APPLICATION OF

BIOETHICAL PRINCIPLES
TO THE CARE OF THE SICK

by:
Melissa D. Sarmiento, RN, RM, MSN
 PATIENT’S RIGHT
Means the moral and
inviolable power vested in
him as a person to do, hold,
or demand something as his
own
 TYPES OF PATIENTS RIGHTS
 Right to Self-determination
- Related to the principle of autonomy
- It states that a patient, as an
autonomous individual has the moral
right to determine what is good for
himself, usually upon the advice of a
health professional
Patient’s Rights……
Right to Informed Consent
Informed Consent – refers to
the knowledge or information about
and the consent to, a particular
form of medical treatment, before
that treatment is administered
information include the
risks, expenses, and
advantages of any medical
treatment that concerns the
patient
 Four Elements of
Informed Consent
Competence – patient’s
capacity for decision making
Disclosure – refers to the content of
what a patient is told or informed about
during the consent negotiation
- Patient must be informed and must
understand the information concerning
medical treatment to be undertaken, so
that a moral action can be made
Comprehension – refers to whether the
information given has been understood
Voluntariness – it means that consent
must be voluntary
- The patient must of his own free will
agree or does not agree to the course of
treatment
Right to Informed Decision
Informed Decision – refers
to the necessary information of,
and decision on, a medical
treatment before it is to be
carried out
Informed Decision……
- Information and understanding are
necessary for genuine deliberation
- The patient must be informed about the
whole process and must understand
what this information pertains to so
that an appropriate moral decision can
be arrived at
Right to Informed Choice
Informed Choice – refers to the
to the necessary information a
patient should know a medical
treatment or experiment so that a
moral choice can be made
Informed Choice……
- The patient has the right to be
informed about all possible
alternative courses of action ( or
other forms of treatment) to be
taken, together with the possible
consequences
Right to Refusal of Treatment
- The patient has the right to
refuse medical treatment because
his religious convictions
prohibits him from doing so
INTERNATIONAL COUNCIL OF NURSES
CODE OF ETHICS
In providing care, the nurses
promotes an environment in
which the human rights, values,
customs and spiritual beliefs of
the individual, family and
community are respected
 LIMITATION OF PATIENT’S RIGHTS
 Patient’s right do not include the right
to be allowed to die.
 A patient in a moribund condition does
not possess the necessary mental
capacity or emotional stability to make
an informed choice.
 Patient’s right are not absolute.
TWO WAYS OF OBTAINING INFORMED
CONSENT IN THE PHILIPPINES
Written Consent
- A consent form to be filled
up and signed by a patient as
he/she checks in for
admission in a hospital
Two Ways…..
Verbal Consent
- When the patient verbally
signifies his/her willingness to
undergo medical treatment,
informed consent is met
Usually made after a physician
has briefed the patient together
with the next of kin about the
medical process to be
undertaken
 TYPES OF PATIENTS WHO DOES NOT REQUIRE
INFORMED CONSENT in Emergency Cases

