→ This theory states that for any action to have
NCM 108: BIOETHICS
CHAPTER 3: TYPES OF ETHICAL THOUGHTS
DEONTOLOGICAL ETHICS
DEONTOLOGY
→ states that people should adhere to their obligations and
duties when engaged in decision making when ethics are
in play.
→ means that a person will follow his or her obligations to
another individual or society because upholding one’s duty
is what is considered ethically correct.
→ For instance, a deontologist will always keep his promises
to a friend and will follow the law. A person who adheres
to deontological theory will produce very consistent
decisions since they will be based on the individual’s set
duties
→ It is this emphasis on duty that earns them the name
“deontological”, which is derived from the Greek word
“deon” for “duty” or “obligation”
→ There are different versions of deontology. We examine
two of them, those of Immanuel Kant and W. D. Ross
■ KANTIAN ETHICS
→ Good Intentions come from Good Will
→ The use of Reason to inform Good will help
highlight your Duty in any situation
→ Your duty can be role-based, but also based on
categorical imperatives.
→ You also need your reason to figure out if you
are acting by a universalisable maxim
Deontological Theory
1 BIOETHICS
any moral worth we can only look at the motives
or intentions behind the act
○ Immanuel Kant (1724-1804)
→ German philosopher
→ Concerned with duty and reason
→ Believed that the intentions behind an action
were more important than the consequences
→ We cannot predict the consequences so we
cannot judge a person good or bad based on the
consequences of their actions
CATEGORICAL IMPERATIVES
→ Categorical means applicable in all situations, an absolute.
→ Imperative means something that must be done, an
obligation
→ In other words, a moral decision that you make must be
made because you think it would be good for everyone
CATEGORICAL VS HYPOTHETICAL
→ The categorical imperative is to act for the sake of duty
only
→ Whereas the hypothetical imperative is acting in order to
receive some kind of reward,
→ Kant argues that the categorical imperative is the only
way to act
→ For example one should help an old lady across the road
simply because it is a good thing to do, not because it will
make you feel good.
→ Even if a good act makes you feel good, this is not a
reward, it is a bonus according to Kant.
MAXIMS AND UNIVERSALISABILITY
 → A maxim is an absolute moral statement; Kant stated that
these had to be universalisable. For example do not
murder.
→ Universalisability is the ability to use a maxim
everywhere, and by everyone so that the maxim is never
broken.
→ For example, for Kant the Decalogue is a set of maxims
which should be universal.
→ “A man is acting morally only when he suppresses feelings
and inclinations and does what he is obliged to do, e.g.
“doing one’s duty”
→ “There is a difference also between actions which are in
accord with duty and those done from duty. The former
are not necessarily moral but the latter are.”
Kant: Deontological Ethical Theory
→ Kant’s theory is an example of a deontological or
duty-based ethics: it judges morality by examining the
nature of actions and the will of agents rather than goals
achieved.
→ A deontological theory looks at inputs rather than
outcomes
→ One reason for the shift away from consequences to
duties is that we cannot control the future. We are praised
or bailed for actions within our control, and that includes
our willing, not our achieving.
→ This is not to say that Kant did not care about outcomes of
our actions — we all wish for good things.
→ Kant insisted that as far as the moral evaluation of our
actions was concerned, consequences did not matter.
SCENARIO:
Michael works as a staff nurse on a specialist unit for people with
neurological disorders. Elizabeth, a twenty six year old teacher who
has recently given birth to her first baby was admitted with a
history of muscle weakness and changes in sensation in her legs
2 BIOETHICS
and lower body. Following initial investigations the medical team
feel that the most likely diagnosis is multiple sclerosis.
It is very difficult to predict how each patient’s MS will progress
during early stages of the disease. Some may deteriorate rapidly
