Health Care Docs for Nursing students

1. Health Care Ethics
ETHICS
 a philosophical and practical science
that deals with the study of the morality
of human acts or human conduct
 rooted from the greek word ethikos
which means moral duty
Ethics as a Science
Ethics is a systematized body of knowledge;
therefore, ethics is a science.
Ethics as a Philosophical Science
Ethics take a look at the ultimate cause,
principle and truth by the use of human reason
alone; therefore, ethics is philosophy
Ethics as a Practical Science
study of that which is to be acted upon is a
practical science; ethics deals with the study of
that which is to be acted upon; therefore ethics
is a practical science.
Customs
long established practices common to a
particular community, class or race
Habit
applied to an individual and implies the
repetition of the same action as to develop a
natural, spontaneous or rooted tendency or
inclination to perform it
Practice
applies to a regularly followed procedure or
pattern in conducting activities
Etiquette
observance of social norms as required by good
breeding
Morality
refers to social conventions about right and
wrong human conduct that are so wildly
shared that they form a stable, communal
consensus in a certain population or in a certain
specific society. (Beauchamp and Childress
(1994)
Common Morality
comprises socially approved norms of human
conduct
Biology
science of life and of living organisms,
including their structure, function, growth,
origin, evolution, and distribution. It includes
botany and zoology and all their subdivisions
BIOETHICS
 coined from the terms, bios, which mean
life and ethics
 term used to describe the application of
ethics to biological sciences, medicine,
and related fields.
 is a systematic study of human
behavior, specifically, in the fields of life
sciences and health care, as examined in
the light of moral values and principles.
 in philosophy, it is a branch of ethics
that is concerned with issues
surrounding health care and the
biological sciences.
HEALTH ETHICS
science that deals with the study of the morality
of human conduct concerning health and
health care.
PRINCIPAL ETHICS
 a division of ethics that relates to
professional behavior.
 includes the moral duty or obligations
which a member of the profession owes
to the public, his profession, to his
colleagues, and to his clients.
Main Functions of Principal Ethics
 to reassure the public
 to provide guidelines for the profession
to discipline and regulate its members
 to provide a framework on which
individual members can formulate their
decisions

2. Health Care
the prevention, treatment and management of
illness and the preservation of mental and
physical well- being through the services
offered by the medical and allied health
professions
2 PARTS OF ETHICS
General ethics – deals with basic principles
which are the morality of human acts.
Social Ethics – tackles the basic principles
affecting man as a member of society
IMPORTANCE OF ETHICS
 Rapid changes in the society,
environment, and especially in the
fields of medicine and biotechnology,
that touch our lives
 With the advances in biotechnology and
biomedicine, there is a need to establish
bioethical guidelines in order to draw a
line between what is morally and
ethically correct and what is not.
 It enhances the competence of members
of the health profession by
understanding that the patient is a
person and a holistic individual.
What is morality?
 the quality of human acts where the acts
could either be good or right, evil or
wrong.
What makes good, good?
 an act is good when it is in agreement of
conformity with the dictates of right
reason.
What makes evil, evil?
 an act is evil when it is not in agreement
or conformity with and is in
transgression of the dictates of right
reason.
What makes a reason RIGHT?
 reason is considered right when it is
conformity with the truth- which must
be objective in its sense. Meaning, the
truth is not that which acceptable only
to some but not to others as relativist
would contend:” what is true for you,
may not true form me”- and vice versa
THEORIES AND PRINCIPLES
A. Ethical Theories
 Deontology
 Teleology
 Utilitarianism
Deontology
 is an ethical study or ethical inquiry
regarding duty
 coined by Charlie Dunbar Broad
 “deon” means obligation or duty
 “logos” mean inquiry or study
 do the right thing, even if that produces
more harm (or less good) than doing the
wrong thing
Deontologists’ moral rules:
1.It is wrong to kill innocent people
2.It is wrong to steal
3.It is wrong to tell lies
4.It is right to keep promises
Deontological Theorists
1. Sir Immanuel Kant
 Epistemology, Metaphysics, Ethics
Logic
2. Sir William David Ross
 Ethics, Greek Philosophy
IMMANUEL KANT
Categorical Imperative
the most significant and important idea in
deontology
2 Critical Elements
1. Perfect Duty to Universalizability - Kant
argues that all people have a perfect duty to act
in such a way that their actions could be
universalized and no logical contradiction
would occur.

