BIOETHICS PART 1.pptx

BIOETHICS Part 1 Sarah K. Midtimbang, RN  LEARNING OUTCOMES  Differentiate ethics from morality.  Define bioethics in the context of healthcare setting  Define the different Ethical theories.  LEARNING OUTCOMES  Analyze different ethical principles and its imp...

BIOETHICS Part 1 Sarah K. Midtimbang, RN  LEARNING OUTCOMES  Differentiate ethics from morality.  Define bioethics in the context of healthcare setting  Define the different Ethical theories.  LEARNING OUTCOMES  Analyze different ethical principles and its implication to the nursing practice  Integrate the different theories in explainingethical dilemma experience by nurses in clinical setting  ETHICS  Canbe understood as science of the morality of human conduct or human act  Deals with goodness or badness or the rightness or wrongness of the human act.  What makes good, good?  Asfar as ethics being a moral philosophy is concerned, an act is good when it is in agreement or conformity with the dictates of right reason.  What makes reason, right?  Reason is considered right when it is in conformity with the truth,  meaning the truth is not that which is acceptable only to some but universally acceptable to all human persons regardless of time, space, & culture.  ETHICS vs MORALITY Ethics is the formal, systematic study of moral beliefs. Morality is adherence to informal personal values  ETHICS vs MORALITY RELATION DISTINCTION ethics and a. Ethics pertains to the knowledge of a.Both what to study about- that is the morality deal with goodness or evil of a human act; human act or Morality pertains to the application human conduct of this knowledge in the performance of human act. b.Ethics studies b. Ethics provides learning about about morality morality of a human conduct. Morality provides ways in  ETHICS vs MORALITY RELATION DISTINCTION a. Morality gives ethics a perspective of what to a. Ethics indicates study about- that is that “theory”; the rectitude of morality indicates whether an act is the good or bad. “practice.” b. Morality provides ethics with a quality that determines and distinguishes right conduct from wrong  BIOETHICS As a science that deals with the study of the morality of human conduct concerning human life in all its aspects from the moment of its conception to its natural end.  BIOETHICS Its etymological root derived from bio meaning (life) and ethos (ethics) or the philosophical discipline that deals with the morality of human conduct.  BIOETHICS Itis a result of the collective efforts in philosophy, theology, law & medicine as it confronts the complex crisscrossing and intertwining of science & technology in the ambit of human life.  BIOETHICS Interested in the ends and purposes of life sciences, healthcare, meaning & implication of justice, death, pain, suffering, rights, duties, & responsibilities to the sick person, his family, society & state.  Health Ethics Isa science that deals with the study of the morality of human conduct concerning health and health care. Employed to regulate human conduct in the practice of health care so that good may be done and evil may be avoided.  BIOETHICS Concerned with: a. reproduction b. fertilization c. sperm bank d. gene manipulation e. genetic engineering f. cloning, repair of hymen g. vaginal rejuvenation/tightening h. organ transplant i. surrogate motherhood k. stem cell manipulation  FILIPINO PRIMAR Y PRINCIPLES OF BIOETHICS Grouped into 3 main divisions: Goodness Beneficence Family  GOODNESS The primary principle of goodness is demonstrated through the practice of justice, respect for autonomy, compassion, veracity, fidelity, & confidentiality. Concretely, Filipinos practice this through delicate and generous hospitality  GOODNESS Also shown in community sharing of goods including lending of money, materials, equipment, & even human resources. Kababayan (compatriots) Utang na loob (indebtedness or gratitude)- runs through generation because of the belief that good favors done to one member should be perpetuated in acts of gratefulness forever.  GOODNESS In bioethics- goodness is also veracity but telling the truth should be done with compassion & full of respect- appropriate timing and suitable occasion.- Filipinos’ gift of pakiramdaman (sensitivity) is of big help. In nursing, the primary principle of goodness should be the motivating guideline in caring for patients because goodness in health care means giving and caring so that the patient will feel better.  BENEFICENCE No harm should be done to anyone and we should contribute to their welfare and growth. Connotes blessings, acts of mercy, kindness, charity, altruism, love, humanity. Moral obligation to act for the benefit of others.  FAMILY Very important in Filipino culture Solid bank one can rely on where withdrawal of help & support is endless and the resource is never exhausted. Parents are looked up to as mature, respectable and responsible adults.  ETHICAL THEORIES Each theory emphasizes different points, a different decision-making style or a decision rule- such as predicting the outcome and following one’s duties to others in order to reach what individual; considers an ethically correct decision.  