BIOETHICS
IMPORTANCE OF HEALTH CARE ETHICS
● Bioethics in healthcare brings
understanding and knowledge among
healthcare professionals about medical
practice.
● Bioethics involves medical ethics and
studying about equilibrium between
benefits, harm and duties. It does have an
influence both on patients and health
professionals
● Relevance of bioethics varies from birth to
end of life.
● Bioethics not only provides a guideline to
medical professionals about clinical
decision-making, advancements in medical
technologies, but also playing vital role in
policy changes and legislation in recent
years.
● Bioethics is a blend of scientific and
humanistic constituent and does not have
need of the recognition of certain
long-established standards that are basic
to medical ethics.
● Bioethics contributes to the rights and
responsibilities of patients as persons.
● Its significance replicates in various
divisions e.g. medical care, researches and
overall community
Ethical problems are created as a result of:
● Changes in the society
● Advances in technology
● Scientific advances
● Conflicts within the nurses re itself
● Nurses conflicting loyalties & obligation
● As technology has expanded, the role of the
nurse, the ethical dilemmas associated with
the client care have increased & often
become legal issues as well.
● Nurses familiarity with ethico-moral-legal
implications of nursing enhances their
ability to be client advocate.
Definition of Terms
Ethos – moral duty. Refers to a standard of a
moral life.
Moralis – social consensus about moral
conduct.
Ethics- “What should I do in this situation?”
● A set of principles of right or good conduct
concerned with values and morality
● Method of inquiry about the rightness or
wrongness of human actions
● The science which guides one’s judgment
concerning the morality of human acts
Morality
● Quality of human acts where the acts could
either be good or right, evil or wrong
● Concerned with what people believe to be
right or good conduct
● The act is good when it is in conformity with
the dictates of right reason
● The act is evil when it is not in conformity
with and is in transgression of the dictates
of the right reason
Philosophy
● 2 Greek words “philos” (love) and “sophia”
(knowledge/ wisdom)
● Love of wisdom to person makes a
deliberate effort to seek the truth
● Defined as the knowledge of all things
acquired through the use of reasoning
● Main objective: to seek explanation for
existence and the nature of being
Moral Philosophy
● Philosophical discussion of what is
considered good or bad, right or wrong in
terms of moral issues
Code of Ethics
● declarations of faith, beliefs and ideals
which the profession upholds and the
members conform to and follow
● “statement about what the profession itself
believes and its purpose to be”
Example:
Amended Code of Ethics for Nurses:
Pursuant to section 3 of Republic Act No. 877,
known as the Philippine Nursing Law, and Section 6
of P.D. No. 223
Foreword. Health is a fundamental right of every
individual. The nurses’ primary responsibility is to
preserve health at all cost. This responsibility
encompasses promotion of health, prevention of
illness, alleviation of suffering and restoration of
health.
Code of conduct
● Paradigm of moral action or a framework of
behavior
● “a statement about how the profession
considers its members should behave
toward clients, the society as a whole and
each other”
Example: human life in all its aspects from the
1. The patient and his / her family are entitled moment of its conception to its
to know information or facts within the natural end.
limits determined by the physician.
2. Any information gathered by the nurse Scope of Bioethics
during the course of caring for the patient 1. Ethical problems associated with medical
shall always be treated confidential. This practice e.g. abortion
duty extends even after the patient’s death. 2. Social issues related to health, animal
welfare and environmental concern
Christian Health Ethics
● Each human being is created by God in his Significance of Bioethics
own image and likeness, thus the worth of 1. Keep members of the health profession
the person is based on his biblical aware of the do’s and don'ts of medical
teachings practice
● The best way to solve ethical issues in the
health care delivery system is to appeal to 2. Enhance their competence by
God since He is the source of truth, morals understanding that the patient is a person
and justice and a holistic

Elements Determining Morality 2. Health ethics

● Science that deals with the study of
1. The act itself
morality of human conduct
2. Purpose - reason for which the act is
concerning health and health care
performed
● Health care -medical services,
3. Circumstances - factors distinct from the
nursing care & all other types of
act itself and from the purpose which may
health services given by health care
affect the morality of an act
practitioners who in one way or
another engage in any duly
Ethics and Morality
recognized form of health care
practice

Bioethics & Health Ethics

3. Nursing ethics
Divisions of Ethics ● Deals with the ethico-moral behavior
1. Bioethics in the practice of nursing
a. The science that deals with the study ● Nursing professional ethics- treats of
of the human conduct concerning the moral principles, duties or
 behavior of the members of the
nursing profession toward their
co-nurses, to their profession, to
other health care workers, to the
patients and to the public in general
Example:
Nightingale Pledge
I solemnly pledge myself before God and in
the presence of this assembly to pass my life in
purity and to practice my profession faithfully.
