BIOETHICS (NCM 108N)

❖ Study of the norm of human acts as guided by

INTRODUCTION TO ETHICS human reason
SHORT HISTORY OF ETHICS IN HEALTHCARE TYPES OF ETHICS:

• Since the era of Hippocrates (460 – 370 BC), the
proper, ethical treatment of patients by healthcare
providers has been emphasized. The Hippocratic
oath and other more modern versions have all
stated how to appropriately treat patients.
• More recently, four pillars of bioethical decision
making in healthcare have been developed:
autonomy, beneficence, nonmaleficence and
justice. Each of these must be taken into
consideration when treating patients.
• Most hospitals have ethics review boards that use
these pillars to determine the proper and
appropriate treatments for patients in difficult and
ethically challenging situations. These boards
provide guidance to healthcare providers, the
patients and their families facing these unique
circumstances.
1.Descriptive: It is the description of the values
and beliefs of various cultural, religious or social
groups about health and illness.
2.Normative: a study of human activities in a
broad sense in an attempt to identify human
actions that are right or wrong and good and bad
qualities. In nursing normative ethics addresses:
scope of practice of different categories of nurses
and, level of competence expected.
3.Analytical: analyzes the meaning of moral terms.
It seeks the reasons why these action or attitudes
are either wrong or right.
CATEGORIES OF ETHICS

WHAT IS ETHICS?

❖ derived from the Greek word ethos which can mean

custom, habit, character or disposition

❖ also referred to as the philosophy of morality

❖ system of moral values or principles of conduct for BIOETHICS

individuals or groups
❖ concerned with what is good for individuals and society
❖ covers the following dilemmas:
• how to live a good life
• our rights and responsibilities
• the language of right and wrong • moral
decisions - what is good and bad?
❖refers to a method of inquiry about the rightness or
wrongness as human actions
❖the practices or beliefs of a group
❖the standards of moral behavior described in the
group’s formal code of ethics
❖ethics as applied to “life situations”
❖philosophical study of ethical issues brought
about by advances in scientific and medical
technologies
❖study of moral and ethical choices faced in
medical research and in the treatment of patients
especially when the application of advanced
technology is involved
❖aims to consider on to how maintain respect for
and protection of the individual in light of our
expanding knowledge of the life sciences and their
applications
 BIOETHICS (NCM 108N)
SCOPE OF BIOETHICS
IMPORTANCE OF BIOETHICS
• Tales of abuse of person, person’s rights and
personal autonomy in research, health care
delivery and training programs abound. They
arouse shame and indignation.
• Healthcare is not morally neutral. Today’s
healthcare provider must face competing and
compelling claims upon which he must act.
• The problems are here and now and moral
decisions have to be made.
• Every healthcare provider is a moral agent who
must judge the goodness or evil of his goal and
actions.
• He cannot depend on scientific knowledge that
can judge only the effectiveness of the means
to achieve the desired goal.
• Goodness must be determined by
considerations of man, his needs, and his
ultimate ends, his economic, cultural, social
and spiritual ramifications.
HEALTH ETHICS
❖ branch of ethics that deals with ethical issues in
health, health care, medicine and science
❖ involves discussions about treatment choices and
care options that individuals, families, and health care
providers must face
❖ requires a critical reflection upon the relationships
between health care professionals and those they serve, as
well as the programmes, systems, and structures
developed to improve the health of a population
❖ involves deliberating about the allocation of
resources, and reflecting on the complex moral choices
arising from ongoing health care restructuring and
advancing technology
❖ entails a critical, political, and ethical
analysis of the definition and the determinants of
health
ISSUES IN HEALTH ETHICS
❖making decisions about end-of-life care
❖determining whether to allocate funds to the
treatment of disease or the promotion of health
❖critically examining the discrepancies in health
status between populations and our ethical
obligations to ensure equitable access to health
services
❖ensuring ethical conduct in health research
PROFESSIONAL ETHICS
❖principles that govern the behaviour of a person
or group in a business environment
❖provide rules on how a person should act towards
other people and institutions in such an
environment
❖encompass the personal and corporate standards
of behavior expected by professionals
❖examine issues, problems, and the social
responsibility of the profession itself and individual
practitioners in the light of philosophical and, in
some contexts, religious principles among which
are duty and obligation.
❖Ethical principles underpin all professional codes
of conduct.
❖Ethical principles may differ depending on the
profession.
❖However, there are some universal ethical
principles that apply across all professions,
including:
• honesty
• trustworthiness
• loyalty
• respect for others
• adherence to the law
BIOETHICS (NCM 108N)
• doing good and avoiding harm to others
• accountability

