ETHICS

● GREEK - ETHOS (MORAL DUTY)

● A standard to examine and understand moral life
● Studies how people make judgment in regard to right or wrong
● Making choices that are best for the individual or society

MORALS
● Specific ways of behavior or of accomplishing ethical practices
● MORALITY- refers to private, personal standards of what is right and wrong in conduct, character and
attitude
BIOETHICS
● A specific domain of ethics that focuses on moral issues in the field of health care
● Evolved into a discipline as a result of life and death dilemmas faced by health care practitioners
NURSING ETHICS
● Related to all the principles of right conduct as they apply to the nursing profession
● Ethical theories/principles, codes of conduct

WHY DO WE NEED TO STUDY ETHICS?

● Makes clear why one act is better than another
● Keeps an orderly social life by having agreement, understanding, principles or rules of procedure
● Moral conduct and ethical systems must be appraised
● Seeks to point out to men the true values of life as it attempts to stimulate the moral sense

ETHICAL DILEMMA
Problem in decision making because there is no correct or wrong choice. This way result in having to
choose an actions that violates one’s principle or value in order to promote another
TELEOLOGICAL APPROACH
● Greek “telos”,”goals or end”
● “The right thing to do is the good thing to do”
● Act utilitarianism (“the goof resides in the promotion of happiness or the greatest net increase of
pleasure over pain”)
○ Good is agape- the general goodwill or love for humanity (Fletcher)
○ Human need determines what is or what is not ethical
○ An action is “good” if it will have a good and or purpose”
Guidelines for making ethical decisions (Fletcher):
● Considerations for people as human beings
● Considerations of consequences
● Proportionate good to come from the choices
● Propriety of actual needs over ideal or potential needs
● A desire to enlarge choices and reduce chance
● A courageous acceptance of the consequence of the decision
Example:
City Health Department planning for annual budget
Modernization of city hospital vs nutrition and immunization programs of poverty stricken families

DEONTOLOGICAL
NATURAL LAW(THOMAS AQUINAS)
● Good is to be done and pursued and evil is to be avoided
● Rightness is self-evident and determined by nature not by customs or preferences
 ● Greek “deon”,”duty”
● The basic rightness or wrongness of an act depends on intrinsic nature(moral obligation)rather than
upon the situation or its consequences.
● Action is more important than consequences
● Kant- a person is morally good and admirable if his actions are done form a sense of duty and reason
(moral obligation). It is only through dutiful actions that people have worth
● Ex. Nurse assigned to care for a patient ith AIDS. Could she reasonably care for the patient on the
ground that the patient's condition may threaten her health?

WHAT IS VIRTUE ETHICS?

● Also known as “aretaic ethics”- greek “arete”
● Focuses on the traits and virtues of a good person such as courage, temperance, wisdom and justice
● Doing the right thing is not all that is needed
○ One must have right motivator, disposition and traits for being good and doig right
■ Courage, honesty, justice, beneficence
VALUES
● Enduring belief or attitudes about the worth of a person, object, idea or action
● Influence decisions and actions

CORE VALUES OF A PROFESSIONAL NURSE

(American Association of Colleges of Nursing or AACN)
● Altruism - concern for welfare and well being of others
● Autonomy - right to self-determination
● Human dignity- respect for inherent worth and uniqueness of individuals and populations
● Integrity - acting in accordance with an appropriate code of ethics
● Social justice - upholding moral, legal and humanistic principles
ETHICAL PRINCIPLES:
1. AUTONOMY
a. RIGHT TO MAKE ONE’S OWN DECISION
b. SELF-GOVERNMENT/SELF-DETERMINATION
c. THE PERSON MAKING THE DECISION MUST BE DEEMED COMPETENT
d. THERAPEUTIC PRIVILEGE- legal exception of the rule of informed consent, which allows
caregiver to proceed with the care in case of emergency, incompetence, wiver or implied
consent.
e. How is this principle violated in the health care setting? Give an example
● Patient’s Rights
● Patient’s Bill of Rights
● Informed Consent
● Proxy Consent/Legally Acceptable Representative
● Confidentiality
● Privacy
● Ex. clients provide informed consent before tests, procedure, or participating as a research subject
PROXY CONSENT
● People with the legal right to consent to medical treatment for themselves or for a minor or a ward
delegate that right to another person. There are three fundamental constraints on this delegation:
a. The person making the delegation must have the right to consent
b. The person must be legally and medically competent to delegate the right to consent
c. The right to consent must be delegated to a legally and medically competent adult
● 2 types of proxy consent for adults:
 a. Power of attorney- delegates the right to consent to a specific person
b. Living will

