NCM 108 LECTURE (WEEK 8)

Morality of Human Act

HUMAN ACT
Human acts are actions that are deliberately and involve the use of human intellect
or reason. Therefore, they are performed consciously and knowingly. Human acts is the
subject matter of ethics.

Three elements of human act

1. ​Advertens ​– To be considered as human act, a person must know what he is doing. 2.
Volition ​– The person must deliberately will the act or exercise his freewill in wanting to
do the act. Passion such as fear and anger are possible impediments as they cloud a
person’s judgement and freewill
3. ​Execution ​– the way the person do the act.

Double effect: ​Human act with good and bad effects

To be judged as morally good, an action with double effects must meet the following
criteria:
1. The action must be morally good and must not be evil in itself.
2. The good effect must be willed, and the bad effects merely allowed. The person intends
only the good effect and the evil effect, though foreseen and permitted, is not wanted. 3.
The good effect must not come from an evil action but must come from the initial action
itself directly. The good effect must immediately occur after the action is performed or at
least occur simultaneously with the evil effect.
4. The good effect must have the greater effect than the bad effect

MORALS
Are fundamental standards of right and wrong, learned and internalized in early
childhood, often based on religious beliefs.

The moral virtues

1. ​Justice ​– “the virtue that allows man to give his neighbor what rightfully belongs to his
neighbor”
2. ​Temperance ​– “is the virtue that moderates the possible overindulgence of the
concupiscible appetite”
3. ​Fortitude ​– “Is the virtue that gives courage to a man in times of overwhelming odds”.
When the man is faced with hardships. Fortitude enables man to be strong and persist
to attain his goal.
4. ​Prudence ​– Is the virtue of knowing how things are to be done rightly and well.

MORALITY
Morality is a code of values that guide man’s choice and actions. Morality is
concerned with doing what is right with the goodness and badness of man’s action as they
conform to some set of standards imposed by society.
Elements in determining morality
1. ​Object ​– the object is the act itself and is the primary and essential element. Ex. To end
the life of a fetus is the object of abortion.
2. ​End ​– the end is the purpose, intention, motive or the reason for which the act is
performed. Without the purpose the act will not be carried out.
3. ​Circumstance ​– the circumstance are accidental aspects surrounding the act, this factors
are distinct from the act itself and from the purpose but may affect the morality of the
act. It includes place, time, educational background, etc.

PRINCIPLES OF JUDGING MORALITY

1. An act is morally good if the act itself, the purpose and circumstance are substantially
good.
2. If an act is intrinsically evil (evil by its nature), the act is not morally allowable regardless
of the purpose or circumstance.
3. Circumstance may create, mitigate or aggravate the immorality of an act. 4. If the act is
itself good or at least indifferent, its morality will be judged by the purpose and
circumstances.

CONDITIONS AFFECTING MORALITY

1. ​Ignorance ​– Is the absence of intellectual knowledge in a man.
2. ​Fear ​– Is one of the most common passions of man. It is agitation of the mind caused by
the apprehension of impending evil. It ranges from slight disturbance to actual panic. 3.
Concupiscence ​– Are the passion of man which include, love, hatred, joy, grief, desire, etc.
4. ​Violence ​– or coercion. Is external force applied toa person for a purpose of compelling
him to perform an act.
5. ​Habit ​– Act that comes out naturally, undeviating and difficult to change. They are
voluntary at first but when they are engaged repeatedly they become automatic and
done without awareness.

How to develop a good habit:

1. There must be a strong desire or will power to form a habit. The person should have the
initiative to be able to start the habit formation, otherwise, if there is only determination
without implementation, the desire will find no fulfillment. 2. Repetition and uninterrupted
practice must be religiously observed.
3. No exceptions must be tolerated
4. The will must be daily strengthened by small sacrifices, penitential works and all other
acts which tend to strengthen the will

How to eliminate bad habits:

1. There must be a strong desire or will power to break the habit
2. Breaking the habit must be done gradually with no exceptions
3. Following the law of disuse, the person must refrain from performing the bad habit
 4. Find a substitute
MORALITY OF COOPERATION
Man is morally responsible not only for his own actions but also on the effect of his
action to other people as well as his reaction to other men’s action.

