NCM 108: Health Care Ethics: Divine Word College of Bangued

DIVINE WORD COLLEGE OF BANGUED
Bangued, Abra
School of Health Sciences

Bachelor of Science in Nursing
NCM 108: HEALTH CARE ETHICS
INSTRUCTOR: Mrs. Jennifer Morondoz-Alfiler, RN
NCM 108 HEALTH CARE ETHICS Prepared by: Jennifer M. Alfiler, RN

This module is a property and is exclusively used by the DWCB College Department. Any duplication and reproduction, storing in any retrieval system,
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HEALTH CARE ETHICS
COURSE PROFILE:
Course Code: NCM 108
Course Title: HEALTH CARE ETHICS (Lecture)
Prerequisite: NCM 103 ETHICS
Instructor: JENNIFER M. ALFILER, RN
Contact no. 09451725384
E-mail Add.: alfilerjennifer@gmail.com
FB Acct. miajen_20@yahoo.com
Course Description:
This course deals with the application of ethico-moral concepts and principles affecting care
of the individuals, families, population group and community. It involves discussion of issues and
concerns in varied health care situations. The learners are expected to apply sound ethical decision-
making in varied health scenarios.
Learning Outcomes:
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 nurse.
Course Outline and Timeframe

Lesson Modules/Topics WEEKS/DURATION
1 Module 1: THEORIES AND PRINCIPLES OF HEALTH

ETHICS
A. Ethical Theories
1. Deontology
2. Teleology 1
3. Utilitarianism
B. Virtue Ethics
1. Virtues Ethics in Nursing
2. Core Values of a Professional Nurse
2 C. Ethical Principles
1. Autonomy
Patient’s Rights
Patient’s Bill of Rights 2-3
Informed Consent
Proxy Consent/ Legally Acceptable
Representative
Confidentiality
Privacy
2. Confidentiality
3. Veracity
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Truth Telling and Right to Information
4. Fidelity
5. Justice
6. Beneficence
7. Non-maleficence
3 D. Other Relevant Ethical Principles

1. Principle of Double Effect
2. Principle of Legitimate Cooperation 4
3. Principle of Common Good and Subsidiarity
4 E. Principles of Bioethics
1. Principle of Stewardship and Role of Nurses as
Stewards
Personal 5
Social
Ecological
Biomedical
5 2. Principle of Totality and its Integrity

Ethico-moral Responsibility of Nurses in
Surgery
Sterilization/Mutilation 6
Preservation of Bodily Functional Integrity
Issues on Organ Donation
3. Principle of Ordinary and Extraordinary Means
4. Principle of Personalized Sexuality
6 Module 2: BIOETHICS AND ITS APPLICATION IN

VARIOUS HEALTH CARE SITUATIONS
A. Sexuality and Human Reproduction
1. Human Sexuality and its Moral Evaluation
2. Marriage 7
Fundamentals of Marriage
Issues on Sex Outside Marriage and
Homosexuality
Issues on Contraception, its Morality and
Ethico-moral Responsibility of Nurses
7 3. Issues on Artificial Reproduction, its Morality and

Ethico-moral Responsibility of Nurses
Artificial Insemination 8-9
In-vitro Fertilization
Surrogate Motherhood
4. Morality of Abortion, Rape and other Problems

Related to Destruction of Life
8 B. Dignity in Death and Dying
1. Euthanasia and Prolongation of Life
2. Inviolability of Human Life
3. Euthanasia and Suicide 10
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4. Dysthanasia
5. Orthothanasia
6. Administration of Drugs to the Dying
7. Advance Directives
8. DNR or End of Life Care Plan
9 C. Nursing Roles and Responsibilities
D. Ethical Decision Making Process 11
10 Module 3: BIOETHICS AND RESEARCH
A. Principles of Ethics in Research

1. Nuremberg Code
2. Declaration of Helsinki
3. Belmont Report 12
B. Ethical Issues in Evidenced Based Practice
C. Ethico-moral Obligations of the Nurse in

Evidence-Based Practices
1. Introduction to Good Clinical Practice Guidelines
11 Module 4: GUIDELINES AND PROTOCOL IN

DOCUMENTATION AND HEALTH CARE RECORDS
Module 5: ETHICAL CONSIDERATION IN LEADERSHIP

AND MANAGEMENT 13
A. Moral Decision Making

1. Principles of Moral Discernment
2. Principle of Well-Formed Conscience
3. Strategies of Moral Decision Making Process
Ethical Dilemma
12 B. Meaning and Service Value of Medical Care
1. Allocation of Health Resources 14
2. Issues Involving Access to Care
13 Module 6: ETHICAL ISSUES RELATED TO TECHNOLOGY