3. 2. Ends in Themselves – we should act in such
a way that we do not treat people as mere
means to ends, but as ends in themselves
HIGHLIGHTS
 Kant, unlike some other philosophers,
argues that people have free will.
 Kant is perhaps best known for his
belief that lying is always wrong
because it treats people as means rather
than as ends in themselves
 People have dignity and need to be
respected, they are not machines
 He also argued against suicide, stating
that its universalization would result in
a logical contradiction
 Kant argues that a person is good or
bad depending on the motivation of
their actions and not on the goodness of
the consequences of those actions
 Kant argues that one can have moral
worth (i.e., be a good person) only if one
is motivated by morality
Duties to Others
Perfect
1. Tell truth
2. Don’t break promises
3. Don’t steal, murder, enslave
4. Develop talents
5. No suicide of other forms of self-
destruction
Imperfect
1.Help others in need
2. Assist others achieve goal
SIR WILLIAM DAVID ROSS
 made significant contributions to the
translation and interpretation of the
works of Aristotle and to moral
philosophy
 The Right and the Good (1930) is
arguably one of the most important
works of moral philosophy published in
the twentieth century
Prima Facie Duties
a duty that is binding or obligatory, or other
things being equal
Elements of the Moral Theory
 A variety of relations among
individuals are morally significant
 Each of these relations is the foundation
of what Ross calls a "prima facie duty.”
 According to Sir William David Ross, a
prima facie duty is a duty we think we
should follow generally before any
particular situations enter into the
picture
 According to him, we determine a
prima facie duty by our moral intuition
because a prima facie duty is self-
evident
Prima Facie – a Latin term which means “on
the first appearance” or based on the first
impression
Ross’ Distinctive Moral Framework
The RIGHT
Ross believes the prima facie duty of:
1. fidelity, that is, a duty to keep our promises
2. reparation or a duty to act to right a previous
wrong we have done
3. gratitude, or a duty to return services to
those from whom we have in the past accepted
benefits
4. promote a maximum of aggregate good
5. non-maleficence, or a duty not to harm
others.
6. Duties of Self-improvement- improving
one's own condition with respect to virtue or
intelligence
7. Duties of Justice or Fairness - duty to
prevent or correct such a mismatch
- requires that one act in such a way that one
distributes benefits and burdens fairly.
Notes:
He does not see these duties as equally
important.
He holds that the duty of non-maleficence is
more important than the duty to promote a
maximum of aggregate good

4. He suggests that the duties of fidelity,
reparation, and gratitude are in general
weightier than the duty to promote the good
It is important to Ross that we can stand in the
obligation-generating relations ‘of promisee to
promiser, of creditor to debtor, of wife to
husband, of child to parent, of friend to friend,
of fellow countryman to fellow countryman,
and the like.
THE GOOD
Ross contends that four things are intrinsically
good:
1. Justice
2. Pleasure
3. Knowledge
4. Virtue – righteousness
Notes:
Ross holds that virtue is the most important
and that some virtuous motives are more
important than others (e.g., the desire to do
one's duty is more valuable than the desire to
promote others’ pleasure
Knowledge is the next most important of the
values. Knowledge is more important than
right opinion, since the former has certainty
which the latter lacks
Knowledge of general principles is
intellectually more valuable than knowledge of
isolated matters of fact
Prima Facie Wrong
An act is prima facie wrong when there is a
moral reason against doing the act, but one that
can be outweighed by other moral reasons.
An act is prima facie wrong when it has at least
one wrong-making feature.
Prima Facie Duties
An act is a prima facie duty when there is a
moral reason in favor of doing the act, but one
that can be outweighed by other moral reasons.
An act is a prima facie duty when it has at least
one right-making feature. (‘prima facie right’)
TEOLOGY [Consequence-Oriented]
 judge the rightness or wrongness of
decisions based on outcomes or
predicted outcomes.
 what is right maximizes some good
Teleological Ethics
 from Greek telos, “end”; logos,
“science”
 theory of morality that derives duty or
moral obligation from what is good or
desirable as an end to be achieved.
Consequence Oriented Theory
Utilitarianism
 the good resides in the promotion of
happiness or the greatest net increase of
pleasure over pain.
 Jeremy Bentham (1748- 1832) and John
Stuart Mill (1806- 1873) are the progeny
of utilitarianism
 Utilitarianism is a normative ethical
theory that places the locus of right and
wrong solely on the outcomes
(consequences) of choosing one
action/policy over other
actions/policies.
 an ethical theory that espouses the
concept that if one is happy or pleased
with one’s act, then one is a good
human person
 the view that the right moral action is
the one that maximizes happiness for all
Two divisions of Utilitarianism:
1. Act – the man should act so as to
produce the greatest happiness to the
greatest number of people.
2. Rule – holds that human persons should
act so that the rule governing their
actions will produce the greatest
happiness for the most number of
people.
Two Classic Utilitarianism
1.Jeremy Bentham (1748- 1832)
2. John Stuart Mill (1806- 1873)
Jeremy Bentham
 hedonistic philosophy (from the Greek
work hedone means pleasure)

