BIOETHICS PRELIM-ENDTERM Notes PDF

Hiiii, Student Nurse! As a senior who have walked the same path you’re on now, it’s a privilege to share these review materials with you, hoping they will assist you in passing your classes and reach your academic goals. Reflect on the reasons you chose this noble profession – the lives you want t...

Hiiii, Student Nurse! As a senior who have walked the same path you’re on now, it’s a privilege to share these review materials with you, hoping they will assist you in passing your classes and reach your academic goals. Reflect on the reasons you chose this noble profession – the lives you want to impact, the difference you aim to make, and the passion that drives you forward. Hold onto these reasons. Let these motivations be your guiding light through every challenge you face. Also a quick note: if you decide to print these materials, please handle them responsibly and avoid leaving them anywhere. Study hard, stay focused, and keep that fire burning. I believe in you and your potential to become amazing nurses. With my sincerest encouragement, Kisha Jayn A. Tulio, SN.   It indicates a physician's duty to keep a patient away from harm and injustice.  It emphasizes the significance of medical An Ethical Dilemma: confidentiality between doctors and patients. You are a nurse assigned to patient Elsa, a 3-year old girl with  THE ART OF MEDICINE: dengue hemorrhagic fever. The doctor recommends blood o To relieve pain transfusion to replace the blood loss and increase platelet o To reduce violence of disease count. The family does not approve of the blood transfusion o To refrain from trying to cure whom the because of a religious belief and conviction. disease has conquered What will be your approach to the client’s family? What are the conflicts you can see in the situation stated? If the patient dies after being denied blood  Deon = duty, necessary transfusion, are you at fault for being part of the team that took care of the patient?  Nonconsequentialist Theory  Immanuel Kant (1724 – 1804)  A person is morally good and admirable if his actions are done from a sense of duty or reason. ETHICS  Principle of obligation must be followed by all - Is a well-founded standards of right and regardless of the consequences. wrong and what humans ought to do in terms  Even when a person does not want to do his duty, of rights, and obligations to benefit others he is required to do so. - Greek word "ethos" which means moral duty,  The basic rightness or wrongness of an act character or custom. It refers to the practices or depends on its intrinsic nature rather upon the values that distinguish one person, situation or consequence. organization, or society from others.  Example: - It pertains to the knowledge of what to study o Suppose a nurse is assigned to care for a about - that is the Goodness or Evil of human patient with AIDS. Could she reasonably refuse act or human conduct. to care for the patient on the ground that the - Ethics is not: patient’s condition may threaten her health? As o Ethics is not the same as feelings. practitioners of the healing art, nurses are to o Ethics is not religion. take care of the sick even if patients have o Ethics is not following the law. conditions that have threaten their personal o Ethics is not following culturally accepted health. Nurses, however, must observe the norms. necessary precautions to protect their health. o Ethics is not science.  Jeremy Bentham (1748-1832) o a book (1926) described the “five types of MORALITY ethical theory.” - A social consensus about moral conduct o the study of duty and obligation - Application of ethical knowledge in doing an  Immanuel Kant (1724 -1804) act o A German Enlightenment Philosopher is - A system of principles and values concerning one of the main proponents of Deontology. people’s behavior, which is generally accepted o According to Kant, duty is a demand for by a society or a particular group of people. action that respects the dignity of the - Greek word "moralis" refers to social other person. consensus about moral conduct. It pertains to ▪ You need to act toward a universal the application of ethical knowledge in the good. performance of human act or human conduct. ▪ You need to treat others as you treat your family. ▪ You need to act like it would be the best thing for humanity. Ethical Theories - Normative Ethics or Approaches  Telos = goal, end - Based on the consequences of human action;  Consequentialist Theory action is morally right if the consequences of o a reason or explanation for something as a such action are favorable. function of its end, purpose, or goal, as opposed to as a function of its cause.  Situation Ethics  John Stuart Mill (1806 – 1873) and Jeremy  One of the oldest known formulations of Bentham (1748 – 1832) medical ethics  Judge morality of action by the good or bad  Named after Hippocrates (460-357 B.C) consequences of an act. “Father of Medicine”  Good is the general goodwill or love for humanity.  If an act helps people, then it is good. If it hurts people, then it is bad.  