Topic 1: Foundations of Health Professional-Patient Relationship

 Autonomy, Paternalism, and Medical Models

 Informed Consent and Truth Telling

 Conflicting Roles and Responsibilities

Learning outcomes
1. Demonstrate understanding of traditional moral theories in health care
2. Recognize the varieties of ethical challenges facing contemporary health care,
3. Apply ethical standards to practical decision-making and ethical questions that arise in
everyday practice.

Reflection

“Medicine is an art whose magic and creative ability have long been recognized as residing in
the interpersonal aspects of patient-physician relationship.”
                                           Hall et al.,1981

Trust is a fundamental characteristic of the physician-patient relationship. Patients must

trust that their physicians will work in their best interests to achieve optimal health outcomes.
Throughout history, there has been much debate regarding the “ideal” physician-patient
relationship.
Beneficence, nonmaleficence, autonomy, and justice constitute the 4 principles of ethics. The
principle of beneficence is the obligation of physician to act for the benefit of the patient and
supports a number of moral rules to protect and defend the right of others, prevent harm,
remove conditions that will cause harm, help persons with disabilities, and rescue persons in
danger.
Nonmaleficence is the obligation of a physician not to harm the patient. This simply stated
principle supports several moral rules – do not kill, do not cause pain or suffering, do not
incapacitate, do not cause offense, and do not deprive others of the goods of life.
The philosophical underpinning for autonomy is that all persons have intrinsic and unconditional
worth, and therefore, should have the power to make rational decisions and moral choices, and
each should be allowed to exercise his or her capacity for self-determination.
Justice is generally interpreted as fair, equitable, and appropriate treatment of persons. Of the
several categories of justice, the one that is most pertinent to clinical ethics is distributive justice.
Distributive justice refers to the fair, equitable, and appropriate distribution of healthcare
resources determined by justified norms that structure the terms of social cooperation

The requirements of informed consent for a medical or surgical procedure, or for research,
are that the patient or subject

(i) must be competent to understand and decide,

(ii) receives a full disclosure
(iii) comprehends the disclosure
(iv) acts voluntarily
(v) consents to the proposed action.

As competence is the first of the requirements for informed consent, one should know how to
detect incompetence. Standards (used singly or in combination) that are generally accepted for
determining incompetence are based on the patient’s inability to state a preference or choice,
inability to understand one’s situation and its consequences, and inability to reason through a
consequential life decision

Truth-telling is a vital component in a physician-patient relationship; without this

component, the physician loses the trust of the patient. An autonomous patient has not
only the right to know (disclosure) of his/her diagnosis and prognosis but also has the
option to forgo this disclosure.

In terms of confidentiality, physicians are obligated not to disclose confidential information

given by a patient to another party without the patient’s authorization. An obvious
exception is the sharing necessary of medical information for the care of the patient from
the primary physician to consultants and other healthcare teams.

Each one of the 4 principles of ethics is to be taken as a prima facie obligation that must be
fulfilled, unless it conflicts, in a specific instance, with another principle. When faced with
such a conflict, the physician has to determine the actual obligation to the patient by
examining the respective weights of the competing prima facie obligations based on both
content and context.
https://karger.com/mpp/article/30/1/17/204816/Principles-of-Clinical-Ethics-and-Their

Critique
Reporters:
Abigail Nicole K. Bulusan, OTRP
Benhur Corpuz, OTRP

Criteria Total
Presentation/ Content 40 /40
Presentation/ Design 15 /15
Presentation/ Oral Delivery 15 /15
Presentation/ Notes/ Transcript 5 /5
Contribution to group 25 /25
25 /25
Timeliness and Length of Presentation
Total 100 /100

Topic 2: Allocation, Social Justice, and Health Policy

 Justice, Health, and Healthcare

 Allocating Scarce Resources

 Organ Transplantations

 Poverty, Health, and Justice

Learning outcomes
1. Discuss Justice, Health, and Healthcare
2. Recognize Rawl’s theory of justice and inequalities.
3. Identify healthcare as a unique and important prerequisite and determine the allocation of
healthcare including its criteria.

