Unit I: Theories and Principles of Health

Ethics

MA.CORAZON R. DULAY,RN,RM,MAT-HED,MAN
Department of Nursing
ST. PAUL COLLEGE OF ILOCOS SUR
 Unit I: Theories and Principles of Health Ethics

OBJECTIVES:
1. Identify the different Theories and Principles of
Health Ethics.
 Unut I: Theories and Principles of Health Ethics

Health Care Ethics

is the field of applied that concerned with the vast array of moral
decision-making situations that arise in the practice of medicine in
addition to the procedures and the policies that are designed to
guide such practice.

brief history of health ethics:

medical term - designates the intention to identify and to understand
disease states in order to be able to diagnose and treat patients who
might suffer from them.
includes not only medical but also health status of people, the
diseases, practice of health care, and also cultural,societal, economic,
education and legislative factors either negative or positive.
 includes also the professional clinicians example:
physician, nurse, medical technicians and social worker etc.

Theories and Principles of Health Ethics

A. Ethical theories
1. Deontology
2. Telecology
3. Utilitarianism
 Theories and Principles of Health Ethics
A. Ethical theories
1. Deontology
is an ethical theory that says actions are good and bad
according to a clear set of rules.
greek words deon meaning duty
actions that align with these rules are ethical, while
actions that don’t are not.
examples: in ten commanmends “honor your
father and mother, do not kill, do, not steal
KANT’S THEORY by philosopher Immnuel kant
belief that humans possess the ability to reason and
understand universal moral laws that they can apply in al situations.
does not focuse on the consequences of individual actions.

characterisctics of deontology
moral right - one’s duty, how one should act is defined
independently of moral good.

philosopher Immnuel Kant

believes that ethical actions follow universal moral laws such
as “don’t lie, Don’t steal.

:
examples of deontology ethics
do not kill
do not steal
religious belief
keeping promises
cheating
do not lie
respects the elder
2. Teleology theory
theory of morality that derives duty or moral obligation
from what is good or desirable as an end to be
achieved.
comes from greek word meaning
telos- meaning end,purposeor goal
logos - meaning explanation or reason
an explanation of something that refers to its
end, purpose or goal
example: kitchen knife - ask why the knife
takes the form or features that it does.

simple term: the study of ends or purpose

example of teleontology:
stealing a loaf of bread from the neighborhood grocery
store.
the motive has nothing to do with the right or wrong
of the act
3. Utilitarianism
an ethical theory that determines right or wrong by focusing on
outcomes.
holds that the most ethical choice is the one that will produce the
greatest good for the greatest number
example: choosing ice cream for your self, choose the flavor that will
give you the most pleasure.
example: chocolate

simple term: action is right as it conforms to a rule that leads to the

greatest good...
or the rightness or wrongness of a particular action is a function of
the correctness of the ruleof which it is an instance
it implies that we should make helping others a very significant part of
our lives.
example: redistribution of excess money from the rich to poor.
B. Virtue Ethics
1. Virtues ethics in Nursing
2. Core Values of a Professional Nurse

Virtue Ethics
the oldest ethical theory in the world
defines good actions as ones that display embody virtuous
character traits, like courage, loyalty or wisdom.
example: honesty and morality of a person, practicing
good habits such as honesty, generosity and virtuous
person
Virtues ethics in Nursing
is concerned with the character of individual nurses and seeks ways
to enable nurses to develop character traits approrpiate for actions that
enhance wellbeing.
medical ethics - investigates how the doctor’s good moral
character enables them to promote the good for the patient
examples: beneficence, non-maleficence, autonomy and
justice
examples of virutues in health care ethics:
1. honesty - truth-telling
2. courage - acting on one’s own values and willingness to take a risks
3. compassion - empathetic to the pain and suffering of the patient
4. generosity - act of freewill, without obligation
5. fidelity - keeping ons’s promises
6. integrity - treat others respect, follow your commitments
7. fairness- be fair when they distribute care
8. self-control - temperance is a habit of excellence, signifies self-
mastery
9. prudence - enables nurses and patients to engage in a deliberative
process by which ethical means of treatment are proposed and
decided upon
virtues needed by a nurse in health care:
1. professional knowledge
2. skills -
3. trustworthiness - a person both deserves the trust of others
and does not violate that trust
4. morality - taking tough stands for what is right
5. ethical conduct - obtaining informed concent from the
patient or treatment
6 Core Values of a Professional Nurse
1. emphathy
it helps build trust to the patient, enables to focus on their point of view,
strengthen ability to effective communication and provide better care to
the patient

2. professionalism
remain professionals to patient and collegues no matter how stressful
the environment
remain strong and stable, reaasure that they are st the
right hands
3. autonomy
recognize patients rights to accept or refuse care provision

4. altruism
not to expect somthing inreturn for the care that you
provides and advocating for fair treatment for patient

5. accountability
ability to acknowledge responsibility for the actions and
learn from mistakes

6. curiosity
ask questions on the job to learn more about the role and
responsibilities
C. Ethical principles
Ethics - is the branch of philosophy which takes a systematic
approach to define social and individual morality.- the fundamental
standards of right and wrong that the whole society as well as
individuals, learn from their culture and peears.

