HEALTH CARE ETHICS Being ethical is clearly not a matter of following

Philosophy feelings
Way of thinking Feeling frequently deviate from what is ethical
Deep understanding
4 R’s (responsiveness, reflection, reason and re- Typical replies – Ethics has to do with my religious
evaluation) beliefs.
Learn to think better, act more wisely, improve Religion
quality of life Do advocate high ethical standards
Provides intense motivations for ethical behavior
Ethics Should not be identified with ethics
Ethics – Greek ethos Cannot be confined to religion nor is the same
Morals – Latin mores
Nature of ultimate value and the standards by Typical replies – Being ethical is doing what the law
which human actions can be judged right or requires.
wrong Law
Both derived from the word for: Ethics is not equal to law
Custom, Manners, Disposition Incorporates ethical standards to which citizens
Also called Moral Philosophy - Concerned with to subscribe
what is morally good and morally right and Law can deviate from what is ethical (slavery,
wrong apartheid)
Concept of good and right
Intrinsic good, instrumental good, summum Typical replies – Ethics consists of the standards of
bonum (ultimate good) behavior our society accepts.
Socially acceptable behavior
Scientific – Based on or characterized by the methods Ethics is not equal to “whatever society accepts”
and principles of science, systematic, methodical, Standards of behavior can deviate from what is
organized, rigorous, exact, precise, accurate, ethical. (slavery, nazi Germany)
mathematical. Ethics
Humanism – Outlook attaching prime importance to Science of the highest good
human rather than divine or supernatural matters, Science of the supreme ideal of human life
focusing on the potential goodness of human beings, The study of what is right or good in human
emphasizing common human needs, and seeking conduct or character
rational ways of solving human problems.
Naturalism – The philosophical belief that everything Right
arises from natural properties and causes, and Honesty – taking straight, being genuine and
supernatural or spiritual explanations are excluded or ethical
discounted. Courage – taking accountability for results, being
Morality – Principles concerning the distinction between up front about mistakes and taking considered
right and wrong or good and bad behavior. A particular risks
system of values and principles of conduct, especially Fairness – treating people justify and equitably
one held by a specified person or society. Respect – treating individuals with dignity
Caring – listening carefully to others, working
Health care ethics is the field of applied ethics that is together to achieve shared goals
concerned with the vast array of moral decision making Trust – keeping our promises
situations that arise in the practice of medicine in
addition to the procedures and the policies that are Healthcare ethics = Applied ethics
designed to guide such practice. Moral judgements about:
- Actions
Typical replies – Ethics has to do with what my feelings - Conditions
tell me is right or wrong. Framework for discussing:
Feelings - Medical issues
Many equate ethics with feelings - Medical decision making
Theories of Health Ethics Autonomy, only the patient can accurately
Utilitarianism determine what action will bring him to greatest
Deontology happiness
Feminist ethics
Communitarianism Utilitarianism has been criticized as being simple and
unable to cope with the complexities of real-life
Doing the right thing situations: three of these claims
The right things mean to act with the intention Utilitarianism requires us to do whatever act will
of doing good bring about the greatest good, even if that
It also matters what people do and what the means doing something we would otherwise
outcomes of their action are consider immoral
True calculations of happiness are impossible
Utilitarianism – is a form of ethical theory that is Utilitarianism does not consider issues of
concerned with the outcomes of actions distributive justice
A form of ethical theory that is concerned with
the outcomes of actions Utilitarianism requires us to do whatever act will bring
The action itself that is right or wrong, not the about the greatest good, even if that means doing
person performing the action something we would otherwise consider immoral
A type of consequentialist theory • If we can bring about a good, then, according to
utilitarian theory, we are required to do that action.
Jeremy Bentham • However, there are some goods that can be achieved
Introduced the name Utilitarianism only through means that most of us would consider
Central thesis: the greatest happiness of the wrong.
greatest number is the measure of right and Ex: A patient asks that her family not be informed of her
wrong diagnosis or prognosis
The greatest good for the greatest number
The good is defined very simply as happiness • By utilitarian reasoning, it would required that you
disclose this information to the family
John Stuart Mil • However, respecting patient confidentiality is an
Refined the idea of utilitarianism important element of patient care
Pleasure and freedom from pain are the only two • Most clinicians would agree that it is absolutely wrong
things desirable as ends in themselves to disclose patient information without the
The creed which accepts as the foundations of patient’s consent
morals, Utility, or the Greatest Happiness • following utilitarian reasoning could put one in a
Principle, holds that actions are right in situation in which breaking ethical standards is
proportion as they tend to promote happiness, required
wrong as they tend to produce the reverse of • Utilitarians’ have addressed this problem is to adopt a
happiness. By happiness is intended pleasure, rule utilitarian stance
and the absence of pain; by unhappiness, pain,
and the privation of pleasure. (Mill, 1863/1998, A rule utilitarian would reply: Disclosing confidential
p. 14) patient information would bring about more harm than
good and therefore one should always follow the general
Utilitarianism applied in healthcare ethics rule of maintaining confidentiality.