IN THE DELIVERY OF HEALTH CARE
A. Data Protection and Security

1. Data Privacy Act 2012 (RA 10173 Series of 2012) 15
B. Benefits and Challenges of Technology
C. Current Technology: issues and Dilemma

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14 Module 7: CONTINUING EDUCATION PROGRAMS ON
ETHICO-MORAL PRACTICE IN NURSING
16
A. Lobbying/ advocating for Ethical Issues Related
to Health Care
15 B. Code of Ethics for Nurses

1. International Code of Ethics
2. Code of Ethics for Filipino Nurses
Registered Nurses and People 17
Registered Nurses and Practice
Registered Nurses and Co-Workers
Registered Nurses and Society and
Environment
Registered Nurses and the Profession
As a student of Divine Word College of Bangued, you are given the following GUIDELINES ON FLEXIBLE
LEARNING in order to pass this subject/course.
GENERAL INSTRUCTIONS.
The Covid 19 pandemic has forced all learning institutions to shift from the classic teaching mode to
the flexible modality of teaching -learning as to ensure the continuity of education of the youth. The Divine
Word College of Bangued, your school, despite its limitation has done all means to make education
relevant to its students as it endeavors to offer quality education amidst this pandemic. Hence, a module for
this course has been prepared for you, to read, study and work on while you are enrolled but have to study
at home. Do remember that your success in accomplishing what are contained in your modules lies in your
hands! Therefore, make time to read the content and honestly answer the learning tasks. If your internet
connection will allow it and online platforms will be agreed upon in this class, participate as much as you
can in the discussions. Thus, to pass in this subject, you MUST:
1. Go through the modules and read thoroughly their contents. Participate actively in all activities
including asynchronous online discussion fora when possible and agreed upon.
2. Submit assignments and learning tasks required during the specified time.
3. Explore other learning resources, online and offline, to accomplish required tasks.
4. Submit final requirement/s.
5. Take and do pass the periodic examinations (prelims, midterms and finals)
ONLINE DISCUSSION FORA. In addition to the scheduled face-to-face interactions when it becomes
possible, on online classroom will also be conducted for an easier processing of on-line tasks and
clarifications in the given tasks. Google classroom and/or FB messenger /group chat will be set up
whichever is more feasible considering the limitations. You are encouraged to keep yourself updated on
any development. In any case, you are expected to participate in the discussion. As such, you are expected
to:
1. Demonstrate a basic understanding of the course content.
2. Develop a deeper understanding of the topics through a collaborative exploration of ideas,
reflection and analysis, application and synthesis.
3. Read the questions and instructions very carefully.
4. Contribute and respond to the questions posted in the forum during the allotted time.
5. Read and react or make a comment in response to the ideas posted by your professor or
classmates. Participation in the online discussions will be assessed according to the scoring guide which
will be provided.
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Assignments: Assignments will be given in the module, GC or online classrooms whichever is
feasible. Be sure to answer according to the instructions which will be provided.
IMPORTANT REMINDERS:
1. Manage your time wisely. Make your timetable and stick to it. Allot time to read and understand
every part of each module given to you. Read for comprehension not for compliance and get settled with
being able to submit something for submission sake. You should rather strive to have excellent
performances in the given activities.
2. Be Consistent. Stick to your schedule so that you can do the activities in every module given to
you. Note that studying from home can be tricky as you may think that you have plenty of time until you
realize that you no longer have enough time to do your tasks and then cram.
3. Ask for help. If you do not understand the readings and other tasks, take time to read again.
After re-reading and you still cannot decipher the text, do not hesitate to ask members of your family for
help however, do not rely on them by letting them do the work for you. If no member of your family can help
you, ask the assistance of your respective subject professors. Refer to the contact information you see at
the beginning of this module. Your professor will be ready and more than willing to help you but only during
your SCHEDULED CLASS HOUR or the TIME AGREED UPON by your class.
4. Be Resourceful. You may browse different resources that may help you to better understand
and learn from the module.
5. Observe deadlines. You will be given a schedule to secure and submit your module. Do not
miss your assigned day / time and any activity in every lesson. Make sure to communicate with your
professor or your dean/ program head in case circumstances will not allow you to come to school. Before
the end of the prelims, midterm and finals, you must submit other requirements asked by your professor for
they deem necessary in the computation of your marks/grades.
6. Strictly follow the instructions. Read the instructions carefully before answering the
assessment and evaluation activities. Be reminded that the activities in this module are academic in nature
which means that relevant academic conventions apply. Think reflectively before you write.
a. Your answers should express your thoughts clearly using correct grammar. Do not use
abbreviations and acronyms unless included in the module. Refrain from writing in text-speak (
eg: atm for at the moment/ u, for you / otw for on the way ); also avoid using all caps.
b. In writing a reflection, start from the text or the class topic and make sure to relate it to your
own experiences, leading to a resolution. If space provided is not enough for your answer, use
another paper (bond paper or as instructed by your professors)
c. Answer precisely and concisely. Stick to the instructions to avoid going astray. Make use of
the space provided in the module and stick to it.
d. Always cite your sources if you quoted from someone’s work in answering your activities.
7. Keep in touch. Refer to your professors’ contact information provided at the end of this Student
Guide if there is something you do not understand or are not sure of in the modules given to you. Call or
message only the instructor/professor of the course you are enrolled in. Remember that your professors’
contact information are personal, therefore DO NOT give them away without their permission; meaning, if
somebody asks you your professor’s contact information, you SHOULD ask your professor’s permission
first and give IF permitted, if not, politely tell that you are not in the position to divulge personal information
of other people- be guided by the Data Privacy Law.
PLAGIARISM. No student shall claim or submit any academic work of another and claim it as his own. You
are expected to come up with your own original work in each given task. If found to have submitted a
written assignment copied from any classmate or just photocopied his/ her papers, you may face the
consequence of a failing grade as a result of dishonesty. So do not plagiarize or copy the exact content of
someone else’s work or copy passages from other sources and do some changes. If you wish to quote
others’ work, always acknowledge them. Write your source/s. (eg: books, magazine, e-net -url, etc)

