BIOETHICS

FINALS REVIEWER
PREPARED BY: PKDC
Reports and PPTX’s are owned by Ma’am Shing and the Class of Block-C (S.Y. 2023-2024)

TABLE OF CONTENTS:

I. Ma’am Shing Slides

Bio-Ethics and Its Application in Various Health Care Situation…………………………………………………………………………….……2

Dignity in Death and Dying………………………………………………………………………………………………………………….…….5

II. PowerPoints of Reporters

Goal of Research Ethics………………………………………………………………………………………………………..……………….….7

Code of Ethics for Nurses………………………………………………………………………………………………………………………….8

Ethical Considerations in Nursing Leadership…………………………………………………………………………………………………......8

Ethical Considerations in Nursing Leadership and Management….………………………………………………………………………………10

Continuing Education Programs on Ethico-Moral Practice in Nursing…………………………………………………………………...……….11

Ethical Approach and Principles………………………………………………………………………………………………………………...…12

Ethical Issues Related to Technology and Delivery of Health Care…………………………………………………………….…………..……..14

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Bio-Ethics and Its Application in Various Health Physiologic and Psychologic effect of sexual stimuli to human

Care Situation
A. Sexuality and Human Reproduction
1. Human Sexuality and Its Moral Evaluation
2. Marriage
• Fundamentals of Marriage
• Issues on Sex outside Marriage and Homosexuality
• Issues on Contraception, its morality, and ethico-moral
responsibility of Nurses
3. Issues on Artificial Reproduction, its morality and Ethico-
moral responsibility of Nurses
• Artificial Insemination
• In-Vitro Fertilization
• Surrogate Motherhood
4. Morality of Abortion, Rape and other Problems related to
Destruction of Life.

Sexuality and Human Reproduction

Sexuality

-The gender of a particular person; genital characteristics and social attitudes

- sense of being a sexual individual

Sexual Expression
- Include how one looks, behaves, and relates to others.
Bisexuality – Sexual attraction to and activity with both genders
- the sum og physical, functional, and psychological attributes that are
Heterosexuality – M-F sexual relationship
expressed by one’s gender identity and sexual behavior
Homosexuality – Sexual Attraction to a member of the same gender

Transvestism – Obsession with wearing clothing of the opposite gender

How does nursing relate to sexuality?

As Nurses; We should assist individuals to understand physical and

psychosocial dimensions of sexual growth and development. Types of Sexual Expression

- Celibacy
- Masturbation
Breaking the Binary
- Erotic Stimulation
Gender Identity – How you think about yourself - Fetishism
- Transvestism
Gender Expression – How you demonstrate your gender - Voyeurism
- Sadomasochism
Biological Sex – Organs, hormones and chromosomes - Exhibitionist
- Pedophiles
Sexual Orientation – Physical, spiritual and emotional attraction - Zoophilia

What is Sexual/Gender Identity? LGBTQIA+

Biological Gender – denote a person’s chromosomal sex; Male (XY) / - Lesbian

Female (XX) - Gay
- Bisexual, Pansexual
Gender Identity – Inner sense of a person has of being male/female, which - Transgender, Genderqueer
may be the same as or different from biologic gender. - Queer
- Intersex
- Agender, Asexual, and other queer – identifying community

Development of Gender Identity
1. Infancy – Gender Identity is established early in life.
2. Preschool – Distinguish between males and females
3. School-age – Imitating adult roles (gender roles0
Sexual Orientation and Gender Identity Expression (SOGIE) Equality
Bill
House Bill No. 4982 or “An Act Prohibiting Discrimination on the Basis of
Sexual Orientation or Gender Identity or Expression (Sogie) and Providing
Penalties Therefor”

4. Adolescent – Establishment of sense on identity
5. Young Adult – choose way(s) on expressing sexuality.
6. Middle-age adult – achieved a degree of stability
7. Older adult – enjoys active sexual relationship
The Purpose: The SOGIE Equality Bill is meant to fulfill the rights set forth in
the 1987 constitution, particularly the equal protection clause. It recognizes
the LGBTQ++ as equals and ensures that their rights are protected inasmuch
as everyone’s is. The bill also acknowledges the Philippines duties under
international law particularly the Universal Declaration of Human Rights and
the International Covenant on Civil and Political Rights. It thus recognizes the
non-discrimination of the LGBTQ++ as both a national and international duty.

2. Marriage

Fundamentals of Marriage

Marriage

-defined differently, and by different entities, based on cultural, religious, and

personal factors.

- a formal union and social legal contract between two individuals that unite
their lives legally, economically and emotionally.

- gives legitimacy to sexual relations within the marriage.

- (Traditionally) is often viewed as having a key role in the preservation of

morals and civilizations.

- another human construction; ensure continuity of the family and the eventual
perpetuation of human specie

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The New Family Code of Philippines (Effective: August 3, 1998) – Define 8. Sexual infidelity or perversion;
Marriage; special contract of permanent union between a man and a woman 9. Attempt by the respondent against the life of the petitioner; or
entered into in accordance with law for the establishment of conjugal and the 10. Abandonment of petitioner by respondent without justifiable cause
family life. for more than one year.

Contractual Marriage Forms of Marriage

- Implies that couple has legal obligations to each other throughout 1. Monogamy – 1 man and 1 woman
their lives or until they decide to divorce. 2. Polygamy/ Plural marriage; 3 forms
a. Polygyny – 1 husband and 2 or more wives
Aspects of Marriage: b. Polyandry – 1 wife and 2 or more husbands
c. Group Marriage – 2 or more husbands and 2 or more wives
First (Legal POV)
Basis on Choosing a Marriage Partner
- Posits that marriage is a contract
1. Parenteral Selection or Arranged Marriages
Second (Religious POV) - Families that have important stake in the type of spouse their son
or daughter will take usually practice.
- Posits that marriage a sacrament. 2. Romantic Love
- “What god has put together let no man put asunder” - Become an important basis for marriage in society; theme of most
of popular sopgs. Subject of many movies, TV shows, and made
active in scores of popular books and magazine articles.
Essential Requisites for Marriage
Why People Marry?
Family Code of the Philippines provides:
1. Love
Art. 2: No Marriage shall be valid, unless these essential requisites are 2. Economic Security
present: 3. Emotion Security
4. Parent’s wishes
1. Legal capacity of contracting parties (18yrs or upwards), who must 5. Escape from loneliness
be a male and female; and 6. Common interest
2. Consent freely given in the presence of the solemnizing officer 7. Parenthood
8. Physical attraction
Art. 3. The Formal Requisites of Marriage are: 9. Responsibility
10. Compatibility Spouse
1. Authority of solemnizing officer 11. Martial Bliss and Happiness
2. A valid marriage license except in cases provided in cases provided 12. Unhappy Home Situation
in chapter 2 of this title; and 13. Money
3. A marriage ceremony which takes place with takes place with the 14. Companionship
appearance of the contract parties before the solemnizing officer 15. Protection
and their personal declaration that they take each other as husband 16. Adventure
and wife in the presence of not less than two witnesses of legal 17. Sex and Sexual Attraction
age: 18. Begetting and Rearing of Children
19. Acceptance
Art. 4. The absence of any of the essential or formal requisites shall render the 20. Death of a former spouse
marriage “void ab initio” (void from the beginning) except as stated in Article 21. Care and nurturance
35(a)
Issues on Sex outside Marriage and Homosexuality.

- Filipinos remain a morally conservative lot compared to other

C. Annulment of a Marriage societies, going by the results of a survey on where people in 40
countries stand on 8 moral issues.
Annulment - Most religions tend to disapprove of extramarital and Premarital
sex
- Refers to the legal process of filing a petition in the appropriates
court seeking a judicial declaration of making a marriage null and KANT
void ab initio or from the beginning as if no marriage took place.
- Sex is morally permissible within the context of a heterosexual,
Art. 45. Enumerates the grounds for annulment of marriage, as follows: lifelong, and monogamous marriage
- Any sexual act outside these context; homosexuality, masturbation,
adultery, premarital sex; morally wrong.
1. One of the contracting parties is 18 yrs. Of age or over but below 21 and ST. AQUINAS and OTHER NATURAL LAW THEORISTS
without parental consent;
- Sexual faculties have one true end – procreation
2. Either party was unsound mind;
- Sex is pleasurable but it is pleasurable in order to fulfil this end. If
3. Consent of either party was obtained by fraud, force and intimidation; this is correct then sexual activity is good if and only if; consistent
with procreation and bad in so far as it frustrates that end.
4. Either party was physically incapable of consummating the marriage with
the other; and Traditional Natural Law
- Theory, premarital sex, masturbation, bestiality, contraception, homosexual
5. Either party was afflicted with a sexually transmissible disease found to be acts, pornography and adultery are all wrong. Premarital sex is wrong because
serious and incurable. children would be brought into the world outside the safe confines of
marriage. Homosexual acts have no tendency towards procreation at all;
contraception frustrates procreative ends; masturbation and pornography focus
the sexual acts inwards towards onself, frustrating procreative ends.
D. Legal Separation
However, it is vital to make a number of clarifications
- refers to the legal process of filling a petition in the appropriate court seeking
a judicial declaration of legal separation for married couples.
Issues on contraception, its morality, and ethico-moral responsibility of
Nurses
Art. 55. A petition for legal separation may be filed on any of the following
grounds: Church teaches that contraception is morally wrong since it violates the very
purpose and nature of human sexuality, and this further undermines the
dignity of the human person. The Church’s condemnation of artificial
1. Repeated physically violence or grossly abusive conduct directed contraceptives has been unchallenged for centuries.
against petitioner
2. Physical violence or moral pressure to compel petitioner, a political The moral case for contraception is largely based on the absence – in the eyes
affiliation; of supporters – of any good reason for considering birth control morally
3. Attempt of respondent to corrupt or induce petitioner, a common wrong. But there are many positive reasons why people believe that it is right
child, or child of petitioner, engage in prostitution, or connivance to allow people to practice birth control.
in such corruption or inducement;
4. Final Judgement sentencing respondent to imprisonment of more
than 6 yrs; even if pardoned;
There are at least 15 methods of contraception available and these include:
5. Drug addiction or habitual alcoholism of the respondent;
6. Lesbianism or homosexuality of the respondent; 1. Combined methods (pill, ring, and patch)
7. Contracting by the respondent of a subsequent bigamous marriage, 2. Progesterone only pulls (POPs)
whether in the Philippines or Abroad 3. IUDs

