Health Care Ethics Module Editted

Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND

TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
HEALTH CARE
ETHICS
NCM-108
SEVILLA C. GUINTO, MAN, RN

APRILYN H. GOMEZ, MAN, RN
UNIT I
2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

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THEORIES AND PRINCIPLES OF HEALTH

ETHICS
I. Introduction
Health Care Ethics (a.k.a “clinical ethics” or "medical ethics") is the application of the
core principles of bioethics (Autonomy, Beneficence, Nonmaleficence, Justice) to medical and
health care decisions.
Health ethics promotes the consideration of values in the prioritization and justification of
actions by health professionals, researchers and policymakers that may impact the health and
well-being of patients, families, and communities. Ethics is the practical discipline that deals with
the ethical aspects of nursing practice. It is a branch of bioethics or health care ethics. As they
outline ethical standards, discuss ethical facets of nursing, and produce ethical recommendations,
three domains of nursing ethics interact with one another. wherein each person has the freedom to
choose for himself, in accordance with their own views and ideals.
Healthcare ethics is the collection of principles that guide doctors, nurses, and other
clinicians in providing medical care. It combines moral beliefs — a sense of right and wrong —
with a sense of the provider's duty toward others. Healthcare ethics covers how providers treat
patients.
Ethics is a generic term for various ways of understanding and examining the moral life.
Some approaches to ethics are normative (that is, they present standards of right or good action),
others are descriptive (that is, they report what people believe and how they act), and still others
analyse the concepts and methods of ethics.
The division of ethics that relates to human health. And it resides in the realm of human
values, morals, customs, personal belief and faith. (according to Jean N. Guillasper, Ph.D, RN
2016)
II. Objectives
At the end of this unit, the learner will be able:
1. Achieved essential knowledge and provide safe environment to their patient.

2. Have relevance to guidelines and principles of evidence-based practice in the delivery of
care.
3. Practice nursing in compliance with all applicable laws, rules, and moral, ethical, and ethical
standards.
4. Utilize culturally appropriate vocabulary to successfully communicate in speaking, writing,
and presentation situations.
5. Uphold the ethical values of service, love, and dedication to humanity.
III. Lesson Proper
A. ETHICAL THEORIES
Ethical Theories are aiming to provide a clear, unified account of what our ethical obligations
are. Provide with perspectives and methods for identifying ethical dilemmas and issues,
analysing cases, determining the possible choices, and selecting a righter choice. Nursing ethics is
part of the modern movement of bioethics.

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1. DEONTOLOGY (Kantianism)
Its name comes from the Greek word deon, meaning duty. Actions that obey these rules are
ethical, while actions that do not, are not. This ethical theory is most closely associated with
German philosopher, Immanuel Kant (The Ethics Centre, 2016).
His work on personhood is an example of deontology in practice. Kant believed the
ability to use reason was what defined a person.
From an ethical perspective, personhood creates a range of rights and obligations because
every person has inherent dignity – something that is fundamental to and is held in equal measure
by each and every person.
This dignity creates an ethical ‘line in the sand’ that prevents us from acting in certain
ways either toward other people or toward ourselves (because we have dignity as well). Most
importantly, Kant argues that we may never treat a person merely as a means to an end (never just
as a ‘resource’).
Kant’s ethics isn’t the only example of deontology. Any system involving a clear set of
rules is a form of deontology, which is why some people call it a “rule-based ethic”. The Ten
Commandments is an example, as is the Universal Declaration of Human Rights.
Example:
 If a nurse is assigned to care for a patient with AIDS, could he/she reasonably refuse to
care for the patient because the patient's condition may threaten her health?
 As practitioners of the healing process, nurses are to take care of the sick even if patients'
conditions threaten their health. Nurses, however, must observe the necessary precautions
to protect their health.
2. Teleology
Teleological ethics, (teleological from Greek telos, “end”; logos, “science”), theory
of morality that derives duty or moral obligation from what is good or desirable as an end to be
achieved. Also known as consequentialist ethics, it is opposed to deontological ethics (from the
Greek deon, “duty”), which holds that the basic standards for an action’s being morally right are
independent of the good or evil generated (Duignan, Encyclopaedia Britannica).
Modern ethics, especially since the 18th century German

deontological philosophy of Immanuel Kant, has been deeply divided between a form of
teleological ethics (utilitarianism) and deontological theories.
Teleological theories differ on the nature of the end that actions ought to
promote. Eudaemonist theories (Greek eudaimonia, “happiness”), which hold that ethics consists
in some function or activity appropriate to man as a human being, tend to emphasize the
cultivation of virtue or excellence in the agent as the end of all action. These could be the
classical virtues—courage, temperance, justice, and wisdom—that promoted the Greek ideal of
man as the “rational animal”; or the theological virtues—faith, hope, and love—that distinguished
the Christian ideal of man as a being created in the image of God.
One example of teleological ethics is Utilitarianism, which holds that actions are right
insofar as they promote the greatest amount of pleasure for all affected.
The teleological approach is also termed as an act of utilitarianism where the good resides
in the promotion of happiness or the most significant net increase of pleasure over pain.
Utilitarianism is synonymous with consequentialism. Utilitarianism is ethical if;
1. It minimizes pain and suffering.

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2. It maximizes pleasure
3. It seeks the happiness of the majority
Guidelines for making ethical decisions (Joseph Fletcher):

1. Consideration for people as human beings.
2. Consideration of consequences.
3. Proportionate good to come from the choices.
4. Propriety of actual needs over ideal or potential needs.
5. A desire to enlarged choices and reduce the chance.
6. A courageous acceptance of the consequences of the decision.
Example:
 Applying a wrist restraint to a patient without a doctor's order can be a teleological action
by the nurse. For the client and family, the action could be demeaning but for the client to
prevent injuries and control their violent behaviour, applying a restraint can be an ethical
teleological action.
3. Utilitarianism
Consequentialism is a label affixed to theories holding that actions are right or wrong according
to the balance of their good and bad consequences. The right act in any circumstance is the one that
produces the best overall result, as determined from an impersonal perspective that gives equal
weight to the interest of each affected party. The most prominent consequence-based-theory,
utilitarianism, accepts the one and only one basic principle of ethics: the principle of utility. The
principle asserts that we ought always to produce the maximal balance of positive value over disvalue
(or the least possible disvalue, if only undesirable results can be achieved). The classical origins of
this theory are found in the writings of Jeremy Bentham (1748-1832) and John Stuart Mill (1806-
1873).
Main Teaching:
a. The rightness and wrongness of actions is determined by the goodness and badness of their
consequences. There is only one principle, that is, the principle of utility. The utility or
usefulness of an action is determined by the extent to which it promotes happiness rather than
its reverse.
b. “An action is good insofar as it promotes happiness, and bad if it tends to promote
unhappiness,” according to John Stuart Mill. How are we to determine whether an action
tends to promote happiness or produce pain? The answer is its consequence or result rather
than the action itself.
c. No action seems to be intrinsically right or intrinsically wrong
d. The goodness of badness of an act does not depend upon the motive, intention or past action
of the doer.
e. CONSEQUENCES, EFFECTS, RESULTS and OUTCOMES are most important; they

determine the goodness or badness of the act. We ought to choose the action that produces
the most benefits (comfort) at the least cost of pain or unhappiness. Why, for example, take a
diet and exercise when you can be sexy without it or with minimum sacrifices by taking some
pills or undergo liposuction.
An example could be a person with a life support machine which is practically

keeping the patient alive (but virtually dead); at the same time making his family financially
bankrupt, jeopardizing the future of his family if the artificial life support system is
continued. Is it morally acceptable to stop the life support machine?

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Utilitarian ethics’ answer is: YOU SACRIFICE ONE for the SAKE of the MANY.
The death of one (taking the life support system) is the happiness of many. Similarly, if to
kill a man (corrupt, abusive or a liability to an organization) causes happiness to many, then,
it is justifiable.
Utilitarianism
- Right action is that which has greatest utility or usefulness

- No action is, in itself, either good or bad
- The only factors that make actions good or bad are the outcomes
Act-Utilitarianism
- A person performs the acts that benefit the most people, regardless of personal feelings or
the societal
constraints such as laws.
Rule-Utilitarianism
- Seeks to benefit the most people but through the fairest and most just means available. It
takes into
account the law and is concerned with fairness.
Example of Utilitarianism
 When faced with multiple simultaneous patients in the emergency department it is

important to have a way of reaching a decision quickly about which patient to attend to
first. Triage rules are potentially justified by a form of rule utilitarianism that enables
rapid intuitive decisions.
The Role of Ethics in Healthcare
Ethics in healthcare provides guidance as to the proper course of action to take in adherence
to human life and dignity, and to the ETERNAL LAW inscribed within the heart of man. It maintains
observance of the order of nature in the field of healthcare without which moral turmoil or disorder
takes place primarily in terms of misjudgement of the sense of goodness to be done at the sense of
evil to be avoided. Indeed, absence or non-observance of moral norms and ethical standards lead to
the ambiguity of even loss of the distinctive human character of healthcare that paves the way to
inhuman practices. Some of this are abortion, euthanasia, embryo stem cell research and others which
are evident in some healthcare institutions.
Furthermore, ethics is a harmony with the principal purpose of health care. It works for
genuine restoration and promotion of health and wellness in keeping with the order of nature. When
the performance of healthcare practices for health restoration and promotion goes against the dictates
of reason, ethics sets proper direction in its citation of specific moral and ethical principle to employ.
Ethics as a Science
As defined by Sambajon (2007), Ethics is a philosophical and practical science that deals
with the study of the morality of human acts or conduct.
Ethics is a Natural Science
- It employs the power of human reason, which is purely a natural reason.

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- Being a branch of philosophy, it arrives at its conclusions by the used of human reason,
which is the philosophy’s only tool.
Ethics is a Practical Science
- It is not studied for the love of learning.

- All are bound in conscience to apply its principles to their conduct.
Ethics is Not a Physical Science
- It does not deal with physical laws (such as “water seeks its own level”)
- It is a moral science, dealing with free acts of men.
Difference between Ethics and Morals
Ethics guides our human judgement concerning the morality of human acts that is commonly
associated with customs, habit, practice, and etiquette.
Morals is the application of ethics.

 It is possible for a nurse to have good ethics and bad morals.
 His/her principles are correct, but she falls to apply them.
Basis of Ethics
1. Human reason is capable in discovering some truths.
2. God exists.
3. God is Just
4. A good life shall merit God’s reward.
5. An evil life shall merit God’s punishment.
6. Man has a soul.
7. Man’s soul is immortal.
8. Man’s soul has soul has the faculties of intellect and will.
9. The object of the intellect is truth.
10. The object of the will is goodness.
11. Man’s will is free and is therefore capable of moral good or moral evil.
12. Good must be done; evil must be avoided.
13. An act is good when it is in conformity with right reason.
14. An act is evil when it is not in conformity with right reason.
B. Virtue Ethics
1. Virtue Ethics in Nursing
When people practice virtue ethics, they do not use universal rules or principles to guide
their actions. Since the time of Aristotle (384-322 BCE), virtues, arête in Greek, have referred to
excellences of character (Pence, 2000). Aristotle was one of the most influential thinkers on
virtue ethics. Virtue ethics deals with questions, such as "what sort of person must I be?" and
"what makes an individual a good or virtuous person?", rather than "what is right or good to do?".
Virtues are thought of as purposive dispositions and character traits that are developed throughout
life (Mappes & DeGrazia, 2001). Schools, social institutions, and families help to shape a
person's moral character.
Everyone upholds someone in their personal or professional lives as morally out-
standing because that person seems to have an almost unblemished character. Although these
people are judged superior in character and are seen as models for others, an in- finite number of
other people are also considered to be virtuous or as having the potential to develop a virtuous
character. Most, but not all, virtues, are considered a mean between two kinds of vices, involving
either an excess or a deficiency. For instance, Aristotle (trans. 2002) named courage as a virtue,
the excess of courage as rashness, and the deficiency of courage as cowardice. One other example
names truthfulness the mean; imposture the excess; and self-deprecation the deficiency. The

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mean for each virtue is unique for each situation and each person; in other words, the mean is not
always the exact aver- a0e. Some of the other virtues include benevolence, compassion,
thoughtfulness, fairness, justice, generosity, wisdom, temperance, and patience. Aristotle and
others identified many other virtues that people practice in their daily lives.
When virtuous people are faced with complex moral dilemmas, they will choose the right
course of action because doing the right thing comes from a developed character. Aristotle
believed that in order for moral character to be developed, an individual must make a personal
effort through training and routine practice.
Virtues of Health Care Provider
1. Fidelity
2. Honesty
3. Integrity
4. Humility
5. Respect
6. Compassion
7. Prudence
8. Courage
Theological Virtues
1. Faith
2. Hope
3. Charity
2. Core Values of a Professional Nurse

Caring is greatest proven by a nurse's capability to represent the five core values of
professional nursing. Core nursing standards is essential to bachelor education include human
integrity, autonomy, selflessness, and social justice. The caring professional nurse integrates these
values in clinical practice (Fahrenwald, Tschetter, White, and Winterboer, 2005).
Teaching Core Values in Nursing

1. Core values are the significant values of an individual or society.
2. These guiding principles dictate behaviour and can support individuals understand the
variance among true from erroneous.
3. Core values also help companies to determine if they are on the right path and fulfilling their
goals by creating an unwavering guide.
4. There are many different examples of core values in the world, depending upon the context.
Core Values About Life

Frequently, once you get somebody confer why they fell in love with their other half,
they will mention that they have similar beliefs. In this situation, they are often discussing
about core values, or inner opinion that dictate how life should remain existed.
Examples of core values that people influence their life are the following:
1. Belief, or lack thereof, in God or an affiliation with a religious/spiritual institution.
2. Belief in existence a decent bailiff of resources and in exercising prudence.
3. Belief that clan is of ultimate significance.
4. Belief that morality is continuously the finest strategy and trust has to be made.
5. Belief in sustaining a healthy work.
Parents also try to impart these types of positive core values in children in an effort to
give them guiding principles for living a good life. Core values aren't always positive. Certain
persons can be determined by egotism or greediness, (give an ex. of specific greediness) and
these are core values, too, if they order the way the people live their lives.

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Negative attitudes in core values can also develop when people live in anxiety and
mandatory to focus on existence in problematic situations.
Examples of negative core values are the following:
1. Belief that the creation is a basically cruel domicile and that only the tough live.
2. Belief that individuals are weak transformation their destinies or personal
situations.
3. Belief that people don’t merit decent things or dealings in life.
4. Belief that added people are basically unreliable and unloving.
5. Belief that existence is worthless.
For individuals looking to discover a vocation that includes serving, caring, and
nurturing those around them, nursing is a prodigious path to triumph. Becoming a nurse is one
of the greatest satisfying, rewarding vocation tracks that students can pursue, with each
specialized you must be dedicated in helping people around you. Here are some core values of
nursing fundamental to your nursing education:
1. Empathy and Caring
Nursing school should teach its students the true value of empathy and compassionate
care. Empathy is a nurse’s capacity to comprehend, understand, be sensitive to, and
vicariously experience the spirits, feelings, and involvements of the patient and their family.
The faculty considers that it is the student nurse’s capability and enthusiasm to “tune in” to
and emphasis on the patient’s involvements that is important that the approaches of nurses to
accomplish care. Empathy is based upon the admiration for the self-respect of the client and
gratitude for the freedom and self-actualization of the patient.
2. Communication
We believe communication—the conversation of opinions, communications, or
information—is of vital importance to the nursing procedure. A nurse uses communication
skills—speech, signs, script, and conduct—during patient assessment, as well as the
preparation, applying, and valuing of nursing care. A nurse connects with patients, families,
groups, and members of the health care team. They are knowledgeable in verbal and written
methods of communication, as well as in performances of therapeutic communication.
3. Teaching
One of the greatest significant parts of a nurse is to contribute patients and their
families with receiving information necessary for maintaining a patient’s best health. A nurse
delivers patients and families with information that is founded on their measured knowledge
requirements, their capabilities, their knowledge preference, and their enthusiasm to study.
Fundamental to the delivery of patient education is a nurse’s belief that patients have the right
to informed what decisions about their care. Nurses provide information that is kind of
treatment, procedures that patient’s needs. A nurse often clarifies information delivered by
other members of the health care team.
4. Critical Thinking
Nurses are continuously involved with creation precise and suitable scientific choices.
We believe nurses must be able to think critically and make decisions when patients present
problems for which there may not be clear, model explanations. A nurse must query, surprise,
and be able to discover numerous perceptions and potentials in order to greatest help patients.
Critical thinking involves vigorous, systematized perceptive procedure intended to permit a
nurse to discover and challenge expectations. Nurses that involve in critical thinking reflect on
past involvements, think autonomously, take jeopardies based on information, bear in the face
of difficulties, are inquiring, innovative, and decent.
5. Psychomotor Skills
They believe that important to nursing is the “laying on of hands” to deliver
relaxation, and the use of specific skills to achieve patient assessment, deliver and evaluate
nursing care. Nursing skills are utilized in a manner that maximizes client comfort and self-
respect, enhances the client’s capability to respond definitely, delivers the highest level of
correctness of information, and delivers for the most promising patient outcomes.
Psychomotor skills are best learned through practice after achieving an understanding of the
basic principles of services as part of nurse’s education at an excellent nursing school like
Goodwin University.
6. Applied Therapeutics

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The nurse applies medically-ordered therapeutic modalities, like pharmacological and
nutritional interventions (Total Parenteral Nutrition). A nurse’s presentation of these
modalities is based on a knowledge, concerning their therapeutic practices, as well as skills in
patient assessment, implementation and evaluation. The competent presentation of nutritional
knowledge also involves its uses in health and wellness, as well as when therapeutic diets are
prescribed.
7. Ethical and Legal Considerations
A nurse strategy, delivers, and evaluates nursing care directed by detailed principles
and lawful limitations. They believe the Code of Ethics for Nurses provides the perfect
framework for harmless and precise performs and conduct. Ethical behavior also includes
responsibility, accountability, confidentiality, honesty, loyalty, and fairness. Nurses who
elucidate their standards are improved in their aptitude to preparation morally.
Legal parameters of nursing are defined by constitutional, controlling, and common
law. In addition, specialized values of care deliver the legal strategies for nursing practice.
Legal deliberations in the care of clients include issues like neglect, misconduct, desertion,
assault, battery, and informed consent. Nurses must comprehend lawful limitations to defend
their patients’ and their own rights.
8. Professionalism
Professionalism includes the characteristics of a nurse that replicates his or her
professional status. These features include performances with regard to personality, patients,
others matter, and the public as they reproduce the standards of the nursing vocation. Professional
personalities are well-informed in their subject matter, conscientious in their activities, and
accountable for themselves and others. Written standards for repetition and specialized
presentation guide the performances of professional practitioners. We believe nurses enhance
their professionalism by sympathetic history, educational choice, professional research and
philosophy, and their professional organizations and standards.
C. Ethical Principles
1. Autonomy (Self-Determination)
Autonomy involves self-determination and freedom. Autonomy is the right of a rational

person to self-rule and to generate personal decisions independently (Beaucham & Childress,
2001). Some people argue that autonomy has top priority among the other principles. However,
there is no general consensus about this issue, and many argue that other principles, such as
beneficence, should take priority. Ideally, when using a framework of principlism, no one
principle should automatically rule supreme.
The principle of autonomy is sometimes described as respect for autonomy (Beau champ
& Childress, 2001). In the domain of health care, respect for a patient's autonomy includes
actions, such as obtaining informed consent for treatment; facilitating patient choice regarding
treatment options; allowing the patient to refuse treatment; dis closure by the provider of personal
medical information, diagnoses, and treatment options to the involved patient; and maintaining
confidentiality. Restrictions on autonomy may occur in cases where there is a potential for harm
to others through communicable diseases or acts of violence. People basically lose their
autonomy or right to self-determination in such instances.
Patient Self-Determination Act

The Patient Self-Determination Act of 1990, enacted in 1991, was the first federal statute
designed to facilitate the knowledge and use of advance directives (Devettere 2000; Guido,
2001). With the help of agencies, staff, and institutions, all health care providers must provide
written information to adult patients regarding the right to make health care decisions, refuse or
withdraw treatments, and write advance directives.
It is important that dialogue about end-of-life decisions and options not be lost in hospital
admission processes and office paperwork. Nurses provide the vital communication link between
the patient's wishes, the paperwork, and the provider. When the opportunity arises, nurses need to
take an active role toward increasing dialogue in regard to patients’ rights and end-of-life

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decisions. In addition to responding to the direct questions that patients ask, nurses would do well
to look for the subtle cues that patients give that signal their anxieties and uncertainty about end-
of-life care. A good example of compassion is the alleviation of suffering and fears in regard to
end-of-life nursing care and decision making. Beneficence The principle of beneficence addresses
deeds of "mercy, kindness, and charity Beauchamp & Childress, 2001, p. 166).
What is Autonomy in Nursing?

