Condes-K BioEthics Module2

no universal moral rules or rights REPUBLIC OF THE PHILIPPINES
NORTHERN NEGROS STATE COLLEGE OF SCIENCE AND

TECHNOLOGY
OLD SAGAY, SAGAY CITY, NEGROS OCCIDENTAL
(034)722-4169/www.nonescost.edu.com
COLLEGE OF
NURSING AND
ALLIED HEALTH
SCIENCES
COURSE MODULE IN
BIOETHICS
1st Semester; A.Y. 2021 – 2022
COURSE FACILITATOR: KRISTINE A. CONDES, RN, LPT, MN
FB/MESSENGER: Kristine Acanto Condes
Email: kcondes@nonescost.edu.ph
2
Phone No: 09338154712
This document is a property of NONESCOST

Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) MODULE Module 2 | Page 1
Prepared by: Kristine A. Condes, RN, LPT, MN
VISION
SUN-NEGROS: A glocally recognized university offering distinctively – niched academic
programs engaged in dynamic quality instruction, research and extension by 2025.
MISSION
To produce glocally viable graduates through innovative learning and research environment and
to contribute to nation – building by providing education, training, research and resource
creation opportunities in various technical and disciplinal areas.
GOAL
UPGRADEd instruction, research, extension and governance for glocal recognition.
INSTITUTIONAL OUTCOMES
1. Demonstrate logical thinking, critical judgment and independent decision-making on any

confronting situations
2. Demonstrate necessary knowledge, skills and desirable attitudes expected of one’s
educational level and field of discipline
3. Exhibit necessary knowledge, skills and desirable attitudes in research
4. Exhibit proactive and collaborative attributes in diverse fields
5. Manifest abilities and willingness to work well with others either in the practice of one’s
profession or community involvement without compromising legal and ethical
responsibilities and accountabilities.
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Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Kristine A. Condes, RN, LPT, MN
PROGRAM LEARNING OUTCOMES
CHED BS Nursing Program Outcomes:
The program shall produce a graduate who can:

Graduates of a Bachelor of Science in Nursing program nurses who have the ability to:
a. apply knowledge of physical, social, natural and health sciences and humanities in
the practice of nursing;
b. perform safe, appropriate, and holistic care to individuals, families, population groups,
and community utilizing nursing process;
c. apply guidelines and Principles of evidence-based practice in the delivery of care;
d. practice nursing in accordance with existing laws, legal, ethical and moral principles;
e. communicate effectively in speaking, writing and presenting using culturally
appropriate language;
f. report /document client care accurately and comprehensively;
g. collaborate effectively with inter-, intra-, and multi-disciplinary and multi-cultural
teams;
h. practice beginning management and leadership skills, using systems approach in the
delivery of client care;
i. conduct Research with an experienced researcher;
j. engage in lifelong learning with a passion to keep current with national and global
developments in general, and nursing and health developments in particular;
k. demonstrate responsible citizenship and pride in being a Filipino;
l. apply techno-intelligent care systems and processes in health care delivery;
m. uphold the nursing core values in the practice of the nursing profession;
n. apply entrepreneurial skills in the delivery of nursing care.
NONESCOST BS Nursing Program Outcomes:

The program shall produce a graduate who can:
1. deliver safe and quality client-centered care observing moral and ethico-legal
principles in the application of the nursing process in any given situation;
2. manage and deliver health programs and services in any health care setting utilizing
appropriate mechanism for networking, linkage and referrals;
3. engage in nursing research and utilize scientific and evidenced-based knowledge
which promote and maintain quality improvement of client-centered care.

Warm greetings!
Welcome to the first semester of School Year 2021-2022! Welcome to the College of
Nursing and Allied Health Sciences and welcome to NONESCOST! I am so excited to learn
with you for this semester.
For the next eighteen weeks, you will explore fundamental moral issues that arise in
medicine, nursing and science. It is designed to introduce you to the range of issues that
define bioethics, together with core concepts and skills.
You are right now browsing your course module in HENCM 108. As you read on, you will
have an overview of the course, the content, requirements and other related information
regarding the course. The module is made up of 6 lessons. Each lesson has seven parts:
INTRODUCTION- Overview of the

lesson
LEARNING OUTCOMES- Lesson objectives for you to ponder

on
MOTIVATION- Fuels you to go on
PRESENTATION- A smooth transition to the lesson
TEACHING POINTS- Collection of ideas that you must discover
LEARNING ACTIVITIES – To measure your learnings in the lesson where you

wandered
ASSESSMENT – To test your understanding in the lesson you discovered

Please read your modules and learn the concepts by heart. It would help you prepare to
be effective and efficient professional in your respective fields. You can explore more of
the concepts by reading the references and the supplementary readings.
I encourage you to get in touch with me in case you may encounter problems while
studying your modules. Keep a constant and open communication. Use your real names
in your FB accounts or messenger so I can recognize you based on the list of officially
enrolled students in the course. I would be very glad to assist you in your journey.
Furthermore, I would also suggest that you build a workgroup among your classmates.
Participate actively in our discussion board or online discussion if possible and submit
your outputs/requirements on time. You may submit them online through email and
messenger. You can also submit hard copies. Place them in short size bond paper inside
a short plastic envelop with your names and submit them in designated pick-up areas.
I hope that you will find this course interesting and fun. I hope to know more of your
experiences, insights, challenges and difficulties in learning as we go along this course. I
am very positive that we will successfully meet the objectives of the course.
May you continue to find inspiration to become a great professional. Keep safe and God
bless!

Course Outline in HENCM 108 – The Contemporary World
Course
HENCM 108
Number
Course Title Bioethics
This course deals with the application of ethico-moral and legal
Course concepts and principles to issues that affect the practice of nursing. These
Description provide the basis for appropriate decision making given the varied situations,
to prepare learner to render effective, efficient and safe nursing care.
No. of Units 3 units
Pre-requisites HENCM 100, HENCM 101, HENCM 102, HENCM 103
1. Demonstrate essential understanding of the nature of bioethics meaning,
history, application and concepts.
2. Render nursing care consistent with the patient’s bill of rights (i.e.
Course confidentiality of information, privacy, etc.)
Intended 3. Apply relevant bioethical principles in nursing and health related situations.
Learning 4. Adhere to the Code of Ethics for Nurses and abide by its provisions
Outcomes 5. Adhere to practices in accordance with the nursing law and other relevant
legislation including contract and informed consent.
6. Accept responsibility & accountability for own decisions and actions
7. Protect a positive image of the profession
Content MODULE 1
Coverage
INTRODUCTIONTO BIOETHICS
a. Definition of Terms
b. History of Bioethics
c. Importance of Bioethics
THE HUMAN PERSON

a. The Personhood
b. Human Acts and Acts of Human
MODULE 2
TYPES OF ETHICAL THOUGHTS

a. Kant ethics
b. Utilitarian Ethics
c. Situation Ethics
d. Christian Ethics
e. Pragmatist’s Ethics
f. Ross Ethics
THE HEALTH CARE PROFESSION

a. Nurses Code of Ethics
b. Patient’s Bill of Rights
MODULE 3
BIOETHICAL PRINCIPLES
a. Justice
b. Non-maleficence
c. Beneficence

APPLICATION OF BIOETHICAL PRINCIPLES IN HEALTH CARE
a. Rights of a Patient-
principle of autonomy, informed consent,
truthfulness, professional secrecy and privacy
b. Bioethical and Moral Issues-contraception, mutilation and plastic

surgery, abortion, stem cell research, artificial insemination, euthanasia,
suicide
SUPPLEMENTARY READINGS:
1. Nunes, Rui. (2014). Bioethics: Medical. 10.1007/978-3-319-05544-2_44-1.

Retrieved from https://www.researchgate.net/publication/
302530114_Bioethics_Medical
2. Sanderson, C. (2016). Ethical and Bioethical Issues in Nursing and Health

Care. Retrieved from https://nursekey.com/ethical-and-bioethical-issues-in-
nursing-and-health-care/
REFERENCES:
TEXTBOOK:
T1 Rick, K. (2015). Introduction to Bioethics and Ethical Decision Making, 7 th

Edition
T2 Singer, P. & Viens, A. (2016). The Cambridge Book of Bioethics, 2 nd
Edition
References T3 Clement, N. (2013). Nursing Ethics, 1st Edition
ONLINE REFERENCES:
OR1 Butts, JB (2013). Ethics in Professional Nursing Practice. Jones and

Bartletts Publisher. Retrieved from:
https://samples.jblearning.com/0763748986/48986_ch03_pass3.pdf
OR2 Coppens, C (2016). Moral Philosophy. Retrieved from:
https://maritain.nd.edu/jmc/etext/mp04.html
OR3 The Code of Ethics for Nurses, (2014). Retrieved from:
https://homecaremissouri.org/mahc/documents/CodeofEthicswInterpretiveStat
ements20141.pdf
OR4 Principles of Healthcare Ethics, (2020). Retrieved from:
https://www.open.edu/openlearncreate/mod/oucontent/view.php?
id=225&printable=1
OR5 Chonko, L. Ethical Theories (2012). Ethical Theories. Retrieved from:
https://www.dsef.org/wp-content/uploads/2012/07/EthicalTheories.pdf
1. Active class participation (online discussion board, FB Closed group

account)
Course
2. Submit all activities required
Requirements
3. Quizzes/Exam
4. Project/Term Paper
Prepared by: Kristine A. Condes, RN, LPT, MN

Reviewed and Approved by:
Subject Area Coordinator :NATASHA KAY V. CHAN, RN, MN
Dean, CAS : AILEEN G. SYPONGCO, MN, RN, RM, MN
GAD Director : MARY ANN T. ARCEŇO, LPT, Ph. D.
CIMD, Chairperson : MA. JANET S. GEROSO, LPT, Ph. D.
QA Director : DONNA FE V. TOLEDO, LPT, Ed. D.
VP- Academic Affairs : SAMSON M. LAUSA, Ph. D.

Declaration of Copyright Protection
This course module is an official document of Northern Negros State
College of Science and Technology under its Learning Continuity Plan on Flexible
Teaching-Learning modalities.
Quotations from, contractions, reproductions, and uploading of all or any
part of this module is not authorized without the permission from the faculty-author
and from the NONESCOST.
This module shall be used for instructional purposes only.

