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Quiambao-Udan, J., Cu, N.R., Cañete, G.,

Introduction: and Bartolata, R. (2023). Health
Care Ethics. APD Publishing House: rapidly evolving and complex
healthcare environment
Foundational Ethical Concepts Manila, Philippines
Timbreza, F. (2007). Bioethics and Moral
and Historical Perspective Of Decisions. C & E Publishing Inc. Why study
References Quezon City, Philippines
ethics in technological development
Ethics In Nursing Estoesta, R. and Javines, R. (2009).
Bioethics with Contemporary nursing?
gjsporque Readings and Issues: A Text-
Workbook. Educational Publishing
House, Inc: Manila, Philippines difficult encounters
Kuan, L. (2006). Bioethics in Nursing.
Educational Publishing House, Inc:
Manila, Philippines

1 2 3

• Resuscitation state of the patient Emergency care providers are frequently with stressful
• Futile treatment situations, make decisions quickly but face barriers to
• Not telling the truth ethical decision-making such as
Difficult Ethical Oncology • Dying with dignity
Encounters Nurses Ethical • Conflicting values in pain
management
experienced by Nurses in Dilemmas • Use of resources
the Clinical Setting • Decision-making at the end-of-life
care
Perception of
the situation
Patient-related
factors
Input and
output
Uncoordinated
health system
imbalance
• Giving bad news

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Ethical Dilemmas
lack good-quality patient-health professional Organizational Low staffing levels
communication about diagnosis and prognosis Unsupportive Organizational environments
• cancer-care at times fail to
Environments be supportive
Overload of work
• neonatal care to caring for old people
Hierarchical interactions that do
not promote the dignity of nurses

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Situations

1. Violated the rights, safety, or well-being of the patient or
relatives
2. Those that threatened nurses’ dignity and professionalism
3. Inadequate attention to the moral conflict of nurses’ values
4. The physician-nurse power hierarchy
5. The influence of culture and insufficiency of patient care
6. Professional collaboration
Moral Distress / Ethical Dilemma
by professional nurses, newly-
graduates and nursing students
Moral Distress
Moral distress - internationally and significantly
occurring health and social care phenomenon occurs
when one knows the right thing to do, but constraints
make it nearly impossible to pursue the right course
of actions (Wenwen et.al, 2018, Ohnishi et al., 2019).

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Feelings associated Feelings associated Feelings associated

with Moral Distress
Professional anguish over patient care
decisions (concerns of continuing life
support measures perceived not in the
patient’s best interest or futile care)
with Moral Distress
Team and unit level concerns (poor
communications , bullying, working with
incompetent colleagues, witnessing
practice errors and lack of collegial
collaboration)
with Moral Distress
System-level factors (feeling unsupported
by senior administration and institutional
culpability as a result of health care
processes and system constraints impeding
reliable patient care delivery)

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Introduction: • Withdrawal from the moral

Foundational Ethical Concepts dimensions of patient care
Unaddressed create dilemmas and
and Historical Perspective Of • Moral disengagement leading
Moral to ethical insensitivity New uncertainties through practice
Ethics In Nursing Distress may Graduates that is not aligned with their
• Burn-out expectations
gjsporque lead to
• Ultimately causing nurses to
leave the profession

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Vulnerability to
Negative Workplace
Culture due to… Nursing Students
• Bullying
• Exclusion Perceive ignore morally Basic Ethical Concepts
• Being a scapegoat
• Collegial incivility
inexperienced distressing situations
• New graduates among the health to avoid conflict and
experience
disillusionment from
care team confrontations
lost ideals about
ethical practice

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What are Human Acts? St. Thomas Aquinas

• voluntary acts which proceeds from the free will
• depend on human’s judgement and choice
• entail a moral responsibility
• form the human personality and structure
• The doing or the absence of doing builds the
kind of life the person lives
(Ocampo, 2018)
What is the difference
human acts are said to be proceeding from between human acts and
man’s will
natural acts of man?
Acts performed by the individual which are not
subject to his will and reason are not called
strictly human acts but rather are natural acts.