Autonomy is about a person’s right to make their own decisions. To do this
effectively, they need to have enough information. Patients do not always fully understand
what they have been told, or they may not have been told. Decisions are best made without
undue influence, and the person making the decision should also be deemed capable of doing
so.
Patient choice and autonomy are considered key in palliative care. Part of the nurse’s
role, wherever possible, is to advocate for a competent patient’s right to decide their own
course of action, whether it is something that the nurse feels is appropriate or not. Decision
making is complex and includes cultural and social aspects that are not always
acknowledged.
a. Patients’ Rights
Every person has a right to health and medical care corresponding to his state of health,
without any discrimination and within the limits of the resources, man power and competence
available for health and medical care at the relevant time. The patient has the right to
appropriate health and medical care of good quality. In the course of such, his human dignity,
convictions, integrity, individual needs and culture shall be respected. If any person cannot
immediately be given treatment that is medically necessary, he shall, depending on his state
of health, either be directed to wait for care, or be referred or sent for treatment elsewhere,
where the appropriate care can be provided.
1. Right to Appropriate Medical Care and Humane
2. Right to Informed Consent
3. Right to Privacy and Confidentiality
4. Right to Information
5. Right to Choose health care provider and facility
6. Right to Self-determination
7. Right to Religious belief
8. Right to medical records
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence and receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligations
b. Patients’ Bill of Rights

A Patient’s Bill of Rights is a document that provides patients with information on how
they can reasonably expect to be treated during the course of their hospital stay. These
documents are, in almost all cases, not legally-binding. They simply provide goals and
expectations for patient treatment. The Patient’s Bills of Rights was recently renamed the
Patient Care Partnership.
c. Informed Consent
Informed consent is based on the moral and legal premise of patient autonomy: You
as the patient have the right to make decisions about your own health and medical conditions.
Informed consent is when a healthcare provider — like a doctor, nurse, or other healthcare
professional — explains a medical treatment to a patient before the patient agrees to it.
This type of communication lets the patient ask questions and accept or deny
treatment. In a healthcare setting, the process of informed consent includes:
1. your ability to make a decision
2. explanation of information needed to make the decision
3. your understanding of the medical information

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4. your voluntary decision to get treatment
These components are essential elements of the shared decision-making process

between you and your healthcare provider. Most importantly, it empowers you to make
educated and informed decisions about your health and medical care.
What types of procedures need informed consent? The following scenarios require
informed consent:
1. most surgeries (major/minor surgeries)

2. blood transfusions
3. anesthesia
4. radiation
5. chemotherapy
6. some advanced medical tests, like:
a. biopsy
b. most vaccinations
c. some blood tests, like: HIV test
An informed consent agreement should include the following information:

1.diagnosis of your condition
2. name and purpose of treatment
3. benefits, risks, and alternative procedures
4. benefits and risks of each alternative
d. Proxy Consent
Proxy consent is the process by which people with the legal right to consent to
medical treatment for themselves or for a minor or a ward delegate that right to another
person.
There are three 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.
3. The right to consent must be delegated to a legally and medically competent adult.
There are two types of proxy consent for adults.
1. First, the power of attorney to consent to medical care, is usually used by patients
who want medical care but are concerned about who will consent if they are rendered
temporarily incompetent by the medical care. A power of attorney to consent to
medical care delegates the right to consent to a specific person
2. Second, Legally Authorized Representative (LAR): An individual or judicial, or
other body authorized under applicable law to grant permission on behalf of a
prospective participant for their participation in research activities.
e. Privacy
Privacy is essential to autonomy and the protection of human dignity, serving as the
foundation upon which many other human rights are built.
Privacy is important as it provides a secure environment for patients where they
receive medical care and provide complete and accurate information, and which reinforces
confidence in health care and emphasizes the importance of respect for patient autonomy.
Privacy enables us to create boundaries and protect ourselves from unwarranted
interference in our lives, allowing us to negotiate who we are and how we want to interact
with the world around us.

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Importance of Privacy
Medical privacy or health privacy is the practice of maintaining the security and
confidentiality of patient records. It involves both the conversational discretion of health care
providers and the security of medical records. The terms can also refer to the physical privacy
of patients from other patients and providers while in a medical facility.
Modern concerns include the degree of disclosure to insurance companies,
employers, and other third parties. The advent of electronic medical records (EMR) and
patient care management systems (PCMS) have raised new concerns about privacy, balanced
with efforts to reduce duplication of services and medical error.
2.Confidentiality
Confidentiality is the right of an individual to have personal, Identifiable medical

information keep private. Such information should be available only to the physician of
record and other health care and insurance personnel as necessary.
Confidentiality in nursing ethics
Maintaining patient privacy and confidentiality is an ever-present legal

and ethical duty of nurses. ... In any circumstance, the nurse is duty-bound to prevent, insofar
as humanly possible, any unauthorized release of an individual's identifiable health
information.
Patient confidentiality is sacred trust. Nurses are important in ensuring that
organizations create an environment to safeguard patients' rights to confidentiality. Nurses,
physicians, and all who provide care, are entrusted with the patient's health information solely
to be of service to that patient.
One of the most important elements of confidentiality is that it helps to build and
develop trust. It potentially allows for the free flow of information between the client and
worker and acknowledges that a client's personal life and all the issues and problems that they
have belong to them.
5 Ways to Maintain Patient Confidentiality

1.Create thorough policies and confidentiality agreements.
2.Provide regular training.
3.Make sure all information is stored on secure systems.
4.No mobile phones.
5.Think about printing. (how do you apply this to your patient)
Some Examples of Ways you could Unintentionally break patient/therapist

confidentiality:
1.Sharing confidential information about a client with a family member or friend.
2.Talking about confidential information somewhere you can be overheard.
3.Leaving your computer containing confidential information open to others.
The types of information that is considered confidential can include:
a. name, date of birth, age, sex and address.
b. current contact details of family, guardian etc.,
c. bank details.
d. medical history or records.
e. personal care issues.
f. service records and file progress notes.
g. individual personal plans.
h. assessments or reports.

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The principle of confidentiality is about privacy and respecting someone's wishes. It
means that professionals shouldn't share personal details about someone with others, unless
that person has said they can or it's absolutely necessary.
Confidentiality of information like privacy, is safeguarded by the law. In 2012 the
Philippines passed the Data Privacy Act 2012, comprehensive and strict privacy legislation
“to protect the fundamental human right of privacy, of communication while ensuring free
flow of information to promote innovation and growth.” (Republic Act. No. 10173, Ch. 1,
Sec. 2).
3. Veracity
Veracity is defined as being honest and telling the truth and is related to the principle of
autonomy. It is the basis of the trust relationship established between a patient and a health care
provider. This allows patients to use their autonomy to make decisions in their own best interest.
Patients are expected to be truthful about their medical history, treatment expectations, and other
relevant facts (Beemsterboer, 2020).
Principle of truth telling

a. It is grounded in respect for persons and the concept of autonomy
b. It is being completely truthful with patients; nurses must not withhold the whole truth from
clients even when it may lead to patient distress.
The Importance of Truth.

Truth matters, both to us as individuals and to society as a whole. As individuals, being
truthful means that we can grow and mature, learning from our mistakes. For
society, truthfulness makes social bonds, and lying and hypocrisy break them.
4. Fidelity
The ethical principle of fidelity is often related to the concept of faithfulness and the
practice of keeping promises. Society has granted nurses the right to practice nursing through the
processes of licensure and certification. "The authority for the practice of nursing is based on a
social contract that acknowledges professional rights and responsibilities as well as mechanisms
for public accountability" (ANA, 1995, p. 3). The process of licensure is one that ensures no
other group can practice within the domain of nursing as defined by society and the profession.
Thus, to accept licensure and become legitimate members of the profession mandates that nurses
uphold the responsibilities inherent in the contract with society. Members are called to be faithful
to the society that grants the right to practice -to keep the promise of upholding the profession's
code of ethics, to practice within the established scope of practice and definition of nursing, to
remain competent in practice, to abide by the policies of employing institutions, and to keep
promises to individual patients. To be a nurse is to make these promises. In fulfilling this
contract with society, nurses are responsible to adhere to these basic principles faithfully and
consistently.
On another level, the principle of fidelity relates to loyalty within the nurse-patient
relationship. It gives rise to an independent duty to keep promises. or contracts (Veatch, 2000)
and is a basic premise of the nurse-patient relationship. Problems sometimes arise when there is
a conflict between promises that have been made and the potential consequences of those
promises in cases in which carrying them out will cause harm in other ways. Though fidelity is
the cornerstone of a trusting nurse-patient relationship, most ethicists think there are no absolute,
exceptionless duties to keep promises that, in every case, harmful consequences of the promised
action should weigh against the benefits of keeping the promise.
5. Justice
Justice is a principle in health care ethics as well as the basis of a duty-based ethical
theory. In other words, the concept of justice is all encompassing in the field of ethics
(Beauchamp & Childress, 2001). Justice –is the quality of being just; righteousness,
equitableness, or moral rightness: to uphold the justice of a cause, rightfulness, or lawfulness, as
of a claim or title; justness of ground or reason. It is a concept on ethics and law that means that
people behave in a way that is fair, equal, and balanced for everyone. The idea of justice

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occupies centre stage both in ethics, and in legal and political philosophy. We apply it to
individual actions, to laws, and to public policies.
The principle of justice states that there should be an element of fairness in all medical
decisions: fairness in decisions that burden and benefit, as well as equal distribution of scarce
resources and new treatments, and for medical practitioners to uphold applicable laws and
legislation when making choices.
Three principles of justice
Contemporary reviews of the psychology of distributive justice have tended to

emphasize three main allocation principles, equity, equality, and need, and to propose that each
operates within a specific sphere of influence.
Equity proceeds in the principle that a right or liability should as far as possible be
equalized among all interested. In other words, two parties have equal right in any property, so it
is distributed equally as per the concerned law.
The Right to Equality and Non-discrimination. The general principle of equality and
non-discrimination is a fundamental element of international human rights law. Thus, the right
to equal treatment requires that all persons be treated equally before the law, without
discrimination.
The principle of need—the idea that resources should be allocated according to need—is
often invoked in priority setting in the health care sector. Yet, if two needs are dissimilar but of
seemingly equal magnitude, the comparative relation does not change by a small adjustment of
one of the factors.
Why is justice important in nursing?
Social justice is a core nursing value and the foundation of public health nursing.
Social justice ideology requires nursing students to uphold moral, legal, and humanistic
principles related to health. Social justice implies that there is a fair and equitable distribution of
benefits and burdens in a society.
Some Moral Issues:
a. What are some of the hospital practices you observe that could be considered as acts of
injustice against patients?
c. Identify some behavior or acts of medical doctors or nurses that are considered a violation of
justice? These acts could be committed against patients or simply neglecting their duties?
c. How may a patient commit an injustice to a medical professional?
6. Beneficence
It is the principle of doing act of goodness, kindness, and charity. Thus, the principle is
stated as: “DO NO HARM and PRODUCE DOOD,” or “DO GOOD and DO NO HARM.”
Health professionals should take great care not to compound or aggravate the ill patient’s
condition by causing further injury. Harm could be in a form of physical, emotional or verbal
abuse, negligence of duty on the part of the care givers and similar acts that would cause
physical pain and psychological suffering for the patient (Tago Jr.)
Beneficence is an ethical principle that addresses the idea that a nurse's actions should
promote good. Doing good is thought of as doing what is best for the
patient. Beneficence should not be confused with the closely related ethical principle of non-
maleficence, which states that one should not do harm to patients.
Some Moral Issues:

a. If a fetus is detected to be deformed or defective through a process known as amniocentesis
(a laboratory-based method of human reproduction), would one be doing good than harm by
aborting it?
b. If you operate on an individual for an enlarged appendix, are you inflicting injury and pain
upon this person? Will you be doing more harm than good?

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7. Non-maleficence
Nonmaleficence means non-harming or inflicting the least harm possible to reach a

beneficial outcome. Harm and its effects are considerations and part of the ethical decision-
making process in the NICU. Short-term and long-term harm, though unintentional, often
accompany life-saving treatment (Sundean and McGrath, 2013).
Nonmaleficence non maleficence basically means do no harm. Example of non-
maleficence include not saying hurtful things to another (give example; giving harmful drugs) in
the practice of medicine, stopping a medication that is shown to be harmful or refusing to
provide a treatment that has not been shown to be effective. Many people consider that non
maleficence is the primary consideration of ethics since it is more important not to harm the
patients than to do them good. Since many treatment methods involve some degree of harm, the
concept non maleficence would imply.
D. Other Relevant Ethical Principles
1. Principle of Double Effect
For an act to be good, it must be good in all determinants. A defect in any one of them
renders the act evil and is morally prohibited (Sambajon Jr., 2007). Not infrequently, a single act
done produces two or more effects. A good act may have several good effects and is worthy of
being performed thereby increasing its goodness or even adding new goodness. An evil act may
also have several evil effects and is unworthy of being chosen. Besides, it may intensify its evil or
even add new evil malice. Now, there are times an act is done with two effects, one is good and
the other is evil. The question is “Is it morally permissible to do such an act – with both good and
evil effects?”.
The answer is, yes, provided the Principle of Double Effect is invoked whose conditions
must be satisfactorily fulfilled.
The four conditions:
a. The act must be good in itself, or at least, morally indifferent.
b. The evil effect should not be directly intended, but morally allowed to happen as a
regrettable consequence.
c. The evil effect should not outweigh the good effect.
d. The unavoidable evil effect is the only way to produce the good effect.
2. Principle of Legitimate Cooperation
The Principle of Legitimate Cooperation portrays the Principle of the Double Effect in a
scenario in which more than one person participates in the actions being evaluated.
Principle of legitimate cooperation:
1.The cooperation is not immediate.
2.The degree of cooperation and the degree of scandal are taken into account.
The principles governing cooperation differentiate the action of the wrongdoer from the
action of the co-operator through two major distinctions.
1. The first is between formal and material cooperation. If the cooperator intends the object of
the wrongdoer's activity, then the cooperation is formal and, therefore, morally wrong.
2. The second distinction deals with the object of the action and is
expressed by immediate and mediate material cooperation. Material cooperation is immediate
when the object of the cooperator is the same as the object of the wrongdoer.
3. Principle of Common Good and Subsidiarity
“Subsidiarity is the coordination of society's activities in a way that supports the internal
life of the local communities” The common good is “the totality of social conditions allowing
persons to achieve their communal and individual fulfilment” (Benedict XVI, 2008).

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Human beings exist in relation to one another. We are called to live with others, aware of
others, communicating, sharing, enjoying moments of joy and being there together in times of
sadness. All of us are called to participate, to join in, and to work alongside others for the
common good of all.
The Hebrew word for Peace is shalom, but shalom can also be translated in English as
fullness or completeness. Therefore, this theme also links social well-being and development at
both individual and community level. In many ways this explains the theme of Peace much better
because it is not just an absence of war or conflict that constitutes peace in the eyes of Catholic
Social Teaching, but a complete trust and fraternity between people. Pacifism has not always
been the approach taken towards resolving conflict within Catholic Social Teaching, but it is
however growing in influence. “Peace results from that harmony built into human society by its
divine founder, and actualized by men as they thirst after ever greater justice”.
E. The calling of a Health Care provider
1. The Health Care Profession
Is an occupation requiring advanced, specialized, and systematic study and training in the
knowledge of health care designed to provide services to society in that field.
2. The health care Professional / Practitioner
Is one who has acquired an advanced, specialized, and systematic training and experience in
the knowledge of healthcare with scientific specializations and techniques.
 Profession- occupation, vocation, calling, require advanced training and experience in
some specific body of knowledge.
3. What does it take to be a health care practitioner?

-To be a man or women for others-
- Clients who are in need of health care services.
4. Basic Attitudes of a Health Care Practitioner

1. Caring and warm
2. Comforting
3. Courteous
4. Affirming, accepting, and loving (allow patients to ventilate feelings)
F.Principles of Bioethics
Etymological meaning: from Greek word, BIOS, meaning life; hence, Bioethics,
etymologically means, ethics of life (Tago, Jr.) Broadly considered, Bioethics is the ethics of
medical care. Strictly speaking, Bioethics is defined as:
“A branch of applied ethics which investigates practices and developments

in the life sciences and or biomedical fields. It is, in other words,
an applied study of ethical issues and values not only in medicine and biology
but also, in the behavioral sciences. (Tago, Jr.)
The primary and major predicaments with which bioethics deals are those concerning
life, health, and death that have resulted from modern technology (e.g. biomedical engineering and
genetic therapy), particularly the way they have affected human values.
The “BIO” part of bioethics leads us to examine new findings and data from the physical
and natural sciences. We take seriously the scientific knowledge derived from the disciplines and we
evaluate them in the light of the ethical principles.
Bioethical approach is inter-disciplinary, that is, as much as possible, all pertinent
biological, philosophical, medical, legal, psychological, and sociological knowledge available at hand
must be pooled together to settle certain moral dilemmas.

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1. Principle of Stewardship
This moral principle is both a philosophical truth and a deduction from the Christian and
Biblical teachings. Everything in this world is created by God or Caused by Him. He is the First
Cause, the Origin, the Beginning of all that is (all beings) (Tago, Jr.)
The First Cause of everything that exist is named by the Bible and Christian faith as the
God, the Creator and Father of all. God gave man the inherent power to perpetuate human life
throughout the ages aside from causing directly his existence into this planet. Since, man is the only
created being (in this planet) endowed with reason and freedom, he is entrusted by his creator to take
care of all creation including his own life and the life of other people. He is also given the
responsibility to sustain, preserve, develop, and even bring into perfection or fruition or achieve the
destiny of every created being including and most especially the destiny of every human being. The
basic moral responsibility to take care of all creation is what we called stewardship principle (Tago,
Jr.)
Nurse Leaders as Stewards:
1. Stewardship refers to the expression of one’s responsibility to take care, nurture, and
cultivate what has been entrusted to him.
2. In health care practice, stewardship refers to the execution of responsibility of the
health care practitioners to look after, provide necessary health care services, and
promote the health and life of those entrusted to their care.
3. Stewardship requires us to appreciate the two great gifts that a wise and loving God
has given:
a. The Earth, with all its natural resources and our own human nature, with its biological,
psychological, social, and spiritual capacities.
b. This principle is grounded in the presupposition that God has absolute Dominion over
creation, and that in so far as human beings are made in God’s image and likeness, we have
been given a limited Dominion over creation and are responsible for its care.
c. In the Book of Genesis, God appoints humanity as the steward of all creation. Civilization
was responsible for the regulation of medical practice and pharmaceuticals. The broad
definition of state-orientated stewardship is that the function of nurse leaders or stewards will
need to use of mentors and personal coaches.
What are stewards of healthcare?

Decision-making by nurses involves personal and moral values to ensure high standards
in the quality of healthcare. Nurses become stewards or teachers to patients who may not have the
expertise or experience in the disease process, but who understand the consequences of their
illness.
2. Principle of Totality and its Integrity
The whole is greater than its parts. This principle justifies sacrificing the part for the
benefit of the whole. Thus, to cut one’s legs is morally acceptable if this is the only way to save
the whole person’s life, otherwise, it would be a case of mutilation, which is morally wrong –
against the principle of stewardship. Moreover, the person’s right to life (which is protected and
preserved by cutting the legs) is more important than the parts of his body being sacrificed
(Tago, Jr.)
However, taking away any parts of the human body for any other purposes, aside from
preserving one’s life, cannot be made morally acceptable. Thus, selling one internal organ to
have money to buy some needs is morally wrong. In this particular case, the principle of totality
does not apply.
Satisfying a human need (that is not equal to the preservation of human life) is a lesser
value compared to the loss of a body part, which, although may not immediately result to death,

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but may weaken the person’s capability to maintain his healthy status. Such would be against
the principle of stewardship and eventually against the right to life principle.
A. Ethico-moral Responsibility of Nurses in Surgery

Registered Nurse (RN) has ethical and moral responsibility to represent the patient's
interests, show humility, respect and protect patient autonomy and preserve patient dignity. They
have responsibility to themselves, their profession, and their patients to maintain the highest
ethical principles. It is important to advocate for patient care, patient rights, and ethical
consideration of practice.
Ethico-Moral Aspects in Nursing. Autonomy-the right/freedom to decide (the patient
has the right to refuse despite the explanation of the nurse) Example: surgery, or any procedure.
Nonmaleficence-the duty not to harm/cause harm or inflict harm to others (harm maybe
physical, financial or social).
B. Mutilation/ Sterilization
Mutilation
Mutilation refers to the procedure that diminishes or destroys the functional integrity of
the human body (Sambajon, Jr., 2007).
Types of Mutilation
1. Major Mutilation
Refers to the procedure that destroys the functional integrity of the human body so
that it becomes incapacitated of its natural function. It may usually be done by means of
surgical procedures. Ex. Radical Mastectomy, Appendectomy, Herniorrhaphy, Caesarean
Section, Craniotomy.
2. Minor Mutilation
Refers to the procedure that diminishes but does not destroy the functional integrity
of the human body. Ex. Biopsies (mole, warts), excision of ingrown.
Is Mutilation Moral?
When the health of the body or life of the person is in danger and there is no other
means by which health can be restores or life can be saved except through mutilation, the
right reason dictates that mutilation can be done. Restoration of health or preservation of life
can be a sufficient reason for the performance of mutilation.
The Three Conditions:

There are three conditions that need to be satisfactorily fulfilled so that the surgical
removal of a healthy organ can be morally allowed, to wit:
a. That the preservation or functioning of a particular organ provokes a serious damage
or constitutes a threat to the complete organism (whole body)
b. That this damage cannot be avoided, or at least notably diminished, except by the
amputation (or mutilation) in question and that is efficacy is well assured; (ex:
Diabetic case, trauma or accident)
c. That it can be reasonably foreseen that the negative effect, namely, the mutilation and
its consequences, will be compensated by the positive effect; exclusion of a damage
to the whole organism, mitigation of the pain, etc.
The aforementioned conditions are in conformity with the principle of totality which
provides that in case of conflict, a particular organ must be subjected and subordinated to the
whole body since the body as the organic whole is greater than any of its part. Hence it is morally
permissible for a healthy organ to be surgically removed in order to address the pathologic state
of another organ, to restore health and to save life indicating the fulfilment of the given
conditions.
If the mutilation is a minor one, and a reasonable cause exists for the excision, it would
be moral to remove the organ.

