NCM67: BIOETHICS be obtained from the child without the need of consent from a

parent or guardian; and

(c) consent to voluntary HIV testing shall be obtained from the
child's parent or legal guardian if the person is below fifteen
WEEK 6: SPECIFIC ETHICAL ISSUES (6/30/2022) (15) years of age or is mentally incapacitated. In cases when
the child's parents or legal guardian cannot be located despite
reasonable efforts, or if the child's parent or legal guardian
refused to give consent of the minor, shall also be required
A. SPECIFIC ETHICAL ISSUES
prior to the testing.
 
1. ACQUIRED IMMUNODEFICIENCY SYNDROME
Compulsory HIV Testing. Compulsory HIV testing shall be
(AIDS)
allowed only in the following instances:
(a) When it is necessary to test a person who is charges with
HUMAN IMMUNODEFICIENCY VIRUS (HIV) - a retrovirus
any of the offenses punishable on serious and slight physical
that is transmitted through the exchange of body fluids.
injuries, and on rape and simple seduction, amended by The
 
Revised Penal Code and The Anti-Rape Law of 1997.
1. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) – it
(b) When it is necessary to resolve relevant issues under
is a condition characterized by a combination of signs and
Executive Order No. 209, otherwise known as "The Family
symptoms, caused by HIV.
Code of the Philippines"; and
(c) As a prerequisite in the donation of blood in compliance
When a person’s T-cell count goes below 200, he/she is
with the provisions of Republic Act No. 7170, otherwise known
considered as having AIDS.
as the "Organ Donation Act of 1991", and Republic Act No.
7719, otherwise known as the "National Blood Services Act of
These exchanges can take place by needle sharing,
1994".
unprotected sexual intercourse (vaginal, rectal or anal),
 
transmission from mother to child through breast milk, and
Thus, all forms of testing for HIV should be with the informed
blood transfusions. These are the tangible causes of HIV
consent of the person being tested and the person to be tested
transmission. It is not transmitted through tears, saliva, insects,
should be offered pre-test and post-test counseling.
toilet seats, swimming pools, linens, dishes, utensils, or a
 
government conspiracy.
2. Confidentiality – Confidentiality and privacy are
constitutional and human rights entitlements. Dilemmas
SOCIAL STIGMA - HIV disease, in particular, carries with it
brought about by HIV and AIDS are justified in the interest of
the social stigmatization that complicates mental health and
public health.
threatens life-sustaining activities.
Should the law allow/require partner notification of HIV results
 
to anybody?
“Telling friends I’m HIV positive is not the same as telling them
Is there a right for anybody to know?
I’m gay”—double coming out, the first closet and the second
 
closet.
Based on REPUBLIC ACT No. 11166 or the Philippine HIV
 
and AIDS Policy Act
LGBTQ+ people may experience 'dual stigma', where they are
constructed as 'tainted' or 'undesirable' both because of their
Disclosure of Confidential HIV and AIDS Information. - it shall
sexual orientation / gender identity, and because of their health
be unlawful to disclose, without written consent, information
condition. 
that a person has AIDS, has undergone HIV-related test, has
HIV infection or HIV-related illnesses, or has been exposed to
ETHICAL ISSUES RELATED TO AIDS:
HIV.
 
1. Testing for HIV – the legal and ethical question raised by
Exceptions. - Confidential HIV and AIDS information may be
testing is whether it should be mandatory or voluntary. The
released by HIV testing facilities without consent in the
legal basis of consent is the constitutional and universal right to
following instances:
autonmy/self-determination.
 
