ETHICS FOR HEALTHCARE

PROFESSIONAL
3. Axioms
Module 1 - ethics belong to (cluster of ethics)

- axiology is the philosophical study of goodness,

Philosoph
philosophical study of value and worth

- Philo (love) Sophia (wisdom)

- considered as ideal

- it is an activity

- it is about asking questions

- Both a science and art

4. Logic
‣ s c i e n c e i s s t r u c t u re d , p ro c e d u r a l , o rg a n i z e - most practical sub elds or division in philosophy

- practical in the sense that we are engaging in these

methodological or systematic

‣ Science is not based in common sense

things without us even knowing

‣ science aims to uncover the truth

- Logic is the study of reasoning

‣ Procedure: Scienti c Method

‣ good and bad reasoning

‣ Art of Rational Thinking

- Fallacies

‣ It is important to have Continuous Practice to develop

‣ errors in reasoning or errors we commit when we
- We are naturally curious and we tend to ask questions
construct our arguments

- It is a fundamental principle of everything

‣ Ad hominem - most commonly committed logical
- Philosophy includes questioning, critical decision and fallacies

‣ Hasty Generalization- very common error in

rational argument

reasoning Ex. don’t want to go to LPU because one

student are arrogant (small sample size)

Branches Of Philosoph ‣ AD HOMINEM- attacking/against a person Ex. i

1. Epistemology won’t listen to what you are saying because you are
- study of the origin of knowledge
ugly

‣ knowledge is inherit to us
- Logical reasoning helps as the ability to defend ourselves
‣ mind is a powerful tool/instrument
on surge and the onslaught in the attacks of
‣ through reason alone we will able to know things
misinformation or disinformation online

‣ Knowledge is a-priori- before experience

‣ knowledge is acquired not inherent

Ethic
‣ We can understand phenomenon by relying on our - From the Greek word ethos which means ‘character’ or
reason alone

‘manners’.

‣ rationalism associated by Plato

- Also called moral philosophy, the discipline concerned
‣ Aristotle (students of plato) countered plato

with the standards of good and bad and right and wrong
‣ According to Aristotle, reason is not enough to know
(Britannica)

things
- The discipline dealing with what is good and bad and
‣ Our mind is like a clean state or blank slate or
with moral duty and obligation (Merriam-Webster)

TABULA RASA
‣ it is not enough to know how to distinguish from
‣ it is through experience that we get understand the right and wrong or good from bad, we also have the
world we living in

duties, obligation and responsibility to apply them

‣ Knowledge is based on empirical evidence.

- Standards of good and bad, right and wrong that are
‣ if there is no empirical presence, then the existence of imposed by some outside group, a society or a
that thing is questionable or doubtful

profession.

‣ it don’t rely on reason alone it needs empirical ‣ not only personal it can also be external

evidence
‣ it can also be imposed upon us by some outside
‣ it is also called empiricists
group

‣ the empiricists believe that knowledge is a posteriori ‣ as future health care professionals, there are
(after experience)

standard of good and bad or right and wrong that

‣ we will only get to understand things once we get will be expected from you

experience it
- The study of what we should aspire in our lives, and of
‣ The theory of knowledge
how we should live.

‣ Branch of philosophy concerned with nature of ‣ presence of should and ought

knowledge, its possibility, scope, and general basis

- formation of character, proper conduct and right manners

but it is more than that

2. Metaphysics - behaviors of individuals

- “Meta” means beyond

- no universally accepted single de nition of ethics
- “Physics” means physical

because we are di erent ways of interpreting and

- the study of the nature of the reality

understanding

- recognizes that there are certain things that cannot be

seen by the naked eye

Some of the questions:

Metaphysical questions:

‣ Is time real?
• is morality a human invention? or is in some way
‣ is there a life after death?
objective?

‣ Is God real?
• is there any such thing in all of us?

- Questions nothing about the nature of reality

• What is it to be human and have a good life?

- Metaphysics is beyond what is physical = non-physical

- The most abstract (existence, substance, or accidents) Ethics and Moral

part of philosophy, having to do with features of ultimate - Most of ethics and morality can be boiled down to one
reality (what really exists?), what really exists and what is simple concept that can be expressed using the words
that distinguishes and makes it possible
should and ought.

