Theories and Principles of Health Ethics

● Ethics:
○ the study of social morality and philosophical reflection on society’s norms and
practices.
○ Practical application of moral philosophy
○ Gives us groundwork making legal and consistent decisions based upon morality
or formal moral theory.
○ Offered structured guidelines, but not tell us what we ought to do.
● Major Ethical Theories:
○ Consequential ethical theories or teleological ethics.
■ Moral goodness in consequences of our behavior and not behavior itself
○ Non-consequential ethical theories or deontological approach or duty ethics.
■ Focuses on rightness and wrongness consequences of those actions.
■ Several variants of non-consequentialist approach such as: Divine
Command Theory; Natural Law Theory.
○ Utilitarianism
■ Moral theory advocates actions promote overall happiness or pleasure
and reject actions that cause unhappiness or harm.
■ Philosophy associated with Jeremy Bentham and John Stuart Mill, two
towering British philosophers and political thinkers.
○ Critism of Utilitarianism
■ May result in unethical and immoral choices as it judges morality by
results only, and not by the means.
● Virtue Ethics
○ Developed by Aristotle and other ancient Greeks.
■ Quest to understand and live life of moral character.
○ We acquire virtue through practice.
○ Virtue ethics in nursing
■ Deals with most personal and private aspects of people’s lives.
■ Six virtues- Florence Nightingale
● Truthfulness and honesty
● Humility
● Integrity
● Compassion
● Respect
■ Four Obligations:
● Protecting privacy and confidentiality,
● Communicating honestly
● Conducting an ethically valid informed-consent process.
○ Patient’s ability to make informed decision about his care.
○ Assess his ability to understand issues related to his care
and give valid consent.
● Advocating for patient’s best interests.
○ Core Values of Professional Nurse
 ■ Compassion
● Encompassess empathy, caring and promotion of each patient’s
dignity.
■ Trustwrothiness
■ Humility
■ Accountability
■ Curiosity

Ethical Principles, Virtues Ethics and Core Values of a Professional Nurse

● Principles:
○ Basic ideas starting points for understanding and working through problem.
● Ethical principles
○ Right-making characteristic of actions.
○ Guide to moral decision making and moral action.
● Autonomy
○ autos=self,nomos=governance.
○ Every individual’s right of self-determination, independence and freedom to make
their own choices.
○ Informed Consent
■ Elements
● Explanation of procedure/treatment.
● Names and qualifications of people performing and assisting in
procedure.
● Description of serious harm/death that may occur as result of
procedure and anticipated pain and/or discomfort.
● Explanation of alternatives therapies to proposed
procedure/treatment and risk of doing nothing.
● Right to refuse procedure/treatment w/o discontinuing supportive
care.
● Refuse procedure/treatment even after procedure began.
■ Criteria
● Voluntariness (in deciding)
● Decision
● Capacity (to understand and decide)
○ Physically, mentally and legally capacitated.
● Disclosure (of information)
● Recommendation
● Understanding
● Authorization
○ Patient’s bill of rights
■ Right to considerate and respectful care
■ Right to information about diagnosis, treatment and prognosis
■ Right to informed consent.
■ Right to refuse treatment
 ● Right to privacy
■ Right to confidentiality
■ Right to services and to transfer
■ Right to know relationship with other health care and educational
institutions.
■ Right not to be subjects of research as experimentation
■ Right to expect reasonable continuity of care
■ Right to examine and receive explanation of his bill
■ Right to know what hospital rules and regulations apply to his conduct as
patient.
○ Proxy consent/legally acceptable representative (LAR)
■ The ability to act on behalf of another person.
● Patient not competent to make medical decisions himself/herself.
○ Privacy
■ Bodily privacy
● Freedom to decide what happens to one’s body
■ Decisional privacy
● Control over intimate decisions one makes
■ Informational privacy
● Underlies the notion of confidentiality on information of patient.
● Confidentiality
○ Non disclosure of private or secret information with which one is interested.
● Veracity
○ Being honest and telling the truth.
● Fidelity
○ Faithful to one’s commitments and promises.
■ Providing safe care and maintaining competence in nursing practice
● Justice
○ Complex ethical principle and entails fairness, equality and impartiality.
○ RA 7432 Senior Citizen Act
○ Triage Schemes
○ RA 7875 National Health Insurance Act of 1995
○ Distributive Justice
■ Individual have right to be treated equally.
● Beneficence
○ Doing or promoting good
○ Provides nursing’s context and justification.
○ Three components:
■ Promote good
■ Prevent harm
■ Remove evil/harm
● Non-Maleficence
○ Avoid doing harm either intentionally or unintentionally to clients.
● Other relevant ethical principles
 ○ Principle of double effect
■ One good, one evil.
■ An act is permissible even though it has bad effect as long as it is not
intentionally done or intent of dong the act is to produce something good
even if it had cause something bad.
○ Principle of legitimate cooperation
■ 3 principles of evaluate partnership:
● Mediate material never formal/immediate material.
● Partnership, must agree decision is appropriate
● Straightforward
■ 2 types of cooperation
● Formal cooperation
○ Intends in helping act of assailant then cooperation is
formal.
○ Principle of common good and subsidiarity
■ Common good
● Standard of moral values.
■ Subsidiarity
● Giving power to minority