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 4. Intrauterine Systems (Mirena, Jaydess, Lavosert) - Often the victim is blamed by others and receives no support from
5. Subdermal Implants (Nexplanon) significant others
6. Condoms (male and female) o ACQUAINTANCE RAPE – Involves someone known
7. Sterilization (male and female) to victim
8. Diaphragms o STATUTORY RAPE – act of sexual intercourse;
9. Natural fertility awareness person younger than age of legal consent; EVEN IF
10. LAM MINOR CONSENTS
o MMARITAL RAPE – Being forced to perform sexual
Women’s health can be enhanced if women are given the opportunity to make acts they did not wish to perform and being physically
their own reproduction choices about sex contraception, abortion and abused during sex.
application of reproductive technologies.
Nursing Ethics arise from the principle of non-maleficence, or not doing harm.
By the use of contraception, it is possible to lessen maternal, infant and child Under this principle, nurses have a duty to treat people with compassion and
mortality and to reduce the prevalence of sexually transmitted diseases. to respect the inherent worth and dignity of each individual.

Research and development of new effective reversible contraceptives for
women and men is needed.
Dissemination of information about the safety and effectiveness of
contraceptive methods is of great importance.
Victims of abuse have been violated in physical, sexual or emotional ways;
nurses are expected to deliver care no matter how difficult or ugly the
situation may be. Nurses have an ethical expectation to be advocates for their
patients, which includes to protect them or support them in situations of abuse.

3. Issues on Artificial Reproduction, its Morality and Ethico-

Moral responsibility of nurses

The main issues that raise ethical dilemmas following the development of
assisted reproduction techniques are:

- Right to procreate or reproduce

- The process of in-vitro fertilization itself-is it morally acceptable to
interfere in the reproduction process/
- The moral status of the embryo;
- The involvement of a third party in the reproductive process by
genetic material donation;
- The practice of surrogacy, cryopreservation of pre-embryos;
- Genetic manipulation
- Experiments on pre-embryos, etc.

Artificial Insemination (AI)

Consist of depositing a man’s semen to vagina, cervical canal/uterus, through

use of instruments (syringe) to bring about conception unattained or
unattainable by sexual intercourse

Types of AI

- Homo- and Hetero- -logous Insemination (AIH) and (AID)

Justification for AIH

1. Husband’s impotence – husband is incapable of penile erection

2. Anatomical defects on husband’s urethra, affecting the conveying
of semen
3. Deficient sperm count
4. Some type of spinal injury and certain physical and psychological
problem that hinder normal intercourse
5. Some husbands undergo vasectomy for contraceptive purposes

Justification for AID

1. Husband is sterile
2. Husband is carrier of certain hereditary disease
3. The wife’s oocytes are defective or she may be a carrier of certain
genetically-linked disorder
4. Wife’s fallopian tubes are severely damaged by gonorrhea

In Vitro Fertilization

- Fertilization within a glass; opposed to fertilization in utero

Surrogate Motherhood

- Biomedical technique whereby a fertilized ovum is implanted into

uterus of another woman who will carry the baby to term either as
a favor or for a fee.

4. Morality of Abortion, Rape and other Problems related to destruction

of life

- Induced abortion raises ethical issues related to the rights of the

woman versus the rights of the fetus. For those who consider life to
begin at conception abortion always equals murder and is therefore
forbidden.
- Those who believe in the absolute autonomy of the woman over
her body take the other extreme approach
- The discussion surrounding abortion usually centers on whether it
should be legal or illegal
- Access to safe abortion is critical to the health of women and to
their autonomy.

Rape

- Engaging in another person in a sexual act or sexual intercourse

through the use of force and without the consent of the sexual
partner.