- How is It possible? How it existed?

- But is ethics and morality the same? there is slight
- physics means everything around us are knowable or we di erence

can determine and measure

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 - if ethics and legality were the same thing all laws would
be ethica
Morals - not all laws is responsive to the needs of the peopl
- Morality is one’s own personal sense of right and wrong. - Legal are written, quali ed rules formulated by policy
It is not imposed by anyone, it is what you think is good leader
and bad personally.

- Morality refers to personal character, beliefs, and Putting law in its proper place
behavior; ethics is about the re ection on morality and
Laws, legal opinions, and court rulings, however, can also
deciding how to act as a person or a professional.

- own idea or sense of what right or wrong

affect medical ethics
• Informed consen
Ethics ‣ the patients should be knowledgable of what kind of
- Ethics is about the re ection on morality and deciding treatment he/she will receiv
how to act as a person or a professional.
‣ make a choice whether they would accept or refus
- Acceptable and unacceptable ways of behaving in a
given eld (e.g. professional ethics such as legal ethics, • Advance directive
educational ethics, medical ethics)
‣ why prolong the agony
‣ expected standards of behavior from you as part of ‣ also known as advance wishes of the patients must
the society, or a given profession
also be recognize or acknowledg
- what is expected from you as part of the community or
profession
• Abortion and birth contro
‣ Birth control- RH LAW providing lipinos with option and
alternative for family planning in using contraception
‣ it also has exemption in the Philippines such as
a. in cases where the life of the mother is at risk
(ectopic pregnancies)
b. Rape (in other countries

• Euthanasi
‣ mercy killing usually performed to the terminally ill or
brain dead person
‣ allowing the patient to end his life in a humane manner
or with respec
‣ putting death in a painless wa
‣ agony of the patien
- as a person, you should respect their religio ‣ Assisted suicide - even healthy individuals can avail
- morality and ethics are not entirely matchin this in Europe (mostly old people who has no
meaningful life and disabled people) “how about the
quality of the life of the individual
Is everything that is moral, ethical?
- Not all the tim
• Privacy and con dentialit
- Example: Robin Hood is a robber from the rich whom he
‣ they are not forced to disclose their health status
believed know wasn’t deserving to amass that the society
because that’s part of their data privac
is highly unequal. He is stealing to feed the poo
‣ the physician has no right to disclose the health status
Scienti c Questions Ethical Questions of their patient without permission of their parents if it is
What will be the e ect of Ought we to be detona ng disclos
detona ng a nuclear weapon nuclear weapons around large ‣ HIV/AIDS- severe punishment, HIV is not contagious
in a major city? numbers of people
What caused the Philippine Should endangered species be • Access to medical car
Eagle to be cri cally protected from human hunting ‣ Health care access is the ability to obtain healthcare
endangered?
services such as prevention, diagnosis, treatment, and
Is there a beer in the fridge? Should i really have that last beer management of diseases, illness, disorders, and other
in the fridge before driving home health-impacting conditions.

‣ the budget allocated by our government

Ethics, Morals, and Law ‣ determined by the political leaders

- Even though you don’t need to differentiate ethics and

Moral, Ethical, and Legal Examples
morality, you should distinguish between the concepts of
ethics (or morality) and legality 1. “Do not do unto others, what you don’t want others do
- There’s some overlap between ethics and the law, but unto you” Mora
they aren’t always in line with one another. 2. As an educator, you have to care for your students.
- If ethics and legality were the same thing, all laws would Ethica
be ethical, and all ethical acts would be permitted under 3. You have to express your condolences to someone who
the law. thus, an unjust law couldn’t exist has lost a loved one. Mora
- Laws are modi es and written 4. Individuals below the age of 18 are not allowed to drink
- Laws are rigid and stric any alcoholic beverage. Lega
- Laws are also not perfec 5. As an elected of cial, you have to treat public of ce as a
- some laws are being revise public trust. Ethica
- the laws of the land should serve the best interest of the
peopl
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 - intentional and non intentional should be avoide

