Ethical

Principle
s
HEALTH CARE ETHICS
Group 1
BSN-3A
Overvie
w
Advincula, Twinkle K.
 An ethical principle refers to the general judgments
serving as justification for a person's behavior or actions.
Ethical principles in nursing are the foundation upon which
nursing actions are based. They describe what is expected of
nurses in terms of right and wrong, good and bad, and correct
and incorrect.
 Reasons Why Ethical Principles Are so
Important in Nursing
1. Using ethical principles as the foundation of practice assists
nurses in making good judgment calls.
2. Ethical principles in nursing guide nurses in providing high
quality care within the laws that govern nursing practices.
3. Nurses who work within the guidelines of ethical principles
support the emotional, physical and mental health of each patient,
acting with their best interest in mind.
4. Applying principles of ethics in nursing is beneficial to
developing strong nurse patient and interdisciplinary
relationships, which is essential for collaboration and quality
patient care.
 7 Main Ethical Principles

• Autonomy
• Confidentiality
• Veracity
• Fidelity
• Justice
• Beneficence
• Non-maleficence
Autonom
y
Agapito, Lhyka Marie C.
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My Body,
My choice,
- Unknown
 What is Autonomy?

 Autonomy, is defined as the capacity to think,

decide, and act freely and independently on the
basis o such thought and decisions.
 Why is patient autonomy important?

 Autonomy is important because we need to make

sure that the patient is actively involved in their
diagnosis and treatment.
 Principles of Autonomy
 We act autonomously.

 Patients have the right to refuse medical therapy.

 Self determination.

 Freedom from coercion.

 Independence.
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 Autonomy:
The Rights of the
Patients’
Alicaya, Lita Mea M.
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13 Patient
Rights
according to Saint
Anthony Mother and
Child Hospital.
 13 Patients Rights
1. Right to Appropriate Medical care and Humane Treatment
Every person has a right to health and medical care corresponding to his
state of health, without any discrimination and within the limits of the
resources, manpower and competence available for health and medical care at
the relevant time.

2. Right to Informed Consent

The patient has a right to a clear, truthful and substantial explanation,
in a manner and language understandable to the patient, of all proposed
procedures, whether diagnostic, preventive, curative, rehabilitative or
therapeutic, wherein the person who will perform the said procedure shall
provide his name and credentials to the patient, possibilities of any risk
of mortality or serious side effects, problems related to recuperation, and
probability of success and reasonable risks.
 13 Patients Rights
The patient will not be subjected to any procedure without written informed
consent, except in the following cases:

a) in emergency cases, when patient is at imminent risk of physical injury. In

such cases, the physician can perform any diagnostic or treatment procedure
as good practice of medicine dictates without such consent;
b) when the health of the population is dependent on the adoption of a mass
health program to control epidemic;
c) When the patient is either a minor, or legally incompetent, in which case. a
third party consent Is required;
d) when disclosure of material information to patient will jeopardize the
success of treatment, in which case, third party disclosure and consent shall
be in order;
e) When the patient waives his right in writing.
 13 Patients Rights

Informed consent shall be obtained from a patient concerned if he is of legal

age and of sound mind. In case the patient is incapable of giving consent and a
third party consent is required. the following persons, in the order of
priority stated hereunder, may give consent:

i. spouse;
ii. son or daughter of legal age;
iii. either parent;
iv. brother or sister of legal age, or
v. guardian

If a patient is a minor, consent shall be obtained from his parents or legal

guardian.
 13 Patients Rights
3. Right to Privacy and Confidentiality
The privacy of the patients must be assured at all stages of his treatment.
The patient has the right to be free from unwarranted public exposure. The
patient has the right to demand that all information, communication and
records pertaining to his care be treated as confidential. Any health care
provider or practitioner involved in the treatment of a patient and all those
who have legitimate access to the patient's record is not authorized to divulge
any information to a third party who has no concern with the care and
welfare of the patient without his consent

4. Right to Information
The patient or his/her legal guardian has a right to be informed of the
result of the evaluation of the nature and extent of his/her disease, any other
additional or further contemplated medical treatment on surgical procedure or
procedures, bills and post-operative medications.
 13 Patients Rights
5. The Right to Choose Health Care Provider and Facility
The patient is free to choose health care provider to serve him as well as
the facility. The patient has the right to discuss his condition with a consultant
specialist, at the patient's request and expense. He also has the right to seek
for a second opinion and subsequent opinions, if appropriate, from another
health care provider/practitioner.