 
(a) When complying with reportorial requirements of the
REPUBLIC ACT No. 11166 or the Philippine HIV and AIDS
national active passive surveillance system of the DOH:
Policy Act
Provided, that the information related to a person's identify
shall remain confidential;
HIV Testing. - As a policy, the State shall encourage voluntary
 
HIV testing. Written consent from the person taking the test
(b) When informing other health workers directly involved in the
must be obtained before HIV testing. HIV testing shall be made
treatment or care of a PLHIV: Provided, that such worker shall
available under the following circumstances:
be required to perform the duty of shared medical
(a) If the person is fifteen (15) to eighteen (18) years of age,
confidentiality; and
consent to voluntary HIV testing shall be obtained from the
 
child without the need of consent from a parent or guardian;
(c) When responding to a subpoena duces tecum and
(b) Any young person aged below fifteen (15) who is pregnant
subpoena ad testificandum issued by a court with jurisdiction
or engaged in high-risk behavior shall be eligible for HIV
over a legal proceeding where the main issue is the HIV status
testing and counseling, with the assistance of a licensed social
of an individual.
worker or health worker. Consent to voluntary HIV testing shall
 
Disclosure of HIV-Related Test Results. - The result of any test
related to HIV shall be disclosed by the trained service provider
who conducts pre-test and post-test counseling only to the
individual who submitted to the test. If the patient is below
fifteen (15) years old, an orphan, or is mentally incapacitated,
the result may de disclose to either of the patient's parents,
legal guardian, or a duly assigned licensed social worker or
health worker, whichever is applicable" Provided, That when a
person below fifteen(15) years of age and not suffering from
any mental incapacity, has given voluntary and informed
consent to the procedure, the result of the test shall be
disclose to child: Provided, further, That the child should be
given age-appropriate counseling and access to necessary
health care and sufficient support services.
 
Disclosure to Persons with Potential Exposure to HIV. - Any
person who, after having been tested, is found to be infected
with HIV is strongly encouraged to disclose this health
condition to the spouse, sexual partners, and/or any person
prior to engaging in penetrative sex or any potential exposure
to HIV. A person living with HIV may seek help from qualified
professionals including medical professionals health workers,
peer educators, or social workers to support him in disclosing
this health condition to one's partner or spouse. Confidentiality
shall likewise be observed.
 
RECOMMENDATIONS FOR COUNSELING MOTHERS
LIVING WITH HIV ABOUT FEEDING THEIR INFANTS
According to the Centers of Disease Control and Prevention
(2022), it is recommended that mothers living with HIV not
breastfeed their infants to prevent HIV transmission. HIV is a
virus that attacks the body's immune system and is spread
through certain body fluids, including breast milk.
 
