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BioEthics Presentation (Philippines)

BioEthics Presentation (Philippines)

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  • 1. MSN I: BIOETHICS DEMELU D. MONTA, RN, MPA
  • 2. What is the relationship between ETHICS and the LAW? Are all laws ethical and just?
  • 3. System of process for of A formal binding rules makingor conduct that action logical andIndividuals’ cognitive consistent decisions of governs the behavior examination of right people in respect to based upon moral and wrong & good relationships with others beliefs.and with thebad. and government.
  • 4. FUNCTIONS OF LAW IN SOCIETY • To define relationships among members and to declare which actions are permitted and not permittedLatin: Lex • To describe what constraints may be applied to maintain rules, and by whom they maybe applied • To furnish solutions to problems • To redefine relationships between people when circumstances of life change.
  • 5. CHARACTERISTICS OF LAW 1. Authority or the right to declare the rule exists 2. That such rule isLatin: Lex pronounced or expressed and that its source can be identified 3. Right to enforce DECLARED IN WRITING & is OBLIGATORY
  • 6. CHARACTERISTICS OF LAW • The law establishes 1. Authority or the rules that define our right to declare the rights and rule exists obligations, and sets 2. That such rule is penalties for thoseLatin: Lex pronounced or who violate them. expressed and that its source can be • Law can serve as the identified public’s instrument 3. Right to enforce for converting DECLARED IN morality into clear- WRITING & is cut social guidelines. OBLIGATORY
  • 7. MARTIN LUTHER KING, JR.
  • 8. Hindi makataoang batas! Hindi makatarungan ang batas! What is the relationship between ETHICS and the LAW? Are all laws ethical and just?
  • 9. DEONTOLOGY vs. UTILITARIANISM: TRIAGE Is the law dealing with expectant tags ethical? “Do your sworn duty. “Do the greatest good The rightness & for the greatest number wrongness of an act of people.”depends upon the nature of the act, rather than the consequences.”
  • 10. Are all laws ethical? REASONS FOR THE DISCREPANCY:  Differences between ethical points of view: Usually… but not deontology & utilitarianism. necessarily true. Some  Human behavior andlaws can be considered to motivation are more be unethical and some complex than can be fairlyillegal acts are considered reflected by law. by many to be ethical.  The legal system judges action rather than motivation.  Laws change (ex. Rape – RA 8353 & DofD, RH Bill, Abortion).
  • 11.  To ensure that the nurse’s decision and actions are consistent with current legal principles.  To protect the nurse from liability.FUNCTIONS OF LAW IN NURSING YES!  It provides a framework for establishing which nursing actions in the care of clients are legal.  It differentiates the nurse’s responsibilities from those of other health professionals.  It helps establish the boundaries of independent nursing action.  It assists in maintaining a standard of nursing practice by making nurses accountable under the law.
  • 12. NURSING JURISPRUDENCE JURISPRUDENCE Juris + Prudentia  is defined as a branch of law Latin which deals with the study of nursing laws, lawsuits, Juris Law or liabilities, legal principles, legal knowledge rules and regulations, case laws and doctrines affecting Prudentia one who behaves the nursing practice. prudently or wisely because he has knowledge of thepossible consequences of a particular action
  • 13. General or Individual orKINDS OF LAW Public Law Private Law International Civil Law Law Divine Law Law promulgated Constitutional Mercantile by our Creator Law Law Administrative Procedural Law Law Human Law Law promulgated by man to regulate human Criminal Law relations Religious Law
  • 14. “Ignorance of the law excuses no man; Not that all men knowthe law, but because „tis an excuse every men will plead, and no man can tell how to confute John Selden him.” Ignorantia legis neminem excusat
  • 15. Sources of law in the Philippines Constitution Legislations or statutes Regulations issued by the Executive Branch of the government Case decisions or judicial opinions / Common Law Presidential Decrees – Examples:  PD 651 – Birth Registration within 30 Days.  PD 996 – Compulsory Immunization of children below 8 yrs old against Preventable Diseases.  PD 442 – New Labor Code Letters of Instructions – Ex. LOI 1000 – Members of accredited professional organizations are given preference in hiring or attendance to seminars. Administrative law – “Implementing Rules and Regulations”  RA 9173 – Philippine Nursing Act of 2002  RA 6758 – Salary Standardization of Government Employees (SG: 15)