Principle of Stewardship and Role of Nurses as Stewards

● Stewardship
○ The earth, all its natural resources/ human nature, biological, psychological,
social and spiritual capacities.
○ Embodies responsible planning and management of resources
● Principle of Stewardship
○ Requires gifts of human life and natural environment be used w/ profound
respect for their intrinsic ends.
○ Gift of human creativity be used to cultivate nature and environment, recognizing
limitations of our actual knowledge and risks of destroying gifts.
○ Healthcare, execution of responsibility of healthcare practitioners to look after,
provide necessary healthcare services, and promote health and life of those
entrusted to their care.
● Role of Nurses as Stewards
○ The Stewardship of Self
■ Personal
● Virtue Ethics in Stewardship
● virtue = quality, enables individual move toward achievement of
specific human goal.
● Cultivating character, person acts without knowing exact outcome
of his/her actions; he/she acts in belief action will be worthwhile.
■ Social
● Social role of Nurses as Stewards
○ Nurses help families
 ○ Nurses innovate
○ Nurses provide ongoing assessment of people’s health
■ Ecological
● Ecological Role of Nurses in Stewardship
○ Ability to use their trusted skill sets and lead way for
sustainable, healthy communities and environments in
which they serve.
○ Current healthcare waste disposal methods
○ Nurses comprise largest profession in healthcare and
adept at educating, researching, and leading in waste
reduction.
■ Biomedical
● Biomedical Role of Nurses in Stewardship
○ Branch of applied ethics refer discipline dealing with ethical
implications of biological research and applications esp in
medicine.

