HEALTH CARE ETHICS

ETHICS
Greek word ethicos which means “custom” or “character”
Defined as the philosophical science (normative and theoretical) that deals with the morality of human conduct
Difference Between Ethics and Morality
Ethics (Greek) ethos
Morality (Latin) mos/moris
Both means custom
The former provides the theories & principles of right or wrong/ good or bad actions while the later, actualizes
these theories & principles.
Health Care Ethics
 Concerned with the type of conduct or character that is approved or disapproved of in terms of right or wrong
or good or bad related to health-care service.
 Designed to promote orders and maintain civility.
Ethical Theories
 Provides a schema, structure or framework in order that the rightness or wrongness, and goodness or badness
of human conduct will be determined
- Mappes & DeGrazia
 A guiding principle in resolving moral judgements, problems and issues.
Ethical Theories
Deontology
 Came from the Greek word DEON, which means duty, implying obligations.
 A system of ethics which judges the rightness or wrongness of action based on whether they adhere to a rule or
set of rules
 Duty or principle based theory
 An act is right if it conforms to an overriding moral duty
 A moral duty or principle is one that is:
laid down by god / supremely rational being or is in accordance with reason / rationality or would be agreed by
all rational beings
Teleology
 Refers to moral system that determines the moral value of actions by their outcomes or results.
 Came from the Greek word TELOS meaning END. An action is morally right if its favorable consequences are
greater than its adverse outcomes.
Utilitarianism
 Derived from the Latin term utilis which means “useful”.
 Is the most influential consequentialist theory.
 States that what is useful is good, and that the moral value of action are determined by the utility of its
consequences.
 Utilitarianism explains that those actions that bring about favorable effects are moral while those that produce
damaging results are immoral.
 Utilitarianism is opposed to ethical theories that considers God’s will. For example, in lying. Lying is bad for it is
against God’s 8th commandment which is “Thou shalt not bear false witness against thy neighbor.” or basically
means, thou shall not lie at all cost and honor the truth. But for utilitarianism, lying is good if the action brings
good outcome, or greater good.
Virtue Ethics
Virtue-based ethical system are often called aretaic ethics, which is translated as virtue or excellence
 Its primary focus is the heart of the moral agent making the decision rather than the reasoning to a right action.
 It is primarily about personal character and moral habit development rather than a particular action
 Not “what shall I do?” but rather “how should I carry out my lie if I am to live well?”.

What is virtue ethics in nursing?

 An approach to moral dilemmas in nursing. ... On the contrary, decision-making about moral issues in healthcare
demands that nurses exercise rational control over emotions. This clearly focuses the attention on the nurse as
moral agent and in particular their character.

Core Values of a Professional Nurse

 Love of God and Country
 Caring
 Quality and Excellence
 Integrity
 Collaboration
-PNA
Ethical Principles
Autonomy
 Comes from the Greek word autos (self) and nomos (governance).
 In healthcare, it has come to mean a personal liberty, where the individual is free to choose and implement his
or her own decision, free from deceit, duress, constraint or coercion.
Nurses must respect the right of patients to make decisions on their own behalf. Every individual has a unique
perspective and is entitled to hold beliefs, opinions and values. The nurse might not agree but must respect the
individual's right to them. Nurses must allow patients to make decisions without judgment or coercion. Nurses must
respect a patient's right to accept or reject any or all courses of treatment.

Patient’s Rights
1.Right to Appropriate Medical Care and Humane Treatment.
2. Right to Informed Consent
3. Right to Privacy and Confidentiality
4. Right to Information.
5. The Right to Choose Health Care Provider and Facility
6. Right to Self-Determination.
7. Right to Religious Belief.
8. Right to Medical Records.
9. Right to Leave
10. Right to Refuse Participation In Medical Research.
11. Right to Correspondence and to Receive Visitors
12. Right to Express Grievances.
13. Right to be Informed of His Rights and Obligations as a Patient.