Distributing resources so that the greatest number of
people can get the most benefit from them is a direct
application of utilitarian theory. True calculations of happiness are impossible
Criticism of utilitarianism: in practice it is
Ethical problems we face in nursing are directly about impossible for an individual or a group to
people’s happiness accurately calculate all the pleasure and freedom
Quality of life from pain that any specific act will entail.
Decisions about withdrawing treatments as a
means to end suffering Supporters of utilitarianism reply to this criticism
even though not all consequences are
 foreseeable, the major ones are. For most reciprocal altruism, feelings of sympathy, and
situations, most of the time, a reasonable consolation are evolutionary traits that have
enough calculation can be made. contributed to human survival.

KANTIAN theory (Immanuel Kant)

Utilitarianism does not consider issues of distributive Morality is only possible in a community of
justice. beings that possess the natural attributes of
rationality and free will. Thus, we cannot justly
Utilitarianism only requires that happiness be
hold someone responsible for his/her actions
maximized, not that there be any sense of
unless that person can know right from wrong;
fairness regarding who gets to be happy.
and unless that person is capable of doing right
Utilitarian’s response: fairness or justice is and avoiding wrong. Knowing what’s right or
generally a method of increasing happiness, then wrong is different from doing what’s right or
this is a suitable goal and can be made a criterion wrong.
for distributing health care resources, not For Kant, and all deontological theorists, the
because justice or fairness is good in and of itself, morality of human action cannot be separated
but because promoting it will promote happiness from intent. Morally good actions arise out of
in general. good intentions and morally bad actions arise
out of bad intentions.
Deontology – derived from the Greek work deon
meaning duty Examples of Divine Command theory in action, as well as
Deontologists believe that actions are right or its drawbacks, are profuse in the health care setting:
wrong insofar as they satisfy a moral obligation • Orthodox Church has a very strong pro life stand.
or duty, regardless of whether that maximizes Orthodox Jewish patients often taking a more stringent
the good interpretation of God’s command to respect and
The action is morally right if and only if it preserve life.
conforms to one’s moral duties and obligations • Jehovah’s Witnesses, although agreeing with the duty
Earliest and most prevalent forms of deontology to respect and preserve life, claim that there is a higher
is known as “divine command” theory duty, given by divine command, not to ingest blood, and
- duties and obligations that are to be therefore refuse blood transfusions
followed are those that have been given • Even people who do not identify with a particular
to people by God religious tradition may have their own sense of what God
It is defined as an ethical theory that the requires of them
morality of an action should be based on
whether that action itself is right or wrong Reflecting on the work of Immanuel Kant
under a series of rules, rather than based on the Kant believed that all moral duties and
consequences of the action. obligations could be determined through the
Duties, in the deontological tradition, are most application of practical reason
often associated with obeying absolute moral Kant’s view , apply our powers of reason to
rules. The rightness or wrongness of a moral rule ascertain which rules of obligation we should act
is determined independent of its consequences on.
or how happiness or pleasure is distributed as a according to Kant, we must act in accordance
result of abiding by that rule, or not abiding by it. with our obligations, which are governed by
rules.
