NCM 114: HEALTH CARE ETHICS •

Lesson 1: Concepts, Theories, and Ethics is not the same as feelings…

Principles of Health Ethics • Ethics is not religion…

Ethics • Ethics is not following the law…

Ethics • Ethics is not following culturally

• Greek word "ethos" which means moral • accepted norms…

duty, character or disposition, custom, habit.
• It refers to the practices or values that
distinguish one person, organization, or
society from others.
• Branch of knowledge that deals with Moral
principles.
• Moral principles that govern a person’s
behavior or actions
• Examines the rational justification for our
Moral Judgements
• Studies what is Morally Right or wrong in
human conduct.
• Ethics is not science…
Socrates
Socrates
• Father of Ethics
• whose process of questioning continues to
inform philosophical and ethical inquiry
today.
Covers the following dilemmas:
1) how to live a good life
2) our rights and responsibilities

• It pertains to the knowledge of what to study 3) what is right and wrong

about - that is the Goodness or Evil of human
act or human conduct.
• Affect how people make decisions and lead
their lives.
• Concerns with what is good for individuals
and society, is also described as Moral
Philosophy
• are well-founded standards of right and
wrong and what humans ought to do in
terms of rights, and obligations to benefit
others.
Relation of Ethics to the following:
• ETHICS =/= FEELINGS
• ETHICS > RELIGION
• ETHICS =/= LAW
4) when making moral decisions–
knowing what is right and wrong.
Morality
• Greek word "moralis" refers to social
consensus about moral conduct.
• It pertains to the application of ethical
knowledge in the performance of human act
or human conduct
• Is a system of principles and values
concerning people's behavior, which is
generally accepted by a society or by a
particular group of people
• Deals with the principles concerning the
distinction between right and wrong or good
and bad behavior.

• ETHICS =/= SOCIAL ACCEPTED

BEHAVIOR

Ethics is NOT:

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Bioethics - a well-known passage in Latin from the
writings of Hippocrates
Bioethics
- means to help at least or to do no
• Greek word "bios" which means "life“ harm.

• "Ethics of Life“ - This is regarded as the first concept of

ethics in medical and human history.
• The application of ethics to the field of
medicine and healthcare The Art of Medicine
• Is a science that deals with the study of the 1) to relieve pain
morality of human conduct concerning
2) to reduce the violence of disease
human life in all its aspects from the moment
of its conception to its natural end 3) to refrain from trying to cure those whom the
disease has conquered, acknowledging that
Health Ethics
in such cases medicine is powerless.
• Is a science that deals with the study of the
morality of human conduct concerning Ethical Theories
health and health care.
1.) Deontology
Health Care
• Greek word- “deon”- duty or being
• Is the prevention, treatment and necessary;
management of illness
• It is the way people judge morality and
• and the preservation of the well-being actions of others based on rules;
through the services offered by the medical
• A person is morally good and admirable if his
and allied health professions.
actions are done from a sense of duty or
Health Care Ethics reason

• "Medical Ethics " • ”Non-consequentialist Theory”

• a formulation of ethical norms for the • Also known as “principle of obligation “ must
conduct of health care professional in the be followed by all irregardless of the
treatment of patients. consequences

Hippocratic Oath • Proponent: Immanuel Kant

o One of the oldest known formulations of Immanuel Kant

medical ethics
Immanuel Kant
o Named after Hippocrates (460-357 B.C)
"Father of Medicine“ • a German Enlightenment Philosopher and
one of the central Enlightenment thinkers
o It indicates a physician's duty to keep a
patient away from harm and injustice. • one of the main proponents of Deontology

o It emphasizes the significance of medical • He expressed the concept of morality as the