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Is Sterilization Moral?
As long as it is direct, that is the very purpose for which it is employed rendering the
process of reproduction impossible, sterilization is gravely immoral. It is a patent violation of
the natural law. In fact, aside from evil of contraception it incurs, sterilization also earns the
evil of mutilation. This means that sterilization dose not only arbitrarily thwart and distort
the natural power of the marital act to generate life(contraception), but also destroys the
functional integrity of the human body, particularly, of the reproductive system rendering it
unfit for its natural functions.
C. Preservation of Bodily of Functional Integrity
Directive 29 supports respect for bodily integrity, stating that "All persons served by
Catholic health care have the right and duty to protect and preserve their bodily and functional
integrity." The 1977 ERD, Directive 33, states that "unnecessary procedures, whether diagnostic
or therapeutic, are morally and that is part of treatment.
The letter to the Corinthians (1 Corinthians 12:18) reiterates God's genius as man's
Creator. "But that isn't the way God has made us. He has made many parts for our bodies and has
put each part just where he wants it".
4. Organ Donation
Organ donation and transplantation (ODT) is a modern-day success story: everything

about it can be seen in a positive light (Simpson, 2012). For the donor and their relatives,
something good has emerged from a disaster. For the recipient, there is the opportunity for a new
independent life, free from many of the constraints of supportive therapy. For the medical
profession, there is an opportunity to bring about a cure for an otherwise intractable acute or
chronic disease, and for society as a whole, it provides an exceedingly cost-effective solution. The
‘Holy Grail’ of treatment for organ failure remains the ability to regenerate individual organs for
an individual patient using stem cell technology. However, ODT is currently the most realistic
option for chronic organ failure, which (particularly in the case of renal failure) can occur in an
otherwise fit and healthy individual. Indeed, solid organ and tissue transplantation, either singly
or combined, is being used for increasingly complex diseases and situations way beyond those
currently considered usual, such as the kidney, liver, pancreas, heart, and lung. Furthermore,
composite tissue transplants (e.g. involving the trachea, the face, or a whole limb) are being
developed; undoubtedly, these will become more routine in the future.
Despite this success, organ donation carries with its significant moral and ethical
obligations. In most developed countries, organ donation is an entirely altruistic act irrespective
of whether the donor is alive or dead. Hence, the recipient is obliged to do their utmost to ensure
the survival and success of the organ. This includes enrolment in clinical trials and long-term
compliance with appropriate medication to support its continuing function. Health-care
professionals involved in the donation and the transplant must ensure that the organs are obtained
in optimal condition and that the care provided to the donor, the donor's family, and the recipient
is of the highest standard.
Despite its widespread potential, the continuing success of organ donation depends upon
an adequate supply of organs. It is It is increasingly apparent that the number of organs obtained
in the traditional way from brain-stem dead donors has reached a plateau. In the UK, there is still
around a seven to one discrepancy between those requiring a kidney transplant and the number of
donors. Furthermore, this imbalance between the need and availability of suitable donor organs is
set to continue, for kidney and other transplants.
3. Principle of Ordinary and Extraordinary Means
Ordinary means reasonable hope of benefit/success; not overly burdensome; does not
present an excessive risk and are financially manageable. Ordinary means “all medicines,
treatments, and operations, which offer a reasonable hope of benefit for the patient and which can
be obtained and used without excessive expense, pain, or other inconvenience” (Kearns, 2018).

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Extraordinary means no reasonable hope of benefit/ success; overly burdensome;
excessive risk and are not financially manageable. No obligation to use it/morally optional.
Extraordinary means “all medicines, treatments, and operations, which cannot be obtained or used
without excessive expense, pain, or other inconvenience, or which, if used, would not offer a
reasonable hope of benefit” (Kearns, 2018).
Elements of Ordinary Means
1) Reasonable/proportionate hope of benefit/success
2) Common diligence
3) Proportionate – physical/social/financial
4) Not unreasonably demanding
Elements of Extraordinary Means
1) “Certain impossibility” – physical or a moral
2) Great effort – excessive
3) Pain
4) Exquisite and extraordinarily expensive

5) Severe dread or revulsion
4. Principles of Personalized Sexuality
The Principle of Human Sexuality may be stated as follows:
a. The gift of human sexuality must be used by husband and wife in keeping with its basic,
inseparable, specifically human teleology.
b. It should be a tender, fleshly, pleasurable expression of the complimentary, permanent
self-giving of a man and a woman to each other, which is open to fruition in the
perpetuation and expansion of this personal communion through the family they beget
and educate.
Sexuality
a. Sexuality is a complex and aspect of our personality and ‘self’. Our sexuality is defined
by sexual thoughts, desires and longings, erotic fantasies.
b. Sex is a search for sexual pleasure and satisfaction, releasing physical and psychic
tensions.
c. Sex is a search for the completion of the human person through an intimate personal
union of love expressed by bodily union.
d. Sex is a symbolic (sacramental) mystery, somehow revealing the cosmic order.
I. Reflection
A. Should we always live by the rules? What are the advantages and disadvantages of following
rules?
B. How did you learn right and wrong? What was the influence of your parents? Society and
other forces?
C. Since nurses and doctors knows more about the since of health care, when, if ever, is it
appropriate for them to make decisions about the health care regimen, without participation
of the patient?
II. Post Test
Read the following case and answer the questions that follow:
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A. Martha is a seventy-five-year-old woman who has terminal cancer of the bladder. During the
course of her therapy, she sustains third-degree radiation burns to her lower abdomen and
pelvic area. Her wounds are extensive and deep., involving her abdominal wall, bladder, and
vagina. The physician’s orders frequent medicinal douches and wound irrigations. These
treatments are very painful, and the patients wants the treatments discontinued but is too
timid to actually refuse them. The physician will not change the order.
1. Discuss the situation in terms of beneficence and nonmaleficence.

2. How does this patient express her autonomy?
3. What is the nurse’s responsibility in assisting the patient to maintain autonomy?
4. How does the nurse deal with conflicting loyalties and principles?
B. A female patient is admitted and diagnosed to have a carcinoma of the uterus. Her condition
necessitates immediately hysterectomy, non-removal of which endangers her life.
Hysterectomy takes away the organ in which fetus normally develops and from which
menstruation occurs thereby destroying the reproductive faculty of the patient. Obviously,
the surgical procedure produces two effects, one is the removal of the uterine cancer thereby
saving the patient as the good effects, and the other is the patient’s inability to get pregnant
as the evil effect.
1. In which case, is hysterectomy morally justified?

2. Explain your answer using the four conditions.
C. A patient who is still conscious, yet, whose irreversible death because of terminal prostatic
cancer is fast approaching, verbally signifies his wish.
Patient: I want to donate some of my vital organs to the organ bank for life-sustenance of
others. You can have my kidneys, corneas, heart, lungs and liver removed for future
transplantation.
Doctor: Okay, but it’s better for you and your relatives to sign a document consenting to the
donation of your vital organs.
Relatives: Alright, no problem.
In short, they sign the necessary document giving their consent. After sometime, as he is
dying, the patient is taken to the operating room for the removal of the said vital organs in
pursuance to the agreement.
1. Is it morally permissible for the health care practitioners to remove the vital organs of the
dying patient?
2. Explain your answer.
III. References
Burkhardt, Margaret A. and Nathaniel, Alvita K. Ethics and Issues in Contemporary Nursing. 2 nd
Edition (2002). Thompson Learning Asia.
Rich, Karen and Butts, Janie. Nursing Ethics: Across the Curriculum and into the Practice. Jones
and Bartlett Publishers.
Tago, Bonifacio C. Jr., Bioethics
Sambajon, Jr., Marvin Julian L. Health Care Ethics: A College Textbook for Nursing, Medicine,
and Other Health-care Related Courses (2007). C & E Publishing, Inc.

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https://ethics.org.au/ethics-explainer-deontology/
https://www.britannica.com/topic/teleological-ethics
https://ethics.org.au/ethics-explainer-deontology/#:~:text=Deontology%20is%20a%20theory
%20that,with%20German%20philosopher%2C%20Immanuel%20Kant.
https://pubmed.ncbi.nlm.nih.gov/15682160/
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce510/
veracity#:~:text=Veracity%20is%20defined%20as%20being,and%20a%20health%20care
%20provider.&text=This%20allows%20patients%20to%20use,in%20their%20own%20best
%20interest.
https://plato.stanford.edu/entries/principle-beneficence/#:~:text=The%20term%20beneficence
%20connotes%20acts,kindness%2C%20generosity%2C%20and%20charity.&text=Whereas
%20beneficence%20refers%20to%20actions,to%20act%20to%20benefit%20others.
https://www.medscape.com/viewarticle/811079_5
https://www.coursehero.com/file/8582543/920-notes/#:~:text=View%20full%20document-,The
%20Principle%20of%20Legitimate%20Cooperation%20When%20it%20is%20applied
%20Whenever,committing%20a%20morally%20evil%20act.
http://www.arthurstreet.com/MEDICAL_ETHICS1995.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375653/#:~:text=%E2%80%9CSubsidiarity
%20is%20the%20coordination%20of,%E2%80%9D%20(Benedict%20XVI%202008).
https://academic.oup.com/bja/article/108/suppl_1/i3/237272
http://www.beaumont.ie/media/OrdinaryandExtraordinaryTreatment1.pdf
UNIT II. BIOETHICS AND ITS APPLICATION IN VARIOUS HEALTH

CARE SITUATIONS
I. Introduction
Everyone makes decisions as part of everyday living. Some decisions seem routine, such
as what to have for lunch or what to wear to work. Other decisions, like where to go to
college, which job to accept or whether to marry, call for more deliberation. Nurses
constantly make decisions. We decide matters related to management of care, institutional
policy or when to collaborate or initiate referrals. Often, we make decisions without
conscious awareness of the process but have an innate sense of knowing what to do.
Ethical decision making may not seem as clear-cut as decisions made in other areas of
life. How do we decide whether to remove life support measures for a parent or whether to
cut funding for childhood immunizations in lieu of other, equally important programs? What
factors are involved in ethical dilemma that makes “the right choice” either evident or
obscure? This unit defines concept of different bioethical issues that would help and be a
guide for ethical decision making.
II. Objectives/Competencies

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At the end of this unit, I am able to:
1. describe and differentiate ethical dilemmas, moral uncertainty, practical dilemmas,
moral distress, and moral outrage;
2. describe the process of making thoughtful decisions;
3. describe the role of emotions in ethical decisions; and
4. apply the ethical decision-making process to clinical case situations.
III. Pre-Test
Encircle the letter of the correct answer.

1. Do not resuscitate in common language except:
a. "Do everything in your power to keep me alive"
b. "Don't put me on life support"
c. “Do Not Intubate”
d. "Don't revive me"
2. This means making sure that consent has been granted, not assumed, following an
educational process that facilitates the weighing of benefits, risks, and available options
a. Informed consent
b. Confidentiality
c. Decision-making capacity
d. Veracity
3. A patient decision-making capacity includes the ability to:
a. Make a choice
b. Understand consequence of the choice
c. Reason for his/her choice
d. All of the above
IV. Lesson Proper
A. Sexuality and Human Reproduction
1. Human Sexuality and its Moral Evaluation

Throughout history, Christian ethics has centered its consideration of human sexuality in
committed monogamous lifelong heterosexual Christian marriage. Such marriage has been
normative, in that it has provided the standard on the basis of which sexual desire and behavior
have been evaluated. Such marriage, seen biblically and theologically, has the potential to signify
Christ's union with the Church. It is also a manner of life that may be beneficial to the individuals
involved and to the larger society of which they are a part; and it may serve as a school for human
relationships. But even within this understanding of Christian marriage, for some major strands of
ethics, sexuality is only a good in so far as it is open to procreation. For other major strands,
sexuality is both a good in itself and a means of achieving other goods and purposes, including
for example such things as commitment, fidelity, mutual joy and comfort. (Wondra, 2012)
Christian ethics is about how people may lead a moral Christian life in the midst of the
changes and chances of human existence, ethicists recognize that ideally normative forms of
relationship (such as sexuality within a particular understanding of marriage) may not be possible
for some people in some situations. At their best, sexual desire and sexual behavior enhance the
qualities that characterize moral relationships; they are, in the language of moral theology,
ordered or oriented toward those qualities. Such ordering may be found where desire may not be
a factor or may not be recognized; and it is true where sexual behavior may be absent or
deliberately curtailed. And of course, such ordering or orientation may be found in other
situations as well, such as those where desire is a factor but behavior is not, or where both desire
and behavior are factors.
At their worst, sexual desire and sexual behavior diminish and even destroy the qualities
that characterize moral relationships. As much as sexuality, created by God for the good of
humanity, may enhance and fulfil our humanity, it may also distort and destroy it. And this latter

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possibility is present even within what Christian ethics has prescribed as normative: committed
monogamous lifelong heterosexual Christian marriage.
2. Marriage
Marriage is a legally or formally recognized union of two people a partner in a personal
relationship (historically and in some jurisdictions specifically a union between a man and a
woman) (Lexico). A formal union and social and legal contract between two individuals that
unites their lives legally, economically, and emotionally. Being married also gives legitimacy to
sexual relations within the Marriage; a the state of being united to a person of the opposite sex as
husband or wife in a consensual and contractual relationship recognized by law; an act of
marrying or the rite by which the married status is effected; especially: the wedding ceremony
and attendant festivities or formalities.
a. Fundamental of Marriage
They have learned to invest their money, energy, and time into the (8) eight essentials of
a healthy marriage:
1. Love/Commitment. At its core, love is a decision to be committed to another
person.
2. Sexual Faithfulness.
3. Humility.
4. Patience/Forgiveness.
5. Time.
6. Honesty and Trust.
7. Communication.
8. Selflessness.
b. The Reality of Sex Outside Marriage
The important and integral role that sex plays in an individual’s desire to be fully
human has, to some extent, remained unclear, doubtful, and even sinful, due primarily to
culturally patterned negative attitude of the Filipinos towards human sexuality. Many still find
an open and sane discussion of sex a taboo [bawal] or a mortal sin. Traditional sex attitudes, in
other words, are conservative and strict. Sex is something to be tolerated, being done, but kept
secret [“in the dark”], not openly discussed in public and seldom between children and parents,
between the young and their elders. (Tago, Jr.)
Whatever our sex attitude may be, the irrefutable fact is that individual is born out of
human sexuality, either by choice, by design or by accident. We have been “thrown” into this
world through sex, without our knowledge. Sex is a fact of life; an essential part of human
nature, hence an integral component of being human. Though, at times, human being may be
born out of accident; it is never an accident to be sexual.
To what extent, if at all, does sex play a considerable role in an individual’s desire to
become authentically human? Is human sexuality meaningful or meaningless?
Homosexuality
Homosexuality is romantic behavior between members of the same sex or gender. In
1952, when the American Psychiatric Association published its first Diagnostic and Statistical
Manual of Mental Disorders, homosexuality was included as a disorder. Even if gay marriage is
already legalized, not all accept and embrace this practice.
Homosexual persons are likely to experience more violence and marginalization due
to their sexual orientation. Due to this adverse social behaviour directed towards homosexual
males, there is higher incidence of suicide attempt and suicide related deaths. The term
‘homosexuality’ was coined in the late 19 th century by an Austrian-born Hungarian psychologist,
Karoly Maria Benkert. Although the term is new, discussions about sexuality in general, and
same-sex attraction in particular, have occasioned philosophical discussion ranging from
Plato’s Symposium to contemporary queer theory. Since the history of cultural understandings of
same-sex attraction is relevant to the philosophical issues raised by those understandings, it is
necessary to review briefly some of the social history of homosexuality. Arising out of this

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history, at least in the West, is the idea of natural law and some interpretations of that law as
forbidding homosexual sex.
Fornication- is generally consensual sexual intercourse between twonpeople not married to

each other.
Pre-Marital Sex-is sexual activity practiced by people before they are married.
Extramarital Sex-occurs when a married person engages in sexual activity with someone
other than his or her spouse.
c. Issues on Contraception, its Morality, and Ethico-moral Responsibility of Nurses
Contraception the deliberate use of artificial methods or other techniques to prevent

pregnancy as a consequence of sexual intercourse. The major forms of artificial contraception are
barrier methods, of which the most common is the condom; the contraceptive pill, which contains
synthetic sex hormones that prevent ovulation in the female; intrauterine devices, such as the coil,
which prevent the fertilized ovum from implanting in the uterus; and male or female sterilization.
Is Contraception Moral?
Contraception is not wrong even it carries health risks Contraception may damage the
health of the individual using it in two ways; either through side effects of the contraceptive or
because using contraception allows people to have more sexual partners and thus increases the
possibility of catching a sexually transmitted disease.
The moral case for contraception is largely based on the absence - in the eyes of
supporters - of any good reason for considering birth control morally wrong. But since there are
many positive reasons why people believe that it is right to allow people to practice birth control.
3. Issues on Artificial Reproduction, its Morality and Ethico-moral Responsibility of

Nurses
a. Artificial Insemination (AI)

Artificial insemination is a fertility treatment method used to deliver sperm
directly to the cervix or uterus in the hopes of getting pregnant. Sometimes, these sperm
are washed or “prepared” to increase the likelihood a woman will get pregnant.
Is Artificial Insemination Moral?

If one wants to deal with the casuistry of artificial insemination (AI). it is necessary
to bring forth certain theological and anthropological presuppositions. If one wants to deal
with the casuistry of artificial insemination (AI). It is necessary to bring forth certain
theological and anthropological presuppositions on the basis of which individual instances of
AI are judged.
b. In-vitro Fertilization
In vitro fertilization (IVF) is a process by which an egg is fertilized by sperm outside
the body: in vitro. A major treatment protocol for meaning in “glass”, is used, as early
biological experiments involving cultivation of tissues outside the living organism were
carried out in glass containers such as beakers, test tubes, or petri dishes. A colloquial term
for babies conceived as the result of IVF, is "test tube babies”.
The first Test-Tube Baby

On July 25, 1978, Louise Brown, the first Test-Tube Baby, the first baby conceived in
a Petri dish, was born Dr. (R.G.) Edwards and Dr. (Patrick)
In vitro fertilization applies the following situation:

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1. Women or wives whose fallopian tubes are obstructed and rendered unable to
accommodate the natural passage of the sperm and its union with the egg.
2. Men or husbands who are suffering from low sperm count.
3. Couples who are infertile.
4. Scientific experimentation and biological research out of which potential therapy for
specific and various diseases can be formulated.
c. Surrogate
Surrogate Motherhood: is a woman who bears a child on behalf of another woman,
either from her own egg fertilized by the other woman's partner, or from the implantation in
her uterus of a fertilized egg from the other woman, practice in which a woman (the surrogate
mother) bears a child for a couple unable to produce children in the usual way, usually
because the wife is infertile or otherwise unable to undergo pregnancy.
Two Kinds of Surrogate Mother:

1. Traditional surrogate
It's a woman who gets artificially inseminated with the father's sperm. She then
carries the baby and delivers it for you and your partner to raise.
2. Gestational surrogates
A technique called "in vitro fertilization" (IVF) now makes it possible to gather eggs
from the mother, fertilize them with sperm from the father, and place the embryo into the
uterus of a gestational surrogate.
The surrogate then carries the baby until birth. She doesn't have any genetic ties to
the child because it wasn't her egg that was used.
Who Uses Surrogate Mother?

