ANGELES UNIVERSITY FOUNDATION

COLLEGE OF NURSING

NCM 0108 Health Care Ethics

Summer, Academic Year 2020-2021

MODULE 1

THEORIES AND PRINCIPLES OF HEALTH CARE ETHICS

MODULE OVERVIEW

This self-instructional module is designed and prepared for BSN II students to provide
them with adequate knowledge to be able to understand the very core concept of the
Theories and Principles of health care ethics. This module contains core values of a
Professional nurse and the virtues of a health care provider, which are very essential in
the nursing practice.

Health ethics 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. Health ethics involves deliberating about the allocation of resources, and
reflecting on the complex moral choices arising from ongoing health care restructuring
and advancing technology. It also entails a critical, political, and ethical analysis of the
definition and the determinants of health.
Nurses touch people’s lives during some of the peaks and troughs of human existence.
Therefore it is important that we think about nurses and nursing. What do our patients
require from nurses and how do we, as a society, as nurses, and as health service
leaders, meet patient need? The first step is to recognize that nursing, as a practice, has
moral values at its core. The nurse-patient relationship, which is central to the provision
of nursing care, has ethical importance and is of ethical significance. It is also vital to
consider that the context within which nurse practice can shape and be shaped by the
moral values of nursing.

These moral values form what can be termed the ethical dimension of nursing. It is
therefore important that we explore and examine these moral values. Codes of conduct
are examples of the nursing profession’s collective attempt to express its underlying
values. The institutions within which nurses work help or hinder the actual expression of
these values in nursing practice and patient care. We need to recognize the interplay of
these various factors in order to ensure that we as nurses, as potential patients, and as
members of society understand what good nursing practice means, what it looks like in
practice, and how it can be supported.

This module will help the student to set out to identify the ethical domain of nursing
practice, and signal its relevance for good nursing care and a safe, supportive patient
experience. This module will also provide core values of a professional nurse through
which to identify, analyze and discuss ethical issues in nursing practice, with a view to
providing tools for the nurse to practice in an ethically sensitive and appropriate manner.

In this module you will spend 9 HOURS for discussion and activities. Below are the details of the
content, the activities that you need to accomplish and estimated time of completion:

PARTS OF THE MODULE ACTIVITIES ESTIMATED TIME OF FOR COMPLETION

Day 1: Synchronous

1. Course Orientation 30 minutes

2. Video Conferencing 1
- Pretest 10 items 2 hours
- Theories and Principles of Health Care
Ethics
15 minutes
3. Film Viewing: Inside a Covid I.C.U., Through
a Nurse's Eye https://youtu.be/KR4ifeGxdQw

4. Asynchronous Activities: Film Review

15 minutes

Day 2: Synchronous

5. Video Conferencing 2
- Discussion of virtue ethics 2 hours

- Case presentation of the scenarios

given to the students in the film review

6. Feedback on the given Activity

1 hours

Day 3: Synchronous
 7. Video Conferencing 3 1 hours
- Continuation of presentation
8. Summary and Conclusion 30 minutes
9. Reflective Questions 50 minutes

SUMMATIVE EVALUATION
Uploaded in myClass as Graded Quiz

10. Quiz No. 1: 30 Items multiple Choice 40 minutes

LEARNING HOURS 9 HOURS

MODULE LEARNING OUTCOMES:

Upon completion of this module, the learner should be able to:

● Integrate relevant principles of social, physical natural and health

sciences and humanities in a given health and nursing situation.

● Apply the concepts of the different ethical theories in specific

scenarios.

● Demonstrate caring as the core of nursing, love of God, love of

country and love of people.

● Manifest professionalism, integrity and excellence

● Project the positive professional image of a Filipino Professional

Nurse.

● Outline existing laws, legal, ethical and moral principles and adhere
to norms of conduct and protecting patient’s rights in different scenarios.

● Explain the applicable law, legal, ethical and moral principles in

different case scenario.

DISCUSSION
Contained by the framework of effective teaching-learning method and a precise
emphasis on learner-centered capability on the direction of learning, engaging
strategies that integrate the synchronous and asynchronous conferences
specifically through video conferences, self-directed learning activities, concept
integration, and skill-enhancement can appropriately address this module’s
learning objectives and outcomes. More specifically, be guided by the detailed
allocation of learning activities:

Module Content

PRETEST:

1. A moral framework in which actions are judged primarily by their results. It holds that
actions or policies that achieve good results; particularly the greatest good for the greatest
number of people are judged to be moral:

A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

2. This principle states that it is not the consequences of actions that make them right or
wrong but the motives of the person who carries out the action:

A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

3. Its primary focus is the heart of the moral agent in making decision rather than the
reasoning to a right action:

A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

4. A type of ethical principle which believes that there is a Divine Being who has set
down finite series of rules that adherents claim can provide guidance to all moral
decision:
A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

5. This calls for our individual responsibility to take care of our health, not to kill or put
ourselves in danger:

A. Self-preservation
B. Justice
C. Propagation of species
D. None of the Above

6. 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:

A. DEONTOLOGY
B. TELEOLOGY
C. VIRTUE ETHICS
D. DIVINE COMMAND ETHICS

7. It is the expression of selfless concern for others when there is no obvious reward to
be gained for oneself, except the belief someone else will benefit or avoid harm:

A. AUTONOMY
B. INTEGRITY
C. HUMAN DIGNITY
D. ALTRUISM

8. It refers to having respect for the inherent worth and uniqueness of individuals,
families, and communities and characterizes all interactions a nurse should have with
them:

A. AUTONOMY
B. INTEGRITY
C. HUMAN DIGNITY
D. ALTRUISM

9. It serves as the underpinning for how decisions are made in terms of the equitable
distribution and allocation of health care services and resources regardless of age,
gender, nationality and social status:

A. SOCIAL JUSTICE
B. AUTONOMY
C. COMPASSION
D. PRUDENCE

10. It is the faithfulness to responsibilities one has undertaken:

A. RESPECT
B. HONESTY
C. FIDELITY
D. PRUDENCE

DISCUSSION:

ETHICAL THOUGHTS
1. Teleology

● Also known as CONSEQUENCE-ORIENTED THEORY, CONSEQUENTIALISM

AND UTILITARIANISM.
● It came from the Greek word telos which means END.
● The Fathers of Utilitarianism:
● Jeremy Bentham
● John Stuart Mill

THREE THOUGHTS IN TELEOLOGY

● Utilitarianism
● Act Utilitarianism
● Equal Consideration of Interest

UTILITARIANISM

● Refers to those moral theories which judges the rightness or wrongness of action
based on outcomes or predicted outcomes.
● It holds that actions or policies that achieve good results. “Greatest good for the
Greatest Number”
● *The good resides in the promotion of happiness or the greatest net increase
pleasure over pain

The ends justify the means".

● Bending the rules to achieve one’s goal
● The need to compromise is always been considered
● The focus is to get the goal whatever it takes

Act Utilitarianism

● Decision based on possible alternatives for action

● Weighing each to amount of pleasure or utility it provides
● Selecting course of action that maximizes pleasure

Equal Consideration of Interest

● Individual not allowed to increase his share of happiness at expense of another

● One ought to act to produce greatest balance of happiness over unhappiness,
everyone considered

Teleological (Consequence-oriented) Theories

45510056. Deontology

● Also known as DUTY-ORIENTED, FORMALISM and KANTIANISM

● It came from a Greek word deon , DUTY
● Immanuel Kant (1742-1804), a brilliant German thinker
● He based his moral philosophy on the ground that we are rational being, and a
central feature of this rationality was that principles derived from reason are universal

*One such maxim relevant to ethics is “We must always treat others as ends and not as
means only.

● An approach to ethics that determines goodness or rightness from examining acts.

● Deontologists look at rulesand duties.
● To act in the morally right way, people must act from duty
● it is not the consequences of actions that make them right or wrong but the motives
of the person who carries out the action
● Deontology also implies that ethics are derived from fulfilling duties.
● NURSE’S CODE OF ETHICS
o Stress the importance of fulfilling duties that are inherently owed to patients and
the importance of preserving the dignity and autonomy of each individual patient

1. Categorical Imperative:

● Categorical= Moral rules that do not admit exceptions

● Imperative= denotes a command that is derived from principles

● “No action can be judge RIGHT which cannot reasonably become a strict Law.”

● We need to follow UNIVERSAL LAW.

Three elements of Imperative:

1. Universal Principle

2. Unconditionally

3. Demanding an action

2. Practical Imperative

● We must always treat others as ENDS and not as MEANS only.

● Domination of one person over another is MORALLY WRONG

45510144. Virtue Ethics

● Another philosophical idea that has been central to medical ethics which holds that
those who are taught to be good will do what is right
● Its primary focus is the heart of the moral agent in making decision rather than
the reasoning to a right action.
● The belief is that someone who has appropriate moral virtues will act naturally in
certain ways.

● Aristotle’s Traits of a Virtuous Character

● Virtuous acts must be chosen for their own sakes

● Choice must proceed from firm and unchangeable character

● Virtue is a disposition to choose the mean

● Its primary focus is the heart of the moral agent in making decision rather than the

reasoning to a right action.

● The belief is that someone who has appropriate moral virtues will act naturally in

certain ways.

VIRTUE ETHICS

A VIRTUOUS CHARACTER

1. Should have the right motivation and disposition in life

2. Should have good traits to know the best and right decision

3. Virtues are inherent.

4. Ethics of Care

1. Psychologist Carol Gilligan

1. Males embrace ethic of rights and justice, using quasi-legal terminology

2. Females affirm ethic of care on responsiveness toward needs of others and

prevention of harm

4. Divine Ethics:

● Believes that there is a Divine Being who has set down finite series of rules that
adherents claim can provide guidance to all moral decision.
o Judeo-Christian Ten Commandments
o Buddhism’s Four Noble Truths and Eight-Fold Path

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

● is concerned with the character of individual nurses and seeks ways to enable
nurses to develop character traits appropriate for actions that enhance wellbeing.

CORE VALUES OF A PROFESSIONAL NURSE

1. ALTRUISM
2. AUTONOMY
3. HUMAN DIGNITY
4. SOCIAL JUSTICE
5. INTEGRITY

1. ALTRUISM
● Refers to the concern for the welfare and wellbeing of others. It is the expression
of selfless concern for others when there is no obvious reward to be gained for oneself,
except the belief someone else will benefit or avoid harm.

45510224. AUTONOMY
● Refers to the right to self-determination and self-direction, even amid challenges,
obstacles, and disadvantages.

45510272. HUMAN DIGNITY

● Refers to having respect for the inherent worth and uniqueness of individuals,
families, and communities and characterizes all interactions a nurse should have with
them.

45510312. SOCIAL JUSTICE

● Refers to upholding moral, legal and humanistic principles. It serves as the
underpinning for how decisions are made in terms of the equitable distribution and
allocation of health care services and resources regardless of age, gender, nationality
and social status

45510352. INTEGRITY
● Refers to nurses acting in accordance with an appropriate code of ethics and
accepted standards of practice.

VIRTUE

● Virtues are not passing feelings or emotions. They are not single acts of
generosity or piety.

● Virtue involves a habit, a constant effort to do things well in spite of obstacles and
difficulties

ACCORDING TO ST. AUGUSTINE:

● virtue is a good quality of the mind by which one lives rightly

VIRTUES OF A HEALTH CARE PROVIDER

1. FIDELITY
2. HONESTY
3. RESPECT
4. COMPASSION
5. PRUDENCE
6. COURAGE
1. FIDELITY
● Faithfulness to trust and promise
● The individual’s obligation to keep the commitment he/she has made
● It is the faithfulness to responsibilities one has undertaken

THE NIGHTINGALE’S PLEDGE

45510400. HONESTY
● Truth telling

45510440. RESPECT

● a positive feeling or action shown towards someone or something considered

important, or held in high esteem or regard
● The process of honoring someone by exhibiting care, concern, or consideration
for their needs or feelings.
● a fundamental pillar of their relationship
45510480. COMPASSION
● Feeling for the loss/suffering of another
● Self-sacrifice, given voluntarily for the benefit of another without no hope in
return, gain recognition of payment but given because of the other’s need is greater

45510528. PRUDENCE

● Habitual deliberateness, caution and circumspection in action

● Foresight
● Taking into consideration all possible circumstances and consequences before
acting.
● Consider how the different options may affect others making a decision

45510568. COURAGE
● Doing what is right without undue fear
● Standing up against one sees as wrong doing even if it means standing up alone