Patient’s Bill of Rights

1. The patient has the right to considerate and respectful care irrespective of socio-economic status.
2. The patient has the right to obtain from his physician complete current information concerning his diagnosis,
treatment and prognosis in terms the patient can reasonably be expected to understand. When it is not medically
advisable to give such information to the patient, the information should be made available to an appropriate person in
his behalf. He has the right to know by name or in person, the medical team responsible in coordinating his care.
3. The patient has the right to receive from his physician information necessary to give informed consent prior to the
start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include
but not necessarily limited to the specific procedure and or treatment, the medically significant risks involved, and the
probable duration of incapacitation. When medically significant alternatives for care or treatment exist, or when the
patient requests information concerning medical alternatives, the patient has the right to such information. The patient
has also the right to know the name of the person responsible for the procedure and/or treatment.
4. The patient has the right to refuse treatment/life – giving measures, to the extent permitted by law, and to be
informed of the medical consequences of his action.
5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case
discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those not
directly involved in his care must have the permission of the patient to be present.
6. The patient has the right to expect that all communications and records pertaining to his care should be treated as
confidential.
7. The patient has the right that within its capacity, a hospital must make reasonable response to the request of patient
for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of care. When
medically permissible a patient may be transferred to another facility only after he has received complete information
concerning the needs and alternatives to such transfer. The institution to which the patient is to be transferred must
first have accepted the patient for transfer.
8. The patient has the right to obtain information as to any relationship of the hospital to other health care and
educational institutions in so far as his care is concerned. The patient has the right to obtain as to the existence of
any professional relationship among individuals, by name who are treating him.
9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation
affecting his care or treatment. The patient has the right to refuse or participate in such research project.
10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what
appointment times the physicians are available and where. The patient has the right to expect that the hospital will
provide a mechanism whereby he is informed by his physician or a delegate of the physician of the patient’s
continuing health care requirements following discharge.
11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.
12. The patient has the right to know what hospital rules and regulation apply to his conduct as a patient.
 Informed Consent
The process by which a patient learns about and understands the purpose, benefits, and potential risks
of a medical or surgical intervention, including clinical trials, and then agrees to receive the treatment or participate in
the trial. Informed consent generally requires the patient or responsible party to sign a statement confirming that they
understand the risks and benefits of the procedure or treatment.
Proxy Consent
The process by which people with the legal right to consent to medical treatment for themselves or for a
minor or a ward delegate that right to another person.
There are three fundamental constraints on this delegation:
1.The person making the delegation must have the right to consent.
2.The person must be legally and medically competent to delegate the right to consent.
3.The right to consent must be delegated to a legally and medically competent adult.

Types of proxy consent for adults:

1. The power of attorney to consent to medical care - is usually used by patients who want medical care but are
concerned about who will consent if they are rendered temporarily incompetent by the medical care. A power
of attorney to consent to medical care delegates the right to consent to a specific person.
2. Living will - a written statement detailing a person's desires regarding
their medical treatment in circumstances in which they are no longer able to express informed consent, especially
an advance directive.

Confidentiality
The principle that binds the practitioner to hold in strict confidence those things learned about a patient
in the course of medical practice

Privacy
A national standard to protect individuals’ medical records and other personal health information and
applies to health plans, healthcare clearinghouses, and those health care providers that conduct certain health care
transactions electronically.

Veracity
Truth telling. The practice of health care is best served in a relationship of trust in which practitioner and
patient are bound to the truth

Fidelity
Derived from the Latin word fidelitas meaning faithfulness.
Fidelity in nursing means that nurses must be faithful to the promises they made as professionals to provide
competent, quality care to their patients.

Justice
Justice means fairness. When nurses care for a group of patients, care must be given equitably, fairly
and justly to each individual. A nurse cannot play favorites or compromise care because of personal opinions or beliefs.
Justice means fairness. When nurses care for a group of patients, care must be given equitably, fairly
and justly to each individual. A nurse cannot play favorites or compromise care because of personal opinions or beliefs.

Beneficence
The principle that imposes on the practitioner a duty to seek the good for patients under all
circumstances
Do unto others what you want others do unto you
- Kong Zi

Non-Maleficence
The principle that imposes the duty to avoid or refrain from harming the patient. It does not matter whether the
harm is intentional or unintentional.