FAMILY Isthe source of all right conduct, ethics, morals, justice, autonomy, beneficence, respect, goodness that flow in continuity among the children from the eldest down to the youngest. The kind of our personhood often depends on the nurturance, rearing, & breeding we have received from the family. Deontology (or formalist theory) The term deontology was coined by Charlie Dunbar Broad (1857-1971) Derived from the Greek word “deon” which means “obligation” or “duty”; & the Greek word “logos” which means “inquiry” or “study” It means ethical study or ethical inquiry regarding duty. Duty based- theory States that people should adhere to their obligations and duties when engaged in decision making when ethics are in play. Itmeans that a person will follow his or her obligations to another individual or society because upholding one’s duty is what considered ethically correct. Implies people are sensitive to moral duties- require or prohibit certain behaviors irrespective of the consequences. Duties are absolute & unconditional- CATEGORICAL IMPERATIVE- all people have perfect duty in that if their action were universalized, there will be no contraindications. It teaches us about always acting in good faith and adheres to the Golden Rule: “to treat others the way you want to be treated by them”. Adheresto the theory that an “end does not justify the means.” Do not use others for selfish reasons.  TELEOLOGICAL ETHICS The term teleological is derived from the Greek word “telos” which means “end” or “purpose” and “logos” which means “science.” Derives moral obligation from what is considered good or desirable as an end or purpose to be achieved.  TELEOLOGICAL ETHICS The focus is on the consequences of the act that is executed by the agent premised on the purpose or reason why the agent performs the act. Ifthe result of the choice is right, then it follows that the choice is morally right, if on contrary, it is wrong.  TELEOLOGICAL ETHICS Judge the rightness and wrongness of decisions based on the outcomes or predicted outcomes. Itis also called “Consequence-Oriented theory”. It involves examining past experiences in  TELEOLOGICAL ETHICS The most common form of consequence- oriented reasoning is UTILITARIANISM  UTILITARIANISM  Basedon the concept of “the greatest good for the greatest number of people”.  Alsoreferred to be the “Greatest Happiness Principle”- it measures how much overall pleasure can be derived from a certain action & how much pain is averted.  The choice that yields the greatest benefit to the most people is the one that is ethically correct.  UTILITARIANISM  The primary motive of the performance of action is happiness and/or pleasure in their highest degree to its greatest number of recipients.  Doingwhatever actions produce a result that is agreeable to many people.  The end always justify the means.  UTILITARIANISM  Itclaims that there is only one and only moral principle “Principle of utility”- formulated by John Stuart Mill (1806- 1873)  an action are good in so far as they tend to promote happiness, bad as they tend to produce unhappiness.  Rule- takes into account the law and is concerned with fairness. It seeks to benefit the most people but through fairest and most just means available. It values justice and includes beneficence at same time.  Disadvantage:  Use life experiences to attempt to predict outcomes but sometimes no one can be certain that one’s prediction will be accurate. Uncertainty can lead to unexpected results making utilitarian appear unethical as the choice did not benefit the most people as predicted.  Two Types  1. act utilitarianism (eudaimonistic)-based on the notion of happiness  2. rule utilitarianism (hedonistic)- based on the notion of pleasure  Act- a person performs acts that benefit the most people regardless of personal feelings or societal constraints such as laws.  It takes into account possible results of each particular act.  We have to explore and weigh all the possible consequences of each of these alternatives & make the decision.  Rule of Utilitarianism-considers the possible results in the light of a rule.  Absolutistic Utilitarianism- for once a rule or policy has been formulated it must be followed given the same set of circumstances.  Relativistic Utilitarianism because if the rule/policy becomes irrelevant to the demands of new circumstances, it will be revised, modified, & altered.  Disadvantage-one individual’s right may be infringed upon in order to benefit a greater number of people.  Inother words, it is not always concerned with justice, beneficence or autonomy for an individual, if oppressing the individual leads to the solution that benefit a majority of the people.  VIRTUES OF ETHICS Virtue is usually construed as an act fitting to a man, man being ver Put much weight on the moral character of the person rather than of what he/she has done. Judgesthe person through his character by what he does.  Beauchamp & Walters A virtuous person is one whose inner self or character is always trained toward choosing and doing what is good. A morally good person will more likely: a. Understand what should be done b. Perform required acts c. Form an act on moral ideals  Ted Chambers A virtuous professional is: a. One who can discern the right course of action in the situation without relying on principles & rules b. One who desires to do what is right and avoid what is wrong  Plato 4 Basic virtues: A. wisdom- arises in the rational soul B. Courage- in the spiritual soul C. Temperance- appetitive soul D. Justice- comes when there is an equilibrium among wisdom, courage, & temperance.  Plato Wisdom supremely rules over other virtues just as the rational soul commands supremacy over the other level of the soul of the man. Plato posits that temperance means moderation. Platoasserts that justice means “the observance of duty & righteousness which is what is due to or from a person.”  