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DIGNITY IN DEATH AND DYING
B. DIGNITY IN DEATH AND DYING
Euthanasia and Prolongation of Life
Inviolability of Human Life Euthanasia and Suicide
Dysthanasia
• Administration of Drugs to the Dying
• Advance Directives
• DNR or End of Life Care Plan
Life, Death and Dying
▪When a person is dying and there is no expected improvement in the patient’s
condition, decisions have to be made to start, stop, or withdraw life sustaining
measures ,(Johnstone 2004, p. 294).
▪Who decides and when do these measures get stopped?
Euthanasia and Prolongation of Life
Euthanasia and assisted suicide
generally considered medical procedures that should not be delegated to
nurses. However, nurses have been involved directly with aiding someone to
die or have been witness to it simply because of providing end of life care to
patients. Furthermore, as nurses, you may decide one day to travel and work
in another part of the world. It is important, therefore, to know about,
contemplate, and formulate your own thinking concerning the ideas and ethics
around euthanasia and assisted suicide.
Not prolonging life?
➢ Figuring out when life prolonging interventions are no longer of benefit to
the patient, and relating this to the patient and family, are difficult situations
for health care professionals.
➢ What may be helpful in this circumstance is to agree to a specified period
of time to try aggressive treatment. If no improvement is seen or the patient is
deteriorating at the end of this time period, then interventions are deemed
futile* and are stopped.
➢ In this way, the patient and the family are assured that all has been done to
assist the patient.
Inviolability of Human Life
✓According to the sanctity of life principle, life is of intrinsic value.
Grounded in mainstream Christian beliefs, this principle prohibits intentional
killing—in both active and passive forms. Life is considered a stewardship or
loan from the Creator, and the power to live or die resides with the Creator
alone.
✓According to the qualified sanctity of life principle, one cannot actively and
intentionally hasten death; however, one can refrain from preventing natural
death. Treatment can, therefore, be omitted, allowing death to occur
“naturally.”
✓The quality of life principle, in sharp contrast, permits intentionally
hastening death using either acts of omission (withholding or withdrawing
treatment) or commission (prescribing overdoses or administering lethal
injections). Although the quality of life principle is now the dominant ethos,
its acceptance unfolded gradually over time. This occurred largely in response
to shifting public attitudes towards intentional death, as reflected in legal
documents and case law.
Definition of Euthanasia
The term euthanasia comes via New Latin from Greek
eu : (meaning easy, happy or good)
thanatos: (meaning death) it is translated literally as ‘good death’ or ‘happy
death’.
Contemporary English definitions of euthanasia vary. The action of inducing a
quiet and easy death.
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The act of killing someone painlessly, especially to relieve suffering from an
incurable illness.
An act or practice of painlessly putting to death people suffering from
incurable conditions or disease’.
Basic Terms:
Euthanasia – the deliberate killing of a person for the benefit of that person.
Assisted Suicide – a situation where the person is going to die, needs help to
kill themselves, and asks for it. A qualified medical practitioner supplies the
patient with the means. The patient kills him/herself. It may be as simple as
getting drugs for the person and putting them within reach.
Mercy Killing – often used interchangeably with euthanasia, however, the
killing may be done without the patient request or consent. An example, a
father kills his cerebral palsy child by suffocating her; done to relieve
prolonged pain and suffering, sacrifice, and/or financial ruin for the child and
the father.
Suicide – an act where a person deliberately plans and follows through on
taking their own life. Palliative Care – medical, emotional, and spiritual care
given to a person which is terminally with the aim as reducing suffering and
not curing. (www.bbc.co.uk)
Euthanasia Beauchamp and Davidson (1979) argue that for an act to be an
instance of euthanasia, it must satisfy at least five conditions:
1. Intentionality. Death must be intended and not be merely accidental, and
further must be intended by at least one other human being.
2. Suffering and evidence of suffering. Here suffering may be in the form of
conscious pain, mental anguish, and/or serious self-burdensomeness (as may
occur in cases of high quadriplegia, or tetraplegia, or the like).
3. Reasons for death and the means of death. death-causing acts must be
motivated by beneficence or other humanitarian considerations (such as the
demand to end suffering).
4. Painlessness. This condition is related to the previous one and demands,
quite simply, that any death act performed must be as painless and as merciful
as possible.
5. Non-fetal humanity. Beauchamp and Davidson contend that if this simple
qualification is not included then we would not be able to distinguish acts of
abortion from acts of euthanasia
Euthanasia & assisted suicide
Orthothanasia – letting the incurably diseased person “die his own death’
while making no extra efforts to prolong his life.
Passive Euthanasia – refraining of any medical treatment aimed at retarding
death
Active Euthanasia – terminating a person’s life in a painless way, at his
request & with the intention to prevent person from suffering.
Dysthanasia - is the term for futile or useless treatment, which does not
benefit a terminal patient. It is a process through which one merely extends
the dying process and not life per se. Consequently, patients have a prolonged
and slow death, frequently accompanied by suffering, pain and anguish.
Death & Advance refusals of Treatment Apparent
Death – the cessation of life as indicated by the absence of all vital functions
Legal Death – the total absence of activity in the brain and central nervous
system, the cardiovascular system, & the respiratory system as observed and
declared by a physician.
Criterion
Do-not-resuscitate orders
Why would someone want euthanasia or assisted suicide?
In most cases,
• The person is terminally ill
• Their quality of life is severely damaged
• There is no hope of recovering from their illness
• They fear loss of control or of dignity
• They fear severe pain and suffering
• They dislike being dependent or a burden
Views to Support Euthanasia/Assisted Suicide
1. Right to Choose - A person has the right to self-determination which
includes the right to decide to choose death and at a time suitable for him/her.
It is their own body.
2. Right to Die with Dignity - A person should be permitted to die with
dignity and without pain. Medical advances that prolong life, but erode a
person’s self-esteem, character, and self-worth seem inhumane.
3. Right to Justice/Fair Treatment - It is wrong to make people live longer
than what they want, to become a burden to themselves and others, and to
suffer intolerably. If we do so, we are violating their personal freedom and
human rights.
4. Reduction of Suffering - People ought to be spared intense, prolonged, and
intractable suffering. It would seem merciful to end their suffering and cruel to
deny them a choice of death.
Arguments Against Euthanasia/Assisted Suicide
1.Autonomy – Euthanasia on the grounds of patient autonomy disregards the
rights of and harmful effects for others, specifically family and friends,
medical professionals and other carers.
2. Right to Die with Dignity – The right to die with dignity might equally
include respect for the person’s wish to have everything medically possible
done and to sustain a sense of hope.
3.Right to Justice/Fair Treatment – To deny treatment to a person based on
the notion of it prolonging a hopeless life is unfair. What is in the best interests
of the patient may be to have “everything possible done” which supports the
meaning and value of life only the patient can assign. Arguments Against
Euthanasia/Assisted Suicide
4. Clinical Uncertainty – Once euthanasia is performed it is irreversible.
Diagnoses can be uncertain, and incorrect. Sometimes patients do recover
spontaneous from life threatening illnesses and there is always hope of cures
being found.
5. Risk of Abuse – Euthanasia/assisted suicide would be abused by doctors
who might stereotype patients as unworthy of saving or might not consult the
patient and family at all about end of life decisions. There is fear of abuses by
family members who might benefit from a loved ones death and use coercion
to get them to request euthanasia when they don’t really want it. Regulation of
euthanasia/assisted suicide is too difficult to control. Arguments Against
Euthanasia/Assisted Suicide
6. Non-Necessity – Palliative care makes euthanasia/assisted suicide
unnecessary.
7. Devalues Lives – Euthanasia/assisted suicide suggests that some lives (i.e..
severely disabled newborns, severely brain injured persons, people with end
stage Alzheimer’s) are not worth living. It also exposes vulnerable people,
who may feel themselves a burden, to pressure themselves into asking to end
their lives.
8. Sanctity of Life - This argument contends that life is sacred and must not
be taken. Religions draw heavily on the sanctity of life argument. Most
religions disapprove of euthanasia/assisted suicide and some absolutely forbid
it.
9. “Slippery Slope” Argument - Many people worry that if we permit (make
legal) euthanasia for consenting persons, inevitably we will then relax our
moral standards and let euthanasia be practiced on nonconsenting persons
such as “infants, the mentally impaired, demented, brain injured, dependent,
frail, elderly, and simply the unhappy” (Oglivie & Potts 1994 as cited in
Johnstone 2004, p. 250).
Arguments Against Euthanasia/Assisted Suicide Should the Nursing
Profession Take a Stand on Euthanasia?
According to Dierckx de Casterlé, B., et al., nurses' involvement starts when
the patient requests euthanasia and ends with supporting the patient's relatives
and healthcare colleagues after the potential life terminating act. Nurses
stressed the importance of having an open mind and of using palliative
techniques, also offering a contextual understanding of the patient's request in
the decision-making process. Concerning the actual act of performing
euthanasia, palliative care nurses saw their role primarily as assisting the
patient, the patient's family, and the physician by being present, even if they
could not reconcile themselves with actually performing euthanasia.
Administration of Drugs to the Dying
Palliative care works to achieve one of the primary goals of healthcare—
relief of symptoms.
Palliative care is an option for patients who are seriously or terminally ill. It
focuses on achieving the best possible quality of life for a patient by
emphasizing total and comprehensive care for all a patient’s needs: pain and
symptom management, spiritual, social, psychological, and emotional well-
being.
A study found that morphine, midazolam and haloperidol were the most
frequently prescribed drugs at the day of death for patients in the largest
palliative care center in the Netherlands (Masman, A. D., et al). These drugs
are given to relieve symptoms such as pain, restlessness and agitation, which
are frequently seen in advanced cancer.
Palliative care supporters believe that failing to address the suffering of a
patient with a terminal illness violates two of the main ethical principles
behind health care:
1) Providing help or benefit to a patient (beneficence) – Failing to relieve
pain and other symptoms does not help the dying patient.
2) Not harming a patient (non-maleficence) – Failing to relieve pain and
other symptoms can actually harm a patient and the patient’s loved ones. For
dying patients, palliative treatment provides relief of suffering from pain and
other symptoms.
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Withdrawal Vs. Withholding Treatments
▪ What is the difference between the two terms?
▪ Are they ethical? Are they legal?
Definition of terms: Withholding treatment is the act of not instituting
measures that would serve to either prolong life or delay death.
Withdrawing treatment is defined as the removal or discontinuation of life-
sustaining/life-prolonging therapies of a treatment considered medically futile
in promoting an eventual cure or control of disease or symptoms (Lesage &
Latimer, 1998; Sulmasy, 1998).
Common Reasons for Withholding/Withdrawing Therapy
1. Patient choice
2. Burdens outweigh benefits
3. Undesirable quality of life
4. Prolonging the dying process Pearl for practice:
▪ Health care professionals may find it difficult to stop life-sustaining
treatment because they have been trained to do everything possible to support
life
▪ Withdrawal or withholding treatment is a decision/action that allows the
disease to progress on its natural course. It is not a decision/action intended to
cause death.
What is an advance directive?
An advance directive is a document that tells your health care provider and
family what kind of medical care you'd want (or wouldn't want) if you become
terminally ill and can't speak for yourself. An advance directive takes effect
only if you can't express your wishes (for example, if you're in a coma).
Types of Advance Directives
✓ The living will. ...
✓ Durable power of attorney for health care/Medical power of attorney. ...
✓ POLST (Physician Orders for Life-Sustaining Treatment) ...
✓ Do not resuscitate (DNR) orders. ...
✓ Organ and tissue donation.
DNR or End of Life Care Plan ‘Do Not Resuscitate’ (DNR) Directive
➢ To deal with the moral and legal issues that arise in performing CPR on
hopeless medical cases, some countries and health care facilities have
implemented the ‘Do Not Resuscitate’ directive.
➢ This directive states that “in the event of a cardiac arrest, doctors, nurses,
and other health personnel are not to perform basic or advanced life support”
(Cushing 1981, & Honan 1991 as cited in Johnstone 2004, p. 297)
➢ This directive is written by doctors to prevent CPR abuses in cases where
the doctor judges the person’s disease to have a hopeless prognosis. but what
does that mean?
DNR Meaning
• Do Not Resuscitate (DNR) order is a part of advanced medical directives
allowed by federal law passed in 1991, expanding the notion of patient
autonomy to situations in which they may not be able to make crucial medical
decisions due to incapacitation.
• It instructs medical personnel not to perform life-saving (CPR) or other
