HEALTH ETHICS

INSTRUCTOR – JENELYN V. NAPURAN

Ethical Principles
Autonomy
• Refers to personal self- governance or those that pertain to personal rule of the self by
adequate understanding while remaining free from being controlled by others or by one’s
own limitations that may prevent one from making choices.
• Implies independence and firmness in one’s conviction, perspective, or personal stance.
PRINCIPLE OF AUTONOMY
• Healthcare providers are duty-bound to acknowledge the autonomy of their patients; they
have to recognize and appreciate the views, decisions, choices, beliefs and values of their
patients.
• “Autonomy of action should not be subjected to controlling constraints by others”.
( Beauchamp and Walters)
• The patient has the right to determine his/her destiny; he/she may refuse medical
interventions even treatment, if he/she wishes.
PRINCIPLE OF AUTONOMY
Principle of autonomy is anchored on the deontological ethics of Immanuel Kant. Kant accords
and vests individuals the right for self governance , self direction, and self control. • Personal
accountability
PRINCIPLE OF AUTONOMY
As a person, a patient has the right to be treated as a subject whose stature is that of a rational
individual endowed with self-determination. Thus, a patient can refuse participation in a
medical research that may involve his illness, his behavior, or the effects of medication in his
body.
➢ Principle respect for autonomy
• Nurses and other healthcare providers are mandated to respect what their patients want
with themselves; these involve their bodies and health conditions.
Dilema on blood transfusion –Jehovah‘s Witness

Patient Rights
are those basic rule of conduct between patients and medical caregivers as well as the
institutions and people that support them
Patient Rights
• The right to be treated with Respect
All patients , regardless of their means or health challenges, should expect to be treated
respectfully and with discrimination by their providers, practitioners and payers. •
The right to obtain medical records
This provides patients a right to obtain their medical records, including doctors’ notes, medical
test results and other documentation related to their care.
• The right to privacy of medical records
This is also outlines who else , besides you ( the patient), may obtain your records, and for what
purposes. Patients are often surprised about who has these rights.
• The right to make a treatment choice
As long as a patient is considered to be of sound mind, it is both his right and responsibility to
know about the options available for treatment of his medical condition and then make the
 HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN

choice he feels is right for him. This right is closely associated with the right to informed
consent.
• The right to informed consent
No reputable practitioner or facility that performs tests, procedures or treatments will do so
without asking the patient or his guardian to sign a form giving consent. This document is called
“informed consent” because the practitioner is expected to provide clear explanations of the
risks and benefits prior to the patient’s participation, although that does not always happen as
thoroughly as it should.
• The right to refuse treatment
A patient may refuse treatment as long as he is considered to be capable of making sound
decisions, or he made that choice when he was of sound mind through written expression( as is
often the case when it comes to end-of-life care. This includes the right to refuse surgery. • The
right to make decisions bout end-of-life care
All over the country govern how patients may make and legally record the decisions they make
about how their lives will end, including life-preserving measures such as the use of feeding
tubes or ventilators .

Patient’s Bill of Rights

A patient's bill of rights is a list of guarantees for those receiving medical care. It may take the
form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees
patients information, fair treatment, and autonomy over medical decisions, among other rights.

PATIENTS BILL OF RIGHTS

1. The patient has the right to considerate and respectful care.

2. The patient has the right to obtain from his physician complete and current information
concerning his diagnosis, treatment, and prognosis in terms the patient can reasonably
expect to understand.
3. The patient has the right to receive from the physician information necessary to give
informed consent prior to the start of any procedure and/or treatment.
4. The patient has the right to refuse treatment and to be informed of the medical
consequences of his action.
5. The patient has the right to every consideration of his privacy concerning his own
medical care program.
6. The patient has the right to expect that all communications and records pertaining to his
care should be treated as confidential.
7. The patient has the right to expect within its capacity, a hospital must take reasonable
response to the request of a patient for service.
8. The patient has the right to obtain information as to any relationships his hospital has to
other health care and educational institutions insofar as his care is concerned. 9. The patient
has the right to be advised if the hospital propose to engage in or perform human
experimentation affecting his care or treatment.
10. The patient has the right to expect reasonable continuity of care
HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN
 11. The patient has the right to examine and receive an explanation of his bill. 12. The
patient has the right to know what hospital rules and regulations apply to his conduct as a
patient.

