3.
with regards to promotion of good and prevention
UNIVERSAL BIOETHICAL PRINCIPLES
A. AUTONOMY
- This principle marks the significance of individual
autonomy which mandates a strong sense of personal
responsibility for one's own life.
Words ni sir:
- Self governing, the ability to make own decisions
without any external control.
- Give care to your patients based on your own
opinion on what should be done.
ELEMENTS OF AUTONOMY
A. Person should be respected
B. He should be able to determine his personal goals.
C. He should have the ability to decide on plans of actions
D. He should have the freedom to act upon his choice
PATERNALISM
- From the greek word “pater” or “paternos” which means
being fatherly
- The act of being fatherly to someone as if the latter was
one’s offspring
- It violates the principle of autonomy
TYPES OF PATERNALISM
1. With regards to recipients welfare
● Ano yung ginagawa mo for your significant others.
A. Pure paternalism
- Justifies interventions into a person's life for the
sole welfare of that person.
- Purely beneficial to other people
B. Impure paternalism
- not only for the welfare of that person but also for
others.
2. With regards to recipients defects and safety
A. Restricted paternalism
- Support intervention which overrides and
individuals actions because of some defects or
weaknesses
- Example, you cannot swim or dive because
sasakit yung ears natin. You can still swim but you
cannot dive
B. Extended paternalism
- an individual is restricted from doing something
because it is too risky or dangerous.
- For example, pregnant women cannot ride a bike
or even participate in a long run or marathon
because it is very risky for the child.
of harm
A. positive paternalism - for the promotion of good
B. negative paternalism - for the prevention of harm
4. with regards to patient's sense of values
A. soft paternalism - patient's values are used to
justify the intervention
B. hard paternalism - patient's values are not used
to justify paternalistic acts
5. with regards to the recipient of the benefit
A. direct paternalism - the individual who should
receive the said benefit is the one whose values
are disregarded for his own good
B. indirect paternalism - a particular individual will
benefit if he is restricted from doing something
6. Personal paternalism
- when an individual decides on the basis of his best
knowledge and capacity for the good of another
person.
7. State Paternalism
- refers to the control exerted by the legislature,
agency, or any governmental bodies over a
particular practice and procedure
- This are the rules and policies within this state
PATIENT’S RIGHT
- the moral and inviolable power vested in a person to
do, hold, or demand something as his own.
- something that by nature belongs to a patient
TYPES OF PATIENT’S RIGHT
1. Right to informed consent
● relates to a process by which patients are informed
of the possible outcomes,alternatives, and risks of
treatments, and patients are required to give their
consent freely.
● Very common in the hospital procedure
● We need to provide the patients acceptance that
the patient allow us to carry out the procedure and
that he knows the possible outcomes of such
procedure.
● Types of Consent
1. Admission Agreement
● prior to admission so that the patient will abide by
the hospital policies. Example; no bringing of knife
or sharp objects, no bringing of durian.
 ● The patient allows the hospital to take care of the ● "If we don't take option 1, what would be the other
patient regardless of the procedures. options"
2. Blood transfusion consent ● The patient has the right to be informed with
● given prior to the administration of blood products different types of choices.
for your blood transfusion.
3. Surgical Consent 4. Rights to refuse treatment
● Common in OR ● the patient has the right to refuse treatment to the
● This is submitted before the operation, to ensure extent permitted by law and to be informed of the
that the patient is aware of the possibilities and medical consequences of his action.
outcomes after the procedure
4. Research consent 5. Right to self-determination
● Submitting yourself to the study of vaccines or new ● the patient as an autonomous individual has the
drugs moral right to determine what is good for himself,
5. Special Consent usually upon the advice of a health care provider
● Procedures that are not common or unique.

Functions of Informed consent PATIENT’S RIGHT

1. To avoid fraud and duress
2. To encourage self- scrutiny by professionals ● the moral and inviolable power vested in a person to
3. To foster rational decision making do, hold, or demand something as his own.
4. To involve the larger society in the debate ● something that by nature belongs to a patient

