THEORIES

OF HEALTH
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A. Teleological Ethics-
- greek telos, teleos “end” or
“ourpose”
- it stresses the end-result, goal
or consequence of an act as
v the determining factor of its
\’‘, rightness and wrongness,
~- consequential ethics
B. deontological Ethics-
- Greek deon, deontos,
discourse y duty or
obligation
- it stress duty of tHeRorn of
moral action, \
- is also called duty ethics
C. Utilitarianism
an action or practice is right
if it leads to the greatest
() possible balance of good
© consequences in the world
- asawhole.
 Four conditions

a. The Principle of Utility :Maximize the

good
b. Theory of Value: Standard of Goodness
c. Consequentialism: Whatever its precise value
theory
d. Impartiality (Universalism)
d. Thomistic Ethics

- St. Thomas Aquinas

(1225-1274)
- Christian/Roman
Catholic Ethics
- Natural Law Ethics
- Scholastic Ethics
synderesis
-inherent capacity of every individual,
lettered or unlettered, to distinguish the
good from the bad

- voice of right reason or voice of

conscience !
Man’s threefold natural inclination.

1. self-preservation
2. just dealings with
| others
3. propagation of
Species
Three determinants of moral action

1. the object

-that which the will intends

directly and_ primarily
- could be a thing or a procedure
2. The Circumstance
- there are conditions which,
when superadded to the
nature of the moral act, will
affect its morality
- mitigating or aggravating
circumstance
 Who?
- this circumstances has something to
do with the special quality, prestige,
rank, or excellence of the person
involved in the moral act
 What?
this circumstance refers to the
quantity or quality of the moral
object
 Where?
this circumstance denotes the place
where the act occurs
 By what means?
this refers to the means used in
carrying out the act
 How?
this circumstance indicates the
manner in which the action is done
 When?
this circumstance refers to the time
element involved in the performance
of an action, not only with regard to
quantity but to quality as well.
3. The End or Purpose

- here we take end in the sense of

end or purpose of the doer
or agent
- it also affects the goodness or
badness of anactionor
decision in a number of
important ways
 Vala eel =
ETHICS in
Nursing | (/
 VIRTUE ETHICS IN NURSING

VIRTUE ETHICS or CHARACTER ETHICS

- individual actions are based
upon a certain degree of
innate moral virtue.
 VIRTUE ETHICS IN NURSING
3 Criteria of a virtuous character:

1. Virtuous acts must be chosen for their own

sake
2. Choice must proceed from a firm and
unchangeable character
3. Virtue is a disposition to choose the mean
 VIRTUE ETHICS IN NURSING
Florence Nightingale- virtue is an important trait of
a good nurse
Nightingale Pledge - implies virtue of character as
nurses promise purity, faith, loyalty, devotion,
trustworthiness, and temperance
Good character is the cornerstone of good nursing
A nurse with virtue will act according to principle
Aristotle - believe that virtue can be practiced and
learned, so we can learn through practice.
 FOCAL VIRTUES
1. COMPASSION - ability to imagine oneself in
the situation of another
2. DISCERNMENT- sensitive insights involving
acute judgment and understanding
resulting in a decisive action
3. TRUSTWORTHINESS - a confident belief in
the moral character of another person
4. INTEGRITY - soundness, reliability,
wholeness, and an integration of moral
character
 CORE NURSING VALUES

"As yur actions are informed by your awareness of

values, your thinking and your ideas are shaped ard
changed by yur experiences with thse actions
(Chim, 2.004)
 Values
* one set of personal beliefs and attitudes
about the truth, beauty and worth of any
thought, object or behavior.

¢ are action oriented and give direction and

meaning to one's life’.

HATH K
¢ Personal values
are values internalized from the society or
culture in which one lives.
Professional values
are values acquired during socialization
into nursing from codes of ethics, nursing
experiences, teachers, and peers.

HATH K
core values of nursing
¢ Human Dignity
¢ Integrity
¢ Autonomy
¢ Altruism
¢ Social justice
Human Dignity

¢ls a respect for the inherent worth and

uniqueness of individuals and
populations.

FATIH
Integrity

¢refers to adherence to moral

norms that is sustained overtime

POH
¢ Autonomy
¢ Is the right to self determination.
¢ considered to be an important criterion in
judging professional status

PT
¢ Altruism is a concern for the welfare and well
being of others.