2. ABORTION
The most controversial subjects in modern society is abortion.
We aim to convey the main perspectives on abortion in a way
that is as objective as possible in the purpose of fostering
knowledge of the topic.
One of the strictest abortion laws in the world is found in the
Philippines. There are no express exceptions to the rule that
abortions are banned in all situations. The Penal Code of 1870,
passed during Spanish colonial control, made abortion illegal.
The penal provisions were then integrated into the Revised
Penal Code, passed during American occupation of the
Philippines in 1930, and are still in effect today. Nevertheless,
abortion is prevalent in the nation due to the high rates of
unintended pregnancies. According to projections that used the
most recent available data on the national abortion rate from
2000 and took into account population growth, there were
560,000 abortions in 2008 and 610,000 in 2012.The
Reproductive Health Law (RH Law), passed in 2012, has
several provisions that have the potential to dramatically
improve women’s health and reduce maternal mortality, and to
confer social and economic benefits that would help families,
communities and the nation. In contrast to the liberalizing trend
in contraceptive policy, abortion in the Philippines remains
illegal under all circumstances and is highly stigmatized.
Although a liberal interpretation of the law could exempt
abortion provision from criminal liability when done to save the
woman’s life, there is no such explicit provision. There are also
no explicit exceptions to allow abortion in cases of rape, incest
or fetal impairment. 
Liberty is a right enshrined in the Constitution. However, as a
testament to the impossibility of determining what it truly
means to be free, neither the Constitution nor our
jurisprudence has attempted to define its metes and bounds.
This case challenges this Court to ascertain the extent of the
protection of the right to liberty. This Court is called to answer
the question of how free a woman is in this country to design
the course of her own life. A woman’s legal right to decide in
favor of an abortion has not resolved many of the ethical
issues surrounding the procedure. Every woman is not legally
free to obtain an abortion, but the ability to exercise this
freedom does not necessarily render abortion ethically
acceptable. That is, the legal right does not necessarily imply
the moral right. Even for those who decide that abortion is, in
principle, acceptable in certain circumstances, the ethical
decision must still be made as to which circumstances those
are. In addition, a nurse, if she is to be a responsible moral
agent, must also decide what her role in abortion procedures
ought to be. Even if a patient decides in favor of an abortion, it
remains an open question whether healthcare personnel will
and should choose to participate.
The nurse encounters many moral questions pertaining to
abortion. In addition to facing them as a lay person making
personal and public policy choices, he or she must face them
as a clinical professional. For some nurses, all abortion is
morally unacceptable, no matter what the reason. Presumably,
a nurse with this belief would face a serious ethical conflict if
asked to participate in performing an abortion. 
TYPES OF ABORTION
 Natural Abortion- expulsion of fetus through natural or
accidental causes 
 Direct/ intentional- deliberately induced expulsion of a
living fetus before it has come viable Therapeutic
Abortion- induced expulsion of a living fetus to save
the mother from danger of death brought on by
pregnancy 
 Eugenic Abortion- cases where certain defects
discovered in the developing fetus Indirect abortion-
removal of fetus occurs as a secondary effect of a
legitimate or licit action.
THREE GENERAL VIEWPOINTS OF ABORTION
 The conservative- abortion is never permissible, or at
most, is permissible if and only if it is required to save
the pregnant woman's life 
 The liberal- abortion is always permissible, whatever
the state of fetal development. 
 The moderate or intermediate-abortion is morally
permissible up to a certain stage of fetal development
or for a limited set of reasons sufficient to justify the
taking of life in that special circumstance
DEFINITION OF TERMS
a) Abortion: A pregnancy that ends before 20 weeks’
gestation, spontaneously or electively;A method of birth control
in which conception is terminated rather than
prevented;Expulsion of a living fetus from a mother's womb
before it is viable
b) Induced Abortion -Type of abortion that is
therapeutic or elective reasons exist for terminating pregnancy
c) Medical abortion - is a procedure that uses
medication to end a pregnancy
d) Pro-choice view - pro-choice position holds that
induced abortions are morally permissible (morally allowable,
not morally wrong).
e) Pro-life view - pro-life position holds that induced
abortions are morally impermissible (morally wrong, morally
prohibited).  personal-religious value system, and the obligation to self to
CONFLICT OF ETHICAL PRINCIPLE, RIGHTS AND
RESPONSIBILITIES
• Woman’s decision about having a baby, not to have a
baby or to have abortion are among critical decision she will