NATURAL LAW Kant provides us with a formula for determining
Aristotle wrote that nature is organized for which rules (or maxims, as he calls them) are a
good purpose. valid reflection of our duties and obligations
It claims to provide an objective and universal This formula, or test, is called the “categorical
foundation. Moral rules based on natural law, imperative.” It is also known as the
like the dictates of science, are portrayed as universalizability criterion: Act only on that
objective and existing independent of personal, maxim by which you can at the same time will
social, or cultural beliefs. Typically, they argue that it should become a universal law.” In
that moral behaviors such as kinaltruism,
 colloquial terminology, We should act only if we There rarely exist relationships between two
can desire that all others act in the same way people or groups with absolutely identical
strengths and weaknesses
Application of Immanuel Kant’s formula, “categorical Health care provider patient relationship
imperative or universalizability criterion” in the health “ethics of care”
care and medical setting: moral action is through the emotions

First criterion, the categorical imperative requires us to Example, when the parents of a very sick child inquire
test this action to see whether, in doing so, we would be about the latest rounds of tests or how the child is
appropriately discharging our obligation to the patient responding to treatment

Example: A friend of your patient approaches you and Answer: it is important that the information be relayed
says, “I know my friend is getting the results of his lung in a way that is responsive to the family’s needs
biopsy today. Can you tell me what they are so I can be In the hospital setting this may mean finding a
ready to support him?” quiet corner in which the family will not have to
strain to hear over all the other noises of the unit
Answer: We cannot generalize this action into a universal being gentle but firm in relaying bad news, so
rule, we cannot release the test results to the that the family does not feel assaulted, but at the
Friend same time does not misunderstand the news;
taking time to answer questions and provide
Example: The father of your patient approaches you and comfort so that the family feels supported.
says, “I know my son is getting the results of his lung
biopsy today. Can you tell me what they are so I can be Communitarianism - all people and principles owe their
ready to support him?”. Your patient is a minor, 12 years existence to and are partly constituted by a community
old. or group of communities.

Answer: I should release medical information to a minor Communities can be understood in a variety of
patient’s parent(s) so that he (they) can make informed ways as geographical groups, nationalities,
decisions.” institutions, social units, and so on
Includes:
Second criterion of the categorical imperative is that - the patient
no person should be treated merely as a means but, - the family of the patient
rather, as an end. - the community of people directly
- involved with the patient’s care
Answer: one cannot treat patients as tools or use them - the health care institution
merely to achieve an objective. Patient’s must be treated - the society in which the patient lives.
with respect. Patient’s interests and well being must be communities, is integral to the identity of all
taken into account people
institution of medicine
Kantian ethics has become almost synonymous
with deontology Example: Babies who are born with severe anomalies. If
they live, many of these children will face surgery after
Feminist ethics - much of the work of daily living revolves surgery, requiring intensive hospital and home care, and
around people and relationships, and because morality is may be physically, emotionally, and financially
about how we understand the world and how we should dependent on their parents for the rest of their lives.
act in it, we need to look to these relationships and Parents have to decide whether they are capable of
associated values to understand morality. meeting the demands presented by such children
Will there be enough time and resources to
When one is in a relationship with another it is expected adequately care for all the children in the family?
that each party will give special consideration to the Will the family be able to function as a social unit,
needs of the other over the needs of people in general or will it break apart in resentment and
dysfunction?
Answer: presenting issue is whether to treat the baby, - both a harmful and a beneficial
vital considerations involve the well being of others in outcome.
the home. - to be justified, an act that has both a
the good of the community is a primary concern harmful and a beneficial outcome must
primary unit of moral consideration is the meet the following guidelines:
community, a. The act itself must be either good or
Communitarians claim that, just like everything morally neutral.
else, moral principles, rules, and customs are b. The good effects must be intended
derived from the community itself and the harmful ones unintended,
though they may be foreseen.
Ethical Principals c. The harmful effects may not be a
Non maleficence means to the beneficial or good
Beneficence effects.
Autonomy Example: Pregnant woman in the first trimester who is
Justice discovered to have ovarian cancer. Aggressive radiation
therapy may be necessary if there is to be any chance of
Non maleficence recovery. Although the radiation treatment may produce
obligation to NOT inflict harm on others the morally good effect of saving the woman’s life, it also
- medical ethics codes to “do no harm.” entails killing the fetus.
to abstain from injuring others and to help
others their own well being by removing harm By the standards of double effect, this is a permissible act
and eliminating threats because:
oblige one to avoid doing harm (example 1. Radiation therapy is itself a morally neutral act.
preventing someone at risk for harm) 2. The intention of the therapy is to eradicate the cancer,
Something that one considers a harm may not be and though it is clear that the therapy will also kill the
to another fetus, it is not the intention to do so.