MODULE 2
LESSO
N
1 TYPES OF ETHICAL THOUGHTS

12
HOURS
Different ethical thoughts provide part of the decision-making foundation because these
represent the viewpoints from which individuals seek guidance as they make decisions.
Each thought emphasizes different points – a different decision-making style or a
decision rule—such as predicting the outcome and following one’s duties to others in
order to reach what the individual considers an ethically correct decision. In order to
understand ethical decision making, it is important for students to realize that not
everyone makes decisions in the same way, using the same information, employing the
same decision rules. In order to further understand this, let us dig deeper on the different
types of ethical thoughts
At the end of this lesson, you are expected to:

a. compare and contrast the concepts of the different ethical thoughts;
b. give reactions/insights on different clinical scenarios.
Try to reflect on this scenario: Peter is an unemployed poor man. Although he has no
money, his family still depends on him; his unemployed wife, Sandra is sick and needs
money for treatment, and their little children, Ann and Sam have been thrown out of
school because they could not pay tuition fees. Peter has no source of income and he
cannot get a loan, even John, his friend and a millionaire has refused to help him. From
his perspective, there are only two alternatives: either he pays by stealing or he does
not. So, he steals from John in order to pay for Sandra’s treatment and to pay the
tuition fees of Ann and Sam. Could say that the stealing of Peter is wrong? Why or why
not? Write your thoughts:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
As future nurses, it is vital that your actions, choices and decisions for your
patients/clients are moral and ethical. Now, explore the different ethical thoughts.
Kant Ethics
An explanation of Kant’s concept of “an end-in-itself”, often put more informally as the
idea that we should not “use” other people.
An end-in-itself
The word "end" in this phrase has the same meaning as in the phrase "means to
an end".
The philosopher Immanuel Kant said that rational human beings should be treated
as an end in themselves and not as a means to something else. The fact that we are
human has value in itself.
If a person is an end-in-themselves it means their inherent value doesn't depend

on anything else - it doesn't depend on whether the person is enjoying their life, or
making other people's lives better. We exist, so we have value.
Most of us agree with that - though we don't put it so formally. We say that we
don't think that we should use other people, which is a plain English way of saying that
we shouldn't treat other people as a means to our own ends.
This idea applies to us too. We shouldn't treat ourselves as a means to our own
ends; instead, we should respect our inherent worth. This can be used as an argument
against euthanasia, suicide and other behaviours that damage ourselves.
The idea also shows up in discussions of animal rights, with the idea that if they
have rights, animals must be treated as ends in themselves.

Utilitarian Ethics
Deontological (duty-based) ethics are concerned with what people do, not with the
consequences of their actions.
Duty-based ethics
Deontological (duty-based) ethics are concerned with what people do, not with the
consequences of their actions.
 Do the right thing.

 Do it because it's the right thing to do.
 Don't do wrong things.
 Avoid them because they are wrong.
Under this form of ethics you can't justify an action by showing that it produced
good consequences, which is why it's sometimes called 'non-Consequentialist'.
The word 'deontological' comes from the Greek word deon, which means 'duty'.
Duty-based ethics are usually what people are talking about when they refer to
'the principle of the thing'.
Duty-based ethics teaches that some acts are right or wrong because of the sorts
of things they are, and people have a duty to act accordingly, regardless of the good or
bad consequences that may be produced.
Some kinds of action are wrong or right in themselves, regardless of the

consequences.
Deontologists live in a universe of moral rules, such as:
 It is wrong to kill innocent people

 It is wrong to steal
 It is wrong to tell lies
 It is right to keep promises
Someone who follows Duty-based ethics should do the right thing, even if that
produces more harm (or less good) than doing the wrong thing:
People have a duty to do the right thing, even if it produces a bad result.
So, for example, the philosopher Kant thought that it would be wrong to tell a lie in
order to save a friend from a murderer.
If we compare Deontologists with Consequentialists we can see that

Consequentialists begin by considering what things are good, and identify 'right' actions
as the ones that produce the maximum of those good things.
Deontologists appear to do it the other way around; they first consider what
actions are 'right' and proceed from there. (Actually this is what they do in practice, but
it isn't really the starting point of deontological thinking.)
So a person is doing something good if they are doing a morally right action.
Situation Ethics

Situation ethics teaches that ethical decisions should follow flexible guidelines rather
than absolute rules, and be taken on a case by case basis.
In situation ethics, right and wrong depend upon the situation.
There are no universal moral rules or rights - each case is unique and deserves a
unique solution.
Situation ethics rejects 'prefabricated decisions and prescriptive rules'. It teaches

that ethical decisions should follow flexible guidelines rather than absolute rules, and be
taken on a case by case basis.
…reflective morality demands observation of particular situations, rather than fixed

adherence to a priori principles
So a person who practices situation ethics approaches ethical problems with

some general moral principles rather than a rigorous set of ethical laws and is prepared
to give up even those principles if doing so will lead to a greater good.
Since “circumstance alter cases”, situationism holds that in practice what in some
times and places we call right is in other times and places wrong…
For example, lying is ordinarily not in the best interest of interpersonal

communication and social integrity, but is justifiable nevertheless in certain situations.
Situation ethics was originally devised in a Christian context, but it can easily be
applied in a non-religious way.
Elements of situation ethics

The elements of situation ethics were described by Joseph Fletcher, its leading
modern proponent, like this:
 Moral judgments are decisions, not conclusions

 Decisions ought to be made situationally, not prescriptively
 We should seek the well-being of people, rather than love principles.
 Only one thing is intrinsically good, namely, love: nothing else
 Love, in this context, means desiring and acting to promote the wellbeing of people
 Nothing is inherently good or evil, except love (personal concern) and its opposite,
indifference or actual malice
 Nothing is good or bad except as it helps or hurts persons
 The highest good is human welfare and happiness (but not, necessarily, pleasure)
 Whatever is most loving in a situation is right and good--not merely something to be
excused as a lesser evil
 Moral theology seeks to work out love's strategy, and applied ethics devises love's
tactics.
 Love "wills the neighbour's good" [desires the best for our neighbour] whether we like
them or not
 The ultimate norm of Christian decisions is love: nothing else
 The radical obligation of the Christian ethic to love even the enemy implies
unmistakably that every neighbour is not a friend and that some are just the
opposite.
 Love and justice are the same, for justice is love distributed
 Love and justice both require acts of will
 Love and justice are not properties of actions, they are things that people either do or
don't do
 Love and justice are essentially the same
 Justice is Christian love using its head--calculating its duties. The Christian love
ethic, searching seriously for a social policy, forms a coalition with the utilitarian
principle of the 'greatest good of the greatest number.'
 The rightness depends on many factors
 The rightness of an action does not reside in the act itself but in the loving
configuration of the factors in the situation--in the 'elements of a human act' --i.e., its
totality of end, means, motive, and foreseeable consequences.
Christian Ethics
Christian morality consists of living one’s life with guidance and inspiration from
the Christian scriptures and traditions. Christian ethics as an academic discipline uses
these scriptures and traditions in developing and critiquing ethical norms and theories
and applying them to ethical issues. Most Christian ethicists agree that the sources for
doing ethics include revelation (scripture) and tradition, as well as human reason and
experience.
Being shaped by Biblical revelation is the primary way that Christian ethics can be
distinguished from alternative ethical perspectives, both religious and secular; thus one
important question for a Christian ethicist is how morality (the practice) or ethics (ideas
about the practice) depends on religion (convictions and commitments) or theology
(critical discussion about those convictions and commitments).
Few people, whether religious or not, would deny an historical dependency; the
great ethical teachers tended to be prophets or founders of religion, and for most of
human history the influential ethical authorities tended to be religious authorities. Of
course, atheists could cheerfully admit this historical point and then claim that, in
western culture at least, the 18th century Enlightenment changed that dependency,
encouraging ethicists to avoid religious or theological assumptions and, as Immanuel
Kant famously put it in his essay “What is Enlightenment?” to dare to think for
themselves.
Christian ethicists can affirm the need to think for one’s self but claim that such
thinking reveals that ethics depends on theology in ways other than merely historical.
One venerable view is the meta-ethical theory that ethics requires a theological
foundation in order to avoid nihilism (no real values) or subjectivism (values are relative
to each person). This claim has been developed in at least two different ways, the first
being what is called “The divine command theory of ethics.” One version of this theory
is to claim that only God’s will makes things right or wrong; it is sometimes stated as “X
is good (or obligatory)” just means “God approves of (or demands) X.” Divine
command theorists admit that, of course, atheists and others can use moral ideas
without realizing their foundation; people can use a building, for example, without giving
a thought to its foundation. Only when they start questioning will they see a need for a
foundation.
Entirely apart from the view that theology is needed for the foundation of ethics is
the view of many Christian ethicists that scripture reveals at least some of the content
of ethics. Most of them agree that through reason and natural law humans can know
some and maybe even most of morality, but claim that scripture provides distinctive
features and emphases for moral and spiritual life. Love for all, including one’s
enemies, in the sense of self-sacrificing agape, is perhaps the most commonly cited
distinctively Christian ethical teaching (see, for example, The Love Commandments:
Essays in Christian Ethics and Moral Philosophy, eds. Edmund Santurri and William
Werpehowski). Other teachings include an emphasis on calling to discipleship and
stewardship (see, for example, Douglas Schuurman’s Vocation: Discerning our
Callings in Life), to mercy and forgiveness, and to economic justice. Intramural debates
among Christian ethicists who affirm a distinctly Christian content for morality include
the following: is the revelation one of specific rules, like the ten commandments (which
might tend toward text-citing and legalism) or more general basic principles, such as
the love commandments; or is it more a matter of basic virtues, such as the “fruits of
the spirit” cited several times by St Paul (as in Galatians 5: love, joy, peace,
forbearance, kindness, goodness, faithfulness, gentleness and self-control), virtues
taught more by stories than rules.
Other Christian ethicists think that we can know about morality quite
independently of our religious beliefs and that, although Christian ethics may have
distinctive emphases, few if any of its rules, principles, or virtues are unique to
Christianity or even to religious outlooks. So they question whether ethics is
epistemologically dependent on theology (that is, dependent on it for knowing the
content of morality). Rather, they see the distinctively Christian feature as one of
motivation: we can have the proper convictions about what is morally appropriate or
required but will we be motivated to commit ourselves to do it? The oldest form of the
claim that morality is motivationally dependent on religious commitment is the appeal to
rewards and punishments, the “fire and brimstone” preaching that “put the fear of the
Lord” into people. “Fear” here is understood as being scared of God, which does not
necessarily involve respect or love. This appeal, of course, is to self-interest—save
your eternal skin—and is rejected by others who point to a different sort of motivation,
such as a sense of calling or vocation nurtured by covenantal gratitude for creation and
redemption.
Pragmatist Ethics
Pragmatism is generally considered to be the first and only philosophical school of

thought or tradition to have emerged in North America. The term was originated by
C.S. Peirce, who would later term his form of the new movement "pragmaticism" in
order to distinguish his ideas from those of the most famous exponents: William James
and John Dewey. G.H. Mead and F.S.C. Schiller were lesser known members of this
tradition in the late nineteenth and early twentieth centuries when it flourished. The
original formulation of pragmatism by Peirce applied to epistemology (the idea that
knowledge must be tested by its usefulness), but the concept was quickly extended by
James. Pragmatism in ethics is a form of consequentialism as presented in this work.
The focus of pragmatism is on the resultant actions while utilitarianism emphasizes
usefulness. Pragmatism, according to William James, is derived from the Greek word
pragma, which means action and serves as the basis of our English words practical
and practice.(Greek pragma = "action" while Latin utilis = "use"). Pragmatism
established human needs and the practical interests of humans as the basis for
judgment and evaluation. Pragmatism rejects any form of absolutism and universality
of thought. Pragmatism fosters a form of relativism. Pragmatism in ethics rejects the
idea that there is any universal ethical principle or universal value. It holds for ethical
principles being social constructs to be evaluated in terms of their usefulness.
For pragmatists the matter of ethics is approached practically. Our practices are

our habits. In pragmatic ethics there is the Primacy of Habits, which empower and
restrict. They explore the Social nature of habits and the relation of habit to will. For
them Morality Is a Habit and being fallibilists, pragmatists know that no habits are
flawless. They also hold that Morality is social and that Changing habits for moral
reasons is necessary.
Features of pragmatic ethics:

 Employs criteria, but is not criterial
 Gleaning insights from other ethical theories
 Relative without being relativistic
 Tolerant without being irresolute
 Theory and Practice
Ross Ethics
W. D. Ross was a moral realist, a non-naturalist, and an intuitionist. He argued
that there are moral truths. He wrote:
The moral order is just as much part of the fundamental nature of the universe and
of any possible universe in which there are moral agents at all, as is the spatial or
numerical structure expressed in the axioms of geometry or arithmetic.
Thus, according to Ross, the claim that something is good is true if that thing
really is good. Ross also agreed with G.E. Moore's claim that any attempt to define
ethical statements solely in terms of statements about the natural world commits
the naturalistic fallacy.
Ross rejected Moore's consequentialist ethics. According to consequentialist
theories, what people ought to do is determined only by whether their actions will bring
about the most good. By contrast, Ross argues that maximising the good is only one of
several prima facie duties (prima facie obligations) which play a role in determining
what a person ought to do in any given case.
In The Right and the Good, Ross lists seven prima facie duties, without claiming
his list to be all-inclusive: fidelity; reparation; gratitude; justice; beneficence; non-
maleficence; and self-improvement. In any given situation, any number of these prima
facie duties may apply. In the case of ethical dilemmas, they may even contradict one
another. Someone could have a prima facie duty of reparation, say, a duty to help
people who helped you move house, move house themselves, and a prima facie duty
of fidelity, such as taking your children on a promised trip to the park, and these could
conflict. Nonetheless, there can never be a true ethical dilemma, Ross would argue,
because one of the prima facie duties in a given situation is always the weightiest, and
over-rules all the others. This is thus the absolute obligation or absolute duty, the action
that the person ought to perform.
It is frequently argued, however, that Ross should have used the term "pro tanto"
rather than "prima facie". Shelly Kagan, for example, wrote:
It may be helpful to note explicitly that in distinguishing between pro tanto and
prima facie reasons I depart from the unfortunate terminology proposed by Ross, which
has invited confusion and misunderstanding. I take it that – despite his misleading
label – it is actually pro tanto reasons that Ross has in mind in his discussion of what
he calls prima facie duties.
Explaining the difference between pro tanto and prima facie, Kagan wrote: "A pro
tanto reason has genuine weight, but nonetheless may be outweighed by other
considerations. Thus, calling a reason a pro tanto reason is to be distinguished from
calling it a prima facie reason, which I take to involve an epistemological qualification: a
prima facie reason appears to be a reason, but may actually not be a reason at all".
A frequent criticism of Ross's ethics is that it is unsystematic and often fails to
provide clear-cut ethical answers. Another is that "moral intuitions" are not a reliable
basis for ethics, because they are fallible, can vary widely from individual to individual,
and are often rooted in our evolutionary past in ways that should make us suspicious of
their capacity to track moral truth.

Name the proponent/s of each Ethical Thought:
1. Kant ethics - ________________________________________
2. Utilitarian Ethics - ________________________________________
3. Situation Ethics - ________________________________________
4. Pragmatist Ethics - ________________________________________
5. Ross Ethics - ________________________________________
I. Give a short description on the main points of each Ethical Thought. (5 points/item)
1. Kant ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. Utilitarian Ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3. Situation Ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. Christian Ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. Ross Ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
II. Identify a scenario in a clinical setting where the following ethical thought can be
applied (10 points/item)
1. Utilitarian Ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. Situation Ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3. Pragmatist Ethics
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
III. You play the role of a hospital administrator who has been asked to set up an Ethics
Task Force in the hospital. The task force will deal with ethical dilemmas that may
confront hospital staff and advise in establishing ethical guidelines for the treatment of
patients. (a) What kind of persons would you look for to fill this position? What values
would you want them to hold? What types of ethical sensitivity would you be looking
for? (20 points)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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Rubric for Assessment
Point/Grade Description
A Presents solid understanding of the topic, using course
readings to accurately discuss the main points/thoughts.
B Uses course readings to discuss the concepts of the topic
within a broader framework, but does not always present
solid understanding of the major themes.
C Uses course readings to place the argument within a
broader framework, but major concepts are poorly defined
or not defined at all.
D Uses course readings, but paper does not place the
argument within a broader framework.

LESSON
2 NURSES CODE OF ETHICS

3
HOURS
To practice competently and with integrity, today's nurses must have in place several
key elements that guide the profession. The Nursing Code of Ethics has guided and
supported nursing practice in a variety of settings. Learning how to use the ethics code
as your guide can make your daily work less stressful, improve your team's morale, and
lead to better patient outcomes. In this chapter, you will explore the history of the Code
of Ethics, the modern or some revision of the Code of Ethics and its implication to
nursing practice.
At the end of this module, you are expected to:

a. enumerate and discuss the Nurses Code of Ethics;
b. validate the significance of the health care profession as a vocation.
So, what do you think the Nursing Code of Ethics can do for you as a future nurse
practitioner?
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The Code of Ethics for Nurses with Interpretive Statements
The Code of Ethics for Nurses serves the following purposes:
 It is a succinct statement of the ethical values, obligations, duties, and professional
ideals of nurses individually and collectively.
 It is the profession’s nonnegotiable ethical standard.
 It is an expression of nursing’s own understanding of its commitment to society.
Provision 1
The nurse practices with compassion and respect for the inherent dignity, worth, and
personal attributes of every person, without prejudice.
Provision 2
The nurse’s primary commitment is to the patient, whether an individual, family, group,
community, or population.
Provision 3
The nurse promotes, advocates for, and protects the rights, health and safety of the
patient.
Provision 4
The nurse has authority, accountability, and responsibility for nursing practice, makes
decisions, and takes action consistent with the obligation to provide optimal care.
Provision 5
The nurse owes the same duties to self as to others, including the responsibility to
promote health and safety, preserve wholeness of character and integrity, maintain
competence, and continue personal and professional growth.
Provision 6
The nurse, through individual and collective action, establishes, maintains, and improves
the moral environment of the work setting and the conditions of employment, conducive
to quality health care.
Provision 7
The nurse, whether in research, practice, education, or administration, contributes to the
advancement of the profession through research and scholarly inquiry, professional
standards development, and generation of nursing and health policies.
Provision 8
The nurse collaborates with other health professionals and the public to protect and
promote human rights, health diplomacy, and health initiatives.
Provision 9

The profession of nursing, collectively through its professional organizations, must
articulate nursing values, maintain the integrity of the profession, and integrate
principles of social justice into nursing and health policy.
Provision 1
The nurse practices with compassion and respect for the inherent dignity, worth, and
personal attributes of every person, without prejudice.
1.1 Respect for Human Dignity
A fundamental principle that underlies all nursing practice is respect for the inherent
dignity, worth, and human rights of all individuals. The need for and right to health care is
universal, transcending all individual differences. Nurses consider the needs and respect
the values of each person in every professional relationship and setting; they lead in the
development of changes in public and health policies that support this duty.
1.2 Relationships with Patients
Nurses establish relationships of trust and provide nursing services according to need,
setting aside any bias or prejudice. When planning patient, family and population centered
care, factors such as lifestyle, culture, value system, religious or spiritual beliefs, social
support system and primary language shall be considered. Such considerations must
promote health, address problems and respect patient decisions. This respect for patient
decisions does not require that the nurse agree with or support all patient choices.
1.3 The Nature of Health
Nurses respect the dignity and rights of all human beings regardless of the factors
contributing to the health status. The worth of a person is not affected by disease,
disability, functional status, or proximity to death. Nurses assess, diagnose, plan, intervene,
and evaluate patient care in accord with individual patient needs and values. Respect is
extended to all who require and receive nursing care whether in the promotion of health,
prevention of illness, restoration of health, alleviation of suffering, and provision of
supportive care to those who are dying. Optimal nursing care enables the patient to live
with as much physical, emotional, social, and religious or spiritual well-being as possible
and reflects the patient’s own values. Supportive care is extended to the family and
significant others and is directed toward meeting needs comprehensively across the
continuum of care. This is particularly important at the end of life in order to prevent and
alleviate the cascade of symptoms and suffering that are commonly associated with dying.
Nurses are leaders who actively participate in assuring the responsible and appropriate
use of interventions in order to optimize the health and well-being of those in their care.
This includes acting to minimize unwarranted or unwanted medical treatment and patient
suffering. Such care must be avoided and advance care planning throughout many clinical
encounters helps to make this possible. Nurses are also leaders who collaborate in
alleviating systemic structures that have a negative influence on individual and community
health.
1.4 The Right to Self-Determination
Respect for human dignity requires the recognition of specific patient rights, in particular,
the right of self-determination. Patients have the moral and legal right to determine what
will be done with their own person; to be given accurate, complete, and understandable
information in a manner that facilitates an informed decision; to be assisted with weighing
the benefits, burdens, and available options in their treatment, including the choice of no
treatment; to accept, refuse, or terminate treatment without deceit, undue influence,
duress, coercion, or prejudice; and to be given necessary support throughout the decision-
making and treatment process. Such support includes the opportunity to make decisions
with family and significant others and to obtain advice from expert/knowledgeable nurses
and other health professionals. The acceptability and importance of carefully considered
decisions regarding resuscitation status, withholding and withdrawing life-sustaining
therapies, forgoing medically provided nutrition and hydration, aggressive pain and
symptom management, and advance directives are widely recognized. Nurses provide
patients with assistance as necessary with these decisions. Nurses should promote
conversations around advance care planning and must be knowledgeable about the
benefits and limits of various advance directive documents. The nurse should provide
interventions to relieve pain and other symptoms in the dying patient even when those
interventions entail risks of hastening death. However, nurses may not act with the intent
to end life even though such action may be motivated by compassion, respect for patient
autonomy, or quality of life considerations. Nurses have invaluable experience, knowledge,
and insight into effective and compassionate care at the end of life and should be actively
involved in related research, education, practice, and policy development. Nurses have an
obligation to be knowledgeable about the moral and legal rights of patients. Nurses
preserve, protect, and support those rights by assessing the patient’s understanding of
both the information presented and the implications of decisions. When the patient lacks
capacity to make a decision, a formally designated surrogate should be consulted. The role
of the surrogate is to make decisions as the patient would, based upon the patient’s
previously expressed wishes and known values. In the absence of an appropriate
surrogate decision maker, decisions should be made in the best interests of the patient,
considering the patient’s personal values to the extent that they are known. Nurses include
patients or surrogate decision-makers in discussions, provide referrals to other resources
as indicated, identify options, and address problems in the decision-making process.
Support of patient autonomy also includes respect for the patient’s method of decision-
making and recognition that different cultures have different understandings of health,
autonomy, privacy and confidentiality, and relationships as well as varied practices of
decision-making. For example, nurses reaffirm the patient’s values and respect decision-
making including those that are culturally hierarchical or communal.
Individuals are interdependent members of the community. Nurses recognize situations in

