MARGARETTE CATAO, BSN 2I – Bioethics Page 1

BRANCHES OF ETHICS
I. INTRODUCTION TO BIOETHICS 1. Health Ethics
2. Professional ethics
This course deals with the application of ethico-moral 3. Bioethics – where we will focus
and legal concepts and principles in issues that affect
the practice of health care.
BCG Vaccine – Bacillus Calmette Guerin for Tuberculosis

Morality – refers to the area of right and wrong in the

theory and practice of human behavior Bioethics

Ethics – is a practical and normative science based on - Bio > life

reason which studies human acts and provides norms - Bios – comes from the Greek word which means
for its goodness and badness. life
- Ethics of life
- Ethics of medical care
- It is “the division of Ethics that relates to the
human life or the ethics of the life sciences and
Bioethics as a practical science health care, both delivery and research
- Systematized body of knowledge that can be
used, practiced, and applied to human action
SCOPE OF BIOETHICS
Bioethics based on reason
Initial Stage
- Does not rely on divine revelation
- It investigates and analyses facts - Bioethics was concerned with ethical problems
associated with medical practice.
Bioethics applied only to Human acts
Later Stage
- They are performed with intellectual
deliberation and freedom - It has expanded to include social issues related
to health, animal welfare, and environmental
concerns.
Healthy Ethics

- It is a science that deals with the study of the STAGES OF HUMAN ISSUES AND QUERIES
morality of human conduct concerning health
and health care. 1. The beginning of life contraception and family
planning
2. The middle of life -genetic engineering and
Biology abortion
3. The end of life -death and euthanasia
- bios - “life” logy
- “study of”
- It is a science that employs the scientific
method to study living things.
 MARGARETTE CATAO, BSN 2I – Bioethics Page 2

EVOLUTION OF BIOETHICS THEORIES OF HEALTH ETHICS

I. Medical Ethics A. Teleological Ethics

- Oldest phase of bioethical exploration - greek telos, teleos “end” or “purpose”

- The formulation of ethical norms for the - it stresses the end-result, goal or consequence
conduct of health care professionals in the of an act as the determining factor of its
treatment of patients. rightness and wrongness
- consequential ethics
Hippocratic Oath
B. Deontological Ethics
- No prescription of fatal drugs
- Rule out any form of abortificient - Greek deon, deontos, discourse on duty or
- No sexual relations between doctors and obligation
patients - it stress duty as the norm of moral action,
- Moral significance of confidentiality or medical - is also called duty ethics
secrecy
C. Utilitarianism

- an action or practice is right if it leads to the

II. Research Ethics greatest possible balance of good consequences
in the world as a whole
- Second phase in bioethical studies
- Biomedical Research – refers to the use of The 4 Four conditions
humans as experimental specimens
- The Principle of Utility :Maximize the good
Third Reich Era (1935-1945) - Theory of Value: Standard of Goodness
- Consequentialism: Whatever its precise value
Friedrich Nietzche
theory
- The “superman” philosopher who strengthened - Impartiality (Universalism)
Hitler’s conviction that the German is the super
d. Thomistic Ethics
race
- St. Thomas Aquinas (1225-1274)
Nuremburg Code (1947)
- Christian/Roman Catholic Ethics
- Humanize the cruel and barbaric nature of - Natural Law Ethics
experiments - Scholastic Ethics
- It takes into account the experimental objects’
consent (informed consent/decision/choice)

Contributions
Synderesis
- Respect of patients right through informed
consent - inherent capacity of every individual, lettered or
- Right of the patient to decline/not submit to unlettered, to distinguish the good from the bad
any health care procedure - voice of right reason or voice of conscience