confidentiality between doctors and patients. right thing, is to do one’s duty by each
person
o “premium non nocere”
• It is advocating the highest good for
everybody
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NCM 114: HEALTH CARE ETHICS
You need to act towards Universal
good.
o You need to treat others as you treat
your family.
o You need to act like it’s the best thing
for humanity.
According to Kant:
• ”Duty is a demand for action that respects
the dignity of the other person.”
• ”Happiness is not a quality to be enjoyed by
all people. The only good that is applicable
to everyone is the good will that we as
people can be of use to everyone.”
2.) Teleology
• Greek word "telos" means end result,
purpose or goal; “Teleos”- complete.
• Actions are "Right or Wrong" according
to the balance of their Good or Bad
consequences.
• Consequentialism Ethics
• a reason or explanation for something as
a function of its end, purpose, or goal, as
opposed to as a function of its cause.
• Also known as “Principle of Obligation“
must be followed by all irregardless of
the consequences.
Teleological Ethics
• the goodness or badness of an action by
examining its consequences.
• ” Consequentialist theory”
Deontological Ethics
• determines the goodness or badness of the
action by examining the action itself.
• ” Non-consequentialist theory”
3.) Utilitarianism
• Advocates actions that foster happiness or
pleasure and opposes actions that cause
unhappiness or harm
Jeremy Bentham and John Stuart Mill
• Their ethical doctrines states that the
Rightness and Wrongness of actions is
determined by the goodness and
badness of their consequences.
• Refers to the Greatest Good to the
Greatest number of People.
• Maximization of Good Utility
• The utilitarian doctrine focuses on
happiness, well-being, and the material
outcomes of our actions.
• Lays weight on consequences rather than
rules or character traits
• Places the concepts of good and bad
before the ideas of right and wrong
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 NCM 114: HEALTH CARE ETHICS
VIRTUE ETHICS
• Greek word for virtue is arête means "
Excellence" focused on the quality of
everything you do and experience.

• Virtue is a way of living, learned through

experience.

• focuses on the heart of the person doing the

act including motivation, disposition, and
traits.

• (Modern) First to propose the virtue ethics is

Rosalind Hursthouse; EUDAIMONIA
➢ She developed one detailed account of Eudaimonia
eudaemonist virtue ethics
• “human flourishing”
➢ She argues that the virtues make their
• a perfection of character nurtured by
possessor a good human being.
engaging in virtuous acts over a life of
• First founded by Philosophers in 4th Century experience.
BC by Aristotle who first took the concept of
• Means a contented state of being happy,
VIRTUE and formed it into a theory, VIRTUE
healthy and prosperous
ETHICS.
• Means “highest human good”
➢ He believed by honing virtues habits,
people will likely make the right choice
when faced with ethical challenges.

• Plato also contributed by maintaining a virtue

based eudaemonistic conception of ethics.

➢ According to him, “happiness or well-

being (eudaimonia) is the highest aim of
moral thought and conduct, and the
virtues (arete’: excellence”) are the
requisite skills and dispositions needed to
attain it. Character Traits and Virtues for Nurses:

• Virtue Ethics is simply what you believe in, or • Truthfulness/Honesty

your motive for doing something.
• Integrity
• One has to live the virtues to learn them.
• Sympathy/Compassion/
• GOOD PERSON = DOES GOOD THINGS
• Caring
• VIRTUE ETHICS = by Ancient founders- Aristotle
• Humility
and Plato
• Thankfulness
• "aretaic ethics”

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6 C’s Core values of Professional Nurses 5.) COMMITMENT
• Caring • The state or quality of being dedicated to
• Compassion a cause, activity, etc.

• Competence 6.) COMMUNICATION

• Courage • The imparting or exchanging of

information or news.
• Commitment • Basic element of human interaction that
allows nurses to establish maintain and
• Communication
improve contact with others.
Core Values of Professional Nurses
1.) CARE

• the “Heart of Nursing”

• the provision of what is necessary for the

health, welfare, maintenance, and
protection of someone or something.