Principle of Totality and Its Integrity

● Principle of Totality
○ Individual not dispose of his organs or destroy their capacity to function.
● Integrity
○ The practice of being honest and showing consistent and uncompromising
adherence to strong moral and ethical principles and values.
● Ethico-moral Responsibility of Nurses in Surgery:
○ Ethos (character/culture)
■ Branch of philosophy determines right/wrong
○ Moral
■ personal/private interpretation from what is good and bad.
● Sterilization
○ medical/surgical procedure, purpose of which is to render someone incapable of
begetting or procreating life.
○ Most common method of contraception among married couples
○ Types of Sterilization
■ Male Sterilization
● Vasectomy, ducts are cut and tied permanently or temporarily.
● Castration, removal of testes.
● Emasculation, suppression of genital apparatus.
■ Female Sterilization
● Tubal ligation, cutting and tying fallopian tubes
● Hysterectomy, removal of uterus.
○ Ethical Considerations in Sterilization
■ Direct Sterlization
● Contrary to principle of totality or body integrity, no basic human
function may be sacrificed unless necessary to save person’s life.
 ■ Indirect Sterilization
● Not primary desired effect, becomes necessary side effect of
another treatment.
● Mutilation
○ Cutting off or causing injury to body part of person so that permanently damaged,
detached or disfigured.
● Preservation of bodily functional integrity
○ A principle frequently invoked in both law and morality.
○ Considered unconsented physical intrusion as human rights violation.
○ Bodily integrity
■ Inviolability of physical body and emphasizes importance of personal
autonomy, self-ownership, and self-determination of human beings over
their own bodies.
■ One of Martha’s Nussbaum’s ten principle capabilities.
● Principle of Personalized Sexuality
○ Sexuality
■ Complex aspect of our personality and ‘self’.
■ Defined by sexual thoughts, desires and longings, erotic fantasies, turn
ons and experiences.
○ Personalized sexuality
○ The Gift of Sexuality
■ Must be loving, bodily, pleasurable expression of complementary,
permanent self-giving of a man and woman to each other.
○ Generally recognized values:
■ Sex
● Search for sensual pleasure and satisfaction, releasing physical
and psychic tensions.
● Search for completion of human person through intimate personal
union of love expressed by bodily union.
○ Norms of Sexual Morality
■ Laws or social attitudes hinder human freedom to achieve values in ways
individual desires are unjust and oppressive.
■ Sexual behavior, entirely private matter to determined by personal choice,
free from any moral guilt.

