A.

Ethico - moral
Responsibilities

Compiled:
Jocelyn A. Apalla, MAN, MCD, RN
Instructor

jaapalla Feb 2021

 Disclosure/ Conflict of Interest

• I have no conflict of interest to declare.

• This is purely for learning purposes.

• The images used are from the UB SN module , syllabus, Google,

and several electronic sources. No copyright infringement
intended.

jaapalla Feb 2021

Chapter 3: professional Adjustment &.
Nursing Jurisprudence

A.Ethic-moral Responsibilities
B.Legal Responsibilities
C.Personal and Professional Responsibilities

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 Self-directed learning
✓ Ethics and morality
✓ Ethical rights of a patient: Patient’s bill of right
✓ Bills of right of registered nurses
✓ Review Code of Ethics for Filipino Nurses
✓ Read RA 9173
✓ Contract and will

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Flow of activity
Morning Class Afternoon Class
8am- 8:15am………...Attendance----------- -----------1:00-1:15pm
8:15am-9:00am….….Discussion------------------------1:15-2:00pm
9:00-10:00am………Discussion--------------------------2:00-3:00pm
10am-10:15am……..Health Break --------------------- 3:00-3:15pm
10:15-10:45am……..Discussion------------------------- 3:15-3:45 pm
10:45am-11:45am… Quiz---------------------------------3:45pm-4:45pm
 Outcome:
• Adhere to ethical-legal considerations when providing safe, quality and
professional nursing care.
• Implements strategies/policies related to informed consent as it applies in
multiple contexts.
• Protect clients’ and nurses’ rights
• Applies ethical reasoning and decision-making process to address situations of
ethical distress and moral dilemma
• Customized nursing intervention based on Philippine culture and values.
• Adheres to established norms of conduct based on the Philippine Nursing Law
and legal, regulatory and institutional requirements relevant to safe and
nursing practice.
• Assumes responsibility for lifelong learning, own personal development and
maintenance of competence
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 Outcome:
• Demonstrates continued competence and professional growth.
• Models professional behaviour project the good image of a Filipino nurse.
• Develop a professional nursing portfolio.
• Manifest caring as a core of nursing, including the love for God and people
• Engages in advocacy activities to influence health and social care service
policies and access to services.
• Engages in advocacy activities to deal with health-related concerns and adapts
policies that foster the growth and development of the nursing profession.

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CONTENT
A. Review of Ethico-moral responsibility
1. Definition : Ethics, Nursing ethics
2. Approaches
3. Universal principles of biomedical ethics

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NURSING ETHICS
ETHICS:
✓study of principles that govern human
behaviour =➔ defining
what is right or wrong

NURSING ETHICS:
✓Branch of ethics that provide professional
Standards for nursing activities=➔ standards
protect both the nurse and the patient.

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NURSING ETHICS
• It is the examination of all ethical and bio-ethical issues from the
perspective of nursing theory and nursing ethics (Johnston)

• It is In the field of nursing that focused on the needs and experiences of

practicing nurses, the exploration of its meaning and that of ethical
practice in terms of the perception of these nurses. (Vercoe)

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APPROACHES

1. Teleological

2. Deontological

3. Virtue

4. Divine Command Ethics

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 1. Teleological
Approach ▪ end-result, goal or consequences of an
(Consequential act as the determining factor of its rightness
ethics)
& wrongness===➔If the consequences of
my action give comfort to my patient then
it is right

Forms: Ethical relativism, Situational

ethics, pragmatism, utilitarianism
I explained BP to the client and the
client cooperated in the conduct. She
was smiling after the procedure.
✓- If the consequences of my action gives
comfort to the patient then it is right.

I argued to the patient because she is not

cooperative. She does not like to take her
medication. The BP of my patient
increased.
X -If the consequences of my action increase
the blood pressure of my patient then it is
wrong.
FORMS OF TELEOLOGICAL APPROACH
Ethical relativism o Some ethnic group practice cultural
Standard of right and wrong
activities to cleanse the patient from
are relative to a particular
sickness.
culture or society
“ When in Rome, do as the o Some religious group accepts blood
Romans do.” transfusion but others do not.

