BIOETHICS Ethics is two things:

THEORIES AND PRINCIPLE OF ETHICS  first, ethics refers to well-founded standards of right
and wrong that prescribe what humans ought to do,
ETHICS usually in terms of rights, obligations, benefits to
 Is a system of moral principles. They affect how society, fairness, or specific virtues.
people make decisions and lead their lives.  Secondly, ethics refers to the study and development of
 Is concerned with what is good for individuals and one’s ethical standards.
society and is also described as moral philosophy.
 Is derived from the Greek word ethos which can Ethics is about the ‘other’
mean custom, habit, character or disposition.  At the heart of ethics is a concern about something or
someone other than ourselves and our own desires and
Ethics covers the following dilemmas: self-interest
 How to live a good life  is concerned with other people's interests, with the
 Our rights and responsibilities interests of society, with God's interests, with "ultimate
 The language of right and wrongs good", and so on
 Moral decisions – what is good and bad?  So when a person 'thinks ethically' they are giving at
Our concepts of ethics have been derived from religions, least some thought to something beyond themselves
philosophies and cultures. They infuse debates on topics like
abortion, human rights and professional conduct. Where does ethics come from?
Philosophers have several answers to this question:
Approaches to Ethics  God and religion
Philosophers divided ethical theories into three areas:  human conscience and intuition
 META-ETHICS deals with the nature of moral  a rational moral cost-benefit analysis of actions and their
judgement. It looks at the origins and meaning of ethical effects
principles.  the example of good human beings
 NORMATIVE ETHICS is concerned with the content  a desire for the best for people in each unique situation
of moral judgements and the criteria for what is right or  political power
wrong.
 APPLIED ETHICS looks at controversial topics like Nursing Ethics and Medical Ethics
war, animal rights and capital punishment.  Nursing is concerned with health, whereas medicine
focuses on cure.
 If ethical theories are to be useful in practice, they  Also, there is a functional difference between care and
need to affect the way human beings behave. healing.
 Some philosophers think that ethics does do this.  It is useful here first to consider the history of nursing
They argue that if a person realizes that it would be as it pertains to ethics. The historical influence on ethics
morally good to do something then it would be might begin by considering Florence Nightingale’s 1893
irrational for that person not to do it. paper.
 But human beings often behave irrationally – they
follow their ‘gut instinct’ even when their head NURSING ETHICS MEDICAL ETHICS
1. Care 1. Healing
suggests a different course of action.
2. Treating of person 2. Treat disease
 However, ethics does provide good tools for 3. Concerned with health 3. Focuses – Curing as
thinking about moral issues. response to occurrence if
disease condition
4. Focus on patient’s active 4. Illness oriented profession
Introduction: What is ethics? participation
 Ethics or moral philosophy is a branch of philosophy 5. Health oriented profession 5. Consultative – physical
that "involves systematizing, defending, and patient encounter
recommending concepts of right and wrong behavior." 6. Locus of care – 6. Hospital as center for best
The field of ethics, along with aesthetics, concerns compassionately aids medicine
individuals
matters of value, and thus comprises the branch of 7. In depth and personal 7. Episodic in nature –
philosophy called axiology values and adoptive/ complex surgical,
 promote the values essential to good communication, restorative process biochemical and technical
such as trust, accountability, mutual respect and fair interventions
8. Nurses’ ever presence
medical care. 9. Trusting relationship
 moral principles that govern a person's behavior or the 10. Advocacy
conducting of an activity. 11. Nursing itself
 ETHICAL THEORIES
DEONTOLOGY
 Is a modern combination of Classical Greek terms, and
means the study or science (logos) of duty, or more
precisely, of what one ought to do (deon).
 In contemporary moral philosophy, “deontology” is
used most commonly to refer to moral conceptions
which endorse several theses regarding the nature of
duty (the right), the nature of value (the good), and the
relationship between the primary ethical concepts of the
right and the good
Theorists:
PLATO
 is one of the founding fathers of philosophy and has
had a massive impact on the history of western thought.