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Acts of persons asleep or under

Human Acts Natural Acts of Man hypnosis

• actions can be done consciously and freely by the • actions beyond one’s consciousness; not dependent on the intellect
& the will
ACTS not Reflex actions where the will has
no time to intervene
agent/ or by man
• ESSENTIAL QUALITIES/ Constituent Elements of
• ESSENTIAL QUALITIES of Acts of Man morally
Acts of performed under serious
Human Acts
• Done without knowledge
• Without Consent accountable physical violence
1. Knowledge of the act • Involuntary
2. Freedom • hostage obliged to do an evil action
• Ex. Unconscious, involuntary, semi-deliberate, spontaneous actions • will is constrained  not a normal act
3. Voluntariness which could be evaluated
• Man takes into responsibility of these actions

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responsibility and/or
Why do we accountability that comes What is A person will encounter such a
need to with it an Ethical negative experience when that
person knows the right way for
study Socrates Dilemma performing something, but
organizational limits would make
Ethics is that field of
human philosophy that specifically “The unexamined life is not / Moral the execution impossible for him.

acts? studies human acts in the worth living”. Distress? Jameton (1984)
light of morality.

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first model of moral

distress - experienced How can • develop sound ethical
mental imbalance and nurses judgment
negative emotion when
assist • good grasp of ethical Ethical Dilemma
Wilkinson the individual makes an theories, principles,
ethical decision but is patients guidelines and codes Encountered
not able to act in line and • scientific knowledge
with their decision. and interpersonal skills
clients?

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A woman with
congestive heart
You want to pass the
A young You as a nurse believed disease is pregnant, You respect the patient's summative exam to You believe in the
woman asking in that inviolability of being asked to autonomy and believes in maintain your principle of veracity that
for abortion life yet you also terminate the inviolability of life, yet scholarship, but you supports truth regarding
because she is understand the young pregnancy but you also recognize the risk did not study. Then, your capacity, yet you also
not ready for a woman's predicament wants to deliver the and harm the patient is here comes your do not want to fail the
baby and has on raising the child and baby to full term facing due to her classmate offering summative exam and lose
no job. respect her autonomy. despite the risk on pregnancy. help by sharing her the scholarship.
her part. answers.

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Plato: single form of

good and virtue
What is good?
Aristotle: multiple
What is good? What is good? virtues of varying Aristotle’s
degrees Nicomachean Ethics:
goodness in the
virtues can be moral world for him,
acquired through allows for degrees,
levels, and difference
the practice of habit

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The sense of good or the good of
man can be understood not only
Key Points on
on how the said good effects
Moral Good himself but also with those
around him since man is a
political animal.
Aside from existing degrees, levels
and differences, the senses of
Key Points on good can be understood in an
empirical manner. The good (of
Moral Good human experience) has to be
seen, heard, touched, tasted and
felt.
All forms of good actions seek
happiness.
Key Points on
To understand moral goodness,
Moral Good
study the soul of man – one does
not grow in true understanding if
the soul is unknown

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Moral goodness must be Moral goodness is described in

The content of moral goodness
contextualized in different times terms of honorable good, useful
passes through reason and will
Key Points on Key Points on and places hence there is a need Key Points on good, and pleasurable good. The
and the mark of moral goodness
to study different cultures, language and classification of
Moral Good passes through rationality among Moral Good histories, and cases to understand
Moral Good these goods are based on the
different people, places, and
the core of the moral goodness at natural movements of man’s
cultures.
that time and space. dynamic appetite.

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Pleasurable Good
Honorable Good
also silences desire and
• desired in itself because of its
What is good? intrinsic goodness
produces joy
• man naturally tends towards
these goods examples: sense-perceptible
good, produces pleasure or
delight and satisfaction produced
any virtue, health, science, and by virtue of scientific knowledge
wellness

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Useful Good Good

Useful Good
• good not desired for its own
goodness but for the sake of
attaining some other good
• good desired as a means
• not desired for its own sake but for
the sake of honorable or
pleasurable good
• any useful good is directed towards an ultimate
honorable, pleasurable, and useful goods are
good. analogous and relate to each other in varying
situations
Example: bitter medicine to obtain health or a painful
surgery to help a person recover from a diseased
organ and be healthy

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Good
honorable and
pleasurable good
linked together
since the source of
joy is the good and
the root of pain is
evil
Goodness
• Goodness is objective and is not a matter of man’s
subjective take on the goodness of the things in the
world.
• The default mode of the rational appetite of man is to
go after the good.
Example, how does a baby learn that breastmilk is its food? No one taught the baby
to consume milk. Yes, the mother offered her breast, but the baby consumed the
breastmilk.
Goodness
• Moral good especially the higher moral, the honorable
good is acquired through the exercise of virtue and
reason.
• Any existent thing or living being is not good because
it is desirable. It is desirable because it is good.