ETHICS VS MORALS

LEC 2: THE HUMAN PERSON

THE NOTION OF A PERSON

Definition:

• a being that has certain capacities or attributes

such as reason, morality, consciousness and
being a part of a culturally established form of
social relations

• an individual substance of a rational nature

(Boethius)

• any entity that has the moral right to self-

determination

Legal View: a person is a human being or a

corporation recognized in law as having certain
rights and obligations

Philosophical View: a person is a being

characterized by consciousness, rationality, and
a moral sense, and traditionally thought of as
consisting of both a body and a mind or soul

Metaphysical View: a person is a rational,

conscious, moral agent capable of initiating
action, engaging in moral judgments, and using
language.

HUMAN ACTS

• refer to actions that are free and deliberate

• proceed from the free and conscious acts of
man

• acts that are always done for a purpose

• acts that, after some deliberation, is performed
with knowledge of the end and consent of the
will
 BIOETHICS (NCM 108N)
• acts that are proper to man as man
WHEN IS AN ACT FREELY DONE?
1.Under the control of the will – it is the power
tending toward choosing, adhering to and taking
pleasure in a good known by the intellect – voluntary
2.We do things because we want to, we own the
decision or the action
3.We face the consequences of our actions or
decisions – we face it with full responsibility
NATURE OF FREEDOM
• Proceeds from the intellect and will
• Based on reason which the will follows
• When a man makes decisions, he is free
• Man is accountable for what he is doing because he is
conscious of what he is doing, why he is doing it and
how he is doing it.
ACTS OF MAN
• ones that are not dependent upon intellect and free will
• actions beyond one’s consciousness
• acts done without knowledge and consent (involuntary
or spontaneous)
• essentially considered as animal acts
• acts of man can become human acts when he employs
his intellect & will in performing the act
ACTS NOT MORALLY ACCOUNTABLE
• Acts of persons asleep or under hypnosis
• Reflex actions where the will has no time to intervene
• Acts performed under serious threats or physical
violence
HUMAN ACTS VS ACTS OF MAN
ELEMENTS OF THE HUMAN ACT
(1) Knowledge: the person doing the act has
intellectual knowledge or awareness of the means
to employ the act
(2) Freedom: the person doing the act does so
under the control of his will
(3) Actual choice or voluntariness: requires the
presence of knowledge and freedom; willful act
For an act to be considered a human act, it must
possess the following essential attributes:
1.It must be performed by a conscious agent who is
aware of what he is doing and of its consequences.
2.It must be performed by an agent who is acting
freely, that is by his own volition and power.
3.It must be performed by an agent who decides
willfully to perform the act.
MORAL DETERMINANTS OF HUMAN ACTS
1. Object : act itself, the objective act chosen
by the human person When the moral object is evil,
the act is intrinsically evil and always immoral,
regardless of intention or circumstances. In order to
judge the morality of human act, we must consider
the act itself. Moral judgment must be based not
only on the physical aspect of an act but also on its
moral aspect.
2. Intention : purpose or goal for which the act
was chosen; reason for which an act is performed,
or the intention of the agent It should be observed
 BIOETHICS (NCM 108N)
that the purpose will not always change the morality of an
act because some acts are intrinsically wrong (evil by
nature).
3. Circumstances: events; occasions or conditions
that make the act concrete; modify acts either by
increasing or diminishing the moral goodness or evilness of
an act/responsibility of the agent; lighten or aggravate the
weight of moral accountability of the performer
The circumstances do not change the specific nature of the
human act
PRINCIPLES FOR JUDGING MORALITY
1. An act is morally good if the act itself, the
purpose and the circumstance are substantially good.
2. If an act itself is intrinsically evil (evil by its very
nature), the act is not morally allowable regardless of
purpose or circumstances.
3. If an act is in itself morally good or at least
indifferent, its morality will be judged by the purpose or
circumstances.
4. Circumstances may create, mitigate, or
aggravate sin. They may change an indifferent act into
one that is morally sinful.
5. If all three moral elements (the act, purpose and
circumstances) are good, the act is good. If any one
element is evil, the act is evil.
MODIFIERS OF HUMAN ACTS
• ignorance: lack of knowledge of moral duties;
absence of intellectual knowledge; in some cases, we are
responsible for knowledge, in other cases, we are not.
• fear: an agitation or disturbance of mind
resulting from some present or imminent danger.
• concupiscence: strong human impulses or
tendencies toward the possession of something good or
avoidance of something evil
• violence: an external force applied by someone
on another in order to compel him to perform an action
against his will.
• habit: readiness for doing a certain thing