¢ Social Justice is acting in accordance with fair

treatment regardless of economic status, race,
ethnicity, age , citizenship,disability or sexual
orientation

PT
 Other Nursing values:
¢ Safe
& competent
¢ Health
& well —being
¢ Choice
¢ Dignity
* Confidentiality
° Justice
¢ Accountability
¢ Diversity

SAK
UNIVERSAL
BIOETHICAL
PRINCIPLES
A. AUTONOMY

- this principle marks the

significance of individual autonomy
which mandates a strong sense of
personal responsibility for one’s own
life.
Elements of autonomy
a. person should be respected
b. he should be able to determine
his personal goals
c. he should have the ability to
decide on plans of actions
d. he should have the freedom to
act upon his choice
Paternalism
- from Greek word pater or
ry paternos which means being
fatherly
- the act of being fatherly to
someone as if the latter was
one’s offspring
-it violates the principle
of autonomy
Types of paternalism

1. with regards to recipient’s welfare

a. pure paternalism — justifies

interventions into a person’s life for the sole
welfare of that person

b. impure paternalism — not only for the

welfare of that person but also for others
2. with regards to recipient’s defects and
safety

a. restricted paternalism — support

intervention which overrides and individual’s
action because of some defects or
weaknesses
b. extended paternalism — an individual
is restricted from doing something because it
is too risky or dangerous
3. with regards to promotion of good and
prevention of harm

a. positive paternalism — for the

promotion of good

b. negative paternalism — for the

prevention of harm
4. with regards to patient’s sense of values

a. soft paternalism — patient’s values are

used to justify the
interrvention

b. hard paternalism — patient’s values

are not used to justify
paternalistic acts
5. with regards to the recipient of the
benefit

a. direct paternalism — the individual

who should receive the said benefit is the
one whose values are disregarded for his
own good
b. indirect paternalism — a particular
individual will benefit if he is restricted from
doing something
6. personal paternalism

— when an individual decides on

the basis of his best knowledge
and capacity for the good of
another person
7. state paternalism

— refers to the control exerted by the

legislature, agency, or any
governmental bodies over a
particular practice and procedure
 PATIENT’S RIGHTS
-the moral and inviolable power vested
in a person to do, hold, or demand
something as his own.

-- something that by nature belongs to a

patient
 TYPES OF PATIENTS RIGHTS

1. Right to informed consent

-relates to a process by which patients
are informed of the possible outrcomes,
alternatives, and risks of treatments, and
patients are required to give their consent
freely.

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 Types of consent

1.Admission agreement
2.Blood Transfusion consent
3.Surgical Consent
4.Research Consent
5.Special Consent

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 Functions of Informed consent

1.To avoid fraud and duress

2.To encourage self- scrutiny by
professionals
3.10 foster rational decision making
4.To involve the larger society in the
debate

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 Elements of Informed Consent
1.Competence
- This refers to a patient’s
capacity for decision-making

A competent individual is:

a.Can make decision
b.Able to justify the decision
c.Able to justify decision in a reasonable
manner

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 2. Disclosure
- This refers to the content of what a
patient is told or informed about
during the consent negotiation

3. Comprehension
-This refers to whether the
information given has been
understood

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 4. Voluntariness

- This means that the consent must

be from his
own free will without being forced

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 2. Right to informed decision

- refers to the necessary

information of and
understanding so a genuine
deliberation is carried out
before making moral decision
on a medical treatment

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 3. Right to informed choice

- The patient has the right to

be informed about all possible
alternative courses of action to be
taken, together with the possible
consequences.

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 4. Rights to refuse treatment

- the patient has the right to

refuse treatment to the extent
permitted by law and to be
informed of the medical
consequences of his action.

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 5. Right to self-determination

- the patient as an autonomous

individual has the moral right to
determine what is good for himself,
usually upon the advice of a health
care provider

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 LIMITATIONS OF PATIENT’S
RIGHTS

1.Patient’s rights do not include patient’s

rights to be allowed to die
2.Patients in a moribund condition does
not posses the necessary mental,
physical, or emotional stability to make
decision
3.Patient’s rights are not absolute

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 Patient's Bill of Rights from DOH

1. Right to appropriate Medical care and

Humane treatment
2. Right to informed consent
3. Right to privacy and confidentiality
4. Right to information

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 Right to choose health care provider
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and facility
Right to self determination
oOo ON ©

. Right to religious belief

. Right to medical records
. Right to leave

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 10. Right to refuse participation in
medical research
11. Right to correspondence and to
receive visitors
12. Right to express grievances
13. Right to be informed of his rights and
obligations as a patient

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 Proxy Consent

¢ The process by which people with the

legal right to consent to medical
treatment for themselves or for a minor
or a ward delegate that right to another
person.

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 Fundamental constraints on this
delegation:

¢1. The person making the delegation

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

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 Confidentiality and Privacy are
interrelated

¢ Confidentiality -nondisclosure of
private or secret information about
another person with which one is
entrusted. It requires that one maintain
the privacy of another

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 Confidentiality and Privacy are
interrelated

¢ Privacy refers to the right of the

individual to control the personal
information or secrets that are
disclosed to others. It is a fundamental
right of individuals

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B. BENEFICENCE

- the practice of doing acts of

goodness, kindness and charity.

