Ethical Principles

Joyce D. Cajigal,RN
 Proxy Consent / Legally Acceptable Representative

• The Mental Capacity Act was written to protect and empower vulnerable
people who may not be able to make their own decisions (Department of
Constitutional Affairs (DCA) 2005).
• If a person lacks capacity to make decisions or is incompetent then every
effort is made to find out what that person would like to happen and then
continue to treat that person with the same respect as any other person.
• People who are incapacitated and over 16 years of age can appoint a person
to make decisions for them, which includes health-related issues. That
person could be their parent or foster parents or a person appointed by a
court. Consent must be obtained from this appointed person if and when
the need arises.
Confidentiality
Keeping privileged information private

• The literal meaning is con (Latin) meaning completeness

and fidere meaning to trust, to be faithful, so
confidentiality implies giving information to someone
who is considered completely trustworthy and loyal.
• The public expect nurses and health professionals to
maintain confidentiality about their diagnosis and
personal circumstances. One of the first statements
written in the code of conduct for nurses (NMC 2008: 3)
states: ‘you must respect people’s right to
confidentiality’.
 Four Conditions cited to justify the violation of confidentiality

• When keeping the secret may be detrimental to the

common good;
• When the subject of the secret intends to inflict grave
injury upon an innocent third party;
• When it is necessary for the subject of the secret avert
grave injury
• When it is necessary for the one keeping the secret to
avoid grave injury
Veracity
• the obligation to tell the truth. Meaning
TRUTHFULNESS.
• To be true is to accept one’s self as one is.
To respect veracity in relationships is to
deal honestly to patients and colleages as
they are.
 Fidelity (the obligation not to deceive and to keep promises).

• One tries not to promise anything unless one can keep to it.
• By fidelity, we mean the obligation to act in good faith and
to keep vows and promises, fulfill agreements, maintain
relationships and fiduciary responsibilities.
• The model for fidelity
– Keeping one’s word of honor
– Loyalty to commitments
– Reliability
 Fidelity (the obligation not to deceive and to keep promises).

• Fiduciary responsibilities refers to the contract of

relationship we enter into with the patient.
• Fiduciary relationship bank of trust and confidence.
This means that once the physician or nurse enters
into a relationship with the patient, these
professionals become the trustees of the patient’s
health and welfare.
Justice

• Seeks fairness. Treats “equals” equally.

Treats “un equals” according to their
differences.
• It signifies fairness which also to give to
each one what he deserves.
• In general, justice refers to what is owed or
due to the individual members of society
Four types of Justice

1. Cumulative Justice- refers to what is owed between

individuals, e.g. In conducting business transactions
2. Contributive Justice- refer to what individuals owe to
society for the common good.
3. Legal Justice- refers to rights and responsibilities of
citizens to obey and respect the rights of all and the laws
devised to protect peace and social order.
4. Distributive justice – refers to what society owes to its
individual members; e.g. the just allocation of resources
• Principle of justice refers to a moral principle by
which certain actions are determined and deemed as
just or unjust, as due or undue.
 Beneficence (Doing Good )
“DO NO HARM AND PRODUCE THE GOOD “ OR “DO GOOD AND DO
NO HARM”.
• Refers to action that benefits others based on the Hippocratic
Oath to “apply measures that will benefit the sick”.
• Is the practice of doing acts of goodness, kindness, and charity.
• Duty of beneficence implies the obligations of:
– acting for the benefit of others;
– helping others further their important and legitimate interests;
– acting in the interests of others.
 NON- MALEFICENCE (“DO NO HARM”)
• Refers to prevention of harm and the removal of
harmful conditions.
• The duty of non-maleficence is the obligation not to
cause harm to another person.
• Beauchamp and Childress (2009: 151) claim that the
duty of non-maleficence: ‘requires...intentionally
refraining from actions that cause harm’
 Principles of Double effect

• The principle applies to a situation in which a good

effect and an evil effect will result from good cause.
• We may have a good action which will yield two
effects, a good one and an evil one. According to the
principle, under certain conditions, some evil effect
voluntary in cause- may be permitted to occur.
 Principles of Double effect

Example: The case of a woman who is three months

pregnant and is found to have a cancerous uterus. To
save the woman’s life, her uterus must be removed at
the earliest possible time; but to do so, the life of the
fetus would be sacrificed.
 Principles of Double effect

• In the resolution of these kinds of conflict, four conditions of the

principle at issue must be met:
A. The act itself must be morally good or at least morally indifferent.
B. The bad effect is sometimes said to be indirectly voluntary.
C. The good effect must follow from the action at least as
immediately as the bad effect.
D. The good effect must be sufficiently desirable to compensate for
the allowing of the bad effect.
 
Principles of legitimate cooperation

• Cooperation comes from the latin word

CUM which means “with” and OPERARI
which means “to work”.
• Cooperation- is working with another in the
performance of an action.
Principles of legitimate cooperation

• The degrees of cooperation may vary according to the gravity or essentiality

of the shared act in the performance of an evil action.
1. Formal cooperation -consist of an explicit intention and willingness for the
evil act. The one formally cooperating categorically wills and intends the
evil action.
Example: a medical doctor who wills and intends the evil act of
contraception by means of hysterectomy at the request of a n interested party,
by arranging with the members of the operating room team as to the
operation and its schedule.
Material Cooperation – consists of an act other than the evil act itself but
facilitates and contributes to its achievement. The one materially cooperating
may provide means apart from the evil act itself which is used to carry out the
performance of an evil act.
Principles of legitimate cooperation

