te | Nursing Ethic ETHICS came from the Greek word ethos which means moral duty. Ethics refers to a standard to examine and understand mora life. Ethical theories, principles and codes of conduct serve as guides of human conduct provided by ethical systems. Ethics studies how people make judgment in regard to right or wrong. Morals, on the other hand, are specific ways of behavior or of accomplishing ethical practices. Morality is derived from the Greek word moralis which refers to social consensus about moral conduct for human beings and society. Human decency, right or wrong, good or evil, proper or improper, cruel or benevolent acts are explained in terms of morality.' Ethics is about making choices that are best for the individual or society at certain times and in particular situations and then evaluating such choices and outcomes. Ethicist Joseph Fletcher differentiates morality from ethics. He states that morality is what you believe is right and good while ethics is the critical reflection about morality and rational analysis about it” Professional ethics is a branch of moral science concer: with the obligations that a member of the profession owes the public, Health care ethics, on the other hand, is the division of ethics that relates to human health, It resides in the realm human values, morals, customs, personal beliefs, and faith Bio-ethics is a specific domain of ethics that focuses 000" issues in the field of health care, It evolved into a discipline onits own asa result of life and death dilemmas faced by hea! care practitioners. It is a systematic study of human behav in the field of life science and health care in the light of My values and principles. While originally, bio-ethics was COP with ethical issues described with medical practice * jot 102Nursing Ethics expanded to issues surrounding health and biological sciences and social issues including environmental concerns. As members of the health team, nurses have to make independent decisions in the performance of their daily duties. Within the health team, however, many decisions are also made interdependently. Also, nurses are expected to exhibit bio-ethical behavior in their professional duties. Knowledge of ethical challenges enable them to hone their skills in decision making regarding their patients’ life-and-death issues and integrate ethical principles and theories into their practice thereby helping, them resolve moral conflicts. Nursing ethics is related to all the principles of right conduct as they apply to the profession. Nursing ethics reinforces the nurses’ ideals and motives in order to maximize the effectivity of their service. Oftentimes, nurses find it difficult to resolve ethical issues partly because they do not have the sensitivity to recognize ethical problems and conflicts or to display the needed knowledge and experience in every situation that they face. Johnstone defines nursing ethics as the “examination of all ethical and bio-ethical issues from the perspective of nursing, theory and nursing ethics.” Vercoe, et.al., emphasize that “the field of nursing ethics be focused on the needs and experiences of practicing nurses, the exploration of its meaning and that of ethical practice in terms of the perception of these nurses.” > ETHICAL PRINCIPLES AND OTHER APPROACHES Teleological Approach Teleology comes from the Greek word telos or “goal or end.” This is expressed in the maxim, “the right thing to dois the good thing to do.” The teleological approach is also termed as act utilitarianism where the good resides in the promotion of happiness or the greatest net increase of pleasure over pain.* In recent formulation of act utilitarianism, Joseph Fletcher, a situation ethicist, holds that good is agape, the general goodwill or love for humanity. In the final analysis human need 103Professional Nursing in the Philippines determines what is or what isnot ethical. Ifthe act help, then it is a good act, andl if it hurts people, then it is.a hap OP, Inhis writings, Fletcher provides the guidelines fg 0°" ethical decisions: These are: Making 1. consideration for people as human beings; 2. consideration of consequences; 3. proportionate good to come from the choices; 4. propriety of actual needs over ideal or potential neeg 5. a desire to enlarge choices and reduce chance; ang” 6. a courageous acceptance of the consequence of the decision. An example may be given of a City Health Department planning for their annual budget. To which program should they allot a bigger budget—the modernization of the city hospital or the nutrition and immunization programs of the poverty-stricken families of the city? Will promotion of health and prevention of illness have priority over treatment of illness and rehabilitation? Deontological Approach or Duty-Oriented Theory The word deontology came from the Greek word deon which means duty. In this theory, the ethicist feels that the basic rightness or wrongness of an act depends on the intrinsicnature rather than upon the situation or its consequences. Immanuel Kant, a German