ETHICAL PRINCIPLES
AUTONOMY
 The belief that every competent person
has the right to determine his or her own
course of action.
 independence or freedom, as of the will or  approaches
one's actions.
 the condition of being autonomous; self-
government, or the right of self-go .
 Individual freedom is the basis for the
modern concept of bioethics.
 This freedom, usually spoken of as
autonomy, is the principle that a person
should be free to make his or her own
decisions.
 It is the counterweight to the medical
profession’s long-practiced paternalism
(parentalism), wherein the practitioner
acted on what he or she thought was
"good" for the patient, whether or not the
patient agreed.
 This principle does not stand alone but is
derived from an ancient foundation for all
interpersonal relationships a respect for
persons as individuals
Examples of autonomous behavior that can
impair recovery or treatment:
1. Smoking
2. Refusing to take medication
3. Refusing to receive a blood transfusion
Health Care example of Autonomy
The case of Mrs. G., an 89-year-old woman
admitted to the hospital with difficulty breathing.
She has previously been diagnosed and treated
for lung cancer that has now metastasized to her
brain. On this admission, she is diagnosed with
pulmonary edema and congestive heart failure.
To try to determine whether, as a health care
professional, you have an ethical obligation to
cure Mrs. G. makes no sense because, quite
simply, you cannot do that. On the other hand, the
question whether to treat Mrs. G. aggressively in
order to extend her life another several weeks
(assuming that would be possible) or to provide
comfort care only may be experienced by all
involved as having very significant ethical
implications, both professional and personal.
Thus we might say that those things that we
ought to do as health care professionals compose
a subset of the universe of things that we can do.
"Can" here, then, is roughly synonymous with
clinically possible.
NONMALEFICENCE
 Duty to cause no harm to others
 Physiological, psychological, social,
spiritual
 Helps guide decisions about treatment
BENEFICENCE
 Duty to promote good and to prevent harm
 Providing benefit
 Balancing benefits and harm
Paternalism
o is a negative outcome of beneficence.
o occurs when health care providers
decide what is “best” for clients.
JUSTICE
 Based on concept of fairness
 Equality in treatment and allocation of
resources
Material Principle of Justice
o Determines when there can be
unequal allocation of scare resources
VERACITY
 Truthfulness, neither lying nor deceiving
others.
 Deception can take the form of intentional
lying, nondisclosure of information, or
partial disclosure.
FIDELITY
 Faithfulness and keeping promises
 Demonstrated by nurses in the role of
client advocate
Values and Ethics
 Values are individual rather than universal.
 Individuals often fail to consider the impact
of values on decisions.
 Nurses often care for clients whose value
systems conflict with theirs.
Values Clarification
 The process of analyzing one’s own
values to better understand what is truly
important
 Three-step process of valuing:
1. Choosing
2. Prizing
3. Acting
CLIENTS’ RIGHTS
Clients have certain rights to:
 Make decisions regarding their
care.
  Be actively involved in the
treatment process.
 Be treated with dignity and
respect.
PATIENT BILL OF RIGHTS
 Increases awareness of the need to treat
clients in an ethical manner.
 Encourages health care providers to
protect the rights of clients.
Ethical Dilemmas
 Occur when there is a conflict between
two or more ethical principles.
 The most beneficial decision depends on
the circumstances.
 Ethical analysis is not an exact science.
Frequently Occurring Ethical Dilemmas
1. Informed Consent
2. Refusal of Treatment
3. Use of Scarce Resources
4. Cost-Containment Initiatives that
Negatively Affect Client Well-Being
5. Incompetent Health Care
Providers
 Euthanasia
 Refusal of Treatment
 Scarce Resources
SCARCE RESOURCES
 The availability of specialists and organs,
is contributing to a scarcity of resources.
 The use of expensive services is
influenced by social and political forces.
 Health care reform is needed to ensure
services to all.
Ethical Decision Making
Ethical Reasoning
 Thinking through what one ought to do in
an orderly, systematic manner
 Justification of actions based on principles
PROFESSIONAL CODE OF ETHICS
 Professional code of ethics is a set of
statements listing minimum criteria for
ethical performance which usually
includes outlining the professions mission
& objectives. It also symbolizes that this
group of professionals is differentiating
itself from the other.
Common Problems Associated with
Professional Codes
 Vagueness as to duties & responsibilities
 Incompleteness as to duties
 Vagueness with regards to self-regulation
& peer enforcement
 Excessive concern with financial &
business interest
Institutional Ethics Committee
 An interdisciplinary body of health care
provider, community representative & non-
medical professionals who address ethical
questions within the health care institution,
especially on the care of patients.
CODE OF NURSING ETHICS IN THE
PHILIPPINES
 R.A. No. 877 – also known as the
Philippines Nursing Law as amended by
the PD No. 233, the Board of Nursing with
the approval of the PRC adopts the rules
& regulations necessary for the
maintenance of an efficient technical,
moral & professional standard in the
practice of nursing.
 These rules shall be known as the Code
of Nursing Ethics in the Philippines
The Amended Code of Ethics for Nurses in the
Philippines
 It was adopted by the PNA House of
Delegates in 1982, & amended by the
Board of Nursing in its Resolution No.
1955 series of 1989, approved by the
General Assembly of Nurses on October
25, 1990.
 June 22 1973 – under section 6 of PD No.
233, the house of delegate adopted the
Amended Code of Ethics of Nurses
recommended & endorsed by the PNA to
govern the practice of nursing.
Foreword to the Amended Code of Ethics for
Nurse
The nurses’ primacy responsibility is to preserve
health at all cost. This responsibility
encompasses: promotion of health, prevention of
illness, alleviation of suffering and restoration of
health.
1. Values, customs & spiritual beliefs held by
the individual are to be respected.
2. The nurse holds in strict confidence
personal information acquires in the
process of giving care. They use
discrimination judgement in sharing this
information.
3. The nurses are accountable for their own
nursing practice. They are responsible for
their personal & professional growth &
development.
4. Values, customs & 4. Nurses maintain or
modify standards of practice within the
reality of any given situation. Quality care
is their goal.
5. Nurses are the advocate of patients. They
take appropriate steps to safeguard the
patient’s right & privileges.

6. Nurses are aware that their actions have

professional, ethical, moral & legal
dimensions. They strive to perform their
work in the best interest of all concerned.

7. Nurses maintain collaborative working

relationship with their co-workers & other
members of the health team. They
recognize their capabilities & limitations in
accepting responsibilities & those of their
co-workers when delegating
responsibilities to them.

8. Nurses are contributing members of the

society. They assume responsibilities
inherent in being members & citizens of
the community/society in which they
live/work.

9. Nurses recognize the need for changes &

initiate, participate & support activities to
meet the health & social needs of the
people,

10. Nurses are expected to be members of

the nursing professional organization.
Inherent in this responsibility is to support
& uphold its constitution & by laws.

11. Nurses help to determine & implement

desirable standards of nursing practice &
nursing education.

12. They participate actively in the

development & growth of the nursing
profession.

13. They strive to secure equitable socio-

economic & work condition in nursing
through appropriate legislation & other
means.