2B Weeks 2 6 Bioethics

04/02/2021
Obligations of
a Professional
NCM 108: Health Care Ethics
February 1-6, 2021
200+ Specialties
Were added to the Health Care Team under the umbrella
of Allied Health.
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Entering a Health Care Profession
Characteristics of a Profession
1. Competence in a Specialized Body of Knowledge and Skill
2. Provision of a particular service to society
3. Standards of education and practice
4. Self-regulation – an acknowledgment of specific duties and

responsibilities towards patients, colleagues and society
Self-Regulation
1. Specialty Practice Acts
2. Professional Etiquette
3. Code of Ethics
In regard to clients and patients, practitioners have a fiduciary relationship, which

requires them to act primarily in the best interests of those they serve.
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Specialty Practice Acts address the following:

1. Scope of Professional Practice
2. Requirements and Qualifications for Licensure or Certification
3. Exemptions to Basic Requirements
4. Grounds for Administrative Actions
5. Penalties and sanctions for unauthorized practice
1. Sanctions for Lapses
Area Judgment Sanction

Ethical Conduct Right or Wrong Loss of professional reputation, loss of
professional affiliations
Legal Requirement Legal or Illegal Punishment as prescribed by law
Professional Proper or Improper Loss of professional respect and
Etiquette fellowship
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Professional Etiquette
Involves issues such as:

1. Need to avoid talking badly about another practitioner
2. Maintenance of appropriate relationship at the worksite
3. Need to stay within the role boundaries of the specialty
Note: Usually not written or codified but if broken, can face serious
consequences
Health Care Ethics
Code of Ethics bind together a group of Practitioners and Express the

aims and aspirations of that group
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Health Care Ethics
Sample Ethical Questions:

1. When is it permissible to take a gift or gratuity from a patient?
2. When is the legitimate and perhaps mandatory to break a patient’s
confidence?
3. Is it permissible to lie to a client if it is for his or her own good?
4. What should I do if I make a medication error that no one else knows about
but it appears harmless to my patient?
5. What if I come upon a practice that is legal but appears to me personally to be
unethical?
6. What obligations do I have to a colleague and fellow practitioner when I
suspect that the colleague I am working with is abusing alcohol or appears
chemically impaired while on duty?
7. If I begin to have feelings for a patient, can I ethically date him or her?
The Client
1. The summit of the meaning of the healthcare profession

2. He/she is the center of which our profession revolves around
3. Everything that healthcare professionals learn, the skills they acquire
and the knowledge they possess are for the benefit of the client
4. Every human being who becomes ill is somebody who the healthcare
provider is morally obligated to care for
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The Client
5. The healthcare provider disregards race, culture, religion and belief in

dealing with clients.
6. We cannot choose to whom we would give care for.
7. It is the moral and legal responsibility of the healthcare professional to
render services to anyone who seeks medical attention.
8. It is morality that regulates the relationship of the nurse or any
healthcare provider and the client.
The Health Care Provider
1. The healthcare provider, especially the nurse, is no ordinary

professional whose duties and obligations can just be accomplished by
mere compliance of those he/she is expected or required to do
2. The paramount obligation of the nurse is the client
3. The healthcare profession is a very delicate undertaking in asmuch as it
deals with human life
4. The nurse must be imbued with virtues to come into terms with all
her/his duties and responsibilities
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Qualities and Responsibilities of a good Health Care Provider

to its Client
1. Communication Skills
2. Emotional Stability
3. Empathy
4. Flexibility
5. Good Attention to Details
6. Interpersonal Skills
7. Physical Endurance
8. Problem Solving Skills
9. Quick Response, Prepared and Ready
10. Respect

to its Profession
1. Reporting misconduct
• Nurses are bound to protect patient’s right.
2. Providing current information
• Legally bound to acquire appropriate education in order to give care in the
best possible way.
3. Facilitating patient participation
• Responsibility of the nurse to let the patient participate in his/her own
wellbeing.
4. Providing critical and general information
• Intervention of the nurse for the awareness of the patient regarding
his/her own wellbeing.
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to its Profession
5. Code of ethics
• Duty to care for a patient is one of the responsibilities of the nurse
6. Personal limits
• Nurse’s understands own limits and remove oneself from patient care if cannot
provide excellent care that may result in harming others
7. Follow Professional Standards

• Conducting interviews with the patient & keeping of records

to Society
1. Autonomy
• Self-governing
• Involves self-determination, responsibility, accountability, independence, and a

willingness to take the risk
• Professionals have the power and authority to control various aspects of their work,
including goals toward which to work, whether to work and with whom to work with,
and details of how the work is to be done and so forth.
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to Society
2. Accountability
• ANA: Refers to being answerable to someone for something one has
done. It is grounded in the moral principles of fidelity and respect for
dignity, worth, and self-determination of clients.
• Safe autonomous practice is ensured through various processes of
nursing accountability.
• Accountability is related to both responsibility and answerability
The Foundations of Law
Basic Sources for Modern Law:
Common Statutory Administrative

Law Law Law
emanates from arise from from rules and

judicial decisions legislative bodies regulations and
decisions of
administrative
agencies
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Fundamental Principles of Law
● A concern for justice and fairness
● Plasticity and change
● Acts are judged on the universal standard of the reasonable person
● Doctrine of Indivudual Rights and Responsibilities
○ Failure to meet one’s responsibilities affets one’s rights. Every
person is liable for his or her own actions.
Common Misunderstandings About The Nature of Law
● Law is all inclusive and that if you need a legal determination, all you
need to do is apply the correct legal precedent
● If no one does this, the law will do that.
● The law tells you what to do.
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The Lawsuit
Plaintiff Defendant Prima Facie

case
A person who brings A person against Legally sufficient to
an action in a court of whom an action is establish a case
law brought
Has enough burden of Has enough ample

proof time to respond to
the case – (1) admit,
(2) deny, (3) plead
ignorance to each
allegation
Elements of a Complaint
● A short statement laying out the grounds on which the court’s
jurisdiction depends
● Statement of the claims that calls for relief for the plaintiff
● A demand for judgment for a relief to which the plaintiff feels entitled
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Discovery
● Fact-finding phase to eliminate surprises, clarify what the lawsuit is
about, and make parties decide if they should settle or drop the claims
● Major elements:
○ Interrogatories
○ Document requests
○ Depositions – opportunity for each side to question witness and
parties toa suit to elicit information about the case
Trial and Judgment

Before a judge or a jury (in some countries e.g. USA)
Appeal
May be done by the losing party to a higher court
Arbitration
Recognized in some countries or states and involves a neutral third
party that both sides have agreed will have the power to decide the
outcome and render a binding decision
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Human Value
Development and the
System of Public Law
NCM 108: Health Care Ethics
February 1-6, 2021
Maslow’s Hierarchy of
Needs
Abraham Maslow (1987)
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Hume’s Law or
Hume’s Guillotine
David Hume
There is an unbridgeable gap between facts and value.
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Common Decision-Shaping Values in Health Care
● Independence
● Autonomy
● Privacy/Confidentiality
● Self-Esteem
● Well-being
● Security
● Sense of belonging
● Sexual and Spiritual Support
● Freedom from Disability
● Accomplishment
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Kohlberg’s Stage Theory of

Moral Reasoning
Lawrence Kohlberg
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Conflicts of Kohlberg’s Theory
● Carol Gilligan: Kohlberg’s research methods were flawed and gender

biased
○ Separate value development for Females (personal
responsibility) and Males (legalistic equality)
● Somewhat confirmed by the typographical profile developed by
Isabel Myers and Katherine Briggs
○ Decision-Making Category: Male fall predominantly in the
“thinking” category while female are more likely to fall into the
“feeling” category
● Kohlberg took the criticisms wells, thus making revisions to account

for possible gender bias
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Generational Theory
Morris Massey, 1970s-1980s
The critical period of value programming is between birth

and teens, with approximately 90% being firmly in place
by the age of 10.
Beyond this, values change if we are affected by a

significant emotional event.
Generational Cohort
Generational Cohort Birth Years

Traditionalists (Silent) 1929-1945
Baby Boomers 1946-1960
Generation X 1968-1989
Millennials Mid-1980s-2000
Generation Z (Homeland, Late 1990s-2025
Digitarians, Gen Tech)
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Silent Generation (Traditionalists, Veterans)

1929-1945
● Value programming
was by the events
surrounding the
Great Depression
and World War II
● Core Values:
○ Conformity
○ Stability
○ Security
Silent Generation (Traditionalists, Veterans)

1929-1945
● Values and Characteristics:

○ Loyalty
○ Respect for position
○ Private
○ Conform to rules
○ Self-sufficient
○ Reticent to express
emotion
○ Hard work
○ Frugal
○ Law and Order
○ Sacrifice
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Baby Boomers
1946-1960s
● Value programming was in good

fiscal times following World War II
● Often thought of as the “Me
Generation”
● Core Values:
○ Personal and Social
Expression
○ Idealism
○ Health
○ Wellness
Baby Boomers
1946-1960s

○ Team Orientation
○ Personal Gratification
○ Big Talkers
○ Socially Revolutionized
○ Image
○ Personal Growth
○ Media Savvy
○ Skepticism in regard to rules
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Generation X / Xers
1968-1989
● Initially underrated by the previous

generation and labeled by some as
“slacker generation”
● Value programming was in era of
social change; both parents
working, contraceptive pills among
others, and blurring of gender roles
● Core Values:
○ Free agency
○ Independence
○ Cynicism
Generation X / Xers
1968-1989

○ Entrepreneurial spirit
○ Pragmatism
○ Self-Reliance
○ Change
○ Diversity
○ Risk takers
○ Choice
○ Informality
○ Techno-literacy
○ Individualism
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Millennials
Mid-1980s-2000
● Defined by events immediately

following the Cold War
● Grew up in a global work
● Being confident, if not a bit
arrogant, demand reasons and
rationales for decisions
● Core Values:
○ Collaboration
○ Social activism
○ Tolerance for diversity
Millennials
Mid-1980s-2000

○ Positive Reinforcement
○ Media Overload
○ Global Citizens
○ Confidence
○ Networkers
○ Techno-savvy
○ Ethical consumption
○ Street Smart
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Generation Z
Late 1990s-2025
● Significant shaping events:

Great Recession, 9/11
● Core Values:
○ Masters at multitasking
○ Techo-savvy
○ Personally tolerant
regarding social and
ethnic diversity
○ Thrive on instant
gratification
○ Fiscally pragmatic
Generation Z
Late 1990s-2025

