BIOETHICS
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THE ORIGIN AND NATURE OF ETHICS
ETHICS comes from the Greek word ethos (character). It is concerned with
the development of a virtuous and moral character.
The Greeks believed that developing character would lead one not
only to knowing the right thing to do, but to actually doing the right thing
or living the right way of life.
Socrates – the Greek moralist, was the first to recognize the value of questions
that affect how a person should live. He introduced the Socratic method.
This consists of asking people about ideas they presumably know about.
Socrates demonstrated the importance of applying the critical method of
rational inquiry. By tearing down man’s unfounded assumptions, man comes
closer to the truth.
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A. DEFINITION OF TERMS
Ethics
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is the theory of right conduct or the Philosophy of Morals.
the standard of character set by a particular society of men.
a science of moral duty, of ideal human character and standards of human
conduct.
study of moral judgments.
a way of life based on a religiously-inspired moral code.
a study of the methods and principles used to distinguish good from bad,
right from wrong actions.
these are the principles underlying the desirable types of human conduct.
Studies of human acts or conduct from a moral perspective as to whether
they are good or they are bad.
Commonly associated to customs, morals and etiquette
Customs are acts approved by a group or society
Etiquette is social observance required by good breeding (table manners;
dress codes, etc.)
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Biology
• Science of life: the science that deals with all forms of
life, including their classification, physiology, chemistry
and interactions.
• Life in one place: the forms of life in a particular
environment and their behavior, development and
history.
• Particular organism’s make-up: the structure and
functioning of a particular organism.
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Bioethics
term first used by the biologist Van Rensselaer Potter
that refers to a new field devoted to human survival and an improved
quality of life.
• The branch of ethics that refers to the broad terrain of the moral
problems of life sciences ordinarily taken to encompass medicine,
biology and some aspects of the environmental population and social
sciences.
• It addresses the moral and ethical issues arising from clinical practice,
medical and biological re-search, resource allocation, and access to
biomedical technology.
• A branch of ethics concerned with issues surrounding health care and
the biological sciences. These issues include the morality of abortion,
euthanasia, in vitro fertilization, and organ transplants.
• A science that deals with the study of morality of human conduct
concerning human life in all its aspects from the moment of conception
to its natural end.
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• is the term used to describe the application of ethics to biological
sciences, medicine and other fields.
Health Ethics
• is a science that deals with the study of the morality of human conduct
concerning health and health care.
Health Care pertains to medical services, nursing care, and all other
types of health services given by health care practitioners such as
medical doctors, nurses, midwives and all the rest who, in one way or
another, engage in any duly recognized form of health care practice.
• Health Ethics is employed to regulate human conduct in the practice of health
care so that good may be done and evil maybe avoided thereby ensuring that
the purpose of health care, which delves into the alleviation of suffering,
prevention of sickness, and promotion of health, is being met in the light of
fundamental principles of morality.
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Relation and Distinction of Bioethics and
Health Ethics
RELATION
DISTINCTION
HEALTH ETHICS
BIOETHICS
a. Both are concerned
about health and life.
a. Health ethics is
concerned about life
only in relation.
a. Bioethics is concerned
not just about health
but also about other
fields in relation to life.
b. Both regulate human
conduct by means of
moral principles in
relation to health and
life.
b. Health ethics regulates
human conduct in the
practice of health care.
b. Bioethics regulates
human conduct not
only in the practice of
health care but also in
all aspects of human
life.
c. Health Ethics is a part
of Bioethics.
c. Bioethics is not part of
health ethics. It has an
encompassing scope
of discipline.
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Professional Ethics
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Being a member of a certain professional discipline carries with it special
responsibilities. One abides by some general principles that serve as
reminders of the variety of responsibilities assumed as members of the
profession.
Guided by a deep conviction of the worth and dignity of the advancement of
knowledge, recognize the special responsibilities placed upon them.
The primary responsibility to the professional discipline is to seek and to state
the truth as they see it.
As members of the profession, devote their energies to developing and
improving their scholarly competence.
Accepts the obligation to exercise critical-discipline and judgment in using,
extending and transmitting knowledge.
Practice of intellectual honesty.
Interests must never seriously hamper or compromise their freedom
of inquiry.
Branch of moral science that treats of the obligations which a member
of a profession owes to the public, to his profession and to his clients.
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Why do we need to study Ethics?
• We live in a world where we must not only make decisions, but where
there are right ways and wrong ways of doing things.
• In order to have an orderly social life, we must have agreements, undertakings, principles, or rules of procedure.
• Moral conduct and ethical systems, both of the past and that of the
present, must be intelligently appraised and criticized.
• Ethics seeks to point out to men the true values of life… it attempts to
stimulate moral sense, discover the true values of life, and inspire men to
join in quest for these values.
• Ethics is essential to the practice of health care for it provides knowledge
of the morality of an act and serves as a guiding principle for health care
practitioners to observe in addressing health care issues that are, in the
first place, moral issues where the forces of goodness should prevail over
the forces of evil.
• Adherence to ethics gives proper direction and fundamental ways to live an
upright life in the health care profession thereby being conformed to the
marvelous order of reason, of human nature, and of man’s final destiny.
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B. The Human Person
Personhood
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As health care professionals we must care for human persons in a scientific
and humane way.
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Human person has an inner worth and inherent dignity.
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As a human person he must be respected regardless of the nature of his
health problem, social status, competence, past actions, etc.
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Health must aim at the maximum integrated satisfaction of his needs:
biological, psychological, social and spiritual.
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Human Acts
• Is an act which proceeds from deliberate free will of man.
• Not all acts of man are human acts.
• Human acts must have the following elements:
a. knowledge – of what it is about and what it means.
b. freedom – to do or leave it undone without coercion or
constraint. It implies voluntariness which is to rationally
choose by deliberate will the object.
Voluntariness does not necessarily imply freedom .
Note: the more complete the elements are, the greater is the
person’s responsibility for the act.
Essential Attributes of the Human Acts:
1.
2.
3.
It must be performed by a conscious agent who is aware of what he is
doing and of its consequences.
It must be performed by an agent who is acting freely, that is, by his own
volition and powers.
It must be performed by an agent who decides willfully to perform the act.
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c. Conscience
• according to Panizo, is the personal practical
judgment of reason upon a particular individual
act as good and to be performed or as evil and
to be avoided.
• It involves:
➢Reasoning about moral principles
➢Understanding the particulars of the case
➢ reaching a specific decision
• is the proximate norm of morality. Its function is
to examine, to judge and to pass “sentence” on
all moral actions.
• According to Tillich, the word conscience is
derived from the Latin word “conscientia” which
means “Trial of Oneself” both in accusation and
defense.
• It is but an extension of the Natural Law which
guides man to seek the good of nature.
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Types of Conscience:
1. Correct or True Conscience judges what is good and what is
evil.
2. Erroneous Conscience judges incorrectly that which is good as
evil and what is evil as good.
Types of Erroneous Conscience:
a. Inculpable Conscience – whose error is
not willfully intended. It is an involuntary error.
b. Culpable Conscience - whose error is due to
neglect, or malice. It is voluntary error on the
part of the person.
c. Certain Conscience - is a subjective assurance
of the lawfulness of an act.
d. Doubtful Conscience is one which leaves a
person undecided to the proper course of action.
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e. Scrupulous Conscience is a rigorous conscience, extremely
afraid of committing evil.
f. Lax Conscience is one which refuses to be bothered about the
distinction of good and evil.
Obligation Relative to Conscience
When our conscience is honestly and correctly formed, we are obliged to
follow it in any circumstances. Once we are convinced that we have a
obligation to do a certain action, we are duty bound to act upon our convictions.
Education of Conscience:
1. One has the obligation to cultivate a clear and true conscience
2. Cultivation of good habits
3. Militate against evil, condemning it where we find it and fight it.
4. We must learn how to use our freedom.
Human Freedom according to Haring: if it is true freedom in action, is not
the coercive pressure of external force, but self-fulfillment through inner love of
the good in accordance with the pattern of divine holiness which is the External
Law reflected in Man’s own nature.
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Moral Distinctions of Human Acts
Human Acts may either be in conformity or not with the
“Dictates of Reason”
Dictates of Reason refers to the shared
consciousness of prudent people about
the propriety of a certain action or manner
of behavior. It stands for the norm of morality
which is the standard by which actions are
judged as to their merits or demerits.
Classifications of Actions in Relation to the Norm of Morality:
1. Moral Actions – those actions which are in conformity with the
norm of morality.