1.Same Sex Couple
2.Medical problems with your uterus
3.You had a hysterectomy that removed your uterus
4.Conditions that make pregnancy impossible or risky for you, such
as severe heart disease.
Surrogacy is often thought to be a ‘treatment’ option for the infertile or an alternative

to adoption, and so to be celebrated in fulfilling people’s desires to be parents. However,
surrogacy also brings a wealth of more complex ethical issues around gender, labour,
payment, exploitation and inequality.
4.Morality of Abortion, Rape and other Problems Related to Destruction of Life
Abortion refers to the expulsion of human fetus before the period of viability. The
expulsion of fetus takes place intentionally or unintentionally, deliberately or accidentally.
Is Abortion Moral?
As long as it is direct- that is, it is perform deliberately and willfully, abortion is
immoral. Employed as an end, or a means of another end, abortion is directly willed and, as
such is imputable to the agent.
5.Rape
Rape is a type of sexual assault usually involving sexual intercourse or other forms of
sexual penetration carried out against a person without that person's consent. An individual
may be charged with the crime of rape or other specific types of rape such as statutory rape,
date rape, gang rape, incestual rape, prison rape or marital rape.

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Other Problems Related to Destruction of Life
a. Climate change
Climate Change a change in global or regional climate patterns, in particular. A
change apparent from the mid to late 20th century onwards and attributed largely to the
increased levels of atmospheric carbon dioxide produced by the use of fossil fuels.
b. Crime
A crime is an offence that merits community condemnation and punishment, usually
by way of fine or imprisonment. While the short-term effects of crime can be severe, most
people don't suffer any long-term harm. Occasionally, people do develop long-term problems,
such as depression or anxiety-related illnesses, and a few people have a severe, long-lasting
reaction after a crime, known as post-traumatic stress disorder (PTSD)
c. Drug Addiction
Drug Addiction are ssubstances such as alcohol, marijuana and nicotine also are
considered drugs. When you're addicted, you may continue using the drug.
5.Ethico-moral Issues affecting Nurses
1. Surrogacy- an arrangement, often supported by a legal agreement, whereby a women (the

surrogate mother ) agrees to bear a child for another person’s, who will become the child’s
parent’s after birth.
2. Euthanasia- active killing of a patient by a physician, on the patients request and, in the
patient’s interest.
3. Gender reassignment and gender Dysphoria- describes a heterogenous group of

individuals who express varying degrees of dissatisfaction with their anatomic gender and the
desires to possess the secondary sexual characteristics of the opposite sex.
4. Incest- human sexual activity between family members or closed relatives. This typically
includes sexual activity between people in consanguinity (blood relations), and sometimes
those related by affinity (marriage or stepfamily), adoption, clan, or lineage.
This may include marriages between brothers and sisters and between parents and
their children, and generally unacceptable in every human culture.
On the physiologic aspects, studies found that incest produces genetic malformations
among products of such relations.
5. Abortion- defined as the termination of the product of conception before the age of
viability.
6. Cloning- is the creation of a genetically identical copy or clone of a human. The term is
generally used to refer to artificial human cloning, which is the production of human cells and
tissue.
B. Dignity in Death and Dying
1. Euthanasia and Prolongation of Life

Euthanasia comes from the Greek word “thanatus” which means “easy or happy
death”. Implicit in this etymological meaning is the outright rejection and avoidance of the
opposite : “a difficult or sorrowful death”, the condition of a dying person which is
characterized by intense pain and suffering can be reason to opt for a willful maneuvering
into that which paves the way to an “easy death” Obviously, “easy death”, in this context,
means earlier death that is intentionally caused in order to get rid of a “difficult death”.
Hence, the Sacred Congregation for the Doctrine of the Faith states:

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Euthanasia is the act of intentionally ending a life to relieve suffering - for example a
lethal injection administered by a doctor.
Types of Euthanasia
1.Euthanasia by Commission is also called active euthanasia. It refers to the
positive act of causing death that is geared towards termination of pain and suffering. By
positive act is meant a measure necessary to end the life of a suffering person is directly used.
Example: a lethal dose is injected into the terminally ill patient to cause immediate death.
2.Euthanasia by Omission is also called passive euthanasia. It refers to the negative
act of causing death that geared towards termination of the pain and suffering. By negative
act is meant a measure necessary to sustain the life of a suffering person is omitted, withheld
or withdrawn. Example: food and water are withdrawn to bring about the earlier death of a
terminally ill patient.
Categories of Euthanasia
a. Voluntary Euthanasia indicates the measure of causing the death of the patient at
his willful consent or request.
b. Non-Voluntary Euthanasia indicates the measure of causing the death of the patient
who is unable to express his will and make his intentions known as in unconscious or
comatose state.
c. Involuntary Euthanasia indicates the measure of causing the death of the patient in
defiance of his expressed will and / or against his consent.
Conditions of the Option for Euthanasia

1. When patient is terminally ill or incurably sick
2. When the patient experiences unbearable suffering
3. When the patient makes a voluntary decision
4. When the patient’s life is deemed to be not anymore “worth-living”
2.Inviolability of Human Life

Since life is the most precious gift of God and it is sacred, it is inviolable. No one can
directly dispose of an innocent human life and justify it. "Thou shalt not kill," our Blessed
Lord commands. "Every human being, even a child in the mother's womb, has the right to life
directly from God and not from the parents or from any human activity. Hence there is not
human authority, no science, no medical, eugenic, social, economic or moral 'indication' that
can offer or produce a valid juridical title to a direct, deliberate disposal of an innocent life"
(Pope Pius XII, October 29, 1951).
Human life at any stage of development, from the moment of conception until its
natural decline, must be respected and protected. Inviolability means that no life can be
directly killed.
3.Euthanasia and Suicide

Euthanasia was generally less acceptable than physician assisted suicide, but this
difference disappeared when requests were repetitive.
Suicide is the act of intentionally causing one's own death. Mental disorders—
including depression, bipolar disorder, autism, schizophrenia, personality. Under English law
euthanasia is illegal and is considered man slaughter or murder.
Assisted suicide
Intentionally helping another person to kill themselves is known as assisted suicide.
This can include providing someone with strong sedatives with which to end their life or
buying them a ticket to Switzerland (where assisted suicide is legal) to end their life.
Assisted dying

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The campaign group Dignity in Dying wants a law allowing assisted dying. In
contrast to euthanasia and assisted suicide, assisted dying would apply to terminally ill people
only.
The group says people with terminal illnesses should be allowed to have a choice
over the manner and timing of their imminent death.
There would be legal safeguards, and patients would have to meet strict criteria, it says,
before they were given the option of taking life-ending medication and dying peacefully at home.
4.Dysthanasia
Dysthanasia means "bad death" and is considered a common fault of modern

medicine. Dysthanasia occurs when a person who is dying has their biological life extended
through technological means without regard to the person's quality of life;
Is Dysthanasia Moral?
From the moral point of view, dysthanasia is morally questionable because of the
following reason:
1. Against Natural Law
2. An insult to the Sovereign Master of Life and Death
3. Master of life and death
4. Contrary to Human Dignity
5. Orthothanasia
Orthothanasia refers to the mere allowing and acceptance of natural death in its definitely
inescapable occurrence in due time as the final moment of one’s earthly life.
Is Orthothanasia Moral?
By natural inclination and by reason of principle of stewardship, everyone is morally
obliged to nurture and take care of his life even for its prolonged existence. It is in accordance
with the dictates of reason to avoid that which will tarnish the quality of one’s life and that which
will shorten his life. As already stated, it does not evoke any awful surprise for one to seek
medical care when life is deemed in danger because of serious and life- threatening health
condition.
Administration of Drugs to the Dying

Many of the medications used to manage these symptoms may cause a degree, to drugs,
including doses and routes of administration, even when symptoms. The order of presentation of
these 3 problems in the recommendations below is
What drugs are used in end of life care?

Common Hospice Medications
-Acetaminophen. According to a study published by the National Institutes of Health
(NIH), acetaminophen is the most commonly prescribed hospice medication. ...
-Anticholinergics. ...
-Antidepressant medications. ...
-Anxiolytics. ...
-Atropine ampules. ...
-Fentanyl. ...
-Haldol (also Known as Haloperidol). ...
-Lorazepam (Ativan)
6. Advance Directives
Advance directives are legally binding documents that spell out what medical care you
want and who will guard those choices for you. These papers help to avoid confusion by
conveying your wishes to loved ones and clinicians in case illness or injury makes you unable to
communicate.
What are considered advanced directives?

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Advance directives are legal documents that allow you to spell out your decisions about
end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and
health care professionals and to avoid confusion later on.
Types of Advance Directives

1. POLST (Physician Orders for Life-Sustaining Treatment)
2. Do not resuscitate (DNR) orders
3. Organ and tissue donation
4. The Living Will
5. Durable power of attorney/medical power of attorney
7. DNR or End of life Care Plan

A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It
instructs health care providers not to do (CPR) cardiopulmonary resuscitation if a patient's
breathing stops or if the patient's heart stops beating DNR/do-not-resuscitate order, also known as
no code or allow natural death, is a legal order, written or oral depending on country, indicating
that a person does not want to receive cardiopulmonary resuscitation if that person's heart stops
beating.
C. Nursing Roles and Responsibility

A nurse is a caregiver for patients and helps to manage physical needs, prevent illness, and
treat health conditions. To do this, they need to observe and monitor the patient, recording any
relevant information to aid in treatment
Nurses are responsible for recognizing patients' symptoms, taking measures within their
scope of practice to administer medications, providing other measures for symptom alleviation,
and collaborating with other professionals to optimize patients' comfort and families'
understanding and adaptation.
Compassionate care has to be at the forefront of all nursing care but is even more
fundamental in the provision of caring for dying.
D. Ethical Decision-Making Process

Ethical decision-making refers to the process of evaluating and choosing among
alternatives in a manner consistent with ethical principles. In making ethical decisions, it is
necessary to perceive and eliminate unethical options and select the best ethical alternative.
(Josephson Institute of Ethics, 2016)
The process of making ethical decisions requires:
1. Commitment: The desire to do the right thing regardless of the cost

2. Consciousness: The awareness to act consistently and apply moral convictions to daily
behavior
3. Competency: The ability to collect and evaluate information, develop alternatives, and
foresee potential consequences and risks
Good decisions are both ethical and effective:
1. Ethical decisions generate and sustain trust; demonstrate respect, responsibility, fairness and
caring; and are consistent with good citizenship. These behaviors provide a foundation for
making better decisions by setting the ground rules for our behavior.
2. Effective decisions are effective if they accomplish what we want accomplished and if they
advance our purposes. A choice that produces unintended and undesirable results is
ineffective. The key to making effective decisions is to think about choices in terms of their
ability to accomplish our most important goals. This means we have to understand the
difference between immediate and short-term goals and longer-range goals.
Steps involved in the process of ethical decision making:

a. Gather data and identify conflicting moral claims
b. Identify key participants

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c. Determine moral perspective and phase of moral development of key participants
d. Determine desired outcomes
e. Identify options
f. Act on the choice
g. Evaluate outcomes of action
V. Reflection
Describe a situation in which you or someone you know experienced moral distress, noting
moral and nonmoral claims in the situation.
VI. Post Test
Read the following case and answer the questions that follow:
A. A pregnant patient is admitted with excessive accumulation of amniotic fluid in her uterine
cavity.
Doctor: There is an excessive accumulation of amniotic fluid in her uterine cavity. We have
to do something about it.
Nurse: The fetus is still non-viable. If we drain it off, the fetus will die.
1. Is it morally justifiable for the health care practitioners to get rid of the excessive
accumulation of amniotic fluid resulting to the fetus death?
2. What possible alternative solution would you suggest as a health care practitioner?
B. A terminally ill patient refuses to take food and drinks in an intention to hasten his death as in
suicide. Food and drinks under the circumstance belong to ordinary means of care that should
be administered since they are deemed beneficial in terms of addressing problems of hunger
and thirst.
1. If you encounter such a patient, are you going to respect his decision? Why?
2. What and how would you respond?
VII. References
https://www.cambridge.org/core/journals/journal-of-anglican-studies/article/goods-of-human-
sexuality-ethics-and-moral-theology/5FB6655E5517D2E812ACA714E6766926/core-reader
https://www.lexico.com/definition/marriage
https://blink.ucsd.edu/finance/accountability/ethics/process.html

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UNIT III. BIOETHICS AND RESEARCH

I. Introduction
Nurses must be accountable for the quality of care they deliver, and research is one way
of documenting the efficacy of nursing practice. Both art and science of nursing are expanded
through research. Research is necessary for the ongoing development of the unique body of
knowledge that undergirds the discipline of nursing, and provides an organizing framework
for nursing practice (Burkhardt and Nathaniel, 2002).
Participating in research can be exciting and encourage professional growth. It can also
present some dilemmas for the nurse and nurse researcher in the academic and clinical
realms. Seeking new knowledge and understanding is the expected motivation for conducting
research. A nurse who works in clinical areas where research is being conducted must be
aware of the principles for the conduct of research, regardless of whether the nurse has an
active role with the research project.
II. Objectives/Competencies
At the end of this unit, I am able to:

1. describe principles and nursing standards undergirding the protection of human rights
in research;
2. discuss the nursing role regarding protection of human rights in research; and
3. describe principles guiding personal response to dilemmas regarding nursing
scholarship.
III. Lesson Proper
A. Principles of Ethics in Research

Research ethics are based on three fundamental principles:
The term autonomous means that a person can make his or her own decisions about what
to do and what to agree to. Researchers must respect that individuals should make their own
informed decisions about whether to participate in research.
1. Nuremberg Code
The Nuremberg Code (German: Nürnberger Kodex) is a set of research ethics principles
for human experimentation created as a result of the Nuremberg trials at the end of the Second
World War;
Nuremberg is often referred to as the "unofficial capital" of the Holy Roman Empire,
particularly because the Imperial Diet (Reichstag) and courts met at Nuremberg Castle. The Diets
of Nuremberg played an important role in the administration of the empire.
The Nuremberg trials

Nonetheless, Simon Wiesenthal, Hugh Thomas and Reinhard Gehlen refused to accept
this. Gehlen further argued Bormann was the secret Russian double agent 'Sasha'. Karl Dönitz
– Guilty, sentenced to 10 years' imprisonment. Hans Fritzsche – Acquitted
What did the Nuremberg trials accomplish?
Held for the purpose of bringing Nazi war criminals to justice, the Nuremberg
trials were a series of 13 trials carried out in Nuremberg, Germany, between 1945 and 1949.
Heinrich Himmler Became Hitler's personal surgeon after a recommendation from
Schutz staffel (SS) chief Heinrich Himmler.
Prominent official in Nazi Germany. He gained immense power by using his position
as Hitler's private secretary to control the flow of information and access to the Führer.

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How many Schutz staffel (SS) soldiers were executed? Approximately 32,000
prisoners were liberated; 300 SS camp guards were quickly neutralized." Military historian
Earl Ziemke describes the event: The Americans came on April 29, a Sunday.
How many Japanese were executed for war crimes? War crimes trials Of these,
984 were initially condemned to death, 920 were actually executed, 475 received life sentences,
2,944 received some prison terms, 1,018 were acquitted, and 279 were not sentenced or not
brought to trial. These numbers included 178 ethnic Taiwanese and 148 ethnic Koreans How did
2. Declaration of Helsinki
The Declaration of Helsinki – its history and its future Urban Wiesing Helsinki,
11.11.2014.
The ethical principle “do no harm” cannot be realized in therapy without clinical
research. But clinical research is ethically critical because it violates the principle “do no harm”.
This ethical dilemma is much older than the Declaration of Helsinki. The ethical dilemma arose
when medicine wanted to become a science-based discipline. And the declaration is by no means
the first regulatory response to this conflict. Some national institutions had been aware of this
problem since the end of the 19th century. The Declaration of Helsinki gave the most important
answer to the dilemma associated with research involving human subjects. This is the historical
achievement of the declaration. It gives an answer to an unavoidable dilemma of modern
medicine, to an unavoidable conflict between the role of a physician and the role of a researcher.
The declaration regulates an unavoidable tension between exposing current patients to risks for
the benefit of future patients.
Therefore, the declaration stresses the protection of the participants on the one hand and
medicine’s need for research on the other. The debate on whether the Declaration of Helsinki is
too “research-friendly” or too restrictive persists up to the present day. But if a document is
criticized to be too liberal and also criticized to be too restrictive it may very well be a balanced
compromise. In an open society, in the modern world the Declaration of Helsinki is the object of
controversial discussions. This is unavoidable; it is a sign of an open society. It has to be
welcomed; it is nothing but necessary. It can only serve to improve the document. There is no
doubt: The international literature on the declaration was extremely helpful for the last revision
process. First of all, the Declaration of Helsinki embodies the acceptance that research involving
human subjects not only has scientific and technical but also ethical dimensions. It underlines that
the ethical aspects can by no means be answered by science alone. More than science is needed,
what is needed is ethics. In this respect, the declaration is also based on the acknowledgment of
the limits of science. It is a document of scientific prudence. Science can say how the world is.
But science cannot say how the world should be. Science can say how one is supposed to go
about researching something, but not whether it should be researched at all. The declaration is
based on the acceptance of these fundamental theoretical distinctions and argumentative integrity.
Therefore, it is a document of argumentative transparency. In this sense the declaration is
simply modern. The declaration also secures trust. Thanks to the declaration and others this
research no longer has an exclusively negative image. The declaration not only limits research on
human beings, but it also legitimizes it. The declaration not only protects the participants but the
researchers as well. This not only stabilizes the medical profession but gives the system of
research hope that the people will accept it. The acceptance and trust in research is essential in
modern, open societies. The declaration expresses a profession’s will and capability of self-
control. I have to remind you that other institutions, organizations etc. could have adopted a
comparable regulation. But that is not what happened. The declaration was created and adopted
by an organization of physicians for physicians, thus creating a close relationship to the
profession and the professionals. The Declaration is an expression of a voluntary assumption of
responsibility. It is an expression of the free will of the profession and of practical reason. If the
declaration didn’t exist it would have to be invented. There is no substitute for the declaration.
“Why is the Declaration of Helsinki important?”

The Declaration of Helsinki gave the most important answer to the dilemma associated with
research involving human subjects. Therefore, the declaration stresses the protection of the
participants on the one hand and medicine's need for research on the other.
3. Belmont Report

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The Belmont Report is a critical document for those involved in research. However, the
report is also applicable to clinical practice.
The primary purpose of the Belmont Report is to protect the rights of all research subjects or
participants. The Belmont Report also serves as an ethical framework for research. There are 3 major
components: (1) respect for persons, (2) beneficence, and (3) justice. This article will review these
principles and show how they can be applied to the clinical as well as the research setting and address
some concerns for the 21st century
The Belmont Report was written by the National Commission for the Protection of Human
Subjects of Biomedical and Behavioral Research.
The five main principles of ethics are usually considered to be: Truthfulness and
confidentiality. Autonomy and informed consent. Beneficence. Belmont Park, with its wide,
sweeping turns and long homestretch, is considered one of the fairest racetracks. It is a 1.5-mile-long
(2.4 km) horse race, open to three-year-old Thoroughbreds.
B. Ethical Issues in Evidenced Based Practice

A lack of clarity about the categorization of various types of evidence-based
practice activities leads to ethical issues that may go unrecognized in the clinical setting by over-
zealous nurses who may lack training in conducting research studies.
1. Ethical values are essential for any healthcare provider. Ethics ... The nurse has authority,
accountability, and responsibility for nursing practice.
2. Give issues that you know in evidence-based practice since nurses are accountable with this?
3. What are the challenges and barriers to evidence-based practice?
The most common barriers to implementation are difficulty in changing
current practice model, resistance and criticism from colleagues, and lack of trust in evidence or
research
C. Ethico-moral Obligations of the Nurse in Evidence Based Practices
1. Introduction to Good Clinical Practice Guidelines.