ARISTOTLE Two kinds: A. Intellectual virtues- arises from teaching & through the reflection of theoretical moral truths and the discovery of rational principles that ought to control our actions. B. Moral virtues- arises as a consequence habit or of one’s habitual choice of action in consonance with rational principles. The virtue ethical theory judges a person by his/her character rather than by an action that may deviate from his normal behaviour. Ittakes the person’s moral, reputation, and motivation into account when rating an unusual and irregular behavior that is considered unethical. Disadvantage- it does not take into consideration a person’s change in moral character.  a sudden change from moral to immoral character may go unnoticed until significant amount of evidence mounts up against him/her.  CLINICAL VIRTUES  Are character traits that dispose (place) nurses to provide good care to patients, families, & communities.  VIRTUES OF HEALTH CARE PROVIDER S Fidelity-a steadfast faithfulness associated with pledge of loyalty or the practice of keeping promises.  Honesty-the quality of being honourable and upright in character and a actions. (TO BE FAIR …. To be HONEST with ONESELF and in his human acts).  Selfhonesty demands that one must not try to be something he is not.  Virtues of a Health Care Provider InHealth care Profession: Nurses spontaneously and consistently show in their personal and professional life their wholehearted support in upholding applicable laws, code of ethics, policies, and promises entered into with clients/patients.  Humility-meekness of heart (gentle nature of the heart).It calls for submission, docility/ obedient , and courtesy. (NURSES epitomize the way humility works in their life). Respect- means esteem or honour by which a person shows recognition or high regard to self- worth, self-respect with dignity, respect for authority, and respect for others with tolerance. Compassion-signifies sympathy. it implies feeling for another’s sorrow or Prudence-signifies carefulness, precaution, attentiveness, and good judgment as applied to action or conduct. Courage-signifies bravery and fearlessness. Courage applies to moral strength - (more of a state or quality of mind). BRAVERY applies to a kind of courage that is shown by bold, fearless, and daring action in the presence of danger.  Vices of the health care provider isan evil fault, an imperfection, an immoral conduct, tendency, practice or habit. (As applied to an animal nature of a person, it is a bad habit or failing). Fraud-Taking advantage over another by misrepresentation, false suggestions, or by suppression of truth. ~ ACTUAL or CONSTRUCTIVE ActualFraud – consists of deceit, artifice, trick, design and some direct and active operation. Constructive Fraud – consists of act of commission or omission contrary to legal or ethical duty, trust or confidence reposed. In relation to the nursing profession, a nurse may be guilty of and penalized for fraud as defined by the Philippine Nursing Act of 2002 (RA 9173). Greed -the quality of wanting more than one’s share. -Synonymous to avidity, avarice, cupidity, covetousness, and other analogous terms. Pride-high opinion of oneself that suggests neither proper self-respect nor personal dignity.  CORE VALUES OF PROFESSIONAL NUR SES The 6 C’s of Caring in Nursing  Compassion- awareness of one’s relationship to others, sharing their joys, sorrows, pain & accomplishments.  Competence- having the knowledge, judgment, skills, energy, experience & motivation to respond adequately to others with in the demands of professional responsibilities.  Confidence- the quality that fosters trusting relationship. Comfort with self, client, and family.  Conscience- morals, ethics, and an informed sense of right and wrong. Awareness of personal responsibility.  Commitment- convergence between one’s desires and obligations and the deliberate choice to act in accordance with them.  Comportment- appropriate bearing, demeanor, dress, and language, that are in harmony with a caring presence.  ETHICAL PRINCIPLES Respect for Autonomy- derived from the Greek word autos (self) and nomos (rule or law) therefore refers to self-rule.  Entails the ability to make a choice free from external constraints.  Theconcept of autonomy implies independence and firmness in one’s conviction, perspective, or personal stance.  Respect for autonomy  Healthcareproviders are duty bound to acknowledge the autonomy of their patients; they have to recognize and appreciate the views, decisions, choices, beliefs, and values of their patients.  Notabsolute because if the choice wantonly jeopardizes the health of others or disrupts or hampers the just distribution of resources the choice must be objected.  PATIENTS’ RIGHTS  Means the moral and inviolable power vested in him as person to do, hold, or demand something as his own.  Everyright in one individual involves corresponding duty in others to respect this right and not violate it.  Everyone ought to respect another person’s right.  TYPES OF PATIENTS’ RIGHT  The patient as an individual person has the moral right to determine what is good for himself.  Beauchamp & Walter (1979) 4 rights: a. Right to informed consent b. Right to informed decision c. Right to informed choice d. Right to refusal of treatment  Right to informed consent  The patient has the right to receive all necessary information concerning diagnosis & treatment in order to be able to give consent based on his/her value system.  Informed consent- refers to the knowledge or information about the consent to a particular form of medical treatment before that treatment is administered.  