Bioethics

  Is the study of typically controversial ethics brought about by advances in biology and medicine.
   It is also moral discernment as it relates to medical policy, practice, and research.
  It also includes the study of the more commonplace questions of values ("the ethics of the ordinary")
which arise in primary care and other branches of medicine.

ETHICS
  Defined as the philosophical science that deals with the morality of human conduct.

INTELLECT
 Acts as the thinking faculty of the human person

WILL
 It does or implements what it has chosen.

PROFESSIONAL ETHICS
 assesses the moral dimension of human activity in the classic occupations of law, medicine, ministry and
by extension higher education, engineering, journalism, management and other occupations that aspire
to professional status.
 is concerned with the standards and moral conduct that govern the profession and its members. 

 ETHICAL  THEORIES

 Deontology
The term “deontology” is a modern combination of Classical Greek terms, and means the study or science (logos)
of duty, or more precisely, of what one ought to do (deon). In contemporary moral philosophy, “deontology” is
used most commonly to refer to moral conceptions that endorse several theses regarding the nature of duty (the
right), the nature of value (the good), and the relationship between the primary ethical concepts of the right and
the good.
An ethical theory that uses RULES to distinguish what is right from wrong.

 Teleology
The term “teleological” comes from the Greek word telos for goal or aim. The idea of teleological ethics in recent
usage has been understood, most fundamentally, as standing in contrast with “deontological” approaches to
ethics. Focuses on the result of the act.

 Utilitarianism
A prominent, compelling, and controversial theory about the fundamental basis of morality, utilitarianism holds
that human conduct should promote the interests or welfare of those affected.
The ethical theory determines right from wrong by focusing on outcomes

Theorists
 Plato - Plato is one of the founding fathers of philosophy and has had a massive impact on the history of
western thought.
 Aristotle - Aristotle, a Greek philosopher, and protégé of Plato is considered the Father of the Scientific
Method, the creator of formal logic, and one of the greatest thinkers in the history of the Western world.
  Friedrich Nietzsche - Friedrich Nietzsche has emerged as perhaps the most influential thinker of the recent
past. To a significant degree, this is due to the fact that he took time seriously in terms of both cosmology
and ethics.
 Immanuel Kant- Immanuel K Kant, like Plato and Aristotle, counts as one of the most influential
philosophers of all time.
 Jeremy Bentham - Jeremy Bentham is known today chiefly as the father of utilitarianism.
 John Stuart Mill - John Stuart Mill (1806–73) changed the way in which the modern world views and legal
systems address the issues of individual liberty of thought, expression, lifestyle, and action. His ideas
remain both influential and controversial to this day.

 BASIC ETHICAL PRINCIPLES

The place of principles in bioethics:

    Ethical choices, both minor and major, confront us every day in the provision of health care for persons
with diverse values living in a pluralistic and multicultural society.
  Due to the many variables that exist in the context of clinical cases as well as the fact that in health care
there are several ethical principles that seem to be applicable in many situations. These principles are not
considered absolutes, but serve as powerful action guides in clinical medicine. 
   Thus, in both clinical medicine and in scientific research it is generally held that these principles can be
applied, even in unique circumstances, to provide guidance in discovering our moral duties within that
situation.
 
DEFINITION OF TERMS:
 PRINCIPLE
 the fundamental law or truth upon which others are based; a moral standard
 STEWARDSHIP
 The individuals’ responsibility to manage his life and property regarding the rights of others; the office,
duties and obligation of a steward.
 STEWARD
 One employed in a large household or estate to manage domestic concerns such as keeping accounts and
supervision of servants; one who actively directs affairs.
 TOTALITY
 wholeness; sum; state/ quality of being total
 COOPERATION  
 common effort; association of persons for common benefits
 SOLIDARITY
 unity as a group or class that produces or is based on community of interests, objectives and standards
 
LEGITIMATE
  lawfully begotten; accordance with the law
 
 
ETHICAL PRINCIPLES:
 
1. Stewardship
 
  This principle is grounded in the presupposition that God has absolute Dominion over creation, and that,
insofar as human beings are made in God’s image and likeness(Imago Dei), we have been given a limited
dominion over creation and are responsible for its care.
 The principle requires that the gifts of human life and its natural environment be used with profound
respect for their intrinsic ends.
  The principle of stewardship implies a responsibility to see that the mission of health care is carried out
as a ministry with its particular commitment to human dignity and the common good.
 
