NCM 108HEALTHCARE ETHICS
C. Ethical Principles
D. Veracity
is a concept that relates to the
ethics of truth-telling and the
responsible communication of
information, especially in professional
settings like healthcare. The views of
Zolkefli (2018) and Amer (2019) on
veracity can be summarized as follows:
1. Veracity and Truthfulness:
Veracity is fundamentally about
theethics of telling the truth. It entails
dealing honestly with
individuals,including patients and
colleagues, in various
interpersonalrelationships. This means
that in professional and
personalinteractions, individuals should
strive to be truthful and transparent.The
Ethical Commands of Truthfulness: The
traditional ethicalprinciples of
truthfulness can be distilled into two
commands:
Do Not Lie:
This command emphasizes the
importance ofrefraining from telling
falsehoods deliberately. It suggests
thatwhen one communicates, one
should avoid lying.
Communicate with the Right to
Truth:
The second commandemphasizes
the responsibility to communicate
truthfully to thosewho have a legitimate
right to know the truth.
Complexity of Ethical
Commands:
Zolkefli and Amer point outthat
these ethical commands may seem
straightforward but canbecome quite
complex in real-life situations. They
elaborate on thenuances of these
commands:
The First Command:
It allows for the possibility of
notcommunicating, remaining silent,
evading a question, or eventelling a
falsehood. However, it underscores that
if you choose tocommunicate, you
should not lie."Veracity in nursing"
refers to the application and practice
oftruthfulness and honesty within the
field of nursing. It involvesrespecting the
principles of veracity in patient care
andcommunication. Here's where
veracity stands in nursing:
1. Respect for Autonomy:
In healthcare, including
nursing,respecting the autonomy of
patients is crucial. Autonomy meansthat
individuals have the right to make
informed decisions abouttheir own
healthcare. Veracity plays a vital role in
this context byensuring that patients are
provided with accurate and
completeinformation about their health
condition, treatment options, risks,and
benefits. Nurses have a duty to facilitate
this process bycommunicating truthfully
and transparently.
Informed Consent:
Veracity is closely tied to the
concept of informedconsent. Nurses
have an ethical obligation to ensure that
patients fullyunderstand the nature of
their medical condition, proposed
treatments,and potential consequences.
Patients can only provide valid
informedconsent if they have been
given truthful and comprehensive
information.
Patient Trust:
Trust is fundamental in the nurse-
patient relationship.Patients rely on
nurses to provide them with reliable and
honestinformation. Violating veracity,
whether through deliberate
lies,omissions, or misleading
communication, erodes trust and can
harm thenurse-patient
relationship.Ethical Codes: Nursing is
guided by ethical codes and
professionalstandards that emphasize
the importance of veracity. These codes
ofteninclude principles related to truth-
telling and transparency in patient
care.Nurses are expected to adhere to
these ethical guidelines in their practice.
Clinical Decision-Making:
 Nurses are often involved in
assisting patientsand their families in
making difficult healthcare decisions.
Veracity is criticalduring these
discussions to ensure that all relevant
information is provided,allowing patients
to make choices that align with their
values andpreferences.End-of-Life
Care: Veracity becomes especially
Legal and Ethical Obligations:
Nurses have legal and
ethicalobligations to uphold veracity.
Failing to provide truthful informationor
engaging in deceitful practices can have
legal and professionalconsequences for
nurses.The ethical principle of veracity,
which involves truth-telling andhonesty
in professional-patient relationships, is
indeed essential inhealthcare and has
several important reasons for its
significance:
Respect for Autonomy and
Informed Consent:
Veracity isrooted in the respect
owed to patients. When
healthcareprofessionals provide
thorough and truthful information to
patientsabout medical procedures,
interventions, risks, and benefits,
theyenable patients to make informed
decisions about their ownhealthcare.
This ensures that any consent given by
the patient isvalid and based on a clear
understanding of the
situation.Obligations of Fidelity and
Promise-Keeping: Veracity is
closelyassociated with the ethical
obligations of fidelity and promise-
keeping.Healthcare professionals
implicitly promise to speak truthfully and
notdeceive their patients. Upholding
veracity reinforces the trustworthiness
ofthe healthcare provider-patient
relationship.
