PRELIM: NCM 108 – HEALTH CARE ETHICS • Amoral: Describes someone who

• Health Ethics acknowledges the difference between right and

• Virtue Ethics in Nursing wrong, but who is not concerned with morality
• Values
• Ethical Principles 2. Utilitarianism
• A specific type of consequentialism that
focuses on the greatest good for the greatest
NURSING number.
• Universal • According to consequentialism, the right
• Working for a noble cause course of action is determined by examining the
• Dealing with human life consequences or outcome of an action and
• Respect for human rights including cultural selecting the one that produces the greatest
rights good.
• Treating clients with dignity • Thus, no action is itself right or wrong – it is the
• Care to humanity action’s consequences that determine whether
• Right to life and choice it is right or wrong.

What is Ethics? 3. Deontology

• A category of normative ethical theory that
ETHICS encompasses any theory which is primarily
• The word 'ethics' is derived from the Greek concerned with adherence to certain rules or
word ethos, which means 'custom', or duties.
‘character’. • Actions that align with these rules are ethical,
• The branch of knowledge that deals with moral while actions that don’t aren’t.
principles that govern a person's behavior or the • Do the right thing, because it’s the right thing
conducting of an activity. to do – it is what your duty demands.
• The study of how human beings treat each
other and the natural environment; it is the 4. Teleology
systematic examination of the attitudes and • From Greek telos, “end”; logos, “science”
behaviors of people. • Theory of morality that derives duty or moral
obligation from what is good or desirable as an
HEALTH ETHICS end to be achieved.
• Health ethics is the branch of ethics that deals • Rightness of an act is determined by its end.
with ethical issues in health, health care, • Consequences drive the moral decision.
medicine, and science.
• Health ethics promotes the consideration of • MORALITY - actions are based on standards in
values in the prioritization and justification of society to be right and accepted
actions by health professionals, researchers, and • UTILITARIANISM - no actions is right or wrong,
policymakers that may impact the health and consequences should be greatest good for
well-being of patients, families, and greatest number
communities (WHO, 2022). • DEONTOLOGY - actions that align with rules
are ethical, we look on the actions itself to be
Importance of Health Ethics right or wrong
• It is essential for health care professionals, and • TEOLOGY - actions are based on the
especially those aspiring to be in healthcare outcome/quality of outcomes to be right or
management to understand not only health care wrong
regulation and compliance, but medical ethics as
well. Healthcare professionals should want to
provide the best care they can for their patients VIRTUE ETHICS IN NURSING
— which involves care driven by a solid moral
compass. • Virtue ethics is an approach that focuses on
character with the assumption that a person of
ETHICAL THEORIES good character will tend to behave in ways that
• 1. Morality are consistent with their character.
- The set of standards that enable people to live • A virtue ethics for nursing is therefore
cooperatively in groups. It’s what societies concerned with the character of individual
determine to be “right” and “acceptable.” nurses and seeks ways to enable nurses to
• Immoral: Describes someone who purposely develop character traits appropriate for actions
commits an offensive act, even though they that enhance wellbeing.
know the difference between what is right and
wrong “Character matters.”
• Nonmoral: Describes situations in which Florence Nightingale, the founder of the modern
morality is not a concern era of the nursing profession, recognized the
importance of personal character and virtue to VALUES
those who would aspire to become a nurse.
Nurses who understand how patients’ values
What VIRTUES are needed? and their own values shape nurse-patient
interactions, and who continually develop
1. Truthfulness/Honesty sensitivity to the ethical dimensions of nursing
• The lack of honesty and truthfulness is at the practices, are best able to provide quality care
root of the ongoing problem of cheating, and advocate for their patients.
plagiarism and other shortcuts all too many
students are willing to pursue to get a passing •Values are enduring beliefs or attitudes about
grade. the worth of a person, object, idea, or action.
• If a nurse is willing to lie and compromise the •Values are important because they influence
truth for his/her benefit, this will follow them in decisions and actions, including nurses’ ethical
practice when an error is made and needs to be decision making.
disclosed. If a student is willing to be deceitful in An individual is not born with values, they are
academics, they will also be deceitful in practice. formed during a lifetime involving influences
from the environment, family, & culture.
2. Integrity
• To be a person of Integrity involves a personal Common Modes of Value Transmission
choice to hold oneself to consistent high moral
and ethical standards. It is living out practically • Modeling - children learn values by observing
the ethical principles you value and believe others
internally. • Moralizing - children taught a complete value
• Integrity is also closely related to honesty. For system that allows little opportunity to weigh
example, a lack of disclosure and honesty with different values
any type of error or mistake does not just impact • Laissez-faire - children left to explore values on
you, it also affects the patient and can result in a their own, little or no guidance, likely to lead to
possible adverse outcome. confusion
• Rewarding and punishing - children rewarded
3. Sympathy/Compassion for values held by parents and punished for
• Caring and compassion remain the core virtue demonstrating unacceptable values
ethics of the nursing profession and their • Responsible choice - encourages children to
relevance remains obvious. The essence of explore competing values and to weigh their
caring as a nurse is that you recognize the value consequences, support and guidance are offered
and worth of those you care for and that the •Personal Values – are learned values from
patient and his or her experience matters to you. society and perceived and internalized by an
• In order for the nurse to bring holistic care that individual as his own.
includes the “art” of nursing into his/her •Professional Values – are acquired during
practice, sympathy and compassion for others socialization into nursing from Code of Ethics,
must be evident. nursing experiences, teachers and peers.

4. Humility Core Values of A Professional Nurse

• Humility is being humble, or in nursing is
reflected as an attitude that finds joy and •Altruism – is a concern for the welfare and well
satisfaction in serving others. The best nurses being of others. In professional
have a strong desire to serve their patients and practice, altruism is reflected by the nurse’s
putting their needs ahead of their own. concern for the welfare of patients, other nurses,
• A nurse with a humble, servant motivation; has and other health care providers.
a love and empathy for others, is secure and
does not feel that it is beneath them to serve •Autonomy – is the right to self determination.
others, but embraces and enjoys meeting the Professional practice reflects autonomy when
needs of the patient and their family. the nurse respects patients’ rights to make
decisions about their health.
5. Thankful
• Student entitlement that sees education as a •Human dignity - is respect for the inherent
“right” and being owed a passing grade because worth and the uniqueness of
they paid for it is the antithesis of gratitude and individuals and populations. In professional
thankfulness. practice, human dignity is reflected when nurse
• The mindset of students who work hard values and respects all patients and colleagues.
knowing that they are blessed just to have the
opportunity to have an education and go to •Integrity – is acting in accordance with an
school removes any sense of entitlement appropriate code of ethics and accepted
thinking. standards of practice. It is reflected in
professional practice when the nurse is honest
and provides care based on an ethical framework The patient will not be subjected to any
that is accepted within the profession. procedure without his written informed consent,
except in the following cases:
•Social justice – is upholding moral, legal and • a) in emergency cases,
humanistic principles. This value is reflected in • b) when the health of the population is
professional practice when the nurse works to dependent on the
ensure equal treatment under the law and equal adoption of a mass health program to control
access to quality health care. epidemic;
• c) when the law makes it compulsory for
• Altruism: concern for welfare and well-being everyone to submit a procedure;
of others • d) when the patient is either a minor, or legally
• Autonomy: right to self-determination incompetent, in which case. a third party
• Human dignity: respect for inherent worth and consent Is required;
uniqueness of individuals and populations • e) when disclosure of material information to
• Integrity: acting according to code of ethics patient will jeopardize the success of treatment,
and standards of practice in which case, third party disclosure and consent
• Social justice: upholding moral, legal, and shall be in order;
humanistic rights • f) When the patient waives his right in writing.

ETHICAL PRINCIPLES 3. Right to Privacy and Confidentiality

• The privacy of the patients must be assured at
Non- maleficence all stages of his treatment. The patient has the
Autonomy right to be free from unwarranted public
Beneficence exposure, except in the following cases:
Confidentiality a) when his mental or physical condition is in
Justice controversy and the appropriate court, in its
Fidelity discretion, orders him to submit to a physical or
Veracity mental examination by a physician;
b) when the public health and safety so demand;
1. AUTONOMY and
• The freedom to make decisions about oneself c) when the patient waives this right in writing.
• The right to self-determination
• Healthcare providers need to respect patient’s • The patient has the right to demand that all
rights to make choices about healthcare, even if information, communication and records
the healthcare providers do not agree with the pertaining to his care be treated as confidential.
patient’s decision. Except:
a) when such disclosure will benefit public health
PATIENT’S BILL OF RIGHTS and safety;
b) when it is in the interest of justice and upon
1. Right to Appropriate Medical Care and the order of a competent court; and
Humane Treatment c) when the patient waives in writing the
• Every person has a right to health and medical confidential nature of such information;
care corresponding to his state of health, d) when it is needed for continued medical
without any treatment or advancement of medical science
discrimination and within the limits of the subject to de-identification of the patient and
resources, manpower and competence available shared medical confidentiality for those who
for health and medical care at the relevant time. have access to the information.

2. Right to Informed Consent 4. Right to Information

• The patient has a right to a clear, truthful and • In the course of his/her treatment and hospital
substantial explanation, in a manner and care, the patient or his/her legal guardian has a
language understandable to the patient, of all right to be informed of the result of the
proposed procedures, whether diagnostic, evaluation of the nature and extent of his/her
preventive, curative, rehabilitative or disease, any other additional or further
therapeutic, wherein the person who will contemplated medical treatment on surgical
perform the said procedure shall provide his procedure or
name and credentials to the patient, possibilities procedures.
of any risk of mortality or serious side effects,
problems related to recuperation, and 5. The Right to Choose Health Care Provider and
probability of success and reasonable risks Facility
involved. • The patient is free to choose the health care
provider to serve him as well as the facility
except when he is under the care of a service
facility or when public health and safety so
demands or when the patient expressly waives 11. Right to Correspondence and to Receive
this right in writing. Visitors
• The patient has the right to communicate with
6. Right to Self-Determination relatives and other persons and to receive
• The patient has the right to avail visitors subject to reasonable limits prescribed
himself/herself of any recommended diagnostic by the rules and regulations of the health care
and treatment procedures. Any person of legal institution.
age and of sound mind may make an advance
written directive for physicians to administer 12. Right to Express Grievances
terminal care when he/she suffers from the • The patient has the right to express complaints
terminal phase of a terminal illness: and grievances about the care and services
• Provided that received without fear of discrimination or
• a) he is informed of the medical consequences reprisal and to know about the disposition of
of his choice; such complaints.
• b) he releases those involved in his care from
any obligation relative to the consequences of 13. Right to be Informed of His Rights and
his decision; Obligations as a Patient
• c) his decision will not prejudice public health • Every person has the right to be informed of his
and safety. Alternative Hybrid Education and rights and obligations as a patient.
Asynchronous Distance Learning
2. CONFIDENTIALITY
7. Right to Religious Belief • Anything stated to nurses or healthcare
• The patient has the right to refuse medical providers by patients must remain confidential
treatment or procedures which may be contrary • The only times this principle may be violated
to his religious beliefs, subject to the limitations are:
described in the preceding subsection: Provided, • If patients may indicate harm to themselves or
That such a right shall not be imposed by parents others
upon their children who have not reached the • If the patient gives permission for the
legal age in a life-threatening situation as information to be shared
determined by the attending physician or the
medical director of the facility. 3. VERACITY
• This principle implies “truthfulness”
8. Right to Medical Records • Nurses need to be truthful to their clients
• The patient is entitled to a summary of his • Veracity is an important component of building
medical history and condition. He has the right trusting relationships
to view the contents of his medical records,
except psychiatric notes and other incriminatory 4. FIDELITY
information obtained about third parties, with • Loyalty
the attending physician explaining the contents • The promise to fulfill all
thereof. commitments
• The basis of accountability
9. Right to Leave • Includes the professionals faithfulness or
• The patient has the right to leave hospital or loyalty to agreements & responsibilities
any other health care institution regardless of his accepted as part of the practice of the profession
physical condition
• Provided That: 5. JUSTICE
• a) he/she is informed of the medical •Every individual must be treated equally
consequences of his/her decision •This requires nurses to be nonjudgmental
• b) he/she releases those involved in his/her
care from any obligation relative to the 6. BENEFICENCE
consequences of his decision; • This principle means “doing good” for others
• c) his/her decision will not prejudice public • Nurses need to assist clients in meeting all their
health and safety. needs
• Biological
10. Right to Refuse Participation In Medical • Psychological
Research • Social
• The patient has the right to be advised if the
health care provider plans to involve him in 7. NON-MALEFICENCE
medical research, including but not limited to • Requires that no harm be caused to an
human experimentation which may be individual, either unintentionally or deliberately
performed only with the written informed • This principle requires nurses to protect
consent of the patient. individuals who are unable to protect
themselves
 Principle of Legitimate Cooperation
OTHER ETHICAL PRINCIPLES • Developed over the centuries by moral
theologians in light of Catholic teaching on the
•Principle of Double Effect morality of human acts.
•Principle of Legitimate Cooperation • It is unethical to cooperate with an immoral act
•Principle of Common Good and Subsidiarity if it intends directly to the evil act, but it is ethical
to cooperate with an immoral act if it intends
Principle of Double Effect indirectly to the harmful consequences.
• “People should never do anything that is not
• The principle has its historical roots in the morally permissible.”
medieval natural law tradition, especially in the
thought of Thomas Aquinas (1225?-1274), and Types of Cooperation:
has been refined both in its general formulation 1.Formal cooperation- occurs when a person or
and in its application by generations of Catholic organization freely participates in the actions of
moral theologians. a principal agent. Implicit formal cooperation
• According to the principle of double effect, occurs when even though the cooperator denies
sometimes it is permissible to cause a harm as a intending the object of the principal agent, the
side effect (or “double effect”) of bringing about cooperator participates in the action.
a good result even though it would not be 2. Immediate material cooperation- occurs
permissible to cause such a harm as a means to when the cooperator participates in
bringing about the same good end. circumstances that are essential to the
• The first principle that proposes to distinguish commission of an act, such the act
between a good and an evil. could not occur without this participation.

Classical formulations of the principle of double 3. Mediate material cooperation - occurs when
effect require that four conditions be met if the the cooperator participates in circumstances
action in question is to be morally permissible: that are not essential to the commission of the
action, such that the action could occur even
1. Direct - The act itself must be morally good or without cooperation.
at least indifferent.
2. Indirect - The agent may not positively will the When you are performing an action that is
bad effect but may permit it. If he could attain intertwined with evil, you can use the following
the good effect without the bad effect, he should criteria to judge how legitimate your
do so. The bad effect is sometimes said to be cooperation with the evil is
indirectly voluntary. • The moral object of your action is good, and
you are operating out of good intentions.
3. Foreseen Side Effect - The good effect must • The evil is only tolerated as a side effect of your
flow from the action at least as immediately (in action
the order of causality, though not necessarily in • Your cooperation is only material cooperation,
the order of time) as the bad effect. In other not formal
words, the good effect must be produced • Your cooperation is remote rather than
directly by the action, not by the bad effect. proximate, so it causes minimal evil effects
Otherwise, the agent would be using a bad • Your action does not cause scandal
means to a good end, which is never allowed.
Principle of Common Good and Subsidiarity
4. Unforeseen Side Effect - The good effect must
be sufficiently desirable to compensate for the • The term the "common good" has been used
allowing of the bad effect in various contexts to identify actions or
outcomes that have some definable benefit that
• The theory of double effect has use in medical extends beyond individual gain. The common
ethics when dealing with abortion, euthanasia, good has been addressed in professional
and other decisions where there is a conflict literature pertaining to ethics, political action,
between a good and an evil. the environment, nursing, and health care.
• For example, under this view, abortion is an evil • Although nursing literature does not address
but saving the life of a mother is a good. Under the common good from a theological
this view, euthanasia is an evil, but relieving pain perspective, it clearly addresses related concepts
using morphine is a good. If the person dies and such as concern for the whole person in the
the death was not intended, then is it community and outcomes associated with the
acceptable? Major issues arise in the application common good, such as distributive justice.
of the theory concerning how to determine a Consistent with the Catholic perspective of the
person’s intent. common good, nursing also addresses the need
to balance the preservation of individual dignity
and respect against societal integrity.
• The common good is reached when we work
together to improve the well-being of people in
our society and the wider world. The rights of the
individual to personal possessions and
community resources must be balanced with the
needs of the disadvantaged and dispossessed.
• The principle of subsidiarity, which was
developed as part of Catholic Social Teaching,
states: What individuals can accomplish by their
own initiative and efforts should not be taken
from them by a higher authority.