- the beneficence principle

States “do no harm and ,
oroduce the good” or
“do good and do
no harm”.
C. NONMALEFICENCE

- Hippocratic oath: “I will never

use treatment to injure or wrong the
Sick”.
- this seems to be similar to the
duty of beneficence, where the
practitioner work to maximize the
good for the patient and to minimize
harm
D. VERACITY

- relates to the practice of telling

the truth

- binds both health practitioner

and patient in an association of truth.
E. CONFIDENTIALITY

-iS an important aspect

of the trust that patients
place in health care
professionals.
 Justification Of Truth Telling

1. It is argued that our human and moral

quality as persons is taken away from us
if we are denied whatever knowledge is
available about our condition as patient.
 Justification Of Truth Telling

2. as patient, we have entrusted to the

physician any knowledge he has about
ourselves, so the facts (findings) are ours
and not his, hence to deny them to us is
to steal from us..
 Justification of Truth telling

3. the highest conception of the

physician-patient relationship is a
personalistic one which is based on
mutual confidence and respect for each
other’s rights.
 Justification of truth telling

4. to deny a patient pertinent knowledge

about himself, especially in a life and
death situation, is to deprive him the
ample time to prepare for his own death
or to carry out responsibilities that are
based solely on his decisions or actions.
Practitioner is allowed to intentionally
withhold information based on his/her
“sound medical judgment” that to divulge
the information might potentially harm the
depressed and unstable patient for an
unpleasant fact.....

BENEVOLENT DECEPTION
Two Approaches of Truth Telling

person- centered- considers patient as a

person with a problem, but
not as a problem
himself/herself

problem-centered — considers the patient's

condition, illness or diseases
Types of Relationships (Martin Buber)

“|-it’- it is a relationship describes a

person’s relationship with things,
objects, or “its

“I-THOU”- defines our relationship with

other persons or subject
 CONFIDENTIALITY VS. PRIVACY

privacy — refers to the right of an individual

to control the personal information
or secrets that are disclose to others.

confidentiality — demands nondisclosure of

private or secret information about
another person with which 2084 a
entrusted CONE LD
 JUSTIFICATIONS OF violation of
Confidentiality

a. When keeping the secret would be detrimental

to the common good.
b. When the subject of the secret intends to
inflict grave injury upon an innocent third
party.
c. When it is necessary for the subject of the
secret to avert grave injury.
d. When it is necessary for the one keeping the
secret to avoid grave injury.
F. FIDELITY

- loyalty, trustworthiness,
reliability, faithfulness

- jt requires that health care

practitioner should practice faithfully
within the constraints of the role.
G. JUSTICE

rendering of what is due

or merited
Two Types of Justice

1. comparable justice
- what a particular patient receives is
determined by the gravity of the
condition or need.
2. noncomparable justice
- distribution of goods/resources is
determined by a certain standard
CRITERIA OF DESTRIBUTION

1. criteria of inclusion- selection of

candidates

a. constituency- is the person a member

of the community?
b. progress of science- can new
knowledge be gained from the
case?
c. success- is the treatment effective?
2. criteria of comparison
a.the likelihood of successful treatment
compared with others in the
group
b. life expectancy of the person
c. the person’s family role
d. the potential of the person in making
future contribution.
e, the person’s record of services or
contribution.
3. random selection (James Childress)

a.first come first serve basis

b.lottery
H. PRINCIPLE OF DOUBLE EFFECT

- an act is foreseen to have both

good and bad effects
ETHICAL CONSIDERATIONS

a. good effect must be directly intended.

b. good effect or bad effect must occur
simultaneously or bad effect must
follow the good effect.
c. bad effect may be permitted to occur
after the intention of good effect.
1. PRINCIPLE OF STEWARDSHIP

- it refers to the expression of

a one’s responsibility to take
care of, nurture and
cultivate what has been
Stewardship entrusted to
ot Creation him.
AS
1. PRINCIPLE OF STEWARDSHIP

> personal
> social
o > ecological
> biomedical
Stewardship
ot Creation
a
J. PRINCIPLE OF TOTALITY

- the whole implies the existence

of its part
- the existence of parts indicates
* the existence of the whole
ps
G
ee ad

Nursing Profession
J. PRINCIPLE OF TOTALITY

Consider the entire person when

deciding which therapies,
medications or
procedures a patient
bh
should receive.
a

Nursing Profession
J. PRINCIPLE OF TOTALITY

A member of the human body is to be

disposed of according as it may profit the
whole...if a member is healthy and continuing its
natural stare, it cannot be cut off to the
detriment.of the whole...
: St. Thomas Aquinas

Nursing Profession
K. PRINCIPLE OF SOLIDARITY

- professionals must nurture and

Support the principle of one organi
for all the members 9
- professionals are obliged tolp :
broader interest of the profession \")
above one’s personal ambition’: and
preference T

lhustiahions com #8213734

L. PRINCIPLE OF COOPERATION

- cooperation comes from the latin

word cum which means “with”, and
operari which means “to work”
- cooperation is w
working with another -, we”
in the performance ati t
of an action. ao
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