I will abstain from whatever is deleterious
and mischievous and will not take nor knowingly
administer any harmful drug.
I will do all in my power to maintain and
elevate the standard of my profession.
I will hold in confidence all personal matters
committed to my keeping and all family affairs
coming to my knowledge in the practice of my
profession.
With loyalty will I endeavor to work closely
with the health team and devote myself to the
welfare of those committed to my care.
So help me GOD.
4. Professional ethics
● Relates to professional behavior;
includes moral duty or obligation
which a member of the profession
owes to the public, to his profession,
to his colleagues and to his clients.
● 3 main functions:
○ To reassure the public
○ To provide guidelines for the
profession to discipline and
regulate its members
○ To provide a framework in
which individual members
can formulate their decisions
Example:
Criteria of a Profession:
1. Must satisfy an indispensable social need
and must be based upon well established &
socially accepted scientific principles
2. Must demand adequate pre-professional
and cultural training
3. Must demand the possession of a body of
specialized and systematized training
4. Must give evidence of needed skills which
the public does not possess
5. Must have developed a scientific technique
which is the result of tested experience
6. Must require the exercise of discretion &
judgment as to time & manner of
performance of duty
7. Must have a group of consciousness
designed to extend scientific knowledge in
technical language
8. Must have sufficient self- impelling power to
retain its members throughout life.
9. Must recognize its obligations to society by
insisting that its members must live up to
an existing code of ethics.
Ethical Systems
1. Islamism - A philosophy of life, a complete
system of living based on the word of God
revealed to Mohammed. The five pillars:
a. Confession of Creed: there is no God
but Allah and Mohammed is his
prophet
b. Prayer brings man in the right
relationship with God
c. Charity
d. Observance of the Ramadan
e. Pilgrimage to Mecca
2. Buddhism - The Greatest Value is the
liberation of man from suffering through
the abandonment of all egoistic desires.
Four noble truths:
a. Life is the root of all sufferings.
b. Sufferings are caused by desires.
c. Desires can be eliminated by
negating life.
d. Elimination of desires can be
achieved by accumulating karma or
deeds that eventually free the
individual.
3. Communism (Karl Marx) - The Greatest Good
is absolute equality. The mission is the
production of material wealth by means of
collective labor so that each would give
according to his powers and would receive
according to his needs. A classless society.
4. Christianism - Based on the teachings and
life of Jesus Christ. The greatest value is
Love because God is Love. Christian
morality is essentially based on love which
embraces even the enemy.
TYPES OF ETHICAL SCHOOLS OF THOUGHT
1. KANTIAN ETHICS
● a set of universal moral principles
that apply to all human beings,
regardless of context or situation.
● A good person is someone who
always does their duty because it is
their duty. It is fine if they enjoy
doing it, but it must be the case that
they would do it even if they did not
enjoy it. (Kant)
● Kant's moral theory is often referred
to as the “respect for persons” theory
of morality.
● The overall theme is: to be a good
person you must be good for
goodness sake
Example:
If you hide an innocent person from violent
criminals in order to protect his life, and the
criminals come to your door asking if the person is
with you, what should you do?
Kantianism would have you tell the truth, even if it
results in harm coming to the innocent person?
● Truth-telling is a key issue in the
nurse–patient relationship in the oncology
setting. Oncology nurses always encounter
the challenge of truth-telling to patients
with cancer. Nurses make decisions on a
regular basis regarding what information to
tell cancer patients.
● Study reported that most oncology nurses
expressed that truth-telling was the
physician's responsibility. The participants
also expressed that truth-telling was
difficult for them. Other nurses expressed
that family members required that the truth
of cancer diagnosis and prognosis be
concealed. Information issues have been
reported to impact the psychological
well-being of patients with cancer. (Huang
et al)
2. Rawl’s Ethic
● defines individuals as; healthy,
physically and psychologically able
and rational equal ideals.
● The first principle of justice is to
have equal access to the essential
resources for welfare, self-respect,
fundamental liberties and fair equal
opportunity; the primary social
goods.
● In A Theory of Justice, Rawls
attempts to reconcile freedom and
equality in a principled way, offering
an account of "justice as fairness".
● Central to this effort is his famous
approach to the seemingly
intractable problem of distributive
justice.
