● Marriage breakdown, and especially outright divorce, is
BIOETHICS Unit 4 harmful to children.
Bioethics and its Application in
Various Health Care Situations
A. Sexuality and Human Reproduction:
● Human reproduction is any form of sexual reproduction
resulting in human fertilization. It typically involves
sexual intercourse between a man and woman.
● During sexual intercourse, the interaction between the
male and female reproductive systems results in
fertilization
● Sexual activity has been essential to reproduction, and
does not preclude the non reproductive importance of
sexual relationship and non conceptive copulation. But
advancement in technology allows for both sex without
reproduction and reproduction without sex.
● Always a classic picture is of sex for reproduction and as
bonding between mating partners.
● Though, these human activities may now be carried out
independently. As reproduction is possible, not only
without sex but, even through the intervention of more
than 2 partners. of the woman's ovum by the man's sperm.
1. Human Sexuality and Its Moral Evaluation
● Sexual ethics seeks to understand, evaluate, and critique
the conduct of interpersonal relationships and sexual
activities from social, cultural, and philosophical
perspectives.
● Sexual ethics involve issues such as gender identification,
sexual orientation, consent, sexual relations, and
procreation.
● Christian ethics has always taken a complex view of the
goods
● and purposes of human sexuality and its role in human
relationships.
● Sexual desire and behavior have to be seen always within
the overarching moral imperatives of love of God and love
of neighbor.
2. Marriage
● also called matrimony or wedlock, is a culturally
recognised union between people, called spouses.
● establishes rights and obligations between them, as well as
between them and their children, and between them and
their in-laws.
Fundamentals of Marriage
● the fragility of contemporary marriages—and the
corresponding high rates of divorce—can be explained (in
large part) by a three-part mismatch:
1.) between the relationship values,
2.) evolved psychobiological natures, and
3.) modern social, physical, and technological
Environment.
Relationship–obligations of parents.
● Parents have an obligation to protect their children from
harm, all else being equal.
● Therefore, parents have an obligation (all else being equal)
to preserve and enhance their relationships—for the sake
of their offspring
Sex Outside Marriage
● Fornication is generally consensual sexual intercourse
between two people not married to each other.
● When one of the partners having consensual sexual
intercourse is a married person, it is called adultery.
● Is it okay?
● Having intercourse before marriage may give them the
attraction and physical fulfillment at the moment, but it
won't last long.
● Men always think that this is just a part of a relationship
whereas the women think that they have given their entire
life to the guy and become more close to him.
Homosexuality Issues
● People who are homosexual are romantically and
physically attracted to people of the same sex: females are
attracted to other females; males are attracted to other
males.
● Homosexuals (whether male or female) are often called
"gay." Gay females are also called lesbian. Bisexual.
● In ways without precedent in human history, a same sex
culture has emerged in the large contemporary cities of the
developed world and, it is a social force in
communication, entertainment, business and commerce,
and politics.
● Men and women who acknowledge their homosexuality
hold prominent and influential social positions, as do men
and women who choose not to disclose their
homosexuality.
● The social visibility of homosexuality has not dispelled all
moral and religious condemnation. In less developed parts
of the world, homosexuality is sometimes far less visible
but not altogether absent.
Issues on Contraceptives
Contraception may damage the health of the individual using it in
two ways; either through side effects of the contraceptive or because
using contraception allows people to have more sexual partners and
thus increases the possibility of catching a sexually transmitted
disease.
Contraceptive: It’s Morality and Ethics.
Moral Responsibility of Nurses.
1. Attitudes and Beliefs toward Adolescent Sex and
Contraception
2. Attitudes and Beliefs Toward Emergency Contraception-
nurses “expressed punitive attitudes” toward the adolescents’
“irresponsible behavior
3. Barriers and Opportunities to Provision of Emergency
Contraception-
1. Social judgment.
2. Provision of emergency contraception.
3. Emergency contraception knowledge and experience.
4. Emergency contraception in the emergency department.
5. Refusal, prioritizes patient safety and the patient’s best interest.
6. Education.
3. Issues on Artificial Reproduction, its Morality.
Responsibility of Nurses.
● Other ethical questions raised have involved the unusually
high rate of multiple births (twins, triplets, etc.) associated
with IVF. ... IVF has also raised a number of unresolved
moral issues concerning the freezing (cryopreservation)
of ovaries, eggs, sperm, or embryos for future
pregnancies.
● Snowflake children is a term used by organizations that
promote the adoption of frozen embryos left over from in
vitro fertilization to describe children that result, where the
children's parents were not the original cell donors.
Options to couples who have stored, frozen
embryos that will not be used for their own future
IVF cycles:
● You can pay indefinitely to keep them frozen and
stored. Couples have the option to pay the storage fees to
keep the embryos stored indefinitely.
● You can donate them to other infertile couples just like
you. Donating your embryos to an infertile a couple is an
exceedingly generous way to give the gift of parenthood to
others. Even so, this can be a very difficult and