Elements of Informed Consent
1. Competence
● This refers to a patient's capacity for decision-
making
● Able to decide for himself
A competent individual is:
A. Can make decision
B. ble to justify the decision
C. Able to justify decision in a reasonable manner
2. Disclosure
● This refers to the content of what a patient is told
or informed about during the consent negotiation
● This is particular information about the procedure;
the benefits, pros and cons of undergoing a
specific procedure.
3. Comprehension
● This refers to whether the information given has
been understood
4. Voluntariness
● This means that the consent must be from his own
free will without being forced
● It must be voluntary without any negotiation.
2. Right to informed decision
● refers to the necessary information of an
understanding so a genuine deliberation is carried
out lis before making moral decision on a medical
treatment
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.
Rights are necessary because every individual lives in a
community of persons in relation. “No man is an island,” so
the saying goes. Man is a being with others in the world. For
this reason, human life is more meaningful and worth living
only in the presence and help of others, in communion with
others, and for the benefit of others. This holds true for all
kinds of human relationships, including physician-patient
relationships. A patient, like the physician, is an individual
human being endowed with reason and freedom: As such,
he/she enjoys natural and inalienable rights, such as the right
to life and the right to privacy, among others.
What is meant by a patient's right? In the medical context, a
Patient's right means the moral and inviolable power vested in
him as a person to do, hold, or demand something as his
own. By Nature, every person enjoys a moral and inviolable
power (i.e., right) to do, hold, enjoy, and exact those things
proper to one's whole being. Every right in one individual
involves a corresponding duty in others to respect for this right
and not to violate it. As the patient enjoys some Nights, for
example, so the doctor must respect these rights. Duty,
therefore, is the correlative of right. A right is something mine
or yours, something that belongs to a person by nature; it is
sometimes, but not always, reinforced by law. Hence,
everyone ought to respect another person’s right. The moral
oughtness (or obligation) to do or omit something in favor of
another according to the demands of strict justice is known as
duty.
From the foregoing, if the patient has the right to do, hold, or
demand something, it is the duty of the physician not to
interfere with this right; rather, he has the obligation to
perform or omit an action corresponding to the patient's right.
This obligation arises from strict justice—i.e., giving the
patient his own due by nature. Only in this way can equality
between one person and another—which is the essence of
justice—be realized and established.
TYPES OF PATIENT’S RIGHT
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. The
patient has the right to be informed about all possible
alternative courses of action to be taken, together with
the possible consequences. In reality, however,
“informed consent, decision and choice” go together in
moral decision-making. As soon as the patient has
been informed about what the process involves and
has understood it, he/ she will either consent to it or
will not. Whichever is the case, a decision is made,
and whatever decision arrived at becomes the
patient’s moral choice.
Right to Refuse 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.
● In conjunction with the “Statement on a Patient's Bill
of Rights” presented by the American Hospital
Association, “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”.
In many instances, a patient may refuse medical
treatment because their religious convictions prohibit
them from doing so (e.g., a patient who is a member
of a particular sect may refuse to undergo blood
transfusion). Many regard this right to refuse
treatment as fundamental in a free society, especially
among those who advocate the freedom or right to
die if and when the prevailing circumstances warrant
it. Moreover, the invasion of, person's body (e.g., the
patient) without valid consent is an assault, and
physicians may be subjected to legal sanctions.
Right to Self Determination
● the patient as an autonomous individual has the moral
right to determine what is good for himself, usually
upon the advice of a health care provider
● (also known as the principle of autonomy) mentioned
in Chapter One as one of the major themes in
bioethical literature, is the central element in the
moral issue of patients’ rights. The patient, as an
individual person, has the moral right to determine
what is good for himself. This-right is an important
consideration in the discussion of patients’ rights in
the medical context (1) right to informed consent; (2)
right to informed decision; (3) right to informed choice:
and (4) right to refusal of treatment.
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 for a
particular form of medical treatment, before that
treatment is administered. The information should
include the risks and advantages of any medical
treatment that concerns the patient.
Four Major Elements of Informed Consent
1. Competence. This refers to a patient’s capacity for
decision- making (Shannon: 1013; Beauchamps and
Childress: 66-82). One is considered competent when (a)
one has made a decision (i.e., one can choose between
alternatives); (b) one has the capacity to justify one’s
choice (e.g. give reasons for one’s choice)—competence
here requires some process of deliberation, justification,
and an articulation of why one has made this particular
choice; (c) one does not only justify one’s choice but does
so in a reasonable manner.
2. Disclosure. This 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 medical treatment to be
undertaken, so that a moral decision can be made. The
disclosure of the information must be conducted in such a
way that the patient understands the whole process and is
aware of the possible outcomes of his/her moral choice.
Should there be a language barrier between the physician
and the patient, an interpreter might be consulted to
communicate the pertinent information,
3. Comprehension. This refers to whether the information
given has been understood. The disclosure of information
is not enough; equally important is the comprehension of
that information. If the patient does not understand what
he/she has been told, then information has not been
relayed at all. Health care professionals have a
professional language and so they are expected to
translate their jargon so that it will be intelligible to their
patients. They must be sensitive to their patients’ needs.
4. Voluntariness. This means that consent must be
voluntary. The patient must of his own free will agree to
become a research subject, as the case maybe. He/she
must make a choice without being unduly pressured by
anyone else, Being free in making a decision means that
the patient owns the decision, that the decision is the
 patient's alone, that the patient has chosen the option
based on the information disclosed to him/her.
In the Medical Context
● two methods of obtaining informed consent:
1)written consent, Which is a consent form to be filled up
and signed by a patient as he/ She checks in for
admission in a hospital. This practice, by all indications,
appears to be only perfunctory, because the clerk or
admission personnel does not bother to explain the
content of the “consent form to the patient. Usually, the
latter will just sign it.
2)verbal consent. Whenever the patient verbally signifies
his/her willingness to undergo medical treatment,
informed consent is met. Verbal consent is usually made
alter a physician has briefed the patient about the
medical process to be undertaken (Alfidi: 251-958).
i.
● In emergency cases, however, the following types of
patients need not require informed consent: (1)
comatose or obtunded patients; (2) blind or illiterate
patients; (3) underaged patients or those unable to
understand the circumstances; and (4) language-barrier
patients. In principle, the parents, immediate relatives,
guardians, or next of kin should be informed when the
patient is comatose, blind or illiterate, underage or
unable to understand the language of the physician. In
actual experience, however, the expediency of the
situation may be such that the physician, exerting a
Solomon-like judgment, may not have time to consult the
patient’s next of kin. In emergency situations, for
instance, time is of the essence. An instant decision is a
matter of life and death. A physician's delayed action
may be fatal to a particular patient.
Right to Informed Decision
● Information and understanding are necessary for
genuine deliberation. The patient cannot make a moral
decision unless these two important elements are
present. “Informed decision” refers to the necessary
information and decision on medical treatment before
the latter is carried out.
● The patient must be informed about the whole process
and must understand what this information pertains to
so that an appropriate moral decision can be arrived
at.
In short, as the patient consents to undergo treatment,
he/she decides on it; as the patient makes a decision,
he/she makes a choice between two or more alternatives.
Thus, the emphasis on “informed consent” involves the
information and agreement or disagreement, consent or
nonconsent; “informed decision,” the information and the
decision made; and “informed choice,” the information and
the choice taken from among several alternatives.
LIMITATION OF PATIENT’S RIGHT
● Patient's rights do not include patient's rights to be
allowed to die.
○ Under the concept of personal paternalism, the
physician may make the moral decision for and in
behalf of the patient who can no longer decide by
and for himself, as in the case of a comatose patient.
It is the sworn duty of the attending physician to do
whatever is medically possible to save the patient's
life.
● Patients in a moribund condition does not possess the
necessary mental, physical, or emotional stability to
make decision.
○ A dying patient, or one who lapses into
unconsciousness, becomes mentally incompetent to
make a decision. In such a situation, the attending
physician may perform a paternalistic act for the
well-being of the patient.
● Patient's rights are not absolute
○ Paternalistic concern limits the competent adult
patient's freedom of choice (e.g., refusal of
treatment) for his/her own good in order to prevent
harm from befalling that patient. This precept is
enshrined in the Hippocratic Oath: “I will apply
dietetic measures for the benefit of the sick
according to my ability and judgment; I will keep
them from harm and injustice” (Beauchamp and
Walters: 138).
PATIENT’S BILL OF RIGHTS FROM DOH
1. Right to appropriate Medical care and Humane
treatment
2. Right to informed consent
3. Right to privacy and confidentiality
4. Right to information
5. Right to choose health care provider and facility
6. Right to self determination
7. Right to religious belief
8. Right to medical records
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence and to receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligations as a
patient
PROXY CONSENT
● The process by which people with the legal right to
consent to medical treatment for themselves or for a
minor or a ward delegate that right to another person.