which the right to self-determination may be outweighed or limited by the rights, health,
and welfare of others, particularly in public health. The limitation of individual rights must
always be considered a serious deviation from the standard of care, justified only when
there are no less restrictive means available to preserve the rights of others and the
demands of the law.
1.5 Relationships with Colleagues and Others
Respect for persons extends to all individuals with whom the nurse interacts. Nurses
maintain professional, respectful and caring relationships with colleagues and are
committed to fair treatment, integrity-preserving compromise, and the resolution of
conflicts. Nurses function in many roles and many settings, including direct care provider,
care coordinator, administrator, educator, researcher, and consultant. In every role, the
nurse creates a moral environment and culture of civility and kindness, treating others,
colleagues, employees, co-workers, and students with dignity and respect. This standard of
conduct includes an affirmative duty to act to prevent harm. Disregard for the effect of
one’s actions on others, bullying, harassment, manipulation, threats or violence are always
morally unacceptable behaviors. Nurses value the distinctive contribution of individuals or
groups, and collaborate to meet the shared goal of providing efficient, effective, and
compassionate health services seeking to achieve quality outcomes in all settings
Provision 2
The nurse’s primary commitment is to the patient, whether an individual, family, group,
community, or population.
2.1 Primacy of the Patient’s Interests

The nurse’s primary commitment is to the recipients of nursing and healthcare services—
the patient—whether individuals, families, groups, communities, or populations. Any plan
of care must reflect the fundamental commitment of nursing to the uniqueness, worth and
dignity of the patient. Nurses provide patients with opportunities to participate in
planning and implementing care and support that is acceptable to the patient. Addressing
patient interests requires recognition of the patient’s place within the family and other
relationships. When the patient’s wishes are in conflict with others, nurses help to resolve
the conflict. Where conflict persists, the nurse’s commitment remains to the identified
patient.
2.2 Conflict of Interest for Nurses
Nurses may experience conflict arising from competing loyalties in the workplace,
including conflicting expectations from patients, families, physicians, colleagues,
healthcare organizations and health plans. Nurses must examine the conflicts arising
between their own personal and professional values and the values and interests of others
including those who are also responsible for patient care and healthcare decisions, and
perhaps patients themselves. Nurses address these conflicts in ways that ensure patient
safety and promote the patient’s best interests while preserving the professional integrity
of the nurse and supporting interdisciplinary collaboration. Conflicts of interest may arise
in any domain of nursing activity including clinical practice, administration, education,
consultation and research. Nurses in all roles must identify and, whenever possible, avoid
conflicts of interest. Nurses who bill directly for services and nurse executives with
budgetary responsibilities must be especially aware of the potential for conflicts of
interest. Changes in healthcare financing and delivery systems may create conflict between
economic self-interest and professional integrity. Bonuses, sanctions, and incentives tied
to financial targets may present such conflict. Any perceived or actual conflict of interest
should be disclosed to all relevant parties and, if indicated, nurses should withdraw from
further participation.
2.3 Collaboration
In health care the goal is to address the health of the patient and the public. The complexity
of healthcare requires effort that has the strong support and active participation of all
health professions. Nurses should actively foster collaborative planning to provide high
quality, patient-specific health care. Nurses are responsible for articulating, representing
and preserving the unique contribution of nursing to patient care and the nursing scope of
practice. The relationship with other health professions also needs to be clearly
articulated, represented and preserved.

Collaboration intrinsically requires mutual trust, recognition, respect, transparency,
shared decision-making, and open communication among all who share concern and
responsibility for health outcomes. Nurses assure that all relevant persons, as moral
agents, are participatory in patient care decisions. Patients do not always know what
questions to ask. Nurses assure informed decision-making by assisting patients to secure
the information that they need to make choices consistent with their own values.
Collaboration within nursing is fundamental to address the health of patients and the
public effectively. Nurses who are engaged in non-clinical roles, such as educator,
administrator, consultant, or researcher, though not primarily involved in direct patient
care, collaborate for the provision of high quality care through the influence and direction
of those who provide direct care. In this sense, nurses in all roles are interdependent and
share a responsibility for outcomes in nursing care and for maintaining nursing’s primary
commitment to the patient.
2.4 Professional Boundaries
The nature of nursing work is inherently personal. Within their professional role, nurses
recognize and maintain appropriate personal relationship boundaries. Nurse–patient
relationships and collegial relationships have as their foundation the protection,
promotion, and restoration of health and the alleviation of suffering. Professional
relationships are therapeutic in nature yet at times remaining within professional
boundaries can be tested. The intimate nature of nursing care, the involvement of nurses
in important and sometimes highly stressful life events, the mutual dependence of
colleagues working in close concert, all may contribute to the risk of boundary violations.
This is compounded by the need for nurses to maintain authenticity in expressing
themselves as individuals. In all communications and actions nurses are responsible for
maintaining professional boundaries and for seeking the assistance of peers or supervisors
in managing difficult situations or taking appropriate steps to remove themselves from the
situation.
Provision 3
The nurse promotes, advocates for, and protects the rights, health and safety of the patient.
3.1 Protection of the Rights of Privacy and Confidentiality
Privacy is the right to control access to and disclosure or nondisclosure of information

pertaining to oneself, and to control the circumstances, timing, and extent to which
information might be disclosed. The need for health care does not justify unwanted or
unwarranted intrusion into people’s lives. Nurses safeguard the individual’s, family’s, and
community’s right to privacy. The nurse advocates for an environment that provides
sufficient physical privacy, including privacy for discussions of a personal nature. Nurses
also participate in the maintenance of and policies and practices that protect both personal
and clinical information at institutional and societal levels. Confidentiality pertains to the
nondisclosure of personal information that has been communicated within the nurse–
patient relationship. Central to that relationship is an element of trust and an expectation
that personal information will not be divulged without consent. The nurse has a duty to
maintain confidentiality of all patient information, both personal and clinical in the work
setting and off duty in all venues, including social media or any other means. Because of
the rapidly evolving means of communication and the porous nature of social media,
nurses must maintain vigilance regarding commentary that intentionally and/or
unintentionally breaches their obligation to maintain and protect patients' rights to
privacy and confidentiality. The patient’s well-being could be jeopardized and the
fundamental trust between patient and nurse damaged by unauthorized access to data or
by the inappropriate or unwanted disclosure of identifiable information. Patient rights are
the primary factors in any decisions concerning personal information, whether from or
about the patient. This pertains to all information in any manner that is communicated or
transmitted. Nurses are responsible for providing accurate, relevant data to members of
the healthcare team and others who have a need to know. The duty to maintain
confidentiality is not absolute and may need to be modified in order to protect the patient,
other innocent parties, and in circumstances of required disclosure such as mandated
reporting or for safety or public health reasons.
Information used for purposes of peer review, professional practice evaluation, thirdparty
payments, and other quality improvement or risk management mechanisms may only be
disclosed under defined policies, mandates, or protocols. These written guidelines must
assure that the rights, well-being, and safety of the patient remain protected. Only that
information directly relevant to a task or specific responsibility should be disclosed. When
using electronic communications or in electronic health records, special effort should be
made to maintain data security.
3.2 Protection of Human Participants in Research
Stemming from the right to autonomy or self-determination, individuals have the right to
choose whether or not to participate in research as a human subject. Participants or legal
surrogates must receive sufficient and materially relevant information to make informed
decisions and to understand that they have the right to decline to participate or to
withdraw at any time without fear of adverse consequences or reprisal. Information
needed for informed consent includes the nature of participation, potential harms and
benefits, available alternatives to taking part in the study, and how the data will be
protected. It must be communicated in a manner that is comprehensible to the patient.
Prior to implementation, all research must be approved by a formally constituted and
qualified review board to ensure participant protection and the ethical integrity of the
research.
Nurses should be aware of the special concerns raised by research involving vulnerable
groups, including patients, children, minority populations, prisoners, pregnant women,
fetuses, the elderly, cognitively impaired persons, and economically or educationally
disadvantaged persons. The nurse who directs or engages in research activities in any
capacity should be fully informed about the qualifications of the principal investigator, the
rights and obligations of all those involved in the particular research study, and the ethical
conduct of research in general. Nurses have a duty to question and, if necessary, to report
research that is ethically questionable and to decline to participate.
3.3 Performance Standards and Review Mechanisms
Professional nursing is a process of education and formation that involves the ongoing
acquisition and development of the knowledge, skills, dispositions, practice experiences,
commitment, relational maturity, and personal integrity essential for professional practice.
Nurse educators must ensure that basic competence and commitment to professional
practice exist prior to entry into practice. Nurse managers and executives similarly ensure
that nurses have the required knowledge, skills, and dispositions to perform clinical
responsibilities requiring preparation beyond the basic academic programs. In this way
nurses— individually, collectively and as a profession—are responsible and accountable
for nursing practice and professional behavior.
3.4 Professional Competence in Nursing Practice
Nurses must lead in the development of policies and review mechanisms to promote
patient health and safety, reduce errors, and create a culture of excellence. When errors
occur, nurses must follow institutional guidelines in reporting errors to the appropriate
authority and ensure responsible disclosure of errors to patients. Nurses must establish
processes where mistakes or errors are revealed and nurses are personally accountable,
and any system factors that led to error are rectified. Error should be corrected or
remediated, not punished. When error occurs, whether one’s own or an error of a
coworker, nurses may not participate in, or condone through silence, any attempts to hide
it. Engaging the appropriate intra-institutional sequence of reporting and authority is
critical to maintaining a safe patient care environment. Nurses must use the chain of
authority when a problem or issue has escalated beyond their problem-solving ability
and/or scope of responsibility or authority. Issue reporting escalation ensures that