C. Ethical principles
1. Autonomy
• Patient’s rights
• Patients’s bill of rights
• Informed consent /legally acceptable representative
• Confidentiality
• Privacy
 C. Ethical principles
1. Autonomy - refers to every individual’s right of self determination
and freedom to make their own choices.
respect their client’s right to make decisions about their
own health
• Patient’s rights
The 13 Rights of the Patient
1. right to appropriate medical care and humane treatment
2. right to informed consent
3. right to privacy and confidentiality
4. right to information
5. the right to choose health care provider and facility
6. right to self determination
7. right to religious belief
8. right to medical records
9. right to leave
10.right to refuse participation in medical research
11. right to correspondence and to receive visitors
12. right to express grievances
13. right to be informed of his rights and obligations as a
patient
• Patients’s bill of rights
- ensures that the rights and dignity of each person receiving medical services are
respected and valued.
a document that provides patients with information on how they can reasonably expect t
o be treated during the course of their hospital stay.
senate # 812 - introduced by senator bong Revilla Jr
a declared policy of the state to ensure and protect the rights of patients
decent , humane and quality health care.
proposed magna carta of patients rights shall provide patients the
following basic rights:
right to proper and appropriate medical care and
humanetreatment
right to informed consent, right to privacy and confidentiality, right to
information, right to choose physician and health care provide, right to self-
determination,right to religious belief, right to medical record, ight to leave,right to refuse,
participation in medical research,right to correspondence and to receive visitors,right to
express grievances, right to be informed of his rights and obligations as patient
2. Confidentiality
- to keep secret by which we mean knowledge or information that a
person has the right or obligation to conceal

3. Veracity
Truth telling and right to information

4. Fidelity
when a nurse remains true to the values, principles, and tandards
example; a nurse who told their patient to come back in 30 min to
check the pain, either come back or delegate someone else to come
back if they got tied up
 Justice
5.

- is a complex ethical principle and entails

fairness, equality and impartiality meaning it is the
obligation to be fair to allpeople

types:
1.distributive justice
- means that individuals have the right to be
treated equally regardless of ethnic group,
gender, culture,age, marital status,medical
diagnosis,social standing, economic
level, political or religious beliefs, or any
ndividual characteristics
 2. social justice - is based on the application of equitable
rights to access and participation in all aspects of good
and services provided in a society regardless of their
individual characteristics.

• Informed consent /legally acceptable representative

means that each person who has any sort of procedure done
to them in a healthcare context should give their approval for
that procedure to be done to them.
Confidentiality
- to keep secret by which we mean knowledge or
information that a person has the right or obligation to conceal
example: family with HIV results , do not gve unless the
patient tells you
• Privacy
- encompasses a number of aspects includes personal
apace, personal data, or information, personal choices
including religous and cultural affiliation, and personal
relationships with family members and other intimates
6. Beneficence
- tells about “doing good” for the client
example: giving immunization

7. Non-maleficence
- tells about “do not harm” either intentionally or
unintentionally to your client
example: not abondoning a client who is need of the
services
D. Other relevant ethical principles
1. Principle of double effect
sometimes it is permissible to cause a harm as side effect ( or
“double effect”)of bringing about a good result even though it would not
be permissible to cause such a harm as a means to bringing about the
same good end.
example: performing an abortion when continuing the pregnancy
would risk killing the mother

death of a human being , side effect of promoting some good end

killing someone to save someone else’s life

4 principles of double effect
1. the action itself is good or at least neutral
2. the good effect, not the bad effect is what is
intended
3. the good effect is not produced by the bad effect
4. there is a proportionately grave reason for
permitting the bad effect
2. Principle of legitimate cooperation
is an application of the principle of double effect to situations
involving cooperation with someone else’s actions
example: the doctor who performs a prescribed procedure

3.Principle of common good and subsidiarity

subsidiarity - is the coordination of society’s activities in a
way that supports the internal life of a local communities.
emphasizes and respects the role of the person’s free will in
his or her life choices.
human person is the essential actor in the care of his or her
health
example: each person insured pays the same percentage of
its income into the health insurance
common good
- is the totality of social conditions allowing persons to
achieve their communal and individual fullfillment
example: accessible and affordable public health care
system, peace among the nations of the world
E. Principles of bioethics role of a nurse
1. Principle of stewardship and role of nurses as stewards
Personal
role of a nurse as personal involves valuing and respecting patient’s
priorities and self-determination
example: nurses become stewards or leader or teacher to patients
without expertise or experience interms of disease process but
understan consequences of illness
Social
social role of a nurse as stewards is providing support and help families
learn to be healthy by helping to understand the variety of emotional,
physical mental and cultural interactions they encounter during health
assessment
Ecological biomedical
ecological stewards
conserves natural resources, combats pollution and protects
biodiversity, or protect and sustain our environment for future
generation
examples: recycling, replacing inefficient appliances or
making efficient transport choices

biomedical stewardship
refers to the execution of responsibility of the health care
practitioner to look after, furnish fundamental health care services,
and promote the health and life of those entrusted to their care
2. Principle of totality and its integrity
• Ethico-moral responsibility of nurses in surgery

