BIOETHICS  Branch of ethics that deals with ethical issues

in health, healthcare, medicine, and science

 More on decision-making in the management
Values – freely chosen, influence decisions and  BASED ON WHAT PROFESSION DO YOU
actions HAVE

 Personal Values – learned through Professional Ethics

observation and experience, influenced by a
 Principles that govern the behavior of a person
person’s sociocultural environment
or group in a business environment
- simula pagkabata
 Has a set of rules which a particular group of
 Professional Values – acquired during
people uses
socialization into the profession from the code
of ethics, experience, and teaching Nursing Ethics
- by personal & professional experience
 Related to all the principles of right conduct as
Beliefs – based on faith than a fact and may or may not they apply to the profession
be true  Focused on the needs and experiences of
practicing nurses, etc.
Attitude – mental positions or feelings toward a
person, object, or idea Human Act
 Actions that are proper to humans
 Free will, knowledge, and voluntarily
Ethics
Ex: studying, working, eating
 Greek word “ethos” means moral duty
 Standard to examine and understand moral life Acts of Man
 Serves as guidelines for human conduct  Without free will and intellect, some are done
provided by ethical systems by instinct
 Studies how people make judgement in regard  Without consent, involuntary
to right or wrong Ex: breathing, digestion, air circulation
 YOU HAVE BASIS = BASED ON
DUTY/PROFESSION
Knowledge – an act is done according to the
Morals knowledge acquired regarding the certain things

 Specific ways of behavior or of accomplishing Freedom – having the ability to live according to
ethical practices moral standards
 Morality – Greek work “moralis” which refers
Conscience – what a person believes is right and how
to social consensus about moral conduct for
a person decides what is right
human beings and society
 Explanation of human decency, right or
wrong, good or evil, proper or improper, cruel
Kantian Ethics
or benevolent acts
 BASED ON BEHAVIOR/PERCEPTION  Set of universal moral principles that apply to
all human beings, regardless of context or
Bioethics
situation
 Focuses on moral issues in the field of health  Defined by morality and level of freedom
care
Rawl’s Ethics
 Systematic study of human behavior in the
field of life science and health care in light of  Contends that the most rational choice for the
moral values and principles parties in the original position are two
 Primarily concerned with ethical issues principles of justice
described in medical practice

St. Thomas Aquinas

Health Ethics
 Ethical understanding comes through virtue
and that virtue is a skill that must be developed
 Human learns what is ethical through reason  The action shall be morally good.
 The good effect must be willed and the bad effect
Ross’ Ethics merely allowed. (acceptable)
 The good effect must not come from an evil action
 Suggests that the duties of beneficence, self-
but from the initial action itself directly.
improvement, and justice could be subsumed  The good effect must be greater than the bad effect.
under a single duty to promote intrinsic values,  Principle of Totality – the whole is greater than any of
that is, things that are intrinsically good its parts.
 Prima Facie  Epikia – “Exception to the general rule.” (applies
mostly in hospital, especially in ER)
 One who acts through an agent is himself responsible.
Prima Facie Duties
 A Latin term “on the first appearance” or Spiritual Commitment of Nurses – holistic care means that
“based on the first impression” the spiritual aspect is included as well.
 A duty that is binding or obligatory, other
things equal that is unless it is overridden or The Good Samaritan Law
trumped by another duty  based on the biblical story of a man who aided an
injured person who was waylaid by thieves and was
Duty of: left half-dead.
1. Fidelity – promising loyalty, commitment  Has been passed to encourage on-the-spot
2. Reparation – repair, forgive volunteer first aid in emergency situations by
3. Gratitude – thankful/grateful persons with proper knowledge and skills.
4. Justice – fair, equality  A nurse who renders first aid is relieved of the
consequences of the act.
5. Self-improvement – promote own good,
undergo trainings, continuing studies Virtues of Healthcare Providers
6. Beneficence – do good
 Ethical codes are systematic guides for developing
7. Non-maleficence – do no harm
ethical behavior.
 These codes answer normative questions of what
beliefs and values should be morally accepted.
Nurse Advocate  No code could possibly provide absolute or
complete rules that are free from conflict and
 An advocate is someone who pleads the cause ambiguity.
of another  Promulgated by the Professional Regulation
 Means preserving human dignity, promoting pt Commission (PRC) on July 23, 2003. Stating that
equality, and providing freedom from the hallmark of all professionals is their willingness
suffering to accept a set of professional and ethical principles
 Also about ensuring that pt have the right to which they will follow in the conduct of their daily
make decisions about their own health lives.
 Inform & Support  Good Governance – governs our profession. Do
something good/professional.
 Health teaching
General Principles:
 Ensures pt is aware of bill of rights
 Service to others
 Integrity and objectivity (do responsibility
truthfully)
 Professional competence (continuing
education, updated with the latest trend)
 Solidarity and teamwork (maintain and
support other professionals)
 Social and civic responsibility (carry out
duties with consideration)
 Global competitiveness
Week 7
 Equality of all professions (all
Principles: professionals are treated equally)

 Golden Rule – “Do unto others what you would like

others do unto you.”
Virtues and Principles
 Two-fold Effect - the situation may have both good and
bad effects: 1. Fidelity – loyalty or promise
2. Honesty/Veracity – truthful (ex: IV therapy)  Avarice – a blanket term that can describe many
3. Integrity – do right even no one is watching other examples of greedy behavior (ex: disloyalty,
4. Humility – being humble, open-mindedness to betrayal, treason, esp. for personal gain or bribery)
truth
5. Respect – respect the patient’s values, beliefs, Intellectual Virtues
personal bg (blood transfusion)  Deep and personal qualities or character strengths
6. Compassion – deep and sincere concern to others of a good thinker or learner.
(empathic)  Conscientiousness, open-mindedness
7. Prudence – utilizing the best resources to give the
best care Intellectual Vices
8. Courage – confident/strong-will to do assigned
 Dogmatism, close-mindedness, prejudice
task
Professional Virtues

 Enable members to fulfill their professional role

Week 8
well, to achieve the goals of their professions
Vices (bisyo) – a practice or habit that is considered  Relate less to the science of meds and more to the
immoral, depraved, and degrading in the associated society. uniqueness of the pt’s expi of illness, continuity of
care, etc.
1. Fraud – fake/false  Altruism, integrity, respect
2. Pride – gratification (doing this because of a sense
of fulfillment) Professional Vice
3. Greed – materialism (sobra-sobra ang hangad)
 Personal factors hinder or obstruct the fulfilling of
one’s professional role.
 Tendency to close ranks, unwillingness to own up
Fraud to mistakes. (sisi sa iba)
 Trying to trick someone in order to gain an
advantage.
 A deliberate misinterpretation which causes Week 9
another person to suffer damages (usually
Beneficence – do good
monetary)
 Considered a crime and a civil law violation Non-maleficence – do no harm
 Can be committed through media or through bait
and switch
Confidential Information

Pride  Privileged communication because it is given based

on trust.
 Excessive belief in one’s own abilities, that  Any info. gathered by the nurse during the course
interferes with the individual’s recognition of of caring for the patient should always be treated
other’s action and talents. confidential.
 Has been called the sin from which all others arise.  Confidential info. may be revealed ONLY when:
 Also known as Vanity. 1. The patient permits such revelation as in the case of
 “The love one’s own excellence.” – St. Augustine claim for hospitalization, insurance benefits, among
 Sometimes viewed as excessive or as a vice, others.
sometimes as proper or as a virtue (as Aristotle 2. The case is medico-legal such as attempted suicide,
considers pride a profound virtue, most world gunshot wounds which have to be reported to the
religions consider it a sin. local police or NBI.
3. The patient is ill of a communicable disease and
Greed
public safety may be jeopardized. (RA 11332:
 Excessive desire to possess wealth or goods with mandatory reporting of communicable diseases)
the intention to keep it for one’s self. a. Type 1 – report within 24hrs (covid,
 Like lust or gluttony, it is a sin of excess. neonatal tetanus, SARS, poison)
 It is an inappropriate expectation applied to a very b. Type 2 – report within 7days (dengue,
excessive or rapacious desire and pursuit of wealth, measles, mumps, TB)
status, and power. 4. Given to members of the health team if info. is
 “A sin against God, just as all mortal sins, in as relevant to his care.
much as man condemns in things eternal for the 5. May also be revealed as provided for by-law in
sake of temporal things.” – St. Thomas Aquinas Article IV, Section 4 (1) of the New Constitution.
(SUBPOENA – court)
Emergency Situations

Responsibilities of Patients:  When an emergency situation occurs, no consent is

necessary because inaction at such time may cause
1. Providing Information – complains, hx, medications, greater injury.
level of understanding. Family is responsible for doing  If time is available and an informed consent is possible,
so in their behalf. it is best that this be taken for the protection of all
2. Complying with Instructions parties involved.
3. Informing the Physician of Refusal to Treatment
4. Paying Hospital Charges Refusal to Consent
5. Following Hospital Rules and Regulations
6. Showing Respect and Consideration  A patient who is mentally and legally competent has the
right to refuse the touching of this body or surgical
procedure no matter how necessary
 The patient may refuse to consent due to inadequate
Consent info., regarding the procedure to be done.
 Free and rational act that presupposes knowledge  If after the explanation, he still refuses, he should be
of the things to which consent is beoing given by a made to fill out the release form to protect the hospital
person who is legally capable to give the consent. and agency.
 Signed by the pt or his/her legal guardian or Content for Sterilization (magpapatali)
authorized repre
 It is only in the case of emergency where the  Husband and wife must consent to the procedure.
consent requirement does not apply (informed  If medically necessary (abruptio placenta, ectopic,
consent) bleeding) patient’s consent alone is sufficient

Nature of Consent:

Consent is an authorization, by a pt or a person authorized Consent Form:

by law to give the consent on the patient’s behalf.
1. Patient demographics (pt’s details)
2. Doctor’s full name
3. Procedure/treatment to be performed
Informed Consent 4. Agreement clause
Established principle of law that every human being of adult 5. Patient’s signature
years and sound mind has the right to determine what shall 6. Signature of witness (nurse)
be done with his/her own body. 7. Signature of representative (for minors/unable to
sign)
8. Time and date
Elements: Abortion
1. Diagnosis and explanation of the condition, Termination of a pregnancy by removal or expulsion of an
2. Fair explanation of the procedure to be done and embryo or fetus.
used and the consequences.
3. A description of alternative treatment or 1. Spontaneous – or miscarriage, unintentional
procedures. expulsion of an embryo or fetus before the 24th
4. Description of the benefits to be expected. week of gestation.
5. Prognosis, if the reco care of procedure is refused. Still birth – more than 24wks.
2. Induced – therapeutic abortion when it is
performed to save the life of a pregnant woman.
Elective or voluntary when it is performed at the
Consent
request of the woman for non-medical reasons.
The patient is the one who gives the consent on his/her own
behalf. Article 259, Revised Penal Code
Abortion practiced by a physician and/or midwife and
Considerations: dispensing of abortive agents.
1. Incompetent (minors, mentally ill)
Elements of the crime:
2. Physically unstable, but not an emergency case
1. The woman must be pregnant
3. Consent for minors shall be taken from the parents
2. The offender must be a physician or midwife
(parental consent is needed if the minor is already
3. The physician and midwife causes abortion on the
married or otherwise emancipated)
pregnant woman
4. Consent for the mentally ill shall be taken from the
parents or legal guardian
4. The physician or midwife took advantage of his Problems in Medicine and Biomedical and
scientific knowledge and skill in procuring the Behavioral Research.
abortion.  An individual who has sustained either (1)
irreversible cessation of circulatory and respiratory
Euthanasia functions, or (2) irreversible cessation of all
 Practice of intentionally ending life to eliminate pain functions of the entire brain, including the brain
and suffering. (not applicable in PH) stem, is dead.
 Critics of euthanasia typically argue that killing is  A determination of death must be made in
always wrong, that non-voluntary or involuntary accordance with accepted medical standards.
euthanasia violates patient rights, or that physician-
assisted suicide violates an obligation to do no harm.
Biological and Clinical Death

1. Active Euthanasia – by active means. Sometimes Clinical – when a person has stopped breathing, resulting
called “aggressive” euthanasia. from oxygen not entering the body and the organs,
Ex: lethal injection especially the brain, which affects brain function.
2. Passive Euthanasia – intentionally letting a pt die (REVERSIBLE – CPR, basic life support)
by withholding artificial life support such as mech
Biological – will occur when the brain has been deprived of
vent or feeding tube.
blood and oxygen long enough and the cells begin to die.
Ex: (DNR, DNI)
3. Voluntary Euthanasia – with the consent of the pt
4. Involuntary Euthanasia – w/o the consent of the
pt In-vitro Fertilization
Ex: if the pt is unconscious and his/her wishes are
 Surrogacy
unknown
 A complex series of procedures used to help with
5. Self-administered Euthanasia – the pt administers
the fertility or prevent genetic problems and assist
the means of death
with the conception of a child.
Ex: suicide
 Mature eggs are collected (retrieved) from ovaries
6. Other-administered Euthanasia - another person
and fertilized by sperm in a lab. Then, the fertilized
administers the means of death
egg (embryo) are transferred to a uterus.
7. Assisted Euthanasia – the pt administers the
means of death but with the assistance of another Stem-cell Technology
person, such as a physician
8. Mercy Killing – active, involuntary or non-  Stem cell therapy, also known as regenerative
voluntary, other-administered euthanasia medicine, promotes the repair response of disease,
Ex: Someone kills a pt w/o their explicit consent to dysfunctional or injured tissue using stem cells or
end the pt’s suffering their derivatives.
9. Physician-assisted Euthanasia – active, voluntary,  In the future, they may be used to replace cells and
assisted euthanasia where a physician assists the pt. tissues that have been damaged or lost due to
A physician provides the pt with a means, such as disease.
sufficient medication, for the patient to kill
him/herself

Arguments:

 Killing vs. Letting Die

 Ordinary vs. Extraordinary Treatment (withhold
artificial treatments)
 Death Intended vs. Anticipated

Determination of Death

Uniform Determination of Death Act

 A model state law that was approved for the US in

1981 by the National Conference of
Commissioners on Uniform State Laws, in
cooperation with the American Medical
Association, the American Bar Association, and the
President’s Commission for the Study of Ethical