BIOETHICS

NURSING
IDIANALE BATCH 2024
ST. LUKE’S COLLEGE OF NURSING

TOPIC 1: INTRODUCTION TO ETHICS

Types of Ethics

● Bioethics or clinical ethics

o ethics applied to human life or

health

▪ abortion or euthanasia

● Nursing ethics

o refers to ethical issues that occur in

the practice

▪ patient confidentiality or
INTRO TO ETHICS
being patient advocate
Ethics
● Management or business ethics
● Greek word “ethicos or ethos” (custom or
ETHICAL FRAMEWORK
character)
Ethical Framework
● Philosophical ideals of right and wrong
behavior. ● Utilitarian
● Philosophical discipline that provides the ○ Most good, least harm
principles on the morality of human acts ○ Most common approach, “First do
and conduct no harm” is related to this.
Attempts to produce the greatest
● Provides theories and principles of right or
good with the least harm.
wrong and good or bad actions

● The study of the rightness of conduct. ● Rights-Based

● The goal of ethics: to explore the nature of ○ Best protects the rights and
moral experience, its universality and its respects the moral rights of those
diversity. affected
○ Begins with idea of human dignity
● Deals with one’s responsibilities (duties and freedom of choice. The patient
and obligations). has the right to make the decision.
● Ethical persons put their beliefs into
action. ● Duty-Based

Remember ! ○ Duty to do or to refrain from doing

something
● Ethics - the ‘should’ of human behavior ○ Decisions are made because there
is duty!
● Ethics is not religion or law

● Nurses have a duty to practice ethically ● Common good

and morally ○ Best for community/society

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○ Decisions should be made on what
is good for the community as a
whole, not necessarily for the
individual.
○ Many of our nation’s laws are based
● Virtue
○ actions consistent with certain ideal
virtues
○ decisions should be directed at
maintaining virtues (honesty,
courage, compassion, etc.) A person
using this approach may ask
themselves, “if I carry out these
actions what kind of person will I
be?”
Morality
Remember !
● Morality arise from an individual’s
conscience
● Morality act as a guide for individual
behavior
● Morality are learned
Kohlberg’s Stages of Moral Development
● Lawrence Kohlberg explain the moral
development of children, which he
believed follows a series of stages.
● Kohlberg defined three levels of moral
development: preconventional,
conventional, and postconventional.
Each level has two distinct stages.
1.) Pre-Conventional Level
● Obedience and punishment stage
○ Based on avoiding punishment, a
focus on the consequences of
actions, rather than intentions;
intrinsic deference to authority.
● Individualism and exchange stage
○ The “right” behaviors are those that
are in best interest of oneself; tit for
tat mentality.
2.) Conventional Level
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● Latin word “mos or moris” which means
custom
● Deeply influenced by several cultural
factors, such as history, traditions,
education, religious beliefs, etc.
● Actualizes the theories and principles
(provided by Ethics)
● Principles concerning the distinction
between right and wrong or good and bad
behavior.
● Other term is “Applied ethics”
● Interpersonal relationships stage
○ “Good boy or Good girl” attitude,
individuals as filling social roles.
● Authority and Social Order stage
○ Law and order as highest ideals,
obedience is a must to maintain
functional society.
3.) Post-Conventional Level
● Social Contract
○ Begin to learn other’s have different
values; realization that law is
contingent on culture.
● Universal Principles
○ Develop internal moral principles;
individual begins to obey these
above the law.
Ethics and Morality
● Ethics and morality are generally taken as
synonyms, because they originally had the
same meaning: the study of the
disposition, character, or attitude of a
specific person, group of people or culture,
and ways of promoting or perfecting it.
Ethics vs. Morality
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NURSING
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● If you are moral, you can be ethical.
● While they are sometimes used
interchangeably, they are different:
o Ethics refer to rules provided by an
external source, e.g., codes of
conduct in workplaces or principles
in religions
o Morals refer to an individual's own
principles regarding right and
wrong
BIOETHICS
Bioethics
● Van Rensselaer Potter: BIO means life +
Ethos means morals
o oncologist
o popularized in 1970
o Biology combined with diverse
humanistic knowledge forging a
science that sets a system of
medical and environmental
priorities for acceptable survival.
(Global Bioethics, 1988)
● Ethos (ethics/custom)
● Daniel Callahan together with Willard
Gaylin (1969)
● Discipline that deals with morality of
human conduct
● Multidisciplinary (law, philosophy, religion,
medicine)
● Aldo Leopold
o first bioethicist
o A thing is right when it tends to
preserve the integrity, stability, and
beauty of the biotic community. It is
wrong when it tends otherwise.
(Country Almanac, 1949)
● Branch of ethics that
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o Deals with the life sciences
(medicine, health care, genetics,
biology and research) and their
impact in society
o Analyzes moral values in the
context of biomedical sciences
o The emergence of Bioethics has
been triggered by and a response
to the new scientific/technological
developments in biomedical and
life sciences.
● Introduced in the 70’s
● Concept
o Rightness of conduct
o Duties and obligation
o Belief into action
● morality reflects personal and religious
belief
● ethics rooted in the legal system
Legal and Ethical Concepts
● Acts that are ethical and legal
● Legal system judges action rather than
intention
● Ethical opinions reflect individual
differences
● Laws change according to social and
political influences
Ethics in health care
● Application of ethical principles
● Provide structure by raising questions that
ultimately lead to answers
Factors Contributing to the Need for Ethics in
Health Care
● Technological advances
● Changing fabric of society
● increased consumer demand for health
care information
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● Decreasing allocation of funds for health ○ can also be in a form of OATHS or

