BIOETHICS of rights in cases where both

parties involved are private

Morals citizens.
 An individual’s own code for  Two basic types:
acceptable behavior  Torts
 They arise from an  Contract Law
individual’s conscience TORTS
 They act as a guide for  Tort law is deals with
individual behavior situations in which a person
 They are Learned has suffered harm or injury
due to the wrongful actions
Ethics of another. In nursing, tort
 Ethics deals with the law is particularly relevant
“rightness” or “wrongness” of because nurses have a duty
human behavior of care to their patients and
 Concerned with the can be held liable if they
motivation behind the breach that duty.
behavior
 Bioethics is the application of TWO CATEGORIES OF TORTS
these principles to life-and- 1. NEGLIGENCE
death issues (UNINTENTIONAL TORTS)
 Is the unintentional act
Bioethics of commission or
• Is a field of study concerned omission being the
with the ethics and charge when
philosophical implications of something just
certain biological, and happens- when there is
medical procedures, no intent, when the
technologies and treatments outcome is
such as organ transplants, unexpected, but the
genetic engineering and care injury occurs.
for terminally ill patients.
• Also known as the oldest Ds of NEGLIGENCE CASE:
phase of bioethical Duty- a provider-patient
exploration; it is a relationship must be
formulation of ethical norms established. A duty to care
for conduct of healthcare must exist.
professionals in the Dereliction of duty- a
treatment of patients. breach of duty, when the
provider fails to act as an
Private Law ordinary competent provider
 The law that deals with the would have acted in similar
relationships between citizen situation.
and citizen, or that is Direct cause- the breach of/
concerned with the definition, duty was the direct and
regulation, and enforcement
 proximate cause of the injury, that the reputation of the
damage or loss. person about whom the
Damage- an injury or loss discussion was held is
actually took place. harmed.
 Written communication
Examples: is termed Libel, whereas
• Failure to properly monitor a spoken defamation is
patient's vital signs slander.
• Failure to follow physician  False imprisonment and
orders or nursing protocols invasion of privacy
• Failure to properly administer  False Imprisonment-
medications The illegal confinement
• Failure to properly document of an individual against
a patient's condition or care his or her will by another
• Failure to communicate with individual right to be
other healthcare providers from restraint or
about a patient's condition movement.
 Invasion of Privacy-
2. INTENTIONAL TORTS The right to privacy is
 Intentional torts are actions implied in the
that are deliberately taken constitution and is
with the intention of causing recognized by the law
harm or injury to another that it is the right to live
person. one’s life without having
Intentional Torts are often one’s name, picture or
found in healthcare practice private affairs made
including: public against one will.
 Assault and Battery
Assault and Battery – any The Basic objectives of
unlawful touching of another tort law are:
that is without justification or 1. Preservation of peace
excuse is both tort and a between individuals
crime. 2. Determining of fault
 Assault- is committed 3. Compensation of injury
without physical contact.
 Battery – requires Legal Implications for Nurses
physical contact or some  Nurses involved in tort cases
sort of bodily injury or may face legal ramifications
offensive touching. that impact their professional
 Defamation of character and personal lives.
(libel and slander) Depending on the severity of
 Defamation of the harm caused, nurses may
Character occurs when be held liable for damages,
one person communicates face disciplinary action by
to a second person about regulatory bodies, or be
a third in such manner subject to professional
 malpractice lawsuits. It is medical treatment or
crucial for nurses to procedures, even if
understand the legal they have not explicitly
implications and practice stated it. It applies in
within the boundaries of their situations where
professional scope. emergency medical
care is required, and
Preventing Torts in Nursing the patient cannot
Practice provide informed
 Importance of consent due to their
Documentation condition or other
 Effective Communication circumstances.
 Proper Training and Education • Implied consent is
based on the principle
Principle of Biomedical Ethics that a reasonable
 Autonomy person would agree to
It comes from the Greek medical treatment or
autos (self) and nomos procedures in the same
(governance), in health care, situation. For example,
it means to have a personal if a person is found
liberty, where the individual unconscious on the
is free to choose and street and requires
implement his or her emergency medical
decision. The term self- care, it is assumed that
determination is often used they would consent to
synonymously with receive treatment if
autonomy. Healthcare they could.
providers need to respect
patient’s rights to make  Veracity
choices about healthcare, Binds both the health
even if the healthcare practitioner and the patient
providers do not agree with in the association of truth.