make in her life.  wrongness of the patient's action or behavior.  "Where a
• The right to life of a fetus or the woman right to control
her own body by choosing to carry a pregnancy term, have a
baby and parent it.  participate on moral grounds....The nurse is obliged to provide
• Beneficence requires the provider to act in the best
interest of the patient and her welfare and is closely related to
nonmaleficence, the basic obligation to do no harm.
• Justice underlies the principle of nondiscrimination
and the obligation of health care providers to work for the
public good.
• Respect for autonomy leads to such principles as
informed consent and confidentiality, as well as respect for the
decisions of colleagues.
• Bill of rights (Section 1. No person shall be deprived
of life, liberty, or property without due process of law, nor shall
any person be denied the equal protection of the laws.)
POINT OF ARGUMENT ON ABORTION
Pro-choice  responsibilities related to abortion and sterilization
 Abortion is legally permissible regardless of morality
involved
 A woman has basic right to make up her own mind
about choices of pregnancy or abortion
 Her right always prevails over any other (including
fatal right)
 Beginning of life: (1)The fetus does not have human
life until the mother is in the 17th weej of gestation, (2)
the fetus with sentinence and moral status has human
life at the 7th month of gestation.  of other parties (e.g., the perception of movement by
Pro-life  the pregnant woman) and acceptance by others
 Life begins at conception
 Abortion is immoral and murderous  rigorous justification for the abortion of a fetus at 18
 Embryo, from the time of conception and throughout
the development of fetus, has the right to life due to
each person living outside womb
 Personhood begins in lieu of conception as a single-
cell zygote and moral status is acquired at
conception.
 Beginning of life: ethical reflection- at conception:
after the fertilized egg splits into
ETHICAL REFLECTION:
1. How do you think a country should address conflicts
between respecting a woman’s reproductive freedoms
and the conscience protections of healthcare
professionals
2. When does life begin?
3. Is the fetus a person?
4. When does the human soul fuse or unite with the
body? From the moment of conception? During a
certain stage of fetal development? at viability? at
birth or after birth?
NURSING ETHICAL ISSUES
Initially, there is the ethical dilemma of an individual nurse's
live according to it. In essence, professional standards typically
endorse a provider's right to step away, or "withdraw," from
providing a health care service that violates his or her moral or
religious beliefs. The nurse has the ethical obligation to provide
the best nursing care possible without judging the rightness or
particular treatment, intervention, activity, or practice is morally
objectionable to the nurse....the nurse is justified in refusing to
for the patient's safety, to avoid patient abandonment, and to
withdraw only when assured that alternative sources of nursing
care are available to the patient."—American Nurses
Association, Code of Ethics
"Nurses have the right, under responsible procedures, to
refuse to assist in the performance of abortion and/or
sterilization procedures....Nurses have the professional
responsibility to provide high quality, impartial nursing care to
all patients in emergency situations....to provide nonjudgmental
nursing care to all patients, either directly or through
appropriate and timely referral....[and] to inform their
employers, at the time of employment, of any attitudes and
beliefs that may interfere with essential job functions."—
Association of Women's Health, Obstetric and Neonatal
Nurses, position statement on nurses' rights and
CASES INVOLVING ABORTION
Moral standing- who it is “who has moral claims”on the rest of
the community
a.  Biologic or genetic” position- is based on what
appears to be a biologic fact: That a new individual
with a new and fixed genetic endowment begins at
conception.
b. Social position-claim that capacities for speech and
rationality, as well as events involving the responses
c. Incrementalists - This position requires a much more
weeks than it does at 5 or 6 weeks because more of
the purportedly critical events have taken place,
giving the fetus more of a claim.
CRIMINALIZATION LAW ON ABORTION
Senate bill 2264: AN ACT INCREASING THE PENALTY OF
IMPRISONMENT FOR ABORTION PRACTICED BY
PHYSICIANS, MIDWIVES, INCLUDING NURSES AND THE
ACCESSORY PENALTY THEREFOR TO PERPETUAL LOSS
OF LICENSE TO PRACTICE PROFESSION AND FOR
OTHER PURPOSES
Legislative status is Pending in the Committee (6/7/2006)
PROTECTION OF THE UNBORN CHILD ACT OF 2010/
Senate bill 2497-Filed on September 13, 2010 by Enrile, Juan
Ponce, Sotto III, Vicente C., Ejercito-Estrada, Jinggoy - AN
ACT TO UPHOLD THE HUMAN RIGHTS AND PROMOTE
THE WELFARE OF THE UNBORN CHILD, AMENDING FOR
THE PURPOSE ARTICLES 256, 257, 258 AND 259 OF THE
REVISED PENAL CODE, AND FOR OTHER PURPOSES
• Legislative status-Pending in the Committee
(9/27/2010)
The Penal Code- renders abortion a criminal offense,
punishable by up to six years in prison for doctors and