procedures to restart the heart or breathing once they have ceased and with the
purpose of such advanced cardiopulmonary techniques, it is possible to keep
almost any patient's heart and lungs functioning, independent of how terminal
or hopeless
• Description: DNR orders affect a small group of patients and are designed
to avoid the suffering of a terminal illness or other serious conditions that are
medically irreversible.
• Reference: Death and Dying." In Merck Manual, Home Edition. [cited May
5, 2003]. http://www.merck.com/mrkshared/mmanual_home/sec1/4.jsp DNR
Meaning
▪Example: A patient with poor prognosis and life expectancy of 6 months,
developed a respiratory arrest related to an allergic reactions to certain food he
has ingested, shall you perform CPR for him in this case even if his chart was
labeled DNR ?
•What do you think?
•Is his arrest related to his hopeless medical condition?
•Is it a reversible condition? how is that going to affect his life expectancy?
Specific Problems with DNR Ethical Proponents of a DNR order would say
that it is a legal and reasonable directive; critics would argue that such an
order is simply a moral decision based on beliefs about the quality and
sanctity of life (Johnstone 2004).
Let’s look at some of these issues.
1. Quality of Life as Criterion: The quality of life criteria, often used to
justify withholding life sustaining medical treatment such as DNR, it is
controversial because of the variety of personal meanings assigned to quality
of life. One definition of quality of life is “the capacity or potential capacity to
have human relationships/to pursue human purposes/to live life
independently.” Johnstone 2004, p. 312).
How this definition gets interpreted is individual and may change over time?
1. Quality of Life as Criterion
➢How many of you assume a person who suffers a severe spinal cord injury
causing quadriplegia has a poor quality of life? How many of you have said
you would prefer to be dead if found in that situation? Interestingly, research
has shown that the attitudes of health care professionals toward quality of life
following spinal cord injury to be more negative than patients who had such
an injury.
For example:
✓“18% of emergency health care workers imagined they would be glad to be
alive with a severe spinal cord injury; whereas, 92% of those who had a true
spinal cord injury were glad to be alive.
✓17% of emergency health care workers anticipated an average or better
quality of life after the accident; whereas 86% of those who had a spinal cord
injury had an average or better quality of life.” (Gerhart et al. 1994 as cited in
Johnstone, 2004, p. 313).
1. Quality of Life as Criterion
- The danger this example illustrates is that health professionals must not
assume to know under what conditions quality of life is possible and apply
their own views on patients with devastating injuries. Likewise end of life
treatment choices for one patient might be the wrong choices for another
patient in terms of their perception of quality of life outcomes. Health
professionals must take care to understand what quality of life means to
patients and its relevancy to decisions about care options. Ultimately, the
person whose quality of life is at issue, is the best to judge what counts as
being their quality of life!
2. Sanctity of Life Criterion
• If one respects sanctity of life in making end of life treatment choices, even
intolerable and intractable suffering would not give cause to ending it.
• DNR would be considered wrong.
• Consider the 70 year old woman who was resuscitated over 70 times in a few
days (Johnstone 2004, p.302).
• Is this action preserving sanctity of life?
3. Excluding Patients from Decision-Making
➢ Some health professionals and institutions believe that, in the medically
hopeless cases, patients should not be burdened with the decision to
resuscitate or not, even though the principle of autonomy is highly regarded.
➢ Some claim that even if the patient wants CPR, if the doctor warrants CPR
as having no possible benefit to the patient, it should not be initiated.
➢ Excluding patients and their families from the decision of DNR may cause
unnecessary suffering to patients (who survive) and their families who want
doctors and nurses to try to save their loved one.
4. No Code Does Not Mean No Care
• Sometimes DNR policies are misunderstood which can lead to poor care.
• For example, Saunders and Valente (1986) describe a case where a dying
patient had copious amounts of secretions from pulmonary congestion.
The nurses misinterpreted the DNR order to mean withholding suctioning and
thus the patient was left suffering and drowning in his secretions.
- Remember the issue of exact meaning of DNR?!
5. Documentation and Communication of DNR
• If DNR directives are given verbally, and not written in the patient’s chart,
this can lead to confusion and inappropriate action taken at the time of an
arrest.
- Nowadays according to JAHCO, DNR must be appropriately documented on
the chart or on a special form called advanced directives, and an informed
consent should be obtained, along with a witness, who might be a nurse taking
that role, or one of the family members.
DNR and the law:
➢ The practice of putting DNR policies in place in health care institutions
really started in the 1990’s and is increasing.
➢ The degree to which these policies are complied with is unknown and the
quality of the policies in providing direction varies widely (Johnstone 2004, p.
297).
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Goal of Research Ethics
What is Research Ethics?
• Research ethics comprises Ethical guidelines that guide
Researchers in conducting and Communicating scientific Research.
• It is a set of guidelines for Performing research Responsibly.
What is research ethics?
According to wagle:
• Focused on Exploring ethical Issues arising When individuals
Participate in Studies.
• Research ethics Committee/institution Al review board, in
Evaluating research to ensure it meets Ethical standards.
What are the Goals of Research Ethics?
1ST GOAL
The primary and foremost objective Is to ensure the protection and Well-being
of human participants, Preserving their dignity, rights, And welfare.
Examples:
• Considering a clinical trial for a new drug.
• Conducting surveys for a project.
Informed consent: In a clinical trial, potential participants must be fully
informed about the nature Of the study, the experimental drug, potential risks
and benefits, and alternative Treatment options.
Protection of rights and welfare: In the context of a drug trial, this involves
ensuring that participants are not Subjected to undue risks and that their health
and well-being are protected. The Research team must carefully design the
study to balance the potential benefits Of the new drug with the potential risks
to participants.
Confidentiality and privacy: In a clinical trial, strict measures are
implemented to safeguard participant Privacy, and data is anonymized to
prevent the identification of individual Participants.
2ND GOAL
• The second goal is to ensure that Research is focused on improving
The welfare of individuals, Groups, and/or the community as A
whole.
Examples:
• How can clinical instructors use research to provide Knowledge to
students nurses.
• Covid-19 vaccine research and development
Informed consent: - participants in a survey must be provided with clear and
Understandable information about the purpose of the survey, the Nature of the
questions, and how their responses will be used. Informed consent is obtained,
and participants are made aware that Their participation is voluntary.
Confidentiality and anonymity: - researchers must take measures to ensure
the confidentiality of Participants' responses. This involves using anonymous
surveys Whenever possible and carefully handling any personal Information
collected.
3RD GOAL
Managing risk: we want to be Sure that the research doesn't Put people at
unnecessary risk or harm.
Examples: Imagine we're testing a new medicine. Before we start, we
Carefully look at all the possible things that could go Wrong or cause harm.
We want to minimize those risks as Much as possible
Code of Ethics for Nurses
International Code of Ethics
• In 1953 the International Council of Nurses (ICN) adopted the first
international code of ethics for nurses. Throughout the years, it has been
updated and confirmed several times; the most current revision and review
was finished in 2021. Moreover, The International Council of Nurses (ICN)
has established a Code of Ethics for Nurses, guiding principles that emphasize
patient well-being, confidentiality, professional competence, and societal
responsibility.
Code of Ethics for Filipino Nurses
• The professional code of ethics for Filipino nurses strongly emphasizes the
four- fold responsibility of the nurse, the universality of nursing practice, the
scope of their responsibilities to the people they serve, to their co-workers, to
society and environment, and to their profession.
• Before 1984, Filipino nurses followed the International Council for Nurses'
(ICN) Code of Ethics.
• In 1982, a Code of Ethics for Filipino Nurses was developed but not
implemented.
• In 1984, the Board of Nursing adopted the ICN's Code of Ethics, adding the
"promotion of spiritual environment" as the fifth-fold responsibility.
• In 1989, the Code of Ethics promulgated by the Philippine Nurses
Association (PNA) was approved by the Professional Regulation Commission
and recommended for use.
• On October 25, 1990, the PNA general assembly approved the Code of
Ethics.
• On July 14, 2004, a new Code of Ethics for Filipino Nurses was adopted
under R.A. 9173 and promulgated by the Board of Nursing (BON).
Preamble (ICN)
•Nurses have four fundamental responsibilities: promote health, prevent
illness, restore health, and alleviate suffering.
❑Universal Need for Nursing
• Nursing is universally essential for promoting health and addressing health-
related concerns.
❑ Respect for Human Rights
• Nursing upholds human rights, including cultural rights, the right to life,
choice, dignity, and respectful treatment.
❑ Inclusive Care
• Nursing care is inclusive. Respecting individuals without discrimination
based on age, color, creed, culture, disability, gender, sexual orientation,
nationality, politics, race, or social status.
❑Comprehensive Health Services
• Nurses provide health services to individuals, families, and communities,
coordinating with related groups for holistic care.
Registered Nurses & People Ethical Principles
1. Values, customs, and spiritual beliefs held by individuals shall be
represented.
2. Individual freedom to make rational and unconstrained decisions shall be
respected
3. Personal information acquired in the process of giving nursing care shall be
held in strict confidence.
Guidelines to be observed REGISTERED NURSES MUST PRACTICE:
➢ Patient-Centric Care:
• Consider individuality and totality of patients.
➢ Spiritual Sensitivity:
• Respect patients' spiritual beliefs and practices in diet and treatment.
➢ Rights Advocacy:
• Uphold the rights of individuals.
➢ Cultural Competence:
• Consider patients' culture and values in nursing care.
• Prioritize welfare and safety in conflicts.
8|Page
Registered Nurses and Practice
• Human life is inviolable.
• Quality and excellence in the care of patients are the goals of nursing
practice.
• Accurate documentation of actions and outcomes of delivered care is the
hallmark of nursing accountability.
• Registered nurses are the advocates of the patients: they shall take
appropriate steps to safeguard their rights and privileges.
• Registered Nurses are aware that their actions have professional ethical,
moral and legal dimensions. They strive to perform their work in the best
interest of all concerned.
Registered Nurses and Co-workers ETHICAL PRINCIPLES:
• The Registered Nurse is in solidarity with other members of the healthcare
team in working for the patient's best interest.
• The Registered Nurse maintains collegial and collaborative working
relationship with colleagues and other health care providers.
Registered Nurses and Co-workers Guidelines to be observed:
Registered Nurses must
• maintain their professional role/identity while working with other members
of the health team.
• conform with group activities as those of a health team should be based on
acceptable: ethico-legal standards.
• contribute to the professional growth and development of other members of
the health team.
Registered Nurses and Co-workers
• actively participate in professional organizations
• not act in any manner prejudicial to other professions.
• honor and safeguard the reputation and dignity of the members of nursing
and other professions; refrain from making unfair and unwarranted comments
or criticisms on their competence, conduct, and procedures; or not do anything
that will bring discredit to a colleague and to any member of other
professions.
• respect the rights of their co-workers.
Registered Nurses, Society, and Environment
• Registered Nurses are dedicated to preserving life, upholding human rights,
and advancing a healthy environment.
• RNs actively engage with the public to support local, national, and
international initiatives addressing health and social needs, emphasizing their
role as valuable contributors to society.
Registered Nurses and the Profession
• Maintenance of loyalty to the nursing profession and preservation of its
integrity are ideal.
• Compliance with the by-laws of the accredited professional organization
(PNA)and other professional organizations of which the RN is a member is a
lofty duty.
• Commitment to continual learning and active participation in the
development and growth of the profession are commendable obligations.
• Contribution to the improvement of the socio-economic conditions and
general welfare of nurses through appropriate legislation is a practice and
visionary mission.
Ethical Considerations in Nursing Leadership
Introduction
• Last Decades of 20th Century; clamor for ethical leadership approach as it
began to appear in leadership/management literature.
• Nursing; Ethical Leadership involves creating and supporting a working
environment for the provision of high quality and cost effeective healthcare
and ensuring ethical behaviors among nurses
• literature, character, conduct, and institutional practices; form major aspect
of ethical leader ship
Literature • Ethical decision-making confidence develops from clinical expertise and it is
a core competency for nurse leaders.
• Altruistic, Honest, Disciplined, Efficient, Fair, and able to navigate moral
distress to arrive at a harmonious decisions.