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Lastly, keep in mind that the completion of the module is your responsibility. Your family and friends may be
able to extend some help, but be the only one to do the activities prepared for you. In everything you do,
remember to demonstrate the Divinian core values on Integrity, Social Responsibility, Excellence, and
Evangelization. We believe in your capacity to succeed in this endeavor. We are confident that even in the
absence of a face to face classroom setting and, in the absence of your professors, you can, and you will
accomplish your tasks honestly and learn greatly. Believe in yourself and hold on to your faith. Trust and
enjoy the process. Surely, something good will come out of what we all experience at the present time.
You are now and will always be a Divinian! Always remember- we mold people, we build dreams
and shape the future with you. Welcome to Divine Word College of Bangued!
Objectives:
At the end of this lesson, the student should be able to:
 Discuss the purpose of philosophy.

 Explain the basic premise of each major theory of ethics.
 Identify appeals to each of these theories when they are presented in a discussion about patient
care.
 Discuss the strengths and failings of each theory as they apply to particular situations.
 Define the terms moral philosophy and ethics.
 Discuss the importance of a systematic study of ethics to nursing.
 Discuss the importance of ethical theory.
 Describe utilitarianism.
 Describe deontological ethics, defining the terms catergorical imperative and practical imperative.
 Define the terms virtue and virtue ethics.
 Identify conflicts among principles when applied to a case.
 Weigh conflicting principles against one another and determine which is most compelling in a given
case.
MODULE 1: Lesson 1 THEORIES AND PRINCIPLES OF HEALTH ETHICS
Glossary
Accountability - The state of being answerable to someone for something one has done.
Active voluntary euthanasia - an act in which the physician both provides the means death for a patient,
such as a lethal dose of medication and administers it.
Activitism - A passionate approach to everyday activities that is committed to seeking a more just social
order through critical analysis, provocation, transformation and rebalancing of power.
Autonomy - right to self-determination; being one’s own person without constraints by another’s actions or
psychological and physical limitations
Beneficence - duty to do good.
Categorical imperative - The Kantian maxim stating that no action can be judged as right which cannot
reasonably become a law by which every person should always abide.
Confidentiality - holding information entrusted in the context of special relationships as private.
Ethics - a formal process for making logical and consistent decisions based upon moral beliefs.
Fidelity - duty to keep one’s promise or word.
Gratitude - duty to make up for a good; what do I owe?
Justice - treating people fairly; equitable distribution of risks and benefits.
Nonmaleficence - duty to do no harm.
Reparation - duty to make up for a wrong.

