LESSON 2: ETHICAL RESPONSIBILITIES OF THE
HEALTHCARE PROFESSIONALS
Most professional organizations affirm that a
healthcare provider’s primary responsibility is
to the patient.
They also have responsibilities to members of
the patient’s family, to the institution they work
for, to a referring institution, to society, to the
profession, to themselves, and most especially
to God.
Responsibilities and some situations in which conflicts
arise.
I. Welfare of the patient.
One of the nurse’s central responsibilities is to
be genuinely concerned about the patient's
welfare.
This means that the needs of the patient, not
the nurse, assume primary importance in the
therapeutic relationship.
It also implies that a therapeutic relationship
should be maintained only as long as the
patient is benefitting from
II. Making referrals.
Doctors also have a responsibility to know when
and how to refer patients to appropriate
resources.
It is crucial for professionals to know the
boundaries of their own competence and to
refer patients to other professionals when
working with them is beyond their professional
training or when personal factors interfere with
a fruitful working relationship.
LESSON 3: MORAL PRINCIPLES IN BIOETHICS
MORAL PRINCIPLE
refers to a fundamental rule of moral law
containing certain truth from which knowledge
of a definite moral action for performance
proceeds along with the provision of solutions
to specific moral problems or issues.
I. THE PRINCIPLE OF BENEFICENCE
provides that good must be done either to
oneself or to others.
This fundamental moral principle binds and
urges everyone to do what is good and perform
for good as a moral obligation.
It mandates the right of every human person to
the preservation of life, promotion of quality
life, physical integrity, and health.
patients are in need most of what is good for
them.
to do good is an expression of love.
In fact, the greatest kind of good is love - and
the greatest love is the love of God
II. THE PRINCIPLE OF NON – MALEFICENCE
Provides that evil or harm should not be
inflicted either on oneself or on others.
This fundamental moral principle binds and
urges everyone to avoid inflicting harm as a
moral obligation.
It mandates the right not to be killed, the right
not to have bodily injury, or pain inflicted (on)
oneself, (and) the right not to have one’s
confidence revealed to others.
Dr. Angeles Tan Alora
enumerates some of the violations of the
principle of non-maleficence, to wit:
I. Physically harming a person as in suicide, abortion,
infanticide, mutilation, torture, and violence;
II. Exposing a person to physical harm as in subjecting a
person to unnecessary treatment or to a dangerous
procedure without a commensurate important goal’
and
III. Harming a person’s reputation, honor, property, or
interests as by revealing confidential information.
NOTE:
both the principles of beneficence and nonmaleficence advocate high regard and respect
for human life and dignity.
Practically, the two principles can go together
in the performance of healthcare services
III. THE PRINCIPLE OF DOUBLE EFFECT
For an act to be good, it must be good in all its
moral determinants.
A defect in any one of them renders the act evil
and is morally prohibited.
Not infrequently, a single act produces two or
more effects.
A good act may have several good effects and is
worthy of being performed thereby increasing
its goodness or even adding new goodness.
4 CONDITIONS:
1. The act must be good in itself, or at least, morally
indifferent.
Being the primary moral determinant, the set
by its very nature must be good.
2. The good effect must directly proceed from the act
itself and not from the evil effect. At the very least,
both effects must occur simultaneously.
It indicates the fact that the good effect is the
one that is being directly willed and not the evil
effect in the performance of an act.
3. There must be sufficient reason for the
performance of an act in its attainment of the good
effect.
As determined by the nature of the act and its
circumstances, the sufficiency of reason exists
when there is no other means by which the
desired good effect can be achieved. It
4. The motive of the agent must be holy and honest.
When Can the Principle of Double Effect not be
invoked?
When the four conditions are not satisfactorily met,
with:
1. When the act by its nature is evil.
It is blatantly contrary to the dictates of the
right reasons to perform an evil act no matter
what the circumstances are.
2. When the good effect directly proceeds from the
evil effect and not from the act itself.
It means that the evil effect is the one that
directly proceeds from the act itself and, as
such, is directly willed.
3. When there is no sufficient reason for the
performance of an act with two effects, one good, the
other evil.
It proceeds from the fact that there are still
other alternatives by which the good effect can
be obtained and that the desired good effect.
4. When the motive of the agent is not honest.
This means that the main motive behind the
performance of an act is the occurrence of the
evil effect for being ahead of the good effect
V. THE PRINCIPLE OF STEWARDSHIP
Stewardship
refers to the expression of one’s responsibility
to take care of, nurture, and cultivate what has
been entrusted to him.
Consists in the practical recognition that man is
not the absolute master of himself or of his
possessions.
He has received every gift and grace from God.
He must use them in a responsible manner to
promote the interest of God and to establish his
Kingdom in the heart of men.
IV. PRINCIPLE OF INDIRECT VOLUNTARY ACT
effect that is not directly intended though
foreseen or foreseeable.
A directly willed set whose evil effect is not
directly willed holds the agent responsible
provided that the principle of indirect voluntary
act is employed whose conditions are fulfilled.
3 CONDITIONS:
NOTE:
As a steward, man does not have absolute
ownership of his life in the sense that he can do
whatever he wishes without corresponding
responsibility before God.
1. The evil effect must be foreseen or foreseeable in
the performance of the act at least in a general way.