TYPES OF COOPERATION WITH EVIL

A. Positive and Negative Cooperation
• ​Positive cooperation – Is voluntarily doing an act which contributes to the evil act of
another.
• ​Negative cooperation – Is cooperation by omission in which the person did not do
anything to prevent to prevent another person from committing an evil act. ​B. Direct
and Indirect Cooperation
• ​Direct cooperation – happens when a person’s cooperation occurs while the act is being
performed.
• ​Indirect cooperation – Is committed before or after the evil act, however, the
cooperation is not necessary for the evil act itself.
C. Formal and Material Cooperation
• ​Formal – Consist of an explicit intention and willingness for the evil act ​• ​Material –
Consist of an act other than evil act itself but facilitates or contributes to its
achievement.

COMMON PRINCIPLE OF HUMAN ACTS

Principle of Stewardship
The principle of stewardship includes but is not reducible to concerns for scarce
resources, rather, it also implies a responsibility to see that the mission of health care is
carried out with its particular commitment to human dignity and common good.

Principle of totality
Refers to preserve intact the physical component of the integrated bodily and
spiritual nature of human life. The whole is greater than any of its part.

Principle of lesser evil

For special case that you are out of options and only have two both bad effects.
You have to choose for a lesser evil.
 LECTURE – NCM108
HEALTH CARE ETHICS (WEEK 10)

CONSCIENCE FORMATION

Conscience ​– ​It is your personal self. We describe conscience as a “little voice” inside our
mind telling us what to do; sometimes we picture conscience as an inner police officer or as
parent tapes.

In moral theology
• ​Conscience is the judgement of the intellect on the goodness or evil of an act performed
or about to be performed.
• ​It is also the judgement on the goodness or evilness of the action, not in the its
usefulness or other practical considerations.

Concepts of conscience
1. ​Heteronomous conscience​ ​– tied to normative ethics, focusing solely on laws and
obligations, commands and prohibitions, in such a way that there is hardly any place for
the conscience to evaluate and decide.
2. ​Autonomous conscience ​– Totally subjective, which ignores the law determines by
itself what is right and wrong.

Levels of Conscience
1. ​Antecedent actual conscience​ ​– the whole process of making a judgement in
conscience before performing moral acts.

Example: For instance I’ve seen a crime, “Am I obliged to give this information to
the proper authorities so they can act upon it?”

2.​ ​Concomitant actual conscience ​– refers to our actual awareness of being morally
responsible for the goodness or the badness of a particular act which we are carrying
it out. In effect, our own conscience informs us that “I am acting in a good way,” or “I
am doing something that is morally reprehensible.”

3.​ Consequent actual conscience –​ involves the process of reflection on one’s

moral responsibility relative to past actions.

Qualities of Conscience

Qualities which refer to a personal freedom

 1. ​Free​ ​– One is able to assume a personal moral stand with regard to a particular attitude,
or moral responsibility for a particular action in a way that is unhindered or unimpeded
2. U​ nfree ​–​ One’s moral attitude or responsibility for a particular action is hindered or
impeded by some obstacles or influences ex. Fear, anger, and force.
Qualities which refer to objective values
1.​ ​Correct ​– One’s subjective perceptions, discernment, dictates and decisions of
conscience are in conformity with the objective moral values and demands that one
is striving to possess and to express in one’s own personal action.
2. ​Erroneous​ ​– there is lack of conformity between the objective values and moral
demands that they carry with them, and one’s subjective moral perceptions,
discernment, dictates, and decisions which an individual has or makes in the habitual
or actual levels of conscience.
3. C ​ ulpable ​– One is in error through one’s own fault, and is therefore responsible for such
an erroneous state of conscience.
4. I​ nculpable ​– One is in error through no fault of one’s own, having erred “in good faith”
while making reasonable attempt to form a correct conscience.
•​ ​Vincible​ ​– Can be corrected of overcome
•​ ​Invincible​ ​– It is not possible to correct the error

