THEORIES AND PRINCIPLES OF You can’t obey it a little –

HEALTH ETHICS either you kill innocent

people or you don’t.
There’s no middle ground.
I. Ethics o Imperfect duties do allow
for some middle ground.
1. Deontology “Learn about the world
- A theory that suggests actions are around you” is an
good or bad according to a clear imperfect duty because we
set of rules. can all spend different
amounts of time on
Its name comes from the Greek education and each be
word “deon”, meaning duty. fulfilling our obligation.
Actions that obey these rules are How much we commit to
ethical, while actions that do not, imperfect duties is up to
are not. us.
This ethical theory is most closely
associated with German
philosopher, Immanuel Kant. By focusing on a person’s
intentions, it also places ethics
His work on personhood is an entirely within our control –
example of deontology in practice. we can’t always control or
Kant believed the ability to use predict the outcomes of our
reason was what defined a actions, but we are in
person. complete control of our
intentions.
From an ethical perspective,
One way of resolving this
personhood creates range of right
problem is though an idea
and obligations because every
called threshold deontology,
person has inherent dignity –
which argues we should
something that is fundamental to
always obey the rules unless in
and is held in equal measure by
an emergency situation, at
each and every person. Most
which point we should revert
importantly, Kant argues that we
to a consequentialist
may never treat a person merely
approach.
as a means to an end (never just a
‘resource’).
2. Teleology
Most deontologists say there are
- From Greek name “telos”, end,
two different kinds of ethical
and “logos”, reason – explanation
duties, perfect duties and
by references to some purpose,
imperfect duties.
end, goal, or function. Human
o Perfect duties are
conduct insofar as it is rational, is
inflexible. “Do not kill
generally explained with reference
innocent people” is an
to ends or goals pursued or
example of a perfect duty.
alleged to be pursed.
 The philosophy itself suggest that
acts are done with a forgone
purpose in mind – people do
things knowing the result they
Virtue Ethics
wish to achieve. As Aristotle said,
“Nature does nothing in vain.” Virtue Ethics in Nursing
- Concerns with the character of
individuals nurses and seeks ways
3. Utilitarianism
to enable nurses to develop
- Its core idea is that whether
character traits appropriate for
actions are morally right or wrong
actions that enhance wellbeing.
depends on their effects. More
specifically, the only effects of
actions that are relevant are the
Core Values of a Professional Nurse
good and bad results that they
produce. A key point in this article - Nursing Values are any set of
concerns the distinction between beliefs that direct the work of
individual actions and types of nurses. While there are many
actions. different theories on nursing,
Act utilitarian’s focus on the some of the common core values
effects of individual actions (such are caring, professionalism,
as John Wilkes Booth’s respect, integrity, diversity, and
assassination of Abraham Lincoln) excellence.
while rule utilitarian’s focus on the
effects of types of actions (such as
killing or stealing). 4 Core Ethical Principles of Nursing
Autonomy, Justice, Beneficence, Non-maleficence
Utilitarians believe that the
purpose of morality is to make life
better by increasing the good
A. Autonomy
things (pleasure, happiness) and
Patient’s Bill of Rights
decreasing the bad things in the
world (pain, unhappiness).
1. Right to Appropriate Medical Care
They reject moral codes or and Humane Treatment
systems that consist of commands
or taboos that are based on - Every person has a right to health
customs, traditions, or orders and medical care corresponding to
given by leaders or supernatural his state of health, without any
beings. Instead, utilitarian’s think discrimination and within the
that what makes a morality be limits of the resources, manpower
true or justifiable is its positive and competence available for
contributions to human (and health and medical care at the
perhaps non-human beings). relevant time. The patient has the
right to appropriate health and
medical care of good quality.
  A. In emergency cases, when the
In the course of such, his human patient is at imminent risk of
dignity, convictions, integrity, physical injury, decline of death if
individual needs and culture shall treatment is withheld or
be respected, if any person cannot postpones. In such cases, the
immediately be given treatment physician can perform any
that is medically necessary, he diagnostic or treatment procedure
shall (depending on his health) as good practice of medicine
either be directed to wait for care, dictates without such consent;