emotionally draining decision. Most favored option, for
me particularly.
(Just like adoptions, an open embryo donation means that your
contact information is shared with the
embryo’s recipient parents. A closed version means your identity is
kept completely confidential.)
● Donating the Embryos to Medical Research. Now that
the ban has been lifted on stem-cell research, you can also
choose to donate your embryos to university-based and
other research clinics that use stem cells to advance
medical research.
● Allow them to thaw. Perhaps the most difficult choice of
all, you and your partner can choose to thaw your
embryos, which means they are no longer viable. Some
couples decide not to renew their embryo storage and let
the clinic handle it. Others choose to become involved,
becoming a part of the thawing process and having some
sort of ceremony to pay honor to the embryos as they
transition from their frozen to thawed state.
In Vitro Fertilization
● Other ethical questions raised have involved the unusually
high rate of multiple births (twins, triplets, etc.) associated
with IVF. ... IVF has also raised a number of unresolved
moral issues concerning the freezing (cryopreservation) of
ovaries, eggs, sperm, or embryos for future pregnancies.
Artificial Insemination
● Artificial insemination, in vitro fertilization, and surrogate
motherhood are immoral because they involve sexual acts
that are procreative, but not unitive. And, rightful
conception must respect the inseparability of the two
meanings of the sexual act.
● The latter include concerns about the safety of donated
sperm, the confidentiality of sperm donors, and the right
of a child born as the result of donor sperm to know his or
her complete parentage or the genetic/medical aspects of
that parentage.
● The legal and ethical questions are amplified in cases of
post-mortem insemination, and sperm donor replacement
without the consent of the spouse or steady partner.
● The son born after post-mortem insemination is called
posthumous child.
Surrogate Motherhood
● Surrogate parenthood is a highly controversial and
emotionally charged topic that both reflects and has
implications for our notions of parenthood and family.
● The Committee on Ethics general view is that the
surrogate mother, who both carries the fetus and delivers
the infant,
1) should be the sole source of consent for all questions regarding
prenatal care and delivery and
2) should have a specified time period after the birth of the infant
during which she can decide whether or not to carry out her original
intention to place the infant" for adoption.
● Thus, in all relevant respects the position of the surrogate
mother should be the same as the position of any other
woman who, either prenatally or postnatally, has
expressed the intention of placing an infant for adoption.
4. Morality of Abortion, Rape, and Other Problems Related to
Destruction of Life
Why abortion is wrong?
● Donald Marquis argues that killing actual persons is
wrong because it unjustly deprives victims of their future;
that the fetus has a future similar in morally relevant
respects to the future lost by competent adult homicide
victims,
● and that, as consequence, abortion is justifiable only in the
same circumstances in which killing competent adult
human beings is justifiable. The metaphysical claim
implicit in the first premise, that actual persons have a
future of value, is ambiguous.
● Abortion is the intentional destruction of the fetus in the
womb, or any untimely delivery brought about with the
intent to cause the death of the fetus
● (1). As it is evident in definition, it is the intention to
terminate the life of a living being which has made
abortion a controversial issue. Hippocrates (d. 322 B.C.)
wrote in his oath: "I will not give to a woman a pessary to
cause abortion"
● (2). The history of abortion goes to that far back, perhaps
further. How can abortion which contradicts such basic
imperatives of medical practice, like 'Do not harm' or
'Respect human life', be so deep rooted in history of that
practice? What made (and still makes) health professionals
carry out abortions on such a scale?
Argument: RAPE - morally justifiable.
● As sex is a social practice that varies widely in the ways
that it is understood, performed, and discussed, there is
much to be said for a critical and comprehensive study of
sexual ethics and norms.
 ● Historically, the prevailing notions of what was deemed as
sexually ethical have been tied to religious values. More
recently, the feminist movement has emphasized personal
choice and consent in sexual activities
Ethics on Distraction of Life
● Morality, thus, consists of the urge or predisposition to
judge human actions as either right or wrong in terms of
their consequences
● for other human beings. ... The ability to anticipate the
consequences of one's own actions is the most
fundamental of what is required for ethical behavior.
B. Ethical Issues: Infant and Child
● The ability to provide life support to ill children who, not
long ago, would have died despite medicine's best efforts
challenges pediatricians and families to address profound
moral questions.
● Our society has been divided about extending the life of
some patients, especially newborns and older infants with
severe disabilities
● AAP supports individualized decision making about
life-sustaining medical treatment for all children,
regardless of age, jointly made by physicians and parents,
unless good reasons require invoking established child
protective services to contravene parental authority.
(Copyright © 1996 by the American Academy of Pediatrics)
Universal Vaccination
Universal Immunisation Programme (UIP) is a vaccination
program launched by the Government of India in 1985. It
became a part of Child
Survival and Safe Motherhood Programme in1992 and is currently
one of the key areas under National Rural Health Mission since
2005.
Abuse and Neglected Child
