ST. PAUL UNIVERSITY PHILIPPINES ST.

RITA OF CASCIA 2023

SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021

CONTENTS
● He said we have an obligation to do the right thing. Duty
I. INTRODUCTION TO THE COURSE
II. THEORIES AND PRINCIPLES IN HEALTH ETHICS Ethics say we have a duty to achieve good.
A. ETHICAL THEORIES
1. Deontology
IMMANUEL KANT
2. Teleology
3. Utilitarianism He defined…
B. VIRTUE ETHICS 1. did not like a morality based on laws, church laws
1. Virtue ethics in Nursing
2. Core values of a professional nurse
2. morality has its roots/foundation in the condition of
C. ETHICAL PRINCIPLES goodwill among people
1. AUTONOMY
3. we have an obligation to do the right thing
a. Patient’s Rights
b. Patient’s Bill of Rights 4. people/actions are moral when they achieve the
c. Informed Consent good/goodwill
d. Proxy Content/Legally Acceptable Representative
e. Confidentiality 5. morality is discovered by pure reason not by law or
f. Privacy consequences
2. CONFIDENTIALITY
a. Truth telling and right to information 6. Place special emphasis on the relationship between duty
3. VERACITY and the morality of human actions.
4. FIDELITY
5. JUSTICE 7. Holds that the basic standards for an action’s being
6. BENEFICENCE morally right are independent of the good and evil
7. NON-MALEFICENCE
generated.
8. It holds that at least some acts are morally obligatory
regardless of their consequences for human welfare.
ETHICS 9. An action is considered morally good because of some
characteristics of the action itself, not because the
• Ethics is the branch of philosophy that deals with the
product of the action is good.
principles of morality and the well-defined standards of
right and wrong that prescribes the human character and
KANT’S CONCEPTS
conduct in terms of obligations, right, rules, and benefit to
● Reason
society and fairness. o Foundation of a sound ethics (reason in itself can
only be the sensible foundation of what is ethical
• It is divided into two different ways of looking at the for man)
morality of humanity. These are:
o Functions as the very effort to think through
• Consequential - the outcome determines the
moral principles and apply what he/she knows to
morality of the act. get to the right thing to do.
• Non-consequential- the source of morality ● Goodwill – source/origin of ethical obligation
comes from something else such as law, God’s o What is morally binding is rooted in reasons as
law, moral law, sense of duty and your definition “doable for the human person”
of what is the virtuous thing to do. o the good that is relevant to the person who
through his/her reason knows what
one ought to do, is that which he/she can do
ETHICAL THEORY and known as good. (He/she is of his/her own
● Is the systematic effort to understand moral concepts and doing able to carry out his/her obligation)
justify moral principles. ● Duty – motivation for reason and goodwill of the human
person
DEONTOLOGY o It is that which the reason determines as our
Greek: deon “duty” and logos “science” obligation
● Deontology is an ethical theory that uses rules to o Doable good for the human will (since it is the
distinguish right from wrong. It is often associated with doable obligation for the human person, it is
not a duty is it is impossible for a man to do it)
philosopher Immanuel Kant.
● Category of normative ethical theories that encompasses RULES OF DEONTOLOGY
any theory which is primarily concerned with adherence to • First, act only according to that maxim (rule), which can be
certain rights or duties (duty-centered theory). a universal law for all people in all circumstances.
● He said there’s one thing that human beings have in • Second, the calls for the principle of Reversibility. It says,
common, and that is the ability to reason. Pure reasoning the maxim (rule) is right if one would want to be treated
is the source of morality. that way themselves.

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ST. PAUL UNIVERSITY PHILIPPINES
SCHOOL OF NURSING
• Third, do not use others as a (mere) means to one’s end.
This is called Practical Imperative.
APPLICATION IN NURSING PRACTICE
• Healthcare providers should act in such a way that any
other provider making the same decision would be
justified and considered acting morally.
• A clinical-based application of Kant’s ethical theory to
client care involves disclosing medical errors to clients.
Many barriers surround disclosing errors to clients,
including fear of litigation, shame about the error, and
lack of training on how to discuss errors with clients.
These barriers and organizational culture influences may
lead providers to believe that bringing the error to light
does more harm than good. However, applying Kant’s
deontological theory to this type of decision clearly
favours truth telling and full disclosure of errors.
According to Gallagher, patients want their providers to
show respect for them by being honest about errors. Part
of the disclosure process involves issuing an apology for
the error, which is an important move in the direction of
soothing distress, maintaining a trusting client-provider
relationship, and restoring client dignity.
Pro’s Con’s
Creates a foundation for human Creates a paradox
conduct
Creates higher levels of Becomes useful as supernatural
personal responsibility excuses
Creates moral absolutes A matter of subjective opinion
Emphasizes the value of every Do not incorporate self-defense
person ideas
Provide certainty Based on actions that we take
Suggest You should always do
the right thing no matter what
Absolutist
TELEOLOGY
Greek: telos, “end”; logos, “reason”
● Finality
● Reason or explanation for something as a function of its
end, purpose, or goal.
● Any philosophical account that holds that final causes
exist in nature, meaning that, analogous to purposes
found in human actions, nature inherently tends toward
definite ends.
● Teleology is the study of the ends or purposes that things
serve, and Aristotle's emphasis on teleology has
repercussions throughout his
philosophy. Aristotle believed that the best way to
understand why things are the way they are is to
understand what purpose they were designed to serve.
ST. RITA OF CASCIA 2023
1ST SEMESTER, A.Y. 2020-2021
• According to Aristotle: "Every action and purpose may be
said to aim at some good"
• Every action that we do aims on achieving as a supreme
good and this is our general purpose
Example: In the human excellence, when someone strives to
do good purpose or the supreme good they develop good
habits out and get their virtues.
● Happiness is another foundation of Aristotle's teaching. It
can only be found in the context of the community as we
used other people to find good task to perform.
● It is a results-oriented approach that defines ethical
behaviour by good or bad consequences.
● It justifies inherently what most people would call evil acts
by their desirable outcomes, if the good of the outcome
outweighs the bad of the act.
TYPES OF TELEOLOGY
1. Natural teleology: hypothetically, the inherent purpose
or end of a natural entity; in Aristotle’s classic example,
the oak tree is the natural purpose of the acorn.
2. Cybernetics: the study of mechanical systems with built in
goals, e.g. a thermostat, a self-adjusting valve, or the
human metabolism; note that robots and artificial
intelligences will all incorporate cybernetics when they
eventually work.
3. Consequentialism: any philosophy claiming that “the
ends justify the means,” such as utilitarianism. In other
words, teleological ethics.
APPLICATION IN NURSING PRACTICE
1. A pregnant woman about to give birth but due to so many
complications only one can be saved, the mother or child.
As per the nurse, you need to decide which one has the
higher survival rate and inform the family.
2. Most people would agree that lying is wrong. But if telling
a lie would help save a person’s life, consequentialism says
it’s the right thing to do. An example of this is when we tell
a patient or their relatives that they are going to be fine
when we know that they will probably not survive the
night, we tell this things to be tactful and save the patient
from the concern.
-IN TEOLOGY, THE ENDS JUSTFIES THE MEANS-
UTILITARIANISM
● An ethical theory that determines right from wrong by
focusing on outcomes and treats intentions as irrelevant.
● A form of CONSEQUENTIALISM. (good
consequences=good actions)
● Most ethical choice=one that produces the greatest good
for the greatest number.
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SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021

● A HEDONISTIC MORAL THEORY (good=pleasant)- we STRENGTH WEAKNESS

ought morally to pursue good and happiness, and work to ✔ A possible answer for ✔ It is difficult to predict the
avoid pain. every situation, it is an consequences.
● is a philosophy or belief suggesting that an action is absolute system.
morally right if the majority of people benefit from it
✔ It gets at the substance of ✔ It is difficult to define
● It also advocates actions that foster happiness or pleasure morality because it has a what constitutes
and opposes actions that cause unhappiness or harm material core: promoting happiness.
• Actions should be measured in terms of the happiness or human good and
pleasure that they produce. (happiness=final end) alleviating pain.

