NCM67: BIOETHICS
An example of this is when lobbyist
WEEK 10: CONTINUING EDUCATION PROGRAMS
ON ETHICO-MORAL PRACTICE IN NURSING
(7/07/2022)
A. LOBBYING/ADVOCATING FOR ETHICAL ISSUES
RELATED TO HEALTH CARE
Advocacy means a coordinated combination of problem
identification, solution creation, strategy development, and
actions taken to make positive change. In the context of
nursing practice, it is a distinction made between “case
advocacy” directed at individual patients, and “class advocacy”
directed at changing policies and social conditions.
There are two (2) levels of advocacy: Case Advocacy and
Class Advocacy
Case advocacy is well known to nursing professionals, being
part of the field’s traditions and continuing professional values.
Class advocacy on the other hand, is a more overtly political
approach, it is quite different. Instead of focusing mainly on the
client’s opportunity choices, class advocacy focuses on
changing the system of opportunities itself to further the
interests of larger groups, organizations, or communities.
There are three (3) basis of Nursing Advocacy: First is
preserving human dignity. Nurses are in a unique position
that allows them to integrate all aspects of patient care,
ensuring that concerns are addressed, standards are upheld
and positive outcomes remain the goal. Second is patient
equality. Nurses must remain above the fray, advocating for
patients “with compassion and respect for the inherent dignity,
worth, and uniqueness of every individual, unrestricted by
considerations of social or economic status, personal attributes
or the nature of health problems”. Lastly is the freedom from
suffering. Nurses enter the profession because they have a
desire to help others. The core value of helping to prevent or
manage suffering is a significant art of this. This can be
achieved at the physical, emotional, or psychological level, and
is one of the most important aspects of patient care. Nursing
professionals should be available for patients and their families
as advocates for their well-being.
Nursing advocacy may defend a patient’s rights in a general
way by speaking out against policies or action that might
endanger their well-being or conflict with rights. Whereas,
according to the “Principles for the Ethical Conduct of
Lobbying” developed by Georgetown’s Woodstock Center,
lobbying means “the deliberate attempt to influence political
decisions through various forms of advocacy directed at
policymakers on behalf of another person, organization or
group.” The term called to individuals who communicate and
advocate certain views to members of the government in the
hope of influencing policy at local, state or federal levels are
lobbyists.
Lobbying usually involves attempting to influence legislation. It
always involves advocacy however, advocacy does not
necessarily involve lobbying. It involves contacting or getting
the public to contract the policymakers in order to support or
oppose certain legislation.
asks the governmental official to vote for or against an
introduced legislation. On the other hand, advocacy covers a
much broader range of activities that might not include
lobbying. It refers to attempts to bring positive change which
includes raising awareness and informing the public about an
idea, cause or policy, researching new solutions creating
coalition of like-minded people, and public campaigning. An
example of this is educating an elected government official
about the effects of a policy on the community.
HEALTHCARE MANAGEMENT ETHICS AND THE POSITIVE
VIEW OF LOBBYING
According to Dr. Weber, director of the Ethics Institute,
University of Detroit Mercy, Detroit. He’s a member of the
Catholic Health Association’s Task Force on Healthcare
Management Ethics, a challenge that healthcare manage face
is how to influence public policy in a peaceful and legal way
Healthcare managers and supervisor know that some changes
in public policy promote appropriate and effective healthcare
delivery and some do not. They also know that it’s not
responsible to stand back in silence, let others set policies, and
then react later. The word “lobbying” may suggest behaviours
that are somewhat questionable from an ethical explanation,
when done with the intention and goal of improving the
common good for the majority, lobbying is often the
appropriate or best thing to do.
LOBBYING’S NEGATIVE REPUTATION
Lobbying has always acquired a questionable reputation
among ethically sensitive people for two possible reasons:
 The methods that sometimes used in trying to influence
legislation corrupt the legislative system by providing personal
advantages and benefits to policy maker.
 Lobbyists often appear to some to be less interested in good
policy than in protecting their own gain and interests.
Philosopher Mark Sagoff always makes a distinction between
our role as consumers and our role as country citizens. Sagoff
stated that when we act as consumer, we seek to acquire what
we want and the best for ourselves: Each person follows his
own concept of the good life, his own self-interest. On the other
hand, when we act as citizens, we seek to achieve and
implement what is right or best for the entire community; we try
to promote a good society. The problem with so much of
lobbying is that personal or institutional self-interest is
sometimes placed above concern for the public greatest good.
On the contrary to this view, another way of thinking about
lobbying is as an advocacy which is an effort to positively
influence public policy for the benefit of those who are not
recognized in the lower level by those in power. Although those
people who seek greater protection from increased
environmental degradation or more low income housing for
homeless people are 5 examples of special interests, their
advocacy is a different kind of lobbying from those which seeks
simply a better deal for oneself. Self-interest is always
legitimate in many circumstances, but it is not ordinarily an
adequate enough basis on which and how to determine good
public policy.
Healthcare managers’ responsibility is to work for a just,