FUNDAMENTAL CONSTRAINTS ON THIS
DELEGATION
1. The person making the delegation must have the right
to consent
2. The person must be legally and medically competent to
delegate the right to consent
3. The right to consent must be delegated to a legally and
medically competent adult.
CONFIDENTIALITY AND PRIVACY
ARE INTERRELATED
● Confidentiality - nondisclosure of private or secret
information about another person with which one is
entrusted. It requires that one maintain the privacy of
another.
● Privacy - refers to the right of the individual to control
the personal information or secrets that are disclosed
to others. It is a fundamental right of individuals.
B. BENEFICENCE
● The practice of doing acts of goodness, kindness and
charity
● The beneficence principle states “do not harm and
produce the good” or “do good and do no harm”
● This basically talks about the benefits of the patient
such as doing good things for the benfit of the patient
● Beneficence: you have to do good
C. NONMALEFICENCE
● Hippocratic oath: “I will never use treatment to injure or
wrong the sick”
● This seems to be similar to the duty of beneficence,
where the practitioner work to minimize the good for
the patient and to minimize harm
● Nonmaleficience: you don’t do any harm
D. VERACITY
● Relates to the practice of telling the truth
● Binds both health practitioner and patient in an
association of truth
JUSTIFICATION OF TRUTH TELLING
1) It is argued that our human and moral quality as
persons is taken away from us if we are denied
whatever knowledge is available about our condition as
patient.
2) As patient, we have entrusted to the physician any
knowledge he has about ourselves, so the facts
(findings) are ours and not his, hence to deny them to
us is to steal from us.
3) The highest conception of the physician-patient
relationship is a personalistic one which is based on
mutual confidence and respect for each other’s rights.
4) To deny a patient pertinent knowledge about himself,
especially in a life and earth situation, is to deprive him
the ample time to prepare for his own death or to carry
out responsibilities that are based solely on his
decision or actions.
BENEVOLENT DECEPTION
● Practitioner is allowed intentionally withhold information
based on his/her “sound medical judment” that to
divulge the ifnormation might potentially harm the
depressed and unstable patient for an unpleasant fact -
there is a right time to tell the truth to the patient
TWO APPROACHES OF TRUTH TELLING
1) Person-centered - considers patient as a person with
a problem, but not as a problem himself/herself
2) Problem-centered - considers the patient’s condition,
illness or diseases
TYPES OF RELATIONSHIPS
(MARTIN BUBER)
● “I-it” - it is a relationship describes a person’s
relationship with things, objects, or “its”
● “I-THOU” - defines our relationship with other persons
or subject
E. CONFIDENTIALITY
● It is an important aspect of the trust that patient place
in health care professionals
CONFIDENTIALITY VS. PRIVACY
● Privacy - refers to the right of an individual to control
the personal information or secrets that are disclose to
others
● Confidentiality - demands nondisclosure of private or
secret information about another person with which
one is entrusted
JUSTIFICATION OF VIOLATION OF
CONFIDENTIALITY
a. When keeping the secret would be detrimental to the
common good.
b. When the subject of the secret intends to inflict grave
injury upon an innocent third party.
c. When it is necessary for the subject of the secret to
avert grave injury
d. When it is necessary for the one keeping the secret to
avoid injury.