- Example: radiation treatments involve 3. Killing the fetus is not what kills the cancer
the risk of infertility
what might objectively seem like a harm may Beneficence
actually be perceived of as a good to further an requires that we seek to do or produce good for
individual. others
- Example: “ultimate harm” person who obliges one to provide good (example promote
has a terminal prognosis some one’s welfare)
the most important determination of harm is American Nurses Association (2001) described
what the patient himself or herself considers a the role of nurses as “promoting, advocating for
harm and striving to protect the health, safety and
rights of the patient
Derivatives Principles of Nonmaleficence
Principle of due diligence Derivatives Principles of Beneficence
- refers to the care that a reasonable Principle of Compassion
person exercises in a given situation to - or caring
ensure that he or she does not harm - directly derived from beneficence.
another person - good done through an act is not limited
- Example: Washing one’s hands before to the causal effects of the action, but
and after patient contact to prevent the depends on the way in which the action
spread of disease is done
- Breaches of due diligence are termed - Example: Having patients’ wound
negligence dressings changed in a caring manner by
Principle of double effect a nurse
- is derived from Catholic moral theory Principle of Veracity
regarding the permissibility of acts that - honesty or truth telling
will have
 - patients cannot act in their own interest the streets, over sleeping overnight in a
unless they are fully informed of their warming shelter. When determining
medical condition what is in a person’s best interests, one
- two instances in which truth telling may needs to consider which of the available
be morally prohibited: options has the greatest potential to
a. the case of minor patients create benefit to that person and
b. patient decides that he does not promote the possibility of achieving his
want to be informed of certain or life goals. Person with a Mental health
information or details disease that affects decision making
- Example: parents do not want to know capacity may define what is in his or her
the gender of their child when an best interests differently than a person
ultrasound, they simply want to know with a healthier mental status
whether the fetus is healthy Principle of Proportionality
Principle of Fidelity - requires us to choose those actions or
- one to be faithful in relationships and options that confer a greater good than
matters of trust harm or produce a greater benefit than
- keep promises, or more broadly as a burden
requirement to actively uphold one’s - higher the ratio of benefit to burden, the
end of the patient clinician relationship more ethically compelling is the act
- Health care Provider: acting in the best - Example: Ethically mandatory for a
interest of the patient, maintaining clinician to offer an antibiotic for the
confidentiality, obtaining informed treatment of a sexually transmitted
consent, being honest, educating the disease because the benefit is great and
patient, and being responsive to his or the burden, both in terms of cost and
her needs side effects, is relatively low. Whereas
- principle of trust or obligation of not be ethically required at all to offer a
covenant patient an expensive experimental drug
Principle of Paternalism for a disease that can be managed in
- entails overriding a patient’s expressed other ways.
wishes
- Paternalism is a common societal Autonomy
response for protecting another (usually that obliges one to allow individuals to self
someone the person perceives to have determine their plans and actions
less knowledge and experience and/or respecting the personal liberty of individuals and
fewer problem solving skills) from harm. the choices they make, based on their personal
- Paternalism is derived from the word values and beliefs.
parent clear violations of individual autonomy:
- Example: Ms. Juana lives on the street - Tuskegee study poor AfricanAmerican
and has been diagnosed with men enrolled in a study of syphilis were
schizophrenia with paranoid features. never informed of an effective and
She believes that everyone is attempting inexpensive treatment that had become
to steal her personal belongings and available for the disease and were
physically harm her. Ms. Juana refuses to allowed to remain sick for years and
avail herself of community sponsored even die
health clinics, soup kitchens, or warming Derivatives Principles of Autonomy
shelters. When the outside temperature Principle of Privacy and Confidentiality
drops below 0 F, the question must be - Two related derivative principles of
raised whether Ms. Juana’s refusal to autonomy are privacy and
seek shelter and health care services for confidentiality
exposure related symptoms is in her - Privacy to avoid intruding on the
best interest. Ms. Juana prioritized personal space and business of a patient
safeguarding her possessions, which are
instrumental to her ability to survive on
 - Confidentiality confers an obligation on - treating people in such a way as to
health care providers to protect the recognize and value their status as fellow
personal information of the patient human beings
- Example:
a. Principle of Privacy- knocking before TYPES OF PATERNALISM
entering a room requesting Recipient’s Welfare
permission before touching - Pure Paternalism justifies intervention
someone into a person’s life for the sole welfare of
b. Principle of Confidentiality – vigilant that person
about holding conversations that - Example: child is told by his parents eat
include references to specific vegetables because it is good for his
patients health
Principle of Advocacy - Impure Paternalism justifies interference
- advocacy on the part of nurse is required with another person not only in that
to ensure that patients needs and values person’s welfare but also for the welfare
are heard and respected of another
- Patients usually have the least powerful - Example: the parents of a Jehovah’s
position in the any health care setting. witness should have a blood transfusion
- Patients has least recognized opinions in not only for his own good but also for the
any health care setting. good of his children
- Nurse is usually the health care provider Recipients Defect And Safety
most intimately connected to the patient, - Restricted Paternalism support
they bear a special obligation to act as intervention which overrides an
advocates for their patients individual’s action because of some
- This obligation is based in respect for defect in that individual
patient autonomy. - Example: prohibit a child from doing
Principle of Informed Consent something because of chronological or
- Informed consent requires that patients psychological incompetence
receive all pertinent information about - Extended paternalism individual is
their health condition and the options for restrained from doing something because
treatment and that they explicitly choose it is too risky or dangerous
their own treatments - Example: riding motorcycles without
- This principle ensures that it is the wearing helmet is not encourage, i.e. it is
patient’s will, not the provider’s, that is unlawful, because of the imminent
being carried out. danger it incurs
Promotion of good and prevention of harm
Justice - Positive paternalism
The ethical principle that obliges one to treat - Example: patient is forced into
those who are equal rehabilitation program to promote
When individuals are unequal, in relevant his/her own good.