efficient and effective healthcare system, and not just for the
benefit of interests of their own organizations, is recognized in
the Code of Ethics of the American College of Healthcare
Executives. According to the preamble of the code (as
amended in 1992): It stated that the fundamental objectives of
the healthcare management profession are to enhance the
overall quality of life, dignity and well-being of every human
needing and seeking healthcare services, management and to
create a more equitable, accessible, effective and efficient
healthcare system.
GOOD CITIZENS, GOOD LOBBYISTS
It seems essential; therefore, that healthcare managers and
supervisors support and promote lobbying with good
intentions. They need to review frequently the goals and
objectives of lobbying efforts to ensure that they remain
focused on creating “a more equitable, accessible, effective
and efficient healthcare system in the country.” Given the
nature of so much of the lobbying that takes place in our
political system, it is important for healthcare managers to
guard against the tendency to focus almost exclusively on the
institution’s more immediate and narrowly defined goals to set
goals that is good for the majority. Good lobbying is citizen
behaviour, not consumer behaviour.
LOBBYING METHOD
A third dimension to the lobbying ethics is how it is done.
Public officials are obligated to put the public interest first. The
Government Ethics Center of the Josephson Institute. Stated
that public servants should treat their office as a public trust,
only using the powers and resources of public office to
advance public interests, and not to attain personal benefits or
pursue any other private interest incompatible with the public
good. (Preserving the Public Trust: Principles of Public Service
Ethics, Marina del Rey, CA, 1990) The responsibility of those
trying to influence public policy is to interact with public officials
in such a way that they do not ask or tempt those officials to
put private interests above the public good.
Conflict-of-interest analysis is an important tool that identifies
public official’s ethical responsibility. I believe conflict-of-
interest analysis could be equally important in identifying
ethically unacceptable lobbying techniques and strategies that
encourage public officials to put private interest above the
public good.
Healthcare managers and supervisors must pay careful
attention to the methods of lobbying their organizations use to
save time, effort and energy. What message is sent when a
healthcare political action committee contributes to the
campaign of a particular legislator? What are the implications
of hiring a professional lobbyist to represent the organization?
A healthcare manager should not assume that professional
lobbyists have the same ethical commitments that he or she
does. Unless healthcare managers make an explicit effort to
know and monitor the methods of the lobbyists they hire, they
cannot assume that those methods will always be appropriate.
Lobbying can be an activity in which ethically sensitive persons
take pride. Advocating effectively and with political integrity for
public policies that contribute to a more just healthcare system
is fulfilling a professional responsibility, achieving an
institutional goal, and performing a major public service.
B. CODE OF ETHICS
1. International Code of Ethics
An international code of ethics for nurses was first adopted by
the International Council of Nurses (ICN) in 1953. It has been
revised and reaffirmed at various times since, most recently
with this review and revision completed in 2012
ELEMENTS OF THE CODE
A. Nurses and People
 The nurses’ primary professional responsibility is to people
requiring nursing care.
 In providing care, the nurse promotes an environment in
which the human rights, values, customs and spiritual beliefs of
the individual, family and community are respected.
 The nurse ensures that the individual receives accurate,
information in a culturally appropriate manner on which to base
consent for care and related treatment.
 The nurse holds in confidence personal information and uses
judgement in sharing this information.
 The nurse shares with society the responsibility for initiating
and supporting action to meet the health and social needs of
the public, in particular those of vulnerable populations.
 The nurse advocates for equity and social justice in resource
allocation, access to health care and other social and
economic services.
 The nurse demonstrates professional values such as
respectfulness, responsiveness, compassion, trustworthiness
and integrity
B. Nurse and Practice
 The nurse carries personal responsibility and accountability
for nursing practice, and for maintaining competence by
continual learning.
 The nurse maintains a standard of personal health such that
the ability to provide care is not compromised.
 The nurse uses judgement regarding individual competence
when accepting and delegating responsibility.
 The nurse at all times maintains standards of personal
conduct which reflect well on the profession and enhance its
image and public confidence.
 The nurse, in providing care, ensures that use of technology
and scientific advances are compatible with the safety, dignity
and rights of people.
 The nurse strives to foster and maintain a practice culture
promoting ethical behaviour and open dialogue.
C. Nurses and the Profession
 The nurse assumes the major role in determining and
implementing acceptable standards of clinical nursing practice,
management, research and education.
 The nurse is active in developing a core of research-based
professional knowledge that supports evidence-based practice.
 The nurse is active in developing and sustaining a core of appropriate nursing services through varied learning situations.
professional values. PRC-BN
 The nurse, acting through the professional organisation, d. if they are administrators, be responsible in providing a
participates in creating a positive practice environment and favorable environment for the growth and developments of
