Bachelor of Science in Nursing 2YC
NCMA218: BSN 2ND YEAR SUMMER FINAL 2022
Coverage for Final: Modules 10-17
• Nursing Roles and Responsibilities on Euthanasia,
Advance Directives and DNR
• Bioethics and Research and Guidelines in Documentation
• Ethical Consideration in Leadership Management
• Meaning and Service Value of Medical Care
• Ethical Issues Related to Technology in the Delivery of
Health Care
• Continuing Education Program on Ethico-Moral Practice
in Nursing
• Integration of all Ethical Theories and Principles
ETHICO-MORAL RESPONSIBILITY OF NURSES
Discussed by Prof. Ma. Diosul Roque
Euthanasia
- The delivery of high-quality, compassionate, holistic and
patient-centered care, including end-of-life care, is central to
nursing practice.
- Means cutting the life of a person either aided by the person or
the patient itself
- Euthanasia is inconsistent with the core commitments of the
nursing profession and profoundly violates public trust.
- Nurses are ethically prohibited from administering medical aid
in dying medication. Yet they must be comfortable supporting
patients with end-of-life conversations, assessing the context
of a medical aid in dying request (hindi tayo snag bibigay ng
gamot para makapatay. How do you deal with the patient
suffering too much that wants to die “nurse tanggalin mo na
ung ventilator, bigyan mo nkong gamot na-nakaka overdose”
we have to have active listening to the patient means we don’t
get easily distracted, we stay focused to the patient, and listen
attentively)
- Nurses should reflect on personal values related to medical aid
in dying and be aware of how those values inform one’s ability
to provide objective information in response to a patient’s
request. (magbibigay ka ng info pero sasalungatin mo, we
should always remember the fact to be alert. In no manner
should our decision be subjectively base on our personal
decision.)
2 options of end-of-life
1. Medical aid in dying – patient with terminal illness, self-
determination, voluntary choice and informed request to self-
administer medication to hasten death
2. Euthanasia – occurs when someone other than the patient
administers medication in any form with the intention of
hastening the patient’s death
Hallmarks of end-of-life care
- include respect for patient self- determination, nonjudgmental
support for patients’ end-of-life. Preferences and values and
prevention and alleviation of suffering
1. Respect for patient self-determination (end of life care is
just like any other matters that concern patient care, also
allows patient to exercise his right to self-determination, the
right to decide for himself, exercise autonomy and give his full
consent)
2. Nonjudgmental support for patients’ end-of-life
preferences and values (as a nurse hindi dpat pumasok ung
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ating mga prejudices, biases, values na iimpose sa patient. The
people who usually wish the end of life is. What ever it is that
fall under the basic needs of the patient or ordinary measures
that are needed to sustain the life we still continue that)
3. Prevention and alleviation of suffering. (if terminal cases we
need to accept the fact together with the patients that they will
suffer. For example, emotionally, disfigurement, etc. we
cannot prevent suffering because it is natural therefore, we can
only comfort them through the process.)
Therefore, nurses should be clear about the:
• Ethical foundation of their own views on medical aid in
dying (Place yourself in the position of the patient)
• Personal and professional values related to end-of-life
options and care to help them recognize the conditions to
which they may wish to conscientiously object (the time will
come that they will ask you to do contrary to your conscience
at nag pasabi kana na object ka at dpt malinaw ito sa umpisa
pa lang. conscience expression advantage is you will not be
forced to do it.)
Therefore, the American Nurses Association supports
recommendations that nurses:
- It is a shared responsibility of professional nursing
organizations to speak for nurses collectively in shaping health
care. Hence it supports recommendations that nurses:
1. Remain objective when discussing end-of-life options
with patients who are exploring medical aid in dying.
2. Have an ethical duty to be knowledgeable about this
evolving issue.
3. Be aware of their personal values regarding medical aid in
dying and how these values might affect the patient-nurse
relationship.
4. Have the right to conscientiously object to being involved
in the aid in dying process.
5. Never “abandon or refuse to provide comfort and safety
measures to the patient” who has chosen medical aid in
dying (Ersek, 2004, p. 55). Nurses who work in
jurisdictions where medical aid in dying is legal have an
obligation to inform their employers that they would
predictively exercise a conscience-based objection so that
appropriate assignments could be made.
6. Protect the confidentiality of the patient who chooses
medical aid in dying. (This is not something to talk in the
group and not something to be shared who is not direct
provider of care to the patient)
7. Remain objective and protect the confidentiality of health
care professionals who are present during the aid in dying
process, as well as the confidentiality of those who choose
not to be present.
8. Be involved in end-of-life policy discussions and
development (Ersek, 2004) on local, state, and national
levels, including advocating for palliative and hospice
care services.
9. Furthermore, research is needed to better understand the
phenomenon. (Phenomenon kung bakit ung ibang tao
pinipili euthanasia. I-research ntin ung dpt na approach sa
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
pt.para kung ano ung gusto mong gawin sayo sa ganung
sitwasyon ganun dpt gawin mo sa ptient mo)
10. Important that nurses are clear about the ethical
foundations of their own views on medical aid in dying.
11. Clarity about personal and professional values related to
end-of-life options and care can also help nurses
recognize the conditions to which they may wish to
conscientiously object
Advance Directives
- Is a legal document in which a person specifies what actions
should be taken for their health if they are no longer able to
make decisions for themselves because of illness or incapacity.
(What kind of medication should be given to the patient or
who is tasked to decide if something happens to the patient)
- Advance directives are written, legally-recognized documents
that state your choices about health- care treatment or name
someone to make such choices for you if you are not able to
do so (Reyes, 2010).
- nurses have a key role and responsibility in ensuring that
patients have an opportunity to complete advance directives,
and in interpreting and following through with patient’s
wishes as expressed through these directives.
- As nurses, we need to know our state’s statutes that guide and
govern advance directives
- be aware of the policies and procedures regarding advance
directives where we work
Purposes
• Appointment of health care proxy
• Make decision and guide doctors about life sustaining
procedures in the event of terminal condition, persistent
vegetative state and end stage condition i.e DNR, Pain
management, Organ Donation, Euthanasia. (Should be treated
as regular basis or should be given higher doses? Does the
patient decide for organ donation?)