● any recent act or failure to act on the part of a parent or
caretaker which results in death, serious physical or
emotional harm, sexual abuse or exploitation or an act or
failure to act which presents an imminent risk of serious
harm.
● Each State is responsible for providing its own definitions
of child abuse and neglect.
● Most States recognize four major types of
● maltreatment:
● (1) physical abuse, (2) neglect, (3) sexual abuse, and (4)
emotional abuse.
● Additionally, many States identify:
● (1) abandonment, (2) parental substance use, and
(3)human trafficking as abuse or neglect.
● While some of these types of maltreatment may be found
separately, they can occur in combination.
Impaired and Critically Ill Child
Critical illness any severe problem with the airway, breathing or
circulation, or acute deterioration of conscious state; includes
apnoea, upper airway obstruction, hypoxaemia, central cyanosis,
severe respiratory distress, total inability to feed, shock, severe
dehydration, active bleeding (requiring transfusion),
unconsciousness or seizures.
Impairment in a person's body structure or function, or mental
functioning; examples of impairments include loss of a limb, loss of
vision or memory loss. Activity limitation, such as difficulty seeing,
hearing, walking, or problem solving.
C. Ethical Issues: Adolescent
● group in their in-between status
● The adolescent desire for privacy and independence
balanced with the knowledge that adolescents are not fully
mature raises 3 ethical issues: consent, confidentiality, and
decision-making capacity.
● The issue of consent comes up whenever physicians must
consider whether a patient is able to make decisions
independent of parental permission.
Depression and Suicide Ideation
● Depression is under recognized and undertreated in
adolescents, with close to 75% of depressed adolescents
not receiving treatment.
● Untreated depression in adolescence is associated with
various adverse adult outcomes, including lower
educational attainment and poorer physical health. Beyond
the suffering and impaired functioning that depressed
adolescents experience as well as the potential for future
negative outcomes, the reality is that some affected
adolescents commit suicide, further heightening the need
for proactive assessment and treatment.
Alcohol and Substance Abuse
Substance use can do the following:
(1) Affect the growth and development of teens, especially brain
development.
(2) Occur more frequently with other risky behaviors, such as
unprotected sex and dangerous driving.
(3) Contribute to the development of adult health problems, such as
heart disease, high blood pressure, and sleep disorders.
● The earlier teens start using substances, the greater their
chances of continuing to use substances and developing
substance use problems later in life.
● When teens begin drinking at an early age, they increase
the chance of becoming addicted to or continuing to abuse
substances later in life.
Sexual Abuse
● Sexual abuse often takes place within the family, by a
parent, stepparent, sibling or other relative; or outside the
home, for example, by a friend, neighbor, childcare
person, teacher, or stranger.
● When abuse occurred, a child develops many distressing
feelings, thoughts and behaviors. Children may be
threatened by the abuser and be fearful to tell anyone else,
especially if the abuser is someone they know well.
● This is why it is so important to identify it as soon as
possible, seek help for these children, and focus on
preventing it in the future
Eating Disorders
● Personality traits: neuroticism, perfectionism, and
impulsivity.
● Cultural preferences: thinness and exposure to media
promoting such.
 ● Differences in brain structure and biology plays a role in
eating disorder.
● Serotonin and Dopamine may be factors.
● Other factors: genetics (hereditary), brain biology,
personality traits and cultural ideals.
❖ Anorexia Nervosa- view themselves overweight.
❖ Bulimia Nervosa- binge eating until full, foods that
they normally avoid. Purge to relieve gut discomfort.
❖ Binge eating disorder- eat unusually large amount of
food, does purging behaviors (vomiting, excessive
exercise to compensate eating).
❖ Pica- consumes non food substances, fatal.
❖ Rumination- re chew- re swallow food or spit it out.
❖ Avoidant/ Restrictive food intake disorder (ARFID)-
feeding disorder from infancy to childhood. Lack of
interest in eating (taste, smell).
Nurses role:
➢ Understand the importance and limits of confidentiality in
treating adolescent patients. Listen.
➢ Assess all biopsychosocial systems with adolescent
patients. Nutritional requirement and intake.
➢ Identify circumstances in which adolescent patients'
abilities to consent for their own care (drug testing,
aesthetic surgeries, psycho- medical treatment, abortion,
nutritional management)
➢ Learn the factors involved in determining whether an
adolescent patient is ready for the transition to adult
specialty care. Referral.
➢ Provide dependent adolescents with preventive and
therapeutic health care.
D. Ethical Issues: Adult
➢ Biologically, an adult is an organism that has reached
sexual maturity. In human context, the term adult
additionally has meanings associated with social and legal
concepts.
➢ Alternative Title: adult. Adulthood, the period in the
human lifespan in which full physical and intellectual
maturity have been attained. Adulthood is commonly
thought of as beginning at age 20 or 21 years. Middle age,
commencing at about 40 years, is followed by old age at
about 60 years.
Compliance, Adherence
★ Why is 18 considered the age of adulthood? Because
that's when people get to vote. ... Before the passage of the
26th Amendment in 1971, 21 was the minimum voting
age in most states—and thus served as the age of
adulthood in most areas of law.
https://slate.com/news-and-politics/2013/04/new-york-
★ Around the world, the idea of adulthood - when it