6. Right to Self-Determination
The patient has the right to avail himself/herself of any recommended
diagnostic and treatment procedures. Any person of legal age and of sound
mind may make an advance written directive for physicians to administer
terminal care when he/she suffers from the terminal phase of a terminal illness:
Provided That a) he is informed of the medical consequences of his choice; b) he
releases those involved in his care from any obligation relative to the
consequences of his decision; c) his decision will not prejudice public health and
safety.
 13 Patients Rights
7. Right to Religious Belief
The patient has the right to refuse medical treatment or procedures
which may be contrary to his religious beliefs, subject to the limitations
described in the preceding subsection: Provided, That such a right shall not be
imposed by parents upon their children who have not reached the legal age in a
life threatening situation as determined by the attending physician or the
medical director of the facility.

8. Right to Medical records

The patient is entitled to a summary of his medical history and condition.
He has the right to view the contents of his medical records, except psychiatric
notes and other incriminatory information obtained about third parties, with
the attending physician explaining contents. The health care institution shall
safeguard the confidentiality of the medical records and to likewise ensure the
integrity and authenticity of the medical records and shall keep the same
within a reasonable time as may be determined by the Department of Health.
 13 Patients Rights
9. Right to Leave
The patient has the right to leave hospital or any other health care
institution regardless of his physical condition: Provided. That a) he/she is
informed of the medical consequences of his/her decision b) he/she releases
those involved in his/her care from any obligation relative to the consequences
of his decision; c) his/her decision will not prejudice public health and safety.

10. Right to Refuse participation in Medical Research

The patient has the right to be advised if the health care provider plans
to involve him in medical research, including but not limited to human
experimentation which may be performed only with the written informed
consent of the patient.

11. Right to Correspondence and to Receive Visitors

The patient has the right to communicate with relatives and other
persons and to receive visitors subject to reasonable limits prescribed by the
rules and regulations of the health care institution.
 13 Patients Rights
12. Right to Express Grievances
The patient has the right to express complaints and grievances about the
care and services received without fear of discrimination or reprisal and to
know about the disposition of such complaints. Such a system shall afford all
parties concerned with the opportunity to settle amicably all grievances.

