Health care ethics

ETHICS defined: Ethics Morals

Origin Greek word Latin word
-Comes from a Greek word "ethos" which means moral “ethos” “more”
duty. Literally, it means custom or particular behavior. meaning meaning
-Means "character" “character” “custom”
What are they? The rules of Priciples or
-The principle of right or good conduct conduct habits with
recognized in respect to right
-Studies how people make judgment in regard to right
respect to a and wrong
or wrong.
particular class conduct. While
-The philosophical study of voluntary human acts with or human morals also
the purpose of determining what good, right is and to actions or a prescribed do’s
be done, and what bad, wrong and not to be done. particular group and don’ts,
morality is
-Cafferty defines ethics as the study of standards of ultimately a
conduct and the moral judgment and values upon which personal
these standards are based compass of
-Is a system of moral principles or standard governing right and wrong
conduct. It is the science of human duty. Where do they Social system- Individual-
come from? external internal
-Ethics teaches us when and why our actions are good Why we do it? Because society Because we
or bad, right or wrong. says it is the believe in
right thing to do something
being right and
Importance of ethics in nursing: each person has their wrong.
own set of personal ethics and morals. Ethics within Flexibility Ethics are Usually
healthcare are important because workers must dependent on consistent,
recognize healthcare dilemmas, make good judgments others for although can
and decisions based on their values while keeping definition. They change if an
within the laws that govern them tend to be individual’s
consistent belief change.
within a certain
MORALS comes from Latin word "mores", which means context, but can
customs or values. vary between
context.
*Morals deal with the conduct of man, the right and Acceptability Ethics are Morality
wrong behaviour of man in his relationship with his governed by transcends
fellowmen professional cultural norms.
*Morals are fundamental standard of right or wrong, and legal
learned & internalized in early childhood, often based guidelines
on religious beliefs. within a
particular time
and place.
How we differentiate ethics from morals?
MORALITY
ETHICS & MORALS
-Morality is concerned with knowing and doing what is
Ethics can be defined as a set of principles that governs
right.
one's behaviour, whereas Morals relates to an
individual's character and own personal principles -Morality is a code of values to guide man's choices and
regarding right and wrong (Collins, 2006). actions
HEALTH CARE ETHICS
-A science that deals with the study of the morality of
human conduct concerning health and health care.
-Deals with the conduct and moral issues that arise in
the practice of health care professionals, nurses &
midwives included.
-It is concerned with health care values, obligations,
rights and needs. It strives to resolve ethical issues that
often confront health care professionals
ETHICAL THEORIES - Ethical theories attempt to provide
a system of principles and rules for resolving ethical
dilemmas. These theories consist of fundamental beliefs
about what is morally right or wrong
1. UTILITARIANISM - determines what is right or wrong
based on an action's consequences.
-Using this system, decision makers determine and
choose those actions that will result in the greatest
good for the greatest number of people.
-This theory accepts that if the end justify the means,
then it is right.
-Using this system, ethical decisions most often are
made through a process called risk- benefit analysis.
-It can be argued that some individual rights can be
sacrificed for the sake of the greater happiness of the
many.
2. DEONTOLOGY - decision making is based on moral
rules and unchanging principles that centers on duty
and obligation to others.
- Comes from a Greek word "deon" meaning "duty". - -
Deontology emphasizes moral obligation or
commitment.
- A person is morally good and admirable if his actions
are done from a sense of duty or reason
- A follower of pure deontology believes in the
absoluteness of principles regardless of the
consequences of the decision.
-According to this theory, honouring ethical obligations
ensures good, even though actions may be difficult and
consequences painful.
Virtues defined
-are attitudes, dispositions, or character traits that
enable us to be and to act in ways that develop this
potential.
-They enable us to pursue the ideals we have adopted. -
Examples of virtues: Honesty, courage, compassion,
generosity, fidelity, integrity, fairness, self-control, and
prudence.
Ethical Dilemma
-An ethical dilemma is the choice between two or more
equally justifiable alternatives.
-Sometimes it requires an individual to make a choice
between two equally unfavourable alternatives.
-The individual who must solve an ethical dilemma is
the only person who can ascertain if actions taken were
congruent with personal values
-Ethical dilemma occurs because people have different
ethical philosophy, follows different philosophy in life
and see life situations at different perspectives.
Virtue ethics in nursing is therefore concerned with the
character of individual nurse and seeks ways to enable
nurses to develop character traits appropriate for
actions that enhance well-being.
CORE VALUES OF A PROFESSIONAL NURSE Values
-comes from the Latin word "valere" - which means to
be strong.
- Indeed they are strongly held beliefs or convictions
about what a person holds to be important and worthy
in his or her life.
-Values are ideals and concepts that give meaning to an
individual's life.
-Values are shaped out of society's norms, religion and
family orientation. Values are not permanent
characteristics; they may change for the better or for
the worse.
What is meant by "core values"?
Core values are the values we put on
•Our work
• Our clients
• Ourselves
•They can be central to the way we give care and live
our lives.
