Bioethics Lecture Notes: Principles and Applications PDF

 DEFINITION OF TERMS Ethics – is a set of principles of right conduct which its motivation based on ideas of right and wrong. It guides to moral behavior by making choices or judgments. Ethics vs Morals – Morals are an individual framework for decision making that includes person...

 DEFINITION OF TERMS Ethics – is a set of principles of right conduct which its motivation based on ideas of right and wrong. It guides to moral behavior by making choices or judgments. Ethics vs Morals – Morals are an individual framework for decision making that includes personal values. Ethics are generalized conceptual framework for decision making. Nursing Ethics – it is a system of principles that govern the actions of the nurse in relation to patients, families, other health care providers, policymakers and society.  DEFINITION OF TERMS Bioethics is a branch of applied ethics that studies the philosophical, social, and legal issues arising in medicine and the life sciences. It is chiefly concerned with human life and well-being, though it sometimes also treats ethical questions relating to the nonhuman biological environment.  PRINCIPLES OF BIOETHICS Respect for Autonomy- respect for the individual patient and his or her ability to make decisions with regard to own health and future; right to self- determination. Non-maleficence- “Doing no harm”; “Avoiding harming” Beneficence- Doing and promoting good; preventing and removing evil or harm. Justice – Maximizing benefit to patients and society while emphasizing equality, fairness and impartiality PRINCIPLES OF BIOETHICS Fidelity – remaining loyal and faithful Veracity – remaining honest at all times Accountability – responsible for all actions Practice Question  ACCOUNTABILITY IN BIOETHICS Accountability means the state of being responsible or answerable for a system, its behavior, and its potential impacts. Accountability is an acknowledgement of responsibility for actions, decisions, and products. Responsibility can be legal or moral (ethical). Accountability (ANA) – to be answerable to oneself and others for one’s own action. Accountability in nursing requires nurses to follow an ethical code of conduct based in the “principles of fidelity and respect for the dignity, worth and self- determination of patients”.  Reproductive Situation – Voluntary reproductive sterilization as a contraceptive method maybe contrary to the moral, ethical or religious beliefs of a caregiver. BIOETHICAL Abortion – Legalized abortions allows for induced termination of pregnancy. SITUATIONS HIV and Other Infections – Confidentiality, privacy and informed consent are human rights that should be protected but the right to healthcare should also be protected.  Quality of Life – Critical decisions before or during any interventions regarding the quality of patient’s lives after procedures. BIOETHICAL Euthanasia – Is mercy killing, legal or justified? SITUATIONS Right – to – die – Courts have determined that patients have a constitutional right to privacy in choosing to die with dignity or a common law right to withhold consent and refuse treatment.  BIOETHICAL SITUATIONS Organ Donation and Death and Dying – These issues Transplantation – Anatomical Gift include patient’s decision-making Act of 1968 or asking the family if capacity and right to refuse they wish to allow it. Irreversible treatment, withholding and coma for potential donors includes withdrawing life-sustaining unresponsiveness, no spontaneous treatment, medical futility and movement of respiration, no assisted suicide. reflexes and a flat ECG.  BASIC ETHICAL PRINCIPLE 1. Principle of Stewardship – it is grounded in the presupposition that God has absolute Dominion over creation and that in so far as human beings are made in God’s image and likeness (Imago Dei). Human have been given limited dominion over creation and responsible for its care. Stewardship is the act of making wise use of natural resources.  Committed to selfless service – no desire of power, do not need to be in charge or exert control over others. Characteristics Believe in sustainability – understand of Good that they are building value not for themselves but for their customers, Steward members or future generations. Practice inclusiveness – welcome all into the fold, no one is turned away. Always find way to bring new blood into the organization.  Embraces innovation and change – welcome new ideas and perspectives. Team players – quick to give others credit. Working together to reach Characteristics goals. of Good Steward Believe in communication and being transparent – gladly seek advice and feedback from their stakeholders. Always acknowledge and thank the master they serve.  Principle of Stewardship Role of a Nurse Stewardship could be a form of leadership by which a nurse leaders may establish health care environments that promote values-based practices that embody values, including respect for person’s dignity and self determination, as well as equity and fairness.  A broader over arching responsibility over the functioning of the health system as a Stewardship whole and ultimately, over the health of the population. It should nurture itself at in Healthcare all levels of healthcare so that there is coordinated involvement of all departments and sectors.  