MAY JACKLYN C.

RADOC, RN, RPT

BIOETHICS
 PHILOSOPHY
 Cosmology
 Logic
 Ethics – Moral Philosophy
 Epistemology
 Aesthetics
 Theology
 ETHICS
 Research Ethics
 Medical Ethics
 Bioethics
 Professional Ethics
 ETHICS
 PRACTICAL and
 NORMATIVE science

 Based on REASON

 Studies HUMAN ACTS

 GOODNESS vs. BADNESS

 RELIGIONIST – There is only ethics
with GOD

 ETHICIAN – There is ethics without

GOD
 ETHICS – critical reflection of right and
wrong (Fletcher)

 MORALS – what one believes to be

right and wrong
 ACTS
 HUMAN ACTS – done with
KNOWLEDGE and WILL; with
VOLITION
Person is held morally responsible

 ACTS OF MAN – done without above

conditions
Person is NOT held morally responsible
 IGNORANCE
 VINCIBLE IGNORANCE – can be
overcome with effort
Person is held morally responsible

 INVINCIBLE IGNORANCE – cannot be

overcome with effort
Person is not held morally responsible
 THE DEMAND FOR
MORALITY
 ANSWER OF DIVINE COMMAND
The CREATION argument – since we are
created by God, we should obey God
The OBEDIENCE argument – we should
love God, and therefore obey

 ANSWER THAT MORALITY PAYS

Act from self interest
GOOD DEEDS are REWARDED
 FAIR PLAY or COMMON INTEREST
Life is a game of rules, we should play by
the RULES

 BECAUSE IT IS RIGHT ARGUMENT

A person should acts simply because it is
the right thing to do
MAY JACKLYN C. RADOC, RN, RPT

DIVISION OF ETHICS
 DIVISION OF ETHICS
 I. METAETHICS
RELATIVISM – ethics is relative according
to CULTURE
Ex. Eskimos abandon old people in the
snow and allow them to die
Ex. Israelites and Muslims marry his
brother’s widow
Ex. Offering of virgins to volcanoes
Ex. Japanese women with terminal illness
kills young child
 PSYCHOLOGICAL ISSUES
EGOISM – man is self-centered; actions are
directed for self-interest
HEDONISM – Pleasure!
ALTRUISM – man is capable of showing
sincere and pure goodwill; instinctive
benevolence
 NORMATIVE ETHICS
VIRTUE ETHICS – ARETAIC ETHICS
VIRTUE – acquired good habits
VICE – opposite of virtue
Ex. WISDOM, COURAGE, TEMPERANCE,
JUSTICE, FORTITUDE, GENEROSITY,
SELF-RESPECT, SINCERITY
 DUTY/DEONTOLOGY/
NONCONSEQUENTIALIST

 IMMANUEL KANT
 Gr. DEON means DUTY – moral
obligation
 SENSE of DUTY
Look at the MOTIVE
 CATEGORICAL IMPERATIVE
UNIVERSAL APPLICATION
UNCONDITIONALALITY
DEMANDING AN ACTION

Ex. Lifeguard: Should lifeguards rescue?

Unconditional? Requires actions of a
lifeguard?
Ex. Stealing: Should all steal?
Unconditional? Required actions of all?
 RULE-DEONTOLOGY
 WILLIAM DAVID ROSS
 Actual Duty – Duty Proper
One’s real duty
 Prima Facie Duty
Directs what one ought to perform

 Act in accordance with the stronger/severe

PF duty
 Act in accordance with greater weight of
rightness
 PRIMA FACIE DUTIES
 FIDELITY – faithful to duties
 REPARATION – undoing
 GRATITUDE – appreciate
 JUSTICE – equitable distribution
 BENEFICENCE – do good
 NONMALEFICENCE – do no harm
 SELF-IMPROVEMENT – develop
ourselves
 THEORY OF JUSTICE

 JOHN RAWLS
 Original position – “Veil of Ignorance”
 Egalitarian
 Equal access to the basic human rights
and liberties
 Fair equality of opportunity and the
equal distribution of social inequalities
 Triaging

 Medical prognosis or medical utility

 Social utility or social worth
 First come, first served
 Ability to pay
 Laws: Justice

 Article XIII
Gives priority to females, pregnant, elderly,
the sick, the disabled, children, paupers
 National Health Insurance Act of 1995
 Republic Act 7432 – Senior Citizens Act
 NATURAL LAW ETHICS

 ST. THOMAS AQUINAS

 REASON – MORAL LAW
 “The good must be done and evil
avoided”
 Voice of conscience – voice of reason
 In accord with human nature
Self preservation, just dealing with others,
propagation of our species
Determinants of Moral Action

 The OBJECT
Specific action, the means, what the person
chooses to do
 The END
The purpose, intention, motive
 The CIRCUMSTANCES
Who, where, when, what, why, how
 TELEOLOGICAL/
CONSEQUENTIALIST

 Gr. TELOS – GOAL or END

 “The right thing to do is the good thing to
do”
 SITUATIONALISM

 JOSEPH FLETCHER
 Moral norm depends on the situation
 Should act in the name of Christian Love
Eros
Philia
Agape
 PRAGMATISM
 CHARLES PIERCE and WILLIAM
JAMES

 Experimental Beneficial
 Instrumental Workable Good
Practicable
 Ex. Drug Testing, Family Planning
 UTILITARIANISM

 JEREMY BENTHAM and JOHN

STUART MILL
 Utility – Usefulness to promote
happiness
 “The greatest good for the greatest
number of people”
 At the sacrifice of a few
 SOCIAL CONTRACT
THEORY
 JEAN JACQUES ROUSSEAU
 CODE OF ETHICS
 CODE OF GOOD GOVERNANCE
Promulgated by PRC
 General Principles
Service to Others
Integrity and Objectivity
Professional Competence
Solidarity and Teamwork
Social and Civic Responsibility
Global Competitiveness
Equality of All Professions
 1982, PNA Special Committee, Julita Sotejo
– Code of Ethics; approved by PNA; not
implemented
 1984, BON, PRC adopted Code of Ethics of
ICN through BR 633; adding promotion of
spiritual environment as 5th-fold
responsibility
 1989, COE of PNA, approved by PRC
through BR 1955
Approved by general assembly of PNA during
Nurses Week, October 25, 1990
 October 23, 2003, Iloilo City, COE adopted
under RA 9173 through BR 220
MAY JACKLYN C. RADOC, RN, RPT

UNIVERSAL PRINCIPLES
OF BIOMEDICAL ETHICS
 AUTONOMY
 Gr. Autos – self; nomos - governance
 Self-determination or self-governance
 Manifested as informed consent
Age qualifications
Disclosure
Comprehension
Voluntariness
Competence
Freedom from duress, force, coercion,
deception
 Exceptions to Autonomy
 Therapeutic Privilege
In case of emergency
Incompetence
Waiver
Implied consent
Outlaws

 PATERNALISM – intentional limitation of

autonomy; appeals to benefits
 VERACITY
 TRUTH-TELLING
 The patient has the responsibility to
provide, accurate and complete
information about his complaints, past
illness, previous hospitalizations,
medications being taken, allergies,
religious restrictions, etc.
In case the patient, the family and SO
should do so
 The physician should tell the patient and
his family the diagnosis, length of
treatment, possible expenses,
alternatives, possible risks

 BENEVOLENT DECEPTION or
PATERNALISTIC LIE
 WHISTLE-BLOWING
 BENEFICENCE

 DOING GOOD
 Positive statement
 Promoting the Patient’s Bill of Rights
 Considerate and respectful care;
 Understandable information
 Information before procedures/treatment
 In case of refusal – alternatives!
 Privacy concerning medical care
 Communications and records are confidential
 The hospital should make reasonable responses
to requests for services
 Obtain information about relationship
 Be advised in human experimentation
 Reasonable continuity of care
 Explanation of his bill
 Right to know rules/regulations
 NONMALEFICENCE

 DO NO HARM
 Negative statement
 Ex. Not assisting in abortion,
euthanasia, suicide, revealing
confidential information;
 JUSTICE

 Fairness
 Equality
 CONDIFENTIALITY

 PRIVILEGED COMMUNICATION
 If the patient insists on knowing his
diagnosis, the nurse may only repeat
what the doctor wants to disclose
 All information during professional
interaction is confidential, this extends
up to patient’s death
 Exceptions to Confidentiality
 The patient permits the revelation
 The case is medico-legal (suicide,
gunshot), to be reported to police or NBI
 The patient is ill of communicable
disease and public safety may be
jeopardized
 Given to members of health team if
information is relevant to his care
 Article 4, Section 4 of New Constitution
 Principle of Double Effect
 Acceptable if:
The act itself is morally-good
The good effect must be willed and the bad
effect merely allowed
The good effect must not come from an evil
action
The good effect must be greater than the
bad effect
 Principle of Totality

