2. Communicating honestly.
VIRTUE ETHICS  Veracity is the ethical principle that obligates you to
DEFINITION
 Virtue ethics is an approach that focuses on character
with the assumption that a person of good character
will tend to behave in ways that are consistent with
their character.
VIRTUE ETHICS FOR NURSING
 A virtue ethics for nursing is therefore concerned
with the character of individual nurses and seeks
ways to enable nurses to develop character traits
appropriate for actions that enhance wellbeing.
 This chapter offers some insights into the nature of
virtue ethics from an Aristotelian perspective and
includes an outline of the virtue of phronesis
(practical wisdom) which provides guidance in
situations where it is not obvious what action would
be the virtuous action.
 Virtue ethics is contrasted with modern ethical theory
(deontology and utilitarianism) and some ways in
which virtue ethics can enhance professional nursing
practice are considered
 Nurses face ethical dilemmas such as these every
day, often with little to guide them. In this article, I'll
provide a practical road map to sorting through
difficult ethical issues by focusing on two
perspectives: your obligations as a professional nurse
and the virtues needed to make morally sound
decisions, such as honesty, compassion, and self-
respect.
FOUR OBLIGATIONS, SIX VIRTUES
 Obligations
1. respecting the patient's privacy and protecting
confidentiality
2. communicating honestly about all aspects of the
patient's diagnosis, treatment, and
prognosis
3. conducting an ethically valid pvirtue
4. rocess of informed consent
5. advocating for the patient's expressed interests or
best interests.
 Virtues
 Virtues are best understood as qualities a person
possesses that motivate her to act in a moral or
ethical way. The Code defines virtues as character
traits that incline people to do the right thing.
 These six virtues apply to nursing:
1. professional competence
2. honesty and integrity
3. caring and compassion
4. fairness and justice
5. respect and self-respect
6. courage
HOW KEY VIRTUES APPLY TO NURSING:
1. Protecting privacy and confidentiality.
 The basic obligation to maintain a patient's privacy
and confidentiality has existed since the time of
Hippocrates, yet many nurses violate this principle
without thinking.
 For example, suppose a friend asks you about your
neighbor who's been admitted to the hospital unit
where you work. Even a casual reply about his
condition violates his privacy. In fact, so does simply
verifying his admission to the hospital.
tell the truth.
 At times the truth may be painful for the patient or his
family to hear, but honesty is a core virtue; only under
unusual circumstances is violating it acceptable.
 To act from the virtues of honesty and compassion
requires you to make sure that bad news is delivered in
an honest and compassionate way.
3. Conducting an ethically valid informed-consent
process.
 What's your responsibility in the process of informed
consent? Most nurses believe they're responsible only
for witnessing the signature of the patient.
 For example, you're obligated to assess the patient's
ability to make an informed decision about his care.
His cognitive abilities may fluctuate because of
medication, surgery, unfamiliar surroundings, or his
disease.
 As his nurse, you're in the best position to assess his
ability to understand issues related to his care and give
valid consent.
4. Advocating for the patient's best interests.
 This is what puts action into your obligations. Being
passive or active is a choice. Positioning yourself as
the patient's advocate in the case we just discussed
would be very difficult, especially if you suspect the
surgeon will be angry and know that the patient may
back down in the face of pressure from her daughter.
 To act with courage, which involves supporting your
professional obligations, standing up to an angry
physician, and doing what you think is right for the
patient.
 Advocacy is often inhibited by the institutional
bureaucracy. Nurses must feel free to engage in
advocacy roles in health care environments; otherwise,
patient self-determination will be truly lost in the
morass of rules, regulations, and nurse timidity.
 Standing up in advocacy requires overcoming the
challenges of moral blindness, moral complacency,
and moral distress.
A QUESTION OF MORALS
 Here are three ways of responding to moral
problems. To practice ethically, all must be
overcome.
1. Moral blindness
 describes seeing a dilemma as an administrative or
clinical quandary rather than an ethical issue.
 For example, the understaffing of the unit doesn't
allow for time-consuming comfort care to terminally
ill patients, but the problem is considered an
administrative staffing problem rather than a moral
problem. Or inadequate pain control might be seen as
lack of pain management expertise instead of a nurse's
lack of awareness of her ethical obligation to manage
pain.
2. Moral complacency
 Indicates a general satisfaction with one's own opinion
of a situation.
 For example, a nurse might conclude that all
terminally ill patients are naturally depressed. This
contentment with one's opinion can lead to a lack of
action in advocating to treat a patient' depression. A
nurse who lacks the virtue of competency doesn't think
through the problem critically.
3. Moral distress
  can be described as "the conflict between the nurse's
knowledge of the ethically appropriate action and
the institutional constraints that prevent or make
the action difficult. “This definition speaks to the
organization's responsibility for providing an ethical
work environment.
 However, no matter how difficult, the nurse's ethical
duty is to advocate for patients. This requires the
virtues of integrity, respect, caring, and courage.
details that may lead to a diagnosis, or information that
could help you better care for him or her.”
 When the patients are relaxed, Heitmeyer added, they
often have a shorter length of stay in the hospital,
decreased pain, decreased anxiety and an overall
optimistic outlook on their recovery.
 “The patient looks upon the nurse for guidance,
information and truly to make them better,” Heitmeyer
explained.