PATIENT’S RIGHT
1. Right to appropriate Medical care and Human Treatment
2. Right to Informed Consent
Exemptions:
A. In emergency cases
B. When the health of the population is dependent on the adoption of a mass health program to
control epidemic;
C. When the law makes it compulsory for everyone to submit a procedure;
D. When the patient is either a minor, or legally incompetent
E. When disclosure of material information to patient will jeopardize the success of treatment, in
which case, third party disclosure and consent shall be in order;
F. When the patient waives his right in writing.
3. Right to Privacy and Confidentiality
a. Protect Patient Information
4. Right to Information
5. The right to Choose Health Care Provider and Facility
6. Right to self-determination (ex. Advance directive)
7. Right to Religious Belief
8. Right to Medical Records
9. Right to Leave
10. Right to Refuse Participation in Medical Research

PATIENT’S BILL OF RIGHTS

ETHICAL PRINCIPLES
2. CONFIDENTIALITY
a. Non-disclosure of private or secret information with which one is entrusted
b. Nightingale Pledge: “i will do all in my power to elevate the standard of my profession and will
hold in confidence all personal matters committed to my keeping and all family affairs coming to
my knowledge in the practice of my profession.”
c. “Harm principle” - harm caused by upholding confidentiality
i. Ex. compulsory screening prevent spread of communicable disease (public interest)
3. VERACITY
a. Truth telling and Right to Information
b. Patient must tell the truth in order that appropriate care can be provided
c. Revised AMA code of ethics- no longer permissible for a doctor to withhold information from a
patient, even on grounds that it may be harmful
d. The loss of trust in the nurse and the anxiety caused by not knowing the truth usually outweigh
any benefits derived from lying
e. Fraud - deliberate deception intended to produce unlawful gain
i. Defamation- character assassination verbal or written
1. Libel - written
2. Slander - verbal
ii. Medical record
4. n/a
5. JUSTICE
 a. “Fairness”
b. Right to demand to be treated justify, fairly and equally
c. Nurse making home visits finds one client tearful and depressed and knows she could hely by
staying for 30 minutes to talk.however, that would take time from her next client, who is diabetic
who need a great deal of teaching and observation
6. BENEFICENCE
a. “Doing good”
b. Implement actions that benefit clients and their support persons
c. Acts of kindness and mercy that directly benefit the patient
d. A nurse may advise a client about a strenuous exercise program, to improve general health but
should not to do do, if the client is at risk of heart attack
7. NON-MALEFICENCE
a. “Do no harm”
b. Harm can mean intentionally causing harm. Placing someone at risk of harm, intentionally
causing harm
c. In nursing, intentionally causing harm is never acceptable
d. A client may be at a risk of harm as a known consequence of a nursing intervention that is
intended to be helpful
e. Ex. hot water bag- pain relief

PRINCIPLE OF DOUBLE EFFECT

● PROVIDES A NEAT ALGORITHM FOR SOLVING ALL MORAL DISPUTES IN WHICH AN ACT ILL
HAVE 2 EFFECTS, ONE GOOD AND THE OTHER BAD
● An act has good and bad effects is morally justified as long as certain conditions are met:
○ The action intended in and itself is must be good or at least morally neutral
○ The evil must not be directly intended but morally allowed only as a side issue (side effect)
○ The evil effect must not be the means by which the good effect is achieved
○ The good effects must outweigh the evil or at least proportional
● Ex. save and losing lives
● A woman whose life and that of the baby are equally both at risk due to a delicate pregnancy

PRINCIPLE OF LEGITIMATE COOPERATION

● When you are performing an action that is intertwined with evil you can use the following criteria to
judge how legitimate your cooperation with the evil is
● The moral object of your action is good and you are operating out of good intentions
● The evil is only tolerated as a side effect of your action
● Your cooperation is only material cooperation, not formal
● Our cooperation is remote rather than proximate so it causes minimal evil effects
● Your action does not cause scandal

PRINCIPLE OF COMMON GOOD AND SUBSIDIARITY

● “Societal good”
● The constellation of services provided by nurses is supportive of the common good
● Concern for the whole person in the community
● Outcomes associated with the common good, such as distributive justice
● Nursing also addresses the need to balance the preservation of individual dignity and respect against
societal integrity
● Ex. examining instances of ethical misconduct in clinical research and the evolution of the health acre
delivery system
PRINCIPLE OF STEWARDSHIP
● Power to take good care of creation and do not have sole authority to do whatever we want
● No to suicide and euthanasia
● Roles of Nurses a stewards

PRINCIPLE OF TOTALITY AND ITS INTEGRITY

● A part of the human body exists for the good of the whole
● It is only when an infectious organ is putting the entire body at risk, that it may be removed
● Mutilation or removal of healthy organs for commercial purposes is immoral
● Ex. amputation
● Ethico-moral Responsibility of Nurses in surgery
○ Sterilization / Mutilation (FGM)
■ Medicalisation of female Genital Mutilation is denounced by the World health
Organization
○ Issues on Organ Donation

ORGAN TRANSPLANTATION
● May come from living donors or from donors who have just died
● Living donors give consent under the Uniform Anatomical Gift Act
● Ethical Issues:
○ Allocation of organs
○ Selling of body parts
○ Involvement of children as potential donors
○ Consent
○ Conflict of interest between donors and recipients

PRINCIPLE OF ORDINARY AND EXTRAORDINARY MEANS

● ORDINARY MEASURES
○ Based on medication or treatment which is directly available and can be applied without
incurring severe pain, costs or other inconveniences but which give the patient in question
justified hope for a commensurate improvement in his health
● EXTRAORDINARY MEASURES
○ Based on medication or treatment which cannot be applied without incurring severe pain,costs
or other inconveniences. Their application, however, would not give the patient any justified
hope for a commensurate improvement in his health.
● If assessed from ethical point of view, it is possible to distinguish between on the one hand life
prolonging measures the application of which is morally obligatory (ordinary measures)- as they are
likely to help the patient- and on the other hand those measures which can be applied optionally
(extraordinary measures) as the benefit to the patient is not immediately obvious or subject to
considerable debate.

PRINCIPLE OF PERSONALIZED SEXUALITY

● One of the basic traits of a person and must be developed in ways consistent with enhancing human
dignity

ETHICAL PRINCIPLES IN DECISION MAKING

1. Identify and setting up the ethical problem
2. State the relevant facts
3. Identify the stakeholders
 4. Identify the relevant options
5. Determine the most appropriate action

WHAT IS ETHICAL DECISION MAKING?

 When faced with an ethical dilemma the objective is to make judgment based on well-reasoned,
defensible ethical principles
 The risk is poor judgment
 A low quality decision can have a wide range of negative consequences

Two types of ethical choices

 Right vs wrong: choosing right from wrong is the easiest
 Right vs right
o Situation contains shades of gray i.e. all alternative have desirable and undesirable results
o Choosing “the lesser of two evils”
o Objective: make a Defensible Decision

FACTORS THAT INFLUENCE EDM

1. CODES FOR NURSES
2. THE PATIENTS RIGHTS
3. SOCIAL AND CULTURAL ATTITUDES
4. SCIENCE AND TECHNOLOGY

1. LEGISLATION
2. JUDICIAL DECISIONS
3. FUNDING
4. PERSONAL RELIGIOUS AND PHILOSOPHIC VIEWPOINT

FACTORS IN THE WORK ENVIRONMENT THAT AFFECT EDM

1. Statues as an employment
2. Collective bargaining contracts
3. Collegial relationships
4. Authoritarian and paternalistic background
5. Ethics committees in health care
6. Consumer involvement in health care

SOME GUIDELINES FOR MAMING ETHICAL DECISIONS

1. CHOOSE CORRECT MORAL LANGUAGE (OFTEN THE WAY IN HICH YOU INITIALLY
CONCEPTUALZE A SITUATION WILL AFFECT WAHT MORAL CONCLUSIONS YOU WILL MAKE)
2. BE AS CLEAR AS YOU CAN ABOUT THE FACTS
CONSIDER THE RELEVANT MORAL PRINCIPLES AND RULES, AND MAKE YOUR BEST JUDGMENT