BIOETHICS HANDOUTS

MORALITY - Refers to the general area of right and wrong in theory and practice of human behaviour

ETHICS – it is a practical and normative science, based on reason, which studies human acts and provides norms for their
goodness or badness.

BIOLOGY - is the science concerned with the study of life and living organism.

BIOETHICS -It is a branch of applied ethics which investigates practices and developments in the life science and or
biomedical fields.

EVOLUTION OF BIOETHICS

1. Medical Ethics
Formulation of Medical Ethics:
a. Hippocratic Oath-(Hipppocrates, the Father of Medicine, Greece 460-357BC)
-Underscores the physician’s all-out concern for the patient to be kept from harm & injustice
- No prescription of fatal drugs
- Rule out any form of abortifacient
- No sexual relations between doctors & patients
- Moral significance of confidentiality or medical secrecy
- Fulfilment of the oath will bring about honor, fame & joy in medical practice
b. Percival’s Medical Ethics (England, 1803)
c. American Medical Association’s Code of Ethics (1847)
d. Followed by a supplement of similar code of ethics for many groups of health professionals such as:
dentists’ code of ethics, the teachers’ code of conduct, nursing code of ethics.
e. Other nonmedical professions contribute to the articulation of ethical issues such as: secretarial
ethics, business ethics, journalists ethics

2. Research Ethics- Second Phase in bioethical studies

- Biomedical Research-refers to the use of humans as experimental specimens.E.g. prisoners,
poor patients, children, fetuses.
- Use of non-consenting concentration camp prisoners during the dictatorial regime of Adolf
Hitler & the Nazis for the reproduction of “super offspring”.
- Third Reich (covers the years 1933-1945
- Nuremburg Code (1947) was drafted in an attempt to humanize the cruel
& barbaric nture of experiments

3. Public Policy -Emphasizes the participatory aspect of decision making in a democratic set-up with regard to the
formulation of public policies.

Health Ethics -It is “the division of ethics that focuses on human health
Professional Ethics -Professional ethics is a branch of moral science concerned with the obligations which a member of a
profession owes to the public, to his profession and to his clients.

THE HUMAN ACTS AND ACTS OF MAN

A.Knowledge
Human Acts- are performed with intellectual deliberation and freedom.
Acts of Man- refers to those which are performed in the absence of either or both of the two conditions
(of a human act)- knowledge and consent of the will.

B. Freedom - It is the condition of being able to act, move without restrictions

C. Voluntariness
ETHICAL SCHOOL OF THOUGHTS (THEORIES)

A.Teleological – or consequential (Greek word telos, teleos means end or purpose)

B.Deontological – (Greek word deon, deontos means discourse on duty or obligation)
C.Natural Law Ethics – St. Thomas Aquinas (1225-1274) a profound Italian philosopher and theologian.
-The source of moral law is reason itself because it directs us towards the good as the goal of our action, and
that good is discoverable within our nature

Threefold Natural Inclination of man:

Self-preservation
Dealing with others
Propagation of our species

Three determinants of moral action:

1.The object – which the will intends directly and primarily
2.The circumstances – the conditions which, when superadded to the nature of the moral act, will affect
its morality.
-Aggravating or mitigating circumstances
Who? – the person involved in the moral act, his prestige, rank, excellence.
What? – the quantity or quality of the moral object.
Where? – denotes the place where the act occurs.
By what means? – the means used in carrying out the act.
How? – the manner in which the action is done
When? – time element involved in the performance of the act ,quantity & quality
3.The end or purpose- a good act with a bad motive makes the moral action bad.

synderesis
-inherent capacity of every individual, lettered or unlettered, to distinguish the good from the bad
- voice of right reason or voice of conscience

d. Utilitarianism - an action or practice is right if it leads to the greatest possible balance of good consequences in the
world as a whole.

VIRTUE ETHICS in Nursing

VIRTUE ETHICS or CHARACTER ETHICS
- individual actions are based upon a certain degree of innate moral virtue.

3 Criteria of a virtuous character:

1. Virtuous acts must be chosen for their own sake
2. Choice must proceed from a firm and
unchangeable character
3. Virtue is a disposition to choose the mean

Florence Nightingale- virtue is an important trait of a good nurse

Nightingale Pledge - implies virtue of character as nurses promise purity, faith, loyalty, devotion,
trustworthiness, and temperance
Good character is the cornerstone of good nursing
A nurse with virtue will act according to principle
Aristotle - believe that virtue can be practiced and learned, so we can learn through practice.