- constant (applicable to all
Other basic concepts in Ethics
Moral decision • Bene cenc
- one is placed in a situation and confronted by the choice - physician must act in the best interest of the patient
of what act to perfor - counter part of nonmali cenc
- referring to moral issue - the healthcare providers are required to promote their
- a choice we mak patients health and well being at all time
- must help their patients at all cos
Moral judgement - too much will possibly lead to unintentional side effect
- when a person is an observer making an assessment on and here will be the cause of nonmali cen
the actions and behavior of someone - too much can also be harmfu
- assessment/evaluation of the moral decision - case by cas
- may not always be the same to othe
Moral dilemma - suite your providing service according to the needs of
- a complicated situation wherein one is torn between the patien
choosing one of two goods or choosing between the - Example: Leg injury- the best way to treat is to amputate
lesser of two evils or cut the legs to prevent the infection (saving the leg is
- more complicated of moral issu the priority, amputation is the last plan
- complicated in the sense of a person is faced of torn - what would be the best for the patien
between choosing one of two good or choosing between
the lesser of two evils • Justice
- faced by very two options (usually two options - refers to fairness with respect to the distribution of
medical resources
- the healthcare providers must be able away the
Moral decision, judgement, or dilemma situation fairly so the medical resources will be
- “I make a choice to refuse to accept bribe from someone” distributed equally yo those people who are in need
Moral Decision
- “A mother may feel con icted between stealing food from
a store and wanting to get that food to be able to feed her APPROACHES IN THE STUDY OF ETHICS
hungry child” Moral Dilemma 1. Absolutism/Non-consequentialism
- “A friend of mine chooses to shoplift from a convenience - an ethical view that all actions are intrinsically right or
tore, and I make an assessment that this is wrong” Moral wrong.“Killing is bad, therefore, in all cases killing is
Judgemen bad.”
- an action can already be judge as right or wron
What are Medical Ethics - we can automatically judge by using our rational
- Guidelines and behaviors that we expect a medical thinkin
professional with moral integrity to exhibit - duty at all time
- Ethics has developed over the centuries as a code of - duty no to kill, steal or any other wrong doing
conduct, especially for professionals. • Deontological – duty-based ethic
- Healthcare providers have so much knowledge about the
human body, so much potential power over patients, and 2. Consequentialism
the ability to change and save lives - consequences of one's conduct are the ultimate basis for
any judgment about the rightness or wrongness of that
Four Principles of Medical Ethics conduct. “It depends on the outcomes
• Autonom - Ex. “killing is not always bad or wrong” “killing a terrorist
- focused on the patient’s independence or liberty • Utilitarian – action that maximizes good consequences
- freedo for everyone is good
- right to decide for his or her own bene
- right to make decision about what happens to his/her 3. Fallibilis
bod - Open to the possibility of new explanations and evidence
- purely out of their own wil that may contradict previously held belief
- adult can refuse medical care or treatmen - if the society continuously changes and people change
- responsible to a consequences of his own decisio therefore our moral principle and ethical standard should
- when the patient is minor, seek the decision of the also keep up with the changing time
parents or legal guardians
- The doctor has to be transparent to the patient because 4. Relativism
they have the rights to kno - “Good/bad and Right/Wrong is relative”
- everything is relativ
• Nonmale cence - it varies from person to person, and society to societ
- must not harm patient through carelessness, malice, - it can heavily in uence by cultur
vengeance, or dislike, or even through treatments - sometime one society approves the action others may no
intended to help the patient • Emotivism - emotions
- the central rule is do not harm the patien • Cultural Relativism – as long as society approves the
- learn how to separate your personal live to your action, it is good.
professional career
- Do not let your emotion to overcome your decisio
- unintentional pain should also be avoided (pain reliever
or anesthesia
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 5. Skepticism NON-MORAL STANDARD

- “we cannot have knowledge of moral values, principles, or - Conventional standards; standards by which we judge
truths what is good or bad/right or wrong in manners are
- The most extreme form of ethical vie unrelated to moral or ethical considerations
- question all including ethic - include manners/etiquette, standards of aesthetics, house
- there is no such thing as moral person or ethical person rules set by parents, or religion
because all of us will never be truly or completely ethica - traditional rule
- we cannot have complete knowledge of moral value - no moral equivalenc
- try to undermine or challenge our notion of ethics itself
and the importance of ethics in our societ MORAL vs. NONMORAL STANDARD
1. Moral standards involve serious wrongs or signi cant
Why be ethical bene ts.
• Ethics can be in your self-interest. 2. Moral standards are overriding and take precedence over
• Ethical people tend to live in harmony with those around other standard
them. 3. Moral standards are not established by authority gures.
• Ethical people also seem capable of living happier, more 4. Moral standards are based on impartial considerations
ful lled social lives. (universal applicability
• Ethics is required if you want to live a life of integrit
• Some level of ethical behavior is necessary for having a MORAL OR NONMORAL STANDARDS
cohesive societ 1. A physician should not refuse to accept a patient because
of his potential inability to pay. MORA
—————————————————————————— 2. Children need to go to bed before 9 pm to get enough

