ETHICAL CONSIDERATION IN

LEADERSHIP & MANAGEMENT

VALUES AND PROFESSIONAL ETHICS

PAMANTASAN NG LUNGSOD NG MAYNILA
INTRAMUROS, MANILA
MORAL DECISION MAKING

• is the ability to produce a reasonable and defensible answer to

an ethical question.
• Decision-making (DM) in healthcare can be understood as an interactive
process addressing decision makers' reasoning as well as their visible
behavior after the decision is made. Other key elements of DM are ethical
aspects and the role as well as the treatment options of the examined
professions
• Further, In today's healthcare system requires that nurses have strong
medical-technical competences and the ability to focus on the ethical
dimension of care. For nurses, coping with the ethical dimension of care in
practice is very difficult. Often nurses cannot act according to their own
personal values and norms. This generates internal moral distress, which
has a negative impact on both nurses and patients.
PRINCIPLE OF MORAL DISCERNMENT

• Moral discernment is defined as the moral convictions that determine one's

behavior and ultimately one's life. The person with moral integrity can lives
with consistent of convictions or believes of themselves. Moral discernment
defines the moral convictions that determine one’s behavior and ultimately
one’s life.
• It is a process that should move inexorably toward a decision.
• It is both to understand and to decide.
Four Principles of Moral Discernment

• Principle of Formal Cooperation

• Principle of Material Cooperation
• Principle of Lesser Evil
• Principle of Double Effect
Principle of Formal Cooperation
• Formal Cooperation Is Always Illicit  
• Explicit formal cooperation occurs when someone wills the evil action of the principal
agent, such as a doctor who openly encourages or recommends a direct abortion. 
• Implicit formal cooperation happens when a person, for the sake of a good aim, establishes
the structure (procedure, protocol, or contractual agreement) by which a specifically
described immoral action will take place, grants formal approval to an immoral action, or
wills the principal agent’s evil action as the means for achieving some other good. This can
be a very common pitfall in institutional collaboration, particularly in prescribing
medications, filling prescriptions, and making referrals, as when a doctor who opposes
abortion refers a woman to a place where he knows she will obtain a direct abortion.
Principle of Material Cooperation
• Material Cooperation May Be Licit with a Proportionate Reason
• It is immediate material cooperation when the action is so intimately linked with the
principal agent’s immoral act that they are nearly indistinguishable, as, for example, when
an operating room nurse assists a surgeon in a direct sterilization procedure. Many consider
such cooperation to be always illicit, others consider it licit with only the gravest of reasons,
as when one’s life or a good of similar weight is a stake. In practice, it is virtually never
licit. 
• Mediate material cooperation occurs when there is is a degree of causal (not physical)
separation between the action and the principal agent’s immoral act. The degree of causal
distance may vary along a scale from proximate to remote.
Principle of Lesser Evil

• The lesser of two evils principle, also referred to as the lesser evil principle
and lesser-evilism, is the principle that when faced with selecting from two
immoral options, the least immoral one should be chosen.
The Case of Tom, Dick and Harry
• Tom, Dick and Harry are neighbors. Tom and Dick have a longstanding grudge that boils
over into a murderous rage one day when Dick inadvertently drives over part of Tom’s lawn
while navigating around a bicycle left in the driveway. Tom confides in Harry that this is the
last straw and that when Dick returns home shortly from his errand he’ll be met by Tom’s
shotgun. Harry tries his best to dissuade Tom from his homicidal intent, but without success,
and off in the distance he sees Dick’s S.U.V. approaching. Thinking quickly, Harry says to
Tom that if Dick is killed he’ll certainly be dead, but that would be the end of it, whereas if
Tom were to decimate Dick’s prize rose bushes, Dick would suffer their loss daily. Tom
hesitates for a moment and begins to waver. Seeing this, Harry says, “Let’s get those bushes
now!” Whereupon Tom drops his gun and joins Harry in whacking the bushes.
• What is going on here morally? To an observer, it might look as though Tom and Harry are engaged
in identical evil actions, but the two actions actually differ in one critical element: intention. While
Tom is giving vent to his sinful anger, Harry is trying to protect Dick’s life—albeit at the expense of
the roses. While Harry could stand piously by and do absolutely nothing (avoiding all evil), Thomas
Aquinas would probably not judge abstaining from such a diversionary act to be a good use of
practical reason—using our moral acumen in a concrete situation. The key difference between Tom
and Harry is not in what their hands and feet are doing, but in their heads and hearts, which give
meaning to these movements. Tom is consumed by anger, but Harry is cleverly channeling that
anger down a less destructive path. Harry’s action is safeguarding Dick’s life; Tom’s action is sinful.
• In the moral tradition, an act with a moral character includes three elements: the act itself, the
intention of the agent and the circumstances. When the church deems certain actions to be
“intrinsically evil,” it takes into account all three. For example, although death is the result in
both homicide and murder, moralists would not say that every homicide is sinful, but that every
murder is. What’s the difference? Murder by definition includes an intent to kill. Since the
intention and/or the circumstances can change the nature of the action itself, one cannot get at
the moral meaning of the act in itself without paying sufficient attention to the intention and
circumstances. In the case of Tom, Dick and Harry, Tom is intending to harm Dick while Harry
is intending to save Dick’s life. While in these circumstances Tom could easily forgo his
unrighteous anger, the same circumstances do not allow Harry many effective options to save
Dick’s life.
Principle of Double Effect
• The doctrine holds that, in the context of actions that have both good and bad
effects, an action that has a bad effect is morally permissible if:
• (a) the action itself is good,
• (b) its perpetrator's intention is solely to produce the good effect, (c) the
good effect is not achieved through the bad, and
• (d) there is sufficient reason to permit the bad effect.
• Gillon concludes that, while the doctrine of double effect is unlikely to be
accepted fully by non-absolutists, some of its claims are useful in deciding which
clinical interventions are morally justified.
Principle of Well-Formed Conscience
• indicates that people are obligated to inform themselves about ethical norms, incorporate that
knowledge into their daily lives, act according to that knowledge, and take responsibility for those
actions.
• A good conscience makes judgments that conform to reason and the good that is willed by the
Wisdom of God. A good conscience requires lifelong formation. Each baptized follower of Christ is
obliged to form his or her conscience according to objective moral standards. The Word of God is a
principal tool in the formation of conscience when it is assimilated by study, prayer, and practice.
The prudent advice and good example of others support and enlighten our conscience. The
authoritative teaching of the Church is an essential element in our conscience formation. Finally,
the gifts of the Holy Spirit, combined with regular examination of our conscience, will help us
develop a morally sensitive conscience.
Strategies to Moral-Decision Making Process

