Fiel Angelo G.

Mallari, RN
 Ethicsand morals relate to “right” and
“wrong” conduct. While they are sometimes
used interchangeably, they are different:

 Ethicsrefer to rules provided by an external

source, e.g., codes of conduct in workplaces
or principles in religions.

 Moralsrefer to an individual’s own principles

regarding right and wrong.
 Much of the confusion between these two words can
be traced back to their origins. For example, the
word "ethic" comes from Old French (etique), Late
Latin (ethica), and Greek (ethos) and referred to
customs or moral philosophies. "Morals" comes from
Late Latin's moralis, which referred to appropriate
behavior and manners in society. So, the two have
very similar, if not synonymous, meanings originally.

 Morality and ethics of the individual have been

philosophically studied for well over a thousand
years. The idea of ethics being principles that are set
and applied to a group (not necessarily focused on
the individual) is relatively new, though, primarily
dating back to the 1600s. The distinction between
ethics and morals is particularly important for
philosophical ethicists.
 Ethics are external standards that are provided
by institutions, groups, or culture to which an
individual belongs. For example, lawyers,
policemen, and doctors all have to follow an
ethical code laid down by their profession,
regardless of their own feelings or preferences.
Ethics can also be considered a social system or
a framework for acceptable behavior.

 Morals are also influenced by culture or society,

but they are personal principles created and
upheld by individuals themselves.
 Ethics are very consistent within a certain
context, but can vary greatly between contexts.
For example, the ethics of the medical
profession in the 21st century are generally
consistent and do not change from hospital to
hospital, but they are different from the ethics
of the 21st century legal profession.

 An individual’s moral code is usually unchanging

and consistent across all contexts, but it is also
possible for certain events to radically change an
individual's personal beliefs and values.
 One professional example of ethics conflicting with
morals is the work of a defense attorney. A lawyer’s
morals may tell her that murder is reprehensible and
that murderers should be punished, but her ethics as
a professional lawyer, require her to defend her
client to the best of her abilities, even if she knows
that the client is guilty.

 Another example can be found in the medical field.

In most parts of the world, a doctor may not
euthanize a patient, even at the patient's request, as
per ethical standards for health professionals.
However, the same doctor may personally believe in a
patient's right to die, as per the doctor's own
morality.
 auto- "self“
 nomos - "law/”governance”

 Definition: Autonomy is the “personal rule of

the self that is free from both controlling
interferences by others and from personal
limitations that prevent meaningful choice.”
 Itrefers to the capacity of a rational
individual to make an informed, un-coerced
decision.

 Competent, informed patients have the right

to choose among treatment options and
refuse any unwanted medical interventions.
 Freeand rational act that presupposes
knowledge of the thing to which consent is
being given by a person who is legally
capable to give consent

 INFORMED CONSENT - consent signed by

patient/ authorized representative upon
admission is for the initial diagnosis and
treatment
 Subsequent treatments/ operations require
individual informed consent

 In cases of emergency, informed consent

would be not necessary prior to application
of treatment
 Diagnosis and Explanation

 Procedure and Consequence

 Alternative Treatments

 Benefits to be expected

 Prognosis
 Disclosure

 Understanding

 Voluntariness

 Competence

 Consent
The patient who is:
 Of legal age
 Of sound mind

Who can give a PROXY consent?

 Power of attorney
 Married - spouse, children of legal age
 Not married - parents, uncles/aunts, siblings
CONSENT OF MINORS
 Given by parent/ guardian
 Parental consent is not needed if the child is
emancipated

CONSENT OF THE MENTALLY ILL

 Given by parent/ guardian
REFUSAL TO CONSENT
 a patient who is mentally and legally
competent has the right to refuse the
touching of his body
CONSENT FOR STERILIZATION
 Sterilization - Termination of the ability to
produce offsprings
 Husband and wife must both consent to the
procedure
 If medically necessary, patient’s consent
alone is sufficient
 Deliberaterestriction of people’s autonomy by
health care professionals based on the idea that
they know what’s best for the clients

 Doing
good should take precedence over
autonomy
 Beneficence is action that is done for the
benefit of others.

