THEORIES AND PRINCIPLES OF ETHICS
healthcare team, problems of job dissatisfaction
B. Virtue Ethics
- developed by Aristotle & other Ancient Greeks
- attitudes, dispositions, or character traits
- derived from “natural internal tendencies” but need to
be nurtured
A virtuous person is someone who has IDEAL
character traits
Theories and Principles of Health Ethics
- Honesty, courage, compassion, generosity, fidelity,
integrity, fairness, self-control, and prudence
1. Virtue Ethics in Nursing
E. Arries, M. Cur, Ph.D.; M.Phil. (Ethics) School of
Nursing, University of Johannesburg
• By virtue of our practice, we are member of the health
profession who have the most contact with patients
• As a result, we are confronted with situations of
intense potential moral conflict more often than any
other member of the healthcare team
• The moral distress experienced by nurses often results
from a conflict between a professional duty to care and
personal convictions, such as values and beliefs
• Nursing ethics revolves around three central concepts:
- nurse (“self “), patient (“other”) and health (“the
good”) (Rossouw & Van Vuuren, 2004)
- These 3 dimensions determines whether the
response by the nurse to a situation of moral
distress is ethical or not
• Nurses often based their ethical decisions on their
engagement with the holistic needs of the patient
Ethics of care - the involvement, harmonious relations
between a nurse and a patient as well as the needs of
other people within every unique ethical situation plays
an important role in solving an ethical problem
- Doctors plays a dominant role in ethical decisions
(principalism)
- Nurses feel they are marginalised and excluded
from moral decisions that affect them equally
- Nurses are often expected to carry out ethical
decisions made by doctors Ex: DNR order
- Often leads to tension among members of the
and burn-out among nurses
2 KINDS OF VIRTUE ETHICS:
1. Those that relate to a person’s character (moral
virtue)
2. Those that relate to a person’s intellect (intellectual
virtue)
Intellectual virtue as a disposition enables a
nurse to reason well, while acting in accordance with
right reason requires moral virtue
A nurse who applies the principle of
benevolence, that is the wish to do good for his/her
patient, decides to act in direct opposition to a doctor’s
do not resuscitate (DNR) prescription.
Without apparent self- interest, the nurse might
feel that the patient is being treated unfairly and thus
decide to act on the patient’s behalf
CARE AS A VIRTUE
- Natural care refers to situations where people act
voluntarily in the interest of others.
- Ethical care arises from natural care. However, care
as a virtue involves an inherent disposition or
attitude and is based on a deep sense of
responsibility and empathy.
Noddings (in Botes, 1997:10)
• Van Hooft (1999:200) concludes that caring embraces
both thinking right and feeling right, and having the
right goal in the context of an ethical practice
• Being a caring nurse is enough to ensure that one will
act well (Van Hooft, 1999:200)
- In this vein, when nurses act from the virtue of care,
they will be doing what anyone could judge to be
right
RESPECT AS A VIRTUE
- Kant stipulates that one should never treat people
as a means to achieve an end, but as ends in them
selves (Arrington, 1998:104)
- NURSES should treat people as human beings with
respect
JUSTICE AS A VIRTUE
- Enables the nurse to have an awareness of, and a
special concern for, the vulnerability of a patient
- Fairness in the distribution of nursing care and
health resources
COURAGE AS A VIRTUE
- A nurse is someone who is capable of free thought,
undertakes responsible actions and carries them
out, whatever their implications might be.
- However, in nursing practice, a courageous act
cannot always be justified on the basis of being right
or of its consequences for example when driven by
compassion
- Mary Seacole was a Jamaican born nurse who
helped soldiers during the Crimean War. Her work
was praised at the time, but she became even more
famous a century later.
- A British nurse Saved the lives of soldiers without
discrimination
- Helped some 200 Triple Entente soldiers escape
from Germanoccupied Belgium during the First
World War
- Accused of treason, found guilty by a court-martial
and sentenced to death
REASON AS A VIRTUE
- Nurses are often accused of responding to ethical
situations in an emotional and irrational way (Botes,
1997)
HONESTY AS A VIRTUE
- It is a quality of not lying, cheating, stealing or being
insincere, but qualities of truth, sincerity and
reliability (Botes & Rossouw, 1995:25)
TRUST AS A VIRTUE
- Patients trust nurses thus confiding their private
vulnerabilities
- Trust must be earned, because if there is distrust on
the part of the patient, it could be because the
nurses fail to perform what is necessary for the
patient The idea of being good is important, and to
be good, one must look and work at one’s character
and develop certain character traits, called virtues
CORE VALUES OF A PROFESSIONAL NURSE
CHED MEMORANDUM ORDER (CMO)
No. 5 Series of 2008
Within the context of the Philippine society,
nursing education with caring as its foundation,
subscribes to the following core values which are vital