  • 16. Branches of Law that are directly applicableto Filipino nursesConstitutional Constitutional LawCriminal Criminal LawCivil Civil LawLabor Labor LawAdministrative Administrative LawCivil Service Civil Service LawCase Case Law
  • 17. Branches of Law that are directly applicableto Filipino nursesConstitutional  Constitution of the Philippines or Saligang Batas ng Pilipinas (1987)Criminal  Supreme law of the Philippines  Divided into 18 parts calledCivil ARTICLES.  Article III – Bill of RightsLabor  Article IX – Constitutional CommissionsAdministrative  Article XI – Accountability of Public OfficersCivil Service  Article XIII – Social Justice and Human Rights.Case
  • 18. Branches of Law that are directly applicableto Filipino nurses ARTICLE III. BILL OF RIGHTSConstitutional  Section 1. No person shall be deprived of life, liberty, or property without due process ofCriminal law, nor shall any person be denied the equal protection of the laws. (CRIMINAL LAW, ex. Homicide, murder)Civil  Section 2. The right of the people to be secure in their persons, houses, papers, and effectsLabor against unreasonable searches and seizures of whatever nature… (Civil Law, Ex. Assault, Battery, etc)Administrative  Section 5. No law shall be made respecting an establishment of religion, or prohibiting theCivil Service free exercise thereof. (Transcultural Nursing)  Section 8. The right of the people, includingCase those employed in the public and private sectors, to form unions, associations, or societies for purposes not contrary to law shall not be abridged. (PNA)
  • 19. Branches of Law that are directly applicableto Filipino nursesConstitutional ARTICLE IX. CONSTITUTIONAL COMMISSIONSCriminal 1. Common Provisions 2. The Civil Service CommissionCivil 3. The Commission on Elections 4. The Commission on AuditLabor ARTICLE XI – ACCOUNTABILITY OFAdministrative PUBLIC OFFICERS  Board of NursingCivil Service  RA 9173 – Philippine Nursing Act of 2002Case  Roles of BON  Leakage  NLE NLE
  • 20. Branches of Law that are directly applicableto Filipino nursesConstitutional ARTICLE XIII. SOCIAL JUSTICE & HUMAN RIGHTSCriminal 1. LaborCivil 2. Agrarian and Natural Resources ReformLabor 3. Urban Land Reform and HousingAdministrative 4. Health 5. WomenCivil Service 6. Roles & Rights of People’sCase Organization 7. Human Rights
  • 21. Branches of Law that are directly applicableto Filipino nursesConstitutional  branch of law that governs and regulates the relationship ofCriminal employers and employees. The Labor Code must be read withCivil caution because it is one of theLabor most frequently amended laws in the country.Administrative  P.D. 442- Labor CodeCivil Service Defines among other things, hours of work, contract and nurse staffing inCase industrial clinics  Lawyers Labor
  • 22. Branches of Law that are directly applicableto Filipino nursesConstitutional  branch of law which deals with the activities or functions of executive orCriminal administrative agencies such as the departments, bureaus, boards, orCivil commissions or all other offices under the administrative supervision of theLabor office of the President. An example ofAdministrative this – Professional Regulations Commission (PRC).Civil ServiceCase
  • 23. Branches of Law that are directly applicableto Filipino nursesConstitutional  branch of law which deals with the civil service in all branches, subdivisions,Criminal instrumentalities and agencies of the government, including governmentCivil owned and controlled corporations (GOCC).Labor  Related to HIRING OF QUALIFIEDAdministrative APPLICANTS (TPH)Civil ServiceCase
  • 24. Branches of Law that are directly applicableto Filipino nursesConstitutional  that body of the prevailing jurisprudence or decisions of theCriminal Supreme Court interpreting theCivil laws or the Constitution or applying them to certain sets ofLabor facts or actual cases ofAdministrative controversies.Civil ServiceCase