○ Collaborative and
creative
○ Little concern for privacy
○ Need for quick
information
○ Embrace social and
ethnic diversity
○ Fiscally risk aversive and
pragmatic
○ Value
contentment/passion
over salary
○ Innovative and
entrepreneurial
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Generation
“Alpha”
May have began to form yet it is still
to be described
World Views
Moral Nihilism
Believe that there are no moral truths, no moral rules, no moral
knowledge or responsibilities.
Ethical Relativism
Holds that all morality is relative to the society in which one is brought
up; nothing can be considered right or wrong without a consideration of
the culture and social context.
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Unacceptable Acts to Most Cultures
Rape Slavery Genocide

Forcing Human bondage Attempting to
unwanted eliminate an
intercourse entire people
Torture Sexism
Inflicting severe Unequal and
pain in order to harmful
gain benefit treatment based
on gender
System of Public Law
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Two Basic Elements of System of Law
Private Law Public Law

Law that deals with Law that deals with
relationships relationships
between citizen and between private
citizen parties and
government
Concerned with the
definition, regulation 1. Constitutional
and enforcement of 2. Administrative
rights in cases where 3. Criminal
both parties are
4. International
involved
Crimes
Felonies Misdemeanors
Far more serious Crime punishable by
breach of law less than a year
incarceration in a jail
Punishable by death or correctional
or imprisonment in a institution
state or federal
penitentiary
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Criminal vs Civil Law
Criminal Law Civil Law

Prohibits conduct Proof needed is less
deemed to be rigorous and the
injurious to the public reparation called for
order is monetary rather
than punitive
Thank you!
Reference: Edge, R. & Groves, J. R. (2019). Ethics of Health Care: A
Guide for Clinical Practice (4th ed.). Singapore: Cengage Learning Asia
Pte Ltd
CREDITS: This presentation template was created by Slidesgo, including icons by

Flaticon, and infographics & images by Freepik
28
Name: Bacon, Chloe Monleon, Hannah Date: 02/13/21
Carillo, Carlos Olila, Jose Miguel
Literato, Sophia Racaza, Brian
Miranda, Shannen Troyo, Earl Joash
Clinical Instructor: Mrs. Bellavic Tropezado, RN, MAN
III. Theories and Principles of Health Ethics

Ethical Stories
1. Deontology
● Duty-Oriented Theory/Nonconsequentialist Theories

● Deontology came from the Greek word “deon” which means duty
● Involve logical and formal processes and emphasize individual rights, duties, and obligations.
● Requires us to follow universal rules we give to ourselves. These rules must be in accordance
with reason.
● The disregard of the consequences of our actions can lead to disastrous results
● A person is morally good and admirable if his actions are done from a sense of duty or reason.
● An act itself would be either right or wrong, it could not be both.
Example:
❖ Murder is ethically wrong even if it is self defense.
Immanuel Kant
● A theory deeply associated with him
● He attempted to define a person as a rational human being with freedom, moral worth, and ideally
having a good will. (meaning that person should act from a sense of duty)
● Because of rationality, Kant believed, humans have the freedom to make moral judgements.
● Even when individuals do not want to fulfil their duty, Kant believes that they are required to do
so if they want to be ethical.
● Based on principles of obligation that must be followed by all irregardless of the consequences.
A formally operative from principles that can be brought to the fore:
● Reason (foundation) = ventures to know what is ethical not on the authority of
what is external to the self but grounded on reason itself. Tells the human person
to do the obligation that is doable for the goodwill since it’s their duty.
● Goodwill (source) = relevant to the person who through their reason knows what
one ought to do, is where they can do and know as good. Implies the
achievability of what is known through reason.
● Duty (motivation) = Follows what reason deems as the action which is worthy of
our humanity.Obligation is the motivation for reason and goodwill of the human
person.
2 types of duties:
➔ Hypothetical Imperatives
❏ Duties or rules the people ought to observe if certain ends are to
be achieved
❏ Sometimes call “if-then” imperatives, which are conditional:
(For instance, “If I want to pass my nursing course, then I should
be diligent in my studies”)
➔ Categorical Imperatives
❏ An action could be known to be right when it was in accordance
with a rule the satisfied a principle
❏ When acting according to a categorical imperative, one should
ask this question: “If I perform this action, would I will that it
become a universal law?”
Example:
➔ As a nurse it is our duty to respect patient confidentiality
➔ As a nurse it is our duty to give fair and quality care to all patients
➔ As a nurse it is our duty to always tell the truth to dying patients as what
the physicians instructed to do so.
2. Teleology
● From the Greek word telos which means end

● Ends justify the means
● Also known as consequence-oriented, consequentialist, consequence-based theories
● Some teleological theories include: ethical egoism, utilitarianism, eudaimonism
Ethical Egoism is about doing actions for one’s own self-interest.
Utilitarianism is about doing actions for the most good for most people.
Eudaimonism is about doing actions to fulfill goals.
● Knife --- Sharp --- To cut --- Good
● Human --- Virtuous --- Eudaimonia (human flourishing) --- Good
3. Utilitarianism
Jeremy Bentham (1748- 1832) and John Stuart Mill (1806-1873)

- Fathers of Utilitarianism
-Bentham was the one who founded, while Mill was the one who developed and popularized
Jeremy Bentham’s Model of Utilitarianism

-Happiness is simply the absence of pain
-”Felicific” calculus- measures the degree of happiness or pleasure that a specific action may
produce. It includes intensity, duration, certainty, propinquity, fecundity, purity, and extent.
-The intense (intensity) the pleasure, the better; the longer (duration) it lasts, the better; the more
certain (certainty) that it will happen, the better; the close (propinquity) that it will occur, the
better; the greater the possibility (fecundity) that it will be followed by another pleasure, the
better; the purer (purity) the pleasure, the better; the greater the number of people that it benefits
(extent), the better.
-Formula: Happiness - Pain = Balance, wherein balance iis the basis of morality of an action
John Stuart Mill’s Model of Utilitarianism

-Disagrees with Bentham
-Cannot calculate amount of pleasure or pain that an act produces
-Basis of morality: The majority of the people that attains happiness
-It is better to be socrates dissatisfied, than a pig satisfied
Utilitarianism
- Founded in the principle of utility: An act is good if it promotes happiness, and bad or immoral
if it produces pain
- Most common consequence-oriented reasoning
- The good resides in the promotion of happiness or the greatest net increase of pleasure over
pain.
- Moral theory that focuses on the results, or consequences of our actions, and treats intentions as
irrelevant.
- Actions should be measured in terms of happiness, or pleasure that they produce
- A Utilitarian would not care whether an action is done out of deception, lie, or manipulation as
long as it produces maximum benefits to many people
- Utilitarians agree that a moral theory should apply equally to everyone. But they thought the
way to do that was to ground it in something that’s really intuitive — and there’s really nothing
more basic than the primal desire to seek pleasure and avoid pain.
Principle of Utility
- Requires the rule to bring about positive results when generalized to a wide variety of situation.
- “We should act always so as to produce the greatest good for the greatest number”
Act of Utilitarianism
- Decision is based on listing the possible alternatives for action, weighing each in regard to the
amount of pleasure or utility it provides and selecting the course of action that maximizes
pleasure.
- Utilitarian principle should be applied to a particular act in a particular situation or circumstance
-The basis of the morality of an action is the ACT itself
Criticisms of Act Utilitarianism

-Calculation of all possible consequences of action
-May be used to sanction unfairness and the violation of human rights
- Not sensitive to the agent-relatively of duty
-Does not seem to give enough respect to persons
-It is justifiable to prevent others from doing what we believed to be harmful acts to themselves
-Alone, it does not provide a basis for our own moral attitudes and presumptions
Rule Utilitarianism
- Allows us to refrain from acts that might maximize utility in the short run, and instead follow
rules that will maximize utility for the majority of time.
-An act is morally right if it conforms to a justified moral rule
Virtue Ethics
1. Virtue Ethics in Nursing
Ethics
- Attribute of character or role duty
- System of moral principles
Consequence Oriented System
- Focus on reasoning to an appropriate action
- It is the action itself rather than the character of the agent that is the heart of the matter
Example Situation: A nurse gave the wrong medication to a patient
Nurse 1: did not hesitate at all and directly reported her/his mistake
Nurse 2: doubted about telling the truth due to the consequence it might bring, but in the end
she/he reported her/his mistake.
In this situation, basing on Consequence oriented system, they are both equally moral because the
action they take is the same in the given scenario
Virtue Ethics
- is person rather than action based
- it looks at the virtue or moral character of the person carrying out an action, rather than at
ethical duties and rules, or the consequences of particular actions.
- Primary Focus: heart of the moral agent making the decision rather than the reasoning to a right
action.
- Primarily about personal character and moral habits development rather than a particular action.
What is Virtue Ethics in Nursing?
- Is concerned with the character of individual nurses and seeks ways to enable nurses to develop
character traits appropriate for actions that enhance wellbeing.
NURSES NEED TO:
- Examine their own values and their client’s values. They need to understand how their values
influence their decisions
- Develop sensitivity to ethical dimensions of nursing practice
- Think ahead what are the possible moral problems they are likely to face.
VALUES
- Freely chosen
- Influences decisions and actions such as nurse’s ethical decision making
- BELIEFS and ATTITUDEs about the worth of a person, object, idea or action
BELIEFS
- Opinion, interpretation or conclusions that people accept as true
ATTITUDES
- Mental position or feelings toward a person, object or idea (compassion, acceptance,openness)
- Attitude lasts over time and belief may only last briefly.
-EXAMPLE: some clients may feel strongly about their privacy whereas others may dismiss it as
unimportant
VALUES CLARIFICATION
- A process by which people identify, examine, and develop their own individual values
PERSONAL VALUES
- Acquired through observation and experience
- Affected by socio-cultural environment (societal conditions, family, peers)
↓
Nurses keep in mind the influences of values on health
↓
PROFESSIONAL VALUES
- Acquired during socialization into nursing from code of ethics, nursing experiences,teachers and
peers
Nursing Ethics
- Refers to ethical issues that occur in nursing practice
Ethical problems in nursing has been growing due to:
(a) Social and technological changes
(b) Nurse’s conflicting loyalties and obligations
According to the nursing code of ethics, the Nurse’s first loyalty is to the client
> What makes virtue ethics distinct from Teleology and Deontology?
> Two categories of virtue:

● Intellectual virtue
- Virtues of the mind
- E.g. ability to understand, reason, and make sound judgment
- Good qualities in your thinking
● Moral virtue
- Actions and feelings
- Through practice and doing
- Character state that allows us to feel emotions
> Intellectual virtues nurses should have:
● Open-mindedness - no stereotypic beliefs about cultural differences
● Integrity - withhold information or the truth
● Empathy - becoming more conscious about her presentation and responses
● Autonomy - respecting patient’s decisions
> Moral Virtues should have:
● Courage - regulates fear and confidence
● Temperance - regulates bodily pains and pleasures
● Generosity - giving full attention and doing act of kindness
> Golden mean - a balance point
> Examples:
1. Is abortion permissible?
Reasons:
● Afraid of being a parent
- Acting from the vice of cowardice
● She wants the child but knows it will have genetic defect which will greatly hamper the
quality of life
- Acting from the virtues of compassion and courage
> Virtue ethics focuses on:
● Character
● Person
● Seeks the mean between excess and deficiency
● Feeling and action
2. Core Values of a Professional Nurse
5 CORE VALUES FOR A PROFESSIONAL NURSE