or be referred or sent for
treatment elsewhere, where the  B. When health of the population
appropriate care can be provided. is dependent on the adoption of
If the patient has to wait for care, mass health program to control
he shall be informed of the reason epidemic;
for the delay. Patients in
emergency shall be extended  C. When the law makes it
immediate medical care and compulsory for everyone to
treatment without any deposit, submit a procedure;
pledge, mortgage or any form of
advance payment for treatment.  D. When the patient is either a
minor, or legally incompetent, in
which case, a third-party consent
is required;
2. Right to Informed Consent
 E. When disclosure of material
- The patient has a right to a clear,
information o patient will
truthful and substantial
jeopardize the success of
explanation, in a manner and
treatment, in which case, third
language understandable to the
party disclosure and consent shall
patient, of all purposed
be in order;
procedures, whether diagnostic,
preventive, curative, rehabilitation
or therapeutic, wherein the  F. When the patient waives his
person who will perform the said right in writing.
procedure shall provide his name
and credentials to the patient,
possibilities of any risk of mortality - Informed consent shall be
of serious side effects, problems obtained from a patient
related to recuperation, and concerned if he is of legal age and
probability of success and of sound mind. In case the patient
reasonable risks involved: is incapable of giving consent and
Provided, that the patient will not a third-party consent is required.
be subjected to any procedure The following persons, in the
without his written informed order of priority stated hereunder,
consent, except in the following may give consent;
cases. o Spouse
o Sone/Daughter of legal age
 o Either Parent provider or practitioner involved
o Brother/Sister of legal age, in the treatment of a patient and
or all those who have legitimate
o Guardian access to the patient’s record is
not authorized to divulge ay
information to a third-party who
- If patient is a minor, consent shall has no concern with the care and
be obtained from his/her parents welfare of the patient without
or legal guardian. If next of kin, his/her consent, except;
parents or legal guardians refuse
to give consent to a medical or A. when such disclosure will
surgical procedure necessary to benefit the public health safety;
save the life or limb of a minor or B. when it is in the interest of
a patient incapable of giving justice and upon the order of a
consent, courts, upon the petition competent court, and;
of the physician or any person C. when the patients waives in
interested in the welfare of the writing the confidential nature of
patient, in a summary proceeding, such information;
may issue an order giving consent. D. when it is needed for continued
medical treatment or
advancement of medical science
3. Right to Privacy and Confidentiality. subject to de-identification of
patient and shared medical
- The privacy of patients must be confidentiality for those who have
assured at all stages of his/her access to the information.
treatment. The patient has the
right to be free from unwarranted
public exposure, except in the - Informing the spouse or the family
following cases; to the first degree of the patient’s
medical condition may be allowed;
a) when his mental or physical provided that the patient of legal
condition is in controversy and the age shall have the right to choose
appropriate court, in its discretion, on whom to inform. In case the
order him to submit to a physical patient is not of legal age or is
or mental examination by a mentally incapacitated, such
physician; information shall be given to the
b) when the public health and parents, legal guardian or his next
safety so demand; and of kin.
c) when the patient waives this
right in writing.
4. Right to Information
- The patient has the right to
demand that all information, - In the course of his/her treatment
communication and records and hospital care, the patient or
pertaining to his care be treated his/her legal guardian has a right
as confidential. Any health care to be informed of the result of the
evaluation of the nature and
extent of his/her disease, any further treatment, and which shall
other additional or further be provided by the attending
contemplated medical treatment physician.
on surgical procedure or
procedures, including ay other He/ she is likewise entitled to the
additional medicines to be explanation of, and to view, the
administered and their generic contents of medical record of
counterpart including the possible his/her confinement but with the
complications and other pertinent presence of his attending