Perioperative nurses
are obligated morally to respect the dignity and worth of
individual patients.

care must be provided in a manner that preserves and

protects patient autonomy and human rights

Supporting patients rights and choices:

1. Preserve and protect their patient’s autonomy, dignity and human
rights with specific interventions including supporting a patient’s
participation in decision-making confirming informed consent and
implementing facility advance directive policies
2. Explain procedures and the OR environment before initiating
actions.
3. Respect patient ‘s wishes in regard to advance directives and
end-of-life choices.
4. Help patients make choices within their scope of care as
applicable.
5. Provide patients with honest and accurate answers to their
questions especially related to perioperative teaching, formulate
ethical decisions with helpfrom available resources( eg. ethics
committee, counselors, ethicists)
5. as moral agent for the patient , must be ready and able to
advocate for the patient’s rights and needs whenever necessary
while providing care.
Respect for others:
1. Nurses must be able to interact with a variety of other
professionals and ancilliary providers in the preoperative
environment.
- treating with professionalism
- respect the performance of the health care team
- fair treatment regardless of disability, or economic,
educational, cultural religious, race age and life styles

2. The nurse recognizes the contributions of each member of

the health care team and collaborates to achieve quality
patient care.
Ethical dilemma
nurses often faced with an ethical dilemma when a
patient is anxious because he or she does not understand
fully what is going to happen in surgery and the nurse is
being pressured for a fast turn of overtime.
patients emotional need
expectation to be efficient
FOR SURGERY:
1. managing fluid and electrolyte balance
2. managing nutrition
3. managing pain
4. managing infection control
5. managing wound and wound care
6. managing stress and anxiety
7. managing possible altered image
• Sterilization/mutilation
an ethical approach to the provision of sterilization
must:
promote access for women who wish to use
sterilization as a method of contraception, and
safeguard against coercive or other wise unjust uses

sterilization
is removal of a procreative member or element of the
human in order to prevent procreation
all mutilation was against nature and therefore against
morality
sterilization unethical if :
when performed without consent, violates an individual’s
rights to dignity , humane treatment, health family, information,
privacy and freely decide the number and spacing of children.

how do we sterilize a human?

through surgical sterilization method include;
1. tubal ligation in females - tubes tied
2. bilateral salpingectomy in females - tubal removed
3. vasectomy

mutilation
1. clitoridectomy
• Preservation of bodily functional integrity
issues on organ donation
organ donation
is when you decide to give an organ to save or transform
the life of someones else

is the process of surgically removing an organ or tissue

from one person and replacing it into another person
issues on organ donation:
major ethical concerns about organ donation
by living related donors focus on the possibility of
undue influence and emotional pressure and
coercion

major ethical issues:

the autonomy of the donor and recipient and the utility
of the procedure
some ethical issues on organ donation includes:
1. autonomy
2. benevolence
3. non-maleficence
4. free and informed consent
5. respecting the dignity
6. integrity and equality of human beings
7. fairness
8. common good
Principles of ordinary and extraordinary means
In assessing when there is a duty to preserve life, the Church
distinguishes between ordinary and extraordinary means.
Ordinary means - it must be taken to preserve life
Extraordinary means - can be morally refused

Ordinary means
are all treatments, medicines and operations which offer a
reasonable hope of benefit and which can be obtained and used
without excessive expense, pain or other inconvenience.

obligatory care given to any and all patients

Extraordinary means
are those which cannot be obtained or used without
excessive expense, pain or other inconvenience, or which if
used would not offer a reasonable hope of benefit.

they involve a disproportionately great burden on the

patient or community.

it may harm the patient

example: HIV medication, treatment for hepatitis C, all

emergency transfortation and emergency treatment, all durable
medical equipment including prosthesis, wheel chairs and
glasses
Principles of personalized sexuality
it should be a loving, bodily, pleasure expression of the
complimentary, permanent self-giving of a man and a woman
to each other, which is open to fruition in the perpetuation
ad expansion of this personal communion through the family
they beget and educate

Principles of personalized sexuality In health care

Sex is a social necessity for the procreation of children
and their education in the family so as to expand the
human community and guarantee its future beyond the
death of individual members.
4 main ethical principles;
beneficence
nonmaleficence
autonomy
justice

PERSONALIZED SEXUALITY
must be loving, bodily pleasurable, expression of the
complementary, permanent self-giving of a man and a
woman to each other
as the image of God:
man is created for love.
genesis 1-3
Teaches that God created person as male and
female and blessed their sexuality as a great and good
gift.
END