2. Immoral Actions – are those actions which are not in
conformity with the norm of morality.
3. Amoral Actions – are those actions which stand neutral in
relation to the norm of morality.
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Determinants of Morality
1. The Act Itself or the Object
Physical sense some actions are bad because they produce
such evils as pain, hunger, illness or death.
Moral sense –actions are bad because they disturb the
harmony within the acting person.
Moral Evils can become:
Intrinsic Evil – implies a quality inherent in a thing; an
act which is evil by its nature.
Extrinsic Evil – an act which in itself is not evil but is
made evil nonetheless on account of something.
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Situational Analysis:
ELEMENTS OF HUMAN ACT
SITUATION
Carlo, a second year nursing student has
means the act is done in the light of the learned how to do the intramuscular
agent’s knowing faculty. He is aware and injection during RLE class demonstration.
conscious of what he is doing. He knows And he does the act of injecting during his
tour of duty in the hospital. In the first place,
what he is performing means.
he is aware and conscious that he is
injecting intramuscularly and what it means.
He knows what he is doing.
What is the knowing act?
KNOWLEDGE
FREEDOM
means that the act is performed in
accordance with and not against the will. It
is under the control of the will determining
the act. In other words, the power resides in
the will to choose to do or not to do an act.
It is therefore, a free act done without any
element of force or coercion.
Though he is following the doctor’s order of
doing the act of intramuscular injection
under the supervision of his clinical
instructor, Carlo does the act of injecting.
Where is freedom applied?
Situational Analysis:
ELEMENTS OF HUMAN ACT
SITUATION
VOLUNTARINESS
Carlo is aware how to do the act of
administering intramuscular injection and
what it means (knowledge). In the first
place, he can choose to do or not to do it
(freedom). Though, he is perhaps,
following doctor’s order and instruction from
his clinical instructor, he is still free to do or
not to do the act. (His sense of duty does
not even take away his being physically
free to choose to perform his duty or leave
it unperformed). Now, knowing what
intramuscular injection means and how it is
administered, and being free to choose to
do or not to do, the act as determined by
his will, Carlo decides to do the act of
injecting.
What is the voluntariness of the act?
means that the act done by the agent is
intentional. When he voluntarily performs
an act, the agent intends it as a product of
his decision which is within the power of his
will. In other words, it proceeds from the
employment of knowledge and freedom.
The agent cannot voluntarily do an act if he
does not know it in his intellect. He cannot
also voluntarily do it without his freedom.
Voluntariness is there only when knowledge
and freedom are present.
Two Rational Faculties of Man
INTELLECT is a rational faculty that tends towards the truth as its
object. It is commonly called mind or intelligence.
FREE WILL is a rational faculty that tends towards the good as its
object.
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Acts of Man is an act that does not proceed from the deliberate free
will of man. In contrast with human act, act of man does not require
the employment of the rational faculties of intellect and free will.
ACTS OF MAN
SITUATION
1. There is no element of knowledge
Act of man is not deliberately done
which means the agent is not aware
and conscious of what he is doing and
what it means.
Somnambulism, indicates that the person
is not aware or conscious that he is walking
while asleep. It is, therefore not a deliberate
act.
2. There is no element of freedom
Act of man is not freely done which
means that the power of the free will to
determine the act it chooses to elicit or
not is not invoked and employed.
All acts of human infants require no
employment of the free will to determine the
acts. An infant acts in accordance with his
sensation and not with rational faculties, not
with freedom.
3. There is no element of voluntariness
Act of man does not proceed from
both knowledge and freedom requiring
no decision of the will to make the agent
intend and willfully do such an act.
The act of digesting is not stimulated by the
employment of both knowledge and
freedom requiring no decision to make the
agent intend to do it. It is governed by the
physical law of nature of the digestive
system.
Morality is the measure of relation between the human act performed and its
norm according to the dictates of right reason, human nature, and
ultimately, God’s Eternal Law.
Good Act is that which is in agreement with right reason, human rational
nature, and God.
Evil Act is that which is in disagreement or in opposition to the said norms.
Indifferent Act is that which is neither
in agreement nor in disagreement
with right reason, human nature and
God. It is silent in terms of its
relation with them.
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Situation 1 - What is a good act, evil act and indifferent act?
• Joey does the act of walking. He knows what he is doing. He
chooses to do it and it is done without force and coercion. He
voluntarily does it as a product of his will. He walks towards the
delivery room of a hospital with an intention to assist, as a nurse,
in the abortion of a baby.
• Carla does the act of walking. She walks towards the delivery
room with an intention to assist, with tenderness, love and care, as
a nurse in a delivery case.
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Situation 2 - Can an act of man turn out to be human act?
Cathy is not aware that the student nurses and staff nurses at the
nurses’ station are gossiping. Even if she overhears it as she enters to get
the BP apparatus, the gossiping only presents itself before the ears of Cathy
but does not penetrate her mind to the extent of knowing the nature of the
story. How would you describe this act?
If upon overhearing, Cathy entertains in her thoughts
the very story of what the student nurses and staff
nurses at the nurses’ station are gossiping about, intently
listens to them and eventually joins the group and even
adds more gossips. How does it become a human act?
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Determinants of the Morality of Human Act
• The Act Itself
refers to the deed done or performed.
• The Motive (Finis Operantis)
refers to the end or purpose or goal to be achieved by means
of the act.
• The Circumstances
refer to the conditions in which
the act is done affecting the
morality in one way or another.
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Different Circumstances
CIRCUMSTANCES
EXAMPLE
1. The Circumstance of
Person refers to the agent
performing the act or the
person to whom the act is
done.
A medical doctor does the act of killing. The one killed is the baby
inside the womb of a mother. The act of killing is evil. It adds new
moral character of evil, a new evil, in fact, which is abortion, for the
person killed is a baby who, by reason of his helpless existence,
demands unconditional caring and sustenance. Moreover, the one
who aborts is a medical doctor who, by the very nature of his
profession, is duty-bound to save life and not to kill it.
2.
The Circumstance of
Quantity or Quality of the Act
refers to what is the extent of
the act.
A certain medication is mistakenly and carelessly given to a patient
who is not supposed to take it. Consequently, the patient suffers the
evil effect of the malpractice. To find out the circumstance of quantity
or quality of the object or act determining if it aggravates or worsens
the evil of the act committed, questions must be asked like: what is
the extent of the evil effect? Is it serious or slight?
3.
The Circumstance of
Place refers to the venue
where the act is performed
Student nurses are very noisy, loudly chatting, and gossiping about
their clinical instructor who is, at the moment, supervising a certain
student nurse in administering medication at the ward. They are
doing the loud gossiping at the I.C.U. The act of gossiping is an act of
injustice against the C.I. who does not know that she is being talked
about and thus cannot defend herself. It takes a new, added evilagainst charity by reason of the circumstance of place since the act is
performed at the I.C.U. where patients in their most delicate and
crucial health conditions are supposed to be provided with quiet
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atmosphere.
CIRCUMSTANCES
EXAMPLE
4. The Circumstance of
Means or Instrument refers to
that which is used and
employed in the performance
of an act. It is deemed
associated with the act in its
performance.
500 cc of blood is transfused into a patient who is badly in need of it.
However, the said amount of blood is stolen from a blood bank. The
act of blood transfusion is good-it sustains life that has to be
preserved. But then, the act becomes evil by reason of the
circumstance of means or instrument-the stolen amount of blood.
5.
The Circumstance of
Manner refers to the condition
in which the act is done or the
way (how) it is performed by
the agent.
The act of giving oral medication to heal the patient is a good act. But
it becomes evil (or slightly, as the case may be) by reason of the
circumstance of manner, or how it is done which maybe
characterized by lack of respect, tenderness, love and care, or a
sense of being inconsiderate, etc.
6. The Circumstance of Time
refers to the time when an act
is done and how long does an
intention to do an act to take
place.
Abortion is gravely evil. Its moral gravity is enormously aggravated by
reason of the circumstance of time-as it has long been desired in the
heart of the agent.
7. The Circumstance of the
Motive of the Agent has
already been elaborated on
with
special consideration
apart
from
all
other
circumstances.
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Moral Principles in the Judgment of Morality
MORAL PRINCIPLES
EXAMPLE
1. A good act which is done for a good
motive becomes doubly good.
A nurse does her duty of caring for her patients with all
dedication and commitment in order to alleviate their
suffering and to honor God.
2. An evil act which is done for an evil
motive becomes doubly evil.