  • 25. DEFINITION CIVIL LAW CRIMINAL LAW branch of law that pertains  branch of law which to the “organization of the defines crimes, their family and the regulation of nature and punishment. property. “ (Tolentino, Criminal law covers 1990). offenses resulting to Republic Act 386 – New injuries or death of the Civil Code (NCC) or the Civil patient. Code of the Philippines, is the principal legal  The principal legal document in the study of document in the study of civil law in the Philippines Criminal Law in the EO 209 – The Family Code Philippines is Act No. related to Informed 3815 – Revised Penal Consent. Code (RPC)
  • 26. General or Individual orKINDS OF LAW Public Law Private Law International Civil Law Law Divine Law Law promulgated Constitutional Mercantile by our Creator Law Law Administrative Procedural Law Law Human Law Law promulgated by man to regulate human Criminal Law relations Religious Law
  • 27. Negligence Unintentional Malpractice AssaultTORTS Battery False Intentional Imprisonment Invasion of Privacy Libel Defamation Slander
  • 28. LAWSUIT – court proceedings CRIMINAL CASE CIVIL CASERegular Court > judge WHERE PRC > BONMoralTurpitude GROUND Sec. 23: Revocaion or suspension of licenseConviction VERDICT GuiltyImprisonment PUNISHMENT Revocation/suspensionRespondent NURSE DefendantComplainant PATIENT Plaintiff• Subpoena Ad Nurse is called to: • SummonTestificandum • Summon• Subpoena Duces Tecum
  • 29. is a civil wrong committed against a person or a person’s property.Torts are usually litigated in court by civil action betweenindividuals.
  • 30. What is the difference betweenIntentional Tort Unintentional Tort the act was done on  do not require intent purpose or with intent; but do require the no harm, injury or element of harm. damage is needed to  Ex. Negligence and be liable. malpractice Ex. Assault & Battery
  • 31. Intentional Torts What is the  Assault - an attempt or threatdifference between to touch another person ASSAULT unjustifiably; mental or physical & threat BATTERY Ex. forcing a pt. to take his medication or treatment, even simple gestures  Battery - physical harm through willful touching of person or clothing without consent. Ex. giving of injection without pt’s consent
  • 32. Informed Consent What is  free and rational act thatInformed Consent presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consent.  signed by the patient or his authorized representative/legal guardian upon admission is for initial diagnosis and treatment. Subsequent treatments or operations require individual informed consent, except for emergencies.
  • 33. Informed Consent What are the  Express Consent – obtained by TYPES of having or requiring a patient to sign a written consent, whether in his/herInformed Consent own statement or in a prescribed legal document, or thru an oral agreement. Whether oral or written, consent must be understood by the patient and witnessed by another person to comply with the requirements of law.  Implied Consent – arise by implication of certain circumstances. This is manifested in case of medical emergency (Doctrine of Emergency – administrative consent by physician in charge)
  • 34. Informed Consent What are the 1. The diagnosis and explanation Essential Elements of the conditionof Informed Consent 2. A fair explanation of the (to be done by the procedures to be done and used MD & witnessed by and the consequences RN) 3. A description of alternative treatments or procedures 4. A description of the benefits to be expected 5. Material rights if any 6. The diagnosis if the recommended care, procedure is refused.
  • 35. Informed Consent WHO should give  THE PATIENT HIMSELF the CONSENT  AUTHORIZED REPRESENTATIVE IF:  Minor  Mentally ill  Physically unable  If a nurse is uncertain if the client is competent or not – consult supervisor or physician.  Determination of competency is not only a medical decision, it is one made through court hearings.
  • 36. Informed ConsentWHO are authorized  Minor – RA 6809: 21> 18 to represent the  Parents patient if –  Grandparents MINOR or  paternal (1st priority) mentally Ill  maternal (2nd priority)  Eldest brother or sister who is not a minor  Guardians  Relatives  Godparents  Fiancé (man)/fiancée (woman)  Best friend  Teacher (Doctrine of Loco Parentis)
  • 37. Informed Consent WHO are  For married minors or emancipated EXEMPTED minors (free from restrictions), the From Parental husband/wife has the legal right to Consent give consent.  EO No. 209 Family Code of RP - Art. 236. Emancipation for any cause shall terminate parental authority over the person and property of the child who shall then be qualified and responsible for all acts of civil life.