CORE VALUES OF A PROFESSIONAL  JUSTICE IS FAIRNESS.

NURSE  Nurses must be fair when they distribute care, for
 Love of God and Country example, among the patients in the group of patients that
 Caring they are taking care of. Care must be fairly, justly, and
 Quality and Excellence equitably distributed among a group of patients.
 Integrity  Examples of justice in practice include offering the
 Collaboration same treatment options to two patients, even where one
may have a condition through no fault of their own and
 PROFESSIONAL COMPETENCY the other through personal behaviour (e.g. lung cancer
and smoking), and allocating resources equally among
 Professional competency has been proposed as a
members of the population.
fundamental element in the provision of nursing care.
 Respect for patients' privacy, dignity and religious and
 In fact, professional competency in nurses is defined
cultural beliefs is demanded by The Patient's Charter.
as a combination of skills, knowledge, attitudes,
All levels of nursing are permeated by the concept of
values and abilities that bring about effective or high
respect, and without respect patients are dehumanised
performance in occupational and professional
and may be abused.
positions.
 INTEGRITY
 COURAGE
 Integrity is defined as the quality of being honest, and
 is a virtue vital for good nursing, and has brought many
fair; possessing high moral principles.
benefits and advancements to the nursing profession, yet
 This kind of trust relationship is what makes a
it has received little credit as a nursing skill. ... It also
successful nurse, and a nurse who possesses integrity
identified caring, knowledge, and the ability to
among her core character traits, is well suited for
overcome fears as some of the defining attributes of
success in patient care.
courage.
 In nursing, integrity should come organically. When
 In other words, nurses with courage believe in
you behave in a genuine and authentic manner,
themselves and their skills. Even more important, they
integrity and other core values of nursing, make up
do not blame others for their shortcomings or failures.
who you are, as a nurse and as a person, no matter
They hold themselves 100% accountable and recognize
who-if anyone-is observing. When nurses take care to
the value of courageous will.
preserve their integrity, the task of truly caring for
their patients becomes much easier.

 YOUR INTEGRITY PRECEDES YOU

 Integrity defines your character. Those around you
identify you as someone who can be counted on to do
the right thing, whether covering for a coworker, or
assisting wherever you’re needed. You can be trusted
to keep confidences, which is why your patients share
information with you easily, and more readily than
even with their own physician. You have others’ best
interest at the forefront of all you do, meaning your
patient care is above reproach. This is what makes a
you an outstanding nurse.

 THE ROLE OF COMPASSION AND PRESENCE

 “Patients want to feel cared for and listened to and
[whether they feel that way] is based on the actions of
the nurses,” said Kelly Hancock, RN, MSN, NE-BC,
chief nursing officer at Cleveland Clinic in Ohio. “It
begins with nurses providing compassionate, patient-
centered care.”