Dignity in Death and Dying

● Dignity
○ Dignitus (merit) and dignus (worth)
○ Actual ‘practical’ meaning of dignity remains complex and unclear because it is
multidimensional concept.
○ Can be upheld by measures such as:
■ Symptom control
■ Promoting independence
■ Privacy
 ■ Social support and positive tone of care
■ Listening
■ Giving appropriate information
■ Having caring bedside manner and showing respect
■ Empathy and companionship
■ Spiritual care.
○ Brain dead
■ Irreversible loss of all functions of the brain.
■ Three essential findings:
● Coma, absence of brainstem reflexes, and apnoea.
○ Vegetative state
■ Clinical condition of complete unawareness of the self and environment,
accompanied by sleep-wake cycles, with either complete or partial
preservation of hypothalamic and brain-stem autonomic functions.
■ Show no evidence of sustained, reproducible, purposeful, or voluntary
behavioral responses to visual, auditory, tactile, or noxious stimuli.
■ Defined present one month after acute traumatic or nontraumatic brain
injury or lasting for at least one month in patients with degenerative or
metabolic disorders or developmental malformations.
○ Difficult Decisions in End-of-life-care
■ Inviolability of Human life
● Principle of implied protection regarding aspects of sentient life
that are said to be holy, sacred value that are not to be violated.
■ Euthanasia and Prolongation of life
● “Eu”= good, “thanatos”= death.
● Hastening of death of a patient to prevent further sufferings.
● Active euthanasia
○ Physician deliberate act, usually administration of lethal
drugs, to end an incurably or terminally ill patient’s life.
○ Three types of active euthanasia
■ Voluntary
■ Non-voluntary
■ involuntary
● Passive euthanasia
○ Withholding or withdrawing treatment which is necessary
for maintaining life.
■ Euthanasia and Suicide
● Assisted suicide
○ Suicide undertaken with the aid of another person
● Opposition
○ Code of Ethics
■ Physician-assisted suicide if prohibited
○ Hippocratic Oath
■ Oath taken by physicians.
 ○ Declaration of Geneva
■ A revision of Hippocratic Oath, first drafted in 1948
by World Medical Association in response to forced
euthanasiai, eugenics and other medical crimes
performed in Nazi, Germany.
○ International Code of Medical Ethics
■ “A physician shall always bear in mind the
obligation to respect human life”
○ Statement of Marbella
■ Adopted by the 44th World Medical Assembly in
Marbella, Spain, 1992.
■ “Physician-assisted sucide, like voluntary
euthanasia, unethical and must be condemned by
medical profession”.
● Dysthanasia
○ Term for futile or useless treatment.
○ Bad death, considered common fault of modern medicine.
○ Occurs when person who is dying has their biological life
extended through technological means without regard to
the person’s quality of life.
● Orthothanasia
○ “Orthos” = correct, “thanatos” = death.
○ Allows patient to understand human finitude and to die in
peace.
● Administration of Drugs to the Dying/Palliative Sedation
○ Palliative sedation
■ The use of medications to induce decreased or
absent awareness in order to relieve otherwise
intractable suffering at the end of life.
■ Used at the end of life to relieve an unacceptable
degree of suffering that is refractory to other
therapies or when other therapies are estimated the
be unhelpful in the given time frame.
● Advance Directives
○ A document which person makes provision for health care
decisions in event that he/she becomes unable to make
those decisions.
○ Two main types of advance directive: (Living Will/Durable
Power of Attorney for Health Care)
■ Living will
● Oldest type of health care advance directive
● A signed, witness document called
“declaration” or “directive”.
■ Durable Power of Attorney for Health Care
 ● Signed, witnessed in which signer
designates an agent to make healthcare
decisions if signer is temporarily or
permanently unable to make such
decisions.
■ Physician Orders for Life-Sustaining Treatment
(POLST)
● Recently developed program that designed
to improve quality of care people receive at
the end of life.
■ Limitations
● DNR
○ Docotr is not required to resuscitate a patient if their heart
stops and designed to prevent unnecessary suffering.
○ Usual circumstances in which it is appropriate not to
resuscitate are:
■ When it will not restart the heart or breathing
■ When there is no benefit to the patient
■ When benefits are outweighed by the burdens
● End-of-life Care Plan
○ Encompasses many aspects of care: pain and symptom
management, culturally sensitive practices, assisting
patients and their families through death and dying
process, and ethical decision making.
○ Hospice care provides comprehensive physical,
psychological, social, and spiritual care for terminally ill
patients.
■ Serve terminally ill patients from comforts and
relaxed surroundings of their own home, although
there are some located in inpatient settings.
■ Help patient achieve a full life as possible, with
minimal pain, discomfort, and restriction.

Principles of Ethics in Research

● Principles of Beneficence
○ Respect for human dignity and justice underlie ethical conduct of research.
○ Implies right to protection from harm and discomfort, including balance between
benefits and risks of study.
● Principle of respect for human dignity
○ Implies the right to full disclosure and self-determination or autonomy.
● Principle of justice
○ Implies the right of fair treatment and privacy including anonymity and
confidentiality.
● Nuremberg code
 ○ A set of principles for ethical conduct of research against which experiments in
concentration camps could be judged.
○ Voluntary informed consent
○ Likelikhood of some good resulting
○ Animal models
○ Avoidance of physical or psychological injury or harm
○ Benefits should outweigh risks
○ Proper experience of researcher
○ Right to withdraw consent
○ Research must stop if harm is resulting
● Declaration of Helsinski
○ Issued by World Medical Assembly in 1964 and revised in 1975 and in 2001 to
guide clinical research.
● Belmont Report
○ The principles set forth, serves as basis for policies developed by United States
National Commission for Protection of Human Subjects of Biomedical and
Behavioral Research.