5.  held that humans were ruled by two
sovereign masters — pleasure and pain.
We seek pleasure and the avoidance of
pain, they “…govern us in all we do, in
all we say, in all we think…”
 also promulgated the Principle of
Utility as the standard of right action on
the part of governments and
individuals.
Principle of Utility
actions are approved when they are such as to
promote happiness, or pleasure, and
disapproved of when they have a tendency to
cause unhappiness, or pain.
Seven categories and questions as a method
for determining the level of utility:
1. Intensity – how intense
2. Duration – how long will it last
3. Certainty – how sure are you that it will
happen
4. Propinquity or Proximity – how long
will you experience
5. Fecundity – how many times
6. Purity – pain free
7. Extent – how many will experience
Ethical Relativism
 Also known as Moral Relativism
 claims that there are no universal or
absolute principles
 standards of right or wrong are always
relative to a particular culture or society
Situation Ethics
 advocated by Joseph Fletcher, an
American protestant, a medical doctor
and the author of SITUATION ethics:
The New Morality
 states that the moral norm depends
upon a give situation, but whatever the
situation maybe, one must always act in
the name of Christian love
 A situation in this context refers to
human condition or any state of moral
affairs and issues that demands a moral
judgement or action
Christian Love cited by Fletcher
1. Erotic Love
2. Filial Love
3. Agapeic Love
Six Propositions fundamentals of Christian
conscience:
 Only one thing is intrinsically good,
namely love: nothing else
 The ultimate norm of Christian
decisions is love: nothing else
 Love and Justice are the same, for
justice is love distributed
 Love wills the neighbor’s good whether
we like him or not
 Only the end justifies the means:
nothing else
 Decisions ought to be made
situationally, not prescriptively
Pragmatism
 attributed to Charles Peirce and William
James
 more of a theory of knowledge, truth,
and meaning than morality.
 holds that the true and valid form of
knowledge is one which is practical,
workable, beneficial and useful.
 being practical is the one that we can
practice, and it produces practical
results
 being workable, it is one that we can put
to work, it can be worked out, and it
works
 being beneficial, it benefits people; and
is being useful, it is one can be used to
attain good results
Virtues of a HC Worker [8]
 Fidelity
 Integrity
 Honesty
 Humility
 Respect
 Compassion
 Prudence
 Courage
Nursing Core Values [5]
Human Dignity, Integrity, Autonomy,
Altruism, Social Justice