Reflection
One major issue facing healthcare is the allocation of that healthcare. Resources, in
terms of doctors, medicine, hospital space, and more are generally limited, and they are very
expensive. Some countries have enacted government-sponsored healthcare, sending the
message that it is morally good for all people, regardless of station in life, to have access to
healthcare services.
Our health is affected not simply by the ease with which we can see a doctor though that surely
matters but also by our social position and the underlying inequality of our society. Culture,
social organization, and government policies also help determine population health. One
important factor in explaining the health of a society is the distribution of income, the health of a
population depends not just on the size of the economic pie, but also on how the pie is shared.
Differences in health outcomes among developed nations cannot be explained simply by the
absolute deprivation associated with low economic development and lack of access to the basic
material conditions necessary for health, such as clean water, adequate nutrition and housing,
and general sanitary living conditions. The degree of relative deprivation within a society also
matters.
Rawls called his concept of social justice
"Justice as Fairness." It consists of two
principles. The First Principle of social justice
concerns political institutions: Each person
has the same and permanent claim to a fully
adequate scheme of equal basic liberties,
which scheme is compatible with the same
scheme of liberties for all.
This principle means that everyone has the
same basic liberties, which can never be
taken away. Rawls included most of the
liberties in the U.S. Bill of Rights, such as
freedom of speech and due process of law. He added some liberties from the broader area of
human rights, like freedom of travel.
The Second Principle of social justice concerns social and economic institutions: Social and
economic inequalities are to satisfy two conditions: first, they are to be attached to offices and
positions open to all under conditions of fair equality of opportunity; and second, they are to be
to the greatest benefit of the least-advantaged members of society.
This Second Principle focused on equality. Rawls realized that a society could not avoid
inequalities among its people. Inequalities result from such things as one's inherited
characteristics, social class, personal motivation, and even luck.
Emanuel et al. (2020) provided four important recommendations for allocating medical
resources in the current crisis. The first is that maximizing benefits is the most important value,
and therefore, the priority should be allocating resources to save the most lives and providing
more years of life.
The second recommendation is that front‐line care health workers should be given priority
because they are essential to deal with the crisis and therefore have instrumental value.
The third recommendation is that if patients have a similar prognosis then an allocation method
that ensures equality (such as a lottery method) should be used instead of first‐come, first‐
served.
The fourth recommendation centers on prioritizing anyone who has participated in research to
find vaccines or therapies to combat the virus. These individuals are providing a wider benefit
whilst also putting themselves at risk and therefore should be rewarded.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323072/

https://www.utilitarianism.com/ethics101.pdf
https://sci-hub.se/10.1162/152651601300168834
https://www.crf-usa.org/bill-of-rights-in-action/bria-23-3-c-justice-as-fairness-john-rawls-and-his-
theory-of-justice

Critique
Reporters:
Eggie Escueta
Jupiter Dolores

Criteria Total
Presentation/ Content 40 /40
Presentation/ Design 15 /15
Presentation/ Oral Delivery 15 /15
Presentation/ Notes/ Transcript 5 /5
Contribution to group 25 /25
25 /25
Timeliness and Length of Presentation
Total 100 /100

