HEALTH ETHICS

 It is the branch of ethics that deals with ethical issues in health, health care,
 medicine and science.
 It involves discussions about treatment choices and care options that individuals, families, and
health care providers must face.
 It requires a critical reflection upon the relationships between health care professionals and
those they serve, as well as the programs, systems, and structures developed to improve the
health of a population.

Examples:

 Making decisions about end-of-life care.

 Determining whether to allocate funds to the treatment of disease or the promotion of
 health
 Critically examining the discrepancies in health status between populations and our ethical
obligations to ensure equitable access to health services
 Ensuring ethical conduct in health research.
 Deliberating upon the ethical implications of genetic cloning technology.

Types of Ethics

 Descriptive Ethics

The aim of descriptive ethics is to depict and clarify moral opinions and practices, and to

explicitly articulate the concepts and assumptions implicit in these. For example, “What does

group X think about the morality of abortion?” is a question of descriptive ethics.

 Normative Ethics

Normative ethics concerns making moral judgments about what is right and wrong, good

and bad etc. It also involves developing action guides to direct ethical behaviour. For

example, “Is aborting a fetus ethically justifiable?” is a normative question.

 Meta-Ethics

The discussion here is not about what particular people think ethics is or what ought or

ought not to be considered ethical. Rather, meta-ethics involves analyses of the language,

concepts, and methods of reasoning in health care. For example, “What does ‘ethically

justifiable’ mean?” is a meta-ethical question.

Some Theoretical Concepts in Ethics

 Consequentialism

According to consequentialism, the right course of action is determined by examining the

consequences or outcome of an action and selecting the one that produces the greatest good.

Thus, no action is in itself right or wrong – it is the action’s consequences that determine

whether it is right or wrong. One consequentialist theory is utilitarianism, which defines the

greatest good as happiness. Using a utilitarian approach to an ethical dilemma, one would

choose the course of action that will produce the greatest happiness for the greatest number

of people. Critics of utilitarianism highlight the difficulty of measuring happiness and

accurately predicting the consequences of one’s actions. They also point out that one could

potentially sacrifice the happiness of the minority for the happiness of the majority.

 Deontology

According deontology, or duty-based ethics, the right course of action is that which is

consistent with one’s moral duties. According to Immanuel Kant, the theory’s most well

known proponent, one of these duties is to never use another person as a means to one’s

own ends. Additionally, before making a decision, one should think about whether it would

be reasonable for everyone to act in the proposed way. If it is indeed reasonable to

“universalize” a course of action, then one can deem that act to be ethical. According to

deontology then, an action itself has features that are distinct from the action’s

consequences, and that make the action right. One critique of Kant’s deontology is its

rigidity in abiding by these rules despite the potential consequences of one’s actions.

 Virtue Ethics

Unlike consequentialism and deontology, virtue ethics does not focus on rules, consequences

or principles to determine ethical behaviour. Instead, the emphasis is on one’s character and

what kind of person one ought to be, which are defined by our traditions and communities.

Critics of virtue ethics question the emphasis on tradition and community, given that our

world consists of a mosaic of cultures and ethnicities. That is, it is problematic to achieve a

common morality derived from so many traditions and communities. Additionally, critics
sometimes argue that virtue ethics does not provide sufficient guidance on how to act in

difficult situations.

 Relational Ethics

Relational ethics understands the individual not as autonomous and independent, but as a

relational, interdependent being, and emphasizes relationships as integral to human existence

and consciousness. Nel Noddings’ defines “ethical caring” not in terms of one person

naturally caring for another, but one person caring for another because they believe it is the

right thing to do. Noddings “care ethics” rejects the need for universal principles for

behaviour, arguing that a care decision must be made in the context of the particular

relationship. Although relational ethics is recognized as a feminist ethics, some have

criticized it for reinforcing traditional stereotypes of women as caregivers. Others have

argued that relational ethics is too ambiguous and contextual and doesn’t offer concrete

guidance for ethical action.

 Principlism

Much of contemporary Western bioethics is founded upon or makes reference to four

principles outlined by Tom Beauchamp and James Childress in Principles of Biomedical Ethics2.