F. FIDELITY
● Loyalty, trustworthiness, reliability, faithfulness
● It requires that health care practitioner should practice
faithfully within the constraints of the role
● Doing the role of a nurse faithfully, doing the job with
excellence (your fidelity)
● To promote trustworthiness where the patient can
reply on with all the faithfulness and loyalty to the
benefit of the patient
G. JUSTICE
● Rendering of what is due or merited
TWO TYPES OF JUSTICE
1. Comparable justice
● What a particular patient receives is determined
by the gravity of the condition or need.
● If the patient needs immediate or delicate care,
we give it to the patient according to the gravity of
the condition of the patient
2. Noncomparable justice
● Distribution of goods/resources is determined by a
certain standard
● Under the rules, we give what is right for the
patient.
CRITERIA OF DISTRIBUTION
1. Criteria of inclusion - selection of candidates
● Talks about criteria
● How we give justice or care to the patient
a. Constituency - is the person a member of the
community?
b. Progress of Science - can new knowledge be
gained from the case?
c. Success - is the treatment effective?
2. Criteria of Comparisons
a. The likelihood of successful treatment compared
with others in the group
b. Life expectancy of the person
c. The person’s family role
d. The potential of the person in making future
contribution.
e. The person’s record of services or contribution.
3. Random Selection (James Childress)
a. First come first serve basis
b. Lottery
● Or handpick, which to one to serve first
H. PRINCIPLE OF DOUBLE EFFECT
● An act is foreseen to have both good and bad effects
○ Kanang ani sya guys, naay pregnancies diba
na dli good for the mother, so tagaan ug option
si mother if ipa abort or i keep, if i keep ang
baby kay naay health risks or complications sa
baby and mother.
○ It depends on the situation, mao na ang
principle sa double effect.
ETHICAL CONSIDERATION
a. Good effect must be directly intended.
b. Good effect or bad effect must occur simultaneously or
bad effect must follow the good effect
c. Bad effect may be permitted to occur after the intention
of good effect.
● These are the considerations of the principle of the
double effect
I. PRINCIPLE OF STEWARDSHIP
● It refers to the expression of one’s responsibility to take
care of, nurture and cultivate what has been entrusted
to him.
○ This talks about one’s responsibility to take
care
○ Personal
○ Social
○ Ecological
○ Biomedical
J. PRINCIPLE OF TOTALITY
● The whole implies the existence of its part
● The existence of parts indicates the existence of the
whole
● Consider the entire person when deciding which
therapies, medication or procedures a patient should
receive
○ During the treatment of a patient, we need
to consider the patient, not just about the
money, not just about the effect of the
patient but about the moral, the
standpoint.
● St. Thomas Aquinas
○ A member of the human body is to be disposed of
according as it may profit the whole… if a member
is healthy and continuing its natural stare, it cannot
be cut off to the detriment of the whole…
● The whole implies the existence of its part
● The existence of parts indicates the existence of the
whole
K. PRINCIPLE OF SOLIDARITY
● Professionals must be nurture and support the
principle of one organization for all the members
● Professionals are obliged to put a broader interest of
the profession above one’s personal ambition and
preference.
● We have to work together in one organization to
make the treat successful for our patient
L. PRINCIPLE OF COOPERATION
● Cooperation comes from the latin word cum which
means “with” and operari which means “to work”
● Cooperation is working with another in the
performance of an action

APPLICATION OF ETHICAL THEORY

● Natural law ethics regards the right to informed
consent as morally legitimate, Should a patient decide
to give his/her consent, it must given freely and not the
consequence of intimidation, deception, or coercion.
Under the principle of stewardship and the inviolability
of life, natural law ethics seems to be against the
patient's right to refusal of treatment if the latter means
an act of commission and/or an act of omission which
results in self-killing (suicide) or euthanasia.
● With Kant’s ethical principle that we must always be
treated as ends and never only as means, patients
must not be deceived by their physicians, no matter
how good their intentions may be. As rational and
autonomous individuals, patients have a right to be
told what they are getting into so that they can decide
whether they want to go through with it or not.
● Utilitarianism’s principle of utility requires health care
professionals to design medical treatment in a way that
minimizes suffering and harm. As far as informed
consent is concerned, utilitarianism does not seem to
require it. If more social good is to be gained by
making patients research subjects without receiving
their consent, then it is morally legitimate.
● Rawls’s principles of justice do not allow medical
treatments or experiments that violate freedom which a
patient is entitled to by virtue of being a member of
society. All experiments and medical treatments that
make use of coercion and deception are ruled out.
Inasmuch as a patient has a right to decide what risks
he/she is willing to undergo, voluntary informed
consent is required of all subjects of research.