Forms
• Living will
• Health care proxy
• Health care power of attorney – specific for health care only.
Pero pag power of attorney lang it is for how patient will be
taken care of and the finances
Advantage
• Unnecessarily prolonged painful hospitalization
• Prevents unnecessary prolonged comatose or vegetative state
(pumapasok na ung kaisipan kung tatanggalin na ba or hindi
ung life support)
• Prevents burden of rising medical costs (meron kasing family
na inadequate sa budget)
• Releases responsibility of love ones of difficult decisions
(meron nang sariling desisyon ung pasyente para ung maiiwan
nyng kamag anak hindi na mahihirapn mag decide for him)
Disadvantage
• Family or loved ones may disagree with your medical
decisions. (dumating na ung time na nag aagaw buhay ung pt.
kaya ung family sabi gawin lahat kaso bago ka mamatay
sinabi mo ng wag ka ng buhayin)
• Difficulty in predicting what treatments will be available and
preferred in a “future” crisis. (pag meron ka ng advance
directive bawal na siyang bawiin, baka bawiin kase may
J.A.K.E 2 of 12
natuklasan pa alng makakapag pagaling na e kaso Nakagawa
na ng advance directive)
• Uncertainty over who can/should be a health care agent,
especially for individuals without available (or willing) family.
Nursing Role and Responsibilities
• Whatever the work setting, nurses have a key role and
responsibility in ensuring that patients have an opportunity to
complete advance directives, and in interpreting and following
through with patient’s wishes as expressed through these
directives.
• As nurses, we need to know our state’s statutes that guide and
govern advance directives.
• We also need to be aware of the policies and procedures
regarding advance directives where we work. (court will
decide kung pwede pang baguhin ung ginawang advance
directive ng pt.)
Ethical Decision-Making Process
Problem Analysis
- A problem is a discrepancy between the current situation and a
desired state. Problems are usually unplanned and often
unexpected. They may be simple or complex, routine or moral.
Before you can begin to solve a problem, you must be able to
identify and categorize it.
Moral Uncertainty
- occurs when we sense that there is a moral problem, but are
not sure of the morally correct action;
Moral/ethical dilemma
- A dilemma is a problem that requires a choice between two
options that are equally unfavorable and mutually exclusive.
Pattern of decision making
1. Recognizing a problem
2. Gathering data
3. Comparing options/action implies uncertainty – list of options
4. Making a choice/implemented decision
Nursing Process and Ethical Decision Making
• Ethical decision-making models are related to nursing care in
the ethical realm in the same way that the nursing process is
related to nursing care in the physical realm.
• As nurses we commonly use the nursing process model for
decision making.
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
• Utilizing logical thinking and intuitive knowing, the nursing
process is a deliberate activity that provides a systematic
method for nursing practice
Attributes of an Effective Ethical Decision Maker
1. Moral integrity – binds all of a person’s moral virtues into a
coherent package it creates a wholeness and stability of
character that leads to trustworthiness. (kabuuan ng buong
opag katao mo at walang pwedeng makasira nito dahil nabuo
na ‘to simula nung pag ka bata mo)
2. Sensitivity, compassion, and caring - they hear what patients
say and understand the meaning
3. Responsibility. - has a sense of duty to the patient, an
obligation to do whatever is necessary, within reason, to care
for the patient or solve a problem
4. Empowerment - suggests that a person has self-confidence
that he or she can effect change. (paano ka na-eempower to do
things)
5. Patience and willingness to deliberate
What will you do…?
1. In the case of a terminally ill patient. While most would think
it is morally right to preserve life, many would believe it is
morally wrong to prolong suffering.
2. In deciding who must have the priority to get a critical care
bed. Should the decision be made relative to who is most
deserving, who arrives first, who can pay, or who has the best
chance of survival?
3. Would you rather make your own life/death situation via A.D.
or let your loved ones do the decision making?
4. If you are the medical power of your comatose mother would
you have the strength to obey their advance directive if it
stated to turn of the respirator to ease their suffering?
Thoughts to ponder
• “End of life decisions should not be made at the end of life”
(mag desisyon kana habang kaya mo pa essence ng advance
directives kase dk ana makakapag desisyon kapag mamamatay
kana)
• Just because you talk about death it doesn’t mean you are
gonna die right now
• Be brave enough to start a conversation that matters
BIOETHICS AND RESEARCH AND GUIDELINES IN
DOCUMENTATION
Discussed by Prof. Ma. Diosul Roque
Principles of Ethics and Research
Nuremberg code of 1947
- formulated 50 years ago, in august 1947 in Numberg Germany
by American judges sitting in judgement of Nazi doctors
accused of conducting murderous and torturous human
experiments in the concentration camps (the so -called Doctors
Trial). (kinukuha mga prisoners for trials at bawal silang
tumanggi)
• Ethics principles for human experimentation resulting
from Nazi
• Focus on human rights and welfare
10 Elements of The Numberg Code
1. Voluntary consent is essential
2. The results of any experiment must be for the greater good of
society
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3. Human experiments should be based on previous animal
experimentations.
4. Experiments should be conducted by avoiding physical/mental
suffering and injury
5. No experiments should be conducted if it is believed to cause
death /inquiry (kaya meron animals’ experiments muna)
6. The risks should never exceed the benefits
7. Adequate facilities should be used to protect subjects
8. Experiments should be conducted only by qualified scientists
9. Subjects should be able to end their participation at any time
10. The scientist in charge must be prepared to terminate the
experiment when injury, disability or death is likely to occur
Declaration of Helsinki
- Statement of ethical principles for medical research involving
human participants, including identifiable human material and
data; doctors doing medical research on patients (basis for
good clinical practice)
• For all involved in medical research
• Basis for Good Clinical Practice (GCP)
General Principles
• Purpose: understand disease, improve interventions (like covid
vaccines)
• Human participants necessary
• Primacy of patient’s best interest: health, well-being, rights
• Duty and responsibility of researcher even if with consent of
participants (treat subject properly)
• Subject to ethical standards: International and national
guidelines cannot reduce Helsinki
• Respect and protect participants
• Minimize harm to environment
• Qualified researcher
• Fair access to research
Risks, Burdens, and Benefits
• Pre-assess then monitor
• Importance of objectives outweigh R/B for participants.