1. Altruism - nurse’s concern for the welfare of patients,other nurses and other health care providers
Examples:
- sacrificing your own time for your patient
- volunteer in community organizations and such
- mentoring other professionals
2. Autonomy
Patient autonomy: focuses on respect for the patient’s right to make decisions, even when those
decisions conflict with the values of the nurse.
Nurse autonomy: reflects a moral obligation to provide competent care to clients and to protect
clients from unsafe practice.
Examples:
- respecting patients right to make decisions about healthcare
- plan care in partnership
- provide information so patients can make informed choices
3. Human Dignity- nurses values and respects the inherent worth and uniqueness of all patients and
colleagues
Examples:
- competent and culturally sensitive care
- protect privacy and confidentiality
- design care with sensitivity to individual patient needs
4. Integrity- nurses acts honestly and provides ethical care based on ethical framework
Examples:
- honest information to patients and public
- document care accurately and honestly
5. Social Justice - nurses upholds moral,legal and humanistic principles by ensuring equal treatment
and equal access to quality health care
Examples:
- access to healthcare, not denying care
- fairness and non-discrimination
- universal access to healthcare
- encourage laws and policies consistent with advancement of nursing and healthcare
Other values that a professional nurse should have:
● Caring
● Diversity
● Excellence
● Compassion
References:
Carlson, S. C. (2019, November 14). Golden ratio. Encyclopedia Britannica.

https://www.britannica.com/science/golden-ratio
CrashCourse. (2016, November 22). Retrieved from Youtube:

https://www.youtube.com/watch?v=-a739VjqdSI
Edge, R. & Groves, J. R. (2019). Ethics of Health Care: A Guide for Clinical Practice (4th ed.).
Singapore: Cengage Learning Asia Pte Ltd.
Maputi, L. (2015). Legal Issues in Nursing and Bioethical Issues. Slideshare.

https://www.slideshare.net/Maputi24/nursing-ethics-2-51012972?fbclid=IwAR0M08KUHi
oVAk73CJavxLmXhRJbbwnkYc8tRkaIhnBEMzOjfAWO94b-2WM
Pettigrove, G & Hursthouse, R. (2018). Virtue Ethics. Stanford Encyclopedia of Philosophy.

https://plato.stanford.edu/entries/ethics-virtue/
PHILO-notes. (2020, January 19). Retrieved from Youtube:
https://www.youtube.com/watch?v=01Y1zVGv9h0
Wilson, A.T. (2017). Avoiding the Conflation of Moral and Intellectual Virtues. Ethic Theory Moral Prac
20, 1037–1050. https://doi.org/10.1007/s10677-017-9843-9
Zak, J. (2020). Aristotle Nicomachean Ethics Book 2 Ch 7: Examples of Moral Virtues. Retrieved from
Youtube:
https://www.youtube.com/watch?v=NssxFTQ9cYQ&fbclid=IwAR2z7IVRlHk3gFav-3AuEVz7
6QCx78u65qKwbiIs_9sz5F7WhXcGHvCIrk0
VELEZ COLLEGE - COLLEGE OF NURSING
41 F. Ramos Street, Cebu City, Philippines
Name: Brigola, Karyl L. Muniz, Irene Ivette Romero Date: 02/18/21

Egay, Pamela Louise N. Sabas, Maria Sophia
Galaura, Loraine D. Tutor, Princess Isabel A.
Moleta, Renee Bernadette A. Villamor, Julia Abby G.
Clinical Instructor: Mrs. Bellavic Tropezado, RN, MAN
III. Theories and Principles of Health Ethics

C. Ethical Principles
1. Autonomy
- The term “self- determination,” is often used synonymously with autonomy
- The word autonomy comes from the Greek word, autos (self) and nomos (governance). In
health care, it has come to mean a form of personal liberty, wherein the individual is free to
choose and implement his/ her own decisions, free from deceit, duress, constraint or
coercion. 3 basic elements seem to be involved in this process:
● The ability to decide- for without adequate information, and intellectual
competence, autonomy seems hollow
● The power to act on your own decisions- it is obvious that those in the death
camps of World War II could have made all the decisions they might have
wished but lacked power to implement them.
● A respect for the individual autonomy of others- it is the provision of a
general respect for personal autonomy for both practitioner and patient
alike that ennobles and professionalizes the process.
- One of the great areas of struggle in health care ethics is that of autonomy versus
paternalism.
- Paternalism = the intentional limitation of the autonomy of 1 person by another, in which
the person who limits autonomy appeals exclusively to grounds of benefit to the other
person.
- Health care professionals have a special “fiduciary relationship” with patients based on the
confidence placed in us and the inequality of our positions with regards to information. This
relationship places an affirmative duty on practitioners to seek the best for patients.
- What would be done when a patient, acting on the impulse of personal autonomy, chooses a
path away from health? Does the patient have the right to be wrong?
- This right to refuse treatment in no way speaks to the quality of decisions, only to the
patients’ right to make them. As healthcare professionals, we are fortunate to serve in the
profession that generally are viewed by our patients and clients as positions of confidence
and trust. This allows most healthcare questions to be solved through a process of
negotiation based on fidelity, respect and shared values.
a. Patient’s Rights
- The right to health and well-being is a fundamental right that influences all aspects
of life. The most effective way for healthcare professionals to fulfill their obligations
under the “right to health” approach is to ensure that they provide the highest
possible standard of care while respecting the fundamental dignity of each patient.
Patient rights are those basic rules of conduct between patients and healthcare
providers, covering such matters as access to care, respect, communication, patient
dignity, confidentiality and consent to treatment. Patients have the right to be
treated and dealt with in a humane and respectful manner. Health care providers
are urged to pay careful attention to this vital aspect of clinical management, they
must keep the welfare and the rights of the patient above any other consideration.
- Hippocratic Corpus = the oldest medical code, known as the Hippocratic oath that
contains several elements, emphasizing the commitment to the well-being of
patients.
- A fundamental concept of the human rights movement is that the decisions are
made autonomously by informed patients. Human rights are a dominant force in the
society and have substantial, positive implications for health care and medical
ethics. And they had a positive impact on the development of patients’ rights.
- Types of Patients’ Rights:
a.) Right for a Good Quality Care
- Access to health care services should be provided without
discrimination, regarding race, religion, sex, national origin or
disability. Patients should be free from discrimination on the basis of
their disease with respect to both employment and health insurance
accessibility.
b.) Right for Informed Consent and Choice of Treatment
- Patients should be empowered to participate in decision making, and
the health care team should respect those decisions. Consent may
either be expressed or implied. The underlying condition and
treatment options are explained to the patient and treatment is
rendered or refused.
c.) Right for Access to Information and Clear Disclosures
- Patients should receive adequate information about their illness,
possible interventions and known benefits and risks of specific
treatment options. Even if it is sometimes uncomfortable to clinician
or patient, information that is essential to the patient must be
disclosed.
d.) Right for Confidentiality

- Confidentiality is a fundamental aspect of medical care. It is matter
of respecting the privacy of patients, encouraging them to seek
medical care and discuss their problems candidly, and preventing
discrimination on the basis of their medical conditions. The
physician must not release information without the patient’s consent
(termed as a “privileged communication”).
e.) Right for Access to Medical Records
- Patients should be permitted to review their medical records and
obtain copies for free or for a reasonable fee. Healthcare providers
should be available to explain the contents of medical records to
patients.
f.) Rights of Nonconscious/ Incapacitated Patient
- When a patient lacks decision-making capacity (i.e. the ability to
receive and express information and to make a choice consonant
with that information and one’s value), an appropriate surrogate
should make decisions with the physician. Healthcare providers
should take reasonable care to ensure that the surrogate’s decisions
are consistent with the patient’s preferences and best interest.
g.) Right for Information, Health Education and Prevention
- Individuals should be advised with the respect to the prevention of
diseases (communicable and noncommunicable diseases, cancer,
etc.) and should be provided any preventive interventions that are
evidence based and available.
h.) Right for Human Dignity
- Patients should be treated with dignity at all times. Quality care in
cancer and other chronic diseases require pain, palliative and
supportive care including the use of opioid analgesics. Health
professionals should respect the autonomy of the patient and help
him/ her to overcome fear, pain and suffering with control of pain
and other symptoms in order to provide the best quality of life
possible.
i.) Right for Spiritual Assistance
- Religious belief and the teachings of various faith communities are
relevant to medical care. Religion offers powerful perspectives on
suffering, loss and death.
j.) Right to Make Decisions: About End of Life Care
- Patients may make and legally record the decisions they make about
how their lives will end including life preserving measures such as
the use of feeding tubes/ ventilators.
Ethical Dimensions of Patient’s Rights

- It is essential that patients’ rights and medical ethics move in the same
direction. The principle of ethics currently embraced by healthcare
professionals are as follows: (a) autonomy refers to respect for a person’s
self-determination, alluding to a patient’s wishes regarding treatment
choice; (b) beneficence means doing good to patients; (c) fidelity emphasizes
faithfulness to a healthcare professional’s duties and obligations, (d) justice
dictates that a healthcare professional’s decisions on patient treatment is
made fairly and impartially and (e) utility implies that a healthcare
professional’s actions should yield good results, achieving maximum
benefits for the patient without wasting resources.
b. Patient’s Bill of Rights

The Patient’s Bill of Rights was adopted first by the American Hospital Association
in 1973 and was revised in October of 1992. This document provides patients with
information on how they can reasonably expect to be treated during the course of their
hospital stay. It has close and similar rights as previously mentioned with only a few
revisions and certain specific details pertaining to the hospital and healthcare providers to
their patients:
1. The patient has the right to considerate and respectful care.