Qualities refer to moral attitude

1.​ ​Lax​ ​– Is remiss or careless in its efforts to clearly perceive or internalize particular moral
values.
2. ​Strict ​– When conscience ends to judge moral obligation too harshly, especially in an
excessively legalistic way, adhering more to the letter than the spirit of the law.
3.​ ​Scrupulous​ ​– A conscience that tends to judge sin to be present where, in fact, there is
none.
4. P​ harisaical​ ​– Tends to be self-righteous as for one’s own moral evaluation is concerned,
while tending to be judgmental towards others, making unwarranted conclusions on the
basis of external observance of the law.
5. C ​ lear ​– A conscience which confidently and freely acts and with due regards for
perceiving, appreciating and internalizing true values and making the proper transition
in one’s actual conscience when confronted with a moral decision regarding a particular
way of acting
6. C ​ allous ​– This is the worst type of conscience because it has love sensitivity to sin and
god; as if the person as no conscience at all.

Qualities refer to degree of certitude

1. ​Perplexed​ ​– One judges it to be equally wrong to act in particular way, or to refrain from
acting, and, therefore, one cannot make a morally good choice.
2. ​Doubtful ​– The conscience in its efforts to form a clear conscience on a particular
 attitude or way of acting, lacks sufficient evidence to make or leave a judgment.
3. P​ robable ​– The conscience arrives at a point where it finds security in its own formation
of a moral attitude at the habitual level or of a practical judgement at the actual level,
even while still admitting the possibility that the opposite maybe true.
​ ertain ​– The conscience is able to reach a degree of certainty in its own formation of
4. C
formal judgement so that all practical doubts are resolved
Therefore, the qualities of a fully mature and responsible conscience
are: ​• ​Free
• ​Correct
• ​Clear
• ​Certain

Formation of conscience
Following one’s conscience does not mean doing what one feels like doing. It does mean
to work – often – Hard work – of discerning what is right and what is wrong.

One must try to make sure that one’s moral judgement is right. This can be achieved
by: ​1. Diligently learning the laws of the moral life (through spiritual formation)
2. Seeking expert advice in difficult cases (spiritual direction).
3. Asking God for light (prayer)
4. Removing the obstacles to right judgement: habitual moral disorder or bad habits.
5. Personal examinations of conscience.

Remedies for scrupulous conscience are:

1. Removal of its cause
2. Strict obedience to one’s confessor
3. Orderly and suitable recreation
4. Prayer which increases light
5. Trust in God who is our father

Remedies for Lax Conscience

1. Removing its causes
Usual Cause: Poor moral education, Disorder passion, long time immersion to
vice, dealing with depraved people
2. Frequent sacramental confession and,
3. Asking light from God

Resolving Doubtful Conscience​ – ​We must always strive for a certain conscience before
acting

1.​ Direct solution to doubt​ – Applying general principle to a particular case

and consultation of expert.
 2. ​Indirect solution to doubt ​– use reflex principles
• ​In doubt, the condition of the professor is favored
• ​In doubt, a judgement should be made in favor of an accused favor
• ​In doubt, presumption stands in favor of validity
• ​In doubt, favorable should be amplified and what is unfavorable should be
restricted
• ​A doubtful law does not bind

PATIENT’S BILL OF RIGHTS (WEEK 11)

1. ​Right to Appropriate Medical Care and Humane Treatment. - Every person has a right
to ​health and medical care corresponding to his state of health, without any discrimination and
within the limits of the resources, manpower and competence available for health and medical
care at the relevant time. The patient has the right to appropriate health and medical care of
good quality. In the course of such, his human dignity, convictions, integrity, individual needs
and culture shall be respected. If any person cannot immediately be given treatment that is
medically necessary, he shall, depending on his state of health, either be directed to wait for
care, or be referred or sent for treatment elsewhere, where the appropriate care can be
provided. If the patient has to wait for care, he shall be informed of the reason for the delay.
Patients in emergency shall be extended immediate medical care and treatment without any
deposit, pledge, mortgage or any form of advance payment or treatment.