Topic 3: Foregoing life-sustaining treatment and euthanasia

 Decisional capacity and right to refuse treatment

 Choosing for once-competent patients

 Choosing for never-competent patients

Learning outcomes
1. Differentiate between life-sustaining treatment and euthanasia.
2. Identify factors when deciding the capacity and right to refuse treatment, choosing once-
competent patients, and choosing for never-competent patients.
Reflection
Withholding or withdrawing a life-sustaining treatment tends to be very challenging for
healthcare providers, patients, and their family members alike. When a patient’s life seems to be
nearing its end, it is generally felt that the morally best approach is to try a new intervention,
continue all treatments, attempt an experimental course of action.
In contrast to this common practice, the authors argue that in most instances, the morally safer
route is actually to forgo life-sustaining treatments, particularly when their likelihood to effectuate
a truly beneficial outcome has become small relative to the odds of harming the patient. The
ethical analysis proceeds in three stages.
First, the difference between neglectful omission and passive acquiescence is explained. Next,
the two necessary conditions for any medical treatment, i.e., that it is medically indicated and
that consent is obtained, are applied to life-sustaining interventions. Finally, the difference
between withholding and withdrawing a life-sustaining treatment is discussed.
The moment of dying must be a natural right of the patient who must be respected in the name
of maintaining his dignity. Because of this, the practice of euthanasia is guided at its core by
solidarity with suffering and respect for the individual will. This rationale meets two principles
discussed in bioethics: the principle of autonomy and the principle of dignity.
Respect for the autonomy of the person is combined with the principle of the dignity of human
nature, accepting that the human being is an end in itself, not only a means of satisfying the
interests of third parties, commercial, industrial, or the professionals themselves and health
services. Respecting the autonomous person presupposes the acceptance of ethical-social
pluralism, characteristic of our time.

https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-9-14
http://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-6-
270.php?jid=cmrcr#:~:text=The%20moment%20of%20dying%20must,respect%20for%20the
%20individual%20will.

Critique
Reporters:
Eileen Navalta, OTRP
Evangeline Mateo, OTRP
Virgilio Mercado Jr., PTRP

Criteria Total
Presentation/ Content 40 /40
Presentation/ Design 15 /15
Presentation/ Oral Delivery 15 /15
 Presentation/ Notes/ Transcript 5 /5
Contribution to group 25 /25
25 /25
Timeliness and Length of Presentation
Total 100 /100

Topic 4: Life, Death, and Moral Status

 Decisional capacity and right to refuse treatment

 Choosing for once-competent patients

 Choosing for never-competent patients

Learning outcomes

 Define Life, Death, and Moral status

 Distinguish elements when deciding the capacity and right to refuse treatment, choosing
for once-competent patients, and choosing for never-competent patients.

Reflection
Decision-making capacity is a clinical determination that refers to whether a patient has the
mental capability to understand relevant information, appreciate the medical situation they are in
and its possible consequences, reason through risks, benefits and alternatives of treatment
options, and communicate a choice freely and voluntarily based on their own values. Only adult
patients with decision-making capacity are able to provide informed consent.
“Capacity is not the same as Competence.” Competence is a legal term that is used to indicate
whether a person has the legal authority to make their own decisions related to their medical
care, their finances and other personal choices. 
Every competent adult has the right to refuse unwanted medical treatment. This is part of the
right of every individual to choose what will be done to their own body, and it applies even when
refusing treatment means that the person may die. The right to refuse treatment applies to those
who cannot make medical decisions for themselves, as well as to those who can; the only
difference is how we protect the rights of people who cannot make decisions for themselves.
A person might decide against having a recommended treatment for any number of reasons.
Some people for religious reasons do not want to receive blood transfusions. Others decide that
they don’t want a recommended treatment because it is too risky or expensive or because even
if the treatment works, there is little or no chance it will get them back to a quality of life they
could enjoy or accept. Many people do not want life-sustaining treatments like ventilators or
feeding tubes if these treatments are only going to prolong the dying process.
Having the right to refuse medical treatment does not mean that a decision to forgo treatment
will be accepted without question. Any time a patient turns down a recommended treatment, it
means that he or she and the doctor view the situation differently. That’s OK. It is not the
patient’s job to simply “go along” with what is being recommended. Rather, the patient’s job is to
consider all the options and decide what is best for him or her. What is most important from the
medical point of view may not be most important from the patient’s point of view, because goals
and values may differ. As long as the patient has been given all the relevant information about
his or her treatment options and knows the risks and benefits of each option, including the risks
and benefits of turning down treatment, the patient’s wishes come first.
https://vtethicsnetwork.org/medical-ethics/right-to-refuse-treatment

Critique
Reporters:
Christine S. Porillo, PTRP
Rachelle M. Rena, PTRP, CertWSP-ISWP

Criteria Total
Presentation/ Content 40 /40
Presentation/ Design 15 /15
Presentation/ Oral Delivery 15 /15
Presentation/ Notes/ Transcript 5 /5
Contribution to group 25 /25
25 /25
Timeliness and Length of Presentation
Total 100 /100