 “Compassion allows a patient to feel cared for, respected

and trust that the nurse has his or her best interest in
mind,”
 Heitmeyer said. “When patients feel that a nurse truly
cares, they begin to allow you in, offering the small

ETHICAL PRINCIPLES
DEFINITION
 Ethical principles are the basis of all nursing practice
and provide a framework to help the nurse in ethical
decision making.
PRIMARY ETHICAL PRINCIPLES
 Patients’ Rights
1. RIGHT TO APPROPRIATE MEDICAL CARE AND
HUMANE TREATMENT.
 Every person has a right to health and medical care
corresponding to his state of health, without any
discrimination and within the limits of the
resources, man power and competence available
for health and medical care at the relevant time.
 The patient has the right to appropriate health and
medical care of good quality. In the course of such,
his human dignity, convictions, integrity,
individual needs and culture shall be respected.
 If any person cannot immediately be given
treatment that is medically necessary he shall,
depending on his state of health, either be directed
to wait for care, or be referred or sent for treatment
elsewhere, where the appropriate care can be
provided.
 If the patient has to wait for care, he shall be
informed of the reason for the delay. Patients in
emergency shall be extended immediate medical
care and treatment without any deposit, pledge,
mortgage or any form of advance payment for
treatment
2. RIGHT TO INFORMED CONSENT.
 The patient has a right to a clear, truthful and
substantial explanation, in a manner and language
understandable to the patient, of all proposed
procedures, whether diagnostic, preventive,
curative, rehabilitative or therapeutic, wherein the
person who will perform the said procedure shall
provide his name and credentials to the patient,
possibilities of any risk of mortality or serious side
effects, problems related to recuperation, and
probability of success and reasonable risks
involved: Provided, That the patient will not be
subjected to any procedure without his written
informed consent, except in the following cases:
 in emergency cases, when the patient is at
imminent risk of physical injury, decline of death
if treatment is withheld or postponed. In such
cases, the physician can perform any diagnostic or
treatment procedure as good practice of medicine
dictates without such consent;
b) when the health of the population is dependent
on the adoption of a mass health program to
control epidemic;
c) when the law makes it compulsory for everyone
to submit a procedure;
d) When the patient is either a minor, or legally
incompetent, in which case. a third party consent
 Informed consent shall be obtained from a patient
concerned if he is of legal age and of sound mind.
In case the patient is incapable of giving consent
and a third party consent is required. the following
persons, in the order of priority stated hereunder,
may give consent:
 Spouse
ii. son or daughter of legal age;
iii. either parent;
iv. brother or sister of legal age, or
v. guardian
 If a patient is a minor, consent shall be attained from
his parents or legal guardian. If next of kin, parents or
legal guardians refuse to give consent to a medical or
surgical procedure necessary to save the life or limb of a
minor or a patient incapable of giving consent, courts,
upon the petition of the physician or any person
interested in the welfare of the patient, in a summary
proceeding, may issue an order giving consent.
3. RIGHT TO PRIVACY AND CONFIDENTIALITY
 The privacy of the patients must be assured at all
stages of his treatment.
 The patient has the right to be free from
unwarranted public exposure, except in the
following cases:
a) when his mental or physical condition is in
controversy and the appropriate court, in its
discretion, order him to submit to a physical or
mental examination by a physician;
b) when the public health and safety so demand;
and
c) when the patient waives this right in writing.
 The patient has the right to demand that all
information, communication and records
pertaining to his care be treated as confidential.
 Any health care provider or practitioner involved
in the treatment of a patient and all those who have
legitimate access to the patient's record is not
authorized to divulge any information to a third
party who has no concern with the care and
welfare of the patient without his consent, except:
a) when such disclosure will benefit public health
and safety;
b) when it is in the interest of justice and upon the
order of a competent court; and
c) when the patients waives in writing the
confidential nature of such information;
d) when it is needed for continued medical
treatment or advancement of medical science
subject
to de-identification of patient and shared medical
confidentiality for those who have access to the
information.
4. RIGHT TO INFORMATION
 In the course of his/her treatment and hospital care,
the patient or his/her legal guardian has a right to be