midwives who perform the procedure and by 2–6 years in
prison for women who undergo the procedure. A separate set
of laws under the Midwifery Act, Medical Act and
Pharmaceutical Act permit the revocation or suspension of the
licenses of any practitioner who performs abortions or provides
abortifacients.
• Art. 255. Infanticide. — The penalty provided for
parricide in Article 246 and for murder in Article 248 shall be
imposed upon any person who shall kill any child less than
three days of age.
• If the crime penalized in this article be committed by
the mother of the child for the purpose of concealing her
dishonor, she shall suffer the penalty of prision correccional in
its medium and maximum periods, and if said crime be
committed for the same purpose by the maternal grandparents
or either of them, the penalty shall be prision mayor.
• Art. 256. Intentional abortion. — Any person who
shall intentionally cause an abortion shall suffer:
• 1. The penalty of reclusion temporal, if he shall use
any violence upon the person of the pregnant woman.
• 2. The penalty of prision mayor if, without using
violence, he shall act without the consent of the woman.
• 3. The penalty of prision correccional in its medium
and maximum periods, if the woman shall have consented.
• Art. 257. Unintentional abortion. — The penalty of
prision correccional in its minimum and medium period shall be
imposed upon any person who shall cause an abortion by
violence, but unintentionally.
• Art. 258. Abortion practiced by the woman herself of
by her parents. — The penalty of prision correccional in its
medium and maximum periods shall be imposed upon a
woman who shall practice abortion upon herself or shall
consent that any other person should do so.
• Any woman who shall commit this offense to conceal
her dishonor, shall suffer the penalty of prision correccional in
its minimum and medium periods.
• If this crime be committed by the parents of the
pregnant woman or either of them, and they act with the
consent of said woman for the purpose of concealing her
dishonor, the offenders shall suffer the penalty of prision
correccional in its medium and maximum periods.
• Art. 259. Abortion practiced by a physician or midwife
and dispensing of abortives. — The penalties provided in
Article 256 shall be imposed in its maximum period,
respectively, upon any physician or midwife who, taking
advantage of their scientific knowledge or skill, shall cause an
abortion or assist in causing the same.
• Any pharmacist who, without the proper prescription
from a physician, shall dispense any abortive shall suffer
arresto mayor and a fine not exceeding 1,000 pesos.
3. ALLOCATION OF SCARCE HEALTH RESOURCES
1. Utilitarianism: Maximizing Net Benefits 
Three more or less standard positions regarding the means of
deciding how resources should be allocated have emerged.
The most easily understood position simply answers the
allocation question by reverting to the principles of beneficence
and nonmaleficence—of trying to produce the most good on
balance. This is the answer given by the classical utilitarians
such as Jeremy Bentham2 and John Stuart Mill.3 When trying
to decide between two or more courses of action, the strategy
of utilitarianism would be to count up the amount of good each
course would do for each person and subtract the amount of
harm it would do, thus producing a measure of each
individual’s net benefit. The sum of all of the individual’s net
benefits results in the overall net amount of benefit for each
course of action. The decision maker is morally obligated to
choose the course that produces the most overall good.
2. Libertarianism: Respecting Autonomous Choices 
Whereas one group of ethical theorists insists that resource
allocation questions should be answered simply by calculating
benefits and harms, a second group, holding to libertarianism,
believes that the principle of autonomy—or liberty, as they
sometimes refer to it—provides an important alternative to
allocating based on consequences. Libertarians believe that
resources should be allocated according to the free choices of
those who rightfully own or control them. The utilitarians and
libertarians have in common the fact that they solve resource
allocation problems by appealing to other ethical principles:
beneficence and nonmaleficence in the case of the utilitarians
and autonomy in the case of the libertarians.
3. Justice As an Independent Principles
A third important group of thinkers rejects both of those
answers. These theorists believe that resources should be
allocated according to another principle—the principle of
justice. It is sometimes said that people have a right to health
care, that health care should be allocated on the basis of need,
or that increased equality of health status should be the goal of
resource allocation decisions. These are all rather crude
reflections of the belief that neither maximizing benefits nor
granting total liberty is an adequate way to allocate resources.
4. MANAGEMENT OF PERSONAL HEALTH
INFORMATION
HIPAA - The Health Insurance Portability and Accountability
Act of 1996
4 OBJECTIVES OF HIPAA
1. Assure health insurance portability by eliminating job-lock