Troy, a second year college student, cuts Health Care
Class to meet and engage in sexual activity with his
girlfriend in a hotel.
3. A good act which is done for an evil
motive becomes evil.
Dan helps his classmate, Sylvia in making and preparing
her NCP for submission tomorrow. He does it to carry
out his long desired intention to taking advantage of
making Sylvia accede to his indecent proposal.
4. An evil act which is done for a good
motive does not become good. “The end
does not justify the means”
A man snatches a wallet to sustain the hospitalization of
his sick mother who is in dire need of medicine.
5. An indifferent act which is done for a
good motive becomes good.
A student nurse makes the act of singing. He sings
before his patients to make them feel a certain sense of
well-being.
6. An indifferent act which is done for an
evil motive becomes evil.
A student nurse makes the act of singing. He sings to
annoy his classmates, making them feel uneasy.
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Kinds of Human Acts
Elicited Acts are those performed by the will and are not bodily
externalized.
Wish is a tendency of the will towards something, whether this be
realizable or not.
Intention the tendency of the will toward something attainable but
without necessarily committing oneself to attain it.
Consent is the acceptance of the will of those needed to carry out an
intention.
Election is the selection of the will of those means effective enough to
carry out the intention.
Use is the command of the will to make use of those means elected to
carry out the intention.
Fruition is the enjoyment of the will derived from the attainment of the
thing a person had desired earlier.
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Commanded Acts are those acts done either by man’s mental or
bodily powers under the command of the will. These can either
be internal or external actions.
Modifiers of Human Acts/
Conditions Affecting Morality
Modifiers of Human Acts are
factors that influence man’s
inner disposition towards
certain actions. They affect
the mental and emotional
state of the person to the
extent that the voluntariness
involved in the act is either
increased or decreased.
Principle the greater the knowledge
and the freedom, the greater the
voluntariness and moral responsibility.
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Five Conditions Which May Lessen or Even Remove
Moral Responsibility
1. IGNORANCE is the absence of knowledge which a person ought to
possess or capable of knowing.
a. Ignorance of the law lack of knowledge that a particular law exists.
b. Ignorance of the fact lack of realization that one is violating a law.
c. Vincible ignorance is that which can and should be dispelled. It implies
culpable negligence. The subject could know and ought to know.
simple vincible ignorance is present when one makes some but not
sufficient effort to dispel his ignorance.
cross vincible ignorance that which results from a mere lack of effort.
affected vincible ignorance is that which is deliberately fostered
in order to avoid any obligation that knowledge might bring to light.
d. invincible ignorance that which cannot be dispelled.
Moral Principles Concerning Ignorance:
Invincible ignorance eliminates responsibility.
Vincible ignorance does not eliminate moral responsibility but lessens it.
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2. FEAR is an agitation or disturbance of mind resulting from some present or
imminent danger.
Light Fear is that type of fear in which the evil threatening is either present
but slight or grave but remote.
Grave Fear is that which is present when the evil threatening is considered
serious.
Intrinsic Fear is that agitation of the mind which arises because of a
disposition within one’s own mind and/or body.
Extrinsic Fear is that agitation of the mind which arises from something
outside oneself. It also arises because of some external physical law
of nature.
Free Extrinsic Fear is that type of fear arising from the free will of some
other person. It maybe justly or unjustly caused.
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Moral Principle Concerning Fear:
- “Fear diminishes the voluntary nature of the act.”
- some acts are done because of fear .
- some acts are done with fear present but would have been done anyway.
- any acts which are done and would have been done, whether fear is
present or not are clearly voluntary and if they are morally wrong, the
person is morally responsible.
- a sinful act done because of fear is somewhat less free and therefore
less sinful than the act done under the influence of fear.
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Basic Ethical
Schools of
Thought
Naturalism is a view of moral judgment that
regards ethics as dependent upon nature
and psychology.
Rationalism is a view that feelings and
perceptions may not be similar. A
rationalist believes there are truths that
are superior to the information that are
actually received by the senses.
Moral beliefs and values may
differ in different situations or
maybe influenced by different
traditions and also similarities
making it difficult to identify the
standards of morality.
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The Ethical Schools
of Thought
A. Ethical Relativism ((Munson
1979 and Pahl)
- also known as moral relativism
- a doctrine which claims that there
are no universal or absolute
moral principles.
- standards of right or wrong are
always relative to a particular
culture or society.
B. Situation Ethics (advocated by Joseph Fletcher)
Three Approaches to Morality
1. Legalism
- prescribes certain general moral prescriptions, laws or norms
by which to judge, determine and settle the rightness or
wrongness of human judgments or decisions.
2. Antinomianism
- there are no absolute precepts
or moral principles by which to
be guided in making decisions.
3. Situationism
- states the moral norm depends
upon a given situation, but
whatever this situation maybe,
one must always act in the name
of Christian Love.
Christian Love:
eros – erotic love means sexual love which normally relates
a man to a woman.
philia – heterosexual relationship; filial love refers to affection
that binds parent to child, a brother to sister, a brother
to brother, sister to sister.
agape refers to one’s care and concern and kindness towards
others.
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Six Propositions Fundamental to Christian Conscience
1. Only one thing is
intrinsically good,
namely love:
nothing else.
• points to the nature of • Love is never selfish or
love
self-conceited, neither
biased nor unfair.
• Geared towards the
good of the other
because
it
cares,
respects, and protects
the dignity of the other.
2. The ultimate norm of • all codes, laws and
Christian decisions
rules or principles can
is love: nothing else.
be reduced to the love
canon alone. “no
respecter of
persons” seeking the
good of the other
radically and nonpreferentially”.
• Christian love goes
beyond racism and
religionism. One loves
another because
he/she is a human
being with dignity,
shares the same
humanity one
possesses.
3. Love and Justice are • Love and justice go • When we love a
the same, for justice
together
person , we care, we
is love distributed.
respect and protect
his/her dignity as we
expect the same to be
done for us and ready
to face and accept the
consequences of our
act of love.
4. Love wills the
neighbor’s good
whether we like him
or not.
• Liking a person
because of his good
qualities or disliking a
person because of his
bad traits.
• It is a matter of
humane attitude, not
one of feeling, so that
we can still love the
people we hate.
5. Only the end
justifies the means:
nothing else
• The end does not
justify the means.
• No matter how good or
beneficial the end
maybe, one may not
employ evil means to
attain it.
6. Decisions ought to
be made situationally,
not prescriptively.
• There is no ethical • There is no general
system
of
prescription by which
prefabricated morality.
an
individual
can
• A “prefab” code of
decide
on
certain
ethics offers a readymoral problems. Moral
made moral norm, a
decisions are relative
ready-made answer to
to the situation.
moral problems.
• Tactical Formula:
• Situation ethics puts a
The indicative plus
high
premium
on
the imperative equals
freedom
and
the normative (what
responsibility.
is, in the light of what
love demands shows
what ought to be)
C. Pragmatism (Charles Peirce and William James)
• Is more of a theory of knowledge, truth, and meaning than
of morality.
• Holds the true and valid form of knowledge:
practical one that we can practice and produce practical
results.
workable – one that we can put to work, it can be worked
out, and it works.
beneficial – it benefits people.
useful – one that can be used to attain good results.
Examples:
Contraceptive methods
Divorce
Abortion
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D. Utilitarianism or Consequentialism (Jeremy Bentham
and John Stuart Mill) is a kind of moral reasoning
known as teleological reasoning.
(telos – a Greek term which literally means “end”.
- an ethical doctrine that states that the rightness or
wrongness of actions is determined by the goodness
or badness of their consequences.
- Utilitarian utility principle:
“Principle of the Greatest Happiness”
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Types of Utilitarianism:
ACT UTILITARIANISM
RULE UTILITARIANISM
• suggest that people choose actions • suggest that people should act
that will, in a given circumstance,
according to rules that tend to
increase the overall good.
maximize happiness and diminish
• They believe that that it is best to
unhappiness.
tell the truth, keep promises or
avoid killing and so on. But
sometimes it is better for everyone
if it is not followed.
•
Takes into account the possible • Considers the possible results in
results of each particular act.
the light of a rule.
•
Have to weigh and explore all the • Rules such as “provide all
possible consequences of each of
necessary medical care for infants
the alternatives and then make the
with deformities” or put to death all
decision.
newborn babies with serious
deformities, would help us decide
on what right action to take with,
without much intellectual
deliberation.