happens and how it is defined - is being challenged.
★ In Australia, the Greens’ Jordon Steele-John introduced a
bill to give 16- and 17-year-olds the right to vote;
Malaysian minister Syed Saddiq Abdul Rahman
announced the country may lower the voting age to 18
before the next elections; and Japan recently lowered its
voting age from 20 to 18 for referendums, following the
2016 decision to lower the voting age in general elections.
★ Japan’s decision was in part to address voter apathy and
help young people feel more engaged in politics. But it
may also signal that social views regarding the
commencement of adulthood have shifted.
★ Socially, determinants of adulthood traditionally focus on
a person taking increasing responsibility for their lives in
various ways. Completing school, commencing full-time
employment, getting married and parenthood – these are
all observable indicators used to determine when a person
is viewed as adult (Zacares, Serra, & Torres, 2015)
★ Completion of school or degree is the most observable
indication of adulthood in many cultures.
Chronic Illness/ Disease
● Lifestyle.
● Although common and costly, many chronic diseases are
also preventable. Many chronic diseases are linked to
lifestyle choices that are within your own hands to change.
● Eating nutritious foods, becoming more physically active
and avoiding tobacco can help keep you from developing
many of these diseases and conditions.
Organ Transplant: Donor/ Recipient
ALTRUISM
● Organ donation is founded on the pillars of altruism.
● the moral value of an individual’s actions are focused
mainly on the beneficial impact to other individuals,
without regard to the consequences on the individual
herself, the individual’s actions are regarded as
“Altruistic”.
● Auguste Comte coined the word “Altruism” (French,
altruisme, from autrui: “other people”, and also derived
from Latin alter: “other”). living for others was
“Altruism”. Altruism can be classified into two
types-obligatory and supererogatory.
● Obligatory altruism is defined as a moral duty to help
others.
● Supererogatory altruism is defined as morally good, but it
is not morally required-going “above and beyond” one’s
duty.
● The act that maximizes good consequences for all of
society is known as Utilitarianism.
Underlying ethical principles considered were:
(1) acts that promote the opportunity to donate viable organs
respect the patient's potential interest in becoming an organ
donor;
(2) the legitimacy of surrogate decision making for critically ill
patients whose wishes are unknown extends to decisions
regarding organ ...Jun 24, 2015
PRESUMED CONSENT
World Health Organization (WHO) defines presumed consent as a
system that permits material to be removed
from the body of a deceased person for transplantation and, in some
countries, for anatomical study or research, unless the person had
expressed his or her opposition before death by filing an objection
with an identified office or an informed party reports that the
deceased definitely voiced an objection to donation.
E. Ethical Issues: Aging/ Elderly
● some ethical and value issues are unique to the care of the
elderly, many are shared with other age groups in medical
and nursing practice.
● major ethical imperative for health care providers relates
to making ourselves available for the care of the elderly in
the context of an appreciation of these patients' tasks in the
final stage of development.
Quality of Life
● The term quality of life (QOL) references the general
well-being of individuals and societies. ... Instead,
standard indicators of the quality of life include not only
wealth and employment but also the built environment,
physical and mental health, education, recreation and
leisure time, and social belonging.
● As a result, standard of living should not be taken to be a
measure of happiness. Also sometimes considered related
is the concept of human security, though the latter may be
considered at a more basic level and for all people.
● An indicative list of quality of life indicators, grouped in
the following categories, is given: (1) air quality, (2) water
quality, (3) soil quality, (4) natural conditions and hazards,
(5) shelter quality, (6) urbanization, (7) communications,
(8) nutrition, (9) health, (10) education, (11) economic
conditions, (12) security, (13) social, (14)
leisure/recreation.
● Low quality of life means to decrease living standard in
the absence of basic needs as well as social, cultural,
emotional and spiritual needs. Low quality of life means
poor living standard of life.
● Effects of low quality of life. Lack of fulfillment of basic
needs. Problem of health and sanitation.
Home/ Long Term Facility
● Long-Term Care. A patient who can no longer remain at
home because he requires 24-hour nursing care and
monitoring is often admitted to a nursing home, also
known as a long-term care center or extended care facility
(ECF). These nursing homes provide their patients with
assistance in an institutional environment.
● Nursing homes are professionally staffed with nurses,
nursing aides, social workers, dieticians, etc.
Elderly Abuse Abandonment and Neglect
Here are 6 most common types of elder abuse:
● Physical Abuse. ...
● Emotional or Psychological Abuse. ...
● Sexual Abuse. ...
● Neglect or Abandonment by Caregivers. ...
● Financial Exploitation. ...
● Healthcare Fraud & Abuse.
F. Dignity in Death and Dying
Dying is a process. It involves the cessation of physical,
psychological, social and spiritual life here on earth. What
happens beyond death is unknown. Typically, before a person
dies, there is a cascade of events that are collectively known as
the dying process. The dying process is the transition that a
person goes through that ultimately ends in death. Each
person’s dying process and death is individual to that person.
Dying is an individualized experience and each person dies in