due to pre-existing medical conditions.
2. Reduce healthcare fraud and abuse
3. Enforce standards for health information.
4. Guarantee security and privacy of health information
Patient Confidentiality – Refers to the right of patients to
keep their records private
Importance of Patient Confidentiality:
1. Patient confidentiality is necessary for building trust between
patients and medical professionals.
2. Patient will report symptoms honestly
Exceptions to Patient Confidentiality
Patient safety: A healthcare professional can breach patient
confidentiality to protect a patient’s safety
Example:
Melinda, a 15 year old patient, was sent to Ms. Simpson
pediatric nurse practitioner (PNP) due to low hemoglobin. The
patient’s mother expected that her daughter’s low hemoglobin
was due to an ankle fracture that happened 4 months ago.
During the nutrition-counseling session, Melinda confided to
Ms. Simpson that she was 6-weeks pregnant. She also told
Ms. Simpson that she was scheduled to have an abortion the
following week and did not want her mother to know. Ms.
Simpson is concerned about Melinda. She is convinced that
Melinda should not be facing her abortion on her own. But they
live in a state that does not require parental notification for a
minor’s abortion, so Ms. Simpson fears that Melinda’s mother
will never be told.
Public health: If a reported case of an infectious disease puts
public health at risk, healthcare professionals must reveal the
patient’s information for the well-being of the community.
Health outcomes. Healthcare practitioners are permitted to
share information for clinical purposes, such as discussing a
diagnosis with colleagues, referring patients to another facility,
or speaking with a pharmacist.
5. NURSING ROLES AND RESPONSIBILITIES (WHAT
ARE THE ROLES AND RESPONSIBILITES OF
NURSES WHEN DEALING WITH ISSUES STATED
ABOVE)
A. AIDS - Nurses should ‘have the knowledge, skills, and “right
attitude” to be able to respond to the issues in an appropriate,
ethically warranted and just manner’.
Stigmatization and Discrimination
The word stigma comes from the Greek word, meaning a mark
of disgrace or shame.
Stigmatization can lead to discrimination resulting in unequal
or unjust outcomes. HIV-related stigma derives from
association with the ways transmission occurs, such as sex
between men, sharing drug injecting equipment, and sexual
transmission per se.
HIV-related discrimination has been defined as: Unfavorable
treatment on the basis of known or imputed HIV status; action
or inaction that results in people being denied full or partial
access to otherwise generally available services or
opportunities because of known or imputed HIV status.
DIRECT AND ACTIVE (Intentional and Planned) - such as the
placing of alerts on an HIV-positive person’s file, or refusing to
care for a person with HIV.
INDIRECT AND PASSIVE – such as the establishment of
rules, policies or conditions that in themselves do not appear
discriminatory but which result in discrimination against those
who are unable to meet the required conditions.
STRATEGIES FOR NURSES TO ADDRESS
DISCRIMINATION
Quality nursing care aims to provide appropriate non-
discriminatory care and seeks to eliminate prejudicial attitudes.
Strategies nurses can use to help change attitudes and
promote ethical care of people with HIV/AIDS include:
 Role modelling and demonstrating kindness, core
actions to support care that is respectful of human
rights
 Educating other health-care workers and the general
community about HIV and AIDS
 Providing education about the appropriate use of
standard precautions; educational interventions
around HIV-related fear and myths and
misunderstandings about transmission risks
 Leading discussions about ethical issues and
providing an open forum for questions and
clarification of concerns
 Moral consciousness-raising among colleagues about
the effects of stigma and discrimination
B. Confidentiality - Ethical management of information
involves respecting privacy and confidentiality without
compromising health or safety. Considerations for nursing
practice include implementing strategies to avoid inadvertent
breaches of confidentiality – such as:
 Systematic procedures requiring staff check who is
present with the patient when discussing discharge
medications to ensure HIV status is not accidentally
disclosed
 Ascertaining to whom the patient has or has not
disclosed his or her HIV status and documenting this
information
 Using numbers instead of names in waiting rooms
 Informing patients about the limitations to
confidentiality, such as by advising them of the legally
mandated requirement for the nurse to inform child
protection authorities where sexual contact with a
minor is disclosed.
 Disclosure without consent can only be justified
ethically and legally in certain circumstances: if there
is an imminent risk to another person’s health or
safety or if it is directly needed for the treatment or
care of that person, in accordance with local laws.
 Best practice involves creating a supportive
environment in health services, where people can feel
safe and confident in disclosing their HIV status.
C. Abortion - "Women's right to health and well-being must be