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Law, Norms and Codes as Eternal law refers to the plan of
Reference Points for divine wisdom
Human Acts Natural Law
natural law - “is itself the eternal
law, implanted in beings endowed
with reason, and inclining them
towards the right action and end.”
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designed by Men of goodwill who are
also guided using their reason and
protect the freedom of the people intellect
Civil Laws freedom comes responsibility Civil Laws all civil laws are anchored on the
Natural Law
adhere to the limitations of the
civil laws to avoid evil and do good reason why the preamble of the
constitution is stated in this manner.
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• consists of the very light reason
that enables man to discern
good from evil and has the
force of law as the voice and
Natural Law the interpreter of the “higher
reason” of the divine Lawgiver
• “natural” because it consists of
the light of reason that each
person has by nature.
57
We, sovereign Filipino people,
imploring the aid of almighty God, in
order to build a just and humane
society, and establish a government
that shall embody our ideals and
aspirations, promote the common
Preamble good, conserve and develop our
patrimony, and secure to ourselves
and our prosperity, the blessings of
independence and democracy under
the rule of law and the regime of
truth, justice, freedom, love, equality,
and peace, do ordain and promulgate
this Constitution.”
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Cultural Norms
Law, Norms and Codes as Reference
Points for Natural Laws • product of the time and space-related
concerns
Human Acts Civil Laws • living conditions and needs of a particular
culture in the context of time and space it
is happening
• ever-changing depending on the cultural
conditions surrounding them

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Professional Code
Code of Ethics of Ethics Ethics
formal statements of the group's contract with the • important practical science
ideals and values that society on how the • studies how human acts are
1. shared by members of the group professionals will directed towards man's purpose
2. reflects their moral judgment behave in or end
overtime accordance with
3. serves as a standard for their the rule dictated by
professional actions the society

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Ethics 4 Elements of Data

• does not stop at the contemplation James Rest’ s Collection
of truth but applies that learning into Four Component
actions Model of Moral
Behavior
• provides the necessary knowledge so psychological processes
man can choose what is good and
consequently lead in a morally that occur before moral
upright way behavior takes place

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Moral Sensitivity Moral Judgement or Reasoning Moral Motivation

• recognition that an ethical problem exists
• requires being aware of how our behavior impacts others
• identifying possible courses of action
• determining the consequences of each potential strategy
• Moral sensitivity is key to transformational effects
• choose among the courses of action identified
• make judgments about what is the right or wrong thing to do in this
specific context
• motivated to follow through on their choices
• Moral values often conflict with other important values like job
security, career advancement, social acceptance, and wealth
• Ethical behavior will only result if moral consideration takes
precedence over competing priorities.

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Moral Character • Comes from the Greek word “ethos”

or “ethous” meaning use, custom,
way of behaving, character
• executing the plan - requires character
• Corresponds to the Latin term “mos”
• overcome active opposition, cope with fatigue, Ethics or “moris”
resist distractions, and develop sophisticated
What is ethics? according to • basic human behaviors that are
strategies for reaching their goals Aristotle specific and inherent to human
beings
• They are natural to humans which
confers and develops goodness in
them.

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Code of Ethics - delineates nursing’s

•applied discipline that
studies the ethical
What is dimensions and issues
nursing
in nursing practice
ethics?
•subset of health care
ethics
basis for the professional
code of ethics in nursing
What is which specifies a system
nursing of principles and rules for
resolving dilemmas and
ethics?
ethical issues that occur
in nursing practice
moral ideals, provides guidelines for
Nurse ethically principled behavior, and
Practice Acts holds nurses morally accountable
for their actions
vs. Code of Nurse Practice Acts - laws that
ethics
govern the nursing profession which
all nurses must adhere to, to
protect the people

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BON Resolution 220 series s2004

provides guidance for carrying out To promote health Nurses and people
nursing responsibilities consistent
with the ethical obligations of the International
To prevent illness Nurses and practice
Nursing Code
profession Council of Nurses
• Provides guidelines for safe and 4 elements in
of Ethics Code of Ethics: 4 the ICN
compassionate care To restore health Nurses and the profession
• Guarantees the public that nurse
Fundamental
adheres to standards of Responsibilities To alleviate suffering
professional practice Nurses and co-workers