their own way and time (ELNEC, 2010).
Every nurse has an obligation to facilitate their patient’s wishes
regarding their care preferences at the end of life. As nurses, we
cannot with 100% certainty ensure that each of our patient’s
dying process will go smoothly without any problems.
Euthanasia/ Prolongation of Life
● Euthanasia is illegal in the Philippines. In 1997, the
Philippine Senate considered passing a bill legalizing
passive euthanasia. The bill met strong opposition from
the country's Catholic Church. If legalized the Philippines
would have been the first country to legalize euthanasia
● Physician-assisted suicide entails making lethal means
available to the patient to be used at a time of the patient's
own choosing. By contrast, voluntary active euthanasia
entails the physician taking an active role in carrying out
the patient's request, and usually involves intravenous
delivery of a lethal substance.
● Euthanasia is a grave violation of the law of God, since it
is the deliberate and morally unacceptable killing of a
human person. The Roman Catholic church regards
euthanasia as morally wrong. It has always taught the
absolute and unchanging value of the commandment "You
shall not kill"
Misthanasia
● The premature death of a vulnerable human due to a
failure to provide appropriate help in the context of social
injustice.
Dysthanasia
● undue prolongation of life by artificial means in a person
who cannot otherwise survive.
● dysthanasia means "bad death" and is considered a
common fault of modern medicine.
● Technologies such as an implantable cardioverter
defibrillator, artificial ventilation, ventricular assist
devices, and extracorporeal membrane oxygenation can
extend the dying process.
● Dysthanasia is a term generally used when a person is
seen to be kept alive artificially in a condition where,
otherwise, they cannot survive; typically for some sort of
ulterior motive. The term was used frequently in the
investigation into the death of Formula One driver Ayrton
Senna in 1994.
Orthothanasia
 ● used for the first time in the 1950s. It means correct
dying, or allowing to die or letting die.
● First possibility: when the treatment to prolong life is
useless or futile for the patient, and therefore ought not to
be given. We remember the word of an anonymous poet:
For man to want to live when God wants him to die is
madness.
● Second possibility for letting die: when the prolongation
of life or the postponement of death is unduly burdensome
in the first place for the patient – also for the family.
● Third possibility for allowing to die: when the patient
needs painkillers or medical sedation, which does not
intend the death of the patient. These painkillers directly
mitigate suffering and indirectly may shorten life.
Physicians and significant others are committed to relieve
pain and suffering, which is their professional
commitment, or moral duty limited only by the prohibition
against direct killing. (CCC, 2279).
● Death with dignity then is an ambiguous expression that
may mean two opposite things. One meaning is the
justification of killing – of euthanasia and assisted suicide
– based upon the unethical principle of absolute personal
autonomy. A secondmeaning is this: “letting die in peace”
or allowing to die, which is ethical.
● Palliative care helps achieve a death with dignity that is, a
death that comes after achieving peace with God, with
ourselves, loved ones, and neighbors
Advance Directives
● The ethical principles include autonomy, beneficence,
nonmaleficence, justice, and fidelity. Physicians should
encourage dialogue about end-of- life care and use of
advance directives(autonomy can be preserved even if
decision- making capacity is lost).
● Since medical science has evolved over the time and now
has a potentiality to reshape the circumstances during
death and in turn prolong lives, various ethical issues
surround end-of-life care
G. Ethical Issues: Maladaptive/ Mental Disorders
Mental health professionals frequently work with family
caregivers in the provision of psychotherapy services to
individuals with serious mental illness.
When working with family caregivers:
(1) practitioners utilize the American Psychological
Association’s Ethics Code (2010), legal codes, and a complex
decision-making plan;
(2) identify and communicate ethical obligations to family
caregivers;
(3) consider the unmet needs of this population;
(4) avoid harm resulting from multiple relationships; and
(5) balance ethical duties of beneficence and respect for
autonomy
stigma
● Webster's New Twentieth Century Dictionary (1983)
defines stigma as "something that detracts from the
character or reputation of a person, group, etc.; a mark of
disgrace or reproach; a mark, sign, etc. indicating that
something is not considered normal or standard.“
● Goffman (1963) defines stigma in terms of undesirable,
"deeply discrediting" attributes that "disqualify one from
full social acceptance" (preface) and motivate efforts by
the stigmatized individual to hide the mark when possible.
Seclusion/ Restraints
● Restraint and seclusion are behavioural management
interventions that should be used as a last resort to control
a behavioural emergency. Behavioural emergencies are
often the result of unmet health, functional, or
psychosocial needs. Often reduced, eliminate, or manage
such emergencies by addressing the conditions that
produced them.
● Restraints include the use of physical force, mechanical
devices, or chemicals to immobilize a person.
● Seclusion, a type of restraint, involves confining a person
in a room from which the person cannot exit freely.
● Restraint and seclusion are not therapeutic care
procedures.
● In fact, restraint and seclusion can induce further physical
or psychosocial trauma. In short, these procedures pose a
safety risk to the emotional and physical well-being of the
person and have no known long-term benefit in reducing
behaviours.