Example:
● We think it is fair and just when a parent
gives his own children more attention and
care in his private affairs than he gives the
children of others;
● we think it is fair when the person who is
first in a line at a theater is given first
choice of theater tickets;
● we think it is just when the government
gives benefits to the needy that it does not
provide to more affluent citizens;
● we think it is just when some who have done
wrong are given punishments that are not
meted out to others who have done nothing
wrong;
● Justice in nursing relates to impartiality
regarding a patient's age, ethnicity,
economic status, religion, or sexual
orientation. Examples of justice in nursing
include impartiality when assigning clinical
or prioritizing patient care.
3. St. Thomas Aquinas
● Virtues are habits or dispositions
that enable human beings to act in
accordance with natural law.
● Virtues are acquired through
practice and habituation, and they
enable human beings to develop the
capacity to act in accordance with
reason and to control their desires.
● Virtue denotes a certain perfection
of a power. A thing's perfection is
considered chiefly in regard to its
end. But the end of power is act.
Wherefore power is said to be
perfect, according as it is
determinate to its act.
● Thomas defined the four cardinal
virtues : prudence, temperance,
justice, and fortitude.
● The cardinal virtues are natural and
revealed in nature, and they are
binding on everyone.
● There are, however, three theological
virtues: faith, hope, and charity.
These are supernatural and are
distinct from other virtues in their
object, God.
● Virtue ethics in nursing can be viewed
as an approach of ethical deliberation
about the moral character and
dispositions of nurses as moral agents
that enables them, as virtuous human
beings, to fulfil their purpose and
function as professional people.
4. Ross Ethics
● The ethical theory of W.D. Ross
speaks to several moral obligations
and reflects common-sense moral
commitments.
● Ross devised seven categories of
what he called prima facie duties,
with a person's actual moral duties
dependent on relationships and
context.
● Per Ross's ethical principles, all
human beings should follow before
the factors such as the benefit or
utility of outcomes and results, like
justice-fair distribution of benefits,
risks, and costs.
● Ross perceived that moral rules
should not be absolute and
inflexible.
● Moral rules serve as moral
guidelines in such a way that they
must be adjusted and modified.
 ● Prima facie - means “at first view” or
“as it appears.”
TYPES OF PRIMA FACIE DUTIES
● Duty of Fidelity - telling the truth, keeping
actual implicit promises
● Duty of Gratitude - recognizing the service
others have done for us
● Duty of Justice - preventing distribution of
pleasure or happiness that is not in keeping
with the merit of the people involved.
● Duty of Beneficence - helping to better the
condition of beings with respect to virtue,
intelligence and comfort
● Duty of Improvement - bearing ourselves
with respect to virtue or intelligence
● Duty of Non-maleficence - avoiding or
preventing injury to others
● Duty of Reparation - righting the wrong we
have done to others
● Duty of Compensation – to do good to make
up for the repair to the damage done
Moral Principles
● Principle- a comprehensive and
fundamental law or doctrine
● Moral Principle- a fundamental rule of moral
law containing certain truth from which
knowledge of a definite moral action for
performance proceeds along with the
provision of solution to specific moral
problems or issues
BASIC MORAL PRINCIPLES
1. Principle of Stewardship
● A person’s responsibility to take care
of, nurture and cultivate what has
been entrusted to him
● In health practice, execution of
responsibility of the health care
practitioners to look after, provide
necessary health care services &
promote the health & life entrusted
to their care
● Man has dominion over God’s
creations, himself (life and health),
other creatures and the
environment.
● One should reasonably, responsibly
and respectfully protect them or
benefit from them for service, and
not domination.
● We have to treat them with utmost
respect, use originality, creativity to
cultivate them, know and respect
their limits. We cannot contradict
human nature.
Case Example:
Marissa, a 16 year old girl is pregnant- on her
gestational embryonic stage. Her pregnancy was
caused by gang rape. She was notified that a
certain school of medicine is looking for specimen
for embryonic stem cell research. Marissa submits
the embryo in her womb. She was paid by the
school of medicine.
Analysis:
1) A human embryo is a gift from God that
needs to be nurtured, taken cared of and
given the opportunity to reach maturity
stage towards birth
2) The institution supposed to sustain &
promote life destroys it under the guise of
medical research
2. Principle of Beneficence
good must be done either to oneself or to
others
- To do good and not to do harm
- One ought to prevent evil or harm
- One ought to remove evil of harm
3 major components
1) Do or promote good
2) 2. Prevent harm
a) ICN Code of Ethics (2000)- “The
nurse takes appropriate
action to safeguard individual
when their care is
endangered by a co- worker
or any other person”
3) 3. Remove evil or harm
a) Express concern to person
carrying out questionable
practice
b) Report practice to proper
authority
Example:
● Providing ALL patients including terminally
ill patients with EQUAL CARING attention
● Treating every patient with respect and
courtesy
● Obligation to help others further their
legitimate and important interests
● Contribute to the well being of another
Case Example:
A patient is suffering from severe renal failure
because of cancer of the kidney. He refuses to
undergo dialysis. The attending nurse continues to
take care of him by calling the Chaplain to
administer the last sacraments, by bathing and
providing him personal hygiene and by just being
there.
