Theories and Principles of Health Ethics

father and mother, do not kill, do, not steal

Health Care Ethics
KANT’S THEORY by philosopher Immanuel
 is a field that concerned with the vast array
kant(18th century)
of moral decision- making situations that  belief that humans possess the ability
arise in the practice of medicine in to reason and understand universal
addition to the procedures and the moral laws that they can apply in all
policies that are designed to guide such situations. does not focused on the
practice. consequences of individual actions.

Ethics characteristics of deontology

moral right - one’s duty, how one should act is

 is the branch of philosophy which takes a defined independently of moral good.
systematic approach to define social and Philosopher Immanuel Kant
individual morality.- the fundamental
standards of right and wrong that the whole  believes that ethical actions follow
society as well as individuals, learn from universal moral laws such as “don’t
their culture and peers. lie, Don’t steal.

Theories and Principles of Health Ethics examples of deontology ethics

A. Ethical theories  do not kill

 do not steal
1.Deontology  religious belief
 keeping promises
2.Teleological
 cheating
3.Utilitarianism  do not lie
 respects the elder
A.Ethical theories
Types of deontological ethical
1.Deontology
theories
 is an ethical theory that says actions are
Negative and positive right theories
good and bad according to a clear set
of rules.  asserts that an action is right if it
 motives and actions are morally right protects the individual from harm or
independent of their unwarranted interference from other
consequences people or the government while
 greek words deon meaning duty actions exercising his right.
that align with these rules are ethical,
example: selling your property without the ,
while actions that don’t are not.
interference of others
examples: in ten commandments “honor your
Positive right theory
  suggests that an action is right if it  an action is good if it results in
provides an individual with anything maximum satisfaction for a large
that he needs to exist. number of people who are likely get
affected by the action.
Example: the right to adequate health care
Example: redistribution of excess money
Social contract theories from the rich to the poor
 suggests that people contract with each 3. Eudaimonism
other to abide by the moral and
political obligations towards the society  an action is good if it results in the
in which they live. fulfillment of a goals along with the
welfare of the human beings
example: killing one another because to much
hatred, stealing money example: volunteer to help others
and property
3.Utilitarianism
Social justice theories  An action is right if it increases
 Action is right if it is confirms the satisfaction and happiness.
fairness in the distributive, retributive Example: redistribution of excess money from
dimensions of cost and rewards the rich to the poor
2.Teleological theory B.Virtue Ethics
 rightness and wrongness solely depend 1.Virtues ethics in Nursing
on the consequences either positive or
negative 2.Core Values of a Professional Nurse

example: stealing
Virtue Ethics
Study of final causes – by Baron Christian von
wolff (1679-1754) a german philosopher  defines good actions as ones that
comes from greek word meaning telos- display embody virtuous character
meaning end, limit, purpose or goal, result, traits, like courage, loyalty or
fulfillment, completion wisdom.
logos - meaning explanation or reason an example:
explanation of something that refers to its end,
purpose or goal  honesty and morality of a person,
 practicing good habits such as honesty,
3 types of Teleological theories generosity and virtuous person

1. Ethical egoism Virtue – refers in excellence in character

an action is good if it produces or is likely to Virtues – are the character of the health care
produce results that maximize the person’s provider which are morally praiseworthy traits
self-interest which the person himself defines.
Virtues ethics in Nursing
2. Utilitarianism
  is concerned with the character of an character as a person and as a nurse in the
individual nurses and seeks ways to profession:
enable nurses to develop character
Insight (Sophia) - Sophia is translated as
traits appropriate for actions that
wisdom.
enhance wellbeing.
The ability to think well about the nature of the
examples: beneficence, non-maleficence,
world and it involves careful deliberation of
autonomy and justice
universal truths.
The following code of ethics for nurses have
Practical wisdom (phronesis)
implied statements:
 Phronesis is sometimes translated as
1. The nurse at all times maintains
prudence. It is the capability to consider
standards of personal conduct which
the mode of action in order to deliver
reflects well on the profession and
change especially to enhance the quality
enhance public confidence
of life.
( International code of ethics by nurses).
2. The nurse owes the same duties to self Choice (prophairesis )
as to others including the responsibility
to preserve integrity and safety.  morality is achieved through choice
( American nurses Association’s code of facilitated by insight, practical wisdom
ethics for nurses) and evenness of emotional states.
3. Nurses must perform their professional Goal or telos
duties Inconformity with existing laws,
rules, regulations, measures and  it embodies personal and professional
generally acceptable principles of moral excellence in nursing which is
conduct and proper decorum( code of characterized as active happiness and
ethics for filipino registered nurses) well being that is consistent with an
enlightening awareness of the causes of
Religious virtues moral suffering as well as the awareness
 Roman catholic tend to affirms both of the sacredness of the day to day moral
Greek and Christian virtues have seven nature of nurse’s work
virtues namely prudence, justice, Virutes of the health care
temperance, fortitude, faith, hope and
love.
provider