✔ There is no defense for

PROPONENT OF MODERN UTILITARIANIS
JEREMY BENTHAM (1748-1832)
✔ Regarded as the founder of Modern Utilitarianism.
“It is the greatest happiness of the greatest
number that is the measure of right and wrong.”
● Provided the Bentham’s Felicific/Hedonistic Calculus-
a method or guide to balance the pros and cons of a
proposed course of action in relation to the balance
of pleasures and pains it potentially produces.
FACTORS AND QUESTIONS TO CONSIDER ON BENTHAM’S
FELICIFIC
1. Intensity: How strong is the pleasure?
2. Duration: How long does the pleasure last?
3. Certainty or Uncertainty: How likely or unlikely that the
pleasure will occur?
4. Propinquity or Remoteness: How soon does the pleasure
occur?
5. Fecundity: What is the probability that the action is
followed by sensations of the same kind?
6. Purity: What is the probability that it is not followed by
sensations of the opposite kind?
7. Extent: How many people are affected?
JOHN STUART MILL (1806-1873)
✔ His Utilitarian Theory of Morality is a development and
clarification of the theory created by Jeremy Bentham.
✔ Predominance of Pleasure over Pain.
✔ Highlighted distinction between qualities and quantities of
pleasures and pains.
2 TYPES OF UTILITARIANISM
ACT-UTILITARIANISM:
• An act is right if and only if it results in as much good as
any available.
RULE-UTILITARIANISM:
• An act is right if it conforms to a valid rule if it conforms to
a valid rule within a system of rules whose acceptance
leads to greater utility for society.
minorities.
THE GREATEST HAPPINESS PRINCIPLE
• Actions are considered moral when they promote the
utility and immoral when they promote the reverse.
• The main elements of this philosophy are one’s actions
and their resulting utility.
• In order for the action to be moral, it must be the optimal
choice in increasing utility and minimizing pain.
THE ULTIMATE SANCTION
According to Mill:
• It is man's "feeling for humility" that constitutes the
ultimate sanction of the principle of utility.
External Sanction
• One's fear of displeasing God
• Fear of disapproval from other people
Internal Sanction
• Conscience is the internalization of the external sanctions
of morality that feels remorse each time one acts without
considering first the effect or consequences of one's
action in other people’s lives.
MILL’S REPLIES TO THE OBJECTIONS OF UTILITARIANISM
Mill’s Replies:
❑ If the objectors define happiness as a continuity of highly
pleasurable excitement, then it is true that such a life is
indeed impossible.
❑ Those who find no happiness are generally those who care
for no one but themselves and those who have cultivated
friendships and have left a lasting legacy of fellow feeling
for mankind retain their happiness in any circumstances.
❑ Some experience difficulties in being happy because they
lack mental cultivation.
❑ Therefore, HAPPINESS is attainable if one understands it
realistically and lives one’s life in solidarity with others and
cultivates one’s deeper capacity to enjoy that which
endures in the transitory.

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SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021

To the objection that UTILITARIAN MORALITY IS rights and duty. For utilitarianism, we have to follow or do things
INCOMPATIBLE WITH SELF SACRIFICE and aim to create healthcare policies which promote for the
Mill’s Replies: greatest number of patients. For teleology, we have to be careful of
❑ Utilitarianism does recognize the goodness of self- our actions so we can avoid bad consequences that might result
sacrifice which places the welfare of others over and from our actions.
above one’s own but only the extent that it is done for the
One principle is not superior to the other. There should be a
sake of promoting the greatest happiness of the greatest
balance.
number and for no other reason it is acceptable other than
this.
❑ If self-sacrifice is merely done for its own sake, utilitarian ETHICAL PRINCIPLES
sees it as a waste. ● Ethical principles are general standards of conduct that
❑ Utilitarianism upholds the belief that a truly moral person make up an ethical system.
always tries to incorporate the good of others in every
decision he makes. ● By this view, an action or decision is generally considered
morally right or good when it accords with a given
relevant moral principle, and morally wrong or bad when it
To the objection that SOCIAL CONCERN IS A RARE MOTIVE FOR
ACTION does not.
Mill’s Replies:
ETHICAL PRINCIPILISM
❑ Do people actually have society in mind whenever they ● the view that ethical decision-making and problem solving
choose a course of action? is best undertaken by appealing to sound moral principles
❑ For Mill, a distinction must be made between the motives ● ETHICAL PRINCPLES:
and the consequences of one’s actions with respect to • autonomy,
which of the two is the basis for judging an act to be moral • non-maleficence
or not. The act itself is moral so long as it promotes the • beneficence
good of the greatest number. • justice
From other references:
• Veracity
APPLICATION IN NURSING PRACTICE
Utilitarianism would assume that the core values of nursing can all • Fidelity
be explained by the effects that decisions have on patients, families, • Confidentiality
health professionals, or other stakeholders.
VIRTUE ETHICS
EXAMPLES:
1. In relation to the principle of utility, this states that an act ● Its primary focus is the heart of the moral agent making
must result in the greatest amount of good for the the decision rather than the reasoning to a right action.
greatest number of people involved in a situation. Often, ● It is primarily about personal character and moral habit
individuals attempt to use utilitarian theory when they development rather than a particular action.
seek to divide scarce resources such as healthcare. They ● Emphasizes being rather than doing.
might justify the denial of a single individual access to a ● The term given to an approach that has a focus on
heart transplant if the money could be spent on providing character. More specifically, it focuses on the character of
vaccine for thousands. the actor or agent.
2. Triage System- triage’s purpose is to save as many lives ● Emphasizes that character guides conduct.
● Lead to holiness.
and prevent as much disability as possible. However, in
● Requires that those who wish to act good need to develop
doing this, healthcare providers like nurses, sometimes
good traits of character.
tend to ignore bioethics that usually govern medical
● It means building up our character by doing the right thing
practice and protect individual patients. But if they defy
always BUT IN THE
the bioethics and saved many lives as their action’s
consequence, it would still be the right thing to do 1. Right time
regardless of the action being right or wrong based on 2. Right way
laws. 3. Right amount
4. Right people
CONCLUSION
● General Principle: We should always act in accordance
These three principles are very vital in nursing practice. For
with the virtues or as a truly virtuous person would.
deontology, we have to use our reasons in order to balance our