acquired by the regular and persistent
performance of the same act.
THE HEALTH CARE PROFESSION
• organized provision of medical care to
people and communities
• comprises a wide variety of professions and
occupations who provide some type of healthcare
service, including but not limited to, such direct
care practitioners (physicians, respiratory
therapist, nurses, surgeons, dentists, physical and
behaviour therapist) as well as allied health
professionals (phlebotomists, medical laboratory
scientists, dieticians and social workers).
• plays a central and critical role in improving
access and quality health care for the population
• provide essential services that promote
health, prevent diseases and deliver health care
services to individuals, families and communities
based on the primary health care approach
• a profession in which a person exercises skill
and judgment or provides a service related to:
❖the preservation or improvement of the
health an individual or the community
❖the treatment or care of individuals who
are sick, injure, harmed, disabled or
infirmed
• a special calling; service characterized by a
trusting and caring relationship between a
healthcare giver who provides help and a
dependent patient who needs and receives care
FIELDS OF HEALTH CARE
Clinical Healthcare
• involves doctors, nurses, and assistants who
work with patients to diagnose and treat health
issues • includes provision of preventive care to
help patients maintain good health Therapy and
Rehabilitation
• include services that help patients recover
their independence after an injury, illness, or
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surgery (pain management, occupational therapy,
physical therapy, speech therapy)
Healthcare Administration
• involves making both daily and long-term decisions that
reflect the healthcare system’s business strategies
• involve the oversight and management of:
❖ an entire healthcare system
❖ specific facilities, such as physician’s practices,
hospitals, and home health agencies
❖ specific departments or units, such as critical
care units, emergency departments, and cardiac
care units.
❖ specific clinical areas, such as nursing, physical
therapy, and cardiology
❖ specific areas, such as staffing, facility
administration, admissions, and finances
Public Health
• deals with the health and well-being of populations and
communities as a whole Biostatistics
❖environmental health sciences
❖epidemiology
❖health policy and management
❖social and behavioral sciences
Principles of Team-Based Health Care
Shared goals: The team—including the patient and,
where appropriate, family members or other support
persons-works to establish shared goals that reflect
patient and family priorities, and can be clearly
articulated, understood, and supported by all team
members.
Clear roles: There are clear expectations for each team
member's functions, responsibilities, and
accountabilities, which optimize the team's efficiency
and often make it possible for the team to take
advantage of division of labor, thereby accomplishing
more than the sum of its parts.
Mutual trust: Team members earn each other’s' trust,
creating strong norms of reciprocity and greater
opportunities for shared achievement.
Effective communication: The team prioritizes and
continuously refines its communication skills. It
has consistent channels for candid and complete
communication, which are accessed and used by
all team members across all settings.
Measurable processes and outcomes: The team
agrees on and implements reliable and timely
feedback on successes and failures in both the
functioning of the team and achievement of the
team's goals. These are used to track and improve
performance immediately and over time.
QUALITIES OF AN EFFECTIVE HEALTH CARE
PROVIDER
• fidelity • compassion • humility
• honesty • justice • courage
The Concept of Person
WHAT IS A PERSON?
When you are working as a nurse and are
administering an injection or checking temperature,
measuring blood pressure or fixing an I.V. fluid line,
changing a wound dressing or feeding a patient, do
you ever wonder whether the individual in front of
you – whether it be an adult, a child, or a new born
baby – is a person? Is there a difference between
considering someone to be a person and considering
them to be only a human being?
=When we first think about what a person is, we may
envisage that a person is someone who has a sense
of who they are within a context of a past, present
and future
=A person is someone who has an ability for thinking
and communicating, who can direct their life
through choices, preferences and values, who is able
to evaluate actions from the perspective of right and
wrong, duty and obligation, virtue and vice and who
can make moral choices and take moral actions
What constitutes a person? What are the attributes
and traits that are needed to be a person? Is a
person a kind of entity that is rational? To whom
does the concept of person apply? Is a human being
de facto a person? Are there some human beings
who are not persons? Are there some animals who
 BIOETHICS (NCM 108N)
are persons? How we come to answer such questions can
have significant moral implications.