2. Totality
 These principles dictate that the well-being of the whole person must be taken into account in deciding
about any therapeutic intervention or use of technology.
 In this context:
 
a.     "integrity"
  Refers to each individual’s duty to "preserve a view of the whole human person in which the values of the
intellect, will, conscience, and fraternity are pre-eminent”.
 
b.    ” Totality"
§  Refers to the duty to preserve intact the physical component of the integrated bodily and spiritual nature of
human life, whereby every part of the human body "exists for the sake of the whole as the imperfect for the sake
of the perfect".
 
3. Double Effect
 
 An action that is good in itself that has two effects--an intended and otherwise not reasonably attainable
good effect, and an unintended yet foreseen evil effect--is licit, provided there is a due proportion
between the intended good and the permitted evil.
  When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises
as to whether the obligation to avoid evil requires one to abstain from a good action in order to prevent a
foreseen but merely permitted concomitant evil effect. The answer is that one need not always abstain
from a good action that has foreseen bad effects, depending on certain moral criteria identified in the
principle of double effect. Though five are listed here, some authors emphasize only four basic moral
criteria (the fifth listed here further specifies the third criterion):

1. The object of the act must not be intrinsically contradictory to one's fundamental commitment to God and
neighbor (including oneself), that is, it must be a good action judged by its moral object (in other words, the action
must not be intrinsically evil);
 
2. The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful
effects as far as possible, that is, one must only indirectly intend the harm;
 
3. The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other
means of achieving those effects are available;
 
4. The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate
judgment);
 
5. The beneficial effects must follow from the action at least as immediately as do the harmful effects.
 
4. Cooperation
  Along with the principles of double effect and toleration, the principles of cooperation were developed in
the Catholic moral tradition as a way of helping individuals discern how to properly avoid, limit, or
distance themselves from evil (especially intrinsic evil) in order to avoid a worse evil or to achieve an
important good.
 In more recent years, the principles of cooperation have been applied to organizations or "corporate
persons" (the implication being that organizations, like individual persons, are moral agents). Like the
principle of double effect and some other moral principles, the principles of cooperation are actually a
constellation of moral criteria:
 
 Formal Cooperation.
 Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal
agent, or shares in the agent’s intention, either for its own sake or as a means to some other goal. 
 Implicit formal cooperation occurs when, even though the cooperator denies intending the object of the
principal agent, the cooperating person or organization participates in the action directly and in such a
way that it could not be done without this participation.
 Formal cooperation in intrinsically evil actions, either explicitly or implicitly, is morally illicit. 
 
  Immediate Material Cooperation.
 Immediate material cooperation occurs when the cooperator participates in circumstances that are
essential to the commission of an act, such that the act could not occur without this participation.
 Immediate material cooperation in intrinsically evil actions is morally illicit. There has been in the tradition
a debate about the permissibility of immediate cooperation in immoral acts under "duress." When
individuals are forced under duress (e.g., at gunpoint) to cooperate in the intrinsically evil action of
another, they act with diminished freedom.

 Mediate Material Cooperation.

 Mediate material cooperation occurs when the cooperator participates in circumstances that are not
essential to the commission of an action, such that the action could occur even without this cooperation.
 Mediate material cooperation in an immoral act might be justifiable under three basic conditions: 
 
a. If there is a proportionately serious reason for the cooperation (i.e., for the sake of protecting an important good
or for avoiding a worse harm); the graver the evil the more serious a reason required for the cooperation; 
 
b. The importance of the reason for cooperation must be proportionate to the causal proximity of the cooperator’s
action to the action of the principal agent (the distinction between proximate and remote)
 
c. The danger of scandal (i.e., leading others into doing evil, leading others into error, or spreading confusion) must
be avoided.
 
