HEALTH CARE ETHICS
organizations
CONTINUING EDUCATION PROGRAMS
ON ETHICO-MORAL PRACTICE
IN NURSING
Continuing Education Program
a specific learning activity generally
characterized by the issuance of a certificate
or Continuing Education Units (CEU). For the
purpose of documenting attendance at a
designated seminar or course of instruction.
Purpose
- Tends to meet high performance level
needs of the nurses
- Strengthen knowledge, skills and
attitude.
Scope
- Professional and personal growth and
development that relates to
professional and organizational
development
Objectives
- Promote development of KSA for
enhancement of nursing practice
Board of Nursing
- Encourages continuing education
requirements on members who hold
licenses to practice.
- These requirements are intended to
encourage professionals to expand
their knowledge, and stay updated to
new trends and development.
Duties and Responsibilities:
- Conduct licensure exam for nurses
- Issue, suspends, revokes certificates
of registration for the practice of
nursing
- Monitor and enforce quality standards
of nursing practice in the Philippines
- Ensure quality nursing education by
examining prescribed facilities of
Universities or Colleges of Nursing, or
Departments of Nursing
- Conducts hearings and investigations
to resolve complaints against nurse
practitioners for unethical and
unprofessional conduct.
- Promulgate a Code of ethics
- Recognize nursing specialty
- Prescribe, adopt, promulgate
guidelines, regulations and measures,
and decisions as may be necessary for
the improvements of the nursing
practice and advancements of the
profession.
NURSING ETHICS
a branch of moral science that refers to the
conduct and behavior of nursing practitioners
which by reason of public approval has
become customary among professional
nurses.
Code of Ethics
written list of profession's values and
standards of conduct and framework of
decision making for nursing profession
International Council of Nurses (ICN)
- Operated by nurses and leading
nurses internationally.
- Founded in 1899, ICN is the world’s
first and widest reaching international
organization for health professionals
and is headquartered in Geneva,
Switzerland.
Goals:
- To ensure quality nursing care for all.
- Sound health policies globally
- Advancement of nursing knowledge
- The worldwide presence of a
respected nursing profession.
- A competent and satisfied nursing
workforce.
Ethical Conduct
- Essential to the practice of
professional nursing described in the
nursing code of ethics
- Formal statement that determines the
standards of conduct of a professional
nurse
Code of Good Governance
Promulgated by the PRC on July 23, 2003:
– hallmark of all professionals is their
willingness to accept a set of
professional and ethical principles
which they will follow in the conduct of
their daily lives.
General Principles of the Code of Good
Governance:
1. Service to others.
2. Integrity and Objectivity.
3. Professional Competence
4. Solidarity and Teamwork
5. Social and Civic Responsibility
6. Global Competitiveness
7. Equality of all Professions
Code of Ethics for Filipino Nurses
provides direction for nurses to act morally
Four fold responsibility of nurses:
- to promote health
- to prevent illness
- to alleviate suffering
- to restore health
Amended Code of Ethics for Filipino
Nurses
Section 3, Republic Act No. 877
"Philippine Nursing Law"
- An Act to Regulate the Practice of
Nursing in the Philippines, and for
Other Purposes.
Section 6 of P.D. No. 233
"Amended Code of Ethics for Nurses" was
adopted
- October 23, 2003, Ilo-ilo City
consultation was done together with
the accredited professional
organization of RN, PNA and other
affiliate organizations of RN's decided
to adopt a NEW Code of Ethics under
R.A. 9173
- July 14, 2004, a new Code of Ethics
for Filipino Nurse was adopted under
R.A. 9173 and was promulgated by the
BON.
- The Code of Ethics for Filipino Nurses
embodies ethical principles and
guidelines to be observed.
R.A 9173 - "Philippine Nursing Act of
2002."
was enacted in 2002 to provide a
comprehensive definition and understanding
of the nursing profession.
adheres to the universal principle as
enunciated in the Universal Declaration of
Human Rights that “Health is the
fundamental right of every individual.”
The most important articles as summarized
below are:
1. Registered Nurses and People
2. Registered Nurses and Practice
3. Registered Nurses and Co-workers
4. Registered Nurses, Society and
Environment
5. Registered Nurses and the Profession
Filipino Nurses Code of Ethics
Article 1: Preamble
Sec 1: Health is a fundamental right of every
individual.
Sec 2: Nurses have to gain knowledge and
understanding of man's cultural, social,
spiritual, psychological, and ecological
aspects of illness, utilizing the therapeutic
process.
Sec 3: The desire for respect and confidence
for clientele, colleagues, co-workers, and the
members of the community provides
incentive to attain and maintain the highest
possible degree of ethical conduct.
Article 2: Registered Nurses and People
Sec 4:
Ethical Principles
- Values, customs, & spiritual beliefs are
to be respected
- Freedom to make rational and
unconstrained decisions will be
respected