Benefits outweigh risks for participants and groups affected
and managed
• Measures to minimize implemented
• Once risks outweigh the benefits or if there is already a clear
outcome: assess if research should be continued
Vulnerable Groups and Individuals
• Increased likelihood of wrong and harm – Special protection
• Responsive to their health needs
• Cannot be done on non-vulnerable
• Stand to benefit from result
Scientific Requirements and Research Protocols
• Conform to accepted scientific principles
• Respect animals
• Complete protocol including addressed ethical considerations
• Post-trial provisions indicated
Research Ethics Committees
• Transparent, independent, and qualified
• Follow norms
• Approve protocol
• Monitor study, approve amendments, and receive final report
Privacy And Confidentiality – protect the privacy of research
subjects (hindi identified ung taong kukuhanin mo)
Informed Consent – for capable: voluntary, informed. For not
capable: legally authorized representative;
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
Belmont Report 1976
- Emphasize netizens justice and respect for human person
- One of the leading works concerning ethics and health care
research
- Primary purpose: protection of subjects and participants in
clinical trials or research studies
- Consists of three principles beneficence, justice and respect for
persons
- A report created by the national commission for the protection
of human subjects of biomedical and behavioral research
- summarizes ethical principles and guidelines for research
involving human subjects
- The Belmont Report is a report created by the National
Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research
- Was written in response to the infamous Tuskegee syphilis
study in w/c African American with syphilis were lied to and
denied treatment for more than 40 years. Many people died as
result infected others with the disease and passed congenital
syphilis onto their children
- Also brought forth the creation of the national human
investigation board as well as the request for the creation of
institutional revive boards (IRBs)
The three fundamental ethical principles for using any human
subjects for research are:
1. Respect for persons: protecting the autonomy of all people
and treating them with courtesy and respect and allowing for
informed consent. (Information, comprehension and
voluntariness)
2. Beneficence: the philosophy of "Do no harm" while
maximizing benefits for the research project
3. Justice: ensuring reasonable, non-exploitative, and well-
considered procedures are administered fairly
Ethical Issues Related to Evidenced Based Practice
- Evidence-base practice is a systematic inter connecting
scientifically generated evidence with the tacit knowledge of
the expert practitioner
Ethical issues involved in EBP
1. Status of evidence
2. Client Autonomy
3. Conflict of interest
Ethico-Moral Obligations of The Nurse In Evidence-Based
Practices
1. Golden Rule
2. The principle of Totality – The whole is greater than its parts
3. Epikia – There is always an exemption to the rule
4. One who acts through as agent is herself responsible –
instrument to the crime, accessory or accomplice
5. No one is obliged to betray herself – You cannot betray
yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to
him
9. A little more or a little less does not change the substance of
an act.
10. No one is held to impossible
J.A.K.E 4 of 12
Guidelines and Protocol in Documentation and Health Care
Records
The NCCS Documentation Standard
- Documents are permanent legal records that provide a
comprehensive sequential description of relevant facts, data,
and information about the patient’s health status.
- Documentation of nursing actions done to a patient is critical
to determine if the expected standard of care was rendered to a
particular patient.
Importance of documentation
1. Facilitates interdisciplinary communication
2. Coordinates care
3. Provides information
4. Serves as bases for reimbursement
5. Reflects quality and timeliness of nursing care
6. Is utilized as legal document during permissible courtroom
Characteristics Of Good Documentation
1. Factual
2. Complete
3. Current (Timely)
4. Organized
5. Compliant with standards
6. Accurate
Guidelines In Documentation
1. Objective/Factual Documentation Direct observations and
objective descriptions of interventions rendered to clients are
recorded
2. Timeliness Refers to completion of health care notes
immediately within time specific care
3. Use of Space Empty lines or spaces are avoided to prevent
late-entry of data.
4. Use of Abbreviations Abbreviations or acronyms that are
internationally/institutionally accepted
5. Follow-up All follow-up activities related to client care
6. Correcting Errors In isolated cases when errors in
documentation are committed it is advised that the SLIDE rule
(Baker, 2000) be utilized
7. Recording Medication Administration Administration of
medications are immediately documented after administration
8. Recording Assistance with Care There are numerous
circumstances that one nurse is assisted by another nurse in
performing a specific nursing intervention
9. Designated Recorder in Emergency Situations During
emergency situations there must be a designated recorder
10. Clarification of Orders Medical orders that are poorly written
require nurses to call the writer for clarification.
11. Recording a Telephone Conversation with a Client Telephone
conversation with a client does not give the nurse the benefit
of verifying objective findings
12. Interactions with other Health-care Professionals It is the
responsibility of the nurse when formulating nursing care
plans to include outcomes
13. Client Education Educational interventions and related health
teachings that provide comprehensive information to clients
must be documented
14. Documenting an Incident in the Health-care Record It is
imperative that all incidents that occured with its
corresponding pertinent data are documented in the client’s
health record.
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
ETHICAL CONSIDERATION IN LEADERSHIP
MANAGEMENT
Discussed by Dean Maria Luisa Uayan
Moral Decision – Making
• Right
• Wring
• Forbidden
• Duty
• Good
• Corrupt
- refers to the ability to discern what is morally right from
morally wrong that requires moral reflectiveness on the
meaning of good and bad, Olson (2002)
- It refers to ability to draw conclusions from the
discernment to develop convictions.
- discernment – wisdom, clarification, study the facts
- Moral – is a discernment wherein deliberating the issue
existing hindi ka lang basta basta umoo or nag a-agree
pero kinikilatis mo sya
Four Principles of Moral Discernment/Judgment
Principle of Formal Cooperation
- it occurs when someone intentionally helps another person
carry out a sinful act.
Principle of Material Cooperation
- when a person's actions unintentionally help another person do
something wrong.
Principle of Lesser Evil
- The principle that when faced with selecting from two
immoral options, the one which is least immoral should be
chosen. The gravity, the impact. Kahit maliit na aksyon even
less or great evil kapag nag participate ka evil pa din
Principle of Double Effect
- This principle aims to provide specific guidelines for
determining when it is morally permissible to perform an
action in pursuit of a good end in full knowledge that the
action will also bring about bad results.
