BASIC ETHICAL PRINCIPLES STEWARDS

1. STEWARDSHIP
-This principle is grounded in the presupposition that God has absolute Dominion over creation
and that, insofar beings are made in God’s image and likeness (Imago Dei), we have been given
a limited dominion over creation are responsible for its care.

2. TOTALITY
-These principles dictate that the well-being of the person must be taken into account in
deciding about any therapeutic intervention or use of technology. In this context, “INTEGRTITY”
refers to each individual‘s duty to “preserve a view of the whole human person in which the
values of the intellect, will, conscience, and fraternity are preeminent. “TOTALITY” refers to the
duty to preserve intact the physical component of the integrated bodily and spiritual nature of
human life, whereby every part of the human body “exist for the sake of the whole as the
imperfect for the sake of the permitted evil.

3. DOUBLE EFFECT
-An action that is good in itself that has two effects, and an unintended yet foreseen evil
effects-an intended and otherwise not reasonably attainable good effect, and an unintended
yet foreseen evil effect- is licit, provided there is a due proportion between the intended good
and permitted evil.
1. The object of the act must not be intrinsically contradictory to one’s fundamental
commitment to God and neighbor (including oneself), that is it must be a good action judged by
its moral object (in other words, the action must not be intrinsically evil).
2. The direct intention of the agent must to be achieve the beneficial effects and to avoid the
foreseen harmful effects as far as possible, that one must only indirectly intend the harm.
3. The foreseen beneficial effects must not be achieved by the means of the foreseen harmful
effects, and no other means of achieving those effects are available;
4. The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects
(the proportion judgment).
5. The beneficial effects must follow the action at least as immediately as do the harmful
effects.

4. COOPERATION
-Along with the principles of double effect and tolerate, the principles of cooperation were
developed in the Catholic moral tradition as a way of helping individuals discern how to
properly avoid limit, or distance themselves from evil (especially intrinsic evil) in order to avoid
a worse evil or to achieve an important good.
1. FORMAL COOPERATION.
Immediate cooperation occurs when a person or organization freely participates in the action(s)
of a principal agent, or shares in the agent’s intention, either for this own sake as a means to
some other goal.
2. IMMEDIATE MATERNAL COOPERATION
-Occurs when the cooperator participates in circumstances that are essential to the commission
of an act, such that the act could not occur without this participation. Immediate maternal
cooperation in intrinsically evil actions is morally illicit.
3. MEDIATE MATERIAL COOPERATION
-occurs when the cooperator participates in circumstances that are not essential that are not
essential to the commission of an action, such that the action could occur even without this
cooperation.

5. SOLIDARITY
-The principle of solidarity invites us to consider how we relate to each other in community.
Assumes that we recognize that we are apart at least one family our biological family, our local
community but the challenges us to consider that full range of relationship with others. In a
globalizing economy, we participate in a vast, international economic community, one in which
goods and services consider this kind pf extended community and to act in such a way reflects
concern for the well-being of others.

. Beneficence
The principle of beneficence addresses deeds of “mercy, kindness, and charity”
(Beauchamp & Childress, 2001). Beneficence means taking action to promote the welfare of
other people. Although there are limits to what nurses can do, they can promote the interests
and well-being of their patients. Two examples of beneficent nursing actions are practicing
sterile technique during postoperative dressing changes to prevent wound infection and helping
postoperative patients cough and breathe deeply to prevent hypostatic pneumonia. A more
subtle beneficent and kind action would be assisting a 40-year-old female patient experiencing
acute inflammatory rheumatoid arthritis in both hands with her hair and makeup.

The principle of beneficence is a moral obligation to act for the benefit of others. There are 2
aspects of beneficence:
1. Providing benefits
2. Balancing benefits and risks/harms.

The principle of beneficence supports the following moral rules or obligations:

1. Protect and defend the rights of others.
2. Prevent harm from occurring to others.
3. Remove conditions that will cause harm.
4. Help persons with disabilities.
5. Rescue persons in danger.

The ordinary meaning of this principle is that health care providers have a duty to be of
a benefit to the patient, as well as to take positive steps to prevent and to remove harm from
the patient.
No maleficence
No maleficence means to “do no harm” and is considered to be an overriding principle
for everyone who undertakes the care of a patient (Munson, 2004). No maleficence is the other
side of the coin of beneficence, but the two terms cannot be addressed separately (Aiken,
2004). If health care professionals ever violate the principle of no maleficence, it is usually in
terms of a short-term violation to yield a long-term greater good. One example is when a
patient undergoes debilitating cancer chemotherapy and the long exhausting process of
radiation to have a longer life with more quality later.

