Ethical theories

Learning Objectives:

At the end of the lesson, the students will be able to:

1. Discuss the importance of ethical theories in nursing practice
2. Describe each type of ethical theories.
3. Explain the similarities and differences of these ethical theories.
4. Articulate the core values of a professional nurse.
5. Answer the case samples by applying the concepts of deontology,
teleology, utilitarianism, and virtue ethics.
Topics:

 Concept of ethical theory

 Types of Ethical Theories
 Deontology
 Teleology
 Utilitarianism
 Virtue Ethics
When encountering an ethical problem during the
course of their work, nurses are confronted by at least
three basic questions:

1. What should I do in this situation?

2. What is the ‘right’ thing to do?
3. How can I be sure (and be reassured) that my
decisions and actions in the situation at hand are
‘morally right’, all things considered? In short, how
can I be sure that I am behaving ethically and doing
the ‘right thing’
Types of ethical theories

 Deontology
 Teleology
 Utilitarianism
 Virtue Ethics
1. Deontology
 Types of Ethical Theories:
DEONTOLOGY

 The word deontological is derived from the Greek word deon, meaning
'duty’.
 It is a category of normative ethics because what is acceptable behavior
follows the norm of society which is adherence to certain rules and duties.
 Deontological theories holds that actions that are morally right are those in
accordance with adherence to certain rules, duties, rights, or maxims.
 Actions that align with the rules and duties are ethical, while actions that
don’t aren’t.
 This is agent-centered theory because it focusses on the duties of the
person acting rather than the rights of a person acted upon.
 Examples of DEONTOLOGICAL THEORIES

 Divine Command Theory

 The “Golden Rule”
 Natural Law and Natural Rights Theories
 Non-aggression Principle
 Categorical Imperative (Kantian Ethics)
Divine Command Theory:

 The theory asserts that what is moral is determined

by God's commands and that for a person to be moral
he is to follow God's commands.
 The theory asserts that what is moral is determined
by God's commands and that for a person to be moral
he is to follow God's commands.
 Christianity can be an example of deontology, where
someone’s morality is measured by whether or not
they follow The Ten Commandments.
The Golden Rule

 Also known as the ethics of reciprocity, this famous cross cultural

maxim states that “do to others as you want them do to you”
 It is our duty to act in such a manner that we would want
everyone else to act in a similar manner in similar circumstances
towards all other people.
 Natural Law and Natural Rights Theories

 Natural law is a theory in ethics and philosophy that says that human
beings possess intrinsic values that govern their reasoning and
behavior.
 Natural law maintains that these rules of right and wrong are inherent in
people and are not created by society or court judges.
 Example of natural law includes the idea that it is universally accepted and
understood that killing a human being is wrong.
Natural Law and Natural Rights Theories

 Natural rights theory holds that individuals have certain rights–

such as the rights to life, liberty, and property–in virtue of their
human nature rather than on account of prevailing laws or
conventions.
 Example of natural right: It is also universally accepted that punishing
someone for killing that person is right.
 Non-aggression Principle

 The Non-Aggression Principle (NAP) is the idea that

individuals have the right to make their own choices in life so
long as those choices do not involve the initiation of force or
fraud against others.
 Applying the Non-Aggression Principle leads libertarians to
argue that actions or policies such as murder, enslavement,
kidnapping, theft, and fraud are illegitimate whether practiced by
individuals, or by institutions such as government.
Categorical Imperative (Kantian Ethics)

Who is Immanuel Kant?

 Immanuel Kant (Prussia, 1724-1804) was one of the most
influential intellectuals in the field of political philosophy.
 According to Kant, the morality of an act (whether good or
bad; right or wrong) is acting in accordance with categorical
imperative, otherwise it is non-moral or immoral.
 Kant believes that the categorical imperative is the supreme
principle of morality.
What is the categorical imperative?

 Imperative means a command, because a human being may be

inclined to not adhere to a moral code of conduct, as it is only
human to seek pleasure and reduce pain.
Example: Do not cheat; you have to fulfill your promise
 There are two types of command/imperative:
1. Hypothetical – expresses a conditional command (example: if
you want to become a nurse study hard)
2. Categorical – expresses an absolute command (do not cheat)
Kantian Ethics

 To know more of the nature and dynamics of categorical imperative, we need

let us familiarize ourselves with the Core Concepts of Kantian Ethics:
A. The idea of the Good Will
B. The Duty and the moral worth of an act
C. The Formulations of the Categorical Imperative
A. Good Will: GOOD will facilitates human act.
 But what makes a good will good? According to Kant a good will is good not
because it produces good results or greatest happiness to the greatest number
of people as in the case of Utilitarian Ethics but it is good by virtue of its
intrinsic value. It is good without qualification, it is good without a condition.
Kantian Ethics: How is the good will
manifested?

1. According to Kant, it is manifested when it is done for the sake of DUTY,

hence, in order for a good will to be good, it is done for the sake of duty.
Example: Helping some one in need:
a. If helping is done because she expects something in return, then the will is
not Good without qualification.
b. If helping is done because she believes it is her DUTY to do so, then for
Kant, the will is good without qualification
2. Autonomy of the will which means self-legislating and not influenced by
any outside factors or not forced to do it.
Kantian Ethics

B. The Duty and the moral worth of an act

 According to Kant, duty should be the motive of any moral act.
INCLINATION OR SELF INTEREST CAN NEVER BE A MOTIVE OF ANY MORAL
ACT.
 For example, a physician treating a patient, he is moved to treat the
patient because it is his duty as a health care provider and not the interest
of profiting from the patient.
 For Kant, an act is done for the sake of duty has moral worth, if the act is
done out of self-inclination, then it has no moral worth.
Kantian Ethics

B. The Duty and the moral worth of an act

 For Kant, duty are of two kinds: Actions that accord with duty and Actions
for the sake of duty.
 Actions in accord with duty has no moral worth.
 Actions for the sake of duty has moral worth.

C. Formulation of the Categorical Imperative:

First Formulation: Principle of Universality: Act only on the maxim/saying
whereby you can, at the time will, that it should become a
universal law.
Kantian Ethics: Formulation of
Categorical Imperative

First Formulation: Principle of Universality

This means that if an act done is capable of being done by others similarly
situated because it is the right thing to do, then that act has moral worth.
Act done is not capable of being done by others similarly situated because to
many others it is unacceptable, then that act is immoral and has no moral
worth.
Example: Stealing the properties of others and giving them to the poor.
Example: Helping others in need
Kantian Ethics: Formulation of
Categorical Imperative

Second Formulation or Formula of the End: Principle of Humanity: So

act as to treat humanity whether in your person or in that
of another never as means but always as an end.
 Respect for Persons because every person has an inherent worth which
is every one of us is free and rational – to do, to say, to act
 Avoid thwarting others by force, lying, threatening, discriminating are
examples of disrespect of persons
 Ex. Hiring people to kill somebody are treated as mere instruments
Kantian Ethics: Formulation of
Categorical Imperative

Second Formulation or Formula of the End: Principle of Humanity:

 Any act that treats humanity as a means is not morally right.
Example: borrowing money with a false promise to pay later
Example: cheating someone during examination
 DEONTOLOGY: Categorical
Imperative/Universalism
Examples:

 Do Not Kill. We all see killing or murdering as the wrongest human deed
because we are taught since our childhood that killing anybody including
an animal in a wrong act. ...
 Do Not Steal. ...
 Religious Belief. ...
 Keeping Promises. ...
 Cheating. ...
 Do Not Lie. ...
 Respect The Elders.
 Categorical Imperative (Kantian Ethics)

 Duty-based Theory: Thus, believed that for as

long as we perform all moral duties being
categorical imperative, then the consequences
whether it is good or bad is not important, it is
justified or permissible.
 Categorical Imperative (Kantian Ethics)

 According to Kant “The rightness or goodness of

the action does not depend on their
consequences but on whether or not we have
fulfilled our duty.”
 No one is accountable for the wrong outcome
or bad consequences.
Exercises: Read and
resolve the following case
samples
Case No. 1

A staff nurse working in a private hospital is told by the Medical Director who is a
gynecologist to assist him in the tubal ligation of a post D.R. case for purposes of
preventing further conception as per request of the patient on the ground of
having many children already. The said nurse knows it is immoral. Yet, she assists
out of fear of losing her job if ever refusal is made.
1. Is the nurse morally accountable for her act of assisting out of fear?
2. Explain within the context of the principle of Deontology.
 Divine Command Theory
 The “Golden Rule”
 Natural Law and Natural Rights Theories
 Non-aggression Principle
 Categorical Imperative (Kantian Ethics)
Case No. 2

A student nurse suspects that her clinical instructor inadvertently gives her a wrong instruction
as to the specific doctor’s order that is to be carried out to a certain patient. However, she
does not bother to validate it with her C.I. and to refer to the patient’s chart as she is afraid of
being scolded and branded for being wiser than the C.I. She just consoles herself: “Anyway,
she’s my C.I. She has to know more than I do, for all I care!” She does what her C.I. tells her
without knowing the truth of the doctor’s order. Consequently, the patient receives wrong
medication and suffers anaphylactic shock from it.
1. What makes the fear of the student an extrinsic fear?
2. What makes the good thing good?
3. What makes a good thing bad or evil?
4. What are the circumstances that can never justify the performance of an evil act good?
5. In the context of deontology, is the wrong medication that resulted to anaphylactic
shock necessarily makes the C.I. and the student nurse accountable? Why?
6. To whom should accountability be the most?
Case No. 3

A certain patient is rushed to the ER as a victim of “hit and run” accident. He

has no relatives to provide any identification and sign consent forms for he is
just taken by empathetic bystanders. Emergency treatment is given without
much ado as the patient already gets unconscious.
1. Unconscious, does the patient still have voluntary nature of the act of
submitting for immediate treatment? Why?
2. Are bystanders morally obliged to rush the unconscious patient to the ER?
3. Explain what is a duty-based ethics?
2. Teleology
What is Teleology?

 It is derived from the Greek word telos which means end, or

goal or purpose.
 St. Thomas Aquinas: Everything we do has an aim, an end,
a goal, or a purpose. Actions are done for the sake of being
done is actually aiming on something.
 According to Aristotle, every action and purpose may be said
to aim at some good.
 You will not do anything that will interfere with the purpose,
or end, or goal.
Example

• Purpose in eating?
• End in eating?
• When is eating good? Bad? Is it a moral issue?
Example: Sex
What is Teleology?

 It is a theory of morality that derives duty or moral obligation from

what is good or desirable as an end to be achieved.
 Acts are not good or bad in themselves, but only through the results
they produce.
 This theory focuses on the results or outcome of the act, which means
that whether such act is right or wrong depends upon end, purpose,
aim, or goal of the action.
 If the end is good or desirable then the act is good or desirable, and if
the end is bad then the act is bad.
How do we decide what a good purpose
is?