appropriate individuals are aware of the concern. Communication should start at the level
closest to the event and escalate only as the situation warrants.
3.5 Protecting Patient Health and Safety by Action on Questionable Practice
Nurses must be alert to and take appropriate action in instances of incompetent,

unethical, illegal, or impaired practice or any actions that place the rights or best interests
of the patient in jeopardy. To function effectively, nurses must be knowledgeable about
The Code of Ethics of Ethics for Nurses, standards of practice of the profession, relevant
federal, state and local laws and regulations, and the employing organization’s policies and
procedures. When nurses are aware of inappropriate or questionable practice, the concern
should be expressed to the person involved, focusing on the patient’s best interests as well
as the integrity of nursing practice. When practices in the healthcare delivery system or
organization threaten the welfare of the patient, similar action should be directed to the
responsible administrator or, if indicated, to an appropriate higher authority within the
institution or agency, or to an appropriate external authority. When incompetent,
unethical, illegal, or impaired practice is not corrected and continues to jeopardize patient
well-being and safety, the problem must be reported to appropriate external authorities
such as practice committees of professional organizations and regulatory, licensing, and
quality assurance agencies or boards. Some situations are sufficiently egregious that they
may warrant the notification and involvement of all such groups. Nurses should use
established processes for reporting and handling questionable practices. All nurses have a
responsibility to assist those “whistleblowers” who identify potentially questionable
practice and to reduce the risk of reprisal against the reporting nurse. State nurses
associations should be prepared to provide their members with advice and support in the
development and evaluation of such processes and reporting procedures. Accurate
reporting and factual documentation are essential for all such actions. When a nurse
chooses to engage in the act of responsible reporting about situations that are perceived as
unethical, incompetent, illegal, or impaired, the professional organization has a
responsibility to protect the practice of those nurses who choose formally to report their
concerns. Reporting questionable practices, even when done appropriately, may present
substantial risk to the nurse; nevertheless, such risk does not eliminate the obligation to
address threats to patient safety.
3.6 Patient Protection and Impaired Practice
Nurses must protect the patient, the public, and the profession from potential harm when
a colleague’s practice appears to be impaired. When another’s practice appears to be
impaired, the nurse’s duty is to take action to protect patients and to ensure that the
impaired individual receives assistance. This process begins with consulting supervisory
personnel and includes approaching the individual in a clear and supportive manner and
helping the individual to access appropriate resources. The nurse extends compassion and
caring to colleagues throughout processes of identification, remediation, and recovery.
Nurses must follow policies of the employing organization, guidelines outlined by the
profession, and relevant laws to assist colleagues whose job performance may be
adversely affected by mental or physical illness or by personal circumstances. Nurses in all
professional relationships must advocate in instances of impairment for appropriate
assistance, treatment, and access to fair institutional and legal processes. This includes
supporting the return to practice of individuals who have sought assistance and, after
recovery, are ready to resume professional duties. If impaired practice poses a threat or
danger to self or others, regardless of whether the individual has sought help, the nurse
must report the individual to persons authorized to address the problem. Nurses who
report those whose job performance creates risk should be protected from retaliation or
other negative consequences. If workplace policies do not exist or are inappropriate— that
is, they deny the nurse in question access to due legal process or demand resignation—
nurses may obtain guidance from professional associations, state peer assistance
programs, employee assistance programs, or similar resources.
Provision 4
The nurse has authority, accountability, and responsibility for nursing practice, makes
decisions, and takes action consistent with the obligation to provide optimal care.
4.1 Authority, Accountability, and Responsibility
Nurses bear primary responsibility for the nursing care that their patients and clients
receive and are accountable for their own practice. Nursing practice includes independent
direct nursing care activities, care as ordered by an authorized healthcare provider,
delegation of nursing interventions, evaluation of interventions, and other responsibilities
such as teaching, research, and administration. In each instance, nurses have the authority
and retain accountability and responsibility for the quality of practice and for compliance
with state nurse practice acts, and standards of care, including The Code of Ethics for
Nurses. In the context of the increased complexity and changing patterns in healthcare
delivery, the scope of nursing practice evolves. Nurses must exercise judgment in
accepting responsibilities, seeking consultation, and assigning activities to others who
provide nursing care. Where advanced practice nurses have the authority to issue
medication and treatment orders to nurses, these are not acts of delegation. Both the
advanced practice nurse issuing the order and the nurse accepting the order are
responsible for the judgments made and accountable for the actions taken.

4.2 Accountability for Nursing Judgments, Decisions, and Actions
In order to be accountable, nurses act under a code of ethical conduct that includes
adherence to the scope and standards of nursing practice and such moral principles as
fidelity, gratitude, and respect for the dignity, worth, and self-determination of patients.
Nurses are accountable for judgments made and actions taken in the course of nursing
practice, irrespective of other providers’ directives or institutional policies. Systems and
technologies that assist in clinical practice are adjunct to, not replacements for, the nurse’s
knowledge and skill. The nurse retains accountability and responsibility for nursing
practice even in instances of system or technological failure.
4.3 Responsibility for Nursing Judgments, Decisions and Actions
Nurses are accountable for their judgments, decisions, and actions; but, in compromising
circumstances, responsibility may be borne by both the nurse and the institution. Nurses
accept or reject specific role demands and assignments based on their education,
knowledge, competence, experience, and assessment of patient safety. Nurses in
administration, education, and research also have obligations to the recipients of nursing
care. Although their relationships with patients are less direct, in assuming the
responsibilities of a particular role, they share responsibility for the care provided by
those whom they supervise and teach. Nurses must not engage in practices prohibited by
law or delegate activities to others that are prohibited by their state nursing practice acts
or those of other healthcare providers.
Nurses have a responsibility to define, implement, and maintain standards of professional

practice. Nurses must plan, establish, implement, and evaluate review mechanisms to
safeguard patients and nurses. These include peer review processes, credentialing
processes, and quality improvement initiatives. Nurses must bring forward difficult issues
related to patient care, and/or institutional constraints upon ethical practice for discussion
and review. The nurse acts to promote inclusion of appropriate others in all ethical
deliberations. Nurse executives are responsible for ensuring that nurses have access to and
inclusion on organizational committees that affect the quality and the safety of the care of
the patients they serve. Nurses are obligated to attend, actively engage, and contribute to
the dialogue and decisions made by such committees. Nurses are responsible for assessing
their own competence. When the needs of the patient are beyond the qualifications or
competencies of the nurse, consultation and collaboration must be sought from qualified
nurses, other health professionals, or other appropriate resources. Educational resources
should be used by nurses and provided by agencies or organizations to maintain and
advance nurse competence. Nurse educators in any setting collaborate with their students

to assess learning needs, evaluate teaching effectiveness, and provide appropriate learning
resources.
4.4 Delegation of Nursing Activities or Tasks
Nurses are accountable and responsible for the assignment or delegation of nursing
activities. Such assignment or delegation must be consistent with state practice acts,
institutional policy, and nursing standards of practice. Nurses must make reasonable effort
to assess individual competence when delegating selected nursing activities. This
assessment includes the evaluation of the knowledge, skill, and experience of the
individual to whom the care is assigned; the complexity of the assigned tasks; and the
nursing care needs of the patient. Nurses are responsible for monitoring the activities and
evaluating the quality and outcomes of the care provided by other healthcare workers to
whom they have delegated tasks. Nurses may not delegate responsibilities such as
assessment and evaluation; they may delegate interventions. Nurses must not knowingly
assign or delegate to any member of the nursing team a task for which that person is not
prepared or qualified. Employer policies or directives do not relieve the nurse of
responsibility for making delegation or assignment decisions. Nurses in management or
administration have a particular responsibility to provide an environment that supports
and facilitates appropriate assignment and delegation. This includes orientation, skill
development; licensure, certification, and competency verification; and policies that
protect both the patient and nurse from inappropriate assignment or delegation of nursing
responsibilities, activities, or tasks. Nurses in management or administration should
facilitate open communication with staff allowing them, without fear of reprisal, to express
concerns or even to refuse an assignment for which they do not possess the requisite skills.
Nurses functioning in educator or preceptor roles share responsibility and accountability
for the care provided by students when they make clinical assignments. It is imperative
that the knowledge and skill of the nurse or nursing student be sufficient to provide the
assigned nursing care under appropriate supervision.
Provision 5
The nurse owes the same duties to self as to others, including the responsibility to
promote health and safety, preserve wholeness of character and integrity, maintain
competence, and continue personal and professional growth.
5.1 Duty to Self and Others
Moral respect accords moral worth and dignity to all human beings regardless of their
personal attributes or life situation. Such respect extends to oneself as well: the same
duties that we owe to others we owe to ourselves. Self-regarding duties primarily concern
oneself and include promotion of health and safety, preservation of wholeness of character
and integrity, maintenance of competence, and continuation of personal and professional
growth.
5.2 Promotion of Personal Health, Safety, and Well-Being
As professionals who assess, intervene, evaluate, protect, promote, educate, and conduct
research for the health and safety of others and society, nurses have a duty to take the
same care for their own health and safety. Nurses should model the same health
maintenance and health promotion measures that they teach and research, seek health
care when needed, and avoid taking unnecessary risks to health or safety in the course of
their customary professional and personal activities. A healthy diet and exercise,
maintenance of family and personal relationships, adequate leisure and recreation,
attention to spiritual or religious needs, and satisfying work must be held in balance to
promote and maintain the health and well-being of the nurse.
5.3 Wholeness of Character
Nurses have both personal and professional identities that are integrated and embrace the
values of the profession, merging them with personal values. Authentic expression of one’s
own moral point-of-view is a duty to self. Sound ethical decision-making requires the
respectful and open exchange of views among all those with relevant interests: nurses
must work to foster a community of moral discourse. As moral agents, nurses are an
important part of that community and have a responsibility to express moral perspectives,
especially when integral to the situation, whether or not those perspectives are shared by
others and whether or not they might prevail. Wholeness of character pertains to all
professional relationships with patients or clients. When nurses are asked for a personal
opinion, they are generally free to express an informed personal opinion as long as this
maintains appropriate professional and moral boundaries and preserves the voluntariness
of the patient. It is essential to be aware of the potential for undue influence attached to
the nurse’s professional role. Nurses assist others to clarify values in reaching informed
decisions, always avoiding coercion, manipulation, and unintended influence. When nurses
care for those whose personal, condition, attributes, lifestyle, or situations are stigmatized,
or encounter a conflict with their own personal beliefs, nurses still render respectful and
competent care.
5.4 Preservation of Integrity
Personal integrity is an aspect of wholeness of character; its maintenance is a