Conscience
- the act by which we apply to our own conduct our knowledge
of good and evil, whether our judgment be correct or incorrect.
- to seek wisdom
- Ex. Yung sa Ateno. Doctor ang bumaril, think of this na ang
haba ng ginugol nya sap ag aaral to get that degree but look
what he did to the ex-Mayor of basilan, he shoots the ex-
mayor kase nga feeling nya grabe yung pang aapi sakanya,
grabe yung suffering na binigay sakanya. Nagiging mali ang
pananaw natin sa suffering.
Types of Moral Attitude
Callous
- not feeling or showing any concern about the problems and
suffering of other people
Strict - one who chooses the hardest way to do something
Pharisaical
- marked by insincere self-righteousness
Scrupulous
- involves one who is being overly critical of himself. Such a
person always has a fear of sinning when there is no sin, or is
in constant doubt, and/or is in fear of committing a mortal sin;
tends to see sins when there is none
Lax
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- fails to see a sin when actually there is one, tends to minimize
its seriousness.
Degrees of Moral Certitude
Certain
- the judgment about the goodness or evil of a particular action
that is made without fear of being mistaken
Doubtful/Probable
- the suspension of judgment on the moral goodness or evil of
action because the intellect cannot see clearly whether it is
good or bad (doing good but gone wrong)
Perplexed
- when one is compelled to choose between two evils. (Of two
evils, choose the least.)
Principles of Well – formed Conscience
- Informed consent to medical treatment is fundamental in both
ethics and law.
- Patients have the right to receive information and ask
questions about recommended treatments so that they can
make well-considered decisions about care.
Strategies of Moral Decision – Making Process
Ethical Dilemma
- is a problem in the decision-making process between two
possible options, neither of which is absolutely acceptable
from an ethical perspective;
- Ex. thief. Bakit ang mga magnanakaw hindi nahuhuli? Edi
yung dilemma mo naman is “ay ok lang naman pala mag
nakaw eh kase sila hindi nga nahuhuli, edi ako din
magnanakaw nalang” (mga teh wag nyo gagawin yun ah?
kahit kapit na tayo sa patalim HAHAHAHAHA)
Process of Ethical Decision Making
1) Gather data and identify conflicting moral claims
2) Identify key participants – wag isali ang mga dapat hindi na
kasali. Focus on who will receive the big impact
3) Determine moral perspective and phase of moral development
of key participants – 7 ethical principles
4) Determine desired outcomes – something good
5) dentify options – alternatives
6) Act on the choice
7) Evaluate outcomes of actions – masaya ka ba? Did God
become happy with your decision?
MEANING AND SERVICE VALUE OF MEDICAL CARE
Discussed by Dean Maria Luisa Uayan
Allocation of Health Resources
• Cost-effective
- limited resources for health should be allocated to
maximize the health benefits for the population served
- Quantititave ka pero quality ang nakuha mo
- Sa kunting gastos nakakuha ka ng benefits
- Equity means giving more to the person who needed the
most.
- Costs are measured in monetary terms; benefits are measured
in health improvements.
- Cost-effectiveness is not merely an economic concern,
because improving people's health and well-being is a moral
concern, and an allocation of resources that is not cost-
effective produces fewer benefits than would have been
possible with a different allocation
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
• Equity
- is concerned with the distribution of benefits and costs to
distinct individuals or groups.
- Equity in health care distribution is complex and embodies
several distinct moral concerns or issues that this chapter
delineates (Brock 2003a)
Issues involving access to care
1) Access to Quality Care - Patients want to be able to access
their healthcare when they want and need it.
2) Geographic and Manpower Shortage
3) Limited education
4) Poor infrastructures
5) Cost – kahit walang babayaran sa hospital pero yung mga cost
sa byahe, pagkain ganun
6) Scientific evidence vs Cultural Practice
ETHICAL ISSUES RELATED TO TECHNOLOGY IN THE
DELIVERY OF HEALTH CARE
Discussed by Dean Maria Luisa Uayan
J.A.K.E 6 of 12
Reducing Healthcare Costs
- New technology is a great way to reduce costs, offer better
patient care, and encourage innovation. With the right insights
and data, developers can give the healthcare industry much
more efficient, cheaper, and faster treatment options.
Predicting Epidemics
- Various scientific fields, particularly medical science, have
seen a lot of technological innovation in the last few decades.
Such advancements include the use of natural language
processing, medical image processing, and deep learning
techniques. The influence of AI has added a lot of potential in
the healthcare sector to predict diagnoses faster.
Avoiding Preventable Deaths
- According to healthcare and health industry leaders, using
information technology enhances patient safety by preventing
medical errors, assessment errors, and surveillance system
with rapid response and reduces the risk of harm.
- Information technology improves the healthcare system,
regardless of the type of technology used, by one of the
followings: documentation (test results, clinical reports,
recommendations, and consultation), providing
communication between the patient and each other providers,
facilitating data entry, identification, and evaluation of risks.
Improving quality of life/quality care
- Health information technology presents numerous
opportunities for improving the advancement of medical
technology and is vital to the field's continued development.
Modern medications, monitoring equipment, laboratory
services, and imaging devices have all made significant
contributions to medical progress in terms of improving
quality care.
Reducing Healthcare Waste
- Health care facilities generate a tremendous amount of waste
in the course of treating patients. They generate “regulated
medical waste” or infectious waste, hazardous chemical
waste, recyclable, reusable, and solid waste.
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
- In order to fulfill the medical ethic to “do no harm,” it is the
responsibility of the health care industry to create and
implement waste disposal policies.
- Fulfilling this ethic also calls for a cultural shift to consider
disposal technologies and services as part of a total waste
management system.
Improving Mobility/Access
- Health information technology (HIT) is an important tool to
improve the quality, safety, effectiveness, and delivery of
healthcare services in rural communities. HIT can connect
rural patients and providers in remote locations to specialists
in urban areas.
