and use of technology in their care.
3. Oversight and Reporting:
○ Monitor for potential misuse or breaches of technology.
○ Report and address ethical concerns promptly.
4. Compassionate Care:
○ Balance the use of technology with personal, empathetic patient interactions.
Bioethics Reviewer: Advocacy and Code of Ethics for Nurses

A. Lobbying / Advocating for Ethical Issues Related to Health Care

● Definition: Lobbying and advocacy involve efforts by nurses and other healthcare
professionals to influence policies and practices that promote ethical and equitable
healthcare.
● Importance:
○ Addressing systemic barriers to care, such as access disparities or
inadequate staffing.
○ Advocating for patient rights, workplace safety, and healthcare equity.

Key Advocacy Roles of Nurses:

1. Policy Development: Participate in discussions about healthcare laws and

regulations to ensure ethical practices are upheld.
2. Patient Advocacy: Represent patient interests, especially for vulnerable or
marginalized populations.
3. Health Education: Raise awareness of health-related ethical issues within the
community and among stakeholders.

Examples of Advocacy in Practice:

● Supporting legislation for universal healthcare access.

● Advocating for ethical considerations in new medical technologies.
● Campaigning for adequate nurse-patient ratios to ensure quality care.

B. Code of Ethics for Nurses

1. International Code of Ethics (ICN Code)

● Developed by the International Council of Nurses (ICN) to guide nursing practice

globally.
● Core Elements:
○ Nurses and People: Prioritize patient care, uphold dignity, and advocate for
patient rights.
○ Nurses and Practice: Provide competent, evidence-based, and ethical care.
○ Nurses and the Profession: Promote the integrity and advancement of the
nursing profession.
○ Nurses and Co-Workers: Foster collaborative and respectful relationships.

2. Code of Ethics for Filipino Nurses

 ● Established by the Board of Nursing under the Professional Regulation
Commission (PRC).
● Emphasizes Filipino nurses’ ethical responsibilities in various relationships:
1. Registered Nurses and People:
○ Respect the rights, values, and dignity of patients.
○ Provide care without discrimination and uphold patient confidentiality.
○ Ensure informed consent and respect patient autonomy.
2. Registered Nurses and Practice:
○ Deliver care based on professional standards and scientific knowledge.
○ Remain accountable for one’s decisions and actions in practice.
○ Continuously engage in professional development to ensure competence.
3. Registered Nurses and Co-Workers:
○ Promote harmonious and respectful relationships with colleagues.
○ Report unethical or unsafe practices when necessary.
○ Support teamwork and shared accountability in providing quality care.
4. Registered Nurses and Society/Environment:
○ Advocate for environmental health and sustainable practices.
○ Address social determinants of health to improve community well-being.
○ Promote equity and justice in healthcare delivery.
5. Registered Nurses and the Profession:
○ Uphold the integrity of the nursing profession through ethical practice.
○ Mentor and support the development of other nurses.
○ Participate in nursing organizations to advance the profession and ethical
standards.

Summary of Ethical Responsibilities in Nursing

1. Advocacy: Be a voice for patients, communities, and the profession in addressing

ethical issues.
2. Competence: Continuously improve knowledge and skills to provide high-quality
care.
3. Collaboration: Foster teamwork and mutual respect in all professional interactions.
4. Accountability: Own the outcomes of your decisions and actions in practice.
5. Equity and Justice: Strive for fairness in patient care and resource allocation.