Module 2:
sleep. NONMORA
3. Medical practitioners should talk to their patients and
never make assumptions about their needs and desires
MORAL AND NON-MORAL STANDARDS MORAL
4. Do not talk while your mouth is full. NONMORA
MORAL STANDARD 5. Do not wear high heels or makeup when performing
- Principles, norms, or models surgical operations. NONMORA
that an individual or a group
has about what is right or AMORAL
wrong or about what is good - No sense of morality and does not recognize moral
or bad standards (Lacks autonomy to decide or lacks
- Rules people have about the conscience
kinds of actions they believe - Is there such a thing as an “amoral” person?
are right and wrong - Infants; mentally challenged/people with psychological
- moral or ethical or article disorder

MORAL/ETHICAL DILEMM
- Situations where people who are called “moral agents” in
ethics, are forced to choose between two or more
con icting options, neither of which resolves the situation
in a morally acceptable manner
- complicated moral issu
Norm - you have to sacri ce something if you choose on
- Speci c cultural expectations for how to behave in a given
situation FEATURES OF MORAL DILEMM
- Standard rules of behavior as members of the societ 1. The agent is required to do each of two actions. (0r
- Society without norms would be chao options
2. The agent can do each of the actions; but the agent
More cannot do both (or all) of the actions
- strict norms that control moral and ethical behavior. 3. Neither of the con icting moral requirements is
Looked upon by members of society as being extremely overridden.
important and the violation of which results in severe
punishmen Thus, in a moral dilemma, the agent seems
- more external or social in nature imposed upon us by the condemned to a moral failure; no matter what he
society or the vultur does, he will do something wrong, or fail to do
- example: do not steal, do not kil something that he ought to d

Values THREE LEVELS OF MORAL DILEMM

- Abstract standards in a society or group that de ne ideal ● Personal/Individual - experienced and resolved on the
principles. Values are anything members of a culture personal level
aspire to or hold in high esteem. Values are human ● Organizational – encountered and resolved by social
creations organizations. (ex, hospital institution- preservation of lives,
- example: courage, polite, bravery, honesty, trust. hospital facing wherein whether they withdraw life support
- more persona for a dying patient
- balance by norm ● Structural/Systemic – cases involving network of
- human creation institutions and multi-sectoral. (national, countries, global
(ex. quality healthcare to lipinos, universal healthcare)
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 Female Genital Mutilation

- continues to be an integral part of many African, Asian,
and Middle Eastern culture
- total removal of external genitalia
- transition of girlhood to womanhood
- they generally believe that it should be remove because it
reduce the woman libido or sexual desir
- they will not engage in a premarital sex before marriag
- virginity before marriage is importan

CULTURE AND MORAL BEHAVIO

• We invoke the norms of our culture in deciding whether
our choices mirror the true, the good, and the beautiful, or
if it disgraces our cultural moral ideals
Moral Dilemmas faced by the Health sector during
Pandemic Norm
1. How should resources in a hospital (e.g. ICUs, ventilators, • refer to social and cultural regulations and decrees that
and the staff) be rationed fairly? ORGANIZATIONA govern the everyday activities of people, inclusive of its
2. Should our frontliners be prioritized in COVID-19 testing? moral and ethical imperative, customs, and cultural
STRUCTURAL practices (Barker, 2004)
3. Should a healthcare worker retain ventilatory support for a
critical patient who is unlikely to survive or use the ventilator Culture
for a less critical patient with better prognosis? PERSONA • is de ned as the complex whole which includes,
4. Is it the obligation of healthcare workers with aged knowledge, beliefs, arts, morals, law, customs, and any
parents or young children to show up for their jobs? other capabilities and habits acquired by man as a
PERSONAL member of societ
5. When the vaccine comes out, who will be the rst groups • Culture is not biological, culture is acquired

going to be prioritized? STRUCTURA • Family are the one who taught us what to do or what not
6. Should the Health department receive higher budget do

allocation compared to other sectors? STRUCTURA • Culture is not biologically inherent