These principles are rooted in a combination of consequentialism and deontology, and

assume that humans have some basic moral beliefs that can provide a good starting point for

ethical guidance. From these basic beliefs, Beauchamp and Childress have outlined four

principles to guide behaviour:

Respect for Autonomy

Respect for Autonomy is based on self-determination and the right of individuals to make

independent and informed decisions concerning their life, well-being and best interest.

Within the context of autonomy arise issues such as privacy, confidentiality and informed

consent.

 Beneficence

Beneficence, or doing good, involves promoting another’s welfare, acting in an

individual’s best interest and in a manner which benefits others.

  Non-maleficence

Non-maleficence requires one to do no harm and to protect others from harm. This also

includes the duty to maintain professional competence and to be aware of the isolation

and powerlessness of others.

 Distributive Justice

The principle of justice entails that all persons in society are of equal moral worth, thus should be
treated with fairness or equally under similar circumstances.

CODE OF ETHICS FOR FILIPINO NURSES

What are CODES OF ETHICS?

These are systematic guides for developing ethical behavior
They answer normative questions of what beliefs and values should be normally accepted
Code of Good Governance
Promulgated by the Professional Regulation Commission, July 23, 2003

States that:
 The hallmark of all professionals is their willingness to accept a set of professional and
ethical principles which they follow in the conduct of their daily lives.
 The acceptance of these principles requires the maintenance of a standard of conduct higher than what is
required by law.
This code is adopted by the Professional Regulation Commission and the 42 Professional Regulatory
Boards to cover an environment of good governance in which all Filipino professionals shall perform
their duties.

General Principles:
 Service to Others
 Integrity and Objectivity
 Professional Competence
 Solidarity and Teamwork
 Social and Civic Responsibility
 Global Competitiveness
 Equality of All Professions
After consultation on October 23, 2003at Iloilo City with the accredited professional organization of
registered nurses, the code was adopted under the Republic Act 9173 and promulgated by the Board of
Nursing under Resolution No. 220 Series of 2004 last July 14, 2004
.
ARTICLE I Preamble
Sec. 1. Health is a fundamental right of every individual
The Filipino registered nurse believes in the worth and dignity of each human being, recognizes
the primary responsibility to preserve health at all cost.
The Filipino registered nurse believes in the worth and dignity of each human being, recognizes
the primary responsibility to preserve health at all cost.
Sec 2. To assume this responsibility, registered nurses have to gain knowledge and understanding of a
man’s cultural, social, spiritual, psychological, and ecological aspects of illness, utilizing the therapeutic
process.
Cultural diversity and political and socio-economic status are inherent factors to effective nursing
care.

Sec 3. The desire for the respect and confidence of clientele, colleagues, co-workers, and the
members of the community provides the incentive to attain and maintain the highest possible
degree of ethical conduct.

ARTICLE II REGISTERED NURSESAND PEOPLE

Sec.4 Ethical Principles

Values, customs, and spiritual beliefs held by individuals shall be represented.
Individual freedom to make rational and unconstrained decisions shall be respected.Personal information
acquired in the process of giving nursing care shall be held in strict confidence.

Sec 5. Guidelines to be observed

REGISTERED NURSES MUST:

Consider the individuality and totality of patients when they administercare;
Respect the spiritual beliefs and practices of patients regarding diet and treatment;
Uphold the rights of individuals; and
Take into consideration the culture and values of patients in providing nursing care. However, in the
conflicts, their welfare and safety must take precedence.

ARTICLE III REGISTERED NURSESANDPRACTICE

Sec. 6. Ethical Principles

1.Human life is inviolable.
2.Quality and excellence in the care of patients are the goals of nursing practice.
3.Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing
accountability.

Sec.7. Guidelines to be observed

Registered Nursesmust:

a. Know the definition and scope of nursing practice which are in the provisions of R.A. No. 9173,
known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003, the
“Rules and Regulations Implementing the Philippine Nursing Actof 2002”, (the IRR);
b. Be aware of their duties and responsibilities in the practice of their profession as defined in the
“Philippine Nursing Act of 2002” and the IRR;
c. Acquire and develop the necessary competence in knowledge, skills and attitudes to effectively
render appropriate nursing services through varied learning situations;
d. If they are administrators, be responsible in providing favorable environment for the growth and
development of Registered Nurses in their charge;
e. Be cognizant that professional programs for specialty certification by the BON are accredited
through the Nursing Specialty Certification Council (NSCC);
 f. See to it that quality nursing care and practice meet the optimum standard of safe nursing
practice;
g. Ensure that patient’s records shall be available only if they are to be issued to those who are
professionally and directly involved in their care and when they are required by law.
h. Insure that modification of practice shall consider the principles of safe nursing practice;
i. If in position of authority in a work environment, be normally and legally responsible for
devising a system of minimizing occurrences of ineffective and unlawful nursing practice.