respects, one is obliged to treat them in a fair - Negative paternalism
manner - Example: Cigarette taken away from an
The principle of justice is also the most difficult individual to prevent from any harm.
of the four principles to apply Recipients sense of values
organ transplants - Soft Paternalism act the recipients values
are used to justify the intervention with
Derivatives Principles of Justice his/her possible action or decision
Principle of respect - Example a unconscious or comatose
- primary derivative principle of justice patients, is usually detached from life
- efforts to help patients to maintain or support system because he/she signified
preserve dignity or protect them from such preference if ever he/she would be
anything that threatens to impinge on put in such situation
their rights
 - Hard paternalism the recipients values Patient upon consulting the Physician,
are not the ones used to justify the voluntarily transfer part of his autonomy to the
paternalistic physicians based on faith
- Example of Hard paternalism, someone
who supposedly knows what is good for a 2. State Paternalism control exerted by the legislature,
patients directs the latter with regard to an agency (e.g. PRC), or other government bodies
what is to be done or directs someone over particular kinds of practices and procedures in
else to do this for the patient medicine
Recipients of the benefit Justification
- Direct Paternalism the individual who improve the good quality of medical education
should receive the supposed benefit is upgrade ahigh standard of medical care
the one whose values are over ridden for control drug adduction, drug abuses or spread of
his own good. HIV or other sex related diseases
- Example motorcyclist who force by law to
wear a helmet is the one who will benefit Natural law ethics endorse Personal and State
in case of an accident Paternalism
- Indirect paternalism individual will be • While the patient knows what is good and bad for
benefitted if one person is restrained himself, he or she does not know everything
from doing something. • Since the Physician has superior knowledge about
- Example is child abuse, in which parents human pathologies and diseases, he is
are restrained by law in some ways to • In a better position is in a better position to what action
protect a child or decision should be made
• Though individuals posses inherent worth and have the
Application of Paternalism in health care setting freedom to make moral decisions for themselves,
1. Personal Paternalism individual decides on the basis however, individuals may not have the pertinent
of one’s best knowledge of what is good for another information, the sufficient knowledge
person
- Example: Member of Plymouth Brethren Immanuel Kant’s concept of a person as a rational and
Sect disdains the shedding of blood. They autonomous agent, it seem he is against Paternalism
refrain from being operated on for acute • Paternalistic is act interfere with an individual
appendicitis. Upon suffering from autonomy and self regulating will.
ruptured appendicitis, this person • Kant’s position maybe become untenable when an
collapses in unconsciousness. Surgical individual lapses to unconsciousness, in which
resident, then operates and saves the • case the physician must act to save the patient life
person’s life • in keeping with Kant’s precept of not treating any
- Example: attendant doctors performs patient as a means but always as an end, physician
paternalistic act for the benefit of the non performs
consenting patient • a paternalistic act for and on behalf of the unconscious
Justification patients
Recipient of the paternalistic act is sick and
consults a physician to seek medical expertise Teleological (Consequence-oriented) theories
Recipient of the paternalistic act has some Mill defined happiness as a set of higher order
incapacity which prevents him from making a pleasures such: intellectual, aesthetic and social
decision enjoyment rather than sensual pleasure. The
To the best of one’s knowledge and training, purest form of this line of reasoning is Act
there is the probability of harm unless a paternal Utilitarianism.
decision is made. rightness or wrongness of decision based on
The physician needs to determine if all harm s outcomes or predicted outcomes
are equal The right this to do, then, is the good thing to do.