The principle of no maleficence holds that there is an obligation not to inflict harm on others. It
is closely associated with the maxim premium non nicer (first do no harm). The principle of no
maleficence supports the following rules:
1. Do not kill.
2. Do not cause pain or suffering.
3. Do not incapacitate.
4. Do not cause offense.

Justice
Justice is a principle in health care ethics as well as the basis of a duty-based
(deontological) ethical theory. In other words, the concept of justice is all encompassing in the
field of ethics (Beauchamp & Childress, 2001). In terms of principlism, justice refers to the right
and the demand to be treated justly, fairly, and equally.

The principle of justice obliges us to equitably distribute benefits, risks, costs, and resources.
The following arguments (rules) are supported by the principle of justice:
1. To each person an equal share
2. To each person according to need
3. To each person according to effort
4. To each person according to contribution
5. To each person according to merit.

Justice in health care is usually defined as a form of fairness, or as Aristotle once said,
"Giving to each that which is his due." This implies the fair distribution of goods in society and
requires that we look at the role of entitlement.

I.APPLICATION OF BIOETHICAL PRINCIPLES TO THE CARE OF THE SICK

Ethical Concerns in End-of-Life Care
In the sick room, ten cents’ worth of human understanding equals ten dollars’ worth of
medical science. –Martin H. Fischer
Ethics in Medical Decision Making
Ethics is a branch of philosophy that is focused on understanding the moral principles of people
and how they make decisions based on what is considered morally right or wrong (Merriam-
Webster, 2014).

FUNCTIONS OF INFORMED CONSENT

Protective and Participative
Obtaining informed consent for medical treatment, for participation in medical research, and
for participation in teaching exercises involving students and residents is an ethical requirement
that is partially reflected in legal doctrines and requirements. As an ethical doctrine, informed
consent is a process of communication whereby a patient is enabled to make an informed and
voluntary decision about accepting or declining medical care.
If humans are autonomous moral agents who make decisions freely and are held morally
responsible for the consequences of their actions then in order to make the decision the agent
needs to have accurate information concerning the situation and not be under coercion of any
form. Hence, there is a principle of Informed Consent in both moral theory and in the legal
statutes.

Functions of the principles of Informed Consent:

1. Protects individual autonomy
2. Protects the patient’s status as a human being
3. Avoids fraud and duress
4. Encourage doctors to carefully consider their decisions
5. Fosters rational decision making by the patient
6. Involves the public generally in medicine.
A health care provider must reveal to the recipient of care what is in that person’s best
interests to know.
The recipient has a right to self-decision and this shapes the HCP’s duty to reveal the
information. This might not be the customary practice for many HCP’s. The HCP must provide
all material risks. It is a material risk if a reasonable person in the recipient’s condition would
likely attach significance to the risk.

THE RIGHTS OF THE PATIENTS

 1. Right to Appropriate Medical Care and Humane Treatment. - Every person has a
right to health and medical care corresponding to his state of health, without any
discrimination and within the limits of the resources, man power and competence
available for health and medical care at the relevant time. The patient has the right to
appropriate health and medical care of good quality.
 2. Right to Informed Consent. - The patient has a right to a clear, truthful and
substantial explanation, in a manner and language understandable to the patient,
of all proposed procedures, whether diagnostic, preventive, curative, rehabilitative or
therapeutic, wherein the person who will perform the said procedure shall provide his
name and credentials to the patient, possibilities of any risk of mortality or serious
side effects, problems related to recuperation, and probability of success and
reasonable risks involved: Provided, That the patient will not be subjected to any
procedure without his written informed consent, except in the following cases:
 a) In emergency cases, when the patient is at imminent risk of physical injury, decline of
death if treatment is withheld or postponed. In such cases, the physician can perform
any diagnostic or treatment procedure as good practice of medicine dictates without
such consent;
 b) when the health of the population is dependent on the adoption of a mass health
program to control epidemic;
 c) when the law makes it compulsory for everyone to submit a procedure;
 d) When the patient is either a minor, or legally incompetent, in which case. a third
party consent Is required;
 e) when disclosure of material information to patient will jeopardize the success of
treatment, in which case, third party disclosure and consent shall be in order;
 f) When the patient waives his right in writing.
 Informed consent shall be obtained from a patient concerned if he is of legal age and of
sound mind. In case the patient is incapable of giving consent and a third party consent
is required. the following persons, in the order of priority stated hereunder, may give
consent:
 i. spouse;
 ii. Son or daughter of legal age;
 iii. Either parent;
 iv. Brother or sister of legal age, or
 v. Guardian
 If a patient is a minor, consent shall be attained from his parents or legal guardian. If
next of kin, parents or legal guardians refuse to given consent to a medical or surgical
procedure necessary to save the life or limb of a minor or a patient incapable of giving
consent, courts, upon the petition of the physician or any person interested in the
welfare of the patient, in a summary proceeding, may issue an order giving consent.