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● Asks the Questions:
1. “What sort of person should I be?”
2. “If I act in such and such a way, would I be acting in a
way that was virtuous?”
Virtue Ethics in Nursing
● Can be viewed as an approach of ethical deliberation
about the moral character and dispositions of nurses as
moral agents that enables them, as virtuous human
beings, to fulfil their purpose and function as professional
people,
● It implies a characteristic habit that allows the nurse to
become a good practitioner who behaves well,
● An approach to moral dilemmas in nursing. On the
contrary, decision making about moral issues in health
care demands that nurses exercise rational control over
emotions. This clearly focuses the attention on the nurse
as moral agent and in particular their character,
● Virtue is important because it reminds us that nursing is
“reflective practice.” Nursing is not just delivering
something to the patient; it is becoming a certain kind of
person-we do, we learn, we reflect, we become, mind-set
of what is right or good to be based on duty to achieve
good consequences,
● Concerns character of individual nurses and seeks ways to
enable nurses to develop character traits appropriate for
actions that enhance well-being; Weighing obligation and
values.
● CHARACTER- The focus and guide when a Nurse acts.
● Agent-based ethics tends towards asking: ‘what sort of
person should I be?’
CARE AS A VIRTUE
● Care is and should be a central characteristic of nursing.
1. Natural care - refers to situations where people act voluntarily in
the interest of others.
2. Ethical care - arises from natural care.
RESPECT AND INTEGRITY AS VIRTUES
● Respect - demonstrate sensitivity to the differences in the
views that people as human beings might hold and learn
to understand them even if we disagree.
● Integrity - being faithful to one’s commitments; it focuses
on nurses as people and their dedication to their patients.
JUSTICE AND COURAGE AS VIRTUES
● Justice – is a principle (implies fairness and equality) and a
virtue (enables the nurse to have an awareness of, and a
special concern for, the vulnerability of a patient)
● Courage - a courageous nurse is capable of free thought,
undertakes responsible actions and carries them out
REASON AS A VIRTUE
● Reason implies the use of abstract rules and principles to
make decisions or solve problems. Nurses as moral
agents also need a certain disposition to use their reason.
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HONESTY AND TRUST AS A VIRTUE
● Honesty - one of the cornerstones of the nurse-patient
relationship.
● Trust – this must be earned, because if there is distrust on
the part of the patient, it could be because the nurses fail
to perform what is necessary for the patient. The least
that nurses as moral agents acting in the situation can do
is not to violate this trust.
PRACTICAL WISDOM AS A VIRTUE
● Enables the nurse as a moral agent to know what action is
correct in specific situation. To this effect, virtues enable
the nurse to discover the relevant moral aspects of a
moral dilemma and to interpret,judge and evaluate them
and as well to apply the rules, principles and moral
theories wisely to a situation in order to resolve the
dilemma.
TWO KINDS OF VIRTUES
MORAL VIRTUE
● Those that relate to a person's character ------> enables
the nurse to act in accordance with the right reason.
INTELLECTUAL VIRTUE
● Those that relate to a person’s intellect ----> enables the
nurse to reason well.
Core Values of Professional Nurses
ALTRUISM
● concern for the welfare and wellbeing of others;
● do things for other people with the other person’s well-
being in mind, like a sense of duty;
● In professional practice, altruism is reflected by the nurse’s
concern and advocacy- for the welfare of patients, other
nurses, and other healthcare providers.
● Requires that nurses put the needs of their patients before
their own needs, which can be difficult at times.
AUTONOMY
● the right to self-determination;
● professional practice reflects autonomy when the nurse
respects patients’ rights to make decisions about their
health care;
● Means that nurses should be sure patients have all the
needed information that is required to decide about their
medical care and are educated. The nurses do not
influence the patient’s choice;
● Also refers to nurses acting independently within their
scope of practice.
HUMAN DIGNITY
● is respect for the inherent worth and uniqueness of
individuals and populations;
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● is a vague, complex, multidimensional, and fundamental
concept in the nursing profession;
● in professional practice, concern for human dignity is
reflected when the nurse values and respects all patients
and colleagues and treating everyone as a unique human
being;
● in moral codes, it is a duty and a human right, and in the
nurses’ workplace, amoral obligation;
● “Having respect for the inherent worth and uniqueness of
individuals, families, and communities and it characterizes
all interactions a nurse should have with them” - the root
of all values that nurses exemplify in their day-to-day
interactions with patients.
INTEGRITY
● is acting in accordance with an appropriate code of ethics
and accepted standards of practice;
● reflected in professional practice when the nurse is honest
and provides care based on an ethical framework that is
accepted within the profession;
● according to National League of Nursing, a culture of
integrity is evident when organizational principles of open
communication, ethical decision-making, and humility are
encouraged, expected, and demonstrated consistently; it
demands truthfulness and honesty;
● Nursing professionals must also consider the integrity of
patients. Nurses should be cognizant of the ways in which
they can violate a patient’s integrity while caring for them.
SOCIAL JUSTICE
● is acting in accordance with fair treatment regardless of
economic status, race, ethnicity, age, citizenship,
disability, or sexual orientation;
● core nursing value and the foundation of public health
nursing;
● Its ideology requires nursing students to uphold moral,
legal, and humanistic principles related to health. As such,
teaching social justice requires a basis in moral
developmental theory;
● implies that there is a fair and equitable distribution of
benefits and burdens in a society;
● Nurses uphold moral, legal, and humanistic principles by
ensuring equal treatment and health care under the law.
AUTONOMY
● The term ‘autonomy’ comes from the Greek term: autos-
‘self’, nomos- ‘rule’, ‘governance’ or ‘law’
● When autonomy is used as a concept in moral discourse,
what is commonly being referred to is:
➢ a person’s ability to make or to exercise self-
determining choice
➢ treating or respecting persons as ends in
themselves, as dignified and autonomous
choosers, and not as the mere means (objects or
tools) to the ends of others.
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● The principle of autonomy, however, is a little different,
which basically means that people should be free to
choose and entitled to act on their preferences provided
their decisions and actions do not stand to violate the
significant moral interests of others.
● Autonomy refers to the ability of competent individuals to
make decisions over their own lives and in order for
autonomy to be meaningful, a competent individual’s
decisions should be respected even when those decisions
conflict with what others believe to be reasonable
● In addition, In order to act autonomously, a patient ought
to have full access to all information available in order to
be able to make a decision regarding their own welfare.
This puts a heavy burden of disclosure on the physician,
including information that would allow the patient to
reject treatment.
● Autonomy is the freedom and ability to act in a self-
determined manner. It represents the right of a rational
person to express personal decisions independent of
outside interference and to have these decisions honored.
It can be argued that autonomy occupies a central place in
Western healthcare ethics because of the popularity of the
Enlightenment-era philosophy of Immanuel Kant.
However, it is noteworthy that autonomy is not
emphasized in an ethic of care and virtue ethics, and these
also are popular approaches to ethics today.
● Self- governing
➢ Freedom to make choices about issues that affect
one’s life
➢ Respect for persons; unique and valuable members
of the society
➢ Free to choose and implement one’s own decision,
free from lies, restraint or coercion
● This principle assumes rational thinking on the part of the
individual and may be challenged when the rights of
others are infringed upon by the individual
● Lies, restraints, coercion = wrong decision
● No matter what, we must let patients decide for himself
● * Autonomy is NOT absolute.
● Factors that affect decision:
➢ Emotions
➢ Time
● Consider this:
What if the patient wants to do something that will cause
harm to him/herself? Under what circumstances can the
healthcare team intervene?
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● Examples:
1. Elsa goes to the doctor because she has a
vaginal discharge. She however refuses to talk
about her personal life
2. Mia, 16, is afraid of injections and hospitals. She
has acute appendicitis and needs surgery but
she refuses
● Criteria in determining the decision making capacity of
an individual:
1. the ability to comprehend information relevant
to the decision at hand
2. the ability to deliberate in accordance with his or
her own values and goals
3. the ability to communicate with caregivers
PATERNALISM
● Deliberate restriction of people’s autonomy by health care
professionals based on the idea that they know what’s
best for the clients - can be justifiable at times
● Not everything legal is ethical and vice versa
● Doing good should take precedence over autonomy
A. PATIENTS RIGHTS
● What are patients’ rights?
➢ To put it simply, patients’ rights are a
subcategory of human rights.
➢ It is important to clarify that patients’ rights
statements tend to include a mixture of civil
rights, legal rights and moral rights.
THE RIGHT TO HEALTH AND HEALTH CARE
● In keeping with the Universal Declaration of
Human Rights, all people have the right to
health. The World Health Organization (WHO
2002a) has clarified that the right
to health does not entail the right to
be healthy, but the right to the highest
attainable standard of health.
1. The right to equal access to health care
● Access to health care refers to ‘whether people who are —
or should be — entitled to health care services receive
them’ (Emanuel 2000: 8). The right to equal access to
health care raises questions of distributive justice and of
how the benefits and burdens associated with health care
service delivery ought to be distributed.
2. The right to have access to appropriate care
● The right to have access to appropriate care is a second
sense in which a right to health care can be claimed. This
sense concerns the cultural competency and cultural
safety of care as well as its ability generally to
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accommodate people’s personal preferences, health
beliefs, health values and health practices.
● If nurses are to respond to this sense of right to health and
health care, they need to gain knowledge and
understanding of their patients’ health beliefs and health
practices and to negotiate ways in which these can be
accommodated and met appropriately.
3. The right to quality care
● A right to quality care is the third sense which concerns
the accountability, responsibility and competency of
health professionals and health care providers, and about
the standard of care that is actually delivered.
4. The right to safe care
● It is generally accepted that all people receiving health
care have the right to be safe. This right has been
interpreted to mean the right to be kept free of danger or
risk of injury while in health care domains.
B. PATIENT’S BILL OF RIGHTS
● The American Hospital Association presents A Patient's