informed of the result of the evaluation of the nature
and extent of his/her disease, any other additional or
further contemplated medical treatment on surgical
procedure or procedures,
 Including any other additional medicines to be
administered and their generic counterpart including
the possible complications and other pertinent facts,
statistics or studies, regarding his/her illness,
 any change in the plan of care before the change is
made, the person's participation in the plan of care
and necessary changes before its implementation,
 the extent to which payment maybe expected from
Philhealth or any payor and any charges for which
the patient may be liable, the disciplines of health
care practitioners who will fumish the care and the
frequency of services that are proposed to be
furnished.
 The patient or his legal guardian has the right to
examine and be given an itemized bill of the hospital
and medical services rendered in the facility or by
his/her physician and other health care providers,
 regardless of the manner and source of payment. He
is entitled to a thorough explanation of such bill.
 The patient or his/her legal guardian has the right to
be informed by the physician or his/her delegate of
his/her continuing health care requirements
following discharge, including instructions about
home medications, diet, physical activity and all
other pertinent information to promote health and
well-being
 At the end of his/her confinement, the patient is
entitled to a brief, written summary of the course of
his/her illness which shall include at least the
history, physical examination, diagnosis,
medications, surgical procedure, ancillary and
laboratory procedures, and the plan of further
treatment, and which shall be provided by the
attending physician.
 He/she is likewise entitled to the explanation of, and
to view, the contents of medical record of his/her
confinement but with the presence of his/her
attending physician or in the absence of the
attending physician, the hospital's representative.
 Notwithstanding that he/she may not be able to settle
his accounts by reason of financial incapacity, he/she
is entitled to reproduction, at his/her expense, the
pertinent part or parts of the medical record the
purpose or purposes of which he shall indicate in
his/her written request for reproduction.
 The patient shall likewise be entitled to medical
certificate, free of charge, with respect to his/her
previous confinement.
5. THE RIGHT TO CHOOSE HEALTH CARE
PROVIDER AND FACILITY
 The patient is free to choose the health care provider
to serve him as well as the facility except when he is
under the care of a service facility or when public
health and safety so demands or when the patient
expressly waives this right in writing.
 The patient has the right to discuss his condition
with a consultant specialist, at the patient's request
and expense. He also has the right to seek for a
second opinion and subsequent opinions, if
appropriate, from another health care
provider/practitioner
6. RIGHT TO SELF-DETERMINATION
 The patient has the right to avail himself/herself of
any recommended diagnostic and treatment
procedures. Any person of legal age and of sound
mind may make an advance written directive for
physicians to administer terminal care when he/she
suffers from the terminal phase of a terminal illness:
 Provided That
a) he is informed of the medical consequences of his
choice;
b) he releases those involved in his care from any
obligation relative to the consequences of his
decision;
c) his decision will not prejudice public health and
safety.
7. RIGHT TO RELIGIOUS BELIEF.
 The patient has the right to refuse medical treatment
or procedures which may be contrary to his religious
beliefs, subject to the limitations described in the
preceding subsection:
 Provided, that such a right shall not be imposed by
parents upon their children who have not reached the
legal age in a life threatening situation as determined
by the attending physician or the medical director of
the facility
8. RIGHT TO MEDICAL RECORDS
 The patient is entitled to a summary of his medical
history and condition. He has the right to view the
contents of his medical records, except psychiatric
notes and other incriminatory information obtained
about third parties, with the attending physician
explaining contents thereof.
 At his expense and upon discharge of the patient, he
may obtain from the health care institution a
reproduction of the same record whether or not he
has fully settled his financial obligation with the
physician or institution concerned.
 The health care institution shall safeguard the
confidentiality of the medical records and to likewise
ensure the integrity and authenticity of the medical
records and shall keep the same within a reasonable
time as may be determined by the Department of
Health.
 The health care institution shall issue a medical
certificate to the patient upon request. Any other