2. The patient has the right and is encouraged to obtain from physicians and other direct
caregivers relevant, current, and understandable information about his or her diagnosis,
treatment, and prognosis.
- Except in emergencies when the patient lacks the ability to make decisions and the
need for treatment is urgent, the patient is entitled to a chance to discuss and
request information related to the specific procedures and/or treatments available,
the risks involved, the possible length of recovery, and the medically reasonable
alternatives to existing treatments along with their accompanying risks and
benefits.
- The patient has the right to know the identity of physicians, nurses, and others
involved in his or her care, as well as when those involved are students, residents, or
other trainees. The patient also has the right to know the immediate and long-term
financial significance of treatment choices insofar as they are known.
3. The patient has the right to make decisions about the plan of care before and during the
course of treatment and to refuse a recommended treatment or plan of care if it is permitted
by law and hospital policy. The patient also has the right to be informed of the medical
consequences of this action. In case of such refusal, the patient is still entitled to appropriate
care and services that the hospital provides or to be transferred to another hospital. The
hospital should notify patients of any policy at the other hospital that might affect patient
choice.
4. 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 and to expect that the hospital will honor that directive as
permitted by law and hospital policy.
- Health care institutions must advise the patient of his or her rights under state law
and hospital policy to make informed medical choices, must ask if the patient has an
advance directive, and must include that information in patient records. The patient
has the right to know about any hospital policy that may keep it from carrying out a
legally valid advance directive.
5. The patient has the right to privacy. Case discussion, consultation, examination, and
treatment should be conducted to protect each patient's privacy.
6. The patient has the right to expect that all communications and records pertaining to
his/her care will be treated confidentially 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 confidentiality of this
information when it releases it to any other parties entitled to review information in these
records.
7. The patient has the right to review his or her medical records and to have the information
explained or interpreted as necessary, except when restricted by law.
8. The patient has the right to expect that, within its capacity and policies, a hospital will make
reasonable responses 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 also must have the benefit of complete information and explanation
concerning the need for, risks, benefits, and alternatives to such a transfer.
9. The patient has the right to ask and be told of the existence of any business relationship
among the hospital, educational institutions, other health care providers, and/or payers
that may influence the patient's treatment and care.
10. The patient has the right to consent to or decline to participate in proposed research studies
or human experimentation or to have those studies fully explained before they consent. A
patient who declines to participate in research or experimentation is still entitled to the
most effective care that the hospital can otherwise provide.
11. The patient has the right to expect reasonable continuity of care and to be informed by
physicians and other caregivers of available and realistic patient care options when hospital
care is no longer appropriate.
12. 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.
The collaborative nature of health care requires that patients and/or their families and surrogates
participate in their care. The effectiveness of care and patient satisfaction with the course of
treatment depends, in part, on the patient's fulfilling certain responsibilities:
● Patients are responsible for providing information about past illnesses, hospitalizations,
medications, and other health-related matters. .
● Patients must take responsibility for requesting additional information or clarification
about their health status or treatment when they do not fully understand the current
information or instructions.
● Patients are responsible for making sure that the health care institution has a copy of their
written advance directive if they have one.
● Patients are responsible for informing their physicians and other caregivers if they
anticipate problems in following prescribed treatment.
● Patients also should be aware that the hospital has to be reasonably efficient and equitable
in providing care to other patients and the community. The hospital's rules and regulations
are designed to help the hospital meet this obligation.
● Patients and their families are responsible for being considerate of and making reasonable
accommodations to the needs of the hospital, other patients, medical staff, and hospital
employees.
● Patients are responsible for providing necessary information for insurance claims and for
working with the hospital as needed to make payment arrangements.
● A patient's health depends on much more than health care services. Patients are responsible
for recognizing the impact of their lifestyles on their personal health.
Review with the Ethical Theories discussed before:
1. Natural Law Ethics

- Should a patient decide to give his/ her consent, it must be given freely and
not the consequence of intimidation, deception or coercion.
2. Kant’s Ethical Principle
- We must always be treated as ends and never only as means, patients must
not be deceived by their physicians, no matter how good their intentions
may be.
3. Utilitarianism Principle of Utility
- Healthcare professionals are required to design medical treatment in a way
that minimizes suffering and harm.
4. Rawls’s Principle of Justice
- Medical treatments and experiments are not allowed that violates freedom
which a patient is entitled to by virtue of being a member of society.
c. Informed Consent
- One of the basic principle of autonomy
- Contain the elements of disclosure, understanding, voluntariness,
competence, ang permission giving.
- Patients have the right to receive information and ask questions about
recommended treatments so that they can make well-considered decisions
about care.
● The information must be provided at a time when the patient is able
to sort options rationally and is in a position to grant or refuse
consent.
● The right to refuse treatment in no way speaks to the quality of the
decisions, only to the patient’s right to make them. As practitioners,
we are fortunate to serve in professions that generally are viewed by
our patients and clients as positions of confidence and trust.
- Therapeutic Privilege
➢ legal exceptions to the rules of informed consent
➢ refers to an uncommon situation whereby a physician may be
excused from revealing information to a patient when disclosing it
would pose a serious psychological threat, so serious a threat as to
be medically contraindicated.
➢ Made in cases of emergency, incompetence, waiver, and when there
is implied consent.
○ Implied consent - occurs through the actions or conduct of
the patient rather than direct communication through words.
➢ Benevolent Deception - problematic area of therapeutic privilege
○ It is the process by which patients are misled by doctors in
an effort to prevent possible negative effects from the
disclosure of their diagnoses.
○ The practitioner is allowed to intentionally withhold
information based on his sound medical judgement that to
divulge the information might potentially harm a depressed
and unstable patient
d. Proxy Consent/Legally Acceptable Representative
- Proxy consent 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.
● If an individual is personally unable to consent to a medical
intervention on account of their age or lack of intellectual maturity,
the proxy consent of a legal representative is required. In this
context the legal representative is bound by the well-being of the
person on behalf of whom consent is given.
- A LAR is an individual or a legal body authorized under applicable law to
consent, on behalf of a prospective participant, to the individuals’
participation in the clinical trial.
● In case of a situation where a participant is not able to give informed
consent (e.g. unconscious, minor or those suffering from severe
mental illness or disability) or is illiterate, it has been obtained from
a legally acceptable representative (LAR).
2. Confidentiality
Confidentiality is one of the core duties of medical practice. It requires health care providers
to keep a patient’s personal health information private unless consent to release the information is
provided by the patient. It is a critical principle, and regardless of the specialty, the good
practitioner cannot be viewed as cavalier in regard to protecting patients' confidences and privacy.
while it is obvious that confidential information must be shared among practitioners in order to
provide the best care for the patient or to extend the body of knowledge within healthcare, it is
equally obvious that this does not take the form of conversations in elevators, in cafeterias, or with
friends at a party.
● Privacy vs Confidentiality
Privacy is the right of an individual to have some control over how his or her personal
information (or personal health information) is collected, used, and/or disclosed. While on the
other hand, for confidentiality, is a far slimmer concept than privacy. Confidentiality is the duty
to ensure information is kept secret only to the extent possible.
● Why is confidentiality important?
Patients routinely share personal information with health care providers. If the
confidentiality of this information were not protected, trust in the physician-patient relationship
would be diminished. Patients would be less likely to share sensitive information, which could
negatively impact their care. Why is confidentiality important?
Creating a trusting environment by respecting patient privacy encourages the patient to
seek care and to be as honest as possible during the course of a health care visit. It may also
increase the patient’s willingness to seek care. For conditions that might be stigmatizing, such as
reproductive, sexual, public health, and psychiatric health concerns, confidentiality assures that
private information will not be disclosed to family or employers without their consent.
● The 6 Principles of Confidentiality
1. Justify the purpose(s)
Every proposed use or transfer of patient identifiable information within or from an organisation
should be clearly defined and scrutinised, with continuing uses regularly reviewed, by an
appropriate guardian.
2. Don’t use patient identifiable information unless it is absolutely necessary
Patient identifiable information items should not be included unless it is essential for the specified
purpose(s) of that flow. The need for patients to be identified should be considered at each stage of
satisfying the purpose(s).
3. Use the minimum necessary patient-identifiable information
Where use of patient identifiable information is considered to be essential, the inclusion of each
individual item of information should be considered and justified so that the minimum amount of
identifiable information is transferred or accessible as is necessary for a given function to be
carried out.
4. Access to patient identifiable information should be on a strict need-to-know basis
Only those individuals who need access to patient identifiable information should have access to it,
and they should only have access to the information items that they need to see. This may mean
introducing access controls or splitting information flows where one information flow is used for
several purposes.
5. Everyone with access to patient identifiable information should be aware of their

responsibilities
Action should be taken to ensure that those handling patient identifiable information – both clinical
and non-clinical staff – are made fully aware of their responsibilities and obligations to respect
patient confidentiality.
6. Understand and comply with the law
Every use of patient identifiable information must be lawful. Someone in each organisation
handling patient information should be responsible for ensuring that the organisation complies
with legal requirements.
● What does the duty of confidentiality require?

The obligation of confidentiality prohibits the health care provider from disclosing
information about the patient's case to others without permission and encourages the providers
and health care systems to take precautions to ensure that only authorized access occurs.
Appropriate care often requires that information about patients be discussed among members of a
healthcare team; all team members have authorized access to confidential information about the
patients they care for and assume the duty of protecting that information from others who do not
have access. Electronic medical records can pose challenges to confidentiality. In accordance with
the Health Insurance Portability and Accountability Act of 1996 (HIPAA), institutions are required
to have policies to protect the privacy of patients’ electronic information, including procedures for
computer access and security.
● What if a family member asks how the patient is doing?

While there may be cases where the physician feels naturally inclined to share information,
such as responding to an inquiring spouse, the requirements for making an exception to
confidentiality may not be met. If there is not explicit permission from the patient to share
information with family members, it is generally not ethically justifiable to do so. Except in cases
where the spouse is at specific risk of harm directly related to the diagnosis, it remains the patient's
and sometimes local public health officers, rather than the physician's, obligation to inform the
spouse.
● Confidentiality: Case
Your 36-year-old patient has just tested positive for HIV. He asks that you not inform his wife of the
results and claims he is not ready to tell her yet.
What is your role legally? What would you say to your patient?
Confidentiality: Case Discussion
Because the patient's wife is at serious risk of being infected with HIV, you have a duty to ensure
that she knows of the risk. While public health law requires reporting both your patient and any
known sexual partners to local health officers, it is generally advisable to encourage the patient to
share this information with his wife on his own, giving him a bit more time if necessary.
3. Veracity and Right to Information
A. Veracity – Veracity binds both the practitioner and the patient in an association of
truth. The patient must tell the truth so that appropriate care can be provided. The
practitioner needs to disclose factual information so that the patient can exercise
personal autonomy.
B. Violations of Veracity
Veracity can be violated in several ways.
a. Omission means that critical relevant facts are intentionally left out when
disclosing the patient's medical information.
b. Commission means that medical personnel intentionally tell the patient, or
her family, a lie.
c. Concealing the truth in so much medical jargon that the patient or her family
will be unable to understand it.
C. The lies in medical field
a. Reassuring patients about their care
b. Covering up a patient’s prognosis
c. Lying for the sake of convenience
d. Lying about medical errors
e. False entries
● Patients have the right to expect a higher level of truthfulness from us than others
with whom the deal.
● Benevolent Deception - the process by which patients are misled by doctors in an
effort to prevent possible negative effects from the disclosure of their diagnosis.
D. Right to Information
a. The patient has the right to be informed of hospital policies and practices
that relate to patient care, treatment, and responsibilities.
b. 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.
c. The patient has the right to be informed of the hospital charges for services
and available methods.
4. Beneficence - the principle that imposes on the practitioner a duty to seek the good for
patients under all circumstances.
● Commonly used in English terms as “acts of mercy and charity”.
● For the physicians, this echoes their Hippocratic Oath, which states to “Apply
measures for the benefit of the sick”.
● In the Code of Ethics of ANA, this is clearly stated by “The nurse’s primary
commitment is to the health, well-being, and safety of the patient across the lifespan
and in all settings in which health care needs are addressed” .
5. Non-Maleficence
Non-Maleficence is the principle of not inflicting harm on someone. Maleficence by definition
means acts of harm or evil.
In healthcare, applying the principle of non-maleficence means to provide service that gives the
least harm or inflicting no harm at all: “One ought not to inflict evil or harm”
However, one must note that the healthcare practitioner may inflict harm to the patient (it is
unavoidable!) — such as serious side effects of administered medications.
Principle of double effect - applied in order to maintain ethical positions in cases of harm being
caused
Principles of Double Effect (Guiding Elements)
● Course chosen must be good or at least morally neutral
● The good must not follow as a consequence of the secondary harmful effects
● The harm must never be intended but merely tolerated as causally connected with the good
intended.
● The good must outweigh the harm.
6. Fidelity - the quality of faithfulness or loyalty; keeping one’s promises.