1. Personal Role of Nurses as Stewards - their capacity to act upon their character qualities, including self-discipline and courage as well as engage in Roles of practical reasoning. Nurse as Stewards 2. Social Role of Nurses as Stewards – Holistic value and respect patient’s priorities and self-determination  3. Biomedical Role of Nurses as Stewards – Ethical principles and how they make decisions, Roles of how they function, informs what they do. Nurse as Stewards 4. Ecological Role of Nurses as Stewards – that footprint affects the environment, which affects health for individuals, families and communities.  PRINCIPLE OF TOTALITY The principle states that all decisions in medical ethics must prioritize the good of the entire person, including physical, psychological and spiritual factors. (St. Thomas Aquinas, who synthesized the philosophy of Aristotle with the theology of the Catholic Church) Principle of Totality - A particular portion may be sacrificed; if the loss is essential for the good of the whole person. The whole is greater than any of its parts.  Defined as the quality of being honest, and fair; possessing high moral principles. Principle of Integrity When you’re faced with challenges as a nurse, your integrity is what will keep you standing tall. Having a high degree of integrity, in your nursing career, and in your day-to-day life, is the ability to know, in your very fiber, that you’ve done right by everyone concerned.  Sample Issues Covering up Suppressing something that you Lying, cheating, information or the don’t want others to stealing. truth. know. Abusing substances Misrepresenting Not being true to or engaging in yourself. yourself. compulsive behavior.  Ethico – Moral Responsibility The ability to recognize, interpret and act upon multiple principles and values according to the standards within a given field and/or context.  Ethical Issues in Healthcare 1. Do-Not-Resuscitate Orders 2. Doctor and Patient Confidentiality 3. Malpractice and Negligence 4. Access to Care 5. Physician-Assisted Suicide  DNR A Do-Not-Resuscitate (DNR) order is written by a doctor and it instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient stops breathing or if their heart stops beating.  Doctor and Patient Confidentiality The act requires physicians to protect the privacy and security of a patient’s medical records. HIPPA (Health Insurance Portability and Accountability Act) also sets forth who can see the confidential information and who cannot. Despite the law’s straightforwardness, there are some gray areas.  Malpractice and Negligence Negligence involves a person’s failure to exercise care in a way that a reasonable person would have done in a similar situation. Malpractice is a type of negligence that specifically relates to licensed professionals who fail to provide services that meet the required standard of care. Most personal injury claims revolving around malpractice are the result of a negligent health care provider. Nursing malpractice occurs when a nurse fails to competently perform his or her medical duties and that failure harms the patient. Negligence and Malpractice Negligence – failing to do something a reasonably prudent person would do or doing something a reasonably prudent would NOT do. Not acting according to Malpractice – negligence professional standards of by a professional person. care as a reasonably prudent professional would.  As a Nurse, when can you be guilty of Malpractice? 1. Responsible for 2. Did not carry out caring for the patient. that care. 4. Patient’s injury was 3. Patient was injured due to the nurse’s as a result. failure to provide adequate care.  Access to Care Health for All Filipinos On February 2019, President Rodrigo Duterte signed the Universal Health Care Bill into law, ushering in massive reforms in the Philippine health sector. Among the salient features of the UHC Law are the expansion of population, service, and financial coverage through an array of health system amendments.  Access to Care With UHC, all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk. The UHC helps ensure every Filipino is healthy, protected from health hazards and risks, and has access to affordable, quality, and readily available health service that is suitable to their needs.  Physician-Assisted Suicide Is the act of intentionally killing oneself with the aid of someone who has the knowledge to do so. In the most basic sense, the only person fully qualified to participate in the process is a physician. In states where PAS is allowed, a patient who qualifies must be terminally ill, can take the assisted drug themselves, and is mentally capacitated to understand what they’re doing. Ethico-Moral Responsibility of Nurses in Surgery Perioperative nurses are obligated morally to respect the dignity and worth of individual patients Obligation to be knowledgeable about the moral and legal rights of their patients and to protect and support those rights To preserve and protect their patients' autonomy, dignity, and human rights with specific nursing interventions, including supporting a patient's participation in decision making, confirming informed consent, and implementing facility advance directive policies. Ethico-Moral Responsibility of Nurses in Surgery Perioperative nurses explain procedures and the OR environment before initiating actions, and they respect patients' wishes in regard to advance directives and end‐of‐life choices. Mutilation to mean the " removal of a member of the human body." Sterilization is the " removal of a procreative member or element of the human in order to prevent procreation." St. Thomas wrote, that “it was lawful. to save life by cutting off a limb.”  