H. Ethical Issues: Public Health
● Health promotion is a key element of public health
practice. Among strategies aiming to deal with public
health problems, health promotion purports to help people
achieve better health. Health promotion can significantly
alter people’s lifestyles.
3 main ethical issues relate to it:
(1) what are the ultimate goals for public health practice, i.e.
what ‘good’ should be achieved?
(2) how should this good be distributed in the population?
(3) what means may we use to try to achieve and distribute this
good?
● Health Disparity
● Health promotion is a key element of public health
practice, but understanding of the concept is controversial.
The WHO defines health promotion as the process of
enabling people to increase control over, and to improve,
their health
Approaches to health promotion David Buchanan 4 kinds
problematic strategies that health promotion uses to influence
people to change their behaviour:
(1) behaviourist conditioning, e.g. through rewards and punishment;
(2) communicative persuasion, e.g. through subliminal information
or ‘scare’ campaigns;
(3) group pressure, e.g. through meeting strategies where people
are influenced to abstain from certain kinds of behaviour; and
(4) direct instrumental power, e.g. through prohibitions or use of
authority.
● Furthermore, different theories (or models) are used to
underpin the various strategies to change behaviour or
lifestyle.
● To achieve their ends, many strategies use social
psychological theory, e.g. the health belief model, the
theory of reasoned action, or the social cognitive theory.
Communicable Disease Threats: COVID 19
Ethics and COVID-19
● resource allocation and priority-setting, physical
distancing, public health surveillance, health-care worker's
rights and obligations to conduct of clinical trials, the
COVID-19 pandemic presents serious ethical challenges.
These in turn are complicated by the diverse health
systems and unique cultural and socio-economic contexts
of countries. Consequently, there is a great need for
guidance to ensure ethical conduct of research, decision
making in clinical care, and public health policymaking at
every level of the global COVID-19 response.
Global Ethics Response to COVID-19
● global ethics community is working together to address
the ethical implications of the COVID-19 pandemic.
WHO's Global Health Ethics team works to strengthen
communication, collaboration and cooperation in these
endeavors
National Ethics Committees (NECs)
● nations have created official bodies to provide advice to
their executive and legislative branches, and often to the
general public, about bioethics. Provide ethical guidance
have substantially grown in the urgent and rapidly
changing context of the pandemic, in responseto their
needs and facilitating communication, collaboration and
exchange between NECs from around the world to help
countries respond to the ethical challenges presented by
COVID-19.
●
Public Health Emergency Preparedness and Response Ethics
Network (PHEPREN)
● a global community of bioethicists building on
pre-existing expertise and resources to provide real-time,
trusted, contextual support to communities, policymakers,
researchers, and responders in relation to the ethical issues
arising out of global health emergencies, with a current
focus on the COVID-19 pandemic.
● IATF Philippines
OMNIBUS GUIDELINES ON THE IMPLEMENTATION OF
COMMUNITY QUARANTINE IN THE PHILIPPINES
(with Amendments as of July 16, 2020 ) IATF, Ph
● WHEREAS, Article II, Section 15 of the 1987
Constitution provides that the State shall protect and
promote the right to health of the people and instill health
consciousness among them;
● WHEREAS, Executive Order No. (E.O.) 168, s. 2014
created the Inter-Agency Task Force for the Management
of Emerging Infectious Diseases (IATF) to facilitate
inter-sectoral collaboration to establish preparedness and
ensure efficient government response to assess, monitor,
contain, control, and prevent the spread of any potential
epidemic in the Philippines;
● WHEREAS, there is a need to revise existing guidelines
on community quarantine to streamline rules which will
be applicable to transitional community quarantine
classifications
Bioterrorism
● A biological attack, or bioterrorism, is the intentional
release of viruses, bacteria, or other germs that can sicken
or kill people, livestock, or crops.
● Bacillus anthracis, the bacteria that causes anthrax, is one
of the most likely agents to be used in a biological attack.
 ● A bioterrorism attack is the deliberate release of viruses, ● Make patient the focus of the nurses’ work, ensuring they
bacteria, or other germs to cause illness or death. ... provide compassionate patient care and ease or prevent
Scientists worry that anthrax, botulism, Ebola and other suffering. These guidelines help nurses with challenging
hemorrhagic fever viruses, plague, or smallpox could be decision-making.
used as biological agents.
● PREPAREDNESS: Depending on the situation, wear a Situations nurses face almost every day: Nurses’ Responsibilities
face mask to reduce inhaling or spreading germs. If you ● Obtain informed consent. Unless the patient is
have been exposed to a biological agent, remove and bag unconscious, the nurse has a responsibility to obtain a
your clothes and personal items. Follow official patient’s consent prior to any treatment or procedure.
instructions for disposal of contaminated items. Wash Sometimes the patient will refuse treatment, follows the
yourself with soap and water and put on clean clothes. patient’s wishes.
Disasters ● Maintain patient confidentiality. Not everyone needs to
Main ethical principles in the provision of health services during know about the patient’s history or situation, nurses must
the event and an early response phase of disasters are: decide who needs to know without violating
(1) the principles of non-maleficence, confidentiality.
(2) beneficence, ● Tell the truth. Most patients trust nurses, which is one of
(3) justice, and the reasons the profession has the highest rating for ethics
(4) the respect for autonomy. and honesty. Nurses must remain truthful.
● In this phase, reaching the disaster site as quickly as ● Deal with beliefs that conflict with empirical
possible is the most crucial step. knowledge.Patients and their families may refuse standard
● Disasters have been defined in public health terms as treatment that has been proven effective. For example,
destructive events that result in the need for a wide range some religions forbid blood transfusions. Should the nurse
of emergency resources to assist and ensure the survival of explain the benefits of the recommended treatment? Or