Page 41
ACT UTILITARIANISM
RULE UTILITARIANISM
• Situationalistic - insofar as it • absolutistic - once a rule or policy
applies the principle of utility to
has been formulated, it must be
particular cases in particular
followed, given the same set of
situations.
circumstances.
• Relativistic – once a certain policy
or rule becomes irrelevant to the
demands of a new set of
circumstances, it will be revised,
modified or altered.
• though the patient’s health is sometimes maximized through use of
deception – a widespread deception will eventually cause more harm
than good.
• Though some instances of good might result from a particular act, in
the end, the overall good is maximized by following of strict rules in
all situations.
• Use of utilitarianism does not give sufficient thought to respect of
persons.
Page 42
Six Criteria to Measure the Product of the Act in Terms
of Value or Proposed Pleasure: (Jeremy Bentham)
1.
2.
3.
4.
5.
6.
Intensity
Duration Bentham proposed that each criterion
be given a value, and that the sum of
Certainty the values related to the pleasure be
Propinquity weighted against a similar sum of
Fecundity values related to the pain that might
result from any given act
Purity
Critics often referred to his theory as
Hedonistic Utilitarianism.
Page 43
Ethical Principles
Kant’s Ethics (Immanuel Kant)
• also known as Kantianism or deontologism or formalism
• deontologism ( Greek term deontos meaning duty or obligation)
• a form of intuitionism (claims that morality is exclusively within
the human personality; what is morally right or wrong is solely a
matter of intent, motive and will.
intuition means internal motive or intention.
• A Motivist Theory.
• disregards or does not consider important, the
consequences of an act in evaluating ethicality.
• Knowledge of the right course of action in a
given situation could obtained by following
a maxim (rule)
Kant maintains that one acts morally
If and only if one does whatever one
Is obliged to do.
Page 44
Categorical Imperative mandates an action without
conditions whatsoever , and without regard to
consequences that such action may yield.
- Act done from a sense of duty
Formulation of Categorical Imperative:
1. act only on that maxim which you can
at the same time will to become a
universal law.
2. always act so as to treat humanity, either
yourself or others, as an end and never as
only a means.
Types of Duties:
Perfect is one that must always be observed, irrespective of time,
place and circumstances.
Imperfect is one which must be observed on occasions.
Page 45
Hypothetical Imperative is a command with a
corresponding condition or limitation.
- Act done in accord with duty
- Autonomous, self-regulating will
Autonomy – means governing, regulating,
restraining oneself, including one’s
choices or courses of action, in accord
with moral principles which are one’s
own and which are binding on everyone.
Self-regulating – independence, selfreliance, and self-contained capacity to
make moral decisions.
Page 46
Rawls’s Ethics (John Rawls)
• Theory of Justice – recognition of duties to ourselves and to others.
Features:
1. Every individual is inviolable.
• the greater good to be shared by all members should not be used to
justify the loss of freedom of others.
• the larger sum of advantages which is supposedly to be enjoyed by
the many should not outweigh the sacrifices or inconveniences to be
imposed on a few.
2. An erroneous theory is tolerable in the absence of a good one.
• Given two erroneous laws, one should choose the better and the less
erroneous one.
• An act of injustice can be tolerated if and only if it is necessary to
avoid an even greater act of injustice.
• It is the only one available at hand, so reason dictates that it must
be carried out for the sake of those who are supposedly benefited
or affected by it.
3. Individual liberties should be restricted in order to maintain
equality of opportunity.
• Restrictions of individual liberties serve as safeguards against
abuses and misuses of one’s freedom against others.
Page 47
Principles of Justice
1. Equal access to the basic human rights and liberties.
• basic rights and liberties include the right to vote and to be
eligible for public office, freedom of speech and peaceful
assembly, liberty of conscience, freedom of thought, right of
ownership, freedom from arbitrary arrest and seizure as defined
by the concept of the rule of law and not of man.
2. Fair equality of opportunity and the equal distribution of
socio-economic inequalities.
• As much as the availability of resources will allow, everyone
should be given an opportunity for self-development or to
receive medical treatment.
Natural Duties
1. The duty of justice
Justice in Human Relation
2. The duty of helping others in
1. Fairness in our dealings
need or in jeopardy
with others
3. The duty not to harm or injure
2. Fidelity
others
3. Respect for persons
4. The duty to keep our promises
4. Beneficence
Page 48
Natural Law Ethics (St. Thomas Aquinas)
• referred to as Thomistic ethics / Scholastic ethics
• claims that there exist a natural moral law which
is manifested by the natural light of human reason,
demanding the preservation of the natural order
and forbidding its violation.
• basic principle: “Do good, avoid evil”.
• contends that the source of moral law is reason
(directs one toward the good as the goal of action.
• introduced the term synderesis – describes the
inherent capacity of every individual to distinguish
the good from bas.
Voice of Reason - the moral norm, or the
natural capacity of the individual to
determine what is right from what is wrong.
Voice of Conscience this is the immediate
judgment of practical reason applying the
general principle of morality to individual
concrete actions or decisions.
Page 49
Man’s Threefold Natural Inclination:
1. self-preservation
2. just dealings with others
3. propagation of our species
Page 50
Determinants of Human Action
1. The Object – a thing (money) or action (surgical
operation)
2. The Circumstances – conditions that will mitigate
or aggravate the goodness or badness of a
particular act.
Circumstances:
Who
What
Where
By what Means
Why
How
When
Page 51
CIRCUMSTANCE
WHO?
EXPLANATION
EXAMPLE
This has something to
• It is morally bad to rape a
do with the special
woman but even worse to
quality, prestige, rank, or
rape one’s own daughter
excellence of the person • The act of a physician who
involved in the moral act. treats a hospital patient
entrusted to him is morally
good, but that of one who
extends medical assistance
to an indigent unable to
afford confinement is even
better and more
commendable.
• To mistreat one’s own
patient is bad in itself, but to
mistreat him and take
advantage of his ignorance,
is even worse.
CIRCUMSTANCE
WHAT?
EXPLANATION
Refers to the quantity or
quality of the moral object.
EXAMPLE
• The very act of surgical
operation on a sick
person who needs it is
good in itself (done
simply as a daily routine
function) but to perform
the act as excellently as a
skilled surgeon is capable
of heightens the
goodness of the said
action (done with a sense
of service, dedication and
concern for the well-being
of the patient).
Page 53
CIRCUMSTANCE
WHERE?
EXPLANATION
EXAMPLE
Denotes the place where • it makes a big difference
the act occurs.
when a doctor extends
medical assistance to some
brought to the emergency
room for stab wounds
(perfunctory role) and when
a doctor selflessly go out of
his way to take the wounded
victim to his clinic or to a
nearby hospital (Good
Samaritan).
• To abuse a patient
maliciously is a corrupt
medical practice, but to
assault her or him sexually
in one’s own clinic is even
more heinous and
outrageous.
Page 54
CIRCUMSTANCE
BY WHAT MEANS?
EXPLANATION
Refers to the means
used in carrying out the
act.
EXAMPLE
• To take advantage of one’s
weakness is bad enough;
but to deceive and seduce
someone in order to take
advantage of that person
makes matters worse.
• To extend medical help to
an indigent patient is good;
but to give him/her the
money needed for his/her
medication makes the
goodness of the act much
greater.
Page 55
CIRCUMSTANCE
WHY?
EXPLANATION
EXAMPLE
• The end or purpose is
• To seduce a destitute girl is
considered as a
in itself bad; but to do so
circumstance affecting
with the intention of making
the goodness or
her one’s querida or number
badness of the action.
two makes the act doubly
• If the act itself is bad
evil.
and is still carried out
• Helping the girl to finish a
with a bad purpose, the vocational course is in itself
said act becomes much good; and doing so with the
worse.
intent of employing her later
, enabling her to help her
own family, makes the act
even “more” legitimate and
righteous.
Page 56
CIRCUMSTANCE
HOW?
EXPLANATION
EXAMPLE
Indicates the manner in • When facing death through
which the action is done. starvation, the individual
may take surplus goods
from another in order to
avoid death.
• In case of extreme
necessity, the ordinary right
to private property no longer
holds.
• In case of unjust
aggression, it is legitimate to
kill the aggressor who
unjustly attacks and
attempts to kill another
person.
Page 57
CIRCUMSTANCE
WHEN?
EXPLANATION
Refers to the time
element involved in the
performance of the
action.
EXAMPLE
• To commit rape under the
cover of darkness is even
worse than when it is done
in broad daylight.
• To abuse one’s patient
under sedation is much
worse than mere seduction.
