Bullets in BIOETHICS

 Lawrence Kohlberg’s Stages of Moral Development

Level 1 (Pre-Conventional)
1. Obedience and punishment orientation (2-3 y.o.)
2. Self-interest orientation (Reward Orientation) (3-6 y.o.) (Superego development)
Level 2 (Conventional)
3. Interpersonal accord and conformity (The good boy/good girl attitude) (6-10 y.o.)
4. Authority and social-order maintaining orientation (Law and order morality) (10-12 y.o.)
Level 3 (Post-Conventional)
5. Social contract orientation (12-18 y.o.)
6. Universal ethical principles (Principled conscience) (18 and above)
 UTILITARIANISM - The broader good deems to be the better good. “The end justifies the means.”
 DEONTOLOGICAL – Suggests that “good consequences may have to be set aside to respect inalienable human
rights.” “Do no harm.”
 AUTONOMY - “Independence,” “One’s ability to decide for himself”
NOTE: Only a COURT ORDER can overrule the client’s right to Autonomy.
 NONMALEFICENCE - “Do no Harm”
 BENEFICENCE - “Do good for the client’s benefit”
 What is the undesirable outcome of beneficence?
Paternalism – the health care provider decides what is best for the client and attempts to encourage the
client to act against his own choices.
 JUSTICE - “Fairness and Equality”
 FIDELITY - “Being Faithful”
 VERACITY - “Truthful”
 CONFIDENTIALITY - respect for privileged information.
Reasons to disclose Confidentiality:
a. Court Order (criminal cases, abuse)
b. Consent from client
c. Communicable diseases
d. Compromised safety
 Voluntary commitment – the client willfully admitted himself to the hospital.
a. Client must be released when he no longer chooses to be hospitalized.
b. Client has the right to refuse treatment.
 Involuntary commitment – client was brought and admitted to the hospital by his folks against his will.
a. Reasons: Client is mentally ill, Poses a danger to self and others, and Unable to care for self
b. Client may not refuse treatment.
 If a nurse suspects that a co-worker is abusing chemicals, what must she do?
-Report it to the Nurse Manager in a confidential manner
 The goal of reporting the co-worker is?
-Treatment of the impaired colleague and safety of the patient
 When does a nurse’s responsibility to the patient begin?
-Upon admission
 INFORMED CONSENT - Giving the client factual information about the benefits, risks, and alternatives prior to
the procedure he will undergo. Obtained by the Physician or Surgeon
-Role of the Nurse:
a. Witnessing the Consent.
b. Making sure that the client understood the given information.
c. Witnessing the client’s signature.
 Components of Informed Consent: VIC
a. Voluntary – free of coercion or the client was not forced.
b. Informed – client was informed by the physician and understands the procedure.
c. Competent – of legal age (18 y.o. and above), mentally stable, not under the influence of drugs
 Minors can sign the consent only if they are EMANCIPATED MINORS:
a. Married b. in Military Service c. Self-sufficient and Independent

 Types of Informed Consent

1. Expressed Consent - Verbal or written
1
 2. Implied – signed during hospital admission and needs no separate consent; for simple & routine procedures. Used
also during emergency cases.
 A client has signed the consent but he no longer wish to undergo the procedure, what can
the client do?
- Client may withdraw consent anytime!
 Informed consent is waived in EMERGENCY CASES.
 Sterilization: husband & wife must give consent (except in: abruptio placenta, ectopic pregnancy, ruptured uterus)
 Informed Consent is Valid only for: 24 hrs
 ADVANCED DIRECTIVES – any advance declaration by a person regarding his care and medical treatment if he
becomes unable to communicate his wishes.
 Types of Advanced Directives:
o LIVING WILL (it’s a LIST of treatments to be avoided)
- LISTS the medical treatment that a client chooses to omit or refuse if the client becomes unable to make decisions
and is terminally ill.
o DURABLE POWER OF ATTORNEY (with HEALTH CARE PROXY)
- is a legal document that APPOINTS A PERSON (HEALTH CARE PROXY) chosen by the client to carry out the
client’s wishes or to make decisions on the client’s behalf when the client can no longer make decisions.

 Valid for how long? ONE YEAR ONLY

 Must be reviewed with whom after 1 year? PHYSICIAN
 Can a nurse witness in the making of Advanced Directives? No. Any employee of the hospital where the client is
admitted can’t stand as a witness nor the client’s family members.
 DNR ORDER
- Is an order written by a physician when a client has indicated a desire to be allowed to die if the client stops
breathing or the client’s heart stops beating.
- The client or his or her legal representative must provide informed consent for the DNR status.
 ORGAN DONATION
- Any person 18 years of age or older may become an organ donor by written consent, in a living will, or
indicated in his driver’s license.
- In the absence of appropriate documentation, a family member or legal guardian may authorize donation of
the decedent’s organ.
 False Imprisonment
-unlawfully restraining personal liberty.
-unlawful detention
 Types:
a. Actual:
-Use of physical force to prevent departure of client.
b. Implied:
-Use of words, threats, or gestures to restrain client.
 Inclusions in Implied Consent:
a. Refusing to allow client to leave the hospital until bill is paid.
b. Refusing to release newborn until bill is paid.
c. Refusing to allow client to leave without signing against medical advice.

 Incident Reports
a. Only person directly involved in the incident should document the facts.
b. Do not complete an incident report for someone else.
c. Document the facts. Do not:
-Draw conclusions who was to blame.
-State opinions.
-Speculate on who caused or who was responsible for incident.
d. Don’t document any reference to the IR in the chart; the same factual information filed on the incident report should
be included on the chart.
e. Failure to complete an IR could be considered a cover-up.
f. Follow the line of authority within the institution for reporting an incident.