maintaining safe, equitable social and economic working Registered Nurses in their charge.
conditions in nursing. e. Be cognizant that professional programs for specialty
 The nurse practices to sustain and protect the natural certification by the BON are accredited through the Nursing
environment and is aware of its consequences on health. Specialty Certification Council (NSCC).
 The nurse contributes to an ethical organisational f. See to it that quality nursing care and practice meet the
environment and challenges unethical practices and settings. optimum standard of safe nursing practice.
g. insure that modification of practice shall consider the
D. Nurses as Co-workers principles of safe nursing practice
 The nurse takes appropriate action to safeguard individuals, h. If in position of authority in a work environment, be normally
families and communities when their health is endangered by a and legally responsible for devising a system of minimizing
co-worker or any other person. occurrences of ineffective and unlawful nursing practice.
 The nurse sustains a collaborative and respectful relationship i. Ensure that patients’ records shall be available only if they
with co-workers in nursing and other fields. are to be issued to those who are professionally and directly
involved in their care and when they are required by law”.
 The nurse takes appropriate action to safeguard individuals,
families and communities when their health is endangered by a
Ethical Principle under Section 8 Article 3
co-worker or any other person.
1. Registered Nurses are the advocates of the patients: they
shall take appropriate steps to safeguard their rights and
CODE OF ETHICS FOR FILIPINO NURSES
privileges.
Registered Nurses and People
REGISTERED Nurses must:
a. Respect the “Patients’ Bill of Rights” in the delivery of
Ethical Principles under Section 4 Article 2
nursing care.
1. Values, customs, and spiritual beliefs held by individuals
b. Provide the patients or their families with all pertinent
shall be respected.
information except those which may be deemed harmful to
2. Individual freedom to make rational and unconstrained
their well-being.
decisions shall be respect.
c. Uphold the patients’ rights when conflict arises regarding
3. Personal information acquired in the process of giving
management of their care.
nursing care shall be held in strict confidence.
Ethical Principle under Section 10 Article 3
REGISTERED Nurses must:
1. Registered Nurses are aware that their actions have
a. Consider the individuality and totality of patients when they
professional, ethical, moral, and legal dimensions. They strive
administer care.
to perform their work in the best interest of all concerned
b. Respect the spiritual beliefs and practices of patients
regarding diet and treatment.
REGISTERED Nurses must:
c. Uphold the rights of individuals.
a. Perform their professional duties in conformity with existing
d. Take into consideration the culture and values of patients in
laws, rules, and regulations. Measures, and generally accepted
providing nursing care. However, in the event of conflicts, their
principles of moral conduct and proper decorum.
welfare and safety must take precedence.
b. Not allow themselves to be used in advertisements that
should demean the image of the profession (i.e. indecent
Registered Nurses and Practice
exposure, violation of dress code, seductive behaviour, etc.).
c. Decline any gift, favour or hospitality which might be
Ethical Principles under Section 6 Article 3.
interpreted as capitalizing on patients
1. Human life is inviolable
d. Not demand and receive any commission, fee or emolument
2. Quality and excellence in the care of the patients are the
for recommending or referring a patient to a physician, a co-
goals of nursing practice.
nurse or another PRC-BN health care worker; not to pay any
3. Accurate documentation of actions and outcomes of
commission, fee or other compensations to the one referring or
delivered care is the hallmark of nursing
recommending a patient to them for nursing care.
e. Avoid any abuse of the privilege relationship which exists
REGISTERED Nurses must:
with patients and of the privilege access allowed to their
a. Know the definition and scope of nursing practice which are
property, residence or workplace.
in the provisions of R. A. No. 9173, known as the “Philippine
Nursing Act of 2002” and Board Res. No. 425, Series of 2003,
Registered Nurses and Co-workers
the “Rules and Regulations Implementing the Philippine
Nursing Act. Of 2002”, (the IRR).
Ethical Principles under Section 12 Article 4
b. Be aware of their duties and responsibilities in the practice
1. The Registered Nurse is in solidarity with other members of
of their profession as defined in the “Philippine Nursing Act of
the healthcare team in working for the patient’s best interest.
2002” and the IRR.
2. The Registered Nurse maintains a collegial and
c. Acquire and develop the necessary competence in
collaborative working relationship with colleagues and other
knowledge, skills, and attitudes to effectively render
health care providers.
 d. strive to secure equitable socio-economic and working
REGISTERED Nurses must: conditions in nursing through appropriate legislation and other
a. Maintain their professional role/identity while working with means.
other members of the health team. e. assert for the implementation of labor and work standards.”
b. Conform with group activities as those of a health team
should be based on acceptable, ethico-legal standards.
c. Contribute to the professional growth and development of
other members of the health team
d. Actively participate in professional organizations.
e. Not act in any manner prejudicial to other professions.
f. honor and safeguard the reputation and dignity of the
members of nursing and other professions; refrain from making
unfair and unwarranted comments or criticisms on their
competence, conduct, and procedures; or not do anything that
will bring discredit to a colleague and to any member of other
professions.
g. Respect the rights of their co-workers.