5. Solidarity
  The principle of solidarity invites us to consider how we relate to each other in community. It assumes
that we recognize that we are a part of at least one family - our  biological family, our local community, or
our national community.
 Solidarity requires us to consider this kind of extended community, and to act in such a way that reflects
concern for the well-being of others.
 Participation extends the idea of solidarity to make it practical. The demands of solidarity point us to the
principle of participation, so that those affected by an environmental decision can shape how it is made.
 The ethical principle of participation requires us to recognize all of the parties - human and non-human -
likely to be affected by a decision, and to recognize that all parties should have a say in how the decision is
made. Genuine participation requires transparency, meaning that each individual has access to the same
information that everyone else has.
 

MAJOR BIOETHICAL PRINCIPLES

 
 Some of the early founders of bioethics put forth four principles which form this framework for moral
reasoning. These four principles are: 

1.     Autonomy – one should respect the right of individuals to make their own decisions
2.     Paternalism – telling people what is best; an approach to personal relationship, in which the desire tohelp,
advise, and protect may neglect individual choice and personal identity.

3.     Nonmaleficence – one should avoid causing harm 

4.     Beneficence – one should take positive steps to help others
5.     Justice – benefits and risks should be fairly distributed 

 
1.  Respect for AUTONOMY and PATERNALISM

Autonomy
o Comes from the Greek word “autos” meaning self and “nomos” meaning governance.
o It involves self-determination and freedom to choose and implement one’s decision, free from deceit,
duress, constraint or coercion.
 
  Any notion of moral decision-making assumes that rational agents are involved in making informed and
voluntary decisions. In health care decisions, our respect for the autonomy of the patient would, in
common parlance, imply that the patient has the capacity to act intentionally, with understanding, and
without controlling influences that would mitigate against a free and voluntary act.
 
 This principle is the basis for the practice of "informed consent" in the physician/patient transaction
regarding health care.
 
Case 1

In a prima facie sense, we ought always to respect the autonomy of the patient. Such respect is not simply a matter
of attitude, but a way of acting so as to recognize and even promote the autonomous actions of the patient. The
autonomous person may freely choose values, loyalties or systems of religious belief that limit other freedoms of
that person. For example, Jehovah's Witnesses have a belief that it is wrong to accept a blood transfusion.
Therefore, in a life-threatening situation where a blood transfusion is required to save the life of the patient, the
patient must be informed. The consequences of refusing a blood transfusion must be made clear to the patient at
risk of dying from blood loss. A desire to "benefit" the patient, the physician may strongly want to provide a blood
transfusion, believing it to be a clear "medical benefit." When properly and compassionately informed, the
particular patient is then free to choose whether to accept the blood transfusion in keeping with a strong desire to
live, or whether to refuse the blood transfusion in giving a greater priority to his or her religious convictions about
the wrongness of blood transfusions, even to the point of accepting death as a predictable outcome. This
communication process must be compassionate and respectful of the patient’s unique values, even if they differ
from the standard goals of biomedicine.
 
Paternalism
·         Paternalism occurs when the nurse does not respect the patient’s right to autonomy by acting as if he or she
knows what’s best for the patient, rather than the patient (Silva & Ludwick, 1999).
 
·         Paternalism disempowers the patient. A nurse is being paternalistic by acting as an authority to regulate
needs by making decisions on behalf of a patient.
 
 
Examples of Acting Paternalistic 
 The physician decides that the patient needs to have a spiritual leader for a nearby church visit him as he
is. The patient refused to have a visit earlier as he doesn’t have religious faith. The physician’s actions are
dying paternalistic as he assumes that he can make decisions for the patient better than the patient can
himself
 
2.  The Principle of NONMALEFICENCE
 The principle of nonmaleficence requires of us that we not intentionally create harm or injury to the
patient, either through acts of commission or omission. In common language, we consider it negligent if
one imposes a careless or unreasonable risk of harm upon another.
 
 Providing a proper standard of care that avoids or minimizes the risk of harm is supported not only by our
commonly held moral convictions but by the laws of society as well).
 