care directives
○ when made up of rights-claims
● Scarcity of resources ■ bill of rights
Levels of Moral Discourse ○ physicians may consult the code of
ethics of their Medical Association
● Controversies
○ Legalism (no exceptions)
○ Antinomianism (every case is
unique)
○ Situationalism (merely guidelines
and must be evaluated)
○ Rules of practice (morally
obligatory)

Normative Ethics
Casuistry
● Norms of behavior/character are discussed
● relying on paradigms cases (similar) ● Norms of good moral character are
● similar cases should be treated similarly articulated
● new case is similar in all relevant respects ● 3 questions
○ may consult a colleague or refer to ○ ACTION: What principle make
a hospital ethics committee actions morally right?
○ VALUE: What kinds of
Rules and Rights
consequences are good or
● Tell us what is legal and ethical valuable?
○ If considered ethical ○ VIRTUE: What kind of character
■ seen as grounded in our traits are morally praiseworthy?
moral system ● Action Theory
■ groups of rules or ○ questions of ethical principle
right-claims = code of ○ principles of beneficence and
ethics nonmaleficence
○ therefore can consult the Codes of ● Value Theory
Ethics a particular discipline ○ intrinsic goods
■ Rule-like Maxim (Nurse) ○ Money (instrumental)
■ Right-claims (Patient) ○ Happiness, beauty, knowledge and
● Reciprocal in nature health (Valuable)
○ duty to act in a certain way versus ● Virtue Theory
the right to be acted upon in that ○ good character
way ○ Morally praiseworthy character
● When organization gather together traits = virtue
collection of rules or right-claims = they ○ Compassion (Professional virtue)
produce a code of ethics ■ Hippocratic Oath

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○ Benevolence (willingness to do Ethical Theories

good) (Secular virtue)
■ different from beneficence 1. Consequentialism
(principle of action)
2. Deontology
○ Faithfulness (Religious virtue)
■ Christian, Muslim, etc. 3. Virtue theory
Metaethics 4. Principlism

● deals with the most basic questions of 5.Teleology

ethics
○ what is the meaning
○ how can it be justified ● Consequentialism
○ which one is correct - Good: what is likely to produce
● look at the sources more good than bad
● most abstract level consequences.
○ if u cannot agree, use the 3 lower - Bad: what is likely to produce more
levels bad than good consequences.
● Source? ○ E.g. utilitarianism: good is
○ Religious people what produces the greatest
■ Scriptures made and utility (usually understood in
approved by God terms of ‘happiness’) for the
○ Secular people greatest number.
■ Natural law or Contract
(hypothetical) ○ Often used for resource
○ Relativists allocation issues: how can
■ Culture or personal we promote the largest
preference amount of happiness with
● Is it ethical? limited resources?
○ Divine Law or church tradition - ISSUE: Uncertainty, duty to be
○ Secular partial
■ Empirical experience by
Kant
■ Experience of sympathy by
Hume ● Deontology

- From the Greek word for ‘duty’

- rules, which express our duties

-prima facie

-holds that at least some acts are morally

obligatory regardless of their
consequences for human welfare

○ E.g. killing someone to give their

organs to someone else may ignore
our duty to respect that person’s
right to life.

