Other relevant Ethical Principle:

1. Principle of Double Effect

- When an act is foreseen to have both good and bad effects is applied. The direct
freely chosen effect of the act must be morally good while the other indirect not
freely chosen effect may be physically harmful.
- An action that is good in itself that has two effects- an intended and otherwise not
reasonably attainable good effect, and an unintended yet foreseen evil effect– is licit,
provided there is a due proportion between the intended good and the permitted evil.
- A good act may have several good effects and is worthy of being performed thereby
increasing its goodness or even adding new goodness. An evil act may also have
several evil effects and is unworthy of being chosen.
- The four conditions:
1. The act must be good in itself, or at least, morally indifferent.
 Being the primary moral determinant, the act by it very nature must be
good. Its goodness proceeds from within itself. If it not possible to be
good, the act must not be evil in itself. At least, it is morally indifferent.
2. The good effect must directly proceed from the act itself and not from the evil
effect. At the very least, both effects must occur simultaneously.
 It indicates the fact that the good effect is the one that is being directly
willed and not the evil effect in the performance of an act. The good effect
is the very purpose for which the act is done, and as such, it is produced
not by the evil effect but by the act itself. In fact, it comes ahead of the
evil act.
3. There must be sufficient reason for the performance of an act in its attainment
of the good effect.
 As determined by the nature of the act and its circumstances,
sufficiency of reason exists when there is no other means by which the
desired good effect is as equally important as to permit the occurrence of
the evil effect.
4. The motive of the agent must be holy and honest.
 How can the agent be honest in his intention? By directly willing to
obtain the good effect and not the evil effect of the act. This can be proven
when the evil effect just follows after the good effect is achieved.
- When can the principle of double effect not be invoked?
1. When the act by its nature is evil.
2. When the good effect directly proceeds from the evil effect and not from the
act itself.
3. When there is no sufficient reason for the performance of an act with two
effects, one-good, and the other-evil.
4. When the motive of the agent is not honest.
2. Principle of Legitimate Cooperation
- Is the participation of one agent with another agent to produce a particular effect or
joint effect. Cooperation becomes a problem when the action of the primary agent is
morally wrong.
- Cooperation comes from the Latin word cum which means “with” and operari which
means “to work”.  COOPERATION is working with another in the performance of
an action.
- Various degrees of cooperation:
 The degrees of cooperation may vary according to the gravity or essentiality
of the shared act in the performance of an evil action.
- 1. Formal and material
o FORMAL COOPERATION- consists of an explicit intention and willingness
for the evil act. The one formally cooperating categorically wills and intends
the evil action.  Ex: a medical director who wills and intends the evil act of
contraception by means of hysterectomy at the request of an interested party,
by arranging with the members of the O.R. team as to the operation and its
schedule.
o MATERIAL COOPERATION- consists of an act other than the evil act itself
but facilitates and contributes to its achievement. The one materially
cooperating may provide means apart from the evil act itself which is used to
carry out the performance of an evil act.
- 2. Direct and indirect
o DIRECT COOPERATION- consists of direct participation in the performance
of an evil act. The one directly cooperating gets involved by openly and
straightforwardly taking part in the practice of an evil action.
o INDIRECT COOPERATION- consists of an act that is not intimately
connected with the performance of an evil act as in formal and direct
cooperation but whose effect may have an indirect bearing upon it.
- 3. Proximate and remote
o PROXIMATE COOPERATION- consists of an act that is intimately linked
with the performance of an evil action due to its close bearing.  REMOTE
COOPERATION- consists of an act with a distant bearing upon or connection
with the execution of an evil act.
- Moral rules governing cooperation
a. No one should formally and directly cooperate in the performance of an evil
action. b. If a reason sufficiently grave exists, material cooperation in the
performance of an evil action may be morally excused.
c. If the material cooperation is proximate, a reason sufficiently graver should
exist so as to be morally excused without which evil is incurred.
3. Principle of Common Good and Subsidiary
- Often considered a corollary of the principle of the common good, subsidiarity
requires those in positions of authority to recognize that individuals have a right to
participate in decisions that directly affect them, in accord with their dignity and with
their responsibility to the common good.
- Decisions should be made at the most appropriate level in a society or organization,
that is, one should not withdraw those decisions or choices that rightly belong to the
individuals or smaller groups and assign them to a higher authority.
- The principle of subsidiarity is a kind of sociological discipline adhered to and
advocated by the church. Its moral implication is embedded in its meaning.
- It means that what an individual, lower or smaller group can achieve within his/her or
its capacity should not be taken away and transmitted to the custody and performance
of a higher or bigger group.
- Ex: in an effort to control the apparent rapid population growth in the country, the
State formulates program on responsible parenthood which rebounds to the enactment
of a law mandating every family to just limit the number of its offspring only to one
or two under pain of penalty. And so, the State through the Department of Health
conducts contraceptive programs and distributes various forms of contraceptive
methods to ensure the State-directed number of children every family ought to raise.