 This principle affirms the need for medical competence. It is clear that medical mistakes may occur;
however, this principle articulates a fundamental commitment on the part of health care professionals to
protect their patients from harm.
 
Case 2

In the course of caring for patients, there are situations in which some type of harm seems inevitable, and we are
usually morally bound to choose the lesser of the two evils, although the lesser of evils may be determined by the
circumstances. For example, most would be willing to experience some pain if the procedure in question would
prolong life. However, in other cases, such as the case of a patient dying of painful intestinal carcinoma, the patient
might choose to forego CPR in the event of a cardiac or respiratory arrest, or the patient might choose to forego
life-sustaining technology such as dialysis or a respirator. The reason for such a choice is based on the belief of the
patient that prolonged living with a painful and debilitating condition is worse than death, greater harm. It is also
important to note in this case that this determination was made by the patient, who alone is the authority on the
interpretation of the "greater" or "lesser" harm for the self.
 

3.  The Principle of BENEFICENCE

 The ordinary meaning of this principle is that health care providers have a duty to be of benefit to the
patient, as well as to take positive steps to prevent and to remove harm from the patient. These duties
are viewed as rational and self-evident and are widely accepted as the proper goals of medicine.
 
 This principle is at the very heart of health care implying that a suffering supplicant (the patient) can enter
into a relationship with one whom society has licensed as competent to provide medical care, trusting
that the physician’s chief objective is to help.
 
 The goal of providing benefit can be applied both to individual patients and to the good of society as a
whole. For example, the good health of a particular patient is an appropriate goal of medicine, and the
prevention of disease through research and the employment of vaccines is the same goal expanded to the
population at large.
 
Case 3

One clear example exists in health care where the principle of beneficence is given priority over the principle of
respect for patient autonomy. This example comes from Emergency Medicine. When the patient is incapacitated
by the grave nature of accident or illness, we presume that the reasonable person would want to be treated
aggressively, and we rush to provide beneficent intervention by stemming the bleeding, mending the broken or
suturing the wounded.
 
4.  The Principle of JUSTICE 
 
 Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "Giving to each that
which is his due." This implies the fair distribution of goods in society and requires that we look at the role
of entitlement.
 It is generally held that persons who are equals should qualify for equal treatment. This is borne out in the
application of Medicare, which is available to all persons over the age of 65 years. This category of
persons is equal with respect to this one factor, their age, but the criteria chosen says nothing about need
or other noteworthy factors about the persons in this category.
  In fact, our society uses a variety of factors as criteria for distributive justice, including the following:
 
a. To each person an equal share
b. To each person according to need
c. To each person according to effort
d. To each person according to contribution
e. To each person according to merit
f. To each person according to free-market exchanges
John Rawls (1999) and others claim that many of the inequalities we experience are a result of a "natural lottery"
or a "social lottery" for which the affected individual is not to blame, therefore, society ought to help even the
playing field by providing resources to help overcome the disadvantaged situation. One of the most controversial
issues in modern health care is the question pertaining to "who has the right to health care?" Or, stated another
way, perhaps as a society we want to be beneficent and fair and provide some decent minimum level of health
care for all citizens, regardless of ability to pay. Medicaid is also a program that is designed to help fund health care
for those at the poverty level. Yet, in times of recession, thousands of families below the poverty level have been
purged from the Medicaid rolls as a cost-saving maneuver. The principle of justice is a strong motivation toward
the reform of our healthcare system so that the needs of the entire population are taken into account. The
demands of the principle of justice must apply at the bedside of individual patients but also systemically in the laws
and policies of society that govern the access of a population to health care. Much work remains to be done in this
arena.
 
 
APPLICATION OF BIOETHICAL PRINCIPLES TO THE CARE OF THE SICK
 
a. AUTONOMY and INFORMED CONSENT
 

AUTONOMY
 
Autonomy refers to the patients’ rights to make self-governing decisions or self-determine a course of action. In
healthcare, this applies to the patient’s right to make decisions about their own lives and health without
interference from the nurse, physician, or another team member. The nurse must respect the patient’s right to
independent decision making. This involves resisting the urge to interject one’s own feelings, values, or beliefs
onto the patient. Infringement upon this right is unethical.
 