document that the patient may require for insurance
claims shall also be made available to him within
forty-five (45) days from request.
9. RIGHT TO LEAVE
 The patient has the right to leave hospital or any
other health care institution regardless of his
physical condition:
 Provided. That
a) he/she is informed of the medical consequences
of his/her decision
b) he/she releases those involved in his/her care from
any obligation relative to the consequences of his
decision;
c) his/her decision will not prejudice public health
and safety.
 No patient shall be detained against hi$/her will in
any health care institution on the sole basis of his
failure to fully settle his financial obligations.
However, he/she shall only be allowed to leave the
hospital provided appropriate arrangements have
been made to settle the unpaid bills:
 Provided. further, that unpaid bills of patients shall
be considered as loss income by the hospital and
health care provider/practitioner and shall be
deducted from gross income as income loss only on
that particular year.
10. RIGHT TO REFUSE PARTICIPATION IN
MEDICAL RESEARCH.
 The patient has the right to be advised if the health
care provider plans to involve him in medical
research, including but not limited to human
experimentation which may be performed only with
the written informed consent of the patient:
 Provided, That, an institutional review board or ethical
review board in accordance with the guidelines set in
the Declaration of Helsinki be established for research
involving human experimentation: Provided, further,
That the Department of Health shall safeguard the
continuing training and education of future health care
provider/practitioner to ensure the development of the
health care delivery in the country: Provided,
furthermore, That the patient involved in the human
 experimentation shall be made aware of the provisions
of the Declaration of Helsinki and its respective
guidelines.
11. RIGHT TO CORRESPONDENCE AND TO
RECEIVE VISITORS.
 The patient has the right to communicate with relatives
and other persons and to receive visitors subject to
reasonable limits prescribed by the rules and regulations
of the health care institution.
12. RIGHT TO EXPRESS GRIEVANCES.
 The patient has the right to express complaints and
grievances about the care and services received without
fear of discrimination or reprisal and to know about the
disposition of such complaints. Such a system shall
afford all parties concerned with the opportunity to
settle amicably all grievances.
13. RIGHT TO BE INFORMED OF HIS RIGHTS AND
OBLIGATIONS AS A PATIENT.
 Every person has the right to be informed of his rights
and obligations as a patient. The Department of Health,
in coordination with heath care providers, professional
and civic groups, the media, health insurance
corporations, people's organizations, local government
organizations, shall launch and sustain a nationwide
information and education campaign to make known to
people their rights as patients, as declared in this Act
Such rights and obligations of patients shall be posted in
a bulletin board conspicuously placed in a health care
institution.
 It shall be the duty of health care institutions to inform
of their rights as well as of the institution's rules and
regulations that apply to the conduct of the patient while
in the care of such institution.
ETHICAL
PRINCIPLES
 In a healthcare setting, informed consent allows
you to participate in your own medical care.
 It enables you to decide which treatments you
do or do not want to receive.
 It allows you to make decisions with your
healthcare provider.
 This collaborative decision-making process is an
ethical and legal obligation of healthcare
 providers.
 Informed consent is a process that’s required
for most medical procedures.
What types of procedures need informed consent?
 The following scenarios require informed consent:
 ∙ most surgeries
 ∙ blood transfusions
 ∙ anesthesia
 ∙ radiation
 ∙ chemotherapy
 ∙ some advanced medical tests, like a biopsy
 ∙ most vaccinations
In a healthcare setting, the process of informed
consent includes:
1. your ability to make a decisione
2. xplanation of information needed to make the
decision
3. our understanding of the medical information
4. your voluntary decision to get treatment
An informed consent agreement should include
the following information:
1. diagnosis of your condition
2. name and purpose of treatment
3. benefits, risks, and alternative procedures
4. benefits and risks of each alternative
5. With this information, you can make an
educated choice about the procedures you
receive.
Can others sign a consent form on your behalf?
 In some cases, another person can sign a consent
form for you. This is appropriate in the following
scenarios:
 You aren’t of legal age. if you’re younger than
18, a parent or guardian will need to give
consent on your behalf. You want someone else
to make the decisions.