facts, statistics or studies, physician or in the absence of the
regarding his/her illness, any attending physician, the hospital’s
change in the plan of care before representative.
the change is made, the person’s
participation in the plan of care Notwithstanding that he/she may
and necessary changes before it not be able to settle his accounts
implementation, the extent to by reason of financial incapacity,
which payment maybe expected he/she is entitled to reproduction,
from Phil health or any payor and at his/her expense, the pertinent
any charges for which the patient part or parts of the medical record
may be liable, the disciplines of the purpose or purposes of which
health care practitioners who will he shall indicate in his/her written
furnish the care and the frequency request for reproduction. The
of services that are proposed to patient shall likewise be entitled
be furnished. to medical certificate, free of
charge, with respect to his/her
The patient or his/her legal previous confinement.
guardian has the right to be
informed by the physician or
his/her delegate of his/her 5. The Right to Choose Health Care provider
continuing health care and Facility
requirements following discharge,
- The patient is free to choose the
including instructions about home
health care provider to serve him
medications, diet, physical activity
as well as the facility except when
and all other pertinent
he is under the care of a service
information to promote health
facility or when public health and
and well-being.
safety so demands or when the
patient expressly waives this right
At the end of his confinement, the
in writing.
patient is entitled to a brief
written summary of the course of
The patient has the right to
his/her illness which shall include
discuss his condition with a
at least the history, physical
consultant specialist, at the
examination, diagnosis,
patient’s request and expense.
medications, surgical procedure,
ancillary and laboratory
He also has the right to seek for a
procedures, and the plan of
second opinion and subsequent
 opinions, if appropriate, from 8. Right to Medical Records
another health care
- The patient is entitled to a
provider/practitioner.
summary of his medical history
and condition. He has the right to
view the contents of his medical
6. Right to Self Determination
records, except psychiatric notes
- The patient has the right to avail and other incriminatory
himself/herslelf of any information obtained about third-
recommended diagnostic and parties, with the attending
treatment procedures. Any person physician explaining contents
of legal age and of sound mind thereof. At his expense and upon
may make an advance written discharge of the patient, he may
directive for physicians to obtain from the health care
administer terminal care when institution a reproduction of the
he/she suffers from the terminal same record whether or not he
phase of a terminal illness, has fully settled his financial
Provided that; obligation with the physician or
institution concerned.
a) he is informed of the medical
consequences of his choice; The health care institution shall
b) he releases those involved in his safeguard the confidentiality of
care from any obligation relative the medical records and to
to the consequences of his likewise ensure the integrity and
decision; authenticity of the medical
c) his decision will not prejudice records and shall keep the same
public health and safety. within a reasonable time as may
be determined by the Department
of Health.
7. Right to Religious Belief
The health care institution shall
- The patient has the right to refuse
issue a medical certificate to the
medical treatment or procedures
patient upon request. Any other
which may be contrary to his
document that the patient may
religious beliefs, subject to the
require for insurance claims shall
limitations described in the
also be made available to him
preceding subsection.
within forty-five days from
Provided that such a right shall
request.
not be imposed by parents
upon their children who have
not reached the legal age in a
9. Right to Leave
life-threatening situation as
determined by the attending - The patient has the right to leave
physician or the medical hospital or any other health care
director of the facility. institution regardless of his
physical condition: provided that;
 a) he/she is informed of the research involving human
medical consequences of his/her experimentation.:
decision; Provided furthermore,
b) he/she releases those involved that the patient involved in the
in his/her care from any obligation human experimentation shall
relative to the consequences of his be made aware of the
decision; provisions of the Declaration
c) his/her decision will not of Helsinki and its respective
prejudice public health and safety. guidelines.