Building Trust:
Trust is a cornerstone of
successful intervention andcooperation
in healthcare. Patients must have
confidence in their healthcareproviders
to be truthful and transparent. Trust is
essential for patients to feelcomfortable,
cooperate with treatment plans, and
significant inend-of-life care and
discussions about do-not-resuscitate
(DNR)orders, advance directives, and
the withdrawal of life-
sustainingtreatments. Honesty and
sensitivity are essential in these
situationsto support patients and
families in making emotionally
challengingdecisions.
disclose relevantinformation about their
health.
Violations of Veracity can occur in
several ways:
1. Omission:
One way to violate veracity is
through omission, wherecritical and
relevant facts are intentionally left out
when conveyingmedical information to
the patient. This can result in incomplete
ormisleading information, which may
impact the patient'sdecision-making.
2. Commission:
Another violation occurs when
medical personnelintentionally tell a lie
to the patient or their family. This
involves providingfalse information,
which can lead to serious ethical and
legal consequences.
3. A more subtle violation involves
using complex medical jargon
orlanguage that the patient or their
family may not understand. Whilenot a
direct lie, it can still hinder the patient's
ability to makeinformed decisions about
their care. Effective communication
inplain language is essential to avoid
this form of violation.
It's important to strike a balance in
healthcare between providing
patientswith honest and complete
information while also being sensitive to
theiremotional and psychological needs.
In some cases, there may be
ethicaldilemmas where disclosing the
entire truth could cause undue harm
ordistress to the patient. In such
situations, healthcare professionals
shouldconsider the principles of
beneficence and non-maleficence,
which involvedoing what is best for the
patient's well-being while avoiding harm.
Ethicaldiscussions, consultation, and
collaboration with colleagues and
ethicscommittees can help navigate
these challenging situations and
determine thebest course of action while
upholding veracity to the greatest extent
possible.
Truth Telling:
Baillie et al. emphasize the
importance of truth-telling in healthcare:
Every competent person has a right
to information about themselves
andtheir medical condition. This
information is vital for making
informeddecisions for their present and
future health.
The right to truth should only be
rescinded in cases where there is a
verystrong justification, such as when
revealing the truth may cause
extremepsychological harm to the
patient or others.
Cultural Considerations on Truth
Telling (Filipino Perspective):
In the context of the Filipino culture,
truth-telling can be influencedby cultural
norms and values:
Family Orientation to Illness:
Filipinos often prioritize family
inhealthcare decisions. In serious
cases, family members aresometimes
informed before the patient. Family
members mayrequest that the physician
withhold the full truth from the patientto
protect them from hopelessness,
depression, or refusal oftreatment. It's
important to recognize the significance
of family inFilipino culture and their right
to know the truth.
Nonconfrontational Attitude:
In Filipino culture, there is often
anonconfrontational attitude, which can
make it difficult forhealthcare
professionals to disclose unpleasant
news, such as aterminal diagnosis. This
attitude may lead to the use
ofeuphemisms or vague language,
which can result inmisunderstandings
and inappropriate decisions.
Additionally,issues may not be
addressed promptly, leading to more
significantproblems.
Fidelity:
Fidelity in nursing ethics refers to
the ethical obligation ofhealthcare
professionals, including nurses, to act in
good faithand uphold promises and
commitments made to patients andtheir
families. This includes:
Keeping Promises:
Healthcare professionals are
expected tofulfill their professional
promises, such as providing quality
andcompetent care to their patients.
Maintaining Relationships:
Fidelity extends to maintaining
trustand professional relationships with
patients, which includesbeing honest,
respectful, and loyal in the provision of
care.
Fiduciary Responsibilities:
Nurses have fiduciary
responsibilitiesto act in the best
interests of their patients and protect
their rightsand well-being.
Fidelity is indeed a fundamental
ethical principle that guides the conduct
ofhealthcare professionals, including
nurses, in their relationships with
patients.It emphasizes the importance
of trust, loyalty, and keeping
commitments.
1. Fidelity in Nursing Ethics:
Contract of Relationship:
Fidelity refers to the ethical
contract orrelationship established
between healthcare professionals, such
as nurses,and their patients. In this
relationship, healthcare providers
becometrustees of the patient's health
and welfare.
2. Trust and Confidence:
Fidelity is rooted in trust and
confidence. Patientstrust healthcare
professionals to provide competent,
ethical, andresponsible care.