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BIOETHICS
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ST. LUKE’S COLLEGE OF NURSING

-ISSUE: Always following rules may lead to -to do well, to promote well
negative consequences being
3. Non-Maleficence
● Virtue Theory - do no harm, avoid doing
- Focus on the agent of action, rather than harm
on rules or consequences 4. Justice
- treat like alike
- Role-model - The most widely used approach in
Western Bioethics.
-it may fail to guide our actions as there - Incorporates elements from both
are no clear rules that can be applied consequentialist and deontological
-ISSUE: Always following rules may lead to theories.
negative consequences - is an applied ethics approach to the
examination of moral dilemmas that is
based upon the application of certain
ethical principles
● Teleology

- The value of a situation is determined by

its consequences.

- teleological from Greek telos, “end”; logos,

science, theory of morality that derives
duty or moral obligation from what is good
or desirable as an end to be achieved

- Principle of utility states that an act must

result in the greatest good for the greatest
number.

- “Good” refers to positive benefit.

Virtue
Ethical Principles
- Actions consistent with certain ideal virtues
1. Autonomy
- Decisions should be directed at maintaining
virtues (honesty, courage, compassion, etc.). 2. Beneficence

- A person using this approach may ask 3. Nonmaleficence

themselves, “If I carry out these actions, what kind
4. Confidentiality
of person will I be?”
5. Double Effect
● Principlism
6. Fidelity
- ‘The four principles’ approach:
1. Autonomy 7. Justice
- right to self-determination
- in order to give consent: 8. Paternalism
autonomy/competency/capa
9. Respect for Persons
city must be possessed
2. Beneficence 10. Sanctity of Life

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ST. LUKE’S COLLEGE OF NURSING
11. Veracity
Morality
● Latin word “mos or moris” which means
custom
● Actualizes the theories and principles
provided by Ethics
● Principles concerning the distinction
between right and wrong or good and bad
behavior
● Relates to people’s behavior
● Other term is applied ethics.
Ethical Issues
1) Moral uncertainty/conflict
- When an individual is unsure which
moral principle to apply, or even
what the problem is.
- Common with new nurses, they’re
not sure what they are supposed to
be doing.
2) Moral distress
- When an individual knows the right
thing to do but organizational
constraints keep them from doing
it.
3) Moral outrage
- When an individual witness an
immoral act by another but feels
powerless to stop it.
4) Moral/Ethical Dilemma
- When two or more clear principles
apply but they support inconsistent
courses of action.
5) Self-awareness
- not an ethical issue but is
absolutely vital in ethical decision
making.
Examples of Ethical Issues
● Newborns surviving at earlier gestational
ages with serious health problems
● People living longer than ever before
● Organ transplants and the use of bionic
body parts
● Experimental research
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Erroneous Conscience Situation
1.) Act is good although it is bad
○ Knowing it is good, you do it. You
acted in GOOD FAITH = you are
sincere and honest
2.) Act is bad although it is good
○ Knowing it is bad, you still do it. You
acted in BAD FAITH = you are not
sincere and honest with yourself
CODE OF ETHICS FOR NURSES
International Code of Ethics for Nurses
● Assumes various versions depending on
the organization.
● The International Council for Nurses has
embraced a code of ethics since 1953.
● Serves as a guide for right actions towards
social values and needs.
● Basis of worldwide practice for ethical
practice in nursing.
● The ICN* Code of Ethics serves as the
guiding light for professional nurses as
they practice their skills whether on a
hospital setting or community setting.
● This serves as a gauge whether nurses
have given ethical care that encourage
healing or preventing illness.
Code of Ethics for Filipino Nurses
● Promulgated by the Board of Nursing
under Resolution No. 220 Series of 2004
last July 14, 2004.
● Like the ICN International Code of Ethics
for Nurses, however it further stated
administrative penalties, repealing clause
and effectivity.
● It pursues revocation of licenses when
registered nurses in the Philippines have
violated any provisions of the Code.
Legal Basis for Bioethics
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1) RA 9173: The Philippine Nursing Law c. Pledge to Gods/Goddesses can be

