TOPIC 1: VIRTUES, HABITS, AND VICES OF A HEALTH CARE PROVIDER - Nurses should be sensitive to their patients  Operative habits

should be sensitive to their patients
VIRTUES OF A HEALTH CARE PROVIDER:
o VIRTUES – The faculty of the human person to choose what is good against what is deemed to
be bad or evil
 Fidelity
- Derived from the Latin word fidelitas which means faithfulness
- Faithfulness to one’s obligations, duties and responsibilities
- Purtillo (2005) lists five expectations associated with what patients might reasonably
expect in terms of fidelity in the health care context:
1. That you treat them with basic respect.
2. That you, the caregiver or other health care professional, are competent and capable
of performing the duties required of your professional role.
 Operative habits such as science or humaneness are good because they orient the
 Prudence
- An exercise of good judgment, common sense, and caution in the conduct of practical
matters
- The overarching virtue that ties together discretion, foresight, forethought, and
TOPIC 2: BASIC BIOETHICAL PRINCIPLES
circumspection
- Being careful to avoid embarrassing and distressing situations
 Courage
- The quality of mind or spirit that enables a person to face difficulty, danger, and pain
without fear
- Nurses are expected to be bold in undertaking a very sensitive job
- Allows the nurse to face the challenges and dangers of the healthcare profession:
 NURSES TAKING CARE OF COVID-19 PATIENTS
intellect and will respectively toward activities that are desirable;
 error and selfishness on the other hand are bad dispositions because they organize
mind and will toward actions that are negative and undesirable
o Stewardship – “Man comes from nothing for man to be something.”
- Only GOD can create life; humans are capable only of manipulating or destroying it.
- Along with the gift of LIFE, GOD also gave intellect (to discover the truth) and freedom
(humans became creative).
- In as much as life cannot survive on its own without being rooted to something that can
sustain its survival and development, the Divine Author provided humans a place to dwell
(World).

3. That you adhere to a professional code of ethics.  TAKING CARE OF A DYING PERSON - Humans must uphold a solemn conviction that life & the world are gifts from the love &

4. That you follow the policies and procedures of your organization and applicable  ASSISTING DURING CODE BLUE mercy of God.

laws. o VICES - Explains that God is the creator of the earth and our human body; we are made to take care of