 3. Right to Privacy and Confidentiality. - The privacy of the patients must be assured at
all stages of his treatment. The patient has the right to be free from unwarranted public
exposure, except in the following cases: a) when his mental or physical condition is in
controversy and the appropriate court, in its discretion, order him to submit to a
physical or mental examination by a physician; b) when the public health and safety so
demand; and c) when the patient waives this right in writing.
 4. Right to Information. - In the course of his/her treatment and hospital care, the
patient or his/her legal guardian has a right to be informed of the result of the
evaluation of the nature and extent of his/her disease, any other additional or further
contemplated medical treatment on surgical procedure or procedures, including any
other additional medicines to be administered and their generic counterpart including
the possible complications and other pertinent facts, statistics or studies.

 5. The Right to Choose Health Care Provider and Facility. - 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 this right in writing.

 6. Right to Self-Determination. - The patient has the right to avail himself/herself of any
recommended diagnostic and treatment procedures. Any person of legal age and of
sound mind may make an advance written directive for physicians to administer
terminal care when he/she suffers from the terminal phase of a terminal illness.

 7. Right to Religious Belief. - The patient has the right to refuse medical treatment or
procedures which may be contrary to his religious beliefs, subject to the limitations
described in the preceding subsection: Provided, That such a right shall not be imposed
by parents upon their children who have not reached the legal age in a life threatening
situation as determined by the attending physician or the medical director of the facility.

 8. Right to Medical Records. - The patient is entitled to a summary of his medical history
and condition. He has the right to view the contents of his medical records, except
psychiatric notes and other incriminatory information obtained about third parties, with
the attending physician explaining contents thereof.

 9. Right to Leave. - The patient has the right to leave hospital or any other health care
institution regardless of his physical condition: Provided. That a) he/she is informed of
the medical consequences of his/her decision b) he/she releases those involved in
his/her care from any obligation relative to the consequences of his decision; c) his/her
decision will not prejudice public health and safety.
 No patient shall be detained against his/her will in any health care institution on the
sole basis of his failure to fully settle his financial obligations. However, he/she shall
only be allowed to leave the hospital provided appropriate arrangements have been
made to settle the unpaid bills: Provided. Further, That unpaid bills of patients shall be
considered as loss income by the hospital and health care provider/practitioner and
shall be deducted from gross income as income loss only on that particular year.

 10. Right to Refuse Participation In Medical Research. - The patient has the right to be
advised if the health care provider plans to involve him in medical research, including
but not limited to human experimentation which may be performed only with the
written informed consent of the patient.

 11. Right to Correspondence and to Receive Visitors. - The patient has the right to
communicate with relatives and other persons and to receive visitors subject to
reasonable limits prescribed by the rules and regulations of the health care institution.

 12. Right to Express Grievances. - The patient has the right to express complaints and
grievances about the care and services received without fear of discrimination or
reprisal and to know about the disposition of such complaints. Such a system shall
afford all parties concerned with the opportunity to settle amicably all grievances.

 13. Right to be Informed of His Rights and Obligations as a Patient. - Every person has
the right to be informed of his rights and obligations as a patient. The Department of
Health, in coordination with heath care providers, professional and civic groups, the
media, health insurance corporations, people's organizations, local government
organizations, shall launch and sustain a nationwide information and education
campaign to make known to people their rights as patients, as declared in this Act
Such rights and obligations of patients shall be posted in a bulletin board
conspicuously placed in a health care institution.