Bioethics PRELIMS THEORIES AND PRINCIPLES OF HEALTH CARE ETHICS - Ethics is the moral principles that govern a person’s behaviour or the conducting of an activity. - Morals are concerned with the principles of right and wrong behaviour and the goodness or badness of human character. Ethical Issues in Nursing Theories of Ethics - Utilitarianism (Consequentalism) - Act-utilitarianism Rule-utilitarianism - Deontlogy Utilitarianism - Right action is that which has greatest utility or usefulness No action is, in itself, either good or bad The only factors that make actions good or bad are the outcomes Act-Utilitarianism A person performs the acts that benefit the most people, regardless of personal feelings or the societal constraints such as laws. Rule-Utilitarianism Seeks to benefit the most people but through the fairest and most just means available. It takes into account the law and is concerned with fairness. Deontology (Kantianism) - The rightness or wrongness of an act depends upon the nature of the act, rather than its consequences. - People should adhere to their obligations and duties when engaged in decision making when ethics are in play - A person who adheres to deontological theory will produce very consistent decisions since they will be based on the individual’s set duties Virtue Ethics Judges a person by his/her character rather than by an action that may deviate from his/her normal behaviour Bioethics One weakness of virtue ethical theory is that it does not take into consideration a person’s change in moral character. ETHICAL PRINCIPLES - AUTONOMY NONMALEFICENCE BENEFICENCE JUSTICE FIDELITY CONFIDENTIALITY VERACITY ACCOUNTABILITY Autonomy even The freedom to make decisions about oneself The right to self-determination Healthcare providers need to respect patients’ rights to make choices about healthcare, if the healthcare providers do not agree with the patient’s decision. INFORMED CONSENT relates to a process by which patients are informed of the possible outcomes, alternatives, and risks of treatments, and are required to give their consent freely. It assures the legal protection of a patient’s right to personal autonomy in regard to specific treatment and procedures. Patients are given the opportunity to autonomously choose a course of action in regard to plans of medical care. NONCOMPLIANCE – unwillingness of the patient to participate in health care activities Nonmaleficence - Requires that no harm be caused to an individual, either unintentionally or deliberately This principle requires nurses to protect individuals who are unable to protect themselves Beneficence - This principle means “doing good” for others Nurses need to assist clients in meeting all their needs: Biological Psychological Social 3 major components: 1. Do or Promote Good 2. Prevent Harm 3. Remove Evil or Harm Justice Every individual must be treated equally This requires nurses to be nonjudgmental DISTRIBUTIVE JUSTICE – fair and equitable distribution of goods and services Fidelity - Loyalty - The promise to fulfill all commitments Bioethics - The basis of accountability Includes the professionals’ faithfulness or loyalty to agreements & responsibilities accepted as part of the practice of the profession Confidentiality - Anything stated to nurses or health-care providers by patients must remain confidential The only times this principle may be violated are: • If patients may indicate harm to themselves or others • If the patient gives permission for the information to be shared Veracity - This principle implies “truthfulness” Nurses need to be truthful to their clients Veracity is an important component of building trusting relationships Accountability - Individuals need to be responsible for their own actions - Nurses are accountable to themselves and to their colleagues Ethical Dilemmas - Occur when a problem exists between ethical principles Deciding in favor of one principle usually violates another Both sides have “goodness” and “badness” associated with them RELEVANT ETHICAL PRINCIPLES Principle Of Double Effect • One act can embrace two effects – an intended good effect and an unintended bad effect • Morality of the act is governed by the intended effect • Ethically permissible only if: Act is morally good or at least morally neutral - Only good effect is intended Good results outweighs the bad result Principle of Double Effect When can the principle of double effect not be invoked? 1. When the act by its nature is evil. 2. When the good effect directly proceeds from the evil effect and not from the act itself. 