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Sanctity Of Life - the standard that life is precious. This standard is used for appraising other ethical
principles. No human rights and no valuation of human life can be established without presupposing this
principle.
Utility - doing the greatest good or the least harm for the greatest number of people.
Veracity - truth telling or the duty to tell the truth.
At its core, nursing deals with issues and situations that have elements of ethical or moral
uncertainty. A spiralling dependence on technology and the resulting longer lifespans and higher health
care costs, coupled with increasing professional autonomy, creates an atmosphere in which we are faced
with problems of ever – increasing complexity. We need to be able to recognize situations with ethical and
moral implications and make coherent and logical ethical decisions based upon recognized ethical
principles and theory. This text will prepare you to examine issues and come to logical, consistent and
thoughtful ethical decisions. The study of ethics will make you more rational, responsible, self-reliant and
effective.
Ethics can be really hard to define, since what you think is right, or ethical, might be very different from
what your friends or family members think.
However, ethics is loosely defined as established standards of right and wrong that spell out what people
should and should not do in a society, the rights they have, and what benefits they should gain from being a
member of society. These are the standards we establish that keep us from hurting others because, in our
beliefs, hurting others is wrong. From an individual standpoint, ethics could be defined as our own
established standards of right and wrong.
A. Ethical Theories
The test of a useful theory of ethics is its ability to make sense of the world and provide guidance about
how to act in it. Theories of ethics abound, and no single ethical theory has managed to capture and
explain all the important elements of the moral world to the satisfaction of all or even most people. The four
ethical theories discussed in this section have endured over time as ones that capture a fundamental truth
about the world and the way we ought to act.
Moral philosophy
 is the branch of philosophy that examines beliefs and assumptions about the nature of certain
human values.
Ethics
 refers to well based standards of right or wrong that prescribes what human ought to do, usually in
terms of rights, obligations, benefits to society, fairness, or specific virtues.
 is the practical application of moral philosophy;
 that is, given the moral context of good or bad, right or wrong, “ what ought one to do in a given
situation?” the philosopher reveals an integrated global vision in which elements, like pieces of a
puzzle, have a logical fit.
Example: ethics refers to those standards that impose the reasonable obligations to refrain from
rape, stealing, murder, assault, slander and fraud.
 Ethical standards also include those that enjoin virtues of honesty, compassion and loyalty.
 Ethical standards include standards relating to rights, such as the right to life, the right to
freedom from injury and the right to privacy.
 Refers to the study and development of one’s ethical standards
 Came from the Greek word ―ethos‖ which means ―moral duty‖
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 Provide the standards that govern human conduct
 Study of ―good life‖
 Studies how people make judgment in right to right or wrong
 Is about making choices that are best for the individual or society at certain times and in particular
situations and then evaluating such choices and outcomes
 When singular:
 Is also known as ―moral philosophy‖
 A field of philosophy that deals with the study of the moral value of human conduct
and the rules and principles that ought to govern it.
By developing theories of ethics, the philosopher hopes to explain values and behaviour related to cultural
and moral norms. Each theory is based upon the particular viewpoint of the individual philosopher and
maintains, within itself, philosophical consistency.
Deontology
Deontological theories of ethics are based upon the rationalist view that the rightness or wrongness of an
act depends upon the nature of the act, rather than its consequences. The major contender to
consequentialist theory is deontological theory.
 Duty-Oriented Theory/ Nonconsequentialist Theories