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Wide Range of Virtues Wide Range of Virtues Wide Range of Virtues

• Truthfulness • Avoiding impropriety • Exercising moral pluck

• Rectitude • Being a force for good • Voluntary observance of institutional
rules and standards
• Integrity • Maintaining self-discipline and
shunning personal laxity • The exercise of self-discipline in ways
• Doing one’s work decently and in that affirm personal moral and
• Unflinchingly standing firm on intellectual growth as well as both
order what one knows to be morally individuality and community
right • Loving one’s nursing work

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Nursing as a Vocation, Calling,

Wide Range of Virtues and Profession

• Being liberally (that is, broadly) •Vocation

educated •Calling
• Embracing an egalitarian respect for
all regardless of social station or •Profession
economic status
• Genuine compassion, empathy, and
kindness
• A love for humanity

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Nursing as a Vocation, Calling, Early nursing ethics is

and Profession Nurses and physicians relationally-based
nursing, like medicine, is an honorable among nurses
service Ethical with supervisors
Relational
altruistic motives Issues between nurse and patient relative(s)
Center The earliest American Journal
articles on nursing ethics
“matters of asepsis ” (1889) begin by identifying 7
nursing is essentially humanitarian
Classes of Relationship

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The Nurse Patient Relationship Nurse-to-Self (Duties to Self)

Duties of a Nurse into 7 Classes

a. Those she owes to the family

• professional secrets - about the patient and • a nurse should improve her mind by reading
b. Those she owes to the doctor
c. Those owning the family, friends, and servants of the patient family that is personal in nature, and that the the best books at her command
d. To herself nurse must then decide whether or not to
e. To her own friends disclose to the physician • by going out and visiting friends
f. To her own hospital or school
• nurse-patient relationship • and by attending the theater twice a month
g. To other nurses

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Nurse’s Duties to Self (Isabel Robb)

The nurse-to-nurse relationship
• A daily hot bath in the evening for cleanliness and to aid
in sleep • “true harmony” and an “esprit de corps” among Charlotte Aikens wrote: “It is hard to keep
• Vigorous brushing of teeth nurses (Robb, 1990). one’s affection always within safe limits, yet
• Meals are taken regularly • A number of writers speak of the “tone of a
• A “regular amount of well-organized recreation” it is just well to know that friendship has its
school” or the “tone of the hospital” both of which
• Two weeks of vacation (required!), ongoing reading, and are discussions of the moral tone, or what today is dangers and to guard against these dangers
attending alumni association meetings called the moral environment of education or when possible.”
practices.

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Robb too warned nurses about friendship:
“Sentimental, intense personal friendship
between nurses is a mistake, and are rarely
productive of good. In some instances, they
must be regarded as forms of perverted
affection; they are always unhealthy. (Robb,
1990)
97
Physician Abuse
“But if the truth must be told, rare instances occur in which
the physician is unworthy of the respect both of the nurse
and patient, she (the nurse) is not expected to put up with
unjust or rude behavior. She is fully justified in leaving the
case as soon as an efficient substitute has been found to
take her place.” (Robb 1990)
100
The nurse-to-physician relationship
Robb (1990) explained that the nurse is not
qualified to judge a physician’s ability or to
question his treatments, nor may she ever
criticize the physician to the patient or family.
98
Physician Abuse
For Robb, any question about the competence or
appropriateness of medical care must come from the
patient or the family, not the nurse.
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Physician Incompetence
“If a nurse has made up her mind that a physician
is incapable, she can always find some means of
refusing to take charge of the nursing of his
patients, but once having put herself under him,
let her remain loyal and carry out his orders to
the letter. Nor is it honorable for the nurse to cast
discredit in any way upon the physician.”
99
The Nurse-to-Society Relationship
(Social Ethics)
citizenship, democratic ideals, or democracy,
and love for humanity.
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The Nurse-to-Society Relationship The Nurse-to-Society Relationship

(Social Ethics) (Social Ethics)
“The established order of things sometimes has to be upset
before much progress can be made. There are conditions that
are not right in regard to nursing which should be worked on Nurses should have a pioneering spirit and to
The Pivot to Bioethics
till better conditions are assured. In the private nursing field
especially, nurses are most unequally distributed- patients pioneer nursing service beyond the established
who sadly need their skill are unable to secure it; nurses who order of things.
seriously need word are held back from accepting calls to
nurses where their help is sorely needed.” (Aikens, 1923)