the stricken population should the nurse respect the patient’s decision?
Situations nurses face almost every day: Nurses’ Responsibilities
Climate Change Obtain informed consent. Unless the patient is unconscious, the
● the science of climate change, no matter how advanced, nurse has a
will never be sufficient to tell humanity what to do.
Science may be able to inform policy by forecasting how
severe climate change will be, given different greenhouse
gas levels. However, experience teaches that science alone
is never enough. When confronting environmental
challenges, considerations of fairness, equity, and justice
must also inform any successful international agreement.
● 3 major ethical dilemmas(complicating the climate
change debate): (1)how to balance the rights and
responsibilities of the developed and developing world;
(2) how to evaluate geo-engineering schemes designed to
reverse or slow climate change; and (3)how to assess our
responsibility to future generations who must live with a
climate we are shaping today
● Climate change presents a severe ethical challenge,
forcing us to confront difficult questions as individual
moral agents, and even more so as members of larger
political systems. ... It also takes place in a setting where
existing institutions and theories are weak, proving little
ethical guidance.
I. Nurses Role and Responsibility:
The annual Gallup Honesty and Ethics poll in 1999, nurses have
ranked as the number 1 most honest, ethical profession.
● Nurses are advocates for patients and must find a balance
while delivering patient care.
● Appllies the 4 main principles of ethics: autonomy,
beneficence, justice, and non-maleficence.
● Each patient has the right to make their own decisions
based on their own beliefs and values.
● Nursing offers a framework to help them ensure the
safety of patients and their fellow healthcare providers.
 Bioethics and Research
Unit V
What is an ‘ethical issue’?
● When you have to judge what is right or wrong
● Choosing between options
● Deciding whether to do something or do nothing
● Should I or shouldn’t I?
● Weighing up the potential impact of your decisions or
actions
● A dilemma – making a difficult choice
Introduction to ethics:
● Our care for patients should be based on sound judgement
(or evidence based practice!!)
● ..some of this judgement is about having a strong sense of
what is right or wrong
● ..having a strong sense of what we should be doing and
shouldn’t be doing as nurses
● ..having a strong sense of what our priorities ought to be
● Nurses frequently have to make difficult decisions for
which there is not always a quick, easy or ‘correct’ answer
e.g. Can Mrs X be discharged yet? Can Mr Y manage his own
medications safely?
● Nevertheless, nurses still have to be able to explain and
account for these decisions and actions
● The NMC Code can act as a guideThis can be seen as a
‘code of ethics’ – a set of important principles to help
guide nurses
Ethical issues in healthcare:
● We Nurses usually think of the ‘big’ issues
e.g. definition of life, what is a person, quality of life,
prolonging life, ending life, human rights.
● But day to day ethical issues can involve:
○ Respecting people
○ Treating people with dignity
○ Treating people fairly
○ Supporting patient’s choices
● These ‘principles’ are encompassed in the NMC code
● The code is a useful source of ethical principles in health
care
Ethics 2 broad philosophical theories
1) consequentialism – taking the consequences
of our actions into consideration
2) deontology – basing our actions on a set of
principles or duties
RESEARCH ETHICS:
History 0f Research Ethics:
Nazi Medical Experiments (1930s and 1940s)
● Use of prisoners and racial enemies in experiments
designed to test the limits of human endurance, human
reaction to diseases, and untested drugs.
● This is unethical because subjects were exposed to
permanent physical harm or even death and they could not
refuse participation
Tuskegee Syphilis Study (1932-1972)
● by US public health service
● Investigated effects of syphilis among 400 men from a
poor African-American community
● Medical treatment was deliberately withheld to study the
course of the untreated disease.
Others:
● Injection of live cancer cells into elderly patients at the
Jewish Chronic Disease Hospital in Brooklyn
● Revealed in 1993 – US federal agencies had sponsored
radiation experiments since the 1940s to prisoner or
elderly hospital patients.
Code of Ethics:
Nuremberg Code
● One of the first internationally recognized efforts to
establish ethical standards
● Developed after the Nazi atrocities were made public in
the Nuremberg trials.
Declaration of Helsinki
● Adopted in 1964 by the World Medical Associationthen
later revised in 2000
❖ 1995 – American Nurses Association put forth a document
entitled Ethical Guidelines in the Conduct, Dissemination, and
Implementation of Nursing Research
Ethical Guidelines:
● Respect autonomous research participant’s capacity to
consent to participate in research and to determine the
degree and the duration of that participation without
negative consequences.
● Prevents or minimizes harm and promotes good to all
research participants, including vulnerable groups and
others affected by the research.
● Respects the personhood of research participants, their
families, and significant others, valuing their diversity
● Ensures that the benefits or burdens or research are
equitably distributed in the selection of research
participants
● Protects privacy of research participants to the maximum
degree possible
● Ensures the ethical integrity of the research process by use
of appropriate checks and balances throughout the
conduct, dissemination, and implementation of the
research.
● Reports suspected, alleged, or known incidents of
scientific misconduct in research to appropriate
institutional officials for investigation.
● Maintains competency in the subject matter and
methodologies of his or her research, as well as in other
professional and societal issues that affect nursing
research and the public good.
PRINCIPLE OF BENEFICENCE
● MAXIM: “Above all, do no harm.”
● Freedom from Harm- Study participants may be harmed
physically (injury, fatigue) psychologically (stress, fear)
socially (loss of friends) and financially (loss of wages)
 ● Minimize types of harm and discomfort to participants
FREEDOM FROM EXPLOITATION
● Involvement in a research study should not place
participants at a disadvantage or expose them to situations
for which they have not been prepared.
● Eg. A participant reporting drug abuse should not fear
exposure to criminal authorities
● Eg. A prostitute study participant telling where she works
and gets his/her customers should not fear exposure to
criminal authorities