• It makes a difference
whether one commits a
crime in the church when
the mass is being said or
when there is no mass at all.
Page 58
3. The End of the Agent or Purpose
• A good act with a bad motive makes the moral
action bad.
• An evil means in order to attain a good end
makes the action bad.
Example:
• Marrying the person one is engaged to is in itself a
good act; but doing it while motivated by ulterior
and selfish ends – like the possibility of obtaining a
big share of his/her inheritance – makes the whole
action bad.
• To inject a lethal drug into a terminally ill patient,
supposedly for purposes of ending his/her misery,
maybe argued to be legitimate; but to do so with
the end in view of profiting from his/her death
makes the act morally evil.
Page 59
St. Thomas’s view, for an act to be truly good, the three
determinants must be good; otherwise, the act
becomes morally evil.
The Double-Effect Principle
• a situation in which a good effect and evil effect
will result from good cause.
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 in doing so, the life of the fetus
would be sacrificed. In the resolution
of these kinds of conflict,
Page 60
Four Conditions of the Principle of Double-Effect
CONDITION
DISCUSSION
1. The action directly intended must be • in the case cited about the pregnant
good in itself, or at least morally
woman with cancerous uterus, the
indifferent.
surgical operation on the woman’s
- the moral action must be in itself
uterus is good per se because of the
good, otherwise it is evil at the very
condition mentioned.
outset.
2. The good effect must follow from the • they both follow from the operation with
action at least as immediately as the
equal immediacy.
evil effect; or the evil effect may follow • Evil effect - death of the fetus
from the good effect.
• Good effect – the mother’s life is
- Either both good effect and the evil
saved.
effect must occur simultaneously, or
the good effect is produced directly
by the operation, and the evil effect
follows from the good effect . Both
cases are legitimate.
Page 61
CONDITION
DISCUSSION
3. The foreseen evil effect may not be • The killing of the unborn child must not
intended or approved, but merely
be directly intended, but considered
permitted to occur.
only as indirectly intended, then it
becomes the direct, and primary object
of the operation, and hence it is evil.
But since it is only indirectly intended, it
becomes the secondary object of the
operation, and hence it is morally
permissible.
4.
There must be appropriate and • At stake here is the life of the pregnant
sufficient reason for allowing the evil
woman with a cancerous uterus who is
effect to occur while performing the
three months pregnant. At this stage of
action.
pregnancy, the time element is very
crucial. A delayed operation may mean
the loss of both lives.
Page 62
The Principle of Totality
• an individual has the right to cut off, mutilate, or remove any defective or
worn-out non-functioning part of his body; to dispose of his organs or to
destroy their capacity to function. (insofar as the general well-being of the
whole body requires it.
Under the Natural Law Ethics, we have
a natural obligation not only to preserve our
lives, but also the integrity of our bodies.
Accordingly, a diseased organ may be
amputated or excised for the good of the
whole organism. A gangrenous leg or arm or
any other organ that is beyond cure and
threatens the whole organism may be
mutilated to save the person’s life. Health
organs, however, may not be cut off, as this
would weaken a person’s health.
Page 63
OTHER MORAL PRINCIPLES
1.
Principle of Stewardship
It declares that human life comes from God, and no individual is
the master of his/her own body. Humans are only mere stewards or
caretakers.
2.
Principle of the Inviolability of Man
It states that life is God’s and has been
loaned to us; hence it’s inviolable and sacred.
3.
Principle of Sexuality ad Procreation
Purpose of sexual union:
a. The procreation and nurturing of children
b. The expression of loving union and
companionship
Page 64
Cooperation comes from the Latin word “cum” which means
“with” and “operari” which means “to work”. It is working
with another person for an action.
•
There are human actions whose performance is possible and
feasible because of people working together with specific
functions to play.
•
The magnitude and essentiality of the function played
indicate the degree of cooperation in the performance of an
act. The lesser the magnitude and essentiality of the function
shared, the lesser the cooperation. There is no question of
morality if the action performed is good.
Types:
Formal Cooperation when the secondary agent willingly participates as when
one agrees, advices, counsels, promotes or condones.
Material Cooperation when the secondary agent does not willingly participate.
Immediate (Direct) Cooperation when the action of the secondary agent is
inherently bound to the performance of an evil action.
Mediate (Indirect) Cooperation when the action of the secondary agent is not
inherently bound to the performance of the evil action.
NOTE: MATERIAL IMMEDIATE COOPERATION is also as a rule not allowed. When there
is significant reason,, and scandal is avoided, material mediate cooperation, may be
permitted to prevent a greater harm.
Proximate consist 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
a. No one should formally and directly cooperate in the performance
of an evil action.
b.
If a reason sufficiently grave exists, material cooperation in the
performance of an evil action maybe morally excused.
c.
If the material cooperation is proximate, a reason sufficiently graver should
exist so as to be morally excused without which evil is incurred.
Solidarity means to be one with others. In the provision of
health care, it is most important for the provider to be in
solidarity with the patient when seeking, always the latter’s
best interest.
Ross’s Ethics (William David Ross)
• presented the rule-deontological theory
• Recognized that there are exceptions for every rule, and in
some situations.
• He stated that right and good are distinct, indefinable, and
irreducible objective qualities.
Examples:
• Is it morally justified to lie (or withhold
the truth from) someone who has no
right to know about it. The predicament
whether or not one should lie to a
terminally ill patient about his condition,
knowing that it would cause him useless
anguish and apprehensions.
- Should we tell the patient the truth?
- Are we not violating the patient’s
trust in us to act morally and to
Moral rules serve as moral guidelines in
speak the truth.
such a way that they must be adjusted
- Should we withhold information
or modified, if not set aside in some
and lie to him?
Page 68
situations
• Rightness of an act and goodness of a motive
Act – that which is done
Action – doing an act.
Doing – is carrying out or execution
Right acts – moral goodness with good motives.
Example:
Upon seeing a physician giving someone
an injection, you have to determine what
the injection is and why he is injecting
and why the physician is giving the
injection. (These are the nonmoral
properties , the circumstances)
Page 69
Actual Duty and Prima Facie Duty
Actual duty is one’s real duty in a given situation. It is the
action one ought to choose from many other actions.
Prima facie – Prima (Latin meaning “”as a first view” or so
far as it appears. It is one that directs or commands what
one ought to perform when other relevant factors are not
taken into account.
Seven Types of Prima Facie Duties
1. Duty of Fidelity
2. Duty of Reparation
3. Duty of Gratitude
4. Duty of Justice
5. Duty of beneficence
6. Duty of self-improvement\
For Ross, we have to rely on moral
7. Duty of nonmaleficence
intuitions
(intuitionism) as the
ultimate guide to particular cases.
Page 70
PRIMA FACIE
DUTIES0
Duty of FIDELITY
Duty of
REPARATION also
known as
Duty of
COMPENSATION
DISCUSSION
• Being faithful to one’s
• Treachery, deception,
duties, obligations, vows,
hypocrisy, trickery, doubleor pledges
dealing, insincerity,
• Loyalty to a worthy cause,
betrayal, lying, duplicity,
telling the truth as the
cunning or craftiness are
situation demands it,
infarctions against the duty
keeping actual and implicit
of fidelity.
promises, and not
representing fiction as
truth.
• Duty to make amends for
injury that we have
inflicted on others.
• Righting the wrongs that
we have done
• Kung nakagawa ka ng
masama, gumawa ka ng
mabuti
• Asking the other person’s
forgiveness is insufficient.
We have to do that person
good to atone for our
wrongdoing.
Page 71
PRIMA FACIE
DUTIES
Duty of
GRATITUDE
Duty of JUSTICE
DISCUSSION
• To
appreciate
and • The cultural grip of one’s
recognize the services
duty of gratitude to one’s
others have done for us,
parents among Filipinos is
which may be either a
very strong. It is an
favor, kindness, good
essential element of their
fortune, a great help, or
value system, their
saving one’s life.
philosophy of life, by which
they gauge the rightness or
wrongness of their moral
decisions.
• Ross stresses the proper
distribution of social
benefits and burdens.
• The duty of justice
demands fairness for
everyone.
• Equitable distribution of
medical resources must be
observed as far as
availability and/or scarcity
will allow. The distribution
of pleasure or benefits that
are not in keeping with
merit of the people involved
must be prevented.