Caring and Compassion

• The core virtue ethics of the nursing

profession.
• The essence of caring as a nurse is that you
recognize the value and worth of those you
care for and that the patient and his or her
experience matters to you (Benner &
Wrubel, 1989)

2.) COMPASSION

• How care is given through relationships

based on empathy, respect and dignity.
• “to suffer together.”
3.) COMPETENCE
RECAP:
1.) The greatest good for the greatest number of
people, the Maximization of Good Utility

• Set of demonstrable characteristics and - UTILITARIANISM

skills that enable and improve the efficiency
2.) The founder of Teleology
or performance of a job.
- ARISTOTLE
4.) COURAGE
3.) The other name for Metaethics
• means doing the right thing, speaking up
when there are concerns and having the - ANALYTIC ETHICS
strength and vision to innovate and work in
4.) Means Ethics of Life
new, different ways.
- BIOETHICS

5.) This refers to the foundation of Medical ethics

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 - HIPPOCRATIC OATH
NCM 114: HEALTH CARE ETHICS
6.) The highest human good

- EUDAIMONIA

7.) Synonym of bootlicking

- SERVILE

8.) This is considered as the heart of nursing

- CARE/CARING

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 NCM 114: HEALTH CARE ETHICS
Lesson 2: Ethical Principles, Patient’s Right,
Magna Carta, Principles of Bioethics
ETHICAL PRINCIPLES
What are Ethical Principles?
• Ethical principles are part of a normative
theory that justifies or defends moral
rules and/or moral judgments; they are
not dependent on one's subjective
viewpoints.
• These may refer to general judgements
that serve as a justification for particular
ethical prescriptions and evaluation of
human actions.
Autonomy
• Comes from the Greek word "auto"
meaning "self" and nomos meaning
"rule", "custom", "aw or governance"
• A strong sense of personal responsibility
and moral decisions for one's own life.
Principle of Autonomy:
• you shall not treat a patient without the
informed consent of the patient or nis or
her lawful surrogate, except in narrowly
defined emergencies.
• Informed consent: it is a process wherein
a health care provider educates the
patient about the risks, benefits and
alternatives of a given procedure or
intervention.
Confidentiality
• the state of keeping or being kept secret or
private.
• Non-disclosure of private or secret
information with which is entrusted.
• duty to respect privileged information.
• Privilege information: it is regarded as a
secret information that is legally protected
so that it does not have to be given to the
public.
• Usually companies should explicitly
decide what is privilege information and
set up strict protocols for who can access
to it.
• Example Doctor: patient relationship with,
or lawyer client relationship=private
conversations between these entities
Veracity
• Practice of telling the truth
• "Habitual truthfulness" or "conformity to
facts"
• Attitude and personal qualities that
demonstrate truth.
Fidelity
• Loyalty within the nurse-patient
relationship
• Faithfulness and practice of keeping
promises and commitments.
Justice
• fair, equitable and appropriate treatment to
others.
• Focuses on equitable access to
healthcare.
• Healthcare: the right to demand and to be
treated fairly, justly, and equally
• Article XIII of Philippine Constitution
• National Health Insurance Act of 1995
• Republic Act 7432: Senior Citizens Act
Article XIII of Philippine Institution
• "The state shall adopt an integrated
and comprehensive approach to health
development and shall endeavor to
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make essential goods, health and
social services available to all people
at affordable cost."
• Hospital triage is an example of justice.
• Triage
• prioritization of patient care or victims
during a disaster, based on
illness/injury, severity, prognosis,
and resource availability.
• It came from the French verb TRIER
which means to sort.
Beneficence
• practice of doing acts of goodness,
kindness, and charity
• Principle stated: "Do Good."
• Actions that promote the wellbeing of
others
Nonmaleficence
• Maleficence means "a harmful or evil
act", the act of committing harm or evil.
• Duty to refrain from causing damage or
preventing intentional harm.
• PRINCIPLE STATED: "do no harm”
PATIENT'S RIGHT
What is Patient’s Right?
• Refers to the moral and inviolable power
vested in a patient as a person to do.
Types of Patient's Right
1. Right to Informed Consent
• The patient has the right to receive all
necessary information concerning
diagnosis and treatment in order to be
able to give consent based on his/her
value system.
• Harm in clinical setting, it refers to
something which worsens the condition
of the patient; this may refer to pain,
discomfort, inconvenience expense,
