NCM 108 – HEALTHCARE ETHICS capacity to act

January 31, 2023 intentionally. with

understanding, and
Ethical Principles Used in without controlling
influences that would
Health Care act against a free and
voluntary act such as
What are Ethical Principles? coercion or undue
influence.
are widely
- The primary task of
accepted codes
the health care
generally based
ETHICAL provider is to inform the
on the humane
PRINCIPLES patient or the persons
aspect of society
responsible for the
that direct or
patient all the
governs actions.
information there is
reflect what is
about the options
ETHICAL best for the client
available
DECISIONS and society.

c. - It means acting in a
Importance: Ethical principles can be
fatherly manner which
used as guidelines in analysing
involves engaging in
dilemmas and can serve as justification
behavior associated
(rationale) for resolving ethical
PATERNALISM/ with those of the
problems.
PARENTALISM traditional roles of the
father of a family such
PRINCIPLE OF AUTONOMY as leadership, decision
making, discipline and
Autonomy protection.
➢ refers to the individual's right to d. This pertains to health
choose and the individual's ability to care providers making
act on that choice. decisions about a
➢ Promotes self - determination/ STANDARD OF client's health care
freedom of choice BEST INTEREST when they are unable
to make informed
APPLICATION OF AUTONOMY IN HEALTH decisions about their
own care.
CARE ETHICS:
In this situation, the
a. - Refers to the capacity
health care provider
of the patient to accept
INFORMED must decide what the
or refuse treatment.
CONSENT best course of action
- The respect for the for the patient is and
autonomy of the carry it out.
patient means that the
e. Is a Document where a
patient has the
person give instructions

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 ADVANCE about future medical 2. Medical Power of Attorney (Health
DIRECTIVE care should he or she Care Proxy)
be unable to
participate in medical - names a trusted person to act as an
decisions due to agent or proxy in making health care
serious illness or decisions in the event of incapacity.
incapacity.
PRINCIPLE OF CONFIDENTIALITY
AD may provide a
patient's personal KEEPING privileged information private
instruction that:
1. Direct a physician Confidentiality or professional secrecy is
not to put him on both a legal and moral obligation of
prolonged life support health care providers to their clients.
if, in the future, if his Means all information gathered about
condition is such that the patient in the course of his health
there is little or no hope care by a health care professional
of reasonable recover should be safeguarded from others, or
2. Specify a treatment should be a secret between the
to follow. professionals involved in the patient's
3. Name a substitute health care and the patient.
decision maker, a
person who will make PERSONS REQUIRED TO OBSERVE
the medical decisions CONFIDENTIALITY
on behalf of the
A. who deal with the patient
patient when the latter
even for a briefest time at
is incapacitated or in a
Physicians various phases of the
condition where he is
patient's illness or
unable to make such
treatment
decisions.
f. PATIENT'S BILL B. who prepares and
OF RIGHTS Pharmacist dispenses the medication
prescribed to the patient
C. all other nurses, midwives, medical
Forms of Advance Directive: health care technologists, hospital
professionals chaplain, student nurses
1. Living Will (Instructional Directive) involved in and social workers.
- a will in which a competent adult give the care of
directions or instructions for future care the patient
in the event that he becomes D. all other janitors, hospital
incapacitated due to terminal illness or personnel receptionists, secretaries,
impending death. who accountant, treasurer, etc.
attended to
the care of
the patient