Ethical Consideration in Leadership and Management

● Leadership in Nursing
○ Leadership
■ The process through which individual attempts to intentionally influence
another individual or group in order to accomplish a goal.
■ A qualitative statement of personal or individual ability
■ Set of knowledge, skills, and attitudes that can be used by all nurses.
○ Management
■ Tasks, leadership is about perception, judgment, and philosophy.
● Ethical Leadership
○ The study of ethical issues related to leadership and ethics of leadership.
○ Consist of what is right, wrong, good, evil, virtue, duty, rights, obligations, justice,
fairness in human relationships with each other and other living things.
○ Two elements:
■ must act and make decisions ethically.
■ Must lead ethically.
○ Two top leadership qualities:
■ Integrity
● Being strongly committed to doing what he/she knows right.
■ Trustworthiness
● Worthy of being trusted; honest, reliable and dependable.
● Moral Decision-Making
○ A decision made in way so that action or inaction conforms to one’s
morals/typically.
○ Acquired rules of behavior categorized into right or wrong, where rules typically
omit context and nuance.
○ Principle of Moral Discernment
■ Ability to reflect on ordinary events of one’s life, a habit of personal prayer,
self-knowledge, knowledge of one’s deepest desires and openness to
God’s direction and guidance.
■ Ability to discern moral good, moral right from wrong, and must have
standard with measure or compare good thing and bad thing.
■ Defines moral convictions that determine one’s behavior and ultimately
one’s life.
○ Principle of Well-formed conscience
■ One is obliged to form it diligently accordance with some reasonable
processes so that one arrives at right moral decision.
■ Conscience
● Subjective norm of morality
● Maybe erratic and prone to miscalculations
● Based on human intellect which is imperfect, prone to errors.
● Judgment of intellect, it makes declaration of:
○ Truth and untruth
○ Goodness and badness
○ Actions he wants to pursue
○ Thoughts he wants to believe
● May be affected by:
○ Family
○ Environment
○ School
○ Church
○ Individual own biases
■ Narrowness of experience or outlook
■ Moral obligations
○ Strategies of Moral Decision-Making Process
■ Recognizing Personal Circumstances
● Thinking about origins of problem, individuals involved, and
relevant principles, goals & values; considering one’s own role in
causing and/or resoling problem.
■ Anticipating Consequences of Actions
● Thinking about many possible outcomes such consequences for
others, short & long term outcomes based upon possible decision
alternatives.
■ Considering the Effects of Actions on Others
● Being mindful of others’ perceptions, concerns, and impact of your
actions on others, socially and professionally.
■ Seeking Outside Help
● Talking with supervisor, peer, or institutional resource, or learning
from others’ behaviors in similar situations.
■ Questioning Your Own and Ohters’ Judgment
 ● Considering problems that people often have with making ethical
decisions, remembering that decisions are seldom perfect.
■ Dealing with emotions
● Assessing and regulating emotional reactions to the situation
■ Analyzing Personal Motivations
● Considering one’s own biases, effects of one’s values and goals,
how to explain/justify one’s actions to others, & questioning ability
to make ethical decisions.
● Meaning and Service Value of Medical Care
○ Value-based Health Care (Value-Based Care)
■ Payment model rewards healthcare providers for providing quality care to
patients.
■ Focuses on care coordination that ensures patients are given right care
by right provider at the right time.
■ Examples:
● Hospital value-based purchasing program
○ Rewards acute care hospitals with incentive payment for
quality of care they provide to Medicare patients.
● Hospital Readmission Reduction Program
○ Lowers payments to Inpatient Prospective Payment
System hospitals that have too many readmissions.
● Value Modifier Program or Physician Value-based modifier
○ Measures quality and cost of care for Medicare patients.
● Hospital Acquired Conditions Program
○ Encourages hospitals to reduce number of infections or
illness that patients receive while admitted.
○ Benefits of Value-Based Healthcare Delivery
■ Patients spend less money to achieve better health
■ Providers achieve efficiencies and greater patient satisfaction
■ Payers control costs and reduce risk
■ Suppliers align prices with patient outcomes
■ Society becomes healthier while reducing overall healthcare spending
● Allocation of Health Resources
○ Health Care Resources
■ All materials, personnel, facilities, funds, and anything else that can be
used for providing health care services.
■ 4 principles provide guidance for assessing and balancing potential harms
and benefits within medical care:
● Allocation of health care resources should improve people’s
health.
● Patients and members or prospective members of health care
organizations should be informed about how health care
resources are allocated and the rationale for the allocation.
 ● Carries the second step further; once provided with information,
patients, members, and prospective members of a healthcare
organization should have the opportunity to consent to or deny
that organization’s allocation of health care resources.
● Conflicts of interest should be minimized by individuals making
decisions regarding the allocation of health care resources.
● Issues Involving Access to Care
○ Costs and transparency
■ Implementing strategies and tactics to address growth of medical and
pharmaceutical costs and impacts to access and quality of care.
○ Consumer experience
■ Understanding, addressing, and assuring that all consumer interactions
and outcomes are easy, convenient, timely, streamlines, and cohesive so
that health fits naturally into “life flow” of every individual’s family’s and
community’s daily activities.
○ Delivery system transformation
■ Operationalizing and scaling coordination and delivery system
transformation of medical and non-medical services via partnerships and
collaborations between healthcare and community-based organizations to
overcome barriers including social determinants of health to effect better
otcomes.
○ Data and Analytics
○ Interoperability/consumer data access
■ Integrating and improving the exchange of member, payer, patient,
provider data, and workflows to bring value of aggregated data and
systems on near real-time and cost-effective basis
○ Holistic individual health
○ Next-generation payment models
○ Accessible points of care
○ Healthcare policy
○ Privacy/Security