Informed Consent
➢ It is the right and responsibility of every competent individual to advance his or her own
welfare. This right and responsibility is exercised by freely and voluntarily consenting or
refusing consent to recommended procedures, based on a sufficient knowledge of the
benefits , burdens, and risk involved.

Informed Consent depends on:

1. Adequate disclosure of information
2. Patient freedom of choice
3. Patient comprehension of information ;
4. Patient capacity for decision- making.

Necessary conditions are satisfied:

1. That the individual’s decision is voluntary
2. That this decision is made with an appropriate understanding of the circumstances 3.
That the patient’s choice is deliberate in so far as the patient has carefully considered all of
the expected benefits, burdens, risks and reasonable alternatives

Legally, adequate disclosure includes information concerning the ff:

1. Diagnosis
2. Nature and purpose of treatment
3. Risks of treatment
4. Treatment alternatives

PROXY CONSENT
➢is the process by which people with the legal right to consent to medical treatment for
themselves or for a minor or a ward delegate that right to another person.

There are three fundamental constraints on this delegation:

1.The person making the delegation must have the right to consent.
2.The person must be legally and medically competent to delegate the right to
consent. 3.The right to consent must be delegated to a legally and medically
competent adult.

There are two types of proxy consent for adults

1. The first, the power of attorney to consent to medical care, is usually used by patients who
want medical care but are concerned about who will consent if they are rendered temporarily
incompetent by the medical care. A power of attorney to consent to medical care delegates the
right to consent to a specific person.
2. The second type is the living will.
HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN

Confidentiality
 Law and ethics state that the doctor-patient interaction should remain confidential. The
physician should never reveal confidential information unless the patient wants this information
disclosed to others, or unless required to do so by law. If the release of information is
warranted, information should be released in the form of an official signed document

VERACITY
Truth telling
is the principle of truth telling, and it is grounded in respect for persons and the concept of
autonomy. In order for a person to make fully rational choices, he or she must have the
information relevant to his or her decision.

Fidelity
The principle of fidelity broadly requires that we act in ways that are loyal. This includes keeping
our promises, doing what is expected of us, performing our duties and being trustworthy.

Role fidelity
five expectations associated with what patients might reasonably expect in terms of fidelity in the
health care context:
• That you treat them with basic respect.
• That you, the caregiver or other health care professional, are competent and capable of
performing the duties required of your professional role.
• That you adhere to a professional code of ethics.
• That you follow the policies and procedures of your organization and applicable laws. •
That you will honor agreements made with the patient.

Justice

requires that we act in ways that treat people equitably and fairly. Actions that discriminate
against individuals or a class of people arbitrarily or without a justifiable basis would violate this
basic principle.

Types of Justice
Distributive Justice

Methods for the Distribution of Goods and Services

• To each person an equal share
• To each person according to individual need
• To each person according to acquisition in free market( ability to pay) •
To each person according to individual effort ( benefits)
• To each person according to societal contributions ( retirement system) •
To each person according to merit ( jobs and promotions)
HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN

Contributive Justice
Which refers to what individuals owe to society for the common good .
General Legal Justice
Refers to a human person’s wishes and proper actions in consonance with the common good.
This kind of justice has affinity to laws since laws are made not only for the good of certain
individuals, but for the good of the whole community.
The obligations of the government to it's citizens and society.
Ex. Human person judges, wills, and does what is right to others, not necessarily from the
injunction of the moral law, but from civil law.

Particular Legal Justice

Pertains to wishing and doing what is right in relation to another person who is accounted as an
individual with an inherent right to his/her own private good.