ARISTOTLE
 a Greek philosopher and protégé of Plato, is considered
the Father of the Scientific Method, the creator of
formal logic, and one of the greatest thinkers in the
history of the Western world.

TELEOLOGY FRIEDRICH NIETZSCHE

 Comes from the Greek word telos for goal or aim.  has emerged as perhaps the most influential thinker of
 Teleological ethics in recent usage has been understood, the recent past. To a significant degree, this is due to the
most fundamentally, as standing in contrast with fact that he took time seriously in terms of both
“deontological” approaches to ethics. cosmology and ethics.

UTILITARIANISM IMMANUEL KANT

 A prominent, compelling, and controversial theory  like Plato and Aristotle, counts as one of the most
about the fundamental basis of mortality, influential philosophers of all time.
utilitarianism holds that human conduct should promote
the interests or welfare of those affected. JEREMY BENTHAM
 is known today chiefly as the Father of Utilitarianism.
Other Ethical Theories:
KANTIAN ETHICS
JOHN STUART MILL (1806–73)
 Ethical theory of Immanuel Kant (1724-1804)
 changed the way in which the modern world views, and
 Kant’s central ideas, including the good will, the moral
law, moral obligation, acting from duty. legal systems address, the issues of individual liberty
of thought, expressions, lifestyle, and action. His ideas
DUTY AND OBLIGATION remain both influential and controversial to this day.
 Certain acts are required, or ought to be done as
obligations or duties. ETHICAL PRINCIPLES:
 “obligation” is used for more abstract aims (e.g., we 6 BASIC PRINCIPLES OF ETHICAL PRACTICE
would speak more readily of “principles of obligation” Autonomy  Self-determination
than of “principles of duty”) Non-maleficence  Avoiding doing harm
 “duty” for more specific demands. Beneficence  Doing good,
promoting client well-
VIRTUE ETHICS being
Justice  Fair and just treatment
 Are normative ethical theories which emphasize
Fidelity  Making realistic
virtues of mind, character, and sense of honesty.
commitments, keeping
 Discuss the nature and definition of virtues and other
promises
related problems that focus on the consequences of Veracity  Truthfulness and
action. honesty
 Virtue Ethics is a philosophy developed by Aristotle
and other ancient Greeks. This character-based approach Others:
to morality assumes that we acquire virtue through CONFIDENTIALITY
practice.  is a fundamental principle in healthcare, and nurses
 Practicing being honest, brave, just, generous, and so on, must understand how this applies to their practice.
a person develops an honorable and moral character.
 pertains to restricting the sharing of sensitive patient
information and only sharing information when it is
necessary either by law or professional duty.
AUTONOMY
 promotes self-determination/ freedom of choice
BENEFICENCE (Doing Good)
 The actions one takes should be done in an effort to
promote good.
NON-MALEFICENCE
 This principle imposes the duty to avoid harming the
patient based on the Hippocratic Oath of “do no harm:”
 Refers to prevention of harm and the removal of harmful
conditions.
JUSTICE
 Seeks fairness.
 Treats “equals” equally.
 Treats “unequals” according to their differences.
VERACITY
 The obligation to tell the truth.
FIDELITY
 The need to keep promises.
CONFIDENTIALITY
 Keeping privileged information private.
ETHICAL DILEMMA
 Defined as making a choice between two or more
equally undesirable alternatives.
APPLIED ETHICS:
 General worldviews that we developed our social moral
principles and legal rights. Are still in continual state of
evolution.
 Illustration: History at one point embraced slavery then
rejected it, oppressed women and disregard the disabled
and eventually struggled to create a legitimate space
for everyone.
 Society evolved as reactions to vague concepts as “do
good and avoid evil”, or “inherent dignity of the
individual”.
 Morality and ethics still in constant reinterpretation
for every age and time.
 Professional ethics, are applied ethics designed to bring
about the ethical conduct of the profession.
 In health care delivery: pursuit for health, prevention of
death, and alleviation of suffering as secondary goal.
PRINCIPLES OF BIOETHICS
The Principles of Stewardship
 Life comes from God, and humans are "stewards"
responsible for the care of the body. A part of the body
exists for the good of the whole, and therefore limbs, for
example, may be amputated if it is necessary to protect
the rest of the body.\
Roles of Nurses as Stewards:
 Stewardship is an ethic that embodies the responsible
planning and management of resources.