Virtue based on nursing model Fidelity – refers to the obligation of a person to

be faithful to agreements, responsibilities, and
 the moral ground model has its commitments that he has made to himself and
foundation in Aristotle approach- focus to others.
on human morality on moving toward
a final purpose or goal.  main principle that supports the concept
of accountability of nurses
The following activities and attitudes will and other professionals
develop the nurses intellectual and moral
virtues which could facilitate growth in her Honesty
  being fair and just in character and loyalty, honor, trustworthiness, civility,
behavior, not cheating or stealing, free of dependability, shared work pride,
deceit. The same with sincerety, integrity, empathy – which determine the
truthfulness, uprightness, and just. intrinsic and instrumental ethical
 honesty to self and in the performance of quality of work life
duty is expected from the nurse.
3. Professional character ethics – holds that
Humility self-regulation, loyalty, impartial judgements,
altruism, truthfulness, public service determine
 being modest in dealings,
the intrinsic and instrumental ethical quality of
unpretentious, with simplicity and
an individual associated with communities.
submissive.

the nurses are known for this 6 Core Values of a Professional

virtue as they perform their role as Nurse
a member of the health care team
1. emphathy
Respect – showing a deferential esteem felt or
shown toward a person nurse shown respect  it helps build trust to the patient,
to patient to co worker and health care team, enables to focus on their point of
community and Society view, strengthen ability to effective
communication and provide
5. Compassion – it is important to the nurse better care to the patient
this enables her to serve others selfessly
2. professionalism
prudence - enables nurses and patients to
engage in a deliberative process by which  remain professionals to patient and
ethical means of treatment are proposed and collegues no matter how stressful
decided upon the environment
 remain strong and stable, reaasure that
Courage – ability to disregard fear in acting out they are st the right hands
one’s convictions and beliefs
3. autonomy
Types of virtue ethics theories
 recognize patients rights to accept or
1. Individual character ethics – it holds that refuse care provision
identification and development of noble human
4. altruism
traits help in determining both the instrumental
and intrinsic value of ethical interactions.  not to expect somthing inreturn for the
care that you provides and advocating
example of noble traits: courage, self-
for fair treatment for patient
discipline, prudence, gratitude, wisdom,
sincerety, understanding , benovolence 5. accountability

2.Work character ethics  ability to acknowledge responsibility for

the actions and learn from mistakes
 the identification and development of
reflective practitioner noble traits at 6. curiosity
work such as creativity, honesty,
  ask questions on the job to learn more Patient’s rights – are those basic rule of
about the role and responsibilities conduct between patients and medical
caregivers as awell as the institutions and
C.Ethical principles people that support them.
Ethics - is the branch of philosophy which takes The 13 Rights of the Patient
a systematic approach to define social and
individual morality.- the fundamental 1. . right to appropriate medical care and
standards of right and wrong that the whole humane treatment
society as well as individuals, learn from their 2. right to informed consent
culture and peears. 3. right to privacy and confidentiality
4. right to information
C.Ethical principles 5. the right to choose health care provider
and facility
1. .Autonomy
6. right to self determination
2. Patient’s rights
7. right to religious belief
3. Patients’s bill of rights
8. right to medical records
4. Informed consent /legally acceptable
9. right to leave
representative
10. right to refuse participation in medical
5. Confidentiality
research
6. Privacy
11. right to correspondence and to receive
C.Ethical principles visitors
12. right to express grievances
Autonomy 13. . right to be informed of his rights and
obligations as a
 deduced from the Greek word”autos”
patient
meaning “self” and “nomos” meaning
“rule” governance or law” In capsule: the patients rights are as
 refers to freedom from external control follows:
in health care concept – applies to
provider for the autonomy of P-rivacy – talking in private with the patient or
patient simply closing the curtain when doing your care
 right to self determination respect the rights of privacy
 right to accept or refuse any treatments A-autonomous – patient has the right to choose
 refers to every individual’s right of self a provider and plans.
determination and freedom to
make their own choices. Treatment refusal – patient has the right to
 respect their client’s right to make participate in treatment decision
decisions about their own health
I-nformation for consumer responsibilities – the
C. Ethical principles patient will provide information about the
medications he takes for the past illnesses
 Patient Autonomy – is the right of patients
to make decisions about their medical care E-ducation – or information disclosure – patient
without their health care provider trying to has the right to receive an accurate and easily
influence the decision. understandable information about health plans,
health care professionals and healthcare 5. Right to every consideration of his
facilities privacy concerning his own medical care
program
N-ot to be restrained – restraint should only be
6. Right to expect that all communications
used as a last resort when all other
and records pertaining his care should be
interventions failed. Restraint are usually
confidential
ordered by physician
7. Right to expect that within its capacity a
T-o be treated with confidentiality – patients hospital must take reasonable response
health care information should be protected at to the request of a patient for services
all times 8. Right to obtain information as to any
relationship of his hospital to other
S-ervices – patients has the right to access health care and educational institutions
emergency services, they have the right to be in so far as his care is concerned
screened and stabilized using emergency 9. Right to advice if the hospital proposes
services whenever and wherever they need to engage in or perform human
them without having to wait for authorization experimentation affecting his care or
without any financial penalty treatment
Patients’s bill of rights 10. Right to expect reasonable continuity of
care
 ensures that the rights and dignity of each 11. Right to examine and receive an
person receiving medical services are explanation of his bills regardless of
respected and valued. source of payments
 a document that provides patients with 12. Right to know what hospital rules and
information on how they can reasonably regulations apply to his conduct as a
expect t o be treated during the course patient
of their hospital stay.
 recently name as Patient care partnership 2.Confidentiality