Probably benefit of paternal intervention Equal Consideration of interest tells us that
outweighs the probable risk of harm individuals is not allowed to increase his share of
Physician has an obligation to act in the best happiness as expense of other
interest of the patient
 most common form of consequence oriented RIGHT TO INFORMED CHOICE - This refers to the
reasoning is UTILITARIANISM. Jeremy Bentham necessary information a patient should know
& John Stuart Mill are the father of utilitarianism about a medical treatment or experiment so that
a moral choice can be made
Proposed Intrinsic Goods RIGHT TO REFUSAL OF TREATMENT - This is
• Life, consciousness and activity conjunction with the statement on Patient’s
• Pleasure and satisfaction of all or certain kinds Bills of Rights (American Hospital Association.
• Happiness, beautitude, contentment Patient may refuse medical treatment because
• Truth of their religious conviction from doing so ( e.g.
• Knowledge and true opinion of various kinds, wisdom Jehovah’s Witness may refuse to undergo blood
• Beauty, harmony, proportion in object contemplated transfusion)
• Aesthetic experience
• Morally good dispositions or virtues Four major elements of informed consent
• Mutual affection, love , friendship, cooperation COMPETENCE - Refers to a patients capacity for
• Just distribution of goods and evils decision making
• Harmony and proportion on one’s own life - One has made a decision
• Power and experiences of achievement - Justify one’s choice
• Self expression - Justify one’s choice in a reasonable
• Freedom manner
• Peace Security COMPREHENSION - Refers to whether the
• Adventure and novelty information given has been understood or not
• Good reputation, honor esteem - Nurses translate their jargons to be
understood by patients
Utilitarianism are also referred to as Teleological Theory DISCLOSURE - This refers to the content of what
Teleological theory - Greek word “telos”, which means a patient is told or informed about during the
end negotiation
- Interpreter is need in case of language
Consequence – Oriented Reasoning barrier
1. Describe problem VOLUNTARINESS - This means that consent
2. List solutions must be voluntary.
3. Compare solutions with utility - Free will
4. Arrive at correct answer - Not pressured
- Patients’ own decision
Patients’ Right
Duty is correlative to right Limitations of patients’ rights
Patients’ right refers to the moral and inviolable 1.Patients’ rights do not include to be allowed to die.
power vested in him/her as a person to do hold - under the concept of personal paternalism, the
or demand something as his/her own physician may make the moral decision for and behalf
Duty of every individual: respect this right and of the patient who can no longer decide by and for
not to violate it. himself
2. A patient in moribund ( state of dying) condition
Duty - Moral obligations to do or omit something in favor does not possess the necessary mental or emotional
of the another according to the demands of strict justice stability to make an informed choice.
- Attending physician may perform the paternalistic act
Types of Patients’ rights
RIGHT TO INFORM CONSENT- The patients has 3.Patient’s right are not absolute
the right to receive all necessary information - Paternalistic concern limits the competent adult
concerning diagnosis and treatment in order to patient’s freedom for his or her own good in order to
be able to give consent based his or her value prevent harm from befalling the patient
system
RIGHT TO AN INFORMED DECISION -
Information and understanding are necessary for
genuine deliberation
The Patient's Bill of Rights American Hospital Application of Ethical Theories
Association Natural Law ethics regards the right to informed
1. The patient has the right to considerate consent as morally legitimate
and respectful care. Kant’s ethics principal that one must always be
2. The patient has the right to obtain from treated as ends and never only a as a means,
his/her physician complete current patients must not be deceived by their
information concerning his/her Physicians, no matter how good their intentions
diagnosis, treatment, and prognosis in may be
terms that the patient can be reasonably Utilitarianism’s principle of utility requires
expected to understand. healthcare professionals to design medical
3. The patient has the right to receive from treatment in a way to minimize sufferings and
his/her physicians information harm
necessary to give informed consent prior Rawls’s Principles of justice do not allow medical
to the start of nay procedure and or/ treatments or experiments that violate freedom,
treatment which a patient is entitled to by virtue of being
4. The patient has the right to refuse member of society
treatment to the extent permitted by
law and to be informed of the medical John Rawls
consequences of his or her action Rawls’ theory of Justice
5. The patient has the right to every Justice is fairness.
considerate of his/her privacy Everyone is fair to everyone else living under the
concerning his/her medical care veil of ignorance in the hypothetical community,
program which the so called” Original position”.