 If you’d like to let another person make your
future medical decisions, you can fill out a form
called an advance directive. This allows
someone else to give consent on your behalf if
you’re unable to.
 You can’t give consent. Another person can
make your medical decisions if you can’t
provide consent. This may happen if you’re in a
coma, or have a condition like advanced
Alzheimer’s disease.
Obtaining informed consent in medicine is process
that should include:
(1) describing the proposed intervention,
(2) emphasizing the patient's role in decision-making,
(3) discussing alternatives to the proposed intervention,
(4) discussing the risks of the proposed intervention and
(5) eliciting the patient's preference (usually by
signature).
THE DOCTRINE OF
INFORMED CONSENT
 Informed consent is a client’s right to know and
understand before agreeing to a procedure.
 It is the physician’s sole responsibility to obtain
consent from the client, even if other staff assist in
the process.
 Consent should be obtained in writing because
written consent implies an intentional and
deliberate decision
Consider the following examples:
1. A client calls complaining of a persistent,
productive cough. When the receptionist makes
the appointment with the physician, the client
has given consent for examination, which
may include throat examination and culture.
2. When a physician requires a blood test for
diagnosis and the client comes to the laboratory
with a rolled-up sleeve, implied consent is being
given.
3. A client is scheduled for an office surgical
procedure and signs an appropriate consent
form. This action constitutes a medical contract
between the client and the physician. Written
consent has been obtained
PROXY CONSENT
 Proxy consent is 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.
There are two types of proxy consent for adults:
1. The first, the power of attorney to consent to medical
care, is usually used by patients who want medical care
butare 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.The second type is the living will.
PRIVACY AND
CONFIDENTIALITY
 are basic rights in our society. Safeguarding those
rights, with respect to an individual’s personal
health information, is our ethical and legal
obligation as health care providers. Doing so in
today’s health care environment is increasingly
challenging.
 Every nurse understands and respects the need for
patient confidentiality. As professionals, our
connection to our patients and our colleagues
depends on it. But, the truth is, advanced
technology, new demands in health care, and
developments in the world-at-large, make it more
and more difficult to keep this promise. But keep it
we must!
 Privacy is the right of individuals to keep
information about themselves from being disclosed;
that is, people (our patients) are in control of others
access to themselves or information about
themselves. Patients decide who, when, and where
to share their health information.
 On the other hand, confidentiality is how we, as
nurses, treat private information once it has been
disclosed to others or ourselves. This disclosure of
information usually results from a relationship of
trust; it assumes that health information is given
with the expectation that it will not be divulged
except in ways that have been previously agreed
upon, e.g., for treatment, for payment of services,
or for use in monitoring the quality of care that is
being delivered.
 N.B. With the increasing use of technology for the
provision of care in our fast-paced clinical
environments, maintaining privacy and
confidentiality can be a daunting task.
THE IMPACT
OF TECHNOLOGY
 Electronic messaging and new computer
technology, though quick and efficient, might not be
as secure as we would want it to be. This is an
unfortunate reality, but one we must consider. If it
is not absolutely necessary to include patients’
names in electronic correspondences, then we
should refrain from doing so. We must be smart and
sensitive when communicating patient information,
 be it by fax, telephone, email, or other technologies
yet to be developed (Ives Erickson, 1999).
  Stand up to peer pressure when friends or
When communicating with another clinician,
remember this:
1.Others besides the addressee may process messages
during addressee’s usual business hours or
during addressee’s vacation or illness
2.Electronic messages can occasionally go to the wrong
party
3.Electronic communication can be accessed from
various locations
4.Information written by one clinician may be sent
electronically to other care providers
5.The Internet does not typically provide a secure media
for transporting confidential information
unless both parties are using encryption technologies.
The following are other strategies to address
confidentiality challenges facing nurses.
 Communication with family members – always
keep the patient’s best interest in mind. This may
translate into adequately informing long-distance