- Personal information acquired shall be
held in strict confidence
Sec 5:
Guidelines to be observed:
Registered Nurses must:
- consider the individuality and totality of
patients when they administer care.
- respect the spiritual beliefs and
practices of patients regarding diet and
treatment.
- uphold the rights of individuals.
 - take into consideration the culture and
values of patients in providing nursing
care. However, in the event of
conflicts, their welfare and safety must
take precedence.
Article 3: Registered Nurses and Practice
Sec 6:
Ethical Principles:
- Human life is inviolable
- Quality and excellence in care are the
goals of nursing practice.
- Accurate documentation of actions and
outcomes is the hallmark of nursing
accountability.
- Aware that their actions have
professional, ethical, moral and legal
dimensions
Sec 7:
Guidelines to be observed:
Registered Nurses must:
- know the definition and scope of
nursing practice which are in the
provisions of
R.A. No. 9173, known as the
“Philippine Nursing Act of 2002” and
Board Res. No. 425, Series of 2003,
the “Rules and Regulations
Implementing the Philippine Nursing
Act. of 2002”, (the IRR).
- be aware of their duties and
responsibilities in the practice of their
profession as defined in the “Philippine
Nursing Act of 2002” and the IRR.
- acquire and develop the necessary
competence in knowledge, skills, and
attitudes to effectively render
appropriate nursing services through
varied learning situations.
- if they are administrators, be
responsible in providing favorable
environment for the growth and
developments of Registered Nurses in
their charge.
- be cognizant that professional
programs for specialty certification by
the BON are accredited through the
Nursing Specialty Certification Council
(NSCC).
- see to it that quality nursing care and
practice meet the optimum standard of
safe nursing practice.
Article 4: Registered Nurses and Co-
Workers
Sec 12:
Ethical Principles:
- RNs in solidarity with other members
of the healthcare team in working for
the patient's best interest.
- RN maintains collegial and
collaborative working relationship with
colleagues and other healthcare
providers
Sec 13:
Guidelines to be observed:
Registered Nurses must
- maintain their professional role/identity
while working with other members of
the health team.
- conform with group activities as those
of a health team should be based on
acceptable, ethico-legal standards.
- contribute to the professional growth
and development of other members of
the health team.
- actively participate in professional
organizations.
- not act in any manner prejudicial to
other professions.
- honor and safeguard the reputation
and dignity of the members of nursing
and other professions; refrain from
making unfair and unwarranted
comments or criticisms on their
competence, conduct, and procedures;
or not do anything that will bring
discredit to a colleague and to any
member of other professions.
- respect the rights of their co-workers.
Article 5: Registered Nurses, Society and
Environment
Sec 14:
Ethical Principles:
- Preservation of life, respect for human
rights, and promotion of healthy
environment shall be a commitment of
a RN.
 - Establishment of linkages with the
public in promoting local, national, and
international efforts to meet health and
social needs of people as a
contributing member of society is a
noble concern of a RN.
Sec 15:
Guidelines to be observed:
Registered Nurses must
- be conscious of their obligations as
citizens and, as such, be involved in
community concerns.
- be equipped with knowledge of health
resources within the community, and
take active roles in primary health
care.
- actively participate in programs,
projects, and activities that respond to
the problems of society.
- lead their lives in conformity with the
principles of right conduct and proper
decorum.
- project an image that will uplift the
nursing profession at all times.
Article 6: Registered Nurses and the
Profession
Sec 16:
Ethical Principles:
- Maintenance of loyalty to the nursing
profession and preservation of its
integrity are ideal.
- Compliance with the by-laws of the
accredited professional organization
(PNA), and other professional
organizations of which the Registered
Nurse is a member is lofty duty.
- Commitment to continual learning and
active participation in the development
and growth of the profession are
commendable obligations.
- Contribution to the improvement of the
socio-economic conditions and general
welfare of nurses through appropriate
legislation is a practice and a visionary
mission.
Sec 17:
Guidelines to be observed:
Registered Nurses must
- be members of the Accredited
Professional Organization (PNA).
- strictly adhere to the nursing
standards.
- participate actively in growth and
development of nursing profession.
- strive to secure equitable socio-
economic and work conditions through
appropriate legislation and other
means.
- assert for the implementation of labor
and work standards.
Article 7: Administrative Penalties,
Repealing Clause, And Effectivity
Sec 18:
The Certificate of Registration of Registered
Nurse shall either be revoked or suspended
for violation of any provisions of this Code