PRINCIPLES OF ETHICS IN RESEARCH

1. Minimizing the risk of harm

● Types of Harm:
a. Physical harm to participants
b. Psychological distress and comfort
 c. Social disadvantage
d. Harm to participants? Financial status
e. An invasion of participants’ privacy and anonymity
● To minimize harm:
a. Obtaining informed consent from participants
b. Protecting the anonymity and confidentiality of
participants
c. Avoiding deceptive practices when designing your
research
d. Providing participants with the right to withdraw
from your research at any time
2. Obtaining informed consent
● Participants should be volunteers, taking part without
having been coerced and deceived.
● Participants should understand:
a. They are taking part in research
b. What the research requires of them
● responsibilities and boundaries
c. Purpose of the research, the methods being
used, the possible outcomes of the research,
as well as associated demands, discomforts,
inconveniences and risks that the participants
may face
● process of the research, be truthful at all times
when doing research. Let participants know as
well any discomforts and incovenience while
doing the research such as pros and cons.
Include also the good and bad.
● Informed consent - protect researchers and the rights
of the participants. Here, they are able to refuse
3. Protecting anonymity and confidentiality
● Participants will typically only be willing to volunteer
information, especially information of a private or
sensitive nature, if the researcher agrees to hold such
information in confidence.
● Include the data instruments in the informed consent.
Participants should be informed that their data are
secured as well.
● Ask the participants if it’s ok to put their real name or
put an alias to protect the name of the px.
3. Avoiding deceptive practices
● In most circumstances, dissertation research should
avoid any kinds of deceptive practices
● Deception is sometimes a necessary component of
covert research, which can be justified in some cases
where:
a. The identity of the observer (is not used or only
aliases)
b. The purpose of the research is not known to
participants
● dissertation research - talks about safety
● covert research - talks about identity, data was correct
but the information was wrong or covert.
■ It talks more about safety
4. Providing the right to withdraw
● Research participants should always have the right to
withdraw from the research process
● Participants should have the right to withdraw at any
stage in the research process.
● They should not be pressured or coerced in any way to
try and stop them from withdrawing
● This doesn’t mean that you should stop, but rather
explain the procedure to the patient
● Right of the patients to have autonomy
NUREMBERG CODE
● Formulated in August 1947, in Nuremberg, Germany,
by American judges sittin in judgment of Nazi doctors
accused of conducting murderous and torturous
human experiments in the concentration camps (the
so-called Doctors’ Trial)
● This is where informed consent started
● The research became humanitarian
1. The voluntary consent of the human subject is
absolutely essential
● This means that the person involved should have
legal capacity to give consent
● Key word: voluntary, willing, and legal
● Should be legal age and should have sound mind, able
to think rightfully about themselves without mental
challenges
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.
● There are alternatives for such research or study
● There should be fruits or result.
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.
● e.g. lab rats.
● We take into the consideration the safety of the
participants and researchers
● Theres a limitation including the severity and if it
is highly infectious so we should take into
consideration the safety when conducting the
research.
4. The experiment should be so conducted as to
avoid all unnecessary physical and mental
suffering and injury
● Be sensitive when asking questions
● Ask patient first if able to handle such personal
questions
● Consider the mental well being of the participant.
If able to understand the research.
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
● Research should not be leading to death of the
participant. Should not conduct experiment in
expense of the life of the participant.
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.
● Consider the surroundings when doing interview.
Thus, put in a place where there’s no distraction
or causing injury or death. Safety.
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
seemed to him to be impossible.
● The participants should be mentally stable during
the gathering of data.
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.
● Must be able to terminate —- at all states
Summary: Values not only the life, but also the safety
of the participants
DECLARATION OF HELSINKI
● Developed by World Medical Association (WMA) at
Helsinki, Finland, June 1964
● ethical principles for medical research involving human
subjects
● the Declaration is addressed primarily to physicians
THE BELMONT REPORT
● written by the National Commission for the Protection
of Human Subjects of Biomedical and Behavioral
Research
BASIC ETHICAL PRINCIPLES
1. Respect for Person
● individuals should be treated as autonomous agents
● persons with diminished autonomy are entitled to
protection
● Diminished autonomy - those who have mental
problems
● Regarded as autonomous agents because we are
ought to respect the participants
2. Beneficence
● Persons are treated in an ethical manner not only by
respecting their decisions and protecting them from
 harm, but also by making efforts to secure their well-
being.
2 general rules:
(1) do not harm and
(2) maximize possible benefits and minimize possible
harms.
● Beneficence - do good – e.g. give proper nursing care
● Non-maleficence - do not do any harm
3. Justice
● the sense of "fairness in distribution" or "what is
deserved
● Who ought to receive the benefits of research and bear
its burdens?
● During the proposal of the research, include the
qualifications of the participants. The participants
should be equal.
● Research should be fair
● They should be given equal and proper care
ETHICS AND EVIDENCE-BASED PRACTICE
● Evidence-based practice is roughly the use of current
best evidence in making decisions about the care of
patients (Sackett et al. 1996)
● Evidence-based practice is using the best data we
have to guide nursing practice.
● We do things because we have peer-reviewed data
that says we can show that this is beneficial for our
patients in this way.
● It's utilizing the best evidence from research to guide
our practice.
● This was drawn by the approved researches
● E.g. bp taking is more effective on the left arm. This
should be the one being followed.
ETHICAL CONCERNS
1) Some types of knowledge are not included in EBP
2) EBP runs counter to patient-centered care
3) “Testable by RCT” is not the same as “most effective”
4) Decisions based on EBP can be unjust
GOOD CLINICAL PRACTICE (GCP)
● is an international ethical and scientific quality standard
for the design, conduct, performance, monitoring,
auditing, recording, analyses and reporting of clinical
trials
● It also serves to protect the rights, integrity, and
confidentiality of trial subject
ETHICAL DILEMMA
● a conflict in values that causes distress.
● this could be something that's for the nurse, for the
family, for the patient themselves.
● Ex. there's a conflict or a disagreement between
maybe what the family wants and the patient wants, or
what the doctor thinks is in the patient's best interest.
ETHICS COMMITTEE
● exists in most places. It is an interdisciplinary group,
meaning that it is made up of people from multiple
different fields of the profession.
● Ex. nurse, a doctor, a social worker, a chaplain. They
are interdisciplinary team of people whose job it is to
hear about ethical dilemmas happening in that hospital
or that facility.
● they are going to see all of the sides, and review the