Analysis:
 ● Attending to a dying patient is a great act
of self- giving
3. Principle of Non- maleficence
● Evil or harm should not be inflicted
on oneself or on others Do no harm
● Do not commit acts that cause
deliberate harm
Ex. Experimental research
● Avoid harm as a consequence of
doing good
Ex. Immunization of infants
Example:
● Working within the scope of nursing
practice
● Observing safety rules and precautions
● Perform procedures according to protocols.
Never do shortcuts!
● Ask appropriate person if in doubt or
unsure
● Continuing Professional Update
Non- maleficence
Some violations:
● Physically harming a person as in suicide,
abortion, infanticide, mutilation, torture &
violence
● Exposing a person to physical harm e.g.
subjecting him to unnecessary treatment or
to a dangerous procedure without a
commensurate important goal
● Harming a person’s reputation, honor, property
or interests e.g. revealing confidential
information
Case Example:
A man driving his motorcycle slides but manages
to go to the hospital for treatment. He suffers
minor abrasions and contusions. The attending
nurse applies hydrogen peroxide and betadine to
the injured areas. The application of the antiseptic
is painful as verbalized by the patient. Does this
contradict the principle? Why?
4. Principle of Double Effect
● considers moral values & allows an
act that necessarily has evil and
good effects. The dual effects are
expected although the evil is not
intended
Principle of double effect guiding elements:
● The act must be good in itself or at least
morally neutral
● The good must not follow as a consequence
of the secondary harmful effects
● The harm must never be intended but
merely tolerated as casually connected with
the good intended
● The good must outweigh the harm
When the Principle of Double Effect cannot be
Invoked
1) When the act by its nature is evil.
2) When the good effect directly proceeds
from the evil effect and not from the act
itself
3) When there is no sufficient reason for the
performance of an act with 2 effects, one-
good, the other- evil
4) When the motive of the agent is not honest
5. Cooperation
● is the participation of one agent with
another agent to produce a
particular effect or joint effect.
● Cooperation becomes a problem
when the action of the primary agent
is morally wrong.
Example :
A nurse assisting a doctor to perform an abortion
(she herself does not kill the fetus but she helps
the doctor to kill the child), a janitor disposing of
the fetal remains after the abortion
● Cooperation demonstrates the ability to
work effectively and respectfully with
diverse people or teams, make
compromises, build consensus in
decision-making, assume shared
responsibility for collaborative work, and
value the opinions and contributions of
individual team members, from a position
of firm self-identity.
6. Solidarity
● means to be one with others. in the
provision of healthcare, it is most
important for the provider to be in
solidarity with the patient when
seeking, always, the latter’s best
interest.
● pursuit of justice and peace.
● Solidarity is a recognition that we
are 'all in this together,' and is a
commitment to strengthen
community and promote a just
society.
● Healthcare providers should treat all
people with the same level of dignity
and respect. The healthcare system
is designed so that everyone
receives the best possible treatment.
Example:
If the group values the principle of respect for
every point of view, then during a discussion they
will always take the time for everyone to speak who
has a different point of view. They will not use a
“majority vote” to silence the respectful
consideration of all minority viewpoints.
7. Veracity
● The obligation tell the truth and not
to lie or deceive others.
● To maximize the efficiency of
healthcare, the patient and the
healthcare providers are bound to
tell the truth.
● The patient has the responsibility to
provide, to the best of his
knowledge, accurate, and complete
information, about his complaints,
past illness, previous
hospitalizations, medications being
taken, allergies, religious restrictions,
and other matters relevant to his
health.
● The physician should tell the patient
and his family his diagnosis, plan of
care, treatment and possible risks
involved, possible expenses and
other options they make take if there
be any.
The Principle of Veracity
● It is at its core respect for all persons by
being truthful.
● Veracity is the opposite of the concept of
paternalism, which assumes patients need
to know only what their physicians choose
to reveal.
Rules of Veracity:
● Obligation to tell the truth
● Not to lie or deceive others
● Respect for others
● Implicit promise
● Relationships of trust
Examples:
Admit mistakes promptly.
Offer to do whatever is necessary to correct them
Refusal to participate in any fraud
Give an “honest day’s work” every day
8. Confidentiality
● Relates the concept of privacy.