Autonomy was brought to the public’s eye when the Patient Self Determination Act was passed by Congress in
1990. This Act states that competent individuals are allowed to make their own decisions pertaining to the end of
life care. It also outlined patients’ right to appoint a durable power of attorney, which designates another
individual the authority to make end-of-life decisions when the individual is no longer able to do so themselves
(American Nurses Association, 2011).
 
Examples of Applying Autonomy
                                 
 The hospital maintains a supply of brochures in the lobby that provides information on appointing a
durable power of attorney.
 
 The nursing staff of a dialysis clinic has been treating a patient with end-stage renal disease for several
years. One day, the patient informs them that this will be his last visit, as he no longer wants to receive
dialysis after being turned down for a kidney transplant. The nurses realize that the patient is competent
to make such decisions. Although some of the nurses are emotionally distressed about his choice, they
understand that the patient has the right to decline treatment and respect his decision.
 
 The staff of a genetic clinic practices a form of nondirective counseling, which is commonly used in the
field of genetics. The clinician or counselor provides information to a couple that predicts the chances that
 they will have a child with a genetic defect.  While providing this information, they keep the conversation
based on facts, offering data on probability rates as requested, but do not attempt to direct the patients’
decision-making in any way. The right of the patients to make self-governing decisions is respected.
 
INFORMED CONSENT
 
 Informed consent involves the patient’s right to autonomy and self-determination. Accurate information
must be provided to enable patients to make an informed decision about their treatment (Daly, 2009).
There are variations in how it is obtained from the individual; it may be generally implied or expressed. 
 
 Expressed consent can be obtained in either verbal or written methods (Lin & Chen, 2007). Performing a
procedure without consent can be construed as battery or assault. Clinicians and nurses that feel that
they know what’s best and force their beliefs upon a patient are acting in a paternalistic manner. There
are three elements of informed consent.
 

The Three Elements of Informed Consent

  Informed
 Competent
 Voluntary
                                                                       
What it means to be “Informed”
  The state of informed involves communication that facilitates an understanding of a nursing/medical
procedure or research process prior to having the patient participate
  Sufficient information must be provided.
 
What it means to be “Competent”
 The state of competency means that individual must have the mental capacity to understand the
implications of decisions
 This involves the capacity to weigh out the potential benefits in comparison to the risks by applying
“rational reason” 
 
What it means to be “Voluntary”
 The state of voluntary means that the patient is not coerced into participation and that consent can be
withdrawn at any time
 This respects the patient’s right to autonomy
 
 
b. PRIVACY and CONFIDENTIALITY
 
Maintaining privacy and confidentiality involves only sharing patient information on a need-to-know basis. Actions
in healthcare delivery are structured and governed by HIPPA law. The nurse must act to prevent breaches of
confidentiality.
 
Examples of Applying Privacy and Confidentiality
 
  A person comes to the Med-Surg floor, claiming to be the patient’s wife. The nurse checks the document
that lists the individuals authorized to be privy to private healthcare information. The patient’s wife is
indeed listed on the document. However, as the nurse has never seen the woman before, decides to ask
for identification prior to telling her his room number. Upon the request, the woman suddenly becomes
nervous and bails. The nurse later learns that the woman is not the patient’s wife, but a scorned ex-
girlfriend. The patient and his actual wife had obtained a restraining order on her following several
incidents of stalking and harassment
 
 A nurse is working at an urban drug rehabilitation facility. Over the course of several weeks, she has
become close to a woman who is recovering from crack-cocaine addiction. As her release date
approaches, the woman becomes close to another patient. She reveals to the nurse that the two are
planning on “going out” once they are released. stigmatizing and hence needs to be kept confidential
 