III. Public Policy

- Emphasizes the participatory aspect of decision

making in a democratic set-up with regard to
the formulation of public policies

MAN’S THREEFOLD NATURAL INCLINATION
1. self-preservation
2. just dealings with others
3. propagation of our species
THREE DETERMINANTS OF MORAL ACTION
1. The Object
- that which the will intends directly and primarily
- could be a thing or a procedure
2. The Circumstance
- there are conditions which, when superadded
to the nature of the moral act, will affect its
morality
- mitigating or aggravating circumstance
WHO?
This circumstances has something to do with the
special quality, prestige, rank, or excellence of the
person involved in the moral act
WHAT?
This circumstance refers to the quantity or quality of
the moral object
WHERE?
This circumstance denotes the place where the act
occurs
BY WHAT MEANS?
This refers to the means used in carrying out the act
HOW?
This circumstance indicates the manner in which the
action is done
WHEN?
This circumstance refers to the time element involved
in the performance of an action, not only with regard
to quantity but to quality as well.
3. The End or Purpose
- here we take end in the sense of end or purpose
of the doer or agent
- it also affects the goodness or badness of an
action or decision in a number of important
ways
MARGARETTE CATAO, BSN 2I – Bioethics Page 3
II. VIRTUE ETHICS IN NURSING
VIRTUE ETHICS or CHARACTER ETHICS
- individual actions are based upon a certain
degree of innate moral virtue
3 CRITERIA OF A VIRTUOUS CHARACTER
1. Virtuous acts must be chosen for their own sake
2. Choice must proceed from a firm and unchangeable
character
3. Virtue is a disposition to choose the mean
VIRTUE ETHICS IN NURSING
Florence Nightingale – virtue is an important trait of a
good nurse
Nightingale Pledge – implies virtue of character as
nurses promise purity, faith, loyalty, devotion,
trustworthiness, and temperance
Good character is the cornerstone of good nursing
A nurse with virtue will act according to principle
Aristotle – believe that virtue can be practiced and
learned, so we can learn through practice
FOCAL VIRTUES
1. COMPASSION – ability to imagine oneself in the
situation of another
2. DISCERNMENT – sensitive insights involving acute
judgment and understanding resulting in a decisive
action
3. TRUSTWORTHINESS – a confident belief in the moral
character of another person
4. INTEGRITY – soundness, reliability, wholeness, and an
integration of moral character
 MARGARETTE CATAO, BSN 2I – Bioethics Page 4

VALUES CORE VALUES OF NURSING

- one set of personal beliefs and attitudes about - Human Dignity

the truth, beauty and worth of any thought, - Integrity
object or behavior - Autonomy
- are action oriented and give direction and - Altruism
meaning to one's life' - Social justice
- Fundamental Aspects of Legal, Ethical and
Professional Issues in Nursing (2nd ed) by Sally
Carvalho, Maggie Reeves and Jacquie Orford. Human Dignity
Published by Quay Books, I 202 V
- Is a respect for the inherent worth and
Freedom uniqueness of individuals and populations
Trust
Justice Integrity
Love - refers to adherence to moral norms that is
Peace sustained overtime
Prosperity
Dignity Autonomy
Equality
- Is the right to self determination
- considered to be an important criterion in
Personal values judging professional status

- are values internalized from the society or Altruism

culture in which one lives
- It is a concern for the welfare and well-being of
others.

Professional values Social Justice

- are values acquired during socialization into - It is acting in accordance with fair treatment
nursing from codes of ethics, nursing regardless of economic status, race, ethnicity,
experiences, teachers, and peers. age , citizenship,disability or sexual orientation

OTHER NURSING VALUES

- Safe & competent

- Health & well –being
- Choice
- Dignity
- Confidentiality
- Justice
- Accountability
- Diversity
 MARGARETTE CATAO, BSN 2I – Bioethics Page 5

III. UNIVERSAL BIOETHICAL

3. With regards to promotion of good and
PRINCIPLES prevention of harm
a. positive paternalism – for the promotion of
A. AUTONOMY
good
- this principle marks the significance of b. negative paternalism – for the prevention of
individual autonomy which mandates a strong harm
sense of personal responsibility for one’s own
life
4. With regards to patient’s sense of values
Elements of Autonomy
a. soft paternalism – patient’s values are used to
a. person should be respected justify the intervention
b. he should be able to determine his personal b. hard paternalism – patient’s values are not
goals used to justify paternalistic acts
c. he should have the ability to decide on plans of
actions
d. he should have the freedom to act upon his 5. With regards to the recipient of the benefit
choice a. direct paternalism – the individual who
should receive the said benefit is the one whose
values are disregarded for his own good
Paternalism b. indirect paternalism – a particular individual
will benefit if he is restricted from doing
- from Greek word pater or paternos which something
means being fatherly
- the act of being fatherly to someone as if the
latter was one’s offspring
6. Personal paternalism – when an individual
- it violates the principle of autonomy
decides on the basis of his best knowledge and
capacity for the good of another person

Types of Paternalism

1. With regards to recipient’s welfare
a. pure paternalism – justifies interventions into
a person’s life for the sole welfare of that person
b. impure paternalism – not only for the welfare
of that person but also for others
7. State paternalism – refers to the control exerted
by the legislature, agency, or any governmental
bodies over a particular practice and procedure