and become unable to care for themselves within a few years but in
many cases patients with MS recover well after the first episode
and enter a period of remission which may last twenty or more
years. The medical team have a policy of not giving patients a
diagnosis of MS during the first episode and prefer to wait until the
patient has had further episodes before they tell the patient the
diagnosis.
Elizabeth, who is making good progress and is regaining most of her
physical abilities, has asked Michael what the results of the medical
tests have shown.
❓ What duties do you think Michael might have? Who to?
How should he act?
■ ROSS ETHICS
○ Sir William david Ross
→ Born 1877-1971
→ Was Knighted
→ Rejected both Kantianism and
Utilitarianism
❓ When is something our duty?
→ Ross does not propose any general test of
obligation like Kant’s categorical imperative.
Instead, Ross falls within the tradition of “ethical
intuitionism”. After a careful examination of the
facts surrounding a case, he believes that we
then are able to intuit the appropriate duty.
→ Ross claims that our experience with such cases
puts us in a position to come to know our prima
facie duties with the same degree of certainty
 as when we grasp the mathematical truth that a
triangle has three angles.
→ Furthermore, according to Ross, our experience
of many individual cases puts us in a position to
recognize the validity of a general statement like
“It is wrong to cause needless pain.” We come to
see such rules in much the same way that we
come to recognize the letter A after having seen
it written or printed in a variety of handwritings
or typefaces.
W.D ROSS - INTUITIONISM
→ Ross accepted Moore’s version of ethics and also added
that in any given situation moral duties or obligations
become apparent.
→ These are called prima facie duties. Prima facie means “at
first appearance”
PRIMA FACIE DUTIES
→ Ross offers a list of duties that he considers binding on all
moral agents (He did not claim that the list is exhaustive)
● Duties of fidelity: telling the truth, keeping actual and
implicit promises, and not representing fiction as history.
● Duties of reparation: righting the wrongs we have done to
others
● Duties of gratitude: recognizing the services others have
done for us.
● Duties of justice: preventing a distribution of pleasure or
happiness that is not in keeping with the merit of the
people involved.
● Duties of beneficence: helping to better the condition of
other beings with respect to virtue, intelligence, or
pleasure.
● Duties of self-improvement: bettering ourselves with
respect to virtue or intelligence
3 BIOETHICS
● Duties of non-malfeasance: avoiding or preventing an
injury to others.
APPLICATION TO BIOETHICS?
→ In August 2000, conjoined twins, named Mary and Jodie
were born in a hospital in Manchester England. Their
spines were fused, and they had one heart and one pair of
lungs between them. Jodie, the stronger one, was
providing blood for her sister.
→ The prognosis was that without intervention, both girls
would die within six months. The only hope was an
operation to separate them. This would save Jodie, but
Mary would die immediately.
→ In the example of Mary and Jodie, Ross would answer the
question of whether it is right or wrong to separate the
twins by first seeing which of the prima facie duties are
applicable and, in the event their is a conflict, examine the
non-moral facts of the case, and with these facts as
background, weigh the duties against one another.
→ In considering the case, the duties of non-malfeasance
and beneficence seems relevant and it is plausible to rea
them as implying that their is an obligation to separate
the twins.
Thus, there were two options: (a) Not intervene and see both babies
die Or (b) Intervene and save one life, Jodie.
❑What is the acceptable course of action?
 → Roughly, a consequence is bad if it reduces happiness,
good if it increases happiness.
→ Happiness, in turn, is understood to mean: an increase in
pleasure and/or decrease in pain because of the emphasis
on happiness, Utilitarianism is sometimes called “the
greatest happiness principle
APPLICATION OF BIOETHICS
→ Recalling the case of Mary and Jodie, according to the