2. ​Right to Informed Consent. - The patient has a right to a clear, truthful ​and substantial
explanation, in a manner and language understandable to the patient, of ​all proposed
procedures, whether diagnostic, preventive, curative, rehabilitative or ​therapeutic, wherein
the person who will perform the said procedure shall ​provide his name and credentials to the
patient, possibilities of any risk of mortality or ​serious side effects, problems related to
recuperation, and probability of ​success and reasonable risks involved: Provided, That the
patient will not be ​subjected to any procedure without his written informed consent, except in
the following ​ cases:

a) in emergency cases, when the patient is at imminent risk of physical injury, decline ​ ​Of
death if treatment is withheld or postponed. In such cases, the physician ​ ​can perform any
diagnostic or treatment procedure as good practice of medicine dictates ​ ​without such
consent;
b) when the health of the population is dependent on the adoption of a mass health program
to control epidemic;
c) when the law makes it compulsory for everyone to submit a procedure;​ ​d) When the
patient is either a minor, or legally incompetent, in which case. a third party ​ ​consent Is
required;
e) when disclosure of material information to patient will jeopardize the success of
treatment, in which case, third party disclosure and consent shall be in order;​ f) When the
patient waives his right in writing.

Informed consent shall be obtained from a patient concerned if he is of legal age and of sound
mind. In case the patient is incapable of giving consent and a third ​party consent is required.
the following persons, in the order of priority stated ​ hereunder, may give consent:
i. spouse;
ii. son or daughter of legal age;
iii. either parent;
iv. brother or sister of legal age, or
v. guardian

If a patient is a minor, consent shall be ottained from his parents or legal guardian. If next of
kin, parents or legal guardians refuse to give consent to a medical or ​surgical proceoure
necessary to save the life or limb of a minor or a patient incapable of ​giving consent, courts,
upon the petition of the physician or any person interested in the
welfare of the patient, in a summary proceeding, may issue an order giving consent.

3. Right to Privacy and Confidentiality. - The privacy of the patients must be assured at all
stages of his treatment. The patient has the right to be free from unwarranted public exposure,
except in the foHowing cases: a) when his mental or physical condition is in controversy and
the appropriate court, in its discretion, order him to submit to a physical or mental examination
by a physician; b) when the public health and safety so demand; and c) when the patient waives
this right in writing.

The patient has the right to demand that all information, communication and records
pertaining to his care be treated as confidential. Any health care provider or practitioner
involved in the treatment of a patient and all those who have legitimate access to the patient's
record is not authorized to divulge any information to a third party who has no ​concern with
the care and welfare of the patient without his consent, except: a) ​when such disclosure will
benefit public health and safety; b) when it is in the interest of ​justice and upon the order of a
competent court; and c) when the patients waives in writing ​the confidential nature of such
information; d) when it ​is needed for continued medical treatment or advancement of medical
science subject to ​de-identification of patient and shared medical confidentiality for those who
have access to ​ the information.
Informing the spouse or the family to the first degree of the patient's medical condition may
be allowed; Provided That the patient of legal age shall have the right to choose on whom to
inform. In case the patient is not of legal age or is mentally incapacitated, such information
shall be given to the parents, legal guardian or his next of kin.

4. ​Right to Information. - In the course of his/her treatment and hospital care, the patient ​or
his/her legal guardian has a right to be informed of the result of the evaluation of the nature
and extent of his/her disease, any other additional or ​further contemplated medical treatment
on surgical procedure or procedures, including any ​other additional medicines to be
administered and their generic counterpart including the
possible complications and other pertinent facts, statistics or ​studies, regarding his/her illness,
any change in the plan of care before the ​change is made, the person's participation in the plan
of care and necessary ​changes before its implementation, the extent to which payment maybe
expected from ​Philhealth or any payor and any charges for which the patient maybe liable, the
disciplines of ​health care practitioners who will fumish the care and the frequency of services
that are ​ proposed to be furnished.

The patient or his legal guardian has the right to examine and be given an itemized bill of the
hospital and medical services rendered in the facility or by his/her physician and other health
care providers, regardless of the manner and source of payment.He is entitled to a thorough
explanation of such bill.

The patient or hislher legal guardian has the right to be informed by the physician or ​his/her
delegate of hisJher continuing health care requirements following discharge, including
instructions about home medications, diet, physical activity and all other pertinent information
to promote health and well-being.