Commutative Justice
Deals with the fairness of exchange
This kind of justice exists in the relationship between individuals or between entities, like
nations or corporations,

Beneficence
Suggest acts of mercy and charity, although it certainly may be expanded to include any action
that benefits another.
Is an ethical principle that addresses the idea that a nurse's actions should promote good. Doing
good is thought of as doing what is best for the patient.

There are 2 aspects of beneficence:

1. Providing benefits
2. Balancing benefits and risks/harms.

The principle of beneficence supports the following moral rules or

obligations: 1. Protect and defend the rights of others.
2. Prevent harm from occurring to others.
3. Remove conditions that will cause harm.
4. Help persons with disabilities.
5. Rescue persons in danger.

Nonmaleficence

The principle of nonmaleficence holds that there is an obligation not to inflict harm on others. It
is closely associated with the maxim primum non nocere (first do no harm). states that we
should act in ways that do not inflict evil or cause harm to others. In particular, we should not
cause avoidable or intentional harm. This includes avoiding even the risk of harm.
HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN

The principle of nonmaleficence supports the following rules:

1. Do not kill.
2. Do not cause pain or suffering.
3. Do not incapacitate.
4. Do not cause offense.
Principle of Double Effect

an action that is good in itself that has two effects- an intended and otherwise not reasonably
attainable good effect, and an unintended yet forseen evil effect, -is licit, provided there is a due
proportion between the intended good and the permitted evil.

Basic Moral Criteria

1. The object of the act must not be intrinsically contradictory to one’s fundamental
commitment to god and neighbor ( including oneself) , that is, it must be good action
judged by its moral object( in other words, the action must not be intrinsically evil);

2. The direct intention of the agent must be to achieve the beneficial effects and to avoid the
foreseen harmful effects as far as possible. That is, one must only indirectly intend the
harm.
3. The forseen beneficial effects must not be achieved by the means of the forseen harmful
effects, and no other means of achieving those effects are available.
4. The forseen beneficial effects must be equal to greater than the forseen harmful effects
( the proportionate judgment)
5. The beneficial effects must follow from the action at least as immediately as do the harmful
effects.
6.
Principle of Legitimate Cooperation

Cooperation in the ethically significant sense is defined as the participation of one agent in the
activity of another agent to produce a particular effect or share in a joint activity. This becomes
ethically problematical when the action of the primary agent is morally wrong.

Formal Cooperation
when a person or organization freely participates in the action(s) of a principal agent, or shares in
the agent’s intention, either for its own sake or as means to some other goal. Formal cooperation
in intrinsically evil actions, either explicitly or implicitly, is morally illicit.

Implicit Formal Cooperation

occurs when, even though the cooperator denies intending the object of the principal agent, the
cooperating person or organization participates in the action directly and in such way that it
could not be done without this participation.

Immediate Material Cooperation

HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN

occurs when the cooperator participates in circumstances that are essential to the commission of
an act, such that the act could not occur without this participation.

Mediate Material Cooperation

Occurs when the cooperator participates in circumstances that are not essential to the commission
of an action, such that the action could occur even without this cooperation.
Mediate material cooperation in an immoral act might be justifiable under three basic
conditions:
1. If there is a proportionately serious reason for the cooperation ( for the sake of protecting
an important good or for avoiding a worse harm); the graver the evil the more serious a
reason required for the cooperation.

2. B. the importance of the reason for cooperation must be proportionate to the causal
proximity of the cooperator’s action to the action of the principal agent( the distinction
between proximate and remote);
3. C. The danger of scandal( leading others into doing evil, leading others into error , or
spreading confusion) must be avoided.