DEONTOLOGY utilitarian, we need to decide which course of action will

→ Deontology contains many positive attributes, but it also produce the greatest good for the greatest number of

contains flaws. One flaw is that there is no rationale or people effected by the action. ❑It is plausible to

logical basis for deciding an individual’s duties interpret utilitarianism as supporting alternative (b).

→ For instance, a businessperson may decide that it is Surely it is better to save one life rather than not.

his/her duty to always be on time to meetings. Although ■ CONTRACTARIANISM

this appears to be something good, we do not know why

the person chose to make this his duty
UTILITARIANISM
→ According to Utilitarianism, a person should perform
those actions which conform to the Principle of Utility.
→ The Principle of Utility says: a person should choose that
action which produces the greatest good for the greatest
number of people affected by the alternatives open to him.
→ The rightness or wrongness of actions is determined by
the goodness or badness of the actions’ consequences, not
by the actions themselves.
→ Because the morality of an action, according to
utilitarianism, rests on its consequences, utilitarianism is
called a “consequentialist theory of ethics.”
→ There are different views as to what makes a consequence
good or bad.
→ According to the “classical” or “hedonistic” version, what
makes a consequence good or bad is its effect on people’s
happiness.

4 BIOETHICS

■ Rawl’s theory of justice
→ The theory of justice formulated by the
philosopher John Rawls can be understood as
attempting to combine the strengths of
utilitarianism and deontology while avoiding the
weaknesses of each view.
→ For Rawls, the central task of government is to
preserve and promote the liberty and welfare of
individuals. Thus, principles of justice are
needed to serve as standards for designing and
evaluating social institutions and practices.
→ Rawls’ position has direct relevance to such
bioethical issues as who should have access to
health care, how donated organs should be
distributed, and who should pay for society’s
medical costs.
PRINCIPLES OF JUSTICE RAWLS ARGUES THAT THERE ARE TWO
FUNDAMENTAL PRINCIPLES OF JUSTICE:
5 BIOETHICS
1. Each person is to have an equal right to the most
extensive total system of equal basic liberties compatible
with a similar system of liberty for all.
2. Social and economic inequalities are to be arranged so
that they are both
a) to the greatest benefit of the least advantaged
b) attached to offices and positions open to all under
conditions of fair equality of opportunity.
PRINCIPLES OF JUSTICE:
→ For Rawls, these two principles are taken to govern the
distribution of all social goods: liberty, property, wealth,
and social privilege.
→ The first principle has priority. It guarantees a system of
equal liberty for all. The second principle governs the
distribution of social goods other than liberty.
→ Though Rawls’ overall position has relevance to individual
medical decisions, its most important application is to the
social institutions and practices of medical care and
research.
Bioethical Example:
● Consent
→ According to Rawls’s principles it is wrong to
exploit one group of people or even one person
for the benefit of others.
→ Thus, experiments in which people are forced to
be subjects or are tricked into participating are
ruled out.
→ A person has a right to decide what risks she is
willing to take with her own life and health.
Thus, voluntary consent is required before
someone can legitimately become a research
subject.
● Health Care
 → The implication of Rawls position seems to be
that everyone is entitled to health care.
→ First, it could be argued that health is among the
“primary goods” that Rawls’s principles are
designed to protect and promote. (“Primary
goods” are the rights, opportunities, powers,
wealth, and such that are both worth possessing
in themselves and are necessary to securing the