- Key components of HIT can include: Electronic health
records (EHR), Electronic transmittal of medical test results,
Telehealth applications to increase access to providers,
Telemonitoring applications that allow patients to transmit
vitals or diagnostic information to providers remotely,
Electronic communication between healthcare providers, as
well as patients, Electronic prescribing, Mobile devices and
tablets to update patient records in real-time and document at
the point of care
Developing New Drugs and Treatments
- Technologies are helping drug manufacturers go further and
faster in monitoring patient safety. They’re also helping to
reduce costs and promote efficiencies by reducing manual
input.
- Technology that reports back on how patients are faring may
help drug manufacturers understand the real effectiveness of
their products and help spot side effects that might otherwise
have been missed. It could even help identify emerging
problems and help catch them before they escalate.
Security E.G. Data Hacking/Phishing
- One of the biggest advantages to using technology in
healthcare is the ease in how data is generated, stored, and
transferred between systems and parties. When it works well
this proliferation in data allows for better healthcare
management: from diagnosis to treatment.
- But It opens up the potential risk for data to be accessed by
third parties. Whether intentionally breached by malicious
actors or accidentally exposed, cases abound of patient data
making its way into the wrong hands.
- Those who lack advanced cybersecurity expertise may be
putting the patients who use their systems at risk.
Volume of Data In Icloud
- Cloud computing makes medical record-sharing easier and
safer, automates backend operations, and even facilitates the
creation, and maintenance of, telehealth apps.
- Another great benefit of digital technology is that it allows
clinicians to gather big data in minimal time. For those
conducting epidemiological studies, research, or clinical trials,
digital technology allows for the instant collection of data
from a much more diverse and larger population than ever
before.
- Such data collection allows for meta-analysis and permits
healthcare professionals to stay on top of cutting-edge
techniques and trends.
Dangers with AI central data point
- Artificial intelligence (AI) is rapidly entering health care and
serving major roles, from automating drudgery and routine
tasks in medical practice to managing patients and medical
resources.
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- As developers create AI systems to take on these tasks, several
risks and challenges emerge, including the risk of injuries to
patients from AI system errors, the risk to patient privacy of
data acquisition and AI inference, and more.
Impersonal patient-healthcare provider relationships
- Interpersonal relationships and information are intertwined
as essential cornerstones of health care. Although,
information technology (IT) has begun to develop systems
that allow patients to enter their own clinical data directly
into computer systems, using automation and integration
tools. We are not even close to realizing its full potential.
Indeed, issues related to mismanaging health information
often undermine relationship-centered care. Information
technology must be implemented in ways that preserve and
uplift relationships in care.
Connectivity
- The digital revolution has also resulted in the development of
hundreds of health apps. These apps enable patients to monitor
their health and disease, provide them with medical
information, allow them access to test results, and prompt
them when it is time to get their check-ups. Also, healthcare
apps enable healthcare workers to quickly check on test
results, drug dosing recommendations, and other information
they need urgently.
- With increased demands placed on home internet connections
and the nation's internet infrastructure, users focused on the
quality and affordability of home internet connections.
Cost
- New technology is a great way to reduce costs, offer better
patient care, and encourage innovation. With the right insights
and data, developers can give the healthcare industry much
more efficient, cheaper, and faster treatment options.
Structured methodologies, strong innovation, multidisciplinary
perspective, and an eye for how to adopt and use these
technologies in a clever way can go a long way in making
healthcare better and accessible for all.
Fast and Numerous Changes
- Healthcare Technology Trends and Innovations have enhanced
the entire experience for both patients and medical
professionals.
- healthcare technology will continue to improve in every area.
Although security will improve across the industry, threats are
always evolving that must be dealt with through prevention
rather than response. Quality and efficiency of care will
continue to improve due to groundbreaking and evolving
technologies like artificial intelligence, machine learning, and
extended reality.
Current technology: Issues and dilemma
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
Security
- The privacy and security of patient health information is a top
priority for patients and their families, health care providers
and professionals, and the government. Security breaches
threaten patient privacy when confidential health information
is made available to others without the individual's consent or
authorization.
- Without the correct security protocols, patients’ connected
medical devices may be accessed with the intention of altering
functionality. In the worst-case scenario resulting in serious
device malfunction in life and death situations.
- Cybersecurity risk doesn’t just pertain to the exposure of
private data or the ransoms that are sometimes associated with
data breaches. The risks related to altered data can have
serious consequences. Patients and healthcare professionals
that are relying on data to make treatment decisions depend on
correct and accurate datasets. If data is deleted or altered it can
lead to a wrong diagnosis or treatment plan, or other adverse
events.
Portability
- The ability of software to be transferred from one machine
or system to another may endanger personal information of
the client.
- Even with the most advanced technology, human error can’t
be erased completely. Mobile devices can be easily lost or
stolen, and they’re also vulnerable to hacking, malware, and
viruses (especially if the devices are used on unsecured
internet connections).
Cost
- Medical technology has contributed to rising health care
costs. One of the disadvantages of medical technology is the
increased cost of treatment. Almost all treatments and
surgeries involving technology are extremely costly, such as
robotic surgery. Other kinds of surgeries using technological
machinery can be very expensive too..
- A new technology may bring benefits such as improvements
in service delivery or transparency that are worth extra
expenses. An assessment of the cost-effectiveness and
potential benefits should be made before committing to a
new technology.
Real-Time Events
- Utilizing technology can help keep healthcare professionals
and patients connected, even when they are not physically
present together.
- However, the way in which technology has become the
interface between patients and providers has the potential to
cause issues.
- Dealing with dashboards on connected medical devices and
computers removes the human touch of treatment, resulting
in a lack of empathy towards patient care.
Equity
- Although there has been significant growth worldwide in
access to computers and the Internet, the “digital divide”
continues to be a major form of social and economic
exclusion for many peoples who are struggling with the use
of technology across the globe.
- The phrase “digital divide” is everywhere in healthcare IT.
It’s typically described as a situation in which economic,
educational, and social inequities exist between those who
have computers and online access and those who do not.
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Justice
- Worldwide, digital health is transforming healthcare
systems. It promises to improve population health but may
also result in health disparities. Adopting a fair approach is
thus crucial from an ethical standpoint. Among them are
challenges related to digital illiteracy, which leads to
inequities in access to healthcare, truthful information
sharing to end-users, fully informed consent, and dignity and
fairness in data storage, access, sharing, and ownership. All
stakeholders are responsible for shaping digital health in an
ethical and equitable manner.