Good Clinical Practice (GCP) is an international ethical and scientific quality standard for the
design, conduct, performance, monitoring, auditing, recording, analyses and reporting of clinical
trials. It also serves to protect the rights, integrity and confidentiality of trial subjects
Good Clinical Practice (GCP) is an international ethical and
scientific quality standard for the design, conduct, performance, monitoring,
auditing, recording, analyses and reporting of clinical trials. GCP provides
assurance that the data and reported results are credible and accurate, and that
the rights, integrity and confidentiality of trial subjects are respected and
protected.
IV. Reflection
A. How did protection of human rights come to be required for research involving human
subjects?
B. What guidance do nursing standards offer nurses who are participating in or
conducting research? What principles underlie ethical conduct of research? Discuss.
V. References

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UNIT IV:
GUIDELINES AND PROTOCOL IN DOCUMENTATION AND
HEALTH CARE RECORDS
Introduction
Clinical records keeping is an integral component in good professional practice and
the delivery of quality healthcare. Regardless of the form of the records (i.e electronic or
paper), good clinical records keeping should enable continuity of care and should enhance
communication between different healthcare professionals. Consequently, clinical records
should be updated, where appropriate, by all members of the multidisciplinary team that are
involved in a patient's care (physicians, surgeons, nurses, pharmacists, physiotherapists,
occupational therapist, psychologist, chaplains, administrators, or students). Should the need
arise to patients themselves should have access to their records to be able to see what has
been done and what has been considered. Clinical records are also valuable documents to
audit the quality of healthcare services offered and can also be used for investigating serious
incidents, patient complaints, and compensations cases. (Breathe, 2016).
Objectives/ Competencies
At the end of the Unit, the student will be able to:
1.Described ethical consideration in documentation and health care records; and
2.Discuss the nursing role regarding protection of patient’s health care records.
Lesson Proper:
Guidelines for Medical Record and Clinical Documentation

a. Confidentiality
b. Legal Foundation of Privacy
c. Modern Health Care and Confidentiality.
Health Insurance Portability and Accountability

Act. Legitimate Interestf. Human Subject Researchg. Institutional Review Boards
DEFINITION MEDICAL RECORD AND CLINICALDOCUMENTATION SHOULD BE:
 Clear
 Concise
 Complete
 Contemporary

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 Consecutive
 Correct
 Comprehensive
 Collaborative
 Patient Centered
 Confidential
KEY POINTS
 Documentation includes all forms of documentation by a doctor, nurse or allied health professional
(physiotherapist, occupational therapist, dietician etc) recorded in a professional capacity in relation to
the provision of patient care.
 Documentation and record keeping is a fundamental part of clinical practice. It demonstrates the
clinician’s accountability and records their professional practice.
 Documentation is the basis for communication between health professionals that informs of the care provided,
the treatment and care planned and the outcome of that care as a continuous and contemporaneous record.
 Documentation is a record of the care and the clinical assessment, professional judgement and critical
thinking used by a health professional in the provision of that care
 Documentation should be clear, concise, consecutive, correct, contemporaneous, complete,

comprehensive, collaborative, patient-centered and confidential.
 Documentation must be patient focused and based on professional observation and assessment that does not
have any basis in unfounded conclusions or personal judgements.
 Clinical staff must able to competently communicate effectively with individuals and groups
using formal and informal channels of communication and ensuring documentation is accurate and maintains
confidentiality.
 Clinical staff are required to make and keep records of their professional practice
inaccordance with standards of practice of their profession and organisational policy and procedure.
 Documentation is often used to evaluate professional practice as a part of quality assurance

mechanisms such as performance reviews, audits and accreditation processes, legislated
inspections and critical incident reviews.
 Documentation systems should promote appropriate sharing of information amongst the

multidisciplinary and teams.
 Accurate and comprehensive documentation is a valuable source of data for data coding, health
research and a valuable source of evidence and rationale for funding and resource management.
 Documentation should record both the actions taken by

clinical staff and the patient’s needs
and/or their response to illness and the care they receive.
 Clinical staff have legislative, professional and ethical obligations to protect patient
confidentiality. This includes maintaining confidential documentation and patient records

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 Precautions must be taken to ensure that clinicians are fully informed of appropriate, safe and
secure use of electronic information systems and the potential risks involved in using such
systems in ensuring and maintain confidentiality.
 It should be assumed that any and all clinical documentation will be scrutinised at some point
PURPOSE OF GUIDELINES
These guidelines support employers, policymakers, managers and clinical staff in documentation practices
and policies that demonstrate the professional obligation, accountability and legal requirements to
communicate patient health information and clinical interventions in the public interest. It should be
assumed that any and all clinical documentation will be scrutinised at some point.
 Highlight
 Add Note
 Share Quote
PROFESSIONAL DOCUMENTATIONINCLUDES:
Any and all forms of documentation by a clinician recorded in a professional capacity in relation to the
provision of patient care. This documentation may include written and electronic health records, audio
and video tapes, emails, facsimiles, images (photographs and diagrams),observation charts,
check lists, communication books, shift/management reports, incident reports and clinical anecdotal
notes or personal reflections(held by the clinicians personally or any other type or form of
documentation pertaining to the care provided.
PURPOSE OF PROFESSIONAL DOCUMENTATION
Communication
Documentation in medical records is the basis for communication between health

professionals. It informs of the care provided, the treatment and care planned and the
outcome of that care as a continuous and contemporaneous record.
Accountability
 Documentation demonstrates the clinician’s accountability and records their

professional practice. It may be used to determine responsibility of care providers and to
resolve questions or concerns in relation to care required.
Legislative requirements
 Nurses and midwives are required to make and keep records of their professional practice in accordance
with standards of practice of their profession and organizational policy and procedure. Legislation in
different countries may further identify and require specific information and content to be recorded and
maintained.
Quality improvement
 Documentation may be used to evaluate professional practice as a part of quality assurance mechanisms
such as performance reviews, audits and accreditation processes, legislated inspections and
critical incident reviews

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Research
 Medical Record documentation is a valuable source of data for health researchers. It provides
information in relation to clinical interventions, evaluates patient outcomes, patient care and is a
concise record, essential for accurate research data and evidence-based practice.
Funding and Research Management
 Data accessed from medical record documentation and coded can be used as an appropriate tool for
identifying the type of care that patients require, the services provided and the efficiency and
effectiveness of care.
PRINCIPLES OF DOCUMENTATION
Guiding Principle 1:
 Comprehensive and complete record Clinical staff have a professional obligation to maintain documentation
that is clear, concise and comprehensive, as an accurate and true record of care.
 Patient centered and Collaborative Documentation is patient centered, patient focussed,
collaborative and appropriate to the setting in which the care is provided and the purpose for which the
information recorded
 Ensure and maintain confidentiality Documentation systems (including electronic systems) will
ensure and maintain patient confidentiality, in all care settings.
EXAMPLES AND SCENARIOS AS APPLICABLE

Scenarios for Guiding Principle 1:
1. Clinicians may obtain information from a third person that is relative to the patient’s care (eg a
family member). In these circumstances the information is documented and should include the source
of the information. The exception to this is if the person is another patient, if so, they should not be
identified by name e.g. patient in next bed stated…).
2. The clinician who provided the care or witnessed the event should be the person who documents the
information. An exception may be where a specific scenario has a designated recorder (such as in a
cardiac arrest), or where one clinician assists another to provide care(such as another clinician to support a patient to
ambulate). Where a clinician is documenting information (as a designated recorder) the recorder must
identify the
other person/s (and their role or professional designation) to accurately identify them as part of the care
provided or the event.3. Transcription of data potentially increases the risk of error
of documentation due to for example inaccurate, misinterpreted misspelt information. It is not
appropriate or a clinician to transcribe Medication Orders unless they are an authorized prescriber.
Scenarios for Guiding Principle 2:

1. Clinical staff often collaborate with other health professionals and care providers. This may involve speaking
with a medical practitioner or allied health professional and may occur in person or using such means as telephone,
case conferences, teleconferencing and other electronic or communication technologies. This may also
involve shared documentation (including pro forma, patient progress notes, history taking etc).This
collaboration is documented in the patient record and should include information in relation to the nature or
the collaboration, the persons involved and the plan of actions and/or outcomes agreed upon and any
determination in terms of continued collaboration.
2. Clinical staff document conclusions and decisions that can be supported by data. Documentation
does not reflect value judgements about a patient, their behavior or their circumstances. Value
judgements or any other unfounded conclusions maybe taken by others to reflect fact and have the
potential to influence (even unconsciously) other health professionals or providers in their assessment
of the patient and/or their relationship with the patient.

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 Nurses and midwives should avoid statements such as ‘patient uncooperative’ or ‘patient depressed’.
Documentation reflects observed behavior such as ‘patient
refuses bath, shouts’
DEFINITION
Confidentiality
The principle and practice of

Keeping s e n s i t i v e i n f o r m a t i o n p r i v a t e
unless the owner or custodian of the data gives explicit consent for it to be shared with another
party.
IMPORTANCE OF PATIENT CONFIDENTIALITY
 Patient confidentiality is
necessary for b u i l d i n g t r u s t
between patients and medical professionals. Patients are more likely to disclose health information if
they trust their healthcare practitioners. Trust-based physician-patient relationships
can lead to b e t t e r i n t e r a c t i o n s a n d h i g h e r - q u a l i t y h e a l t h v i s i t s
 Healthcare professionals who take their privacy obligations seriously, and who take thetime
to clearly explain confidentiality rules, are more likely to have patients who report their symptoms
honestly. This makes it easier for doctors to make better-informed decisions, more accurate diagnoses,
and personalized treatment plans that lead to better health outcomes.
PRESENT STATE IN THE PHILIPPINES ANDOTHER PARTS OF THE WORLD

Health Insurance Portability a n d Accountability Act (HIPAA-H e a l t h
Information Privacy)
 A federal law that applies to most health care practitioners and its regulation, known as the
Privacy Rule
, sets detailed rules regarding privacy, access, and disclosure of individually identifiable health information,
referred to as protected health information.
Magna Carta of Patient’s Right and Obligation

Act of 2017
 In the Philippines
 Under Section 4-I
Right to Patient Privacy and Confidentiality
 The patient has the right to privacy and protection

from unwarranted publicity
 The right to privacy shall include the patient's right not to be subjected to exposure, private or public, either
by photography, publications, video-taping, discussion, or by any other means that would
otherwise tend to reveal his person and identity and the circumstances under which he was, he is,
or he will be, under medical or surgical care or treatment.
 All identifiable information about a patient's health status, medical condition, diagnosis, prognosis
and treatment, and all other information of personal kind, must be kept confidential even after
death; Provided, that descendants may have a right of access to information that will inform them of
their health risks.NC
EXAMPLES OF ETHICAL DILEMMA OF CONFIDENTIALITY

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Scenario 1:
Wanting to hurt someone

Many patients who regularly see a psychologist, therapist, or psychiatrist suffer from behavioral
ailments. Some experience seemingly random outbursts of rage and anger. Other people are more methodical
and calculated with their emotions and actions. If a patient reveals that they intend to harm someone,
their mental health professional can legally disclose information about their patient to protect the
individual in danger. The mental health professional legally needs to protect the public from a valid, perceived
threat.
Scenario 2:
Child Abuse
If a healthcare provider find s concerning marks, bruises, or
injuries, they’re legally obliged
to contact the authorities. If a
child’s well
-being is in danger, a healthcare professional needs to breach patient confidentiality to protect the patient.
This could mean that the doctor calls child protective services and/or the police.
Scenario 3:
Second o p i n i o n s
Doctors have the right to breach patient confidentiality for clinical purposes. This means that doctors
may discuss a diagnosis with colleagues if the disclosure is necessary for treatment. When doctors need to
share PHI amongst each other, they need to follow the Minimum Necessary Standard. This means that a
health care professional may only share PHI to the least amount possible. Health care professionals are also
allowed to share confidential information if they are referring the patient to another practice or when
speaking with a pharmacist. These disclosures are necessary for the successful treatment of a patient.
Therefore, they’re legally permissible.
Scenario 4:
Public Health C r i s i s
Healthcare professionals can disclose PHI (Protected Health Insurance), to the least amount necessary,
if the disclosure can protect the general public from a health crisis.
What does this mean?
If someone in the hospital has a contagious disease that can have lasting side effects or a concerning mortality
rate, the healthcare entity needs to tell the public about the situation. Any and every patient,
visitor, and staff member could contract the disease, exposing more people in the public and at home.
According to the HHS ( Health and Human Services), the HIPAA (Health Insurance Portability and
Accountability Act) Privacy Rule recognizes that sometimes public health authorities and others responsible for
ensuring public health and safety need to access PHI. The information helps other healthcare
professionals protect their patients from the crisis at hand. The Privacy Rule also recognizes that the
public health reports made by covered entities help identify threats to public health. Now,
this doesn’t mean that doctors
can declare that you are the one who contaminated everyone with an infectious disease. Nor do health care entities
have the ability to disclose non-relevant information about you. In a public health crisis, doctor’s are only
allowed to disclose information that can help protect the greater population.
Scenario 5:
E l d e r l y Neglect
Psychologists have the right to disclose information without the patient's consent to protect the patient. This
could mean that doctors share information with the family of elderly
patients so that they can get the proper care. Similarly, if a doctor determines that an elderly patient is
enduring neglect, the health care professional may breach patient confidentiality. If the neglect is

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pervasive enough, the perpetrators could face a criminal trial. Therefore, a healthcare professional needs
to disclose health information when elderly neglect is at hand.
*In situations where you believe an ethical or legal exception to confidentiality exists, ask yourself the
following question: will lack of this specific patient information put another person or group you
can identify at high risk of serious harm? If the answer to this question is no, it is unlikely that an
exception to confidentiality is ethically (or legally) warranted. The permissibility of breaching
confidentiality depends on the details of each case. If a breach is being contemplated, it is
advisable to seek legal advice before disclosure.
ETHICAL, MORAL, AND LEGAL NURSINGRESPONSIBILITIES
As nurses, how can we ensure patient confidentiality is maintained?
1. Adhere to workplace security and privacy policies in protecting confidential patient information.
2. Understand and be compliant with HIPAA rules and regulations.
3. Understand the definition of individually identifiable health information, known as protected health information
(PHI),
and when it can be shared, how it can be shared, and with whom it can be shared.
4. Learn how to implement reason able safeguards to limit incidental uses or disclosures and avoid patient
disclosure pit falls. Remember, the patient is the final arbiter of what information is shared and/or
transmitted.
5. Always keep anything with patient information out of the public’s eye.
6. Learn how to discard confidential information appropriately in accordance with your workplace privacy policy.
7. Consult with your HIPPA office or Human Resource office for any suspicious activities that may
compromise patient confidentiality. Do not be afraid to ask for the guidelines and workplace security
and privacy policies and procedures.
LEGAL FOUNDATION OF PRIVACYDEFINITION
 The right of privacy is, most simply, the right of a person to be let alone, to be f r e e f r o m
u n w a r r a n t e d p u b l i c i t y , and to live without unwarranted interference by the public
in matters with which the public is not necessarily concerned.
Strutner v. Dispatch Printing Co., 2Ohio App. 3d 377 (Ohio Ct. App., Franklin County 1982).
THE BASIC LAW
 The right of privacy is:
o the right of a person to be free from unwarranted publicity
o the unwarranted appropriation or exploitation of one’s personality
o the publicizing of one’s private affairs with which the public has no legitimate concern
o the wrongful intrusion into one’s private activities in such manner as to outrage or cause mental
suffering, shame or humiliation to a person of ordinary sensibilities.
 The right of privacy has two main aspects:

General Law o f P r i v a c y
 Which affords a t o r t a c t i o n f o r d a m a g e s resulting from an unlawful invasion of privacy

C o n s t i t u t i o n a l Right of Privacy
 Which p r o t e c t s p e r s o n a l p r i v a c y
against unlawful governmental invasion

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 Invasion of privacy is a tort based in common law allowing an aggrieved party to bring a lawsuit against an
individual who unlawfully intrudes into his/her private affairs, discloses his/her private information,
publicizes him/herin a false light, or appropriates his/her name for personal gain.
VIOLATION OF THE RIGHT TO PRIVACY
 Invasion of privacy is the considered the intrusion upon, or r e v e l a t i o n o f , s o m e t h i n g

private
.
Huskey v. National Broadcasting Co.,632 F. Supp. 1282 (N.D. Ill. 1986).
 One who intentionally intrudes, physically or otherwise, upon the solitude or seclusion of another or
his/her private affairs or concerns, is subject to liability to the other for invasion of privacy
 2007 Guidelines for Clinical Doc
Document16 pages
Medical Record Documentation Guidelines
Complete and accurate documentation in the medical record is an essential part of quality patient
care. In addition, it is fundamental to ensuring compliance with CMS and NCQA billing guidelines.
The following is being provided to ensure that all AgeWell New York providers are knowledgeable
about what constitutes a compliant medical record and to provide the tools to support proper coding
and documentation of diagnoses in the medical record.
KEY COMPONENTS OF A COMPLIANT MEDICAL RECORD

Legibility: All entries in the medical record must be legible. While a digital or typed record is ideal,
any handwritten entries in a medical record must be easily read. Poor handwriting may be responsible
for legibility issues, as are the use of acronyms that are not otherwise widely used by the medical
community.
Patient identification on each page: Each page of the medical record should clearly identify the
patient. Utilization of at least two patient identifiers is required. Acceptable patient identifiers include
patient’s first and last name along with either date of birth, account number or medical record
number. Alternatively, if the pages following the first page documenting a patient visit do not include
patient identifiers, entries such as page number (coupled with visit date) may be used to ensure that a
reviewer of the record can easily determine that the pages reference the same visit.
Visit date: The medical record must include the date of the patient’s visit, including month, day and
year.
Telehealth: Telehealth visits may be documented as a face-to-face visit only when the services are
provided using an interactive audio and video telecommunications system that permits real-time
interactive communication.
Provider name, credentials, and signature: Each encounter in the medical record should include
a legible signature of the provider’s name and credentials (e.g.: MD, DO, NP, PA, etc.) The provider
name and credentials may be pre-printed in a documentation form, in which case the form should be
separately signed by the provider. An electronic signature is also acceptable. In this case, the record
must indicate that the record was signed electronically.
DOCUMENTATION OF BILLED DIAGNOSTIC CODES
Age Well New York adheres to the ICD-10-CM Official Coding Guidelines, which are released an
updated annually. If an ICD-10-CM code is billed by a provider, the following documentation must
be present:

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Diagnosis by appropriate provider:

Only a physician or other qualified and licensed provider legally accountable for establishing
a patient’s diagnosis can “diagnose” a patient.
All billed diagnoses must be documented: Written documentation to substantiate a billed diagnostic
code must be included in the notes for the date of service associated with the claim. The existence of
“history of” a diagnosis is not sufficient. If the information does not exist in the visit note, CMS
considers that it did not happen. CMS looks for a full description of the patient’s condition. A
diagnosis may only be coded when it is explicitly named in the medical record.
Each encounter:
Documentation of an encounter must be complete and not depend on reference to another
encounter. Therefore, statements such as “same as last visit” or “see results from <date>” are not
acceptable.
Monitored, Evaluated, Assessed/Addressed, Treated (MEAT): ICD-10—CM Official Coding

Guidelines specify that all conditions should be coded and documented which affect patient care,
treatment and management. Evidence of any billed diagnosis codes should be described fully
described in the medical record, except for status codes (see below). This documentation may be
described as MEAT and should validate that the condition was Monitored, Evaluated,
Assessed/Addressed and/or Treated.
Diagnoses and the MEAT that support those diagnoses may be described in the patient’s:
Health Problem list (HPI)

Review of Systems (ROS)
Physical Exam (PE)
Assessment/Impression/Diagnosis
Treatment Plan
Any additional free-form text portion of the medical record.
The information described above does not need to be present in a particular portion of the medical
record documentation and need not appear together in the same section or portion of the note.
Documentation of Medications Relating to Diagnoses:

Notation of specific medications or other treatment relative to the diagnosis is considered
adequate to demonstrate that a condition has been addressed during the visit, as long as the note
specifies that the medication or treatment is associated with the specific diagnosis. This is especially
important when medications are listed in a separate Medication List without correlating information.
Documentation of Referral for Specific Diagnosis(es):

Documentation of referral to a specialist for a specific condition also meets criteria. An
explanation of the specific treatment to be rendered by the specialists is not required.
Chronic conditions:
A chronic condition must be restated in the medical record each time it is assessed or treated
by the provider and billed on a claim. A chronic condition may be coded and reported as many times
as the patient receives treatment and care for the condition(s). Note that chronic conditions may not
be carried visit-over-visit or year-over-year without specific documentation of assessment and plan.
At the beginning of each year, CMS sets a patient’s diagnosis burden to “zero”; therefore, each
chronic condition should be assessed and documented at least once per year.
Historical conditions / Status Codes:

Do not code conditions that have been successfully treated and no longer exist in the patient.
However, do code any relevant “status codes” representing late status of an historical event (i.e., toe
amputation status, previously amputated”). Such statuses can and should be coded even if no specific
attention (“MEAT”) is paid to the issue during the current visit, due to the historical nature of these

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codes. Status codes that represent a current medical regimen (i.e., renal dialysis status; long-term
insulin use) may also be coded without MEAT.
Conditions “in remission”:

When a provider documents that a condition is “in remission”, the condition may be
considered a Status Code and may be coded without further MEAT, as the term “remission” is
considered as the relevant status reflecting the progress of the condition. When a provider codes a
condition “in remission” and documents “history of…” or lists it in the Past Medical History section
of the medical record, it may be coded if MEAT is present to indicate that the condition is having an
impact on treatment.
For certain cancers, such as breast, prostate, lung, etc., documenting it as ‘in remission” may not
mean that the disease is entirely eradicated. If treatment is being received it should be coded as an
active cancer. If no treatment is being received, consider this to be a “history of” the specified cancer.
For other chronic diseases which are cyclical in nature, with intermittent symptoms, any such
conditions documented as being “in remission” should still be coded as an active condition.
Examples include Crohn’s disease, lupus, rheumatoid and other forms of arthritis, multiple sclerosis,
etc.
Note that “history of” in ICD coding specifically means that the condition has resolved and is no
longer present. However, “history of” can have two different meanings (e.g., chronic condition or the
condition no longer exists). Documentation should clearly state whether or not a condition is chronic
and still impacts the patient’s health management or that the condition no longer exists.
Guidelines for Medical Record and Clinical Documentation

Confidential; Patient centered; Collaborative; Comprehensive; Correct; Consecutive;
Contemporary; Complete; Concise; Clear.
confidential clear
Collaborative
concise
contemporary Medical Record and correct

Clinical documentation
Complete consecutive
Comprehensive Patient centered
Key Point Summary
• Documentation includes all forms of documentation by a doctor, nurse or allied health professional
(physiotherapist, occupational therapist, dietician etc) recorded in a professional capacity in relation
to the provision of patient care.
• Documentation and record keeping is a fundamental part of clinical practice. It demonstrates the
clinician’s accountability and records their professional practice.
• Documentation is the basis for communication between health professionals that informs of the
care provided, the treatment and care planned and the outcome of that care as a continuous and
contemporaneous record.
• Documentation is a record of the care and the clinical assessment, professional judgement and
critical thinking used by a health professional in the provision of that care
• Documentation should be clear, concise, consecutive, correct, contemporaneous, complete,

comprehensive, collaborative, patient-centered and confidential.