• Role models of ethical behavior Phases of Development of Core Competency (Hamric and Delgado 2013)

• Possess positional power and personal power to create an ethical climate at PHASE 1: KNOWLEDGE DEVELOPMENT-MORAL SENSITIVITY
work
PHASE 2: KNOWLEDGE APPLICATION
• promote ethical behavior and enforce sanctions for unethical conduct
PHASE 3: CREATING AN ETHICAL ENVIRONMENT
Character
PHASE 4: PROMOTING SOCIAL JUSTICE WITHIN THE HEALTH CARE
• Possession of skills and making visible ethical acts, recognizing ethical SYSTEM
issues; demonstrating features of role modelling, motivation and authenticity.
18 indicators are identified in the development of ethical decision-making
Conduct confidence scale:(Birkholz et al., 2022)

• convey relationship between ethical standards and high-quality care, 1. Recognize a genuine ethical dilemma in practice
supporting ethical acts in daily practice and implementing sanctions in the
case of ethics violation while performing nursing care 2. Make a sound ethical decision

Institutional Practices 3. Explain ethical decisions using correct ethical terminology and language

• EXPRESSES created ethical climate, upholding dignity, safety, and PT’s
rights and establishing professional routines according to ethical and
professional principles and values of nurses towards the patients, colleagues,
institutions, the nursing profession and society as a whole.
Ethical Leaders
⚬ Altruistic, honest, disciplines, efficient, fair, able to navigate moral distress
experienced by department; arrive at harmonious decisions.
4. Provide a clear statement of the personal values that guide your ethical
decision-making and practice
5. Articulate legal guidelines related to complex ethical issues in patient care
(i.e., assisted suicide, informed consent, research involving minors)
6. Articulate the difference between ethical dilemmas, moral distress, issues
related to interprofessional collaboration and communication, difficult
patients, etc.

⚬ Serve as role models for ethical behavior
⚬ Possess positional power; personal power; create ethical climate at work.
FLORENCE NIGHTINGALE
⚬ FIRST nursing leader; demonstrated high regard; ethical dimension of
nursing practice; writings in 1860; ethical guidelines for nursing leaders
AT PRESENT, Profession; governed by ethical codes published in various
nursing literature. Nursing Leaders in present times; play key role; ensuring
ethical codes are observed; SUSTAINING an ethical practice of the profession
7. Articulate the definition of moral distress and provide an example of your
experience of moral distress in your practice
8. Identify ethical issues in complex patient care (i.e., identify scenarios
requiring ethical decision-making and/ or ethical consult team guidance
9. Apply ethical decision-making models or structured processes to complex
clinical problems
10. Participate in and/or guide mediation related to complex clinical problems
involving ethical dilemmas or moral distress
11. Recognize and manage moral distress in self and others

✔ ETHICS 12. Role model collaborative problem solving in complex clinical problems
involving ethical dilemmas or moral distress
• activating manpower
13. Engage in preventative ethics initiatives to address the ethical environment
• achieving organizational goals in your practice area

✔ Nursing leaders ethical behavior 14. Mentor others to develop ethical practice behaviors

- can promote CARE QUALITY 15. Address barriers to ethical practice through systems changes

• nurses performance 16. Use preventative ethics to decrease unit level moral distress

• positive consequences 17. Engage in health policy initiatives supporting social justice

✔ ETHICAL CLIMATE 18. Provide leadership at the unit, organizational, local, state and federal level
for policy
- takes place in Moral Sensitivity

related to MORAL COURAGE

• Ethical Decision-making process is the processes of choosing the best
(careful thought/ deliberation) alternative for achieving the best results or outcomes compliance with
individual and social values, moral, and regulations
- forms through MORAL DISTRESS
• Nurses employ Ethical Decision-Making whenever there are Ethical
(know the ethical action yet, still not doing it) Dilemmas.
Thus, affecting decision-making and influencing MORAL COURAGE and • An ethical dilemma or ethical paradox is a decision-making problem
ethical behavior. between two possible moral imperatives, neither of which is ambiguously
acceptable or preferable.
✔ ETHICAL WORK CLIMATE
• ethical dilemmas may be invoked to refute an ethical system or moral code,
• positive correlation: MORAL COURAGE or to improve it so as to resolve paradox
o (careful thought/ deliberation)
• negative correlation: MORAL • Making good ethical decisions to solve Ethical Dilemma requires a trained
o (what the society sanction as right or acceptable) sensitivity to ethical issues and a practiced method for exploring the ethical
aspects of a decision. Having a method for ethical decision making is
MORAL SENSITIVITY co-exist and positively correlated to ETHICAL absolutely essential.
DECISION-MAKING.
• Ethical decision should be based on ethical principles and codes rather than
Important aspect in decision-making: on emotions, thoughts, fixed policies. Ethics should concern all levels of life:

- preserving moral courage and preventing moral distress associated with • acting properly as individuals
controversial practical situations.
• creating responsible organization and governments
A. ON MORAL DECISION-MAKING
• making our society as a whole more ethical
• Moral decision making is imperative to arrive at an ethical action or
intervention.