disfigurement, or disability.
• Health care professionals have
developed numerous protocols to
protect the patient, families or
organization, community or themselves.
Failure to engage in this protocols is an
act of omission as opposed to directly
doing harm.
• An ethical understanding supports the
view that such a failure is Negligence.
• Negligence occurs when the person has
not exercised the due diligence expected
of someone in his or her role and level or
responsibility.
Informed Consent
• Refers to the knowledge or information
about and the consent to a particular
form of medical treatment before that
treatment is administered.
2. Right to an Informed Decision
• Information and understanding are
necessary for genuine deliberation.
Informed Decision
• Refers to the necessary information of
and the decision on a medical treatment
before to be carried out.
3. Right to Informed Choice
• The patient has the right to be informed
about all possible alternative courses of
action to be taken, together with the
possible consequences.
Informed Choice
• Refers to the necessary information a
patient should know about a medical
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treatment or experiment so that a moral
choice can be made.
4. Right to Refusal of Treatment
• The patient has the right to refuse
treatment to the extent permitted by law
and to be informed of the medical
consequences of his action.
MAJOR ELEMENTS OF INFORMED CONSENT
1. Competence
• Refers to patient's capacity for decision
making.
• One is considered competent when:
o One has made a decision.
o One has the capacity to justify
one's choice.
o One does not only justify one's
choice but does so in reasonable
manner.
2. Disclosure
• Refers to the content of what a patient is
told or informed about during the consent
negotiation.
• The patient must be informed and must
understand the information concerning
the medical treatment to be undertaken
so that a moral decision can be made
with the whole process and is aware of
the possible outcomes of his/her moral
choice.
3. Comprehension
• Refers to whether the information given
has been understood or not.
4. Voluntariness
• This means that the consent must be
voluntary.
• The patient must, of his/her own FREE
WILL, make a choice without being
unduly pressured by anyone else.
3 METHODS OF OBTAINING INFORMED CONSENT
1. Written Consent
• A consent for to be filled out and signed
by a patient as he/she checks in for
admission in a hospital.
2. Verbal Consent
• Is usually made after a physician has
briefed the patient about the medical
process to be undertaken.
3. Third (3rd) Party Consent
• In case the patient is incapable of
giving consent, in order of priority may
give consent.
o Spouse
o Either Parent
o Immediate Relatives
o Guardian
OTHER FORMS OF CONSENT
1. Consent By Presumption
• This is reasonably presumed to be
present in the subsequent employment
and series of procedures as they are
aligned with the primary procedure to
which explicit consent is expressed.
2. Consent By Proxy
• This is done when the patient is not
capable of giving informed consent and
is legitimately represented by a
competent surrogate who acts on his
behalf.
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Emergency Cases
(Types of patients need NOT require Informed
Consent)
1. Comatose or Obtunded Patients
2. Blind or illiterate Patients
3. Underage patients or those unable to
understand the circumstances.
4. Patients limited by language barriers.
Magna Carta of Patient's Rights and Obligation
The Filipino Patient's Bill of Rights (Bill 812) July
3, 2007
Objectives of the Policy:
• To ensure and protect the rights of the
patient to decent, humane and quality
health care.
• To adopt an integrated and
comprehensive approach to health and
other services available to the people
at affordable costs.
• To provide free medical care to the
poor.
Patient's Rights
1. Right to Appropriate Medical Care and
Human 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
▪ Right of the patient to choose his/her
own health care provider, to serve
him well, as well as the facility, except
when he is under the care of a
service facility, or when public health
and safety so demands or when the
patient expressly waives his right in
writing.
6. Right to Self-Determination
▪ involves people choosing and settling
their own goals, involved in making
life’s decisions, self-advocating, and
working to reach their goals.
7. Right to Religious Belief
8. Right to Medical Records
9. Right to Leave
10. Right to Refuse Participation in a Medical
Research
11. Right to Correspondence and to Receive
Visitors
12. Right to Express Grievances
▪ Grievance Mechanism-is a
procedure that provides a clear and
transparent mechanism for
addressing grievances from patients