Sec. 8. Ethical Principle

4.Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard
their rights and privileges.

Sec. 9. Guidelines to be observed

Registered Nurses must

a. Respect the “Patient’s Bill of Rights” in the delivery of nursing care;

b. Provide the patients or their families with all pertinent information except those may be
deemed harmful to their well-being and
c. Uphold the patient’s rights when conflict arises regarding management of their care.

Sec. 10. Ethical Principle

5.Registered Nurses are aware that their actions have professional, ethical, moral, and legal dimensions.
They strive to perform their work in the best interest of all concerned.

Sec. 11. Guidelines to be observed

Registered Nurses must

a. Perform their professional duties in conformity with existing laws, rules, regulations, measures,
and generally accepted principle of moral conduct and proper decorum;

ARTICLE IV

REGISTERED NURSEANDCO-WORKERS

Sec.12. Ethical Principles

1.The Registered Nurse is in solidarity with other members of the healthcare team in working for the
patient’s best interest.

2.The Registered Nurse maintains collegial and collaborative working relationship with colleagues and
other health care providers.

Sec.13. Guidelines to be observed

Registered Nurse must

 a. Maintain their professional role/identity while working with other members of the health team;
b. Conform with the group activities as those of a health team should be based in acceptable,
ethico-legal standards;
c. Contribute to the professional growth and development of other members of the health
team;d.Actively participate in professional organization;
d. Not act in any manner prejudicial to other professions;
e. Honor and safeguard the reputation and dignity of the members of nursing and other
profession; refrain from making unfair and unwarranted comments or criticisms on their
competence, conduct, and procedures; or not do anything that will bring discredit to a
colleagueand to an member of other professions; and
f. Respect the rights of their co-workers.

ARTICLE V

REGISTERED NURSE, SOCIETY AND ENVIRONMENT

Sec.14. Ethical Principles

1.The preservation of life, respect for human rights, and promotion of healthy environment shall be
a commitment of a Registered Nurse.

2.The establishment of linkages with the public in promoting local, national, and international
efforts to meet health and social needs of the people as a contributing member of society is a noble
concern of a Registered Nurse.

Sec.15. Guidelines to be observed

Registered Nurse must

a. Be conscious of their obligations as citizens and, as such, be involved in community concerns;

b. Be equipped with knowledge of health resources within the community, and take active roles in
primary health care;
c. Actively participate in programs, projects, and activities that respond to the problems of society;
d. Leads their lives in conformity with the principles of right conduct and proper decorum; and
e. Project an image that will uplift the nursing profession at all times;

ARTICLE VI

REGISTERED NURSEANDTHE PROFESSION

Sec.16. Ethical Principles

1. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited professional organization (PNA) and other
professional organizations of which Registered Nurse is a member is a lofty duty.
3. Commitment to continual learning and active participation in the development and growth of
the profession are commendable obligations.
4. Contribution to the improvement of the socio-economic conditions and general welfare of
nurses through appropriate legislation is a practice and visionary mission.
Sec.17. Guidelines to be observed

Registered Nurse must

a. Be members of the accredited professional organization which is the PNA.

b. Strictly adhere to the nursing standards;
c. Participate actively in the growth and development of the nursing profession;
d. Strive to secure equitable-economic and work conditions in nursing through appropriate
legislation and other means; and
e. Assert for the implementation of labor and work standards.

ARTICLE VII

ADMINISTRATIVE PENALTIES, REPEALING CLAUSE AND EFFECTIVITY

Section 18.

The Certificate of Registration of the Registered Nurse shall either be revoked or suspend for
violation of any provisions of this Code pursuant to Sec. 23 (f), Art.IV of R.A. No. 9173 and Sec.23 (f),
rule III of Board Res. No. 425, Series of 2003, the IRR