• requires ethical judgement and such judgement needs a basis

-specific reference point

-criteria or condition

9|Page
-The process of making ethical decisions requires:
• COMMITMENT
• CONSCIOUSNESS
• COMPETENCY
-GOOD DECISIONS ARE BOTH ETHICAL AND EFFECTIVE:
• ETHICAL DECISIONS- generate and sustain trust; demonstrate respect,
responsibility, fairness, and caring; and are consistent with good citizenship.
• EFFECTIVE DECISIONS- are effective is we have accomplished what we
want to accomplished and if they advance our purposes. A choice that
produces un-intended and undesirable result is ineffective.
To make a conscientious ethical decision one must do the following:
• Proceed on the basis of fundamental commitment to God and to human
person (including oneself) according to their God-given and graced human
nature.
• Among possible actions that might seem to be means of fulfilling that
commitment, exclude any that are contradictory to it (or those that are
intrinsically evil)
• Consider how one’s own motives and other circumstances may contribute to
or nullify the effectiveness of these other possible actions as means to fulfill
one’s fundamental commitment
• Among the possible means not excluded or nullified, select one by which
one is mostly likely to fulfill that commitment and act on it
C. Principle of Well-Formed Conscience
- To attain the true goals of human life by responsible actions in every free
decision involving an ethical question, people are morally obliged to do the
following:
* Informed themselves as fully as practically possible about the facts and the
ethical norms.
* Form a morally certain judgement of conscience on the basis of the
information.
* Act according to this well-formed conscience.
* Accept responsibility for their actions
Conscience formation
· The word conscience arises from Latin, conscienta, and French, conciense
and was defined as the internal sense of what is right and wrong, and one’s
ability to choose between, as well as act upon, what one perceives is the
cornerstone for their ethics relevant to ethical nursing care.
· In nursing, conscience is broadly perceived as an authority, a warning signal,
demanding sensitivity, an asset, a burden, inherent in nursing, and culturally
dependent.
· When nurses can follow their conscience guiding them to provide quality
care, conscience is positively perceived. Nurses who cannot follow their
conscience report having troubled conscience
· Nurses’ troubled conscience have been associated with feelings of guilt
when:
-Nurses’ core beliefs conflict with social of professional beliefs
-Nurses cannot fulfill their care obligations to patients due to time
constraints
-Nurses are placed in scenarios when they feel they are working
against their conscience.
· A troubled conscience can also occur when external factors such as
workload compromises nurses’ ability to provide appropriate care, generating
internal misgivings over perceptions of fallen standards.
· Stress of conscience is that type of stress that can arise for nurses when they
are repeatedly experience stressful situations that trouble their conscience.
· When nurses have stress of conscience, this can negatively affect their
practice, cause them to act against their conscience, and spill over into their
personal lives, creating disharmony between their professional and personal
sense of self.
· Stress conscience is also related to burnout, where nurses report deadening
their conscience to be able to carry on working in relation to lack of
professional supports; nurses who view conscience as an asset and can
effectively address their conscience issues in practice report less stress of
conscience.
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Conscience then is the practical judgement of reason upon individual act as
either good and to be performed or as evil and to be avoided. It follows
personal freedom and autonomy. It is the capacity to make practical
judgements in matters involving ethical issues. It involves reasoning about
moral principles and must be rooted in reality and truth, not on mere will or
desire or blind choice.
According to Teisberg et al (2020). Value aligns care with how patients
experience their health by focusing on the outcomes that matter most to
patient. In this context, health outcomes can be described in terms of
capability, comfort, and calm.
· Capability is the ability of patients to do the things that define them as
individuals and enable them to be themselves. It is often tracked with
functional measures.
· Comfort is relief from physical and emotional suffering. In addition to
reducing pain, improving patient’s comfort requires addressing the distress
and anxiety that frequently accompanying or exacerbate illness.
· Calm is the ability to live normally while getting care. It encompasses
freedom from the chaos that patients often experience in the healthcare
delivery system, and it is especially important for people with chronic and
long-term conditions.
Care that improves outcomes in all 3 of these dimensions creates a better
experience for patients. Moreover, capability, comfort, and calm describe
outcomes that result from the efficacy and empathy of health care, rather than
its hospitality (Teisberg er al, 2020).
Ethical Considerations in Nursing Leadership
and Management
• Another important area of concern for nursing is the medical care that is
often rendered to patients in need of medical attention based on urgency.
• The value that underlies the implementation of medical care can be
measured by the improvement of patients’ outcomes for the cost of achieving
the said desired outcome (Teisberg et al, 2020)
Value-based Healthcare and Triple Aim Paradigms.
• The Better Health concept aims to improve the general status of the patient.
Better Health Systems are intended to provide the best care possible to
achieve healthy populations. This concept can be related to paradigms such as
Evidence-Based Medicine that seek the best evidence for selecting the best
care protocols and Personalized medicine, which is more focused on finding
specific protocols for specific patients.
• The Better Care concept is related to the patient’s experience of care. This
concept aims to improve the patient’s perceptions of their interaction with the
health system. Also, this concept is related to the Personalized Medicine
concept because, in this paradigm, by selecting the best treatments, the
experience of care is taken into account.
• Finally, the main aim of the Lower Cost concept is to optimize care in order
to ensure the sustainability of health systems
I. Allocation Of Resources
• Health care requires resources, and resources in turn entails cost and
budgetary requirements, therefore as value-based healthcare is to be promoted
it is imperative to allocate adequate resources that are costeffective to meet
the patient’s outcome.
According to Teisberg et al (2020), Value aligns care with how experience
their health by focusing on the outcomes that matter most to patient. In this
context, health outcomes can be described in terms of capability, comfort, and
calm
• Capability is the ability to patients to do the things that define them as
individuals and enable them to be themselves. It is often tracked with
functional measures.
• Comfort is relief from physical and emotional suffering. In addition to
reducing pain, improving patients’ comfort requires addressing the distress
and anxiety that frequently accompany or exacerbate illness
• Calm is the ability to live normally while getting care. It encompasses
freedom from the chaos that patients often experience in the healthcare
delivery system, and it is especially important for people with chronic and
long-term conditions
Care that improves outcomes in all 3 of these dimensions creates a better
experience for patients. Moreove, capability, comfort, and calm describe
outcomes that result from the efficacy and empathy of health care, rather than
its hospitality (Teisberg et al, 2020)
II. Issues involving access to care
• Access to health care means having “the timely use of personal
health services to achieve the best health outcomes” (AHRQ, 2018
on IOM, 1993)
• In order to understand what issues are involved with regards to
access to care, we must first determine the elements of access to
healthcare according to the Agency for Healthcare Researcher and
Quality, AHRQ
Elements of Access to Healthcare (AHQR, 2018)
• Coverage: facilitates entry into the healthcare system. Uninsured people are
likely to receive medical care and more likely to have poorstatus
• Services: Having a usual source of care is associated with adults receiving
recommended screening and prevention screening services. • Timeliness:
ability to provide health care when the need is recognize.
• Workforce: capable, qualified, culturally competent providers
“BAHALA NA” mentality drains our healthcare system. Shortage of
Healthcare workers, limited access to healthcare facilities, and high amount of
pocket expenses for hospitalization and healthcare needs are among the
problems that we face because of “Bahala na” mentality
1.Financial Barriers:
1. Issue: High healthcare costs, lack of insurance, and financial
barriers limit access to medical care for many individuals.
2. Impact: Financial barriers can lead to delayed or foregone
medical care, exacerbating health issues and reducing the
effectiveness of preventive measures.
2.Geographic Accessibility:
1. Issue: Unequal distribution of healthcare facilities and
professionals results in limited access for individuals in rural or
underserved areas.
2. Impact: Geographic disparities in access can lead to delayed or
inadequate care, particularly for preventive services and
specialized treatments.
1.Cultural and Linguistic Barriers:
•Issue: Cultural and linguistic differences can create barriers to effective
communication and understanding between healthcare providers and patients.
•Impact: Limited cultural competence can result in misunderstandings, lower
adherence to treatment plans, and reduced trust in the healthcare system.
2.Healthcare Provider Shortages:
•Issue: Shortages of healthcare professionals, including physicians and nurses,
contribute to limited access to timely and quality care.
•Impact: Provider shortages can result in longer wait times for appointments,
reduced continuity of care, and challenges in meeting the healthcare needs of
growing populations.
3.Structural and Systemic Barriers:
•Issue: Structural and systemic issues, such as institutional discrimination and
biases, contribute to disparities in access to medical care.
•Impact: These barriers can lead to inequities in health outcomes, with certain
demographic groups facing greater challenges in accessing needed care.
Addressing these issues involving access to medical care is crucial for
building a healthcare system that provides equitable, affordable, and culturally
competent services to all individuals, regardless of their background or
circumstances.
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Continuing Education Programs on Ethico-
Moral Practice in Nursing
Topic
A. Lobbying/ Advocating for Ethical Issues Related to Health Care
B. Code of Ethics for Nurses
A. Lobbying/Advocating for Ethical Issues in Health Care
Advocacy -”the act or process of promoting a cause or proposal, " - to raise
and publicize an issue within a community, such as making health care a topic
of national debate and media attention.
Lobbying -"the act or process of influencing public officials to promote
(something, such as a project) or secure the passage of (legislation)." -process
of directing one ' s efforts toward individuals in positions of authority, such as
public officials, politicians, government bodies, and regulatory agencies
Nurses' primary responsibilities include the preservation and promotion of
human rights in health and health care (ANA, 2016). All nurses must fight for
patients, colleagues, and communities human rights.
Nurses can use the following initiatives to advocate for ethical issues in
health care:
• Because the practice environment and rights of nurses influence
the practice and moral context of nursing, nurses may advocate for
ethical and just nursing practice by building and maintaining
environments that promote established norms of professional
behavior.
• Nurses may improve practice environments by refusing to practice
in ways that are detrimental to patient care quality.
• Nurses may reinforce and strengthen nursing beliefs and ideals
through their professional organization, which interprets and
explains nursing ' s place and role in society.
• Human rights abuses involving patients, nurses, health care
professionals, and others must be closely monitored by healthcare
institutions / organizations.
• Health care institutions must support policies and practices that
actively maintain environments that ensure ethical nursing
practice, safeguard human rights, and means for reporting
infractions, as well as take action to prevent a recurrence.
• Nurses from all practice settings may serve on ethics committees,
seek to encourage colleagues to consider ethics and human rights,
and take political action to clarify and promote health policy that
improves access to and equality of treatment.
• Nurses must examine the conflicts that arise between their own
personal and professional values and the values and interests of
others who are responsible for patient care and health-care
decisions, and they must resolve these conflicts in ways that ensure
patient safety and promote the patient' s best interests. Nurses may
collaborate with other health care professionals to build moral
communities and professional stakeholders that promote, protect,
and preserve ethical practice and the human rights of all patients
• Nurse educators must use the notions of justice and care as guiding
principles in teaching local communities to global communities.
students about ethics and human rights in health care settings all
over the world.
• Through material, clinical and field experiences, and critical
thinking, nurse educators must firmly anchor students in nursing
professional duty to challenge unjust systems and structures,
reflecting the profession ' s commitment to social justice and
health.
• Nurse researchers, must ensure that human rights are respected
trough obtaining ongoing informed permission, assessing the risk
vs benefit of research participants, and avoiding damage.
• Nurse researchers may undertake research relevant to communities
of interest, are guided by community participation in identifying
research challenges, and endeavor to improve patients, society, and
professional practice.
• Nurse administrators must put ethical and human rights concepts
into practice by keeping an eye on the practice environment for
actual or potential human rights breaches by patients, nurses, and
other healthcare employees.
• Nurse administrators must evaluate policy and practice to detect
risks of diminished care quality as a result of unrecognized human
rights breaches: In their organizations and beyond, nurse
administrators may actively foster a caring, just, inclusive, and
collaborative environment.
B. Code of Ethics for Nurses
International Code of Ethics
- a statement of the ethical values, responsibilities and professional standards
of nurses and can serve as a regulatory tool to guide and define ethical nursing
practice
-Nurses have four fundamental responsibilities: to promote health, to prevent
illness, to restore health and to alleviate suffering.
- Inherent in nursing is a respect for human rights, including cultural rights,
the right to life and choice, to dignity and to be treated with respect. Nursing
care is respectful of and unrestricted by considerations of age, color, creed,
culture, disability or illness, gender, sexual orientation, nationality, politics,
race or social status.
- Nurses render health services to the individual, the family and the
community and coordinate their services with those of related groups
The four elements of the ICN Code of Ethics for Nurses
• Nurses and people
• Nurses and practice
• Nurses and the profession
• Nurses and co-workers
Nurses and people
• In providing care, the nurse promotes an environment in which the
human rights, values, customs and spiritual beliefs of the
individual, family and community are respected.
• Nurse ensures that the individual receives accurate, sufficient and
timely information in a culturally appropriate manner on which to
base consent for care and related treatment
• Nurse holds in confidence personal information and uses
judgement in sharing this information
• Nurse shares with society the responsibility for initiating and
supporting action to meet the health and social needs of the public,
in particular those of vulnerable populations
• Nurse advocates for equity and social justice in resource allocation,
access to health care and other social and economic services.
• Nurse demonstrates professional values such as respectfulness,
responsiveness, compassion, trustworthiness and integrity.
Nurses and Practice
• Nurse carries personal responsibility and accountability for nursing
practice, and for maintaining competence by continual learning.
• Nurse maintains a standard of personal health such that the ability
to provide care is not compromised.
• Nurse uses judgement regarding individual competence when
accepting and delegating responsibility.
• Nurse at all times maintains standards of personal conduct which
reflect well on the profession and enhance its image and public
confidence.
• Nurse, in providing care, ensures that use of technology and
scientific advances are compatible with the safety, dignity and
rights of people.
• Nurse strives to foster and maintain a practice culture promoting
ethical behavior and open dialogue.
Nurses and the Profession
• Nurse assumes the major role in determining and implementing
acceptable standards of clinical nursing practice, management,
research and education.
• Nurse is active in developing a core of research-based professional
knowledge that supports evidence-based practice and and
sustaining a core of professional values.
• The nurse, acting through the professional organization,
participates in creating a positive practice environment and
maintaining safe, equitable social and economic working
conditions in nursing.
• Nurse practices to sustain and protect the natural environment and
is aware of its consequences on health.
• Nurse contributes to an ethical organizational environment and
challenges unethical practices and settings.
Nurses and Co-workers
• Nurse sustains a collaborative and respectful relationship with co-
workers in nursing and other fields.
• Nurse takes appropriate action to safeguard individuals, families
and communities when their health is endangered by a co-worker
or any other person.
• Nurse takes appropriate action to support and guide co-workers to
advance ethical conduct
• 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.
Nurses and nursing students can therefore:
• Study the standards under each element of the Code.
• Reflect on what each standard means to you. Think about how you
can apply ethics in your nursing domain: practice, education,
research or management.
• Discuss the Code with co-workers and others.
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• Use a specific example from experience to identify ethical
dilemmas and standards of conduct as outlined in the Code.
Identify how you would resolve the dilemmas.
• Work in groups to clarify ethical decision making and reach a
consensus on standards of ethical conduct
“Ethical Approach and Principles”
Ethical Approaches in Research
Research Ethics Committee (REC); A Central University Committee
