NCM 108 – HEALTH CARE ETHICS

By: Trishia Marlou D. Rubi

TOPIC: BASIC BIOETHICAL o As stewards of life and the divine gifts of

nature, humans are accountable to life and
PRINCIPLES
the world.
Stewardship
• “Man comes from nothing for man to be
Principle of Totality
something.”
• Pursues the issue of the dignity of the whole person,
• Only GOD can create life; humans are capable only
in essence of the integrity of human life.
of manipulating or destroying it.
o Demands respect for the self and respect
• Along with the gift of LIFE, GOD also gave intellect
for others.
(to discover the truth) and freedom (humans
o Respect is never a cause but always an
became creative).
effect.
• In as much as life cannot survive on its own without
• Golden Rule:
being rooted to something that can sustain its
o “Do unto others what you want others do
survival and development, the Divine Author
unto you.”
provided humans a place to dwell (World).
• Respect of the self and others in a condition sine qua
• Humans must uphold a solemn conviction that life &
non (something essential) in a given social order.
the world are gifts from the love & mercy of God.
• As a member of a given society, every individual is
• Explains that God is the creator of the earth and our
duly accountable for the whole society.
human body; we are made to take care of them
• This is why legislators draft and pass laws to punish
therefore we don’t have the right to destroy or use it
violators of the dignity and value of human life.
for our immoral act.
o These laws encompass everyone.
• We must be morally responsible for God's creation
• Principle of totality can also be applied to the human
for we are just its caretaker
body.
• Requires that the gifts of human life and its natural
o Person has the right to cut off, or remove
environment be used with profound respect for their
defective, non-functioning part of his body
intrinsic ends.
on the premise that the intention is meant
• Simply because something can be done does not
to safeguard the totality of the well-being of
necessarily mean that it should be done (the fallacy
the body.
of the technological imperative).
• Principle of totality can also be seen in the context of
the journey of human life, from conception to the
Principle of Stewardship
time of death.
• Humans must respect the sanctity of life and the
o For contemporary fetal psychologists
world.
(DiPietro, Als, De Casper, Lecanuet and
o They have no authority over life and the
Devlin), human behavior does not begin at
world.
birth but 5 wks. after conception where the
o The God-given gifts of the environment and
embryonic cell has come to terms of
humanity are placed in the care of people.
forming a human development.
o In consonance with the obligation to take
• As early as 5 wks., the fetus’s cerebral cortex is
care of the world (Martin Heidegger:
already showing vital signs of development (grow,
“Humans are the shepherds of being in the
move, think, speak, plan, and create as a human
world”), a commitment should also be
being).
made to take care of the body, mind, &
• As early as 9 wks. of gestation, fetus can perform the
freedom.
following:
• Human life comes from GOD, and no individual is
o 1) He/she can hiccup
the master of his/her own body.
o 2) Can react to loud noises
o Humans are mere stewards or caretakers,
o 3) Can hear, feel, smell
with the responsibility of protecting and
o 4) Experience rapid eye movement
cultivating spiritual and bodily functions.
o 5) Capable of yawning, sucking, swallowing
o 6) Can savor mother’s meals
 o 7) Can distinguish between the voice of
mother and that of a stranger
o 8) Can walk around the womb by pushing
his/her feet
Totality
• Refers to the duty to preserve intact the physical
component of the integrated bodily and spiritual
nature of human life.
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.
• Being honest & fair
• Incorruptible.
Totality and Integrity
• 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.
Double – Effect Act
• St. Thomas Aquinas recognized that there are times
when the action one thinks one ought to do will have
good and bad effects.
• Indirect Voluntariness, or voluntary in causa, refers
to an act desired not as an end in itself but as a
foreseen effect or consequence of an act.
• Two problems presented:
o 1) When can the agent be responsible for
the evil effect of a cause directly willed?
o 2) When can the agent perform an act not
evil in itself, but bears two effects, one
good, the other, evil
When can the agent be responsible for the evil effect of a
cause directly willed?
• 3 conditions:
• If the agent foresees the evil effect at least in a
general way.
• If the agent is free to refrain from doing that which is
the cause of the evil effect
• If the agent knows that he is morally bound not to
do that which is the cause of the evil effect.