 Beneficentactions can be taken to help

prevent or remove harms or to simply
improve the situation of others.
 Nursesmust act in the best interests of their
patients

 Patientsare vulnerable because of illness and

lack medical expertise. Therefore, patients
rely on physicians and nurses to offer sound
advice and to place the their well-being
first.
 resuscitating a drowning victim

 providing
vaccinations for the general
population

 encouraging a patient to quit smoking and

start an exercise program

 talking
to the community about STD
prevention.
 Requires the non-disclosure of private or
secret information with which one is
entrusted
Why Keep Confidentiality?
 Respect for patients
 Encourages care-seeking
 Allows discussion of sensitive topics.
 Prevents harmful consequences to patients
 Do no harm
 Primum non nocere = latin
 “First do no harm”
 "given an existing problem, it may be better
not to do something, or even to do nothing,
than to risk causing more harm than good."
 Physiciansand nurses must refrain from
providing ineffective treatments or acting
with malice toward patients. This principle,
however, offers little useful guidance to
physicians and nurses since many beneficial
therapies also have serious risks.

 Thepertinent ethical issue is whether the

benefits outweigh the burdens.
 Equality

 Theprinciple of distributive justice deals

with issues of treating patients equally.

 No discrimination on the basis of sex, race,

religion, age and socioeconomic status
 Theneeds of everyone, even if its due,
cannot all be served

 Involves
allocation of scarce and expensive
health care resources
 Truth-telling,
or veracity, can be defined as
the avoidance of lying, deception,
misrepresentation, and non-disclosure in
interactions with patients or relevant to
patient care.
 Prima facie wrong
Lying is viewed as an inherent wrong—something that we naturally
consider unethical.

 Barrier to Patient Autonomy and Informed Consent-

It is inappropriate for a doctor to lie because it precludes the patient
from making an informed decision and providing informed consent, thereby
trampling over the patient’s autonomy. If the doctor provides improper or
insufficient information, the patient will not possess adequate information to make
the most personally meaningful decision

 Destroys patients trust

If the doctor lies to the patient and the patient later finds out about the
betrayal, the patient will be less likely to trust the physician in the future. This
destroys the foundation of an effective patient-physician relationship, in which the
patient trusts the doctor to provide appropriate information regarding diagnosis,
prognosis, and treatment. Accordingly, if one patient tells another patient about
his/her experiences with mistrust, then this may lead to a slippery slope in which
other patients may subsequently mistrust their physicians, leading to countless
shaky patient-physician relationships.
 Most patients want to know
According to one survey, 94% of patients said they “would want to know
everything” about their medical condition, “even if unfavorable.” Even more patients
wanted to know about a diagnosis of cancer. Therefore, it is inaccurate for doctors to
think that their patients want to be spared the bad news.

What happens if a family member declares that the patient should not
receive any information about the diagnosis, perhaps due to cultural reasons?

Although a family member may wish to uphold the cultural values of

protecting the patient from bad news, the doctor must ensure that these wishes also
reflect those of the patient. Therefore, the doctor must explicitly ask the patient
how he/she wishes to receive the information, if at all. It is important to confirm the
family member’s request with the patient in order to uphold patient autonomy—after
all, there may be some cases in which the patient still chooses to receive the
information, regardless of the family member’s request.

 Lying is impractical
One lie will naturally lead to another, creating a web of
deceit. Furthermore, other members of the healthcare team may notify the patient
at some point during the course of illness, leading to the patient’s resentment at not
having received the information directly from the physician in the first place.
 Obligation
of an individual to be faithful to
commitments to him/herself and also to others

 This
includes keeping information confidential
and maintaining privacy and trust

 Mainsupport for the concept of accountability

Accountability - acknowledgment and
assumption of responsibility for actions
When you are confronted with situations where
moral judgment is necessary, you may be
guided by the following rules:
“Do Not Do Unto Others What You Do Not Want
Others To Do Unto You”
If you are faced with a situation which may have
both good and bad effects, how should you choose
which one to follow? The basis of action maybe the
following:

 Action must be morally good

 Good effect willed, bad effect merely allowed
 Good effect must not come from an evil action
 Good effect must be greater than the bad effect
 THE WHOLE IS GREATER THAN ITS PART

Lower functions are never sacrificed except for

the better functioning of the whole person and
even then with an effort to compensate for
this sacrifice.
 EXCEPTION TO THE GENERAL RULE

 Itis a reasonable presumption that the authority

making the law will not wish to bind a person in
some particular case, even though the cases is
covered by the letter of the law.

 Ifa mental patient went berserk and the doctor

could not be contacted, the patient maybe
restrained by the virtue of epikia
 For example, a patient wants to have an
abortion and asks a nurse if she can do it.
The nurses refuses, but then recommends a
doctor who is capable of performing an
abortion. The nurse becomes liable to such a
crime, since she is an accomplice of the said
doctor
 In testifying before a court, no one can force
any person to answer a question if such will
incriminate him/her
 Giving a sleeping tablet to a chronically ill
person so he/she can die in peace is morally
wrong
 Patients with cleft lip/palate may have their
defects corrected by plastic surgery
 Suppose a patient subjects himself/herself
willingly to an experimental and he/she has
been told of the possible effects of the
same, is of right age, and is sane, there is no
violation of human rights.
 If a nurse gets medicine from a hospital stock
without permission/prescription, he/she will
be guilty of theft even if he/she got only one
tablet of medicine
 During an epidemic, immunization against
communicable diseases is administered to
the people. Although there may be some who
may have slight reactions to the vaccine, the
greatest majority of the population shall be
considered rather than the isolalated few.
 Topromise that a patient with heart
transplant will live may be an impossibility.