the patient’s decision. The patient must tell the
 Informed consent- truth in order that
which generally contain appropriate care can be
the elements of provided. The practitioner
disclosure, needs to disclose factual
understanding, information so that the
voluntariness, patient can exercise personal
competence and autonomy.
permission giving.  This principle implies
 Implied consent “truthfulness”
• Implied consent is a  Nurses need to be truthful to
legal concept that their clients
assumes a person has
given their consent to
 Veracity is an important Ethical Decision-Making
component of building Process
trusting relationships  Describe the problem
 Gather the facts
 Beneficence  Clarify values
The term suggests acts of  Note reactions
mercy and charity.” This  Identify ethical Principles
principle means “doing good”  Clarify legal rules
for others. Nurses need to  Explore options and
assist clients in meeting all alternatives
their needs  Decide on a recommendation
 Biological  Develop an action plan
 Psychological  Evaluate the plan
 Social
NURSING CODE OF ETHICS
 Nonmaleficence Gen. Principles
Most healthcare professional 1. Service to Others. This
pledges or codes of care the implies a commitment to a
principle paraphrased from life of sacrifice and genuine
the Hippocratic Oath selfishness in carrying out
statement “I will never use their professional duties even
treatment to injure or wrong at the expense of personal
the sick”. In some way, this gain.
seems very similar to the 2. Integrity and Objectivity.
duty of beneficence. This Professionals should perform
principle requires nurses to their responsibilities with the
protect individuals who are highest sense of integrity and
imbued with nationalism and
unable to protect
spiritual values.
themselves. 3. Professional Competence.
A certain level of competence is
 Confidentiality necessary in undertaking only
Anything stated to nurses or these professional services they
health-care providers by can reasonably deliver
patients must remain 4. Solidarity and Teamwork.
confidential Each professional shall
 The only times this principle maintain and support one
may be violated are: professional organization that
◦ If patients may indicate promotes a deep spirit of
harm to themselves or solidarity and teamwork
others among its members.
◦ If the patient gives 5. Social and Civic
permission for the Responsibility. Professionals
information to be shall always carry out their
shared. professional duties with due
consideration of the broader
interest of the public, serve
 them with professional concern and override family relations or
consistent with their kinship, pakikisama, utang na loob,
responsibilities to society and as regionalism or partyrism.
Filipinos, contribute to MORAL ISSUES
attainment of
• The Moral Issues Abortion
the country’s national
 The practice of Abortion
objectives.
is as old as mankind
6. Global Competitiveness.
itself. It is a method of
Professionals shall remain open
birth control in which
to the challenges of a more
conception is terminated
dynamic and interconnected
rather than prevented.
world, rise up to global
 In the Philippines,
standards and maintain levels
Abortion is illegal, but is a
of professional practices fully
clandestine practice.
aligned with global best
Article II, section 12 of
practices.
the 1986 Philippine
7. Equality of All Constitution. The state
Professions. All recognizes the sanctity of
professionals shall treat their life shall protect and
colleagues with respect and strengthen the family as
strive to be fair in their basic autonomous social
dealings with one another. No institution.
one group of professionals is
superior to or above others. MEANING AND TYPE OF
All professions perform an ABORTION
equally important, yet Abortion Refers to the expulsion of
distinct, service to society. In a living fetus from a mother's
the eyes of the Professional womb before it is viable.
Regulation Commission, all Types of Abortion
Professions are equal and • Natural or
therefore, every one shall Spontaneous
treat other professionals with Abortion
respect and fairness. -In layman's term
it is called
Moral Issue and Moral miscarriage, it in
unintentional and
Reasoning
involuntary
A moral issue is a case problem,
expulsion of fetus
situation or subject matter of great through natural or
interest and crucial significance accidental causes.
that demands a moral decision; it -It is assuming a
may also be understood as that moral bearing if
which involves the rightness or and when it is
wrongness of an action. voluntary.
It plays an important and crucial • Direct or
and important role . There are pros intentional
and cons of a given moral issue. Abortion
The right and just must transcend
 -Refers to the the fact that death is
deliberately both certainty and
induced expulsion uncertainty at the same
of a living fetus time, insofar as they are
before it becomes sure they are going to
viable. die, but they do not now
• Therapeutic when, how and where.
Abortion  Death is therefore is a
-Which is human experience that
deliberately one cannot experience
induced in the manner that
expulsion of a another individual can.
living fetus to This is precisely the
save the mother crucial point in this
from danger of issue. When does life
death brought by actually begin, and
pregnancy. when it actually ends?