Common sense gives anyone the capacity to
foresee that an evil effect, though indirectly
willed, may happen as it proceeds from a
human act that is to be performed.
IN HEALTHCARE PRACTICE
STEWARDSHIP
2. There must be freedom to choose not to do the act
which is the cause of the evil effect.
Refers to the execution of the responsibility of
the health care practitioners to look after,
provide necessary health care services, and
promote the health and life of those entrusted
to their care.
To be a health care steward is to be just and
honest with the exercise of his duties and
obligation to uphold the goodness of human life
as God’s creation.
As previously learned, as free act is elicited by
the will having the power to choose to do or not
to do it. However, freedom cannot be exercised
if there is no light of knowledge in the intellect.
3. Refraining from doing the act which is the cause of
the evil effect holds the agent morally bound.
Reason dictates that when the evil effect is
foreseen or foreseeable and that the agent is
free, he is morally obliged not to pursue the
performance of an act which serves as the
cause of the evil effect
VI. THE PRINCIPLE OF JUSTICE
JUSTICE
the rendering of what is one’s due.
A person who is justify doing an act to another
person gives the latter what is his due.
Principle of Justice
refers to a moral principle by which certain
actions are determined and deemed as just or
unjust, as due or undue
RIGHT
is a moral power of performing, of possessing,
or of requiring something which is due
RIGHT IS JUST
refers either to natural rights as incumbent
upon the nature and dignity of the human
person, or rights granted by positive law
whether Divine or human
DUTY
enable the patient (or his watcher) to make the
relevant decision
VII. THE MEDICAL SUCCESS PRINCIPLE
gives priority to those for whom treatment has
the highest probability of medical success
Limitations:
This principle may overlook the real existing
need for immediate health care intervention
among other patients.
Thus, it poses a great argument as to whether
or not it constitutes a claim that has to be
chosen.
VIII.THE PRINCIPLE OF IMMEDIATE USEFULNESS
a moral obligation incumbent upon a person to
do or omit something.
Generally, what is to be done is good while
what is to be omitted is evil.
MAIN DUTIES AND OBLIGATIONS OF HEALTH CARE
PRACTITIONERS
gives priority to the candidate who is of the
greatest immediate service to the larger group
under the circumstances
Limitation:
said principle can be contested with an
argument as to whether it is indicative of a
claim that has to be attended to over others.
1. Preservation of life and health.
This consists of the prevention and treatment of
sickness, alleviation of suffering, and promotion
of health.
2. Protection of bodily integrity from harm.
This consists in the prevention of unjust
mutilation and sterilization, of subjecting a
person to medical research with undue burden
and harm, and the like.
3. Respect for human dignity.
This consists of the provision of all the
necessary means of care, high regard for the
person of the patient, needed information to
IX.THE PRINCIPLE OF CONSERVATION
gives priority to those candidates who require
proportionally smaller amounts of resources
and therefore more lives would be saved.
Limitation:
Patients in dire need of a bigger amount of
health care resources by reason of their serious
condition are excluded from the health care
benefits.
More often than not, seriously ill patients are
the ones whose condition requires more
healthcare resources than the not too seriously
ill. This principle foments dispute as to
whether or not it is against justice
X. THE PARENTAL ROLE PRINCIPLE
gives priority to those who have the largest
responsibility to dependents.
The father with dependent children would be
given priority over a bachelor with no
dependents
Limitation:
This principle can be contested with a
pathological condition that necessitates
instantaneous medical treatment.
XI.THE PRINCIPLE OF GENERAL SOCIAL VALUE
gives priority to those believed to have the
greatest general social worth thus leading to
the good of society.
The municipal or city mayor has a right to
medical treatment deemed greater than an
ordinary citizen
Limitation:
an ordinary citizen who urgently needs health
care services due to a severe medical condition
will have to wait in favor of the one looked up
as having a general social value whose condition
may not be as serious as that of the ordinary
patient.
Thus, it may even convey a discriminatory
message against those who are voiceless and
marginalized
XII. 12. THE PRINCIPLE OF SAVING NO ONE
gives priority to no one because not all can be
saved.
If there are not enough resources for all who
need them, then no one should receive any.
Limitation:
This is a tangible denial of health care to all those
who need it.
Much worse, it deprives, particularly those who
are in urgent and awful need, of their right to
immediate medical intervention.
It provokes moral objection.
XIII. THE PRINCIPLE OF MEDICAL NEEDINESS
gives priority to the candidates with the most
pressing medical needs.
Patients who are the most seriously ill are the
ones who benefit from the limited health care
resources.
Limitation:
It may draw waste of health care resources
when the most seriously ill patients who are the
recipients are not able to recover and survive
after all.
XIV.THE PRINCIPLE OF GENERAL NEEDINESS
gives priority to the most helpless or generally
neediest in an attempt to bring them as nearly
as possible to the level of well-being equal to
that enjoyed by others.
The poorest candidate would receive the
available resource.
Limitation:
Like the other cases, what if the poorest
candidate does not have a pressing medical need
as compared to a middle-class patient”? Again it
may not be expressive of a claim to prevail over
others.
XV. THE PRINCIPLE OF FIRST COME, FIRST SERVED BASIS
gives priority to those who arrive first.
This principle is practical.
It may apparently convey a message of giving
one what is his due as determined by the time he
arrives.
It also helps establish order in the distribution of
health care goods.