2. Direct and indirect –

• Direct cooperation- consists of direct participation in the
performance of an evil act. The one directly cooperating
gets involved by openly and straightforwardly taking part
in the practice of an evil action.
• Indirect Cooperation- consist of an act that is not
intimately connected with the performance of an evil act
as in formal or direct cooperation but whose effect may
have an indirect bearing upon it.
Principles of legitimate cooperation

3. Proximate and remote

• Proximate Cooperation- consists of an act
that is intimately linked with the performance
of an evil action due to its close bearing.
• Remote Cooperation- consists of an act with
a distant bearing upon or connection with the
execution of an evil act.
Moral rules governing cooperation

• No one should formally and directly cooperate in

the performance of an evil action.
• If a reason sufficiency grave exists, material
cooperation in the performance of an evil action
may be morally excused.
• If the material cooperation is proximate a reason
sufficiently graver should exist so as to be morally
excused without which evils is incurred.
Principle of Common Good and Subsidiarity
• Often considered a corollary of the principle of the common
good, subsidiary requires those in positions of authority to
recognize that individuals have right to participate in decisions
that directly affect them, in accord with their dignity and with
their responsibility to the common good.
• Decisions should be made at the most appropriate level in a
society or organization, that is ,one should not withdraw those
decisions or choices that rightly belong to the individuals or
smaller groups and assign them to a higher authority.
Principle of Common Good and Subsidiarity
Example: In an effort to control the apparent rapid
population growth in the country, the State formulates
program on responsible parenthood which rebounds to the
enactment of a law mandating every family to just limit the
number of its offspring only to one or two under pain of
penalty. And so, the State through the Department of Health
conducts contraceptive methods to ensure the State-
directed number of children every family ought to raise.
Principle of Stewardship and Roles of Nursing as Stewards

• The principle of stewardship declares that human

life comes from God, and no individual is the
master of his/ her own body.
• Humans are only mere stewards or caretaker, with
the responsibility of protecting and cultivating
spiritual and bodily functions. We are obliged to
take good care of ourselves, to maintain a sound
mind and body, and to safeguard our dignity.
Principle of Stewardship and Roles of Nursing as Stewards

In health care practice Stewardship refers to

the execution of responsibility of the health
care practitioners to look after, provide
necessary health care services, and promote
the health and life of those entrusted to their
care.
 Principle of Totality and Integrity
• These principles dictates that the well -being of the
whole person must be taken into account in deciding
about any therapeutic intervention or use of
technology.
• Therapeutic procedures that are likely to cause harm
or undesirable side effects can be justified only by a
proportionate benefit to the patient.
 Principle of Totality and Integrity
The principle of totality
• The whole is greater than any of its parts.
• Suppose a man’s foot is gangrenous, should he
consent to an amputation? Since the amputation will
save the patient’s life and he can still walk through
the aid of crutches or artificial limb, he can consent
to an operation.
 Principle of Totality and Integrity
a. Ethico-moral responsibility of nurses in surgery
 Principle of Totality and Integrity
Contraception – defined as the voluntary prevention of
conception by the positive use of artificial means which
hinder the generative cells from uniting during
the sexual act.
 
 Principle of Totality and Integrity
Sterilization / Mutilation
• is defined as the mutilation of sexual power in a man
or woman so as to render conception impossible
• Sterilization is also a form of contraception insofar as
its purpose is the prevention of conception- not by
the positive use of artificial methods but by cutting
off the sexual capacity in a man or a woman.
 Principle of Totality and Integrity
Types of Sterilization, As to decision or volition (Bittle:
387-390).
1. Voluntary sterilization is that in which a person wills
and requests that the procedure be done on himself or
herself.
2. Involuntary/ Compulsory sterilization- is that which
is done by order of the public authority of state.
 Principle of Totality and Integrity
As to purpose or ends:
1. Therapeutic Sterilization/contraceptive – means the
removal of a reproductive organ or a portion thereof in
order to save one’s life or to promote bodily integrity.
 Principle of Totality and Integrity
Justifications:
1. Serious illness of either husband or wife- who may, for example, be tubercular ,epileptics,
syphilitics and lepers. These are also humans who have the right to marry and to be happy.
Due to their communicable diseases, they have to undergo contraceptive sterilization in
order to prevent the conception of offspring affected with the same diseases.
2. The probability of genetic abnormality. An individual for instance, who is contemplating
marriage and who has been diagnosed to be carrirer of defective genes may avail of
contraceptive sterilization so that the birth of malformed or abnormal babies can be
prevented.
3. Severe financial burden. A couple, for example, may not be financially capable to support
another child, so they resort contraceptive sterilization.
4. When child bearing puts one’s health in danger. This is particularly true when a wife is sickly
or physically weak, and hence unable to bear a child without risking her life.
 Principle of Totality and Integrity
2. Eugenic and social sterilization – are performed for the
purpose of hindering the conception of undesirable and
physical or mentally infit offspring. This is sort of social
engineering- i.e., to design a society that is free from
individuals afflicted with social disease or grave, mental
defects, such as lepers, idiots, imbeciles, morons, and insane
persons. Also included here other mentally incompetents and
those with congenital, inherited or acquired, incurable,
communicable diseases, and carries of defective genes.
 Principle of Totality and Integrity
3. Punitive Sterilization- on the other hand is done as a
punishment for crime or antisocial behavior, particularly
rape and other sex related offenses. This is compulsory
or involuntary sterilization. A few Catholic theologians
have defined punitive sterilization under the double
effect principle: the sterilization is not “direct” since the
primary and intended effect is punishment, and the
contraceptive effect therefore is “indirect” or secondary.
• The moral issue of contraception is
concerned with the rightness or wrongness
of the use of various methods by which
conception can be prevented in the
conjugal union.
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