Principle of Subsidiarity
is a principle of social organization that holds that social and political issues should be dealt with
at the most immediate (or local) level that is consistent with their resolution. Often considered a
corollary of the principles of the common good, subsidiarity requires those in positions of
authority to recognize that individuals have a right to participate in decisions that directly affect
them, in accord with their dignity and with their responsibility to the common good. Decisions
should be made at the most appropriate level in a society or organization, that is, one should not
withdraw those decisions or choices that rightly belong to individuals or smaller groups and
assign them to a higher authority..
Principle of Subsidiarity
However, a higher authority properly intervenes in decisions when necessary to secure or protect
the needs and rights of all. The principle implies that, when a decision is to be made, we should
identify the most appropriate forum and level of decision making, and how best and to what
degree those individuals most affected should participate in the decision making process.

Principle of Solidarity
Solidarity means to be one with others. In the provisions of healthcare, it is most important for
the provider to be in solidarity with the patient when seeking, always the latter’s best interest.
PRINCIPLE OF STEWARDSHIP
➢ Requires us to appreciate the two great gifts that a wise and loving God has given: the
earth, with its biological, psychological, social and spiritual capacities.
HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN

➢ This principle is grounded in the presupposition that God has absolute Dominion over
creation, and that, in so far as human beings are made in God’s image and likeness (Imago
Dei) , we have the limited dominion over creation and are responsible for its care.
➢ The principle requires that the gifts of human life and its natural environment be used with
profound respect for their intrinsic ends. The gift of human creativity especially should be
used to cultivate nature and the environment, recognizing the limitations of our actual
knowledge and the risks of destroying these gifts.
➢ The principle of stewardship includes but is not reducible to concern for scarce resources,
rather, it also implies a responsibility to see that the mission of Catholic health care is
carried out as ministry with its particular commitment to human dignity and the common
 good.

Principles of Stewardship and Role of Nurses as Stewards

1. Personal
2. Social
3. Economical
4. Biomedical

Principle of Totality and its Integrity

These principles dictates that the well-being of the whole person must be taken into account in
deciding about any therapeutic intervention or use of technology. Therapeutic procedures that are
likely to cause harm or undesirable side effects can be justified only by a proportionate benefit to
the patient.
INTEGRITY
refers to each individuals duty to “preserve a view of the whole human person in which the
values of the intellect, will, conscience and fraternity are pre-eminent”
TOTALITY
refers to the duty to preserve intact the physical component of the integrated bodily and spiritual
nature of human life, whereby every part of the human body “exists for the sake of the whole as
the imperfect for the sake of the perfect”.

The Ethical Responsibilities of Nurses

Nurses must maintain professional competency by continuing their education and participating
in professional development. The ethical responsibilities of nurses include promoting health,
preventing disease and alleviating suffering.

Mutilation

Mutilation or maiming is cutting off or injury to a body part of a person so that the part of the
body is permanently damaged, detached or disfigured.
HEALTH ETHICS
INSTRUCTOR – JENELYN V. NAPURAN

They suggested that dismemberment involves “the entire removal, by any means, of a large
section of the body of a living or dead person, specifically, the head (also termed decapitation),
arms, hands, torso, pelvic area, legs, or feet.” Mutilation, by contrast, involves “the removal or
irreparable disfigurement, by any means, of some smaller portion of one of those larger sections
of a living or dead person. The latter would include castration (removal of the penis),
evisceration (removal of the internal organs), and flaying (removal of the skin).”

Sterilization
is a procedure that closes or blocks your fallopian tubes so you can’t get pregnant. (Your tubes
are where eggs and sperm meet.) Guys also have a sterilization option—a vasectomy blocks the
tubes that carry a man’s sperm.
Organ Donations
➢ The Department of Health (DOH) is encouraging families to consider organ donation of
deceased relatives, including those who have been declared legally and medically brain
dead, to help others in need of transplantation.
➢ With the passage of Republic Act No. 7170, otherwise known as the Organ Donation Act
of 1991, as amended by Republic Act No. 7885, organ and tissue donations from donors
who have been declared brain dead has been allowed.
➢ Human transplantable organs include the kidneys, liver, lungs, heart, intestines, and
pancreas, in addition to human tissues such as eye tissues (corneas, sclera, etc.), bones,
skin, and blood vessels.