Page 72
PRIMA FACIE
DUTIES
Duty of
BENEFICENCE
DISCUSSION
• This type of duty enjoins • We should contribute in
us not only to bring about
whatever small way we
what is good for others
can to their health and
but also to help them
well-being.
better
their conditions • Equally important is the
with respect to virtue,
duty to balance the good
intelligence, or comfort.
that our decision may
• Our duty to confer
yield against the harm
benefits and to prevent
that may result from
and remove harm is
doing or not doing what
important in biomedical
we honestly believe to be
and behavioral contexts.
beneficial to the patient.
• In short, this duty
requires the provision of
benefits and balancing
the benefits and harm for
all people concerned in
given circumstances.
Page 73
PRIMA FACIE
DUTIES
Duty of SELFIMPROVEMENT
Duty to
NONMALEFICENCE
DISCUSSION
• To help others better • Unless one performs or
themselves.
carries out one’s duty to
• We have our duty to
self-improvement –
improve and develop
morally, intellectually and
ourselves with respect to
physically, one is in a
virtue, intelligence, and
better position to fulfill
happiness.
duties to others.
• “Primum Nocere”
• One should prevent evil
• Avoid inflicting evil, injury
or harm which
or harm upon others as
encompasses pain,
we avoid doing this to
suffering, disability and
ourselves.
death.
Page 74
The Calling of the Health Care Provider
• The Health Care Profession is a special
calling, a service characterized by a trusting
and caring relationship which cannot be
measured in monetary terms.
• Providing health care is not a career, it is a
vocation.
The Healthcare Provider-Client Relationship
• The relationship between a healthcare
provider and a patient is not a contract but a
covenant.
• It is a caring relationship wherein healthcare
provider and receiver have a sense of oneness.
Healthcare Provision
• the obligation to provide healthcare
The Threefold Responsibilities
of the Health Care Provider
• To the PATIENT
• the extent to which healthcare
should be provided when the
disorder is self inflicted,
preventable/curable.
• the limitations to healthcare
provision: scarce resources;
others more in need (justice)
•To the PROFESSION
• To the SOCIETY/
GOVERNMENT
A sick individual becomes a patient if
THE PATIENT
• he admits that he is sick
• that he can no longer take care of
himself
and
• so, he asks for help or aid
• A patient is vulnerable
• He must be given the best possible care
and taught how to take care of himself
• He must accept responsibility for his care
• He must cooperate with his healthcare giver
• He must give respect, gratitude and
compensation to his health care provider
In all these,
• the patient remains always as a person with dignity
• must be treated with respect
• his privacy and autonomy must not be violated
THE PATIENT’S BILL OF RIGHTS
1. The patient has the right to considerate and respectful care.
2. The patient has the right to obtain from physician complete current information
concerning his diagnosis, treatment and prognosis in terms the patient can be reasonably
expected to understand. When it is not medically advisable to give such information to
the patient, the information should be made available for coordinating his care.
3. The patient has the right to receive from his physician information necessary to give
informed consent prior to the start of any procedure and/or treatment, the consent should
include but not necessarily limited to specific procedures and/or treatment, the medically
significant risks involved, and the probable duration of incapacitation. Where medically
significant alternatives for care or treatment exist, or when the patient requests
information concerning medical alternatives, the patient has the right to know the name of
the person responsible for the procedure and/or treatment.
4. The patient has the right to refuse treatment to the extent permitted by law, and to be
informed of the medical consequences of his action.
5. The patient has the right to every consideration of his privacy concerning his own medical
care program. Case discussion, consultation, examination, and treatment are confidential
and should be conducted discreetly, those not directly involved in his care must have the
permission of the patient to be present.
6. The patient has the right to expect that all communication and records pertaining to his
care should be treated as confidential.
7. The patient has the right to expect that in its capacity a hospital must take
8.
9.
10.
11.
12.
responsibility to the request of a patient for service. The hospital must provide evaluation,
service and/or referral as indicated by the urgency of the case. When medically
permissible, a patient may be transferred to another facility only after he has received
complete information and explanation concerning the need for and alternatives to such a
transfer. The institution to which the patient is to be transferred must first have accepted
the patient for transfer.
The patient has the right to obtain information as to any relationship of his care is
concerned. The patient has the right to obtain information as to the existence of any
professional relationship among individuals by name, and who are treating him.
The patient has the right to be advised if the hospital proposes to engage in/or perform
human experimentation affecting his care or treatment. The patient has the right to refuse
to participate in such research projects.
The patient has the right to expect reasonable continuation of care. He has the right to
know in advance what appointment times the physician are available and where. The
patient has the right to expect that the hospital will provide a mechanism whereby he is
informed by his physician or delegate of the physician of the patient’s continuing health
care requirements following discharge.
The patient has the right to examine and receive an explanation, of his bill regardless of
source of payment.
The patient has the right to know what hospital rules and regulations apply to his conduct
as a patient.
THE HEALTHCARE PROVIDER
1. One who is committed to healthcare
2. Invested with authority with corresponding
responsibilities to patients, his/her profession, and society
3. Must be a patient advocate
4. Competent in both scientific and interpersonal skills
5. Must always be understanding, humane and compassionate
6. Must recognize his/her limitations
7. As authority, must contribute to knowledge
8. Conduct oneself in an ethical professional way
9. Must be a role model to his younger colleagues
10. Must maintain and upgrade the standards of his/her profession
11. Must manifest social conscience
12. Needs to be competent in mind and compassionate of heart
13. Recognize the right to cooperation when making personal
inquiries or examining patients
14. Just compensation, respect and good reputation
THE NURSES’ CODE OF ETHICS
(PNA Code)
Fundamental Concepts
Health is a fundamental right of every individual. Therefore, the nurses’ primary
responsibility is to preserve health at all cost. This responsibility encompasses promotion
of health, prevention of illness, alleviation of suffering, and restoration of health.
Basic to nursing is the knowledge and understanding of man. For effective healthcare
knowledge of man’s cultural, social, pathophysiological, psychological, and ecological
aspects of illness and the therapeutic process is essential. Differences in ethnicity, political
and social status are not barriers to effective nursing care.
Standards of practice vary in different settings.
Society is ever-changing and the nurse responds to change.
Respect for the rights and dignity of individuals is basic to the practice of the profession.
Nurses and People
Values, customs and spiritual beliefs held by individuals are to be respected.
The nurse holds in strict confidence personal information acquired in the process
of giving nursing care. She/he uses discriminative judgment in the sharing time.
Nurses and Practice
The nurse is accountable for her/his own nursing practice. She/he is responsible
for her/his personal and professional growth and development.
The nurse maintains or modifies standards of practice within the reality of any
given situation. Quality care is her/his goal.
The nurse is the advocate of the patient. She/he takes appropriate steps to
safeguard the patient’s rights and privileges.
The nurse is aware that her/his nursing actions have professional, ethical, moral,
and legal dimensions. She/he strives to perform her/his work in the best interest of all
concerned.
The nurse observes personal and professional decorum at all times.
Nurses and Co-workers
The nurse maintains collaborative working relationship with her/his co-workers and other members of the
health team.
The nurse recognizes her/his capabilities and limitations in accepting responsibilities
and those of her/his co-workers when delegating responsibilities to them.
Nurses and Society
The nurse is a contributing member of society. She/he assumes responsibilities inherent
in being a member and citizen of the community/society in which she/he lives/works.
She/he recognizes the need for change and initiates, participates and supports activities
to meet the health and social needs of the people.
Nurses and Profession
The nurse is expected to be a member of the nursing professional organization. Inherent
n this responsibility is to support and uphold its constitution and by-laws.
The nurse helps determine and implement desirable standards of nursing practice and
nursing education.
She/he participates actively in the development and growth of the nursing profession.
She/he strives to secure equitable socio-economic and work conditions in nursing through
Appropriate legislation and other means.
THE SCOPE OF NURSING PRACTICE (R.A. 9173 – Phil. Nursing Act 2002,
Article VI, Sec. 28.)
A person shall be deemed to be practicing nursing within the meaning of this
Act when he/she singly or in collaboration with another, initiates and performs
nursing services to individuals, families and communities in any healthcare setting.
It includes, but not limited to, nursing care during conception, labor, delivery,
infancy, childhood, toddler, pre-school, school age, adolescence, adulthood, and
old age. As independent practitioners, nurses are primarily responsible for the
promotion of health and prevention of illness. As members of the health team,
nurses shall collaborate with other members of the health care providers for the
curative, preventive, and rehabilitative aspects of care, restoration of health,
alleviation of suffering, and when recovery is not possible, toward peaceful death.