 To make sure that our purpose itself is good, it has to be

intrinsically good – things like justice, security, health and
happiness, rather than things that are a means to an end, like
profit or personal gain.
 Something is 'intrinsically good' if it is good in itself (as an end
itself), not with respect to its instrumental goodness--not
what it is good for (not as a means to an end).
TELEOLOGY

 The key difference between teleological and

deontological ethics is that the teleological
ethics determines the goodness or badness of
an action by examining its purpose, end, aim,
goal whereas deontological ethics determines
the goodness or badness of the action by
examining the action itself.
Exercises: Read and
resolve the following case
samples
Case No. 1

A nurse whose faith differs from that of the Catholic Church refuses to assist in
a certain medical mission on family planning in a densely populated urban
poor community as her conscience certainly tells her that it is morally wrong.
The Chief of Mission also a Catholic and armed with sound moral principles
and precepts explains that the mission is much needed because statistics
show that overpopulation implies poor health and its consequences impacts
economy and development.
1. Is the nurse duty bound to follow her conscience or that binding force as
explained by the Chief of Mission? Why?
2. Is this within the concept of Teleological Ethics? Why
Case No. 2

Based on his thorough study, a medical doctor discovers a certain medicine

that gives him a well-founded reason to believe that it is probably the most
effective cure whose effect is even fastest among others for a certain
sickness. Other than his discovery, there is a medicine available at the
pharmacy which is sure and definite cure for the said sickness.
1. Is the doctor morally allowed to use the medicine that gives him the solidly
probable reason to be the most effective cure for the sickness? Why?
2. Is the concept of teleology applicable here in this case?
3. UTILITARIANISM
 UTILITARIANISM

 English philosophers and proponents of Utilitarianism

 Jeremy Bentham
 John Stuart Mill
 Utilitarianism is an ethical theory that determines right from
wrong by focusing on outcomes.
 ‘ends justify the means’
UTILITARIANISM

Three Generally accepted axioms of Utilitarianism

 Pleasure or happiness is the only thing that has
intrinsic value
 Actions are right if they promote happiness and
wrong if they promote unhappiness
 Everyone’s happiness counts equally
UTILITARIANISM

 Jeremy Bentham
 “Ethics at large may be defined as the art of directing men’s
actions to the production of the greatest possible quantity of
happiness.”
HAPPINESS – PAIN = NET HAPINESS
= NET PAIN
 NET HAPPINESS – MORALLY RIGHT
 NET PAIN – MORALLY WRONG
 EXAMple: studying hard

HAPPINESS PAIN NET

PASS THE SUBJECT TIRED 5 IN FAVOR TO
GET HIGH GRADES LACK OF SLEEP HAPPINESS
WILL GRADUATE
WILL GET A GOOD JOB
WILL GET HIGHER SALARY
FINANCIALLY STABLE
SUCCESSFUL
VIRTUE
ETHICS
 Virtue ethics

 A philosophy developed by Aristotle and other Ancient Greeks.

 Itis a moral theory that focuses on the development of moral
character.
 It is a quest to understand and live a life of moral character.
 Virtuesare engrained dispositions to act by standards of
excellence.
 Virtue ethics

 It is a character-based approach of determining right or wrong action or good

or bad results or consequences of a particular action.
 An action is only RIGHT if it is an action that a virtuous person would carry
out in the same circumstances.
 Virtue ethics is an approach that focuses on character with the assumption
that a person of good character will tend to behave in ways that are
consistent with their character.
Virtue ethics

 CHARACTER is the key to the moral life, for it is in the

VIRTUOUS CHARACTER that moral conduct and values
naturally arise.
A virtuous person is a righteous person.
A person practicing good habits such as honesty, justice,
generosity, bravery, and so on, develops an honorable
and moral character of a virtuous person.
What is virtue ethics example?

 "Virtues" are attitudes, dispositions, or character traits

that enable us to be and to act in ways that develop
this potential.
 They enable us to pursue the ideals we have adopted.
 Honesty, courage, compassion, generosity, fidelity,
integrity, fairness, self-control, and prudence are all
examples of virtues.
For Aristotle, EUDAIMONIA is the highest
human good, the only human good
that is desirable for its own sake (as an
end in itself) rather than for the sake of
something else (as a means toward
some other end).
 What is the purpose of eudaimonia?

 In
Greek philosophy, Eudaimonia means achieving the
best conditions possible for a human being, in every
sense–not only happiness, but also virtue, morality, and
a meaningful life. It was the ultimate goal of
philosophy: to become better people—to fulfill our
unique potential as human beings.
 Example: Eudaimonia

 Ifyou’re a parent, you should excel at raising your

children; if you’re a doctor, you should excel at
healing people; and if you’re a philosopher, you
should excel at gaining knowledge and wisdom, and
teaching. Of course, each person plays many roles life,
and it’s by excelling in all of them that one achieves
Eudaimonia.
Eudaimonia vs. Happiness

Happiness Eudaimonia

Emotion State of being

Temporary Ongoing
Measured by pleasure Measured by excellence
Can be achieved by immoral Can only be achieved by living
means a moral life
Connected with luck Connected with effort
How does virtue lead to a good life?

 By having virtues or positive character traits, he or

she is committed to doing the right thing no
matter what the personal cost, and does not bend
to impulses, urges or desires, but acts according to
values and principles.
 These virtues or positive character traits will lead
humans to happiness and a good life.
 By practicing the virtues every day without FAIL will become a habit
 Habits lead to EXCELLENCE
 Excellence produce VIRTUE
Will Batman Kill Deontologist Teleologist Utilitarianism Virtue Ethics
Joker?

Answer No Yes Yes No

Reason for Do not kill is a End, aim, The act is said to
be morally right if
Batman is a
the action Commandm purpose, goal its consequence or super hero
of the act outcome brings
ent of God
determines greater happiness Killing Joker is
than pain.
the goodness not his option.
Action must or evil of the
be duty- action itself The act of killing Superheroes
Joker will provide
based A great number of happiness to the are virtuous
people will benefit people living in the persons.
the good city and relieve
them of the
consequence as
unnecessary pain, The act of a
they will be safe
and secured of stress and anxiety virtuous
their lives. Joker brings if person is
allowed to live.
always
morally right.
Will Batman Kill Deontologist Teleologist Utilitarianism Virtue Ethics
Joker?

Answer No Yes Yes No

Ethical/Moral Let Joker The means The means Let the
Intervention be used to used to wheels of
captured eliminate by eliminate by justice
and have killing Joker killing Joker determine
him is ethically is regarded the
brought to good and as morally appropriate
trial for his justified useful and punishment
wrongdoin because if permissible of Joker
gs. he is because it without
eliminated, brings necessarily
then lives of happiness killing him.
many will to many.
be
Virtue Ethics in Nursing

 A virtue ethics for nursing is therefore concerned with the

character of individual nurses and seeks ways to enable
nurses to develop character traits appropriate for actions
that enhance wellbeing.
 Virtuousness is about the doing virtue, doing what is right.
 Virtue in nursing practice is about doing right for patients,
their loved ones, our practice and ourselves as well as
the broader society.
Core Values of a Professional Nurse

 Nursing values are fundamental to the practice of nursing.

They guide standards for action, provide a framework for
evaluating behavior and influence practice decisions.
 Caring is best demonstrated by a nurse's ability to embody
the five core values of professional nursing such as human
dignity, integrity, autonomy, altruism, and social justice.
Ethical Theory?

 Ethical Theories are attempts to provide a clear, unified

account of what our ethical obligations are.
 Ethical theories are thus formal statements about what we ought to do,
when faced with an ethical dilemma.
 An ethical theory is an answer to the question “what makes a thing good
or bad”?
 In trying to answer such questions, it becomes clear that one of the central
issues in ethics is whether we should focus on the consequences or the
nature of actions.
Course Outline
• Introduction: The Philosophy of Man
• Ethics and Health Care
What is Ethics?
Morality of Human Act or Conduct
Sources of Ethics
Moral Philosophy, Objectivity of Morality
Division of Ethics
Bioethics? Health Ethics? Health Care?
Learning Objectives:

At the end of the topic the students will be able to:

• Understand the importance of ethics to the human
person.
• Explain why should human persons arrive at the
objective norm or standard morality
• Discuss the importance of morality to health care
practice.
Philosophy of Man
The concept of man
• Two main problem of Man:
1. The nature of man
 What is Man?
 Who is Man?
2. The condition of being human
 What is the state or condition of being human?
 Why does man exist?
 How does man exist?
The nature of man?
• Human person is a rational being because he is endowed with rational faculties of
intelligence and free will.
• His intelligence enables him to reason out, think, and know the truth.
• His free will enables him to do what is good, and to love as the greatest kind of good.
• His rational nature makes him essentially distinct from a brute animal.
• The tremendous success in science and technology, medicine and communications
system, etc. are tangible affirmation that man is superior to any other being existing
under the sun.
The nature of man?
• Truth and goodness are the very objects toward which the intellect and free will
of man are inscribed.
• Any operations contrary to truth and goodness go against the nature of man.
• Any human activity that conforms to falsity is contrary to truth and is evil as they
are contrary to what is good, are opposed to the rationality of man.
• Hence, it is innate in man to tend to do what is good and avoid what is evil.
The condition of being human:
• The human condition is all of the characteristics and key events of human
life, including birth, learning, emotion, aspiration, morality, conflict, and
death.
• Man’s experience of existing and living as man are indispensable ground where
man discover the meaning of his existence.
• At this junction, ethics plays a significant role in making man conform his human
actions to his nature, to that for which his faculties are intended.
• Man needs to learn and internalize knowledge of what ethics is all about.
WHAT IS ETHICS?
 The term is derived from the Greek word ethos which can mean custom,
habit, character or disposition.
 Ethics is a moral philosophy which is concerned with what is morally good
and bad and morally right and wrong or what is just or unjust and so on, of
the custom, habit, character or disposition.
 Ethics are moral principles that govern how the person or a group will
behave or conduct themselves to the right and wrong of actions and
encompasses the decision-making process of determining the ultimate
consequences of those actions.
 WHAT IS ETHICS?
• Ethics is a philosophical and practical science that deals with the study of
the morality of human acts and human conduct.
• As a science, ethics is a systematized body of knowledge comprising
data on morality of human acts that are put together and arranged in
order along with the causes and reasons by which said data are held to
be factual.
• As a philosophical science, ethics deals with the ultimate cause, principle
and truth concerning the morality of human conduct by the use of human
reason alone.
WHAT IS ETHICS?