 
c. Patient’s Bill of Rights
 
1. The patient has the right to considerate and respectful care.
2. The patient has the right to obtain from his physician complete and current information concerning his
diagnosis, treatment, and prognosis in terms the patient can be reasonably expected to understand.
3. The patient has the right to receive from his physician information necessary to give informed consent
prior to the start of any procedure and/or treatment.
4. The patient has the right to refuse treatment and to be informed of the medical consequences of his
action.
5. The patient has the right to every consideration of his privacy concerning his own medical care program.
6. The patient has the right to expect that all communications and records pertaining to his care should be
treated as confidential.
7. The patient has the right to expect within its capacity, a hospital must make a reasonable response to the
request of a patent for services.
8. The patient has the right to obtain information as to any relationship his hospital has to other health care
and educational institutions insofar as his care is concerned.
9. The patient has the right to be advised if the hospital proposes to engage in or perform human
experimentation affecting his care or treatment.
10. The patient has the right to expect reasonable continuity of care.
11. The patient has the right to examine and receive an explanation of his bill.
12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.
 
Patient’s Responsibilities
1. Providing information
2. Complying with instructions
3. Informing the physician of refusal to treatment
4. Paying hospital charges
5. Following hospital rules and regulations
6. Showing respect and consideration

A Patient’s Bill of Rights

  A Patient's Bill of Rights was first adopted by the American Hospital Association in 1973. This revision was
approved by the AHA Board of Trustees on October 21, 1992.
 Introduction Effective health care requires collaboration between patients and physicians and other
healthcare professionals.
 Open and honest communication, respect for personal and professional values, and sensitivity to
differences are integral to optimal patient care.
 As the setting for the provision of health services, hospitals must provide a foundation for understanding
and respecting the rights and responsibilities of patients, their families, physicians, and other caregivers.
  Hospitals must ensure a health care ethic that respects the role of patients in decision making about
treatment choices and other aspects of their care.
 Hospitals must be sensitive to cultural, racial, linguistic, religious, age, gender, and other differences as
well as the needs of persons with disabilities.
 The American Hospital Association presents A Patient's Bill of Rights with the expectation that it will
contribute to more effective patient care and be supported by the hospital on behalf of the institution, its
medical staff, employees, and patients.
 The American Hospital Association encourages health care institutions to tailor this bill of rights to their
patient community by translating and/or simplifying the language of this bill of rights as may be necessary
to ensure that patients and their families understand their rights and responsibilities.
 Bill of Rights these rights can be exercised on the patient’s behalf by a designated surrogate or proxy
decision maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.
 
1. The patient has the right to considerate and respectful care.
2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant,
current, and understandable information concerning diagnosis, treatment, and prognosis.
 Except in emergencies when the patient lacks decision-making capacity and the need for treatment is
urgent, the patient is entitled to the opportunity to discuss and request information related to the specific
procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically
reasonable alternatives and their accompanying risks and benefits.
  Patients have the right to know the identity of physicians, nurses, and others involved in their care, as
well as when those involved are students, residents, or other trainees.
 The patient also has the right to know the immediate and long-term financial implications of treatment
choices, insofar as they are known.

3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment
and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and
to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other
appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify
patients of any policy that might affect patient choice within the institution.
 
4. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable
power of attorney for health care) concerning treatment or designating a surrogate decision maker with the
expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital
policy. Health care institutions must advise patients of their rights under state law and hospital policy to make
informed medical choices, ask if the patient has an advance directive, and include that information in patient
records. The patient has the right to timely information about hospital policy that may limit its ability to fully
implement a legally valid advance directive.
5. The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and
treatment should be conducted so as to protect each patient's privacy.

6. The patient has the right to expect that all communications and records pertaining to his/her care will be
treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when
reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the
confidentiality of this information when it releases it to any other parties entitled to review information in these
records.

7. The patient has the right to review the records pertaining to his/her medical care and to have the information
explained or interpreted as necessary, except when restricted by law.

8. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable
responses to the request of a patient for appropriate and medically indicated care and services.

 The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case.
 When medically appropriate and legally permissible, or when a patient has so requested, a patient may be
transferred to another facility.
 The institution to which the patient is to be transferred must first have accepted the patient for transfer.
 The patient must also have the benefit of complete information and explanation concerning the need for,
risks, benefits, and alternatives to such a transfer.