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• Documentation must be patient focused and based on professional observation and assessment that
does not have any basis in unfounded conclusions or personal judgements.
• Clinical staff must able to competently communicate effectively with individuals and groups using
formal and informal channels of communication and ensuring documentation is accurate and
maintains confidentiality.
• Clinical staff are required to make and keep records of their professional practice in accordance with
standards of practice of their profession and organizational policy and procedure.
• Documentation is often used to evaluate professional practice as a part of quality assurance

mechanisms such as performance reviews, audits and accreditation processes, legislated inspections
and critical incident reviews.
• Documentation systems should promote appropriate sharing of information amongst the

multidisciplinary and teams.
• Accurate and comprehensive documentation is a valuable source of data for data coding, health
research and a valuable source of evidence and rationale for funding and resource management.
• Documentation should record both the actions taken by clinical staff and the patient’s needs and/or
their response to illness and the care they receive.
• Clinical staff have legislative, professional and ethical obligations to protect patient confidentiality.
This includes maintaining confidential documentation and patient records.
• Precautions must be taken to ensure that clinicians are fully informed of appropriate, safe and secure
use of electronic information systems and the potential risks involved in using such systems in
ensuring and maintain confidentiality.
• It should be assumed that any and all clinical documentation will be scrutinized at some point.
Purpose of Guidelines
These guidelines support employers, policy makers, managers and clinical staff in
documentation practices and policies that demonstrate the professional obligation, accountability and
legal requirements to communicate patient health information and clinical interventions in the public
interest. It should be assumed that any and all clinical documentation will be scrutinized at some
point.
Professional documentation includes Any and all forms of documentation by a clinician recorded in a
professional capacity in relation to the provision of patient care. This documentation may include
written and electronic health records, audio and video tapes, emails, facsimiles, images (photographs
and diagrams), observation charts, check lists, communication books, shift/management reports,
incident reports and clinical anecdotal notes or personal reflections (held by the clinicians personally
or any other type or form of documentation pertaining to the care provided.
Other documentation not directly related to the patient

Other documentation may be relevant to evidence of clinical practice and of interest to the employer,
a regulatory authority, the Ministry of Health, courts, a funding body or the general public.
This may include;
• policies, procedures and protocols
• critical incident / occupational health and safety reports
• statistical and research data
• reports related to service and funding agreements
• staffing rosters
• personnel files
• performance appraisals

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• clinical assessments
• published reports/papers.
Purpose of Professional Documentation Communication

Documentation in medical records is the basis for communication between health
professionals. It informs of the care provided, the treatment and care planned and the outcome of that
care as a continuous and contemporaneous record. Documentation enables health professionals and
other care providers to use current, consistent data, and care goals to facilitate continuity of care.
Clear, complete, accurate and factual documentation provides a reliable, permanent record of patient
care and is an accurate record of the history of the patient’s health care. Accountability
Documentation demonstrates the clinician’s accountability and records their professional practice. It
may be used to determine responsibility of care providers and to resolve questions or concerns in
relation to care required. The clinician’s documentation may be used in relation to performance
management, internal organizational inquiries and/or legal proceedings (such as civil lawsuits or
coronial inquests). Legislative requirements Nurses and midwives are required to make and keep
records of their professional practice in accordance with standards of practice of their profession and
organizational policy and procedure. Legislation in different countries may further identify and
require specific information and content to be recorded and maintained. Failure to keep and maintain
certain documentation records as required, falsifying documentation, incomplete or inaccurate
documentation, signing or issuing a document that the person knows or suspects to be false or
misleading, may be found to constitute unprofessional conduct by a regulatory authority. Quality
improvement Documentation may be used to evaluate professional practice as a part of quality
assurance mechanisms such as performance reviews, audits and accreditation processes, legislated
inspections and critical incident reviews. Clinical staff can also use this information to reflect on their
practice and implement changes based on evidence. Documentation is evidence of the quality
provision of care and services to the public. Research Medical Record documentation is a valuable
source of data for health researchers. It provides information in relation to clinical interventions,
evaluates patient outcomes, patient care and is a concise record, essential for accurate research data
and evidence based practice. Funding and resource management Data accessed from medical record
documentation and coded can be used as an appropriate tool for identifying the type of care that
patients require, the services provided and the efficiency and effectiveness of care. Any of these
factors may impact on funding and resource allocation. Accurate and comprehensive documentation
of interventions provides a valuable source of evidence and rationale for funding and resource
management.
Maintaining Quality Documentation Practice

As partners in efforts to achieve a quality practice setting clinical staff, medical record staff
and hospital managers have a shared responsibility and legal accountability to create and maintain
environments that support competent clinicians in providing quality, evidence based outcomes for
patients. In ensuring quality documentation practice, these documentation guidelines encourage
employers, medical record and clinical staff to incorporate strategies, policies and procedures that
strengthen effective documentation practices within the work setting. Strategies to maintain quality
documentation practice include;
Organizational Support
• Effective systems to support accurate and concise documentation of practice in medical records
• Appropriate policies and procedures in relation to effective documentation systems, practices and
management of patient health information
• Risk management strategies that support effective documentation of practice (including incident
reporting)
• The provision of adequate time allocation to document appropriately and review previous
documentation as part of patient care. Leadership
• Encouragement of clinical staff to be involved in decision making in relation to selecting,
implementing and evaluating documentation systems
• Implementing quality improvement processes related to effective documentation
• Promotion of documentation as an integral and core part of practice and professional responsibility.
Resources

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• Access to an appropriate physical environment that supports and increases efficiency and
confidentiality of documentation
• Reliable, accessible and appropriately maintained equipment
• Documentation systems appropriate to/for the setting in which the care occurs. Professional
Development
• Appropriate information, education and orientation for staff in relation to documentation systems
and practices
• Performance management processes that provide opportunity to improve documentation practices.
Communication Systems
• Documentation systems that promote appropriate sharing of information amongst the
multidisciplinary team
• Effective exchange of information whilst ensuring and maintaining patient confidentiality
• Integrated progress notes for use by all disciplines and care providers
• Secure electronic data and transmission systems where appropriate
• Appropriate processes for patients to access information in relation to their care. Responsive to
Change • Documentations systems and practices that are responsive to change, (eg in relation to
changing models of care, legislation)
• Systems that are responsive to, and accommodate changing patient population needs
Documentation Policy Medical Record Officers should ensure they have documented policy,
procedure and quality assurance mechanisms in place which clarify:
• the legislative requirements for documentation
• the minimum requirements for documentation
• format and type of documentation (including acceptable documentation tools and forms)
• the roles and responsibilities of the clinical staff in relation to documentation
• accepted abbreviations in the organization (including their agreed meaning)
• any requirements for witnessing or counter signing documentation (and the meaning and
responsibility assigned to these practices)
• requirements for access, storing, archiving and retaining documentation
• requirements for documentation of verbal orders and provision of telephone advice/information
• requirements for confidentiality and privacy.
Monitoring of documentation
An audit process is one component of appropriate risk management. An audit process will
play and important role in monitoring quality and standard of care and the ability to produce accurate
and complete coded data from available documentation and records. Audit tools developed at a local
level to monitor the standards of documentation form the basis for review. The need to maintain
confidentiality of patient information equally applies to documentation audit processes.
Organizations are encouraged to develop and implement an appropriate documentation policy and
undertake regular auditing and monitoring of documentation and record keeping. As maintaining the
highest standard of patient care and the highest quality of coding rely significantly on the
completeness, accuracy and currency of documentation, auditing and monitoring processes should
focus on evaluating these areas.
A review of the standard and quality of the documentation may include compliance with;
• relevant documentation policy and procedures

• professional/industry/sector standards
• relevant legislation
• consistency of understanding/documentation practices across organization
• identified gaps of inconsistencies/discrepancies in documentation
• content/context of documentation
• requirements for coding.
A review of the evidentiary compliance of the documentation may include;
• that the document is contemporary

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• that the documentation is a factual and true record (authentic)
• that the documentation is based on evidence and observation (accurate)
• the timeliness of entries
• inclusive of planned care provided and actions taken
• that the documentation is a complete record.
Clinical Competence in Relation to Documentation Appropriate documentation promotes;
• a high standard of clinical care

• continuity of care
• improved communication and dissemination of information between and across service providers
• an accurate account of treatment, intervention and care planning
• improved goal setting and evaluation of care outcomes
• improved early detection of problems and changes in health status
• evidence of patient care. A clinician’s documentation should be able to demonstrate;
• a full account of the clinician’s assessment of the patient and the care planned and provided
• relevant information in relation to the patient’s condition at any given time and the interventions
and actions taken to achieve identified health outcomes and/or respond to actual or potential adverse
events • evidence that the clinician met their duty of care and taken all reasonable decisions and
actions to provide the highest standard of care
• evidence that the clinician met their duty of care and that any actions or omissions did not
compromise the patients safety or identified health
GUIDING PRINCIPLES FOR DOCUMENTATION
Comprehensive and complete record Clinical staff have a professional obligation to maintain
documentation that is clear, concise and comprehensive, as an accurate and true record of care.
Professional documentation by clinical staff is an integral part of practice to ensure safe and effective
care. Documentation is a record of the care provided, and the judgement and critical thinking used by
a health professional in the provision of that care. Documentation acts as evidence of the unique and
important contribution of each staff member to health care. It forms the basis for evidence of care that
can be used for research, legal analysis and determination, allocation of resources and as a primary
communication between health professionals.
Comprehensive and complete documentation and record keeping
• clear, concise, complete record of clinical care (including, assessment, plan of action outcomes and
evaluation of care)
• factual, accurate, true and honest record
• avoids duplication of information
• legible and non-erasable, permanent, retrievable, confidential, patient-focussed and non- judgmental
• representative and reflective of professional observations and assessment
• timely and completed as close as possible after episode of care or event
• a complete record including completed forms, charts, methods and systems
• chronological record of care (late entries recorded as soon as possible as to rectify the absence)
• prefaced with date and time of care or event (including recording of late entries, changes or
additions)
• identifying details of person who provided / documented care
• identifying of source of information (including information provided by another health care
professional or provider)
• inclusive of signatures (or initials) and professional designation of person recording information
• contains meaningful and relevant information (avoids meaningless phrases such as ‘slept well or
‘usual day’)
• minimize transcription of data
• easily interpreted over time and after significant time has elapsed

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• avoid use of abbreviations (other than those approved and documented in organizational policy by
the Medical Record Department)
• detailed documentation in relation to critical incidents such as patient falls, harm to patients, or
medication errors.
Additional details for Principle 1 (cont)
• Legal or regulatory proceedings may eventuate after a significant period of time has elapsed after
the event. As a general rule legal proceedings tend to find that written records are considered more
accurate and credible when recorded in a timely manner. Further written records are more credible
than verbal accounts after the event (more influenced by memory). Health care documentation is
admissible in legal proceedings without the person who documented giving additional evidence.
Therefore it is pertinent that documentation be able to be clearly interpreted and understood over
extended period of time as stand alone evidence and without further clarification or explanation from
the person who wrote the. Timeliness should be seen to mean at the time the clinician
undertook/provided the care or as soon as practicable after the care was provided.
• Abbreviations and symbols can be an effective and efficient form of documentation if their
meaning is well understood by the health provider who is using them and/or reading them.
Abbreviations that are obscure, poorly defined and open to broad interpretation or have multiple
meanings can lead to confusion and error in relation to patient care. Abbreviations should only be
used where they are approved and defined by organizational policy
• Organizational policy normally requires documentation of critical incidents involving patients to be
documented on a purpose specific form. Regardless of whether a separate report is required, clinical
staff have a professional obligation to document such incidents in the patient health care record as a
true and honest record of the event and the actions taken in response to it.
• Legislation and standards of practice of the professions require nurses and midwives to document
the care that they provide as a record of their accountability for their actions and decisions. Clinical
staff sign their entries in patient records to indicate their accountability for their actions and decisions.
Patient centered and Collaborative Documentation is patient centered, patient focused,

collaborative and appropriate to the setting in which the care is provided and the purpose for which
the information recorded.
Documentation must be patient-focused. Clinical documentation may record diverse information

within and across services and settings. Given the diversity of care provided, clinicians must consider
the purpose of documentation and how, by whom and for what purpose that information is to be used.
Effective documentation systems require regular review and revision.
Patient centered documentation and record keeping
• documentation systems and practices appropriate to the specific needs of the patient/patient
population and context of the care
• appropriate documentation systems to support shared documentation processes
• a record of independent and collaborative actions with other health professionals or care providers
(eg those ordered by another appropriate health professional)
• contemporary, secure, resource efficient documentation systems
• documentation systems relevant to the setting in which the care occurs (including patient held
records, electronic records and mobile record systems)
• identification of objective and subjective data in documenting assessment of the patient needs/health
status
• individualized, comprehensive and current plan of care
• based on professional observation and assessment that does not have any basis in unfounded
conclusions of personal judgements
• identifies problems that have arisen and actions taken to rectify/address
• frequency of documentation consistent with professional judgement in relation to
complexity/stability of patient, organizational policy, standards and legislation
• documented valid consent of any clinician proposed intervention or operation

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• accessible relevant previous/other documentation (including patient history, long and short term
intervention, diagnostic investigations most recent previous documentation by other clinical staff
• appropriate supporting documentation systems and forms
• documentation of in Additional details for Principle 1
• Information documented during or immediately after care is provided or an event has occurred is
considered to be more reliable and a more accurate record of care or an event than information
recorded later, based on memory.
• Chronological entries present a clear picture and sequence of care provided and events over time
and facilitate better communication amongst and between care providers. Late entries should be
appropriately recorded as soon as possible as to rectify the absence.
• For documentation to be reliable it must clearly state when care was provided or an event occurred.
Ensuring entries are made as close to the time of the care or the event is essential but where this has
not occurred clinical staff may make late entries. The time should be an accurate record of the correct
time of the event. Late entries must only be made when the clinician can accurately recall the care
provided or the event. For this reason, making a late entry into the patient records must be voluntary
and should be clearly identified as a late entry. Changes or additions should be minimized as they can
lead to confusing records and perceptions of poor care and decision making practices. Changes or
additions should be clearly marked as such and should not obscure or delete any previously recorded
entry or data. Changes must only be made to the clinician’s own documentation (never to another
person’s documentation).
• Clinicians may obtain information from a third person that is relative to the patient’s care (eg a
family member). In these circumstances the information is documented and should include the source
of the information. The exception to this is if the person is another patient, if so they should not be
identified by name eg patient in next bed stated…).
• The clinician who provided the care or witnessed the event should be the person who documents the
information. An exception may be where a specific scenario has a designated recorder (such as in a
cardiac arrest), or where one clinician assists another to provide care (such as another clinician to
support a patient to ambulate). Where a clinician is documenting information (as a designated
recorder) the recorder must identify the other person/s (and their role or professional designation) to
accurately identify them as part of the care provided or the event.
• Transcription of data potentially increases the risk of error of documentation due to for example
inaccurate, misinterpreted misspelt information. It is not appropriate for a clinician to transcribe
Medication Orders unless they are an authorized prescriber.
approved and defined by organizational policy
Additional details for Principle 2 • Generally, organizations who employ health professionals to
document or record information in relation to patient health care needs and interventions of care are
the legal owners of that documentation. Increasingly however, documentation and records may be
held by the patient and/or may be shared (including shared responsibility and ownership) across a
number of organizations or service providers.
Patients may also own their own health records. When keeping shared records, consideration must be
given to each organization’s and individual’s responsibility in relation to recording data/events,
access (to read/document in), retaining/archiving records, review of documentation (eg care plans)
and informing others of change.
Such consideration may identify the need to retain copies of shared records within negotiated
protocols. • Clinical staff often collaborate with other health professionals and care providers. This
may involve speaking with a medical practitioner or allied health professional and may occur in
person or using such means as telephone, case conferences, teleconferencing and other electronic or
communication technologies. This may also involve shared documentation (including pro forma,
patient progress notes, history taking etc). This collaboration is documented in the patient record and
should include information in relation to the nature or the collaboration, the persons involved and the
plan of actions and/or outcomes agreed upon and any determination in terms of continued
collaboration.
• Documentation should record both the clinical actions and any information given, and the patient’s
response to illness and the care they receive, including refusal of treatment. Subjective data is an
important component of assessing the patient’s health status and care needs. It must also however be
supported by objective assessment that is non-judgmental and based on observation and evidence.