 ―Deontology‖ is derived from the Greek word ―deon” meaning “duty‖ (Webster’s College Dictionary,
1991, p. 387).
 Ethicist feels that basic rightness and wrongness of an act depends on the intrinsinc nature rather
upon the situation or its consequences.
 is called formalism; some writers refer to this type of ethical theory as Kantianism.
 A person is morally good and admirable if his actions are done from a sense of duty or reason.
 Even when individuals do not want to fulfil their duty, Kant believes that they are required to do so.
 It may happen that the same action both satisfies a moral obligation and maximizes the good, but
deontologists would see the maximizing of the good as a side benefit only.
 Based on principles of obligation that must be followed by all irregardless of the consequences
Example: suppose a nurse is assigned to care for a patient with AIDS. Could she reasonably
refuse to care for the patient on the ground that the patient’s condition may threaten her
health? As a practitioner of the healing art, nurses are to take care of the sick even if patients
have conditions that threaten their personal health. Nurses, however, must observe the
necessary precautions to protect their health.
 One of the earliest and most prevalent forms of deontology is known as ―divine command‖ theory.
In this theory, the duties and obligations that are to be followed are those that have been given to people by
God. Most adherents to this theory do not realize that they are practicing ―divine command deontology.‖
Rather, they are upholding and following the dictates of their religion. Almost everyone, whether they
subscribe to this philosophy or not, will have some sense of duty and obligation that emanates from their
acceptance of or exposure to religious mandates. However, exactly what each person believes God has
commanded differs from religion to religion, if not from person to person. Examples of this theory in
action, as well as its drawbacks, are profuse in the health care setting:
Decisions about foregoing life-sustaining treatment will often involve considerations of one’s
obligation toward preserving life, with Orthodox Jewish patients often taking a more stringent
interpretation of God’s command to respect and preserve life.
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Jehovah’s Witnesses, although agreeing with the duty to respect and preserve life, claim that there
is a higher duty, given by divine command, not to ingest blood, and therefore refuse blood
transfusions even if the consequence is that they will lose their lives or the lives of their children.
Even people who do not identify with a particular religious tradition may have their own sense of
what God requires of them. An example of this is a decision to not pursue aggressive treatment,
waiting instead to see what outcome God desires, or trusting that conservative treatment will work if
God so intends. This may be a reflection of a duty to trust in God and yield to the path that God has
ordained.
 Although the ultimate authority in divine command deontology is God, other versions of deontology do
not reference a particular authority. These deontologists believe that actions are intrinsically right or
wrong and that this can be discerned either through reason or intuition.
 No real discussion of deontology can occur without reflecting on the work of Immanuel Kant (1724–
1804). Kant (1785/1959) believed that all moral duties and obligations could be determined through the
application of practical reason.
Kantianism
 is based upon the writings of the German philosopher Immanuel Kant, who shaped many
deontological formulations.
 Kant was born at Konigsberg, Prussia, in 1724. After an uninspiring academic career, he surprised
the world with his groundbreaking ethical theory.
In the 18th century, the Age of Enlightenment was in full swing. People were beginning to rely on the
principles of natural law, which states that there is a right and a wrong and that we must use reason, or our
personal sense of logic, to figure out the difference. During this time, a German philosopher named
Immanuel Kant developed a branch of ethics that was solely based upon one's sense of duty to act in the
way we see as right.
ɤ Kant's deontology
 is guided by an individual's own personal sense of morality, or what is right and what is
wrong to us.
 Deontology also implies that ethics are derived from fulfilling duties. One must act for the
sake of duty or obligation.
 sometimes called deontological ethics, starts by acknowledging that actions and their
outcomes are independent things. Basically, there are things you have to do, even though
you know they are wrong, such as shooting that intruder to protect your family.
 According to deontology, you need to focus on the act, such as protecting your
family, and not the likely death it will mean for the intruder. Kant wrote several
books about the topic, including The Groundwork of the Metaphysics of Morals in
1785, Critique of Practical Reason in 1788, and Metaphysics of Morals in 1797.
 Kant asserted that moral rules are absolute and apply to all people, for all times, in all
situations. He believed that ethical rules could be known by rational humans.
 Kant provides us with a formula for determining which rules (or maxims, as he calls them)
are a valid reflection of our duties and obligations.
 Knowledge of the right course of action in any given situation could be obtained by following a
maxim that he called the categorical imperative.
 Kant believed that all imperatives of duty can be deduced from his categorical imperative
(one should act as if one’s actions could become universal law for all people) and must also
comply with his practical imperative (treat all people as ends, none as means to an end).
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 Deontology is an attractive ethical theory. It is, in fact, a most popular foundation for many
contemporary beliefs. It provides clear guidelines for judging the rightness or wrongness of
action. It recognizes the dignity and autonomy of individuals and allows all people equal
consideration. It serves as a basis for much of the contemporary ethical thinking that guides
health care delivery.
Example: a nurse might attempt to justify informing the spouse of a patient with a communicable
disease against the patient’s wishes in order to prevent cross-infection of the spouse. The nurse has a duty
to protect the patient’s confidentiality and also a duty to protect the public. She would need to inform the
patient of her duty to report (mandated by state). She should also encourage the patient to discuss it with
his/her spouse.
Provision 2 of the ANA (2001) Code defines the nurse’s paramount duty as commitment to the
patient. Section 2.2 states, ―Nurses... must seek to ensure that employment arrangements are just and fair
and do not create unreasonable conflict between patient care and direct personal gain‖ (p. 10), which
outlines a sense of duty that places the patient first, ahead of a nurse’s personal gain.
Categorical
 refers to moral rules that do not admit exceptions; imperative denotes a command
that is derived from principle. ‖
 It is also known as the universalizability criterion; Kant said there is only one
categorical imperative: “Act only according to that maxim by which you can at
the same time will that it should become a universal law.” (1959, p. 39)
 In more colloquial terminology, this means that we should act only if we can
desire that all others act in the same way.
ɤ We can test the effectiveness of this formula by examining a situation common to many medical
settings: A friend of your patient approaches you and says, ―I know my friend is getting the results of
his biopsy today. Can you tell me what they are so I can be ready to support him?‖
 The categorical imperative requires us to test this action to see whether, in doing so, we
would be appropriately discharging our obligation to the patient. In other words, can we
make ―release medical information to friends of the patient‖ a rule that we would want
everyone to follow?
 In general, this seems like a bad idea. Most patients would resent having a friend know
private test results before they do. Many may not want the friend to know the results at
all. Therefore, because we cannot generalize this action into a universal rule, we cannot
release the test results to the friend.
ɤ In the foregoing example, if the patient had been a minor and the ―friend‖ was the father of the
patient needing to know the results because he had to make medical decisions for the patient, then
we could formulate a rule such as, ―I should release medical information to a minor patient’s
parent(s) so that he (they) can make informed decisions.‖ This rule is one that we can be
comfortable universalizing.
The second criterion of the categorical imperative is that ―no person should be treated merely as a
means but, rather, as an end.”
 Essentially what this means is that one cannot treat others as tools or use them merely to
achieve an objective.