What is right in one society o Abortion is acceptable in other

may be wrong in others countries but not in the Philippines.
FORMS OF TELEOLOGICAL APPROACH
Situational Ethics
▪ Moral judgments must be within
the context of the entirety of a
situation…but whatever this
situation may be, one must
always act in Agape=one’s care,
concern and kindness towards
other
FORMS OF TELEOLOGICAL APPROACH
Pragmatism
▪ workability, practicality or usefulness of an idea as the criterion of
true knowledge
▪ promotes respect for the individual, as it appreciates that each
person has unique needs=➔ NCP
▪ The usefulness or workability of our interventions depends on our
perceived health needs of our client.
FORMS OF TELEOLOGICAL APPROACH
Utilitarianism
▪ based on the principle that an action is morally right if it
produces (consequences) greater quantity of good or
happiness than any other possible actions.

▪ It emphasizes the “The greatest good for the greatest

number” , in which they say that utilitarianism involves “moral
calculus”.
▪ Example
oWhen you will be a Public Health Nurse and will be involved in the
planning of the Provincial Health Board. You will be one of those who will
decide to which program should you allot a bigger budget, would it be the
modernization of the hospital or escalating the preventive programs like
nutrition and immunization programs.
oIn this scenario, you will consider the greatest good for the greatest
number.
oWill promotion of health and prevention of diseases have priority over
treatment of illness and rehabilitation?
 The following are guidelines for making ethical decisions provided
by Fletcher:
1. Consideration for people as human beings;

2. Consideration of consequences;

3. Proportionate good to come from the choices;

4. Propriety of action needs over ideal or potential needs;

5. A desire to enlarge choices and reduce chance; and

6. A courageous acceptance of the consequence of the decision.

Deontological It embraces duty-oriented and the
Approach
principle of universalizability (Kant Ethics)

Basic rightness or wrongness of an act

depends on its intrinsic nature rather than
on the situation or the consequences=➔
An act in itself would be either right or
wrong, it could not be both
1987 Philippine Constitution https://www.officialgazette.gov.ph/constitutions/1987-constitution/
Article II: Declaration of principles and state policies

SECTION 12. The State recognizes the sanctity of family life

and shall protect and strengthen the family as a basic
autonomous social institution. It shall equally protect the
life of the mother and the life of the unborn from
conception. The natural and primary right and duty of
parents in the rearing of the youth for civic efficiency and the
development of moral character shall receive the support of
the Government.
FORMS OF TELEOLOGICAL APPROACH
VIRTUE
▪ not only doing the right thing but also to develop the trait and
qualities of a good person

▪ In nursing practice, virtues expected are professional competence,

honesty and integrity, caring and compassion
A nurse who has developed the virtue of being punctual is often
referred to as a punctual person because she tends to be on
time in all circumstances and became an inherent in the
character of the nurse.
Divine Command Ethics
✓Based on the theory, a supreme or divine being sets down the rules to guide
moral decisions.
https://www.slideshare.net/aquinas_rs/divine-command-theory-149439303
What would a teleological thinker say, is it good or bad?
What about a deontological thinker, is it good or bad?

A nurse allows a granddaughter to see his dying Lola even

though it is not a visiting hour.

A father steals food to be able to feed his starving family.

A patient decided to go home and the doctor ordered MGH

against medical advice.
universal principles of biomedical ethics:

1. autonomy,
2. veracity,
3. Confidentiality
4. beneficence,
5. non-maleficence,
6. Justice’
A terminally ill client preferred to stop already his succeeding scheduled dialysis.
In this situation, the nurse is expected to perform which of the following?

A. Impose to the patient to continue the dialysis

B. Schedule the patient in his next dialysis
C. Support client’s right to information and counseling in making a decision
D. Condemn the action of the client
The student nurse Rosa was on duty 7-3am and assigned to Peter XX in one of the
hospital in Baguio City. At 3 o’clock pm, Student nurse Roselito, who is the
incoming duty 3-11, requested brief information about his patient Peter XX from
the outgoing nurse Rosa . What is the expected action of student Nurse Rosa?