 The concepts of stewardship can be applied to the
environment and nature, economics, health,
property, information, theology, cultural resources,
etc.
Personal, social, ecological and biomedical.
 There are 3 main types of ecological stewardship. A
person can take action, donate money, and practice
good stewardship on a daily basis.
Principle of Totality and Integrity:
 The human body is an integral part of the human person
and is therefore worthy of human dignity. It must be kept
whole. No body part should be removed, mangled or
debilitated unless doing so is necessary for the health of
a more essential body part or the body of a whole.
Explanation
 Human nature is an integration of body and spirit.
These two dimensions can never be separated (in fact,
separation of the spirit from the body is the definition of
death).
 The human body shares in the dignity of the human
person.
Applications
 Surgeries that needlessly remove body parts or organs
are immoral
 Tattoos and piercings are not inherently immoral but
they may be immoral if they deface the body by
quantity or content.
 Torture is a moral evil because it seeks to dis-integrate
the body and the spirit
 Self-mutilation is self-hatred expressed through spite
of the body
 That chemical contraception effectively shuts down a
healthy bodily system is part of what makes it immoral.
 Even if the pro-choice argument that an embryo is part
of the woman’s body rather than an independent
human person is true, it should not be removed except
when its presence endangers the woman’s life.
Principle of Ordinary and Extraordinary Means:
Ordinary Means
 Ordinary means = reasonable hope of benefit/success;
not overly burdensome;
 Does not present an excessive risk and are financially
manageable
 Proportionate to the state of the patient • “Ethically
indicated” (Strong 1981 p. 84).
Extraordinary Means
 Extraordinary means = no reasonable hope of
benefit/success;
 Overly burdensome;
 Excessive risk and are not financially manageable
 No obligation to use it/morally optional
Principle of Personalized Sexuality:
Personalized sexuality
 is based on an understanding of sexuality as one of the
basic traits of a person and must be developed in ways
consistent with enhancing human dignity.
 Hence, sexuality is not only a private matter, although
it involves the most intimate of relationships.
The Gift of Sexuality
 Must be used in keeping with its intrinsic, invisible,
specifically human teleology.
 Must be loving, bodily, pleasurable expression of the
complimentary, permanent self-giving of a man and a
woman to each other
Generally Recognized Values:
1. Sex is a search for sensual pleasure and satisfaction,
releasing physical and psychic tensions.
2. Sex is a search for the completion of the human
person through an intimate personal union of love
expresses by bodily union.
3. Sex is a social necessity for the procreation of
children and their education in the family so as to
expand the human community and guarantee is
future beyond the death of individual members.
4. Sex is a symbolic (sacramental) mystery, somehow
revealing the cosmic order.
For Secular Humanist: Reasonable Uses of Sex
1. Use sex purely for sake of pleasure apart from any
relation to love or family.
2. Use it to reproduce (making test tube babies)
without any reference to pleasure or love.
3. Expression of unselfish love, but without any
relation to marriage or family.
2 Norms of Sexual Morality
1. Laws or social attitudes that hinder human freedom
to achieve these values in ways the individuals
desires are unjust and oppressive.
2. Sexual behavior, at least among consenting adults,
is entirely a private matter to be determined by
personal choice, free from any moral guilt.
THE INFORMED CONSENT
Informed consent
 the process in which a health care provider educates a
patient about the risks, benefits, and alternatives of a
given procedure or intervention.
 The patient must be competent to make a voluntary
decision about whether to undergo the procedure or
intervention. (Jun 1, 2020)
Obtaining informed consent in medicine is process that
should include:
(1) describing the proposed intervention,
(2) emphasizing the patient's role indecision-making,
(3) discussing alternatives to the proposed intervention,
(4) discussing the risks of the proposed intervention and
(5) eliciting the patient's
Provided, that the patient will not be subjected to any
procedure without his written informed consent, except
in the following cases:
a) in emergency cases, when the patient is at imminent
risk of physical injury. 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 Is
required;
e) When disclosure of material information to patient
will jeopardize the success of treatment,in which case,
thirdparty disclosureand consent shall be in order
f) When the patient waives his right in writing.