Ethical Issues Related to Technology in the Delivery of Health Care

● Telemedicine
○ The use of medical information and technology to advance clinical care at
distance has potential to transform-patient-centered care.
○ Can integrate remote monitoring and sensing mechanisms with automated
interactions and reminders to better engage patients when they are not in
doctor’s office.
● Telehealth
○ The use of telecommunication technologies in support of clinical health care,
education, and public health.
○ Service include not only traditional video conferencing but also e-mail, remote
patient monitoring devices and even facsimile.
 ○ Allows physicians and other providers to consult and assist with data
interpretation and patient care regardless of geographic separation.
● eHealth
○ The use of information and communication technologies in healthcare.
○ Combine intelligent health record aggregation and clinical referral coordination.
○ Key benefits of eHealth technologies include:
■ Save a lot of time
■ Give people more information about their health
■ Doctors can safely and easily share information with colleagues.
○ Services and concept can be applied and utilized in the following areas:
■ Medical and healthcare management
■ Health education
■ Strategic health planning
■ Medical education and training
■ Patient care and support
■ Preventive health services
■ Knowledge-based services
■ Electronic medical record
■ Telemedicine communication
■ Evidence-based medicine (EBM)
■ Epidemiological surveillance
■ Geographic information systems
■ Three Possible benefits for application of eHealth services:
● Quantitative benefits
○ Perceived and calculated benefits of application of ehealth
such as financial economic benefits.
● Qualitative and non-direct benefits
○ Improving efficiency and quality of health services,
reducing medical errors, increasing speed of response,
access of information, sharing of access and use of
information.
● Strategic benefits
○ Data collection and utilization in research and strategic
planning processes and identification of long term needs.
○ Common types of technology in healthcare include:
■ Common desktop applications
■ Medical devices and equipment
● Imaging technologies
○ Positron emission tomography (PET)
○ Computerized Tomography (CT)
○ Digital radiology
○ Remote cameras
■ Advanced surgical applications
● Robotic surgery
 ● Monitoring devices
● Automated devices
○ Bed lifts and sterilization equipment
○ Implants (pacemakers and prosthetic joints)
● Medical system software application
○ Electronic health records
○ Event notification system
○ Practice management software
○ Digital image repositories and distribution software
● Information technology
○ Electronic reminders
○ Electronic clinical decision support aids
○ Electronic medication ordering system
○ Advantages of Medical Technology
■ Communication Systems in Healthcare Hospitals
■ Technology Improving Healthcare in Hospitals
■ Electronic Health Records of Patients in Hospitals
○ Disadvantages of Medical Technology
■ Increased Cost of Treatment for the Patients
■ Show the Wrong Result of the Patients Condition
■ Lack of Information of the Patients
■ Time consuming in recovery
■ Damaging cells and organs of the body of the patients
■ Patients online treatment through technology
■ Automatic machine treatment
● Data Protection and Security
○ Data Privacy Act of 2012 (RA 10173 Series of 2012)
■ A comprehensive and strict privacy legislation “to protect the fundamental
human right of privacy, of communication while ensuring free flow of
information to promote innovation and growth”.
● Benefits of Technology in Healthcare
○ Reducing healthcare costs
○ Predicting epidemics
○ Avoiding preventable deaths
○ Improving quality of life
○ Reducing healthcare waste
○ Improving efficiency and quality of care
○ Developing new drugs and treatments
○ Challenges of Technology in Healthcare
■ Access to budget and capital resources to introduce major initiatives.
■ Resistance from clinical staff to new technologies
■ Lack of fit with workflow
■ Lack of safety evidence
■ Lack of IT staff resources
 ■ High turnover rate
■ Resistance from facility’s executive and organizational leadership