A. Rosa will share what was done and those that should be considered in the
care of Patient XX
B. Rosa will inform Roselito to assess the client as the basis of his nursing
process
C. Rosa will inform Roselito that it is his obligation not to disclose information to
anyone.
D. Rosa will ignore Roselito.
1. Autonomy
▪ Clients & nurses has
▪ expression of self-
the right to exercise
determination and freedom
their autonomy to
to choose and implement
maintain a quality
one’s own decision free from
health care.
deceit, duress, constraint and
coercion
For a client to be able to decide appropriately, the client has the
following rights:

a. Right to informed consent

b.Right to informed decision

c. Right to informed choice

d.Right to refusal of treatment

▪ Client who makes decision
must be:
➢Competent
➢intellectual capacity
➢legal age 18 yrs. old and
above
➢decision is of her free will
“ I’m so glad he waited” (Edge R., Groves J.R pg 71)
The case involves an elderly couple who are both in nursing homes. The husband
has a heart attack and the wife is brought from another floor. Before she get to
the room, the man dies but to spare the woman from pain, the staff allows her
to think that he is still alive when she gets to the room. In that she is feeble, with
poor eyesight, she does not know that he is dead. The women is then told that
her husband’s respiration is growing weaker and that he appeared to have been
waiting for her before he died. As she leaves the room, she tells the staff that
she is so glad he waited for her so that she could see him alive one more time.

Truth telling ( veracity) is a basic principle in health care delivery—do you think
the staff’s “little white lie” is justified in this case? Explain your answer?
2. Veracity
▪ we have the obligation to tell the truth.

▪ Health care provider and the patient/client are bond to tell the truth
==➔ to accurately assess=➔ come up with nursing diagnosis➔
decide on appropriate intervention =➔ to be able to have a better
evaluation of the health care.

▪ In the International Council of Nurses Code of ethics and in the

Code of ethics for Filipino Nurses, point out that nurses should
practice veracity
Cont’n…..Veracity
▪ International Council of Nurses code of ethics: https://www.icn.ch/sites/default/files/inline-
files/2012_ICN_Codeofethicsfornurses_%20eng.pdf
The nurse ensures that the individual receives accurate, sufficient and
timely information in a culturally appropriate manner of which to base
consent for care and related treatment.

▪ Code of Ethics for Filipino Nurse ARTICLE III Sec

https://www.prc.gov.ph/uploaded/documents/Board%20of%20Nursing-CE.pdf
The nurses to provide the patients or their families with all pertinent
information except those which may be deemed harmful to their well-
being
The following are the patient’s responsibilities (Venzon, 2005):
Patient’s or clients also has obligations to practice veracity .They have also the responsibilities to
tell the truth to be able to help in their effective and efficient health care.
a. Providing information
b. Complying with instructions
c. Informing the physician of refusal of treatment
d. Paying hospital bill
e. Following hospital rules and regulation
f. Show respect and consideration
Benevolent Deception
▪ withholding temporarily information base on sound medical
judgement that to divulge the information might potentially harm a
depressed and unstable client
Ethical concern in the application of benevolent deception:
Case #1 If informed… would it not be more advantageous?
✓ Wife would be examined, protected or treated
✓ Wife would be able to do precautionary measures for herself
✓ Wife would be able to understand the husband’s illness and
participate in the care
Case #2 If informed….. Would it not be advantageous?
✓ Gently telling her the truth would help convince her to participate in
the treatment plan, spiritual preparation towards peaceful death.
3. Confidentiality
▪ non-disclosure of information communicated within the nurse–
patient relationship.

▪ The nurse has a duty to maintain confidentiality of all patient

information, both personal and clinical in the work setting and off
duty in all venues, including social media or any other means.
The duty to maintain confidentiality is not absolute ,and
may need to be modified in order to protect the patient, other
innocent parties, and in circumstances of required disclosure
such as mandated reporting or for safety or public health
reasons. (ANA, 2014)
Republic Act 10173 : Data Privacy Act of 2012
Section. 13. Sensitive Personal Information and Privileged
Information :The processing of sensitive personal information
and privileged information shall be prohibited, except in the
following cases:
 Confidentiality of information may be revealed (5 C) on the following
circumstances: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922345/

a.Consent : patient permits revelation

b. Comply with existing law and regulations : Case of Medico-
legal to comply with mandatory reporting such as in attempted
suicide, gunshot wounds which have to be reported to the police
c. Communicate a threat