13. Right to be Informed of His Rights and Obligations as a Patient

Every person has the right to be informed of his rights and obligations as
a patient. The Department of Health, in coordination with heath care
providers, professional and civic groups, the media, health insurance
corporations, people's organizations, local government organizations, shall
launch and sustain a nationwide information and education campaign to
make known to people their rights as patients, as declared in this Act Such
rights and obligations of patients shall be posted in a bulletin board
conspicuously placed in a health care institution.
 Autonomy:
Patient’s Bill of
Rights
Arceno, Trexie Jane C.
 The Patient's Bill of Rights is a collection of rights which
individuals have in the health care system and which
healthcare providers are required to observe.
 Why is
Patient’s Bill
of Rights
Important?
It protects
both the patients
and the hospital.
 The Patient’s Bill of Rights is an evolving document related
to providing culturally competent care. In 1973 the
American Hospital Association (AHA) adopted the Patient’s
Bill of Rights.
 GOAL: To protect patients and guarantee they get
appropriate care
 Patient’s Bill of rights
1. The patient has the right to considerate and respectful care.
2. The patient has the right to and is encouraged to obtain from physicians and other direct
caregivers relevant, current, and understandable information concerning diagnosis,
treatment, and prognosis.
3. Except in emergencies when the patient lacks decision-making capacity and the need
for treatment is urgent, the patient is entitled to the opportunity to discuss and request
information related to the specific procedures and/or treatments, the risks involved, the
possible length of recuperation, and the medically reasonable alternatives and their
accompanying risks and benefits.
4. Patients have the right to know the identity of physicians, nurses, and others involved
in their care, as well as when those involved are students, residents, or other trainees.
5. The patient has the right to know the immediate and long-term financial implications of
treatment choices, insofar as they are known.
 Patient’s Bill of rights
6. The patient has the right to make decisions about the plan of care prior to and during
the course of treatment and to refuse a recommended treatment or plan of care to the extent
permitted by law and hospital policy and to be informed of the medical consequences of this
action. In case of such refusal, the patient is entitled to other appropriate care and services
that the hospital provides or transfer to another hospital. The hospital should notify patients
of any policy that might affect patient choice within the institution.
7. The patient has the right to have an advance directive (such as a living will, health care
proxy, or durable power of attorney for health care) concerning treatment or designating a
surrogate decision-maker with the expectation that the hospital will honor the intent of that
directive to the extent permitted by law and hospital policy. Health care institutions must
advise patients of their rights under state law and hospital policy to make informed medical
choices, ask if the patient has an advance directive, and include that information in patient
records. The patient has the right to timely information about hospital policy that may limit
its ability to implement fully a legally valid advance directive.
 Patient’s Bill of rights

8. The patient has the right to every consideration of privacy. Case discussion,
consultation, examination, and treatment should be conducted so as to protect each patient’s
privacy.
9. The patient has the right to expect that all communications and records pertaining to
his/her care will be treated as confidential by the hospital, except in cases such as
suspected abuse and public health hazards when reporting is permitted or required by law.
The patient has the right to expect that the hospital will emphasize the confidentiality of
this information when it releases it to any other parties entitled to review information in
these records.
10. The patient has the right to review the records pertaining to his/her medical care and to
have the information explained or interpreted as necessary, except when restricted by law.
 Patient’s Bill of rights

11. The patient has the right to expect that, within its capacity and policies, a hospital will
make a reasonable response to the request of a patient for appropriate and medically indicated
care and services. The hospital must provide evaluation, service, and/or referral as indicated
by the urgency of the case. When medically appropriate and legally permissible, or when a
patient has so requested, a patient may be transferred to another facility. The institution to
which the patient is to be transferred must first have accepted the patient for transfer. The
patient must also have the benefit of complete information and explanation concerning the
need for, risks, benefits, and alternatives to such a transfer.
12. The patient has the right to ask and be informed of the existence of business relationships
among the hospital, educational institutions, other health care providers, or payers that may
influence the patient’s treatment and care.
 Patient’s Bill of rights
13. The patient has the right to consent to or decline to participate in proposed research studies
or human experimentation affecting care and treatment or requiring direct patient involvement
and to have those studies fully explained prior to consent. A patient who declines to
participate in research or experimentation is entitled to the most effective care that the hospital
can otherwise provide.
14. The patient has the right to expect reasonable continuity of care when appropriate and to
be informed by physicians and other caregivers of available and realistic patient care options
when hospital care is no longer appropriate.
15. The patient has the right to be informed of hospital policies and practices that relate to
patient care, treatment, and responsibilities. The patient has the right to be informed of
available resources for resolving disputes, grievances, and conflicts, such as ethics
committees, patient representatives, or other mechanisms available in the institution. The
patient has the right to be informed of the hospital’s charges for services and available
payment methods.
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“Health is a
human necessity;
health is a human
right”
― James
Lenhart
Autonomy:
Informed
Consent
Bulawan, Andrew C.
 Informed Consent

 a process of communication between you and your health care

provider that often leads to agreement or permission for care

 the main goal of acquiring informed consent is to protect the

patient
 The Role of the Nurse

The nurse is responsible and accountable for the verification of and

witnessing that the patient or the legal representative has signed the
consent document in their presence and that the patient, or the legal
representative, is of legal age and competent to provide consent.
 Essential elements of
Informed Consent
1. Research Description
2. Risks and Discomforts
3. Benefits
4. Alternatives
5. Confidentiality
6. Contacts
7. Voluntary participation and withdrawal
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 Research Description