When can the agent perform an act not evil in itself, but
bears two effects, one good, the other, evil.
• 4 conditions must be present:
• Action must be morally good in itself.
• The good effect of the act must precede the evil
effect which is morally allowed to happen as a
regrettable consequence.
• There must be a grave or sufficient reason in doing
the act.
• The evil effect should not outweigh the good effect,
or at least the good effect is at least equivalent in
importance to the bad effect.
Cooperation
• Developed 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.
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.
• Formal cooperation in intrinsically evil actions, either
explicitly (openly shown) or implicitly, is morally
illicit.
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
his participation.
• Immediate material cooperation in intrinsically evil
actions is morally illicit.
Mediate Maternal 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.
Solidarity
• Invites us to consider the “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 – but then
challenges us to consider the full range of
relationships with others.
• Requires us to consider an extended community, and
to act in such a way that reflects concern for the
well-being of others.
Proportionate and Disproportionate Means
• Holds that one is obliged to preserve his or her own
life by making use of ordinary means, but is under no
obligation to use extraordinary means.
Proportionate Means
• Any treatment that, in the given circumstances and
in the judgment of the patient or the patient’s
surrogate, offers a reasonable hope of benefit and is
not too burdensome for the patient or others.
Disproportionate Means
 • Any treatment that, in the given circumstances and
in the judgment of the patient or the patient’s
surrogate, either offers no reasonable hope of
benefit or is too burdensome for the patient or
others.
Common Good
• Consists of all the conditions of society and the
goods secured by those conditions, which allow
individuals to achieve human and spiritual
flourishing.
• The human community must be actively concerned
in promoting the health and welfare of every one of
its members so that each member can contribute to
the common good of all.
• Three essential elements:
o Respect for persons.
o Social welfare.
o Peace and security.
Subsidiarity
• Requires those in positions of authority to recognize
that individuals have a right to participate in
decisions that directly affect them, in accord with
their dignity and with their responsibility to the
common good.
Topic: Major Ethical Principles
Ethical Principles
• The ethical principles provide a foundation for
nursing practice. Ethical principles are defined as
basis for nurse’s decisions on consideration of
consequences and of universal moral principles
when making clinical judgments
• The most fundamental of these principles is the
respect for persons.
• The primary and basic ethical principles are the
following:
o Respect for autonomy
o Nonmaleficence
o Beneficience
o Justice
• The secondary ethical principles that can be
incorporated with the primary principles when
interpreting ethical issues and making clinical
decisions are the following:
o Veracity
o Confidentiality
o Fidelity
Respect for Persons
• According to the American Nurses Association (ANA),
the most fundamental principle of professional
behavior is the respect for persons.
• This principle not only applies to the clinical settings
but to all life’s situations.
• This principle emphasizes that all people should
treat others as a worthy individual.
• In nursing practice this principle should be simplified.
Thus, respect for persons generally means
respecting a client’s autonomy.
Respect for Autonomy
• Respecting a client’s rights, values and choices is
synonymous to respecting a person’s autonomy.
• Informed consent is a method that promotes and
respects a person’s autonomy.
• For a client to make an autonomous decision and
action, he or she must be offered enough
information and options to make up his or her mind
free of coercion or external and internal influences.
• In clinical settings, this is promoted by proving
informed consent to the client.
Autonomy
• Any notion of moral decision-making assumes that
rational agents are involved in making informed and
voluntary decisions.
• The capacity to act intentionally, with
understanding, and without controlling influences
that would mitigate against a free and voluntary act.
• Having the freedom to make choices about issues
that affect one’s life
• Self-governing
• Contrast undesirable states: dependency, coercion,
paternalism, thoughtlessness, habit
• Personal liberty of action
• Self-determination
• Independence
• Self- reliance
• Freedom of choice
• Ability to make decisions
Four Basic Elements
• The autonomous person is respected.
• The autonomous person must be able to determine
personal goals.
• The autonomous person has the capacity to decide
on a plan of action.
• The autonomous person has the freedom to act
upon the choices.
Violations of Patient Autonomy
 • Nurses may falsely assume that patients have the
same values and goals as themselves.
• Failure to recognize that individuals’ thought
processes are different.