Continuing Education Programs on Ethico-Moral Practice in Nursing

● Lobbying/Advocating for Ethical Issues related to Health Care
○ Advocacy
■ Coordinated combination of problem identification, solution creation,
strategy development and actions taken to make positive change.
■ The act or process of supporting cause or proposal.
○ Lobbying
■ “To promote or secure the passage of (legislation) by influencing public
officials.
■ Nurse lobbyist
● Can be differentiated through their express intent to drive those
conversations toward clear objective: influencing public policy or
the creation of legislation.
● May employed by:
○ Health care organizations
○ Pharmaceutical companies and insurance groups
○ Professional associations
○ Groups that focus on advancing public health or patient
rights
○ Health care technology firms developing telehealth
solutions or implantable devices
○ Governmental bodies like Department of Veterans Affairs
or nurse unions
● Code of Ethics for Nurses
○ A set of ethical principles that reflects the group’s moral judgements over time
and serves as a standard for their professional actions.
○ Functions
■ To inform public about minimum standards of profession and to help them
understand professional nursing conduct.
■ To provide sign of profession’s commitment to public it serves.
■ To provide general guidelines for professional behavior.
■ To remind nurses of special responsibility they assume when caring for
sick.
○ Nine Provisions
■ Guide nurses to act ethically in their daily duties and responsibilities.
■ Compassion
■ Commitment
■ Advocacy
■ Responsibility
■ Self-Regard
■ Safety
 ■ Healthcare Advancement
■ Human Rights
■ Social Justice
● A Nurse’s Core Values and Commitments
○ Reinstate the nursing profession’s fundamental values and commitments.
○ Identifies the boundaries of duties and loyalty.
○ Explains how nurses’ roles extend beyond individual patient interactions.
○ Addresses many relationships nurses have with other healthcare professionals,
patients’ families, and public.
○ Makes nurses more aware of sociopolitical, economic, and environmental context
of their profession.
● International Code of Ethics
○ A guide for action based on social values and needs.
● Preamble
○ Four fundamental responsibilities:
■ To promote health
■ Prevent illness
■ Restore health and alleviate suffering.
○ Inherent in nursing is respect for human rights, including cultural rights, the right
to life and choice, to dignity and to be treated with respect.
○ Nurses render health services to the individual, the family and community and
coordinate their services with those of related groups.
● Four basic ethical principles
○ Fundamental responsibility of the nurse is four fold
○ Nurse renders service regardless of race, creed, nationality or political belief.
○ Nurse protects life and respects the dignity of man
○ Nurse works in collaboration with members of the health team.
● Elements of the Code
○ Registered Nurses and People
○ Registered Nurses and Practices
○ Registered Nurses and Co-Workers
○ Registered Nurses, Society and Environment
○ Registered Nurses and the Profession
● Code of Ethics for Filipino Nurses
○ Emphasizes the fourfold responsibility of the nurse:
■ The universality of nursing practice
■ The scope of their responsibilities to the people they serve
■ To their co-workers
■ To society and environments and their profession.
● Code of Good Governance
○ Sets out the principles and key elements of good governance for the boards of
voluntary and community organizations.
○ Was adopted under the Republic Act of 9173 and promulgated by the Board of
Nursing under Resolution No. 220 Series of 2004.
● General Principles of Good Governance
○ Service to others