(UREC)/Devolved Committee
- A Method that uses a structured, transparent procedure with University-wide
standards, ensuring all applicants are treated equally.
Representation for a wide range of fields and ideally, includes lay members
Concentration on individual disciplines, faster responses to applicants, and
less bureaucracy
Ensures they have delegated authority to ensure that issues have been
addressed to a suitable minimum standard before their research progresses;
proper proposal scrutiny
In drafting of proposal; students and personnel doing research involving
human participants must evaluate the ethical implications of the study they
propose to conduct.
Israel (2015), before considering the practical aspects of gaining ethical
approval, it is important to understand some of the theoretical issues that
underly research ethics in relation to human participants.
There are THREE MAIN APPROACHES;
A. Goal-Based
B. Duty-Based
C. Rights-Based
Goal-Based
• FIRST MAJOR approach to ethical thought
• Assumes researcher should aim to generate BEST FEASIBLE
balance of benefit over dis-benefit, based on consequentialist
theory.
• believes if intended goal is worth while; then methods for reaching
outcome are worthwhile
• Individual’s discomfort justified by societal implications.
• Research is USELESS if outcome is unimportant; must be crucial
as procedure
• Good research promotes good; and the bad research promotes bad
Duty-Based
• 2ND STRATEGY
• RESPONSIBILITY is based on own set of moral ideals; researcher
will owe a duty to himself/herself as well to others who are taking
part in the study.
• EVEN if research’s outcome is for a worthy cause; if researcher
lies to or deceives participants in any manner, the research would
be considered UNETHICAL.
• Deontological ethics
• some acts are right or wrong because of the sorts of things they are,
and people have a duty to act accordingly, regardless of the good or
bad consequences that may be produced
Rights-Based
• COMPARABLE to DUTY-BASED APPROACH (perspectively)
• Individual rights; paramount. Hence a participant’s freedom to
decline must be respected regardless of research’s implications.
• Founded on notion that scientists should ALWAYS adhere to
natural rules and rights.
• Researcher’s ethical obligations are FIRST AND FOREMOST to
the individual and every human being, including themselves, must
be respected, even if it has been unintended repercussions.
The Ethical Principles in Research
• Involving human subjects is required to recognize and follow 4
essential ethical principles; autonomy, non-maleficence,
beneficence, and justice.
• May conflict with one another and as a result; principles are
prioritized over others in terms of importance
• The principles are always binding UNLESS they clash with other
principles, in which case a researcher will need to defend why one
principle was chosen over the other.
• Moral thinking is built on this foundation.
Informed Consent
• wherein a person GRANTS informed permission to participate in
research; consciously, voluntarily, and wisely.
• Autonomous freedom to participate in research.
• Informing participant about the study’s goal, their involvment and
any potential advantages or risks.
Respect for Person/Respondent
• PROTECTION of persons with impaired or diminished autonomy.
• requires that those who are dependent/vulnerable be provided with
security against harm or abuse.
• to be treated with respect for capacity of self-determination
Beneficence
• Maximizing participant’s advantages.
• MAXIMIZE their potential benefits while minimizing potential
damage.
Non-maleficence/Protecting the subjects (human)
• Do not cause any harm. Human harm or risk is minimized. Privacy,
individuality, and dignity are all protected.
• This simply stated principle supports several moral rules − do not
kill, do not cause pain or suffering, do not incapacitate, do not
cause offense, and do not deprive others of the goods of life.
• When conducting human subjects research, it is essential that
researchers are familiar with the ethical principles delineated in the
Belmont Report. These principles are respect for persons,
beneficence, and justice.
Responsible Publication
• Publishing responsibility in order to promote and spread research
or information. There will be no duplicate publication
• Publish in order to advance research and scholarship, not to
advance just your own career. Avoid wasteful and duplicative
publication.
• Responsible publication involves a commitment to accuracy,
transparency, and accountability in the reporting of research
results, and it is important for ensuring the integrity of the
scientific process.
Protecting Anonymity
• It involves not revealing the participants' names, castes, or any
other information that would reveal their identify. It also involves
keeping the participants' identities private.
Confidentiality
• Information is protected. includes details on the research's
introduction and goals, its purpose, expected benefits, potential
harm from the research, how it will be used, the participants' role
in the research, their right to refuse or withdraw, ways to protect
their confidentiality and anonymity, and their freedom to refuse to
answer any questions or to withdraw from the study.
• Protected materials include trade or military secrets, employment
records, articles or grants submitted for publication, and medical
records containing confidential information.
Non – Discrimination
• Discrimination based on age, sex, color, ethnicity, or other
characteristics that violate human rights and other unrelated to the
study is prohibited.
• Individuals or groups of individuals which are in comparable
situations should not be treated less favorably simply because of a
particular characteristic such as sex, racial or ethnic origin, religion
or belief, disability, age or sexual orientation.
• Non - discrimination basically means treating each and every
human being equally and with respect.
Openness
• A researcher must be willing to share findings, data, and other
resources. Accepting both positive and constructive feedback is
also important. Data, outcomes, ideas, tools, and resources are all
shared. Be receptive to fresh ideas and criticism.
• Openness encourages the sharing of information, ideas, and
perspectives freely without prejudice or exclusivity.
Carefulness and respect for intellectual property
• essential in research to uphold ethical standards.
• Keeping an eye out for potential errors and biases.
• Researchers must uphold ethical standards, citing sources
accurately and obtaining permissions when necessary.
• Researchers should meticulously cite sources, avoid plagiarism,
and adhere to ethical standards to uphold the integrity of their
work.
Justice
• The obligation to distribute benefits and burdens fairly, to treat
equals similarly, and to justify differential treatment.
• It ensure fair and unbiased participant selection in studies is
crucial, promoting equitable representation in research outcomes.
• Ensuring that decisions are made in accordance with recognized
norms or ideals and that individuals are treated fairly.
Transparency
• Openness of communication to others and would be able to see the
data that needed to be evaluated.
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• Methods, materials, assumptions, and analysis
Accountability
• Accepting the responsibility of the research conducted
(contributions, and why performed)
Responsible Mentoring
• Educating, Mentoring, and advising students. Allowing them to
make their own decisions and promoting their welfare.
• take steps to ensure that research is conducted in a collegial
environment.
• counsel trainees about how to work with collaborators and to treat
them in a respectful manner.
Respect for Colleagues
• Respecting and Treating Co-workers fairly
• must promote social welfare and try to avoid harm or reduce it
through research, public education, and advocacy activities.
• Applies not merely to Colleagues but also to your participants in
the study.
Social Responsibility
• Via research, public education and advocacy; Researchers strive to
promote social good while preventing or minimizing social harm.
• Principle of Beneficience
• a moral obligation on a company or an individual to take decisions
or actions that is in favour and useful to society.
Non-Discrimination
• Discrimination against coworkers or students based on their sex,
color, ethnicity, or other considerations related to scientific
competence and integrity is prohibited.
Competency
• Maintaining or increasing one’s own professional competence and
expertise through lifelong education and learning, as well as taking
actions to promote science-related competence in general.
Legality
• Knowing and obeying relevant and institutional and governmental
policies.
Animal care
• When employing animals in research, researchers must treat them
with respect and care. Experiments with animals that are not
essential or are poorly designed.
Human Subjects Protection
• Minimizing harms and risks while maximizing benefits when
conducting research on human subjects; preserving human dignity,
privacy, and autonomy; taking extra measures with vulnerable
groups; and attempting to spread the rewards and burdens of
research fairly.
Advantages of Research Ethics
• Goals of research are promoted by the research ethics
• Boosts respondent’s faith in the researcher
• Protect dignity, rights and well-being of study participants
• Researchers are HELD RESPONSIBLE for their acts and held
accountably.
• Concerned with the promotion of social and moral ideals
• Promote research goals such as comprehension, veracity, and
avoiding mistakes.
• Preserve principles; belief, accountability, mutual respect, and
impatiality; for cooperative work.
• Build public support for research; people believe in research effort
if they believe in its value and reliability
Limitations of Research Ethics for Research Subjects
Physical Integrity risks, including those associated with experimental drugs
and transactions, as well as other involvements that will be utilized in the
study.
Ex: measures used to observe research participants, such as blood
sampling, X rays or lumbar punctures.
Physiological risks: a questionnaire
Ex: may indicate risk if it expresses a dread or traumatic
occurrences or situations that are particularly painful.
Risks to participant’s social, legal, and economic well-being:
Ex: If personal data acquired during a study is mistakenly
revealed, individuals may be judged and stigmatized.
Certain tribal or indigenous groups may face discrimination or stigmatization
as a result of research, particularly if members of those groups are identified
as having a higher-than-usual risk of contracting a specific disease.
The research may have an impact on the current health system.
Ex: Allocating human and financial resources to research may
divert focus away from more pressing healthcare needs in the community
Ethical Issues Related to Technology and
Delivery of Health Care
A. Data Protection and Security
• Data Protection is the act of protecting information, both sensitive
and personal sensitive to unauthorized access and use.
• Protection is a strategy used within systems to handle hazards and
ensure proper operation
• Protection has various advantages. It allows employees to safely
share shared logical and physical address spaces.
• Security is employed to deal with threats from outside systems in
order to keep the system running effectively
Security is typically defined by three main attributes
• Availability relates to the prevention of unauthorized actors
withholding information, for as during a ransomware assault.
• Confidentiality and Integrity are concerned with information
staying private, undamaged, and undamaged by malevolent actors
⁃ Policy is the primary distinction between Security and Protection.
⁃ Security Policy determines whether or not a person may use a system. It
provides a technique for protecting both user and system resources from
unauthorized external entities in terms of functionality.
⁃ Protection policy determines the user’s access to certain data resources. It
provides a framework for controlling access to data, processes, programs, and
other resources.
⁃ External dangers are often classified as either indirect or direct.
Implication to Practice
⁃ Healthcare services rely heavily on the open exchange of information among
all participants (customer, healthcare professionals, health institution)
⁃ A health organization that values data privacy is one that cares about its
patients.
⁃ It ensures that their data is secure at all times and is not vulnerable to risks
and vulnerabilities such as unlawful access, processing, sharing, and
disclosure.
Data Privacy Act (National Privacy Commission, 2021)
⁃ Republic Act No. 10173 is also known as the Data Privacy Act of 2012
(DPA).
• (1) It protects the privacy of individuals while ensuring free flow of
information to promote innovation and growth.
• (2) regulates the collection, recording, organization, storage, updating or
modification, retrieval, consultation, use, consolidation, blocking, erasure or
destruction of personal data;
• (3) ensure that the Philippines complies with international standards set for
data protection through National Privacy Commission.
⁃ National Privacy Commission (NPC) is the country's privacy watchdog; an
independent body mandated to administer and implement the DPA, and to
monitor and ensure compliance of the country with international standards set
for data protection.
Who are covered by the DPA?
⁃ The DPA applies to the processing of all types of personal information and to
any natural or juridical person involved in personal information processing,
including personal information controllers and processors who, while not
located or established in the Philippines, use equipment located in the
Philippines, or those who maintain an office, branch, or agency in the
Philippines subject to the immediately following paragraph: Provided, That
the requirements of Section 5 are complied with.
Does the hospital or health care setting need a Data Privacy Officer?
⁃ Appointing a Data Protection Officer (DPO) is a legal requirement for
personal information controllers (PICs) and personal information processors
(PIPs), under the Data Privacy Act of 2012.
⁃ An individual PIC or PIP shall be a de facto DPO.
⁃ In the healthcare industry, among such PICs or PIPs are the following:
hospitals including primary care facilities, multi-specialty clinics, custodial
care facilities, diagnostic or therapeutic facilities, specialized outpatient
facilities, and other organizations processing genetic data.
Policy Notice
- A Privacy Impact Assessment (PIA) is a systematic process that helps
organizations, including healthcare settings, identify and mitigate the potential
risks and impacts on privacy associated with the collection, use, and
disclosure of personal information.
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Privacy Management Program
- A Privacy Management Program is a comprehensive and strategic
framework implemented by organizations to systematically address the
collection, use, and protection of personal information. It encompasses
policies, procedures, and practices aimed at ensuring compliance with privacy
laws, fostering a privacy-aware culture, and protecting individuals' rights.
Privacy Impact Assessment
- A Privacy Impact Assessment (PIA) is like a careful checkup for
organizations, especially in places like healthcare. It helps them find and fix
any potential problems that might affect people's privacy when collecting,
using, or sharing personal information.
IPI or PIP
-is instructed to implement reasonable and appropriate measures to protect
personal data against natural dangers such as accidental loss or destruction and
human dangers such as unlawful access, fraudulent misuse, unlawful
distruction, alteration and contamination.
Data Processing Guidelines
-Under the DPA, the consent of the data subject is defined as any freely given,
specific, informed indication of will, where by the data subject agrees to the
collection and processing of personal information about and/ or relating to him
or her. Consent shall be evidenced by written, electronic or recorded means.
What are the guidelines and accessing personal data?
-As the Commission has often said, health practitioners and anyone involved
in the delivery of health care services must gather only the required personal
information. Access to health data must be granted solely on a "need-to-know"
basis, which implies that only individuals on the health team must have the
minimum and essential access to execute their tasks.
What do I need to keep in mind when storing Client’s Information?
- The DPA and its IRR provides that personal data shall not be retained longer
than necessary:
1. For the fulfillment of the declared, specified, and legitimate purpose, or
when the processing relevant to the purpose has been terminated.
2. For the establishment, exercise or defense of legal claims; or
3. For legitimate business purposes, which must be consistent with standards
followed by the applicable industry or approved by appropriate government
agency.
How may personal data be disposed of?
- Under the IRR (Implementing Rule & Regulations), personal data shall be
disposed or discarded in a secure manner that would prevent further
processing, unauthorized access, or disclosure to any other party or the public,
or prejudice the interests of the data subjects
Relevant Issues and Concerns of Data Privacy to COVID-19 Response
1. What are the guidelines when conducting contact tracing?
On 17 April 2020, DOH released Department Memorandum No. 2020 – 0189,
or the updated Guidelines on Contact Tracing of Close Contacts of Confirmed
Coronavirus Disease (COVID-19) Cases, which contains provisions on how to
properly conduct effective contact tracing while being mindful of data privacy
and rights of data subject. Through the NPC PHE No. 13, emphasized that
successful contact tracing can only happen when there is mutual trust between
public health authorities and the citizenry. Organizations must ensure that
processing systems and applications used in the implementation of contact
tracing must be designed with data privacy in mind.
2. Can I share information about COVID-19 Patients?
NPC issued PHE Bulletin No. 6 stating that sharing and disclosure of data
related to COVID-19 patients must only be done to the proper authority. There
are laws that allows to share of information about COVID-19 patients from
one another institution to one another, PCIs must ensure that such is kept to a
minimum extent keeping in mind the three general data privacy principles:
Transparency, Legitimate purpose, and Proportionality.
3. Can I publicly disclose the identities of COVID-19 Patients?
Contact Tracing does not require public disclosure oof identities of COVID-19
patients. Unbridled disclosure of patients’ personal data to the public has been
proven to cause actual harm such as physical assault, harassment, and
discrimination. Its does not prevent the processing of personal data when
necessary to full their mandates.
GOALS
1. Improved Care Coordination
Despite increased focus, care coordination remains a difficulty for
organizations, particularly during transitions of care, resulting in adequate care
quality and safety. According to a report by the Center for Healthcare
Research & Transformation, poorly coordinated care transitions from hospitals
to other care settings $12 billion and $44 billion. Technological advancements
have potential improve provider communication.
2. Improved Population Health Management 8. Organizational Practices