family members so they are able to properly
respond and support elderly or demented parent’s
needs. Verify identity as legal guardian or
executor, if necessary.
 Never assume you have the right to look at any
type of health information unless you need it in
order to do your job.. For example, co-workers’
phone numbers for personal reasons may be
looked up by the interested party on the Internet
or the phone book. Phone numbers needed for
work-related reasons may be obtained from the
supervisor or the employee database if you have
been authorized for access. Always ask yourself,
"Do I need-to-know this information?" Need-to-
Know is defined as that which is necessary for one
to adequately perform one's specific job
responsibilities.
 Hold your colleagues as accountable as you hold
yourself when it comes to respecting patient
privacy. When you see a nurse or physician
carrying progress notes on their tray in the
cafeteria for others to see, gently and politely
remind them to turn them over in the name of
confidentiality. When you are hearing a
conversation between two care providers in the
elevator or the hospital shuttle, politely ask them
to please continue their discussion in a private
area.
 Be a privacy mentor to nursing students just
starting out in the profession. For example, keep
medical records closed on desktops, close out
results on computer screens, send out text paging
with minimum necessary information (last name
first initial), restrict excessive printing of health
information from computers, restrict the removal
of all copies of health information from the
hospital, even if reports have been de-identified.
neighbors ask you to do a favor by obtaining for
them copies of their records or copies of a family
member’s records. Always get written
authorization and follow proper procedure. In
many organizations, failure to follow proper
procedures regarding release of information may
result in disciplinary action, up to and including
termination of employment or suspension of
privileges.
 If in doubt when releasing health information to
patients, confer with your health information
services department or privacy office for advice
and assistance.
PRIVACY
 The nurse safeguards the patient's right to privacy.
The need for health care does not justify unwanted
intrusion into the patient's life. The nurse advocates
for an environment that provides for sufficient
physical privacy, including auditory privacy for
discussions of a personal nature and policies and
practices that protect the confidentiality of
information
CONFIDENTIALITY
 Associated with the right to privacy, the nurse has a
duty to maintain confidentiality of all patient
information.
 The patient's well being could be jeopardized and
the fundamental trust between patient and nurse
destroyed by unnecessary access to data or by the
inappropriate disclosure of identifiable patient
information.
 The rights, well being, and safety of the individual
patient should be the primary factors in arriving at
any professional judgment concerning the
disposition of confidential information received
from or about the patient, whether oral, written or
electronic.
 The standard of nursing practice and the nurse's
responsibility to provide quality care require that
relevant data be shared with those members of the
health care team who have a need to know
DOCTRINE OF
DOUBLE EFFECT
 The doctrine (or principle) of double effect is
often invoked to explain the permissibility of an
action that causes a serious harm, such as the
death of a human being, as a side effect of
promoting some good end
  According to the principle of double effect,
sometimes it is permissible to cause a harm as a
side effect (or “double effect”) of bringing about
a good result even though it would not be
permissible to cause such a harm as a means to
bringing about the same good end.
Formulations of the principle of double effect
 Thomas Aquinas is credited with introducing the
principle of double effect in his discussion of the
permissibility of self-defense
 Aquinas observes that “Nothing hinders one act
from having two effects, only one of which is
intended, while the other is beside the intention. …
Accordingly, the act of self-defense may have two
effects: one, the saving of one’s life; the other, the
slaying of the aggressor.”
Four conditions for the application of the principle
of double effect:
1. The act itself must be morally good or at least
indifferent.
2. The agent may not positively will the bad effect but
may permit it. If he could attain the good effect without
the bad effect he should do so. The bad effect is
sometimes said to be indirectly voluntary.
3. The good effect must flow from the action at least as
immediately (in the order of causality, though not
necessarily in the order of time) as the bad effect. In
other words the good effect must be produced directly
by the action, not by the bad effect. Otherwise the