philosopher and ethicist in the 18th century, defines a person as a “rational human being with freedom and social worth.” A person is morally good and admirable if his actions are done from a sense of duty and reaso"- He states that it is only through dutiful actions that people have moral worth. Even when individuals do not want to fulfill their duty, Kant believes that they are required to do so” Suppose a nurse is assigned to care for a patient with’ Could she reasonably refuse to care for the patient Vi, ground that the patient's condition may threaten her he ma As practitioners of the art of healing, nurses are to take ca! ith AIDS. 104 flNursing Ethics sick even if patients have conditions that threaten their ersonal health. Nurses, however, must observe the necessary precautions to protect their health. Virtue Ethics Approach Virtue ethics, known as aretaic ethics (from the Greek word aréte) is focused primarily on the heart of the person performing, the act. It focuses on the traits and virtues of a good person such as courage, temperance, wisdom, and justice. However, doing the right thing is not all that is needed. One must have the right motivation, disposition and traits for being good and doing right such as courage, magnanimity, honesty, justice, and beneficence. Intellectual virtue is the power to deliberate about things good for oneself. Moral virtues, on the other hand, must be lived over time in order to be learned. Nurses, when faced with a particular situation must be able to know what to do. They must be able to integrate virtue ethics with duty. Suppose a student is requested by her classmate, who is also her best friend, to let her copy in their examination so that she will pass. The student should not allow this to happen as formal cooperation in an evil act is never allowed. She will be as equally guilty as the one who will cheat as she will be serving as an accomplice to the evil act. DIVINE COMMAND ETHICS Divine command ethics is based on the theory that there is a Supreme or Divine being that sets down the rules to provide guidance to moral decisions. For Christians, these rules are found in the Ten Commandments. Differences in religion, however, pose problems such as what to do when the decision would conflict with one’s religious beliefs. For example, members of the Jehovah's Witnesses will not receive blood transfusion even if their lives will be put in danger. Suppose a nurse is approached by a friend who requests for an abortion. The nurse refuses but refers the friend to a doctor 105Nursing Ethics duress to do so. Every adult of sound mind must have the right to determine what should be done to his body. Therapeutic privilege is the legal exception of the rule of informed consent, which allows the caregiver to proceed with the care in case of emergency, incompetence, waiver or implied consent, Veracity—To maximize the efficiency of healthcare, the patient and the healthcare providers are bound to tell the truth. The patient has the responsibility to provide, to the best of his knowledge, accurate and complete information about his complaints, past illness, previous hospitalizations, medications being taken, allergies, religious restrictions, and other matters relevant to his health. If the patient cannot provide the information, his family or significant others should do so in order that accurate diagnosis could be arrived at and immediate treatment provided. The physician should tell the patient and his family his diagnosis, plan of care, treatment and possible risks involved, length of treatment, possible expenses, and other options they make take if there be any. There are times, however, that the physician or health practitioner is requested not to tell the relative the exact nature of the patient's illness, Sometimes, the relative requests the physician not to tell the patient his true diagnosis or condition. At times the practitioner himself intentionally withholds information according to his sound judgment when such revelation would do more harm to an emotionally unstable or depressed person. This is called a benevolent deception. Several cases are therein cited: 1. Ayoung, married male who was diagnosed to have AIDS, requests the doctor not to tell his diagnosis to his wife. 2. The children of an aged grandmother suffering from metastatic cancer request the doctor not to tell their mother her diagnosis and instead to proceed with the chemotherapy. In the case cited above of the young, married man who has AIDS, telling the wife would be far more advantageous so that she can be examined, protected or treated as the case may be. 107Professional Nursing in the Philippines She would be able to use proper precautionary mea herself, understand the husband's illness, and partici care. In the case of the grandmother, gently telling her thet would help convince her to participate in the treatment is including spiritual preparation towards peaceful death Itis very important that health care workers be very discreet in providing information. While telling the truth