THE IMPORTANCE OF THE CONCEPT OF A PERSON

Today the concept of person is not only of interest for such
theological matters but can be used to justify certain
positions on acute ethical issues that can affect nursing
practice and health care The great advancements in
medicine and technology have led to many positive
possibilities at our disposal regarding the efficacy of
nursing and health care to respond to sickness and disease
Continual breakthroughs made by medical research have
given the concept of person a renewed emphasis and the
impetus to develop a concept of person that aims to speak
to a contemporary world has gained momentum
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LEC 3: MORAL THEORIES GUIDE NURSES IN ETHICAL
DECISION MAKING
Consequentialism/Consequence based
- judge the rightness of the action based on the
consequences it produces (the end justifies the
means)
EGOISM
- self-interest of the doer determines goodness of the
act.
RELATIVISM/ SUBJECTIVISM-/ RELATIONSHIP BASED
- standard of right or wrong is relative to people, to
time and to place.
- stresses courage, generosity, commitment and the
need to nurture and maintain relationships.
LEC 3: ETHICAL THEORIES
A. DIVINE COMMAND THEORY
 assumes the existence of a divine being who has set
down a finite series of rules that adherents claim can
provide guidance to most, if not all, moral decisions.
 claims that morality is ultimately based on the
commands or character of God, and that the morally right
action is the one that God commands or requires
 specific content of these divine commands varies
according to the particular religion
The Euthyphro Dilemma:
An ancient Greek argument which challenges Divine
Command Ethics posed by Socrates
The Euthyphro Dilemma asks: do the gods love good action
because it is good, or is good action good because it is loved
by the gods?
B. NATURAL LAW THEORY
• moral standards that govern human behavior are objectively
derived from the nature of human beings and the nature of
the world
• shares the idea that the rightness of actions is something
determined by nature itself, rather than by the laws and
customs of societies or the preferences of individuals
• human beings possess intrinsic values that govern our
reasoning and behaviour
• through the application of reason, it should be possible to
establish a body of moral principles and rules (doctrines of
natural law)
• maintains that rules of right and wrong are inherent in
people and are not created by society
• sees the universe as organized and structured in such a way
that everything in it has a goal or purpose
• we rely upon reason to determine what our ends are and
how we can achieve them
• reason directs us toward our good as the goal of our action,
and what that good is, is discoverable within our nature
• the good is that to which we are directed by our natural
inclinations as both physical and rational creatures
• constant throughout time and across the globe because it is
based on human nature, not on culture or customs
C. DEONTOLOGICAL THEORY
• derived from the Greek word “deon” meaning duty
• emphasizes on the relationship between duty and the
morality of human actions
 BIOETHICS (NCM 108N)
• category of normal ethical theories that encompasses any
theory which is primarily concerned with adherence to certain
rules or duties
• most closely associated with German philosopher,
Immanuel Kant (Father of Modern Deontology)
• there are objective obligations, or duties, that are required
of all people
• suggests actions are good or bad according to a clear set of
rules
• long term consequences are more important than short
term consequences
The following must be considered in predicting the outcomes
of an action for those involved and society as a whole
1. the immediate consequences for everyone involved
2. the amount and comparative value of the pleasure or harm
for everyone involved
3. the indirect and far-reaching results for society
E. VIRTUE ETHICS