5. That you will honor agreements made with the patient.
THE NIGHTINGALE’S PLEDGE:
- I solemnly pledge myself before God and in the presence of this assembly, to
pass my life in purity and to practice my profession faithfully. I will abstain
from whatever is deleterious and mischievous, and will not take or knowingly
administer any harmful drug. I will do all in my power to maintain and elevate
the standard of my profession, and will hold in confidence all personal matters
committed to my keeping and all family affairs coming to my knowledge in the
practice of my calling. With loyalty will I endeavor to aid the physician, in his
work, and devote myself to the welfare of those committed to my care.
 Honesty
- Derived from the Latin word honestus which means honor
- A nurse is supposed to be sincere, truthful, straightforward, decent, comely (pleasing
appearance), tidy, open, upright, virtuous, trustworthy, fair, honorable, creditable, and of
good moral character
- A nurse should not cheat or steal anything from his/her patient
 Integrity
- Comes from the Latin word enteros which means whole
- Makes a human person complete
- A nurse practices integrity when he/she does his/her duties and obligations according to
the beliefs, principles, and values he/she claims to embrace
- Free from hypocrisy.
 Humility
- Humility does not mean that one has to think less of himself/herself; rather, it invites one
to think of himself/herself less.
- A nurse ceases to think of his/her own needs as he/she transcends his/her attention to the
needs of the patients
 Respect
- An act through which one takes notice of others
- Regard other with special attention, esteem, and care, or to consider other worthy of
esteem and honor
- Patients are also bound to respect nurses
- Acknowledge the feelings, beliefs, convictions, status, and condition of the patient
 Compassion
- A feeling of deep sympathy and sorrow for someone struck by misfortune, accompanied
by a desire to alleviate the suffering
them therefore we don’t have the right to destroy or use it for our immoral act.
- Derived from the Latin word vitium which means failing or defect
- We must be morally responsible for God's creation for we are just its caretaker.
- The product of a repeated sinful act
- Requires that the gifts of human life and its natural environment be used with profound
- Immoral, depraved, or degrading act to all the members in a given society
respect for their intrinsic ends.
- Defect, infirmity, fault, iniquity, offence, wickedness or corruption
- Simply because something can be done does not necessarily mean that it should be done (the
 Fraud
fallacy of the technological imperative).
- False representation of fact
- Deliberate deceit; trickery; an intentional perversion of truth for the purpose of inducing PRINCIPLE OF STEWARDSHIP:
another in reliance upon it to part with some valuable thing belonging to him, or
 Humans must respect the sanctity of life and the world.
surrender a legal right
 They have no authority over life and the world.
 tampering patient’s medical record or willfully changes data in the patient’s record
 The God-given gifts of the environment and humanity are placed in the care of people.
 Signing in a medication sheet even if the medication was not given
 In consonance with the obligation to take care of the world (Martin Heidegger: “Humans
 Not returning patients medication prior to discharge
are the shepherds of being in the world”), a commitment should also be made to take care
 Using another’s account in accessing patient’s record
of the body, mind, & freedom.
 Pride
 Human life comes from GOD, and no individual is the master of his/her own body.
- A feeling of gratification arising from association with something good or laudable
 Humans are mere stewards or caretakers, with the responsibility of protecting and
- A high or inordinate opinion of one’s own dignity, importance, merit, or superiority;
cultivating spiritual and bodily functions.
conceit; arrogance
 As stewards of life and the divine gifts of nature, humans are accountable to life and the
- Egoism or vanity and often apply to offensive characteristics
world.
 A nurse supervisor reprimanding the staff nurse in front of the other staff nurses and
doctors in the station PRINCIPLE OF TOTALITY:
 A staff nurse shouting at her patient because the patient couldn’t understand her
o TOTALITY – pursues the issue of the dignity of the whole person, in essence of the integrity of
instruction
human life.
 Greed
- Demands respect for the self and respect for others.
- Comes from the Latin word avaritia which means avarice or covetousness
- Respect is never a cause but always an effect.
- Excessive desire for wealth or possessions
- Golden Rule:
- Example: Nurse stealing patient’s medication for personal use
 “Do unto others what you want others do unto you.”
o HABITS – types:
- Respect of the self and others in a condition sine qua non (something essential) in a given
1. Entitative Habit social order.
- habits of being; connatural qualities - As a member of a given society, every individual is duly accountable for the whole society.
- those that arise out of the nature and structure of ourselves, that are necessary parts or - This is why legislators draft and pass laws to punish violators of the dignity and value of
propensities arising from our constitution human life.
 (GOOD HABITS) includes: HEALTH - STRENGTH - BEAUTY  These laws encompass everyone.
2. Operative Habit - Principle of totality can also be applied to the human body.
- habits of acting; tendencies we have developed in ourselves from repeated acts  Person has the right to cut off, or remove defective, non-functioning part of his body on
- those that can be acquired or relinquished the premise that the intention is meant to safeguard the totality of the well-being of the