Patient’s bill of rights in the Philippines  to keep secret by which we mean

knowledge or information that a
1. Right to considerate and respectful care person has the right or obligation to
2. Right to obtain from his doctor complete conceal
current information about his diagnosis,
treatment and prognosis interms the 3.Veracity
patient can be reasonably expected to  Truth telling and right to information
understand  when a nurse remains true to the values,
3. Right to receive from his doctor principles, and tandards
information necessary to give informed
consent prior to the start of any example; a nurse who told their patient to
procedure or treatment come back in 30 min to check the pain, either
4. Right to refuse treatment to the extent come back or delegate someone else to come
permitted by law and to be informed of back if they got tied up
the medical consequences of his action
4. Justice
  is a complex ethical principle and entails affiliation, and personal relationships
fairness, equality and impartiality with family members and other intimates
meaning it is the obligation to be fair
to all people
6. Beneficence
 tells about “doing good” for the client
TYPES:
example: giving immunization
1.distributive justice
7. Non-maleficence
 means that individuals have the right to
be treated equally regardless of ethnic  tells about “do not harm” either
group, gender, c ulture,age, intentionally or unintentionally
marital status,medical diagnosis,social to your client
standing, economic level, political or example: not abondoning a client who is need
religious beliefs, or any ndividual of the services
characteristics
D.Other relevant ethical principles
2. social justice
1. Principle of double effect
 ix based on the application of equitable
rights to access and participation in all  sometimes it is permissible to cause a
aspects of good and services harm as side effect ( or “double
provided in a society regardless of their effect”)of bringing about a good result
individual characteristics. even though it would not be
 Informed consent /legally acceptable permissible to cause such a harm as a
representative means to bringing about the same good
 means that each person who has any sort end.
of procedure done to
 them in a healthcare context should give example: performing an abortion when
their approval for thatprocedure to be continuing the , pregnancy would risk killing
done to them. the mother , death of a human being , side
effect of promoting some good end , killing
Confidentiality someone to save someone else’s life
 to keep secret by which we mean 4 principles of double effect
knowledge or information that a
person has the right or obligation to 1. the action itself is good or at least neutral
conceal 2. the good effect, not the bad effect is what is
example: family with HIV results , do not gve intended
unless the patient tells you 3. the good effect is not produced by the bad
Privacy effect

 encompasses a number of aspects 4. there is a proportionately grave reason for

includes personal apace, personal data, permitting the bad effect
or information, personal choices 2. Principle of legitimate cooperation
including religous and cultural
  is an application of the principle of double  social role of a nurse as stewards is
effect to situations involving cooperation providing support and help families learn
with someone else’s actions to be healthy by helping to understand
the variety of emotional, physical mental
example: the doctor who performs and
and cultural interactions they encounter
prescribed procedure
during health assessment
3. Principle of common good and
Ecological biomedical
subsidiarity
 ecological stewards conserves natural
 subsidiarity - is the coordination of
resources, combats pollution and protects
society’s activities in a way that
biodiversity, or protect and sustain our
supports the internal life of a local
environment for future generation
communities.
 emphasizes and respects the role of the examples: recycling, replacing inefficient
person’s free will in his or her life choices. appliances or making efficient transport choices
 human person is the essential actor in the
biomedical stewardship
care of his or her health
 refers to the execution of responsibility of
example: each person insured pays the same
the health care practitioner to look
percentage of its , income into the health
after, furnish fundamental health care
insurance
services, and promote the health and
common good life of those entrusted to their care