KANT’S CATEGORICAL IMPERATIVES
Principle of the Law of Nature
•"Act only according to that maxim by which you can also
will that it would become a universal law.”
Principle of the Ends
•“Act in such a way that you always treat humanity,
whether in your own person or in the person of any other,
never simply as a means, but always at the same time as an
end.
Principle of Autonomy
•“Act as though you were, through your maxims, a law-
making member of a kingdom of ends.”
D. TELEOLOGICAL THEORY
• derived from the Greek word “telos” meaning “end” or
purpose
• focuses on the possible outcomes of an action
• emphasis is placed on doing what will maximize benefits and
minimize harm to individuals and to society as a whole
• promotes the greatest good for the greatest number
• emphasize the role of character and virtue in moral
philosophy rather than either doing one’s duty or acting in
order to bring about good consequences
• ethics based on character
• declares that a virtuous person is someone who has ideal
character traits which derive from natural internal tendencies
• a person who has acquired the proper set of dispositions will
do what is right when faced with a situation involving a moral
dilemma
• right actions flow out of character and the virtuous person
has a disposition to do the right things
Eudaimonia – condition of human flourishing or of living well
highest human good, the only human good that is desirable
for its own sake (as an end in itself) rather than for the sake of
something else (as a means toward some other end).
eudaimonia consists of the good performance of the
characteristic function of human beings
human virtue or excellence is that combination of traits or
qualities that enables humans to perform that function well
6 CATEGORIES OF VIRTUES

• the good of the society as a whole is more important than

the pleasure of one or a few individuals

• suggests that an action is good if serves a good “end” or

purpose

• higher order pleasures (intellectual and aesthetic pleasures,

concern for others) are preferable to lower order pleasures
(gratification of physical appetites)
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LEC 4: ETHICAL PRINCIPLES
ARISTOTLE’S GOLDEN MEAN ETHICAL PRINCIPLES IN HEALTH CARE

• Autonomy
• Confidentiality
• Veracity -Fidelity
• Justice -Beneficence
• Non-maleficence

A. AUTONOMY
▪individual right to self-determination, independence
and freedom to make choices

SUMMARY OF THEORIES
▪ethical obligation of the practitioner to respect their
clients’ right to make decisions about their own health

▪relates to being “free from controlling influences or

personal limitations such as inadequate
understanding”

▪conditions in which personal choice or autonomy

may be restricted include instances wherein public
health and safety are at stake

▪respect for autonomy demands health care

professionals to exert effort to ascertain the level of
comprehension of each patient, and to convey, in
language that is understandable by the patient, all
relevant medical information necessary to enable the
patient to make quality health care decisions

▪patients have the right to decide for themselves in

regard to the treatment plan, provided that they
receive complete, accurate and comprehensive
information.

INDIVIDUAL RIGHTS OF PATIENTS

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

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6. right to self-determination ▪ when the health of the population is dependent on the
adoption of a mass health program to control epidemic
7. right to religious belief
▪ when the law makes it compulsory for everyone to
8. right to medical records
submit a procedure
9. right to leave
▪ when the patient is either a minor, or legally
10.right to refuse participation in medical research incompetent, in which case a third-party consent is
required
11.right to correspondence and to receive visitors
▪ when disclosure of material information to patient will
12.right to express grievances jeopardize the success of treatment, in which case, third
party disclosure and consent shall be in order
13.right to be informed of his rights and obligations as a
patient ▪ when the patient waives his right in writing
SOCIAL RIGHTS OF PATIENTS

1. right to health In case the patient is incapable of giving consent and a

2. right to access to quality public health care
3. right to healthy and safe workplace
4 right to prevention and education programs
5. right to participates in policy decisions
INFORMED CONSENT
▪permission granted in the knowledge of the possible
consequences, typically that which is given by a patient to
a doctor for treatment with full knowledge of the possible
risks and benefits
▪both an ethical and legal obligation of medical
practitioners and originates from the patient's right to
direct what happens to their body
The following conditions must be observed and satisfied
in the process of obtaining informed consent:
third-party consent is required. the following persons, in
the order of priority stated hereunder, may give consent:
1. spouse
2. son or daughter of legal age
3. either parent
4. brother or sister of legal age
5. guardian
If a patient is a minor, consent shall be obtained from his
parents or legal guardian. If next of kin, parents or legal
guardians refuse to give consent to a medical or surgical
procedure necessary to save the life or limb of a minor or
a patient incapable of giving consent, courts, upon the
petition of the physician or any person interested in the
welfare of the patient, in a summary proceeding, may
issue an order giving consent.