6. The patient has the right to expect that Theory of justice. Every individual is inviolable
all communication and records
pertaining to his /her care should be Case: When Aging Parents Can No Longer Live
treated as confidential Independently
7. Patient has the right to expect that, Principle of Autonomy
within its capacity, the hospital must
provide a reasonable response to Joyce Fisher, a home health agency nurse, has just
his/her request for services. received a telephone call from the daughter of a patient,
8. The patient has the right obtain 82 year old Mr. Sims, whom she had visited some months
information regarding any relationship before The daughter was very distraught, telling Ms.
of his/he hospital to other healthcare Fisher that her father had fallen at home but refused to
and educational institutions insofar as be seen by a physician Mrs. Sims, her mother, had called
his/her care is concerned. the daughter at her place of business and pleaded with
9. The patient has the right to be advised if her to come to their home and stay with them The
the hospital proposes to engage in or daughter was exasperated by the frequency of these calls
perform human experimentation from her parents in recent weeks and was appealing to
affecting his/her care or treatment. The Ms. Fisher for help in making some long term decisions
patient has the right to refuse to for the care (and safety) of her parents.
participate in such research projects.
10. The patient has the right to expect Ms. Fisher remembers well the conversations she had
reasonable continuity of care. The with Mr and Mrs Sims and their daughter several months
patient has the right to refuse to ago, following Mr Sims’s last hospitalization The Simses
participate in such research projects. live alone in a small home and are frequently visited by
11. The patient has the right to examine and their married daughter, who buys their groceries and
receive an explanation of the hospital takes them to their various health appointments Mr Sims
bill, regardless of the source of payment has always been the decision maker of the family, but he
12. The patient has the right to know what allows this amount of assistance from the daughter “for
hospital rules and regulations apply to Mama’s sake Another daughter lives in a nearby city, but
his/her conduct as a patient she has chronic health problems that prohibit her active
involvement in the affairs of her parents A son lives on
the West Coast and travels constantly in his line of Legally, the children have no authority to take over
business He supports his parents by sending money for decisions for their parents, even if they are well
their expenses to his sister (Mr Sims has refused direct motivated in wanting to do so. Certainly, a health care
financial aid from any of the children) All three children professional has no such authority. If there is to be a
are concerned about the future welfare of their parents, declaration of incompetency, the only agency with the
but they have been unsuccessful in persuading them to legal authority to make that declaration is a court of
change their mode of living. proper jurisdiction.

The present problem is caused by the fact that Mr and They might first approach the problem by looking at the
Mrs Sims are losing their ability to live independently and consequences of going beyond persuasion and offering
make their own decisions Mr Sims’s unexplained falls are reasons for the alternative they favor The children might
also increasing, a constant source of worry for Mrs Sims argue that they have seen the dangers increasing and
and a genuine concern for their married daughter They know their parents well enough to realize that they are
all look toward Joyce Fisher as the person who can help at risk Ms Fisher might argue that she has seen elderly
them make and support a decision that will preserve people similarly situated so that she knows the risks they
some autonomy for the aging parents and respect their are taking. The consequentialist argument for respecting
choices and lifestyle Yet Ms Fisher doubts that what is the liberty of the parents to make their own decisions
best for all concerned (parents as well as children) can rests on at least two considerations First, probably
avoid infringing upon the choices and self respect of the neither the children nor the nurse is in a particularly good
older Simses. Is there no happy medium for aging parents position to know the disadvantages of a more protected
when they can no longer live independently? living arrangement The parents are probably in a better
What is the role of the home health nurse in assisting position than anyone else to know the psychic trauma of
individuals in reaching decisions with which they can a major lifestyle change Second, the mere fact that they
live? would be losing control would appear to be an important
disadvantage of a more protected arrangement Mr Sims
INTRODUCTION appears particularly distressed by that possibility Thus,
Mr and Mrs Sims both are people whose capacities for even on consequentialist grounds alone, there are good
autonomous decision making are beginning to be reasons for the Simses to retain their freedom of choice.
compromised The critical decision, both for Ms Fisher
and for the Simses daughters and son, is whether they SOLUTION
will treat the Simses as autonomous agents If they do and Mixture of family and healthcare professionals could do
if they are convinced that it is in the Simses interest to what is best for persons who have never been declared
change their living arrangements, they may try to incompetent, those committed to an ethical principle of
persuade them of the wisdom of a change They will autonomy would still argue that it would be wrong to
present reasons why a change would be appropriate they take over the decision making. According to the principle
may try to argue with them If they are to respect their of autonomy, an action is wrong insofar as persons with
autonomy, however, they will not make decisions against substantial capacities for autonomous decision making
their will They will not coerce them into a living are not permitted to exercise that autonomy
arrangement to which they do not consent.