selfregarding duty. Nurses may face threats to their integrity in any healthcare
environment. Threats to integrity may include requests to deceive a patient, to withhold
information, to falsify records, to misrepresent research aims, as well as enduring verbal
abuse by patients or coworkers. Expectations that nurses will make decisions or take
action in ways that are inconsistent with the ideals, values, or ethics of nursing, or that are
in direct violation of this Code of Ethics for Nurses, may also occur. Nurses have a right and
a duty to act according to their personal and professional values and to accept compromise
only if reaching a compromise preserves the nurse’s moral integrity and does not
jeopardize the dignity or well-being of the nurse or others. Integrity-preserving
compromises can be difficult to achieve, but are more likely to be accomplished where
there is an open forum for moral discourse and a safe environment of mutual respect.
When nurses are placed in circumstances that exceed moral limits or violate professional
moral standards, in any nursing practice setting, they must express their conscientious
objection to participating in these situations. When a particular decision or action is
morally objectionable to the nurse, whether intrinsically so or because it may jeopardize a
specific patient, family, community or population, or when it may jeopardize nursing
practice, the nurse is justified in refusing to participate on convenience, or arbitrariness.
Acts of conscientious objection are acts of moral courage and may not insulate nurses from
formal or informal consequences. Nurses who decide not to participate on the grounds of
conscientious objection must communicate this decision in timely and appropriate ways.
Such refusal should be made known as soon as possible, in advance, and in time for
alternate arrangements to be made for patient care. Nurses are obliged to provide for
patient safety, to avoid patient abandonment, and to withdraw only when assured that
nursing care is available to the patient. When the moral integrity of nurses is compromised
by patterns of institutional behavior or professional practice, nurses must express their
concern or conscientious objection collectively to the appropriate authority or committee
and seek to change enduring activities or expectations in the practice setting that are
morally objectionable. moral grounds. Conscience-based refusals to participate exclude
personal preference, prejudice, bias, convenience, or arbitrariness. Acts of conscientious
objection are acts of moral courage and may not insulate nurses from formal or informal
consequences. Nurses who decide not to participate on the grounds of conscientious
objection must communicate this decision in timely and appropriate ways. Such refusal
should be made known as soon as possible, in advance, and in time for alternate
arrangements to be made for patient care. Nurses are obliged to provide for patient safety,
to avoid patient abandonment, and to withdraw only when assured that nursing care is
available to the patient. When the moral integrity of nurses is compromised by patterns of
institutional behavior or professional practice, nurses must express their concern or
conscientious objection collectively to the appropriate authority or committee and seek to

change enduring activities or expectations in the practice setting that are morally
objectionable.
5.5 Maintenance of Competence and Professional Growth
Maintenance of competence and professional growth involve the control of one’s own
conduct in a way that is primarily self-regarding. Competence affects one’s self-respect,
self-esteem, and the meaningfulness of work. Nurses must maintain competence and strive
for excellence in their nursing practice, whatever the role or setting. Nurses are
responsible for developing criteria for evaluation of practice and for using those criteria in
both peer and self-assessment. To achieve the highest standards, nurses must evaluate
their own performance and participate in substantive peer review.
Continual professional growth, particularly in knowledge and skill, requires a commitment

to lifelong learning. Such learning includes continuing education, networking with
professional colleagues, self-study, professional reading, specialty certification, and
seeking advanced degrees. Nurses must continue to learn about new concepts, evolving
issues, concerns, controversies, and healthcare ethics relevant to the current and evolving
scope and standards of nursing practice. When care that is required is outside the
competencies of the individual nurse, specialized consultation should be sought or the
patient should be referred to others for appropriate specialized care.
5.6 Personal Growth
Nursing care addresses the whole person as an integrated being; nurses should also apply
this principle to themselves. As such, professional and personal growth reciprocate and
interact. Activities that broaden nurses’ understanding of the world and of themselves
affect their understanding of patients; those that increase and broaden nurses’
understanding of nursing’s science and art, values, ethics, and policies also affect the
nurse’s self-understanding. Thus, in continuity with nursing ethics’ historic and enduring
emphasis, nurses are encouraged to read broadly, continue life-long learning, engage in
personal study, seek financial security, participate in a wide range of social advocacy and
civic activities, and to pursue leisure and recreational activities that are enriching.
Provision 6
The nurse, through individual and collective action, establishes, maintains, and improves
the moral environment of the work setting and the conditions of employment, conducive
to quality health care.
6.1 The environment and moral virtue and value

Virtues are universal, learned, and habituated attributes of moral character that
predispose persons to meet their moral obligations; that is, to do what is right. There is a
presumption and expectation that we will commonly see virtues such as integrity, respect,
temperance, and industry in all those whom we encounter. Virtues are what we are to be
and make for a morally “good person”. There are more particular attributes of moral
character, not expected of everyone, that are expected of nurses. These include knowledge,
skill, wisdom, patience, compassion, honesty, and courage. These attributes describe what
the nurse is to be as a morally “good nurse”. Furthermore, virtues are necessary for the
affirmation and promotion of the values of human dignity, well-being, respect, health,
independence, and other ends that nursing seeks. For virtues to develop and be operative
they must be supported by a moral milieu that causes them to flourish. Nurses must create,
maintain, and contribute to morally good environments that enable nurses to be virtuous.
Such a moral milieu fosters mutual respect, communication, transparency, moral equality,
kindness, prudence, generosity, dignity, and caring. This applies to all whether nurse,
colleague, patient, or others.
6.2 The Environment and Ethical Obligation
Virtues focus on what is good and bad in whom we are to be as moral persons; obligations
focus on right and wrong or what we are to do as moral agents. Obligations are often
specified in terms of principles such as beneficence or doing good; nonmaleficence or
doing no harm; justice or treating people fairly; reparations, or making amends for harm;
fidelity, and respect for persons. Nurses, in all roles, must create, maintain, and contribute
to practice environments that support nurses and others in the fulfillment of their ethical
obligations. Environmental factors include all that contribute to working conditions. These
include but are not limited to: clear policies and procedures that set out professional
ethical expectations for nurses; uniform knowledge of The Code of Ethics for Nurses with
Interpretive Statements; and associated ethical position statements. Peer pressure can also
shape moral expectations within a work group. Organizational processes and structures,
position descriptions, performance standards, health and safety initiatives, grievance
mechanisms that prevent reprisal, ethics committees, compensation systems, disciplinary
procedures, and more, all contribute to a practice environment that can either present
barriers or foster ethical practice and professional fulfillment. Environments constructed
for equitable, fair, and just treatment of all reflect the values of the profession and nurture
excellent nursing practice
6.3 Responsibility for the Healthcare Environment
Nurses are responsible for contributing to a moral environment that demands respectful
interactions among colleagues, mutual peer support, and open identification of difficult
issues that includes on-going formation of staff in ethical problem solving. Nurse
executives have a particular responsibility to assure that employees are treated fairly and
justly, and that nurses are involved in decisions related to their practice and working
conditions. Unsafe or inappropriate activities or practices must not be condoned or be
allowed to persist. Nurses should address concerns about the healthcare environment
through appropriate channels. After repeated efforts to make change, nurses have a duty
to resign from healthcare facilities, agencies, or institutions that demonstrate sustained
patterns of violation of patient’s rights, or where nurses are required to compromise
standards of practice or personal integrity, and where the administration is unresponsive
to nurses’ expressions of concern. Following resignation, efforts to address violations
should continue. The needs of patients may never be used to hold nurses hostage in
persistently morally unacceptable work environments. Remaining in such an environment,
even if from financial necessity, nurses risk becoming complicit in ethically unacceptable
practices and may have both untoward personal and professional, and potentially legal,
consequences.
Organizational changes are difficult to achieve and require persistent, sometimes collective
efforts over time. Participation in collective action and interdisciplinary effort for
workplace advocacy to address conditions of employment is appropriate. Agreements
reached through such actions must be consistent with the nursing profession’s standards
of practice, state law regulating practice, and The Code of Ethics for Nurses. The workplace
must be a morally good environment to ensure ongoing quality patient care and
professional satisfaction for nurses and to minimize and address moral distress, strain,
and dissonance. These organizations advocate for nurses by supporting legislation;
publishing position statements; maintaining standards of practice; and by monitoring
social, professional and healthcare changes. Through professional associations, nurses can
help to secure the just economic and general welfare of nurses, safe practice environments,
and a balance of patient–nurse interests.
Provision 7
The nurse, whether in research, practice, education, or administration, contributes to the

advancement of the profession through research and scholarly inquiry, professional
standards development, and generation of nursing and health policies.
7.1 Contributions through Research and Scholarly Inquiry
All nurses must participate in the advancement of the profession through knowledge
development, evaluation, dissemination, and application to practice. Knowledge
development relies chiefly, though not exclusively, upon research and scholarly inquiry.

Nurses engage in scholarly inquiry in order to expand the body of knowledge that forms
and advances the theory and practice of the discipline in all its spheres. Nursing
knowledge draws from and contributes to corresponding sciences and humanities. Nurse
researchers test existing and generate new nursing knowledge. They may involve human
participants in their research, as individuals, groups, or communities. In such cases,
nursing research conforms to national and international ethical standards for the conduct
of research employing human participants. Where research is conducted with the use of
animals, all appropriate ethical standards are observed. In every situation care is taken
that research is soundly constructed, significant, and worthwhile. Dissemination of
research findings, whether positive or negative, is an essential part of respect for the
participants. Knowledge development also occurs through the process of scholarly inquiry,
clinical and educational innovation, and interdisciplinary collaboration. Dissemination of
findings is fundamental to ongoing disciplinary discourse and knowledge development.
Nurses remain committed to patients/participants throughout the continuum of care and
during their participation in research. Whether the nurse is data collector, investigator, or
care provider, patients’ rights and autonomy must be honored and respected.
Patients’/participants’ welfare may never be sacrificed for research ends. Nurse executives
and administrators must develop the structure and foster the processes that create an
organizational climate and infrastructure conducive to scholarly inquiry. In addition to
teaching research methods, nurse educators also teach the moral standards that guide the
profession in the conduct of its research. Research utilization is an expected part of
nursing practice in all settings.
7.2 Contributions through Developing Maintaining, and Implementing Professional