9. The patient has the right to ask and be informed of the existence of business relationships among the hospital,
educational institutions, other health care providers, or payers that may influence the patient's treatment and
care.

10. The patient has the right to consent to or decline to participate in proposed research studies or human
experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies
fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to
the most effective care that the hospital can otherwise provide.
11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by
physicians and other caregivers of available and realistic patient care options when hospital care is no longer
appropriate.

12. 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.
 The collaborative nature of health care requires that patients, or their families/surrogates, participate in
their care.
  The effectiveness of care and patient satisfaction with the course of treatment depend, in part, on the
patient fulfilling certain responsibilities.
 Patients are responsible for providing information about past illnesses, hospitalizations, medications, and
other matters related to health status.
 To participate effectively in decision making, patients must be encouraged to take responsibility for
requesting additional information or clarification about their health status or treatment when they do not
fully understand information and instructions.
  Patients are also responsible for ensuring that the health care institution has a copy of their written
advance directive if they have one.
 Patients are responsible for informing their physicians and other caregivers if they anticipate problems in
following prescribed treatment.
 Patients should also be aware of the hospital's obligation to be reasonably efficient and equitable in
providing care to other patients and the community.
 The hospital's rules and regulations are designed to help the hospital meet this obligation.
 Patients and their families are responsible for making reasonable accommodations to the needs of the
hospital, other patients, medical staff, and hospital employees. 
 Patients are responsible for providing necessary information for insurance claims and for working with the
hospital to make payment arrangements, when necessary. A person's health depends on much more than
health care services.Patients are responsible for recognizing the impact of their life-style on their personal
health.

Hospitals have many functions to perform, including the enhancement of health status, health promotion, and
the prevention and treatment of injury and disease; the immediate and ongoing care and rehabilitation of
patients; the education of health professionals, patients, and the community; and research. All these activities
must be conducted with an overriding concern for the values and dignity of patients.

d. Nurses’ Bill of Rights

1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who
receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in accordance with professional
standards and legally authorized scopes of practice.
3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance
with the Code of Ethics for Nurses and its interpretative statements.
4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of
retribution.
5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience,
and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and their patients.
7. Nurses have the right to negotiate the conditions of their employment, either individually or collectively,
in all practice settings.
 
 THE FOUR BASIC PRINCIPLES OF HEALTH CARE ETHICS

1. Autonomy: In medicine, autonomy refers to the right of the patient to retain control over his or her body. A
health care professional can suggest or advise, but any actions that attempt to persuade or coerce the patient into
making a choice are violations of this principle. In the end, the patient must be allowed to make his or her own
decisions – whether or not the medical provider believes these choices are in that patient’s best interests –
independently and according to his or her personal values and beliefs.

 2. Beneficence: This principle states that health care providers must do all they can to benefit the patient in each
situation. All procedures and treatments recommended must be with the intention to do the most good for the
patient. To ensure beneficence, medical practitioners must develop and maintain a high level of skill and
knowledge, make sure that they are trained in the most current and best medical practices, and must consider
their patients’ individual circumstances; what is good for one patient will not necessarily benefit another.

 3. Non-Maleficence: Non-maleficence is probably the best known of the four principles. In short, it means, “to do
no harm.” This principle is intended to be the end goal for all of a practitioner’s decisions and means that medical
providers must consider whether other people or society could be harmed by a decision made, even if it is made
for the benefit of an individual patient.

 4. Justice: The principle of justice states that there should be an element of fairness in all medical decisions:
fairness in decisions that burden and benefit, as well as equal distribution of scarce resources and new treatments,
and for medical practitioners to uphold applicable laws and legislation when making choices.

Core Values Every Nursing Professionals should have

Empathy and Caring

  Empathy is a nurse’s ability to understand, be aware of, be sensitive to, and vicariously experience the
feelings, thoughts, and experiences of the patient and their family. It is the nurse’s ability and willingness
to “tune in” to and focus on the patient’s experiences that is fundamental to the methods nurses use to
manage care. Empathy is based upon respect for the dignity of the client and an appreciation for the
independence and self-actualization of the patient.
 Caring involves knowing and trusting the patient, an interest in their growth and well-being, honesty,
courage, and humility. A caring nurse knows that he or she does not know all there is to know about the
patient and projects the confidence and patience to help them maintain hope or the sense of continued
possibility for growth and change. Caring involves the planning and provision of culturally sensitive and
appropriate care.