literature,
● They don’t impose decisions; they simply offer a
recommendation.
● Wherein the patient or the family may choose to
proceed in a different way, but the ethics committee
had the opportunity to explain what they believe is in
the patient's best interest or what is ethically correct.
AMERICAN NURSES ASSOCIATION
● they are going to be the group that establishes the
ethical standards of care for the nursing profession.
● They are responsible for the Nurse Practice Act
wherein they set the ethical standard for nurses.
INFORMED CONSENT
● is a patient's voluntary decision to undergo a
procedure or intervention.
● provider’s role - the provider needs to explain the
nature of the procedure to the patient, explain the
risks and benefits of the procedure to the patient,
provide alternative solutions to whatever problem
exists, and explain the risks and benefits of those
alternatives.
● The provider needs to make sure the patient fully
understands the information and answer any
questions that they have.
● nurse’s role - as the nurse, you are not explaining the
procedure or the risks and benefits.
■ What you are responsible for doing is signing
the consent form as a witness and making
 sure the patient received all of that information
from the provider and make sure the patient is
competent to provide consent and gave their
consent voluntarily.
PATIENT’S COMPETENCY
● In order to be competent to give consent.
● In general, you have to be over 18 and not impaired in
some way.
● So patients who are under the influence of drugs and
alcohol, patients who are schizophrenic and may be
having hallucinations, and patients with dementia.
● Those patients may not be able to provide informed
consent.
● Also, there are some exceptions to that over 18 rule.
○ So if there are minors who are emancipated, in
the military, or married, they actually may be able
to provide informed consent.
○ Also, minors who are seeking mental health
services may be able to do so without parental
consent in most states.
○ So, if as a nurse, when you come to have the
patient sign their informed consent form, and you
are signing as a witness, if the patient decides,
○ "You know. I have some more questions about this
procedure," it is not your responsibility to answer
those questions about the procedure. You need to
call the provider up, have them come back, or call
the patient to answer those questions.
PATIENT’S RIGHT
● Once the patient has signed that consent form,
they have the right to change their mind prior to
the procedure if they want to, because that is their
right - they have the right to refuse treatment at
any time, even if they already signed that consent
form.
MORALS
● An individual's own code for acceptable behavior
● They arise from an individual's conscience
● They act as a guide for individual behavior
● They arise from individual’s conscience
ETHICS
● Bioethics deals with the "rightness" or "wrongness" of
human behavior
● Concerned with the motivation behind the behavior
● Can’t judge based on own beliefs – comes from own
ethical principle
ETHICAL PRINCIPLES
Ethical Principles Other Concept
● Autonomy ● Double Effect
● Nonmaleficence ● Stewardship
● Beneficence ● Total cooperation
● Justice ● Ordinary and
● Fidelity extraordinary
● Confidentiality ● Personalized sexuality
● Veracity
AUTONOMY
● The freedom to make decisions bout oneself
● The right to self-determination
● Healthcare providers need to respect patient’s rights to
make choices about healthcrae, even if the healthcare
providers do not agree with the patient’s decision.
● a patient has the right to decide what treatment they
will and will not accept.
● It is the patient's right to make their own healthcare
decisions.
● to advocate for that patient and support their right to
autonomy, wherein if a patient says, "I don't want that
treatment," or, "I do want that treatment," we need to
advocate for their wishes to be respected.
● so they need to be able to make their own healthcare
decisions, and they have a right to refuse medication
or any type of procedure.
● It is the patient's right to refuse
● We allow the patient to have choices
● Documentation is important
Clinical Autonomy
● is the nurse’s authority to make independent
judgments about patient care. Clinical autonomy
encompasses the nurse’s right to freedom and
discretionary practices within their scope of practice,
which promote positive patient outcomes.
● e.g. vital signs, doing nursing procedures
(catheterization) – autonomous action to do what is
good to the patient
Practice Autonomy
● is the type of autonomy in nursing that describes the
nurse’s influence over their practice setting. Decisions
about organizational rules, policies, procedures,
structure, and operation are included in Practice
Autonomy.
● rules set by the hospital (remind watchers about the
visiting hours, don’t bring formula)
● Hospitals have different rules and procedures
Clinical Practice Sample
● Administering PRN medications
● Changing the positions of the bed
● Checking vital signs when concerned about the
patient’s state
● Delegating tasks to Nurse aide
● Making decisions in emergency health situations, i.e.
providing CPR
● E.g. Change the position of the bed to ease the pain
and promote comfort
● Do not wait for the doctor, you as a nurse already
know what to do
BENEFICENCE
● This principle means “doing good” for others
● Nurses need to assist clients in meeting all their needs
● Biological - provide side rails
● Psychological - encourage to verbalize their pain
● Social - communicate to the patient
● means promoting good
● to help our patient and assist them in a therapeutic
way.
● Ex. if you took a patient outside to get fresh air
because they've been cooped up in the hospital for
weeks.
NONMALEFICENCE
● Requires that no harm be caused to an individual,
either unintentionally or deliberately
● This principle requires nurses to protect individuals
who are unable to protect themselves
● Examples:
○ the patient is blind, set certain nursing priorities
○ Don’t prolong the BP cuff
● avoiding harm.
● non means against, and mal means bad.
● So do not do harm which is essentially to avoid
causing harm.
● Ex. But when you check a medication label multiple
times to make sure that it's the right med, the right
dose, the right route. In this case, you're performing
non-maleficence because you are working to avoid
causing harm through a medication error.
JUSTICE
● Every individual must be treated equally
● This requires nurses to be nonjudgmental
● Provide equal treatment
● Hippocrates oath
● Tream equally not based on economic status
● to treat fairly and equally
● Nurses provide care equally amongst patients.
● Ex. if I have a four patients and one of them has really
great insurance, has no insurance, has state-
subsidized insurance, and the other one has kind of
middle-of-the-road wherein as a nurse you’re not
providing care differently based on that and you’re not
providing care differently to these patients based on
their race, their sex, and their gender orientation.
● Ex. if you have a patient who has a certain personality
disorder or something else going on, Thus, as a nurse,
you just need to kind of recognize your own feelings
regarding that patient. And you do need to distribute
your care equitably, despite those challenges.
Two Types
1. Comparative - determine how healthcare is delivered
at the individual level. It looks at the disparate
treatment of patients on the basis of age, disability,
gender, race, ethnicity, and religion
● Comparative - e.g. elders first before young ones
○ As the population of the elderly people
increase, funds for this age group also
increases
2. Non-Comparative - healthcare services are
distributed equitably throughout society
Principles of Justice
● To each person an equal share
● To each person according to need
● To each person according to effort
● To each person according to contribution
● To each person according to merit
● To each person according to free market exchanges

