BIOETHICS Ethics is two things:

THEORIES AND PRINCIPLE OF ETHICS  first, ethics refers to well-founded standards of right
and wrong that prescribe what humans ought to do,
ETHICS usually in terms of rights, obligations, benefits to
 Is a system of moral principles. They affect how society, fairness, or specific virtues.
people make decisions and lead their lives.  Secondly, ethics refers to the study and development of
 Is concerned with what is good for individuals and one’s ethical standards.
society and is also described as moral philosophy.
 Is derived from the Greek word ethos which can Ethics is about the ‘other’
mean custom, habit, character or disposition.  At the heart of ethics is a concern about something or
someone other than ourselves and our own desires and
Ethics covers the following dilemmas: self-interest
 How to live a good life  is concerned with other people's interests, with the
 Our rights and responsibilities interests of society, with God's interests, with "ultimate
 The language of right and wrongs good", and so on
 Moral decisions – what is good and bad?  So when a person 'thinks ethically' they are giving at
Our concepts of ethics have been derived from religions, least some thought to something beyond themselves
philosophies and cultures. They infuse debates on topics like
abortion, human rights and professional conduct. Where does ethics come from?
Philosophers have several answers to this question:
Approaches to Ethics  God and religion
Philosophers divided ethical theories into three areas:  human conscience and intuition
 META-ETHICS deals with the nature of moral  a rational moral cost-benefit analysis of actions and their
judgement. It looks at the origins and meaning of ethical effects
principles.  the example of good human beings
 NORMATIVE ETHICS is concerned with the content  a desire for the best for people in each unique situation
of moral judgements and the criteria for what is right or  political power
wrong.
 APPLIED ETHICS looks at controversial topics like Nursing Ethics and Medical Ethics
war, animal rights and capital punishment.  Nursing is concerned with health, whereas medicine
focuses on cure.
 If ethical theories are to be useful in practice, they  Also, there is a functional difference between care and
need to affect the way human beings behave. healing.
 Some philosophers think that ethics does do this.  It is useful here first to consider the history of nursing
They argue that if a person realizes that it would be as it pertains to ethics. The historical influence on ethics
morally good to do something then it would be might begin by considering Florence Nightingale’s 1893
irrational for that person not to do it. paper.
 But human beings often behave irrationally – they
follow their ‘gut instinct’ even when their head NURSING ETHICS MEDICAL ETHICS
1. Care 1. Healing
suggests a different course of action.
2. Treating of person 2. Treat disease
 However, ethics does provide good tools for 3. Concerned with health 3. Focuses – Curing as
thinking about moral issues. response to occurrence if
disease condition
4. Focus on patient’s active 4. Illness oriented profession
Introduction: What is ethics? participation
 Ethics or moral philosophy is a branch of philosophy 5. Health oriented profession 5. Consultative – physical
that "involves systematizing, defending, and patient encounter
recommending concepts of right and wrong behavior." 6. Locus of care – 6. Hospital as center for best
The field of ethics, along with aesthetics, concerns compassionately aids medicine
individuals
matters of value, and thus comprises the branch of 7. In depth and personal 7. Episodic in nature –
philosophy called axiology values and adoptive/ complex surgical,
 promote the values essential to good communication, restorative process biochemical and technical
such as trust, accountability, mutual respect and fair interventions
8. Nurses’ ever presence
medical care. 9. Trusting relationship
 moral principles that govern a person's behavior or the 10. Advocacy
conducting of an activity. 11. Nursing itself
 ETHICAL THEORIES Theorists:
DEONTOLOGY PLATO
 Is a modern combination of Classical Greek terms, and  is one of the founding fathers of philosophy and has
means the study or science (logos) of duty, or more had a massive impact on the history of western thought.
precisely, of what one ought to do (deon).
 In contemporary moral philosophy, “deontology” is ARISTOTLE
used most commonly to refer to moral conceptions  a Greek philosopher and protégé of Plato, is considered
which endorse several theses regarding the nature of the Father of the Scientific Method, the creator of
duty (the right), the nature of value (the good), and the
formal logic, and one of the greatest thinkers in the
relationship between the primary ethical concepts of the
history of the Western world.
right and the good

TELEOLOGY FRIEDRICH NIETZSCHE

 Comes from the Greek word telos for goal or aim.  has emerged as perhaps the most influential thinker of
 Teleological ethics in recent usage has been understood, the recent past. To a significant degree, this is due to the
most fundamentally, as standing in contrast with fact that he took time seriously in terms of both
“deontological” approaches to ethics. cosmology and ethics.