It shall be the duty of the nurse to:
a)
Provide nursing care through the utilization of the nursing process. Nursing
care includes, but not limited to, traditional and innovative approaches,
therapeutic use of self, executing healthcare techniques and procedures,
essential primary health care, comfort measures, health teachings, and
administration of written prescription for treatment, therapies, oral, topical, and
parenteral medications, internal examination during labor in the absence of
antenatal bleeding and delivery. In case of suturing of perineal laceration,
special training shall be provided according to protocol established;
b)
c)
d)
e)
Establish linkages with community resources and coordination with the
health team;
Provide health education to individuals, families, and communities;
Teach, guide, and supervise students in nursing education programs
including the administration of nursing services in varied settings such as
the hospitals and clinics; undertake consultation services; engage in such
activities that require the utilization of knowledge and decision-making skills
of a registered nurse; and
undertake nursing and health human resource development training
and research which shall include, but not limited to, the development of
advance nursing practice;
Provided, That this section shall not apply to nursing students who perform
nursing functions under the direct supervision of a qualified faculty: Provided,
further, That in the practice of nursing in all settings, the nurse is duty-bound to
observe the Code of Ethics for Nurses and uphold the standards of safe nursing
practice. The nurse is required to maintain competence by continual learning
through continuing professional education to be provided by the accredited
professional organization or any recognized professional nursing education:
Provided, finally, The program and activity for the continuing professional
education shall be submitted to and approved by the Board.
VIRTUES AND HABITS OF A HEALTHCARE PROVIDER
Habits
• from Latin word “habere”, meaning to have.
• is either :
Entitative Habit - the disposition to have something; disposes
a thing to have a certain nature or quality of being, such as
to be beautiful, talented, or to be obese.
Operative Habit – the disposition to act in a certain manner;
disposes for doing something in a certain manner, such as
painting, writing, or talking. It is also the readiness to do
something.
Moral Significance of Habits
1. Habit modify not only the use of power of operation but the person
himself.
2. Habit leads to man’s perfection and to his ultimate happiness.
Types of Habits:
Virtues – are good habits
Vices – are bad habits
Virtues are acquired habits or dispositions
to do what is morally right.
• Sometimes known as character ethics
• It represents the idea that individuals’
actions are based upon a certain degree
of innate moral virtue.
Traits of Character or Virtues of a
Healthcare Provider
• Cardinal virtue
a. Wisdom is the habit of the ultimate
causes, such as being aware that the
ecosystem binds both man and lower
creatures.
b. Courage is doing what one sees as right
without undue fear.
c. Temperance is the virtue which helps us
regulate our passions and our use of
earthly goods.
d. Justice is the virtue that inclines us to render another what is due
to him. It is the foundation of any interpersonal relationship. It is
the basis of every reasonable law and promotes peace and
harmony within a community of persons.
• It relates to fair, equitable, and appropriate treatment in light of
what is due or owed to persons, recognizing that giving to some
will deny receipt to others who might otherwise have received these
things. (privacy, fair treatment, anonymity and confidentiality)
Distributive Justice relevant application of the principle focuses on
distribution of goods and services.
• Nurses and other health care providers frequently make decisions
of distributive justice on an individual basis, example: having
assessed the needs of patients, nurses decide how best to allocate
their time (a scarce resource).
• Three Basic Areas of Health Care Where Distributive Justice
Apply:
1. What percentage of our resources is it reasonable to spend
on health care?
2. Recognizing that health care resources are limited, which
aspects of health care should receive the most resources?
3. Which patients should have access to the limited health care
staff, equipment, and so forth?
Ways to Choose Among People:
• To each equally
•To each according to need
•To each according to merit
• To each according to social contribution
• To each according to individual effort
• To each as you would be done by
• To each according to the greatest good
to the greatest number
e. Generosity synonymous to kindness nobility, bigheartedness,
openhandedness, liberality . It is the willingness to give or help.
f. Faith a generic feature of the human struggle to find and maintain
meaning flowing from an integration of ways of knowing or valuing.
• Belief in, devotion to, or trust in somebody or something especially
without logical proof.
• A strongly held set of beliefs or principles.
g. Hope is to want or expect something; to have a wish to get or do
something or for something to happen or to be true, especially
something that seems possible or likely to happen.
h. Charity refers to the voluntary provision of help in terms of money,
materials, or any other form of help to people in need.
i. Loyalty is a feeling of duty or devotion, or attachment to somebody or
something.
j. Purity is the absence of anything harmful, or of a
different type; cleanliness or wholesomeness;
innocence.
j. Devotion is deep commitment, dedication, loyalty;
it is a fervent feeling.
j. Caring is showing concern for others; looking after people’s
physical, medical or general welfare.
k. Responsibility is the state, fact, or position of being accountable to
somebody or for something.
l. Prudence is foresight; a habitual deliberateness, caution and
circumspection in action. The habit of choosing from alternative
values, such as saving for the rainy days.
m. Fortitude is the virtue which gives us the strength in facing dangers
and vicissitudes (variability or unexpected changes) of life.
n. Fidelity is faithfulness.
o. Humility is recognizing one’s capabilities and limitations.
p. Respect means paying attention to others.
•
Moral Virtue is a character trait that is morally valued.
a. Truthfulness is telling the truth corresponding to fact or reality.
b. Kindness is the practice of being or the tendency to be sympathetic
and compassionate or showing consideration or caring attitude.
i. Honesty is the quality, condition, or characteristic of being fair,
truthful, and morally upright.
GOLDEN MEAN of virtuous behavior means practicing in
moderation: avoiding both excess and deficiency.
Basic Moral Question: not “What should one do” but rather
What should one be?
•
Focal Virtues are learned or cultivated which are important to
morality.
a. Compassion is the ability to imagine oneself in the situation of
another.
b. Discernment is the sensitive insight involving acute judgment
and understanding, and it eventuates in decisive action.
c. Trustworthiness is a confident belief in and reliance upon the
ability and moral character of another person.
d. Integrity is soundness, reliability, wholeness, and an
integration of moral character.
•
Inordinate Virtues:
Authority and power the respect one gets
from society, economic rewards of the
profession.
Pride self-esteem, conceit.
Greed acquisitiveness.
Vices is a habit of doing an evil acquired through the
repetition of an evil act.
A vice is opposed to virtue either by excess or by defect.
Vices vs. Prudence
by excess are:
by defect are:
Vices vs. Justice
by excess are:
by defect are:
Vices vs. Fortitude
by excess:
by defect:
cautiousness, fraud, flattery, trickery
imprudence, precipitateness, impulsiveness,
carelessness and stubbornness
profligacy, idolatry, fanaticism and superstition
disrespect for elders, irreligion, non-payment of
legitimate debts
rashness, boldness, recklessness
cowardice, timidity, sensitivity and depression
Vices vs. Temperance
by excess:
rigorousness, lack of self-confidence, moroseness
by defect:
pride, lust, hatred, gluttony, vanity
LEGAL ISSUES
Law is a system of binding rules of action or conduct that governs
the behavior of people in respect to relationships with others
and with government.
Sources of Law That Affect Practice of Nursing:
Constitutional Law is a formal set of rules and principles
that describe the powers of a government and the rights of
the people.
Statutory/Legislative Law formal laws written and enacted by
federal, state, or local legislatures.
Administrative Law involves the operation of government
agencies, National, state, and local governments. (Regulates
activities as education, public health, social welfare programs,
and professions.
Common Law or case law. Decisions are based upon earlier court
rulings in similar cases.
Types of Law
Public Law – defines a person’s rights and obligations in relation to the
government and describes the various divisions of government and their
powers.
Criminal Law deals with crimes (those considered harmful to society
from public drunkenness to murder. Criminal law defines these
offenses and sets the rules for the arrest, the appropriate procedures
to ensure due process, and the punishment of offenders.
Examples:
• directly or indirectly injuring a patient, either intentionally or
unintentionally.
• falsifying narcotic records
• Failure to renew licenses
• Fraudulent billing
Felonies are serious crimes that carry significant fines and jail
sentences. Ex. First and second degree murder, arson,
burglary, extortion, kidnapping, rape, and robbery.
- those participating in the unauthorized removal of life
support from a terminally ill patient could be accused of
first-degree murder because of the intentional nature of
the act which resulted in death.
- A nurse who intentionally causes the death of a patient by
administering a medication to which a patient is allergic
could be charged with second-degree murder
(manslaughter)
Misdemeanor is a less serious crime, usually punishable by a fine, a
short jail sentence, or both..