BENEFITS FROM RESEARCH

● People agree to participate in research investigations for a
number of reasons
● Direct personal benefits
● Access to an intervention that might be otherwise
unavailable to them
● Desire to help others

PRINCIPLE OF RESPECT FOR HUMAN DIGNITY

● Includes right to self-determination and right to full
disclosure, Freedom from Coercion.
● Self-determination
○ Prospective participants have the right to decide
voluntarily whether to participate in a study,
without risking any penalty or prejudicial
treatment.
● Coercion
○ Involves explicit or implicit threats of penalty
from failing to participate in a study
○ Excessive rewards from agreeing to participate.

RIGHT TO FULL DISCLOSURE

● Researcher has fully described the nature of the study, the
person’s right to refuse participation, the researcher’s
responsibilities, and likely risks and benefits.
● Participants have the right to make informed, voluntary
decisions about study participation
● Full disclosure is normally provided to participants before
they begin the study

INFORMED CONSENT
Means that participants have adequate information regarding
the research, are capable of comprehending the information,
and have the power of free choice enabling them to consent
to or decline participation voluntarily.

RIGHT TO PRIVACY
Virtually all research with humans involves intruding into
personal lives. Researchers should ensure that participants’
privacy is maintained throughout the study.
THE PRINCIPLE OF JUSTICE
 ● Family planning
Ethical Consideration in ● Social responsibility
Leadership and Management Unit VI ● Immigration policies
● Resource management.
Continuous Quality improvement (CQI) ● Stem cell research
● Identify indicators ● DNR status
● Collect ongoing data on indicators
● Analyze and evaluate data Nurses take note!
● Implement change ● An issue is not an ethical issue for the nurse unless he or
● (utilize evidence based practice) she has been asked
● Always gather the facts prior to decision-making
How does structured care methodologies ● Consider your personal beliefs and values
work?
● Link process of care (issue) and outcome Why Ethics?
● Determine method of measurement ● current health care system is fragmented, poorly
● Clarify responsibilities of interdisciplinary team organized, inefficient use of resources.
● Facilitate communication among team members ● New technologies, availability of information (IT),
● Document, apply systematic approach to Measurement. decreasing resources, increasing chronic disease states
mandate a change.
Root cause analysis: ● consumer dissatisfaction with current system
Process of learning from consequences; ● Rapid turn over of nurses.
● Determine influences, establish linked chains of
influences, determine necessary influences, analyze root
(initial) cause.
● Currently used to analyze errors and mistakes; attempts to
evaluate series of events that may lead to errors (safety
errors) and determine causative reason for error (process),
rather than punitively blame a person.

B. Meaning and Service Value of Medical Care

ORGANIZATIONAL ETHICS
● Focus on the workplace
● Ethical culture makes a difference
● Senior leadership must promote an ethical culture-do they
ETHICAL DILEMMAS
● Occur when a problem exists between ethical principles
● Deciding in favor of one principle usually violates another
● Both sides have “goodness” and “badness” associated with
them

Ethical decision making

● Consider cause, variables, precipitating events and
implications
● Reflect upon one’s own perspective and values
● Explore options for action: Pros & Cons
● Nurses’ code of ethics, facility standard and ethics, nurse
practice act, legal issues, rights.
● Select appropriate plan. Understand consequences of the
plan.
● Implement
● Evaluate results

Current Global Issues and Trends in Nursing

● Covid 19
● Assisted suicide
● Technology issues-as RN, as patient.
● Gene therapies, genetic counseling
● “Designer babies”, fertility issues, fetal success, IVF
● Organizational climate