FOCAL VIRTUES
1. COMPASSION - ability to imagine oneself in the situation of another
2. DISCERNMENT- sensitive insights involving acute judgment and understanding resulting in a decisive action
3. TRUSTWORTHINESS - a confident belief in the moral character of another person
4. INTEGRITY - soundness, reliability, wholeness, and an integration of moral character

Values - one set of personal beliefs and attitude about the truth, beauty and worth of any
thought, object or behavior. These are action oriented and give direction and meaning to one's life'.
 Personal values - are values internalized from the society or culture in which one lives.
Professional values - are values acquired during socialization into nursing from codes of ethics, nursing
experiences, teachers, and peers.
core values of nursing
Human Dignity - Is a respect for the inherent worth and uniqueness of individuals and populations.
Integrity - respecting the dignity and moral wholeness of every person without conditions or limitation
Autonomy
Altruism
Social justice
Other Nursing values: Safe & competent
Health & well –being
Choice
Dignity
Confidentiality
Justice
Accountability
Diversity

UNIVERSAL BIOETHICAL PRINCIPLES

1.PRINCIPLE OF AUTONOMY – mandate a strong sense of personal responsibility for one’s own life.
Elements of Autonomy:
a. Person should be respected
b. He should be able to determine personal goals
c. He should have the capacity to decide on plan of actions
d. He should have the freedom to act upon his choices

PATERNALISM – from the Latin word “pater or paternos” means father.

Types of Paternalism:
1. With regards to the recipient’s welfare:
a. Pure paternalism – justifies interventions into a person’s life for the sole welfare of that person.
b. Impure paternalism – justifies interference with another person not only for that person’s welfare but
also for the welfare of another
2. With reagards to the recipient’s defect and safety:
a. Restricted paternalism – supports interventions which overrides an individual’s action because of some
defect or weakness in that individual
b. Extended paternalism – individual is restrained from doing something because it is too risky or
dangerous
3. With regards to promotion of good and prevention of harm
a. Positive paternalism – for the promotion of good
b. Negative paternalism – for the prevention of
4. With regards to patient’s sense of values:
a. Soft paternalism – patient’s values are used to justify the intervention
b. Hard paternalism – patient’s values are not the ones used to justify paternalistic act.
5. With regards to the recipient of the benefit:
a. Direct paternalism – the individual who should receive the supposed benefit is the one whose values are
overriden or disregarded for his own good
b. Indirect paternalism –a particular individual will benefit if one person is restrained from doing
something
6. Personal paternalism - when an individual decides on the basis of his best knowledge and capacity for the
good of another person.
7. State Paternalism – refers to the control exerted by the legislature, an agency, or other governmental
bodies over a particular kinds of practice and procedures in medicine.

PATIENT’S RIGHTS
the moral and inviolable power vested in a person to do, hold, or demand something as his own.

TYPES OF PATIENTS RIGHTS

1. Right to informed consent
-refers to the knowledge or information about the consent to a particular form of medical treatment, before that
treatment is administered.
Types of consent
a. Admission agreement
b. Blood Transfusion consent
c. Surgical Consent
d. Research Consent
e. Special Consent

Functions of Informed consent

a. To avoid fraud and duress
b. To encourage self- scrutiny by professionals
c. To foster rational decision making
d. To involve the larger society in the debate

Elements of Informed Consent

a. Competence - This refers to a patient’s capacity for decision-making
A competent individual is:
Can make decision
Able to justify the decision
> Able to justify decision in a reasonable manner
b. Disclosure - This refers to the content of what a patient is told or informed about during the consent negotiation
c.. Comprehension -This refers to whether the information given has been understood
d. Voluntariness - This means that the consent must be from his own free will without being forced

2. Right to informed decision - refers to the necessary information of and understanding so a genuine deliberation is
carried out before making moral decision on a medical treatment
3. Right to informed choice
-. The patient has the right to be informed about all possible alternative courses of action to be taken, together
with the possible consequences
4. Rights to refuse treatment
- the patient has the right to refuse treatment to the extent permitted by law and to be informed of the medical
consequences of his action.
5. Right to self-determination
- the patient as an autonomous individual has the moral right to determine what is good for himself, usually
upon the advice of a health care provider

LIMITATIONS OF PATIENT’S RIGHTS

1. Patient’s rights do not include patient’s rights to be allowed to die
2. Patients in a moribund condition does not posses the necessary mental, physical, or emotional stability to make
decision
3. Patient’s rights are not absolute