4. Principle of Stewardship
- Stewardship requires us to appreciate the two great gifts that a wise and loving God
has given: the earth, with all its natural resources and our own human nature, with its
biological, psychological, social, and spiritual capacities. This principle is grounded
in the presupposition that God has absolute Dominion over creation, and that, in so
far as human beings are made in God’s image and likeness (Imago Dei), we have
been given a limited Dominion over creation and are responsible for its care.
- The principle of stewardship includes but is not reducible to concern for scarce
resources, rather, it also implies a responsibility to see that the mission of Catholic
health care is carried out as ministry with its particular commitment to human dignity
and the common good.
- Refers to the expression of one’s responsibility to take care of, nurture and cultivate
what has been entrusted to him.
- In health care practice, STEWARDSHIP refers to the execution of responsibility of
the health care practitioners to look after, provide necessary health care services, and
promote the health and life of those entrusted to their care.
Role of Nurses as Steward
- Stewards, as well a practicing nurses who seek to preserve and promote values at the
point of service, may influence managers in their decisions about who ought to
receive what services and how, and thus influence change in health care
organizations.
- French urges nurse leaders to engage and work collaboratively to establish and
achieve a vision and purpose that affects the well-being o9f a sytem or organization
rather than promote their self-interests.
a. Personal Role
 Virtue Ethics in Stewardship
- Macintyre, a communication theorist, contends that a person is a narrative
self who seeks purpose, or good for the self, through interpretations of
everyday experiences.
- A nurse who exercises stewardship at the point of service in accordance
with Macintyre’s theory of virtue ethics will facilitate nurses justification
of their shared value priorities within professional settings such as the
Canadian Nurses Association of Ethics.
- Thus, stewards and nurses may preserve and promote what is intrinsically
valuable in nursing practice. It may be argued also that, as stewards
facilitate nurse’s discernment of embedded values, nurses will
increasingly balance self-interests with service to others.
b. Social
 Social Role of Nurses As Stewards
- Health Care has been identified as Canadian’ number one public priority
and nurses play a central role in delivering healthcare.
- Nurses advocate for health promotion, educate patients and the public on
the prevention of illness and injury, provide care and assist in cure,
participate in rehabilitation, and provide support. No other health care
professional has such a broad and far-reaching role.
- Nurses help families learn to become healthy by helping them understand
the range of emotional, physical, mental and cultural experiences they
encounter during health and illness. Nurses help people and their families
cope with illness, deal with it and if necessary live with it, so that other
parts of their lives can continue. Nurses do more than care individuals.
They have always have been at the forefront of change in health care and
public.
- Nurses provide ongoing assessment of people’s health. Their round-the-
clock presence, observation skills, and vigilance allow doctors to make
better diagnoses and propose better treatments. Many lives have been
saved because an attentive nurse picked upon early warning signs of an
upcoming crisis like cardiac arrest or respiratory failure.
c. Ecological
 Ecological Role of Nurses in Stewardship
- The nursing profession is well positioned to tackle the challenges of
waste reduction within hospital systems. The healthcare sector generates
a massive amount of waste, contributing to environmental issues, such
as air and water pollution. By unifying and engaging staff through
shared governance models, nurses can reduce the overhead costs
associated with waste management.
- Nurses have the ability to uses their trusted skill trusted sets and lead the
way for sustainable, healthy communities and environment in which
they serve.
o Current healthcare waste disposal methods.
o Nurses comprise the largest profession in health care and are adept at
educating, researching, and leading in waste reduction.

d. Biomedical
 Biomedical Role of Nurses in Stewardship
- Bioethics (Greek words: bios means life and ethos means behavior) is a
branch of applied ethics that refers the discipline dealing with the ethical
implications of biological research and applications especially in
medicine. It involves issues relating to the beginning and end of human
life.
- Ex. What shall be the role of the nurse in a case in which parents of a
severely deformed newborn child refuse to feed and allow their child to
starve to death?