 Ethics is also called moral philosophy because it delves into the

morality of human act as far as human intelligence can afford.
 Ethics is based on well-founded standards of right and
wrong that prescribe what humans ought to do, usually in
terms of rights, obligations, benefits to society, fairness, or
specific virtues.
 All in all, the goal of ethics is to propose values that we can
pursue to live a life free from regrets.
SCHOOLS OF ETHICS
METAETHICS
NORMATIVE ETHICS
TYPES OF NORMATIVE ETHICS

• DEONTOLOGY
•TELEOLOGY
•UTILITARIANISM
•VIRTUE ETHICS
APPLIED ETHICS
PROFESSIONAL ETHICS
Material and Formal Objects of Ethics
• Material object of science is the subject matter with which science deals in its study.
• In the case of ethics, the material object is the human act or human conduct of a person
in which his rational and higher faculties of intelligence and free will are utilized contrary
to those acts in which said faculties are not used.
• Formal object of science is the very viewpoint, setting, or perspective employed in
dealing with its material object.
• In the case of ethics, the formal object delves into how human act, as the material object,
is to be performed according to what ethics demands-that is the morality or moral
rectitude/uprightness of the human act.
MORALITY
What is morality?
MORALITY

• MORALITY IS THE MEASURE OF RELATION BETWEEN THE HUMAN ACT PERFORMED AND ITS NORM
ACCORDING TO THE DICTATES OF REASON, HUMAN NATURE, AND GOD’S ETERNAL LAW.
Morals and Morality

• The domain of personal values and rules of behavior

• Conventional rules of conduct regulating our social interaction
• Culture specific mores (behavior which society determines to
be acceptable) grounded in our religious and ideologic beliefs
 Moral Values
• Morals – standards of right or wrong, learned and internalized at early age,
society and culture play an important role and moral orientations is generally
based on religious beliefs.
• Moral values are the behavioral practices, goals, and habits which are
validated by the society we are part of.
• Moral values concern themselves with right and wrong that society considers
important.
 Values

• Ideals, beliefs, custom, modes of conduct, qualities or goals that are highly
prized or preferred by individuals, groups, or society
• Each person has a different value set
• As you move through life, values may change
• e.g. when you start a career, success is measured by money and status, hence
it is the top priority, but after you have a family, work-life balance may be what
you value more.
 Value Clarification

• Refers to the process of becoming more conscious of and naming what

one values or considers worthy
• Values that are most important to you often guide your decision making in
all aspects of your life such as career, religion, social circles, etc
• Love, truth, freedom have intrinsic worth, other values such as ambition,
responsibility, and courage, describe traits or behaviors that are
instrumental as means to an end.
Value Conflict

• Internal or interpersonal conflict that occurs in circumstances in

which personal values are at odds with those of patients, colleagues,
or the institution
• Conflicts can result when people have different values, leading to a
clash of preferences and priorities
 Basic Moral Values

• Truth, freedom, honesty, fairness, kindness, politeness,

respect, virtues, perseverance, integrity
• These values are life protecting or life enhancing for all
Moral Integrity

• A focal virtue that relates to soundness, reliability, wholeness, an

integration of character and fidelity in adherence to moral norms
sustained over time.
• The practice of being honest and showing a consistent and
uncompromising adherence to strong moral and ethical principles
and values.
Moral Thought or Moral Reasoning

•Individual’s cognitive examination of right or wrong,

good or bad
•Focuses on simple moral judgments or one’s moral
standards that do not go far beyond the prudential
values to which they are related.
Moral Distress

• The reaction to a situation in which there are moral problems that seem to have
solutions, yet one is unable to follow one’s moral beliefs because of external
restraints, this may be evidenced in anger, frustrations, dissatifaction, and poor
performance to the work setting.
• Occurs when you know the ethically correct action to take but you are constrained
from taking it because of internal or external factors.
• Moral distress profoundly threatens our core values.
• ex: when policies and procedures prevent a nurse from doing what she thinks is
right, that becomes an ethical dilemma that makes nurses powerless, anxious,
depressed.
Ethics and Morality
Morality of Human Conduct

• Morality is that quality of human acts where the acts could either be good
or right, evil or wrong.
• This quality determines whether the kind of human act that is performed is
good or bad.
What makes Good, good?

• An act is good when it is in agreement or conformity with the dictates of

right reason.
• To Christians, an act is good when it is in agreement or conformity not
only with the dictates of reason but also with God’s Moral Law and Gospel
Values exemplified by Christ.
What makes Evil, evil?

• An act is evil when it is not in agreement or conformity with and its

transgression of the dictates of right reason.
• To Christians, an act is evil when it is not in agreement or conformity with
and in transgression not only of the dictates of reason but also of God’s
Moral Law and Gospel Values exemplified by Christ.
What makes Reason, right?
• Reason is considered right when it is in conformity with the truth – which must
be objective in its sense.
• Objective truth means the truth is not that which is acceptable only to some but
not to others or a relative truth.
• Relative truth means “what is true for you, may not be true for me, and vice
versa.”
• Rather, the truth is universally acceptable to all human persons regardless of
time, space, and culture since its capability of being recognized is, anchored
upon the intrinsic demand of human nature which is the same among all men.
What makes Reason, right?

• To Christians, determining what is the truth is no big deal.

The truth is
nothing but Christ who is the Way, the Truth and the Life, upon whom
reason has to be anchored in order to be right.
• This suggests that human reason has to undergo the processes of
information and formation necessarily manifested in its quest for
acceptance of truth and its growth because of the relentless search for
the ultimate truth.
 Ethics and Morality
Relation
a. Both ethics and morality deal with human act
or human conduct
b. Ethics studies about morality.
c. Morality gives ethics a perspective of what to
study about – that is the rectitude of whether
and is good or bad.
d. Morality provides ethics with a quality that
determines and distinguishes right conduct
from wrong conduct.
Distinction
a. Ethics pertains to the knowledge of what to
study about – that is the goodness or evil of a
human act; Morality pertains to the application
of this knowledge in the performance of
human act.
b. Ethics provides learning about the morality of
a human conduct; Morality provides ways in
practicing what is learned.
c. Ethics is the “word”, Morality is the “flesh”.
a. Ethics indicates the theory; Morality indicates
the practice.
Sources of Ethics

1. Human reason as its primary source

2. Contemporary and historical experiences
a. Personal Experience
b. Experiences of others
Moral Theology
• Moral Theology is a sacred science which deals with the study of the morality of human conduct in the
light of human reason guided by faith.
• Being guided by faith, Moral Theology arrives at its conclusions by drawing upon the following sources:
a. Divine Revelation
b. Human Reason
c. Experiences

• Divine Revelation is used as a check on conclusions that ethics arrives at. If some apparent
conclusions of ethics are contrary to God’s revelation, said conclusions must be wrong, since God
cannot contradict Himself.
 Ethics and Moral Theology
Relationship
a. Both ethics/moral philosophy and moral theology
deal with the morality of human conduct.
b. Both ethics/moral philosophy and moral theology
employ the rational operation of human reason.
c. Both ethics/moral philosophy and moral theology
make use of experience as one of the sources from
which their conclusion can be drawn.
d. Both ethics/moral philosophy and moral theology
take a look at and recognize an end.
Distinction
a. Ethics/moral philosophy employs human reason
alone in dealing with the morality of human conduct;
Moral Theology employs not only human reason but
also faith in dealing with the morality of human
conduct.
b. Ethics/moral philosophy draws its conclusion
employs human reason as its primary source and
from experiences; Moral Theology draws its
conclusions not just from human reason and
experiences but also from the Divine Revelation –
the source of faith as interpreted by the Church
Magisterium.
c. Ethics/moral philosophy takes a look at and
recognizes only the natural end; Moral Theology
takes, ultimately, a look at and recognizes the
supernatural end.
 Objectivity of Morality

• Objective morality is the belief that morality is universal, meaning that it isn't up for
interpretation.
• Some people may think of objective morality as commandments from God, while other
people may think the universe has some objective rules we may follow, such as murder,
as inherently bad.
• To some people, they think about the golden rule as an objective rule, which says to treat
others the way you want be treated.
• Objective morality says that morality exists in nature—it's how we were programmed.
 Subjectivity of Morality

• The opposite of objective morality is subjective morality.

• Subjective morality says that our morals are all human-made, and can vary from person
to person.
• While there are strong morals shared by most of humanity, such as killing, many morals
are subjective as to whether or not they are correct.
Objectivity of Morality
• Challenges:
1. Norms are purely internal
2. Norms based on current opinions and customs
3. Norm of expediency
4. Norm of preference
5. Situation Ethics
Challenge #1Norms are purely internal
• Many people today reject any moral norms or standards which would be based on the existence of
values outside of man.
• People argue that the only valid norms are purely internal: to be true to yourself like “do what you feel is
right”, “follow your conscience” ,
• To be true to yourself used as basis of morality of human conduct is highly relative because the self
perceived as true may not be the very self one because the self may be clouded with biases and
prejudices in life.
• “Do what you feel is right” is dangerous because what make right, right is what one feels about it. What
is right that you feel may not be what I feel and may be different from what others feel eventually
destroying its nature as Right.
Challenge #2 Norms based on current opinions
and customs
• This norm contends that the judgment on whether an act is right or wrong must be
subjected to current opinions and customs.
• This is manifested in this very popular statement: “Everybody is doing it”
• If what is good or what is bad is determined by majority opinion, the danger is: judgment
may not be genuinely reflective of what morality truly demands because the number of
people is never a determining factor of the goodness or evil of an act.
• The Right is still right no matter how many people are wrong.
Challenge #3 Norm of expediency

• Many times, morality is derived from what is deemed useful to oneself or to others rather
than what morality objectively demands.
• The performance of the human conduct is guided by the motto “ what is useful is morally
good.”
• If contraceptive method is useful in planning a family to ensure development and
economic prosperity, then it must be good.
Challenge #4 Norm of preference

• This norms pertains to acts performed by people in congruence to what appears to be

desirable or preferred to be done rather than in congruence with what moral teachings
provides.
Challenge #5 Situation Ethics
Division of Ethics