• Eugenic The first part of the
abortion question has been
-Removal of the resolved under the
fetus occurs as a moral issue of abortion.
secondary effect of Several Definition of
a legitimate or licit Death
action, which is the 1. Physiological Definition- a
direct and primary person is dead when the
object of the heart stopped beating.
intention.
2. Religious or
Pro-Life Movement philosophical- Death means
The pro-life position is the the separation of body and
disapproving view of abortion. From soul.
the moment of conception life must 3. Cellular Definition- this
be regarded with the greatest care. refers to the disintegration
The practice of abortion is thus, and breakdown of the
dangerous to other unborn metabolic process if the
humans, physicians, nurses and body’s substance.
other health professionals. There 4. Brain Death - is refer to a
should be support for those who condition in which the brain is
troubles might lead them to completely destroyed, and in
destructive and violent choices. which the cessation of function
of all other organs are imminent
• Redefinition and and inevitable. By and through
Determination of Death the use of
 Only humans know that electroencephalography (EEG)
they will die sometime, and electrocardiogram (ECG),
somehow and health professionals and can
somewhere. What makes determine the toral or
humans more anxious is irreversible loss of circulator and
respiratory functions.
 • Euthanasia Types of Deformities
• Moral issues of suicide Trisomy 21- otherwise known as
• Moral issue of Birth Down’s syndrome. It is genetic
deformities disease that results from the
 A mother who gives birth presence of extra chromosome.
to a horribly deformed The child affected with Down
baby, whose left side is, syndrome is born intellectually
malformed (no left eye, a disabled and with various
deformed left hand, a deformities.
shorter leg, without a left
• Broad skull
ear and unfused
vertebrae) will certainly • Large tongue
draw various reactions • And upward slant of the
depending one various eyelids.
philosophical worldwide There is no cure for this condition,
or religious outlook. and the defective child generally
 For another parent, has an IQ of 50-80. Although
however the birth of requiring the assistance, attention,
such baby would and care for others, the malformed
transform an occasion child can be trained to do easy
of expected joy into tasks.
one enormous sadness. Spina Bifida
A mother’s reaction Spina bifida- a newborn with this
may be an admixture type of deformity has the following
of pity and concern for features
a child with terrible a. An opening in the spine
birth defects. b. A bulging sac resulting from
Meaning and Common Causes the protrusion of the
of Birth Deformities membrane covering of the
Birth Deformities are defect, spinal cord.
malformations or abnormalities of a c. spinal fluid and nerve tissue
child which are present at birth. contained the swelling
Generally, there are two kinds of protuberance.
deformities that may traceable to d. Paralysis below the waist
the genes or may develop in e. No control of the bladder and
uterus. bowel movement.
Genetic Deformities- are Hydrocephaly
hereditary they are the outcome of It is a defective condition
the genetic information of child. characterized by the accumulation
Thus, a carrier of defective genes, of fluid within the ventricles or
who begets a child, can pass on the between the membranes of the
genes resulting in the birth of brain, especially in very young
malformed child. children.
Congenital Deformities stem This causes abnormal swelling or
from radiation, drugs, chemicals, enlargement of the head.
nutritional deficiencies and Pathologically speaking, the flow of
biological disease agents. fluid through the spinal canal is
blocked; thus, cerebro-spinal fluid opening. This birth deformity refers
produced within the brain cannot to the closing of the esophagus.
be released. Surgery is required to correct the
Brain damage follows the pressure condition in order that the child
build-up because the fluid cannot may take food into stomach.
escape, resulting in the death of Duodenal Atresia- In this
child. condition, the duodenum is closed
For this deformity, surgical off; hence food cannot pass
treatment is required by inserting a through and be digested.
thin tube (shunt) to drain fluid from • The Moral issues of
the brain to the heart or abdomen Paternalism and Truth
where it can be absorbed. The Telling
operation is usually successful, • The Moral issue of
although more often than not, Patients' Rights
physical and mental damage may
result. Moral Reasoning which is an
Ventriculoperitoneal shunting argument justifying the reasons
These shunts drain the CSF into the offered for or against moral
peritoneal cavity, the atrium, or the decision.
pleura; thus, appropriately called
ventriculoperitoneal,
ventriculoatrial, and
ventriculopleural shunt.