• Assumptions about patients’ knowledge base.
• The “work” of nursing becomes the major focus.
Informed Consent
• Patients are informed of the possible outcomes,
alternatives, and risks of treatments, and are
required to give their consent freely
• Assures the legal protection of patient’s right to
personal autonomy in regard to specific treatments
and procedures
Paternalism
• Translates to professionals who restrict others’
autonomy, usually to protect that person from
perceived or anticipated harm.
o There must be a sufficient reason why the
autonomy of the individual must be
restricted.
• It is appropriate when a patient is incompetent and
has diminished decision-making capacity
Beneficence
• The duty of health care providers to be of a benefit
to the patient, as well as to take positive steps to
prevent and to remove harm from the patient.
• Applied both to individual patients, and to the
society as a whole.
• Abstain from injuring others.
• Practice of doing good deeds, or showing kindness &
charity to others.
• Taking actions that will promote the welfare of other
people.
• It is the duty to help others further their important
and legitimate interests when we can do so with
minimal risk to ourselves.
• Requires nurses to act in ways that benefit patients--
-beneficent acts are morally and legally demanded
by our professional role.
Three Major Components
• Do or promote good.
• Prevent harm.
o “The nurse takes appropriate action to
safeguard individuals, families and
communities when their care is endangered
by a co-worker or any other person.”
• Remove evil or harm.
o Steps include: expressing concern to the
person carrying out the questionable
practice and reporting the practice to the
appropriate authority within the situation.
Beneficence
• Beneficence is doing or active promotion of good.
This is done by:
• Providing health benefits to the clients.
• Balancing the benefits and risks of harm.
• Considering how a client can be best helped.
Nonmaleficence
• DO NO HARM.
• It is the duty to help others further their important
and legitimate interests when we can do so with
minimal risk to ourselves.
• Requires that we do not intentionally create a
needless harm or injury to the patient, either
through acts of commission or omission.
• Avoid negligent & harmful care.
• Included in this principle are deliberate harm, risk of
harm, and harm that occurs during the performance
of beneficial acts
• Articulates a fundamental commitment on the part
of health care professionals to protect their patients
from harm.
• Do no harm includes:
o Deliberate harm.
o Risk of harm.
o Harm that occurs during performance of
beneficial acts.
• Nonmaleficence means duty to do no harm.
• This is promoted by doing the following nursing
interventions:
o Avoiding deliberate harm, risk of harm that
occurs during the performance of nursing
actions.
o Considering the degree of risk permissible.
o Determining whether the use of
technological advances provides benefits
that outweigh risks.
Negligence
• The legal criteria for determining negligence are as
follows:
o 1. The nurse must have a duty to the
patient.
o 2. The nurse must breach that duty.
o 3. The patient must experience harm.
o 4. The harm must be caused by the breach
of duty.
Justice
• Defined as a form of fairness, or as Aristotle once
said, "Giving to each that which is his due.”
 • Fair, equitable, and appropriate treatment in light of
what is due or owed to persons.
• This implies the fair distribution of goods in society.
• It is generally held that persons who are equal
should qualify for equal treatment.
Secondary Principles of Ethical Conduct
• Veracity – duty to tell the truth
• Confidentiality – duty to respect privileged
Information
• Fidelity – duty to keep promises
TOPIC: TYPES OF ETHICAL
THOUGHTHS
Deontology
• states that people should adhere to their obligations
and duties when engaged in decision making when
ethics are in play.
• means that a person will follow his or her obligations
to another individual or society because upholding
one’s duty is what is considered ethically correct.
• For instance, a deontologist will always keep his
promises to a friend and will follow the law. A
person who adheres to deontological theory will
produce very consistent decisions since they will be
based on the individual’s set duties
• It is this emphasis on duty that earns them the name
“deontological”, which is derived from the Greek
word “deon” for “duty” or “obligation”.
• There are different versions of deontology. We
examine two of them, those of Immanuel Kant and
W. D. Ross.
Kantian Ethics
• Deontological Theory
• This theory states that for any action to have any
moral worth we can only look at the motives or
intentions behind the act
• Good Intentions come from Good Will
• The use of Reason to inform Good will helps
highlight your Duty in any situation
• Your duty can be role-based, but also based on
categorical imperatives.