CONTINUING EDUCATION PROGRAM ON ETHICO-
MORAL PRACTICE IN NURSING
Discussed by Dean Maria Luisa Uayan
- The health care system in a country is often affected by new
legislation and regulations.
- In the Philippines, the legislative branch of the government
influences the health system by passing laws to improve the
financing, delivery and regulation of the health system,
including approval of the annual budget of the Department of
Health (DOH) and health facilities under the management of
other government agencies.
- Often, lawmakers create these laws in a vacuum, without ever
having had hands-on experience in a health care facility.
- As a result, the laws that they create may not operate as
effectively in health care facilities
- Nurses can take an active role in the legislative and political
process to affect change.
- Nurses have an obligation to patients and to the profession to
take an interest and take part in the formulation of the legal
and political infrastructure in which they operate.
- Keep in mind when lobbying for issues affecting nursing
practice, any appearance of impropriety must be avoided, or it
can endanger your license.
- Payoffs, kickbacks, and gifts of persuasion are illegal,
unethical, and certainly unprofessional.
- Political issues of particular interest to nurses fall into four
distinct categories involving moral values, professional
regulation, the health of individuals in society, and distributive
justice.
- Nurses’ opinions on these issues are based upon personal
experience, ethical orientation, religion, cultural bias, and
several other factors.
Selected Samples of Political Issues
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
Nursing, Policy, and Politics
- Nurses are in the unique position to bring insight and
balance to the policy-making process through knowledge,
experience, and intimacy with the health care needs of
people that
- Professional codes of ethics identify the goals and values of
the profession, and explicitly call for nurses to be involved in
policy formulation.
Nurses’ Roles and Responsibilities in
Health Policy Formulation
- Develop the ability to think, teach, research, and act in ways
that are relative to policy
- Be aware of the impact that policies have on health and on
clinical practice
- Conduct research on health policy issues and find strategic
ways to influence national policy agendas
- Recognize health problems as policy issues as the first step
toward policy formulation
Nursing Political Strengths
- The nursing profession boasts an extremely large number of
political constituents as it is the most sizable group of health
care providers. Acting together, nurses have the potential to be
a formidable political force.
- Nurses have traditionally been perceived favorably by the
public. Public views nurses with respect, trust, and admiration.
- Once nurses become involved in health policy, they usually
continue to become active.
- Nursing Political Weakness
- Being relatively new to the political arena, many nurses are
not astute or comfortable in policymaking or lobbyist roles.
- There has historically been a lack of ideological and political
unity within the profession, a weakness Hadley (1996)
believes stems from the lack of uniform educational
requirements and titles (Western countries).
- Though nurses comprise the largest number of professionals,
they have fewer funds specifically earmarked for intense
lobbying than many other special-interest groups.
Lobbying
- Attempts to influence the passage or defeat of legislation or
attempts to create a favorable climate toward legislation
affecting goals or sides of various parties, special interest
groups, individuals or organizations.
Lobbyist
- An individual who attempts to influence legislation on behalf
of others, such as professional organizations or industries
Grassroots Lobbying
- These are actions taken at the local level to influence
policymakers.
Effective Grassroots Methods for Nurses
1. Registering to vote and voting in all elections
2. Joining professional nursing organizations with policy,
advocacy agendas
3. Working in political candidates’ campaigns
4. Meeting with policymakers or their staff members
5. Attending “meet the candidates” meetings
6. Communicating with policymakers by e-mail, fax, and
telephone
• Registering to vote and voting in all elections
J.A.K.E 9 of 12
- Informed voting is necessary to enhance nurses’ political
power to ultimately improve the health of patients and the
nursing care that they receive.
- Becoming informed involves reading legislative
newsletters and finding out about policymakers’
backgrounds, voting records, and current party and
candidate platforms.
- Discussing your findings with nurse colleagues and others
in the community enhances everyone’s understand ding of
candidates and their positions and facilitates informed
voting.
• Joining professional nursing organizations with policy,
advocacy agendas
- The value of a professional nursing organization is that,
together, the nursing profession is much mire powerful
than any individual RN speaking alone
- Joining a professional nursing organization that has a
political action committee (PAC) can help develop the
necessary skills to understand and participate in political
issues and provide increased access to policymakers.
• Working in political candidates’ campaigns
- Most political candidates are not health professionals and
do not fully-understand health-related issues.
- By becoming involved in political campaigns, nurses can
(and should) educate and inform candidates about health
care issues.
- Nurse supporters may also write letters/e-mails to and/or
call other nurses to tell them about their support of the
candidate and to ask for their vote.
• Meeting with policymakers or their staff members
- Face-to-face meetings provide a great opportunity for
nurses to educate policymakers about health care issues.
- Policymakers are very interested in information that will
increase their knowledge about health care and help them
develop options for future health care policy.
• Attending “meet the candidates” meetings
- A strategy that nursing association can use to determine
which candidate(s) to endorse is to invite all candidates
running for a particular office to a town hall meeting to
discuss their positions and platforms directly with nurses.
- This activity will allow the candidates to talk about their
platform to a group of interested likely voters and afford
nurses an opportunity to voice their experiences, opinions,
and concerns about health care issues and assess the
candidates’ view.
• Communicating with policymakers by e-mail, fax, and
telephone
- Contacting policymakers through letters, e-mail, fax, and
telephone can be effective if properly planned and
implemented.
- Timing of the communication is important: it should be
made early before policymakers publicly commit to a
certain policy option and to send a follow-up
communication immediately before the vote on a
particular bill is scheduled.
The ICN Code of Ethics for Nurses
International Council for Nurses
- The International Council of Nurses is a federation of more
than 130 national nurses' associations, representing the more
than 28 million nurses worldwide.
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022
- ICN works directly with these member associations on issues
of importance to the nursing profession. There is no individual
membership to ICN.