➢ Its original meaning regarded duty in a broader sense than the related concept of
fealty. Both derive from the Latin word fidēlis, meaning "faithful or loyal".
● The nurse must be faithful and true to their professional promises and responsibilities by
providing high quality, safe care in a competent manner.
● The ethical principle of fidelity directs us to model care delivery with altruism, loyalty,
caring, and honesty.
● For example, when an older patient with intact cognitive function is diagnosed with a
terminal illness and he or she doesn't want to share that information with immediate family,
it can create an ethical dilemma. To maintain the trust established in the nurse-patient
relationship, don't share any healthcare information without the patient's consent. Consult
with other interdisciplinary team members, such as case managers, social workers, and
clergy, to help identify supportive services that the patient may need as his or her disease
progresses.
REFERENCES:
Bord, J., Burke, W., & Dudzinski, D., (2013). Confidentiality. UW Medicine, Department of Bioethics
and Humanities. Retrieved February 18, 2022, from
https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/detail/58#:~:text=Con
fidentiality%20is%20one%20of%20the,is%20provided%20by%20the%20patient.&text=Patien
ts%20routinely%20share%20personal%20information%20with%20health%20care%20provid
ers.
Burke, A. (2020). Ethical Practice: NCLEX-RN. Registerednursing.org. Retrieved 15 February 2021,
from
https://www.registerednursing.org/nclex/ethical-practice/#:~:text=Fidelity%20is%20keeping
%20one's%20promises,care%20in%20a%20competent%20manner.
CatholicHealthAust. (2014, August 20). Principle of double effect. YouTube.

https://www.youtube.com/watch?v=NY_jFS327Pw
Davis, Charlotte BSN, RN, CCRN Ethical decision making, Nursing Made Incredibly Easy!:
March/April 2018 - Volume 16 - Issue 2 - p 4-5 doi: 10.1097/01.NME.0000529954.89032.f2
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Singapore: Cengage Learning Asia Pte Ltd.
Freepick <a href="https://storyset.com/work">Illustration by Freepik Storyset</a>, <a

href="https://storyset.com/coronavirus">Illustration by Freepik Storyset</a>, <a
href="https://storyset.com/people">Illustration by Freepik Storyset</a>
urseslabs.
Paton, F. (2019, April 30). Veracity in Nursing: Is It Okay to Lie to Our Patients? N
https://nurseslabs.com/veracity-in-nursing-is-it-okay-to-lie-to-our-patients/
Reception Training Administrator (2011, June 24). Confidentiality: The 6 Key Principles.
ReceptionTraining.com. Retrieved February 19, 2021, from
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Seth, V. (n.d.). Informed consent: Express or implied consent? Retrieved February 18, 2021, from
https://www.colleaga.org/article/informed-consent-express-or-implied-consent#:~:text=Impli
ed%20consent%20occurs%20through%20the,agreed%20upon%20time%20for%20surgery.
Sil, A., & Das, N. (2017). Informed consent process: Foundation of the researcher-participant bond.
Retrieved February 18, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527718/
Thompson, E. (2018, November 21). What is the principle of veracity? P ocket Sense.
https://pocketsense.com/what-is-the-principle-of-veracity-12338205.html
VELEZ COLLEGE
COLLEGE OF NURSING
F. Ramos St. Cebu City
NCM 108:
HEALTH CARE ETHICS
Name: Berongoy, Angelique Date: February 27,2021

Icao, Harold
Larrazabal, Zhane Mich Ivy
Ligan, Crystal Gail
Mabini, Michael
Navarro, Julius
Raboy, Philip John
Torrizo, Agustin Ronald
Clinical Instructor: Mrs. Bellavic Tropezado
Written Output
THEORIES AND PRINCIPLES OF HEALTH ETHICS (Cont’d)
C. Ethical Principles (Cont’d)
7. Justice
➢ The principle of justice states that there should be an element of fairness in all medical
decisions: fairness in decisions that burden and benefit, as well as equal distribution of
scarce resources and new treatments, and for medical practitioners to uphold applicable
laws and legislation when making choices.
➢ The major health-related issues of justice involve fair treatment of individuals and
allocation of resource distribution.
a. Formal and Material Justice
● Formal Justice
- The requirements of formal justice according to Aristotle:
i. In distribution, equals must be treated equally, and unequals must
be treated unequally.
ii. Does not attempt to provide any criteria for the determination of
equality and does not state in what respect equals are to be
treated, except that they must be treated equally.
iii. Under formal justice, any criteria could be used provided the
criteria were applied equally in all similar cases. E.g. age, sex,
marital status, land ownership, etc.
● Material Justice
- The material principle of justice is the rationale for determining
when there can be unequal allocation of scarce resources.
- This concept specifies that resources should be allocated:
o Equally
o According to need
o According to individual effort
o According to the individual’s merit (ability)
o According to the individual’s contribution to society
b. Micro- and Macroallocation of Healthcare

➢ The allocation of healthcare resources involves distributing health-related
materials and services among various uses and people. The concept of
allocation can imply that a designated individual or group is responsible for
each level of decision making within a system that is designed to distribute
fixed amounts of resources.
➢ Healthcare allocations are commonly classified in terms of two levels of
decision making: microallocation and macroallocation.
Microallocation
- Microallocation focuses on decisions regarding particular persons. It often
involves "patient selection": determining which patients among those who
need a particular scarce resource, such as a heart transplant, should
receive treatment. Sometimes, however, microallocation entails deciding
for an individual patient which of several potentially beneficial treatments
to provide, particularly when only a limited time is available for treatment.
Macroallocation
- Macroallocation, on the other hand, entails decisions that determine the
amount of resources available for particular kinds of healthcare services.
Macroallocation decisions include how particular health-related institutions
such as hospitals or government agencies budget their spending
(sometimes referred to as mesoallocation). The extent to which health is
fostered through medical care as opposed to nonmedical interventions
such as environmental regulation is also a matter of macroallocation, as is
the amount of money, time, and energy a society allocates to the pursuit of
health rather than to education, defense, and other activities.
c. Theories of Justice
● Libertarianism
- is based on ideas of the maximum freedom of the individual and
minimal state interference. The very formulation of the question that
someone should specifically allocate medical benefits turns out,
from the point of view of this approach, to be fundamentally wrong.
The state’s regulation of medical activities is an interference with
personal freedom, including that it provokes an increasing
dependence of the population on the health care system, as well as
an endless increase in spending on health care financing.
- The most fair solution to the problem would be to provide members
of the society with freedom of action, in which they could choose
how they meet their needs. At the same time, according to
libertarians, a free and pluralistic market provides the best
opportunities for everyone (of course, in the conditions of freedom
protected from violence and infringement of the rights of others),
therefore private forms of providing medical services best serve the
distribution of individual decisions of people regarding their health
and medical care.
● Utilitarianism
- In contrast, advocates the adoption of special policy measures to
regulate medical activities. These measures should be evaluated
from the point of view of the common good through utility. The
greatest fairness occurs when maximum utility is achieved for the
maximum number of people. Effective medical interventions that
lead to cure for diseases or rehabilitation contribute to a real
increase in the level of people's health and contribute to an increase
in the overall public good.
- In the utilitarian approach, justice approaches the idea of
effectiveness. Utilitarianism uses specific methods to analyze the
effectiveness of health system interventions for the specific tasks of
health care.
● Egalitarianism
- is based on the idea of equality. Injustice occurs when a member of
society does not have access to medical care. Therefore, the state’s
task is to ensure equal access to medical care for all members of
society. But how to achieve this and what types and volumes of
medical care should be made publicly available is a separate issue.
d. World Healthcare Models

A. Beveridge Model
- Developed in 1948 by Sir William Beveridge in the United Kingdom.
- The government acts as the single-payer, removing competition in the market to
keep costs low and standardize benefits.
- The government controls the providers on what they do and what they can charge
- Funded by taxes, so a tax-paying citizen is guaranteed the same access to care
- One disadvantage of this model is Overutilization, tax payers can abuse the
system because they can demand for health care even if they do not need it
- Used by the United Kingdom, Spain, New Zealand, Cuba, and Hong Kong
B. Bismarck Model
- Created near the end of the 19th century By Otto von Bismarck
- Employers and employees are responsible for funding their health insurance
through sickness funds created by payroll deductions.
- Providers and hospitals are generally private but the insurers can be public.
- Just like the beveridge model, the government also controls pricing
- They do not provide universal health coverage, they are going to require
employment so it allocated its resources to those who contribute financially.
- One criticism of this model is that how are they going to provide health care to
those who can’t afford contributions including aging populations and retirees.
- Used by Germany, Belgium, Japan, Switzerland, the Netherlands, and France.
C. The National Health Insurance Model
- Like the beveridge model, the government acts as the single payer for medical
procedures. However, like the bismarck model, providers are mainly private.
- They have no concern for profit, it is cheaper and easier to navigate.
- Driven by private providers but the payments come from a government-run
insurance that every citizen pays into (tax).
- Primary criticism of this model is that there is a potential for long waiting lists and
delays in treatment which are considered a serious health policy issue.
- Used by Canada, Taiwan, and South Korea.
D. The out-pocket Model
- The most common model in less developed areas and countries where there aren’t
enough financial resources to create a medical system like the three models
discussed.
- Patients pay for their procedures out of pocket.
- One criticism is that the wealthy get professional medical care and the poor do not
unless they can somehow come up with enough money to pay for it.
- Healthcare is basically driven by income.
- Used by rural areas in India, China, Africa, and South America
e. Standard of Care
- Refers to the level of attentiveness and care that a certain person owes to
another person, typically in a professional or medical setting. It is a duty
determined by a given set of circumstances that present in a particular
patient, with a specific condition, at a definite time and place. In other
words, standard of care is sensitive to time, place, and person. This is a
challenge to healthcare providers who try to adhere strictly to clinical
guidelines because of the absence of absolute standards, it forces
healthcare providers to make judgements that may prove in hindsight to
have been incorrect.
- The ethical principles that nurses must adhere to are the principles of
justice, beneficence, nonmaleficence, accountability, fidelity, autonomy,
and veracity.
- Justice is fairness. Nurses must be fair when they distribute care, for
example, among the patients in the group of patients that they are taking
care of. Care must be fairly, justly, and equitably distributed among a group
of patients
- Standards of Care in Nursing:

● Standards of care in nursing are important because they recognize the trusted role
that a nurse plays. These standards are considered the baseline for quality care.
They must be developed while assessing the state and federal rules, regulations
and laws that govern the practice of nursing. Other agencies and organizations
may also assist in the development of these standards.Standards
of care apply equally to nurses in various settings.
- Importance of Standards:
● They outline professional expectations of nurses
● They guide nurses on proper protocol and give them an objective standard to
evaluate other nurses with
● They provide consistency throughout the profession so that patients receive quality
care
● They give nurses the necessary information that they need to know the quality of
care that they must provide to patients and establish measures in which to evaluate
the care provided
- Legal Implications:
● If a nurse does not meet the accepted standards of practice, he or she may be
found negligent if his or her negligence caused a patient harm. In most litigation, a
nurse is accused of violating a standard of care in a negligence lawsuit. In the
medical profession, this is often referred to as malpractice.
● Nurses may be held liable in malpractice cases if they in appropriately administer
medication, fail to monitor equipment, fail to warn patients about known harms or
fail to protect patients from known dangers. Nurses are required to completely and
accurately report the assessment and observations that they make regarding each
patient in a timely manner. If they do not monitor the patient’s condition or be
alerted to changes in the patient’s condition, they may be found negligent.
● Nurses have a duty to communicate changes to the attending doctor to avoid harm
to the patient. Additionally, not complying with state rules regulating the nursing
practice regarding the delegation of certain tasks to unlicensed individuals or
mishandling patient identification can also cause legal liability to arise.
- Nurses are held to a higher standard than other professionals because we deal with
patients on a constant basis, and our actions could lead to injury or death to someone if
we are not careful. These obligations that nurses should carry out affect the health and
wellbeing of many different individuals each day.
- To meet the practices that a healthcare facility requires of a professional, the hospital and
employers are responsible in ensuring the resources are available along with all necessary
support. In accordance with this, nurses must satisfy both professional and legal
obligations in safety and ethical care for patients. Within these standards, the nurse may
be exempt from legal entanglements with client and patient problems.
D. Other Relevant ethical principles

1. Principle of double effect
2. Principle of Legitimate Cooperation
➢ The Principle of Legitimate Cooperation

• When it is applied?
- Whenever an act we are considering would assist someone else in committing a morally
evil act.
• Principal Agent - Person Committing the immoral act.
• Cooperator - Person aiding the principal agent
Types of Legitimate Cooperation

● Formal cooperation – when you share the other person’s evil intent could involve
approving or taking part in it. It’s never morally permissible, according to Catholics (Your
intent/object is bad).
Example: Harolda wanted to abort her baby before leaving for abroad and her friend agrees and
advises her to take Mifeprex (common abortion pills). After aborting her baby, she tells her mother
about it and forgives her.
● Material cooperation – you do not share the other person’s evil intent, but you still
cooperate.
A. Immediate material cooperation – when you participate in a way that’s essential to the
commission (completion) of the evil act. Never morally permissible (you and the other
person share the same object).
- If one cooperates in an evil act by performing something that is essential for the
performance of the evil action.
Example: A robber pointed a gun at your head and ordered you to drive the car and assist
in loading the stolen object
B. Mediate material cooperation – when you participate in a way that’s NOT essential to the
commission (completion) of the evil act.
- if one cooperates in an accidental or nonessential manner in the evil action
Example: Selling weapons that are later used for homicide
CRITERIA FOR JUDGING THE MORALITY OF COOPERATION

1. Every cooperation which directly influences the evil intention of the person with whom one
cooperates, is always illicit.
- It is a scandal to incite others to do evil and should never be done.
2. Formal cooperation is always illicit

-The reason: cooperation not only affects the evil act but it also affects the will intention by
approving the mode of action.
3. Simple material cooperation is also illicit. One must not help anyone to do evil.
- Nevertheless, in certain specific circumstances it may be licit to cooperate materially in order to
obtain the necessary good or to avoid a more serious harm.
Example: Even if the robbers pointed a gun at your head, you should have not helped them but
only if they already harmed you in a way so that the evil act will not be complete. One solution
could be just giving the car to the robbers or calling the police while driving.
➢ Principle of double effect - also known as the rule of double effect. The doctrine of
double effect is a set of ethical criteria which Christian philosophers, and some others,
have advocated for evaluating the permissibility of acting when one's otherwise legitimate
act. This principle aims to provide specific guidelines for determining when it is morally
permissible to perform an action in pursuit of a good end in full knowledge that the action
will also bring about bad results.
Conditions of the Principle of double effect

● The action must be morally good in itself, or at least morally different
● The good effect of the act must precede the evil effect which is morally allowed to happen
as regrettable consequence.
● There must be a grave or sufficient reason in doing the act
● The evil effect should not outweigh the good effect, or at least the good effect has a
tantamount importance over the evil effect.
➢ Principle of Common Good and Subsidiarity- (Catholic Social Teaching)

The Common Good- The sum total of social conditions which allow people, either as
groups or individuals, to reach their individual and communal fulfillment more fully and
more easily ( Pope John XXIII).
- It helps us to examine the problem with a positive outlook since we are looking for
a common goal that will ultimately benefit each one of us. (win-win situation)
- Involves all the members of the group or society to achieve the common goal for
the common good.
- Common goods include: food, water, clothing, right to education, right to vote, right
to safeguard privacy, right to choose on how to live, freedom, respect, right to work
right to good name and religion.
- All these rights and freedoms are necessary for us to have a good life, not
necessarily being rich, but enables us to fulfill our human flourishing and help us
live to our full potential here on earth.
Common good as both rights and responsibilities:
● We have the right to expect the political,economical, juridical and cultural
structures of our society to honor our God-given dignity .
● But we also have a responsibility to make those structures honor
everyone's dignity.
When can we disqualify a thing as common good?

- Common goods won’t be called common anymore if we stand for injustice, tolerate
discrimination and abuse towards individuals. Simply, It must benefit all people and
respect their human dignity.
“But any kind of social or cultural discrimination in basic personal rights on the
grounds of sex, race, color, social conditions, language or religion must be curbed and
eradicatred as incompatible with God’s design. It is deeply to be deplored that these
basic personal rights are not yet being respected everywhere…”
-1965 Vatican II document Gaudium et Spes, no. 29
Serves as Ideal and Moral Measure:
1.) As an Ideal Measure - the common good points to a state of affairs, a

world where all conditions are in place where everyone can reach their full potential
as persons and as a community; conditions such as access to good education and
healthcare, safe housing, fair wages, and be able to participate in political and
cultural life, In this sense, the common good won't be fully realized but it provides
us with a goal to work towards.
2.) As a Moral Measure- tool we can use to evaluate to see if our choices,
policies and institutions align with this ideal measure and can help people.
Example 1: Does my purchasing decisions reflect on my self concerns and status?
Do I spend money that aligns with environmental sustainability?, Do I live simpler
? so more of your resources can meet the basic needs of others.
Three Essential Elements of Common Good:

1.) Rights- The common good presupposes respect for the person. Public
authorities must respect the rights of the person. In short, respect people.
2.) Needs- The common good requires social well being and development of
the group itself. Authorities should make accessible what is needed to lead
a true human life (food, clothing, health, work, information etc.)
3.) Peace- Public authorities should ensure a morally acceptable means of
security in defense of its people
Paths for fostering the common good:
1.) Regulations and policies (Government)
2.) Non- profit organizations
3.) Organizing charity programs
4.) Reaching out to neighbors
- Nursing Example: In relation to nursing, we are exposed to our target communities
where we’ll conduct health teaching to those families.
- We also learned that whenever we make nursing care plans or health teachings
our goal must be met and so for the common good of everyone, each one of us
should coordinate well and participate to carry out a good and meaningful health
teaching and as well as to meet the goals we want for the community.
Subsidiarity- concerned with the power that is given to the minority or lowest level
of authority, that issues or problems should be taken should be handled at a local level
rather than the highest authority. It guarantees independence for the lower authority in
relation to the highest authority. A community of a higher order should not interfere in the
internal life and community of a lower order.
The highest order like the State should act on the common good of society which
means not depriving local authorities of their power. The higher order should only be
involved in those tasks that could not be carried out at a local level.
Examples:
The State should not dictate on what a city should do.
Higher authorities should not interfere with a family's child rearing practices.
Nursing example:
For instance, the doctor is the highest authority and the nurse is the lower authority.
Suppose that the doctor prescribed a certain drug to a patient but the nurse knows that
the patient has an allergic reaction to the prescribed medication. Thus, the nurse would
not administer the drug and inform the doctor about it. With this in mind, the nurse showed
that she could decide on her own and practiced subsidiarity.
In summary, common goods is where all individuals reach their fulfilment, where
human dignity is respected and society is able to interact with each other in a way that
achieves total human flourishing. While Subsidiarity on the other hand, gives
independence to smaller communities or authorities in doing their tasks.
VELEZ COLLEGE
COLLEGE OF NURSING
F. RAMOS ST., CEBU CITY
Group: 4 Date: 06/03/2021

Year & Section: BSN-2B Professor: Mrs. Bellavic A. Tropezado, RN, MAN
Name of Students:
Carpio, Thallia F. Escarpe, Caryll Mae A.
Cawayan, Janelle G. Lechoco, Therese Erika P.
Cola, Erika Mae M. Mercader, Gale Febb G.
Del Mar, Kiara Annika J. Plarisan, Ysabella Roselle S.
Theories and Principles of Health Ethics:

Principle of Stewardship and the Role of Nurses as Stewards
Principle of Totality and its Integrity
Principle of Stewardship
● Stewardship requires us to appreciate the two great gifts that a wise and loving God has
given: the earth, with all its natural resources and our own human nature, with its
biological, psychological, social, and spiritual capacities.
● The principle is grounded in the presupposition that God has absolute Dominion over
creation, and that in so far as human beings are made in God’s image and likeness, we
have been given a limited dominion over creation and are responsible for its care.
● Stewardship refers to the expression of one’s responsibility to take care , nurture and
cultivate what has been entrusted to him.
● In healthcare practice, stewardship refers to the execution of responsibility of the health
care practitioners to look after, provide necessary health care services, and promote the
health and life of those entrusted to their care.
● Traditional Definitions of Stewardship
○ The parable of ‘talents’ in the New Testament describes another aspect of
stewardship in which a master divides his worldly goods between his three
servants. The moral portrayed here is that when one is entrusted with something
of value, there is an obligation to improve it.
● State-Oriented Definitions of Stewardship
○ The broad definition of state-oriented stewardship is that the function of
government is that it is responsible for the welfare and interests of the population,
especially the trust and legitimacy with which its activities are viewed by the
general public.
● The Metaphor of a Steward
○ “A steward is characterized as a person who preserves and promotes what is
intrinsically valuable.”
○ In the eleventh century, the English word ‘steward’ developed from the term
stigwaerd, meaning ‘warden of the house’.
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○ To be a steward is to ‘devote a substantial percentage of one’s thoughts and

efforts to maintain or enhance the conditions of some thing(s), person(s), and not
primarily for one’s sake’. It was suggested that stewards are motivated to act as
they develop character disposition(s), including self-discipline and courage.
● Nurse Leaders as Stewards
○ Stewards, as well as practicing nurses who seek to preserve and promote values
at the point of service, may influence managers in their decision about who ought
to receive what services and how, and thus influence change in health care
organizations.
○ Nurses leaders are ‘engaged to others and work collaboratively to establish and
achieve a vision and purpose’ that affects the well-being of a system or
organization rather than promote their self-interest.
○ Leaders are either self-oriented or system-oriented.
■ Self-oriented leaders perceive themselves as the decision makers and
others as implementers
■ System-oriented leaders, who hold as their priority the well-being of the
organization, show respect to all its members. The system-oriented
leaders in healthcare organizations will hold the point of service as their
priority and seek the input of nurses in setting collective value.
■ In short, Oriented to self leaders - reflect the value of individualism while
Oriented to the organization or system leaders - reflect the value of
collectivism
○ In order for nurses to influence decision making at the point of service, there is a
need to invigorate nursing leadership. Nurses are urged to establish moral
communities where ‘ethical values are made explicit and shared, where ethical
values direct action, and where individuals feel safe to be heard’.
○ Nursing practices ought to be grounded in respect for persons’ dignity and self-
determination, as well as equity and fairness.
Role of Nurses as Stewards
Stewards of Self: To meet the concept of lifelong learning, nurse leaders or stewards will need to
use mentors and personal coaches to assist them in refining skills and improving competencies.
Health nurse leader stewards will thus become visible and sound role models within their
institutions to maintain the balance between self and professional fulfilment.
● Personal
○ According to a Communitarian theorist, MacIntyre states that a person is a
narrative self who seeks purpose, or good for the self, through interpretations of
everyday experiences. Together with these experiences are virtues that are
central because they affect perceptual judgments about what is relevant in an
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experience. A virtue is defined as ‘a quality which enables an individual to move

towards the achievement of a specific human goal’.
○ Character or identity is cultivated as virtues are habitually exercised.
○ In cultivating a character, a person acts without knowing the exact outcome of his
or her actions; rather, he or she acts in the belief that the action will be
worthwhile.
○ A nurse who exercises stewardship at the point of service in accordance with
MacIntyre’s theory of virtue ethics will facilitate nurses’ justification of their shared
value priorities within professional setting as the American Nurses Association
code of ethics. Thus, stewards and nurses may preserve and promote what is
intrinsically valuable in nursing practice.
○ The potential for improving and enhancing policy outcomes is the predominant
positive potential of stewardship.
● Social
○ Healthcare has long been part of our lives and access to healthcare has become
a basic human right - but for some countries, it is a privilege. Receiving
healthcare is important because without it, people will be put at risk of infections
and diseases.
○ Nurses play a central role in delivering healthcare. They advocate for health
promotion, educate the public about disease prevention, provide holistic care to
the patients, and participate in rehabilitation.
○ The nurses also help the people and their families understand the different
experiences they encounter in dealing with their health and illnesses, like how to
cope, deal, and if necessary, live with it. In the hospital, nurses provide ongoing
assessment of people's health.
○ Nurses do more than care for individuals. They are not merely caregivers but
they also have other roles and functions, such as being a client advocate, a
counselor, and an educator among others.
● Ecological
○ Nurses have many roles, and this includes waste management since the
healthcare sector generates a lot of waste contributing to environmental issues,
such as air and water pollution which may cause problems if not properly
managed.
○ Poor medical waste management unquestionably exposes healthcare workers,
waste handlers, and the community to infections, toxic effects, and injuries
○ Nurses have the ability to use their trusted skill sets and lead the way for
sustainable, healthy communities and environments in which they serve
■ By unifying and engaging staff through shared governance models,
nurses can reduce the overhead costs associated with waste
management.
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■ Being aware of current healthcare waste disposal methods. Is it doing the

job? Or do we need to make changes to better the system? If ever,
nurses should take action if they can see that there are problems
■ Nurses comprise the largest profession in health care and are adept at
educating, researching, and leading in waste reduction.
● Biomedical
○ Most crucial role of nurses as stewards because nurses deal with lives. With one
wrong move, it may cause certain problems, or even compromise the patient.
○ For this reason, nurses may be exposed to criminal charges due to improper
treatment.
■ For example, withholding nutrition can constitute nursing neglect and
expose the nurse to criminal charges of negligence or conspiracy to
commit suicide.
Principle of Totality and its Integrity

The principle of totality states that all decisions in medical ethics must prioritize the good of the
entire person, including physical, psychological and spiritual factors.
● Background
○ This principle derives from the works of the medieval philosopher St. Thomas
Aquinas, who synthesized the philosophy of Aristotle with the theology of the
Catholic Church.
○ The principle of totality is used as an ethical guideline by Catholic healthcare
institutions.
● Integrity
○ Refers to each individual's duty to “preserve a view of the whole human person in
which the values of the intellect, will, conscience, and fraternity are pre-eminent.”
● Totality
○ According to the philosopher Thomas Aquinas, all of the organs and other parts
of the body exist for the sake of the whole person.
○ Because the purpose of the part is to serve the whole, any action that damages a
part of the body or prevents it from fulfilling its purpose violates the natural order
and is morally wrong. This is called the “principle of totality.”
○ However, a single part may be sacrificed if the loss is necessary for the good of
the whole person.
■ For example, the principle of totality would justify the amputation of a
gangrenous limb, because the person could die if the gangrene spread.
● Conditions
○ The action must be morally good or neutral in itself.
■ Providing medicine to a sick patient meets this requirement.
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○ The bad results cannot be the means for achieving the good results.
■ Negative side effects don't cause the medicine to work more effectively.
○ The motivation for carrying out the action must be solely to achieve the good
results.
■ Doctors prescribe medicine to help their patients, not to expose them to side
effects.
○ The good result must be at least as significant as the bad.
■ Prescribing medication with side-effects is acceptable if the health benefits to the
patient will be at least as significant as the harm from the side-effects.
Ethico-moral Responsibility of Nurses in Surgery

● Supporting Patient Rights and Choices
○ Nurses are obligated to morally respect the dignity and worth of individual
patients wherein nursing care must be provided in a manner that preserves and
protects patient autonomy and human rights
○ The nurse, as a moral agent for the patient, must be ready and able to advocate
for the patient's rights and needs whenever necessary while providing care.
Assuming such a stance involves acting on ethical principles and values
● Respect for Others
○ Not only must nurses recognize the individuality of their patients, they also must
recognize the individuality of their colleagues and others.
○ Nurses must be able to interact with a variety of other professionals and ancillary
providers in the perioperative environment
○ The nurse recognizes the contributions of each member of the health care team
and collaborates to achieve quality patient care
● Treating Patients Equally
○ Perioperative nursing care should be provided in a non prejudicial manner that
preserves and protects patient free will, choice, and human rights.
○ When providing patient care, nurses must take into consideration a patient's
values, religious beliefs, and lifestyle choices
■ Age specific care:
● perioperative nurses must act ethically with regard to age‐specific
care and treatment
■ Changing face of culture
● nurses provide nursing care directed to meet the comprehensive
needs of all patients, taking into consideration aspects of culture,
language, perception of pain, significant others, values, and
beliefs
● Recognize Ethical Dilemmas
○ Nurses have the responsibility to recognize and identify ethical issues that affect
staff and patients and make the best possible decisions
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Sterilization/Mutilation
● Sterilization
○ Sterilization involves both genders and pertains to surgical procedures that
leaves either a male or female unable to reproduce. Sterilization then in other
words is the removal of a procreative member or element of the human in order
to prevent procreation.
■ Indirect (Therapeutic) – required for the survival and health of a person,
sexual organs, integrating parts which must yield to the good of the
whole. Licit if:
● Sickness is grave, diagnosed and definitive that offsets the evils
of sterilization
● Necessary is it is the only possibly effective remedy
● Exclusively curative. Intention is important.
■ Direct – immediate effect is to render procreation impossible
○ Types:
■ Eugenic – to avoid transmission of hereditary defects
■ Hedonistic – to evade the complications and responsibilities of
procreation without giving up the sexual pleasure
■ Demographic – to control the birth rate
○ Procedures Involved:
■ Vasectomy (Males) – the cutting and closing of the vasa deferentia which
are tubes that connect the testicles to the prostate. Prevents sperm
produced in the testicles to enter the ejaculated semen.
■ Tubal ligation (Females) – is a procedure that involves severing and tying
the fallopian tubes. This generally involves an anesthetic and a
laparotomy or laparoscopic approach to cut, clip, or cauterize the fallopian
tubes which essentially carry sperm to the ova.
■ Hysterectomy – the surgical removal of the uterus thus permanently
preventing pregnancy and maybe even some diseases such as cancer
■ Castration (male & female) –is any action, surgical, chemical, or
otherwise, by which an individual loses use of the gonads: For males this
procedure is called a Gonadectomy. For females this involves the
removal of the ovaries, otherwise known as Oophorectomy
○ The Ethical Issues Surrounding Sterilization:
■ The Catholic Church
● Strongly condemns all artificial methods of contraception - a
position also held by most protestant churches up to 1930 when
the Anglican church coted for change.
● Indirect sterilization, resulting from the cure of some pathological
condition, has always been allowed.
● The church disapproves direct sterilization because: it separates
unnaturally the dual purpose of the marital act, contradicts the
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nature of man and woman and their intimate relationship, and