Bill of Rights with the expectation that it will contribute to
more effective patient care and be supported by the
hospital on behalf of the institution, its medical staff,
employees, and patients.
1. Right to Appropriate Medical Care and Humane Treatment.
● Every person has a right to health and medical care
corresponding to his state of health, without any
discrimination and within the limits of the resources,
manpower and competence available for health and
medical care at the relevant time.
2. Right to Informed Consent.
● The patient has a right to a clear, truthful and substantial
explanation, in a manner and language understandable
to the patient, of all proposed procedures, whether
diagnostic, preventive, curative, rehabilitative or
therapeutic.
3. Right to Privacy and Confidentiality.
● The privacy of the patients must be assured at all stages of
his treatment. The patient has the right to demand that all
information, communication and records pertaining to his
care be treated as confidential.
● The patient has the right to privacy and protection from
unwarranted publicity.
● Include the patient's right not to be subjected to exposure,
private or public, either by photography, publications,
video-taping, discussion, or by any other means that
would otherwise tend to reveal his person and identity and
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the circumstances under which he was, he is, or he will be,
under medical or surgical care or treatment.
4. Right to Information.
● In the course of treatment and hospital care, the patient
or the legal guardian has a right to be informed of the
result of the evaluation of the nature and extent of the
disease, medicines to be administered and their generic
counterpart including the possible complications, and the
person's participation in the plan of care and necessary
changes before its implementation.
● Right to examine and be given an itemized bill of the
hospital and medical services rendered in the facility or by
his/her physician and other health care providers,
regardless of the manner and source of payment
● Right to be informed by the physician or his/her delegate
of his/her continuing health care requirements following
discharge,
● The patient is entitled to a brief, written summary of the
course of his/her illness which shall include at least the
history, physical examination, diagnosis,
5. The Right to Choose Health Care Provider and Facility.
● The patient has the right to seek for a second opinion
and subsequent opinions, if appropriate, from another
health care provider.
● Every patient has the right to health education that will
assist him/her in making informed choices about personal
health and about available health services.
6. Right to Self-Determination.
● The patient has the right to avail himself/herself of any
recommended diagnostic and treatment procedures.
● The patient is free to choose the health care provider to
serve him as well as the facility except when he is under
the care of a service facility or when public health and
safety so demands or when the patient expressly waives
this right in writing.
7. Right to Religious Belief.
● The patient has the right to refuse medical treatment or
procedures which may be contrary to his religious beliefs.
● The patient has the right to avail himself/herself of any
recommended diagnostic and treatment procedures.
8. Right to Medical Records.
● The patient is entitled to a summary of his medical history
and condition, the contents of his medical records, except
psychiatric notes and other incriminatory information.
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● The patient has the right to refuse medical treatment or
procedures which may be contrary to his religious beliefs:
Provided, That such a right shall not be imposed by
parents upon their children who have not reached the
legal age in a life threatening situation as determined by
the attending physician or the medical director of the
facility.
9. Right to Leave.
● The patient is entitled to a summary of his medical history
and condition.
● The health care institution shall safeguard the
confidentiality of the medical records and to likewise
ensure the integrity and authenticity of the medical record
● The patient has the right to leave hospital regardless of his
physical condition. Provided that:
○ he is informed of the medical consequences of
his/her decision
○ he releases those involved in his/her care from
any obligation relative to the consequences of
his decision
○ his decision will not prejudice public health and
safety
10. Right to Refuse Participation in Medical Research.
● The patient has the right to leave hospital or any other
health care institution regardless of his physical condition
● No patient shall be detained against hi$/her will in any
health care institution on the sole basis of his failure to
fully settle his financial obligations.
● The patient has the right to be advised if the health care
provider plans to involve him in medical research,
including but not limited to human experimentation which
may be performed only with the written informed consent
of the patient:
○ Department of Health shall safeguard the
continuing training and education of future
health care provider to ensure the development
of the health care delivery in the country.
○ The patient involved in the human
experimentation shall be made aware of its
respective guidelines.
11. Right to Correspondence and to Receive Visitors.
● The patient has the right to communicate with relatives
and other persons and to receive visitors subject to
reasonable limits prescribed by the rules and regulations
of the health care institution.
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● The Patient has the right to refuse diagnostic and medical
treatment procedures, provided that the following
conditions are satisfied;
● The Patient is of legal age and is mentally competent;
● The Patient is informed of the medical consequences of
his/her refusal;
● The Patient's refusal will not jeopardize public health and
safety.
12. Right to Express Grievances.
● The patient has the right to express complaints and
grievances about the care and services received without
fear of discrimination.
● The patient has the right to be advised if the health care
provider plans to involve him in medical research,
including but not limited to human experimentation
which may be performed only with the written informed
consent of the patient.
13. Right to be Informed of His Rights and Obligations as a
Patient.
● Every person has the right to be informed of his rights and
obligations as a patient. Also, it shall be the duty of health
care institutions to inform of their rights as well as of the
institution's rules and regulations that apply to the
conduct of the patient while in the care of such institution.
● The patient has the right to communicate with relatives
and other persons and to receive visitors subject to
reasonable limits prescribed by the rules and regulations
of the health care institution.
14. Right to Express Grievances
● The patient has the right to express complaints and
grievances about the care and services received without
fear of discrimination or reprisal and to know about the
disposition of such complaints.
15. Right to be Informed of His Rights and Obligations as a
Patient
● It shall be the duty of health care institutions to inform of
their rights as well as of the institution's rules and
regulations that apply to the conduct of the patient while
in the care of such institution.
C. INFORMED CONSENT: AN ETHICAL WAY OF NURSING
INFORMED CONSENT
● refers to the patient’s deliberate and voluntary
acceptance of a health care procedure which presupposes
sufficient disclosure of the nature and the goal of the
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procedure; it’s possible effects, risks, and benefits, and
the available medical options.
● Nurses should provide precise and simple explanations
and see to it that their patients comprehend the
information by asking them questions and by letting
them speak their mind.
● The goal of informed consent is to assure patient
autonomy.
a. Rights of Unconscious Patients
● If the patient is unconscious or otherwise unable to
express his/her will, informed consent must be obtained
whenever possible, from a legally entitled
representative.In all cases, a physician always strives to
save the life of a patient unless a prior explicit written
document states otherwise (Do Not Resuscitate
b. Rights of Legally Incompetent Patient
● The consent of a legally entitled representative is
required.
● If a legally incompetent patient can make rational
choices, decisions must be respected and he/she has the
right to forbid disclosure of information to his/her legally
entitled representative.
c. Procedures against the Patient’s Will
Diagnostic procedures or treatments against the patient’ s will can
be carried out only in exceptional cases, if specifically permitted by
law and conforming to the principles of medical ethics.
What is involved in an informed consent?
● Legally, this requires that the patient is informed of the
risks, benefits, and alternatives to a treatment.
● A signature on the consent form provides legal
documentation of consent.
● Consent may be withdrawn at any time. Healthcare
providers must accept and support refusal or withdrawal
of consent even if they disagree with the patient.
What can nurses do to improve informed consent?
● Think about consent as a process to assure patient
understanding and agreement, not just signing a form.
● Informed consent should be a collaborative
activity between the physician, nurse, and patient. The
physician should have obtained consent before the nurse
has the patient sign a form.
● Nurses can offer what we do best—patient teaching.
However, our teaching cannot take the place of prior
physician / patient shared decision-making.
To note:
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Remember that informed consent is a way of nursing each of us needs
to live out as we offer our patients ethical practice and quality nursing
care.
● D. PROXY CONTENT/LEGALLY ACCEPTED
REPRESENTATIVE
● Proxy consent is the process by which people with the
legal right to consent to medical treatment for themselves
or for a minor or award delegate that right to another
● An individual or other body authorized under applicable
law to represent the interest of an individual including
providing consent on behalf of the prospective subject to
the subject’s participation in a clinical test.
● They are individuals who can, in accordance with the law,
provide consent on behalf of the patient who is incapable
of giving or who has diminished capacity to give informed
consent.
● A surrogate or proxy decision-maker is charged with
making decisions on behalf of the patient to the best of his
or her knowledge of what the patient would have wanted
had the patient been able to express his or her own
desires. Also they are charged with deciding on behalf of
the patient consistent with their understanding of the
patient’s best interests.
● Further, if a surrogate has not been appointed a situation
may arise wherein family members argue about what the
best course of action is for their elderly relative, which can
place the health care team in the unenviable position of
having to resolve the dispute.
There are three fundamental constraints on this
delegation:
1. The person making the delegation must have the right
to consent.
2. The person must be legally and medically competent to
delegate the right to consent.
3. The right to consent must be delegated to a legally and
medically competent adult. There are two types of proxy
The 6 Principles of Confidentiality
consent for adults. The first, the power of attorney to
1. Justify the purpose(s)
consent to medical care, is usually used by patients who
want medical care but are concerned about who will
consent if they are rendered temporarily incompetent by
the medical care. A power of attorney to consent to
medical care delegates the right to consent to a specific
person. The second type is the living will.