Elements of an Informed Consent
 Information –sufficient info.
 Volunteerism –autonomy.
 Competence –decision making capacity.
 Right to Refuse Treatment.
Nurses’ domain of Responsibility
 Nurses typically are assigned the task of obtaining and
witnessing written consent for health care treatment.
 The goal of informed consent is to assure patient
autonomy.
The following persons, in the order of priority stated
hereunder, may give consent, in patient’s behalf:
 spouse;
 son or daughter of legal age;
 either parent;
 brother or sister of legal age, or
 guardian
ETHICS IN PROFESSIONAL NURSING PRACTICE
The NMC Code:
Professional standards of practice and behavior for nurses,
midwives and nursing associates.
 The Code presents the professional standards that nurses,
midwives and nursing associates must uphold in order to
be registered to practice in the UK.
 Developed in collaboration with many who care about
good nursing and midwifery, the Code can be used by
nurses, midwives and nursing associates as a way of
reinforcing their professionalism.
 The Code contains a series of statements that taken together
signify what good practice by nurses, midwives and
nursing associates looks like. It puts the interests of patients
and service users first, is safe and effective, and promotes
trust through professionalism.
 Prioritize people
 Practice effectively
 Preserve safety
 Promote professionalism and trust
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.
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.
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.
4. Right to Information
 right to be informed of the result of the evaluation
of the nature and extent of his/her disease,
additional or medical treatment on surgical
procedure or procedures, including any other to be
administered (generic counterpart), possible
complications, and other pertinent facts, statistics
or studies, regarding his/her illness, any change in
the from PhilHealth or any charges.
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.
6. Right to Self-Determination
 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. (18 below)
8. Right to Medical Record
 The patient is entitled to a summary of his medical
history and has the right to view the contents of his
medical records, except psychiatric notes.
 The health care institution shall safeguard the
confidentiality of the medical records and to
likewise ensure the integrity and authenticity.
 The health care institution shall issue a medical
certificate to the patient upon 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 his/her will
in any health care institution on the sole basis of his
failure to fully settle his financial obligations.
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.
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.
13. Right to be Informed of His Rights and Obligations
as a Patient
 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.
Nurses’ Role:
1. Knowledge and understanding of Patient’s Rights.
2. Upholding these Rights.
Broad Categories of Patient’s Rights:
1. Right to Health and Health Care
4 Elements:
a. Right to equal access to healthcare.
b. Right to quality care.
c. Right to access to appropriate care.
d. Right to safe care.
2. Right to Informed Consent.
3. Right to Confidentiality.
4. Right to be treated with Dignity.
5. Right to be treated with Respect.
6. Right to Cultural Liberty.
The Patient’s Bill of Rights:
 A Patient’s Bill of Rights is a document that provides
patients with information on how they can reasonably
expect to be treated during the course of their hospital
stay.
RA 10173
 In 2012, the Congress of the Philippines passed
Republic Act No. 10173, also known as the Data
Privacy Act (DPA) of 2012.
 Five years later, the DPA’s Implementing Rules and
Regulations was put in effect on September 9, 2016,
thus mandating compliance.
 In 2014, it was estimated that 2.5 quintillion —or 2.5
billion billion—bytes of data were created every day.
 This includes unprecedented knowledge about what
real individuals are doing, watching, thinking, and
feeling.
 RA 10173, or the Data Privacy Act, protects
individuals from unauthorized processing of personal
information that is (1) private, not publicly available;
and (2) identifiable, where the identity of the individual
is apparent either through direct attribution or when put
together with other available information.
The Professional Code of Ethics for Nurses:
RA 9173: The Philippine Nursing Law
 Code of Ethics for Nurses in the Philippines was
devised as a guide for carrying out nursing
responsibilities which would tackle difficult issues and
decisions that a profession might be facing, and give
clear instruction of what action would be considered
ethical or right in the given circumstance.