Based on the consequences of human action; action is morally right if the consequences of such - Aristotle (384 – 322 BC) action are favorable. - VIRTUE = Greek “arete”, excellence  Decisions are often made through risk-benefit o Focus is on excellence primarily on the analysis. heart of the person doing the act.  Example:  A Way of Living o The City Health Department is planning for their o Learned through experiences; good annual budget. To which program should they allot a bigger budget? The modernization of the city hospital habits that are used to regulate or the Nutrition and Immunization Programs of the emotion. poverty-stricken families in the city? Will promotion of  Heart-Focused health and prevention of illness have priority over o Good traits that are naturally right and treatment of illness and rehabilitation? useful for getting what one wants.  Before any treatment is given to the patient, all treatment options must be discussed to enable the  Cardinal Virtues patient to choose which treatment will produce the o Prudence (Wisdom) greatest amount of relief and the least amount of o Fortitude danger. o Temperance o Justice  Christian Virtues o Faith o Advocates actions that foster happiness or o Hope pleasure and opposes actions that cause o Love unhappiness or harm.  Example: o Jeremy Bentham and John Stuart Mill o A person who has developed the virtue ▪ Their ethical doctrines states that of courage will stand firm in response the Rightness and Wrongness of to feelings of fear when in danger. actions is determined by the goodness and badness of their consequences. ▪ Refers to the Greatest Good to the Greatest number of People. o The utilitarian doctrine focuses on happiness, well-being, and the material outcomes of our actions. o Lays weight on consequences rather than rules or character traits. o Places the concepts of good and bad before the ideas of right and wrong  Holds that good is agape, the general goodwill or love for humanity.  If the act helps people, then it is good, and if it (Not Just Personal Happiness but Human Flourishing) hurts people, then it is a bad one.  Aristotle (384-322 BC)  Often are made through risk benefit analysis.  A person who does all these is the happy and good person who will always do good: TEOLOGICAL ETHICS DEONTOLOGICAL 1. Satisfaction for accomplishment ETHICS 2. Accomplishment gained by working hard to the goodness or badness determines the improve self. of an action by examining goodness or badness of 3. Continually learns. its consequences. the action by examining 4. Hones skills. the action itself  TRUTHFULLNESS o Truth-telling is a key issue within the nurse- patient relationship. Nurses make decisions on a daily basis regarding what information to tell patients.  INTEGRITY o The ability to keep confidences and overall trustworthiness that your patients see who  you are and count on you to do the right thing, as it pertains to their care and comfort.  HUMILITY “Nursing encompasses an art, a humanistic orientation, o A display of meekness and calmness even a feeling for the value of the individual, and an intuitive in difficult moments. sense of ethics, and of the appropriateness of action  THANKFULNESS taken.” – Myrtle Aydelotte o Contrasted with constant complaining of situations around.  COMPASSION o Capacity to care regardless of the situation. Ethical Principles used in Health Care: ✓ Caring And Compassion 1. AUTONOMY The core virtue ethics of the nursing profession.  Auto = self The essence of caring as a nurse is that you  Nomos = rule, law, governance recognize the value and worth of those you care  A strong sense of personal responsibility and for and that the patient and his or her moral decision for one’s own life. experience MATTERS to you.(Benner &  PRINCIPLE OF AUTONOMY APPLIED: Wrubel, 1989).26 Nov 2015 o You shall not treat a patient without the informed consent of the patient or his or her lawful surrogate, except in narrowly defined emergencies. o Allow patient to refuse treatment if he  CARE or she so decides. o the “Heart of Nursing” o Allow patient to disclose his or her o the provision of what is necessary for the ailments. health, welfare, maintenance, and o Allow the patient to choose the mode of protection. treatment.  COMPASSION o Allow the patient to maintain o How care is given through relationships confidentiality of treatment. based on empathy, respect and dignity. o Allow the patient to determine what o “To suffer together.” should be done to his or her body.  COMPETENCE o Set of demonstrable characteristics and 2. CONFIDENTIALITY skills that enable and improve the efficiency  state of keeping or being kept secret or private. or performance of a job.  non-disclosure of private or secret information  COURAGE with which one is entrusted. o means doing the right thing, speaking up  duty to respect privileged information. when there are concerns and having the  Confidential communication is privilege strength and vision to innovate and work in communication or professional secrecy new, different ways because it is given based on trust  COMMITMENT  Both legal and moral obligation of health care o The state or quality of being dedicated to a providers cause, activity, etc  The patient and his or her family are entitled to  COMMUNICATION known information or facts within the limits o The imparting or exchanging of information determined by the physician. or news.  