UTILITARIANISM IMMANUEL KANT

 A prominent, compelling, and controversial theory  like Plato and Aristotle, counts as one of the most
about the fundamental basis of mortality, influential philosophers of all time.
utilitarianism holds that human conduct should promote
the interests or welfare of those affected. JEREMY BENTHAM
 is known today chiefly as the Father of Utilitarianism.
Other Ethical Theories:
KANTIAN ETHICS
JOHN STUART MILL (1806–73)
 Ethical theory of Immanuel Kant (1724-1804)
 changed the way in which the modern world views, and
 Kant’s central ideas, including the good will, the moral
law, moral obligation, acting from duty. legal systems address, the issues of individual liberty
of thought, expressions, lifestyle, and action. His ideas
DUTY AND OBLIGATION remain both influential and controversial to this day.
 Certain acts are required, or ought to be done as
obligations or duties. ETHICAL PRINCIPLES:
 “obligation” is used for more abstract aims (e.g., we 6 BASIC PRINCIPLES OF ETHICAL PRACTICE
would speak more readily of “principles of obligation” Autonomy  Self-determination
than of “principles of duty”) Non-maleficence  Avoiding doing harm
 “duty” for more specific demands. Beneficence  Doing good,
promoting client well-
VIRTUE ETHICS being
Justice  Fair and just treatment
 Are normative ethical theories which emphasize
Fidelity  Making realistic
virtues of mind, character, and sense of honesty.
commitments, keeping
 Discuss the nature and definition of virtues and other
promises
related problems that focus on the consequences of Veracity  Truthfulness and
action. honesty
 Virtue Ethics is a philosophy developed by Aristotle
and other ancient Greeks. This character-based approach Others:
to morality assumes that we acquire virtue through CONFIDENTIALITY
practice.  is a fundamental principle in healthcare, and nurses
 Practicing being honest, brave, just, generous, and so on, must understand how this applies to their practice.
a person develops an honorable and moral character.
 pertains to restricting the sharing of sensitive patient
information and only sharing information when it is
necessary either by law or professional duty.
AUTONOMY PRINCIPLES OF BIOETHICS
 promotes self-determination/ freedom of choice The Principles of Stewardship
 Life comes from God, and humans are "stewards"
BENEFICENCE (Doing Good) responsible for the care of the body. A part of the body
 The actions one takes should be done in an effort to exists for the good of the whole, and therefore limbs, for
promote good. example, may be amputated if it is necessary to protect
the rest of the body.\
NON-MALEFICENCE
 This principle imposes the duty to avoid harming the Roles of Nurses as Stewards:
patient based on the Hippocratic Oath of “do no harm:”  Stewardship is an ethic that embodies the responsible
 Refers to prevention of harm and the removal of harmful
planning and management of resources.
conditions.
 The concepts of stewardship can be applied to the
environment and nature, economics, health,
JUSTICE
 Seeks fairness. property, information, theology, cultural resources,
 Treats “equals” equally. etc.
 Treats “unequals” according to their differences.
Personal, social, ecological and biomedical.
VERACITY  There are 3 main types of ecological stewardship. A
 The obligation to tell the truth. person can take action, donate money, and practice
good stewardship on a daily basis.
FIDELITY
 The need to keep promises. Principle of Totality and Integrity:
 The human body is an integral part of the human person
CONFIDENTIALITY and is therefore worthy of human dignity. It must be kept
 Keeping privileged information private. whole. No body part should be removed, mangled or
debilitated unless doing so is necessary for the health of
ETHICAL DILEMMA a more essential body part or the body of a whole.
 Defined as making a choice between two or more
equally undesirable alternatives. Explanation
 Human nature is an integration of body and spirit.
APPLIED ETHICS: These two dimensions can never be separated (in fact,
 General worldviews that we developed our social moral separation of the spirit from the body is the definition of
principles and legal rights. Are still in continual state of death).
evolution.  The human body shares in the dignity of the human
 Illustration: History at one point embraced slavery then person.
rejected it, oppressed women and disregard the disabled Applications
and eventually struggled to create a legitimate space  Surgeries that needlessly remove body parts or organs
for everyone. are immoral
 Society evolved as reactions to vague concepts as “do  Tattoos and piercings are not inherently immoral but
good and avoid evil”, or “inherent dignity of the they may be immoral if they deface the body by
individual”. quantity or content.
 Morality and ethics still in constant reinterpretation  Torture is a moral evil because it seeks to dis-integrate
for every age and time. the body and the spirit
 Professional ethics, are applied ethics designed to bring  Self-mutilation is self-hatred expressed through spite
about the ethical conduct of the profession. of the body
 In health care delivery: pursuit for health, prevention of  That chemical contraception effectively shuts down a
death, and alleviation of suffering as secondary goal. healthy bodily system is part of what makes it immoral.
 Even if the pro-choice argument that an embryo is part
of the woman’s body rather than an independent
human person is true, it should not be removed except
when its presence endangers the woman’s life.
Principle of Ordinary and Extraordinary Means:
Ordinary Means
 Ordinary means = reasonable hope of benefit/success;
not overly burdensome;
 Does not present an excessive risk and are financially
manageable
 Proportionate to the state of the patient • “Ethically
indicated” (Strong 1981 p. 84).