- It can be a good or bad habit body.
 - Principle of totality can also be seen in the context of the journey of human life, from
conception to the time of death.
 For contemporary fetal psychologists (DiPietro, Als, De Casper, Lecanuet and Devlin),
human behavior does not begin at birth but 5 wks. after conception where the embryonic
cell has come to terms of forming a human development.
- As early as 5 wks., the fetus’s cerebral cortex is already showing vital signs of development
(grow, move, think, speak, plan, and create as a human being).
- As early as 9 wks. of gestation, fetus can perform the following:
1. He/she can hiccup
2. Can react to loud noises
3. Can hear, feel, smell
4. Experience rapid eye movement
5. Capable of yawning, sucking, swallowing
6. Can savor mother’s meals
7. Can distinguish between the voice of mother and that of a stranger
8. Can walk around the womb by pushing his/her feet
- Refers to the duty to preserve intact the physical component of the integrated bodily and
spiritual nature of human life.
o INTEGRITY
- Refers to each individual’s duty to preserve a view of the whole human person in which the
values of the intellect, will, conscience, and fraternity are pre-eminent.
- Being honest & fair
- Incorruptible.
TOTALITY AND INTEGRITY:
- These principles dictate that the well-being of the whole person must be taken into account in
deciding about any therapeutic intervention or use of technology.
o DOUBLE-EFFECT ACT:
- St. Thomas Aquinas recognized that there are times when the action one thinks one ought to
do will have good and bad effects.
- Indirect Voluntariness, or voluntary in causa, refers to an act desired not as an end in itself
but as a foreseen effect or consequence of an act.
- Two problems presented:
1. When can the agent be responsible for the evil effect of a cause directly willed?
 3 conditions:
a. If the agent foresees the evil effect at least in a general way.
b. If the agent is free to refrain from doing that which is the cause of the evil effect
c. If the agent knows that he is morally bound not to do that which is the cause of
the evil effect.
2. When can the agent perform an act not evil in itself, but bears two effects, one good,
TOPIC 3: MAJOR ETHICAL PRINCIPLES
the other, evil.
 4 conditions must be present:
a. Action must be morally good in itself.
b. The good effect of the act must precede the evil effect which is morally allowed
to happen as a regrettable consequence.
c. There must be a grave or sufficient reason in doing the act.
d. The evil effect should not outweigh the good effect, or at least the good effect is
at least equivalent in importance to the bad effect.
o COOPERATION
- Developed as a way of helping individuals discern how to properly avoid, limit, or distance  Justice
themselves from evil (especially intrinsic evil) in order to avoid a worse evil or to achieve an - The secondary ethical principles that can be incorporated with the primary principles when
important good. interpreting ethical issues and making clinical decisions are the following:
 FORMAL COOPERATION – occurs when a person or organization freely participates  Veracity
in the action(s) of a principal agent, or shares in the agent’s intention, either for its own  Confidentiality
sake or as a means to some other goal.  Fidelity
 IMMEDIATE MATERIAL COOPERATION
- Occurs when the cooperator participates in circumstances that are essential to the
commission of an act, such that the act could not occur without his participation.
- Immediate material cooperation in intrinsically evil actions is morally illicit.
 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 PRIMARY AND BASIC ETHICAL PRINCIPLES:
cooperation.
RESPECT FOR PERSONS:
o SOLIDARITY
- Invites us to consider the “how we relate to each other in community.” - According to the American Nurses Association (ANA), the most fundamental principle of
- It assumes that we recognize that we are a part of at least one family – our biological family, professional behavior is the respect for persons. This principle not only applies to the clinical
our local community, or our national community – but then challenges us to consider the full settings but to all life’s situations.
range of relationships with others. - This principle emphasizes that all people should treat others as a worthy individual.
- Requires us to consider an extended community, and to act in such a way that reflects - In nursing practice this principle should be simplified. Thus, respect for persons generally means
concern for the well-being of others. respecting a client’s autonomy.
o PROPORTIONATE AND DISPROPORTIONATE MEANS:  Respect for autonomy
- Holds that one is obliged to preserve his or her own life by making use of ordinary means, - Respecting a client’s rights, values and choices is synonymous to respecting a
but is under no obligation to use extraordinary means. person’s autonomy. Informed consent is a method that promotes and respects a
 PROPORTIONATE MEANS – any treatment that, in the given circumstances and in person’s autonomy.
the judgment of the patient or the patient’s surrogate, offers a reasonable hope of benefit - For a client to make an autonomous decision and action, he or she must be offered
and is not too burdensome for the patient or others. enough information and options to make up his or her mind free of coercion or
 DISPROPORTIONATE MEANS – any treatment that, in the given circumstances and external and internal influences.
- In clinical settings, this is promoted by proving informed consent to the client.
in the judgment of the patient or the patient’s surrogate, either offers no reasonable hope
of benefit or is too burdensome for the patient or others. AUTONOMY:
o COMMON GOOD