▪disclosure Persons who lack capacity to be autonomous

▪understanding ◼ Infants

▪voluntariness ◼ Irrationally suicidal individuals

▪competence ◼ Drug-dependent individuals

EXCEPTIONS TO INFORMED CONSENT

▪ in emergency cases, when the patient is at imminent risk

of physical injury, decline or death if treatment is withheld
or postponed
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B. CONFIDENTIALITY
• duty of an individual to refrain from sharing confidential
information with others, except with the express consent
of the other party; protection of personal information
• rules and regulations in place which impose restrictions
on the circumstances in which a professional, such as a
doctor or attorney, may divulge information about a client
or patient, and other situations may be deemed
confidential by the use of a contract
- It is the policy of the State to protect the fundamental
human right of privacy, of communication while
ensuring free flow of information to promote
innovation and growth.
CONFIDENTIAL INFORMATION
All identifiable patient information, whether written,
computerized, visual or audio recorded or simply held in
the memory of health professionals, is subject to
confidentiality.

• moral responsibility on the part of all health care It covers:

professionals to exercise utmost care in handling personal
Any clinical information about an individual’s diagnosis or
information of the patient such that the access to, and the
treatment
use of, such information is strictly limited to what is
necessary for the proper medical care of the patient A photo, video or audio recording of the patient
▪ full disclosure of information on the part of the patient Anything else that may be used to identify patients
is a prerequisite to quality care and better health directly or indirectly
outcomes
DATA PRIVACY PRINCIPLES
▪communication between health professional and patient
is generally considered privileged
TRANSPARENCY LEGITIMATE
▪health information is valuable and its unauthorized use
PURPOSE
or disclosure may put patients at risk for unwanted
publicity, discrimination, identity theft and other acts
prejudicial to the patient PROPORTIONALITY
“Whatever I see or hear, whether professionally or
privately which ought not to be divulged I will keep secret
BREACH OF CONFIDENTIALITY
and tell no one. “- Hippocratic Oath
disclosure of private information to a third party not
DATA PRIVACY ACT OF 2012
involved with the patient’s care, without patient consent
- AN ACT PROTECTING INDIVIDUAL PERSONAL or court order may be oral, written, by telephone or by
INFORMATION IN INFORMATION AND fax, or electronically, for example, via e-mail or health
COMMUNICATIONS SYSTEMS IN THE GOVERNMENT information networks may include, but not limited to, any
AND THE PRIVATE SECTOR, CREATING FOR THIS of the following:
PURPOSE A NATIONAL PRIVACY COMMISSION, AND
▪malicious/unauthorized disclosure
FOR OTHER PURPOSES
▪unauthorized access to information/intentional breach

▪processing of information for unauthorized purposes

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LEGITIMATE ACCESS TO HEALTH RECORDS ▪often considered as the most important as it encompasses
all other ethical principles

E. JUSTICE

▪ moral obligation to act on the basis of fair adjudication

between competing claims; fairness or equality

▪ dictates the extent to which the delivery of health care is

provided in an equitable fashion

▪ concerned with the degree to which patients are treated in

LEGITIMATE EXCEPTIONS
▪disclosures with consent
▪disclosures required by law
▪disclosures in the public interest
C. VERACITY
▪conformity with truth or fact; truthfulness
▪key element in building a therapeutic relationship
between health professionals and patients based on trust
a fair and impartial manner
▪ demands that the actions taken by health care
professionals, in their professional relationships with
patients, be motivated by a consistent set of standards
concerning the relevance of the variety of factors that are
taken into consideration for such actions
▪ demands that cases, which are relevantly similar, be
treated the same and that cases, which are relevantly
different, be treated in appropriately distinct ways in
recognition of such differences

▪patients must tell the truth in order that appropriate care THEORIES OF JUSTICE
can be provided
a) Egalitarian Theories
▪practitioners need to disclose factual information so that b) Utilitarian Theories
patients can exercise personal autonomy c) Libertarian Theories

Rules of Veracity a. Egalitarian Theories

◼ Obligation to tell the truth ▪ emphasize equal access to goods and services
◼ Not to lie or deceive others ▪ society must provide universal health care to all its citizens
◼ Respect for others ▪ extreme view: any deviation from absolute equality in
◼ Implicit promise distribution is unjust