oversteps the dominion a person has over his or her generative
faculties.
● Includes other means of contraception such as birth control pills or
condoms and the aforementioned surgical methods of sterilization
○ Sterilization in Relation to the Principle of Totality:
■ Medical perspective of Totality - all the parts of the human body, as parts,
are meant to exist and function for the good of the whole body, and are
thus naturally subordinated to the good of the whole body
■ Totality - points to the duty to preserve intact the physical component of
that integrated whole.
■ Sterilization without a medical purpose relevant to the preservation of the
”whole” of an individual’s body is then considered as a violation of the
Principle of Totality.
● Mutilation
● Mutilation or maiming is an act of physical injury that degrades the appearance or
function of the human body, usually without causing death.
● This term is usually used to describe the victims of accidents, torture, physical
assault, or certain premodern forms of punishment
● Types:
○ Direct – willed in itself, as end or means, intended and caused intrinsically
wrong. This offends human dignity and the individual does not have the
right mutilate himself, much less does society
○ Indirect (Therapeutic) – mutilation necessary for the survival of the patient
or to free him of proportional sufferings or infirmities.
● The Importance of Aristotle's View on the Principle of Totality in Relation to
Mutilation:
○ Totum quam parte, prius esse necesse est. – The principle of totality
presupposes that "parts exist for the whole. The good of the part is
subordinated to the good of the whole; the whole is the determining factor
for the part and can dispose of its own interest.
○ Aristotle’s explanation on the Part/s
1. A part denotes any portion of a quantum into which it can "be
divided, for that which is taken from a quantum qua quantum"
remains always a part of it.
Ex. Two can be named "in a sense a part of three."
There are two types of meaning for it. In the first place, part
means "only those which measure the whole," which
includes only two. In another sense a part cannot be
considered as a "part of three."
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2. Part can be understood as the constituent element of a

dividable kind "apart from the quantity."
Ex. Species are part of the genus
3. Whole, which includes a part, can be divided. Here

Aristotle uses the term 'whole' in the sense of "form or that
which has form."
Ex. A bronze sphere or bronze cube which is from bronze
or it can denote a portion of material body which gives form
to that.
4. The constituent "elements in the definition which explain a

thing are also parts of the whole." Here, too, Aristotle gives
the example of genus and species to substantiate his
point. In this understanding "genus is called a part of the
species," in another understanding "the species is part of
the genus.
○ Aristotle’s explanation in the Whole
1. That from which is absent none of the parts of which it is
said to be naturally a whole, and
2. That which so contains the things it contains that they form
a unity; and this in two senses - either as being each
severally one single thing, or as making up the unity
between them."
○ St. Thomas Aquinas’ simplification of Aristotle’s explanation of the
whole:
1. The perfection of the whole be integrated from the parts of
which it is constituted;"
2. That these parts form a unity.
● The Principle of Totality and the Justification of Mutilation by Thomas
Aquinas
○ St. Thomas Aquinas brings the principle of totality under the topic
"injuries to the person."
○ Two perspectives: Penal and Medical
■ Medical mutilation
● mutilation is elicit when it is necessary for the good
of the entire body
■ Penal Amputation
● involves amputation as punishment for performing
wrong acts such as the penal sentence of
amputating a man’s hand for stealing practiced in
Iran
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● Thomas never justifies mutilation against innocent

persons
■ Three basic elements that justify mutilation in the teachings
of Thomas
1. Mutilation is justified for the well-being of the whole
body.
2. It is not against the role of the human person as the
protector of his/her body. This is done on the basis
of a human person's limited power over his/her
body for the betterment of the whole body.
3. Mutilation in the form of a penalty for a crime can
be done by the state.
Preservation of Bodily Functional Integrity

● Bodily Integrity:
○ is the inviolability of the physical body and emphasizes the importance of
personal autonomy, self-ownership, and self-determination of human beings over
their own bodies.
○ the only person with the right to make a decision about one’s body is oneself—no
one else.
○ Bodily Integrity pertains to the respect for a certain wholeness
● Double Meaning
○ Integrum - wholeness, unity, intactness
○ In-tangere - not touching, not hurting
● Issue of Bodily Integrity
○ Practices that violate a person’s bodily integrity can range from piercing a baby
girl’s ears being exposed to toxic chemicals without one’s knowledge to rape and
medical treatment administered against a patient’s wishes.
○ Children are disproportionately vulnerable to violations of their bodily integrity
because most violations happen at very young age when a person is unable to
speak up for and defend themselves, or give — or refuse — consent.
● Problem of Bodily Integrity
○ Forced treatment as opposed to the right to physical integrity (and the ethical
duty of respect for autonomy)
○ A number of these practices are irreversible and due to their surgical nature carry
inevitable health risks. These range from infection and scarring to disfigurement,
amputation, and even death.
● Solution of Bodily Integrity
○ The right to bodily integrity is pivotal in any health-related context and should not
be lightly disregarded.
○ The decision about one’s body should rest only with the person in question and
be taken by them to give their free, prior and informed consent—or to refuse it.
VELEZ COLLEGE
COLLEGE OF NURSING
○ The only exception is when an intervention is medically necessary to save the

person from serious, urgent and irreparable harm.
Issues on Organ Donation

● WHAT IS ORGAN DONATION?
○ A person may will to dispose of his body and to desire it to ends that are useful,
morally irreproachable, and even noble among them, the desire to aid the sick and
suffering.
○ It is a process of surgically removing an organ or tissue from one person (the
donor) and placing it into another person (the recipient).
● Criteria:
○ There’s a serious need on the part of the recipient that cannot be fulfilled in any
other way.
○ The functional integrity of the donor with a human person will not be impaired
even though anatomical integrity may suffer
○ The risk taken by the donor as an act of charity is proportionate to the good
resulting to the recipient.
○ The donor’s consent is free and informed.
○ The recipients for the scarce organs are selected justly.
● Ethical Issues
○ Examining one’s values and beliefs
○ Death and the dead donor rule
■ Brain death/Higher brain death
■ Non heart beating death
○ Informed consent
○ Voluntary Consent
○ Donations, Not Sales
● Role of the nurse in organ donation and transplant
○ Registered professional nurse are often the primary caregivers for patients
approaching the final stage of life.
○ Facilitates the coping of the patient and their families. Work is anchored on
counseling and facilitating the process for organ or tissue donation by educating
and guiding to the donor families.
○ Stays with the patients and help the family understand the organ donation
process, which includes keeping the brain-dead patient’s body functioning until
the organ has been collected.
○ As a transplant coordinator:
○ The nurse must have deep knowledge regarding the following aspects
■ What is organ donation and why it is needed?
■ How does the organ donation help patient with organ failure?
■ What body parts can be donated?
■ Who can be potential donors?
VELEZ COLLEGE
COLLEGE OF NURSING
■ Document required for the donor and for the recipients.

■ Why become an organ donor and how to get registered?
■ How does the family of the deceased organ donor cope up with their loss.
○ Follows the ethics of organ donation
■ The nurses first obligation is the well-being of the patient entrusted to our
care.
■ An act procuring organs should never be the cause of a person’s death.
■ The decision to donate the organ is based on the strict medical criteria
and law.
■ Nurses understand the good of organ donation itself.

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04/02/2021

Entering a Health Care Profession

2. Provision of a particular service to society

3. Standards of education and practice

4. Self-regulation – an acknowledgment of specific duties and

Entering a Health Care Profession

In regard to clients and patients, practitioners have a fiduciary relationship, which

Entering a Health Care Profession

Specialty Practice Acts address the following:

2. Requirements and Qualifications for Licensure or Certification

3. Exemptions to Basic Requirements

4. Grounds for Administrative Actions

5. Penalties and sanctions for unauthorized practice

Entering a Health Care Profession

1. Sanctions for Lapses

Area Judgment Sanction

Involves issues such as:

2. Maintenance of appropriate relationship at the worksite

3. Need to stay within the role boundaries of the specialty

Health Care Ethics

Code of Ethics bind together a group of Practitioners and Express the

Health Care Ethics

Sample Ethical Questions:

1. The summit of the meaning of the healthcare profession

5. The healthcare provider disregards race, culture, religion and belief in

The Health Care Provider

1. The healthcare provider, especially the nurse, is no ordinary

Qualities and Responsibilities of a good Health Care Provider

Qualities and Responsibilities of a good Health Care Provider

Qualities and Responsibilities of a good Health Care Provider

7. Follow Professional Standards

Qualities and Responsibilities of a good Health Care Provider

• Involves self-determination, responsibility, accountability, independence, and a

Qualities and Responsibilities of a good Health Care Provider

The Foundations of Law

Basic Sources for Modern Law:

Common Statutory Administrative

emanates from arise from from rules and

Fundamental Principles of Law

● A concern for justice and fairness

● Plasticity and change

● Acts are judged on the universal standard of the reasonable person

● Doctrine of Indivudual Rights and Responsibilities

○ Failure to meet one’s responsibilities affets one’s rights. Every

person is liable for his or her own actions.

Common Misunderstandings About The Nature of Law

need to do is apply the correct legal precedent

● If no one does this, the law will do that.

● The law tells you what to do.

Plaintiff Defendant Prima Facie

Has enough burden of Has enough ample

● A short statement laying out the grounds on which the court’s

● Fact-finding phase to eliminate surprises, clarify what the lawsuit is

○ Depositions – opportunity for each side to question witness and

parties toa suit to elicit information about the case

Trial and Judgment

There is an unbridgeable gap between facts and value.

Common Decision-Shaping Values in Health Care

Kohlberg’s Stage Theory of

Conflicts of Kohlberg’s Theory

● Carol Gilligan: Kohlberg’s research methods were flawed and gender

● Kohlberg took the criticisms wells, thus making revisions to account

The critical period of value programming is between birth

● From the Greek word telos which means end

Carlson, S. C. (2019, November 14). Golden ratio. Encyclopedia Britannica.

Maputi, L. (2015). Legal Issues in Nursing and Bioethical Issues. Slideshare.

Pettigrove, G & Hursthouse, R. (2018). Virtue Ethics. Stanford Encyclopedia of Philosophy.

Name: Brigola, Karyl L. Muniz, Irene Ivette Romero Date: 02/18/21

Clinical Instructor: Mrs. Bellavic Tropezado, RN, MAN

2. Don’t use patient identifiable information unless it is absolutely necessary

6. Fidelity - the quality of faithfulness or loyalty; keeping one’s promises.

CatholicHealthAust. (2014, August 20). Principle of double effect. YouTube.