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 WHEN CONFIDENTIALITY MAY END:
1. After the patient gives his consent to
reveal information about him or his
health care.
2. When its revelation is for the common
good.
3. The necessity of reporting medico:
legal cases.
PRINCIPLE OF VERACITY
TRUTHFULNESS
The obligation to tell the truth.
Forms of deception:
✓ intentional lying
✓ partial disclosure of information, or
✓ nondisclosure of information.
Telling the truth may be hard, but deciding
how much truth to tell may be very hard.
PRINCIPLE OF FIDELITY
FAITHFULNESS
The need to KEEP PROMISES.
The obligation to be faithful to
the agreements, commitments and
responsibilities that one has made to
oneself and others.
PRINCIPLE OF JUSTICE
It is the obligation to be fair to all
people. It is based on the concept of
fairness extended to each individual;
equal treatment to all.
Principle of Justice - refers to a moral
principle by which certain actions are
determined and deemed as just or
unjust, as due or undue.
Justice - Seeks fairness.
- Treats "equals" equally.
- Treats "unequals" according to their
differences.
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PROBLEMS RELEVANT TO THE PRINCIPLE
OF JUSTICE
Basically, justice can be
manifested in the equitable distribution
of health care resources and goods
because of equality of rights.
However, problems may arise
when extraordinary situations occur
such as calamity, epidemics or sickness
and the like causing difficulties out of
scarcity of health care resources and
health care providers and out of
voluminous number of patients and
distribution of health care burdens.
pertains to a fair scheme of
distributing society's
benefits and burdens to its
Distributive members in health care
Justice milieu.
Ex. Just allocation of resources
refers to various health care
services, while burdens
Benefits include the necessary
payment for the delivery of
health care and
participation in medical
experimental research.
PRINCIPLE OF BENEFICENCE
Provides that good must be done either
to oneself or to others.
➢ Urges everyone to do what is good
and perform for good as a moral
obligation.
➢ Health care practitioners have the
primary obligation to ensure that
good is done to their patients and
clients.
➢ duty to promote good.
Elements: one ought:
a. not to inflict/evil/harm
b. Prevent evil/harm
c. Remove evil/harm
d. To do or promote good
PRINCIPLE OF NON-MALEFICENCE
Provides that evil or harm should not be
inflicted either on oneself or on others.
➢ Urges everyone to avoid inflicting
harm
➢ It mandates the right not to be killed,
right not to have bodily injury, or
pain inflicted (on) oneself, (and) right
not to have one's confidence
revealed to others.
VIOLATIONS OF THE PRINCIPLE OF NON-
MALEFICENCE:
a. Physically harming a person as in suicide,
abortion, infanticide, mutilation, torture
and violence.
b. Exposing a person to physical harm as in
subjecting a person to unnecessary
treatment or to a dangerous procedure
without a commensurate important
goal;
and
c. Harming a person's reputation, honor,
property, or interests as by revealing
confidential information
PRINCIPLE OF THE DOUBLE EFFECT
OR THE TWO-FOLD EFFECT
Action having two effects: a good effect
that is intended and a bad effect that is
foreseen.
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This doctrine was established by St
Thomas Aquinas in the 13th century.
PRINCIPLE OF SUBSIDIARITY
Means that what an individual, lower or
smaller group can achieve within
his/her or its capacity should not be
taken away and transmitted to the
custody and performance of a higher or
bigger group.
Likewise, no bigger or higher
group can arrogate to itself functions
that can capably and competently be
done by an individual or lower group.
PRINCIPLE OF LEGITIMATE
CORPORATION
Basic principle of legitimate cooperation
people should never do anything that is
not morally permissible.
TYPES OF COOPERATION WITH EVIL
1. Positive and Negative Cooperation
Positive Cooperation - a voluntarily
doing an act which contributes to the
evil act of another.
A nurse/midwife who assists an obstetrician
perform an abortion is committing positive
cooperation.
Negative Cooperation - is cooperation
by omission in which the person did not
do anything to prevent another person
from committing an evil act.
A nurse who saw another nurse stealing
medical supplies and does not stop the
latter or report the incident to her supervisor
is committing cooperation by omission.
 2. Immediate/Direct or Mediate/Indirect
Cooperation
Direct cooperation happens when a
person's cooperation occur while the
act is being performed.
A nurse who acts as a "watch" while the
doctor injects a fatal dose of sedative to an
/ unconscious patient is committing direct
cooperation.
Indirect Cooperation is committed
before and after the evil act, however,
the cooperation is not necessary to the
evil at itself.
A nurse destroys all evidence of an abortion
although she did not assist while the surgical
procedure was being performed.
NEXT TOPIC:
Patient’s Bill of Rights
PATIENT'S RIGHTS
Refers to the moral power incumbent
upon the dignity of the patient as a
human person which is enjoined by
both natural law and positive law
requiring what is due must be rendered
to the patient as justice demands
1. RIGHT TO MEDICAL CARE AND
HUMANE TREATMENT
a. Every person has the right to health
and medical care corresponding to his
state of health, without any
discrimination and within the limits of the
resources available for health and
medical care at the relevant time
b. The patient has the right to health
and medical care of good quality.
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In the course of such care, his human
dignity, convictions and Integrity shall
be respected.
His individual needs and culture shall be
likewise respected
c. 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 reasons for the
delay and the estimated waiting time.
d. Patients in emergency who are in
danger of dying and/or may have
suffered serious physical injuries shall be
extended immediate medical care and
treatment without any deposit, pledge,
or mortgage or any form of advance
payment for the confinement of
treatment.
2. RIGHT TO INFORMED CONSENT
Informed Consent
Refers to the capacity of the patient to
accept or refuse treatment.
a. The patient has a right to clear
explanation, in lay person's terms,
 all proposed procedures, whether
diagnostic or therapeutic,