3. Duty to Maintain Care:

Healthcare professionals have a
duty to maintaintheir commitment to the
contract of care. They cannot withdraw
their careabruptly without providing
adequate notice to the patient, their
family, orsignificant others. This notice
allows for the arrangement of
replacementattendants.
4. Model of Fidelity:
The model of fidelity is built on
values like keeping one'sword of honor,
loyalty to commitments and oaths, and
reliability. It emphasizesthe importance
of standing true to one's word.
5. "Palabra de Honor":
The concept of "palabra de
honor," familiar amongFilipinos,
encapsulates the idea of keeping one's
word and maintaining trustand loyalty.
6. Traits of Maturity and
Commitment:
Fidelity encompasses traits such
asmaturity and commitment, which are
essential for healthcare professionals
tofulfill their ethical obligations.
Importance of Fidelity in Nursing
Ethics:
Fidelity is considered one of the
most important ethical principles in
nursingand healthcare ethics for several
reasons:
Governs Ethical Conduct:
Fidelity serves as a cornerstone for
ethicalconduct in healthcare. It guides
the other ethical principles and
obligations thathealthcare professionals
have toward their patients.
Common Source of Ethical
Conflict:
Fidelity can be a common source
ofethical conflicts for healthcare
professionals. They may find
themselves tornbetween their beliefs,
patient preferences, team expectations,
organizationalpolicies, and legal
requirements.
Respect for Patients:
Fidelity requires that nurses treat
all patients withrespect, regardless of
their behavior or circumstances. Even
when patientsexhibit inappropriate
behavior, nurses are expected to
adhere to the standardsof care.
Justice is a fundamental ethical
principle in healthcare, and it
encompassesthe concept of fairness. In
the context of nursing and healthcare,
justicehas two primary categories:
procedural justice and distributive
justice.
1. Procedural Justice:
Procedural justice relates to the
fairness and equity inthe processes and
procedures involved in healthcare
decision-making. Itensures that
decisions are made impartially and that
the rights andinterests of patients are
respected. Key aspects of procedural
justiceinclude:
Transparency:
Allowing patients to understand the
decision-makingprocesses and criteria
used in their care.
Informed Consent:
Ensuring that patients have the
necessary informationto make informed
decisions about their treatment.
Respect for Autonomy:
Respecting the right of patients to
makechoices about their care, within the
bounds of ethical and legalconstraints.
Avoiding Discrimination:
Ensuring that decisions are not
basedon arbitrary factors such as race,
gender, age, or socioeconomicstatus.
Procedural justice ensures that
patients have a voice in their careand
that ethical principles, such as
autonomy and beneficence,are upheld
during the decision-making process.
1. Distributive Justice:
Distributive justice focuses on
the fair allocation ofhealthcare
resources, benefits, and burdens. It
deals with questions of howlimited
resources should be distributed among
individuals or groups withdifferent
healthcare needs. Key aspects of
distributive justice include:
Equity:
Ensuring that healthcare resources
and benefits are distributed fairlyand
equitably, taking into account patients'
needs, vulnerabilities, and theprinciples
of fairness.
Prioritization:
Deciding how resources should be
allocated when there arecompeting
demands. This may involve determining
who receives scarcemedical treatments
or interventions.
Balancing Benefits and Burdens:
Weighing the potential benefits
of aparticular treatment against the
potential burdens and ensuring that
thedistribution is just.
Distributive justice is particularly
relevant in situations where resources
arelimited, and difficult decisions must
be made regarding resource allocation.
Procedural Justice:
1. Due Process:
Procedural justice, often likened
to due process, ensures thatindividuals
receive fair and equal treatment in
accordance with establishedprocedures.
This principle is crucial in healthcare,
just as it is in the legalsystem.
2. Equal Treatment:
Procedural justice in healthcare
means that patientsshould receive the
same attention and care when it's their
turn, without biasor unfair prioritization.
Patients should be treated equally in
terms of accessto care and medical
attention.
3. Adherence to Procedures:
It's not solely about the fairness
of the outcomesbut also about whether
the healthcare system and its
professionals followestablished
procedures correctly. For example, even
if a patient must wait, theprocess should
be fair, and the order should be
determined based on justifiablecriteria.