Communication
 The exchange of thoughts, messages, or information—is of vital importance to the nursing process. 
 A nurse uses communication skills—speech, signals, writing, and behavior—during a patient assessment,
as well as the planning, implementing, and evaluating of nursing care. 
 A nurse communicates with patients, families, groups, and members of the health care team. They are
competent in oral and written forms of communication, as well as in techniques of therapeutic
communication.

Teaching
 One of the most important roles of a nurse is to assist patients and their families with receiving
information necessary for maintaining a patient’s optimal health. 
  A nurse provides patients and families with information that is based on their assessed learning needs,
their abilities, their learning preference, and their readiness to learn. 
 Fundamental to the provision of patient education is a nurse’s belief that patients have the right to make
informed decisions about their care. Nurses provide information that is accurate, complete, and relevant
to client needs. 
 A nurse often clarifies information provided by other members of the health care team.

Critical Thinking
 Nurses are constantly involved with making accurate and appropriate clinical decisions. We believe nurses
must be able to think critically and make decisions when patients present problems for which there may
not be clear textbook solutions. 
 A nurse must question, wonder, and be able to explore various perspectives and possibilities in order to
best help patients. Critical thinking involves an active, organized cognitive process designed to allow a
nurse to explore and challenge assumptions. 
 Nurses that engage in critical thinking reflect on past experiences, think independently, take risks based
on knowledge, persevere in the face of difficult problems, are curious, creative, and ethical.

Psychomotor Skills
 We believe that fundamental to nursing is the “laying on of hands” to provide comfort, and the use of
specific skills to accomplish client assessment and to provide and evaluate nursing care. 
 Nursing skills are utilized in a manner that maximizes client comfort and dignity, optimizes the client’s
ability to respond positively, provides the highest level of accuracy of the information, and provides for
the most favorable patient outcomes.
 Psychomotor skills are best learned through practice after achieving an understanding of the basic
principles of skills as part of a nurse’s education.

Applied Therapeutics
 A nurse applies medically-ordered therapeutic modalities, like pharmacological and nutritional
interventions, etc. 
 A nurse’s application of these modalities is based on a knowledge base regarding their therapeutic uses,
as well as skills in patient assessment and evaluation. 
 The competent application of nutritional knowledge also involves its use in health and wellness, as well as
when therapeutic diets are prescribed.

Ethical and Legal Considerations

 A nurse plan provides and evaluates nursing care guided by specific ethical and legal boundaries. 
 Code of Ethics for Nurses provides the ideal framework for safe and correct practices and behavior. 
 Ethical behavior also involves accountability, responsibility, confidentiality, truthfulness, fidelity, and
justice. 
 Nurses who clarify their values are enhanced in their ability to practice ethically.
 Legal parameters of nursing are defined by statutory, regulatory, and common law. In addition,
professional standards of care provide the legal guidelines for nursing practice. 
 Legal considerations in the care of clients involve issues like negligence, malpractice, abandonment,
assault, battery, and informed consent. Nurses must understand legal boundaries to protect their
patients’ and their own rights.
Professionalism
 Professionalism involves the characteristics of a nurse that reflects his or her professional status. These
characteristics involve behaviors with regard to self, patients, others, and the public as they reflect the
values of the nursing profession. 
 Professional personas are knowledgeable in their subject matter, conscientious in their actions, and
responsible for themselves and others. Written standards for practice and professional performance guide
the behaviors of professional practitioners. 
 Nurses enhance their professionalism by understanding history, educational choice, professional research
and theory, and their professional organizations and standards.

  ( The Nursing Code of Ethics and What it Means for Prospective Nurses August  27, 2020IN "NEWS"
What are the Fundamentals of Nursing? October 14, 2020IN "NEWS"
What the Best Nursing Schools All Have in Common November 22, 2017IN "NEWS").