 including the identity of the person
who will perform the said procedure,
 possibilities of any risk or mortality or
serious side effects,
 problems related to recuperation,
and
 probability of risks involved, and
 he will not be subjected to any
procedure without his informed
consent.
 What if your patient is unconscious? Or
incapable of giving consent?
In cases of emergency, when the
patient is unconscious and/or incapable
of giving consent and there is no one
who can give consent in his behalf, then
the physician can perform any
diagnostic or treatment procedure as
good practice of medicine dictates
without such consent;
B. Informed consent shall be obtained
from a patient concerned if he is of
legal age and of sound mind, from the
next kin in the case the patient is
incapable of giving consent, or from the
parents or legal guardian in the case of
minor or mentally incapacitated
individual.
Who can give consent?
➢ Patient
➢ Parent
➢ Guardian
➢ SO
3. RIGHT OF PRIVACY
a. The patient has the right to be left
alone when this will not prejudice the
provision of necessary medical care.
b. The patient has the right to be free
from unwarranted publicity, except in
the following cases
1. 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.
2. when the public health and safety
so demand; and
3. when the patient waived his right.
4. in medico-legal cases
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4. RIGHT TO INFORMATION
a. The patient has the right to clear,
complete, and accurate evaluation of
the nature and extent of his disease,
➢ the contemplated medical
treatment and surgical procedure
➢ including the medicines to be
administered and
➢ their generic counterparts and its
➢ probable outcome
➢ economic costs,
➢ impact on lifestyle and work,
➢ including side effects and after
effects of the treatment,
➢ possible complications and other
pertinent facts regarding his illness.
What if the disclosure of the information
to the patient will cause mental suffering
and further impair his health, or cause
the patient not to submit to medically
necessary treatment?
If the disclosure of this information to the
patient will cause mental suffering and
further impair his health, or cause the
patient not to submit to medically
necessary treatment, such as disclosure
may be withheld or deferred to some
future opportune time upon due
consultation with the patients next of kin.
b. The patient has the right to know the
name and credentials of the physician
responsible for his care or for
coordinating such care. He may likewise
request for similarly relevant information
about any other health care provider
directly involved in his care
c. The patient has the right to examine
and be given an itemized bill for
services rendered in the facility or by his
physician and by other health care
providers, regardless of the manner and
source of payment.
He is entitled to a thorough explanation
of such bill should he find this
incomprehensible.
5. RIGHT OF PRIVILEGED
COMMUNICATION
(CONFIDENTIALITY)
The patient has the right to demand
that all information, communication
and records pertaining to his care can
be treated as confidential. A physician
is not authorized to divulge in any
information to a third party who has no
concern with the care and welfare of
the patient, except:
Exceptions:
1. When such disclosure will benefit
public health and safety
2. When it is the interest of justice
3. When the patient waives the
confidential nature of such info
6. RIGHT TO CHOOSE A PHYSICIAN
The patient is free to choose the
physician to serve him except when;
1. he is confined in a charity ward,
2. he has entered into a contract with
a health maintenance organization
or any other health Insurance
organization which stipulates that
the patient can only be served by
an Affiliated with the organization.
7. RIGHT TO SELF - DETERMINATION
a. The patient has the right to refuse
diagnostic and treatment procedures.
Provided, that
1. he is of legal age and of sound
mind
2. he is informed of the medical
consequences of his refusal
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3. he releases those involved in his
care from any obligation relative to
the consequences of his decisions
4. his refusal will not jeopardize public
health and safety.
b. An adult with a sound mind may
execute an advance directive for
physicians not to put him on prolonged
life support if, in the future, his condition
is such that there is little or no hope of
reasonable recovery.
8. THE RIGHT TO RELIGIOUS BELIEF
The patient has the right to refuse
medical treatment 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 age of legal
discretion.
9. RIGHT TO MEDICAL RECORDS
a. The patient is entitled to a summary
of his medical history condition which
shall be accomplished by the attending
physician. He has the right to view the
content of his medical records with the
AP explaining the contents thereof.
b. The health care institution shall ensure
and safeguard the integrity and
authenticity of the medical records.
c. The health care institution shall issue
medical certificate, free of charge, to
the patient upon discharge from the
institution. Any other document that the
patient may require for insurance claims
shall also be made available to him
within reasonable period of time.
 10. RIGHT TO LEAVE 15. RIGHT TO BE INFORMED OF HIS RIGHTS
AND OBLIGATIONS AS A PATIENT
a. The patient has the right to leave the
hospital or any other health care Every person has the right to be
institution regardless of his physical informed of his rights and obligations as
condition. a patient.
b. No patient shall be detained against
his will in any health care institution on
the sole basis of his failure to fully settle
his financial obligations with the
physician or the health care institution

11. 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 that may affect his
care or treatment. Such human
experimentation may be performed
only with the written informed consent
of the patient

12. RIGHT TO SELF - DETERMINATION

The patient has the right to
communicate with relatives and other
persons and to receive visitors subject to
reasonable limits prescribed in the rules
and regulations of the health care
institution.

13. RIGHT TO KNOW WHAT HOSPITAL

RULES & REGULATIONS APPLY TO THIS
CONDUCT AS A PATIENT

14. RIGHT TO TO EXPRESS GRIEVANCES

The patient has the right to express

grievances about the care and services
received.

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