4. Application Beyond Patients:
Procedural justice is relevant not
only inpatient care but also in healthcare
administration and employment
decisions. Itensures that standards and
procedures are followed when making
decisions thataffect employees, such as
terminations or salary increases.
Distributive Justice:
1. Fair Allocation:
Distributive justice is concerned
with fairly and equitablydividing benefits
and burdens in healthcare decision-
making. It deals withquestions of
fairness in the distribution of resources
and responsibilities.
2. Examples of Application:
In healthcare, distributive justice
can be seen invarious situations, such
as how physicians allocate their time
among patients,how nurses prioritize
their tasks and respond to patient calls,
and how nursemanagers allocate limited
nursing staff to a large number of
patients.
3. Healthcare Administration:
Distributive justice also extends
to healthcareadministrators who must
make decisions about compensation
and pay raises foremployees. Decisions
about how to distribute financial
resources and rewards,whether by
merit, seniority, or across the board,
should adhere to principles offairness
and equity.
Beneficence
is a crucial ethical principle in
healthcare that underscores the
importance ofpromoting the well-being
and best interests of patients.
Definition of Beneficence:
Beneficence is derived from the
Latin term"bene," which means "well" or
"good." It refers to actions and
behaviors thatare performed for the
good of others. Beneficence
encompasses acts ofkindness, mercy,
charity, and altruism, all of which are
aimed at promoting thewelfare of
individuals.
Forms of Beneficence:
Benevolence is associated with the
character trait orvirtue of being inclined
to do good and act for the benefit of
others. Beneficentacts are often
characterized by their voluntary nature,
as they go beyond mereobligation.
While many acts of beneficence are not
obligatory, there areinstances,
especially in emergency situations,
where individuals are morallyobligated
to provide care to those in need.
Beneficence
4. Higher Moral Burden:
Beneficence represents a higher
level of altruismcompared to simply
refraining from causing harm
(nonmaleficence). It obligatesindividuals
to take positive and direct steps to help
others, even when it may notbe
expected or required.0
5. Connection to
Consequentialism:
The principle of beneficence is
alignedwith the underlying ethical
principle of consequentialism, which
advocates for thegreatest good for the
greatest number. This perspective
emphasizes theimportance of promoting
positive outcomes and benefits.
6. Healthcare Professionals and
Beneficence:
Healthcare
professionals,including nurses, are
expected to demonstrate beneficence in
their actions anddecisions. Acts of
kindness, courtesy, and compassion are
considered part ofprofessionalism in
healthcare. This includes going beyond
basic expectations toprovide comfort
and support to patients.
7. Unique Patient-Centered Care:
Beneficence requires
healthcareprofessionals to view each
patient as a unique individual with
inherent worth. Itinvolves a balance
between beneficent actions and clinical
decision-making thatultimately leads to
the best patient care.
Examples of Nursing
Beneficence:
Nursing beneficence is evident in
variousclinical scenarios, including
resuscitating a drowning victim,
promptly providingpain medication to an
injured patient, taking preventive
measures to ensurepatient safety (e.g.,
lifting side rails), practicing infection
control through properhandwashing,
providing psychosocial support to
anxious patients, andaddressing the
nutritional needs of elderly patients.
Non-Maleficence,
often expressed as "First, do no
harm," is a fundamentalethical principle
in healthcare that emphasizes the
obligation of healthcareprofessionals to
avoid causing harm to their patients.
Origin in Hippocratic Ethical
Teaching:
The principle of non-maleficence
isdeeply rooted in the Hippocratic
ethical tradition. It is derived from the
dictum of"First, do no harm, benefit
only." This principle underscores the
importance ofpreventing harm and
promoting the well-being of patients.
The Hippocratic Oath
is a historic and ethical code of
conduct for physicians andhealthcare
professionals. It is named after
Hippocrates, a renowned ancientGreek
physician often regarded as the father of
Western medicine. The oath isnot a
legally binding document but serves as
a guiding moral framework formedical
practitioners. While the exact wording
can vary, here is a simplifiedversion of
the Hippocratic Oath:
"I swear to fulfill, to the best of my
ability and judgment, this covenant:
 I will respect the privacy and
confidentiality of my patients'
information.
I will do no harm to my patients and
will not intentionally cause them pain or
suffering.
I will treat all individuals with
dignity, regardless of their race, religion,
nationality, gender, orother factors.