more specific goods people may want.)
→ Second, it could be argued that the inequalities
of the health care system can be justified only if
those in most need can benefit from them. Since
this is not obviously the case with the present
system, Rawls’s principles seem to call for a
reform that would provide health care to those
who are unable to pay
TELEOLOGICAL ETHICS
→ Comes from greek word Telos meaning end
→ The theory looks at the consequences, the results of an
action, to decide whether it’s right or wrong.
→ For a teleological thinker, the end justifies the means, and
thus a thinker from this school of thought would judge the
rightness of an action the end it procedure.
6 BIOETHICS
NCM 108: BIOETHICS
CHAPTER 4:CALLING OF A HEALTH CARE PROVIDER
CALLING OF A HEALTHCARE PROVIDER
PROFESSIONAL ETHICS
→ What is right or wrong for a person as a member of a
certain professional or social group
HEALTH CARE PROFESSION
→ Belongs to the ambience of professional ethics.
→ Loaded with a lot of sensitivities and vulnerabilities since
it deals with life
→ Respects both the issues of life and death
→ Concerned with living human person in the context of
Health Maintenance
→ Abide to a lot of norms, principles, theories and values as
a person becomes ill
→ Aided pf certain acceptable guides in decision relative to
healthcare giving.
THE CLIENT
→ The summit of the meaning of the healthcare profession
→ Justifies the essence of the healthcare provider’s
profession
→ Presumed to be vulnerable
→ Someone the healthcare provides has to address all
his/her capabilities, skills and professionalism
HEALTH CARE PROVIDER → Empathy and compassion
→ No ordinary professional → Communication
→ Duties and responsibilities can’t just be accomplished by → Emotional stability
mere compliance of those he/she is expected to do. → Passion for helping others
→ Delicately undertakes to deal with human life → Respect the patient’s rights
→ Cuts across race, religion, affiliations, culture, beliefs → Secure confidentiality
→ Does not have the legal or moral right to choose the kind To society:
of client he/she will take care of → Health professionals play a central and critical role in
HEALTHCARE PROVIDER - CLIENT RELATIONSHIP improving access and quality health care for the
populatioon
→ Healthcare provider-client relationship is regulated by → Healthcare providers create am emvironment that
established rules of professional ethics. responds to the healthcare needs of the community
○ Nursing ethics → They provide essential services that promote health,
→ Paramount concern and responsibility of the healthcare prevent diseases and deliver healthcare services to
provider individual, families and communities based on the primary
→ The relationship established between patients and health health care appraoch.
care providers is fiduciary in nature, which means that it To its profession:
is based on trust → Abide to professional ethics
→ The professional trusts the patient or client to disclose all → Must always show professionalism at all times
the information that may be relevant to his or her Professional ethics that professional services will be rendered in
condition or illness, and to be truthful while disclosing it. accordance with reasonably high standards and acceptable moral
In return: conduct. This confidence enables professionals to exercise relatively
→ The patient or client trusts the healthcare professional to independent judgements in decisions affeting clients.
maintain high standards of competence
NCM 108: BIOETHICS
→ To protect the confidentiality of private information;
CHAPTER 5: VIRTUES, VICES, AND HABITS OF A HEALTHCARE
→ To carry out his or her work in the best interests of the
PROVIDER
patient rather than taking advantage of the patient’s
vulnerability. VIRTUES OF A HEALTHCARE PROVIDER
QUALITIES AND RESPONSIBILITIES OF GOOD HEALTH CARE
PROVIDER ● Fidelity
● Respect
TO CLIENT ● Integrity
The healthcare provider must show: ● Prudence
→ Professionalism ● Humility