 The whole is greater than the sum of its

parts
 Ex. Amputation; removal of breasts
 Principle of Stewardship

 God gave man dominion over His

creations
 Man should take care of his life and
health
MAY JACKLYN C. RADOC, RN, RPT

MORAL PRINCIPLES
 THE GOLDEN RULE
 EPIKIA
 ONE WHO ACTS THROUGH AN AGENT IS
HIMSELF RESPONSIBLE
 NO ONE IS OBLIGED TO BETRAY HIMSELF
 DEFECTS OF NATURE MAY BE
CORRECTED
 IF ONE IS WILLING TO COOPERATE IN THE
ACT, NO INJUSTICE IS DONE TO HIIM
 A LITTLE MORE OR LESS DOES NOT
CHANGE THE SUBSTANCE OF AN ACT
 NO ONE IS HELD TO THE IMPOSSIBLE
MAY JACKLYN C. RADOC, RN, RPT

ETHICS IN NURSING
RESEARCH
 NUREMBERG CODE, 1949
Consent process, protection from harm, risk
to benefit

 DECLARATION OF HELSINKI, 1964

Differentiation of therapeutic to
nontherapeutic research
 Rights of Research Subjects

 Right to Informed Consent

 Right to refuse or withdraw from the
study
 Right to privacy, confidentiality,
anonymity
 Right to protection from harm
 Vulnerable Subjects

 Mentally ill
 Unconscious, comatose
 Mentally retarded
 Institutionalized persons
 Pregnant mothers
 Fetuses – needs third party to consent
 Scientific Misconduct

 Fabrication – making up of data

 Falsification – changing of data
 Plagiarism – copyright infringement,
violation of intellectual property
Averted by citation and seeking permission
to copy statements
MAY JACKLYN C. RADOC, RN, RPT

ETHICAL DILLEMMA
 ETHICAL DILLEMMA

 MORAL ISSUE - A case problem that

demands a moral decision

 MORAL REASONING – the balancing

and weighing of diverse reasons to
support one’s moral action
 Moral Issue of Abortion
 Termination of pregnancy prior to
viability; viable – 28th week/7th month

 Natural/spontaneous abortion –
miscarriage
 Therapeutic abortion
 Eugenic abortion – because of defects
 Indirect abortion
 Issue of life
 Immediate hominization
 Delayed animation
 Implantation
 “Looks human”
 Electrical activity – 8th week
 Quickening – 10th to 12th week
 Viability – 28th week
 Birth
 Curettage prior to implantation absolves
abortion on rape/incest cases

 Viewpoints of abortion
Pro-Life
Pro-Choice
 Moral Issue of Euthanasia

 Easy death
 Active, voluntary euthanasia
 Passive, voluntary euthanasia
 Active, involuntary euthanasia
 Passive, involuntary euthanasia
 Advanced Directives
 Written instructions recognized under
state law; defines care if person
becomes incapacitated
 Living Will – a document prepared by a
competent adult that defines care if
person becomes unable to make
decisions
 Durable power of attorney – health care
proxy
 Hospital Codes
 Code – all efforts of reviving patient are
given; ACLS – oxygenation, ventilation,
cardiac massage, electroshock, drugs
 No Code – DNR
 Slow Codes – theatrical provision of
resuscitation
Chemical Code – provision of drugs but not
other services
 Organ Procurement
 Arrange for consent
 Provide for grieving
 Respect intrinsic worth and dignity of
donor
 The donor must be cared for before,
during, and after donation
 Harm and risk should be minimal
 Moral Issue of Contraception

 Contraception
 Family planning
 Planned parenthood

 Birth control
 Therapeutic sterilization
 Contraceptive sterilization
 Eugenic or social sterilization
 Punitive sterilization
 Justification
 Parenthood and birth are matters of
moral responsibility
 An individual should be able to
determine his/her fertility
 One should be able to decide how many
children they can bear and support
 Contraception checks the transmission
of genetically-linked disorders.
 Methods
  IUD
Douche
  Ligation
Lactation
amenorrhea  Vasectomy
 Withdrawal  Hysterectomy
 Condom  Rhythm/calendar
 Diaphragm  BBT
 Suppository or tablet  Mucus method
 Creams, jellies,  Sympto-thermal
foams
 Pills
 Injections and
implants