I will work to the best of my ability
to prevent disease and promote the
health and well-beingof my patients.
I will always act in the best interests
of my patients and prioritize their
careabove all else.
I will respect and collaborate with
my colleagues, recognizing that
teamwork isessential for the delivery of
quality healthcare.
I will continue to learn and improve
my medical knowledge and
skillsthroughout my career.
I will not misuse my medical
knowledge to harm others or for
personal gain.
I will uphold the principles of
medical ethics and be honest and
transparent inmy professional conduct.
I make this oath willingly and
solemnly, holding myself accountable
for thepromises I have made."
The Hippocratic Oath
reflects the core values of
medicine, emphasizing theimportance of
patient welfare, professional ethics, and
the continuous pursuit ofknowledge. It
serves as a timeless reminder of the
responsibilities and ethicalcommitments
that healthcare professionals should
uphold in their practice.
Do No Harm, Intentional or
Unintentional:
Non-maleficence emphasizes
thathealthcare professionals should
refrain from causing harm to
patients,irrespective of whether the
harm is intentional or unintentional. The
primaryconcern is to protect the
patient's welfare.
Debate on the Meaning of Harm:
While there is a consensus in
healthcareethics about the importance
of avoiding harm, the debate arises
when definingwhat constitutes harm.
Different ethical theories offer varying
perspectives on thenature of harm:
Consequentialist Perspective:
Harm is viewed as anything that
hinders theachievement of the greater
good or utility and leads to outcomes
that are lessfavorable than available
alternatives.
Natural Law Perspective:
Harm is seen as that which goes
against ourrational natures and limits
our potential. It is actions that impede
our inherentcapacities.
Deontological Perspective: Harm is
defined as anything that obstructs
thefulfillment of one's moral duty or
violates the formal conditions of the
morallaw.
Virtue Ethics Perspective:
Harm is considered anything that
deviates frommoderation and prevents
individuals from realizing their proper
ends ashuman beings. It pertains to
actions that lead away from virtuous
behavior.
Ethical Egoist Perspective:
Harm is described as anything that
goes againstone's self-interest and is
detrimental to their own well-being.
Application in Healthcare Ethics:
In healthcare ethics, the principle
ofnon-maleficence guides decisions and
actions aimed at minimizing the risk
ofharm to patients. Healthcare
professionals are expected to prioritize
the safetyand well-being of patients in
all aspects of care.
It's essential to recognize that harm
can encompass a range of
consequencesbeyond bodily injury.
Complexity of Defining Harm:
Defining harm in the clinical
context is a complexmatter. Healthcare
involves various elements, including
pain, discomfort,inconvenience,
financial burden, and potential
disfigurement or disability.Determining
what constitutes harm can be nuanced
and context-specific.
Historical Focus on Physical
Harm:
Traditionally, healthcare has
primarilyfocused on addressing bodily
disorders and physical harm. Many
healthcareprofessionals associate harm
with physical injury to patients.
However, harm canmanifest in diverse
ways.
Harm in the clinical setting is a
multifaceted concept that extends
beyondphysical injury. It encompasses
various consequences, including those
related topatient well-being,
administrative failures, financial impacts,
and policy decisions.Nurses and
healthcare professionals have a duty to
prevent harm and promotethe best
interests of patients and the community.

Non-Physical Forms of Harm:

Harm in healthcare is not limited to

physicalharm. It can also result from
administrative or managerial failures,
such asinadequate supervision, staffing,
or equipment maintenance. Strategic
decisionsthat lead to financial losses
can harm healthcare organizations, as
can decisionsthat put communities at
risk, like improper disposal of hazardous
materials.

Policy Decisions and Harm:

Healthcare policy decisions,
including changes ineligibility
requirements, can lead to harm by
making it difficult for patientpopulations
to access necessary care. These policy
choices can havefar-reaching
consequences for the community's well-
being.

Examples of Nursing Non-

Maleficence:
Nursing non-maleficence
involvespreventing harm or avoiding
actions that could result in harm to
patients. Someexamples include
reporting abuse by incompetent or
impaired healthcarepractitioners,
refraining from participating in
euthanasia, not
administeringmedications or vaccines
not approved by the FDA, and
maintaining respectfuland non-hurtful
communication with patients and
colleagues.