7 BIOETHICS
 ● Courage
● Honest
● Compassion
VIRTUES
→ The faculty of the human person to choose what is good
against what is deemed to be bad or evil
FIDELITY
→ Derived from the Latin word fidelitas which means
faithfulness
→ Faithfulness to one’s obligations, duties and
responsibilities
Purtillo (2005) lists five expectations associated with what
patients might reasonably expect in terms of fidelity in the health
care context:
1. That you treat them with basic respect.
2. That you, the caregiver or other health care professional,
are competent and capable of performing the duties
required of your professional role.
3. That you adhere to a professional code of ethics.
4. That you follow the policies and procedures of your
organization and applicable laws.
5. That you will honor agreements made with the patient.
THE NIGHTINGALE’S PLEDGE
I solemnly pledge myself before God and in the presence of this
assembly, to pass my life in purity and to practice my profession
faithfully. I will abstain from whatever is deleterious and
mischievous, and will not take or knowingly administer any harmful
drug. I will do all in my power to maintain and elevate the standard
of my profession, and will hold in confidence all personal matters
committed to my keeping and all family affairs coming to my
knowledge in the practice of my calling. With loyalty will I endeavor
to aid the physician in his work, and devote myself to the welfare of
those committed to my care.
8 BIOETHICS
HONESTY
● Derived from the Latin word honestus which means honor
● A nurse is supposed to be sincere, truthful,
straightforward, decent, comely (pleasing appearance),
tidy, open, upright, virtuous, trustworthy, fair, honorable,
creditable, and of good moral character
● A nurse should not cheat or steal anything from his/her
patient
INTEGRITY
● Comes from the Latin word enteros which means whole
● Makes a human person complete
● A nurse practices integrity when he/she does his/her
duties and obligations according to the beliefs, principles,
and values he/she claims to embrace
● Free from hypocrisy.
HUMILITY
● Humility does not mean that one has to think less of
himself/herself; rather, it invites one to think of
himself/herself less.
● A nurse ceases to think of his/her own needs as he/she
transcends his/her attention to the needs of the patients
RESPECT
● An act through which one takes notice of others
● Regard other with special attention, esteem, and care, or
to consider other worthy of esteem and honor
● Patients are also bound to respect nurses
● Acknowledge the feelings, beliefs, convictions, status, and
condition of the patient
COMPASSION
● A feeling of deep sympathy and sorrow for someone
struck by misfortune, accompanied by a desire to alleviate
the suffering
● Nurses should be sensitive to their patients
PRUDENCE
 ● An exercise of good judgment, common sense, and
caution in the conduct of practical matters
● The overarching virtue that ties together discretion,
foresight, forethought, and circumspection
● Being careful to avoid embarrassing and distressing
situations
COURAGE
● The quality of mind or spirit that enables a person to face
difficulty, danger, and pain without fear
● Nurses are expected to be bold in undertaking a very
sensitive job
● Allows the nurse to face the challenges and dangers of the
healthcare profession: -
- nurses taking care of covid-19 patients
- taking care of a dying person
- assisting during code blue
VICES
● Derived from the Latin word vitium which means failing or
defect
● The product of a repeated sinful act
● Immoral, depraved, or degrading act to all the members in
a given society
● Defect, infirmity, fault, iniquity, offense, wickedness or
corruption
FRAUD
● False representation of fact
● Deliberate deceit; trickery; an intentional perversion of
truth for the purpose of inducing another in reliance upon
it to part with some valuable thing belonging to him, or
surrender a legal right
● tampering patient’s medical record or willfully changes
data in the patient’s record
9 BIOETHICS
● Signing in a medication sheet even if the medication was
not given
● Not returning patients medication prior to discharge
● Using another’s account in accessing patient’s record
PRIDE
● A feeling of gratification arising from association with
something good or laudable
● A high or inordinate opinion of one’s own dignity,
importance, merit, or superiority; conceit; arrogance
● Egoism or vanity and often apply to offensive
characteristics
○ A nurse supervisor reprimanding the staff nurse
in front of the other staff nurses and doctors in
the station
○ A staff nurse shouting at her patient because
the patient couldn’t understand her instruction
GREED
● Comes from the Latin word avaritia which means avarice
or covetousness
○ Excessive desire for wealth or possessions
Example: Nurse stealing patient’s medication for
personal use
HABITS
INITIATIVE HABITS
● those that arise out of the nature and structure of
