BIOETHICS

Osel Sherwin Y. Melad, RN, MSN, JD

Facilitator
Morality is what people believe to be
right and good
while Ethics is the critical reflections
about morality and the rational analysis
of it.
Ethics then is the study of how we make
judgment in regard to right and wrong.
Ethics offer a way of examining moral
life.
What is Ethics?
Greek word ethos- moral duty
Refers to a standard to examine
and understand moral life (
Venzon & Venzon p. 95)
Ethos- customs, habitual usages,
conduct, and character vis-à-vis
morals- customs or habits (mores)
set of rules or body of principles (
Davis et al p. 1)
ethikos ( Johnstone p.12)
Evolution of Ethics in Nursing Practice
1) the changing philosophy of health care with its
increasing emphasis on the principle of personal
autonomy;
2) the changing philosophy of nursing care with its
emphasis on patient oriented care;
3) the evolution of nursing as profession distinct from
medicine ( Rumbold, 1999: 9-10)
 Cassell, 1984, p.35

Bioethics---ethics as it relates to the health care professions---

came into existence as an independent discipline about 1970:
“….the vocabulary of the moral---right and wrong---has been
added to the vocabulary of scientific medicine– of fact and
content”
 QUESTIONS????
What to do when the patient’s right to know conflicts with
his desire to know?
What should be done with a patient who refuses
appendectomy?
Should a patient in a persistent vegetative state be
allowed to die?
Is a nurse ever justified in not following a physician’s
orders?
Should an individual with dementia be medicated against
his will to make him “easier to handle”?
 Why study Ethics?
1) To develop good moral behavior through words and actions
2) To make good moral decisions regarding human health or
treatment of patients ( De Belen & De Belen, 2007, p. 229)
3) Nurses are expected to exhibit bio-ethical behavior in their
professional duties (Venzon & Venzon, 2005, p. 96)
4) A person is always involved in moral and ethical decision-
making that affects other people. Private morality does not
exist (Butts & Rich, 2005, p. 3)
5) Nurses in all levels and areas of practice are bound by strict
standards of professional conduct and are expected publicly
to uphold the highest ideals of professional practice
(Johnstone, 2009, p.6 )
Tuskegee Study of Untreated Syphilis in the
Negro Male - clinical study conducted
between 1932 and 1972 by the U.S. Public
Health Service

The purpose was to observe the natural

history of untreated syphilis

African-American men in the study were

only told they were receiving free health
care from the United States government
• 399 had latent syphilis and 201 did not have
the disease
• The men were given free medical care,
meals, and free burial insurance for
participating in the study
• told that the study was only going to last six
months, but it actually lasted 40 years
• After funding for treatment was lost, the
study was continued without informing the
men that they would never be treated
• None of the men were told that they had the
disease
• none were treated with penicillin even after
the antibiotic was proven to successfully
treat syphilis.
Philosophical underpinnings
Socrates (born 469 BC)The
ultimate aim of Socrates'
philosophical method is
always ethical. Socrates
believed that if one knows
what the good is, one will
always do what is good. Thus
if one truly understands the
meaning of courage, self-
control, or justice, one will act
in a courageous, self-
controlled and just manner.
 Philosophical underpinnings

Plato (born 428 BC)Plato

maintains a virtue-based
eudaemonistic conception of
ethics. That is to say, happiness
or well-being (eudaimonia) is
the highest aim of moral
thought and conduct, and the
virtues (aretê: ‘excellence’) are
the requisite skills and
dispositions needed to attain it.
Philosophical underpinnings

Aristotle (born 384 BC)

emphasized the practical
importance of developing
excellence (virtue) of
character (Greek ēthikē
aretē), as the way to achieve
what is finally more
important, excellent conduct
(Greek praxis).
Ethics as a branch of philosophical inquiry which
sought dispassionate and rational clarification
and justification of the basic assumptions and
beliefs that people hold about what is to be
considered morally acceptable and morally
unacceptable behavior.
II Ethics and Human Acts
-The Nature of the Ethical Context “The human person, therefore,
Humans- moral agents does not just perceive things but
capable of rational thinking also analyzes, assesses, criticizes,
-human's knowledge does not stop in the
or in a word, intellectualizes
senses like animals, it is further processed by
his intellect in the form of “abstraction” things”. ( Babor, 2006:14)
The perceptual knowledge helps him draw
judgments as he compares ideas so that
eventually he engages in “reasoning”.
II Ethics and Human Acts
-The Nature of the Ethical Context

And since ETHICS deals with the values relating to

human conduct
seeking to understand the nature, purpose,
justification, and the founding principles of moral
rules and the systems they comprise

The human act is one that is proper to a human

being, an act that proceeds from the free will of a
man.
II Ethics and Human Acts
-The Nature of the Ethical Context
Health care ethics is the
field of applied ethics that
Ethical context is comprised of the principles, social is concerned with the vast
norms, and actions that support ethical decision making array of moral decision-
and behavior making situations that
arise in the practice of
medicine in addition to
the procedures and the
policies that are designed
The scope of healthcare ethics encompasses to guide such practice.
numerous issues including economic, medical
political, and legal dilemmas.
II Ethics and Human Acts
-The Nature of the Ethical Context

the domain in the practice of the healthcare profession that sets the
standards or guidelines relative to studies, inquiries and decisions on the part
of the healthcare professionals in relation to the delivery of healthcare
( Ashley & o'Rourke, 1986: 73)

also referred to as Medical ethics, Biomedical ethics and Bioethics

- normative, practical ethics specific to the health sciences
- “normative”- establishing a standard of behavior
- “practical”-actual doing rather than theories or ideas (Davis et al, p.5)
Professional Ethics

- pertains to the
normative moral
system that injuncts
(orders, commands,
or directs) a kind of
behavior that is
expected of a
professional
 Nursing Ethics
Study of ethics or moral conduct in
the nursing practice ( De Belen & De
Belen, p. 237)

Johnstone defined nursing ethics as

the “examination of all ethical and
bio-ethical issues from the
prospective of nursing theory and
ethics.”
 Ethics and the Code of Ethics

Conventionalized set of rules or expectations devised for a select

purpose
A document that sets the rules for the purpose of guiding ethical
professional conduct
Meaningful action guides
Went through consultation, debate, refinement, evaluation and
review
Not a fully developed system of ethics ( Johnstone, 2009, p. 20)
 Ethical and Legal

Unethical and Illegal

Unethical but Legal

Ethical but Illegal

Law defined (workable definition and appropriate meaning of what is right)

Hospital or Professional Etiquette
Hospital or Institutional Policy
Public Opinion or the view of the Majority
Following the orders of a supervisor or
manager
It is one of the many unique qualities of man,
the new sort of animal, that he is the only
ethical animal…..

George Gaylord Simpson