• General ethics presents truths about human acts, and then these truths deduces the
general principles of morality
• Special ethics is applied ethics. it applies the principles of general ethics in different
departments of human activity , both individual ethics and social ethics.
• Individual Ethics as regards God, as regards self, as regards fellowmen.
• Social Ethics in the family, in the state, in the world (international ethics)
• The principles of general ethics applies specifically in the area
of health care practice.
• Since health care practice is a specific department of human
activity in which crucial roles are played concerning human life
and health , principles rooted on objective standard of morality
should be observed.
• Applied ethics, especially concerning life and health may be
called bioethics and health ethics.
Bioethics and Health Ethics
• Bioethics was first used by the biologist Van Rensselaer Potter, to refer to a new field devoted to human survival and an
improved quality of life.
• Bioethics refer to the broad terrain of moral problems of the life sciences ordinarily taken to encompass Medicine, Biology, and
some important aspects of the environmental population and Social Sciences.
• Bioethics is defined as a science that deals with the study of morality of human conduct concerning human life in all aspects
from the moment of conception to its natural end.
• Bioethics provides that human conduct has to be regulated according to the demands of the standard of morality in dealing with
human life.
• To deal with human life is to consider all its aspects, such as physiological, psychological, social, health care and others.
• The encompassing meaning of Bioethics demands that human life in every aspects of its existence should be respected from
the moment it begins to the time it naturally ended.
Bioethics and Health Ethics
• Health Ethics is a science that deals with the study of the morality of human conduct
concerning health and health care.
• Health Care pertains to medical services, nursing care, and all other types of health services
given by health care practitioners such as medical doctors, nurses, midwives, and all the rest
who, in one way or another, engage in any duly recognized form of health care practice.
• Health Ethics is employed to regular human conduct in the practice of health care so that
good may be done and evil may be avoided thereby ensuring that the purpose of health care,
which delves into alleviation of suffering, prevention of sickness, and promotion of health, is
being met in the light of fundamental principles of morality.
Bioethics and Health Ethics
• Both Bioethics and Health Ethics are concerned about life and health.
• Health is integral to life and that good health maintains and sustains life.
• Bioethics regulates human conduct in the light of moral principles in relation to human life in all aspects
which necessarily includes the scope of Health Ethics. Thus Health Ethics is part of Bioethics.
• However, aside from health, Bioethics is concerned about all others affecting human life in one way or
another. That is why it has something to do with the prohibition of death penalty, unjust war, and
terrorism among others, that are beyond the scope of health care practice about which Health Ethics is
exclusively concerned about life in relation to health and not in relation to other fields.
 Relations and distinction of Bioethics and Health Ethics
Relations
a. Both are concerned about health and life.
b. Both regulate human conduct by means of
moral principles in relation to health and life.
c. Health Ethics is part of Bioethics.
Distinction
a. Health Ethics is concerned about life only in
relation to health; Bioethics is concerned not
just about health but also other fields in
relation to life.
a. Health Ethics regulates human conduct in the
practice of health care; Bioethics regulates
human conduct not only in the practice of
health care but also in all aspects of human
life.
a. Bioethics is not part of Health Ethics. It has
encompassing scope of discipline.
What is Health Care?
• Health Care is the prevention, treatment, and management of illness and the
preservation of mental and physical well-being through the services offered by the
medical and allied health care professionals.
• It is the preservation of mental and physical health by preventing or treating illness
through services offered by the health profession.
• The well being of the person is that which is looked after in the practice of health care
which is ordered to the good of the individual.
• Health Care has to be carried out in accordance with what is genuinely good,
recognizable to a formed and informed human reason.
Ethics and Health Care
• Health Care has been confronted with various dilemmas and issues demanding
immediate action on the part of health care practitioners without resolving, through
sound judgment whether said action is good to be done or evil to be avoided.
• More often than not, judgment is made on the basis of expediency, preference, of
situation ethics, and of what the immediate situation seemingly provides.
• The action may also be judged as good if it proceeds from what is perceived to be a
good and noble intention and if it results in a good or favorable consequence without
anymore pursuing to determine whether the act is good or evil in itself – that is, whether
or not it is in harmony with right reason , human nature and man’s ultimate end which is
God.
Ethics and Health Care

• Examples: therapeutic abortion in an intention to save the mother’s life, Euthanasia that
results in seemingly good effect – the patient’s peaceful demise along with the family’s
sense of relief from further financial and emotional burden, and others.
• Said dilemmas and issues besetting health care need to be analyzed and addressed.
But the analysis has to precede sound judgment.
• How can judgment be sound? Since the action pertaining to health care is always
reduced to a moral act – that is whether it be good or evil, surrounding issues must be
tackled in the light of specific moral principles the study of Ethics gives.
Ethics and Health Care

• Health care should never be alienated from the science of Ethics, otherwise, it would be
rendered hostile to what is objectively good leading to the destruction not only of its
practice but also of human life which it ought to serve.
• It would also br in serious disagreement not only with reason and human nature but also
with the ultimate destiny of human existence upon which all human actions, including
health care practice, have significant bearings.
Ethics and Health Care

• Thus, Ethics is essential to the practice of health care for it provides knowledge of the
morality of an act and serves as a guiding principle for health care practitioners to
observe in addressing health care issues that are, in the first place, moral issues where
the forces of goodness should prevail over the forces of evil.
• Adherence to Ethics gives proper direction and fundamental ways to lie an upright life in
the health care profession thereby being conformed to the marvelous order of reason, of
human nature, and of man’s final destiny.
Ethics and Law
Politics and Ethics
 Ethical
Principles
HEALTH CARE ETHICS
Group 1
BSN-3A
Overview

Advincula, Twinkle K.
 An ethical principle refers to the general judgments
serving as justification for a person's behavior or actions.
Ethical principles in nursing are the foundation upon which
nursing actions are based. They describe what is expected of
nurses in terms of right and wrong, good and bad, and correct
and incorrect.
 Reasons Why Ethical Principles Are so
Important in Nursing
1. Using ethical principles as the foundation of practice assists
nurses in making good judgment calls.
2. Ethical principles in nursing guide nurses in providing high
quality care within the laws that govern nursing practices.
3. Nurses who work within the guidelines of ethical principles
support the emotional, physical and mental health of each patient,
acting with their best interest in mind.
4. Applying principles of ethics in nursing is beneficial to
developing strong nurse patient and interdisciplinary
relationships, which is essential for collaboration and quality
patient care.
 7 Main Ethical Principles

• Autonomy
• Confidentiality
• Veracity
• Fidelity
• Justice
• Beneficence
• Non-maleficence
Autonomy

Agapito, Lhyka Marie C.

My Body,
My choice,
- Unknown
 What is Autonomy?

 Autonomy, is defined as the capacity to think, decide,

and act freely and independently on the basis o such
thought and decisions.
 Why is patient autonomy important?

 Autonomy is important because we need to make sure

that the patient is actively involved in their diagnosis
and treatment.
 Principles of
Autonomy
 We act autonomously.

 Patients have the right to refuse medical therapy.

 Self determination.

 Freedom from coercion.

 Independence.
 Autonomy:
The Rights of the
Patients’
Alicaya, Lita Mea M.
13 Patient Rights
according to Saint
Anthony Mother and
Child Hospital.
 13 Patients Rights
1. Right to Appropriate Medical care and Humane Treatment
Every person has a right to health and medical care corresponding to his
state of health, without any discrimination and within the limits of the resources,
manpower and competence available for health and medical care at the relevant
time.

2. Right to Informed Consent

The patient has a right to a clear, truthful and substantial explanation,
in a manner and language understandable to the patient, of all proposed
procedures, whether diagnostic, preventive, curative, rehabilitative or therapeutic,
wherein the person who will perform the said procedure shall provide his name
and credentials to the patient, possibilities of any risk of mortality or serious
side effects, problems related to recuperation, and probability of success and
reasonable risks.
 13 Patients Rights
The patient will not be subjected to any procedure without written informed
consent, except in the following cases:

a) in emergency cases, when patient is at imminent risk of physical injury. In such

cases, the physician can perform any diagnostic or treatment procedure as good
practice of medicine dictates without such consent;
b) when the health of the population is dependent on the adoption of a mass health
program to control epidemic;
c) When the patient is either a minor, or legally incompetent, in which case. a third
party consent Is required;
d) when disclosure of material information to patient will jeopardize the
success of treatment, in which case, third party disclosure and consent shall be in
order;
e) When the patient waives his right in writing.
 13 Patients Rights

Informed consent shall be obtained from a patient concerned if he is of legal age

and of sound mind. In case the patient is incapable of giving consent and a third
party consent is required. the following persons, in the order of priority
stated hereunder, may give consent:

i. spouse;
ii. son or daughter of legal age;
iii. either parent;
iv. brother or sister of legal age, or
v. guardian

If a patient is a minor, consent shall be obtained from his parents or legal

guardian.
 13 Patients Rights
3. Right to Privacy and Confidentiality
The privacy of the patients must be assured at all stages of his
treatment. The patient has the right to be free from unwarranted public exposure.
The patient has the right to demand that all information, communication and
records pertaining to his care be treated as confidential. Any health care provider or
practitioner involved in the treatment of a patient and all those who have legitimate
access to the patient's record is not authorized to divulge any information to a third
party who has no concern with the care and welfare of the patient without
his consent

4. Right to Information
The patient or his/her legal guardian has a right to be informed of the
result of the evaluation of the nature and extent of his/her disease, any other
additional or further contemplated medical treatment on surgical procedure or
procedures, bills and post-operative medications.
 13 Patients Rights
5. The Right to Choose Health Care Provider and Facility
The patient is free to choose health care provider to serve him as well
as the facility. The patient has the right to discuss his condition with a consultant
specialist, at the patient's request and expense. He also has the right to seek for
a second opinion and subsequent opinions, if appropriate, from another health care
provider/practitioner.

6. Right to Self-Determination
The patient has the right to avail himself/herself of any recommended
diagnostic and treatment procedures. Any person of legal age and of sound mind
may make an advance written directive for physicians to administer terminal care
when he/she suffers from the terminal phase of a terminal illness: Provided That a)
he is informed of the medical consequences of his choice; b) he releases those
involved in his care from any obligation relative to the consequences of his
decision; c) his decision will not prejudice public health and safety.
 13 Patients Rights
7. Right to Religious Belief
The patient has the right to refuse medical treatment or procedures
which may be contrary to his religious beliefs, subject to the limitations described in
the preceding subsection: Provided, That such a right shall not be imposed by
parents upon their children who have not reached the legal age in a life threatening
situation as determined by the attending physician or the medical director of the
facility.

8. Right to Medical records

The patient is entitled to a summary of his medical history and condition.
He has the right to view the contents of his medical records, except psychiatric
notes and other incriminatory information obtained about third parties, with the
attending physician explaining contents. The health care institution shall safeguard
the confidentiality of the medical records and to likewise ensure the integrity and
authenticity of the medical records and shall keep the same within a reasonable
time as may be determined by the Department of Health.
 13 Patients Rights
9. Right to Leave
The patient has the right to leave hospital or any other health care
institution regardless of his physical condition: Provided. That a) he/she is
informed of the medical consequences of his/her decision b) he/she releases
those involved in his/her care from any obligation relative to the consequences of
his decision; c) his/her decision will not prejudice public health and safety.

10. Right to Refuse participation in Medical Research

The patient has the right to be advised if the health care provider plans
to involve him in medical research, including but not limited to human
experimentation which may be performed only with the written informed consent of
the patient.

11. Right to Correspondence and to Receive Visitors

The patient has the right to communicate with relatives and other
persons and to receive visitors subject to reasonable limits prescribed by the rules
and regulations of the health care institution.
 13 Patients Rights
12. Right to Express Grievances
The patient has the right to express complaints and grievances about
the care and services received without fear of discrimination or reprisal and to
know about the disposition of such complaints. Such a system shall afford all
parties concerned with the opportunity to settle amicably all grievances.