▪ communicable disease and public safety may be jeopardize ===

RA # 11332: Mandatory Reporting of Notifiable Diseases and Health Events
of Public Health Concern Act
https://www.officialgazette.gov.ph/downloads/2019/04apr/20190426-RA-11332-
RRD.pdf
 Cont’n…….Confidentiality of information may be revealed (5 C) on the following circumstances:

d. Care: A clinician may release confidential information necessary for the

continued treatment of a patient.

e. Court Order: May release confidential information upon the receipt of an

order by a court.
▪ We have to abide with what is stated in the Phil constitution Art IV Sec 4.
The privacy of communication and correspondence shall be
inviolable except upon lawful order of the court or when public
safety and order requires otherwise.
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) is a federal law that required the creation of national
standards to protect sensitive patient health information from
being disclosed without the patient’s consent or knowledge. The
US Department of Health and Human Services (HHS) issued the
HIPAA Privacy Rule to implement the requirements of HIPAA. The
HIPAA Security Rule protects a subset of information covered by
the Privacy Rule.
https://www.cdc.gov/phlp/publications/topic/hipaa.html#privacy-
rule
For further information, you read Republic Act 10173 : Data Privacy
Act of 2012 https://www.privacy.gov.ph/data-privacy-act/
Breach of Confidentiality
▪ Occurs when patient’s information is disclosed to a 3rd party without
his consent or court order

▪ Disclosure maybe through oral, written, by telephone, fax, or

electronically such as posting photos or information in the social media
like Facebook and messenger.
4. Beneficence
▪ Refers to the act of kindness and mercy.
▪ Emphasis that health care provider like nurses should to do good for
the patient.
▪ All the statement of beneficence involved positive action toward
preventing or removing harm and promoting the good.

Example : administer the right drug, right dose of medicine at the right time
to the right patient
Ethical Rights of a Patient ( patient’s bill of right)
For us health care provider to do good to our patient/clients, we have to
uphold the patient’s bill of right.

1. The patient has the right to considerate and respectful care;

2. The patient has the right to relevant, current and understandable

information concerning diagnosis, treatment prognosis, specific procedures,
treatment risks involved, medically reasonable alternative benefits needed
to make informed consent;
Cont’n…Ethical Rights of a Patient ( patient’s bill of right)
3. The patient has the right to make decisions regarding his plan of care; in
case of refusal, he is entitled to other appropriate care and service or be
transferred to another hospital;

4. The patient has the right to have advance directive (such as living will)
concerning treatment or designating a surrogate decision maker;
Cont’n…Ethical Rights of a Patient ( patient’s bill of right)
5. The patient has the right to every consideration of his privacy such as in
case discussion , consultation and treatment;

6. The patient has the right to confidentiality of communications and

records;

7. The patient has the right to review his records concerning his medical
care and have these explained to him except when restricted by law;
Cont’n……Ethical Rights of a Patient ( patient’s bill of right)

8. The patient has the right to be informed of business relationship among

the hospital educational institution, health care providers that may influence
the patient’s treatment and care;

9. The patient has the right to consent or decline to participate in

experimental research affecting his care;
Cont’n…Ethical Rights of a Patient ( patient’s bill of right)
10.The patient has the right to reasonable continuity of care when
appropriate and be informed of other care options when hospital care is
no longer appropriate; and

11. The patient has the right to be informed of hospital policies and
practices that relate to patient care.
Cont’n…Ethical Rights of a Patient ( patient’s bill of right)
12. To receive from his physician information necessary to give informed
consents before starting any procedure or treatment.
13. To refuse treatment to the extent permitted by the law and be informed
of his actions' medical consequences.
14. Every consideration of his privacy concerning his medical care program.
15. Expect that all communications and records about his care should be
treated as confidential.
16. Expect that, within his capacity, the hospital must provide a reasonable
response to their request for services.
Cont’n…Ethical Rights of a Patient ( patient’s bill of right)
17. Obtain information regarding any relationship of his hospital to other
health care and educational institutions in so far as his care is
concerned.
18. Be advised if the hospital proposes to engage in human
experimentation affecting their care or treatment. The patient has the
right to refuse to participate in such research projects.
19. Expect reasonable continuity of care.
20. Examine and receive an explanation of the hospital bill, regardless of
the source of payment.
21. To know hospital rules and regulations apply to their conduct as patient.
You will notice that in some hospitals, the patient’s bill of
right is posted in the walls of the hospital wards and
other hospitals also had it printed and include it as part
of the patient’s kit.