- No patient shall be detained

against his/her will in any health 11. Right to Correspondence and to Receive
care institution on the sole basis Visitors
of his failure to settle his financial
- The patient has the right to
obligations. However, he/she shall
communicate with relatives and
only be allowed to leave the
other persons and to receive
hospital provided appropriate
visitors subject to reasonable
arrangements have been made to
limits prescribed by the rules and
settle the unpaid bills:
regulations of the health care
Provided further, that
institution.
unpaid bills of patients shall be
considered as loss income by
the hospital and health care
12. Right to Express Grievances
provider/practitioner and shall
be deducted from gross - The patient has the right to
income as income loss only on express complaints and grievances
that particular year. about the care and services
received without fear of
discrimination or reprisal and to
10. Right to Refuse Participation in Medical know about the disposition of
Research such complaints. Such system shall
afford all parties concerned with
- The patient has the right to be
the opportunity to settle amicably
advised if the health care provider
all grievances.
plans to involve him in medical
research, including but not limited
to human experimentation which
13. Right to be Informed of his Right and
may be performed only with the
Obligations as a Patient
written informed consent of the
patient: - Every person has the right to be
Provided that, an informed of his rights and
institutional review board or obligations as a patient. The
ethical review board in Department of Health, in
accordance with the guidelines coordination with health care
set in the Declaration of providers, professional and civic
Helsinki be established for groups, the media, health
insurance corporations, people’s
 organizations, local government and the probability of success or
organizations, shall launch and failure as a possible consequence
sustain a nationwide information of said proposed procedure or
and education campaign to make procedures, including the
known to people their rights as implications of withholding
patients, as declared in this Act consent.
such rights and obligations of
patients shall be posted in a On the explanation, the
bulletin board conspicuously comprehensive ability of the
places in a health care institution. patient shall also be considered,
taking into account his level of
It shall be the duty of health care education, the dialect or language
institutions to inform of their right that he speaks and understands,
as well as of the institution’s rules and if possible, with the use of
and regulations that apply to the anatomic sketch or any materials
conduct of the patient while in the or visual aids that may aid the
care of such institution. patient, or his legal
representative, in fully
understanding the proposed
14. Right to Informed Consent procedure or procedures.

- The patient has a right to self-

The right to informed consent
determination and to make free
shall likewise consider the
decisions regarding
voluntariness in which the patient
himself/herself. However, the
or his/her legal representative has
attending physician shall inform
given his/her consent, seeing to it
the patient of the consequences
that the patient or his legal
of his/her decisions.
representative was allowed to ask
questions, or that he/she is given
A patient who is mentally
that hance to consult his/her kin,
competent and is of legal age, or
or to seek another expert opinion.
in his incapacity or age of minority
- his legal representative has a
If the patient is unconscious or is
right to a clear explanation, in
unable to express his/her will,
Layman’s terms, of all proposed or
informed consent must be
contemplated procedures,
obtained whenever possible from
whether diagnostic or therapeutic,
a legal representative.
including the identity and
professional circumstances of the Provided however, that
person or persons who will when medical intervention is
perform the said procedure or urgently needed, the consent
procedures. The explanation shall of the patient may be
include the amount of information presumed.
necessary and indispensable for
Provided further, that a
him to intelligently give his
physician should always try to
consent, including, but not limited
save the life of a patient who is
to the benefits, risks, side effects
 unconscious due to suicide - The right to consent must be
attempt. delegated to a legally and
medically competent adult. There
are two types of proxy consent for
In the case of the patient who is adults.;
legally incompetent or is a minor, o First, the power of
the consent of a legal attorney to consent to
representative is required. medical care – usually used
by patients who want
Provided however, that
medical care but are
the patient must be involved
concerned about who will
in the decision-making process
consent if they are
to the fullest extent allowed
rendered temporarily
by his metal capability. If the
incompetent by the
legally incompetent patient
medical care.
can make rational decisions,
his/her decisions must be
respected, and he/she has the
right to forbid disclosure of
such information to his/her
legal representative.

If the patient’s legal

representative forbids treatment
but in the opinion of the
physician, it is contrary to the
patient’s best interest, the
physician may challenge this
decision in court.
Provided however, that in
emergency cases, the
physician shall act in the
patient’s best interest.
Provided further, that in
emergency cases where there
is no one who can give consent
on the patient’s behalf, the
physician can perform any
emergency diagnostic or
treatment procedure in the
best interest of the patient.

Proxy Consent/legally Acceptable

Representative