2. With regards to recipient’s defects and safety

a. restricted paternalism – support intervention
which overrides and individual’s action because
of some defects or weaknesses
b. extended paternalism – an individual is
restricted from doing something because it is
too risky or dangerous

PATIENT’S RIGHTS
 MARGARETTE CATAO, BSN 2I – Bioethics Page 6

- the moral and inviolable power vested in a 2. Right to informed decision – refers to the necessary
person to do, hold, or demand something as his information of and understanding so a genuine
own deliberation is carried out before making moral decision
- something that by nature belongs to a patient on a medical treatment

3. Right to informed choice – the patient has the right

to be informed about all possible alternative courses of
Types of Patient’s Rights
action to be taken, together with the possible
1. Right to informed consent – relates to a process by consequences
which patients are informed of the possible outcomes,
4. Rights to refuse treatment – the patient has the right
alternatives, and risks of treatments, and patients are
to refuse treatment to the extent permitted by law and
required to give their consent freely.
to be informed of the medical consequences of his
Types of Consent
action
a. Admission agreement
b. Blood Transfusion consent 5. Right to self-determination – the patient as an
c. Surgical Consent autonomous individual has the moral right to determine
d. Research Consent what is good for himself, usually upon the advice of a
e. Special Consent health care provider

Functions of Informed consent

a. To avoid fraud and duress
b. To encourage self- scrutiny by professionals
c. To foster rational decision making LIMITATIONS OF PATIENT’S RIGHTS
d. To involve the larger society in the debate
1. Patient’s rights do not include patient’s rights to be
allowed to die
Elements of Informed Consent 2. Patients in a moribund condition does not posses the
A. Competence – this refers to a patient’s capacity for necessary mental, physical, or emotional stability to
decision making make decision
3. Patient’s rights are not absolute
- Component individual is:
*Can make decision
*Able to justify the decision
*Able to justify decision in a reasonable manner

B. Disclosure

- This refers to the content of what a patient is

told or informed about during the consent
negotiation

C. Comprehension

- This refers to whether the information given has

been understood

D. Voluntariness

- This means that the consent must be from his

own free will without being forced
 MARGARETTE CATAO, BSN 2I – Bioethics Page 7

PATIENT'S BILL OF RIGHTS FROM DOH

1. Right to appropriate Medical care and Humane CONFIDENTIALITY AND PRIVACY ARE INTERRELATED
treatment
Confidentiality – nondisclosure of private or secret
2. Right to informed consent
information about another person with which one is
3. Right to privacy and confidentiality
entrusted. It requires that one maintain the privacy of
4. Right to information
another
5. Right to choose health care provider and facility
6. Right to self-determination Privacy refers to the right of the individual to control the
7. Right to religious belief personal information or secrets that are disclosed to
8. Right to medical records others. It is a fundamental right of individuals
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence and to receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligations as B. BENEFICENCE
a patient - the practice of doing acts of goodness, kindness
and charity
- the beneficence principle states “do no harm
Proxy Consent and produce the good” or “do good and do no
- The process by which people with the legal right harm”
to consent to medical treatment for themselves
or for a minor or a ward delegate that right to
another person. C. NONMALEFICENCE

- Hippocratic oath: “I will never use treatment to

Fundamental constraints on this delegation:
1. The person making the delegation must have the
right to consent
2. The person must be legally and medically competent
to delegate the right to consent
injure or wrong the sick”
- this seems to be similar to the duty of
beneficence, where the practitioner work to
maximize the good for the patient and to
minimize harm

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

and medically competent adult
 MARGARETTE CATAO, BSN 2I – Bioethics Page 8

“I-THOU” – defines our relationship with other persons

or subject
D. VERACITY
E. CONFIDENTIALITY
- relates to the practice of telling the truth
- binds both health practitioner and patient in an - is an important aspect of the trust that patients
association of truth. place in health care professionals.