 RA 9173 was enacted in 2002 to provide a
comprehensive definition and understanding of the
nursing profession. This is in recognition of the vital
role nurses play in the delivery of quality health services
not only in the country, but all over the world.
Importance of Nurses’ Code of Ethics:
 For those entering the nursing profession, the Code of
Ethics serves as a guide.
 It acts as a non-negotiable standard of ethics for nurses. It
also acts as a reminder of nurses' commitment to society.
 The code requires nurses to continue with their learning
and evidence-based practice.
The Nightingale Pledge:
 a Hippocratic Oath for nurses
 I solemnly pledge myself before God and in the presence
of this assembly to pass my life in purity and to practice my
profession faithfully. I will abstain from whatever is
deleterious and mischievous and will not take or knowingly
administer any harmful drug.
 Obligation.
International Council of Nurses:
 The International Council of Nurses is a federation of more
than 135 national nurses’ associations.
 It was founded in 1899 and was the first international
organization for health care professionals.
 It is headquartered in Geneva, Switzerland.
Professional Boundaries and Moral Obligations for Nurses:
 The nurse's responsibility is to delineate and maintain
boundaries.
 Actions that overstep established boundaries to meet the
needs of the nurse are boundary violations.
 The nurse should avoid situations where he or she has a
personal, professional or business relationship with the
patient.
Nurses and Social Media:
 Nurses must observe standards of patient privacy and
confidentiality at all times and in all environments,
including online.
 The nurse's primary commitment is to the patient, and
nurses are ethically required to practice with compassion
and respect for the inherent dignity and worth of every
individual.
Netiquette: La Sallians Should & Not To
 This simply means the use of good manners in online
communication such as e-mail, forums, blogs, and social
networking sites to name a few.
 It is important to use netiquette because communication
online is non-verbal.
 "Netiquette" applies to Internet behavior.
Honesty is still the best policy.
RA 9271 The Quarantine Act of 2004
 If found infected or exposed to the infection, considered as
a dangerous contact, may be isolated
RA 11332 Law on reporting Communicable Disease
 Non reporting
Nurses’ Bill of Rights:
 Registered nurses promote and restore health, prevent
illness, and protect the people entrusted to their care.
 They work to alleviate the suffering experienced by
individuals, families, groups, and communities.
 In so doing, nurses provide services that maintain respect
for human dignity and embrace the uniqueness of each
patient and the nature of his or her health problems, without
restriction with regard to social or economic status.
 To maximize the contributions nurses make to society, it is
necessary to protect the dignity and autonomy of nurses in
the workplace.
The following rights must be afforded: ANA, 2000
1. Nurses have the right to practice in a manner that fulfills
their obligations to society and to those who receive
nursing care.
2. Nurses have the right to practice in environments that allow
them to act in accordance with professional standards and
legally authorized scopes of practice.
3. Nurses have the right to a work environment that supports
and facilitates ethical practice, in accordance with the Code
of Ethics for Nurses with Interpretive Statements.
4. Nurses have the right to freely and openly advocate for
themselves and their patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work,
consistent with their knowledge, experience and
professional responsibilities.
6. Nurses have the right to a work environment that is safe for
themselves and for their patients.
7. Nurses have the right to negotiate the conditions of their
employment, either as individuals or collectively, in all
practice settings
Healthy Nurse, Healthy Nation™
 On May 1, 2017, the American Nurses Association (ANA)
launched the Healthy Nurse, Healthy Nation™ Grand
Challenge(HNHN),
 an ongoing national movement designed to transform the
health of the nation by improving the health of the
nation’s 4 million registered nurses. As one of the most
trusted professions, nurses have enormous potential to lead
health care change as role models, advocates, and
educators.
 Nurses support patients to live life to the fullest, and they
deserve the same privilege. ANA believes that nurse
wellbeing must be safeguarded, and that ill-health should
not be an inevitable by-product of dedicated nursing
practice.
 A healthy nurse lives life to the fullest capacity, across the
wellness/illness continuum, as they become stronger role
models, advocates, and educators; personally, for their
families, their communities and work environments, and
ultimately for their patients.