Right to informed choice  Informed choice- refers to the necessary information a patient should know about a medical treatment or experiment so that moral choice can be made.  Thepatient has the right to be informed about possible alternative course of action to be taken, together with the possible consequences.  Right to informed decision  Information& understanding are necessary for genuine deliberation.  Thepatient cannot make moral decision unless these two important elements are present.  Informed decision- refers to the necessary information of and decision on a medical treatment before the latter is carried out.  4 Major Elements of Informed Consent A. Competence- refers to the capacity of patient for decision making. One is considered competent if:  One has made a decision (can choose between alternatives).  One has the capacity to justify one’s choice (give reason why that is the choice).  One does not only justify one’s choice but does so in reasonable manner B. Disclosure-refers to the content of what a patient is told or informed about during the consent negotiation. C. Comprehension-refers to whether the information given has been understood.  If the patient does not understand what he/she has been told, then information has not been relayed at all. D. Voluntariness-means the consent must be voluntary  Agree on his own volition.  Patient owns the decision, it is patient’s decision alone, had chosen the decision or option based on the information disclosed to him/her.  Right to refusal of treatment  Inconjunction with the statement on a Patients’ Bill of rights (presented by American Hospital Association)- the patient has the right to refuse treatment to the extent permitted by the law and to be informed of the medical consequences of his action.  Limitations of a Patients’ Rights 1. Patients’ rights do not include the right to be allowed to die. 2. A patient in a moribund condition does not possess the necessary mental or emotional stability to make an informed choice. 3. Patients’ rights are not absolute.  2 types of Informed Consent (Phils.) a. Written Consent- signed during admission b. Verbal Consent- verbally signifies willingness to undergo medical treatment. Emergency cases- do not need informed consent: c. Comatose or obtunded patients. d. Blind or illiterate patients. e. Underaged patient or those unable to understand the circumstances. f. Language barrier.  Patients’ Bill of Rights The patient has the right: 1. to considerate and respectful care. 2. to obtain from his physician complete current information concerning his diagnosis, treatment, and prognosis in terms that the patient can be reasonably expected to understand. 3. to receive from his physician information necessary to give informed consent prior to start of procedure or treatment. 4. To refuse treatment to the extend permitted by law & be informed of the medical consequences of his action. 5. To every consideration of his privacy concerning his own medical care program (the issue here is one of privacy & simple courtesy). 6. To expect that all communications & records pertaining to his care should be treated as confidential. 7. To expect that within its capacity, the hospital must provide a reasonable response to his/her request for services. 8. To obtain information regarding any relationship of his hospital to other health care and educational institutions in so far as his care is concerned. 9. To be advised if the hospital proposes to engage in or perform human experimentation affecting his/her care or treatment. The patient has the right to refuse to participate in such research projects. 10. To expect reasonable continuity of care. (the patient has the right to know in advance what appointment schedules & physician are available and where. 11. To examine and receive an explanation of the hospital bill regardless of source of payment. 12. To know what hospital rules & regulation apply to his care/her conduct as a patient.  PROXY CONSENT/LEGALLY ACCEPTABLE REPRESENTATIVE Is the process by which people with legal right to consent to medicaltreatment for themselves or for a minor or a ward delegate that right to another person.  2 types of Proxy Consent for adults Power of attorney to consent to medical care-  usually used by patients who want medical care but are concerned about who will consent if they rendered temporarily incompetent by the medical care.  Delegates the right to consent to a specific person.  2 types of Proxy Consent for adults  Living will-is a document that indicates a patient’s wishes regarding their health care and how they want to be treated should they become seriously ill and unable to make or communicate a decision of their choice.  Legal instructions regarding your preferences for medical care if one is unable to make decisions for themselves.  PRIVACY Refers to the right to be free from interference. Privacy is supposed to enable individuals to exert control over their own lives which includes deciding who should have access to personal information, and when & how this information will be disclosed.  CONFIDENTIALITY Refers to the duty to protect privileged information & to share entrusted information responsibly. Itstems from the notion that a person’s wishes, decisions, & personal information should be treated with respect. Relates to the concept of privacy. Information obtained from an individual will not be disclosed unless it will benefit the person or there is direct threat to the social good.  VERACITY  Obligation to tell the truth and not to lie or deceive others.  