Mutilation and Sterilization Circumcision is usually performed for religious, cultural and personal reasons. Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.  Mutilation and Sterilization Female circumcision, the partial or total cutting away of the external female genitalia, has been practiced for centuries in parts of Africa, generally as one element of a rite of passage preparing young girls for womanhood and marriage.  Preservation of Bodily Functional Integrity “My body, My Choice.” It is a normative principle that seeks to constrain what we should be allowed to do to human bodies or their constituent parts. – Bodily integrity is the sacredness of the physical body and emphasizes the importance of personal autonomy, self-ownerships, and self- determination of human beings over their own bodies. – In the field of human rights, violation of the bodily integrity of another is regarded as an unethical violation, invasive, and possibly criminal act.  Issues Involved in Organ Donation Organ Donation- takes healthy organs and tissues from one person for transplantation into another. Experts say that the organs from one donor can save or help as many as 50 people. Organs you can donate include: Internal organs: Kidneys, heart, liver, pancreas, intestines, lungs Skin, Bone and bone marrow, Cornea, Etc.. Most organ and tissue donations occur after the donor has died. But some organs and tissues can be donated while the donor is alive.  Issues Involved in Organ Donation Organ donation after cardiac death increases organ availability, but raises several legal and ethical issues, including consent. Antemortem procedures can improve the success of organ transplant after cardiac death, but do not serve the patient’s medical interests. Antemortem interventions are ethically and legally justified if the interventions are not harmful and the person concerned wished to be an organ donor.  PRINCIPLE OF ORDINARY AND EXTRAORDINARY MEANS Ordinary Means must be taken to preserve life, and Extraordinary Means can be morally refused. Ordinary Means -is often used to describe those means of prolonging life which are available, offer a reasonable hope of benefit and do not cause unbearable pain and suffering Extraordinary Means - no reasonable hope of benefit/success; overly burdensome; excessive risk and are not financially manageable.”  “end doesn’t justify the means..” A positive outcome isn't, well, a good thing if the methods used were dishonest or harmful to others. What distinguishes “ordinary” from “extraordinary” in Catholic Moral Theology is not whether the treatment is “ordinary” in the sense of being normal or frequently used, but rather whether the treatment is beneficial (ordinary) or excessively burdensome (extraordinary) to the patient.  PRINCIPLE OF PERSONALIZED SEXUALITY Sex is usually categorized as female or male but there is variation in the biological attributes that comprise sex and how those attributes are expressed. Gender refers to the socially constructed roles, behaviors, expressions and identities of girls, women, boys, men, and gender diverse people. Sexual Orientation is a person's identity in relation to the gender or genders to which they are sexually attracted; the fact of being heterosexual, homosexual, etc.  PRINCIPLE OF PERSONALIZED SEXUALITY The Principle of Personalized Sexuality in Nursing Ethics recognizes that each individual has unique sexual preferences, needs, and identities. It emphasizes the importance of respecting and supporting patients' sexual autonomy, privacy, and dignity.  PRINCIPLE OF PERSONALIZED SEXUALITY This principle can be applied in nursing ethics: 1. Informed Consent: Nurses should ensure that patients have the necessary information to make informed decisions about their sexual health and well-being. This includes discussing risks, benefits, and alternatives to various sexual practices or interventions. 2. Non-Discrimination: Nurses should provide care without discrimination based on sexual orientation, gender identity, or any other aspect of a patient's sexual identity. They should create a safe and inclusive environment where patients feel comfortable discussing their sexual concerns  PRINCIPLE OF PERSONALIZED SEXUALITY 3. Confidentiality: Nurses should maintain strict confidentiality regarding patients‘ sexual health information. This includes protecting their privacy and not disclosing any sensitive information without their explicit consent. 4. Cultural Sensitivity: Nurses should be aware of and respect diverse cultural beliefs and practices related to sexuality. They should provide care that is sensitive to patients' cultural backgrounds and values ensuring that their sexual needs and preferences are understood and respected.  PRINCIPLE OF PERSONALIZED SEXUALITY 5. Advocacy: Nurses should advocate for patients' rights to access appropriate sexual health services and resources. This may involve addressing barriers to care, promoting sexual health education, and supporting patients in making informed decisions about their sexual health. By adhering to these principles, nurses can provide patient-centered care that respects and supports individuals' unique sexual identities and needs.