◼ Relationships of trust ▪ John Rawls’ Theory of Justice

D. FIDELITY ❖moral rights and rules of justice are based on social

▪obligation to act in good faith to keep vows and promises,
to honor ethical principles, to fulfill agreements, to
maintain relationships and fiduciary responsibilities
▪commitment to duty
▪professional practice must be guided by the principles
enshrined in the code of ethics
contract
❖society is a system of cooperation for mutual
advantage between individuals
❖all would work toward the equal distribution of goods
and services, unless an unequal distribution would work to
everyone’s advantage

▪all professionals must understand and remain within the ❖ 3 principles: greatest equal liberty principle, equal
constraints of their professional practice act opportunity principle, difference principle)
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b. Utilitarian Theories TYPES OF JUSTICE

▪emphasize a mixture of criteria so that public utility is a.) PROCEDURAL JUSTICE

maximized
Consistency, impartiality, and representation in all
▪public utility: greatest good for the greatest number decision-making processes at work

▪any policy or institution which produces a net gain in terms b.) DISTRIBUTIVE JUSTICE
of utility or pleasure for society is considered just
equitable distribution of scarce resources among all
▪operate on net balance principle; equality is not required socioeconomic groups and population sectors RETRIBUTIVE
JUSTICE criminal justice system based on punishment of
▪ John Stuart Mill’s Theory of Justice:
offenders
❖actions are right in proportion as they tend to promote c.) RESTORATIVE JUSTICE
happiness, wrong as they tend to produce the reverse of
happiness criminal justice system based on the rehabilitation of
offenders through reconciliation with victims and the
❖ justice is based on utility and rights exist only because community at large
they are necessary for human happiness
LEVELS OF RESOURCE ALLOCATION IN HEALTH CARE
c. Libertarian Theories
MACRO-ALLOCATION MICRO-ALLOCATION
▪ emphasize personal rights to social and economic
liberty • entails decisions that ▪ more personal
determine the amount of determination of who will
▪ choice of allocation can be freely chosen resources available for receive limited resources
▪ a just society protects the rights of property and particular kinds of
liberty, allowing persons to improve their circumstances on healthcare services
their own initiative • include how particular ▪ focuses on decisions
▪ justice is understood in terms of fair procedures for the health-related institutions regarding particular
acquisition and transfer of property such as hospitals or persons
government agencies
▪ recognize negative rights only (no positive rights) budget their spending

▪ free market economy: an economic order based on • encompasses the ▪ often involves patient
private property and voluntary market relationships among decisions a nation makes selection: determining
agents concerning what resources which patients among
to devote to particular those who need a particular
▪ Robert Nozick’s Self-Entitlement Theory: anyone who
institutions scarce resource such should
acquires what he has through legitimate means is morally
receive treatment
entitled to it

SUMMARY: THEORIES OF JUSTICE

JUSTICE

Also termed as fairness, means to give to each one

what he deserves or what he is due.

X has a right to his due.

Y has the obligation not to deprive X of his due.

 BIOETHICS (NCM 108N)
Man lives in a finite world. There are limits to funds, medical
supplies, health care services. The needs of everyone, even if
it is his due, cannot all be served.

Justice also means to treat equals equally

X and Y are equal.

X and Y should have equal benefits/ burdens.

F. BENEFICENCE

▪promotion of well being of others through actions that

provide positive benefits and actions that prevent harm

▪ includes protecting and defending the rights of others,

rescuing persons who are in danger and helping individuals
with disabilities

▪ in health care, it entails the promotion of a patient’s best

interest by:

❖understanding patient’s perspective

❖addressing misunderstanding and concerns

❖negotiating on a mutually acceptable plan of care

X has a duty to benefit Y provided:

Y is at significant risk

X’s action is needed

X’s action is likely to succeed

There is no significant risk for X

The benefit to Y outweighs any harm for X

G. NON-MALEFICENCE

▪moral obligation not to inflict harm on others

▪requires intention to avoid needless harm or injury that can

arise through acts of commission or omission

This means to do no harm, to prevent, to remove or not to

risk harm.

X has a right not to be harmed.

Y has an obligation not to harm X.

Harm may be physical, mental, psychological, social, financial,

spiritual, etc.