2) Hippocratic Oath modified
3) Nightingale’s Pledge 2. Code section of the Oath (3 parts/2nd half)
4) Nuremberg Code (1947) a. Dietetics
5) Declaration of Helsinki (1964) b. Pharmacology
6) Declaration of Geneva (1948) c. Surgery
7) .CIOMS Guidelines (1993) 3. 3rd Section
a. Prohibition not to practice surgery
RA 9173: The Philippine Nursing Law (too dangerous)
● Comprehensive legislation regulating i. leave to persons who
various aspects of nursing profession. practice that discipline
b. Not to give deadly drugs
● Provide protection and improvement of c. Core principle
nursing profession by instituting measures i. Benefit the patient
that shall result in relevant nursing according to his ability and
education, humane working conditions, judgment
better career prospects and dignified ii. Paternalistic (Medicine)
existence for nurses. 1. actions intended to
benefit another
Hippocratic Oath person even if that
● An oath of ethics historically taken by person does not
physicians. It is one of the most widely want the benefit
known of Greek medical texts. ● Hallmark of Hippocratic Tradition
○ duty to benefit the patient
● In its original form, it requires a new ○ became the foundation of all
physician to swear, by several healing gods, medical ethics
to uphold specific ethical standards.
Old:
● Summary of medical and moral wisdom
“I swear by Apollo the physician, and Asclepius,
● Part of Hippocratic Corpus and Hygieia and Panacea and all the gods and
goddesses as my witnesses, that, according to my
● Written about 100 years later ability and judgment, I will keep this Oath and
o Island of Cos; Greek Healing Temple this contract

▪ destroyed during To hold him who taught me this art equally dear
Christianization of Greece to me as my parents, to be a partner in life with
him, and to fulfill his needs when required to look
o Edelstein: Hippocratic tradition upon his offspring as equals to my own siblings,
arouse from Pythagorean cult and to teach them this art, if they shall wish to
(interested in science, philosophy, learn it, without fee or contract and that by the
and religion) set rules, lectures, and every other mode of
instruction, I will impart a knowledge of the art to
● Parts of the Oath
my own sons, and those of my teachers, and to
1. Oath of Initiation students bound by this contract and having
a. Pledge of loyalty to teacher sworn this Oath to the law of medicine, but to no
b. Not to reveal the knowledge to lay others
people