pursuant to Sec. 23 (f), Art. IV of R.A. No.
9173 and Sec. 23 (f), Rule III of Board Res.
No. 425, Series of 2003, the IRR.
Sec 19:
The Amended Code of Ethics promulgated
pursuant to R. A. No. 877 and P.D. No. 223 is
accordingly repealed or superseded by the
herein Code.
Sec 20:
This Code of Ethics for Nurses shall take
effect after fifteen (15) days from its full and
complete publication in the Official Gazette or
in any newspapers of general circulation.
NEGLIGENCE
indicates a deficiency in perception or when
the wrongful act may be avoided by paying
proper attention and using due diligence in
foreseeing them.
Commission or omission of an act, pursuant
to a duty, that a reasonably prudent person in
the same or similar circumstance would or
would not do.
The Elements of Professional Negligence:
1. Duty of Care – existence of a duty on the
part of the person charged to use due care
under circumstances
2. Breach of Duty – failure to meet the
standard of due care
3. The Injury – the foreseeability of harm
resulting from failure to meet the standard
4. Causation – the fact that the breach of this
standard result in an injury to the plaintiff.
SPECIFIC EXAMPLES OF NEGLIGENCE
- Failure to report observation to
attending physicians.
- Failure to exercise the degree of
diligence which the circumstances of
the particular case demands.
- Mistaken identity
- Wrong medicine, wrong concentration,
wrong route, wrong dose.
- Defects in equipment such as
stretchers and wheelchairs may lead
to falls thus injuring the patients.
- Errors due to family assistance.
- Administration of medicine without a
doctor's prescription
Negligence in the administration of a drug
which causes injury to the patient may be
attributed to:
1. Drug reaction:
- failure to note history of allergy
- failure to test for signs of reaction
- failure to stop treatment when drug
reactions has been observed.
- failure to provide adequate therapy to
encounter a reaction
- treatment with a drug not proper for
the illness
- overdose of the drug administered.
- wrong route, wrong medicine, wrong
person
THE DOCTRINE OF RES IPSA LOQUITOR
Res Ipsa Loquitor means "the thing speaks
for itself"
Three conditions:
1. nature of injury was that it would not
normally happen or occur unless there
was a negligent act on the part of
someone
2. injury caused by an agency within
control of the defendant.
3. plaintiff himself did not engage in any
manner that would tend to bring about
injury.
Examples:
1. Sponge left in abdomen at the time of C-
section
2. A surgeon stitching a wound on patient’s
cheek allows the needle to enter the patient’s
eye.
3. Removal of a wrong tooth.
MALPRACTICE
improper or unskillful care of a patient by a
nurse; stepping beyond one's authority with
serious consequences
DOCTRINE OF FORCE MAJEURE
"Force Majeure" – irresistible force;
unforeseen or inevitable.
Civil code:
- no person shall be responsible for
those events which cannot be
foreseen, or which though foreseen,
are inevitable except in cases
specified by law.
- floods, earthquakes, fire, accidents
DOCTRINE OF RESPONDEAT SUPERIOR
"let the master answer for the acts of the
subordinate"; liability is expanded to include
the master as well as the employee and not a
shift of liability from the subordinate to the
master.
Subordinate still fully responsible
THE DOCTRINE OF RESPONDEAT
SUPERIOR “Captain of the Ship doctrine”
A defendant surgeon had delivered a baby
boy by Caesarian section. The mother
developed hemorrhage. While he was
attending to her immediate needs, he asked
an intern to apply drops to the baby’s eyes,
The intern used the wrong solution, as a
result, the baby’s eyes were damaged. The
surgeon was held liable for the intern’s
negligence, the intern was under his direct
supervision and control.
INCOMPETENCE
lack of ability or legal qualifications and being
unfit to discharge the required duty.
ETHICAL ISSUES RELATED TO
TECHNOLOGY IN THE DELIVERY OF
HEALTH CARE
Republic Act No. 10173 – Data Privacy Act
 "To protect the fundamental human
right to privacy of communication while
ensuring free flow of information to
promote innovation and growth.
Inherent obligation to ensure that
personal information in information and
communication systems in government
and private sectors are secured and
protected."
 To protect all forms of information, be
it private, personal, or sensitive.
 To cover both natural and juridical
persons involved in the processing of
personal information.
Processing Of Personal Information
Section 3 of RA 10173:
"Processing refers to any operation or any
set of operations performed upon personal
information including, but not limited to, the
collection, recording, organization, storage,
updating or modification, retrieval,
consultation, use, consolidation, blocking,
erasure, or destruction of data."
Section 3 of RA 10173:
"Personal Information refers to any
information whether recorded in a material
form or not, from which the identity of an
individual is apparent or can be reasonably
and directly ascertained by the entity holding
the information, or when put together with
other information would directly and certainly
identify an individual."
Privileged Information
Section 3 of RA 10173:
"Privileged information refers to any and all
forms of data which under the Rules of Court
and other pertinent laws constitute privileged
communication.
Sensitive Personal Information
1. Person's race, ethnic origin, marital
status, age, color, religious,
philosophical, and political affiliations.
2. Person's health, education, genetic or
sexual life, past offenses committed or
allegedly committed by a person, or a
court cases.
3. Social security numbers, health
records, licenses, suspensions, tax
returns.
4. Information established to be kept
private by law.
The Data Privacy Act explicitly states that
its provisions are not applicable in the
following cases:
A. Person who IS or WAS an officer or an
employee of a government institution
that relates to the position or functions
of the individual.
B. Information about an individual who is
or was performing service under
contract for a government institution
that relates to the services performed,
including the terms of contract, and the
name of the individual given in the
course of the performance of those
services.
C. Information related to any discretionary
benefit of a financial nature such as
the granting of a license or permit
given by the government to an
individual, including the name of the
individual and the exact nature of the
benefit.
D. Personal information processed for
journalistic, artistic, literary, or
research purposes
E. Information necessary for banks and
other financial institutions under the
jurisdiction of the independent, central
monetary authority or Bangko Sentral
ng Pilipinas to comply with Republic
Act No. 9510 and Republic Act No.
9160, known as the Anti-Money
Laundering Act and other applicable
laws.
F. Personal information originally
collected from residents of foreign
jurisdictions in accordance with the
laws of those foreign jurisdictions,
 including any applicable data privacy
laws, which is being processed in the
Philippines.
R.A. No. 10173 applies to:
 If the person, either an individual or an
institution, involved in the processing
of personal data is located in the
Philippines.
 The act or practice involves personal
data of a Philippine citizen or
Philippine resident.
 The processing of personal data is
done in the Philippines.
 The act, practice or processing of
personal data is done by an entity with
links to the Philippines, subject to
international law and comity.
NATIONAL PRIVACY COMMISSION (NPC)
MISSION
We shall continuously deliver services to:
1. Be the authority on data privacy and
protection, providing knowledge, know-
how, and relevant technology.
2. Establish a regulatory environment
that ensures accountability in the
processing of personal data and
promotes global standards for data
privacy and protection.
3. Build a culture of privacy, through
people empowerment, that enables
and upholds the right to privacy and
supports free flow of information.
VISION
A world-class regulatory and enforcement
agency upholding the right to privacy and
data protection while ensuring the free flow of
information, committed to excellence, driven
by a workforce that is highly competent,
future-oriented, and ethical, towards a
competitive, knowledge-based, and
innovative nation.
Benefits and Challenges of Technology
Technology
 the application of scientific knowledge
to the practical aims of human life or,
as it is sometimes phrased, to the
change and manipulation of the
human environment.
1. COMMUNICATION
Benefits: Messaging is easy and there
are plenty of options for these easy
ways. (Not to mention, cheap.)
Challenges:
Some things get lost in translation.
Communication becomes more
distant, cold, and it can be easily
misunderstood. It has made people
impatient.
2. DATA COLLECTION
Benefits: For sellers, it's easy to get
data from customers and potential
customers. Social media also makes it
easy for sellers to get to know their
market and make it easier to reach
out. Anybody can make a form now
that asks to fill up your name, address,
age, birthday, etc.
Challenges: There is lesser privacy.
We've heard of data breaches or
scams wherein people can make their
own website that looks like a legit bank
website. It pays to be vigilant! We also
have hackers, not only social media
accounts, but even banks and big
companies can be hacked.
3. INFORMATION ACCESS
Benefits: It's not only a person's data
that is easy to acquire, but Google has
also made it easier for everyone to
learn and search for things.
Challenges: Misinformation can easily
spread. Patients nowadays can easily
search their symptoms or research
about a subject which leads to some to
just self-diagnose and don't get
immediate treatment. Also
misinformation about certain
medications and vaccines which is of
course, potentially dangerous.
4. DISTANCE WORK AND SCHOOL
FROM HOME
Benefits: Attending classes or
meetings through Zoom or Microsoft
Teams has been the new classroom. It
made us more creative and forced us
to work smarter.
Challenges: It has become more
stressful because there is now no
boundary between school, work and
 home. Most people right now report
fatigue of being online almost 18 hours
a day.
5. PATIENT CARE
Benefits: Technologies help us keep
track of our health. Tele-health or E-