• Culture exist in a society and society cannot exist with

culture

FREEDOM AS FOUNDATION OF ETHIC

• Culture is not permanent when no one is no longer
Immanuel Kant:
performing it

- Autonomy as the foundation of moralit • Culture is something we share

- According to kant, all individuals are rational beings • Culture is constantly changing

(capable of deciding for our own good • Culture is a way of life

Autonomy/Freedom – individual’s capacity for self- • Culture can be created and can be lost

determination or self-governance Non-Materia

- idea, knowledge, beliefs, tradition, informations that
Reason and Impartialit we share and pass on to other
- Minimum requirement for moralit
● Reason - helps us to evaluate whether our feelings and Materia
intuitions about moral issues are correct and defensible. - object
●Impartiality - “evenhandedness” or “fair- - tangible material
mindedness”;decisions ought to be based on objective
criteria, rather than on the basis of bias or prejudice. (don’t WHY IS CULTURE IMPORTANT
do to others what you don’t what others do unto yo 1. Culture provides identity to the people in the societ
2. Culture mirrors the laws of the lan
————————————————————————— 3. Culture uni es people in ways that only those who belong

Module 3: in that society understand

4. Culture in uences our concept of moralit

An Indonesian man is publicly caned for being in a

homosexual relationship, in Banda Aceh, Aceh Moral behavior
province, Indonesi - of people is clearly hinged from what was ingrained to him
as right, proper, and acceptable in his cultural context
Menstrual or period hut - Filipinos has distinct way to show politenes
- temporary shelter for the women who experience
menstrual cycl THE FILIPINO WAY
- common in Asia and Africa (Nepal • Gorospe (1966): Distinct Filipino moral norms:

- place of isolation who experiencing menstrual cycle - Group centeredness or group think- Family
because they have a strong menstrual taboos oriented- greatest strength of Filipinos

- menstruation associate with social and religious idea - In terms of making decision, we cannot ignore our
- for them, when a woman has menstruation they are family (what will my Family if i chose this opinion)

unclean, or sinfu - Don’t be caught attitude- “tra c enforcer with

- discriminating against women tra c lights”( its okay to violate as long as you not
- the hut are prone to r caught)

- Complacency - don’t wait the scenario to happen

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 - Rationalization- lipinos not admit to commit

their mistake instead they rationalize or justify their
wrong doings (accountability and justice)

CULTURAL RELATIVISM:
Di erent strokes for di erent folks

• Cultural relativism – the view that moral beliefs and

practices vary with and depend on the human needs and
social conditions of particular cultures (Holmes, 2007).

• cultures are contextual and conditional

• Ex, Body tattooing - men with tattoos symbolizes as

brave while woman with tattoos symbolizes as
beauty. While in a west, men with tattoos are called - goal of cultural relativism

as ex-convict and for women called as unclear or - to live in a society of a multiple background but still live in
unprofessional
peace

• it is not right to compare cultures with one another

- stems from the process of globalization
• morality is relative, it’s not always universal or - process of becoming more and more interconnected
permanent
with one another

• there is no such thing as absolute right or wrong

- technology is the reason why we are interconnected
• appreciation of culture diversity
(transportation and communication)

• right or wrong depending on one’s culture

• There is no culture that can be the basis of all that is good

and true.

• It is important to recognize the vitality of cultural of

cultural di erences since ethical judgements are relative
to cultural contexts.

• Morality can only be understood based on what is

culturally acceptable or not in the society where we
belong.

• Cultural relativism should be understood as a celebration

and appreciation of cultural diversity (Kellenberger, 2011).

Ethnocentrism
- the practice of taking one’s own people, society, and
culture to be the vantage point from which all else is
viewed and judged (Bruce & Yearley, 2006).

- Ethnocentrism leads to the prejudgment of people.

- Judging based on your own cultural standard

- the view of an individual is that their own culture are more

- mass migration - movement of ideas and knowledge

superior than their own

Should cultural diversity lead to moral diversity?