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 People must be treated with respect. Their interests and wellbeing must be taken into
account and our interactions with them should reflect an appreciation of those and further
them whenever possible.
 That does not mean that we cannot profit from our interactions with others. It simply
means that profiting from those interactions should not be our sole aim.
ɤ There is a clear and simple example of this at the heart of health care. Without patients no health
care professional could earn a living. However, caring for patients merely as a means to a paycheck
would not fulfill deontological requirements. In caring for them, we seek to promote their wellbeing
and do things that we might not do if our only aim was to clock in hours. In doing so we explicitly
intend to receive remuneration and, according to the categorical imperative, that is acceptable as
long as we are also treating patients as ends in themselves.
 In other words, no action can be judged as right which cannot reasonably become a strict
law. Following the categorical imperative,
 Kant also described the practical imperative: ―Act so that you treat humanity, whether in your
own person or that of another, always as an end and never as a means only.‖ (1959, p.47)
Teleology
 Teleology is the ethical theory stating that the value of a situation is determined by its
consequences.
 also known as the ―consequentialist‖ theory, was advocated by the philosopher John Stuart
Mill.
 One principle of teleology is the principle of utility, which states that an act must result in the
greatest amount of good for the greatest number of people involved in a situation.
 teleological ethics, (teleological from Greek telos, “end”; logos, “science”), theory of morality
that derives duty or moral obligation from what is good or desirable as an end to be achieved.
 Also known as consequentialist ethics, it is opposed to deontological ethics (from the Greek
deon, “duty”), which holds that the basic standards for an action’s being morally right are
independent of the good or evil generated.
 Expressed in the maxim: “the right thing to do is the good thing to do”
 Based on the consequences of human action; action is morally right if the consequences of
such action are favourable.
Modern ethics, especially since the 18th-century German deontological philosophy of Immanuel Kant, has
been deeply divided between a form of teleological ethics (utilitarianism) and deontological theories.
Teleological theories differ on the nature of the end that actions ought to promote. These could be the
classical virtues—courage, temperance, justice, and wisdom—that promoted the Greek ideal of man as the
―rational animal‖; or the theological virtues—faith, hope, and love—that distinguished the Christian ideal of
man as a being created in the image of God.
Utilitarianism
 Sometimes called consequentialism, is a form of teleological theory.
 “Telos” comes from the Greek and literally means ―end”.
 Utilitarianism is the moral theory that holds that an action is judged as good or bad in relation
to the consequence, outcome, or end result that is derived from it.
 Utilitarianism is an important ethical philosophy that has its basis in naturalism.
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 According to the utilitarian school of thought, right action is that which has greatest utility or
usefulness. No action is, in itself, either good or bad. Utilitarians hold that the only factors that
make actions good or bad are the outcomes, or end results, that are derived from them.
 is a broad term that relates to a number of important theories.
ɤ One of the first utilitarians was the Roman philosopher Epicurus, whose teachings date to about
200-300 B.C.E. Epicurus believed that both good and evil lie in sensation, pleasure being good and
pain being evil. He taught that pleasure can be gained by living a life of moderation, courage, and
justice and by cultivating friendship. Epicurus also believed that deities dwell apart from humans and
are not concerned with the state of human existence. Therefore humans control their own destinies.
Act Utilitarianism
 we judge morality of each action by first determining the good or bad
consequences of a particular act
Hedonistic Utilitarianism
 good resides in the promotion of happiness or the greatest net increase of
pleasure over pain