protected throughout the lifespan.....During their reproductive
years women need control over their reproductive health
rights."
THE NURSE'S ROLE IN OPTIONS COUNSELLING
 Provide information about all available options
 Be nonjudgmental
 Show support for the woman's decision
  Allow her to explore the consequences of her decision
without interference
 Review what to expect in a normal course in terms of
both physical and emotional symptoms
 Review possible deviations from normal that require
immediate intervention
 Provide adequate information about how and where
to seek continued care, including emotional support
Obtaining Consent
 Explanation of the procedure
 Identification of potential complications
 Procedures that might be required as a result of
complications
NURSING ETHICS AND CONSCIENTIOUS OBJECTION
(ETHICAL RESPONSIBILITY)
A nurse who has conscientious objection to participation in
abortion care has the following responsibilities:
 Inform his or her employer
 Request removal from any non-emergent provision of
care
 "Nurses cannot refuse to provide care for these
women"
Patient's safety and the patient's best interest must be
preserved, even when the nurse experiences conflict with the
patient's own choices.
B. ETHICAL DECISION MAKING PROCESS
In their daily work, nurses must mix their clinical knowledge
with moral judgment ability. The nurse is frequently in the
forefront of recognizing moral conundrums because of her
special contact with the patient and her collaborative practice
with the doctor. The nurse not only recognizes the ethical
dilemma but frequently actively participates in the decision-
making process. The process of nursing and ethical decision-
making are somewhat similar. Every stage of assessment,
planning, implementation, and evaluation involves the nurse
actively participating. As members of hospital ethics
committees, more nurses are formally taking part in ethical
deliberation.
Making decisions in accordance with a code of ethics is the
process of making ethical decisions. Making moral choices
encourages fairness, responsibility, and consideration for
others. Recognizing these circumstances, the ethical decision-
making process calls for weighing all available possibilities,
displacing unethical viewpoints, and selecting the most suitable
ethical alternative. Effective and moral decisions are made.
Good decisions foster respect and trust in interpersonal
relationships and are generally congruent with good behavior.
When decisions accomplish the purpose for which they were
intended, they are effective. A decision that, on the other hand,
has unforeseen consequences is ineffectual and, therefore,
undesirable. Consider all of your options in order to reach your
goals. This is the secret to making wise selections.
Understanding the distinction between short-term and medium-
to-long-term objectives is crucial for this reason. Making ethical
decisions calls for awareness to ethical matters as well as a
process for evaluating all the relevant factors.
Furthermore, the huge amount of medical-scientific information
and the many patient values of contemporary multicultural
societies present one of the greatest problems for medical
practitioners in the age of information technology. A current
framework for use by healthcare professionals aims to align
bioethics, evidence-based practice, and patient-centered care
in order to organize and optimize the decision-making process
(DMP) of seriously sick patient care. The DMP is broken down
into four steps by the framework, each with a distinct but
related emphasis, objective, and ethical tenet:
Step 1: It focuses exclusively on the disease, and having
accuracy is its ethical principle. It aims at an accurate and
probabilistic estimation of prognosis, absolute risk reduction,
relative risk reduction, and treatment burdens.
Step 2: Focuses on the individual, using empathic conversation
to discover the patient's values and the meaning of their
suffering. Instead of doing action, emphasis is placed on
learning and attentive listening. Regarding Step 2 ethical
principles, we value empathy and recognition of the suffering of
others as well as respect for them as free moral agents over
beneficence.
Step 3: The healthcare team is the primary focus, and
situational awareness ethics serve as the steps guiding
principle. The objective is to contextualize and connect disease
rates and probabilities to the learning patient's values through
good cooperation, and to offer a summary of which therapies
the team views as acceptable, suggested, perhaps
inappropriate, and futile.
Step 4: Aims to find shared objectives of care (GOC) for the
best and worst case scenarios while focusing on the provider-
patient connection. It seeks consensus through an ethics of
discourse in order to guarantee that both the patient's values
and a scientifically sound medical procedure will be offered. In
conclusion, the moral principles directing each action would
include precision, comprehension, understanding, situational
awareness, and thoughtfulness.
Lastly, in the ethical decision-making process, the client is the
decision maker in health care if they are competent to do so.