Comatose or obtunded patients

Blind or illiterate patients
Underage patients or those
unable to understand the
circumstances
Language-barrier patients
 THE RIGHTS OF PATIENTS
Documented in the American
Hospital Association (AHA)’s
statement on Patient’s Bill of Rights
“Humanizing Elements of
Health Care Ethics”
12 Rights……
The patient has the right
to a considerate and
respectful care.
12 Rights……
The patient has the right to obtain
from his physician complete current
information concerning his
diagnosis, treatment and prognosis
in terms the patient can reasonably
be expected to understand.
12 Rights……
The patient has the right to
receive from his physician
information necessary to give
informed consent prior to the
start of any procedure and/or
treatment.
12 Rights……
The patient has the right to
refuse treatment to the extent
permitted by law and to be
informed of the medical
consequences of the action.
12 Rights……
The patient has the right to
every consideration of his
privacy concerning his own
medical care program.
12 Rights……
The patient has the right to
expect that all circumstances
and records pertaining to his
case should be treated as
confidential.
12 Rights……
The patient has the right to
expect that within its capacity,
the hospital must provide a
reasonable response to his/her
request for services.
12 Rights……
The patient has the right to
obtain information regarding any
relationship of his hospital to
other health care and educational
institution insofar as his care is
concerned.
12 Rights……
The patient has the right to be
advised if the hospital proposes
to engage in or perform human
experimentation affecting
his/her care or treatment.
12 Rights……
The patient has the right
to expect reasonable
continuity of care.
12 Rights……
The patient has the right to
examine and receive an
explanation of the hospital
bill, regardless of source of
payment.
12 Rights……
The patient has the right to
know what hospital rules and
regulations apply to his/her
conduct as a patient.
 PATIENT’S RESPONSIBILITIES
Maintaining your right as a patient
it is also important to review patient’s
responsibilities
just as we have rights as citizens, we have
corresponding responsibilities that help maintain
those rights, the same is true with our medical
care
 PATIENT’S RESPONSIBILITIES
Maintaining healthy habits
that proverbial ounce of prevention is most
definitely more effective and efficient than the
corresponding pound of cure
making healthy food choices, getting plenty of
exercise, resolving stress, getting enough sleep,
moderating alcohol consumption, and refraining
from smoking are those good habits we are all
familiar with, and most of us need to work on
 PATIENT’S RESPONSIBILITIES
Being respectful to providers
just as it’s a patient’s right to expect respect, it is
the patient’s responsibility to show respect in
return
this is not to suggest that patient’s need to be so
respectful that they are afraid to ask questions or
request clarifications on issues regarding their
health
 PATIENT’S RESPONSIBILITIES
Being honest with providers
as an empowered patient, he/she recognize that
being totally honest with the health practitioner is
imperative. This means sharing all information
about your habits and health, as holding back can
mean not getting the care that you need
 PATIENT’S RESPONSIBILITIES
Complying with treatment plans
since the patient, the nurse and the doctor will
have worked together to agree on a treatment
plan, it only makes sense to comply with that
treatment plan. Not doing so works against the
good care that have been put effort into securing
 PATIENT’S RESPONSIBILITIES
Preparing for emergencies
for those who have medical challenges and/or
take prescription drugs to maintain their health,
it is important to be prepared for medical
emergencies
if you find yourself in an emergency room, you’ll
want to be sure hospital personnel know bout the
treatments you are already receiving, or the
cautions needed for effective treatment
 PATIENT’S RESPONSIBILITIES
Reading behind the headlines
we see news everyday about some new study that
changes the way we see certain diseases or
conditions
sometimes, the headlines don’t tell the whole
story
as an empowered patient, you know to look
behind those headlines to find out if they apply to
you
 PATIENT’S RESPONSIBILITIES
Making decisions responsibly
in the face of frightening diagnosis, or a scary
treatment option, it’s difficult to leave our
emotions out of our decisions
we need to make sure our decisions about our
care are based on solid evidence and proven
procedures, rather than wishful thinking
 PATIENT’S RESPONSIBILITIES
Understanding prescription drugs and
their possible effects
there are so many possibilities for drug-related
medical errors that we need to take responsibility
for double-checking all prescriptions, then
comparing them to the drug the pharmacist
delivers to us
this is a safety question that all empowered
patients must address
 PATIENT’S RESPONSIBILITIES
Meeting financial obligations
patients have the right to choose their insurance
or other means for paying for their health care,
and that right is balanced by the responsibility of
taking care of those payments or corresponding
financial obligations
there is no question that medical costs can
become difficult and cumbersome, but they do
need to be dealt with responsibly
 PATIENT’S RESPONSIBILITIES
Reporting fraud and wrong doing
we’ve all heard of medical payment fraud
whether it’s through taking advantage of
Medicare laws or billing for services not rendered
through public or private medical payment
assistance
it is the responsibility of patients who become
aware of such fraudulent activity to report it to
those who can stop it
 PATIENT’S RESPONSIBILITIES
Avoiding putting others at risk
the patient has the obligation not to harm others
either through intentional or unintentional means
it is his/her responsibility to act in such a way
that we keep others from being infected or
injured
APPLICATION OF ETHICAL THOUGHTS
Natural Law Ethics
- Regards the right to informed
consent as morally legitimate
- A patient should decide to give
his/her consent, it must be given
freely and not the consequence of
intimidation, deception or coercion
APPLICATION OF ETHICAL THOUGHTS
Natural law Ethics
- Against the patient’s right to
refusal of treatment under
the principle of stewardship
and inviolability of life.
APPLICATION OF ETHICAL THOUGHTS

Kant’s Ethical Principle

- We must always be treated
as ends and never only as a
means
APPLICATION OF ETHICAL THOUGHTS
• Utilitarian - requires
health care professional to
design medical treatment in a
way that minimizes suffering
and harm
APPLICATION OF ETHICAL THOUGHTS
• Rawl’s principles of Justice –
do not allow medical treatments
or experiments that violate
freedom which a patient is
entitled to by virtue of being a
member of the society
END