ourselves, that are necessary parts or propensities arising
from our constitution
● habits of being; connatural qualities
 ● (GOOD HABITS) includes:
○ HEALTH
○ STRENGTH
○ BEAUTY
OPERATIVE HABIT
● habits of acting; tendencies we have developed in
ourselves from repeated acts
● those that can be acquired or relinquished
● It can be a good or bad habit
● Operative habits such as science or humaneness are good
because they orient the intellect and will respectively
toward activities that are desirable;
● error and selfishness on the other hand are bad
dispositions because they organize mind and will toward
actions that are negative and undesirable
NCM 108: BIOETHICS
CHAPTER 6: BASIC BIOETHICAL PRINCIPLES
STEWARDSHIP
● “Man comes from nothing for man to be something.”
● Only GOD can create life; humans are capable only of
manipulating or destroying it.
● Along with the gift of LIFE, GOD also gave intellect (to
discover the truth) and freedom (humans became
creative)
● In as much as life cannot survive on its own without being
rooted to something that can sustain its survival and
development, the Divine Author provided humans a place
to dwell (World).
● Humans must uphold a solemn conviction that life & the
world are gifts from the love & mercy of God.
10
● Explains that God is the creator of the earth and our
human body; we are made to take care of them therefore
we don’t have the right to destroy or use it for our
immoral act.
● We must be morally responsible for God's creation for we
are just its caretaker.
● Requires that the gifts of human life and its natural
environment be used with profound respect for their
intrinsic ends.
● Simply because something can be done does not
necessarily mean that it should be done (the fallacy of the
technological imperative).
PRINCIPLE OF STEWARDSHIP
● Humans must respect the sanctity of life and the world.
- They have no authority over life and the world.
- The God-given gifts of the environment and
humanity are placed in the care of people
- In consonance with the obligation to take care of
the world (Martin Heidegger: “Humans are the
shepherds of being in the world”), a commitment
should also be made to take care of the body,
mind, & freedom.
● Human life comes from GOD, and no individual is the
master of his/her own body.
- Humans are mere stewards or caretakers, with
the responsibility of protecting and cultivating
spiritual and bodily functions.
- As stewards of life and the divine gifts of nature,
humans are accountable to life and the world.
PRINCIPLE OF TOTALITY
TOTALITY
BIOETHICS
 ● Pursues the issue of the dignity of the whole person, in ● As early a 9 wks. of gestation, fetus can perform the
essence of the integrity of human life. following:
- Demands respect for the self and respect for 1. He/she can hiccup
others. 2. Can react to loud noises
- Respect is never a cause but always an effect. 3. Can hear, feel, smell
● Golden Rule: 4. Experience rapid eye movement
- “Do unto others what you want others to do unto 5. Capable of yawning, sucking, swallowing
you.” 6. Can savor mother’s meals
● Respect of the self and others in a condition sine qua non 7. Can distinguish between the voice of mother
(something essential) in a given social order. and that of a stranger
● As a member of a given society, every individual is duly 8. Can walk around the womb by pushing his/her
accountable for the whole society fee
● This is why legislators draft and pass laws to punish TOTALITY
violators of the dignity and value of human life. ● Refers to the duty to preserve intact the physical
- These laws encompass everyone. component of the integrated bodily and spiritual nature of
● Principle of totality can also be applied to the human human life.
body. INTEGRITY
- Person has the right to cut off, or remove ● Refers to each individual’s duty to preserve a view of the
defective, non-functioning part of his body on whole human person in which the values of the intellect,
the premise that the intention is meant to will, conscience, and fraternity are pre-eminent.
safeguard the totality of the well-being of the ● Being honest & fair
body. ● Incorruptible.
● Principle of totality can also be seen in the context of the TOTALITY AND INTEGRITY
journey of human life, from conception to the time of ● These principles dictate that the well-being of the whole
death. person must be taken into account in deciding about any
- For contemporary fetal psychologists (DiPietro, therapeutic intervention or use of technology.
Als, De Casper, Lecanuet and Devlin), human
behavior does not begin at birth but 5 wks. after DOUBLE-EFFECT ACT
conception where the embryonic cell has come
to terms of forming a human development. ● St. Thomas Aquinas recognized that there are times when
● As early as 5 wks., the fetus’s cerebral cortex is already the action one thinks one ought to do will have good and
showing vital signs of development (grow, move, think, bad effects.
speak, plan, and create as a human being).