Justice Different Criteria of Inclusion and
Selection
● Constituency - a body of customers or supporters.
○ E.g. Privileges given only to members or
specific group
● Random Selection - a representative / a person is
selected from a larger group by chance.
○ Eg. Draw lots/ first come first serve basis
● Success of treatment- chosen base on good
prognosis/ best outcome
○ Eg. Better survivability.
● Life expectancy- number of years a person can
expect to live
○ Eg. Preterm baby vs term baby
Teenager with cancer vs old age with
complicated diagnosis Teenager will be
prioritized since its more likely to live
longer than the latter
FIDELITY
● The promise to fulfill commitments
● Includes the professionals faithfulness or loyalty to
agreements & responsibilities accepted as part of the
practice of the profession
● Mainly talks about loyalty
● We nurses have to be loyal to our patients
● Loyalty and faithfulness
○ Being feeling close, agreements between
the nurse and the patient
● means to be faithful or loyal.
● In nursing practice, it is someone who keeps their
promises.
● Ex.I 'm coming back in 30 minutes to check on your
pain, I'm either coming back, or I'm going to send
somebody to check on you if I get tied up in another
room.
CONFIDENTIALITY
● Anything stated to nurses or healthcare providers by
patients must remain confidential
● The only times this principle may be violated are:
○ If patients may indicate harm to themselves or
others
○ If the patient gives permission for the
information to be shared
● Remain confidential
● Respect the privacy of the patient
VERACITY
● This principles implies “truthfulness”
● Veracity is an important component of building trusting
relationships
● Nurses need to be honest to the patients
● means to tell the truth.
● Ex. "So I'm doing chemotherapy, but the side effects
aren't bad, right?" veracity means that I should say,
"Well, here are the side effects, and here's what you
can expect."
BENEVOLENT DECEPTION
● A common medical practice, is the act of clinicians
withholding information concerning diagnoses in order
to avoid causing patients emotional distress.
● False suggestion - filter out suggestion
● Euphemism - instead of tumor, we call it growth of
tissue to make the conversation light
ADVOCACY
● Is something that you will do all the time as a nurse.
● Ex. if we see a concerning thing or an alarming
condition come up with the patient, we need to reach
out to the provider and get that patient the help they
need.
ACCOUNTABILITY
● Individuals need to be responsible for their own actions
● Nurses are accountable to themselves and to their
colleagues
● Being accountable for mistakes made
REPARATION
● This is a duty to make up for the injuries one has done
to others.
● Ross describes this duty as "resting on a previous
wrongful act"
GRATITUDE
● The duty of gratitude is a duty to be grateful for
benefactions done to oneself and if possible to show it
by benefactions in return.
● Duties of gratitude: these are duties to repay or redo
favors or simply thank others for their kindness
towards us.
ETHICAL DILEMMAS
● Occur when a problem exists between ethical
treatment acceptable desired
principles decision outcomes
● Deciding in favor of one principle usually violates have been
another reached
● Both sides have “goodness” and “badness” associated
with them Collect the Identify Use of Re-evaluate
facts Decision- discussion and as
Makers negotiation necessary
ETHICAL CONSULT
What values List and
● Ethics consult can help:
are in rank the
○ Discover and understand the issues conflict options
○ Serves as a forum for sharing concerns and
questions
○ Identifies possible treatment alternatives ● Planning - present best options but the relative will
○ Provides guidance to the staff, patient, and family decide
members ● Implementation - this is where they decide
○ Resolves conflicts ● Evaluation - goal met or not
● Ethics consult serve also as ethics committee
CASE #1
ETHICAL DECISION MAKING PROCESS ● Patient 89 years old, male with Hyperkalemia,
● Describe the problem ESRD, HTN, and Bladder Cancer.
● Gather the facts
● Clarify values
○ What are these situations?
● Note reactions
○ What did the patient say and do? What did
the doctor say? What did the nurse say?
● Identify ethical principles
● Clarify legal rules
○ Rules inside the hospital
○ Are we obeying the rules and policies of
the hospital?
○ Are there any actions made that did not
observed those rules RESOLUTION
● Explore options and alternatives
○ Instead of being extensive, we explore
other options and alternatives
○ We provide first the options and
alternatives to the patient
● Decide on a recommendation
○ What can we recommend on the
healthcare site
● Develop an action plan
● Evaluate the plan