- Operated by nurses for nurses, ICN works in the following
areas:
- Professional nursing practice (e.g., advancing nursing
knowledge to ensure quality nursing care for all and advocacy
for sound health policies globally)
- Nursing regulation (e.g., credentialing, code of ethics,
standards and competencies)
- Socio-economic welfare for nurses (e.g., occupational health
and safety, human resources planning and policy,
remuneration, career development)
- Philippine Nurses Association, with its then-name Filipino
Nurses Association was accepted by the International Council
of Nurses as one of the member organizations during the
congress held in Montreal, Quebec, Canada on July 8–13,
1929.
ICN Code of Ethics for Nurses 2012 Preamble
- Nurses have four fundamental responsibilities: to promote
health, to prevent illness, to restore health and to alleviate
suffering. The need for nursing is universal.
- Inherent in nursing is a respect for human rights, including
cultural rights, the right to life and choice, to dignity and to be
treated with respect. Nursing care is respectful of and
unrestricted by considerations of age, colour, creed, culture,
disability or illness, gender, sexual orientation, nationality,
politics, race or social status.
- Nurses render health services to the individual, the family and
the community and coordinate their services with those of
related groups.
Four Principal Elements of The ICN Code
Nurses and people
- The nurse’s primary professional responsibility is to people
requiring nursing care.
- In providing care, the nurse promotes an environment in which
the human rights, values, customs and spiritual beliefs of the
individual, family and community are respected.
- The nurse ensures that the individual receives accurate,
sufficient and timely information in a culturally appropriate
manner on which to base consent for care and related
treatment.
- The nurse holds in confidence personal information and uses
judgement in sharing this information.
- The nurse shares with society the responsibility for initiating
and supporting action to meet the health and social needs of
the public, in particular those of vulnerable populations.
- The nurse advocates for equity and social justice in resource
allocation, access to health care and other social and economic
services.
- The nurse demonstrates professional values such as
respectfulness, responsiveness, compassion, trustworthiness
and integrity.
Nurses and Practice
- The nurse carries personal responsibility and accountability for
nursing practice, and for maintaining competence by continual
learning.
- The nurse maintains a standard of personal health such that the
ability to provide care is not compromised.
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- The nurse uses judgement regarding individual competence
when accepting and delegating responsibility.
- The nurse at all times maintains standards of personal conduct
which reflect well on the profession and enhance its image and
public confidence.
- The nurse, in providing care, ensures that use of technology
and scientific advances are compatible with the safety, dignity
and rights of people.
- The nurse strives to foster and maintain a practice culture
promoting ethical behaviour and open dialogue.
Nurses and the Profession
- The nurse assumes the major role in determining and
implementing acceptable standards of clinical nursing practice,
management, research and education.
- The nurse is active in developing a core of research-based
professional knowledge that supports evidence-based practice.
- The nurse is active in developing and sustaining a core of
professional values.
- The nurse, acting through the professional organisation,
participates in creating a positive practice environment and
maintaining safe, equitable social and economic working
conditions in nursing.
- The nurse practices to sustain and protect the natural
environment and is aware of its consequences on health.
- The nurse contributes to an ethical organisational environment
and challenges unethical practices and settings.
Nurses and Co-Workers
- The nurse sustains a collaborative and respectful relationship
with co-workers in nursing and other fields.
- The nurse takes appropriate action to safeguard individuals,
families and communities when their health is endangered
by a co-worker or any other person.
- The nurse takes appropriate action to support and guide co-
workers to advance ethical conduct.
INTEGRATION OF ALL ETHICAL THEORIES AND
PRINCIPLES
Discussed by Dean Maria Luisa Uayan
Code of Ethics for Filipino Nurses
- The Health Care Profession
- A special calling characterized by a trusting and caring
relationship which cannot be measured in monetary terms
- Health professionals provide essential services that promote
health, prevent diseases and deliver health care services to
individuals, families and communities.
- The Patient
- A person who is waiting for or undergoing medical treatment
or care.
- People become patients when they seek assistance because of
illness or for surgery.
Patient’s Individual Rights (15)
1) Right to Good Quality Health Care and Humane Treatment
2) Right to Dignity
3) Right to be Informed of His Rights and Obligations as a
Patient
4) Right to Choose His Physician / Health Institution
5) Right to Informed Consent
6) Right to Refuse Diagnostic and Medical Treatment
7) Right to Refuse Participation in Medical Research
8) Right to Religious Belief and Assistance
9) Right to Privacy and Confidentiality
 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022

10) Right to Disclosure of, and Access to. Information - Repeat back to patient what professional heard that seems
11) Right to Correspondence and to Receive Visitors significant and to ask whether it is what the patient meant
12) Right to Medical Records - Confidentiality –maintain and protect patient’s information
13) Right to Health Education
14) Right to Leave Against Medical Advice Nurses as Professionals
15) Right to Express Grievances • Beletz (1990) describes a professional as “one bound by
values and standards other than those of his or her employing
Patient’s Societal Rights (9) organization, setting one’s own rules, seeking to promote
1) Right to Health standards of excellence, and being evaluated and looing for
2) Right to Access to Quality Public Health Care approval from one’s own professional peers.
3) Right to a Healthy and Safe Workplace • Jameton (1984) suggests that being a professional as similar to
4) Right to Medical Information and Education Programs having a calling – “something one feels called upon to do,
5) Right to Participate in Policy Decisions perhaps by God, by some deep need in one’s being, or by the
6) Right to Access to Health Facilities demands of historical circumstance. A calling is central to
7) Right to an Equitable and Economical Use of Resources one’s life and gives it meaning.”
8) Right to Continuing Health Care • Reed (2000) proposes that nursing is a spiritual discipline,
9) Right to Be Provided Quality Health Care in Times of “one in which the person is said to be “called” or “launched
Insolvency towards others.