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Clinical documentation reflects dignity and respect for the patient, their significant support network
and other members of the health care team.
• Clinical staff document conclusions and decisions that can be supported by data. Documentation
does not reflect value judgements about a patient, their behaviour or their circumstances. Value
judgements or any other unfounded conclusions may be taken by others to reflect fact and have the
potential to influence (even unconsciously) other health professionals or providers in their assessment
of the patient and/or their relationship with the patient. Example: Nurses and midwives should avoid
statements such as ‘patient uncooperative’ or ‘patient depressed’. Documentation reflects observed
behavior such as ‘ patient refuses bath, shouts
Additional details for Principle 3
In relation to electronic documentation systems, the following are important

• maintaining the confidentiality of passwords or any other access information
• changing a password as per the organization’s policy or more frequently if security risk has been
identified
• using passwords that are not easily deciphered (eg date of birth that can be accessed in personnel
record)
• being aware and up to date on policies and procedures related to access to confidential information
• fully logging off when not using the system or when leaving a terminal
• maintaining confidentiality of any hard copy information reproduced from the electronic system
• protecting the confidentiality of information as it is displayed on monitors (including consideration
of the location and direction of monitors)
• never deleting information
• only accessing information for which the clinician has a professional need to access
• using only secure electronic information and communication systems approved by the organization
• use of confidentiality statements and warnings on email transmissions (ie only to be read by
intended recipient)
• verifying that the information is legible and complete when receiving electronic documentation (eg
medical orders being confirmed by fax)
• ensuring the recipient has been informed so as to retrieve faxed documentation as soon as possible.
References: College of Nurses of Ontario Practice Standards Documentation (2004) American Health
Information Management Association Long Term Care health Information Practice and
Documentation Standards (Sept 2001) College of Registered Nurses of Nova Scotia Documenting
Care A Guide for Registered Nurses (first printed 1997, revised 2002) Nursing & Midwifery Council
Guidelines for records and record keeping (April 2002) Navuluri, Ramesh B., (2001) Documentation:
What, Why, When, Where, Who and How? Research for Nursing Practice Spring 2001 Richmond J
(Edit) Nursing Documentation writing what we do Ausmed Pub2001 South Australian Department of
Human Services Medical Record Documentation and Data Capture Standards August (2000) South
Australian Nursing Board Draft Guidelines for Documentation
http://www.nursesboard.sa.gov.au/word/Draft_Guidelines_for_Documentation.doc, accessed
22.8.2007 Staunton & Chiarella Nursing and the Law 5th Edit Churchill Livingstone 2003
UNIT V:
ETHICAL CONSIDERATION IN LEADERSHIP AND
MANAGEMENT
Introduction
Ethical leadership is defined as leadership demonstrating and promoting

normatively appropriate conduct through personal actions and interpersonal
relations. In other words, this really means that ethical leadership is defined as
putting people into management and leadership positions who will promote and
be an example of appropriate, ethical conduct in their actions and relationships

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in the workplace. In this unit you will learn ethical consideration in leadership
and management.
A. Moral Decision Making: is the ability to produce a

reasonable and defensible answer to an ethical question. Moral values, rules, and virtues provide
standards for morally acceptable decisions, without prescribing how we should reach them.
However, moral theories do assume that we are, at least in principle, capable of making the
right decisions. ... Both non-moral and moral decisions may resort to intuitions and heuristics.
The team chose to use the MORAL model for ethical decision making to help frame their
discussion. ... MORAL includes five steps: (1) massage the dilemma, (2) outline the options, (3)
resolve the dilemma, (4) act by applying the chosen option, and (5) look back and evaluate the entire
process
People are as free as they like to hold themselves to a higher moral standard than the law requires, but
only as free as they can get away with to hold themselves to a lower one. If they'd like the standard
of the law to change, one way or the other, they are free to bring about a political discussion to that
end.
1. Principle of Moral Discernment
Moral Discernment: Essential Learning for a Principled Society....Cannon suggests that the capacity
to discern—to observe and make sense or meaning—is central to one's ability to make ethical choices
and to take moral action.
Discernment is defined as the ability to notice the fine-point details, the ability to judge something
well or the ability to understand and comprehend something. Noticing the distinctive details in a
painting and understanding what makes art good and bad is an example of discernment.
Disclaimers. – None of these principles should be read in an absolute sense. They all admit of limits
and distinctions. They are merely principles that guide further reflection. In a brief blog, not
everything can be said about them, and you may wish to use the comments to elaborate some of your
own thoughts and distinctions. Secondly, while not every principle applies to every situation, as a
general rule, these principles ought to be used together and in tandem. It would be wrong merely to
use one principle, and think discernment is complete. Generally these are all part of a process and
their evidence should be considered collectively.
Principle 1 – State of life. There are many different states in life, some permanent, some long-
lasting, some only temporary. We may be single, married, a priest, a religious, young, old, healthy, or
fragile in health. We may be a student, a parent, rich or poor. Being clear about our state in life can
help us distinguish if a call is from God or not.
Principle 2 – Gifts and talents – It is a clear fact that people have different combinations of virtues
and talents, gifts and skills. In discerning the will of God, regarding a course of action, or of accepting
an offer or opportunity, we ought to carefully ponder if it will make good sense based on our skills
and talents.
God has surely equipped us for some things and not others. I am a reasonably good teacher of adults,
I am not a good teacher of young children. Thus, in being offered opportunities to teach or preach, I
am much more open to the possibility that God wants it, if it is for adults. If I am asked to address
young children for more than 5 minutes, I am quite clear God is not asking.
Hence we do well to ask at this stage of discernment to ask, “Is what I am being asked to do, or
what I want to do, a good match to the gifts and talents God has given me? Does it make sense based
on what I am equipped to do?” And while it is a true fact that God does sometimes want us to try new
things, and discover new abilities, it more usually the case that God will ask of us things that are at
least somewhat in the range of the possible, based on our gifts.
Age is something of a factor here too. Young people are often still in a process of discovery as to
their gifts and talents, and should try more new and challenging things. Older adults are more likely
to discern God’s will a little closer to their current skill set.
Principle 3 – Desire – Desire as a principle of discernment surprises some people. We are often
suspicious of our desires, and not without reason. When it comes to most things regarding the Moral
Law and Doctrine, our feelings and desires are largely irrelevant, and should not be determinative of
understanding God’s will. For example that we should not commit adultery remains the clear will of
God, no matter how we feel about. That Jesus is God is true, no matter our feelings.
But when it comes to discerning between various courses of action that are both good (e.g. marriage
and priesthood), feelings and desires do matter and may help indicate the will of God for us. For

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when God wants us to move in a direction of something good, he most often inspires some level of
desire for it. He leads us to appreciate that it is good, attractive and desirable.
Learning to listen to our heart therefore is an important way of discernment. There may, for
example, be a good thing proposed for us to do, yet we feel no joy or desire to do it. Such feelings
should not be wholly dismissed as mere selfishness or laziness. It is possible that our lack of desire is
a sign of a “no” from God. On the other hand, we may experience a joy and zeal to do, even things
that are challenging, and these desires too may help us to discern that God has prepared and wills for
us to do that very thing. Hence desire is an important indicator, among others, in deciding between
courses of action that are both, or all, good. Ultimately God’s will for us gives joy.
Principle 4 – Organic development – This principle simply articulates that God most often moves
us in stages rather than in sudden and dramatic ways. While it is true, in most lives, there are times of
dramatic change, loss, and gain, it is more usual for God to lead us gently and in stages toward what
he wills for us.
Hence, in discernment, it is valuable to ask, “Does this change…, does this course of action, seem
to build on what God has generally been doing in my life? Is there some continuity at work if I move
in this direction? Does moving into the future in this particular way make sense based on how and
where God has led me thus far?”
It is generally a good idea to exercise great caution about “biggie-wow” projects and “out of the blue”
rapid changes. It is better to ask, “What is the next best step in my life?”
While it sometimes happens that “life comes at you fast,” God more often works with slow, steady,
incremental growth, and asks us to be open to changes that make sense for us as the “next best step.”
Discernment will respect this as a general principle, though not an absolute law.
Principle 5 – Serenity – When God leads us, the usual result is serenity (peace) and joy. In my own
priestly life I have at times, been asked to move from one assignment to another. At such moments
there is great sadness, since I had to say goodbye to people I greatly love. And yet, when it is God’s
will that the time has come for moving on, in spite of the sadness, I also feel an inner peace, a
serenity.
Serenity should not be underestimated as a tool for discernment. For it often happens that to
ponder change is stressful, even fearful. But beneath the turmoil of difficult decisions, we must listen
carefully for a deeper serenity that signals God’s will.
Principle 6 – Conformity to Scripture and Tradition. – Some may think that this principle should
be at the top of the list, and you are free to put it there. But I prefer to say that the Word of God and
the teachings of the Church has the last word in any decision.
For it may well be that one goes through principles like these and feels quite certain of a course of
action or of an insight. But the final and most important step is to be sure that our insight or
conclusion squares with the Lord’s stated revelation in Scripture and Church Teaching.
If a person were to strangely think God was telling her of a fourth person in the Godhead, and that she
should build an altar, and spread devotion to this fourth person, we will rightly and surely conclude
she is dead wrong.
2.Principle of Well-Formed Conscience

2.1. “Conscience is a judgment of practical reason that helps us to recognize and seek what is good
and to reject what is evil” (Catechism of the Catholic Church, no. 1778, 1796).
2.2. A well-formed conscience is an ongoing exercise (Catechism of the Catholic Church, no. 1784).
The Church offers the following process in forming one’s conscience:
2.3. When examining any issue or situation, we must begin by being open to the truth and what is
right.
2.4.We must study Sacred Scripture and the teachings of the Church.
2.5.We must examine the facts and background information about various choices.
2.6.We must prayerfully reflect to discern the will of God (Forming Consciences for Faithful
Citizenship, no. 18).
3.Strategies of Moral Decision Making Process

Ethical Decision-making Strategies

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The strategies are: 1) recognizing personal circumstances, 2) anticipating consequences, 3)
considering others' perspectives, 4) seeking help, 5) questioning your own judgment, 6) dealing with
emotions, and 7) examining personal values
3.1. Ethical Dilemma

An ethical dilemma or ethical paradox is a decision-making problem between two possible moral
imperatives, neither of which is unambiguously acceptable or preferable. The complexity arises out of
the situational conflict in which obeying would result in transgressing another.
Some examples of ethical dilemma include:
3.1.1.Taking credit for others' work.
3.1.2.Offering a client a worse product for your own profit.
3.1.3.Utilizing inside knowledge for your own profit.
B. Meaning and Service Value of Medical Care

Value-based healthcare puts what patients value at the center of healthcare. It helps ensure that they
receive the care that can provide them with outcomes they think are important and that limited
resources are focused on high-value interventions.
From the patient's viewpoint, the definition of value may simply be, “What am I getting, and how
much did it cost?” Porter defines health care value as the “health outcomes achieved which matter
to patients relative to the cost of achieving those outcomes” [1].
1. Allocation of Health Resources

Resource allocation refers to the allocation of resources to a service, department or project. Rationing
suggests that the resources to be allocated are scarce, and thus, there will not be enough to provide
everything that is required.
Identify the ethical principles that should be considered when making decisions on allocating
health care resources.
The real question becomes how best to accomplish it. Allocation strategies to ration health care occur
at 3 levels. At the highest level, the policy level, societies determine allocation strategies through
legislation, health insurance plans, and government funding mandates.
2.Issues Involving Access to Care
The country has a high maternal and new born mortality rate, and a high fertility rate. This
creates problems for those who have especially limited access to this basic care or for those living in
generally poor health conditions. Many Filipinos face diseases such as Tuberculosis, Dengue, Malaria
and HIV/AIDS.
Research indicates that staying physically active can help prevent or delay certain diseases, including
some cancers, heart disease and diabetes, and also relieve depression and improve mood. Inactivity
often accompanies advancing age, but it doesn't have to. Check with your local churches or
synagogues, senior center’s, and shopping malls for exercise and walking programs. Like exercise,
your eating habits are often not good if you live and eat alone. It's important for successful aging to
eat foods rich in nutrients and avoid the empty calories in candy and sweets.
The healthcare system in the Philippines is a mixed public-private system. Although the public
healthcare system in the Philippines is considered to be decent, more and more skilled doctors are
turning away from it in favour of private practice or working overseas.
UNIT VI
ETHICAL ISSUES RELATED TO TECHNOLOGY IN THE

DELIVERY OF HEALTH CARE
A.Data Protection and Security

The discussion for the Data Protection and Security was taken from www.privacy.gov.ph data
privacy ac-Data Privacy Act Republic Act 10173 –Data Privacy Act 2012.

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Data privacy or information privacy is a branch of data security concerned with the proper handling
of data – consent, notice, and regulatory obligations. More specifically, practical data privacy
concerns often revolve around: Whether or how data is shared with third parties.
As danah boyd notes, privacy “is a feeling that people have when they feel as though they have two
important things: 1) control over their social situation; and 2) enough agency to assert control”. ... In
general, privacy issues can be thought of in two (related) senses: social privacy and data privacy.
1. Data Privacy Act 2012 (RA 10173 Series of 2012)
This Act shall be known as the “Data Privacy Act of 2012”. ... – It is the policy of the State to
protect the fundamental human right of privacy, of communication while ensuring free flow of
information to promote innovation and growth.
Republic Act No. 10173, otherwise known as the Data Privacy Act is a law that seeks to protect all
forms of information, be it private, personal, or sensitive. It is meant to cover both natural and
juridical persons involved in the processing of personal information.
In 2012 the Philippines passed the Data Privacy Act 2012, comprehensive and strict privacy
legislation “to protect the fundamental human right of privacy, of communication while ensuring free
flow of information to promote innovation and growth.” (Republic Act. No. 10173, Ch. 1, Sec. 2).
This comprehensive privacy law also established a National Privacy Commission that enforces and
oversees it and is endowed with rulemaking power. On September 9, 2016, the final implementing
rules and regulations came into force, adding specificity to the Privacy Act.
The Data Privacy Act is broadly applicable to individuals and legal entities that process personal
information, with some exceptions. The law has extraterritorial application, applying not only to
businesses with offices in the Philippines, but when equipment based in the Philippines is used for
processing. The act further applies to the processing of the personal information of Philippines
citizens regardless of where they reside.
The Philippines law takes the approach that “The processing of personal data shall be allowed subject
to adherence to the principles of transparency, legitimate purpose, and proportionality.”
The act states that the collection of personal data “must be a declared, specified, and legitimate
purpose” and further provides that consent is required prior to the collection of all personal data. It
requires that when obtaining consent, the data subject be informed about the extent and purpose of
processing, and it specifically mentions the “automated processing of his or her personal data for
profiling, or processing for direct marketing, and data sharing.” Consent is further required for
sharing information with affiliates or even mother companies. Consent must be “freely given,
specific, informed,” and the definition further requires that consent to collection and processing be
evidenced by recorded means. However, processing does not always require consent.
The law requires that when sharing data, the sharing be covered by an agreement that provides
adequate safeguards for the rights of data subjects, and that these agreements are subject to review by
National Privacy Commission.
All processing of sensitive and personal information is prohibited except in certain circumstances.
The exceptions are:
1. Consent of the data subject;

2. Pursuant to law that does not require consent;
3. Necessity to protect life and health of a person;
4. Necessity for medical treatment;
5. Necessity to protect the lawful rights of data subjects in court proceedings, legal proceedings,
or regulation.
Privacy breaches disturb trust and run the risk of diluting or losing security; it is a show of disrespect
to the law and a violation of ethical principles. Data privacy (or information privacy or data
protection) is about access, use and collection of data, and the data subject's legal right to the data.
B.Benefits and Challenges of Technology

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While purchasing these new technologies and training employees to use them can be costly,
modern devices and services create many benefits for manufacturing
The following are the pros and cons of technology
Pros.
1. Improves efficiency for Business. The best advantage of any technology is that it
increases the efficiency of a business process.
2. Saves time.
3. Better communication.
4. Reduces cybercrime risks.
Cons. ...
1. Extreme dependability.
2. Expensive.
C. Current Technology: Issues and Dilemma
Technology
Traditional information technology courses stress the mechanics of “how things work” within a
fundamental conceptual framework, both on the computer and across the ether of the Internet. The
supplemental use of current technology topics.
Current technologies related to organ and tissue transplantation, genetic engineering, reproduction,
and sustaining life have profound potential for affecting our lives and health.
Nursing Ethical Dilemma with Using Informatics Technology

An ethical dilemma or ethical paradox is a decision-making problem between two possible moral
imperatives, neither of which is unambiguously acceptable or preferable. The complexity arises out of
the situational conflict in which obeying one would result in transgressing another. Sometimes called
ethical paradoxes in moral philosophy, ethical dilemmas may be invoked to refute an ethical system
or moral code, or to improve it so as to resolve the paradox. Nurses face ethical dilemmas on a daily
basis, no matter where they practice. Nursing information technology and healthcare are going hand
in hand these days. Technology in nursing practice is not new. The universal impact of technology in
health care has created a new role for nurses. There are many ethical issues nurses can face in the
workplace. These include quality versus quantity of life, pro-choice vs. pro-life, freedom versus
control, truth versus cheating, resource allocation, empirical knowledge versus personal beliefs.
Information is a source of authority and, increasingly, the key to prosperity among those who have
access to it. Thus, developments in information systems also involve social and political relations and
therefore ethical considerations in how information is used are more important.
UNIT VII
CONTINUING EDUCATION PROGRAMS ON

ETHICO-MORAL PRACTICE IN NURSING
The discussion for the Continuing Education Programs on Ethico-Moral was taken from
www.nursing world.org Vol.-23-2018 N0 1 –Jan-2018.
Practice in Nursing
Moral Principles:
One who acts through as agent is herself responsible – (instrument to the crime) No one is obliged to
betray herself – You cannot betray yourself. The end does not justify the means. Defects of nature
maybe corrected. If one is willing to cooperate in the act, no justice is being done to him/her.
A.Lobbying / Advocating for Ethical Issues Related to Health Care.
Lobbying an organized group of people who work together to influence government decisions that
relate to a particular industry, issues anything concerned with the organization.
Professional lobbyists are people whose business is trying to influence legislation, regulation, or
other government decisions, actions, or policies on behalf of a group or individual who hires them.
Individuals and nonprofit organizations can also lobby as an act of volunteering or as a small part of
their normal job.

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Advocating is a person who speaks or writes in support or defense of a person, cause, etc. (usually
followed by of): an advocate of peace. a person who pleads for or in behalf of another; intercessor. a
person who pleads the cause of another in a court of law.
In contrast to this view, another way of thinking about lobbying is as advocacy—an
effort to influence public policy for the benefit of those who are not recognized.
Advocacy and lobbying are effective ways for non-profits to create awareness about the impact,
positive or negative, of public policy on individuals and communities. Non-profits can and should use
their knowledge and expertise in community-based issues to advocate and lobby.
Patient Privacy and Confidentiality. The protection of private patient information is one of the most
important ethical and legal issues in the field of healthcare.
1. Transmission of Diseases.
2. Relationships.
3. End-of-Life Issues.
5 Ethical Issues in Healthcare
1. Do-Not-Resuscitate Orders.
2. Doctor and Patient Confidentiality.
3. Malpractice and Negligence.
4. Access to Care.
5. Physician-Assisted Suicide.
5.Ethical Issues in Healthcare Management
1. Patient Confidentiality. Information about a patient's medical condition is considered private.
2. Patient Relationships.
3. Malpractice And Negligence.
4. Informed Consent.
5. Issues Related To Physician Assisted Suicide (PAD)
5. Common Ethical Issues in the Workplace
1. Unethical Leadership. Having a personal issue with your boss is one
thing, but reporting to a person who is behaving unethically is
another.
2. Toxic Workplace Culture.
3. Discrimination and Harassment.

4. Unrealistic and Conflicting Goals.
5. Questionable Use of Company Technology.
Is lobbying ethical or unethical?

The most obviously unethical (and illegal) practice associated with lobbying is paying a policy maker
to vote in a favorable way or rewarding him or her after a vote with valuable considerations. If this
practice were allowed, people and organizations with money would always win the day
The ethics and morals involved with legally bribing or lobbying are complicated. Lobbying can, at
times, be spoken of with contempt, when the implication is that people with inordinate socioeconomic
power are corrupting the law in order to serve their own interests.
The advantages of lobbying, are an easy way for lawmakers to be informed about an issue.
The disadvantages of lobbying are that lawmakers hear only one side of most issues and are
influenced only by corporations or organizations that have the money to hire lobbyists.
Examples of interest groups that lobby or campaign for favorable public policy changes include:
ACLU - American Civil Liberties Union - visit their section on issues before Congress that the ACLU
is following and lobbying on. Animal Legal Defense Fund. Anti-Defamation League fights anti-
Semitism.
B. Code of Ethics for Nurses
1. International Code of Ethics
The international code of ethics presented below will serve as a moral compass to aid global
organizations in business decisions. The stipulated code will serve as a standard in global ethics to
establish and regulate ethical, social, and environmental responsibilities of companies operating in
global markets.