A clear statement that the clinical investigation involves research is

important so prospective subjects are aware that, although preliminary
data (bench, animal, pilot studies, literature) may exist, the purpose of
their participation is primarily to contribute to research (for example,
to evaluate the safety and effectiveness of the test article, to evaluate a
different dose or route of administration of an approved drug, etc.)
rather than to their own medical treatment.
 Risks and Discomforts

The informed consent process must describe the reasonably

foreseeable risks or discomforts to the subject. This includes risks or
discomforts of tests, interventions and procedures required by the
protocol (including standard medical procedures, exams and tests),
especially those that carry significant risk of morbidity or mortality.
 Benefits

The description of potential benefits should be clear, balanced, and

based on reliable information to the extent such information is
available.
 Alternatives

To enable an informed decision about taking part in a clinical

investigation, consent forms must disclose appropriate alternatives to
entering the clinical investigation, if any, that might be advantageous
to the subject.
 Confidentiality

The consent process must describe the extent to which confidentiality

of records identifying subjects will be maintained and should identify
all entities, for example, the study sponsor, who may gain access to the
records relating to the clinical investigation.
 Contacts

The consent process must provide information on how to contact an

appropriate individual for pertinent questions about the clinical
investigation and the subjects' rights, and whom to contact in the event
that a research-related injury to the subject occurs.
 Voluntary Participation and Withdrawal

This element requires that patient be informed that they may decline to
take part in the surgery.
 Autonomy:
Proxy
Consent/Legally
Acceptable
Representative
Baldevia, Klarence Lowell B.
 Proxy Consent/Legally Acceptable
Representative
is the process by which people with the legal right to consent to medical
treatment for themselves or for a minor or a ward delegate that right to
another person. There are three fundamental constraints on this
delegation:
1. The person making the delegation must have the right to consent.

2. The person must be legally and medically competent to delegate the

right to consent.

3. The right to consent must be delegated to a legally and medically

competent adult.
There are 2 types of proxy
consent for adults:

1. The First type is the power of

attorney to consent to medical
care.

2. The second type is the living

will.
Autonomy:
Privacy
Basalo, Kalei Damsel F.
Professional persons in health care delivery fields have legal and
ethical responsibilities to safeguard the confidentiality of
information regarding the clients in their care.

Protecting information gathered in association with the care of the

patient is a core value in health care. Privacy is important in our
profession.
Patients have a right to expect that their private medical information
will be kept confidential. Protecting information gathered in
association with the care of the patient is a core value in health
care. However, respecting patient privacy in other forms is also
fundamental, as an expression of respect for patient autonomy
and a prerequisite for trust.
Patient privacy encompasses a number of aspects, including personal
space (physical privacy), personal data (informational privacy),
personal choices including cultural and religious affiliations
(decisional privacy), and personal relationships with family
members and other intimates (associational privacy).
 Reasons to Protect Privacy and
Confidentiality

1. Rights of all people.

2. Establishes successful physician-patient or nurse-patient
relationship, and enables the practitioners to perform
their jobs better.
3. Protection of privacy and confidentiality benefits the
public health.
4. Breach may result to reputational and financial harm, or
personal harm to patients.
Confidentiality
Boco, Stephen Jil
 Confidentiality

 The state of keeping or being kept secret or private.

 The ethical duty of confidentiality refers to the obligation of an

individual or organization to safeguard entrusted information. The
ethical duty of confidentiality includes obligations to protect
information from unauthorized access, use, disclosure,
modification, loss or theft.
 Examples

 Confidential information includes non-public information

disclosed or made available to the receiving part, directly
or indirectly, through any means of communications or
observation.