13. Right to be Informed of His Rights and Obligations as a Patient

Every person has the right to be informed of his rights and obligations
as a patient. The Department of Health, in coordination with heath care providers,
professional and civic groups, the media, health insurance corporations, people's
organizations, local government organizations, shall launch and sustain a
nationwide information and education campaign to make known to people
their rights as patients, as declared in this Act Such rights and obligations of
patients shall be posted in a bulletin board conspicuously placed in a health care
institution.
 Autonomy:
Patient’s Bill of Rights
Arceno, Trexie Jane C.
 The Patient's Bill of Rights is a collection of rights which
individuals have in the health care system and which
healthcare providers are required to observe.
 Why is
Patient’s Bill
of Rights
Important?
It protects both
the patients and the
hospital.
 The Patient’s Bill of Rights is an evolving document related
to providing culturally competent care. In 1973 the
American Hospital Association (AHA) adopted the Patient’s
Bill of Rights.
 GOAL: To protect patients and guarantee they get
appropriate care
 Patient’s Bill of rights
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.
3. 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.
4. 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.
5. The patient has the right to know the immediate and long-term financial implications of
treatment choices, insofar as they are known.
 Patient’s Bill of rights
6. 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.
7. 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 implement fully a legally valid advance directive.
 Patient’s Bill of rights

8. 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.
9. 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.
10. 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.
 Patient’s Bill of rights

11. The patient has the right to expect that, within its capacity and policies, a hospital will
make a reasonable response 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.
12. 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.
 Patient’s Bill of rights
13. 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.
14. 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.
15. 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.
 “Health is a
human
necessity;
health is a
human right”
― James
Lenhart
 Autonomy:
Informed Consent
Bulawan, Andrew C.
 Informed Consent

 a process of communication between you and your health care

provider that often leads to agreement or permission for care

 the main goal of acquiring informed consent is to protect the

patient
 The Role of the Nurse

The nurse is responsible and accountable for the verification of and

witnessing that the patient or the legal representative has signed the
consent document in their presence and that the patient, or the legal
representative, is of legal age and competent to provide consent.
 Essential elements of
Informed Consent
1. Research Description
2. Risks and Discomforts
3. Benefits
4. Alternatives
5. Confidentiality
6. Contacts
7. Voluntary participation and withdrawal
 Research Description

A clear statement that the clinical investigation involves research is

important so prospective subjects are aware that, although preliminary
data (bench, animal, pilot studies, literature) may exist, the purpose of
their participation is primarily to contribute to research (for example,
to evaluate the safety and effectiveness of the test article, to evaluate a
different dose or route of administration of an approved drug, etc.)
rather than to their own medical treatment.
 Risks and Discomforts

The informed consent process must describe the reasonably

foreseeable risks or discomforts to the subject. This includes risks or
discomforts of tests, interventions and procedures required by the
protocol (including standard medical procedures, exams and tests),
especially those that carry significant risk of morbidity or mortality.
 Benefits

The description of potential benefits should be clear, balanced, and

based on reliable information to the extent such information is
available.
 Alternatives

To enable an informed decision about taking part in a clinical

investigation, consent forms must disclose appropriate alternatives to
entering the clinical investigation, if any, that might be advantageous
to the subject.
 Confidentiality

The consent process must describe the extent to which confidentiality

of records identifying subjects will be maintained and should identify
all entities, for example, the study sponsor, who may gain access to the
records relating to the clinical investigation.
 Contacts

The consent process must provide information on how to contact an

appropriate individual for pertinent questions about the clinical
investigation and the subjects' rights, and whom to contact in the event
that a research-related injury to the subject occurs.
 Voluntary Participation and Withdrawal

This element requires that patient be informed that they may decline to
take part in the surgery.
 Autonomy:
Proxy Consent/Legally
Acceptable Representative
Baldevia, Klarence Lowell B.
 Proxy Consent/Legally Acceptable
Representative
is the process by which people with the legal right to consent to medical
treatment for themselves or for a minor or a ward delegate that right to
another person. There are three fundamental constraints on this
delegation:
1. The person making the delegation must have the right to consent.

2. The person must be legally and medically competent to delegate the

right to consent.

3. The right to consent must be delegated to a legally and medically

competent adult.
There are 2 types of proxy
consent for adults:

1. The First type is the power of

attorney to consent to medical
care.

2. The second type is the living

will.
Autonomy:
Privacy
Basalo, Kalei Damsel F.
Professional persons in health care delivery fields have legal and
ethical responsibilities to safeguard the confidentiality of
information regarding the clients in their care.

Protecting information gathered in association with the care of the

patient is a core value in health care. Privacy is important in our
profession.
Patients have a right to expect that their private medical information
will be kept confidential. Protecting information gathered in
association with the care of the patient is a core value in health
care. However, respecting patient privacy in other forms is also
fundamental, as an expression of respect for patient autonomy and
a prerequisite for trust.
Patient privacy encompasses a number of aspects, including personal
space (physical privacy), personal data (informational privacy),
personal choices including cultural and religious affiliations
(decisional privacy), and personal relationships with family
members and other intimates (associational privacy).
 Reasons to Protect Privacy and
Confidentiality

1. Rights of all people.

2. Establishes successful physician-patient or nurse-patient
relationship, and enables the practitioners to perform their
jobs better.
3. Protection of privacy and confidentiality benefits the
public health.
4. Breach may result to reputational and financial harm, or
personal harm to patients.
Confidentiality
Boco, Stephen Jil
 Confidentiality

 The state of keeping or being kept secret or private.

 The ethical duty of confidentiality refers to the obligation of an

individual or organization to safeguard entrusted information. The
ethical duty of confidentiality includes obligations to protect
information from unauthorized access, use, disclosure,
modification, loss or theft.
 Examples

 Confidential information includes non-public information

disclosed or made available to the receiving part, directly or
indirectly, through any means of communications or
observation.

 HIV Testing
 How is it important?

 It is important because confidentiality builds trust between

employer and employee or more like to patients, have an
obligation to keep the people’s information secure and
confidential.

 Handling confidentiality may be more practical, such as not

leaving sensitive documents in public spaces like printers and
having password access to certain documents and files
 “Confidentiality is
a good practice in
handling patients.”
 Veracity
Truth telling and Right to Information

Bona, Chazzy Esah

 What is Veracity?

 the quality of being true or habit of telling the truth.

 an easy example of this is your best friend who tells you

whether you look good in your haircut, or if your new outfit
suits you.
 In healthcare Ethics:

• requires that healthcare providers to be honest in their

interactions with patient

• WHY?
 In healthcare Ethics:

• TRUTH TELLING
- it shows respect for people and allows them to receive their
right of AUTONOMY.

Lying (it may be withholding certain element or the whole truth

or misleading the person) faces a great threat to the ethical
considerations of nursing and can risk you to face the court.
Also risks the patient’s well-being.
IS IT OKAY FOR NURSES TO LIE FOR THE
PATIENT’S BEST INTEREST?
Fidelity
Bagarino, Retshil-An M.
 Fidelity

 Means nurses must remain true to professional promises,

such as the promise to provide high-quality, competent,
safe, and efficient patient care.

 It also means being supportive of patient decisions,

promoting patient autonomy and the furtherance of the
profession.
5 Reasons Why Fidelity is Important in Nursing

1. Fidelity in nursing helps foster a trusting relationship between patients,

families, nurses, and healthcare team members.

2. When nurses practice fidelity, patients experience more favorable outcomes.

3. Fidelity in nursing practice results in increased patient satisfaction.

4. Fidelity in nursing promotes patient autonomy, which is beneficial to the

patient and the healthcare team.

5. Good habits are easily duplicated.

 What are some examples of fidelity in nursing?
1. If you tell a patient you will be back to check on them, follow through by
doing so.

2. Demonstrating role fidelity

3. Promoting patient autonomy

4. Being faithful to the nursing profession

5. Fulfilling commitments
Justice
Cabornida, Elsie Jhoy
 Justice

 The word justice is derived from the Latin word “jus”

which means “to bind or tie together”.

 This implies that patients have a right to fair and impartial

treatment.

 Justice is a complex ethical principle, it is concerned with

the equitable distribution of benefits and burdens to
individuals in social institutions, and how the rights of
various individuals are recognized.
 Principles of Justice

 Equality – the state of being equal.

 Fairness – impartial and just treatment or behavior without

favoritism or discrimination.

 Access – obtain something such as service.

 Importance of Justice

 Health justice gives human dignity to everyone, regardless

of who they are or where they came from. It means access
to equitable affordable quality care for all.
 Example

 If you were juggling multiple patients, you would not

provide better care based on who has the best insurance.
“Everyone has
a right to be
healthy and to
be treated
fairly.”
Beneficence
Callosa, Tom Airon L.
Introduction
 What is Beneficence?

 Beneficence, is an ethical principle that a nurse’s

action should promote good.

 It comes from the Latin word benefactum, meaning

"good deed.”

 Act in doing what’s in the patient’s best interest.

 “Does it benefit the patient?”

 Beneficence
The moral duty of physicians and
healthcare staff to promote the
wellbeing of their patients and
choose the course of action that will
lead to good outcomes for them.
Beneficence often collides
with “autonomy”
principle, as the patient’s
autonomy can sometimes
prevent the physician from
delivering the best
treatment.

For example: A patient who

broke her hips, but refuses
surgery for hip replacement.
 Beneficence Example:
 An eight-year-old child has been admitted to hospital with a significant
open fracture to their left leg. The limb is deformed with significant
bleeding and the patient is extremely distressed. The parents are
demanding immediate action be taken.

 If the bleeding is life-threatening, the limb sufficiently injured and the risk of
infection extremely high, then amputation could be a treatment option. It
would be “good” for the patient in as much as the injury would be resolved
and the threat to life from bleeding or infection somewhat reduced.

 There are other interventions available to us that have better outcomes

attached. Using blood products to manage the bleeding, reducing the
fracture if possible and orthopedic surgery if necessary will have better
outcomes for this patient. That course of action is “more good” than
amputation.
 Key Concepts
What physicians must do to maintain beneficence:

 Physicians or health care professionals should keep their skills and

knowledge up to date to ensure they are fully capable

 They should consider individual patient needs

 The course of action is agreeable with the patient and meets their

expectations
 Why is Beneficence important?

 Beneficence is important because it

ensures that healthcare professionals
consider individual circumstances and
remember that what is good for one patient
may not necessarily be great for another.
 Questions:
 Beneficence comes from the Latin word benefactum, which
means _________?