11 BIOETHICS
 ● Indirect Voluntariness, or voluntary in causa, refers to an
act desired not as an end in itself but as a foreseen effect
or consequence of an act.
● Two problems presented:
1. When can the agent be responsible for the evil
effect of a cause directly willed?
- If the agent foresees the evil effect at
least in a general way.
- If the agent is free to refrain from
doing that which is the cause of the
evil effect
- If the agent knows that he is morally
bound not to do that which is the
cause of the evil effect
2. When can the agent perform an act not evil in
itself, but bears two effects, one good, the other,
evil.
- Action must be morally good in itself.
- The good effect of the act must
precede the evil effect which is
morally allowed to happen as a
regrettable consequence
- There must be a grave or sufficient
reason in doing the act.
- The evil effect should not outweigh the
good effect, or at least the good effect
is at least equivalent in importance to
the bad effect.
3. There must be a grave or sufficient reason in
doing the act. 4) The evil effect should not
outweigh the good effect, or at least the good
effect is at least equivalent in importance to the
bad effect.
COOPERATION
12
● Developed as a way of helping individuals discern how to
properly avoid, limit, or distance themselves from evil
(especially intrinsic evil) in order to avoid a worse evil or
to achieve an important good.
FORMAL COOPERATION
● Occurs when a person or organization freely participates
in the action(s) of a principal agent, or shares in the
agent’s intention, either for its own sake or as a means to
some other goal.
● Formal cooperation in intrinsically evil actions, either
explicitly (openly shown) or implicitly, is morally illicit.
IMMEDIATE MATERIAL COOPERATION
● Occurs when the cooperator participates in circumstances
that are essential to the commission of an act, such that
the act could not occur without his participation.
● Immediate material cooperation in intrinsically evil
actions is morally illicit.
MEDIATE MATERIAL COOPERATION
● Occurs when the cooperator participates in circumstances
that are not essential to the commission of an action, such
that the action could occur even without this cooperation.
SOLIDARITY
● Invites us to consider “how we relate to each other in
community.”
● It assumes that we recognize that we are a part of at least
one family – our biological family, our local community, or
our national community – but then challenges us to
consider the full range of relationships with others
● Requires us to consider an extended community, and to
act in such a way that reflects concern for the well-being
of others.
BIOETHICS
PROPORTIONATE AND DISPROPORTIONATE MEANS
● Holds that one is obliged to preserve his or her own life by
making use of ordinary means, but is under no obligation
to use extraordinary means
PROPORTIONATE MEANS
● Any treatment that, in the given circumstances and in the
judgment of the patient or the patient’s surrogate, offers a
reasonable hope of benefit and is not too burdensome for
the patient or others.
DISPROPORTIONATE MEANS
● Any treatment that, in the given circumstances and in the
judgment of the patient or the patient’s surrogate, either
offers no reasonable hope of benefit or is too burdensome
for the patient or others.
COMMON GOOD
● Consists of all the conditions of society and the goods
secured by those conditions, which allow individuals to
achieve human and spiritual flourishing.
● The human community must be actively concerned in
promoting the health and welfare of every one of its
members so that each member can contribute to the
common good of all
● Three essential elements:
○ Respect for persons.
○ Social welfare.
○ Peace and security
SUBSIDIARITY
● Requires those in positions of authority to recognize that
individuals have a right to participate in decisions that
13
directly affect them, in accord with their dignity and with
their responsibility to the common good.
NCM 108: BIOETHICS
CHAPTER 7: MAJOR ETHICAL PRINCIPLE
MAJOR ETHICAL PRINCIPLES
ETHICAL PRINCIPLES
→ The ethical principles provide a foundation for nursing
practice. Ethical principles are defined as basis for nurse’s
decisions on consideration of consequences and of
universal moral principles when making clinical
judgments
The most fundamental of these principles is the respect for persons.
The primary and basic ethical principles are the following:
● Respect for autonomy
● Nonmaleficence
● Beneficence
● Justice
The secondary ethical principles that can be incorporated with the
primary principles when interpreting ethical issues and making
clinical decisions are the following:
● Veracity
● Confidentiality
● Fidelity
RESPECT FOR PERSONS
● According to the American Nurses Association (ANA), the
most fundamental principle of professional behavior is the
respect for persons. This principle not only applies to the
clinical settings but to all life’s situations.
● This principle emphasizes that all people should treat
others as a worthy individual.
BIOETHICS
 ● In nursing practice this principle should be simplified.
Thus, respect for persons generally means respecting a
client’s autonomy.
RESPECT FOR AUTONOMY
● Respecting a client’s rights, values and choices is
synonymous to respecting a person’s autonomy. Informed
consent is a method that promotes and respects a
person’s autonomy.
● For a client to make an autonomous decision and
action, he or she must be offered enough information
and options to make up his or her mind free of
coercion or external and internal influences.
● In clinical settings, this is promoted by providing informed
consent to the client
AUTONOMY
● Any notion of moral decision-making assumes that
rational agents are involved in making informed and
voluntary decisions.
● The capacity to act intentionally, with understanding, and
without controlling influences that would mitigate against
a free and voluntary act.
● Having the freedom to make choices about issues that
affect one’s life
● Self-governing
● Contrast undesirable states: dependency, coercion,
paternalism, thoughtlessness, habit
● Personal liberty of action
● Self-determination
● Independence
● Self- reliance
● Freedom of choice
● Ability
● to make decisions
VIOLATIONS OF PATIENT AUTONOMY
1. Nurses may falsely assume that patients have the same
values and goals as themselves.
2. Failure to recognize that individuals’ thought processes
are different.
3. Assumptions about patients’ knowledge base.
4. The “work” of nursing becomes the major focus
INFORMED CONSENT
● Patients are informed of the possible outcomes,
alternatives, and risks of treatments, and are required to
give their consent freely
● Assures the legal protection of patient’s right to personal
autonomy in regard to specific treatments and procedures
PATERNALISM
● Translates to professionals who restrict others’ autonomy,
usually to protect that person from perceived or
anticipated harm
- There must be a sufficient reason why the
autonomy of the individual must be restricted.
● It is appropriate when a patient is incompetent and has
diminished decision-making capacity
BENEFICENCE
● The duty of health care providers to be of benefit to the
patient, as well as to take positive steps to prevent and to
remove harm from the patient.
● Applied both to individual patients, and to the society as a
whole.
● Abstain from injuring others.