agent would be using a bad means to a good end, which
is never allowed.
4. The good effect must be sufficiently desirable to
compensate for the allowing of the bad effect“ (p. 1021
 A person may licitly perform an action that he
foresees will produce a good effect and a bad effect
provided that four conditions are verified at one
and the same time:
 that the action in itself from its very object be
good or at least indifferent;
 that the good effect and not the evil effect be
intended;
 that the good effect be not produced by means
of the evil effect;
 that there be a proportionately grave reason
for permitting the evil effect” (1949, p. 43).
Applications:
 Many morally reflective people have been
persuaded that something along the lines of
double effect must be correct. No doubt this is
because at least some of the examples cited as
illustrations of DE have considerable intuitive
appeal:
 A doctor who intends to hasten the death of a
terminally ill patient by injecting a large dose of
morphine would act impermissibly because he
intends to bring about the patient’s death.
However, a doctor who intended to relieve the
patient’s pain with that same dose and merely
foresaw the hastening of the patient’s death
would act permissibly.
 A doctor who believed that abortion was wrong,
even in order to save the mother’s life, might
nevertheless consistently believe that it would
be permissible to perform a hysterectomy on a
pregnant woman with cancer.
 In carrying out the hysterectomy, the doctor
would aim to save the woman’s life while
merely foreseeing the death of the fetus.
Performing an abortion, by contrast, would
involve intending to kill the fetus as a means to
saving the mother.
Misinterpretations
 First, it is a misinterpretation to claim that the
principle of double effect shows that agents
may permissibly bring about harmful effects
provided that they are merely foreseen side
effects of promoting a good end.
 Applications of double effect always presuppose
that some kind of proportionality condition has
been satisfied. Traditional formulations of the
proportionality condition require that the value
of promoting the good end outweigh the
disvalue of the harmful side effect.
 For example, a physician’s justification for
administering drugs to relieve a patient’s pain
while foreseeing the hastening of death as a
side effect does not depend only on the fact
that the physician does not intend to hasten
death.
 After all, physicians are not permitted to relieve
the pain of kidney stones or childbirth with
potentially lethal doses of opiates simply
because they foresee but do not intend the
causing of death as a side effect!
 A variety of substantive medical and ethical
judgments provide the justificatory context: the
patient is terminally ill, there is an urgent need
to relieve pain and suffering, death is imminent,
and the patient or the patient’s proxy consents.
 Note that this last constraint, the consent of the
patient or the patient’s proxy, is not naturally
classified as a concern with proportionality,
understood as the weighing of harms and
benefits.
 The principle of double effect aims to provide
specific guidelines for determining when it is
ethically permissible for a human being to
 engage in conduct in pursuit of a good end with
full knowledge that the conduct will also bring
about bad results.
 The principle of double effect generally states
that, in cases where an agent contemplates
conduct that has both good effects and bad
effects, the course of conduct selected is
ethically permissible only if it is not wrong in
itself and if it does not require that one directly
intend the bad result.
provide to all members in order to fulfill a relational
obligation they all have to care for certain interests
that they have in common
 Principle of subsidiarity  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

PRINCIPLE OF
BENEFICENCE
“Always do good”

 The term beneficence connotes acts of mercy,

kindness, and charity, and is suggestive of altruism,
love, humanity, and promoting the good of others.
In ordinary language, the notion is broad; but it is
understood still more broadly in ethical theory, to
include effectively all forms of action intended to
benefit or promote the good of other persons.
 The language of a principle or rule of beneficence
refers to a normative statement of a moral
obligation to act for the benefit of others, helping
them to further their important and legitimate
interests, often by preventing or removing possible
harms.

Principle of legitimate cooperation:

1. The cooperation is not immediate

2. The degree of cooperation and the degree of scandal

are taken into account

Cooperation
 Formal- Agent identifies itself with purpose of
evil act.
 Material- Only the act itself but not the purpose

PRINCIPLE OF
COMMON GOOD
 In ordinary political discourse, the “common good”
refers to those facilities—whether material, cultural
or institutional—that the members of a community