At the end of his/her confinement, the patient is entitled to a brief, written summary of ​the
course of his/her illness which shall include at least the history, physical examination,
diagnosis, medications, surgical procedure, ancillary and laboratory procedures, and the plan
of further treatment, and which shall be provided by the attending physician. He/she is
likewise entitled to the explanation of, and to view, the contents of medical record of his/her
confinement but with the presence of ​his/her attending physician or in the absence of the
attending physician, the hospital's ​representative. Notwithstanding that he/she may not be
able to settle his accounts by ​reason of financial incapacity, he/she is entitled to reproduction,
at his/her expense, the ​pertinent part or parts of the medical record the purpose or purposes
of which he ​shall indicate in his/her written request for reproduction. The patient shall likewise
be ​entitled to medical certifICate, free of charge, with respect to his/her previous
confinement.
5. ​The Right to Choose Health Care Provider and Facility​. - The patient is free to choose
the ​health care provider to serve him as well as the facility except when he is under the care of
a ​service facility or when public health and safety so demands or when the patient expressly
waives this right in writing.

The patient has the right to discuss his condition with a consultant specialist, at the ​patient's
request and expense. He also has the right to seek for a second opinion and subsequent
opinions, if appropriate, from another health care provider/practitioner.
​ ight to Self-Determination​. - The patient has the right to avail himself/herself of any
6. R
recommended diagnostic and treatment procedures.Any person of legal age and of sound
mind may make an advance written directive for physicians to administer terminal care when
he/she suffers from the terminal phase of a terminal illness: Provided That a) he is informed ​of
the medical consequences of his choice; b) he releases those involved in his care from any
obligation relative to the consequences of his decision; c) his decision will not prejudice public
health and safety.

7. ​Right to Religious Belief. - The patient has the right to refuse medical treatment or
procedures which may be contrary to his religious beliefs, subject to the limitations described
in the preceding subsection: Provided, That such a right shall not be imposed by parents upon
their children who have not reached the legal age in a life threatening situation as determined
by the attending physician or the medical director of the facility.

8. ​Right to Medical Records​. - The patient is entitled to a summary of his medical history and
condition.He has the right to view the contents of his medical records, except psychiatric ​notes
and other incriminatory information obtained about third parties, with the attending ​physician
explaining contents thereof. At his expense and upon discharge of the patient, he ​may obtain
from the health care institution a reproduction of the same record whether or not he has fully
settled his financial obligation with the physician or institution concerned.

The health care institution shall safeguard the confidentiality of the medical records and to
likewise ensure the integrity and authenticity of the medical records and shall keep the same
within a reasonable time as may be determined by the Department of Health.

The health care institution shall issue a medical certificate to the patient upon request.Any
other document that the patient may require for insurance claims shall also be made available
to him within forty-fIVe (45) days from request.

9. ​Right to Leave. ​- The patient has the right to leave hospital or any other health care
institution regardless of his physical condition: Provided. That a) he/she is informed of ​the
medical consequences of his/her decisionl b) helshe releases those involved in his/her ​care
from any obligation relative to the consequences of his decision; c) hislher decision will not
prejudice public health and safety.

No patient shaD be detained against hi$/her will in any health care institution on ​the sole basis
of his failure to fully settle his financial obligations. However, he/she shall ​only be allowed to
leave the hospital provided appropriate arrangements have been made to ​settle the unpaid
bills: Provided. further, That unpaid bills of patients shall be considered ​as loss income by the
hospital and health care provider/practitioner and shall be deducted from gross income as
income loss only on that particular year.
10. R​ ight to Refuse Participation In Medical Research​. - The patient has the right to be
advised ​if the health care provider plans to involve him in medical research, including but not
limited to human experimentation which may be performed only with the written informed
consent of the patient: Provided, That, an institutional review board or ethical review board ​in
accordance with the guidelines set in the Declaration of Helsinki be established for research
involving human experimentation: Provided, further, That the Department of Health shall
safeguard the continuing training and education of fUture health care provider/practitioner ​to
ensure the development of the health care delivery in the country: Provided, furthermore,
That the patient involved in the human experimentation shall be made aware of the provisions
of the Declaration of Helsinki and its respective guidelines.