 Yet,such procedures are done in the hope of

saving or prolonging a patient’s life.

 The doctor and the nurse cannot be held to

the impossible if they have done their best to
take care of the and the latter dier
 Formal cooperation in an evil act is never
allowed. Immoral operations such as abortion
shall not be participated upon by a nurse
even if the doctor commands it.
 One of God’s Commandments is “Thou shall
not kill”. If God has given man a life, will it
mean that God has already ceded his right to
man?

 Man may appear only a puppet of God, if God

will not let go of his creation – man – to do
what is best for him, i.e., including
euthanasia.
 Code of Ethics for Nurses in the Philippines was
devised as a guide for carrying out nursing
responsibilities which would tackle difficult issues
and decisions that a profession might be facing,
and give clear instruction of what action would be
considered ethical or right in the given
circumstance.
 The Code of Ethics for Registered Nurses in the
Philippines is promulgated by the Board of Nursing
(BON) and was consulted with accredited
professional organizations like the Philippine
Nurses Association. It also coincides with the ideals
of Republic Act No. 9173 or the “Philippine Nursing
Act of 2002.”

 The Code of Ethics for Filipino Nurses was made

after a consultation on October 23, 2013 at Iloilo
City after accredited professional organizations
decided to adopt a new Code of Ethics under the
RA 9173.
PREAMBLE

SECTION 1.

Health is a fundamental right of every individual. The

Filipino registered nurse, believing in the worth and
dignity of each human being, recognizes the primary
responsibility to preserve health at all cost. This
responsibility encompasses promotion of health,
prevention of illness, alleviation of suffering, and
restoration of health. However, when the foregoing
are not possible, assistance towards a peaceful death
shall be his/her obligation.
SECTION 2.

To assume this responsibility, registered nurses have to gain

knowledge and understanding of man’s cultural, social,
spiritual, physiological, psychological, and ecological
aspects of illness, utilizing the therapeutic process. Cultural
diversity and political and socio-economic status are
inherent factors to effective nursing care.

SECTION 3.

The desire for the respect and confidence of clientele,

colleagues, co-workers, and the members of the community
provides the incentive to attain and maintain the highest
possible degree of ethical conduct.
REGISTERED NURSES AND PEOPLE

SECTION 4. Ethical Principles

1. Values, customs, and spiritual beliefs held by individuals shall be respected.

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.

SECTION 5. Guidelines to be observed:

REGISTERED Nurses must

A. consider the individuality and totality of patients when they administer care.
B. respect the spiritual beliefs and practices of patients regarding diet and
treatment.
C. uphold the rights of individuals.
D. take into consideration the culture and values of patients in providing nursing
care. However, in the event of conflicts, their welfare and safety must take
precedence.
REGISTERED NURSES AND PRACTICE

SECTION 6. Ethical Principles

1. Human life is inviolable.

2. Quality and excellence in the care of the patients are the goals of nursing practice.
3. Accurate documentation of actions and outcomes of delivered care is the hallmark of
nursing accountability.

SECTION 7. Guidelines to be observed:

REGISTERED Nurses must

A. know the definition and scope of nursing practice which are in the provisions of R. A. No.
9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of
2003, the “Rules and Regulations Implementing the Philippine Nursing Act. of 2002”, (the
IRR).
B. be aware of their duties and responsibilities in the practice of their profession as defined
in the “Philippine Nursing Act of 2002” and the IRR.
C. acquire and develop the necessary competence in knowledge, skills, and attitudes to
effectively render appropriate nursing services through varied learning situations.
D. if they are administrators, be responsible in providing favorable environment for the
growth and developments of Registered Nurses in their charge.
E. be cognizant that professional programs for specialty certification by the BON are
accredited through the Nursing Specialty Certification Council (NSCC).
f. see to it that quality nursing care and practice
meet the optimum standard of safe nursing
practice.
g. insure that modification of practice shall consider
the principles of safe nursing practice.
h. if in position of authority in a work environment, be
normally and legally responsible for devising a
system of minimizing occurrences of ineffective
and unlawful nursing practice.
i. ensure that patients’ records shall be available only
if they are to be issued to those who are
professionally and directly involved in their care
and when they are required by law.
SECTION 8. Ethical Principle

4. Registered Nurses are the advocates of the patients: they shall

take appropriate steps to safeguard their rights and privileges.

