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SIX KEY ETHICAL PRINCIPLES OF NURSING

1. AUTONOMY
• derived from the Greek word “autos” meaning self & “nomos” meaning rule,
governance or law.
• There is independence or autonomy in the sense that one is able to see, judge, &
decide what is logical & best for the person to survive & enjoy living.
In autonomy, the individual is free from threats or any type of force or coercion🡪
this means that the individual is in full control
of self, totally aware of what is the issue & in a capacity to make appropriate moves &
decisions for the best outcome.
An autonomous person→ must have the capacity for self-governance→ to govern
one’s self, one must have these capacities:
• To understand the issue & what the situation is all about
• To reason out & give one’s own opinion
• To deliberate by weighing the pros & cons of the issue
• To make an independent choice→ basic to this is one’s capacity to make a
choice.
• Even autonomous persons w/ self-governing capacities often fail to govern
themselves in their choice because of temporary constraints imposed by:
- Illness
- depression
- extreme fatigue
- or because of ignorance, coercion or conditions that restrict options.
An autonomous person who signs a consent form without reading or understanding the
form has failed to act autonomously because of failure to read & understand what the
consent demanded.
• Some individuals who are not generally autonomous can at times make
autonomous choices.
Example: some patients who are confined in mental institutions may be unable to
care for themselves & are declared legally incompetent.
• However, they may still be able to make autonomous decisions such as stating
preferences for meals, refusing some medications & interventions, or making
choosing
to talk to certain relatives & friends.
• Autonomy of the client must be respected because this is a person’s right to
exercise freedom of decision & choices.
→ As health care providers, there is a need for each of us to keep this in mind so
that the client is assured of his/her practice of autonomy.
• Principle of autonomy - result principle of respect
for autonomy → we acknowledge the individual’s right to hold views & opinions, to
make choices, & to take action based on personal values.
• Respect is concretized thru action, reaction & attitude→ allowing the person to
act on his/her own, in other words autonomously; and accepting the person for
what he/she is to us.
• Disrespect for autonomy🡪 involves attitudes & actions that ignore, insult, belittle,
despise, or demean a person.

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AUTONOMY
• states that patients should be able to act independently and should be in control
of their fate.
• Patients should make decisions regarding their care or act intentionally, without
being controlled or excessively coerced.
• Nurses may try to influence patients to adopt a particular treatment strategy
when that is the strategy with the strongest evidence base but must not prevent
patients making their own decisions.
• Preserving autonomy for patients can be achieved through patient-centered care
and involving patients in their own care decisions
• An example of behaviors that promote autonomy is presenting all treatment
options to a patient and providing them with sufficient information such that the
patient can make an informed choice in concert with medical advice.
Application of Autonomy
Informed consent – Nurses do not give advice to what course of action, but their primary
task is to provide all information
• Paternalism
ω The principle and practice of paternal administration: government as by a father,
the claim or attempt to supply the needs or to regulate the life of a nation or community
in the same way a father does of the children.” - (Immanuel Kant and Stuart Mill, 1880s)
Principle of Paternalism/Parentalism
– Means acting in a fatherly manner which involves engaging in behaviors associated
with those of the traditional father of the family such as leadership, decision-making,
discipline, and protection.
– Should assist others in pursuing their best interest when they cannot do themselves
• In health care, the concept of paternalism is applied when health care givers,
especially physicians, assume the authority to make decisions for the patients.
• Thought of as a violation of the patient’s right for autonomy or freedom to choose
• Applied in instances where patients have diminished decision-making capacity
such as mentally incompetent, delirious, unconscious or under the influence of
drug
• Nurses can make the decision for the patient to promote patient’s well-being or to
be protected from harm or injury (Justified only to prevent harm to the patient)
The role of nurses as patients advocate is related to this concept
• ω Example:
• – The nurse capacity to restrain a violent patient (without need of asking for the
patient’s consent) who may harm himself or other persons around him
• – An unconscious patient brought to the emergency room who receives medical
treatment without him being made to sign consent for medical treatment first
Standard of Best Interest
• Pertains to health care providers making decisions about the clients ‘health care
when they are unable to make decisions about their own care
• The health care provider must decide what the best course of action for the
patient is and carry it out
• Restrictions on autonomy may occur when there is potential harm to others such
as communicable diseases or acts of violence.

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• For example: a person in the acute stage of contagious disease must be isolated,
even against his will, in order to prevent the spread of disease and protect the
greater public.
• Restrictions on autonomy may occur when there is potential harm to others such
as communicable diseases or acts of violence.
• For example: a person in the acute stage of contagious disease must be isolated,
even against his will, in order to prevent the spread of disease and protect the
greater public.
2. PRIVACY
Defined as the individual’s control over access to him/herself extending to physical or
informational inaccessibility→ the person has the right to control the access.

In hospital settings, when we emphasize “respect for the patient’s privacy” → territorial
inaccessibility & non-exposure to others, as in screening the patient’s territorial area when
giving health care.

Discussing the patient’s case publicly, as in student’s medical rounds w/o asking the patient’s
permission is → trespassing into the patient's privacy.
“privacy is a necessary condition, the necessary atmosphere for maintaining intimate
relationships of respect, love, friendship & trust”. “Without privacy, these
relationships are inconceivable.” (Charles Fried, 1990)
Has such instrumental value.
We grant access to ourselves in order to have & maintain such relationships (health
professional-patient relationship)
For example, we allow physicians access to our bodies in order to protect our health.
● In any relationship, we have to provide time for being alone, for being private, to
breathe & to be just ourselves & be inaccessible to others.
In health care, each person is unique. Each is private. Let us respect our patients’ need
for privacy
● provide time for being alone
● Let us respect our patients’ needs for privacy, for moments of silence.
3. CONFIDENTIALITY
-The ethical principle that requires nondisclosure of private or secret information with
which one is entrusted.
-Keeping in confidence all that one has learned in the course of caring for the patient
and family, is a strong basis for an effective and working professional-patient
relationship.
-To confide in someone like a physician or nurse, one must feel secure that secrets are
securely guarded and kept in confidence.
-Confidentiality does not apply to families because each member knows or will try to
know about each other.
Confidential communication is termed as privilege communication or professional
secrecy because it is given based on trust.
-Both legal and moral obligation of health care providers
-The patient and his/her family are entitled to known information or facts within the limits
determined by the physician.

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-Nurse may only repeat what the doctor wishes to disclose

-Any information gathered by the nurse during the course of caring for the patient
should always be treated confidential until the patient’s death
-Nurses reassures the patient that information gained in the interview will be treated
confidential
Persons required to observe confidentiality: 
a. Physicians who deal with the patient even for a briefest times at various phases of
the patient’s illness or treatment 
b. Pharmacist who prepares and dispenses the medication prescribed to the patient 
c. All other health care professionals involved in the care of the patient such as nurses,
medical technologist, hospital chaplain, student nurses and social workers 
d. All other personnel who attend to the care of the patient such as janitors, hospital
receptionists, secretaries, accountant, treasurer, etc.
Confidential information may be revealed when:
a. The patient himself/herself permits
b. The case is medico-legal
c. The patient is ill of communicable or highly contagious disease and public safety may
be jeopardized
d. Given to the members of the health team if information is relevant to his care
e. Upon order of the court or when public safety and order require otherwise
Distinction between infringement of privacy and
infringement of confidentiality,
- Only a person or institution to whom information is given in a confidential
relationship can be charged with violating rights of confidentiality.
VERACITY
• Truthfulness “telling the truth”
• To be true is to accept oneself as one is.
• To respect veracity in relationships is to deal honestly with patients & colleagues
as they are.
• Is necessary in professional-patient relationships for three reasons:
1. The obligation of veracity is based on respect owed to others.
In asking patients their consent for any necessary intervention, the validity of the
consent depends on the thorough information, full disclosure & enlightenment given to
the patient regarding the procedures or intervention to be done.
→ “respect owed to other human beings includes respect for their liberty.” (Allan
Donagan, 1978)
2. Veracity has a close connection to obligations of fidelity & promise-keeping.
When we communicate with others, we implicitly promise that we will speak truthfully, &
that we will not deceive our listeners.

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The patient gains a right to the truth regarding diagnosis, prognosis & all other patient
information.
The professional gains a right to truthful disclosure of information from patients
3. Relationship of trust between persons are necessary for fruitful intervention &
cooperation.
At the core of these relationships is confidence & reliance on others to be truthful.
Relationships between health care professionals & their patients ultimately depend on
trust & adherence to rules of veracity.
On the other hand, lying & inadequate disclosure show:
1. disrespect for persons
2. violate implicit contracts &
3. threaten relationships
-Telling the truth
• The physician tells the patient and his family his diagnosis, plan of care,
treatment and possible risks involved, length of treatment, possible expenses
and other options they may take if there be any
• Applied in the nurse’s responsibility never to mislead or deceive a patient
• Veracity is necessary in Professional- Patient Relationships for three reasons:
1. The obligation of veracity is based on respect owed to others.
– In asking patients their consent, for any deemed necessary intervention, the validity
of the consent depends on the thorough information, full disclosure, and enlightenment
given to the patient regarding the procedures to be done.
2. Veracity has a close connection to obligations of fidelity and promise- keeping.
- When we communicate with others, we implicitly promise that we well speak truthfully
and that we will not deceive out listeners.
– Example, a relationship is entered into a contract, thereby gaining a right to the truth
regarding diagnosis, prognosis and all other pertinent information.
3. Relationships of trust between persons are necessary for fruitful intervention and
cooperation.
– At the core of these relationships is confidence in and reliance on others to be truthful.
– Truth telling is necessary to foster trust.
– Lying and inadequate disclosure show disrespect for persons, violate implicit
contracts and threaten relationships.
How we say the information oftentimes makes them acceptable or not
ω Example 1:
– The physician or health practitioner is requested not to tell the relative the exact
nature of the patient’s illness: A young married male who was diagnosed to have AIDS
requested the doctor not to tell his diagnosis to his wife.
• Telling the wife would be far more advantageous so that she can be examined,
protected or treated as the case may be.
She would be able to use proper precautionary measures for herself, understand the
husband’s illness, and participate in his case

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Example 2:
– Relative request the physician not to tell the patient his condition or diagnosis:
The children of an aged mother suffering from metastatic cancer request the doctor not
to tell their mother her diagnosis and instead to proceed with the chemotherapy.
-Gently telling her the truth would help convince her to participate in the treatment plan
and includes spiritual preparation towards peaceful death.
Physician intentionally withholds information according to his sound judgement when
such revelation would do more harm to an emotionally unstable or depressed person.
→ This is called benevolent deception.
4. FIDELITY
• The obligation to act in good faith & to keep vows & promises, fulfill agreements,
maintain relationships & fiduciary responsibilities.
Fiduciary responsibility→ the contract of relationship we enter into with the patient.
Model for fidelity→ keeping one’s word of honor, loyalty to commitments & oaths, &
reliability.
Why so? Because the model of fidelity leans on the values of loyalty & trust as well as
standing true to one’s word→ ‘palabra de honor’
With fidelity goes the traits of maturity & commitment of the person.
Fiduciary relationships → bank on trust & confidence
-Once the physician or nurse enters into a relationship with the patient, these
professionals become the trustees of the patient’s health & welfare.
-Hence, both the physician & the nurse are obligated to maintain the contract of care.
-They cannot w/draw their care w/o giving notice to the patient, the relatives or
responsible friends, who need enough time to look for their replacement attendants.
→ Fidelity is possible when a professional nurse knows what is beneficial to others &
when one respects the autonomy of others, because these lead to honesty & trust.
• ABANDONMENT is a breach of fidelity and infidelity amounting to disloyalty.
5. JUSTICE
Is giving each one his/her due.
-An example is; someone who has been working hard on the job does not get the
needed promotion while another one who gets promoted w/o merit🡪 The one who
worked hard is entitled to something; in this case, a promotion.
Some influential theories that go with the principle of justice are the following:
1. Utilitarian – emphasizes a mixture of criteria for the purpose of maximizing public
utility
2. Libertarian – emphasizes rights to social & economic liberty, invoking fair procedures
rather than substantive outcome.
3. Communitarian – stresses the principles & of justice that evolve through traditions in
a community
4. Egalitarian – emphasizes equal access to goods in life that every rational person
values.
The right to demand to be treated justly, fairly and equally
• Fair opportunity rule is based on the EGALITARIAN PRINCIPLE that emphasizes
equal access to goods and services

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• Underlies the nurse commitment to provide services with respect for human
dignity and render nursing care to the best of her ability to every patient
regardless of religion, sex, race, economic status, and
• Basis of the law that provides for equal access to health care for all.
Example: The hospital put up triage schemes to determine who should be served first
We give what is due and we get what we merit for our conduct in life.
FAIRNESS
EQUITABLE
DESERVED
APPROPRIATE
-If an individual needs care, he/she has the right to be cared for because care is his/her
due.
-No one therefore has the right to refuse health care to someone who is in need.
-Emergency: regardless of the individual’s capacity to pay, health care must be given to
the person needing care because as health care professionals, out first duty is to save
lives.
Allocation of Scarce Resources
-To allocate is → to distribute by allotment.
-We should keep in mind that justice in health care implies that every individual should:
1. receive benefits due him/her by right such as life, minimum health care, information
for decision making & confidentiality on private information.
2. receive benefits he/she deserves after balancing competing claims of other persons
against his/hers; i.e. equal opportunity to get an ICU bed, a pacemaker or an organ
transplant.
3. share in the burden of paying for the cost of health care & health research.
The following statements are based on what the Southeast Asia Center for Bioethics
(1995) recognizes:
1. Every human being has a fundamental right to health.
2. Individuals have the primary responsibility to promote their own health
3. As independent social beings, people have the right to seek the help of others in
fulfilling this responsibility. Reciprocally, people have the duty to give some help to
others.
6. BENEFICENCE
• refers to action done for the good of others.
• Bioethicists associate beneficence w/ acts of mercy, kindness & charity.
• Humanity, altruism & love are also considered forms of beneficence.
• Benevolence
• refers to the character trait or virtue of being inclined to do good & act for the
benefit of others.
• Principle of Benevolence🡪 Should help those in need
Five Rules of Beneficence:
1. Protect & defend the rights of others
→ explaining to the patient who will undergo surgery that he/she has the right to know
what the surgery is all about, what benefit versus risks the surgery will bring, & that
he/she has the right to know the alternative management aside from the surgical
intervention.

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Patient’s Rights
A. Right to Medical Care and Human Treatment
B. Right to Informed Consent
C. Right to Privacy
D. Right to Information
E. Right to Privilege Communication
F. Right to Choose Physician
G. Right to Self-determination
a. Right to Religious Belief
b. Right to Medical Records
c. Right to Leave
d. Right to Refuse Participation in Medical Research
e. Right to Correspondence and Receive Visitor
f. Right to Express Grievances
g. Right to be Informed of His Rights and Obligations as a Patients
2. Prevent harm from occurring to others
📫 pulling up the bed’s side rails.
📫 using double gloves when doing an intervention w/ an AIDS patient in order to
prevent harm from occurring to self & others.
3. Remove conditions that will cause harm to others
📫 when caring for patients who are not mentally sound, pills, sharp objects,
hazardous materials such as candles, gasoline & matches should be safely kept away.
4. Help persons w/ disabilities
📫 guiding & holding the hands of blind or deaf individual while crossing the street
-reading a newspaper or book to someone who has defective eyesight.
5. Rescue persons in danger
📫 throwing a lifesaver to someone who is drowning.
📫cheering up someone who is depressed or suicidal
→ are several examples of this rule.
Ideal Beneficence
A benevolent act that involves going out of one’s way to do good to others.
-Example: A nurse was riding on a bus. Suddenly one of the passengers fainted
probably because of hypoglycemia & fatigue. The nurse brings her to the nearest
hospital, stays w/ her until she regains full control of herself.
-In addition, the nurse brought her back to her home & gave her food
→ this act is virtuous & ideal; not everyone would do such a good act for a stranger.
The nurse felt she had to do it because it was her inner extreme moral obligation that
prodded her to do so.
Obligatory Beneficence
• is a mandatory act to do good, to give aid to those who are in need.
Examples:
• In emergency cases, no one should be denied urgent care
• to offer a glass of clean water when someone is thirsty
• to shelter the homeless
• to feed the hungry
• to give love to abandoned children.

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NONMALEFICENCE
• asserts an obligation not to inflict harm intentionally on anyone; one ought not to
inflict evil or harm.
An example is not creating false rumors to destroy another’s reputation.
-Both the principles of BENEFICENCE & NONMALEFICENCE focus on doing good to
others.
-Both are attuned to altruism→ to do acts of kindness & towards self & others because
all by nature are good & all deserve goodness.
BENEFICENCE & NONMALEFICENCE
-The difference lies in the nature of execution:
-Beneficence starts w/ preventing harm from happening to anyone
→ this principle sees to it that any individual will not be harmed in the physical,
emotional, psychological, & spiritual sense.
-Nonmaleficence (asserts an obligation not to inflict harm intentionally on anyone) on
the other hand, focuses mainly on the subject of not inflicting harm.
→ These two principles have more similarities than differences because both aim to do
good deeds to others at all times.
-Other philosophers & even some bioethicists may have other points by w/c they make
a distinction between nonmaleficence & beneficence.
-Nonmaleficence is not doing any harm or inflicting evil on someone especially physical
harm.
-Nonmaleficence here is avoiding any intent or cause that will lead to death.
In 1988, Gert, a bioethicist, working in a moral oriented disciplines, gave the following
typical examples of nonmaleficence:
1. “Do not kill.”
2. “Do not cause pain or suffering to others.”
3. “Do not cause offense to others.”
4. “Do not incapacitate others.”
5. “Do not deprive others of a good life.”
ω Example: – Not assisting in performing abortion
– Not assisting to commit suicide
– Not performing euthanasia or mercy killing
– Not willfully subjecting patients to experimental drugs whose potential harm
may be greater than the benefit
– Not harming a person’s reputation by revealing confidential information
– Not participating in treatments or procedures that will harm the patient
– Not able to perform skin test prior to administration of allergic medications
ω The principle may justly be violated in some medical situations:
– When a pregnant woman with advanced cardiac disease must have abortion
– When you intubate a patient
– Violated in short term to produce greater good for the patient in the long term such
when painful and disfiguring surgery is performed like radical neck dissection for the
purpose of prolonging life in a patient with advanced laryngeal cancer
– When a gangrenous limb of a diabetic patient must be amputated in order to prevent
the spread of infection to the other parts of the body

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Obligations of nonmaleficence🡪 obligations of not including harm, & not imposing risks
of harm.
• A person can harm or place another person at risk w/o malicious or harmful
intent & the agent of harm may or may not be morally or legally responsible.
An admonition in the negative form to remind health practitioners to do no harm
ω Obligation to avoid injuring another individual
ω The legal requirements of duty of care and accountability clearly arise from this
principle
ω “Prinum non nocere” = above all do no harm to anyone
ω The principle affirms the need for professional competence.
ω Expressed in the Hippocratic oath: – “I will use treatment to help the sick
according to my ability and judgment but will never use it to injure or harm them.”
An extension of this is the obligation of health care providers to protect from harm
those who cannot protect themselves such as children, mentally incompetent,
and unconscious client
Natural Law Ethics
← Saint Thomas Aquinas (1225-1274)
← Disseminated by Roman catholic church
← Also influenced by Aristotle
← Rightness of an action is self-evident from the law of nature
← most cases Orchestrated by lawgiver God
← Morality is determined not by customs, and human preferences but is commanded by
law of reason
← Implanted in nature and human intellectual
← Natural law ethicists believed that behavior that is contrary to their views of the laws
is immoral
← Examples are artificial means of birth control, homosexual relationships
MORAL/ETHICAL PROBLEMS
← Moral Uncertainty: sense that a moral problem, but are not sure of morally correct
action, unable to define moral problem what moral theory/ principle apply, sense
something is not right, uncomfortable with the situation
← Can’t figure out the problem
← Nature and cause of inadequacy
Moral/Ethical Dilemma
• A dilemma exists when a difficult seem to have no satisfactory solution or when
all solutions to a problem appear equally (Davis 97)
← Conflicting moral claims
← Conflict = evidence
← Terminally ill patient, preserve life, prolong suffering
← Agent, one or more moral norms exists
← Critical care bed allocation?

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Moral Distress
- face situations seem to have clear solutions, yet unable to follow their moral belief due
to restraints
← No conflicting moral l claims
← Impossible to peruse course of action
← Powerless, hierarchy, culture of silence
← Personal risky = hospitals = hospitals end
Moral Outrage
• Someone else performs an act the nurse believes to be immoral
• Do not participate directly
• No feelings of responsibility but powerlessness
• Whistle blowing may be response to moral outrageousness
IMPORTANT POINTS TO REMEMBER
- Informed Consent is also known as Enlightened consent
Prior to any medical/surgical interventions, clients must have full information on what
the procedure is all about, the need and advantages, outcomes of the procedure (the
positive & the negative sides) and alternative measures are all made clear to the client.
⮚ if it is about a surgical intervention, disclosure includes:
✔ information about the part of the body involved
✔ the procedure to be done
✔ the effects on the whole system
✔ the cost of the procedure
✔ the outcome of the intervention.
⮚ When the patient is in coma, unconscious or incapable of making a decision,
those closest to him/her such as the family or relatives may decide for the best
benefit of the patient.
⮚ In instances when there are no close relatives & decisions must be made, the
health professionals with honest desires & intentions to give the best strategy or
intervention to the patient may decide for the patient.
⮚ The health professionals are expected to execute their advocacy rule to the best
outcome of the patient.
Nurses must be aware that obtaining consent is not our main domain because
disclosure should be complete & this is the duty of the health professional who will
perform the intervention or procedure(medical/surgical)
In this case, the responsibility falls on the physician, surgeon or whoever does the
intervention or procedure.
DIFFERENCE BETWEEN INFRINGEMENT ON PRIVACY & INFRINGEMENT ON
CONFIDENTIALITY:

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An infringement of X’s right to confidentiality occurs only if the person to whom X

disclosed the information in confidence fails to protect the information, or deliberately
discloses it to someone without X’s consent.
in contrast, a person who, without authorization, enters a hospital records room or
computer data bank, violates the right to privacy rather than confidentiality.
In summary, only the person or institution to whom the information is given in a
confidential relationship can be charged with violating rights of confidentiality.
OTHER RELEVANT ETHICAL PRINCIPLES
GUIDELINES, MORAL PRINCIPLES OR THEORIES FOR THE NURSES
ω to use to be able to respond to a given situation with sound moral judgement
ω Moral principles – Are statements about broad
1. GOD IS THE AUTHOR OF LIFE; THEREFORE, NO ONE HAS THE RIGHT TO
TAKE IT EXCEPT HIM
2. HEALTH IS WEALTH.
3. THE GOLDEN RULE: Do unto others what you want would like others do unto you.
4. THEORY OF DOUBLE OR TWO-FOLD EFFECT
– A situation which may both have good and bad effects
– Choose the lesser evil, which may produce greater good effects
– The basis of action may be the following:
1. That action must be morally good
2. That the good effect must be willed and that the bad effect merely allowed
3. That the good must not come from evil action but from the initial action itself directly
4. That the good effect must be greater than the bad effect
ω Example
: – It is not morally good if a boy steals in order to alleviate his hunger because the
action itself is already bad.
– On the other hand, if the patient who has cancer of the uterus submits to
hysterectomy, she will not be able to bear a child. If she does not have the
operation, she will die. It is the gynaecologist’s intention to help the mother and not
harm her.
The surgeon’s action is morally good since saving the mother’s life is the primary
importance. Also the doctor himself did not will that the patient lose her child-
bearing.
5. THE PRINCIPLE OF TOTALITY
– The whole is greater than the sum of its parts.
– Example: a man who has a gangrenous foot must be amputated so as to save his life
and he can still walk through aid of crutches or artificial limbs
6. THE GREATEST GOOD FOR THE GREATEST NUMBER
– The result should be one that benefits the most number of people – During an
epidemic, immunization against communicable diseases is administered to people.
Although some may have some slight reactions to the vaccine, the greater majority of
the population shall be considered rather than the isolated few
7. ONE WHO ACTS AS THROUGH AN AGENT MAY BE HIMSELF RESPONSIBLE.
– Example: a nurse recommends a doctor to an unwed pregnant adolescent for
abortion
8. The end doesn't justify the means

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– If the action taken is bad, the result, no matter how good, is not enough for his bad
action.
– Giving a sedative to a chronically ill person so he/she can die in peace is morally
wrong.
A physician assisted a woman diagnosed as having Alzheimer’s disease in committing
suicide is both legally and morally wrong
8. EPIKIA – Exception to the general rule
– Example: if a mental patient went out of control and the doctor could not be
contacted, the patient may be restrained by the virtue of epikia. Another is allowing a
relative to see a seriously ill patient who expresses the desire to see the former
although it is not yet visiting hours
No one is obliged to betray himself or herself – In testifying in court, no one can force
any person to answer a question if such will incriminate him/her
9. DEFECTS OF NATURE CAN BE CORRECTED.
– Patients with cleft palates may have their defects corrected by plastic surgery.
10. IF ONE IS WILLING TO COOPERATE IN THE ACT, NO INJUSTICE IS DONE TO
HIM/HER.
– Example: suppose a patient subjects himself/herself willingly to an experimental drug
and he/she has been told of the possible effects, is of right age and is sane, there is no
violation to human rights
11. A LITTLE OR LESS DOES NOT CHANGE THE SUBSTANCE OF AN ACT
– If a nurse gets medicine from a hospital stock WITHOUT permission or without
prescription, he or she is guilty of theft even if she got only one tablet
12. NO ONE IS HELD TO THE IMPOSSIBLE
– To promise that a patient with a heart transplant will live may be an impossibility.
Yet such procedures are done in the hope of saving or prolonging a patient’s life. The
doctor or the nurse cannot be held if they have done their best to take care of the
patient and the latter dies
13. THE MORALITY OF COOPERATION
– Man is morally responsible not only for his own actions but also to the effect of his
actions to other people as well as his reaction to others men’s action
– Formal cooperation in an evil act is never allowed

ω Types of Cooperation with Evil:

1. Positive Cooperation:
– Voluntarily doing an act which contributes to the evil act of another
– Example: A nurse who assist in abortion (Immoral operations such as abortion shall
not be participated upon by a nurse even if the doctor commands it)
2. Negative Cooperation:
– Cooperation by omission in which the person did not do anything to prevent another
person from committing the evil act
– Example: A nurse who saw another nurse stealing medical supplies and does not
stop the said nurse or report the incident to her supervisor
3. Direct/Immediate Cooperation:
– happens when a person’s cooperation occur while the act is being performed

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– Example: A nurse who acts as a “watch” while the doctor injects a fatal dose of
sedative to un unconscious patient
4. Indirect/Mediate Cooperation:
– committed before and after the evil act; however, cooperation is not necessarily to the
evil act itself
– Example: A nurse destroys all evidence of an abortion although he did not assist while
the surgical procedure was being performed
PRINCIPLE OF STEWARDSHIP
Call for 3 responsibilities:
1. Personal
“ God is the Lord of Life and of Creation: Persons are their Custodians.”
God made human beings free & intelligent- we have the right & obligation to improve
ourselves🡪 good stewardship
But we must use it with profound respect for God’s creation especially if it will
undermine the very freedom & intelligence given to us by God.
2. Social
⮚ Responsible stewardship of available resources
⮚ Managing resources with prudence & moderation
⮚ Wasting or squandering of scarce resource is a sin
⮚ Not to fall into a trap of the technological imperative.
3. Ecological
Ecological & Biomedical Dimension
Our bodies, our life, our human nature and everything in this earth are gifts we have
dominion over🡪 means we are responsible for them.
We have to treat them with utmost respect, use originality & creativity to cultivate them,
know & respect their limits.
We cannot contradict human nature.
PRINCIPLE RELATING TO THE ORIGIN & DESTRUCTION OF LIFE
One of God’s commandments is “Thou shall not kill.”
Euthanasia
Is direct killing of people who may not have committed any crime deserving of death,
but because of mental or physical defects, are considered worthless to society.
Mercy killing is not allowed because it will lessen the incentive for medical research.
Many patients surprise doctors by recovering from illness.
Giving of narcotics to a dying person shall be withheld if there is no physical pain. He
must be left conscious for as long as God does not take his consciousness away.
The state recognizes the sanctity of human life → the essence of being sacred
“Is human life sacred?” → the sacredness of human life
ORDINARY VERSUS EXTRAORDINARY MEASURES
VIEWPOINT: PHYSICIANS
ORDINARY MEANS → Standard, recognized or established medicines/procedures
during that period at the level of medicine
EXTRAORDINARY MEANS→ a medicine/procedure that might be fanciful, bizarre,
experimental, incomplete, established & not recognized.
VIEWPOINT: MORALISTS

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ORDINARY MEANS: → include not only food, drinks & rest but also hospital practice,
all medicines, treatments, procedures, which offer reasonable hope or benefit for the
patient which can be obtained & used for excessive expense, pain, or other
inconvenience
EXTRAORDINARY MEANS→ all medicines, treatments, and operations which cannot
be obtained or used due to excessive expense, pain, or other inconvenience for the
patient or for others, which if used would not offer a reasonable hope for the patient.
ORDINARY VERSUS EXTRAORDINARY MEASURES
An extraordinary measure→ entails the use of aggressive modalities vis-à-vis the
financial capabilities of the family.
There are cases where families who can very well afford it, continue to take
extraordinary measures i.e. being hooked to respirators & giving third generation
antibiotics indefinitely.
These measures do not necessarily offer any benefit to the patient.
The act is usually to ease the guilt feelings of the family, & for them to feel that they did
everything that they could.
however, these extraordinary measures are artificially prolonging the life of the patient 🡪
loading the patient with more burden & fatigue are in fact a hindrance to letting the
person go in peace & dignity.
Since families who insist on these measures can afford them, the expenditures are
proportionate to their demands.
What we can do as health professionals is to help enlighten these families on the futility
of their actions & that resources can be better used in other channels resulting in more
benefits to others.
Ordinary measures comprise the provision of necessities of life & usually pertain to
food, normal respiration & elimination process.
→ IV fluids, nasogastric tube feedings, indwelling catheters are considered necessary
measures & may be sustained even if the case is ir Ordinary measures comprise the
reversible.
All measures considered to be ordinary may be sustained until the time of death.
→ Subjecting patients to chemotherapy & hemodialysis when they are on the verge of
death may become disproportionately extraordinary because of the burden on the
patient’s already weak body vis-à-vis the intervention will offer no benefit to the patient.
KILLING VERSUS LETTING GO
Nowadays we are beset with the issue of assisted suicide.
Some first world countries have legalized the person’s choice to die at his/her own
chosen time.
Assisted suicide→ is knowingly administering some help to hasten death→ in a way,
this is a form of killing because something is introduced in the body to end life earlier
than its natural schedule.
Letting Go→ is allowing a patient to die by not administering any hastening element.
When treatments & extraordinary measures are withdrawn because these measures no
longer offer any benefit to the patient, you are actually allowing that person to die with
dignity at his/her time of final departure.
What we have to keep in mind is that we should always give the best care- surround the
dying person w/ much love, respect & prayers.

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The Do Not Resuscitate (DNR) order is indicated when the case is far beyond
reversibility & death is very certain.
By not administering any cardiopulmonary resuscitation in the event of cardiac arrest,
we actually letting the person go in peace & dignity.
We should not feel guilty that we have not done our part in these situations so long as
we have rendered our best nursing care.
In all these instance, the principle of beneficence & nonmaleficence should be our
guides in the care of patients.
Nursing Consideration: (DNR)
✔ Nurses need to know which patients under their care have DNR orders & these
orders need to be documented clearly in a patient’s chart
✔ If a patient or appropriate surrogate indicates to the nurse the desire not to be
resuscitated & there is no order in the chart, the nurse should document the
request in the patient’s chart & bring this to the immediate attention of the
physician.
✔ The nurse may need to facilitate discussion of the issue between patient &
physician.
✔ Orders should specify which interventions are to be withheld & considerations
regarding circumstances in which they are to be withheld.
PERSONALIZED SEXUALITY
Basic Concepts/Values Recognized in Sexuality:
✔ Sex is a search for sensual pleasure & satisfaction, releasing physical & psychic
tensions.
✔ Sexuality = male & female = genitals (with natural tendencies)
✔ Sex is the search for the completion of the human person through an intimate
personal union of love expressed by bodily union
✔ Sex is a social necessarily for the procreation of children
Key Points:
* Sex is not always a proof of love, although often is demanded as such
* There is inseparable connection established by God, which man in his own
initiative may not break, between
the (1) unitive significance and
the (2) procreative significance
→ both are inherent to the marriage act.
* Any use of sex outside marriage is ethically wrong because:
1. It is selfish pursuit of pleasure apart from love
= masturbation, prostitution, casual or promiscuous relations
2. It expresses love, but not a committed love involving true self-giving
= adultery or premarital sex(PMS)

3. It is committed but practiced in a way contradictory its natural fulfillment in the family
= use of artificial contraceptive methods, relations of committed homosexuals
CONJUGAL/ MARRIED LOVE

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-is the faithful & exclusive love that unites the spouses according to their truth as
images of God.
-the unity & indissoluble fidelity of the spouses strongly characterize this love.
-is also an act of the total person & not an instinctive impulse.
-it embraces the totality of body & soul in human person.

Characteristics of Conjugal/Married Love:

1. Human (physical & spiritual) → which means saying “yes” to someone else & “no” to
oneself.
→ by it, husband & wife become one heart, one soul, and together they attain their human
perfection.
2. Total - a married person loves generously and shares things without
reservations or selfish calculations.
3. Faithful & Exclusive
“committed” → describes how married love involves a pledging of oneself to another.
→ not self-centered but looks to the other partner.
4. Fruitful
the matrimonial consent has two essential elements:
4.1 conjugal love
4.2 ordination to children

NCM 108 BIOETHICS MARIE VIOLA T. SINGANON,RN,MAN AY 2022-2023