14 BIOETHICS
 ● Practice of doing good deeds, or showing kindness & ● It is the duty to help others further their important
charity to others. and legitimate interests when we can do so with
● Taking actions that will promote the welfare of other minimal risk to ourselves.
people.
● Requires that we do not intentionally create a
● It is the duty to help others further their important and
needless harm or injury to the patient, either through
legitimate interests when we can do so with minimal risk
acts of commission or omission.
to ourselves.
● Avoid negligent & harmful care.
● Requires nurses to act in ways that benefit
patients---beneficent acts are morally and legally
● Included in this principle are deliberate harm, risk of

demanded by our professional role harm, and harm that occurs during the performance
THREE MAJOR COMPONENTS of beneficial acts
● Articulates a fundamental commitment on the part of
Prevent harm. health care professionals to protect their patients
● Do or promote from harm.
● The nurse takes appropriate action to safeguard ● Do no harm includes:
individuals, families and communities when their care is
- Deliberate harm.
endangered by a co-worker or any other person.”
- Risk of harm.
● Remove evil or harm.
- Harm that occurs during performance of
- Steps include: expressing concern to the
beneficial acts.
person carrying out the questionable
Nonmaleficence means duty to do no harm.
practice and reporting the practice to the
This is promoted by doing the following nursing interventions:
appropriate authority within the situation.
- Avoiding deliberate harm, risk of harm that occurs
BENEFICENCE
during the performance of nursing actions.
- Considering the degree of risk permissible.
● Beneficence is doing or active promotion of good.
- Determining whether the use of technological
This is done by:
advances provides benefits that outweigh risks
- Providing health benefits to the clients. •
BENEFICENCE
Balancing the benefits and risks of harm. •
Considering how a client can be best helped.
● The legal criteria for determining negligence are as
NONMALEFICENCE
follows:
● 1. The nurse must have a duty to the patient.
● DO NO HARM.

15 BIOETHICS
 ● The nurse must breach that duty. 3. The patient must
experience harm. 4. The harm must be caused by the
breach of duty
JUSTICE

● Defined as a form of fairness, or as Aristotle once said,

"Giving to each that which is his due.”
● Fair, equitable, and appropriate treatment in light of what
is due or owed to persons.
● This implies the fair distribution of goods in society.
● It is generally held that persons who are equal should
qualify for equal treatment.
SECONDARY PRINCIPLES OF ETHICAL CONDUCT)

VERACITY
→ The Duty to tell the truth
CONFIDENTIALITY
→ duty to respect privileged information
→ FIDELITY
- duty to keep promises

16 BIOETHICS