Practice Standards
Practice standards must be developed by nurses and grounded in nursing’s ethical

commitments and body of knowledge. These standards must also reflect nursing’s
responsibility to society. Nursing identifies its own scope of practice as informed, specified,
or directed by state and federal law, by relevant societal values, and by The Code of Ethics
with Interpretive Statements, and Nursing: Scope and Standards of Practice. Nurse
executives establish, maintain, and promote conditions of employment that enable nurses
to practice according to accepted standards. Professional autonomy and self-regulation are
necessary for implementing nursing standards and guidelines and for assuring quality
care. Nurse educators promote and maintain optimal standards of education and practice
in every setting where learning activities occur. They must also ensure that only students
possessing the knowledge, skills, and moral dispositions that are essential to nursing
graduate from their nursing programs.
7.3 Contributions through Nursing and Health Policy Development
Nurses must lead, serve, and mentor on institutional or agency policy committees within
the practice setting. Nurses ought to participate in civic activities related to healthcare
through local, regional, state, national, or global initiatives. Nurse educators have a
particular responsibility to foster and develop students’ commitment to professional and
civic values and to informed perspectives on nursing and healthcare policy. Nurse
executives and administrators must foster institutional or agency policies that support and
reinforce a work environment committed to nurses’ ethical integrity and professionalism.
Nurse researchers must contribute to the body of knowledge by translating science,
supporting evidence-based nursing practice, and advancing effective, ethical healthcare
policies, environments, and a balance of patient–nurse interests.
Provision 8
The nurse collaborates with other health professionals and the public to protect and
promote human rights, health diplomacy, and health initiatives.
8.1 Health is a Universal Right
The nursing profession holds that health is a universal human right and that the need for
nursing is universal. The right to health is a fundamental right to a universal minimum
standard of health to which all individuals are entitled. Such a right has economic, political,
social, and cultural dimensions. It includes public education concerning health
maintenance and promotion; education concerning the prevention, treatment, and control
of prevailing health problems; food security; potable water; basic sanitation; reproductive
health care; immunization; prevention and control of locally endemic diseases and vectors;
and access to health, emergency, and trauma care. This affirmation of health as a
fundamental, universal human right is held in common with the United Nations and the
International Council of Nurses and many human rights treaties.
8.2 Collaboration for Health, Human Rights, and Health Diplomacy
The nursing profession commits to advancing the health, welfare, and safety of all. This
nursing commitment reflects the intent to achieve and sustain health as a means to the
common good so that individuals and communities here and abroad can develop to their
fullest potential and live with dignity. Ethics, human rights, and nursing converge as a
formidable instrument for social justice and health diplomacy that can be amplified by
collaboration with other health professionals. Nurses understand that the lived experience
of poverty, inequality, and social marginalization contribute to the deterioration of health
globally. Nurses must address the context of health, including social determinants of health
such as poverty, hunger, access to clean water and sanitation, human rights violations, and
healthcare disparities. Nurses must lead collaborative partnerships to develop effective
public health policies, legislation, projects, and programs that promote health, prevent
illness, restore health, and alleviate suffering. Participation includes collaboration to raise
health diplomacy to parity with other international concerns such as treaties, commerce,
and warfare. Human rights must be diligently protected and promoted, interfered with
only when necessary and in ways that are proportionate and in accord with international
standards. Advances in technology and genetics require robust responses from nurses
working together with other health professionals for creative solutions and innovative
approaches that are ethical, respectful of human rights, and equitable in reducing health
disparities.
8.3 Obligation to Advance Health and Human Rights
Nurses collaborate with others to change unjust structures and processes that affect
persons or communities. Structural social inequalities and disparities, inadequate social
policies, or institutional policies or practices exacerbate the incidence and burden of
illness, trauma, suffering, and premature death. Through community organizations and
groups, nurses educate the public; facilitate informed choice; identify conditions and
circumstances that contribute to illness, injury and disease; foster healthy life styles; and
participate in institutional and legislative efforts to protect and promote health. Nurses
collaborate to address barriers to health, such as poverty, homelessness, unsafe living
conditions, abuse and violence, and lack of access by engaging in open discussion,
education, public debate and legislative action. Nurses must recognize that health care is
provided to culturally diverse populations in this country and across the globe. Nurses
collaborate to create a moral milieu that is culturally sensitive to diverse cultural values
and practices.
8.4 Collaboration for Human Rights in Complex and Extraordinary Practice Settings
Nurses must be mindful of competing moral claims (that is, conflicting values or
obligations) and bring attention to human rights violations in all settings and contexts.
Human trafficking; the global feminization of poverty, rape, and abuse as an instrument of
war; the oppression or exploitation of migrant workers; and all such human rights
violations are of grave concern to nurses. The nursing profession must intervene when
these violations are encountered. Human rights may be jeopardized in extraordinary
contexts related to fields of battle, pandemics, political turmoil, regional conflicts, or
environmental catastrophes where nurses must necessarily practice under altered
standards of care. Nurses must always stress human rights protection under all conditions,
with particular attention to preserving the human rights of vulnerable groups such as
women, children, the elderly, prisoners, refugees, and socially stigmatized groups. All
actions and omissions risk unintended consequences with implications for human rights.
Thus, nurses must engage in discernment, carefully assessing their intentions, reflectively
weighing all possible options and rationales, and formulating a clear moral justification for
their actions. Only under extreme and exceptional conditions, while conforming to
international standards and engaging in an appropriate and transparent process of
authorization, may nurses subordinate human rights concerns to other considerations
Provision 9
The profession of nursing, collectively through its professional organizations, must

articulate nursing values, maintain the Collaboration for health, human rights, and
health diplomacy, and integrate principles of social justice into nursing and health policy.
9.1 Articulation of Values
Individual nurses are represented by their professional associations and organizations.

These groups give united voice to the profession. It is the responsibility of a profession
collectively to communicate, affirm, and promote shared values both within the profession
and to the public. It is essential that the profession engage in discourse that supports
ongoing critical self-analysis and evaluation. The language that is chosen evokes the shared
meaning of nursing, its values and ideals, as it interprets and explains the place and role of
nursing in society. The profession’s organizations communicate to the public the values
that nursing considers central to the promotion or restoration of health, prevention of
illness, and alleviation of suffering. Through professional organizations the nursing
profession must reaffirm and strengthen nursing values and ideals so that when those
values are challenged, adherence is steadfast and unwavering. Acting in solidarity, the
ability of the profession to influence social justice and global health is formidable.
9.2 Integrity of the Profession
The profession’s integrity is strongest when its values and ethics are evident in all
professional and organizational relationships. Nursing must continually emphasize the
values of justice, fairness, and caring within the national and global nursing communities,
in order to promote health in all sectors of the population. A fundamental responsibility is
to promote awareness of and adherence to the codes of ethics for nurses (the American
Nurses Association and the International Council of Nurses). Balanced policies and
practices regarding access to nursing education, workforce sustainability, nurse migration,
and utilization are requisite to achieving these ends. Together, nurses must bring about the
improvement of all facets of nursing, fostering and assisting in the education of
professional nurses in developing regions across the globe. The values and ethics of the
profession must be evident in all professional relationships whether interorganizational,
or international. The nursing profession engages in an ongoing formal and informal dialog
with society. The covenant between the profession and society is made explicit through
The Code of Ethics for Nurses, Nursing’s Social Policy Statement, Nursing: Scope and
Standards of Practice, and other published standards of specialized nursing practice;
continued development and dissemination of nursing scholarship; rigorous educational
requirements for entry and continued practice including certification and licensure; and
commitment to evidence-based practice.
9.3 Integrating Social Justice
It is the shared responsibility of professional nursing organizations to speak for nurses

collectively in shaping health care and to promulgate change to improve health care
nationally and internationally. Nurses must be vigilant and take action to influence
legislators, governmental agencies, non-governmental organizations, and international
bodies in all related health affairs for addressing the social determinants of health. All
nurses, through organizations and accrediting bodies involved in nurse formation and
development, must firmly anchor students in nursing's professional responsibility to
address unjust systems and structures, modeling the profession's commitment to social
justice and health through content, clinical and field experiences, and critical thought.
9.4 Social Justice in Nursing and Health Policy
The nursing profession must actively participate in solidarity with the global nursing
community and health organizations to represent the collective voice of U.S. nurses around
the globe. Professional nursing organizations must actively engage in the political process,
particularly addressing those legislative concerns that most impact the public's health and
the profession of nursing. Nurses must promote open and honest communication that
enables nurses to work in concert, share in scholarship, and advance a nursing agenda for
health. Global health, as well as the common good, are ideals that can be realized when all
nurses unite their efforts and energies Social justice extends beyond human health and
well-being to the health and wellbeing of the natural world. Human life and health are
profoundly affected by the natural world that surrounds us; thus, consistent with
Nightingale's historic concerns for environmental influences on health and the meta-
paradigm concepts of nursing, nursing's advocacy for social justice extends to eco-justice.
Environmental degradation, water depletion, earth resources exploitation, ecosystem
destruction, excessive carbon production, waste, and other environmental assaults
disproportionately affect the health of the poor and ultimately affect the health of all
humanity. Nursing must also advocate for policies, programs, and practices within the
healthcare environment that maintain, sustain, and repair the natural world. As nursing

seeks to promote and restore health, prevent illness, and alleviate suffering, it does so
within the holistic context of healing the world.
Having learned the Code of Ethics for Nurses, make a slogan that would summarize its
concept. (10 points)
In 3-5 sentences, briefly explain the main point of each provision of the Nursing Code of
Ethics. (5 points/item)
a. Provision 1
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b. Provision 2
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c. Provision 3
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d. Provision 4
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e. Provision 5
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f. Provision 6
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g. Provision 7
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h. Provision 8
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i. Provision 9
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Rubric for Assessment

