VALUES AND PROFESSIONAL ETHICS

Values and Professional Ethics (1)

PAMANTASAN NG LUNGSOD NG MAYNILA - BACHELOR OF SCIENCE IN NURSING - BATCH 2021-2022 (2ND SEM)

TOPIC OUTLINE
1 Values and Professional Ethics
2 Ethical Theories
3 Ethical Principles
3.1 Autonomy
3.1.1 Patient’s Right
3.1.2 Patient’s Bill of Rights
3.1.3 Informed Consent
3.1.4 Proxy Consent/Legally Acceptable Representative
3.1.5 Confidentiality
4 Privacy
5 Confidentiality
6 Veracity
7 Fidelity
8 Justice
9 Beneficence
10 Non-Maleficence
10.1 Integrity Issues in Organ Donation

VALUES attempted to define a person as a rational human

➔ A person’s or society’s beliefs about good behavior being with freedom and moral worth.
and what things are important. ➔ A person is morally good and admirable if actions are
ETHICS
done from a sense of duty.
➔ Also called moral philosophy, the discipline
concerned with what is morally good and bad and ➔ Stated that people ought to follow a universal
morally right and wrong. framework of moral maxims of rules to guide right
PROFESSIONAL actions and duties because it is through dutiful
➔ A person who belongs to and practice a profession. actions that people have moral worth.
PROFESSIONALISM 2 TYPES OF KANTIANISM
➔ Demonstration of high level of personal, ethical, and 1. HYPOTHETICAL IMPERATIVE
high level of skill characteristics for a member of a ➔ A rule of conduct that is understood to apply to an
profession. individual only if he or she desires a certain end and
ETHICAL THEORIES
has chosen (willed) to act on that desire.
➔ Can generally be broken down into three
2. CATEGORICAL IMPERATIVE
categories: Deontological, Teleological & ➔ Commands or moral laws all persons must follow,
Utilitarian regardless of their desire or extenuating
DEONTOLOGY circumstances.
➔ Is an ethical theory that says actions are good or bad o W.D Ross’s Seven Prima Facie Duties
according to a clear set of rules. → The right and the good is based on his connection
NATURAL LAW THEORY of ethical intuitionism to prima facie (conditional)
➔ St. Thomas Aquinas (1225-1275) rightness of action.
duties.
Use of the highest right reason and rationality.
7 DUTIES
KANTIANISM 1. Duties of Fidelity
➔ Immanuel Kant, a German Philosopher, of the 18th
➔ telling the truth, keeping actual and implicit
century (Munson, 2-4). In his work, Groundwork of
promises.
the Metaphysics of Morals, Kant (trans. 203)
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MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 2. Duties of Reparation ➔ “Right to Appropriate Medical Care and
➔ Righting the wrongs, we have done to others Humane Treatment.”
3. Duties of Gratitude ➔ Every person has the right to a continuous supply of
➔ Recognizing the services others have done to us high-quality health care, subject to the resources,
4. Duties of Justice manpower, and competence available for health and
➔ Preventing a distribution of pleasure or happiness that medical treatment. His human dignity, convictions,
is nor in keeping with the merit of the people involved integrity, particular needs, and culture must all be
5. Duties of Beneficence maintained during this treatment.
➔ Helping to better the condition of other beings B. PATIENT’S BILL OF RIGHTS
6. Duties of Self-improvement 1. The patient has the right to considerate and respectful
➔ Bettering ourselves with respect to virtue or care.
intelligence 2. The patient has the right to and is encouraged to obtain
7. Duties of Nonmaleficence from physicians and other direct caregivers relevant, current,
➔ Avoiding or preventing an injury to others and understandable information concerning diagnosis,
TELEOLOGICAL treatment, and prognosis.
➔ Is a reason or explanation for something as a function 3. Except in emergencies when the patient lacks decision-
of its end, purpose, or goal as opposed to as a making capacity and the need for treatment is urgent, the
function of its cause. patient is entitled to the opportunity to discuss and
➔ Cause and effect request information related to the specific procedures
UTILITARIAN and/or treatments, the risks involved, the possible
➔ The ethical action is the action that maximizes the length of recuperation, and the medically reasonable
welfare of the maximum number of people. alternatives and their accompanying risks and benefits
➔ It should be balance on how you would handle 4. Patients have the right to know the identity of
people. physicians, nurses, and others involved in their care, as well as
VIRTUE ETHICS when those involved are students, residents, or other trainees.
➔ A virtue ethics for nursing is therefore concerned 5. The patient has the right to know the immediate and long-
with the character of individual nurses and seeks term financial implications of treatment choices, insofar as they
ways to enable nurses to develop character traits are known.
appropriate for actions that enhance well-being. 6. The patient has the right to make decisions about the
➔ Being a nurse is multitasking job and needs a plan of care prior to and during treatment and to refuse a
bioethical critical thinking. recommended treatment or plan of care to the extent
CORE VALUES OF PROFESSIONAL NURSE permitted by law and hospital policy and to be informed of the
➔ Core values of nursing includes altruism, medical consequences of this action.
autonomy, human dignity, integrity, honesty, → In case of such refusal, the patient is entitled to
and social justice. other appropriate care and services that the hospital provides
ALTRUISM or transfer to another hospital. The hospital should notify
➔ Is the principle and moral practice of concern for patients of any policy that might affect patient choice within
happiness of other human beings or other animals, the institution.
resulting in a quality of life both material and spiritual. 7. The patient has the right to have an advance directive
➔ You are selfless (such as a living will, health care proxy, or durable power of
attorney for health care) concerning treatment or designating
ETHICAL PRINCIPLES a surrogate decision-maker with the expectation that the
AUTONOMY hospital will honor the intent of that directive to the extent
➔ “The belief that all people have intrinsic and permitted by law and hospital policy. Health care institutions
unconditional worth.” must advise patients of their rights under state law and
➔ As interpreted by philosophers Immanuel Kant hospital policy to make informed medical choices, ask if the
(1724–1804) and John Stuart Mill (1806–1873), patient has an advance directive, and include that information
and accepted as an ethical principle, is that all people in patient records. The patient has the right to timely
should have the power to make rational decisions and information about hospital policy that may limit its ability to
moral choices and that each person should be allowed fully implement a legally valid advance directive.
to exercise his or her capacity for self-determination. 8. The patient has the right to every consideration of
A. PATIENT’S RIGHT privacy. Case discussion, consultation, examination, and

MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
treatment should be conducted to protect each patient’s ➔ Informed consent is the process in which a health
privacy. care provider educates a patient about the risks,
9. The patient has the right to expect that all benefits, and alternatives of a given procedure or
communications and records pertaining to his/her care intervention.
will be treated as confidential by the hospital, except in cases ➔ Implicit in providing informed consent is an
such as suspected abuse and public health hazards when assessment of the patient's understanding, rendering
reporting is permitted or required by law. The patient has the an actual recommendation, and documentation of the
right to expect that the hospital will emphasize the process.
confidentiality of this information when it releases it to any ISSUE OF CONCERNS
other parties entitled to review information in these records. 1. ADEQUACY OF INFORMED CONSENT
10. The patient has the right to review the records ➔ The required standard for informed consent is
pertaining to his/her medical care and to have the determined by the state. The three acceptable
information explained or interpreted as necessary, except legal approaches to adequate informed consent are:
when restricted by law. o Subjective Standard
11. The patient has the right to expect that, within its ➔ What would this patient need to know and
capacity and policies, a hospital will make a reasonable understand to make an informed decision?
response to the request of a patient for appropriate and o Reasonable Patient Standard
medically indicated care and services. The hospital must ➔ What would the average patient need to know to be
provide evaluation, service, and/or referral as indicated by the an informed participant in the decision?
urgency of the case. When medically appropriate and legally o Reasonable Physician Standard
permissible, or when a patient has so requested, a patient may ➔ What would a typical physician say about this
be transferred to another facility. The institution to which the procedure?
patient is to be transferred must first have accepted the 2. EXCEPTIONS TO INFORMED CONSENT
patient for transfer. The patient must also have the benefit of ➔ Several exceptions to the requirement for informed
complete information and explanation concerning the need for, consent include:
risks, benefits, and alternatives to such a transfer. o The patient is incapacitated
12. The patient has the right to ask and be informed of o Life-threatening emergencies with
the existence of business relationships among the inadequate time to obtain consent
hospital, educational institutions, other health care providers, o Voluntary waived consent
or payers that may influence the patient’s treatment and care. 3. CHILDREN AND INFORMED CONSENT
13. The patient has the right to consent to or decline to
participate in proposed research studies or human ➔ Children (typically under 17) cannot provide informed
experimentation affecting care and treatment or requiring consent.
direct patient involvement and to have those studies fully ➔ Some, but not all, examples of an emancipated minor
include minors who are (1) under 18 and married,
explained prior to consent. A patient who declines to
(2) serving in the military, (3) able to prove
participate in research or experimentation is entitled to the
financial independence or (4) mothers of
most effective care that the hospital can otherwise provide.
children (married or not)
14. The patient has the right to expect reasonable
continuity of care when appropriate and to be informed by 4. INFORMED CONSENT FOR BLOOD TRANSFUSION
physicians and other caregivers of available and realistic ➔ Informed consent is essential to patient autonomy.
patient care options when hospital care is no longer ➔ Informed consent is required for many aspects of
appropriate. health care.
15. The patient has the right to be informed of hospital
policies and practices that relate to patient care, treatment, ➔ These include consent for:
and responsibilities. The patient has the right to be informed of
1. Treatment
available resources for resolving disputes, grievances, and
2. Dissemination of patient information,
conflicts, such as ethics committees, patient representatives,
3. Discussion of HIPPA laws
or other mechanisms available in the institution. The patient
4. Specific procedures,
has the right to be informed of the hospital’s charges for
5. Surgery
services and available payment methods.
6. Blood transfusions. &
C. INFORMED CONSENT
7. Anesthesia

MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 ➔ Obtaining informed consent in medicine is ➔ Example: If Mr. Kim, an adult who has had a stroke
process that should include: and is in a coma, needs surgery, the surrogate would
1. Describing the proposed intervention be the person Mr. Kim designated in his durable
2. Emphasizing the patient’s role in decision-making power of attorney for health care (DPAHC).
3. Discussing the risks of the proposed intervention ➔ If he DOESN’T HAVE DPAHC, the state may have
4. Eliciting the patient’s preference (usually by an applicable statute that identifies a surrogate for
signature). the purposes of consenting or refusing medical
treatment.
5.CLINICAL SIGNIFICANCE IN HUMAN CLINICAL
STUDIES
➔ Example: In state of Illinois, the Health Care
Surrogate Act permits a surrogate to be selected from
➔ Informed consent is mandatory for all clinical trials
a Prioritized list, in hierarchical order, legal guardian,
involving human beings
spouse, adult son or daughter, parent, adult sibling,
6.SHARED DECISION-MAKING etc., he/she must make the decisions he/she believes
➔ Informed consent is a collaborative process allowing the incapacitated patient would make.
patients and healthcare providers to make decisions ➔ The surrogate autonomy on behalf of the patient
together when more than one reasonable alternative since he is incapacitated.
exists, accounting for the patient’s unique preferences 2. DECISION-MAKING USING BEST INTERESTS
and priorities and the best scientific evidence STANDARD
available. ➔ Children have an emerging autonomy as they
develop and mature
PROXY CONSENT/LEGALLY ACCEPTABLE ➔ The parents make decisions
REPRESENTATIVE o They may allow their children to make some
1. Legally Authorized Representative (LAR) decisions such as, what sport or hobby they
➔ An individual or judicial, or other person authorized would like to pursue
under applicable law to give informed consent for o They usually do not allow a child to decide
whether to have surgery, take medicine, or
disclosure of information and give informed consent
forgo other recommended medical treatment
to treatment. ➔ There are exceptions
2. Surrogate Consent ➔ Substituted judgment is inappropriate or impossible to
➔ The use of legally authorized representative carry out.
with reasonable knowledge for the health care o Most cases in pediatrics
decision making when no guardian or agent has been
appointed ➔ The child does not have a clear or well-defined values
system
➔ According to Beauchamp and Childress, in Principles ➔ Exceptions may be older adolescence (e.g., 17-year-
olds)
of Biomedical Ethics, the surrogate must:
➔ Children who are more mature than typical for their
age
o Be competent, that is, capable of
understanding the consequences of the
➔ Therefore, parents (or legal guardians) are expected
consent also, capable of making a free
to use the best interests standard
choice.
➔ According to President’s Commission for the Study of
Ethical Problems in Medicine and Biomedical and
o Be free from coercion or undue influence Behavioral Research,1983, the surrogate makes
SURROGATE DECISION-MAKING decision that will “promote the patient’s good”
➔ Two standards in surrogate decision-making
o What will a child's life be like if treatment is
1. Substituted Judgment Standard given, or not given?
2. Best Interest Standard o What is the likelihood of success of this
treatment?
1. DECISION-MAKING USING SUBSTITUTED Will the treatment decision be the first on a
JUDGMENT STANDARD trajectory of decisions?
➔ According to President’s Commission for the Study of
Ethical Problems in Medicine and Biomedical and ➔ Example: Sunny is a 20-month-old with a history of
Behavioral Research,1983, the surrogate makes frequent ear infections. Her parents have had her
the decision that the incapacitated adult would seen by the pediatrician numerous times. Because her
make. language is developing very slowly, her pediatrician

MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 recommended that she see a pediatric right to privacy, the nurse has a duty to maintain
otolaryngologist, or ear-nose-and-throat (ENT) confidentiality of all patient information
physician. The ENT physician recommends insertion o Principle of non-maleficence supports a
of pressure-equalizing (PE) tubes, or middle-ear
person’s right to privacy
ventilation tubes, to reduce the fluid in the middle
ear. The fluid interferes with hearing, thereby o For establishing and maintaining a trusting
interfering with Sunny’s language development. relationship, protecting patient
confidentiality is necessary.
➔ The risks and potential benefits of the procedure are PRIVACY
explained to Sunny’s parents. They are advised that ➔ If there is no privacy and trust, there is no room for
this is a critical learning period for Sunny, so confidentiality.
improving her hearing at this time is very important. WHAT IS PRIVACY
CHILD’S BEST INTEREST VS. THE FAMILY’S BEST
➔ “That which is not open to or controlled by the
INTEREST
public; of or concerning a particular person; that
which is secret and not shared” (ANA, 1995, p. 6)
➔ The speech therapist may believe that the parents are
➔ Privacy belongs to each person and, as such, it
making the decision in their interests, not in Sunny’s
cannot be taken away from that person unless he/she
best interests. However, the parents believe they are
wishes to share it.
making the decision in the best interests of their
➔ Respect for privacy requires us to avoid intruding on
family, which includes Sunny. Should the child’s
the personal space and business of a patient. In
interests be made in isolation from the family’s
health care settings, patients lose a great deal of
interests?
privacy and highly value that which is left to them.
o In rare cases, children are removed from RIGHT FOR PRIVACY
their parents’ custody for medical treatment ➔ first discussed as a legal right in the Harvard Law
Review in 1890
o When treatment is life saving and clearly ➔ A person’s right to privacy is supported by the
efficacious, the courts have awarded ethical principle of non-maleficence
temporary custody to the physician (or IN THE USA:
hospital administrator) ➔ The first federal privacy standards to protect
patients’ medical records and other health
➔ Example: Refusal of blood by Jehovah’s Witnesses. information provided to health plans, doctors,
CONFIDENTIALITY hospitals, and other health care providers took effect
➔ Throughout every nurse’s professional practice, on April 14, 2003.
confidentiality is a primary ethical principle that must ➔ Developed by the U.S. Department of Health and
be maintained. Human Services (DHHS)
➔ It has been defined in many ways: ➔ these standards provide patients with access to their
o “Keeping the secrets of the patient,” medical records and more control over how their
(Hall, 1996, p. 3) personal health information is used and disclosed
o Controlling “access to sensitive (U.S. Department of Health and Human Services
personal information” (Lo, 2000, p. 42) [USDHHS], 2003, p. 1)
o In practice of one’s calling, it is a holding “in IN THE PHILIPPINES:
➔ legislature has adopted the HIPAA model and passed
confidence all personal matters committed to
the Data Privacy Act (DPA), RA 10173 , in 2012.
one’s keeping, also all family affairs coming
➔ Patterned loosely after HIPAA
to one’s knowledge (The Nightingale Pledge
➔ the DPA “protects individuals from unauthorized
for Nursing Student’s Pinning Ceremony,
processing of personal information that is
2001)
o (1) private, not publicly available; and
o Keeping something “classified,
o (2) identifiable, where the identity of the
restricted, undisclosed, secret, or
individual is apparent either through direct
private” (Parsons & Parsons, 1992, p. 37)
attribution or when put together with other
➔ The patient-related information must not be
available information.” From these two
disclosed
important qualifiers, the DPA attempts to
➔ According to ANA Code of Ethics for Nurses with
cover the entirety of data privacy
interpretive statements, 2001, “associated with the
IN GENERAL:
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MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 ➔ These laws provide a minimum acceptable standard ➔ Creating a trusting environment by respecting patient
related to how a patient’s medical records and privacy encourages the patient to seek care and to be
personal health information are to be kept as honest as possible during the course of a health
confidential care visit. It may also increase the patient’s
o For example, patients are guaranteed access willingness to seek care. For conditions that might be
to their medical records and must be stigmatizing, such as reproductive, sexual, public
provided a written statement health, and psychiatric health concerns, confidentiality
➔ Limits have been placed on the type and scope of assures that private information will not be disclosed
personal information shared between health care to family or employers without their consent.
entities or non–health care–related entities WHY DOES THE DUTY OF CONFIDENTIALITY REQUIRE?
o For example, life insurance companies, ➔ The obligation of confidentiality prohibits the health
banks, or marketing agencies. care provider from disclosing information about the
➔ Patients have been given the power to request special patient's case to others without permission and
accommodations for protecting their health care encourages the providers and health care systems to
information take precautions to ensure that only authorized
o for example, requesting that the primary access occurs. Appropriate care often requires that
care provider contact the patient at work information about patients be discussed among
rather than home with laboratory results members of a healthcare team; all team members
(USDHHS, 2003) have authorized access to confidential information
➔ The standards also require that health care entities about the patients they care for and assume the duty
create policies and procedures to protect patient of protecting that information from others who do not
information. Health care entities must provide have access. Electronic medical records can pose
patients with written privacy procedures and provide challenges to confidentiality.
employee confidentiality education ➔ In accordance with the Health Information Portability
➔ Case: You are assigned to a cardiac unit for your and Accountability Act of 1997 (HIPAA), institutions
clinical rotation. As you enter your patient’s room, the are required to have policies to protect the privacy of
patient yells at you, “I am going to sue this hospital patients’ electronic information, including procedures
and every employee! My boss called the hospital and for computer access and security
the switchboard operator told him that I was in the WHAT IF A FAMILY MEMBER ASKS HOW THE PATIENT
cardiac unit before she forwarded the call to my IS DOING?
room. I did not want anyone—especially my boss—to ➔ While there may be cases where the physician feels
know that I have had a heart attack. I thought my naturally inclined to share information, such as
diagnosis would be kept confidential!” responding to an inquiring spouse, the requirements
o Do you believe that this patient’s for making an exception to confidentiality may not be
confidentiality was violated? met. If there is no explicit permission from the patient
o How should you respond to his concerns? to share information with family members, it is
o What recommendations would you suggest generally not ethically justifiable to do so. Except in
to the switchboard operator? cases where the spouse is at specific risk of harm
directly related to the diagnosis, it remains the
CONFIDENTIALITY patient's (and sometimes local public health officers’),
➔ Respecting someone's privacy and abstaining from rather than the physician's, obligation to inform the
sharing personal or potentially sensitive information spouse.
about an individual, especially if that information has
been shared in confidence. WHEN CAN CONFIDENTIALITY BE BREACHED?
WHY IS CONFIDENTIALITY IMPORTANT? ➔ Overriding concerns can lead to the need to breach
➔ Patients routinely share personal information with confidentiality in certain circumstances.
health care providers. If the confidentiality of this o Exception 1: Concern for the safety of other
information were not protected, trust in the physician- specific persons
patient relationship would be diminished. Patients o Exception 2: Legal requirements to report
would be less likely to share sensitive information, certain conditions or circumstances
which could negatively impact their care. A TEST FOR BREACH OF CONFIDENTIALITY

MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 ➔ In situations where you believe an ethical or legal ➔ The condition of the patient’s body is private and is
exception to confidentiality exists, ask yourself the shared only with those he chooses to help him, but
following question: will lack of this specific patient not with anyone else.
information put another person or group you can EXAMPLES OF CONFIDENTIALITY
identify at high risk of serious harm? If the answer to 1. Ask patients and service users before using their
this question is no, it is unlikely that an exception to personal information in ways that do not directly
confidentiality is ethically (or legally) warranted. The contribute to or support the delivery of their care.
permissibility of breaching confidentiality depends on 2. Respect patients’ and service users’ decisions to
the details of each case. If a breach is being restrict the disclosure or use of information, unless
contemplated, it is advisable to seek legal advice exceptional circumstances apply.
before disclosure. 3. Ensure patients and service users understand the
IF CONFIDENTIALITY IS BROKEN, RELATIONSHIPS implications should they choose to agree to or restrict
ARE AT STAKE: the disclosure of information.
➔ You and the patient VERACITY
➔ Patient and all other healthcare providers ➔ Based on the concept of honesty. It is the basis of a
➔ Your reputation to the community trusting relationship between patients and nurses.
➔ You and other community stakeholders Veracity requires nurses to be honest in their
IF CONFIDENTIALITY IS BROKEN, THE FOLLOWING interaction with patients and colleagues. Providing
COULD BE THREATENED: patients with facts, not offering false reassurances.
➔ Privacy IMPORTANCE OF VERACITY
➔ Personal autonomy ➔ Veracity demonstrates respect for patients
➔ Decision making process for the healthcare providers o When the nurses practice veracity, they
and patients demonstrate respect for their patients and
➔ Patient’s responsibility for his or her own health their right to be treated equally and fairly
➔ Public health values ➔ Nurses who practice veracity promote patient’s right
THREE TYPES OF OBLIGATORY SECRETS to autonomy
1. NATURAL SECRET o When nurses are honest, they give patients
➔ The information involved is by its nature harmful if the information they need to choose their
revealed care. Exercising patient autonomy helps
➔ There is obligation to avoid harming others unless patients feel more confident in their
there is proportionate reason for risking or permitting decision-making abilities.
the harm ➔ Honesty strengthens nurse-patient relationships,
➔ Sometimes, the harm that comes from concealing a which positively impacts patient outcomes
natural secret outweighs the harm that is being o Their openness makes it easier for nurses to
avoided. gauge what is or is not working for patients
2. PROMISED SECRET and modify their care plans if needed, which
➔ Knowledge that has been promised to be concealed can improve the patient's health outcome.
➔ Generally, the promise has been exacted because the ➔ Veracity in nursing practice promotes honesty from
matter is also a natural secret. patients
➔ The evil of revealing the secret arises from the o Veracity binds and strengthens nurse-patient
harmful effects of breaking promises relationships and is essential as patients and
➔ The secret may be revealed if the good to be attained healthcare teams seek to establish
offsets the evil that results. achievable treatment goals
3. PROFESSIONAL SECRET ➔ Veracity in nursing practice is essential for strong
➔ Knowledge which, if revealed, will harm not only the team building
professional’s client, but will do serious harm to the o Professional relationships are stronger when
profession and to the society which depends on that honesty and integrity are demonstrated.
profession for important services
➔ The consequences should patients lose faith in the CONSEQUENCES OF LACK OF VERACITY IN NURSING
confidentiality of their dealings with the healthcare ➔ Loss of credibility with other team members
system can be very harmful.

MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 o When nurses are dishonest, it creates an trusting relationships. Trusting relationships can ease
unhealthy work environment including a loss the emotional stress of patients, their loved ones, and
of respect and credibility the nurse by promoting open communication and
➔ Difficulty establishing solid nurse-patient allowing them to establish attainable goals.
relationships ➔ When nurses practice fidelity, patients experience
o When there is a lack of veracity in nursing, more favorable outcomes. Several factors affect
patients often question whether nurses patient outcomes. Nurses who conduct themselves
genuinely care for them and have their best professionally and provide quality patient care help
interests at heart improve the likelihood of positive patient outcomes.
➔ Miscommunication and misunderstanding Patients who feel comfortable with nurses and believe
about important patient information nurses have their best interest in mind are more likely
o When nurses withhold essential information to follow care plans, which also contributes to good
or cloak the truth about a patient's status outcomes.
with medical jargon the patient or family ➔ Fidelity in nursing practice results in increased patient
does not understand, it can lead to patients satisfaction. Patients cared for by nurses concerned
making misinformed decisions about with honesty, integrity, and other principles of fidelity
healthcare. are more satisfied with the care they receive. Patient
➔ Lack of veracity in nursing practice satisfaction is instrumental in establishing a public
demonstrates a lack of respect for a patient’s image for healthcare facilities, strengthening the
autonomy argument in favor of fidelity in nursing.
o When nurses fail to practice veracity, there is ➔ Fidelity in nursing promotes patient autonomy, which
a breakdown in the patient's right to is beneficial to the patient and the healthcare team.
independent decision-making, negatively When nurses encourage patient autonomy, patients
impacting nurse-patient relationships and feel empowered to make decisions about their
patient outcomes. medical care and have the confidence in knowing
➔ Poor patient outcomes their decisions are supported by their nurses and
o The lack of veracity in nursing can have far- healthcare providers. Patients benefit from this by
reaching consequences related to patient having an increased sense of self-confidence and an
care and outcomes. increased likelihood of compliance with their
➔ Examples of Veracity in Nursing treatment plan. Healthcare teams benefit because
o Admitting mistakes patient satisfaction and compliance reduce the risk of
o Helping patients face difficult health negative patient outcomes.
challenges ➔ Good habits are easily duplicated. As a nursing
o Asking for help when you need it instructor, I always advised my students to find a
o Demonstrating accuracy in patient care nursing mentor who is ethical and practices with
o Informed consent integrity and follow their lead. When nurses observe
FIDELITY ethical practices such as fidelity, they inspire others to
➔ An ethical principle that requires one to honor matters demonstrate the same behaviors. One of the benefits
of trust and other expectations in a clinician–patient of fidelity in nursing is that nurses dedicated to
relationship positive patient outcomes and ethical behaviors
➔ Obligation of an individual to be faithful to create an atmosphere conducive to developing and
commitments to him/herself and also to others maintaining good practices.
➔ Main support for the concept of accountability EXAMPLES OF FIDELITY IN NURSING
➔ Keeping information confidential and maintaining ➔ Fidelity in nursing involves demonstrating notions of
privacy and trust faithfulness and loyalty, the importance of honoring
5 REASONS WHY FIDELITY IS IMPORTANT IN commitments and collaboration in nursing care. There
NURSING are several ways nurses can demonstrate fidelity,
➔ Fidelity in nursing helps foster a trusting relationship such as the 10 examples listed below. In some
between patients, families, nurses, and healthcare examples, I will share personal experiences. The
team members. Patients and their loved ones often names of the people in the examples have been
feel anxious or afraid. When nurses practice fidelity, changed to protect patient and nurse privacy.
they create an environment conducive to developing

MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 ➔ If you tell a patient, you will be back to check on o Patient autonomy is the right of competent
them, follow through by doing so. adults to make informed decisions about
o It is common for nurses to have several their personal medical care. Nurses who
patients for whom they provide care each promote patient autonomy demonstrate an
day. If you go to a patient’s room to check excellent example of fidelity in nursing.
on them, perform an assessment, administer When nurses encourage patient involvement
medication or treatment, it is reasonable for in care, it creates a more trusting nurse-
them to expect you to return. Fidelity in patient relationship and supports the nurse’s
nursing means following through with your promise to advocate for the patient.
promises. If you see the need to reprioritize ➔ Honoring a patient's decision and supporting family,
the order you see patients or if an even when you disagree with his choice.
emergency occurs, ask another staff ➔ Being faithful to the nursing profession
member to check on the patient and explain o Nursing is a rewarding profession with
why you have not yet returned. endless opportunities. However, at times it
➔ Patients often feel overwhelmed or afraid and may can be stressful. Fidelity in nursing practice
act rude or disgruntled toward nurses. is demonstrated by nurses who work to
o If you have not yet experienced the promote and protect the profession, despite
rudeness of a patient or one of their family stress or conflicts.
members, wait for it; you will. Sometimes it ➔ Fulfilling commitments
may be challenging to avoid lashing out or o An oath or agreement can be verbal, written,
responding inappropriately to others' or implied. When nurses keep their word and
behavior. As nurses, our commitment to fulfill commitments, patients and colleagues
fidelity means always doing what is right... view them as trustworthy and dependable,
even if others do not. When we actively which are characteristics of fidelity in
practice fidelity in nursing, we learn to nursing.
respond to uncomfortable or stressful ➔ Recognizing and resolving potential risks to fidelity
situations by considering what the patient is before they become an issue
experiencing and finding a peaceful way to ➔ Protecting patient confidentiality
resolve issues. o Fidelity involves not only truth-telling but
➔ Putting the patient first, despite friendships with other confidentiality as well. Nurses must keep
nurses or healthcare team members personal patient information confidential.
o Leigh Anne and Tiffany were two nurses on While some circumstances allow sharing of
my team. They were friends outside of work, information, it is the nurse's responsibility to
which is not uncommon and usually not a follow legal and ethical guidelines to ensure
conflict of interest. One day, Leigh Anne patient privacy and confidentiality. Failure to
came to me and said she was concerned do so can be detrimental to the nurse-
about Tiffany’s ability to perform a few patient relationship and can result in legal
wound care skills. She was worried about ramifications for the nurse and the
Tiffany being angry with her but also organization they represent.
understood patient care and efficient care ➔ Demonstrating role fidelity
are every nurse’s responsibility. As the o Role fidelity is defined as the “faithful
charge nurse, I prioritized my day to include practice of the duties contained in a
assisting with wound care. Tiffany was open particular practice.” Nurses demonstrate
to my help and asked questions about fidelity in nursing by meeting the patient’s
procedures that she did not feel confident reasonable expectations of the nursing
performing. In this instance, Leigh Anne’s profession. For example, patients should
willingness to put the patient first and reasonably expect nurses to be competent,
practice fidelity in nursing helped strengthen respectful, and professional.
the team and promoted growth for her 5 CONSEQUENCES OF LACK OF FIDELITY IN NURSING
friend and coworker. 1. Loss of credibility with colleagues: Fidelity in nursing
➔ Promoting patient autonomy means practicing honesty and integrity. When there is
a lack of fidelity on the part of the nurse, colleagues

MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 may feel jilted or believe the nurse is not dependable. o They represent maintaining or restoring the
The lack of fidelity can lead to the nurse losing equality of persons in need.
credibility among peers and can impact ➔ DISTRIBUTIVE JUSTICE
interprofessional relationships. o The application of the justice principle in
2. Lack of fidelity in nursing can lead to career health care is concerned primarily with
disruptions, including loss of a job or revoked license. divided or partitioned allocation of goods and
Employers and state Boards of Nursing expect ethical services, which is termed distributive justice.
standards of practice to be upheld. When nurses As health care resources become
compromise the integrity of patient care or increasingly scarce, allocation of resources to
organizations by demonstrating a lack of fidelity, it certain programs and rationing of resources
can negatively impact patients, nurses, employers, within certain programs will become more
organizations, and the nursing profession. Nurses evident.
must learn to recognize when instances of poor acts ➔ in fact, our society uses a variety of factors as criteria
of fidelity occur and implement measures to correct for distributive justice, including the following:
those issues. Failure to do so can result in termination 1. To each person an equal share
from a job or, in some cases, loss of nursing license. ➔ This is a simple, straightforward approach to dividing
3. When nurses lack fidelity, patients lose confidence in up the pie. It also only works in the most simple and
them and their ability to provide effective care. This straightforward situations. What it does not address is
lack of trust leads to noncompliance to treatment the fundamental problem stated earlier, that whereas
plans which can negatively impact patient outcomes people may be equal, their needs are not.We can see
and nurse-patient relationships and strain professional how this conception fails by using a slightly silly
relationships. example.

4. Increased risk to patient and nurse safety: Fidelity is ➔ Example: Suppose there is a very large, but
associated with the principle of integrity. Nurses who nonetheless limited supply of bandages in the world.
lack fidelity may not demonstrate integrity in their By this conception of fairness, the right thing to do is
practice which can lead to increased risks to the to divide the number of bandages by the number of
safety and well-being of patients, their loved ones, people in the world and distribute them accordingly.
and teams. So each person may get 100 bandages. This is fine
5. Lack of fidelity in nursing practice can be detrimental for the lucky, graceful, or unadventurous folks who do
to the reputation of a healthcare facility. As nurses, it not tend to scrape their knees often. But for those
is essential to understand our behavior directly who do, 100 bandages over the course of their lives
impacts the reputation of our team and the may be grossly inadequate. But this example is not so
organizations for whom we work. Nurses must silly when we replace the idea of bandages with
understand and appreciate the importance of ethical health care dollars or other limited medical resources.
practices and the role they play in representing a
healthcare facility, nurse, or team. 2. To each person according to need
JUSTICE ➔ The needs of some patient populations are so great
➔ Justice, as a principle in healthcare ethics, refers to that it is conceivable that the vast majority of
fairness; treating people equally and without resources would be spent on a small proportion of the
prejudice; and the equitable distribution of benefits general population. This is already the case in the
and burdens, including ensuring fairness in biomedical current healthcare system. A significant percentage of
research. With escalating healthcare costs, expanded healthcare dollars is spent on the last months and
technologies, an aging population with their own weeks of life. Critics of the current system claim that
special health care needs, and in some cases a these health care dollars would be better spent
scarcity of health care personnel, the question of how meeting the basic health care needs of all people.
to allocate health care becomes even more complex.
➔ Example: In a world with limited resources, how do
PRINCIPLES OF JUSTICE:
we decide which needs are the most important? Does
➔ TRIAGE JUSTICE
one person’s need for a heart transplant rank higher
1. Utilitarian
than another’s need for drug detoxification? What
o Justice as whatever brings about the
about needs that can never be fully met? Should
greatest good of the greatest number
unlimited resources be offered to a person with AIDS
2. Egalitarian
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 even though the underlying problem will never be ➔ In general, In bioethics, justice refers to everyone
cured and the patient will eventually die? Does the having an equal opportunity. This principle seeks to
same answer hold for a person with adult-onset eliminate discrimination in biological studies and
diabetes or for a severely impaired newborn? healthcare. Healthcare and research should not be
based on sex, race, religious beliefs, sexual
3. To each person according to effort,
orientation, etc, if possible. One easy example of this
contribution, and merit
principle occurs frequently in healthcare. Resources
➔ These schemes for the redistribution of goods
such as blood, organs, medications, and medical
essentially ask us to consider social criteria as a
equipment are limited to one degree or another.
guideline for allocating health care resources. That in Everyone needing these resources should have an
itself is problematic. However, the fatal flaw with such equal opportunity to receive them. This may seem
criteria is that there is no good way to make like a no-brainer, but this is not always how it goes.
judgments about the effort, contribution, or merit of
➔ One of the biggest interferences with this example is
an individual.
the ability to pay for the resource. Doctors and
➔ Example: Tying medical benefits to employment is
hospitals are sometimes reluctant to give resources to
common practice. Most people get their medical
those that cannot afford it. The other interference
insurance through their employer, and if they lose
with this is the value that is placed on a person's life
their jobs, they also lose their medical benefits. Highly
due to prejudices, biases, and racism. Healthcare
paid executives often enjoy generous and
workers may feel that a person that helps others
comprehensive health coverage, whereas those
deserves to get resources more than a person who
employed in the service industry are often lucky if
previously committed a crime.
they have access to any sort of health plan, even one
BENEFICENCE
with high premiums and deductibles.
➔ Actions that promote the well-being of others
4. To each person according to free-market ➔ In the medical context, this means taking actions that
exchanges serve the best interests of the patients
➔ Individuals can either pay out of pocket for health ➔ Highlights the duty of the medical provider
care or invest in insurance plans to cover their needs. ➔ To do good and take positive steps to actively
The rationale behind considering this a fair system is contribute you the health and well-being of their
that people will pay for what they value. patients
➔ Example: If they sufficiently value health care, they There is an obligation to:
will spend their money on it or on insurance ➔ confer benefits that is, doing or promoting good, and
premiums. If they do not value health care, then they actively to prevent and remove harm or evil
are free to spend their money on what they do value. ➔ weigh and balance the possible good against the
Proponents claim that this freedom of choice is the possible harm
ultimate in fairness. What this overlooks is the Limitations of Beneficence:
disproportionate burden of health care needs that ➔ The nature of time and space
some people face as well as the extremely high cost ➔ HCP delivers healthcare service to one patient at a
of health care. time
➔ Three Levels of Distribution: ➔ One’s own limitation
1. Macroallocation: ➔ With varying health/illness condition
o how much of society’s resources should be specialization/competencies vary
used for health care as distinct from ➔ Help of other people who is competent to do the job
education, infrastructure, defense, social is needed making referral also an obligation
welfare ➔ Availability of state-of-the-art tools
2. Mesoallocation ➔ Limited by equipment and facilities
o how many of the health care resources ➔ One’s obligation to avoid evil
should go to which kind of services ➔ Sometimes we cannot avoid evil while providing
3. Microallocation healthcare
o how a scarce resource should be distributed ➔ Ex. Adverse effects of drugs are inevitable, but drug
among individuals with competing claims to is necessary and will do better than harm
it NONMALEFICENCE