11. ​RIght to Correspondence and to Receive Visitors.​ - The patient has the right​ ​to
communicate with relatives and other persons and to receive visitors subject to ​ reasonable
limits prescribed by the rules and regulations of the health care institution.

12. ​Right to Express Grievances​. - The patient has the right to express complaints and
grievances about the care and services received without fear of discrimination or reprisal and
to know about the disposition of such complaints.Such a system shall afford all parties
concerned with the opportunity to settle amicably all grievances.

13. ​RIght to be Informed of His Rights and Obligations as a Patient. - Every person has
the ​right to be informed of his rights and obligations as a patient.The Department of Health,in
coordination with heath care providers, professional and civic groups, the media, health
insurance corporations, people's organizations,local government organizations, shall launch
and sustain a nationwide information ​and education campaign to make known to people their
rights as patients, as declared in ​this Act Such rights and obligations of patients shall be posted
in a bulletin board ​ conspicuously placed in a health care institution.

It shall be the duty of health care institutions to inform of their rights as well as of the
institution's rules and regulations that apply to the conduct of the patient while in the care of
such institution.
NURSE’S RIGHTS

Registered nurses promote and restore health, prevent illness, and protect the people
entrusted to their care. They work to alleviate the suffering experienced by individuals,
families, groups, and communities. In so doing, nurses provide services that maintain
respect for human dignity and embrace the uniqueness of each patient and the nature of his ​ ​or her
health problems, without restriction with regard to social or economic status. To ​ m ​ aximize the
contributions nurses make to society, it is necessary to protect the dignity and ​ ​autonomy of nurses
in the workplace. To that end, the following rights must be afforded:
1. Nurses have the right to practice in a manner that fulfills their obligations to society ​ ​and
to those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in ​ ​accordance
with professional standards and legally authorized scopes of practice.​ ​3. Nurses have the
right to a work environment that supports and facilitates ethical ​ p ​ ractice, in accordance
with the Code of Ethics for Nurses with Interpretive ​ ​Statements.
4. Nurses have the right to freely and openly advocate for themselves and their
patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with their
knowledge, experience and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and for their
patients.
7. Nurses have the right to negotiate the conditions of their employment, either as
individuals or collectively, in all practice settings.

Advanced Directives & Bioethics (WEEK 12)

Upon admission to East Liverpool Health System, you or your family member will be asked if you have
made an advance directive. Advance directives are legally valid, written documents to ensure that a
person’s wishes regarding medical treatment – especially the use of life-sustaining treatment – are
respected should they become unable to make and communicate these wishes themselves. Living wills
and durable powers of attorney for healthcare are two types of advance directives, which are
well-defined and recognized under Ohio law.

Living Wills

As defined by Ohio law, a living will:

● becomes effective only when the person is permanently unconscious or terminally ill and unable
to communicate;
● states whether or not a person wishes life-sustaining technology to be used to prolong his or her
existence;
● states whether or not artificial feeding and hydration (water) are to be withheld;
● grants physicians authority to follow the instructions;
● can be revoked or changed by the patient at any time, either in writing or orally;
● gives information about anatomical gifts.
Durable Power of Attorney for Healthcare & Durable Power of Attorney for
Psychiatric Healthcare

Under another type of advance directive, call durable power of attorney for healthcare, a person
designates an individual to make health care decisions should the person become unable to make these
decisions him- or herself. This attorney-in-fact could, for example, give or withhold consent to perform
surgery or other procedures, select or dismiss physicians, order transfer to another medical facility, or
approve a “comfort measures only” order. The document designating health care power of attorney can
incorporate aspects of a living will by including specific statements of the person’s wishes concerning the
use of, for example, ventilators, kidney dialysis, blood transfusions, artificial feeding and hydration.

The durable power of attorney for psychiatric healthcare can name a person to make healthcare
decisions and can designate medication wishes during a psychiatric crisis.

How to Make an Advance Directive

ELCH will keep a copy of your advance directive on file as a permanent part of your medical record. It is a
good idea, however, to make arrangements that, should something happen to you, copies of your
advance directive are given as soon as possible to ambulance workers, emergency room personnel and
your physician.