 is the totality of social conditions allowing 2.Principle of totality and its integrity
persons to achieve their communal and
 Ethico-moral responsibility of nurses in
individual fullfillment
surgery
example: accessible and affordable public
Perioperative nurses
health care system, peace among the nations of
the world  are obligated morally to respect the
dignity and worth of
E. Principles of bioethics role of a nurse
individual patients.
1. Principle of stewardship and role of nurses as  care must be provided in a manner that
stewards preserves and protects patient
autonomy and human rights
Personal
Supporting patients rights and choices:
 role of a nurse as personal involves
valuing and respecting patient’s priorities 1. Preserve and protect their patient’s
and self-determination autonomy, dignity and human rights with
specific interventions including supporting a
example: nurses become stewards or leader or patient’s participation in decision-making
teacher to patients without expertise or confirming informed consent and implementing
experience interms of disease process but facility advance directive policies
understand consequences of illness
2. Explain procedures and the OR
Social environment before initiating actions.
3. Respect patient ‘s wishes in regard to 1. managing fluid and electrolyte balance
advance directives and end-of-life choices.
2. managing nutrition
4. Help patients make choices within their
3. managing pain
scope of care as applicable.
4. managing infection control
5. Provide patients with honest and accurate
answers to their questions especially related to 5. managing wound and wound care
perioperative teaching, formulate ethical
decisions with helpfrom available resources( eg. 6. managing stress and anxiety
ethics committee, counselors, ethicists) 7. managing possible altered image
5. as moral agent for the patient , must be Sterilization/mutilation
ready and able to advocate for the patient’s
rights and needs whenever necessary while  an ethical approach to the provision of
providing care. sterilization must:

Respect for others: promote access for women who wish to use
sterilization as a method of contraception, and
1. Nurses must be able to interact with a safeguard against coercive or other wise unjust
variety of other professionals and ancilliary uses
providers in the preoperative environment.
sterilization
- treating with professionalism
 is removal of a procreative member or
- respect the performance of the health care
element of the human in order
team
to prevent procreation
- fair treatment regardless of disability, or  all mutilation was against nature and
economic, educational, therefore against morality
cultural religious, race age and life styles
sterilization unethical if :
2. The nurse recognizes the contributions of
 when performed without consent,
each member of the health care team
violates an individual’s rights to dignity
and collaborates to achieve quality patient
, humane treatment, health family,
care.
information, privacy and freely decide the
Ethical dilemma number and spacing of children.

 nurses often faced with an ethical how do we sterilize a human?

dilemma when a patient is anxious
 through surgical sterilization method
because he or she does not understand
include;
fully what is going to happen in surgery
1. tubal ligation in females - tubes tied
and the nurse is being pressured for a
2. bilateral salpingectomy in females - tubal
fast turn of overtime.
removed
 patients emotional need
3. vasectomy mutilation
 expectation to be efficient
1. clitoridectomy
FOR SURGERY:
  Preservation of bodily functional integrity Ordinary means
issues on organ donation organ donation
 are all treatments, medicines and
 is when you decide to give an organ to
operations which offer a reasonable
save or transform the life of
hope of benefit and which can be
someones else
obtained and used without excessive
 is the process of surgically removing an
expense, pain or other inconvenience.
organ or tissue from one person and
replacing it into another person
 issues on organ donation:
 major ethical concerns about organ obligatory care given to any and all
donation patients
 by living related donors focus on the Extraordinary means
possibility of undue
influence and emotional pressure and  are those which cannot be obtained or
coercion used without excessive expense, pain
or other inconvenience, or which if used
major ethical issues: would not offer a reasonable hope of
 the autonomy of the donor and recipient benefit.
and the utility of the procedure some  they involve a disproportionately great
ethical issues on organ donation includes: burden on the patient or community.
 it may harm the patient
1. autonomy
example: HIV medication, treatment for
2. benevolence hepatitis C, all emergency transfortation and
emergency treatment, all durable medical
3. non-maleficence
equipment including prosthesis, wheel chairs
4. free and informed consent and glasses

5. respecting the dignity Principles of personalized sexuality

6. integrity and equality of human beings  it should be a loving, bodily, pleasure

expression of the complimentary,
7. fairness
permanent self-giving of a man and a
8. common good woman to each other, which is open to
fruition in the perpetuation ad
Principles of ordinary and extraordinary expansion of this personal communion
means through the family they beget and
educate
In assessing when there is a duty to preserve
life, the Church distinguishes between Principles of personalized sexuality
ordinary and extraordinary means.
In health care
Ordinary means - it must be taken to preserve
life Sex is a social necessity for the procreation of
children and their education in the
Extraordinary means family so as to expand the human
 can be morally refused
community and guarantee its future beyond the
death of individual members.

4 main ethical principles;

 beneficence
 nonmaleficence
 autonomy
 justice

PERSONALIZED SEXUALITY

 must be loving, bodily pleasurable,

expression of the complementary,
permanent self-giving of a man and a
woman to each other
Theories and Principles of Health Ethics