APPROACH
● meet the new attending physicians to the ethics
ASSESSMENT PLANNING IMPLEMENTATION EVALUATION
committee because it is out of control
Am I Determine Work towards a Determine ● Then, provide ways how to inform about the
involved? goals of mutually whether patient’s prognosis

CASE #2
● Patient 88 years old, male with extensive medical
history including end stage Parkinson’s disease.
RESOLUTION
PRINCIPLE OF STEWARDSHIP AND
ROLE OF NURSES AS STEWARDS
STEWARDSHIP
● Stigward - Warden of a house
● Health Care Practice - to look after, provide
necessary health care services, and promote the
health and life of those entrusted to their care
● State - Oriented Definition - responsible for the
welfare and interests of the population, especially the
trust and legitimacy with which its activities are viewed
by the general public
○ something in the community, has people and
organization
NURSE LEADERS AS A STEWARDS
● Oriented to self
○ Reflects the value of individualization
○ Perceive themselves as the decision makers and
others as implementers
■ we function according to our
responsibilities. Individual
responsibilities.
● Oriented to the organization or system
○ Reflects the value of collectivism
■ collectivisim - giving the group as
priority, manage as a group and not an
individual.
○ Leaders in health care organization that we hold
the point of service as their priority and seek the
input of nurses in setting collective values
ROLE OF NURSES AS STEWARDS
The Stewardship of Self (Personal)
● It is crucial that nurse leaders engage with fine
development of self, refining skills and improving
competencies
● A person is a narrative who seeks purpose, or good for
the self, through interpretations of everyday
experiences.
● Virtues are important, they affect perceptual
judgements about what is relevant in an experience.
● Talks about self-building
● Ex. wearing protective devices - as self improvement
● Enroll in a training to develop our practices
Social
● Nurses help people and their families cope with illness
and deal with it
● Nurses innovate
● Nurses provide ongoing assessment of people’s health
● Not only cure but also give information to the
patients
● Assess the totality in their community
Ecological
● The nursing profession is well positioned to tackle the
challenges of waste reduction within the hospital
● Nurses educate, research, and leading in waste
reduction
Biomedical
● Deals with the ethical implications especially in
medicine
● It involves issues relating to the beginning and end of
human life
● E.g. euthanasia
 ○ feed the patient despite being severely
deformed
● Understand what is your role - responsibility to
prolong or preserve the life of the baby/patient
PRINCIPLE OF ORDINARY AND
EXTRAORDINARY MEANS
Ordinary Means
● Are all medicines, treatments and operations that offer
a reasonable hope of benefit and that can be obtained
without excessive expense, pain or other
inconvenience
○ Ex. the patient rushed in the emergency room.
Patient needs a stat surgical procedure.
Extraordinary Means
● Are all medicines, treatments and operations that
cannot be obtained or used without excessive
expense, pain or other inconvenience or that, if used
would not offer a reasonable hope of benefit
● Medical procedure which no longer respond to the
situation of patient
○ Either they are proportionate and bring burden
to the family
● E.g. Stroke
1) Ordinary - give medication, insert nasogastric tube,
IVF medications
● Ordinary - kaya lang (achievable)
2) Extraordinary measures - option of surgical
procedure for your patient; however, this will cost not
only the life but also the financial state and burden to
the patient.
● Extraordinary - options (given to the relatives)
PRINCIPLE OF DOUBLE EFFECT
● Double effect means that our actions sometimes have
two effects (or outcomes): one that was intended and
one that was predictable but not intended
● The principle of double effect explains when we are
allowed to accept a morally bad effect as a
consequence of trying to bring about a morally good
outcome
● E.g. abortion
○ Social stigma
○ killing the baby to save the life of the mother
TOTALITY PRINCIPLE
● The principle of totality states that all decisions in
medical ethics must prioritize the good of the entire
person, including physical, psychological and spiritual
factors.
● Ethico Moral
○ talks about surgical conscience
○ e.g. must be sterile all the time
a. Ethico-Moral Responsibility of Nurses in Surgery
b. Sterilization and Mutilation - sterilization refers to
any process that eliminates, removes, skills, or
deactivates all forms of life and other biological agents.
● Female genital mutilation (FGM) comprises all
prcoedures that involve partial or total removal of
the external female genitalia, or other injury to
the female genital organs for non-medical
reasons.
● Sterilization - the effect of this will avoid
contamination and infection to the patient
c. Preservation of Bodily Functional Integrity
d. Issues on Organ Donation - organ donation is when
a person allows an organ of their own to be removed
and transplanted to another person, legally, either by
consent while the donor is alive or dead with the
assent of the next kin. Donation may be for research
or more commonly, healthy transplantable organs and
tissues may be donated to be transplanted into
another person
● Organ Donation - each organ constitutes to the totality
of the person.
PRINCIPLE OF PERSONALIZED SEXUALITY
● Take note of a humanized sexuality, one that
represents the fulfillment of physical and sensual need
but also evidenced with love and sacramental mystery
● Is based on the understanding of sexuality as one of
the basic traits of the human person and must be
developed in ways consistent with enhancing human
dignity
● This element of human character often leads to a loss
of human dignity and an inability to pursue the truly
fulfilling goals of human life
● Sexuality talks about sex
● Sex is something pleasure and satisfaction
● Achieve a complete humanity
● Social necessity - for the purpose of procreation but be
abounded to marriage to be legally engaged in this act
● Genesis 1-3
● Teaches that God created persons as male and
female and blessed their sexuality as a great and good
gift
● Jesus confirmed this teaching and perfected it by
affirming that men must be faithful in marriage as
women
● Nevertheless, Jesus also taught that although
sexuality is a great gift, its use in marriage is only a
relative value, which can be freely sacrificed for the
sake of higher values “for the kingdom of GOD”
● Talks about men as faithful and belief

● 1 COR 7:25-35
● For the Christian, the celibrate or single life, with its
freedom from domestic cares to be of service to
others, can be a personally mature and fulfilling
married life.
● Talks about virgins and single
● If you’re single your responsibility is to do good and
please the lord.

JEWISH-CHRISTIAN TRADITION
● Sexuality is always seen in relation to the family as
the basic unit of the community and which are
born and educated to and on which the community
is built.

THE PRINCIPLE OF HUMAN SEXUALITY

● May be stated as follows:
● The gift of human sexuality must be used in
marriage in keeping with its intrinsic, invisible,
specifically human teleology.
● It should be a loving, bodily, pleasurable
expression of the complimentary, permanent self-
giving of a man and a woman to each other, which
is open to fruition in the perpetuation and
expansion of this personal communion through the
family they beget and educate

● When you are in a marriage you are not supposed

to be selfish but instead you must be pursuant to
your partner
● The human sexuality promotes procreation;
LGBTQ, in this case, alters the procreation.