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The ICN Code of Ethics for Nurses is a guide for action based on social values and needs. ... To
achieve its purpose the Code must be understood, internalized and used by nurses in all aspects of
their work. It must be available to students and nurses throughout their study and work lives.
The purpose of the revision of the ICN Code of Ethics is to serve as a basis for the discussion of
health policies that harmonize and enhance awareness of standards of ethics for nurses on a wider
basis.
What are the five codes of ethics?
1.Integrity- the quality of being honest and having strong moral principles.
2.Objectivity- the quality or character of being objective : lack of favoritism toward one side or
another : freedom from bias Many people questioned the selection committee's objectivity.
3.Professional competence- The capability to perform the duties of one's profession generally, or to
perform a particular professional task, with skill of an acceptable quality.
4.Confidentiality- the state of keeping or being kept secret or private.
5.Professional behavior- is a form of etiquette in the workplace which is linked primarily to
respectful and courteous conduct.
2. Code of Ethics for Filipino Nurses
Code of Ethics for Nurses in the Philippines was devised as a guide for carrying
out nursing responsibilities which would tackle difficult issues and decisions that a profession might
be facing, and give clear instruction of what action would be considered ethical or right in the given
circumstance.
The Filipino registered nurse, believing in the worth and dignity of each human being, recognizes the
primary responsibility to preserve health at all cost. This responsibility encompasses promotion of
health, prevention of illness, alleviation of suffering, and restoration of health.
2.1 Registered Nurses and People
Registered nurses play a vital role in today's healthcare industry. ... Working as a member of a health
care team, the RN provides a wide range of patient services, including preventative and
primary care, educating patients about disease prevention, operating medical equipment, and
administering medications.
Here are the Ethical Principle:
1.Values, customs, and spiritual beliefs held by individual shall represented.
2.Individual freedom to make rational and unconstrained decision shall be respected.
3.Personal information acquired in the process of giving nursing care shall be held in strict
compliance.
The Registered Nurse must:

3.1. Consider the individuality and totality of patients when they administer care;
3.2. Respect the individual beliefs and practices of patients regarding diet and treatment;
3.3. Upholds the right of individuals; and
3.4. Take into consideration the culture and values of patients in providing nursing care.
However, in the conflicts, their welfare and safety must take precedence.
2.2. Registered Nurses and Practice
The registered nurse (RN) is responsible for the daily care tasks and administration of medications,
often in an inpatient setting, but also in outpatient and home care settings. The nurse is trained to
closely assess patient needs and detect small, yet significant, changes in function and status, which
can be critical for any necessary treatment modifications. A licensed practical nurse (LPN) has been
trained to provide home health or nursing care under the supervision of an RN or a medical doctor.
These individuals, along with nurse’s aides, provide direct patient care, such as oral cleansing. An
LPN provides regular reminders and support services, reinforces exercise and
good nutrition regimens, and may provide daily oral home care. Hospice nurses provide palliative
care, including emotional and spiritual support, for individuals with chronic or terminal illnesses.
Ethical Principles of Registered Nurse and Practice
2.2.1 Human life is inviolable
2.2.2 Quality and excellence in the care of patients are the goals of nursing practice.
2.2.3. Accurate documentation of actions and outcomes of delivered care is the hallmark of
nursing accountability.
Registered Nurse must:

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2.2.3.1. Know the definition and scope of nursing practice which are in the provision of
R.A.No.9173, known as the “Philippine Nursing Act of 2002” and Board Res. No.425, Series of
2003,”Rules and “Regulations Implementing the Philippine Nursing Act2002”, (the IRR);
2.2.3.2. 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;
2.2.3.3. Acquired and develop the necessary competence in knowledge, skills and attitudes to
effectively render appropriate nursing services through varied learning situations;
2.2.3.4. If they are administrators, be responsible in providing favorable environment for the
growth and development
Registered Nurses in their charge;
2.2.3.5.Be recognizant that professional programs for specialt certification by the BON are
accredited through the Nursing Specialty Certification Council (NSCC).
2.2.3.6.See to it that quality nursing care and practice meet the optimum standard of safe
nursing practice.
2.2.3.7.Ensure that patient’s records shall be available only if they are to be issued to those
who are professionally and directly involved in the care and when they are required by law.
2.2.3.8. Insure that modification of practice shall consider the principles of safe nursing
practice.
2.2.3.9. If in position of authority in work environment, be normally and legally responsible
for devising a system of minimizing occurrences of ineffective and unlawful nursing practice.
2.2.4. Registered Nurse are the advocates of the patients: e they shall take appropriate
steps to safeguards their rights and privileges.
2.2.4.1.Respect the “Patients Bills of Rights” in the delivery of nursing care;
2.2.4.2. Provide the patients or their families with all pertinent information except those may
be deemed harmful to their well-being and
2.2.4.3.Upholds the patient’s right when conflict arises regarding management of their care.
2.2.5. Registered Nurses are aware that their actionshave professionals, ethical, moral
and legal dimensions. They strive to perform their work in the best interest of all
concerned.
Registered Nurse must
2.2.5.1.Perform their professional duties in conformity with existing laws, rules, regulations,
measures, and generally accepted principles of moral conduct and proper decorum.
2.3. Registered Nurses and Co-Workers

Ethical Principle Registered Nurses and Co-Workers
2.3.1.The Registered Nurse is in solidarity with other members of the healthcare team in
working for the patient’s best interest.
2.3.2. The Registered Nurse maintains collegial collaborative working relationship with
colleagues and other health care providers.
1.Maintain their professional role/identity while with other members of the health
team;
2.Conform with the group activities as those of a health team should be based in
acceptable, ethico-legal standards;
3.Contribute to the professional growth and development of other members of
the health team;
4.Actively participate in professional organizations;
5.Not act any manner prejudicial to other professions.
6.Honor and safeguard the reputation and dignity of the members of nursing and
other profession; 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 colleagues and to an member of other professions; and
7. Respect the rights of other co-workers.
2.4.Registered Nurses and Society and Environment
Ethical Principle of Registered Nurses and Society and Environment:
1. The preservation of life, respect for human rights, and promotion of healthy environment
shall be commitment of Registered Nurse.

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2. The establishment of linkages with the public in promoting local, national, and international
effort to meet health and social needs of the people as a contributing member of society is a
noble concern of a Registered Nurse.
1.Be conscious of their obligations as citizens and, as such, be involved in
community concerns;
2.Be equipped with knowledge of health resources with in the community, and
take active roles in primary health care;
3.Actively participate in programs, projects and activities that respond to the
problems of the society;
4.Leads their lives in community with the principles of right conduct and proper
decorum ; and
5.Project an image that will uplift the nursing profession at all times.
2.5. Registered Nurses and the Profession
Professional Identity in Nursing: a sense of oneself that is influenced by the characteristics, norms
and values of the nursing discipline, resulting in the individual thinking, acting and feeling like
a nurse
Ethical Principles are the following:

2.5.1. Maintenance of loyalty to the nursing profession and preservation of its integrity are
ideal.
2.5.2. Compliance with the by-laws of the accredited professional organization (PNA) and
other professional organizations of which Registered Nurse is a member is lofty
duty.
2.5.3. Commitment to continual learning and active participation in the development and
growth of the profession are commendable obligations.
2.5.4. Contribution to the improvement of the socio-economic conditions and general
welfare of nurses through appropriate legislation is a practice and visionary mission.
a. Be members of accredited professional organization which is the PNA.
b. Strictly adhere to the nursing standards.
c. Participate actively in the growth and development of the nursing profession.
d. Strive to secure equitable-economic and work conditions in nursing through appropriate
legislation and other means; and
e. Assert for the implementation of labor and work standards.
Glossary
Accountability the fact or condition of being accountable; responsibility "their lack of

accountability has corroded public respect".
Assisted suicide. A situation in which patients receive the means of death from someone, such as
physician, but activate the process themselves.
Assault. The unjustifiable attempt or treat to touch a person without consent that results in fear of
immediately harmful or threatening contact.
Autonomy- An ethical principle that literally means self governing. It denotes having the freedom to
make independent choices.
Battery. The unlawful touching of another or the threatened physical harm including every willful,
angry, and violent or negligent touching of another person, clothes or anything attached to his or her
person or held by him or her.
Belmont Report Policies. Developed by the United States National Commission for the Protection of
Human Subjects of Biomedical and Behavioral Research regarding ethical principles for research
with human subjects.
Beneficence The ethical principles that requires one to act in ways that benefit another. In research,
this implies the protection from harm and discomfort, including a balance between the benefits and
risks of a study; as an act of charity, mercy, and kindness with a strong connotation of doing good to
others including moral obligation.

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Bioethics - can be defined as a science that deals with the study of the morality of human
conduct concerning human life in all its aspects from the moment of its conception to its natural
end. - the study of the ethical and moral implications of new biological discoveries and
biomedical advances, as in the fields of genetic engineering and drug research.
Bioethics was first used by biologist Van Rensseler Potter. Bioethics came to the broad terrain of
the moral problems of the life sciences ordinarily taken to encompass medicine, biology, and some
important aspects of the environmental population and social sciences.
Biology. The study of life. A branch of the natural sciences which studies living organism and how
they interact with each other and their environment.
Confidentiality. The ethical principle that requires nondisclosure of private or secret information
with which one entrusted . In research confidentiality refers to the researcher’s assurance to
participants that information provided will not be made public or available to anyone other than those
involved in the research process without the participants consent.
Consequential. A theory of ethics, sometimes called utilitarianism.
Conscience - is a practical judgment of reason of the goodness of an act that has to be done and the
evil of an act that has to be avoided.
Decision-making Capacity. The ability of person to understand all information about health
condition, to communicate understanding and choices , and to reason and deliberate; the possession of
personal values and goals that guide the decision.
Declaration of Helsinki. Principles issued by the World Medical Assembly to guide clinical
research in 1964; revised 1875.
Deontology . a branch of ethical teaching centered on the idea that
actions must be guided above all by adherence to clear principles
such as respect for free will .
Dilemma. A problem that requires a choice between two options that
are equally unfavorable and mutually exclusive.
Discernment. A focal virtue of sensitive insight, acute judgment, and
understanding that eventuates decisive action.
Disease. The biomedical explanation of sickness. Distribute Justice Application of the ethical
principle of justice that relates to fair, equitable, and appropriate distribution in society determined
by justified norms that structure the terms of social cooperation. Its scope includes policies that allot
diverse benefits and burdens such as property, resources, taxation, privileges, and opportunities.
Ethics. a formal process for making logical and consistent decision based upon moral belief; a
philosophical and practical science that
deals with the study of the morality of human acts or human conduct.
Ethical Dilemma. Occurs when there are conflicting morals.
Ethical Principles. Basic and obvious moral truths that guide deliberation and action. Major ethical
principles include autonomy, beneficence, non maleficent, veracity, confidentiality, justice, fidelity,
and others.
Euthanasia. Causing the painless death of a person in order to end or preventing suffering; called as
“Mercy Killing”.
Expertise. The characteristics of having a high level of specialized skills and knowledge.
Faith. A generic feature of the human struggle to find and maintain meaning flowing from an
integration of ways of knowing and valuing.
Fidelity . An ethical principle related to the concept of faithfulness and the practice of promise-
keeping; the quality or state of being faithful.
Forgery. Includes fraud or intentional misrepresentation.
Health - ability to deal with physical, biologic, psychological, and social stress ; a feeling of well
being ; and freedom from the risk of disease and untimely death.
Health Ethics- is a science that deals with the study of the morality of human conduct
concerning health and health care.
Health Care pertains to medical services, nursing care, and all other types of health services
given by health care practitioners such as medical doctors, nurses, midwifes, and all the rest
who, in one way or another, engage in any duly recognized form of health care practice. ( any
other groups of people that give service to community aside from we mention. BHW, volunteers to
serve the community.
Health Care - is the prevention, treatment and management of illness and the preservation of
mental and physical well-being

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through the services offered by the medical and allied health
professions.
Health Care Practice – is a human act because of the three constitutive elements at work. The
prevention, treatment, and
management of illness and the preservation of mental and
physical well-being through the services of the health care practitioners are act knowingly ,
freely, and voluntary done.
Health Care Practitioner /Professional - one who has acquired an advance specialized and
systematic training and experience in the knowledge of health care with scientific specialization and
techniques.
Human Act - is an act that proceeds from the deliberate free will of man. In ethics, being deliberate
or deliberation means merely advertence or knowledge in the intellect. Human act requires the use
of both the rational faculties of knowing (intellect) and willing (free will). The way human act is
performed is systematically presented in its constitutive elements.
Ignorance – simply means the absence or lack of knowledge. He existence of a certain law.(is that
excuse when you commit mistakes? ) ignorance of the LAW EXCUSE NO ONE.. give specific
example of this?
Illness. A personal response to disease flowing from one’s culture teaches one to be sick.
Informed Consent. A process by which patients are informed of the possible outcomes, alternatives,
and risks of treatment and required to give their consent freely. This implies legal protection of
patient’s right to personal autonomy by providing the opportunity to choose a course of action
regarding plans for health care, including the right to refuse medical recommendations and choose
from available therapeutics alternatives. In research, this had been explained; this refers to the
consent to participate in a research study after the research purpose, expected commitment, risks and
benefits, any invasion of privacy, and ways that anonymity and confidentiality will be addressed.
Justice. An ethical principle that relates to fair, equitable, and appropriate treatment in light of what
is due or own to persons, recognizing that giving to some will deny receipt to others who might
otherwise have received this t5higs. In research, justice implies the rights of fair treatment and
privacy, including anonymity and confidentiality; is fairness. Nurses must be fair when they
distribute
care, for example, among the patients in the group of patients that
they are taking care of.
Law - According to St. Thomas Aquinas, law is an ordinance of promulgated by competent
authority for the common goods.
Lobbying. The art or persuasion-attempting to convince a legislator, a government official, the head
of the agency, or a state official to comply with a request-whether it is convincing them to support a
position on an issue or to follow a particular course of action.
Malpractice. The form of negligence in which any professional misconduct, unreasonable lack of
professional skill, or non adherence to accepted standard of cause injury to a patient or client.
Morality – is that quality of human acts where the acts could either be good or bad, evil or wrong.
This quality indicates and determines whether the kind of human act that that is performed is good
or bad.
Non maleficence. An ethical principle related to beneficence that requires one to act in such a
manner as to avoid causing harm to another, including deliberate harm, risk of harm, and harm that
occurs during the performance of beneficial acts; as means non-harming or inflicting the least harm
possible to reach a beneficial outcome.
Nuremberg Code. A set of principles for the ethical conduct of research against which the
experiments in the Nazi concentration camps could be judged.
Nursing process. A model commonly used for decision making in nursing.
Palliative care. A comprehensive, interdisciplinary, and total care approach , focusing primarily on
comfort and support of patients and families who face illness that is chronic or not responsive to
curative treatment..
Plagiarism . Taking another ideas or work and presenting them as one’s own.
Principle Basic and obvious truths that guide deliberation and action. ;is that from which something
proceeds in any manner, whatsoever. Example : The principle of smoke is fire or cigarette butt. It is
a fire or cigarette butt from which smoke process.

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Precept - is an ordinance promulgated by public or private authority for particular or private
good of one or a group of individuals.
Privacy - Refers to the right of an individual to control the personal information secrets that are
disclosed to others.
Problem - Is a discrepancy between the current situation and a desired state.
Professional Ethics – the concern one’s conduct of behaviour and practice when carrying out of
professional work. Such work may include consulting researching, teaching, and writing.
Institutionalization of Code of Conduct and Code of Practice is common with many

professional bodies for their members to observe. Any code may be considered to be a formalization
of experience into a set of rules. A code is adopted by a community because its members accept the
adherence to these rules, including the restrictions that apply. It must be noted that there is distinction
between a profession such as Information Systems and Controlled professions such as Medicine and
Law,
where the loss of membership may also imply the loss of the
right to practice.
Professional Codes of Ethics. Explicit, discipline-specific rules of behaviour for members of a

profession, which are developed to protect people and profession, serves, ensure the competence of
members, and safeguard the integrity and trust worthiness of the discipline.
Racism. The assumption members of one race are superior to those of another.
Self-awareness. Conscious awareness of one’s thoughts, feelings, physical, and emotional response,
and insights in various situations.
Statutory (legislative) law. Formal laws written and enacted by federal, state, or local legislative.
Sympathy. Sharing, in imagination, of other feelings.
Theory. A proposed explanation for a class of phenomena.
Utilitarianism is a normative ethical theory that places the locus of right and wrong solely on the
outcomes (consequences) of choosing one action/policy over other actions/policies. As such, it moves
beyond the scope of one's own interests and takes into account the interests of others.
Veracity being honest and telling the truth and is related to the principle of autonomy. It is the basis
of the trust relationship established between a patient and a health care provider; Truth-Telling.
Values. Ideals, beliefs, customs, modes of conduct, qualities or goals that are highly prized or
preferred by individuals, groups, or society.
Virtue Ethics. Theories of attributed to Aristotle, which represent the idea that an individual’s
actions are based upon innate moral virtue.
Textbooks:
Bioethics, Jean N. Guillasper, RN, MAN, Ph.D (2016)

Ethico-Moral Legal Aspects and Career Development in Nursing, Jean N. Guillasper, Ph.D, RN
(2016)
100 Most Frequently Ask Bioethics Questions, Angeles Tan-Alora (2015)
Medical Law and Ethics, Bonnie F. Fremgen, (2015, 5th Edition)
Ethics and Health Care, An Introduction, John C. Moskop (2016)
Leadership Roles and Management Functions in Nursing, Theory and Application, Bessie L. Marquis
and Carol J. Huston (2017)
Gerontological Nursing Competencies for Care, Kristen L. Mauk (2017, 4th edition)

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Websites:
https://scholar.google.com/citations?
hl=en&vq=med_bioethics&view_op=list_hcore&venue=srayO4xJHcwJ.2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322057/
https://online.sju.edu/graduate/masters-health-administration/resources/articles/four-principles-of-
health-care-ethics-improve-patient-care
https://vtethicsnetwork.org/medical-ethics
https://study.com/academy/lesson/dying-with-dignity.html
https://www.privacy.gov.ph/data-privacy-act/
BIOETHICS (2009)Text work-book Dr. Rose Mary D. Estoesta/Dr. Romeo R. Javines

Health Care Ethics (2007) Textbook for Nursing Marvin Julian L. Sambajon
ONLINE REFERENCES:
Protection of privacy and confidentiality as a patient right: physicians.
www.alliedacademies.org › articles › protection-of-privacy. May 4, 2016
Nurses Bound by Ethics, Law to Maintain Privacy/Nurse.com Blog
www.nurse.com>blog>2010/03/10>nurse
.https://www.youtube.com/results?search_query=virtue+ethics+vs+utilitarianism+vs+deontology
The ethics of surrogacy
Share on Twitter Share on face book Share on linkedin Share on email
Dr Herjeet Marway
Lecturer in the Department of Philosophy, University of Birmingham and
Chair of Surrogacy UK’s (SUK) Ethics Committee
Posted on 27 Sep 2018
Feedings and Persistent Vegetative State Patients: Ordinary or Extraordinary
Means? Christian Bioethics, 12 (1), 43–64.
Clark, P. (2006).
Sexual Ethics by Todd A. Salzman; Michael G. Lawler
ISBN: 9781589019133
https://www.thespruce.com/definition-of-marriage-2303011
https://www.frc.org/brochure/the-bibles-teaching-on-marriage-and-family
Publication Date: 2012-05-18
End of life and palliative care explained - Better Health Channel Sep 17, 2015
Artificial Insemination & IUI in Humans: Purpose, Procedure ...
www.webmd.com › Infertility and Reproduction › Guide
Artificial Insemination: Process, Success Rates, at Home - Healthline
Side Effects | IUI | Attain Fertility
Is a DNR a Good Idea for You or a Loved One? · ZaggoCare
The ethical hierarchy of do not resuscitate orders: Never say never .
decision -making. Feb 27, 2019
Nurses' Roles and Responsibilities in Providing Care and ...

www.nursingworld.org › official-position-statements
Roles and responsibilities | Fundamentals of End of Life Care ...
rcni.com › hosted-content › rcn › roles-and-responsibili.
May 4, 2016 Making Ethical Decisions: Process - Blink - UC San
Diego
Nurses Bound By Ethics, Law to Maintain Privacy | Nurse.com
Blog www.nurse.com › blog › 2010/03/10 › nurse May 13, 2019
EPH - International Journal of Medical and Health Science
ISSN: 2456 - 6063

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Volume-4 | Issue-1 | January,2018-2020
www.who.int › Health topics
www.nursing world.org Vol.-23-2018 N0 1 –Jan-2018.
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Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND

SEVILLA C. GUINTO, MAN, RN

2020 NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

THEORIES AND PRINCIPLES OF HEALTH

At the end of this unit, the learner will be able:

1. Achieved essential knowledge and provide safe environment to their patient.

III. Lesson Proper

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Modern ethics, especially since the 18th century German

Utilitarianism is synonymous with consequentialism. Utilitarianism is ethical if;

1. It minimizes pain and suffering.

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Guidelines for making ethical decisions (Joseph Fletcher):

c. No action seems to be intrinsically right or intrinsically wrong

e. CONSEQUENCES, EFFECTS, RESULTS and OUTCOMES are most important; they

An example could be a person with a life support machine which is practically

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- Right action is that which has greatest utility or usefulness

 When faced with multiple simultaneous patients in the emergency department it is

The Role of Ethics in Healthcare

Ethics is a Natural Science

- It employs the power of human reason, which is purely a natural reason.

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Ethics is a Practical Science

- It is not studied for the love of learning.

Ethics is Not a Physical Science

Difference between Ethics and Morals

Morals is the application of ethics.

1. Virtue Ethics in Nursing

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Virtues of Health Care Provider

2. Core Values of a Professional Nurse

Teaching Core Values in Nursing

Core Values About Life

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Autonomy involves self-determination and freedom. Autonomy is the right of a rational

Patient Self-Determination Act

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What is Autonomy in Nursing?

b. Patients’ Bill of Rights

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These components are essential elements of the shared decision-making process

1. most surgeries (major/minor surgeries)

An informed consent agreement should include the following information:

There are three fundamental constraints on this delegation:

There are two types of proxy consent for adults.

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Confidentiality is the right of an individual to have personal, Identifiable medical

Confidentiality in nursing ethics

Maintaining patient privacy and confidentiality is an ever-present legal

5 Ways to Maintain Patient Confidentiality

Some Examples of Ways you could Unintentionally break patient/therapist

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Principle of truth telling

The Importance of Truth.

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Three principles of justice

Contemporary reviews of the psychology of distributive justice have tended to

Why is justice important in nursing?

Some Moral Issues:

Some Moral Issues: