Week 8
Abortion
- Premature termination of a
pregnancy.
- Expulsion of non-viable fetus
Types of Abortion
1. Natural/Spontaneous/ Accidental
Abortion
- Removal through accidental
causes.
2. Direct/Intentional Abortion
- Planned removal before it
has become viable / survived
3. Therapeutic Abortion
- Removal of fetus in order to
save mother from death
4. Eugenic/ Selective/ Abortion on
Fetal Indication
- Discovered that the fetus has
anatomical defects & can’t
lived once delivered.
5. Indirect Abortion
- Fetus will be removed as a
secondary effect of the
procedure done to save the
mother's life.
When is abortion become morally right?
1. Always MORALLY WRONG - kase
nagteterminate ka ng life
Artificial Insemination by Husband (AIH)
- Sa husband mismo galing yung
sperm
Artificial Insemination by donor (AID)
- Same as that of AIH except that the
sperm donor is used instead of the
husband.
What is Morally Wrong in Artificial
Insemination?
- it damages the correct term/
prescribe use of marriage
- No unitive aspect of husband & wife
- Procreative aspect (people playing
as God) (iniisip ng tao na kaya
nilang bumuhay ng tao)
- Ginagawang business
Surrogacy
- Carrying pregnancy for intended
parents
Surrogate - substitute or deputy for another
person in specific role
Types of Surrogacy
Gestational Surrogacy
- The child is not biologically
related to surrogate mother
- Also called host surrogacy
/full surrogacy
Pros: - Same sex marriage
- Maintain a genetic link to their child
- Create a meaningful relationship
with their surrogate
Cons: - generally a legally complex & costly
process
- Requires intended parents to
abandon some control as someone
else carries the pregnancy
- If the proposed mother is using
her own eggs in the surrogacy
process, she will have to undergo
fertility treatments and other
medical procedures.
2. Traditional surrogacy - The
surrogate mother uses her own
egg and is artificially inseminated
using sperm from the intended
father or a donor.
- Also known as partial
surrogacy/ genetic surrogacy
Pros: - usually less expensive
- Intended mothers do not need to
undergo medical procedures (eggs
will not be harvested).
Cons: - A traditional surrogate has parental
rights and the power to change her
mind and keep the baby. The
intended parents would then need
to go to court to gain custody of
the child.
2 types of surrogacy arrangements
1. Altruistic Surrogacy
2. Commercial Surrogacy
Ethical Issues
● Ginawang negosyo (pataasan ng
binding)
● Male can distribute as many, hindi
mo alam yung magiging partner mo,
kapatid mo pala (incestous)
To minimize this issue, we need to
considered our ethical principle
Week 9
Withhold and Withdraw Life Support
Withholding - hawak mo lang, hindi mo
ibibigay
- Not to give it at nall
Withdrawing - Stop what is already given
Life Sustaining treatment
● Ordinary Care - Basic Treatment
- help to prolong the pt life
- Must be provided as much as
possible
Example: IVF, NGT feeding, oxygen,
quality of daily living
● Extraordinary Care - Invasive
Treatment
- Present gadgets/ medicines
are no longer for further use
due to futility.
Example : Craniotomy , CPR, Experimental
Treatment, Ventilator, dialysis
● Cardiopulmonary resuscitation
(CPR)
- Used to reverse clinical sign
of death
- Revive
- Loss of cardiac function
- Some pt don’t want to
resuscitate
When to stop CPR?
- Futile/ Hopeless
- More than 30 mins (adult) 15 mins
(newborn)
- Advance directives/ Living will
Life support - our body is a complex
machine
- Lungs
- Heart
- Brain
Withholding Life support
- Refers to never initiating treatment
- Advance directives/ living will
- Decision of relatives
- Is withholding life support is
euthanasia? (case to case basis)
Palliative Care - given in geriatric home
● Counseling - providing emotional
support (need ng kausap)
● Education - to understand the
course of disease
● Assure pt of safety management
● Mental diversion, music/ play
therapy
● Manage expected/ common
complications
● Physical exercise & proper physical
movements (walking)
● Pharmacologic management
-Multimodal analgesia
-Relieve pain w/ opioids
Euthanasia - “eu” means good, well, nice &
merciful (mercy killing but it’s not mercy,
killing lang)
- “Thanatos” ,=means death/ killing
- Act or practice of ending a life
- Morally wrong bc it damages the
sacredness/ sanctity of life (immoral)
(nawawala yung natural end)
Types of Euthanasia
1. Active Euthanasia (Commission)
- Death is brought by an act
- Example : taking a high dose
of drugs, lethal injection.
- (Suicide)
- Pt can be conscious/
unconscious
2. Passive Euthanasia (Omission)
- Death brought by omission
- Example: when someone lets
the person die
- Can be done by withdrawing/
withholding treatment
(decided by ethical
committee)
Assisted Suicide
- Physician assisted suicide
- Doctor knowingly helps someone
end their life
- Person likely experiencing
persistent/ unending suffering.
Issue of Euthanasia
● Religious Beliefs & morality
● Christianity
● Islam
● Shinto
● judaism
● Not legal in PH
● Nurse is obligated to assist in
passive euthanasia
Advance Directives -
Advance - Before a thing happens
Directives - steps that are to be taken
- 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
- Written legally recognized
documents that state your choices
about health care treatment
Purpose:
- Appointment of health care proxy
(Kung sino ang mananagot sa
pasyente)
Types of Advance Directive
1. Living will (Health care
directives)
2. Restricted Directive (in health
aspect) (estate is not
included) (walang gagalaw
nyan)
3. Decision abt life sustaining
procedure in the event the pt
is in impending doom (yung
hindi na kaya mag decide for
himself)
Week 10 & 11
Moral Responsibility of Nurse
Euthanasia to advance
directive (Same sa ppt)
ETHICAL DECISION MAKING PROCESS
- In ethical decision, we always
choose what is right and what is
good but if dalawa yung good, dun
papasok yung ethical decision
making
Problem Analysis
Problem - is a discrepancy between
situation & desired state
Moral uncertainty - when we sense that
there is moral problem but we are unsure of
the morally correct action (the one that
moves toward what is right & good)
Moral/ ethical dilemma - requires a choice
between two option that are equally
unfavorable & 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
1. 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.