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 ➔ It is doing no harm, as stated in the historical o nearly everything we do has some
Hippocratic Oath. Harm can be intentional or undesirable side effect or at least the risk of
unintentional. some evil. Example:
➔ As a future healthcare provider, you ought not to ▪ Taking a pill - side effects of the
inflict evil or harm either by imposition or by drug
actuality. ▪ Undergoing a major surgery –
➔ It is the obligation of medical professionals not to complications
Harm the patient. ➔ Principle of Double Effect
➔ Example: o It states that an action, good itself has two
oMedically administered nutrition and effects:
hydration and in pain and other symptoms 1. An intended good effect
control. The nurse's obligation and intention 2. A foreseen, but not intended evil
to relieve the suffering such as treating the effect
refractory pain or helping the patient to be ▪ Is moral provided there is a just
free with dyspnea, through use of order between the intended good
appropriate drugs. and the permitted evil.
➔ Opposite of Beneficence ➔ Example:
➔ Example: o > Double effect contrasts those who would
o We tend to use beneficence in response to (allegedly permissibly) provide medication to
a specific situation - such as determining the terminally ill patients in order to alleviate
best treatment for a patient. In contrast, non suffering with the side effect of hastening
- maleficence is a CONSTANT in clinical death with those who would (allegedly
practice. Example, if we see a patient impermissibly) provide medication to
collapse in a corridor, our duty is to provide terminally ill patients in order to hasten
or seek medical attention to prevent injury death in order to alleviate suffering. In the
or to prevent harm allegedly impermissible case, the physician’s
TWO JUSTIFICATIONS OF NON-MALEFICENCE ultimate end is a good one — to alleviate
1. Human Dignity suffering — not to cause death.
➔ Everyone deserves the right to be honored and VIOLATIONS OF THE PRINCIPLE OF NON-
respected. MALEFICENCE
o Example: ➔ Physically harming a person.
> As a nurse, we have the ethical obligation ➔ Exposing a person to physical harm as in subjecting a
to provide a working environment that is person.
safe and does not harm everyone in the ➔ Harming a person’s reputation, honor, property or
medical setting. Such an environment that interests.
allows for discussion of concerns without ➔ Withholding information needed by a person to make
fear of reprisal but with respect and honor. an informed decision or to protect himself against
2. Patient’s Rights harm.
➔ Right for the provision of healthcare which is good ➔ Causing unnecessary expense for the patient.
and something that has less complication and side ➔ Increasing patient/family anxiety by failure to use
effects proper communication skills.
o Example: ➔ Case Scenario:
> As a nurse we respect the decisions of o A 52-year-old man collapses in the street
patients such as, for example, respecting complaining of severe acute pain in his right
their decision of not having blood transfusion abdomen. A surgeon happens to be passing
due to religious beliefs or the DNR signed by and examines the man, suspecting that he is
the patient. We tend to do no harm, hence on the brink of rupturing his appendix. The
we respect what the patient thinks is right surgeon decides the best course of action is
for them. to remove the appendix in situ, using his
➔ The Impossibility of Avoiding All Evil trusty pen-knife.
➔ For non-maleficence perspective, we have to examine
the potential harms to the patient:

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 1. The environment is unlikely to be sterile. responsibility because no one can control
2. The surgeon has no other clinical staff available. whether a donation is truly voluntary
3. The surgeon may not have done it at the ➔ Ethical Issues Regarding the Recipient
roadside. o Another moral issue involving the recipient is
INTEGRITY ISSUES IN ORGAN DONATION free and informed consent. A competent
➔ Clinical organ transplantation has been recognized as person who could possibly benefit from
one of the most gripping medical advances of the receiving a transplant should be adequately
century as it provides a way of giving the gift of life to informed regarding the expected benefits,
patients with terminal failure of vital organs, which risks, burdens and costs of the transplant
requires the participation of other fellow human and aftercare, and of other possible
beings and of society by donating organs from alternatives. So should the guardian(s) of an
deceased or living individuals. The increasing incompetent person. A legally incompetent
incidence of vital organ failure and the inadequate person who can understand some things
supply of organs, especially from cadavers, has that are relevant to their condition, a
created a wide gap between organ supply and organ proposed transplant, and decisions that they
demand, which has resulted in very long waiting can make, should be informed of these in an
times to receive an organ as well as an increasing appropriate way
number of deaths while waiting. These events have o Potential recipients and their families can be
raised many ethical, moral and societal issues tempted to pressure, blackmail or bribe a
regarding supply, the methods of organ allocation, potential living donor to donate or a health
the use of living donors as volunteers including care professional to give them a privileged
minors. It has also led to the practice of organ sale by position on the waiting list. Such practices
entrepreneurs for financial gains in some parts the are unethical because they fail to properly
world through exploitation of the poor, for the benefit respect the freedom of the donor or they
of the wealthy violate other potential recipients' rights
regarding access (cf. Garrett et al., 206-7)
ETHICAL ISSUES REGARDING THE DONOR Recipients should also avoid any unethical
➔ From the Deceased cooperation in any abuses (e.g. the organs
o In any case proper respect should always be or tissues have been procured
shown to human cadavers. Although they immorally/illegally) that are sometimes
are by no means on par with a living human associated with transplantation.
body/person, they once bore the presence of ➔ Buying and Selling Human Organs and Tissues
a living person. The probably dying potential o Some argue in favor of allowing human
donor should be provided the usual care that organs and tissues to be bought and sold to
should be given to any critically ill or dying increase the supply and to respect people's
person. autonomy. Others argue against such saying
➔ From Living Persons (Adults, Mentally Disabled, that to treat the human body and its parts as
Minors) commodities violates human dignity. Human
o A competent adult can give free and tissues and organs are in fact being sold in
informed consent to be or not to be a living some places.
donor, but an incompetent person cannot. ➔ Paying for organs can constitute unjust moral
No one is obliged to donate tissue or an pressure on the donor. It could invalidate any free
organ; therefore no one can be forced to do consent or a contract. Some also fear that the buying
so. The decision to donate one's organs and selling of organs and tissues, if it became
while still alive can only be made by the widespread, would undermine the altruism (giving
individual concerned personally. Not even motivated by love) and social bonding now associated
parents are allowed to decide on an organ with transplants. It could also lead to organs going to
donation by their child; they are allowed to the highest bidder. Equity would be violated with
give their consent only for a donation of ability to pay rather than medical need determining
tissue (e.g., donation of bone-marrow). The the distribution of organs. Some others, however,
doctor in this case has a special argue that this could be controlled by regulating
sales, and that totally forbidding the buying and

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MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,
 selling of human tissues and organs would drive the confused about some of the issues of being
market underground a donor.
➔ It makes human organs a commodity for profit and o It is important that some members of the
sale, thus inviting corruption and an unjust and unfair health care team be trained in approaching
system of organ access and distribution and it potential donors and their families in a
predisposes to criminal tendencies of killing children sensitive way. They need to be able to
and women for organ sale, which has been reported. provide the necessary personal and social
For these and other reasons organ sale has been support regarding the grieving process.
forbidden in all Western societies, by all major Some health care professionals also need to
religions and by many countries in the world learn that properly respecting the dead
➔ Media publicity human body is a requirement of our
o At this stage of medical history media humanness.
publicity for a particular case should be ➔ CONCLUSION
tolerated, but in time it should be eliminated o For clinical organ and tissue transplantation
as much as possible. to be fully beneficial and life-saving,
o Furthermore, when exposed to social media everyone involved in the process, including
contents, people are more inclined to physicians and medical institutions, must
conduct additional information and express only respect and consider the best interest of
sentiments, which may further amplify the the patient and honor the ethical, moral and
media campaigns’ impacts religious values of society and not be
➔ Types of Consent tempted to seek personal fame or financial
o Voluntary or Expressed reward.
o Family o For clinical organ and tissue transplantation
o Presumed to be fully beneficial and life-saving,
o Required Request everyone involved in the process, including
o Routine Inquiry physicians and medical institutions, must
➔ Voluntary or expressed consent involves a person only respect and consider the best interest of
making known their free offer to donate one or more the patient and honor the ethical, moral and
of their organs and/or bodily tissue, after they have religious values of society and not be
died or while alive. Concerning cadaver donation, a tempted to seek personal fame or financial
person can express their wishes by some form of reward.
advanced directives, such as by filling out the
Universal Donor Card attached to their driver's
license. Free and informed consent is required when
the transplant is from a living donor. Previously
expressed voluntary consent regarding a deceased
donor is the ideal because it involves an act of love
and responsible stewardship over one's body. It also
communicates to others, including one's family and
health care professionals, one's wishes. In the
absence of clearly expressed voluntary consent, the
family or person lawfully responsible for the body of
the deceased may be approached regarding donation.
Proper respect involves due consideration of the
wishes of the deceased and their loved ones.
➔ Fears, Confusion, and the Need for Education
o Many people are not well informed of the
needs, the shortage of organs and tissues,
and the great potential benefit of many
people for transplants. Many have
unfounded fears or reservations or are

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MADE BY: JAILOUISE A. PEREZ, KRISHLAINE TIU, LINUS ORDONIO, ARIANE SALIBIO,