 HIV Testing
 How is it important?

 It is important because confidentiality builds trust between

employer and employee or more like to patients, have an
obligation to keep the people’s information secure and
confidential.

 Handling confidentiality may be more practical, such as not

leaving sensitive documents in public spaces like printers and
having password access to certain documents and files
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“Confidentiality is a
good practice in
handling patients.”
 Veracity
Truth telling and Right to
Information
Bona, Chazzy Esah
 What is Veracity?

 the quality of being true or habit of telling the truth.

 an easy example of this is your best friend who tells you

whether you look good in your haircut, or if your new outfit
suits you.  
 In healthcare Ethics:

• requires that healthcare providers to be honest in their

interactions with patient

• WHY?
 In healthcare Ethics:

• TRUTH TELLING
- it shows respect for people and allows them to receive their
right of AUTONOMY.

Lying (it may be withholding certain element or the whole truth

or misleading the person) faces a great threat to the ethical
considerations of nursing and can risk you to face the court.
Also risks the patient’s well-being. 
IS IT OKAY FOR NURSES TO LIE FOR THE
PATIENT’S BEST INTEREST?
Fidelity
Bagarino, Retshil-An M.
 Fidelity

 Means nurses must remain true to professional promises,

such as the promise to provide high-quality, competent,
safe, and efficient patient care.

 It also means being supportive of patient decisions,

promoting patient autonomy and the furtherance of the
profession.
 5 Reasons Why Fidelity is Important in Nursing

1. Fidelity in nursing helps foster a trusting relationship between patients,

families, nurses, and healthcare team members.

2. When nurses practice fidelity, patients experience more favorable outcomes.

3. Fidelity in nursing practice results in increased patient satisfaction.

4. Fidelity in nursing promotes patient autonomy, which is beneficial to the

patient and the healthcare team.

5. Good habits are easily duplicated.

 What are some examples of fidelity in nursing?
1. If you tell a patient you will be back to check on them, follow through by
doing so.

2. Demonstrating role fidelity

3. Promoting patient autonomy

4. Being faithful to the nursing profession

5. Fulfilling commitments
Justice
Cabornida, Elsie Jhoy
 Justice

 The word justice is derived from the Latin word “jus”

which means “to bind or tie together”.

 This implies that patients have a right to fair and impartial

treatment.

 Justice is a complex ethical principle, it is concerned with

the equitable distribution of benefits and burdens to
individuals in social institutions, and how the rights of
various individuals are recognized.
 Principles of Justice

 Equality – the state of being equal.

 Fairness – impartial and just treatment or behavior without

favoritism or discrimination.

 Access – obtain something such as service.

 Importance of Justice

 Health justice gives human dignity to everyone, regardless

of who they are or where they came from. It means access
to equitable affordable quality care for all.
 Example

 If you were juggling multiple patients, you would not

provide better care based on who has the best insurance.
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“Everyone has
a right to be
healthy and to
be treated
fairly.”
Beneficence
Callosa, Tom Airon L.
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Introduction
 What is Beneficence?

 Beneficence, is an ethical principle that a nurse’s

action should promote good.

 It comes from the Latin word benefactum, meaning

"good deed.”

 Act in doing what’s in the patient’s best interest.

 “Does it benefit the patient?”

 Beneficence
The moral duty of physicians and
healthcare staff to promote the
wellbeing of their patients and
choose the course of action that
will lead to good outcomes for
them.
Beneficence often collides
with “autonomy” principle,
as the patient’s autonomy
can sometimes prevent the
physician from delivering
the best treatment.

For example: A patient who

broke her hips, but refuses
surgery for hip replacement.
 Beneficence Example:
 An eight-year-old child has been admitted to hospital with a significant open
fracture to their left leg. The limb is deformed with significant bleeding and
the patient is extremely distressed. The parents are demanding immediate
action be taken.