  • 38. Informed ConsentREFUSAL to Consent  A patient who is mentally and legally competent (sane mind and of legal age) has the right to refuse the touching of his body or to submit to a medical or surgical procedure no matter how necessary  he should be made to fill out the release form to protect the hospital and/or agency and its personnel from any liability
  • 39. Informed Consent Consent for  Sterilization is the termination of the Sterilization ability to produce offspring. The husband and wife must consent to the procedure if the operation is primarily to accomplish sterilization. When it is medically necessary, the patient’s consent alone is sufficient.  Ex. Tubaligation:  Wife -Yes  Husband – No  You cannot follow both so ?? You get consent only for MARITAL HARMONY
  • 40. Intentional Torts What is  Doctrine is Liberty of Abode FALSE  the unjustifiable detention of aIMPRISONMENT person without legal warrant to confine. A client must not be detained against his will.  occurs when the person is not allowed to leave a health care facility when there is no legal justification to detain the client.  occurs when restraining devices are used without an appropriate clinical need.
  • 41. Intentional Torts What is  Right to privacy is the right Invasion of to be left alone Privacy &  Right to be free from Breach of Confidentiality unwarranted publicity  Exposure to public view  Divulge information from patient’s chart to improper sources or unauthorized person
  • 42. Intentional Torts Exceptions Confidential information can be revealed if: Patient consent Inform HCT (HIV Counseling and Testing) for precautionary measures Crimes, child abuse, BWS (Battered Woman Syndrome) Communicable disease- R.A. 3573 (Law on Notifiable Diseases) Ethics – Utilitarian Principle
  • 43. SITUATION: BREACH OFINVASION OF PRIVACY CONFIDENTIALITYNurse to another nurse: Nurse to another nurse:“Alam mo bang second wife “Do you know STD pala yung pala ni mayor yung nasa sakit nung nasa room 69?” room 143?” Camera inside the hotel room? Camera inside the Operating Room?
  • 44. Intentional Torts What is  Character assassination Defamation  There must be a third person who hears or read the comment before it can be considered defamation  TYPES:  Slander - oral defamation  Libel - written words
  • 45. QUESTIONS:The nurse writes the Two janitors are having afollowing note in the client’s heated argument as to whochart, “the physician is shall dispose the waste of a patient with typhoid fever. Theincompetent because he first one called the otherordered the wrong drug “lazybone” and “pain in thedosage.” This statement neck” within the hearing of themay lead to a charge of: rest of the nurses. The case is: A. Assault A. Libel B. Slander B. Slander C. Libel C. Invasion of privacy D. Invasion of privacy D. Negligence
  • 46. QUESTIONS: Who OWNS theWhich of the followingpersons cannot have the MEDICAL CHART?access to the patient record? A. Patient B. Doctor C. Nurse A. physical therapist D. Hospital B. lawyer of the family Who OWNS the C. the patient COMMUNICATION? D. speech therapist A. Patient B. Doctor C. Nurse D. Hospital
  • 47. MEDICAL CHART What is  Arrange and organize the DUTY of the chart nurse  Ex. If the chart was not arranged properly and someone was able to read the contents: A. Invasion of Privacy B. Breach of Confidentiality C. Negligence
  • 48. Unintentional Tort What is  Failure of perception. Negligence?  Failure to do something which a reasonable and prudent person should have done.  2 TYPES:  Commission – wrong doing  Omission – total neglect of care (didn’t do anything)  Example: Banana peal  Gross Negligence – involves extreme lack of knowledge, skill, or decision making. Ex. Position during NGT Feeding
  • 49. Unintentional Tort What are the 1. Existence of a duty on the part4 Elements of of the person charged to use Negligence? due care under circumstances 2. Failure to meet the standard of due care 3. The foreseeability of harm resulting from failure to meet the standard 4. The fact that the breach of this standard resulted in an injury to the plaintiff
  • 50. Unintentional Tort What are the  RES IPSA LOQUITUR “The thing speaks for itself.” Doctrines of  The injury is enough proof of negligence. Negligence?  In the absence of 1 – it will not apply:  The nurse failed to make use of appropriate judgment (Common Sense)  The instrument used is within the exclusive control of the nurse  There is lack of voluntary participation on the part of the patient.  RESPONDEAT SUPERIOR “Let the master answer for the acts/liability of the employee/subordinate.”  The liability is expanded to include the master as well as the employee.  There must be an employer-employee relationship.