Often is difficult to achieve.  It may not be difficult to tell the truth, but it can be quite hard to decide how much truth to tell.  In its basic meaning is truthfulness.  To be true is to accept one’s self as one is.  To respect veracity in relationships is to deal honestly with patients and colleagues as they are. Tellingthe truth in personal communication with patients in another characteristic of actions that many people believe is morally required reasons other than just producing good consequences. Nurse must assess whether communication is honest. Veracity is necessary in professional- patient relationship in 3 reasons: A. The obligation of veracity is based on respect owed to others (asking patient to consent- validity depends on thorough information, full disclosure & enlightenment given to patient). Veracity is necessary in professional- patient relationship in 3 reasons: B. Veracity has a close connection to obligations of fidelity & promise–keeping. (when we communicate with others we promise that we will speak truthfully & that we will not deceive our listeners). Veracity is necessary in professional- patient relationship in 3 reasons: C. Relationship of trust between persons are necessary for fruitful intervention & cooperation (at the core of these relationships is confidence in and reliance on others to be truthful).  FIDELITY Means faithfulness and keeping promises. Ethical foundation of nurse-client relationship. When commitment are made to others, other things being equal, most people recognize that there is a moral obligation to keep those commitments. Failure to do so would be assign of lack of respect.  FIDELITY Clients have an ethical right to expect nurses to act in their best interest. Fidelityis demonstrated when nurses: A. represent the client’s viewpoint to other members of the health care team. B. avoid letting their own personal values influence their advocacy for clients. Support the client’s decision even when it conflicts with the nurse’s preferences or choices.  JUSTICE Derived from the Latin term “jus” which means right. Right entails a context of relation since it is a correlative duty. Itmeans that the true meaning of justice can only be achieved in the ambiance of relation.- one can give each human person his/her due only in the context of a relation.  JUSTICE Justice does not mean that everybody should be equal in all of life’s opportunities, concerns, & undertakings.  Human beings can never be equal in all respects. The enactment and promulgation of enumerable laws somehow impedes people to come to terms with equality.  Two Kinds of Justice A.General legal justice- classified into equity & common legal justice. B. Particular justice- classified into commutative justice and distributive justice. General legal justice- refers to human person’s wishes and proper actions in consonance with the common good. Has affinity with laws since laws are made not only for the good of certain individual but for the good of the whole community. Equity- a kind of GLJ by which a human person judges, wills, & does what is right to others not necessarily from the injunction of the moral law but from civil law. Common legal justice- human person shows proclivity to will and do something for the good of others in accordance with the moral law or with the prescription of civil law. Particular legal justice- pertains to wishing and doing what is right in relation to another person who is accounted as an individual with an inherent right to his/her own private good. Commutative justice- deals with fairness of exchange. Exist in the relationship between individuals or between entities like nations or corporations. Distributive justice- refers to a person’s will to share the goods which belong to a community or to individuals who are part of his/her community. Sharing of the wealth of a nation including natural resources and food to indigents & disadvantage.  BENEFICENCE  Duty to do good and active promotion of benevolent acts (goodness, kindness, charity).  Guides the decision maker to do “what is good and right”.  Stipulates that one should strive to achieve the greatest amount of good because people benefit from the most good.  BENEFICENCE  It requires nurses to abstain from injuring patient.  Taking care of the patient is a beneficent act.  The principle of beneficence ought to be cherished & demonstrated by the nurses to their patients.  William Frankena 4 elements of Beneficence:  A. one ought not to inflict evil or harm.  B. one ought to prevent evil or harm.  C. one ought to remove evil or harm.  D. one ought to do or promote good.  Chinese  Believethat everyone shares the same nature hence, they assert that others are as human as they are.  LeadsKong Zi preach his signature “Golden Rule” “do unto others what you want others do unto you” “do not do unto others what you do not want others do unto you”.  Buddhist One must inculcate the right thought (one of the 8th fold paths in Buddhism) which requires the mind to be free from impurities like harm, ill-will, cruelty, & lust).  HINDUS “ahimsa” which means non hurting of all forms of life. Itis clear that the mandate on preventing harm or evil to self and others as well as mandate on the promotion of good is a universal phenomenon.  NONMALEFICENCE Isunderstood as the overriding principle through which everyone is required to undertake the caring of the patient. It is capsulized in the phrase “do no harm”. Principles of NM injunct one’s avoidance of inflicting injury, harm, or pain to others.