Patient’s Obligations (16) Ethical Codes

1) Know Rights
2) Provide Adequate, Accurate and Complete Information
3) Report Unexpected Health Changes
4) Understand the Purpose and Cost of Treatment
5) Accept the Consequences of Own Informed Consent
6) Settle Financial Obligations
7) Respect the Rights of Health Care Providers, Health Care
Institutions and Other Patients
8) Obligation to Self
9) Provide Adequate Health Information and Actively Participate
in his/her Treatment
10) Respect the Right to Privacy of Health Care Providers and
Institutions
11) Exercise Fidelity on Privileged Communication
12) Respect a Physician's Refusal to Treat Him
13) Respect the Physician's Decision on Medical Reasons based
on his/her Religious Beliefs
14) Ensure Integrity and Authenticity of Medical Records
15) Participate in the Training of Competent Future Physicians
16) Report Infractions and Exhaust Grievance Mechanism
Health Care Provider
- any physician, dentist, nurse, pharmacist or paramedic and
other supporting health personnel, including, but not limited
to, dental and medical technicians and technologists, nursing
aides, therapists, nutritionists trained in Health Care and/or
duly registered and licensed to practice in the Philippines as
well as traditional and alternative Health Care practitioner
- any physician, dentist, nurse, pharmacist or paramedic and
other supporting health personnel, including, but not limited
to, dental and medical technicians and technologists, nursing
aides, therapists, nutritionists trained in Health Care and/or
duly registered and licensed to practice in the Philippines as
well as traditional and alternative Health Care practitioner
Health Care Provider-Client Relationship
- Patient advocate (keep patient’s best interest)
- Concern for patient’s well-being
- Knowledge and skill of his/her profession
- Listen to patient
- Systematic guides for developing ethical behavior
- Answer normative questions of what beliefs and values should
be morally accepted
- No code could possibly provide absolute or complete rules that
are free from conflict and ambiguity
Codes of Nursing Ethics
- An explicit, written articulation of the primary goals and
values of the profession
- A means by which a discipline articulates the values that
regulate the conduct of members
- Direct nurses to base professional judgment upon
consideration of consequences and the universal moral
principles of respect for persons, autonomy, beneficence, non-
maleficence, veracity, confidentiality, fidelity, and justice.
Themes of Nursing Ethics
Caring
• Care is the root of ethics (May, 1969).
• The origins of caring in nursing can be traced to the work and
writing of Nightingale.
• Leininger (1984) – “care is the essence and the central,
unifying, and dominant domain to characterize nursing
• Corcoran-Perry (1991) – nursing as the “study of caring in the
human health experience”
• Watson (2010) – “caring is a professional and ethical covenant
that nursing has with society”
• Martha Rogers (1966) – “Nursing is the compassionate
concern for human beings. It is the heart that understands and
the hand that soothes.”
Expertise
• Relates to the characteristics of having a high level of
specialized skill and knowledge.
• Nightingale recognized the importance of an education
consisting of depth and breadth of general knowledge,
combined with a very specific nursing focus.
• Professionals must have the knowledge and functional skills
required to meet the needs of society and thereby fulfill the
purpose of the profession.

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 BIOETHICS – BSN 2ND YEAR SUMMER FINAL 2022

• Expertise allows professions to maintain autonomy because
society trusts that professionals are the only ones who fully
understand the work of the profession.
• Long years of study, minimum level of competence through
licensure exam, and continuing education programs
Autonomy
• To maintain integrity and fully exercise ethical practice, we
must be autonomous.
• 2 levels of nursing autonomy: (1) autonomy of the profession
and (2) autonomy of the individual practitioner
• Self-regulation is the mark of collective professional
autonomy; credentialing such as licensure, educational
requirements, certification are the means by which nurses
restrict others from doing the same work.
• Autonomous practice serves as a safeguard for the patient,
nurse, physician, and institution.
• Nursing codes of ethics support the nurse’s autonomous
decision making and responsibility.
Accountability
• Means that a person has an obligation to accept responsibility
and to account for his or her actions.
• Because society places trust in nurses (gained through
recognition of nurses’ expertise), and because society gives the
profession the right to regulate practice, individual
practitioners and the profession itself must be both responsible
and accountable.
• The Code of Ethics for Filipino Nurses state that a registered
nurse is responsible for all individual actions.
• Article I. Preamble
• The Filipino registered nurse believing in the worth and
dignity of each human being, recognizes the primary
responsibility to preserve health at all cost.
• This encompasses promotion of health, prevention of illness,
alleviation of suffering, and restoration of health. If restoration
of health is not possible, assistance towards a peaceful death
shall be his/her obligation.
• To assume this responsibility, registered nurses must utilize
the therapeutic process to gain knowledge and understanding
of man’s cultural, social, spiritual, psychological, and
ecological aspects of illness.
strive to perform their work in the best interest of all
concerned.
Article IV. Registered Nurses and Co-workers
1. The Registered Nurse is in solidarity with other members
of the healthcare team in working for the patient’s best
interest.
2. The Registered Nurse maintains collegial and
collaborative working relationship with colleagues and
other health care providers
Article V. Registered Nurses, Society, and Environment
1. The preservation of life, respect for human rights, and
promotion of healthy environment shall be a commitment
of a Registered Nurse.
2. The establishment of linkages with the public in
promoting local, national, and international efforts to meet
health and social needs of the people as a contributing
member of society is a noble concern of a Registered
Nurse.
Article VI. Registered Nurses and the Profession
1. Maintenance of loyalty to the nursing profession and
preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited
professional organization (PNA),and other professional
organizations of which the Registered Nurse is a member
is a lofty duty.
3. Commitment to continual learning and active participation
in the development and growth of the profession are
commendable obligations.
4. Contribution to the improvement of the socio-economic
conditions and general welfare of nurses through
appropriate legislation is a practice and a visionary
mission.
Article VII. Administrative Penalties, Repealing Clause and
Effectivity
1. The Certification and Registration of the Registered Nurse
shall either be revoked or suspended for violation of any
provisions of this Code.

Article II. Registered Nurses and People

1. Values, customs, and spiritual beliefs held by individuals
shall be respected.
2. Individual freedom to make rational and unconstrained
decisions shall be respected. Good luck sa Final exam guys, after nito 3rd yr na us yey – Aki
3. Personal information acquired in the process of giving
nursing care shall be held in strict confidence.

Article III. Registered Nurses and Practice

1. Human life is inviolable.
2. Quality and excellence in the care of the patients are the
goals of nursing practice.
3. Accurate documentation of actions and outcomes of
delivered care is the hallmark of nursing accountability.
4. Registered Nurses are the advocates of the patients: they
shall take appropriate steps to safeguard their rights and
privileges.
5. Registered Nurses are aware that their actions have
professional, ethical, moral, and legal dimensions. They

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