Bangued, Abra

B. Virtue Ethics
 Known as aretaic ethic from the Greek word “arête” is focused on primarily on the heart of the
person performing the act
 Virtues: good habits that are used to regulate emotion, good character traits that are natural
right and useful for getting what one wants
 sometimes called character ethics, represents the idea that individuals’ actions are based upon
a certain degree of innate moral virtue.
 First noted in the writings of Homer, and subsequently in the works of Plato, Aristotle and early
Christian thinkers, Western moralism emerged with the idea of cardinal virtues: wisdom,
courage, temperance, justice, generosity, faith, hope and charity (Kitwood, 1990).
 Modern and contemporary writers also include such virtues as honesty, compassion, caring,
responsibility, integrity, discernment, trustworthiness and prudence. Though nearly absent in
nursing ethics texts in the past twenty years, virtue ethics is re-emerging as an important
framework for examining moral behaviour.
Cardinal Virtues: wisdom, courage, temperance and justice
Christian Or Theological Virtues: faith, hope and charity
 Example: a person who has developed the virtue of courage will stand firm in response to
feelings of fear when he or she is face of danger
 virtue theory, as originally developed by the philosopher Aristotle, aims toward the cultivation
of good character. If one learns and practices virtues (e.g., honesty, courage), one will develop
good character from which will flow good actions and good decisions. The cultivation of good
character would be valuable to nurses as they grow themselves within their profession.
 If they work to instill virtues within themselves, good actions and decisions are
more likely to follow. If they fail to do this, sloppy thinking and ill-considered
decisions are likely to follow. Aristotle based his choice of proper virtues on those
that tend toward the proper good of ―man.‖ We can appropriate this way of
thinking and determine that the proper virtues of nurses are those that will tend to
create the best nurses.
 Beauchamp (2001) suggests that virtue should not be thought of as a moral requirement,
because this confuses it with a principle or rule. Rather, we could say that virtue is a character
trait that is socially valued.
 A moral virtue is a character trait that is morally valued such as truthfulness, kindness, or
honesty. A person with moral virtue has both consistent moral action and morally-appropriate
desire.
 The term “ethics” was derived from Aristotle’s word ethika, which refers to matters having to
do with character.
 Aristotle considered goodness of character to be produced by the practice of
virtuous behaviour, rather than virtuous acts being the end result of a good
character.
 According to Aristotle, virtues are tendencies to act, feel and judge that are
developed from a natural capacity by proper training and exercise. He believed
that practice creates a habit of acting in a various way, and that virtue can be
learned and improved.

Bangued, Abra

 Virtue, according to Aristotle, depends on ―clear judgment, self-control, symmetry of desire and
artistry of means‖ (Durant, 1926, p.75).
 He considered virtue to be the fruit of intelligent pursuit. ―it is not the possession
of the simple (person), nor the gift of innocent intent, but the achievement of
experience in the fully developed (person)‖ (Durant, p.75). he considered
excellence to be won by training and habituation and believed that virtuous
character provided three criteria:
1. Virtuous acts must be chosen for their own sake.

2. Choice must proceed from a firm and unchangeable character.
3. Virtue is a disposition to choose the mean.
 Virtues Ethics in Nursing
 In limited sense, is known as, nursing etiquette

 In general sense, it is concerned with moral principles governing the right conduct of nurses
in her relationship with patients, physician’s colleagues, the nursing profession and the public.
 Examination of all ethical and bio-ethical issues from the perspective of nursing theory and
nursing ethics (Johnston).
 Core Values of a Professional Nursing
In a profession, values are standards for action that are preferred by experts and professional groups and
establish frameworks for evaluating behaviour. Nursing is a profession rooted in professional ethics and
ethical values, and nursing performance is based on such values.
Professional values
 Reflection and expansion of personal values
 Acquired during socialization into nursing:
 Codes of ethics
 Nursing experiences
 Teachers
 Peers
 Nursing values: COMPETENCE AND COMPASSION
 Nurse should be VALUE-NEUTRAL
Core Values
- Are the values we put on our work, clients, ourselves
- They can be central to the way we give care and live our lives.
Core values of nursing include altruism, autonomy, human dignity, integrity, honesty and social justice.
Important Values in Nursing (Watson)

1. Strong commitment to service.
2. Belief in the dignity and worth of each person
3. Commitment to education.
4. Autonomy.
However, the values in the care of patients are affected by cultural, social, economic, and religious
conditions dominating the community, making it essential to identify such values in each country.
Bangued, Abra