Registered Nurses, Society and Environment

Ethical Principles under Section 14 Article 5

1. The preservation of life, respect for human rights, and
promotion of a healthy environment shall be a commitment of a
Registered Nurse.
2. The establishment of linkages with the public in promoting
local, national, and international efforts to meet health and
social needs of the people as a contributing member of society
is a noble concern of a Registered Nurse.

REGISTERED Nurses must:

a. Be conscious of their obligations as citizens and, as such,
be involved in community concerns. PRC-BN
b. Be equipped with knowledge of health resources within the
community, and take active role in primary health care
c. actively participate in programs, projects, and activities that
respond to the problems of society.
d. lead their lives in conformity with the principles of right
conduct and proper decorum.
e. Project an image that will uplift the nursing profession at all
times.

Registered Nurses and the Profession

Ethical Principles under Section 16 Article 6

1. Maintenance of loyalty to the nursing profession and
preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited professional
organization (PNA), and other professional organizations of
which the Registered Nurse is a member is a lofty duty.
3. Commitment to continual learning and active participation in
the development and growth of the profession are
commendable obligations.
4. Contribution to the improvement of the socio-economic
conditions and general welfare of nurses through appropriate
legislation is a practice and a visionary mission.”

REGISTERED Nurses must:

a. Be members of the Accredited Professional Organization
(PNA).
b. Strictly adhere to the nursing standards.
c. Participate actively in the growth and development of the
nursing profession