2. Don't use patient identifiable information unless it is absolutely
E. CONFIDENTIALITY
necessary
● Confidentiality protects the autonomy of patients by
allowing them to control information about themselves.
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This is particularly important given the often sensitive and
personal nature of the information that medical
practitioners can acquire, and the damaging ways in which
such information could be used.
● Confidentiality is vital when working confidential within
the healthcare sector. You are privilege to information
that should only be shared with others for the benefit of
the patient.
● The intent of maintaining confidentiality is to afford
protection of patients from the harms of stigma, potential
embarrassment, socio-economic manifestations, and illicit
use of information.
● Despite patient confidentiality being a key priority,
circumstances exist where information disclosure is
demanded. In the safeguarding of children or vulnerable
adults, disclosure is required to prevent harm or prevent
criminal activity from occurring. Disclosure must be
approached carefully due to the continuing need to
protect patients’ personal information.
● Confidentiality is one of the core duties of medical
practice. The obligation of confidentiality prohibits the
health care provider from disclosing information about
the patient's case to others without permission and
encourages the providers and health care systems to take
precautions to ensure that only authorized access occurs.
● Patients routinely share personal information with health
care providers. If the confidentiality of this information
were not protected, trust in the physician-patient
relationship would be diminished.
● Creating a trusting environment by respecting patient
privacy encourages the patient to seek care and to be as
honest as possible during the course of a health care visit.
It may also increase the patient’s willingness to seek care.
● Appropriate care often requires that information about
patients be discussed among members of a health care
team; all team members have authorized access to
confidential information about the patients they care for
and assume the duty of protecting that information from
others who do not have access.
● Every proposed use or transfer of patient identifiable
information within or from an organization should be
clearly defined and scrutinized, with continuing uses
regularly reviewed, by an appropriate guardian.
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● Patient identifiable information items should not be
included unless it is essential for the specified purpose(s)
of that flow. The need for patients to be identified should
be considered at each stage of satisfying the purpose(s).
3. Use the minimum necessary patient-identifiable information
● Where use of patient identifiable information is
considered to be essential, the inclusion of each individual
item of information should be considered and justified so
that the minimum amount of identifiable information is
transferred or accessible as is necessary for a given
function to be carried out.
4. Access to patient identifiable information should be on a strict
need-to-know basis
● Only those individuals who need access to patient
identifiable information should have access to it, and they
should only have access to the information items that they
need to see. This may mean introducing access controls or
splitting information flows where one information flow is
used for several purposes.
● Action should be taken to ensure that those handling
patient identifiable information - both clinical and non-
clinical staff - are made fully aware of their responsibilities
and obligations to respect patient confidentiality.
5. Everyone with access to patient identifiable information should
be aware of their responsibilities
6. Understand and comply with the law
● Every use of patient identifiable information must be
lawful. Someone in each organization handling patient
information should be responsible for ensuring that the
organization complies with legal requirements.
F. PRIVACY
● privacy originates from "privatus" and "privo" in latin and
means "deprive of". The root of privacy is "priv", which
means "an opportunity in one's favor"
● Patient privacy encompasses a number of aspects,
including personal space (physical privacy), personal data
(informational privacy), personal choices including cultural
and religious affiliations (decisional privacy), and personal
relationships with family members and other intimates
(associational privacy).
● Privacy has been defined as the control of a situation,
freedom of choice, mutual interaction, avoidance of
communication and an unreachable area. Additionally,
privacy may be defined as a restriction put by an individual
on access to his/her bodily and mental integrity.
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● In Kant's theory, autonomy is a fundamental value of
being a human. If privacy constitutes an essential to
autonomy and autonomy cannot be understood without
privacy, then losing privacy poses a threat to our most
fundamental values
● Privacy, besides being a fundamental quality of human
beings and bearing an essential value in its own right, is an
instrumental 'good' that enable individuals to achieve
other good values. If privacy constitutes an essential to
autonomy and autonomy cannot be understood without
privacy, then losing privacy poses a threat to our most
fundamental values.
● Privacy is the right to autonomy and comprises the right
to be left alone. It provides individuals with the right to
control the information related to them, including the
restriction of access to this information. It also involves
the right to keep secrets confidential and to share them
only in private conversations
● Privacy is important as it provides a secure environment
for patients where they receive medical care and provide
complete and accurate information, and which reinforces
confidence in health care and emphasizes the importance
of respect for patient autonomy
Confidentiality
• Confidentiality protects the autonomy of patients by
allowing them to control information about themselves.
This is particularly important given the often sensitive and
personal nature of the information that medical
practitioners can acquire, and the damaging ways in which
such information could be used.
• Confidentiality is vital when working confidential within
the healthcare sector. You are privilege to information
that should only be shared with others for the benefit of
the patient.
• Confidentiality is one of the core duties of medical
practice. It refers to the duty to protect privileged
information and to share entrusted information
responsibly. Additionally, it is the cornerstone of trust
between doctor and patient. As a general rule, it requires
health care providers to keep a patient's personal health
information private unless consent to release the
information is provided by the patient.
• The intent of maintaining confidentiality is to afford
protection of patients from the harms of stigma, potential
embarrassment, socio-economic manifestations, and illicit
use of information
• Despite patient confidentiality being a key priority,
circumstances exist where information disclosure is
demanded. In the safeguarding of children or vulnerable
adults, disclosure is required to prevent harm or prevent
criminal activity from occurring. Disclosure must be
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approached carefully due to the continuing need to • ICN (2000) - “ the nurse holds in confidence personal
protect patients’ personal information. information and uses judgment in sharing this
• The principle that binds the practitioner to hold in strict information”
confidence those things learned about a patient in the • An important component of autonomy - maintains dignity
course of medical practice. and respect for the person
• Confidentiality pertains to restricting the sharing of • Do not the tell the diagnosis to those who are not directly
involved – nurse aides and janitors
sensitive patient information and only sharing information
o If directly involved – needs to know dx
when it is necessary either by law or professional duty.
o If not directly involved – use standard
• This –the principle of confidentiality –is what underpins
precaution
the trust between patients/clients and health care
• No need to mention the dx
workers.
• Breaching that trust by disclosing information about a The following are subjects of Confidentiality and should not
patient/client to someone who has no right to the be revealed to anyone except for graver cause:
information is one of the most serious errors a health care 1. Private Secrets
worker can commit. 2. Contractual Secrets
• It can lead to disciplinary proceedings and, if the o Secret comes first before the promise to keep the secret
individual is a registered practitioner, to formal 3. Professional Secrets
professional misconduct hearings. o Understanding at the very start that you will not say
• Your work in health care puts you in the privileged anything before the secret comes out
position of finding out a lot of information about the
people you care for. Graver Cause:
• 1. Personal decision
• You’ll learn about their health problems, their
• 2. Reportable cause
employment, their family, perhaps even their income.
• 3. Legal case
• They will speak to you about things very close to them
personally – sometimes they will talk about things they Mandatory Disclosure
haven’t even discussed with their family. • Communicable disease
• And you’ll be supporting them in some of the intimate • Child is physically abused
aspects of daily life – washing, dressing and going to the o Report even if it is just a suspicion, report to
toilet, for instance. SOCIAL SERVICES
• Amongst the ethical principles, another major one is o Evidence of Child Abuse and Neglect
confidentiality, or the obligation of a physician/nurses to Bruises in different stages of healing – “clumsy”
keep a patient's health information private. This is pretty o Black and blue – fresh
important, since patients have to trust their o Yellowish - healing
physician/nurses but may be afraid to honestly admit to -Bruises under the clothing
illegal or dangerous activity. Maybe they don't want the -Frequent hospitalization
cops to know that they were doing drugs; maybe they just -Child is guarded – withdraws from touch
don't want their mom to know that they were being - Quiet when parents are around but talkative when only healthcare
providers are around
reckless. However, both of these things are really
- Failure to thrive
important for physicians to know before administering
- Child is sexually abused
treatment.
o Familiar with vulgar/ sex language
• So as long as you're over 18, physicians cannot reveal
o Inspect perianal area
anything that you tell them about your personal health -Abusers do not usually penetrate the vagina because it is easily
without your written consent. This confidentiality clause detected by police/ hospital
extends beyond your death. Even if you stop seeing a -They usually penetrate the rectal area
certain doctor, that doctor is bound to the confidentiality -Vulnerable adults
clause. It protects your medical information and records o Elderly
from being released to unauthorized people or parties. o Mental incapacity
• Confidentiality is the protection of personal information.
Confidentiality means keeping a client’s information Example:
between you and the client, and not telling others A 30-year old married man consults a physician complaining about
including co-workers, friends, family, etc. his difficulty in urinating. He attributes this to what he had taken
five days ago when he attended a convention. After examinations of
• Requires the non-disclosure of private or secret
his blood and urine, he was told that he has Gonorrhea. He was
information with which one is entrusted
afraid that his wife might discover it. So he told the Doctor not to
tell anyone, including his wife for fear the she might leave him. He

