Health Ethics: Theories and Principles

Lesson 1: Theories and Principles of Health Ethics

• Ethics is the study of social morality and philosophical norms and practices.
• Bioethics studies the moral dimensions, visions, decisions, conduct, and policies of life sciences and health care.
• Teleology suggests morality is based on the outcome of actions.
• Deontology focuses on the rightness or wrongness of the actions and not the consequences.
• Utilitarianism advocates actions promoting overall happiness or pleasure, aiming for the betterment of society and rejecting actions that causes unhappiness or harm.
• Utilitarianism: "The greatest amount of good for the greatest number of people."

Criticism of Utilitarianism

• Majorities are hard to define, sometimes at the cost of the minority.
• Morality judged by the results, not the means.
• Consequences are difficult to predict.
• Managers measure the benefits and harms to each stakeholder group.

Universalism

• Universalism, developed by Immanuel Kant, is considered a deontological approach.
• Universalism is centered on human autonomy
• What is right for one should be right for all

Virtue Ethics

• Virtue ethics is a philosophy developed by Aristotle.
• Focuses on understanding and living a life of moral character.
• This character-based approach acquires virtue through practice.

Virtue Ethics in Nursing

• Truthfulness, honesty, humility, integrity, compassion, respect, and courage (Aristotle) are nursing virtues.
• Nurses should protect patient privacy and confidentiality.
• Respect the patient's privacy which means not invading or denying it.
• Only share patient's condition with those who need to know.
• Veracity tells the truth.
• Assess a patient's ability to make informed health decisions.
• Advocate for the patient's best interests.

Core Values of a Professional Nurse

• Compassion encompasses empathy, dignity and caring.
• Trustworthiness is essential to integrity and ethical behavior.
• Professional nurses are accountable.
• Professional nurses should express Humility, and Curiosity.

Ethical Principles

• Autonomy respects self-governance and the ability to act according to one's values and beliefs.
• Potential harm to others such as acts of violence restricts Autonomy.
• Illness, depression, extreme fatigue, and comatose may inflict Temporary constraints on Autonomy.
• Paternalism is when a person assumes the authority to decide for another.
• Privacy respects an individual's right to control their personal information from intrusion.
• Confidentiality is an ethical duty that obligates certain individuals, such as healthcare providers, to protect shared personal information.
• Veracity's obligation is based on respect owed to others.
• Veracity is closely connected to Fidelity- to speak truthfully and not deceive.

Justice

• Justice means equitable distribution of healthcare resources and goods.
• The RA 7432 Senior Citizens Act is an example of justice
• Beneficence means doing an act of kindness and mercy that directly benefits the patient.
  • It encompasses promoting good, preventing harm, and removing evil or harm,.
  • Includes the rights of others with the Patient's Bill of Rights, preventing harm, helping persons with disabilities, and rescue persons in danger.

Non-Maleficence

• Do no harm
• Informs the patient of possible outcomes, alternatives, and risks of treatment.
• Patients have the right to considerate and respectful care.
• Patients have the right to information, informed consent, and refusal of treatment.
• Patients have the right to privacy, confidentiality, and to know their relationship with the healthcare staff.
• Patients have the right to not be research subjects and have reasonable continuity of care.
• Patients have the right to receive an explanation of their bill.

Principle of Double Effect

• If the intention is to do good, an act is permissible, even if there may be a bad effect.
• The act must be morally good or at least indifferent.

Principle of Legitimate Cooperation

• This operation is similar to partnership.
• The cooperation should be about material and never formal for immediate material.

Principle of Stewardship

• Stewardship means guarding the house.
• Health practices mean looking after, providing health-care services, and promoting life.
• Stewardship includes patient-population centeredness and safety for both patients and healthcare staff.
• Stewardship leads to increased autonomy for advanced nurse practitioners and more respect towards nurses.

Different Ways to Apply Stewardship

• The different ways include personal, social, ecological and biomedical.
• The stewardship self encompasses self-awarness, self-compassion and care.

Personal Roles as Stewards

• Valuing and respecting patients' priorities and autonomy
• Valuing nurses as teachers in explaining their disease process
• Advocating all patients
• Recording patient medical history, team work etc..
• Fatigue may be a contributing factor in tragic medical treatments

Social Stewardship

• Aims at improving policies
• Reviving a sense of social purpose.
• Nurses assist families in gaining a better understanding of the social, physical, behavioral, and cultural experiences they face
• Nurses innovate care coordination and technology integration.

Sexuality and Human Reproduction

• Sexuality includes; sex, gender, sexual orientation, eroticism, pleasure, intimacy, reproduction etc..
• Gender identity means how an individual feels about their identity.
• Gender is established in infancy.
• Physical Attraction relates to the characteristics of the person.
• Emotional attraction relates to the characteristics of a person that creates romantic feelings.
• Nurses should understand the physical and psychosocial dimensions of sexual growth and development.
• Social roles encompass range of behaviors and attitudes that are considered acceptable.
• Gender has many ranges: LGBTQIA+++ etc.

Fundamentals of Marriage

• A formal union and a legal contract.
• New Family Code of 1998 states marriage is a special contract.
• Religion posits that marriage is sacrament.
• The article of marriage states :No marriage shall be valid unless these essential requisites are made".

Pre-Marital Sex

• A sin
• Damages stable personal relationships.
• Effects of Pre-Marital sex include; unwanted pregnancy, and high-risk of STD, HIV/AIDS.

Homosexuality

• Some view this as related to a mental disorder
• Many religions discourage it
• It sexual attraction to the same sex.

Artificial Contraception

• Some may teach that contraception is both morally the wrong and violates the dignity of any person
• Women should make their own reproductive choices.
• Methods may assist in lessening maternal. infant, and child mortality and to reduce the prevalence of sexually transmitted diseases.

Assisted Reproduction Technology

• Also known by the acronym, ART
• Pregnancy without copulation, considered a miracle half a century
• the process of in vitro fertilization itself raises questions of weather it is morally acceptable to interfere in the reproduction process. .

Different Artificial Contraceptive Method

• Combined Methods (Pill, Ring & patch)
• Progestogen only pills (POPs)
• Intrauterine Devices (Copper IUD)

Aspects of Assisted Reproduction Technology

• Artificial Insemination
• The Skoptsy were a cult that pushed for the removal of reproduction systems

Surrogacy

• Commodification of a the body
• Exploitation of poor and helpless.
• Creates potential moral and other ethical consequences

Issues with Abortions

• Rights of the woman vs right of the fetus
• Is it legal or illegal
• Is access critical

Methods of Abortion

• Medicinal
• Surgical
• Hysterectomy

Aspects of Sterilization

• Can be direct and indirect
• Has both ethical and unethical consequences.
• Can be both voluntary and non-voluntary.
• Hysterectomies can be justifiable under medical circumstances

Important to Note with Sexuality

• Bodily Integrity Should Be Guaranteed By Women
• People should have freedom of movement and security.
• People have the freedom of speech and security.
• Those are fundamentals of marriage