ETHICS
CASE STUDY NO.1
The New Found Use of Placebo Effect
To keep patients from being addicted
to certain pain medications like
morphine, most doctors would prescribe
alternate dosage of morphine and plain
normal saline solution. Both will
create a cessation of pain sensation,
morphine exerting its
pharmacotherapeutic effect and the
normal saline creating a psychological
effect to the patient thinking that it
was morphine being injected. In a
surgical unit of a certain hospital, a
nurse found a new application of the
“Placebo Effect”
Nurse Lucky was a newly hired
registered nurse in the surgical unit
of a hospital. He was hired
immediately because of his brother who
is a nurse supervisor for five years
of that hospital. He was being
oriented on the floor by his senior
nurse. His senior nurse told him that
some of the patients in their floor
will ask for pain medications a lot
but pain medications are not given
liberally because of its addictive
properties. They sometimes administer
Nss solutions as placebo for morphine.
The senior nurse demonstrated how
placebo is carried out and
administered to their patients. He was
instructed to do it under the
prescription of a doctor.
One of his duty days one night, Lucky
decided to do an extra effort of
cleaning the nurses station in line
with the 5s program of the hospital.
As he began his task he found vials of
pain relievers and IV antibiotics
under the sink. The medicines were not
expired, so he wondered why it was
kept under the sink. He also found out
that these medicines cost P2,000 per
vial. He decided to place it back
under the sink and decided to ask his
senior nurse later about it.
One day, a patient’s relative
approached him and asked where he can
find Lucky’s brother. Lucky asked him
why and introduced himself as his
brother. The patient’s relative then
said “Good that he is your brother.
Will you kindly hand him over these
three vials of medicines I bought from
him at half the price. My sister who
is in the surgical unit would no
longer use it because she died this
morning. Kindly ask him If I could get
a refund because I really need the
money to arrange interment.”
Lucky was in shock when he heard the
patient’s relative. He remembered the
medicines he found the other night. He
looked for it under the sink and it
was no longer there. When he asked his
senior nurse about it he replied:
“Just pretend you did not see it.
Everybody is doing it anyway. Welcome
to the club.” Lucky could not quite
comprehend what his senior nurse was
talking about. He decided to
investigate.
He found out that there are some nurse
who do not administer these expensive
medications as ordered. They
administer instead a placebo even if
it was not ordered by the physician.
They also charge the patient with the
medicine even though they administer
placebo. These extra vials are kept
and later sold to other patients who
need it at half the price. The money
is then divided among those who are
involved.
These occurrences are not recorded in
the medication audit being conducted
by nurse supervisors because the nurse
supervisor for their floors is no
other than his brother who is also
involved in the case.
Lucky confronted his brother, he has
this to say: “If it weren’t for these
activities that I am doing, you
wouldn’t have gone to college and
graduate as a nurse… so just keep your
mouth shut because no one else had
benefited more from this than you.”
Lucky was dumbfounded. He does not
know whether he would just keep silent
and join the group to protect his
brother and earn more too or make
noise and make it known to the
detriment of his brother to whom he
owes a lot. Decide with reasons….
CASE STUDY NO.3
For a Worthy Cause
After graduating from college, Ernie
Pascual went on job hunting. It was
not difficult for him though to land a
job because of his admirable
credentials. He graduated with honors
in the premiere university in the
country. He is a born leader with high
ideals and a good set of values. Among
the several companies offering him a
job, he chose the position of a
Project Development Assistant in
Realty Holding, Inc. (RHI), a real