 What should be done if a patient refuses treatment for a life-

threatening condition?
Non-Maleficence
Celis, Amor C.
 Introduction

Every nurse encounter ethical dilemma in various challenging

patient scenarios throughout his career. This can lead to increased stress
as they try to figure out what is the best course of action in each
circumstance. Ethical principles like nonmaleficence gives them a strong
framework for making rational choices.
 Definition

By definition, the term "nonmaleficence" derives from the

ancient maxim primum non nocere, which, translated from the Latin,
means "first, do no harm." The greatest good should be accomplished
through any public health action.
The principle of nonmaleficence holds that there is an obligation not to
inflict harm on others either unintentionally or deliberately. This
principle requires nurses to protect individuals who are unable to protect
themselves
The principle of nonmaleficence supports the following rules:
1.Do not kill.
2.Do not cause pain or suffering.
3.Do not incapacitate.
4.Do not cause offense.
Breach of the obligation to
cause no harm in the
absence of a specific intent
to harm is called
“negligence”. Negligence
is a violation of
nonmaleficence. Because
while there is no specific
intent to harm, reasonable
care was not taken to avoid
harm.
● The principle of nonmaleficence requires that every medical action
be weighed against all benefits, risks, and consequences.
● Nurses apply this principle by choosing action that inflict the least
amount of harm in order to accomplish a desirable output. In medical
setting, it also applies to performing tasks appropriate to an
individual's level of competence and training. Further, it directs
nurses to prioritize the patient’s safety in all aspects of treatment.
 Relevance to Nursing

1.Serves as a direction when making critical decisions

 This is certainly relevant when opposing viewpoints,
challenging environment, or conflicts of opinion complicate
the decision-making process.
2. Ensure that individuals have clear standards to follow.
 Especially when deciding what measures they should and
should not undertake. As nurses we must be aware of
instances where harm may surpass benefit.
 Examples
1. During the endorsement process, the nurse notices that one of the
incoming nurses is clearly impaired and under the influence of illegal
drugs. The nurse immediately reports her observations to the charge
nurse and suggests that no patient be assigned to the impaired nurse
while his condition is unconfirmed. The nurse who reported the
impaired nurse with suspected substance abuse clearly demonstrated
nonmaleficence by preventing patients from suffering or being
injured.
 Examples

1. A patient with multi-resistant Tuberculosis (TB) refuses to visit the

hospital and is not adhering to the treatment regimen. Nonmaleficence
may overthrow the nursing principle of autonomy in this case to
protect the community by compelling the patient to receive proper
treatment. The risk of infecting the entire community in which the TB
patient lives, as well as the potential complications of TB for the
patient if left untreated are both significant.
 Examples

1. A nurse demonstrating nonmaleficence would perform multiple

checks and observe the 10 rights of drug administration before
administering medication to avoid a dangerous medication error.
That in all
things
God may
be
Glorified!
 PRINCIPLE OF STEWARDSHIP AND
THE ROLE OF NURSES AS STEWARDS
Presented by: Lessie Cuyam BSN 3-A
 “Man comes from nothing for man to be something.” Jean-Paul Sartre.

In the context of the Principles of Stewardship, humans must respect the

sanctity of life and the world. Therefore, any act that would defile the
blessedness of life and the world is deemed against the principle of
stewardship.
Stewardship refers to the expression of one’s responsibility to take care,
nurture, and cultivate what has been entrusted to him.
Stewardship requires us to appreciate the two gifts that a wise and
loving God has given:

1. The earth with all its given natural resources.

2. Our human nature, with its biological, psychological, social, and
spiritual capacities.
The principle is grounded in the presupposition that God has absolute
Dominion over creation and that in so far as human being made in God’s
image and likeness, we have been given a limited Dominion over creation
and are responsible for its care.
In health care practice, stewardship refers to the execution of
responsibility of the health care practitioners to look after, provide
necessary health care services and promote the health and life of those
entrusted to their care.
Nurses as stewards focus on being responsible with the care and lives of
the patients they are handling. They serve as if the lives of their patients
are on the palm of their hands. They also make sure that their work
efficiency and environment would make it the best for their patients and
the co-health workers.
These are the desired effect of stewardship:

● patient-population centeredness
● safety for patients and health care personnel
● increased autonomy for advanced nurse practioners
● increased respect for the contributions made by professional nurses
● enhancement of the collaborative practice of the multidisciplinary
health care team.
There are different ways in life where we can practice the principle of
stewardship, and these are through: personal, social, ecological, and
biomedical ways.
Thank you!
PRINCIPLE OF COMMON GOOD
AND SUBSIDIARITY
P R E S E N T E D B Y: M O I R A M A E Q . D E L O S S A N T O S
BSN 3-A
 COMMON GOOD

• It r e fe r s t o t h e s t a n d a r d o f m o r a l
v a lu e s th at is th e mo s t s u ita b le o r
id e a l
• T h is p rin c ip le a llows u s to k n ow
th e b e s t a lt e r n at ive o r o p t io n to
ta ke in d e c is io n ma k in g
It helps us to examine the problem
with positive outlook since we are
looking for a common goal that
eventually will benefit each one of
us.
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 FR

We learned that whenever we make nursing

care plans or health teaching our goal must
be met and so for the common good for
everyone, each one of us should coordinate
well and participate to carry out as good
and meaningful health teaching and as well
as to meet the goals we want to the
community.

Add a footer 19
 FR
SUBSIDIARITY
Concerned with the power that is
given to the minority or lowest level of
authority, that issues or problems
should be handled at the local level as
possible rather that by the highest
authority

Add a footer 20
It guarantees independence
for the lower authority in
relation to the highest
authority.

FABRIKAM RESIDENCES
EXAMPLE:
Fo r i n s t a n c e , i n t h e h e a l t h c a r e s e t t i n g a s s u m e
t h a t t h e h i g h e s t l eve l o f a u t h o r i t y w h i l e n u r s e i s
t h e l o w e s t l eve l o f a u t h o r i t y. S u p p o s e t h e d o c t o r
prescribed the medication but the nur se knew
t h a t t h e d r u g c a n a c t u a l l y h a ve a f f e c t s o n t h e
patient since the nur se lear ned that the patient
has aller gy to the prescribed medication. T hus,
the nur se would not administer the dr ug and
infor m the doctor about it.
THANK YOU FOR LISTENING!
Principle of
Bioethics
Table of contents
Introduction/
Principle of
01 Concept of
Bioethics
04 Totality and Its
Integrity
Principle of Principle of Ordinary
02 Stewardship 05 and Extraordinary
Means

The Role of Nurses Principle of

03 as Stewards 06 Personalized Sexuality
01
Introduction/ Concept of
Bioethics
Kate Meryll Jo B. Delloro
Bioethics
● The study of ethical and moral implications of
new biological discoveries and biomedical
advances, as in the fields of genetic engineering
and drug research.

● Study of human actions of allied health

professionals with regards to human life and
towards the patient.
Bioethics includes:

● Medical Ethics
● Research Ethics
● Environmental Ethics
● Public Health Ethics
Why do we need to study
bioethics?
● Bioethics education for medical practice is
significant in today’s complex world because:
○ Medical policies and patient rights legislation are
ever-changing
○ Health care systems function differently than before
○ Clinical practice now involves decision-making
about many new issues
Why do we need to study
bioethics?
● Development in life sciences has opened new avenues for
questions to be raised
● Where vaccines, genetic manipulations and therapies have
paved way in our society, likewise the risks and threats
also escalated
● Individual decisions
● Public policy decisions
● To instill thoughtful choices
● Promote respect among people with different views
4 Basic Principles of Bioethics
(Beaucham and Childress, 1979)

● Autonomy
● Beneficence
● Nonmaleficence
● Justice
Other Important Principles:

● Principle of proportionality
● Caution
● Principle of nondiscrimination
● Principle of respect for the right to
information
 02
Principle of
Stewardship

Reported by: Francisco, Danica May

BSN-3A
❖ Stewardship requires us to appreciate the two
great gifts that a wise and loving God has
given:
1.The earth, with all its natural resources.
2.Our human nature, with its biological,
psychological, social and spiritual capacities.
➢ Principle is grounded in our
creation in God’s image and
likeness.

➢ In God’s absolute dominion over

creation which is the basis for our
limited dominion and stewardship
over them.
 ❖ Stewardship
➢ refers to the expression of one's
responsibility to take care nurture and
cultivate the has been entrusted to him.

❖ Healthcare practice stewardship

➢ refers to the execution of responsibility of the healthcare
practitioner to look after, furnish fundamental health care
services, and promote the health and life of those entrusted
to their care.
❖ Traditional definition of stewardship

➢ The parable of talents in the New Testament

describes another aspect of stewardship in
which a master divides his worldly goods
between his three servants. The moral portrayed
here is that when one is entrusted with something
of value, there is an obligation to improve it.
❖ State oriented definition of stewardship

➢ The broad definition of state-oriented

stewardship is that the feature of government
is responsible for the welfare and interest of
the population mainly the trust and legitimacy
with which its activities seen by the
widespread public.
❖ The metaphor of a steward

➢ In the eleventh century the English phrase

steward was develop from the term
“stigwaerd” meaning the warden of the
house.
❖ The two frameworks of stewardship:

1. the dominant
2. the keeping
➔ as a capability to interpret the actions of a
steward in relation to the environment.
 ❖ The Domination Framework
▪In natural resource management as well as in theology the
domination of framework is premised on the faith that the
earth exists to serve the needs of the human beings it is an
instrument for human purposes.
▪ John Patterson (2003), a theorist, contends that the hierarchy
exist between humans and nonhuman in which the former has
the higher rank that the latter who serves the former. Within
the domination form work stewardship targets to enhance
natural sources for economic benefits.
 ❖ The Keeping Framework
▪Patterson argues that exploitation and depletion of the environment
has given upward push to the keeping framework which is premised
the belief that surroundings has an intrinsic value, as well the idea
that human and non-human are interconnected.
▪ In Patterson’s terms, stewards till and keep the surroundings or as
he explains the stewards serve and maintain the environment.
Patterson stresses that all folks are jointly accountable for the
wellbeing of the surroundings and that serving the surroundings not
only entails sacrifice however embraces a balance between the pride
of self interest and the need of the environment.
 03
The Role of Nurses
as Stewards
Jeremiah Gavan
03 The Role of Nurses as Stewards

The steward to self - to reach the realms

of health and nursing stewardship, it is
important that nurse leaders participate in
self-development. Succession of preparing
to grow and cultivate and a new generation
of innovative nurse leaders could be the only
way to do this.
03 The Role of Nurses as Stewards

In order to meet the idea of Lifelong Learning

Nurse Leaders or stewards, mentors and
personal trainers would need to be used to
assist them in developing abilities and improving
skills. Healthy nurse leaders will thus become
visible and sound role models within their
institutions to maintain a balance between
self-fulfillment and professional achievement.
03 The Role of Nurses as Stewards

01 PERSONAL_Virtue Ethics of Stewardship

➢ Mcintyre, a communitarian theorist, believes that an
individual is a conceptual self that seeks meaning or good
for itself through the perception of everyday experiences
➢ Virtues are important because they influence
interpretation decisions on what is important in
experience. A virtue is characterized as a quality in which
a person can move towards the accomplishment of a specific
human goal.
➢ Character or reputation is established as virtues are
typically practiced. In creating a character, a person acts
without determining the proper outcome of his or her
actions, rather than acting in the expectation that the action is
worthwhile.
03 The Role of Nurses as Stewards

01 PERSONAL_Virtue Ethics of Stewardship

➢ It can be claimed that personality influences the
protection and promotion of what is objectively
important in one's experience as a result of
perceptual decision.