Core Values of A Professional Nurse
1. ALTRUISM is concern for the welfare and well being
of others. Altruism is reflected by the nurse's concern
and advocacy for the welfare of patients, other nurses,
and healthcare providers. Health care professional is
obligated to attend to the best interest of patients
rather than self interest.
2. Autonomy- is the right to self-determination, it is
when the nurse respects patients' rights to make
decisions about their health care
3. Human Dignity- is respect for the inherent worth and
uniqueness of individuals and population. It is reflected
when the nurse values and respects all patients and
colleagues.
4. Integrity- is acting in accordance with an appropriate
code of ethics and accepted standards of practice. It is
when the nurse is honest and provides care based on an
ethical framework that is accepted within the
profession.
5. Social Justice- is acting in accordance with fair
treatment regardless of economic status, race,
ethnicity, age, citizenship, disability, or sexual
orientation.
6. Accountability- is being accountable to their patients,
to society on issues of public health and to their
profession.
7. Excellence - nurses are obligated to make a
commitment of life-long learning.
8. Duty - should be available and responsive, accepting
a commitment to service within the profession and the
community.
9. Honor and Integrity - should be committed to being
fair, truthful and straightforward in their interactions
with patients and the profession.
10. Respect for others - should demonstrate respect for
patients and their family and to the other members of
the health team.
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.
Right to medical care and humane treatment
→ 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.
→ The patient has the right to health and
medical care of good quality. In the course of
such care, his human dignity, convictions and
integrity shall be respected. His individual needs
and culture shall be likewise 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, he shall be informed of
the reasons for the delay and the estimated
waiting time.
→ 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 or treatment.
Informed Consent
→ Refers to the capacity of the patient to accept
or refuse treatment.
→ 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 relate to
recuperation, and probability of risks involved,
and he will not be subjected to any procedure
without his informed consent.
→ Provided, that in case of emergency, when the
patient is unconscious &/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.
→ Provided further, that when the law makes it
compulsory to everyone to submit procedure, a
consent is not necessary.
→ 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.
→ Provided, that if his parents or legal guardian
refused to give consent to a medical or surgical
procedure necessary to save his life, the court
upon petition of the physician or any person
interested in the welfare of the child, may issue
an order giving such consent.
Right to Privacy
→ The patient has the right to be left alone when
this will not prejudice the provisions of necessary
medical care.
→ the patient has the right to be free from
unwarranted publicity, except in the following
cases:
a. When his mental or physical condition
is in controversy and the 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
demands.
c. When the patient walved his right
d. Medico-legal cases
Right to Information
→ 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 effect of the
treatment, possible complications and
other pertinent facts regarding his
illness.
→ 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.
→ 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.
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 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, such
disclosure may be withheld or deferred to some
future opportune time upon due consultation
with the patients next of kin.
Right of Privileged Communication
(Confidentiality)
→ The patient has the right to demand that all
information, communication and records
pertaining to his care be treated as confidential.
A physician is not authorized to divulge any
information to a third party who has no concern
with the care and welfare of the patient, except:
• When such disclosure will benefit public
health and safety
• When it is in the interest of justice
• When the patient waives the
confidential nature of such information.
Right to choose the physician
→ The patient is free to choose the physician. to
serve him except when:
• He is confined in a charity ward
• 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 a health
care professional affiliated with the
organization.
Right to self-determination
→ The patient has the right to refuse diagnostic
and treatment procedures. Provided, that.
• He is of legal age and of sound mind.
• He is informed of the medical
consequences of his refusal.
• He releases those involved in his care
from any obligation relative to the
consequences of his decisions.
• His refusal will not jeopardize public
health and safety.
→ An adult with 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.
Right to religious belief
→ The patient has the right to refuse medical
treatment which may be contrary to his religious
beliefs. Provided, that such a right shall not be
imposed by parents upon their children who
have not reached the age of legal discretion.
Right to Medical Records
→ 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. At his expense and upon discharge of
patient, he may obtain from health care
institution a reproduction of the same the record,
whether or not he has fully settled his financial
obligations with the physician or institution
concerned.
→ The health care institution shall ensure and
safeguard the integrity and authenticity of the
medical records.
→ 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.
Right to Leave
→ The patient has the right to leave the hospital
or any other health care institution regardless of
his physical condition.
→ 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.
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. That, an institutional review
board or ethical review board in
accordance with the guidelines set in
the Declaration of Helsinki be
established for research involving
human experimentation:
• Provided, further. 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:
• Provided. furthermore. That the patient
involved in the human experimentation
shall be made aware of the provisions
of the Declaration of Helsinki and its
respective guidelines.
Right to correspondence and receive visitor
→ 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.
Right to know what hospital rules &
regulations apply to his conduct as a patient
→ The patient has the right to be informed of
hospital policies and practices that relate to
patient care, treatment, and responsibilities. The
patient has the right to be informed of available
resources for resolving disputes, grievances, and
conflicts, such as ethics committees, patient
representatives, or other mechanisms available
in the institution. The patient has the right to be
informed of the hospital’s charges for services
and available payment methods.
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 Such a system shall afford all
parties concerned with the opportunity to settle
amicably all grievances.
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