It is the responsibility of the nurse to orient the patients

/clients on their rights especially when they are admitted
in the hospital.
5. Nonmaleficence
▪ Stated as an admonition (warning/caution) in the negative form to remind
Health Practitioners to do no harm

▪ Avoid inflicting evil , injury or harm upon others as we would avoid doing
so to ourselves, avoiding pain, suffering, disability and death
Cont’n……Nonmaleficence
▪ Some interventions that may also give harm to patient:
❖Chloramphenicol for typhoid fever with side effect of aplastic
anaemia
❖Analgesic such as morphine given for moderate to severe pain may
lead to a suppression of respiration
❖Ibuprofen for pain given may also upset stomach

▪ To maintain the ethical position of nonmaleficence, mostly

practitioners explained their action through the principle of
double effect.
6. Justice
▪ It refers to the right to demand to be treated justly, fairly and equally.
▪ The hospital management ensure that a nurse is treated justly (equity)
by giving her merit like promotion and certificate of recognition base on
his significant effort, skills and contribution in the effective and efficient
health care implementation that help in the decrease of patient affected
by COVID-19 virus.
▪ Likewise, all health workers assigned to patient affected by COVID 19
virus regardless of position are treated equally and fairly by giving them
complete personal protective equipment (PPE) in recognition that it is
their need and benefit as front liners.
Cont’n…. Justice
▪ For the Filipino Citizen to have an equal access to the services of
Phil health, the Philippine government approved the National Health
Insurance Act of 1995 which ensures the Universal compulsory health
insurance program in the country.
▪ Recognizing also the unique need of the Senior Citizen, the Philippine
government also approved the Republic Act 7432- Senior Citizen Act
which is the legal basis for giving 20% discount to the elderly.
▪ Health is a basic human right. The DOH ensure quality health services
available and affordable by mobilizing resource, providing means to better
health, and arousing community participation.

▪ In advocating justice, we have to support our clients by respecting their

right and at the same time as nurses, we also have to assert our right.
 Bills of rights for registered nurses ( Venzon, 2005)

a. Nurses have the right to practice in a manner that fulfils their obligations
to society and to those who receive nursing care;

b. Nurses have the right to practice in an environment that allows them to

act in accordance with professional standards and legally authorized
scopes of practice;

c. Nurses have the right to a work environment that supports and facilitates
ethical practice, in accordance with the Code of ethics for nurses and its
interpretive statements;
 Cont’n…..Bills of rights for registered nurses ( Venzon, 2005)

d. Nurses have the right to freely and openly advocate for themselves for
their patients, without fear of retribution (revenge);

e. Nurses have the right to fair compensation for their work consistent with
their knowledge, experience, and professional responsibilities;

f. Nurses have the right to a work environment that is safe for themselves
and their patients; and
 Cont’n…..Bills of rights for registered nurses ( Venzon, 2005)

g. Nurses have the right to negotiate the conditions of their employment,

either as individuals or collectively in all practice settings
 Other universal principles of biomedical ethics
Inviolability of Life
✓ It is respecting the life of every person. Avoiding anything that will curtail, end or endanger one’s life.

The Principle of Totality

✓ Each person should know how to take care of every part of himself for the benefit of the whole; parts may be
removed or sacrificed to use other parts.

Stewardship
✓ Taking care and being responsible for something which is entrusted to you.

Fidelity
✓ Loyalty to the profession, Involves prioritizing patient’s needs or care.

Paternalism
✓ Another person or entity intrudes in the affairs of the patient to promote justice and welfare.
 What did we discussed?

1. Definition : Ethics, Nursing ethics

2. Approaches
3. Universal principles of biomedical ethics

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