increases ng, credibility, it is oftentimes how they say this information thy, makes them acceptable or not. SUNS fap ipatein hi Beneficence - The principle of beneficence refers to acs of kindness and mercy that directly benefit the patient. These ads promote thehealth of the patient, preventillness or complication, alleviate suffering, and assist towards peaceful death ifthe inevitable comes. ‘The Patient's Bill of Rights helps the health practtiones provide more effective patient care. The patient has the right 1. considerate and respectful care; 2. relevant, current and understandable information concerning diagnosis, treatment prognosis, spediic Procedures, treatment, risks involved, medically reasonable alternative benefits needed to make informe! consent; make decisions regarding his plan of care; in case refusal, he is entitled to other appropriate care service or be transferred to another hospital; have advance directive (such as a living will) concer treatment or designating a surrogate decision make" every consideration of his privacy such as in © discussion, consultation and treatment; confidentiality of communications and records: irview his records concerning his medical carey". these explained to him except when restricted PY, 8. beinformed of business relationship among the HOF educational institution, health care providers influence the patient's treatment and care: No 108Nursing Ethics 9, consent or decline to participate in experimental research affecting his care; 40. reasonable continuity of care when appropriate and be informed of other care options when hospital care is no longer appropriate; and 11. be informed of hospital policies and practices that relate to patient care. All activities provided to patients must be conducted with deep considerations of their values and dignity. ‘Nonmaleficence—In some way the principleofnonmaleficence js similar to the principle of beneficence. The distinction lies in the fact that the principle of beneficence is stated in a positive form while nonmaleficence is stated as an admonition in the negative form to remind health practitioners to do no harm? Examples of nonmaleficence isnot assisting in or performing abortion, not assisting persons to commit suicide, not performing euthanasia or mercy killing, or not willfully subjecting patients to experimental drugs whose potential harm may be greater than the expected benefit, and notharming a person’s reputation by revealing confidential information. What benefit does it give a patient who is in persistent vegetative state to be attached to a respirator, or fora dying person to be given cardiopulmonary resuscitation? Should a dying person in pain be given a sedative, when the health practitioner knows it would cause respiratory depression or arrest? Nurses should remember that human life is inviolable. They should do what is best for the patient. When biological death is imminent, they should not abandon the patient. Treating them with respect, providing nursing measures safely, gently and with kindness, and providing psychological and spiritual support allow the patient to die with dignity and in peace. Nurses should not Participate in treatments or procedures that will harm the patient. They should make their stand known and should withdraw from team if what is to be done is against their conscience. i Justice ~In healthcare, justice refers to the right to demand © be treated justly, fairly and equally. 109Nursing Ethics Nurses should commit themselves to the welfare of those entrusted to their care. They should be loyal to their sworn duty. This is termed role fidelity. CONFIDENTIALITY OF INFORMATION Confidential information is also termed as privileged communication because it is given based on trust. Patients and/or their relatives are expected to give the necessary information so that proper diagnosis and treatment could be made. Patients and their families are entitled to know information or facts within the limits determined by the physician. If the patients insist on knowing their diagnosis, nurses may only repeat what doctors wish to disclose. Any information gathered by nurses during the course of caring for their patients should always be treated confidential This duty extends even after the patients’ death. Confidential information may be revealed only when: 1. patients themselves permit such revelation as in the case of claim for hospitalization, insurance benefits, among, others; 2. the case is medico-legal such as attempted suicide, gunshot wounds which have to be reported to the local police or NBI or constabulary; 3. the patients are ill of communicable disease and public safety may be jeopardized; and 4. given to members of the health team if information is relevant to his care. Confidential information may also be revealed as provided for by law in Article IV, Section 4(1) of the New Constitution, which states that: “The privacy of communication and correspondence shall be inviolable except upon lawful order of the court or when public safety and order require otherwise.”