• You also need your reason to figure out if you are
acting by a universalisable maxim
Immanuel Kant (1724-1804)
• German philosopher
• Concerned with duty and reason
• Believed that the intentions behind an action were
more important than the consequences
• We cannot predict the consequences so we cannot
judge a person good or bad based on the
consequences of their action
Categorical Imperatives
• Categorical here means applicable in all situations,
an absolute
• Imperative means something that must be done, an
obligation
• In other words, a moral decision that you make must
be made because you think it would be good for
everyone
Categorial VS. Hypothetical
• The category imperative is to act for the sake of duty
only
• Whereas the hypothetical imperative is an acting in
order to receive some kind or reward
• Kant argues that the categorical imperatives is the
only good way to act
• For example one should help an old lady across the
road simply because it is a good thing to do, not
because it will make you feel good
• Even if a good act makes you feel good, this is not a
reward it is a bonus according to Kant
Maxims & universalisability
• A maxim is an absolute moral statement; Kant stated
that these had to be universalisability. For Example:
do not murder
• Universalisability is the ability to use a maxim
everywhere, and by everyone so that the maxim is
never broken
• For Example, for Kant the Decalogue is a set of
maxims which should be universal
Categorical Imperative
Universal Moral Law
• An ethical low can be universal if everybody wish to
follow it equally
• If an action is morally right or wrong it is similar for
everyone
Treat People as Ends
• Treat other and own self as ends
• Individual capability of leading life should be
recognize
Kingdom of Ends
• Imaginary state whose lows protect individual
autonomy
• Morality is not just a matter of individual conduct,
but also the foundation of society
Kantian Ethics
 • “A man is acting morally only when he suppresses
feelings and inclinations and does what he is obliged
to do , e.g. ‘doing one’s duty’.
• “There is a difference also between actions which
are in accord with duty and those done from duty.
The former and not necessarily moral but the latter
are.”
Kant: Deontological Ethical Theory
• Kant’s theory is an example of deontological or duty-
based ethics: it judges morality by examining the
nature of actions and the will of agents rather than
goals achieved.
• A deontological theory looks at inputs rather than
outcomes
• One reason for the shift away from consequences to
duties is that we cannot control the future. We are
praised or blamed for actions within our control, and
that includes our willing, not achieving.
• This is not to say that Kant did not care about the
outcomes of our actions—we all wish for good things
• Kant insisted that as far as the moral evaluation or
our actions was concerned, consequences did not
matter
Scenario
• Michael works as staff nurse on a specialist unit for
people with neurological disorders. Elizabeth, a
twenty six years old school teacher who has recently
given birth to her first baby, was admitted with a
history of muscle weakness and changes in sensation
in her legs and lower body. Following initial
investigations the medical team feel that the most
likely diagnosis is multiple sclerosis
• It is very difficult to predict how each patient’s MS
will progress during the early stages of the disease.
Some may deteriorate rapidly and become unable to
care for themselves with a few years but in many
cases patients with multiple sclerosis recover well
after the first episode and enter a period of
remission which may last twenty or more years. The
medical team have a policy of not giving patients a
diagnosis of MS during the first episode and prefer
to wait until the patient has had a further episodes
before they tell the patient the diagnosis
• Elizabeth, who is making good progress and is
regaining most of her physical abilities, has asked
Michael what the results of the medical test have
shown.
• What duties do you think Michael might have? Who
to? How should be act?
Ross Ethics
Sir William David Ross
• Born 1877-1971
• Was Knighted
• Rejected both Kantianism and Utilitarianism
When is something our duty?
• Ross does not propose any general test of obligation
like Kant’s categorical imperative. Instead, Ross falls
within the tradition of “ethical intuitionism”. After a
careful examination of the facts surrounding a case,
he believes that we then are able to intuit the
appropriate duty.
• Ross claims that our experience with such cases puts
us in a position to come to know our prima facie
duties with the same degree of certainty as when we
grasp the mathematical truth that a triangle has
three angles.