Comfort Care

When a patient’s heart or breathing stops, it is hospital policy and common medical practice to use
cardiopulmonary resuscitation (CPR) to attempt to save the patient’s life. CPR usually involves airway
resuscitation and chest compressions. Advanced CPR may involve electric shock, opening the airway by
inserting a tube, injection of medications to restart the heart and, in extreme cases, open heart
massage.

Patients wishing to receive all available resuscitation measures are said to have a “full code” status.
ELCH recognizes that not all patients wish to be subjected to resuscitation measure. In accord with Ohio
law, a person wishing an alternative code status could choose either “DNR Comfort Care Arrest
(DNRCC-Arrest)” or “DNR Comfort Care (DNRCC).” Your nurse, the hospital chaplain, a social worker or a
member of the bioethics consultation team can help you decide if you desire to have a code status
related to the withholding of resuscitation measures and which is appropriate for you.

Comfort care code statuses are recognized as being medically and ethically appropriate in circumstances
such as when a patient has a terminal illness. Competent patients have the right to request a comfort
care code status for themselves, or specify such a desire in an advance directive.

Patient Right to Decide

Adult patients who are mentally competent have the right to refuse or accept any medical treatment,
including life-sustaining treatment. In the case of minors under the age of 18 (excepting those legally
emancipated), the wishes of parents or legal guardians will be followed unless there are documented
extenuating circumstances. In the case of adult patients who have made advance directives, their wishes
as thus communicated will be followed should they lose the capacity to make their own decisions. In the
case of adult patients who have not made advance directives, health care decisions are to be made by a
surrogate (a guardian, spouse or near relative) if they become incapacitated.

Hospital Rights & Policy

It is the policy of East Liverpool Health System to provide quality medical care to its patients in
conformity with traditional and current ethical and medical standards, with the objective of sustaining
life, preserving health and easing pain and suffering. The hospital strives to preserve patient dignity at all
times and respects the legally defined rights of patients and their families to participate in the bioethical
decision-making process.

Physician Rights & Responsibilities

A physician may decline to participate in the limitation or withdrawal of treatment from a patient.
However, no physician may withdraw from providing care for that patient until another physician has
agreed to accept the patient. It is the physician’s responsibility to inform a patient and/or the family
about therapeutic options and to thoroughly discuss those options so that an informed decision may be
made.

Bioethics Issues

East Liverpool Health System maintains an active Bioethics Committee. Should you have any questions
regarding medical-ethical concerns, please do not hesitate to request a meeting with a member of the
Bioethics Consultation Team. Simply asking your nurse or nurse supervisor for such a meeting can do
this.

Organ & Tissue Donation

Ohio law requires that all hospitals that receive Medicare or Medicaid funding have a procedure in place
to offer organ donation as an option to families of potential donors. East Liverpool Health System
provides the option to consider such a donation. For every potential donor, the patient’s family may be
approached, at or near the time of death, concerning the possibility of organ and tissue donation. Staff
professionals, who are specially trained to identify potential donors will make such a request and work
with families through the process. If you would like more information, your nurse will help you contact
one of these professionals.

ROLE OF THE NURSE

1.Nurses working in areas where they are frequently providing end-of-life care to terminally or dying
patient should​ seek to improve their knowledge and skills in addressing end of life issue.

2.​Nurses must be culturally sensitive​ as to how every patient’s perception of AD is different.

3.The major role of nurses is not to engage in debates and argument but to​ initiate discussion​ with
dying patients and their families.
4.The nurse must ensure that the patient has sufficient information to be able to fully comprehend his
own medical condition,​ all treatment options available, including their risk and benefits, and the
consequences and benefits.

5​.Proper Documentation.

6.The nurse must ensure that the patient know his rights with regards to AD such as:

● Inform those concerned on a need to know basis

● Change his AD anytime he wants

7.When the patient's AD is disregarded, ​Nurses can advocate for the patients​ by contacting the
hospital’s ethics committee.

8​.The nurse must be familiar with the law and institutional policies regarding AD.