Extraordinary Means 2 Norms of Sexual Morality

 Extraordinary means = no reasonable hope of 1. Laws or social attitudes that hinder human freedom
benefit/success; to achieve these values in ways the individuals
 Overly burdensome; desires are unjust and oppressive.
 Excessive risk and are not financially manageable 2. Sexual behavior, at least among consenting adults,
 No obligation to use it/morally optional is entirely a private matter to be determined by
personal choice, free from any moral guilt.
Principle of Personalized Sexuality:
Personalized sexuality THE INFORMED CONSENT
 is based on an understanding of sexuality as one of the Informed consent
 the process in which a health care provider educates a
basic traits of a person and must be developed in ways
patient about the risks, benefits, and alternatives of a
consistent with enhancing human dignity.
given procedure or intervention.
 Hence, sexuality is not only a private matter, although
 The patient must be competent to make a voluntary
it involves the most intimate of relationships.
decision about whether to undergo the procedure or
The Gift of Sexuality intervention. (Jun 1, 2020)
 Must be used in keeping with its intrinsic, invisible,
specifically human teleology. Obtaining informed consent in medicine is process that
 Must be loving, bodily, pleasurable expression of the should include:
complimentary, permanent self-giving of a man and a (1) describing the proposed intervention,
woman to each other (2) emphasizing the patient's role indecision-making,
(3) discussing alternatives to the proposed intervention,
Generally Recognized Values: (4) discussing the risks of the proposed intervention and
1. Sex is a search for sensual pleasure and satisfaction, (5) eliciting the patient's
releasing physical and psychic tensions.
2. Sex is a search for the completion of the human Provided, that the patient will not be subjected to any
person through an intimate personal union of love procedure without his written informed consent, except
expresses by bodily union. in the following cases:
3. Sex is a social necessity for the procreation of a) in emergency cases, when the patient is at imminent
children and their education in the family so as to risk of physical injury. In such cases, the physician can
expand the human community and guarantee is perform any diagnostic or treatment procedure as good
future beyond the death of individual members. practice of medicine dictates without such consent;
4. Sex is a symbolic (sacramental) mystery, somehow b) when the health of the population is dependent on the
revealing the cosmic order. adoption of a mass health program to control
epidemic;
For Secular Humanist: Reasonable Uses of Sex c) when the law makes it compulsory for everyone to
1. Use sex purely for sake of pleasure apart from any submit a procedure;
relation to love or family. d) When the patient is either a minor, or legally
2. Use it to reproduce (making test tube babies) incompetent, in which case. a third party consent Is
without any reference to pleasure or love. required;
3. Expression of unselfish love, but without any e) When disclosure of material information to patient
relation to marriage or family. will jeopardize the success of treatment,in which case,
thirdparty disclosureand consent shall be in order
f) When the patient waives his right in writing.
Elements of an Informed Consent 3. Right to Privacy and Confidentiality
 Information –sufficient info.  The privacy of the patients must be assured at all
 Volunteerism –autonomy. stages of his treatment.
 Competence –decision making capacity.  The patient has the right to be free from
 Right to Refuse Treatment. unwarranted public exposure, except in the
following cases:
Nurses’ domain of Responsibility a) when his mental or physical condition is in
 Nurses typically are assigned the task of obtaining and controversy and the appropriate court, in its
witnessing written consent for health care treatment. discretion, order him to submit to a physical or
 The goal of informed consent is to assure patient mental examination by a physician;
autonomy. b) when the public health and safety so demand;
and
The following persons, in the order of priority stated c) when the patient waives this right in writing.
hereunder, may give consent, in patient’s behalf:
 spouse; 4. Right to Information
 son or daughter of legal age;  right to be informed of the result of the evaluation
 either parent; of the nature and extent of his/her disease,
 brother or sister of legal age, or additional or medical treatment on surgical
 guardian procedure or procedures, including any other to be
administered (generic counterpart), possible
ETHICS IN PROFESSIONAL NURSING PRACTICE complications, and other pertinent facts, statistics
The NMC Code: or studies, regarding his/her illness, any change in
Professional standards of practice and behavior for nurses, the from PhilHealth or any charges.
midwives and nursing associates.
 The Code presents the professional standards that nurses, 5. The Right to Choose Health Care Provider and
midwives and nursing associates must uphold in order to Facility
be registered to practice in the UK.  The patient is free to choose the health care
 Developed in collaboration with many who care about provider to serve him as well as the facility except
good nursing and midwifery, the Code can be used by when he is under the care of a service facility or
nurses, midwives and nursing associates as a way of when public health and safety so demands or when
reinforcing their professionalism. the patient expressly waives this right in writing.
 The Code contains a series of statements that taken together
signify what good practice by nurses, midwives and 6. Right to Self-Determination
nursing associates looks like. It puts the interests of patients  any person of legal age and of sound mind may
and service users first, is safe and effective, and promotes make an advance written directive for physicians
trust through professionalism. to administer terminal care when he/she suffers
 Prioritize people from the terminal phase of a terminal illness:
 Practice effectively Provided that
 Preserve safety a) he is informed of the medical consequences of
 Promote professionalism and trust his choice;
b) he releases those involved in his care from any
Patients’ Rights: obligation relative to the consequences of his
1. Right to Appropriate Medical Care and Humane decision;
Treatment c) his decision will not prejudice public health and
 Every person has a right to health and medical care safety.
corresponding to his state of health, without any
discrimination and within the limits of the resources, 7. Right to Religious Belief
man power and competence available for health and  The patient has the right to refuse medical
medical care at the relevant time. treatment or procedures which may be contrary
to his religious beliefs, subject to the limitations
2. Right to Informed Consent
described in the preceding subsection: Provided,
 The patient has a right to a clear, truthful and
that such a right shall not be imposed by parents
substantial explanation, in a manner and language