Anencephaly MORAL ISSUES OF
The term means “without a brain”. CONTRACEPTION AND
In this deformity the brain is STERILIZATION
partially or almost totally absent.
Some bones of the skull are not Meaning of Contraception
completely formed, thus leaving an The moral issue of contraception is
opening through which the brain concerned with the rightness or
material will swell out, forming a wrongness of the use of various
sac (spina bifida. method by which conception can
There is no medical treatment for be prevented in the conjugal union.
anencephaly. Due to the lack of The instruments that obstruct the
development of babies' brains, union of the sperm and the egg can
about 75 percent of infants are be through chemical or physical
stillborn and the remaining 25 means.
percent of babies die within a few Family planning and planned or
hours, days, or weeks after responsible parenthood refers to
delivery. Care focuses on providing the act when couple decides to use
emotional support to your family. certain contraceptive methods to
Esophageal Atresia and plan the size of their family and the
Duodenal Atresia spacing of their children.
Esophageal Atresia- In medical Although their opinions may differ,
parlance, atresia is the closing or several writers consider
blockage of a normal canal or contraception as synonymous with
family planning, planned lepers. However, despite their
parenthood, responsible illness, they are still humans who
parenthood and birth control. have the right to marry and be
Contraception is thus defined as happy.
the voluntary prevention of Second, is the probability of
conception by the positive use of genetical abnormality. An individual
artificial means that hinder the for instance, who is contemplating
generative cells from uniting during marriage and has been diagnosed
the sexual act. to be a carrier of defective genes
Sterilization is also a form of may avail contraceptive
contraception insofar as its purpose sterilization so that the birth of
is the prevention of conception. It is malformed or abnormal babies can
the method of cutting off the be prevented.
sexual capacity of a man or Third, is severe financial burden.
woman. Sterilization is defined as This introduces an element of
the mutilation of sexual power in a human choice because the idea of
man or woman to render planning one’s family size indicates
conception impossible. a significant change for the
TYPES OF STERILIZATION betterment of person’s social life.
Therapeutic Sterilization Fourth, is when childbearing puts
Means the removal of reproductive one’s health in danger. This
organ or a portion thereof, to save particularly true when a wife is
one’s life or to promote bodily sickly or physically weak; hence,
integrity. she is unable to bear a child
For example: A scared or weakened without risking her life.
uterus, for example resulting from
constant pregnancy, may be METHODS OF CONTRACEPTION
considered a pathological organ; OR FAMILY PLANNING
hence it may be removed (through
hysterectomy) under the Principle FOLKS METHOD
of Totality. These methods have long been
The presence of tumor in a used for contraceptive by common
woman’s ovary is, likewise, a people, hence, the use of the
legitimate justification for name. In does not necessarily
ovariotomy. In a man, a cyst or mean, however, that the
tumor in the testes justifies professional and the learned
castration or vasectomy. people do not resort to them in one
Contraceptive Sterilization way or another.
Is the intentional prevention of
conception through sterilization.
Advocates of this type of PRE-COITAL/POSTCOITAL
sterilization cite the following DOUCHE
justifications. Vinegar and brine are used which
First is a serious illness of either a are both spermicidal however;
husband or wife, who may, for some people experience a burning
example epileptics, syphilitics and sensation in the sensitive
membranes of genitals. As a result,
others prefer post coital douching,
which is believed to flush out and
immobilize the sperm in the
vagina.
MECHANICAL METHODS
There are various forms of
mechanical contraceptives that act
as barriers to block the sperm from
entering the uterus, thus
preventing conception.
CONDOM
Popularly known as the “rubber”, is
a sheath of latex rubber that is put
on the penis during intercourse to
prevent the sperm from entering
the vagina.
Diaphragm
A dome-shaped latex rubber
membrane, the diaphragm is
placed in the vagina to close the
opening of the cervix to prevent
the entrance of the sperm. A doctor
fits the diaphragm for size and
gives instruction for its use. Shortly
before insertion, creams, and jellies
are applied to the diaphragm for
added protection.
The diaphragm is removed six
hours after sexual intercourse.
 THE MORAL ISSUE OF person loses capacity to
EUTHANASIA make health care decisions.
EUTHANASIA Healthcare by Proxy
 Easy death  Health care power of attorney
 Painless and peaceful death; appoints a person to make
it is the deliberate putting to decisions for the person in
death, in an easy, painless the event of incapacity to
way of an individual suffering make health care decisions.
from an incurable and DNR
agonizing disease.  Is a medical order written by
ACTIVE EUTHANASIA a doctor. It instructs health
 A person directly and care providers not to CPR if a
deliberately causes the pt. pt. breathing stops or if the
death pt. heart stops beating.