with emphasis on patient centered
care. The patient has the right to file
complaints and grievances with the
organization when they are
unsatisfied with the treatment
received, and health care
organizations should have the proper
processes in place for handling both
in a timely manner.
13. Right to be Informed of His Rights and
Obligations as a Patient
Societal Rights of Patients
1. Right to Health
2. Right to Access Quality Healthcare
3. Right to Stay Healthy and Safe
Workplace
4. Right to Prevention and Education
Programs
5. Right to Participate in Policy Decisions
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Patient's Obligations
1. Know the rights.
2. Provide accurate and complete
information.
3. Report unexpected health changes.
4. Understand purpose and cost of
treatment.
5. Accept consequences of own informed
consent
6. Settle financial obligations.
7. Relation to others
8. Exhaust grievance mechanism
▪ Grievance Mechanism - this provides
a clear and transparent framework for
addressing grievances; this takes the
form of an internal procedure for
complaints followed by
consideration, and management
response and feedback.
Principle of Bioethics
Principle of Stewardship
• Refers to the expression of one's
responsibility to take care of, nurture and
cultivate what has been entrusted to him.
• In Health Care, Stewardship refers to the
execution of responsibility of the health
care practitioners to look after, provide
necessary health care services, and
promote the health and life of those
entrusted to their care
Role of Nurses as Steward
1. To be Just and Honest with exercise of
his duties and obligations to uphold
goodness of human life as God's
creation.
2. To make all health care facilities and
technologies serve the well-being of the
patients and prevent unnecessary pains.
3. To respect life from the moment of
conception until its natural expiration and
defend it from any unnatural
proceedings meant to contradict its
nature and destroy its dignity.
4. To recognize dependency not so much
on its own capacity but on God - the
Giver of that capacity and to God
ambassador of service for the Sick.
Principles of Totality and Its Integrity
• Properly applied to the individual or the
human person who is an embodied spirit
with all the functions and capacities he
naturally possesses.
• St. Thomas Aquinas:"A part of the
human body may be sacrificed, if that
sacrifice means continued survival for
the person". "If a member is healthy, and
is continuing in its natural state, it cannot
be cut off to the detriment of the whole."
• This Principle dictates that the well-being
of the whole person must be taken into
account when deciding in therapeutic
intervention or use of technology.
Therapeutic procedures that are likely to
cause harm or undesirable side effect,
can be justified only by a proportionate
benefit to the patient.
• INTEGRITY-Refers to each individual’s
duty to preserve a view of the whole
human person, in which the values of the
intellect, will, conscience and fraternity
are pre-eminent.”
• St. Thomas Aquinas-”Its good to cut into
someone to heal—but not to
MUTILATE”…
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Principle Of Ordinary Means And Extraordinary
Means
• an important approach to the analysis of
ethical questions arising from the
general obligation to preserve human life
and the limits of that obligation.
• One is obligated to preserve his or her
own life by making use of ordinary
means but is under no obligation to use
extraordinary means. In other words,
when a medical intervention or means is
proportionate, one has a general
obligation---all things considered, one
has a general obligation—to accept the
treatment.
• When the medical intervention constitute
a disproportionate means, then one is no
longer obliged to undergo the treatment.
behaviors towards other people;
diverse and personal.
• Personalized Sexuality - takes note of a
humanized sexuality, one that
represents fulfilment or physical and
sensual need but also evidenced with
love and sacramental mystery; It 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 the human
dignity.

Two Means of Preserving Life

• Ordinary Means "of preserving life are all
medicines, treatments, and operations,
which offer a reasonable hope of benefit
for the patient, and which can be
obtained without excessive expense,
pain, and Other inconveniences"
(Ramsey, 122)."
• Extraordinary Means "of preserving life
are all those medicines, treatments, and
operations which cannot be obtained
without excessive expense, pain, or
other inconvenience, or which, if used,
would not offer a reasonable hope of
benefit" (Ramsey, 122).

Principles of Personalized Sexuality

• Sexuality
o a person's sexual feelings,
thoughts, attractions, and

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