Health provides doctors that can hold
virtual consultations, allowing the
patient to be safe at home. Modern
technology also allows us to provide
better patient service.
Challenges: Less physical assessment
of the patient Some information gets
lost in the call.
6. DATA STORAGE
Benefits: A large like a terabyte of
information can be hand carried. It
saves space as well. Digital
information is also easier to find, all
you need is a search bar and a click of
a mouse. It saves you time! If a
hospital has a universal data system,
one doctor can input in program and
another doctor can see his input in real
time from another venue. Easy data
transfer and passing it on to another
health care worker.
Challenges: Personal data nowadays
is very attractive to hackers. There
have been multiple cases wherein big
companies, even Facebook,
experienced a data breach. It has
been said that these stolen personal
data are being sold online in the deep
web for who knows what purpose! If
your computer gets wet and if you
didn't back up your data, it could be
gone in a flash especially in cases
wherein it gets wet or a virus corrupts
it.
CURRENT TECHNOLOGY
Issues and Dilemma
HEALTH INFORMATION TECHNOLOGY
 supports decision-making and
promotes quality health care delivery
INCREASED CYBER ATTACKS
 Hacker will lock up the data, making it
inaccessible.
 There are also some medical devices
which are vulnerable due to
manufacturer negligence when it
comes to providing adequate security
protections and the use of legacy
equipment by health care providers.
NON-TRADITIONAL HEALTHCARE
DELIVERY
TELEHEALTH
 The hospital and the patient's home
should both have high-speed internet
to be able to provide/send excellent
video /photos /diagnostic data
transmission between the two. Aside
from that, it should also be affordable
especially for the patients.
APPLICATION MANAGEMENT
 Those in charge of healthcare IT
systems/programs/applications have to
manage a lot, and also there's only a
number of limited staff who are
knowledgeable about this area.
 Experienced / knowledgeable staff
require higher salaries which makes it
harder for hospitals to retain the staff
to help them achieve their IT goals.
DIGNITY OF DEATH AND DYING
DIGNITY
 the quality of a person that makes him
or her deserving of respect, sometimes
shown in behavior or appearance; a
state or a quality of being worthy of
honor or respect.
DEATH
 the total cessation of life processes
that eventually occurs in all living
organisms.
DYING
 approaching death
Signs of Death
1. ALGOR MORTIS
- cooling of the body
 - is translated from Latin as “
cold death” and described as
the postmortem temperature
change after someone has died
2. RIGOR MORTIS
- stiffening of joints & muscles
- is the stiffening of the joints and
muscles, resulting in rigidity of a
body a few hours after death
lasting from one to four days
3. LIVOR MORTIS
- known as lividity; “purple
discoloration”
- Is the settling of blood after
death in gravity-dependent
portions of the body
Principle: Life is inviolable.
“All human life from the moment of
conception, and through all subsequent is
SACRED, It is a gift of GOD, and the fruit of
love.”
The principle recognizes that Death is a
natural end of life and Biological life is not the
highest value.
1) It is never to be broken.
2) It is never to be infringed.
3) It is never to be dishonored.
Issues of Death and Dying
EUTHANASIA
 “easy death”
 is also called “MERCY KILLING”
 act or practice of painlessly putting to
death, persons suffering from painful
and incurable or incapacitating
physical disorder or allowing them to
die by withholding treatment or
withdrawing artificial life support
measures.
 in theory, this affirms the individual’s
right to die in a painless and peaceful
manner.
2 TYPES OF EUTHANASIA
1. SELF-ADMINISTERED
 Active – act of commission
 Passive – act of omission
2. OTHER-ADMINISTERED
 Active and voluntary – the person-in-
charge — doctor or closest kin allows
a procedure
 Passive and voluntary - the person-in-
charge — doctor or closest kin allows
death to take its toll
Safeguards and Guidelines for
Assisted Death
1. Illness must be terminal
2. All measures have been tried
3. Patient repeatedly requests without
being coerced
4. Doctor ensures patient judgement is
not distorted
5. Procedure is carried in a meaningful
physician-patient relationship
6. Other physicians are considered in the
decision
7. Documentation to assure of the
previous steps
DYSTHANASIA
 ”bad death”
 In theory, this affirms taking all
means to preserve life even
beyond recovery.
 refers to the postponement of the
death of this individual, usually due
to the use of drugs and equipment,
which often provide unnecessary
suffering.
ORTHOTHANASIA
 “natural death”
 a normal or natural way of death and
dying
 name given to the process by which
one chooses not to subject a terminal
patient to invasive procedures that
postpone his death, but, at the same
time, compromise his quality of life.
 Thus, orthothanasia focuses on the
adoption of palliative procedures,
seeking to control pain and other.
Should we be allowed to cut life when the
weight of pain, suffering, and hopelessness
becomes unbearable?
NO. It is MURDER.
LEGITIMATE under certain circumstances.