SECTION 9. Guidelines to be observed:

REGISTERED Nurses must

A. respect the “Patients’ Bill of Rights” in the delivery of nursing

care.
B. provide the patients or their families with all pertinent
information except those which may be deemed harmful to
their well-being.
C. uphold the patients’ rights when conflict arises regarding
management of their care
SECTION 10. Ethical Principle

5. 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.

SECTION 11. Guidelines to be observed:

REGISTERED Nurses must

A. perform their professional duties in conformity with existing laws,

rules regulations, measures, and generally accepted principles of
moral conduct and proper decorum.
B. not allow themselves to be used in advertisement that should
demean the image of the profession (i.e. indecent exposure,
violation of dress code, seductive behavior, etc.).
C. decline any gift, favor or hospitality which might be interpreted as
capitalizing on patients.
d. not demand and receive any commission, fee or
emolument for recommending or referring a
patient to a physician, a co-nurse or another
health care worker; not to pay any commission,
fee or other compensations to the one referring
or recommending a patient to them for nursing
care.
e. avoid any abuse of the privilege relationship
which exists with patients and of the privilege
access allowed to their property, residence or
workplace.
REGISTERED NURSES AND CO-WORKERS

SECTION 12. Ethical Principles

1. The Registered Nurse is in solidarity with other

members of the healthcare team in working for
the patient’s best interest.
2. The Registered Nurse maintains collegial and
collaborative working relationship with
colleagues and other health care providers.
SECTION 13. Guidelines to be observed:

REGISTERED Nurses must

A. maintain their professional role/identity while working

with other members of the health team.
B. conform with group activities as those of a health team
should be based on acceptable, ethico-legal standards.
C. contribute to the professional growth and development
of other members of the health team.
D. actively participate in professional organizations.
E. not act in any manner prejudicial to other professions.
f. 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.

g. respect the rights of their co-workers.

REGISTERED NURSES, SOCIETY, AND ENVIRONMENT

SECTION 14. Ethical Principles

1. The preservation of life, respect for human rights,

and promotion of healthy environment shall be a
commitment of a Registered Nurse.
2. The establishment of linkages with the public in
promoting local, national, and international efforts
to meet health and social needs of the people as a
contributing member of society is a noble concern of
a Registered Nurse.
SECTION 15. Guidelines to be observed:

REGISTERED Nurses must

A. be conscious of their obligations as citizens and, as

such, be involved in community concerns.
B. be equipped with knowledge of health resources
within the community, and take roles in primary
health care.
C. actively participate in programs, projects, and
activities that respond to the problems of society
d. lead their lives in conformity with the
principles of right conduct and proper
decorum.

e. project an image that will uplift the nursing

profession at all times.
REGISTERED NURSES AND THE PROFESSION

SECTION 16. Ethical Principles:

1. Maintenance of loyalty to the nursing profession and

preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited professional
organization (PNA), and other professional organizations of
which the Registered Nurse is a member is a lofty duty.
3. Commitment to continual learning and active participation in
the development and growth of the profession are
commendable obligations.
4. Contribution to the improvement of the socio-economic
conditions and general welfare of nurses through appropriate
legislation is a practice and a visionary mission.
SECTION 17. Guidelines to be observed:

REGISTERED Nurses must

A. be members of the Accredited Professional Organization

(PNA).
B. strictly adhere to the nursing standards. PRC-BN
C. participate actively in the growth and development of
the nursing profession.
D. strive to secure equitable socio-economic and work
conditions in nursing through appropriate legislation
and other means.
E. assert for the implementation of labor and work
standards.
 ADMINISTRATIVE PENALTIES, REPEALING CLAUSE,
AND EFFECTIVITY

SECTION 18.

The Certificate of Registration of Registered Nurse

shall either be revoked or suspended for violation
of any provisions of this Code pursuant to Sec. 23
(f), Art. IV of R. A. No. 9173 and Sec. 23 (f), Rule III
of Board Res. No. 425, Series of 2003, the IRR.
SECTION 19.

The Amended Code of Ethics promulgated pursuant to

R. A. No. 877 and P.D. No. 223 is accordingly repealed
or superseded by the herein Code.

SECTION 20.

This Code of Ethics for Nurses shall take effect after

fifteen (15) days from its full and complete
publication in the Official Gazette or in any
newspapers of general circulation.