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loves his wife and family. The wife however, after a week, asks the
doctor as to the condition of her husband because she was a bit
worried why her husband does not want to make love with her. If
you are the doctor, should you confide to the wife about her
husband’s condition knowing that you know the obligation attached
to the Principle of Confidentiality?
Maintaining Confidentiality Include:
-individual files are locked and secured
-support workers do not tell other people what is in a client’s file
unless they have permission from the client
-information about clients is not told to people who do not need to
know
-clients’ medical details are not discussed without their consent.
-adult clients have the right to keep any information about
themselves confidential, which includes that information being kept
from family and friends.
-Respecting the client's right to keep private information about his
or her mental and physical care and related care.
-Allowing only those dealing with client's care to have access to the
information that the client divulges.
-Only under precisely defined conditions can third parties have
access to this information.
-Adult clients can decide which family members, if any, may be
involved in treatment and may have access to clinical information.
Breach of confidentiality
• A breach of confidentiality occurs when a patient's private
information is disclosed to a third party without their
consent. There are limited exceptions to this, including
disclosures to state health officials and court orders
requiring medical records to be produced.
• Computerization of Medical Records
• Access to hospital patient charts
• Patients discussed by colleagues
The 6 Principles of Confidentiality
1. Justify the purpose(s)- Every proposed use or transfer of patient
identifiable information within or from an organization should be
clearly defined and scrutinized, with continuing uses regularly
reviewed, by an appropriate guardian.
2. Don't use patient identifiable information unless it is absolutely
necessary. Patient identifiable information items should not be
included unless it is essential for the specified purpose(s) of that
flow. The need for patients to be identified should be considered at
each stage of satisfying the purpose(s).
3. Use the minimum necessary patient-identifiable information.
Where use of patient identifiable information is considered to be
essential, the inclusion of each individual item of information should
be considered and justified so that the minimum amount of
identifiable information is transferred or accessible as is necessary
for a given function to be carried out.
4. Access to patient identifiable information should be on a strict
need-to-know basis. Only those individuals who need access to
ST. RITA OF CASCIA 2023
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patient identifiable information should have access to it, and they
should only have access to the information items that they need to
see. This may mean introducing access controls or splitting
information flows where one information flow is used for several
purposes. Action should be taken to ensure that those handling
patient identifiable information - both clinical and non- clinical staff
- are made fully aware of their responsibilities and obligations to
respect patient confidentiality.
5. Everyone with access to patient identifiable information should
be aware of their responsibilities. Everyone with access to patient
identifiable information should be aware of their responsibilities
6. Understand and comply with the law. Every use of patient
identifiable information must be lawful. Someone in each
organization handling patient information should be responsible for
ensuring that the organization complies with legal requirements.
What can be considered as confidential information?
Any information that an individual wishes not to make public is
considered as confidential information.
Information that is considered confidential can include:
• name, date of birth, age, sex and address
• current contact details of family, guardian, etc.
• bank details
• medical history or records
• personal care issues
• service records and file progress notes
• individual personal plans
• assessments or reports
• 9 guardianship orders
Truth-telling
Truth-telling or honesty is seen as a basic moral principle, rule or
value. Truth-telling, the act of sharing one's knowledge and the
limitation of one's knowledge with accuracy and sensitivity to the
clinical impact of the disclosure, is also an ethical imperative in
medicine as practiced in this country. The truth-telling duty derives
from the philosophical principle of respect for the truth. It entails
that information must be trustworthy and conveyed in a manner
that can be understood and meaningfully applied by the patient.
The value of telling the truth in health care
1. Respect for the patient as a person who is able to make decision.
- To consent to any health intervention,
a person requires sufficient and
truthful information to make an
informed and conscious choice;
arguably, patients cannot make
effective decisions without truthful
information.
2. The duty and trust; where everyone has a strict duty to tell the
truth even if it might be harmful. According to Kant.
- Kant further supposes that telling the truth is
always a duty, whether it relates to the other’s
right to know or results in innocent people being
severely harmed. In other words, from a
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deontological point of view, competent patients
should be told the truth regardless of the
consequences.
3. The physical and psychological benefits of telling the truth.
- One of which is the positive benefit on the
patient; those who are well informed tend to
collaborate with health professionals and seek
to be treated.
- In terms of psychological benefit, knowing one’s
prognosis and diagnosis is far less debilitating
than worrying about the unknown because
patients who are not given the opportunity to
reveal their own fears and worries may be left
anxious and convinced that they have the most
horrible fate ahead.
The Challenge of telling the truth
✓ Respect for patient as a person to be told the truth may
possibly contradict with a patient’s right not to know such
truth.
✓ In some cases, patients prefer not to be told or have full
information of their health conditions, of a serious
diagnosis, but would rather wish a family member be
informed.
✓ In any health care codes of ethics, it is generally
established that health professionals ought to respect
their patients’ wishes and preferences. Yet, this respect of
wishes is not just about the patient’s right to know, but
extends to respect a patient’s right not to know.
✓ when there is conflict with other obligations, one can
override the other obligation. This is in particular relevant
to the principles of beneficence and non-maleficence
which are used to justify for not telling the truth to
patients.
Veracity
-defined as being honest and telling the truth
-the basis of the trust relationship established between a patient
and a health care provider.
-the obligation of veracity, based on respect for patients and
autonomy, is acknowledged in most codes of ethics, including the
codes of the ADHA and the ADA.
-Habitual observance of truth.
- It is concerned with being open, honest and truthful with people.
-Accurate transfer of information in a way that is suitable for the
individual to understand.
- One of the basic moral and ethical principles in society. It is
entrenched in medical ethics and in nurses’ ethical codes.
-Duty to tell the truth
-Fundamental to the development and continuance of trust among
human beings - truth telling, integrity and honesty
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Consider this:
Is lying to a patient ever justified? If a patient finds out that you
have lied to them, will they have reason to trust you?
Veracity in the Health Care Setting
It refers to comprehensive, accurate, and objective transmission of
information, as well as to the way the professional fosters the
patients or subjects understanding.
Importance of Ethics of Veracity in the Medical/ Health care
• Patients place a great deal of trust in their physician, and
may feel that trust is misplaced if they discover or
perceive lack of honesty and candor by the physician.
• Patients have the right to know their health information,
and physicians are obliged to provide it.