 If the bleeding is life-threatening, the limb sufficiently injured and the

risk of infection extremely high, then amputation could be a treatment
option. It would be “good” for the patient in as much as the injury
would be resolved and the threat to life from bleeding or infection
somewhat reduced.

 There are other interventions available to us that have better outcomes

attached. Using blood products to manage the bleeding, reducing the
fracture if possible and orthopedic surgery if necessary will have better
outcomes for this patient. That course of action is “more good” than
amputation.
 Key Concepts
What physicians must do to maintain beneficence:

 Physicians or health care professionals should keep their skills

and knowledge up to date to ensure they are fully capable
 They should consider individual patient needs
 The course of action is agreeable with the patient and meets their
expectations

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 Why is Beneficence important?

 Beneficence is important because it

ensures that healthcare professionals
consider individual circumstances and
remember that what is good for one
patient may not necessarily be great for
another.
 Questions:
 Beneficence comes from the Latin word benefactum, which
means _________?

 What should be done if a patient refuses treatment for a

life-threatening condition?
Non-Maleficence
Celis, Amor C.
 Introduction

Every nurse encounter ethical dilemma in various challenging

patient scenarios throughout his career. This can lead to increased stress
as they try to figure out what is the best course of action in each
circumstance. Ethical principles like nonmaleficence gives them a strong
framework for making rational choices.
 Definition

By definition, the term "nonmaleficence" derives from the ancient

maxim primum non nocere, which, translated from the Latin, means
"first, do no harm." The greatest good should be accomplished through
any public health action.
The principle of nonmaleficence holds that there is an obligation not to
inflict harm on others either unintentionally or deliberately. This
principle requires nurses to protect individuals who are unable to
protect themselves
The principle of nonmaleficence supports the following rules:
1.Do not kill.
2.Do not cause pain or suffering.
3.Do not incapacitate.
4.Do not cause offense.
Breach of the obligation to
cause no harm in the
absence of a specific intent
to harm is called
“negligence”. Negligence
is a violation of
nonmaleficence. Because
while there is no specific
intent to harm, reasonable
care was not taken to avoid
harm.
● The principle of nonmaleficence requires that every medical
action be weighed against all benefits, risks, and consequences.  
● Nurses apply this principle by choosing action that inflict the least
amount of harm in order to accomplish a desirable output. In medical
setting, it also applies to performing tasks appropriate to an
individual's level of competence and training. Further, it directs
nurses to prioritize the patient’s safety in all aspects of treatment.
 Relevance to Nursing

1.Serves as a direction when making critical decisions

 This is certainly relevant when opposing viewpoints,
challenging environment, or conflicts of opinion complicate
the decision-making process.
2. Ensure that individuals have clear standards to follow.
 Especially when deciding what measures they should and
should not undertake. As nurses we must be aware of
instances where harm may surpass benefit.
 Examples
1. During the endorsement process, the nurse notices that one of the
incoming nurses is clearly impaired and under the influence of illegal
drugs. The nurse immediately reports her observations to the charge
nurse and suggests that no patient be assigned to the impaired nurse
while his condition is unconfirmed. The nurse who reported the
impaired nurse with suspected substance abuse clearly demonstrated
nonmaleficence by preventing patients from suffering or being
injured.
 Examples

1. A patient with multi-resistant Tuberculosis (TB) refuses to visit the

hospital and is not adhering to the treatment regimen. Nonmaleficence
may overthrow the nursing principle of autonomy in this case to
protect the community by compelling the patient to receive proper
treatment. The risk of infecting the entire community in which the TB
patient lives, as well as the potential complications of TB for the
patient if left untreated are both significant.
 Examples

1. A nurse demonstrating nonmaleficence would perform multiple

checks and observe the 10 rights of drug administration before
administering medication to avoid a dangerous medication error.
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That in all
things
God may be
Glorified!