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Ethics Education – done by nursing

The Pivot to
1960s: nursing education
Bioethics being moved into colleges and
universities from hospitals,
nursing’s heritage ethics
school directors shifted to
philosophers and theologians
Medical Ethics - medically-centered (physician
paternalism, withdrawal of life-sustaining
late 1960s: medical treatment, futility), and constituted a radical
advancement > biomedical disjunction.
ethics

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What is Bioethics?

Principlism - abstract, non- What were the

contextual, not-situated, threatening
analytical, ethical principles born as a response to
to examine ethical scientific social progress > conditions that
derived from the two
problems, the antithesis of words bio (life) and
threatening conditions and prompted the birth
critical concerns raising
the way in which nursing ethics (behavior) doubts about human’s of Bioethics?
virtue and practice-based
ability to survive
ethics had proceeded

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115
6. The degree of risk to be taken should never exceed
that determined by the humanitarian importance of
the problem to be solved by the experiment.
7. Proper preparations should be made and adequate
facilities provided to protect the experimental subject
against even remote possibilities of injury, disability,
or death.
118
1. The voluntary consent of the human subject is
absolutely essential.
2. The experiment should be such as to yield fruitful
results for the good of society, unprocurable by other
methods or means of study, and not random and
unnecessary in nature.
3. The experiment should be so designed and based on
the results of animal experimentation and a
knowledge of the natural history of the disease or
other problem under study that the anticipated results
will justify the performance of the experiment.
116
8. The experiment should be conducted only by scientifically qualified
persons. The highest degree of skill and care should be required
through all stages of the experiment of those who conduct or engage
in the experiment.
9. During the course of the experiment the human subject should be at
liberty to bring the experiment to an end if he has reached the physical
or mental state where continuation of the experiment seems to him to
be impossible.
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4. The experiment should be so conducted as
to avoid all unnecessary physical and mental
suffering and injury.
5. No experiment should be conducted where
there is an a priori reason to believe that
death or disabling injury will occur; except,
perhaps, in those experiments where the
experimental physicians also serve as subjects.
117
10.During the course of the experiment the scientist in charge must be
prepared to terminate the experiment at any stage, if he has probable
cause to believe, in the exercise of the good faith, superior skill and
careful judgment required of him that a continuation of the experiment
is likely to result in injury, disability, or death to the experimental
subject.
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What were the critical concerns?

1. Human experimentation Interpretation of Bioethics

2. The discovery of Genetics
The systematic study of moral dimensions-
3. Organ Transplants including the moral visions, decisions,
conduct and policies– of life science and
4. The beginning of life and human healthcare, employing a variety of ethical
procreation methodologies in an interdisciplinary
setting.
5. End of life issues

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Four Areas of Bioethics Competency

Interpretation of Bioethics Bioethics as the critical
1991- The ERICE Document – Refers to the contents of the 1978
Encyclopedia of Bioethics and recognizes four areas in which bioethics
has competence.

Relativistic: This new discipline cannot be

understood as a simple comparison of the
conscience of 1. Ethical problem in the healthcare profession.
2. Ethical problems arise in the field of humans even if it’s not directly
different opinions and the various positions that
exist; rather it must propose standards, values, and
technological civilization therapeutic.
3. Social problems are connected with national and international
effective decision-making approaches providing public health policies with healthcare jobs and with family planning
objective answers based on rationally valid criteria. and population control policies.
4. Problems related to interventions on the other living things (plants,
microorganism and animals) and generally to anything having to do
with the equilibrium of the ecosystem.

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Subdivision of Bioethics Theological Presuppositions in Relation to

Bioethics
General Bioethics: Ethical formulations, discussion of values
• Dignity of Human Person – unitotality of body
and first principles, documentary sources of bioethics and spirit
Hippocratic
Oath • Realism, Cognitivism – rational ability to know
Particular Bioethics: Analyze the major problems always as
part of the general approach both in the medical field and reality
in biology. • Metaphysical View of Reality
Clinical Bioethics: Application of ethical theories and
accepted general principles to concrete clinical case seeking
guidelines of actions.

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