• Furthermore, according to Ross, our experience of
many individual cases puts us in a position to
recognize the validity of a general statement like “It
is wrong to cause needless pain.” We come to see
such rules in much the same way that we come to
recognize the letter A after having seen it written or
printed in a variety of handwritings or typefaces
W.D. Ross – Intuitionism
• Ross accepted Moore’s version of ethics and also
added that in any given situation moral duties or
obligation become apparent
• These duties called prima facie duties
• Prima facie means ‘at first appearance’
Prima facie duties
• Ross offers a list of duties that he considers binding
on moral agents (He did not claim that the list is
exhaustive).
1. Duties of Fidelity: telling the truth, keeping actual
and implicit promises and not representing fiction as
history
2. Duties or reparation: righting the wrong we have
done to others
3. Duties of gratitude: recognizing the services other
have done for us
4. Duties of justice: preventing a distribution of
pleasure or happiness that is not keeping with the
merit of the people involved
5. Duties of beneficence: helping to better the
condition of other being with respect to virtue,
intelligence or pleasure
6. Duties of self-improvement: bettering ourselves with
respect to virtue or intelligence
7. Duties of non-malfeasance: avoiding or preventing
and injury to others
Application to Bioethics
• In August 2000, conjoined twins, named Mary and
Jodie were born in a hospital in Manchester
England. Their spines were fused, and they had one
heart and one pair of lungs between them. Jodie,
the stronger one, was providing blood for her sister.
• The prognosis was that without intervention, both
girls would die within six mounts. The only hope
was an operation to separate them. This would save
Jodie, but Mary would die immediately.
• Thus there were two options:
o Not intervene and see both babies die or
o Intervene and save one life, Jodie
• What is the acceptable course of action?
Ross’s Prima Facie Duties (The Right and the Good 1930)
• Fidelity: obligation to keep promise
• Reparation: obligation to repair the harm
• Gratitude: obligation to recognize a granted benefit
and express it
• Justice: obligation to fairly distribute the good
• Beneficence: obligation to do good to someone
• Self- improvement: obligation to make yourself a
better person
• Non-maleficence: obligation to not harm anyone
Application to Bioethics
• In the example of Mary and Jodie, Ross would
answer the question of whether it is right or wrong
to separate the twins by first seeing which of the
prima facie duties are applicable and, in the event
there is a conflict, examine the non-moral facts of
the case, and with these facts as background, weigh
the duties against one another.
• In considering the case, the duties of non-
malfeasance and beneficence seems relevant and it
is plausible to read them as implying that there is an
obligation to separate the twins.
Deontology
• Deontology contains many positive attributes, but it
also contains flaws. One flaw is that there is no
rationale or logical basis for deciding an individual’s
duties.
• For instance, a businessperson may decide that it is
his/her duty to always be on time to meetings.
Although this appears to be something good, we do
not know why the person chose to make this his
duty.
• What do you think are the reasons for this
behavior?
o Sometimes, a person’s duties are in
conflict. For instance, if the business
person who must be on time to meetings is
running late, how is he/she supposed to
drive? Is speeding breaking his/her duty to
society to uphold the law, or is the
businessperson supposed to arrive at the
meeting late, not fulfilling the duty to be
on time?
• How would you rectify the conflicting obligations to
arrive at a clear ethically-correct resolution?
• Bring into play the consideration of the welfare of
other as a result of the business person’s decision
Utilitarianism
• According to Utilitarianism, a person should
perform those action actions which conform to the
Principle of Utility.
• The Principle of Utility says: a person should choose
that action which produce the greatest good for the
greatest number of people effected by the
alternatives open to him.
• The rightness or wrongness of actions is determined
by the goodness or badness of the actions’
consequences, not by the actions themselves.
• Because the morality of an action, according to
utilitarianism, rests on its consequences,
utilitarianism is called a “consequentialist theory of
ethics.”
• There are different views as to what make a
consequence good or bad.
• According to the “classical” or “hedonistic” version,
what makes a consequence good or bad is its effect
on people’s happiness.
• Roughly, a consequence is bad if it reduces
happiness, good if it increases happiness.
• Happiness, in turn, is understood to mean: an
increase in pleasure and/or decrease in pain
• coz of the emphasis on happiness, Utilitarianism is
sometimes called “the greatest happiness principal”
Application to Bioethics
• Recalling the case of Mary and Jodie, according to
utilitarian, we need to decide which course of action
will produce the greatest good for the greatest
number of people effected by the action.