Points Description
5 Main points of the provision clearly stated and
defensible.
4 Main points of the provision stated but not clearly
defensible.
3 Main pints of the provision somehow stated and somehow
defensible.
2 Main points of the provision somehow stated but not
defensible.
1 Main points of the provision not stated.
LESSO
N
3 3
PATIENT’S BILL OF RIGHTS
HOURS
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.
At the end of this module, you are expected to:

a. enumerate and discuss the Patient’s Bill of Rights;
b. describe the qualities and responsibilities of the health care provider to the client,
society and its profession.
Find words in the puzzle that you think should be considered as patient’s rights.
Q X D S C P E Z G I P O D
R W L I A O T X B S Y E U
P D Y Y R N R D C T S U O
R V T J E S A G X U S R P
I E R S K J I J F I I D T
V F N Z F B O E Z N M E R
A O I N F O R M A T I O N
C G F A C C U K K E I Z H
Y H M T R X Y L R R Y U M
Definition of Terms
(a) Advance Directive- is a document with written instructions made by a person before he/she
reaches the terminal phase of a terminal illness or a persistent vegetative state and incapable of
malting decisions about medical treatment when the question of administering the treatment
arises. It includes, but is not limited to, a health care proxy or a living will. It is preferably, a duly
notarized document executed by a person of legal age and of sound mind, upon consultation
with a physician and family members. It directs health care providers to refrain from providing
extraordinary measures when the person executing such directive reaches the terminal phase
of his terminal illness.
(b) Emergency - an unforeseen combination of circumstances which is unanticipated and
episodic; life-threatening; and there is disability of function which calls for immediate medical
intervention to preserve the life of a person and/or patient as may be determined by a
responsible health care worker.
(c) Health Care -measures taken by a health care provider or that are taken in a health care
institution in order to determine a patient’s state of health or to restore or maintain it.
(d) Health Care Institution - a site devoted primarily to the maintenance and operation of
facilities for the prevention, diagnosis, treatment, and care of individuals suffering from illness,
disease, injury, or deformity if in need of medical and nursing care.
(e) Health Care Professional/Practitioner - any physician, dentist, nurse, pharmacist or
paramedical and other supporting health personnel, including, but not limited to, medical and
dental technicians and technologists, nursing aides, therapists, nutritionists trained in health

care and/or duly registered and licensed to practice in the Philippines as well as traditional and
alternative health care practitioners.
(f) Health Maintenance Organization - any entity licensed by the appropriate government
regulatory agency which arranges for coverage designated health services needed by plan
members for a fixed prepaid premium.
(g) Human Experimentation - the physician’s departure from standard medical practice of
treatment for the purpose of obtaining new knowledge or testing a scientific hypothesis on
human subjects.
(h) Indigent Patient -a patient who has no visible means of income or whose income is
insufficient for the subsistence of his family.
(i) Informed Consent - the voluntary agreement of a person to undergo or be subjected to a
procedure or other bodily intervention based on his understanding of the relevant consequences
of receiving a particular treatment, as clearly, truthfully and reasonably explained by the health
care provider in a manner and language understandable to the patient. Such permission must
be in writing.
(j) Mass Media - embraces means of communication that reach and influence large numbers of
people, including print media, especially newspapers, periodicals, and popular magazines,
radio, television, and movies, and involved in the gathering, transmission and distribution of
news, information, messages, signals and all forms of written, oral and visual communications.
(k) Media Practitioner - any person who is engaged in the practice of mass media.
(l) Medically Necessary - a service or procedure which is appropriate and consistent with
diagnosis and which, using accepted standards of medical practice, could not he omitted
without adversely affecting the patient’s condition.
(m) Patient - a person who avails himself or herself of health and medical care services or is
otherwise the subject of such services
(n) Public Health and Safety - the state of well-being of the population in general, the protection
of which may require the curtailment or suspension of certain rights of patients.
(o) Terminal Care - is an array of services offered by a team of doctors, nurses, therapists,
social workers, clergy and volunteers which provide active total care directed at maintaining or
improving the comfort of a person suffering from terminal illness, including the management of
pain and physical symptoms, and the provision of spiritual, psychological and emotional support
for the person and his family in an institution, a hospital or at the patient’s home. Care does not
hasten nor postpone death. It affirms life and regards dying as a normal process. Care
continues so that the remaining life can be lived to the West until a dignified and peaceful death
comes in the terminal phase of the person’s illness.
(p) Terminal Illness - is an illness or condition resulting in death within the foreseeable future.
(q) Terminal Phase - is the stage of terminal illness when there is no real prospect of recovery
or remission of symptoms on either a permanent or temporary basis.
(r) Traditional and Alternative Health Care - the sum total of knowledge, skills and practices on
health care, other than those embodied in biomedicine, used in the prevention, diagnosis and
elimination of physical or menta1 disorder.
(s) Traditional and Alternative Health Care Practitioner Provider – a person who practices other
forms of non-allopathic, occasionally nonindigenous or imported healing methods, such as
reflexology, acupuncture, massage, acupressure, chiropractic, nutritional therapy, and other
similar methods.
(t) Unwarranted Public Exposure - a situation where the patient is subjected to exposure, private
or public, either by photography, publication, videotaping, discussion, TV broadcasting or radio
broadcasting, or by any other means that would otherwise tend to reveal his person or identity

and circumstances under which he has or will be under medical or surgical treatment without
his/her consent.
The Rights of Patients

The following rights of the patient shall be respected by all those involved in his care:
(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 4 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 care, 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 for treatment.
(2) Right to Informed Consent. - The patient has a right to a clear, experiences and traditions in
developing and critiquing ethical norms , 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 or 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 to 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 third party consent is required, the following persons, in the order of priority stated
hereunder, may give consent: i. spouse; ii. either parent; iii guardian If a patient is a minor,
consent shall be obtained from his parents or Iegal son or daughter of legal age; brother or
sister of legal age, or guardian. If next of kin, parents or legal guardians refuse to give consent
to a medical or surgical procedure necessary to save the life or 1iC.b 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 following cases:
a) when his mental or physical condition is in controversy and the appropriate court, in its
discretion, orders 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. 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 courz; 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 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 furnish 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 his/her legal guardian has the right to be informed by the physician or
his/her delegate of his/her 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 the
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 lusher 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. The patient has likewise the right not to be informed, at his/her explicit
request.
(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
sexice facility or when public health and safety so demands or when the patient expressly or
impliedly waives this right. 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.
(6) Right to Self-Determination. - The patient has the right to avail himself/herself of any
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 a reasonable period of
time.
(9) Right to Leave. - The patient has the right to leave a 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 decision;
b) he/she releases those involved in his/her care from any obligation relative to the
consequences of his decision;
c) his/her decision will not prejudice public health and safety. No patient shall.be detained
against his/her Will in any health care institution on the sole basis of his failure to fully settle is
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, farther, that
unpaid bills of patients shall be considered as lost income by the hospital and health care
provider/practitioner and shall be deducted from gross income as income loss for that particular
year.
(10) Right 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, further, That, an institutional review board or ethical review board jn
accordance with the guidelines set in the Declaration of Helsinki be established for research
involving human experimentation: Provided, 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.
(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. The Secretary of Health, in consultation with
health care providers, consumer groups and other concerned agencies shall establish a
grievance system wherein patients may seek redress of their grievances. 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 health 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 &d 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 patients of their rights as well as the the institution's rules and
regulations that apply to the conduct of the patient while in the care of such institution.
Let’s Recall! Identify what is described in each item. Write your answer on the space
provided:
_________________1. The sum total of knowledge, skills and practices on health care,
other than those embodied in biomedicine.
_________________2. A situation where the patient is subjected to exposure, or by
any other means that would otherwise tend to reveal his person or identity.
_________________3. A person who avails himself/herself of health and medical care
services.
_________________4. Stage of illness when there is no real prospect of recovery.
_________________5. Any entity licensed by the appropriate government regulatory
agency which arranges for coverage designated health services.
_________________6. A service/procedure which is appropriate and consistent with
diagnosis.
_________________7. The voluntary agreement of a person to be subjected to a
procedure.
_________________8. A document with written instructions made by a person before
he/she reaches the terminal phase.
_________________9. It is an unforeseen combination of circumstances which is
unanticipated and life-threatening;
_________________10. A patient who has no visible means of income.
_________________11. The physician’s departure from standard medical practice of
treatment for the purpose of obtaining new knowledge
_________________12. It is a condition resulting in death within the foreseeable
future.

List down the Rights of Patients and provide a brief description of each. Write your
answer on the space provided. (5 points/item)
a. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
b. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
c. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
d. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
e. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
f. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
g. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
h. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
i. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
j. ________________________________________________________________
________________________________________________________________

________________________________________________________________
_______________________________________
k. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
l. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
m. ________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________


Condes-K BioEthics Module2

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no universal moral rules or rights REPUBLIC OF THE PHILIPPINES

NORTHERN NEGROS STATE COLLEGE OF SCIENCE AND

This document is a property of NONESCOST

SUN-NEGROS: A glocally recognized university offering distinctively – niched academic

programs engaged in dynamic quality instruction, research and extension by 2025.

to contribute to nation – building by providing education, training, research and resource

creation opportunities in various technical and disciplinal areas.

UPGRADEd instruction, research, extension and governance for glocal recognition.

1. Demonstrate logical thinking, critical judgment and independent decision-making on any

This document is a property of NONESCOST Module 2 | Page 2

CHED BS Nursing Program Outcomes:

The program shall produce a graduate who can:

NONESCOST BS Nursing Program Outcomes:

This document is a property of NONESCOST Module 2 | Page 3

INTRODUCTION- Overview of the

LEARNING OUTCOMES- Lesson objectives for you to ponder

MOTIVATION- Fuels you to go on

PRESENTATION- A smooth transition to the lesson

TEACHING POINTS- Collection of ideas that you must discover

LEARNING ACTIVITIES – To measure your learnings in the lesson where you

ASSESSMENT – To test your understanding in the lesson you discovered

This document is a property of NONESCOST Module 2 | Page 4

This document is a property of NONESCOST Module 2 | Page 5

THE HUMAN PERSON

TYPES OF ETHICAL THOUGHTS

THE HEALTH CARE PROFESSION

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b. Bioethical and Moral Issues-contraception, mutilation and plastic

1. Nunes, Rui. (2014). Bioethics: Medical. 10.1007/978-3-319-05544-2_44-1.

2. Sanderson, C. (2016). Ethical and Bioethical Issues in Nursing and Health

T1 Rick, K. (2015). Introduction to Bioethics and Ethical Decision Making, 7 th

OR1 Butts, JB (2013). Ethics in Professional Nursing Practice. Jones and

1. Active class participation (online discussion board, FB Closed group

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Subject Area Coordinator :NATASHA KAY V. CHAN, RN, MN

Dean, CAS : AILEEN G. SYPONGCO, MN, RN, RM, MN

GAD Director : MARY ANN T. ARCEŇO, LPT, Ph. D.

CIMD, Chairperson : MA. JANET S. GEROSO, LPT, Ph. D.

QA Director : DONNA FE V. TOLEDO, LPT, Ed. D.

VP- Academic Affairs : SAMSON M. LAUSA, Ph. D.

This document is a property of NONESCOST Module 2 | Page 8

This course module is an official document of Northern Negros State

Quotations from, contractions, reproductions, and uploading of all or any

and from the NONESCOST.

This module shall be used for instructional purposes only.

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1 TYPES OF ETHICAL THOUGHTS

At the end of this lesson, you are expected to:

If a person is an end-in-themselves it means their inherent value doesn't depend

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 Do the right thing.

Some kinds of action are wrong or right in themselves, regardless of the

Deontologists live in a universe of moral rules, such as:

 It is wrong to kill innocent people

If we compare Deontologists with Consequentialists we can see that

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In situation ethics, right and wrong depend upon the situation.

Situation ethics rejects 'prefabricated decisions and prescriptive rules'. It teaches

…reflective morality demands observation of particular situations, rather than fixed

So a person who practices situation ethics approaches ethical problems with

For example, lying is ordinarily not in the best interest of interpersonal

Elements of situation ethics

 Moral judgments are decisions, not conclusions

Pragmatism is generally considered to be the first and only philosophical school of