6. Ethical Principles
 Autonomy
 Patient’s Rights
 Patient’s Bill of Rights
 Informed consent
 Proxy Consent/ Legally Acceptable
Representative
 Confidentiality
 Privacy
 Confidentiality
 Veracity
 Truth telling
 Right to Information
 Fidelity
 Justice
 Beneficence
 Non-maleficence
Major Bioethical Principles
1. Respect for Autonomy
Implications of the Patient’s Autonomy
1.The patient is responsible for his choices and
decisions.
2. His human dignity is upheld and recognized
3. His personal value and worth are affirmed
4.His patient’s rights are protected and are not
unduly interfered with
5. He cannot be constrained or forced to make
decisions and perform his actions against his
will
Application of principles of autonomy to the
care of the sick
A. Rights of a Patient
1.The patient has the right to considerate &
respectful care, irrespective of socio-economic
status.
2. The patient has the right to obtain from his
physician complete current information
concerning his diagnosis, treatment and
prognosis in terms the patient can reasonably
be expected to understand
3. The patient has the right to receive from his
physician information necessary to give
informed consent prior to start of any
procedure and or treatment.
4. The patient has the right to refuse treatment
/ life-giving measures, to the extent permitted
by law and to be informed of the medical
consequence of his action
5. The patient has the right to every
consideration of his privacy concerning his
own medical care program. Case discussion,
consultation, examination and treatment are
confidential and should be conducted
discreetly. Those not directly involved in his
care must have the permission of the patient to
be present.
6. The patient has the right to expect that all
communication and records pertaining to his
care should be treated as confidential.
7. The patient has the right that within its
capacity, a hospital must make reasonable
response to the request of patient for services
8. The patient has the right to obtain
information as to any relationship of the
hospital to other health care and to other health
care and educational institutions in so far as his
care is concerned. The patient has the right to
obtain as to the existence of any professional
relationship among individuals, by name who
are treating him
9. The patient has the right to be advised if the
hospital proposes to engage on or perform
human experimentation affecting his care or
treatment. The patient has the right to refuse or
participate in such research projects.
10. The patient has the right to expect
reasonable continuity of care; he has the right
to know in advance what appointment times
the physicians are available and where.
The patient has the right to expect
that the hospital will provide a mechanism
whereby he is informed by his physician or a
delegate of the physician of the patient's
continuing health care requirements following
discharge.
11. The patient has the right to examine and
receive an explanation of his bill regardless of
source of payment.
12. The patient has the right to know what
hospital rules and regulations apply to his
conduct as a patient.

7. Informed Consent
refers to the patients deliberate and voluntary
acceptance of a health care procedure which
presupposes a sufficient disclosure of the
nature and goal of the procedure; its possible
side effects, risks and benefits and the available
medical options.
Other forms of consent
1.Consent by presumption- this is reasonably
presumed to be present in the subsequent
employment and series of procedures as they
are aligned with the primary procedure to
which consent is expressed
ex. Though it is not utterly expressed, consent
to perineal flushing is reasonably presumed
that is done after the patient is medically
assisted
2.Consent by Proxy - done when the patient is
not capable of giving informed consent and is
legitimately represented by a competent
surrogate who acts on his behalf.
the patient may either be unconscious, insane
or a minor/child who is out of reason or not at
the age of reason
4 components of informed consent:
1. You must have the capacity (or ability) to
make the decision.( Patients competence)
2.The medical provider must disclose
information on the treatment, test, or procedure
in question, including the expected benefits and
risks, and the likelihood (or probability) that
the benefits and risks will occur.
3.You must comprehend the relevant
information.
4.You must voluntarily grant consent, without
coercion or duress.
CONTINUATION [ Major Bio]
2. Justice
 rendering of what is due or merited (
Beauchamp and Childress,1979)
 derived from latin word jus which
means “right”
 the nurse does justice to the patient if
she/he cares for the patients in the
manner that he/she required for
his/her duty. The patient in turn
should, can reciprocate by what he/she
gets from the hospital by paying all his
hospital bills.
3. Non-maleficence
 “do no harm”
 principle of nonmaleficence injuncts
one’s avoidance of inflicting injury,
harm, or pain to others
4. Beneficence
 broad term applied to the range of
cluster of duties that require abstention
from harm and positive assistance
Four elements of the principle of beneficence
 One ought not to inflict evil or harm
(nonmaleficence)
 One ought to prevent evil or harm
 One ought to remove evil or harm
 One ought to do or promote good
5.Confidentiality
 is the right of an individual to have
personal, identifiable medical
information kept private. Such
information should be available only to
the physician of record and other
health care and insurance personnel as
necessary.
6.Veracity
 truth telling and right to information
7.Fidelity
 this includes keeping our promises,
doing what is expected of us,
performing our duties and being
trustworthy.