understandable to the patient, of all proposed
upon their children. (18 below)
procedures, whether diagnostic, preventive, curative,
rehabilitative or therapeutic.
8. Right to Medical Record Broad Categories of Patient’s Rights:
 The patient is entitled to a summary of his medical 1. Right to Health and Health Care
history and has the right to view the contents of his 4 Elements:
medical records, except psychiatric notes. a. Right to equal access to healthcare.
 The health care institution shall safeguard the b. Right to quality care.
confidentiality of the medical records and to c. Right to access to appropriate care.
likewise ensure the integrity and authenticity. d. Right to safe care.
 The health care institution shall issue a medical 2. Right to Informed Consent.
certificate to the patient upon request. 3. Right to Confidentiality.
4. Right to be treated with Dignity.
9. Right to Leave 5. Right to be treated with Respect.
 The patient has the right to leave hospital or any 6. Right to Cultural Liberty.
other health care institution regardless of his
physical condition: Provided, that The Patient’s Bill of Rights:
a) he/she is informed of the medical consequences  A Patient’s Bill of Rights is a document that provides
of his/her decision patients with information on how they can reasonably
b) he/she releases those involved in his/her care expect to be treated during the course of their hospital
from any obligation relative to the stay.
consequences of his decision;
c) his/her decision will not prejudice public health RA 10173
and safety.  In 2012, the Congress of the Philippines passed
 No patient shall be detained against his/her will Republic Act No. 10173, also known as the Data
in any health care institution on the sole basis of his Privacy Act (DPA) of 2012.
failure to fully settle his financial obligations.  Five years later, the DPA’s Implementing Rules and
Regulations was put in effect on September 9, 2016,
10. Right to Refuse Participation In Medical Research thus mandating compliance.
 The patient has the right to be advised if the health  In 2014, it was estimated that 2.5 quintillion —or 2.5
care provider plans to involve him in medical billion billion—bytes of data were created every day.
research, including but not limited to human  This includes unprecedented knowledge about what
experimentation which may be performed only with real individuals are doing, watching, thinking, and
the written informed consent. feeling.
 RA 10173, or the Data Privacy Act, protects
11. Right to Correspondence and to Receive Visitors
individuals from unauthorized processing of personal
 The patient has the right to communicate with
relatives and other persons and to receive visitors information that is (1) private, not publicly available;
subject to reasonable limits prescribed by the rules and (2) identifiable, where the identity of the individual
and regulations of the health care institution. is apparent either through direct attribution or when put
together with other available information.
12. Right to Express Grievances
 The patient has the right to express complaints and The Professional Code of Ethics for Nurses:
grievances about the care and services received RA 9173: The Philippine Nursing Law
without fear of discrimination or reprisal and to  Code of Ethics for Nurses in the Philippines was
know about the disposition of such complaints. devised as a guide for carrying out nursing
responsibilities which would tackle difficult issues and
13. Right to be Informed of His Rights and Obligations decisions that a profession might be facing, and give
as a Patient clear instruction of what action would be considered
 It shall be the duty of health care institutions to ethical or right in the given circumstance.
inform of their rights as well as of the institution's  RA 9173 was enacted in 2002 to provide a
rules and regulations that apply to the conduct of the comprehensive definition and understanding of the
patient while in the care of such institution. nursing profession. This is in recognition of the vital
role nurses play in the delivery of quality health services
Nurses’ Role:
not only in the country, but all over the world.
1. Knowledge and understanding of Patient’s Rights.
2. Upholding these Rights.
Importance of Nurses’ Code of Ethics: Nurses’ Bill of Rights:
 For those entering the nursing profession, the Code of  Registered nurses promote and restore health, prevent
Ethics serves as a guide. illness, and protect the people entrusted to their care.
 It acts as a non-negotiable standard of ethics for nurses. It  They work to alleviate the suffering experienced by
also acts as a reminder of nurses' commitment to society. individuals, families, groups, and communities.
 The code requires nurses to continue with their learning  In so doing, nurses provide services that maintain respect
and evidence-based practice. for human dignity and embrace the uniqueness of each
patient and the nature of his or her health problems, without
The Nightingale Pledge: restriction with regard to social or economic status.
 a Hippocratic Oath for nurses  To maximize the contributions nurses make to society, it is
 I solemnly pledge myself before God and in the presence necessary to protect the dignity and autonomy of nurses in
of this assembly to pass my life in purity and to practice my the workplace.
profession faithfully. I will abstain from whatever is
deleterious and mischievous and will not take or knowingly The following rights must be afforded: ANA, 2000
administer any harmful drug. 1. Nurses have the right to practice in a manner that fulfills
 Obligation. their obligations to society and to those who receive
nursing care.
International Council of Nurses: 2. Nurses have the right to practice in environments that allow
 The International Council of Nurses is a federation of more them to act in accordance with professional standards and
than 135 national nurses’ associations. legally authorized scopes of practice.
 It was founded in 1899 and was the first international 3. Nurses have the right to a work environment that supports
organization for health care professionals. and facilitates ethical practice, in accordance with the Code
 It is headquartered in Geneva, Switzerland. of Ethics for Nurses with Interpretive Statements.
4. Nurses have the right to freely and openly advocate for
themselves and their patients, without fear of retribution.
Professional Boundaries and Moral Obligations for Nurses:
5. Nurses have the right to fair compensation for their work,
 The nurse's responsibility is to delineate and maintain
consistent with their knowledge, experience and
boundaries.
professional responsibilities.
 Actions that overstep established boundaries to meet the
6. Nurses have the right to a work environment that is safe for
needs of the nurse are boundary violations. themselves and for their patients.
 The nurse should avoid situations where he or she has a 7. Nurses have the right to negotiate the conditions of their
personal, professional or business relationship with the employment, either as individuals or collectively, in all
patient. practice settings