3. When there is no sufficient reason for the performance of an act with two effects, one- good, the other-evil. 4. When the motive of the agent is not honest. Bioethics Principle of Cooperation COOPERATION is working with another in the performance of an action. o The degrees of cooperation may vary according to the gravity or essentiality of the shared act in the performance of an evil action. FORMAL COOPERATION - consists of an explicit intention and willingness for the evil act. The one formally cooperating categorically wills and intends the evil action. Ex: a medical director who wills and intends the evil act of contraception by means of hysterectomy at the request of an interested party, by arranging with the members of the O.R. team as to the operation and its schedule. • MATERIAL COOPERATION - consists of an act other than the evil act itself but facilitates and contributes to its achievement. The one materially cooperating may provide means apart from the evil act itself which is used to carry out the performance of an evil act. Principle of Common Good and Subsidiarity • The common good is the "good that comes into existence in a community of solidarity among active, equal agents.“ • Essential to the common good is participation by all in all spheres of society. • PRINCIPLE OF SUBSIDIARITY- means that what an individual, lower or smaller group can achieve within his/her or its capacity should not be taken away and transmitted to the custody and performance of a higher or bigger group. Ex: in an effort to control the apparent rapid population growth in the country, the State formulates program on responsible parenthood which rebounds to the enactment of a law mandating every family to just limit the number of its offspring only to one or two under pain of penalty. And so, the State through the Department of Health conducts contraceptive programs and distributes various forms of contraceptive methods to ensure the State-directed number of children every family ought to raise. Principles of Bioethics Principle Of Stewardship • Human life comes from God and no man is the master of is own body. • Humans are mere stewards or caretakers, with responsibility of protecting and cultivating spiritual bodily functions. • We are obliged to take care of ourselves. • STEWARDSHIP refers to the expression of one’s responsibility to take care of, nurture and cultivate what has been entrusted to him. “No one can in any circumstance, claim for himself the right to destroy an innocent human being.” -Donum Vitae -Donum Vitae is the "Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation" which was issued on February 22, 1987, by the Congregation for the Doctrine of the Faith. Principles of Integrity and Totality • These principles dictate that the well-being of the whole person must be taken into account in deciding about any therapeutic intervention or use of technology. • Therapeutic procedures that are likely to cause harm or undesirable side effects can be justified only by a proportionate benefit to the patient. • INTEGRITY refers to each individuals duty to “preserve a view of the whole human person in which the values of the intellect, will, and conscience are highly distinguished”. Bioethics • TOTALITY refers to the duty to preserve intact the physical component of the integrated bodily and spiritual nature of human life, whereby every part of the human body “exists for the sake of the whole as the imperfect for the sake of the perfect”. • The whole is greater than any of its parts. Organ Donation Ethical Issues - Because these donations require a transplant from one living person to another, a moral dilemma involving the principle of totality arises. According to this principle, the parts of the body are ordered to the good of that specific body. Therefore, the surgical mutilation of a donor for the good of the recipient must not seriously impair or destroy bodily functions or beauty of the donor. For example, both eyes are necessary for certain visual functions. A living person would seriously impair his ability to see if an eye were donated to another. Such a sacrifice would detract from the wholeness or full functioning of the donor's body. It would be a bad means to a good end, and therefore morally wrong. Principle of Ordinary and Extraordinary Means • Ordinary means = reasonable hope of benefit/success; not overly burdensome; does not present an excessive risk and are financially manageable • Proportionate to the state of the patient • “Ethically indicated” (Strong 1981 p. 84). • Extraordinary means = no reasonable hope of benefit/success; overly burdensome; excessive risk and are not financially manageable • No obligation to use it/morally optional Principle of Personalized Sexuality • Personalized Sexuality is based on an understanding of sexuality as one of the basic traits of a person and must be developed in ways consistent with enhancing human dignity. • The gift of human sexuality must be used in marriage in keeping with its intrinsic, indivisible, specifically human teleology. • It should be a loving, bodily, pleasurable expression of the complimentary, permanent selfgiving of a man and a woman to each other, which is open to fruition in the perpetuation and expansion of this personal communion through the family they beget and educate.