estate developer. The job seemed
challenging with a lot of feasibility
and project development studies to
make. Although the remuneration
package offered is not that
attractive, the career path presented
to him was clear.
He was deeply involved in the project
of RHI in Bulacan. He assisted in the
acquisition of the 40 hectare property
in Casipit. Young as he is, he has
been a good help in the project. When
the development of the property
commenced, he became a member of the
3-man team tasked to secure government
licenses, clearances and certification
necessary to start the project. They
dealt with the barangay captains, the
municipal government and other
national government agencies for the
vital licenses.
Enrie never imagined that dealing with
the government would be a very arduous
task. One day, he approached the
municipal Mayor’s office to secure a
clearance. He traveled from Makati
office to Bulacan very early in the
morning to be in time with the 8am
opening of the municipal Mayor’s
office. He arrived there exactly 8am
and proceeded directly to the Mayor’s
office with all the documents
necessary to support their
application. Upon his arrival, he was
asked to return because Mayor cannot
sign the papers immediately. The
secretary said that the application
would still be evaluated and verified
according to their proceedings.
Months have passed and the management
is already impatient with the release
of the clearance. Finally when Ernie
called the Mayor’s office, he was
informed that he should see the Mayor
for the clearance. He arrived at the
Mayor’s office early. Again, the
secretary asked him to wait for the
Mayor to arrive at 9 AM. While waiting
for the Mayor to arrive, he saw he
secretary, the other assistants and
some bystanders chat about some
people’s lives during office hours.
Soon more people entered the Mayor’s
office. Some clad in decent clothes
but what caught his attention are the
people in shabby clothes waiting for
the Mayor together with him. He waited
until 10 AM when the Mayor arrived.
Since he was the first to arrive, he
was given the priority to see the
mayor.
In the Mayor’s office, he introduced
himself and his company. As he spoke,
ETHICS
he noticed a certain glow in the eyes
of the Mayor. When he finished, the
Mayor did not sign the clearance but
asked him to go back tomorrow at 7 AM,
not to his office but to his house not
so far from the municipal hall. He was
also asked to bring with him
preferably someone of higher
authority. He went back to the Makati
office and reported to his supervisor
and other team members the Mayor’s
request.
The next day, Ernie and his manager
went to the Mayor’s house at exactly 7
AM as requested. He noticed that this
very in the morning, many people,
mostly in shabby clothes, were
gathered outside the Mayo’s house. Not
long after, Ernie and his manager were
asked to go inside the house. They
were assisted by the helper to the
dining room. It looked more like a
meeting room but he was surprised to
see a table prepared for atleast 15
people.
Soon the Mayor walked into the room
with a full smile. Ernie noticed that
the Mayor is holding the folder of
their application with the clearance
inside. It was already ready for his
signature. The conversation started
with the Mayor’s expression of full
support to the project in his place of
jurisdiction. He was even encouraging
more developers to enter in Casipit as
they will not only help improve the
amenity of the municipal but also
increase the value of the land.
Slowly he went to discuss the issuance
of the clearance. He went to say that
“I will help you earn your money
through your real estate project and I
hope you’ll help me too. Many
townspeople are depending on me for
their need. You could see people
waiting outside my house this early in
the morning. These are people who are
asking money from me… for their child
who is sick, for their spouse or child
who is dead and is waiting burial, for
they child who needs education or even
job. You can name all reasons why they
need money– even for wedding
reception– people will go to me for
financial aid.
How can I turn them down? If I will
not help them, they will accuse me of
being ‘ingrato’ (or walang utang na
loob) and unfaithful to his
constituents. But if I did, they will
ask for more even if I give them
enough. I feel like if I give them my
hand, they will get my whole body
 ETHICS

instead. If I stop, they’ll say bad

things about me. But you see, what can
I give them? I am just an ordinary
person. I have nothing much. So
I’m asking you to help me finance
their needs. You also have to think
about the farmers who will be
displaced by your project. Definitely,
they will come to me for help when
they have already used up the funds
you gave to them. So, is P\10.00 per
square meter of the land subject to
the clearance good enough?”

Ernie and his manager were startled.

The amount of P\10.00 per square meter
of the land will translate to a huge P
4 million as representation expense!
They left the Mayor with a promise
that they will bring the issue to
higher management for decision. On
their way back to the office, Ernie
and his manager were both quiet trying
to digest the essence of their
conversation with the Mayor. They were
already pressed for time, as the other
clearances will start from the Mayor’s
clearance. What makes the matter worst
was that they have not anticipated the
representation expense and did not
include in their budget approved by
the management. Nonetheless, they have
to report the proceedings of the
meeting to higher management. But
should they recommend the payment of
the P4 million to the Mayor? What
should they do?