Nurses and Social Media: Healthy Nurse, Healthy Nation™

 Nurses must observe standards of patient privacy and  On May 1, 2017, the American Nurses Association (ANA)
confidentiality at all times and in all environments, launched the Healthy Nurse, Healthy Nation™ Grand
including online. Challenge(HNHN),
 The nurse's primary commitment is to the patient, and  an ongoing national movement designed to transform the
nurses are ethically required to practice with compassion health of the nation by improving the health of the
and respect for the inherent dignity and worth of every nation’s 4 million registered nurses. As one of the most
individual. trusted professions, nurses have enormous potential to lead
Netiquette: La Sallians Should & Not To health care change as role models, advocates, and
 This simply means the use of good manners in online educators.
communication such as e-mail, forums, blogs, and social  Nurses support patients to live life to the fullest, and they
networking sites to name a few. deserve the same privilege. ANA believes that nurse
 It is important to use netiquette because communication wellbeing must be safeguarded, and that ill-health should
online is non-verbal. not be an inevitable by-product of dedicated nursing
 "Netiquette" applies to Internet behavior. practice.
 A healthy nurse lives life to the fullest capacity, across the
Honesty is still the best policy. wellness/illness continuum, as they become stronger role
RA 9271 The Quarantine Act of 2004 models, advocates, and educators; personally, for their
 If found infected or exposed to the infection, considered as families, their communities and work environments, and
a dangerous contact, may be isolated ultimately for their patients.
RA 11332 Law on reporting Communicable Disease
 Non reporting