Population Health is the result of a group of individuals, including the
distribution of such outcomes within the group. According to an article
published by Barton Associates, “Without data on the (health) populations you
serve,” and “any population health initiatives become educated guesses at
best.”
Digital technologies have the potential to dramatically alter daily work
practices, and thus the structure and function of organizations. The manner in
which health-care organizations navigate the transition from analog to digital
work environments is likely to have far-reaching consequences for the nature
of healthcare.

3. Improved Patient Education

Patient education used to be mostly based on written information regarding

illness processes, educations, medical treatment, and self-care teaching.
Telemedical advancement now allows people to consult with a healthcare
expert anytime they need one. Moreover, enhanced functionality in current
technologies, such as patient portals, can provide patients with personalized Scary news is: you’re on your own now.
health education information based on their unique requirements and
situations. Cool news is: You’re on your own now.
Challenges of Technology in Healthcare
“You’re On Your Own Kid”
1. Health Organizations

The inability to precisely measure intangible patient and cost advantages -Taylor Swift
makes valuing and justifying capital spending on new technologies
problematic. When compared to broad deployments, remote monitoring
maybe viewed as a compromise.

2. Healthcare Providers

Despite the fact that healthcare technology offers great opportunities to

END
enhance healthcare outcomes, improper used must be addressed. The
technological imperative relates to the inevitability of new technology and its
necessary character, which indicates the necessity for adoption for social
benefit. The dominance of technology in healthcare arguably modifies the
objective of healthcare from preservation and restoration under responsible
autonomy to death prevention.

3. Patients

The implication of the moral obligation bleed over into the issue that patients
face. The necessity to assure appropriate use of costly equipment (At least
during the early adoption period) and the moral obligation to use new
technology directly contradicts the need to protect patient autonomy, as drawn
from the application of personalism to healthcare systems

Current Technology: Issues and Dilemma

1. Privacy and Security

According to Shaw and Donia (2021) it is in the interest of technology

developers and other supporters of digital health to keep attention focused on
technical challenges that can be contained and addressed using technical
approaches.

2. Sociotechnical Health

It pertains to technologies such as applications of digital health are never

solely about the material technology itself, but about the mutual dependencies
between technologies and the social arrangements in which they are built and
used.

3. Application Software

Shaw and Donia (2021) identified that ethical issues at the level of application
software include effectiveness, usability, inclusiveness, transparency, and
other issues related to the functioning and direct use of the digital health
offering.

4. Material Devices and Supply Chains

The actual materials used to build and distribute the devices through which
humans interact with digital health technologies are frequently overlooked in
ethical analyses, but they are crucial for a comprehensive view of digital
health ethics.

5. Infrastructures

This refers to the hardware and software required to operate digital devices.
Shaw and Donia (2021) added that infrastructures include the buildings in
which health care providers work when delivering virtual care, the cables and
wires that enable digital signals to travel over distance, and the corporate
structures of the organizations that make digital communication available.

6. Individual Health-Practices

Shaw and Donia (2021) highlighted that digital technologies are used in a
variety of health- related applications, many of which are intended to promote
healthy activity and the management of disease among individual people.

7. Interpersonal Relationships

Digital health technologies have the potential to have a wide range of effects
on interpersonal relationships. One prominent example is the significant
impact of social media applications on public understanding of health-related
science and policy.

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