components in the development of a professional nurse
and are emphasized in the BSN program
1.1 Love of God
1.2 Caring as the core of nursing
a. Compassion
b. Competence
c. Confidence
d. Conscience
e. Commitment (commitment to a
culture of excellence, discipline, integrity and
professionalism)
1.3 Love of People
a. Respect for the dignity of each
person regardless of creed, color, gender and
political affiliation
1.4 Love of Country
a. Patriotism (Civic duty, social
responsibility and good governance)
b. Preservation and enrichment of the
environment and culture heritage
ETHICAL PRINCIPLES
Autonomy
- Greek autos-nomos meaning “self-rule” or “self
determination”
- According to Kantian ethics, autonomy is based on
the human capacity to direct one’s life according to
rational principles.
- Autonomous people are considered as being ends in
themselves in that they have the capacity to
determine their own destiny, and as such must be
respected
- “That the only purpose for which power can be
rightfully exercised over any member of a civilized
community, against his will, is to prevent harm to
others. His own good, either physical or moral, is
not a sufficient warrant. ... Over himself, over his
own body and mind, the individual is sovereign”
(Mill, 1968, p. 73).
- Autonomy For John Stuart Mill, autonomy involves
the capacity to think, decide and act on the basis of
such thought and decision freely and
independently.
- The principle of not causing harm to others (harm
principle) provides the grounds for the moral right
of a patient to refuse medical treatment and for a
doctor to refrain from intervening against the
patient’s wishes.
- People have the right to have their own choices
respected in health care in as far as these choices
are about themselves as individuals
- This contrasts with the “doctor knows best”
approach (paternalism)
PATIENTS RIGHTS
• Formalized in 1948
• The Universal Declaration of Human Rights recognizes
“the inherent dignity” and the “equal and unalienable
rights of all members of the human family”
- Patients' rights vary in different countries and in
different jurisdictions, often depending upon
prevailing cultural and social norms.
ETHICAL PRINCIPLES
Autonomy - Patient’s Rights
- "Magna Carta of Patient's Rights and Obligations Act
of 2017”
SEC. 4. Individual Rights of Patients
a. Right to Good Quality Health Care and
Humane Treatment
b. Right to Dignity
c. Right to be Informed of His Rights and
Obligations as a Patient
d. Right to Choose His Physician / Health
Institution
e. Right to Informed Consent
f. Right to Refuse Diagnostic and Medical
Treatment
g. Right to Refuse Participation in Medical
Research
h. Right to Religious Belief and Assistance
i. Right to Privacy and Confidentiality
j. Right to Disclosure of, and Access to.
Information
k. Right to Correspondence and to Receive
Visitors
l. Right to Medical Records
m. Right to Health Education
n. Right to Leave Against Medical Advice
o. Right to Express Grievances.
SEC. 5. Societal Rights of Patients
a. Right to Health
b. Right to Access to Quality Public Health Care
c. Right to a Healthy and Safe Workplace
d. Right to Medical Information and Education
Programs
e. Right to Participate in Policy Decisions
f. Right to Access to Health Facilities
g. Right to an Equitable and Economical Use of
Resources
h. Right to Continuing Health Care
i. Right to Be Provided Quality Health Care Teams of
Insolvency
SEC. 6. The Obligations of Patients
a. Know Rights
b. Provide Adequate, Accurate and Complete
Information
c. Report Unexpected Health Changes
d. Understand the Purpose and Cost of Treatment
e. Accept the Consequences of Own Informed
Consent
f. Settle Financial Obligations
g. Respect the Rights of Health Care Providers,
Health Care Institutions and Other Patients
h. Obligations to Self
i. Provide Adequate Health Information and Actively
Participate in his/her Treatment
j. Respect the Right to Privacy of Health Care
Providers and Institutions
k. Exercise Fidelity on Privileged Communication
l. Respect a Physician’s Refusal to Treat Him
m. Ensure Integrity and Authenticity of Medical
Records
 n. Participate in the Training of Competent Future
Physicians
o. Report Infractions and Exhaust Grievance
Mechanism
INFORMED CONSENT
- Before any risky or invasive procedures can be
performed, the health care practitioner must inform
the patient of pertinent of details about the nature
of the procedure, its purpose, potential risks and
any reasonable alternative that might be chosen.
2. The living will
• It is also called a directive to physicians or
advance directive
• It is a document that lets people state their
wishes for end-of-life medical care, in case they
become unable to communicate their decisions.
• It has no power after death.

ELEMENTS OF INFORMED CONSENT

• Disclosure
• Understanding
• Voluntariness
• Competence
• Consent

Proxy Consent/Legally Acceptable Representative

- The process by which people with the legal right to
consent to medical treatment for themselves or for
a minor or delegate that right to another person.

3 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.

Two types of proxy consent for adults:

1. The power of attorney to consent to medical
care
- It 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.