➢ When the character affects his exercise of judgment

when he obtains a discerning insight into the goods
or their values and thereby supports his value
preferences.
03 The Role of Nurses as Stewards

01 PERSONAL_Virtue Ethics in Personal Stewardship

➢ A nurse who demonstrates stewardship at the point of
delivery in compliance with Mcintyre's Theory of Ethics would
make it easier for nurses to explain their common ethical
goals within professional frameworks such as the Canadian
Nurses Association Code of Ethics.

➢ As a result, stewards and nurses will maintain and encourage

what is fundamentally important in patient care. It may also
be argued that, in order to enable nurses' discernment of
embedded values, nurses will progressively balance
self-interest with service to others
03 The Role of Nurses as Stewards

02 SOCIAL_Social role of Nurses as Stewards

➢ Health care has been listed as the number one public priority
in Canada-and nurses play a vital role in the healthcare
system. Nurses advocate for health promotion educating
patients and the public on disease and injury prevention,
providing treatment and helping to restore health, and
providing support. No other health care provider has such
a wide and far-reaching role to play.
➢ Nurses help families learn to be healthy by helping to
understand the variety of emotional physical, mental and
cultural interactions they encounter during health and illness
➢ Nurses do far more than care for people. They always
have always been at the forefront of innovation in healthcare
and public health.
03 The Role of Nurses as Stewards

02 SOCIAL_Social role of Nurses as Stewards

➢ Nurses innovate. Florence nightingale known as the founder
of modern nursing is remembered as the lady with the lamp -
but she also collected evidence to determine that the key cause
of casualties in the Crimean war was not enemy weapon
infections due to insufficient sanitation - was a
pioneering statistician, perhaps the first person in history
to use graphics and charts to force lawmakers to act.
Today 's university educated nurses learn to trust their own
first-hand findings in order to produce valuable research
information on important topics
03 The Role of Nurses as Stewards

03 ECOLOGICAL_Ecological role of nurses in stewardship

➢ The nursing profession is well equipped to solve the
problems of reducing waste within medical systems
➢ The health sector produces a large amount of waste
that leads to environmental problems such as air
pollution and water pollution.
➢ By uniting and engaging workers through shared
governance, nursing frameworks will decrease and
overhead costs associated with waste management.
03 The Role of Nurses as Stewards

03 ECOLOGICAL_Ecological role of nurses in stewardship

➢ Nurses have the potential to use their trustworthy
skills to guide the way to more healthier communities
and societies in which they work. -the emerging
methods of waste management in healthcare. -the
nurses form the largest group in the health sector and
are skilled at informing research and eliminating
waste.
03 The Role of Nurses as Stewards

04 BIOMEDICAL_Biomedical role of nurses in stewardship

➢ Bioethics (Greek words bios means life and ethos
means behavior) is a branch of applied ethics that
refers the discipline dealing with the ethical
consequences of biological science and application
particularly in medicine. It includes questions related
to the beginning and end of human life.
 04
Principle of Totality
and Its Integrity
Principles of integrity and totality

● These principles dictates that the well-

being of the whole person must be taken
into account in deciding about any
therapeutic intervention or use of
technology.
● Therapeutic procedures that are likely to
cause harm or undesirable side effects can
be justified only by a proportionate
benefit to the patient. e.g. X-rays, Scans
STERILIZATION

● Sterilization may be described as any

medical or surgical intervention which
renders a patient woman or a man
incapable of procreation naturally or
operationally temporarily or permanently
Classifications:
For woman:

- Oophorectomy or removal of the ovaries

that produce germ cells.

- Salpingectomy ligation or destruction of

the fallopian tubes

- Hysterectomy or removals of the uterus.

Classifications:
For man:

- Castration or removal of the testicles.

- Vasectomy or ligation or removal of the

vas deferens Emasculation or suppression
of the male genital organ
STERILIZATION
- A different classification is used from a legal point of
view. The reasons for sterilization, rather than the
procedure, are considered.

- Sterilization is classified as:" Eugenic sterilization-to

prevent the birth of a deficient or deceased offspring.
The law of eugenic sterilization had first been approved
in Indiana USA in 1907. Many who suffer from presenile
dementia epilepsy and manic-depressive disorder
become eligible for this form of sterilization
STERILIZATION
- Therapeutic sterilization: the removal of a defective
reproductive organ that endangers the health of the patient.
This is exemplified by the removal of the cancerous uterus.

- " Contraceptive sterilization: whether organic Or

mechanical, it consists of suppressing ovulation in a female
that makes her sterile
The Principle Of Totality

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”
 TOTALITY

● The whole is greater than any of its

parts. Suppose a man’s foot is
gangrenous, should he consent to an
amputation? Since the amputation
will save the patient’s life and he can
still walk through the aid of crutches
or artificial limbs, he can consent to
an operation.
● Accordingly, a part of the human body
may be sacrificed if that sacrifice
means continued survival for the
person.
● While such sacrifices are normally
justifiable under the principles of
integrity and totality, they may
sometimes be forgone under the
principle of disproportionate means.
 INTEGRITY

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”
“Wholeness” – acting in the same
way on and believes he should act.
Ethico-moral
Responsibility of
Nurses in Surgery

Inot, Racee Angelo R.

Ethico-moral Responsibility of Nurses
in Surgery
➢ Codes of ethics for the nursing profession tend to
concentrate on professional conduct and to ensure
that decision-making is as patient-driven as
possible.
➢ Prevents harm to the patient
➢ Collaborates with other healthcare professionals
➢ Promotes a positive image of nursing to the patient
➢ Maintains integrity of profession of nursing
Ethico-moral Responsibility of Nurses
in Surgery
● Respect for other people
The nurse must respect the dignity and value of patients and colleagues
and treat all persons equally regardless of personal characteristics or health
problem. Related to this is the obligation to always respect the patient's
right to self-determination in medical care.

● Commitment to Patient
One of the key ethical duties of the nurse is to collaborate with the patient in
order to provide treatment that will optimize the physical, mental and social
well-being of the patient.
Ethico-moral Responsibility of Nurses
in Surgery
● Honesty and Self-Integrity
Nurses also have an ethical responsibility to be honest with patients and
colleagues, and to maintain self-integrity and high personal moral standards.

● Professional Responsibilities
The nurse also has a variety of ethical obligations related to the nursing
profession and its specialization.
ANA Code of Ethics
● Provision 1
Practices with compassion and respect for the inherent dignity, worth, and
unique aributes of every person.
● Provision 2
Primary commitment: the patient (individual, family, group, community, or
population)
● Provision 3
Promotes, advocates for, and protects: rights, health, and safety of
patients.
● Provision 4
Has: authority, accountability, and responsibility for practice.
● Provision 5
Owes the same duties to self as others
ANA Code of Ethics

● Provision 6
Establishes, maintains, and improves the ethical environment of the work seing
and conditions of employment.
● Provision 7
Advances profession through research and scholarly inquiry
● Provision 8
Collaborate with other healthcare professionals
● Provision 9
Must articulate nursing values
Preservation of
Bodily
Functional
Integrity
Labajoy, Jezzel Ann
Preservation of Bodily Functional Integrity
Principle of integrity- refers to every individual’s
duty to preserve the view of the human person in
which the order/function of the body and it’s
systems are respected and not duly compromised
by medical interventions.
•Anatomical-material or physical integrity of the
body
•Functional-systemic eiciency or functionality of
the body
Preservation of Bodily
Functional Integrity

•These principle dictates that the well-being of the

whole person must be taken into account in deciding
about any therapeutic intervention or use of
technology.
•Therapeutic procedures that are likely to cause
harm or undesirable side eects can be justified only
by a proportionate benefit of the patient.
Preservation of
Bodily Functional Integrity

For Example:

•If one organ is missing from the person’s

body = lack of anatomical integrity
•But if one kidney is healthy, present and
functioning well=functional integrity is
preserved
•The human body is an integral part of the human being and thus
deserving of human dignity. It must be kept whole. No body part
should be removed mutilated or incapacitated unless doing so is
appropriate for the wellbeing of a more important body part or
the body as a whole. An unessential or redundant body part can
be removed for the benefit of person.
•Human nature is a convergence of body and spirit. These two
dimensions can never be separated. The human body retains the
dignity of the individual being. To decapitate the body or
otherwise, human dignity is violated by treating the human being
as a machine or as an object to be used and discarded.
1. There is no morality whatsoever involved in cuing down the
mere anatomical completeness of the body.
2. It is immoral to lessen the functional perfection and
comprehensiveness of the body when such a factor is not
needed for the sustainability of the health and life of the whole
body.
3. Since the whole is greater and more important than any of its
parts, it is morally permissible to reduce the functional
completeness of the body when it is the only eicient way of
ensuring a person’s health or life.
The principle of totality validates a series of surgical
procedures done in daily clinical practice. Particular
operations to not in present moral problems if surgical
ablation involves these diseased organs such as the
appendix, gallbladder, kidneys, lungs, and other
organs. Diiculties are encountered in cases of
cosmetic procedures, organ transplantation and,
above all, for sterilization.
 Issues on Organ
Donation/Transp
lantation
Lagramada, Sarah Joy
Issues on Organ
Donation/Trans
plantation
Organ/Tissue transplantation – transfer of
an organ or tissue from its original site to
another part of the body or to another
individual. Typical examples are kidney and
corneal transplantation and blood donation.
Terminology of Organ/Tissue
Transplantation
•Autograft – the donor and the recipient are the same person. For instance,
a skin graft.
•Homograft – is the transplant of an organ/tissue from one human body to
another.
1. Homograft from the dead – is the transplant of a living organ/tissue
from the dead to a living person (Ex. Corneas from a person who died a few
minutes ago is preserved in the organ bank for future corneal
transplantation).
2. Homograft from the living – is the transplant of an organ/tissue from a
living to another living person. (Ex. Blood donation and kidney transplant).
•Heterograft – the use of an organ/tissue or any derivatives from a dierent
species, such as from an animal to a man.
 Is Organ/Tissue Transplant moral?
• In terms of the transplant or transition of one’s own tissue from one
part of the body to another (autograft), there is no moral objection or
question.
• Homograft from the dead constitutes no moral objection as long as
there is an informed consent among the relatives of the dead and the
dead is treated with respect.
• A moral issue can be raised is the patient’s death is being hastened
for immediate organ/tissue transplant.
• Homograft from the living is a form of mutilation and should be dealt
with according to its general principles. If the functional integrity of the
human body of the donor is destroyed, homograft is not morally
permissible.
Is Organ/Tissue Transplant moral?
• Organ donation requires pure and right intention, and good
conscience on the part of the donor.
• Organ donation syndicated by some unscrupulous persons is
obviously immoral.
• Organ or tissue donation must be regulated and governed by moral
principles along with legal legislation.
• In terms of heterograft, the employment of animal organ/tissue
may be morally justified if it is biologically adaptable and applicable. No
moral objection is oered in the case of tissue derivatives.
Certain requirements govern transplant between two living people. In
order to make it oral, the following requirements are needed:
• On the part of the Donor: that the organ is purely non-essential
to life, that the donation is willing, not forced or pressured even by
family, that it is done for noble reasons and that the donor clearly
understands the risks involved.
• On the part of the recipient: that the transplant is absolutely
important for his or her wellbeing.
• On the part of the procedure: that the procedure has a fair
chance of success and that the gain to the recipient and the
expense to the donor is proportionate.
 05
Principle of Ordinary
and Extraordinary
Means
 Ordinary Means