• It is plausible to interpret utilitarianism as
supporting alternative (b). Surely it is better to save
one life rather than not.
Contractarianism
• The rightness/ wrongness of an action is determined
by whether rational people do, or under
appropriate conditions would, agree to it.
• Example: John Rawls’ Veil of Ignorance (about which
more later on)
An example:
• It might be in our interest to drive at 180 km per
hour on a road that doesn’t have speed cameras(
e.g. so we are not late for work), but we don’t drive
at this speed
WHY?
• Because we might put other people’s lives in danger
and we would not want other people to drive like
this and put our life in danger
Rawl’s Theory of Justice
• The theory of justice formulated by the philosopher
John Rawls can be understood as attempting to
combine the strengths of utilitarianism and
deontology while avoiding the weaknesses of each
view.
• For Rawls, the central task of government is to
preserve and promote the liberty and welfare of
individuals. Thus, principals of justice are needed to
serve as standards for designing and evaluating
social institutions and practices.
• Rawls’ position has direct relevance to such
bioethical issues as who should of access to health
care, how donated organs should be distributed,
and who should pay for society’s medical costs.
Principals of Justice Rawls argues that there are two
fundamental principles of justice:
1. Each person is to has an equal right to the most
extensive total system of equal basic liberties
compatible with a similar system of liberty for all.
2. Social and economic inequalities are to be arranged
so that they are both
◦a) to the greatest benefit of the least advantaged
◦b) attached to offices and positions open to all
under conditions of fair equality of opportunity.
Principles of Justice
• For Rawls, these two principles are taken to govern
the distribution of all social goods: liberty, property,
wealth, and social privilege.
• The first principal has priority. It guarantees a
system of equal liberty for all.
• The second principal governs the distribution of
social goods other than liberty.
• Though Rawls’ overall position has relevance to
individual medical decisions, it’s most important
application is to the social institutions and practices
of medical care and research.
Bioethical example:
Consent
• According to Rawls’s principles it is wrong to exploit
one group of people or even one person for the
benefit of others.
• Thus, experiments in which people are forced to be
subjects or are tricked into participating are ruled
out.
• A person has a right to decide what risks she is
willing to take with her own life and health. Thus,
voluntary consent is required before someone can
legitimately become a research subject.
Health Care
• The implication of Rawls position seems to be that
everyone is entitled to health care.
• First, it could be argued that health is among the
“primary goods” that Rawls’s principals are
designed to protect and promote. (“Primary goods”
are the rights, opportunities, powers, wealth, and
such that are both worth possessing in themselves
and are necessary to securing the more specific
goods people may want.)
• Second, it could be argued that the inequalities of
the health care system can be justified only if those
in most need can benefit from them. Since this is
not obviously the case with the present system,
Rawls’s principals seem to call for a reform that
would provide health care to those who are unable
to pay.
Teleological Ethics
• Teleological comes from the Greek word Telos
meaning end
• The theory looks at the consequences, the results of
an action, to decide whether it’s right or wrong
• For a Teleological thinker, the end justifies the
means, and thus a thinker from this school of
thought would judge the rightness of an action by
the end it produces
 • The faculty of the human person to choose what is
Teleological Deontologist good against what is deemed to be bad or evil
Definition An approach to Approach to • Overlap
ethics focusing on ethics focusing on • Interconnected
the rightness or rightness or • Basic good values a nurse should have
wrongness of wrongness of
• Use to deal with moral dilemmas
actions by actions
• It has been with us—taught to us by our parents
examining its themselves,
consequences without any other • It was shaped by our experience
considerations
Consequences A consequentialist Non- Fidelity
theory as moral consequential • Derived from the Latin word fidelitas which means
right or moral theory as moral faithfulness
wrong is dependent right or moral • Faithfulness to one’s obligations, duties and
on the outcome of wrong is not responsibilities
an action dependent on the • Nightingale’s Pledge: to practice my profession
outcome of an
faithfully
action
Purtillo (2005) lists five expectations associated with what
Weakness Not always possible Rigid and
patients might reasonably expect in terms of fidelity in the
to predict the objective
consequences of an health care context:
action • That you treat them with basic respect.