  • 51. Unintentional Tort What are the  FORCE MAJURE - irresistible force; Doctrines of unforeseen or inevitable. No person Negligence? shall be responsible for those events which cannot be foreseen.  Examples: Fire, Flood, Typhoon, Earthquake  CAPTAIN-OF-THE-SHIP DOCTRINE wherein the surgeon is presumed to be the responsible for everything that happens within the confines of the OR.
  • 52. Unintentional Tort What are some  Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath Examples  Objects left inside the patient’s body; sponges suction tipsof Negligence?  Falls of the elderly, confused, unconscious, sedated patients  Falls of children whose bed rails were not pulled up and locked  Mistaken identity- drug given to the wrong patient  Wrong medicine, wrong concentration, wrong route, wrong dose  Defects in the equipment  Administration of medicine without doctor’s prescription.
  • 53. Unintentional Tort What is  Failure of action. Malpractice?  Doing acts or conducts that are not authorized or licensed or competent or skilled to perform, resulting to injuries.  Stepping beyond one’s authority  Negligent act committed in the course of professional performance  Ex. RN exceeding the Scope of Nursing Practice.
  • 54. CRIME Definition  it an act committed in violation of public (criminal) law and punishable by fine or imprisonment.  A crime does not have to be intended in order to be a crime.  For example – a nurse may accidentally give a client an additional and lethal dose of a narcotic to relieve discomfort  Two elements:  Criminal act - action  Evil/criminal intent – plan/motive
  • 55. Felony vs. Misdemeanor Differentiate  FELONY - a public offense committed with deceit and fault.  crime of a serious nature, such as murder, punishable by a term in prison.  MISDEMEANOR - offense of a less serious nature and is usually punishable by fine or short term jail sentence, or both.  Ex. A nurse who slaps a patient’s face.
  • 56. Classification of Felony According to DEGREE OF Capital above P6k grave PUNISHMENT punishment or >6yrs & 1 day Less 1 month and not > P 6 K 1 day to 6 but not grave years <P200 Light 1 day to 30 fine not > felony days P 200
  • 57. Classification of Felony According to DEGREE OF 1. Consummated all elements EXECUTION executed, with successful result 2. Frustrated all elements executed but no successful result 3. Attempted not all elements executed, no successful result
  • 58. Nursing Liability According to PRINCIPAL a. By direct participation- Primary author doer of the act DEGREE OF b. By inducement - directlyPARTICIPATION force or induce others c. By cooperation- indispensable ACCOMPLICE “cooperates before the A person who act” BUT absent at the cooperates time crime is committed. ACCESSORY “cooperates after the fact” Profits Conceals/ destroys evidence Assists in the escape of the principal
  • 59. Moral Turpitude Define  is the act of baseness or vileness or depravity in social order. It is any act contrary to law, morals, honesty & justice (Black’s Law Dictionary).  Chances are, nurses may be called on to testify on the matter of injuries or death of the patient.  Subpoena Duces Tecum – order of the court requiring you to bring the chart in the court proceeding  Subpoena Ad Testificandum – order to appear in court (to testify)
  • 60. Useful pieces of evidence for criminaloffenses resulting to Death of Patient  Body  Object on or with the body  Injuries sustained  Tissues and body fluids  Other medical evidences or findings
  • 61. Murder vs. Homicide Differentiate  Murder - unlawful & intentional (planned) killing of the human being  Homicide - unintentional killing of another person; committed without criminal intent.  HUMAN BEING = body + soul  Desecration of the Dead
  • 62. Parricide Define  killing by reason of blood relationship in a direct line.  It takes precedence over murder.  Inclusion to the rule: Spouse & legally adopted child.  Direct line: Grandparents  father  mother  Children  Collateral line: brothers & sisters (not parricide but homicide or murder)
  • 63. Infanticide & Abortion Define  Infanticide - killing of an infant less than 3 days or 72 hours.  If EXACTLY 3 days it will now be considered murder or homicide.  The number of days is more legal and binding than the intention.  Abortion - termination of product of conception before the age of viability.  Considered a grave felony.
  • 64. Robbery & Theft Define  Robbery - with force  Anyone who gets a personal property of another with the use of force, violence or intimidation.  Theft - without force. Anyone who gets the personal property of another without permission.
  • 65. QUESTIONSThe hospital research teamoffered Nica the opportunity A client in your med-surgto participate in research on unit has a cousin who is aa new therapy. The nurse- physician and wants to seeresearcher asked you to the chart. Which of theobtain consent. What is the following is the bestmost appropriate nursing response of the nurse?action?A. Be sure Nica understands A. Hand over the chart, anyway the the project before she signs cousin is a doctorB. Read the consent from to B. Call the attending physician and have the doctor speak with the Nica and allow her to ask Qs cousin (Dr – Dr)C. Refuse to be the one to C. Ask the client to sign an obtain Nica’s consent authorization and have someone review the chart with the cousin.
  • 66. QUESTIONSThe nurse caring for an older adulttears the skin of the patient whileremoving a piece of tape. The skin In which circumstance/s mayis attached to the upper arm and the nurse legally andto the tape. The nurse cuts theattached part of the skin with ethically disclosescissors in order to remove the confidential informationtape. The nurse fails tounderstand that if harm comes to about a client?the client during the act of cuttingthe skin with scissors, which ofthe following could the nurse becharged with? A. HIV – Status of a single male client to his family membersA. Malpractice B. The Dx of a pancreatic CA to the client’s SOB. Assault C. The Dx of uncontrolled seizureC. Negligence disorder of a taxi driver to the concerned government unitD. Acceptable practice D. All of the above
  • 67. QUESTIONS Which of the followingA hospital filed a case of situations would possiblydamages against a nurse for cause a nurse to be sued duebreach of contract. Who is to negligence?the nurse in the case? A. Nurse gave a client wrong medication, and an hour later, client complained of dyspnea B. B. While preparing a medication, the nurse notices that instead of 1 tablet, she put two tablets into the client’s medicine cup C. As the nurse was about to administer A. complainant medication, the client questioned why the medication is still given B. accused when in fact the physician discontinued it. C. defendant D. Nurse administered 2 tablets of analgesic instead of 1 tablet as D. plaintiff prescribed. Patient noticed the error and complained.
  • 68. QUESTIONS Wilfred, 30 years old male, was brought to the hospital due to A telephone order is given injuries sustained from a vehicular accident. While being for a client in your ward. transported to the X-ray What is your most department, the straps accidentally broke and the client appropriate action? fell to the floor hitting to his head. In this situation, the nurse is: A. Copy the order on to the chart and sign the physician’s name as closeA. not responsible because of the to his original signature as possible doctrine of respondent superior B. Repeat the order back to the physician, copy onto the orderB. free from any negligence that sheet and indicate that it is a caused harm to pt. telephone orderC. liable along with the employer for C. Write the order in the client’s chart the use of a defective equipment and have the head nurse co-sign it that harms the client D. Tell the physician that you can notD. totally responsible for the take the order but you will call the nurse supervisor negligence
  • 69. QUESTIONS Ivy is two-months pregnant. The nurse out of pity Her parents do not know this. unhooked the patient She informed her friend Noemi from a respirator. The about the problem. Noemi then referred Ivy to Nica, an patient died after 15 abortionist. Ivy had an minutes. This type of abortion. If those involved will felony is: be charge legally, who is considered the principal? A. Consummated A. Ivy B. Frustrated B. Noemi C. Attempted C. Nica D. Murder D. All of them
  • 70. That is all… ThankYou!