• It is very important while sharing medical information that
nothing remains uncertain.
• Telling the patient the truth ensures that the correct
information is given and correct choice for the patient is
made.
• Truth telling fosters trust in the medical profession and
rests on the respect owed to patients as persons.
• Prevents harm, as patients who are uninformed about
their situation may fail to get medical help when they
should.
• Truth-telling obviously is a necessary to avoid another
vital interest that may help in promoting the healing
process which the intervention hopes to achieve
• Truth-telling is important because it shows respect for
people and allows them the right to autonomy – giving
them all the information they need to make their own
choices.
Health Care ethics:
✓ is being completely truthful with patients; nurses must not
withhold the whole truth from clients even when it may
lead to patient distress.
✓ Modern health care is based on a complex set of
covenants between the practitioner and patients, which
work best under conditions of trust, veracity and fidelity
✓ Tolerance for lying damages the system of health care
delivery.
✓ Allied health and nursing specialists should be committed
to the truth
Veracity- Informed Consent
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Patients need to know the truth about their medical situation and
their options. However, some patients or their families may not
want the full truth disclosed to them.
Justifying Less than Full Disclosure
-Sometimes, patients request that information be withheld, but
withholding information does not always undermine veracity or
violate the truth principle.
- Clinical judgment is always required because in some cases, even a
reluctant and intimidated patient who requests not to be informed
needs to know some truths.
The Ethics of Veracity and Cultural Influence
-In this collective decision process, relatives receive information
about the patient’s diagnosis and prognosis and make treatment
choices, often without the patient’s input.
The health care professionals need more awareness, and training to
increase their skills in the ethics of veracity and also the
communication skills especially in the context of breaking bad news
in telling the patient the truth about diagnosis, treatment
outcomes, and prognosis of any serious illness; such skills have been
found to improve doctor-patient relationship, satisfaction with care
and patient health outcomes
Truth. This principle implies that practitioners should tell
patients the truth at all times. ❑Principle binds health care
provider and patient to be truthful.
✓Does a nurse tell the truth when it is known that it will cause
harm?
✓Does a nurse tell a lie when it is known that the lie will relieve
anxiety and fear?
FIDELITY
the ethical principle of fidelity directs us to model care delivery with
altruism, loyalty, caring, and honesty
-unflinching loyalty, steadfastness, and adherence to ones views,
obligations, vows, promises, or morals
- it can also be used to mean accuracy.
- strict observance of promises, duties and by continuing loyalty and
support.
Fidelity refers to meeting the patient’s reasonable expectations
regarding respect, competence, subscribing to a professional code
of conduct, following policies and procedures honoring agreements
made between clinician and patient
NURSES PROMISE TO PROVIDE COMPETENT CARE TO PATIENTS
AND TO DO SO IN A WAY THAT IS HONEST, RESPONSIBLE AND
FAIR.
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Fidelity is considered by many nurses to be the most common
source of ethical conflict. Health care professionals may find
themselves caught between what they believe is right, what the
patient wants, what other members of the health care team expect,
and what is required by organizational policy and the law.
• Obligation of an individual to be faithful to
commitments to him/herself and also to others
• Main support for the concept of accountability
• Keeping information confidential and maintaining
privacy and trust
Consider this:
To whom to do we owe fidelity? Who has the right to access
patient medical records? When should we “blow the whistle”
on unsafe staffing patterns?
• Have continuing education – Professional
Development
• Patient’s record – about the patient but owned by the
hospital
• Doctor’s permission
• Medical records’ permission
Case:
The parents of 9-year old Kevin who is suffering from a
metastatic bone cancer request that the child not be told of the
illness. Should the attending doctor comply?
Dr. E. Kubler Ross, the question:
• “Should we tell the child?”
Should not be an issue, rather we should ask:
• “How do I share this with the patient?”
A. The physician should comply
B. Parents should have full decision control
C. The physician knows what is the best for the child
D. Parents should be allowed considerable time to accept
seriousness of child’scondition and to be honest to their
children
Fidelity in Nursing
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✓ Fidelity in nursing means that nurses must be faithful to
the promises they made as professionals to provide
competent, quality care to their patients.
✓ It directs us to model care delivery with altruism, loyalty,
caring, honesty and respect
✓ It speaks to the special relationship developed between
patients and their healthcare provider
✓ Fidelity is faithfulness, or loyalty. Each owes the other
loyalty; although the greater burden is on the medical
provider, increasingly the patient must assume some of
the responsibility)
✓ Root of fidelity is the importance of keeping a promise, or
being true to your word. The nurse must be faithful and
true to their professional promises and responsibilities by
providing high quality, safe care in a competent manner.
✓ It is important for the nurses to provide competent care to
the patient or client with honesty, responsible and fair.
✓ Health care professionals may find themselves caught
between what they believe is right, what the patient
wants, what other members of the health care team
expect, and what is required by organizational policy and
the law.
✓ Nurses need to put aside any negative feelings they might
have about such patients and adhere to the standard of
care.
✓ Nurses should talk with their team members if they
believe their feelings toward a patient could compromise
care.
✓ Fidelity requires nurses to treat all patients with respect
regardless of their religion, culture and belief.
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Principle of Fidelity can be formulated
in the following manner:
✓ One should keep his/her promises to others and maintain
the trust necessary to retain the relationships which binds
them together.
✓ This principle captures in a special way the element of
trust which must exist between persons who are mutually
bound to each other by circumstances or choice.
✓ It takes the form of the promise of confidentiality and the
pledge to keep the patient from harm, a pledge in which
patients place their most fervent trust.
Obligation that the Principle of Fidelity place upon the
Healthcare professional
✓ The element of trust is often transferred to the
technologies and the human relationship becomes
secondary or sometimes even lost.
✓ This phenomenon is further aggravated by the
vulnerability of the patient
✓ That there is nothing more important than the
relationship which exists between the caregiver and the
patient
✓ It is this relationship which is the medium for genuine
healing and fidelity is the glue which holds it together
JUSTICE
The maintenance of this ethical principle is seemingly simple in the
abstract and complex in application, as it deals with the concept of
fairness, just deserts and entitlement.
• Procedural Justice
• Distributive justice
• Compensatory justice
• Retributive justice
Justice in health care is usually defined as a form of fairness, or as
Aristotle once said, "Giving to each that which is his due.“ This
principle of justice can be applied to nursing process by providing
fair care to poor just like with the rich people.
It is equally possible to conceive of the principle of justice
(sometimes ‘social justice’) as having grounds in the fundamental
value of human autonomy. Thus, proposals for the unequal
treatment of people again require the burden of proof. Justice, to
the contrary, demands equal opportunities.
Justice is also the principle that covers normative aspects that are
often discussed in the terminology of solidarity and reciprocity.