Example:
- disturbing peace, solicitation, assault, and battery (assault
and battery are also considered intentional torts)
- a nurse slapping a patient or giving an injection without
consent can be accused of the misdemeanor of battery.
Private Law is also called civil law. It determines a person’s legal rights
and obligations in any kinds of activities that involve other people.
Branches: Contract and commercial law; tort law; property law; inheritance
law; family law; and corporation law.
Contract Law deals with the rights and obligations of people who make
contracts (agreement between two or more people that can be
enforced by law..
Expressed Contract occurs when the two parties agree explicitly
to its terms, as in an employment contract.
Implied Contract occur when there has been no discussion between
the parties, but the law considers that a contract exists.
(nurse-patient relationship is essentially an implied contract with
which the nurse agrees to give competent care.
Tort Law. A tort is a wrong or injury that a person suffers because of
someone else’s action, either intentional or unintentional.
(ex. Action that can cause bodily harm; invade another’s privacy;
damage a person’s property, business, or reputation, or make
unauthorized use of a person’s property.
Unintentional Torts occurs when an act or omission causes
unintended injury or harm to another person.
Negligence is the omission to do something that a
reasonable person, guided by those ordinary
considerations which ordinarily regulate human affairs,
would do, or doing something which a reasonable
and prudent person would not do.
Malpractice is a type or sub-set of negligence, committed
by a person in professional capacity like professional
misconduct, unreasonable lack of professional skill, or
non-adherence to the accepted standard of care
causes injury to a patient or client. It includes lack of
fidelity, evil practice, and illegal or immoral conduct.
Components of Malpractice:
1.
2.
3.
4.
Duty owed to the patient
Breach of standards of care or failure to carry out duty
Actual harm or injury suffered by the patient
Causal relationship between the breach of standards of care or duty and
the injury.
Basic Nursing Functions:
1. The nurse must possess the knowledge and skill to properly assess and/or
monitor a significant condition or change in the patient.
(There is a duty to know what the patient’s condition should be,
what it has been and what it is now).
2. The nurse must actually carry out the assessment, monitoring, and evaluation.
3. The nurse must notify the physician if assessment, evaluation, or monitoring
reveals a condition that should be reported.
(The nurse must report the patient’s status and must thoroughly document the
patient’s condition and details of when and to whom the condition was reported.
4. The nurse must skillfullly carry out appropriate nursing and medical
interventions in an effort to correct the problem.
(The nurse must continue to assess and monitor until the patient is stable.)
Intentional Torts are willful or intentional acts that violate another person’s
rights or property.
Three Elements of Intentional Tort:
1. The act must be intended to interfere with the plaintiff or his property;
2. There must be intent to bring about the consequences of the act;
3. The act must substantially cause the consequences .
Components of Intentional Torts
1. The defendant’s act must be intended to interfere with the plaintiff or his property.
2. The defendant must intend to bring about the consequences of the act.
3. The act must substantially cause the consequences.
4. There is no legal requirement that the act causes damages or injury- proof of
intention is sufficient.
Fraud is a deliberate deception for the purpose of securing an unfair or
or unlawful gain.
- falsification of information on employment applications; untruthful billing
procedures;
- false representation of a patient’s physical condition in order to induce
contracts for services; and falsification of patient’s records to cover up an
error or avoid legal action.
Right to Privacy is the right to be left alone or to be free from unwanted publicity.
(Individuals have the right to withhold themselves and their lives from public scrutiny.
(Intentional Tort of Invasion of Privacy)
Assault is defined as the unjustifiable attempt or threat to touch a person without consent
that results in fear of immediately harmful contact.Touching need not actually occur.
Battery is the unlawful, harmful, or unwarranted touching of another or carrying out of
threatened physical harm. (willful, angry, violent, or negligent touching of a person’s
body or clothes, or anything held by or attached to the person.
False Imprisonment is unjustifiable detention of a person within fixed boundaries, or an
act intended to result in such confinement.
Defamation occurs when one harms a person’s reputation and good name, diminishing
others’ value or esteem, or arouses negative feelings toward the person in others by
the communication of false, malicious, unprivileged or harmful words.
Slander occurs when one defames or damages the reputation of another by
speaking unprivileged or false words.
Libel consist of printed defamation by written words or images that injure a
person’s reputation or cause others to avoid, ridicule, or view the person
with contempt.
PREVALENCE OF BIOETHICAL ISSUES
Abortion
• In the Philippines, abortion is illegal, but it is a clandestine practice. Article II,
Section 12 of the 1986 Phil. Constitution provides: “The state recognizes the
sanctity of life and shall protect and strengthen the family as a basic
autonomous social institution. It shall equally protect the life of the
mother and the life of the unborn from conception.”
• It means the expulsion of a living fetus from the mother’s womb before it is
viable.
• According to Dr. Andre E. Hellegers, it is the termination of pregnancy,
spontaneously or by induction, prior to viability.
• Based on a study conducted by NEDA, the number of cases of induced
abortion ranges from 150,000 to 750,000 every year. In one Metro Manila
hospital alone, 4,000 cases of abortion are undertaken annually.
• Viability - the child’s capability to live independently of its mother after it has left
the womb. Normally, a child is considered to be viable at about the 28th week
(calculated from the first day of the last menstrual period) or toward the end of the 7th
month (at least the fetus born during this period has about a 10% chance of survival).
Types of Abortion:
a. Natural Abortion – the expulsion of the fetus through natural or
accidental causes. This is also known as spontaneous or
accidental abortion. In laypeople’s terms, it is called a miscarriage
(nakunan). It is unintentional and involuntary, and hence devoid of
moral significance.
b. Direct of Intentional Abortion refers to the deliberately induced
expulsion of a living fetus before it has become viable. It assumes a
moral bearing because it is voluntary in cause.
c. Therapeutic Abortion is the deliberately induced expulsion of a
living fetus in order to save the mother from the danger of death
brought about by pregnancy.
d. Eugenic Abortion or selective abortion or abortion on fetal
indications is recommended in cases where certain defects are
discovered in the developing fetus.
e. Indirect Abortion in which the removal of the fetus occurs as a
secondary effect of a legitimate or licit action, which is the direct
and primary object of the intention.
MORAL ISSUE OF ABORTION
If the phenomenon of ensoulment (fusion of the spiritual soul in the
embryo) occurs from the moment of conception, then the newly
fertilized ovum or conceptus is already a person; hence to expel or
abort it is to commit murder, but if the ensoulment phenomenon occurs
not from conception but at a certain stage of the fetal development,
then eugenic abortion as well as abortion before implantation may be
morally licit. This crucial issue is discussed under two schools of
thought:
• Theory of Homonization:
a. Immediate Homonization – immediately upon
fertilization, a new person exist.
b. Delayed Homonization – personhood is not
present until sometime after fertilization.
• Theory of Delayed Animation
Upholds that ensoulment occurs at a later time
but not from the moment of conception.
Euthanasia
• from the Greek word “eu” (easy) and “thanatos” (death)
= easy death
• It means painless, peaceful death
• Deliberate putting to death, in an easy, painless way, of an individual
suffering from an incurable and agonizing disease.
• popularly known as “MERCY KILLING” regarded
as merciful release from an incurable and prolonged
suffering.
• the art of practice of painlessly putting to death a
person suffering from a marked deformity or from
an unbearable and distressing disease.
• is a theory which affirms an individual’s right to die
in a painless and peaceful manner when he is
confronted with a horrible disease and the quality of
his life deteriorates.
Cases of Euthanasia maybe grouped into self-administered and
other-administered.
SELF-ADMINISTERED:
a. Active (positive) euthanasia
a terminally ill patient will deliberately,
directly terminate his life by employing painless methods. This is an act of commission
insofar as it is voluntary and deliberate.
b. Passive (negative) euthanasia
one allows oneself to die without
taking any medicine or by refusing medical
treatment. This is an act of omission
insofar as one simply refuses to take
anything to sustain life.
OTHER-ADMINISTERED
a. Active and Voluntary Euthanasia is one in which either a physician,
spouse, or a friend of the patient will terminate the latter’s life
upon the latter’s request.
- it is voluntary insofar as it is requested by the patient.
- it is active insofar as some positive means is used to terminate the
patient’s life.
b. Passive and Voluntary Euthanasia is one n which a terminally ill patient
is simply allowed to die by the physician, spouse, or an immediate
relative, upon the patient’s request.
- it is passive insofar as no positive method is employed; the patient
is merely permitted to pass away.
- It is voluntary insofar as this is done upon the patient’s request.