o Regardless of the patient’s background
Scenario o Regardless of the nature of the disease
• Mr. L, a 75 year old man, is hospitalized with o Honor the promises to your patient
multiple fractures and lacerations cause by a motor • That you, the caregiver or other health care
vehicle accident. His wife, who was killed in the professional, are competent and capable of
accident, was taken to the same hospital. Mr. L who performing the duties required of your professional
had been driving the car, constantly question her role.
primary nurse about his wife; however the surgeon o One reason why we need to attend the
has told the nurse not to tell Mr. L about the death seminars and training
of his wife, however the surgeon does not give the o We must be capable to our duties and
nurse any reason for these instructions responsibilities
• The nurse expresses concern to the Nurse Unit o Scientific evidences
Manager, who says the surgeon’s order must be • That you adhere to a professional code of ethics.
followed – that the surgeon will decide when Mr. L o The patient expects to honor our ethics ---
should be told. However, the nurse in not nursing code of ethics
comfortable with this and wonders what should be • That you follow the policies and procedures of your
done. organization and applicable laws.
o Different institutions ---- different laws
o We must follow the policies of the
TOPIC: VIRTUES, VICES, AND HABITS OF A HEALTH CARE institution
PROVIDER o We need to belong to an organization first
• That you will honor agreements made with the
Virtues of a Health Care Provider patient.
• Fidelity o When you make promise that you will be
• Compassion back make sure to fulfill that promise
• Honesty o If not then assure the patient that you will
• Respect visit him/her
• Integrity
• Humility Honesty
• Courage • Derived from the Latin word honestus which means
• Prudence honor
• A nurse is supposed to be sincere, truthful,
Virtues straightforward, decent, comely (pleasing
appearance), tidy, open, upright, virtuous,
 trustworthy, fair, honorable, creditable, and of good
moral character
• A nurse should not cheat or steal anything from
his/her patient
Integrity
• Comes from the Latin word enteros which means
whole
• Makes a human person complete
• A nurse practices integrity when he/she does his/her
duties and obligations according to the beliefs,
principles, and values he/she claims to embrace
• Free from hypocrisy.
• Not to administer medication that might harm the
patient
• You should be honest about the possible effect of
the medication and assure that it is studied with a lot
of scientist
Humility
• Humility does not mean that one has to think less of
himself/herself; rather, it invites one to think of
himself/herself less.
• A nurse ceases to think of his/her own needs as
he/she transcends his/her attention to the needs of
the patients.
• Be like the bamboo, the higher you grow the deeper
you bow
• Put the needs of the patient first before ours
• Be humble
Respect
• An act through which one takes notice of others
• Regard other with special attention, esteem, and
care, or to consider other worthy of esteem and
honor
• Patients are also bound to respect nurses
• Acknowledge the feelings, beliefs, convictions,
status, and condition of the patient
• Respect the different political views
• Respect different religion
Compassion
• A feeling of deep sympathy (empathy) and sorrow
for someone struck by misfortune, accompanied by a
desire to alleviate the suffering
• Nurses should be sensitive to their patients
Prudence
• An exercise of good judgment, common sense, and
caution in the conduct of practical matters
• The overarching virtue that ties together discretion,
foresight, forethought, and circumspection
• Being careful to avoid embarrassing and distressing
situations
• When gathering sensitive information---- assure the
client that you will not disclose the information
Courage
• The quality of mind or spirit that enables a person to
face difficulty, danger, and pain without fear
• Nurses are expected to be bold in undertaking a very
sensitive job
• Allows the nurse to face the challenges and dangers
of the healthcare profession:
o NURSES TAKING CARE OF COVID-19
PATIENTS
o TAKING CARE OF A DYING PERSON
o ASSISTING DURING CODE BLUE
o BRAVE
Vices
• Derived from the Latin word vitium which means
failing or defect
• The product of a repeated sinful act
• Immoral, depraved, or degrading act to all the
members in a given society
• Defect, infirmity, fault, iniquity, offence, wickedness
or corruption
• HABIT
Fraud
• False representation of fact
• Deliberate deceit; trickery; an intentional perversion
of truth for the purpose of inducing another in
reliance upon it to part with some valuable thing
belonging to him, or surrender a legal right
Example:
• tampering patient’s medical record or willfully
changes data in the patient’s record