POST TEST:

1. A moral framework in which actions are judged primarily by their results. It holds that
actions or policies that achieve good results; particularly the greatest good for the greatest
number of people are judged to be moral:

A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

2. This principle states that it is not the consequences of actions that make them right or
wrong but the motives of the person who carries out the action:

A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

3. Its primary focus is the heart of the moral agent in making decision rather than the
reasoning to a right action:

A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

4. A type of ethical principle which believes that there is a Divine Being who has set
down finite series of rules that adherents claim can provide guidance to all moral
decision:

A. Teleological
B. Deontological
C. Virtue Ethics
D. Divine Ethics

5. This calls for our individual responsibility to take care of our health, not to kill or put
ourselves in danger:

A. Self-preservation
B. Justice
C. Propagation of species
D. None of the Above

6. 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:

A. DEONTOLOGY
B. TELEOLOGY
C. VIRTUE ETHICS
D. DIVINE COMMAND ETHICS

7. It is the expression of selfless concern for others when there is no obvious reward to
be gained for oneself, except the belief someone else will benefit or avoid harm:

A. AUTONOMY
B. INTEGRITY
C. HUMAN DIGNITY
D. ALTRUISM

8. It refers to having respect for the inherent worth and uniqueness of individuals,
families, and communities and characterizes all interactions a nurse should have with
them:

A. AUTONOMY
B. INTEGRITY
C. HUMAN DIGNITY
D. ALTRUISM
9. It serves as the underpinning for how decisions are made in terms of the equitable
distribution and allocation of health care services and resources regardless of age,
gender, nationality and social status:

A. SOCIAL JUSTICE
B. AUTONOMY
C. COMPASSION
D. PRUDENCE

10. It is the faithfulness to responsibilities one has undertaken:

A. RESPECT
B. HONESTY
C. FIDELITY
D. PRUDENCE

ANSWER KEY:
1. A
2. B
3. C
4. D
5. A
6. C
7. D
8. C
9. A
10. C

Prepared by:

Shannon Rey P. Pelayo, RN, MAN, EMT

Peer Reviewed by:

Lorna T. Dizon, RN, LPT, MN

Paul Christopher Pineda, JD, MAN, RN

Reviewed and Evaluated by:

Jennie C. Junio, RN, MAN
Level II Coordinator

Noted by:

Debbie Q. Ramirez, RN, PhD

Assistant Dean, College of Nursing

Approved by:

Zenaida S. Fernandez, RN, PhD

Dean, College of Nursing

References:

Alora- Angeles Tan .(c2010). Case book in bioethics 3.UST publication house
Babor, Eddie R.(2010). Bioethics: a philosophical journey and critical analysis into the life sciences
a guide to healthcare providers. C and E publication
Burkhardt, Margaret A.etal.(c2014).Ethics and issues in contemporary nursing.(4th Edition).cengage
learning, USA
Blackwell,Wiley(c2014). Medical ethics.(2nd Edition).john wiley and sons, Inc.
Butt, Janie B. (2016) Nursing ethics: across the curriculum and into practice. jones and barlett
learning 4 edition
th

Davis, A.(c2010). Ethical dilemmas and nursing practice 5 edition: marsha diane mary flower
th

boston. pearson
Eddie, R. (c2010). Bioethics: a philosophical journey and critical analysis into the life sciences:a
guide to health care providers. C and E publication
Ellis, Peter (c2015). Understanding ethics for nursing students. SAGE publication asia-pacific. PLTE
Ltd
Garrett, Thomas M.et.al(2010). Healthcare ethics: principles and problems 5 Edition
th

Frey, Sara T.et.al.(c2011).Case studies in nursing ethics.(4th edition).jOnes and barlett learning,
USA
Griffith, Richard and Cassam Tengnah. (c2014).Law and professional issues in nursing.(3rd
Edition).SAGE publication asia pacific PTE LTD.
Jennings, Bruce (2014). Bioethics .volume 2 . macmillah reference 4 edition.
th

INTERNET SOURCES
www.ethics.ubc.ca/resources/biomed
www.mic.ki.se/diseases
www.sacredchoices.org
www.yale.edu,yihple.geocities.com
http://search.ebscohost.com/login.aspx?authtype=uid