■ Implies commitment to life of sacrifice and genuine selflessness
○ Integrity and Objectivity
■ Refraining engaging any activities that would prejudice their abilities to
ethically carry out their duties nor make any representations that would
likely cause reasonable person to misunderstand and be deceived.
○ Professional Competence
■ Keeping up with new knowledge and techniques in their field and upgrade
their level of competence, taking part in lifelong continuing education
program.
○ SolIdarity and Teamwork
■ Each professional shall maintain and support one professional
organization.
○ Social and Civic Responsibility
■ Carrying out one’s professional duties with due consideration of broader
interest of public and serve them with professional concern.
○ Global Competitiveness
○ Equality of all professions
● The Code of Ethics for Filipino nurses embodies ethical principles and guidelines to be
observed.
○ Responsibilities of Nurses to their Clients
■ Primary responsibility
● Give client kind of care his/her condition needs regardless of
his/her race, creed, color, nationality or status.
■ Ethical Principles
● Values, customs and spiritual beliefs shall be respected.
● Individual freedom to make decisions.
● Personal information acquired must be held in confidence
■ Guidelines to be Observed:
● Individuality and totality of patients
● Respect
● Uphold the rights of the individuals
● Responsibilities of Nurses to their Practice
○ Ethical Principles:
■ Human life is inviolable
■ Quality and excellence in the care of patients
■ Accurate documentation - nursing accountability
■ Optimum standard of safe nursing practice
■ Be morally and legally responsible
■ Patient’s record is considered to be confidential.
○ Guidelines to be Observed:
■ Know the definition and scope of nursing practice
■ Be aware of duties and responsibilities
 ■ Acquire and develop competence in knowledge, skills and attitude.
● Responsibilities of Nurses to other Colleagues
○ Ethical Principles:
■ Work in solidarity with other members of the healthcare team.
■ Maintains collegial and collaborative working relationships.
○ Guidelines to be Observed:
■ Maintain professional identity.
■ Conform with group activities
■ Contribute to professional growth.
■ Actively participate in professional organizations
■ Respect rights of co-workers
● Responsibilities of Nurses to Society and Environment
○ Ethical Principle
■ Preservation of life, respect for human rights and promotion of health
environment
■ Establishment of linkages.
○ Guidelines to be Observed:
■ Be conscious of obligations as citizens
■ Equipped with knowledge of health resources within community
■ Actively participate in programs, projects and activities
■ Right conduct and proper decorum
■ Project image that will uplift nursing profession
● Responsibilities of Nurses to the Profession
○ Ethical Principles:
■ Maintain loyalty
■ Compliance with by laws of accredited professional organizations
■ Commitment to continual learning
■ Contribute to the improvement of the socio-economic conditions and
welfare of nurses.
○ Guidelines to be Observed:
■ Be members of Accredited Professional Organizations - PNA
■ Strictly adhere to nursing standards.
■ Strive to secure equitable working conditions through appropriate
legislation and other means.
■ Assert for the implementation of labor and work standards.
● Responsibilities of Nurses to themselves
○ Should be zealous in her professional growth by keeping abreast with the latest
trends in nursing science.
○ Not perform any act or transaction that may discredit himself or herself or the
profession and to bring to the attention or proper authorities an unethical conduct
of any registered nurse.