• Signing in a medication sheet even if the medication
was not given
• Not returning patients medication prior to discharge
• Using another’s account in accessing patient’s record
Pride
• A feeling of gratification arising from association
with something good or laudable
• A high or inordinate opinion of one’s own dignity,
importance, merit, or superiority; conceit; arrogance
• Egoism or vanity and often apply to offensive
characteristics
Example:
• A nurse supervisor reprimanding the staff nurse in
front of the other staff nurses and doctors in the
station
 • A staff nurse shouting at her patient because the
patient couldn’t understand her instruction
Greed
• Comes from the Latin word avaritia which means
avarice or covetousness
• Excessive desire for wealth or possessions
Example:
• Nurse stealing patient’s medication for personal use
Habits
• Train your brain
Types
• Entitative Habit
o habits of being; connatural qualities
o those that arise out of the nature and
structure of ourselves, that are necessary
parts or propensities arising from our
constitution
o (GOOD HABITS) includes:
▪ HEALTH
▪ STRENGTH
▪ BEAUTY
• Operative Habit
o habits of acting; tendencies we have
developed in ourselves from repeated acts
o those that can be acquired or relinquished
o It can be a good or bad habit
o Operative habits such as science or
humaneness are good because they orient
the intellect and will respectively toward
activities that are desirable;
o error and selfishness on the other hand are
bad dispositions because they organize
mind and will toward actions that are
negative and undesirable
TOPIC: CALLING OF A HEALTH CARE PROVIDER
Health Care Profession
• Belongs to the ambience of professional ethics
Professional Ethics
• what is right or wrong for a person as a member of
a certain professional or social group
Health Care Profession
• Loaded with a lot of sensitivities and vulnerabilities
since it deals with LIFE
• Respects both the issues of life and death
• Concerned with the living human person in the
context of HEALTH MAINTENANCE
• Abide to a lot of norms, principles, theories and
values as a person becomes ill
• Aided of certain acceptable guides in decision
relative to healthcare giving
The client
• The summit of the meaning of the healthcare
profession
• Justifies the essence of the healthcare provider’s
profession
• Presumed to be vulnerable
• Someone the healthcare provider has to address all
his/her capabilities, skills and professionalism
The health Care Provider
• No ordinary professional
• Duties and responsibilities can’t just be
accomplished by mere compliance of those he/she
is expected to do
• Delicately undertakes to deal with human life
• Cuts across race, religion, affiliations, culture, beliefs
• Does not have the legal or moral right to choose the
kind of client he/she will take care of
Health Care Provider – Client Relationship
• regulated by established rules of professional ethics
• e.g. Nursing Ethics
• Paramount concern and responsibility of the
healthcare provide
Rules
• The relationship established between patients and
health care providers is fiduciary in nature, which
means that it is based on trust.
• The professional trusts the patient or client to
disclose all the information that may be relevant to
his or her condition or illness, and to be truthful
while disclosing it.
In return:
• the patient or client trusts the health care
professional to maintain high standards of
competence;
• to protect the confidentiality of private information;
• to carry out his or her work in the best interests of
the patient rather than taking advantage of the
patient's vulnerability.
Preconditioning Activity
• Think of your favorite nurse or the nurse that you
want to become, what are the qualities you like
about him/her?
Qualities and Responsibilities of Good Health Care Provider
To client
• Professionalism
 • Empathy and Compassion
• Communication
• Emotional Stability
• Passion for Helping Others
• Respect the patient’s rights
• Secure confidentiality
To Society
• Health professionals play a central and critical role
in improving access and quality health care for the
population.
• health care providers create an environment that
responds to the health care needs of the community
• They provide essential services that promote health,
prevent diseases and deliver health care services to
individuals, families and communities based on the
primary health care approach.
To its Profession
• Abide to PROFESSIONAL ETHICS
• Must always shows professionalism at all times
• Attends trainings and seminars for self-
improvement
• *** Professional ethics is to assure clients that
professional services will be rendered in accordance
with reasonably high standards and acceptable
moral conduct. This confidence enables
professionals to exercise relatively independent
judgments in decisions affecting clients.