• Ethical Dilemma- an ethical dilemma involves the need to choose from

among two or more morally acceptable options or between equally
unacceptable courses of action, when one choice prevents selection of the
other. Advances in medicine, increasing economic stress, rise of patient
self-determination and differing values between healthcare workers and
patients are among the many factors contributing to the frequency and
complexity of ethical issues in healthcare.
Example of Ethical Dilemmas in Nursing
• The ANA Code of Ethics provides a standard by which nurse managers can assess
ethical issues in nursing. However, the way it addresses ethical dilemmas can vary in
different situations. One ethical dilemma that can occur in healthcare facilities is when
nurses themselves are not properly equipped to complete their duties. Nurses who
notice their coworker’s lack of knowledge face an ethical dilemma of whether they
should bring the issue to their nurse manager. To help curb this ethical dilemma, nurse
managers can work hard to educate their nurses regarding the Code of Ethics as well
as educate them regarding the Code of Ethics for their specific medical facility. Nurse
managers can also provide regular trainings for their nurses regarding recurring issues.
• One example of a common ethical dilemma nurses deal with is establishing
boundaries with patients. Nurses and nurse managers devote their careers to
helping patients receive the care they need, so it can often be difficult to
establish professional boundaries. Patients should not rely on nurses beyond
their professional capacity and should not develop romantic relationships
with them or offer them gifts. Nurse managers can intervene in situations
where ethical and professional boundaries are crossed by either patients or
nurses.
• Another ethical issue in nursing pertains to patient privacy. Nurses and
nurse managers have access to a patient’s records and medical history and
cannot ethically or legally release that information to anyone besides the
patient. Nurses should have the best interest of patients in mind,
understanding that they need to protect their privacy and medical data.
COMMON ETHICAL SITUATIONS FOR NURSE
MANAGERS and NURSING ETHICS EAMPLES
Honesty vs. Witholding information

• Family members may want to withhold medical information from sick

patients to protect their emotions. However, patients have the right to know
about their medical conditions. Deciding how to share this information,
especially if it goes against the family’s beliefs, can be a touchy situation.
ANA advocates for truth telling, or veracity, as a key factor in nurse-patient
relationships.
Science vs. Spirituality
• Healthcare, which is science-based and results driven, can impede religious or
personal beliefs. Some religions restrict medical interventions and lifesaving
techniques. Nurses focus on providing medical care to reduce suffering and to
allow patients to concentrate on self-care. For patients or their families with
strong religious or spiritual convictions, the focus may be on adhering to a
strict set of guidelines. The ANA Code of Ethics states that nurses should
respect the “unique differences of the patient,” including “lifestyle, value
system, and religious beliefs.” However, respect for the belief “does not imply
that the nurse condones those beliefs or practices on a personal level.”
Healthcare needs vs. Resource allocation

• The rising cost of healthcare is increasingly putting nurse managers at odds

with budgeting constraints and patient needs. A large number of medical
facilities have scarce resources, which puts patients at risk for not getting
the care they need. These resources range from medical equipment to
healthcare staff. Research suggests that nurse leaders must include staff in
the budgeting process so that they can better understand the needs and
demands.
Autonomy vs. Beneficence
• . Nurses are required to administer prescribed medicine, but patients, at the
same time, can refuse them. Patient autonomy can go against medical directives,
despite clearly defined needs. Patients have a right to refuse all medical care.
ANA highlights that it is important for nurses and nurse managers to understand
patient backgrounds and individual circumstances to inform the patient of the
medical necessity. ANA explains: “Using ethical principles to arrive at a
solution should be done in an atmosphere of caring, respect, openness, and
honesty. This process should be based on a sound ethical, decision-making
model, using the best evidence-based-practice guidelines available.”
How to deal with ethical dilemmas in Nursing

• Nurses can also benefit by surrounding themselves with well-seasoned

nurses as well as experienced nurse managers. They can rely on the
guidance of nurse managers when it comes to situations they may not know
how to address. Nurse managers can cultivate educational environments, in
which they regularly discuss ethical issues with the nurses in their units. By
having open dialogues about ethical issues, nurses can learn from the
mistakes others have made and learn how to approach ethical issues and
challenges.
THANK YOU!

~Topic to be continued~
• There will be no activity for this week as this is a continuing topic. We will
have the activity nextweek.