Justification of Truth Telling Confidentiality VS Privacy

confidentiality – privacy – refers to the
1. It is argued that our human and moral quality as
demands nondisclosure right of an individual to
persons is taken away from us if we are denied of private or secret control the personal
whatever knowledge is available about our condition as information about information or secrets
patient another person with that are disclose to
which one is entrusted others
2. As patient, we have entrusted to the physician any
knowledge he has about ourselves, so the facts
(findings) are ours and not his, hence to deny them to us Justifications of Violation of Confidentiality
is to steal from us
a. When keeping the secret would be detrimental to the
3. The highest conception of the physician-patient common good
relationship is a personalistic one which is based on
mutual confidence and respect for each other’s rights b. When the subject of the secret intends to inflict grave
injury upon an innocent third party
4. To deny a patient pertinent knowledge about himself,
especially in a life and death situation, is to deprive him c. When it is necessary for the subject of the secret to
the ample time to prepare for his own death or to carry avert grave injury
out responsibilities that are based solely on his d. When it is necessary for the one keeping the secret to
decisions or actions avoid grave injury

Practitioner is allowed to intentionally withhold

information based on his/her “sound medical
judgment” that to divulge the information might
potentially harm the depressed and unstable patient for F. FIDELITY
an unpleasant fact….. BENEVOLENT DECEPTION
- loyalty, trustworthiness, reliability, faithfulness
- it requires that health care practitioner should
Two Approaches of Truth Telling practice faithfully within the constraints of the
role.
person-centered – considers patient as a person with a
problem, but not as a problem himself/herself

problem-centered – considers the patient’s condition,

illness or diseases

Types of Relationships (Martin Buber)

“I-it” – it is a relationship describes a person’s

relationship with things, objects, or “its

G. JUSTICE
- rendering of what is due or merited
Two Types of Justice
1. comparable justice - what a particular patient
receives is determined by the gravity of the condition or
need.
2. noncomparable justice - distribution of
goods/resources is determined by a certain standard
Criteria of Distribution
1. criteria of inclusion – selection of candidates
a. constituency – is the person a member of the
community?
b. progress of science – can new knowledge be
gained from the case?
c. Success – is the treatment effective?
2. criteria of comparison
a. the likelihood of successful treatment compared
with others in the group
b. life expectancy of the person
c. the person’s family role
d. the potential of the person in making future
contribution
e. the person’s record of services or contribution
3. random selection (James Childress)
a. first come first serve basis
b. lottery
MARGARETTE CATAO, BSN 2I – Bioethics Page 9
H. PRINCIPLE OF DOUBLE EFFECT
- an act is foreseen to have both good and bad
effects
Ethical Considerations
a. good effect must be directly intended
b. good effect or bad effect must occur simultaneously
or bad effect must follow the good effect
c. bad effect may be permitted to occur after the
intention of good effect.
I. PRINCIPLE OF STEWARDSHIP
- it refers to the expression of one’s responsibility
to take care of, nurture and cultivate what has
been entrusted to him.
> personal
> social
> ecological
> biomedical
J. PRINCIPLE OF TOTALITY
- the whole implies the existence of its part
- the existence of parts indicates the existence of
the whole
- Consider the entire person when deciding which
therapies, medications or procedures a patient
should receive
- A member of the human body is to be disposed
of according as it may profit the whole…if a
member is healthy and continuing its natural
state, it cannot be cut off to the detriment of
the whole…. St. Thomas Aquinas

K. PRINCIPLE OF SOLIDARITY
- professionals must nurture and support the
principle of one organization for all the
members
- professionals are obliged to put a broader
interest of the profession above one’s personal
ambition and preference
L. PRINCIPLE OF COOPERATION
- cooperation comes from the latin word cum
which means “with”, and operari which means
“to work”
- cooperation is working with another in the
performance of an action
MARGARETTE CATAO, BSN 2I – Bioethics Page 10
III. PRINCIPLE OF ORDINARY AND
EXTRAORDINARY MEANS
⮚ It is generally held that one can forgo
extraordinary means of continuing life but is
obliged to continue ordinary means of care
⮚ “Life, health and earthly actions are allocated,
and thus subordinate, to spiritual purposes.
Death is seen as an integral element of life,
since according to Christian beliefs death is not
the end but transition of new life – Pope Pius XII
Ordinary vs. Extraordinary
- Ordinary means are all medicines, treatments
and operations that offer a reasonable hope of
benefit and that can be obtained without
excessive expense, pain or other inconvenience.
- Extraordinary means are all medicines,
treatments and operations that cannot be
obtained or used without excessive expense,
pain or other inconvenience or that, if used,
would not offer a reasonable hope of benefit.
Principle of Personalized Sexuality
- Takes note of a humanized sexuality, one that
represents the fulfilment of physical and sensual
need but also evidenced with love and
sacramental mystery
MARGARETTE CATAO, BSN 2I – Bioethics Page 11