● Information obtained from an
individual will not be disclosed to
another unless it will benefit the
person or there is a direct threat to
the social good.
Rules of privacy
● Limited access to person and personal
information
● Access allowed to build or maintain
relationships
Privacy violated
● Outsider breaks into a database
● Universal compulsory screening
Limits of Confidentiality
● Harm principle - maintaining confidentiality
will result in preventable wrongful harm to
others
Ex. Venereal disease
● Vulnerability principle - risk or susceptibility
to harm when vulnerable individuals have a
relative inability to protect themselves
Ex. Child abuse
Confidential information may be revealed only
when:
● The patient himself / herself permits such
revelation
● The case is Medico-Legal such as
attempted suicide, gunshot wounds
● The patient is ill of communicable disease
and public safety may be jeopardized
● Given to members of health team if
information is relevant to his or her care.
9. Nursing Malpractice vs Nursing Negligence
Nursing Standard of Care Violation
● A nursing standard of care violation
occurs when a nurse fails to provide
care that meets the accepted
standards of nursing practice.
● The nursing standard of care refers
to the level of care that a reasonably
prudent nurse would provide under
similar circumstances.
● Nurses are held to a high standard
of care, and when they fail to meet
this standard, they can be held
liable for any harm that results.
Example:
● Medication Errors
○ Nurses must ensure that
medications are administered
correctly and at the appropriate
time.
○ A medication error can occur if a
nurse administers the wrong
medication, the wrong dose, at the
wrong time, to the wrong patient, via
the wrong route, or prepared
improperly
● Failure to Communicate
○ Nurses must communicate
effectively with other healthcare
providers, including doctors, other
nurses, and support staff.
○ Failure to communicate can result in
misdiagnosis, delayed treatment, or
other adverse outcomes.
 ● Patient Falls and Injuries ● Negligence - refers to a breach in the
○ Nurses must take steps to prevent standard of care provided by a nurse that
patient falls, including monitoring results in harm to a patient.
patients who are at risk of falling
and ensuring that patients have An example of medical negligence would be
appropriate assistive devices. if a nurse failed to properly monitor a
patient’s vital signs and as a result, the
When a nurse violates the nursing standard of care patient goes into cardiac arrest.
and a patient is harmed as a result, the nurse may be
held liable for malpractice. Even if the nurse followed all of the standards
of care procedures, if they were not monitoring
10. Malpractice vs. Negligence the patient’s vitals closely enough they could
● Malpractice - any professional be considered negligent.
misconduct or any unreasonable
lack of skill or fidelity in the Examples of Nursing Negligence:
performance of professional or ● Failing to report significant changes in a
judiciary duties. patient’s condition to the physician or other
● Nursing malpractice is a type of members of the healthcare team.
negligence in which a nurse fails to ● Failing to properly assess a patient’s
provide the expected standard of condition, leading to a delay in treatment.
care, resulting in harm to the patient. ● Failing to follow a physician’s orders or
treatment plan.
This means that even if the care they ● Failing to properly supervise nursing
provided was not negligent, it would assistants or other staff members.
still be considered nursing malpractice ● Failing to provide adequate education or
if they failed to meet any one of the instruction to a patient or family member
nursing standards of care. regarding care instructions, medications, or
self-care management.
Examples of Nursing Malpractice: ● Failing to properly document a patient’s
care or medication administration
● Failing to turn or reposition a patient,
● Failing to properly use and maintain
leading to pressure ulcers.
medical equipment, leading to injury or
● Failing to provide adequate nutrition or
harm to a patient
hydration, leading to malnutrition or
● Failing to follow infection control protocols,
dehydration.
leading to the spread of infectious diseases.
● Failing to respond to a patient’s call light or
● Failing to provide adequate pain
request for assistance in a timely manner
management or symptom relief to a patient.
leading to injury or delayed treatment.
● Failing to advocate for a patient’s needs or
● Administering the wrong medication or
rights, such as ensuring informed consent
dosage, leading to adverse reactions or
or addressing concerns with the healthcare
harm.
team
● Failing to properly document a patient’s
care, including vital signs, medication
administration, and changes in condition.
● Failing to provide appropriate patient
education or discharge instructions,
leading to poor health outcomes or
readmission to the hospital.
● Failing to follow infection control protocols,
leading to the spread of infectious diseases
● Failing to properly administer or monitor
the use of medical equipment, such as
ventilators or feeding tubes.
● Failing to properly monitor a patient’s
condition, leading to delayed diagnosis or
treatment
● Failing to properly clean and dress a
wound, leading to infection or delayed
healing.