DISCUSSION
If Ms Fisher and the children have doubts about the
parents’ competency or capacity to be substantially
autonomous decision makers, they may try to test them
They may try to determine if the Simses comprehend the
risks of their current situation, the alternatives,
and the advantages and disadvantages of their possible
choices. If one or both parents seem incapable of making
reasonably autonomous choices, Ms Fisher and the
children will face a critical point They might simply take
over the decision making, but even though they might
get away with it, that kind of unilateral “declaration of
incompetency” is problematic both legally and ethically
NUTRI LEC Vitamins
Nutrients Organic compounds
Chemical substances necessary for life Regulate body processes
Functions Examples: vitamins A, B, C, D, E, and K
- Provide energy
- Build and repair tissue Minerals
- Regulate body processes: circulation, Inorganic compounds
respiration, digestion, and elimination Regulate body processes
Six classes Examples: calcium, phosphorus, potassium,
Carbohydrates (CHO) sodium, chloride, iron, magnesium, and zinc
Fats (lipids) Water
Proteins Major constituent of all living cells
Vitamins Composed of hydrogen and oxygen
Minerals
Water The Six Essential Nutrient Classes and Their Functions
Organic nutrients - Function
• No nutrient can work alone. Carbohydrates - Provide energy
• Essential nutrients: those found only in foods Fats - Provide energy
• Organic nutrients: carbohydrates, fats, proteins, Proteins - Build and repair tissues and provide
vitamins energy
• Inorganic nutrients: water, minerals Vitamins - Regulate body processes
Inorganic nutrients - Function
Organic nutrients Minerals - Regulate body processes
Must be broken down before use Water - Regulate body processes
Contains carbon, hydrogen, and oxygen
Function: provide energy, regulate body Characteristics of Nutritional Status
processes, and repair tissues Good
Inorganic nutrients Alert expression
In simplest form when ingested Shiny hair
Function: regulate body processes Clear complexion
Good color
Carbohydrates Bright, clear eyes
Provide major source of energy Pink, firm gums and well developed teeth
Examples: cereal grains, vegetables, fruits, nuts, Firm abdomen
and sugars Swollen abdomen
Firm, well developed muscles
Fats (Lipids) Well-developed bone structure
Normal weight for height
Provide energy Erect posture
Highest kilocalorie value Emotional stability
Sources: meats, milk, cream, butter, cheese, egg Good stamina
yolks, oils, nuts Seldom ill
Healthy appetite
Proteins Healthy, normal sleep habits
Build and repair body tissues Normal elimination
Provide energy Poor
Only one of the six nutrients that contain Apathy
nitrogen Dull, lifeless hair
Sources: meats, fish, poultry, eggs, milk, cheese, Greasy, blemished complexion
corn, grains, nuts, and seeds Poor color
Dull, red rimmed eyes
Red, puffy, receding gums, and missing or cavity
prone teeth
 Swollen abdomen
Underdeveloped, flabby muscles
Bowed legs, “pigeon breast”
Overweight or underweight
Slumped posture
Easily irritated, depressed, poor attention span
Easily fatigued
Frequently ill
Excessive or poor appetite
Insomnia at night, fatigued during the day
Constipation or diarrhea

Malnutrition
Overnutrition - excess energy or nutrient intake
Undernutrition – deficiency energy or nutrient
intake
Overnutrition is a larger problem than
undernutrition in the U.S.
The supersizing, fast food industry contributes to
overnutrition

Cumulative effects of nutrition

Excesses
Excess nutrients over time
Examples: atherosclerosis, obesity,
hypertension, diabetes, gallbladder disease,
some cancers
Deficiencies
Nutrients lacking for extended period
Examples: iron deficiency, beriberi, scurvy,
osteomalacia, osteoporosis, rickets, goiter