Administration of Drugs to the Dying

Bowl with Snake – Symbol of Pharmacists
Bowl – represents Hygeia, Greek goddess of
health
Snake – represents wisdom, healing due to
skin changing ability, but also poison

“the does makes the poison.”

Nurse Symbols

CAP - goal of the nurse-to provide service to

those in need; sign of dedication, honesty,
wisdom, faith

CADUCEUS - most recognized Nursing

symbol; associated with Hermes, Greek God
of boundaries

OIL LAMP - in reference to Florence

Nightingale, she is the founder of modern
nursing practice

WHITE UNIFORM - purity, honesty

cleanliness

Most Common Drug Used to End Life

Barbiturates (secobarbital, Nembutal)

ADVANCE DIRECTIVES
 A written statement of the patient‘s
wishes regarding medical treatment,
often including a living will, made to
ensure those wishes are carried out
should the person be unable to
communicate them to a doctor.
 Legal documents that allow the person
to spell out his decisions about end of
life care ahead of time.
 LIVING WILL - This tells which
treatments a person wants if he is
dying or permanently unconscious. He
or she can accept or refuse medical
care.

DNR (Do Not Resucitate)

 This is a medical order by a doctor
according to the wishes of the patient
or the patient‘s family. This is usually
included in the patient‘s advanced
directives.