- Any notion of moral decision-making assumes that rational agents are involved in making
- Consists of all the conditions of society and the goods secured by those conditions, which
informed and voluntary decisions.
allow individuals to achieve human and spiritual flourishing.
- The capacity to act intentionally, with understanding, and without controlling influences that
- The human community must be actively concerned in promoting the health and welfare of
would mitigate against a free and voluntary act.
every one of its members so that each member can contribute to the common good of all.
- Having the freedom to make choices about issues that affect one’s life
- Three essential elements:
- Self-governing
1. Respect for persons.
- Contrast undesirable states: dependency, coercion, paternalism, thoughtlessness, habit
2. Social welfare.
- Personal liberty of action
3. Peace and security.
- Self-determination
o SUBSIDIARITY – requires those in positions of authority to recognize that individuals have a
- Independence
right to participate in decisions that directly affect them, in accord with their dignity and with
- Self- reliance
their responsibility to the common good.
- Freedom of choice
- Ability to make decisions
o Ethical Principles FOUR BASIC ELEMENTS:
- The ethical principles provide a foundation for nursing practice. Ethical principles are defined
1. The autonomous person is respected.
as basis for nurse’s decisions on consideration of consequences and of universal moral
2. The autonomous person must be able to determine personal goals.
principles when making clinical judgments
3. The autonomous person has the capacity to decide on a plan of action.
- The most fundamental of these principles is the respect for persons.
4. The autonomous person has the freedom to act upon the choices.
- The primary and basic ethical principles are the following:
 Respect for autonomy VIOLATIONS OF PATIENT AUTONOMY:
 Nonmaleficence
1. Nurses may falsely assume that patients have the same values and goals as themselves.
 Beneficence
2. Failure to recognize that individuals’ thought processes are different.
 3. Assumptions about patients’ knowledge base. 1. Do or promote good.
4. The “work” of nursing becomes the major focus. 2. Prevent harm – “The nurse takes appropriate action to safeguard individuals, families and
communities when their care is endangered by a co-worker or any other person.”
INFORMED CONSENT:
3. Remove evil or harm – Steps include: expressing concern to the person carrying out the
- Patients are informed of the possible outcomes, alternatives, and risks of treatments, and are questionable practice and reporting the practice to the appropriate authority within the situation.
required to give their consent freely - Beneficence is doing or active promotion of good. This is done by:
- Assures the legal protection of patient’s right to personal autonomy in regard to specific  Providing health benefits to the clients.
treatments and procedures  Balancing the benefits and risks of harm.
 Considering how a client can be best helped.
PATERNALISM:
 Justice
- Translates to professionals who restrict others’ autonomy, usually to protect that person from - Defined as a form of fairness, or as Aristotle once said, "Giving to each that which is
perceived or anticipated harm. his due.”
 There must be a sufficient reason why the autonomy of the individual must be restricted - Fair, equitable, and appropriate treatment in light of what is due or owed to persons.
- It is appropriate when a patient is incompetent and has diminished decision-making capacity - This implies the fair distribution of goods in society.
 Nonmaleficence - It is generally held that persons who are equal should qualify for equal treatment.
- DO NO HARM.
SECONDARY PRINCIPLES OF ETHICAL CONDUCT:
It is the duty to help others further their important and legitimate interests
when we can do so with minimal risk to ourselves.  Veracity – duty to tell the truth
Requires that we do not intentionally create a needless harm or injury to the  Confidentiality – duty to respect privileged information
patient, either through acts of commission or omission.  Fidelity – duty to keep promises
Avoid negligent & harmful care.
Included in this principle are deliberate harm, risk of harm, and harm that
occurs during the performance of beneficial acts
Articulates a fundamental commitment on the part of health care
professionals to protect their patients from harm.
Do no harm includes: Deliberate harm. - Risk of harm. - Harm that
occurs during performance of beneficial acts.
- Nonmaleficence means duty to do no harm. This is promoted by doing the
following nursing interventions:
Avoiding deliberate harm, risk of harm that occurs during the performance of
nursing actions.
Considering the degree of risk permissible.
Determining whether the use of technological advances provides benefits
that outweigh risks.

NEGLIGENCE:

- The legal criteria for determining negligence are as follows:

1. The nurse must have a duty to the patient.
2. The nurse must breach that duty.
3. The patient must experience harm.
4. The harm must be caused by the breach of duty.
 Beneficence
- The duty of health care providers to be of a benefit to the patient, as well as to
take positive steps to prevent and to remove harm from the patient.
- Applied both to individual patients, and to the society as a whole.
- Abstain from injuring others.
- Practice of doing good deeds, or showing kindness & charity to others.
- Taking actions that will promote the welfare of other people.
- It is the duty to help others further their important and legitimate interests when
we can do so with minimal risk to ourselves.
- Requires nurses to act in ways that benefit patients---beneficent acts are morally
and legally demanded by our professional role.

THREE MAJOR COMPONENTS: