Bioethics in Healthcare

• NCM 108 study notes by Alfred S. Tamon III RN, MAN

Definition of Terms

• Ethics is a set of guiding principles for right conduct, based on ideas of right and wrong, influencing moral behavior and decision-making.
• Morals represent an individual's framework that includes personal values for decision making.
• Ethics is a generalized conceptual framework for decision-making.
• Nursing ethics refers to a system of principles governing nurses'actions concerning patients, families, healthcare providers, policymakers, and society.

Morals vs Ethics

• Morals are personal and internal standards.
• Ethics are external rules and norms.
• Morals are habits/principles related to right and wrong conduct.
• Morals refer to individual beliefs regarding right and wrong.
• Morals define character and are consistent, they can shift based on individual belief changes.
• Someone may feel that lying is wrong, based on their personal moral beliefs.
• Ethics is a branch of philosophy involving systematizing, recommending and defending right and wrong behavior.
• Ethics relates to conduct codes in workplaces and religious principles, which are rules provided by external sources.
• Ethics is often seen as the rules or guidelines set by society.

Bioethics

• Bioethics combines the Greek words "bios," meaning life, and "ethos," meaning custom.
• Bioethics is a branch of applied ethics that studies the philosophical, social, and legal issues arising in medicine and life sciences.
• Bioethics is concerned with ethical questions related to life, human well-being, and the nonhuman biological environment.
• Bioethics is the application of ethical principles to medicine and healthcare.
• Bioethics addresses ethical issues that arise from developments in life sciences like biotechnology and medicine.
• Such as abortion, cloning, euthanasia, suicide, artificial insemination, genetic engineering, organ donation etc

Principles of Bioethics

• Respect for autonomy means respecting individual patients' ability to make their own health decisions and right to self-determination.
• Non-maleficence means "doing no harm" or "avoiding harm".
• Beneficence means doing and promoting good, preventing and removing evil or harm.
• Justice means maximizing benefits to patients and society, fairness, equality, and impartiality.

More Principles of Bioethics

• Fidelity is remaining loyal and faithful.
• Veracity is remaining honest at all times.
• Accountability means being responsible for all actions.

Accountability in Bioethics

• Accountability is being responsible for a system, its behavior, and its impacts.
• Accountability acknowledges responsibility for actions, decisions, and products on a legal or moral level.
• The American Nurses Association (ANA) defines accountability as being answerable to oneself and others for one's actions.
• Accountability in nursing requires an ethical code of conduct based on fidelity and respect for patients' dignity, worth, and self-determination.

Bioethical Situations

• Reproductive situations: Voluntary reproductive sterilization as a contraceptive method may conflict with caregivers' moral, ethical, or religious beliefs.
• Abortion: Legalized abortions allow for induced pregnancy termination.
• HIV and other infections: Confidentiality, privacy, and informed consent are human rights requiring protection, alongside the right to healthcare.
• Quality of life: Critical decisions occur before or during interventions impacting the quality of a patient's life post-procedures.
• Euthanasia: Is mercy killing legal or justified?
• Right to die: Courts have stated the constitutional right to privacy when choosing to die with dignity, or the common law right to withhold consent and refuse treatment.
• Organ donation and transplantation: The Anatomical Gift Act of 1968 involves family consent for donation. Irreversible coma includes unresponsiveness, no respiration, movement/reflexes, and a flat ECG.
• Death and dying: These issues include decision-making capacity/right to refuse treatment, life-sustaining choices, medical futility, and assisted suicide.

Basic Ethical Principle

• The Principle of Stewardship is grounded in the belief of God's dominion over creation and humans' responsibility to care for it.
• Stewardship includes the wise use of natural resources.

Characteristics of Good Steward

• Commitment to selfless service without seeking power or control.
• Believe in sustainability by building value for customers, members, or future generations.
• Practice inclusiveness by welcoming new members into the organization.
• Embrace innovation and change.
• They are quick to give others credit and work together to reach goals.
• Believe in communication and being transparent, seek advice, and are thankful.

Principle of Stewardship

• Stewardship involves leadership that establishes values-based healthcare promoting dignity, self-determination equity and fairness.
• Stewardship is a Christian ethic that suggests that human life comes from God and emphasizes the importance of protecting spiritual, bodily functions, and improving bodies.
• Stewardship involves responsibility towards the health system and population so that there is coordinated involvement of all sectors.
• Personal role is acting on character qualities and in practical reasoning.
• Social roles are the holistic value and respect of patients priorities.
• Biomedical involves ethical principles, decision-making, and actions.
• Ecological includes consideration and the effect on health for individuals and communities.

Principle of Totality

• According to the principle of totality, medical ethics says medical decisions should prioritize the entire person: physical, psychological, and spiritual factors.
• A portion may be sacrificed if essential for the person's good.
• The whole is greater than its parts.
• An ethical principle suggests individuals can remove/mutilate defective or worn-out body parts, while also promoting that every one has the duty to develop, take care and preserve bodily parts.

Principle of Integrity

• It involves being honest, fair, and possessing high moral principles.
• Integrity enables nurses to maintain high standards and do right.
• Sample issues include covering up to avoid judgement, suppressing information or the truth, lying, misrepresenting oneself and compulsive behavior.
• Ethico-moral responsibility includes acting on multiple principles and values according to standards in any context.

Ethical Issues in Healthcare

• Do-Not-Resuscitate Orders
• Doctor and Patient Confidentiality
• Malpractice and Negligence
• Access to Care
• Physician-Assisted Suicide

DNR

• A Do-Not-Resuscitate (DNR) order written by a doctor instructs healthcare providers not to perform CPR if the patient stops breathing or their heart stops.

Doctor and Patient Confidentiality

• Laws require physicians protect patient privacy and security of medical records.
• The Health Insurance Portability and Accountability Act (HIPAA) outlines who can access confidential information, but gray areas exist.

Malpractice and Negligence

• Negligence involves a person's failure to exercise care in a way that a reasonable person would have done.
• Malpractice is negligence by licensed professionals failing to meet required standards, often by a negligent health care provider.
• Nursing malpractice happens when a nurse fails to do their job, which hurts the patient.
• Negligence happens when someone does not do something that a reasonably prudent person would do.
• Malpractice means negligence by a professional failing to act according to care standards.
• As a Nurse, Malpractice includes being responsible for caring for the patient, not providing the correct care, resulting in patient injury because they did not receive with adequate care.

Access to Care

• The ultimate in care should be to provide "Health for All Filipinos."
• President Rodrigo Duterte signed the Universal Health Care Bill into law on February 2019, to have population, service, and provide financial amendments.
• Through UHC, Filipinos are guaranteed equitable access to quality and affordable healthcare, and they are protected against related financial risks.

Physician-Assisted Suicide

• It is the act of intentionally ending one's life with assistance, usually a physician.
• The patient must be terminally sick, and can take the drug themselves, and is mentally capable of understanding what they are doing.

Ethico-Moral Responsibility of Nurses in Surgery

• Perioperative nurses must respect patients' dignity and worth.
• Nurses must know and protect patients' moral and legal rights.
• Nurses need to preserve and protect their patients' autonomy and human rights through nursing interventions, informed consent, patient participation
• Nurses explain procedures and respect wishes of patients.
• Mutilation means the "removal of a member of the human body."
• Sterilization is the "removal of a procreative member to prevent procreation".
• St. Thomas wrote in defense stating that it was lawful to save life through amputation.

Mutilation and Sterilization

• Circumcision is usually performed for religious, cultural or personal reasons.
• Circumcision may violate respecting autonomy/doing no harm.
• Circumcision is generally deferred until the child can provide consent.
• Female circumcision has been practiced in African cultures as a part of womanhood initiation.

Preservation of Bodily Functional Integrity

• "My body, my choice"
• This principle limits what to do to human bodies or parts.
• Bodily integrity is the sacredness of the body, emphasizes personal autonomy/self-determination.
• Violating someone causes both unethical, invasive, criminal acts.

Issues Involved in Organ Donation

• Organ donation involves taking organs and tissues for transplantation from one living or dead person to another.
• A single donor's organs can help as many as 50 people by donating kidneys, heart, liver, pancreas, intestines, lungs, Skin, Bone and bone marrow, and corneas.
• Organs and tissues can be donated while the donor is still alive.
• Organ donation after cardiac death can be ethically questionable.
• Antemortem procedures aimed at increasing organ transplant success, but do not serve patient's medical interests.
• Antemortem interventions require ethical evaluation with the donor's wish.

Principle of Ordinary and Extraordinary Means

• Ordinary means must be taken to preserve life.
• Extraordinary means can be morally refused.
• Ordinary means are available and offer hope of benefit without unbearable pain and suffering.
• Extraordinary means - no hope of benefit, overly burdensome, risky and not financially manageable.
• The positive outcome isn't a good thing if dishonest or harmful.
• Ordinary differs from extraordinary in Catholic Moral Theology by being beneficial.

Principle of Personalized Sexuality

• Sex is typically categorized in binary, but a variation of the biological attributes exists.
• Gender is the social roles, behaviors, expressions, and identities.
• Sexual Orientation is a person's identity related to the gender they sexually attract.
• In nursing ethics, the principle embraces individual sexual preferences/needs, supporting privacy and dignity.
• Nurses must ensure informed consent in sexual health decisions, including discussing risks, benefits, and alternatives.
• Ethical nursing requires providing care without discrimination based on sexual orientation.
• This includes protecting the confidentiality of patients' sexual health information.
• A consideration of cultural practices related to preferences/needs of patients.
• Nurses address care barriers by advocating for access to sexual health, as these principles supports these needs.
• The ultimate goal is to provide sensitive, personalized, and safe health care.

Test your knowledge of bioethical principles in healthcare. This quiz covers non-maleficence, fidelity, and justice. It also touches on accountability and ethical dilemmas faced by healthcare professionals.