Core values and Care

Caring encompasses empathy and connection with other people.
It is the way we behave, treat and look after those under our care.
Motivating others to understand and reach their full potential.
Core values and people’s rights

The rights of the people that we care for are one of our main concerns.
These rights can be promoted through the care and services that we will provide.
We will help each person to participate as fully as possible in the community.
Privacy and Dignity

Clients face many changes when moving into a new home or environment.
We must promote the philosophy of a ―family‖
We must endeavour to retain as much privacy and personal dignity as possible
 By helping clients to personalize their personal space.
 Giving all clients choice, sometimes informed choice
 Allowing clients times of privacy.
 Enabling them to make and receive phone calls
 Enabling them to open and read their mail
 Respecting the clients need for confidentiality of all records and information.
 Treating each client as an individual
Summary:
Ethical theory helps us understand the origin and process of ethical and moral thinking and
behaviour. Two important theories are particularly important to nursing ethics. The ethical theory of
utilitarianism was developed in part by Jeremy Bentham and later refined by John Stuart Mill. Utilitarianism
suggests that ethical decisions should be made in regard to the outcome or end result. Accordingly, no
action in itself is inherently right or wrong. This theory also provides for the greatest good for the greatest
number. Utilitarianism is particulary useful in situations of distributive justice but tends to ignore the rights of
the minority or the individual.
Deontology, or Kantian ethics, was initially developed by Immanuel Kant. This theory, through the
use of the categorical imperative, assists one in making ethical decisions. The categorical imperative
demands that the agent ask the questions, can this action be a law for all people in all circumstances?
Additionally, the theory presents the practical imperative, which requires that we treat all individuals as if
they were ends only, rather than means. Kantian ethics provides clear guidelines for making ethical
decisions, but does not provide for making decisions when there are conflicting duties or obligations.
Virtue, or character, ethics, as described by Aristotle, describes each person as capable of

practicing and learning virtue through repetition of virtuous acts. Thus, the virtuous person is one in whom
virtue is habituated. Virtue ethics complements other ethical theories, and can be used to nurture or predict
character in individuals. Ethical theories and can be used to nurture or predict character in individuals.
Ethical theories can help us understand ethical decision-making models and assist in developing a
cohesive and logical system for making individual decisions.

Bangued, Abra

Enhancement Activity:
Things to do /Questions to Think About: (Rubric: 70% -Content & 30% - Organization)
1. What is the difference between ethics and morality?
2. What are the differences between teleology and deontology?
3. What is one undesirable outcome of beneficence?
4. What are the major ethical principles affecting health care?
(Note: Output for “Things to do” should be written/ encoded on a short bond paper
and submitted to the instructor before the deadline schedule-before getting the next
lesson on February 10, 2022!)
References:
A Vicki D. Lachman, PhD, MBE, APRN. Applied Ethics in Nursing. Copyright © 2006 by Springer Publishing Company, Inc.
Marcia Sue DeWolf Bosek, DNSc, RN and Teresa A. Savage, PhD, RN. The Ethical Component of Nursing Education Integrating
Ethics into Clinical Experience. Copyright © 2007 by Lippincott Williams & Wilkins.
Ethics & Issues in Contemporary Nursing 2nd Edition by Margaret A. Burkhardt and Elvita K. Nathaniel
Beauchamp, T.L. (2001). Philosophical ethics (3rd Edition). Boston: McGraw Hill.
https://www.pagecentertraining.psu.edu/public-relations-ethics/introduction-to-public-relations-ethics/lesson-1/ethical-theories/
https://study.com/academy/lesson/deontology-definition-theory-ethics-
examples.html#:~:text=Deontology%20states%20that%20an%20act,(protecting%20them%20is%20right).&text=In%20our%20example%2C%20tha
t%20means,morally%20best%20thing%20to%20do.
https://www.britannica.com/topic/biocentrism
http://www.delmarlearning.com/companions/content/0766838366/students/ch9/faq.asp#:~:text=Teleology%20is%20the%20ethical%20theory,is%20
determined%20by%20its%20consequences.&text=Deontology%20is%20the%20ethical%20theory,criterion%20for%20determination%20of%20goo
d.
https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-019-0351-
1#:~:text=Core%20values%20of%20nursing%20include,approach%20to%20the%20nursing%20profession.
https://www.slideshare.net/roducado/nursing-ethics-62458894


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DIVINE WORD COLLEGE OF BANGUED

School of Health Sciences