2. As nurses we commonly use the nursing
process model for
decision making.
3. 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.
- rightness of an act
(kabuuan ng buong
opag katao mo at walang pwedeng
makasira nito dahil nabuo
na ‘to simula nung pag ka bata mo)
2. Compassion- delivered in a degree that
it will not be abused (kapag naabuse, it’s
not compassion)
3. Caring - Related to compassion (dapat
may gentleness & accuracy)
34. Empowerment - you give power to the
person to decide ( ang magdedecide lagi ay
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 informed consent (top priority)
(based o autonomy)
2. Fruitful result for the good of the society
(based on theoretical theorist)
3. Prior on animals & prior knowledge the
problems
4.Avoidance of unnecessary physical/
mental injury (go back to ethical principle
nonmaleficence)
5. Banning of known lethal/ disable
procedures
6. Degree of risk should not exceed limit
(benefit is the top priority)
7. Proper preparation & proper facilities to
prevent injury or death (nonmaleficence)
8. Performance of experiments only by
scientifically qualified persons. (perform a
task w/ minimal risk)
9. Participants may freely end the
experimentation (based on autonomy)
10. The experiment must stop if it proves
too dangerous (nonmaleficence)
Declaration of Helsinki (pertains to the
person who will conduct research )
- 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 (underaged, preg, elders,
poor)
• 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;
Belmont Report 1976 (all about the use
of human subjects)
1. Respect for person: protecting the
autonomy of all people & treating
them w/ courtesy & respect &
allowing for informed consent
2. Beneficence: the philosophy of “do
no harm”, while maximizing the
benefits for the research project
(based on nonmaleficence)
3. Justice: ensuring reasonable,
non-exploitative, & well- considered
procedures (administered fairly)
Ethical Issues Related to Evidenced
Based Practice
- Evidence-based practice is a systematic
interconnecting 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 doesn't justify the means
7. Defects of nature may be corrected (hindi
lahat papalitan mo)
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 ()
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.
ETHICAL CONSIDERATION IN
LEADERSHIP MANAGEMENT
- Accdg to Birkholz, Moral Decision
making is imperative to arrive at an
ethical action/ intervention.
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 the 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
1. Principle of Formal Cooperation
- it occurs when someone intentionally helps
another person carry out a sinful act. (sino
yung nag isip na gumawa ng mali)
2. Principle of Material Cooperation
- when a person's actions unintentionally
help another person do something wrong.
(nag contribute/ nadamay)
3. 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)
4. 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. (in
doing something good, the bad is
spontaneously occurs)
5. Principle of Well-formed
Conscience
-To attain true goals of human life by
responsible actions, in every free decisions
involving an ethical question, people are
morally obliged to do the following:
- the act by which we apply to our own
- be aware of facts & ethical norms
-Having a morally certain judgement of
conscience
-Act accordingly to this well formed
conscience
-Accept responsibility for our actions
-Informed consent to medical treatment
-Patients have the right to receive
information and ask questions about
recommended treatments so that they can
make well-considered decisions about care.
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 (Cerebral Activity)
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 – (who is really involved)
4) Determine desired outcomes
(something right & good for pt)
5) Identify options (alternatives)
6) Act on the choice
7) Evaluate outcomes of actions
MEANING AND SERVICE VALUE OF
MEDICAL CARE
• Cost-effective
1. Allocation of Health Resources
- limited resources for health should
be allocated to maximize the health
benefits for the population served
- Quantitative ka pero quality ang nakuha
mo
- Sa konting gastos makakuha 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
2. Equity (Give to the one who needs it
the most )
- 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
HEALTHCARE
Benefits & Challenges of Technology
1. Reducing Healthcare Costs
2. Predicting Epidemics
3. Improving quality of life/quality care
4. Reducing Healthcare Waste
5. Improving Mobility/Access
6. Developing New Drugs and
Treatments (vaccine)
7. Security E.G. Data Hacking/Phishing
8. Volume of Data In Icloud
9. Dangers with AI central data point
10. Impersonal patient-healthcare
provider relationship (nawawala
yung tender loving care)
11. Connectivity & Cost
12. Fast & numerous changes
Current Technology: Issues & Dilemma
- Security
- Portability
- Cost
- Real-time events (can it really br
done)
- Equity (provided for those pt who
need the most)
- Justice
CONTINUING EDUCATION PROGRAM ON
ETHICO- MORAL PRACTICE IN NURSING
Lobbying- The act or process influencing
public officials to promote something /
secure the passage of legislation
Advocacy - the act or process of promoting
a cause or proposal
Code of Ethics for nurses
1. Article 2 - Registered Nurse &
People
Ethical Principle
a. Values, customs, & spiritual beliefs
held by individuals shall be
respected
b. Individual freedom to make rational
 & unconstrained decisions shall be
respected (Principle of Autonomy)
c. Personal information acquired in the
process of giving nursing care shall
be held in strict confidence.
(Principle of Confidentiality)
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.
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 strive to
perform their work in the best interest of all
concerned.
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 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