 When death is brought about
by an act for example when a LEGAL ISSUES: PT. CHARTING
person is killed by being  Accurate and concise pt
given and overdose of pain- charting
killers.  Describes all aspects of a pt.
PASSIVE EUTHANASIA care, including medications
 Don’t directly take the pt. life administered.
 When death is brought about SUBPOENA DUCES TECUM
by an omission  Legal order to produce
 Withdrawing treatment: specific evidence, such as
switching off a machine that written documents, electronic
is keeping a person alive, so files, medical records, etc.
that they die of their disease.  SUBPOENA “under threat of
 Withholding treatment: punishment”
not carrying out surgery that  DUCES TECUM “you shall
will extend life for a short bring with you”.
time.  Served to someone
requesting specific piece of
LEGAL DOCUMENTS evidence.
Advance Directives  The person must then
 Legal documents that produce the evidence within
communicate a person’s the timeframe allotted.
wishes about health care  It does not require a person
decisions in the event the to appear in court or offer
person becomes incapable of their testimony.
making health care decisions.  SUBPOENA AD
Living Will TESTIFICATION: used to
 In advance, a person’s require a person to testify in
instructions or preferences a trial. One person can be
about future medical issued both kinds of
treatments, particularly end- subpoenas at once to attest
of-life care, in the event the
 that the evidence is genuine  DISADVANTAGES: difficult to
and accurate. capture skilled judgement of
IMPORTANCE OF PT. nurses; reduces care to such
DOCUMENTATION repetitions.
 Provide a chronological SOAP (IER) NOTES
account of the pt. progress,  Subjective, Objective,
the care provided, and the pt. Assessment, Plan.
response to that care.  Intervention, Evaluation,
 Legal Pt. Clinical Reports, Revision
providers’ documentation,  Nurses generally uses these
administrators’ records. acronyms to guide them
 Jeopardizing the legal rights, when they’re charting about
claims, and defenses of both a particular problem or
patients and healthcare medical condition
providers  SUBJECTIVE: covers history,
 Putting health care org. and as well as relevant
providers at risk of liability. information, questions, or
 Impending legal fact finding. concerns
 OBJECTIVES: where you add
TYPES OF NURSING the hard date (vs, labs,
DOCUMENTATION exams) observed during the
NARRATIVE NOTES visit.
 Like a running log of  ASSESSMENT: once
everything that happened observations are noted, move
with the pt. during a on your assessment (What is
particular shift. the primary medical record?
 They are straightforward, Etc.)
easy to do, and simple to  PLAN: discuss the outline or
follow. update to the pt. care plan
 At start of a shift, nurses can (prescriptions, self-care
read through the log and get instructions, follow-ups, or
a good sense of what referral).
happened before they  INTERVENTIONS: you put
arrived. anything you did for the pt to
CHARTING BY EXCEPTION (CBE) address the problem
 Only exceptions to the rule identified.
are documented.  EVALUATION: where you
 Information may be note how well the
documented in narrative interventions worked, usually
form in form of objective or
 ADVANTAGES: reduces time subjective data.
spent on documentation;  REVISION: evaluation
repetitive charting; record is signals that you should tweak
easily read and understood; your intervention, you’d then
clearly highlights variations note here what changes are
being made to the care plan.
PIE CHARTING
 Write down their assessment
on a separate form or flow
sheet in the pt. chart and
assign each individual
problem a number
FDAR CHARTING
 Guide and organize nursing
notes.
 Similarly, to problem-
centered charting
 DAR charting organizes notes
by focus, that can span
health changes, pt. concern
or specific events
 Focus identified during the
assessment, and the nurses
note the specific actions they
took
PROPER ERROR CORRECTION
PROCEDURE
 Error is made in a medical
record entry; proper error
correction procedures must
be followed.
 Draw a line through entry
(thin pen line). Make sure
that inaccurate information is
still legible.
ELECTRONIC MEDICAL
RECORDS (EMRS)
 Digital version of the paper
charts in the clinician’s office.
 Contains the medical and
treatment history of the pt. in
one practice.
 Track date over time
 Easily identify which pt. are
due for preventive screening
or check-ups
 Check how their pt. are
doing.