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I will use those dietary regimens which will
benefit my patients according to my greatest
ability and judgment, and I will do no harm or
injustice to them.
I will not give a lethal drug to anyone if I am
asked, nor will I advise such a plan and similarly I
will not give a woman a pessary to cause an
abortion
In purity and according to divine law will I carry
out my life and my art
I will not use the knife, even upon those suffering
from stones, but I will leave this to those who are
trained in this craft
Into whatever homes I go, I will enter them for the
benefit of the sick, avoiding any voluntary act of
impropriety or corruption, including the seduction
of women or men, whether they are free men or
slaves
Whatever I see or hear in the lives of my patients,
whether in connection with my professional
practice or not, which ought not to be spoken of
outside, I will keep secret, as considering all such
things to be private
So long as I maintain this Oath faithfully and
without corruption, may it be granted to me to
partake of life fully and the practice of my art,
gaining the respect of all men for all time
However, should I transgress this Oath and
violate it, may the opposite be my fate”
Modern:
“I SWEAR in the presence of the Almighty and
before my family, my teachers and my peers that
according to my ability and judgment I will keep
this Oath and Stipulation.
TO RECKON all who have taught me this art
equally dear to me as my parents and in the
same spirit and dedication to impart a
knowledge of the art of medicine to others. I will
continue with diligence to keep abreast of
advances in medicine. I will treat without
exception all who seek my ministrations, so long
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as the treatment of others is not compromised
thereby, and I will seek the counsel of particularly
skilled physicians where indicated for the benefit
of my patient.
I WILL FOLLOW that method of treatment which
according to my ability and judgment, I consider
for the benefit of my patient and abstain from
whatever is harmful or mischievous. I will neither
prescribe nor administer a lethal dose of
medicine to any patient even if asked nor counsel
any such thing nor perform the utmost respect
for every human life from fertilization to natural
death and reject abortion that deliberately takes
a unique human life.
WITH PURITY, HOLINESS AND BENEFICENCE I
will pass my life and practice my art. Except for
the prudent correction of an imminent danger, I
will neither treat any patient nor carry out any
research on any human being without the valid
informed consent of the subject or the
appropriate legal protector thereof,
understanding that research must have as its
purpose the furtherance of the health of that
individual. Into whatever patient setting I enter, I
will go for the benefit of the sick and will abstain
from every voluntary act of mischief or corruption
and further from the seduction of any patient.
WHATEVER IN CONNECTION with my
professional practice or not in connection with it I
may see or hear in the lives of my patients which
ought not be spoken abroad, I will not divulge,
reckoning that all such should be kept secret.
WHILE I CONTINUE to keep this Oath unviolated
may it be granted to me to enjoy life and the
practice of the art and science of medicine with
the blessing of the Almighty and respected by my
peers and society, but should I trespass and
violate this Oath, may the reverse by my lot.”
Nightingale’s Pledge
● Named in honor of Florence Nightingale, is
a modified version of the Hippocratic Oath.
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“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.”
Nuremberg Code (1947)
● Set of ethical research principles for
human experimentation created by the
court in U.S. v Brandt, one of the
subsequent Nuremberg trials that were
held after the Second World War.
● 10-point statement delimiting permissible
medical experimentation on human
subjects.
● Humane experimentation is justified only if
its results benefit society, and it is carried
out in accord with basic principles that
“satisfy moral, ethical, and legal concepts.”
Belmont Report
● The National Institute of Health was
commissioned to outline the principles
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that must be used during research
involving human subjects. A 4-day
meeting at the Belmont Conference
Center at Smithsonian Institute.
● 3 Basic Principles:
1. Respect Of Persons
2. Beneficence
3. Justice
● It also contains guidelines how to apply
the principles in research through
o Informed consent
o Assessment of risk and benefits
o Selection of research participants
Declaration of Helsinki
● World Medical Association (WMA) has
developed the Declaration of Helsinki as a
statement of ethical principles for medical
research involving human subjects,
including research on identifiable human
material and data.
● Created to set a balance between the
interests of humanity and individual
patients who are part of clinical trials.
● The basic principles include respect for
individuals, the right to make informed
decisions, recognition of vulnerable
groups, and more.
Declaration of Geneva (1948)
● It is a declaration of a physician's
dedication to the humanitarian goals of
medicine, a declaration that was especially
important in view of the medical crimes
which had just been committed in
German-occupied Europe.
● Intended as a revision of the Hippocratic
Oath to a formulation of that oath's moral
truths that could be comprehended and
acknowledged in a modern way.
Council for International Organizations of
Medical Sciences (CIOMS) Guidelines (1993)
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● Created due to outbreak of the HIV/AIDS
pandemic and proposals for large-scale
trials of prevention and treatment for the