- Yes

Xenocentrism
- belief that one’s own cultural features are a downgrade in
comparison to those of the other cultures.
CULTURAL TOLERANCE
- the view of an individual is that other people’s culture are • Cultural relativism should result to cultural tolerance in
more superior than their own
order to preserve the distinctiveness of people regardless
- not exercising cultural relativism
of whichever context they come from.

• Perpetuation of culture can only be possible through

Which of the following statements are ethnocentric? tolerance.

• How people value certain traditions in their culture is very

1. Never trust anyone over thirty ETHNOCENTRIC
much a part of who they are.

2. Turn o that junk heavy metal music so I can study

• Though cultural tolerance is highly encouraged, it would
ETHNOCENTRIC

not mean that we are to compromise human life and all

3. I don’t like classical music NOT ETHNOCENTRIC the universal rights associated with it.

4. Politicians are sel sh and corrupt ETHNOCENTRIC • A particular culture cannot invoke cultural relativism at all
5. My religion is the only religion which embodies
times.

truth ETHNOCENTRIC
• Cultural sensitivity is the key to cultural tolerance.

6. Sociologists have the answer to social problems • If the cultural practices is violating the life and rights of
ETHNOCENTRIC
the human being then we recognize cultural tolerance
7. The United States is the most economically
are no longer applicable

powerful country on earth NOT ETHNOCENTRIC

CHAPTER SUMMARY

- Although diversity of cultures is heavily encouraged, this

should be exclusive of customs and traditions which
disrupt normal functioning.

- There still are moral absolutes which should precede

cultural norms.

- Since we are all a product of our culture, our societal

norms have always been the basis of our everyday
decisions.

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Module 4:
THE GOLDEN RULE

MORAL UNIVERSALISM The Golden Rule (GR) Theorem:

- Universalists contend that there are at least some ethical - Treat others only as you consent to being treated in the
values, standards, or principles that are not relative same situation.

(Mizzoni, 2017)
- One should treat others as one would like others to treat
- Ethical principles hold for all and not merely for some, one self

that is, for everybody without exception.

- Ethics of reciprocity - mutual exchange

UNIVERSALISM
- Does it make sense to conclude that all human values are
relative to the degree that there are no permanent,
universal, objective values or standards?

- Universalist will say NO.

UNIVERSALISM
- Certainly there is cultural di erence on how cultural
values are manifested, but according to universalism, the
values themselves represent more than arbitrary social
conventions. There’s a common ground:

Limitations with the Literal Golden Rule (LGR):

• “Treat others the way you want to be treated”

- Marriage and family are universally present, they are not • "If you want X to do something to you, then do this same
relatively present
thing to X."

• This can lead to absurdities if we are in a di erent

situation from X or have defective desires about how we
are to be treated.

First, there are cases where you are in di erent

circumstances from X:
- To a patient: If you want the doctor to remove your
appendix, then remove the doctor’s appendix Second,
there are cases where you have defective desires about
how you are to be treated:

- To a masochist who wants to be tortured: If you want x

to torture you, then torture X.

"Therefore, treat others as you (currently) want to be treated

if you were ever in their situation”

Declaration of Universal Human Rights

- The Universal Declaration of Human Rights(UDHR) is a
milestone document in the history of human rights.
- Unity
Drafted by representatives with di erent legal and cultural
backgrounds from all regions of the world, the
Ethics and Human Nature: Declaration was proclaimed by the United Nations
- Biological and Theological explanations
General Assembly in Paris on 10 December 1948 as a
- Belief in a common human traits: e.g.Evolutionists common standard of achievements for all peoples and all
(human language, human facial expressions, way the nations. It sets out, for the rst time, fundamental human
human mind works, human food preferences) and rights to be universally protected

Theologians(universal ethical standards that are in

harmony with God’s intentions)

Ethics and Human Rationality:

- Humans have a rational nature that is not shaped by
their cultural surroundings, but rather, is part of their
human nature (a priori) - In this view, not only is it
believed that there are rules of thought, but that there are
also good rules of thought, that is, rules that humans
should follow when they are thinking

- Lead to Happiness

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Do you think there are universal human rights that are being
violated in our contemporary society? YES