LESSON 2 – ETHICAL PRINCIPLES
→ As nurses is the emergency room or OPD, you need
ETHICAL PRNCIPLES
 Part of a norm that justifies moral rules, standards, or
judgements.
 It includes the following:
1. Autonomy
2. Confidentiality
3. Veracity
4. Fidelity
5. Justice
6. Beneficence
7. Non -maleficence
1. AUTONOMY
 Comes from the Greek word auto meaning "self" and
nomos meaning "custom" and "law or governance”
 A strong sense of personal responsibility and moral
decisions for one's own life.
 More of the right to make one's own decision.
 Patient will decide for themselves.
 We only educate them and give suggestions but they will
be the one to decide.
 We only help them make an informed choice but
the last say is always up to them.
 In the clinical setting, we promote this by letting the patient
sign the informed consent form.
 If they're okay with the treatment or procedure,
we need the informed consent signed by the
patient.
 If patient refused, we need to respect that as long as we
have thoroughly explained the procedure and its benefits.
 Self-autonomy or self-rule.
2. CONFIDENTIALITY
 Greek word confidene which means "to trust"
 Non-disclosure of private or secret information with which
on is entrusted.
 Duty to respect privileged information.
 Paramount in all healthcare fields
 As nurses, we are obligated to follow the state federal or
any facility rules in handling confidential patient records.
 Example: Medical Records, Chart, Informed Consent
Form
 Disclosure of private patient data is grounds for
employment termination or any legal penalties.
3. VERACITY
 Practice of telling the truth.
 "Habitual Truthfulness" or "Conformity to Facts"
 Attitude and personal qualities that demonstrate truth.
 Goes hand in hand with autonomy.
 We are going to tell the truth: their condition, what
treatment they're going to do, etc.
4. FIDELITY
 Loyalty within the nurse-patient relationship.
 Faithfulness and practice of keeping promises and
commitments.
 You need to honor and respect the promises that you
have made with the patient.
5. JUSTICE
 Relates to Fair, Equitable, and Appropriate treatment to
others.
 Focuses on equitable access to health care.
 Article XIII of Philippine Constitution
 National Health Insurance Act of 1995
 Republic Act 7432: "Senior Citizens Act"
 Hospital Triage is an example of justice.
Hospital Triage
→ It is a process of sorting your patient based on their
need for immediate medical treatment.
to prioritize them according to their need.
6. BENEFICIENCE
 Practice of doing acts of goodness, kindness, and charity.
 Principle stated: Do No Harm or Do Good
 Actions that promote the well-being of others.
 More of doing something good for the patient.
7. NON-MALEFICENCE
 Maleficence
 Means "a harmful or evil act"
 The act of committing harm or evil
 Duty to refrain from causing damage or preventing
intentional harm
 Principle stated: Do No Harm
 Do No Harm = Our focus is the safety
 The safety of our patience is our responsibility.
 We have to be vigilant when it comes to administration of
medication since there are cases of medication error.
 If the patient is in the hospital, his or her safety must be
prioritized.
 Ex. Keep the side rails raised or instruct the significant
others to ensure that they are raised.
PATIENT’S RIGHT
 Refers to the moral and inviolable power vested in a
patient as a person to do, hold or demand something as
his/her own.
 Here, we can apply the principle of autonomy.
TYPES OF PATIENT’S RIGHT
 This includes the following:
1. Right to Informed Consent
2. Right to an Informed Decision
3. Right to Informed Choice
4. Right to Refusal of Treatment
1. RIGHT TO INFORMED CONSENT
 The patient has the right to receive all necessary
information concerning diagnosis and treatment in order to
be able to give consent based on his/her value system.
 Informed Consent
 Refers to the knowledge or information about and
the consent to a particular form of medical
treatment before that treatment is administered.
 Whatever medical treatment or medication that
you are going to administer, let the patient sign
first then let them sign the written consent.
2. RIGHT TO AN INFORMED DECISION
 Information and understanding are necessary for genuine
deliberation.
 Informed Decision
 Refers to the necessary information of and the
decision on a medical treatment before to be
carried out.
 Before your patient decides on the procedure,
make sure that you have explained it properly.
 Inform the patient before performing any
procedure or treatment.
Side Effects
→ Anticipated effects of medication; temporary
→ Can be good or bad
Adverse Effects
→ Reaction that must be watched out
→ Harmful or bad
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  Usually made after a physician has briefed the patient
about the medical process to be undertaken.

3RD PARTY CONSENT

3. RIGHT TO INFORMED CHOICE
 The patient has the right to be informed about all possible
alternative courses of action to be taken, together with the
possible consequences.
 Informed Choice
 Refers to the necessary information a patient
should know about a medical treatment or
experiment so that a moral choice can be made.
 In order for the patient to make a good choice in
terms of their treatment, we need to discuss with
them first.
 If the patient asks for an alternative, we need to
explain it and the possible consequences.
4. RIGHT TO REFUSAL OF TREATMENT
 The patient has the right to refuse treatment to the extent
permitted by law and to be informed of the medical
consequences of his action.
MAJOR ELEMENTS OF INFORMED CONSENT
 Includes the following:
1. Competence
2. Disclosure
3. Comprehension
4. Voluntariness
1. COMPETENCE
 Refers to patient's capacity for decision making.
 One is considered competent when:
a) One has made a decision
b) One has the capacity to justify one's choice
c) One does not only justify one's choice but does
so in reasonable manner.
 Patient is not disabled, sensory-impaired, or cognition-
impaired.
2. DISCLOSURE
 Refers to the content of what a patient is told or informed
about during the consent negotiation.
 The patient must be informed and must understand the
information concerning the medical treatment to be
undertaken so that a moral decision can be made with the
whole process and is aware of the possible outcomes of
his/her moral choice.
 In case the patient is uncapable of giving consent, in order
of priority may give consent:
a) Spouse
b) Either Parent
c) Immediate Relatives
d) Guardian
 This sequence must be observed and followed.
OTHER FORMS OF CONSENT
 This includes the following:
1. Consent by Presumption
2. Consent by Proxy
1. CONSENT BY PRESUMPTION
 This is reasonably presumed to be present in the
subsequent employment and series of procedures as they
are aligned with the primary procedure to which explicit
consent is expressed.
 Ex. Patient has normal spontaneous vaginal delivery
(NSVD). After the delivery, the usual procedure that we
perform is perineal care. Perineal care is reasonably
presumed after delivery wherein px explicitly consented.
 Ex. Wound dressing.
2. CONSENT BY PROXY
 This is done when the patient is not capable of giving
informed consent and is legitimately represented by a
competent surrogate who acts on his behalf.
 Especially for babies and pediatric patients, we can make
us of proxy consent, especially in giving injections. See to
it that there is the consent by parents.
EMERGENCY CASES
 Types of patients need not require Informed Consent.
 Includes the following:
1. Comatose or Obtunded Patients
2. Blind or Illiterate Patients
3. Underage patients or those unable to understand
the circumstances.
4. Patients limited by language barriers.

3. COMPREHENSION
 Refers to whether the information given has been
understood or not.
 Make sure that the patient really understands the
procedure that you are going to perform.

4. VOLUNTARINESS
 This means that the consent must be voluntary.
 The patient must, of his/her own free will, make a choice
without being unduly pressured by anyone else.

3 METHODS OF OBTAINING INFORMED CONSENT

 This includes the following:
1. Written Consent
2. Verbal Consent
3. 3rd Party Consent

1. WRITTEN CONSENT
 A consent for to be filled out and signed by a patient as
he/she checks in for admission in a hospital.

2. VERBAL CONSENT

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