- Justice, as a principle in healthcare ethics, refers to
fairness, treating peopleequally and without prejudice,
and the equitable distribution of benefits and
burdens,including assuring fairness in biomedical
research. Most of the time difficulthealthcare resource
allocation decisions are based on attempts to answer
questions regarding who has a right to health care, how
much health care a personis entitled to, and who will pay
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for healthcare costs.Remember, however, justice is one of
Plato’s cardinal virtues.This means that justice is a broad
concept in the field of ethics and is considered to be both
a principle and a virtue.
• The duty to treat all patients fairly
• Equal treatment of equal cases and equal
distribution of benefits - no discrimination on the
basis of sex, race, religion, age and socioeconomic
status
• Involves allocation of scarce and expensive health
care resources
Two Types of Justice
1. DISTRIBUTIVE JUSTICE addresses the degree to which
healthcare services are distributed equitably throughout
society.
Beauchamp & Childress (2013) identify six material
principles that must be considered, while recognizing that
there is little likelihood all six principles could be satisfied
at the same time.
a) To each person an equal share
b) To each person according to need
c) To each person according to effort
d) To each person according to contribution
e) To each person according to merit
f) To each person according to free-market
exchange
2. COMPARATIVE JUSTICE determines how healthcare is
delivered at the individual level. It looks at disparate
treatment of patients on the basis of age, disability,
gender, race, ethnicity, and religion.
BENEFICENCE
It came from the Latin word "benefactum" which means "good
deed". Comes from the Latin “benefices”, from bene (meaning
‘well’ or ‘good’) and facere (meaning ‘to do’).
Acting in such a way to benefit others while promoting their
welfare and safety.
The principleof doing good while preventing and avoiding
harm.
The principle of beneficence prescribes ‘above all, do good’; in
practice, it entails a positive obligation to literally ‘act for the
benefit of others’ viz contribute to the welfare and wellbeing of
others (Beauchamp & Childress 2001: 166).
Acts of beneficence can include such virtuous actions as: care,
compassion, empathy, sympathy, altruism, kindness, mercy,
love, friendship and charity.
“One should render positive assistance to others (and
abstain from harm) by helping them to further their
important and legitimate interests”
• Duty to actively do good for patients
• Primary goal of healthcare is to do good for
patients under their care
Consider this:
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Deciding what interventions should be provided for
patients when some of those interventions may cause
pain
Burn clients receiving mafenide acetate
• Give analgesics prior to wound care
• Stinging sensation when applied
This principle may create a duty when the law doesn’t - Doing
something out of duty at times
Often conflicts with the principle of autonomy
Beneficent act: A nurse prevents a patient from acting
on suicidal impulses
Good Samaritan Act
Examples:
Mon, a so-so swimmer, sees Marco drowning
Jay brings her lunch to school every day. One day, she
saw a thin boy watching her eat. The boy extends his
hands asking for food
Acts of beneficence include such virtuous actions as:
• Care
• Compassion
• Empathy
• Sympathy
• Altruism
• Kindness
• Mercy
• Love
• Friendship
• Charity.
Limitations of the principle of Beneficence
Thus there are some limits to the principle; that is, it is not ‘free
standing’ and its application can be appropriately constrained
by other moral (for example, utilitarian) considerations.
(1) Beneficence can be overridden by the patient's desire to
follow her own value agenda and priorities (according to the
principle of autonomy) which might be at variance with those
of the clinician.
(2) Clinicians are not acting beneficently if they are pursuing a
course of treatment for the patient which is futile or where the
burdens disproportionately outweigh the benefits for the
patient
(3) Clinicians are not required to act beneficently toward
patients by providing interventions which are scare resources,
e.g., certain kinds of transplant surgeries
NON- MALEFICENCE
• This principle holds that there is an obligation not to inflict
harm on others. It is closely associated with the
maxim primum non nocere (first do no harm). This principle
affirms the need for medical competence.
• •Comes from a Latin words:
• ‘non’ to mean ‘not’; malos’ from which ‘male’ is taken to
mean ‘bad/evil’ and ‘faceo’ from which ‘fic’ comes which
means ‘do/make’.
• maintaining a trusting client-provider relationship, and
restoring client dignity.
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• Duty to prevent or Avoid Harm Whether Intentional or
Unintentional
• Does not mean avoidance of harm altogether… avoidance
of harm unless the action promises a greater good
• Different issues on euthanasia, withholding and
withdrawing treatment and the use of artificial nutrition
and hydration
Consider this:
• Is it harmful to accept an assignment to “float” to an
unfamiliar area that requires administration of unfamiliar
medications?
• Is it acceptable to refuse an assignment?
• Go but choose patients that you could handle
• Only do something within your capability
• General Rule: If what you did is what a prudent nurse have
done in the same situation, you are covered – Nursing
Jurisprudence
Examples:
• Tony has AIDS. He is bedridden and emaciated. He asks
the doctor to give him medicine to end his life
• Perla has a lump in the breast. When she consults at a
public hospital, the doctor asks 8 medical students to feel
the lump
• Ben has a urethral secretion, which reveals gonorrhea.
Clara, the clinic nurse on duty, is a good friend of Fe, Ben’s
wife. Fe asks Clara for the result of the test
Case:
Nino, a 52-year old male is in coma in the ICU with a massive
inoperable intracranial bleed. His attending physician orders IV
fluid, medications, intubation and respirator support. He talks
to the family to inform them of the poor prognosis and
probability the patient is going to die in 1 week. The wife insists
that all aggressive measures be done. She has 7 children but no
means of support. What should the doctor do?
A. Do as the wife insists
B. If treatment is useless and impose excessive burden,
recommend stopping the tx
C. Transfer the patient to another MD
D. Transfer patient to the Service ward
• Withholding treatment is an act of omission while
withdrawing treatment is an act of commission.
• Treatment is not only in terms of medications but also
utilization of equipment, intubation, ventilators and
feeding tubes
Two Major Points of NON-Maleficence
1. It acts as a threshold for treatment.
2. non-maleficence is constant in clinical practice.
Criteria in Determining Negligence
The professional must have the duty to the affected party
2. The professional must breach that duty
3. The affected party must experience a harm
4. The harm must be cause by the breach duty
The Principle of Double-Effect
✓ This doctrine says that if doing something morally good
has a morally bad side-effect it's ethically OK to do it
providing the bad side-effect wasn't intended. This is true
even if you foresaw that the bad effect would probably
happen.
There are four conditions that usually apply to the principle of
double effect:
1. The nature of the act.
2. The agent’s intention.
3. The distinction between means and effects.
4. Proportionality between the good effect and the bad
effect.
Additional Notes/Reminders:
1. PPT notes are in BLACK
2. Lecture notes are in RED
3. Information retrieved in books are in BLUE
References

PRINCIPLE OF PROPORTIONALITY
• Do all available means have to be used all the time? Transers
• How long these means should be used?
• Is treatment effective? Cuntapay, Galupo, Molina, Rafanan, Pazzibugan, Zacarias
• Will it impose unacceptable burden?

Euthanasia & Assisted Suicide

• Orthothanasia – letting the incurably diseased person “die
his own death’ while making no extra efforts to prolong
his life.
• Passive Euthanasia – refraining of any medical treatment
aimed at retarding death
• Active Euthanasia – terminating a person’s life in a
painless way, at his request & with the intention to
prevent person from suffering

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