disease. Other factors also – rapid advances
in medicine and biotechnology, changing
research practices such as multinational
field trials, experimentation involving
vulnerable population groups, and a new
perspective in both high- and low-resource
settings, that research involving humans
could be beneficial to participants rather
than threatening.
Universal Declaration on Bioethics and Human
Rights (UNESCO; United Nations Educational,
Scientific, and Cultural Organization 2005)
Foundation
● Ethics - philosophical ideals of right and
wrong behavior
● Ethics is not religion or law
● Nurses have a duty to practice ethically
and morally
● Tells us how human beings should behave,
not necessarily what they do. Not a
religion, not law, but both of these can be
the basis of ethical decisions you make.
● The word duty is a legal term.
HUMAN ACTS
This is done with
● Knowledge
● Full consent of the will
● One knows what one is doing and one
does it freely and willingly
Acts of Man
● Refers to those which are performed in the
absence of either or both of the two
conditions
Ignorance
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● It is the absence of knowledge in an
individual who is supposed to know it.
● Can be either:
o vincible
o invincible
Erroneous Conscience
● Situation in which one’s conscience errs or
is mistaken
1. You believe that a particular act is good
although actually it is bad
a. knowing is good, you do it. You
acted in GOOD FAITH = you are
sincere and honest
2. Particular act is bad although actually it is
good
a. Knowing it is bad, you still do it. You
acted in BAD FAITH = you are not
sincere and honest with yourself
Object and Intention
● Good object + Bad Intention = Immoral
● Bad object + Good Intention = Immoral
● Good object + Good intention = Moral
● Special Consideration: Circumstance
1. Person performing the action
a. age
b. economic status
c. psychological state
2. The content of the action itself
a. what is stolen
MODERN CODES
Percival Code of 1803
● Stand in the Hippocratic Tradition
● Arose from typhoid/typhus epidemic
o there is a need for written ethics
code
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o medicine is divided: pressured =
fight among themselves
● He quitted already but was asked to
mediate the dispute
o Result: volume of ethical guidelines
● Duty of physician to benefit the patient not
putting emphasis on the rights of the
patients
AMA Code of 1847
● Fight among themselves which school is
more dominant
● One group founded the AMA (scientific
medicine)
o Theirs is a profession not a mere
BUSINESS
o They formulated their CODE of
ETHICS
● Used also the Percival Code and
incorporated them in their Code of Ethics
WMA Declaration of Geneva, 1948
● After the 2nd World War, WMA needed a
code to respond to the medical
experiments in the Nazi Concentration
Camps
● 1948, developed Declaration of Geneva
o Similar to Hippocratic Oath
o Deleted the reference to
Gods/Goddesses
o The health of my patient will be my
consideration
COLLAPSE
● The way benefits are assessed
● Conflict to other kinds of moral duties
● Conflict of interests of patient and other
patients
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CODES BREAKING THE HIPPOCRATIC
TRADITION
Nuremberg Code, 1946
● Nazi Physicians about painful and lethal
studies they had been doing on unwillingly
concentrated camp prisoners
● Had abandoned the traditional ethical
commitment to the individual’s patient
welfare
● Nuremberg trials uncovered a serious
problem
o Physicians were not working for the
benefit of their patients
o Go back to the Hippocrates
Formula = focus on patient’s
welfare
o Instead of going back; ACCEPT
(research was for the benefit of
mankind)
o Result: 1st medical ethical
document in the 2500 years after
Hippocratic Tradition
Outside sources
● Religions
o they also have medical ethics
o understand and know traditional
beliefs
o E.g.
▪ CAraka Samhita
▪ Amae; Joshi
ICN Code of Ethics for Nurses
● An international code of ethics for nurses
was first adopted by the International
Council of
● Nurses (ICN) in 1953. It has been revised
and reaffirmed at various times since, most
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recently with this review and revision participants in medical research involving
completed in 2005 .. human subjects

Preamble 3 Main GCP Principles

“Nurses have four fundamental responsibilities: to ● Respect for persons

promote health, to prevent illness, to restore ● Beneficence
health and to alleviate suffering. The need for ● Justice
nursing is universal. Inherent in nursing is respect
for human rights, including cultural rights, the
right to life and choice, to dignity and to be
treated with respect. Nursing care is respectful of
and unrestricted by considerations of age, colour,
creed, culture, disability or illness, gender, sexual
orientation, nationality, politics, race or social
status. Nurses render health services to the
individual, the family and the community and
coordinate their services with those of related
groups.”

Elements

1. Nurses and people

a. the nurse’s primary professional
responsibility is to people requiring
nursing care
2. Nurses and practice
a. the nurse carries personal
responsibility and accountability for
nursing practice and for
maintaining competence by
continual learning
3. Nurses and the profession
a. The nurse assume the major role in
determining and implementing
acceptable standards of clinical
nursing practice, management,
research and education
4. Nurses and Co-workers
a. the nurse sustains a cooperative
relationship with co-workers in
nursing and other fields

Declaration of Helsinki

● The World Medical Association has

developed the Declaration of Helsinki as a
statement of ethical principles to provide
guidance to physicians and other

PROPERTY OF ODLID
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