- Ordinary means = reasonable hope of benefit/success;

not overly burdensome; does not present an excessive
risk and are financially manageable
- Proportionate to the state of the patient
- “Ethically indicated” (Strong 1981 p. 84).
 Elements of Ordinary Means

1. Reasonable/proportionate hope of benefit/success

2. Common diligence
3. Proportionate – physical/social/financial
4. Not unreasonably demanding
In sum: what is reasonable!
 Extraordinary Means

- Extraordinary means = no reasonable hope of

benefit/success; overly burdensome; excessive risk
and are not financially manageable
- No obligation to use it/morally optional
 Elements of Ordinary Means

1. “Certain impossibility” – physical or a moral

2. Great eort – excessive
3. Pain
4. Exquisite and extraordinarily expensive
5. Severe dread or revulsion
In sum: what is inappropriate!
 • Ordinary means = “all medicines, treatments, and
operations, which oer a reasonable hope of benefit for
the patient and which can be obtained and used
without excessive expense, pain, or other
inconvenience”
• Extraordinary means = “all medicines, treatments,
and operations, which cannot be obtained or used
Gerald Kelly without excessive expense, pain, or other
inconvenience, or which, if used, would not oer a
reasonable hope of benefit” (Kelly 1957 p. 129).
Ordinary interventions are those that are based on
medications or services that are readily available and can
be administered without incurring significant discomfort,
expense or other inconvenience, but which oer the
patient in question a reasonable hope for an eective
improvement in his or her health.

Extraordinary measures are those focused on medicine or therapy

that cannot be used without incurring serious discomfort, expense
or other inconvenience. However, their application would not
give the patient a fair chance for a significant change in his
health.
 06
Principle of
Personalized
Sexuality
Sexuality

• is a complex aspect for our personality

and self. Our sexuality is defined by
sexual thoughts, desires and longings,
erotic fantasies, turns-ons and
experiences.
Personalized Sexuality

• is based on the understanding of

sexuality as one of the basic traits of
the human person and must be
developed in ways consistent with
enhancing human dignity.
• this element of human character
often leads to a loss of human dignity
and an inability to pursue the truly
fulfilling goals of human life.
As the image of God, man is created for
love.

GENESIS 1-3

• Teaches that God created person as

male and female and blessed their
sexuality as a great and goal gift.
THE GIFT OF SEXUALITY

• must be used in keeping with its

intrinsic, invisible, specifically human
teleology.
• must be a loving, bodily, pleasurable
expression of the complementary,
permanent self-giving of a man and a
woman to each other.
GENERALLY RECOGNIZED VALUES:

1. Sex is a search for sensual pleasure

and satisfaction, releasing physical and
psychic tensions.

2. Sex is a search for the completion of

the human person through an intimate
personal union of love expresses by
bodily union.
3. Sex is a social necessity for the
procreation of children and their
education in the family so as to expand
the human community and guarantee is
future beyond the death of individual
members.

4. Sex is a symbolic (sacramental)

mystery, somehow revealing the cosmic
FOR SECULAR HUMANIST, REASONABLE
USES OF SEX

Principles of Personalized Sexuality

1. use sex purely for sake of pleasure apart

from any relation to love or family
2. use it to reproduce (making test tube
babies) without any reference to pleasure or
love.
3. expression of unselfish love, but without
any relation to marriage or family.
SEX = SYMBOLIC MYSTERY

LOVE AND ECSTASY

2 NORMS OF SEXUAL MORALITY

1. Laws or social attitudes that hinder

human freedom to achieve these values
in ways the individuals desires are
unjust and oppressive.

2. Sexual behavior, at least among

consenting adults, is entirely a private
matter to be determined by personal
choice, free from any moral guilt.
THAT IN ALL THINGS, GOD MAY BE GLORIFIED
Bioethics and
Its Application
in Various
Health Care
Situations
 Reporters: BSN 3-A
1. Maramba, Kristine Joy
2. Margallo, Emmanuel
3. Martija, Audrey
4. Montes, Helen
5. Pagay, Mary Therese
6. Palacio, Alyssa
7. Pescos, Joshua
8. Quebec, Catherina
9. Quimsing, Jesseca Louise
10. Ranin, Cyprus Nicole
 01
Sexuality and Human
Reproduction
What is Human Sexuality?
5 Components of Human Sexuality
We Have Two Views for Sex…
We Have Two Views for Sex…
HUMAN REPRODUCTION
 02
Human Sexuality and
its Moral Evaluation
Human Sexuality
Human Sexuality
Human Sexuality
Moral Evaluation
Sexual acts can be distinguished as:
1. Morally Obligatory
- are morally right acts one ought to do, one is morally prohibited from not
doing them, they are moral duties, they are acts that are required. In
general something is ‘right’ if it is morally obligatory
- Ex: a spouse might have a moral obligation to engage in sex with the
other spouse.
2. Morally permissible
- Permitted means behaviour that is within the bounds of the moral system.
it is morally permitted to act in any way that does not cause others
unjustified harms. in short, ‘permitted’ is the lowest bar for moral
behaviour. anything that is not morally forbidden is permitted
- Ex: it might be morally permissible for married couples to employ
contraception while engaging in coitus
Moral Evaluation
Sexual acts can be distinguished as:
3. Morally supererogatory
- supererogatory designates any action which deemed morally good, but
which carries or implies no obligations to act. supererogatory are also
known as altruistic actions.
- Ex: one person’s agreeing to have sexual relations with another when the
former has no sexual desire of his or her own but does not want to please
the latter might be an act of supererogation

4. Morally wrong
- are morally prohibited, morally impermissible, acts one ought not to do,
and acts one has duty to refrain from doing.
- Ex: rape and incest are morally wrong
● Note that if a specific type of sexual act is morally wrong (say, homosexual
fellatio), then every instance of that type of act will be morally wrong. However,
from the fact that the particular sexual act we are now doing or contemplate
doing is morally wrong, it does not follow that any specific type of act is morally
wrong; the sexual act that we are contemplating might be wrong for lots of
different reasons having nothing to do with the type of sexual act that it is. For
example, suppose we are engaging in heterosexual coitus (or anything else), and
that this particular act is wrong because it is adulterous.

● The wrongfulness of our sexual activity does not imply that heterosexual coitus
in general (or anything else), as a type of sexual act, is morally wrong. In some
cases, of course, a particular sexual act will be wrong for several reasons: not
only is it wrong because it is of a specific type (say, it is an instance of
homosexual fellatio), but it is also wrong because at least one of the participants
is married to someone else (it is wrong also because it is adulterous).
 03
Marriage
 MARRIAGE
● Marriage is defined differently, and by different entities, based on
cultural, religious, and personal factors. It is a formal union and social and
legal contract between two individuals that unites their lives legally,
economically, and emotionally. The contractual marriage agreement
usually implies that the couple has legal obligations to each other
throughout their lives or until they decide to divorce. Being married also
gives legitimacy to sexual relations within the marriage. Traditionally,
marriage is often viewed as having a key role in the preservation of
morals and civilization.
 MARRIAGE

● Marriage is another human construction to ensure the continuity of the

family and the eventual perpetuation of the human specie.

● The New Family Code of the Philippines, which became effective on

August 3, 1998, defines Marriage as a special contract of permanent union
between a man and a woman entered into in accordance with law for the
establishment of conjugal and the family life.
 Aspects of Marriage:

● First, the legal point of view:

posits that marriage is a contract.

● Second, religious point of view:

posits that marriages a sacrament.
“What God has put together let no man put asunder.” (Matthew 19:6)
 04
Fundamentals of
Marriage
✓ FUNDAMENTALS OF MARRIAGE
✓ Issues on sex outside marriage
 05
Issues on Contraception, Its Morality
and Ethico -Moral Responsibility of
Nurses
Contraception
Different types of
contraception
Different types of contraception
Different types of contraception
Advantages of contraception
Advantages of contraception
Are contraceptives anti-life?
 Contraception is unnatural
Anti
Natural consequence of having
sexual intercourse is conceiving a
child. It is wrong to interfere with
this.
Pro
Humans interfere with the natural
order all the time example is
when doctors cure illnesses.
Some results are good some are
bad. So look at the consequences
of contraception to decide whether it
is good or bad.
 Contraception is anti-life
Anti Pro

“Life is a good thing"; those who use Human rights come in here. The
contraception are anti-life because right to decide.
they intend to prevent a new life
from coming into being. BAD
INTENTION. It is always morally
wrong to do something with a bad
intention.
 Contraception is a form of
abortion
Anti Pro

Some contraception prevent the

implantation of a fertilized egg,
thus this equals to abortion.
Abortion is wrong then these
forms of contraception are wrong
Ethico-Moral Responsibility of
Nurses in Contraception
Primary concern Secondary Concern

● Patient welfare and safety ● Make sure the patient gets

all the information and advice
● Respecting the autonomy of that they need to be able to
the patient choose wisely.
Ethico-Moral Responsibility of
Nurses in Contraception
Other considerations

● Patient needs to know: reliability of the method, ease of use of

the method, potential side effects, and health risks.

● It is unethical for a practitioner to give medical advice influenced

by a non-medical factor without disclosing the information to the
patient.

● Health care practitioners should respect also the confidentiality of a

patient.
 06
Artificial
Reproduction
Artificial Reproduction
Artificial Insemination
In-Vitro Fertilization
Surrogate Motherhood
THE ETHICS OF HEALTH
CARE PROVIDERS
 07
Artificial
Insemination
Artificial Insemination
Two types of AI
Reason people go for AI
Moral Issues on AI
Ethico-Moral Responsibility of
Nurses in AI
 08
In- Vitro Fertilization·
In- Vitro Fertilization
2 TYPES OF IVF
IVF Process
Reasons why they seek IVF
Main problem of IVF:
 09
Surrogate Motherhood
Surrogate Motherhood
Types of Surrogacy
Compensated Surrogacy
Surrogate Motherhood
The Roles of the Nurse in Clinical
Ethical Decision Making
 10
Morality of Abortion and Other
Problem to Destruction of Life
Abortion
Two Principal Moral Considerations:
Moralist on Spontaneous and Induced
Abortion:
Direct and Indirect Abortion
Direct Abortion
Indirect Abortion
Morality of Abortion
Direct Abortion
Indirect Abortion
Rape
Morality of Rape
Euthanasia
Moral Issues of Euthanasia