The nurse may repeat what the doctor wishes o Basic element of human interaction that to disclose. allows nurses to establish maintain and  Any information gathered by the nurse during improve contact with others. the course of caring for the patient should always be treated confidential until the patient’s death.  Nurses must assure the patient that information gained in the interview will be treated utmost confidentiality.  Build trust. Think a million times before sharing a millionth information about a patient. 3. VERACITY  Practice of telling the Truth  habitual truthfulness or conformity to facts   Attitude and personal qualities that This is the main principle that supports the demonstrate truth. concept of accountability between nurses and  The doctor tells the patient and the family of the patients. patient the truth about the diagnosis, plan of care, treatment with all the possible risks 6. JUSTICE involved, length of treatment, possible Fair, equitable and appropriate treatment to expenses and other options they may take if others. there be any Focuses on equitable access to health care.  When applied to the nurse, it is the nurse’s The right to demand to be treated fairly, justly, responsibility NEVER to mislead or deceive a and equally. patient. Health care: the right to demand to be treated  3 STRONG REASONS to APPLY VERACITY: fairly, justly, and equally. o OBLIGATION OF RESPECT: In Article XIII of the Philippine Constitution asking patients their consent, respect National Health Insurance Act of 1995 necessitates truth. o “the state shall adopt an integrated and o PROMISE KEEPING: There is a comprehensive approach to health mutual understanding with regards to development and shall endeavor to truth telling and keeping the truth safe make essential goods, health and for the sake of a fruitful medical output. social services available to all people at o TRUST BUILDING: Truth leads to affordable cost.” reliance and confidence Republic Act 7432: “Senior Citizen’s Act” o …give honor and justice to the elderly 4. NON-MALEFICENCE by giving them a 20% discount in public  Maleficence means “a harmful act or evil art”, establishments like restaurants, the art of committing harm or evil. pharmacies, jeepneys, hospitals, free  Duty to refrain from causing damage or medical and dental check-ups, and free preventing intentional harm. hospitalization in government  Prevent intentional harm hospitals.  Principle stated: " Do No Harm“ Hospital Triage is an example of justice.  An extension of this is the obligation to protect o The way hospitals determine who from harm those who cannot protect should be served first should be based themselves such as children, mentally ill on their health condition. In hospitals, people, and unconscious clients when patients arrive, we usually tend to  Expressed in the Hippocratic oath: patients who are having difficulty of o “I will use treatment to help the sick breathing, those who are bleeding a lot, according to my ability and judgment, or those who are unresponsive. Those but will never use it to injure or harm with fractures can wait. them.”  Typical examples according to Bernard 7. BENEFICENCE Gert, a bioethicist: Practice of doing acts of goodness, kindness, o Do not kill. and charity o Do not cause pain or suffering to Principle stated: “Do Good” others. Actions that promote the well-being of others. o Do not incapacitate others o Do not deprive others of the goods of life.  More practically for nurses: Refers to the moral and inviolable power vested in a o Do not assist in performing abortion. patient as a person to do, hold or demand something as o Do not assist someone who wants to his/her own. commit suicide. o Do not willfully subject patients to RIGHT TO INFORMED DECISION experimental drugs whose potential o Refers to the necessary information of and harm may be greater tan the benefit. the decision on a medical treatment before o Do not harm a person’s reputation by to be carried out. revealing confidential information. o Information and understanding are necessary for genuine deliberation 5. FIDELITY RIGHT TO INFORMED CHOICE LOYALTY: Loyalty within the nurse-patient o Refers to the necessary information a relationship. patient should know about a medical COMMITMENT: Faithfulness and practices of treatment or experiment so that a moral keeping promises and commitments. choice can be made. o The patient has the right to be informed about all possible alternative courses of  action to be taken, together with the and is legitimately represented by a possible consequences. competent surrogate who acts on his RIGHT TO REFUSAL OF TREATMENT behalf. o The patient has the right to refuse treatment o WHEN IN EMERGENCY to the extent permitted by law and to be informed of the medical consequences of his action. HINDERED RIGHT TO INFORMED CONSENT o Language barriers o Refers to the knowledge or information INCOMPREHENSION about and the consent to a particular form o Underage or unable to understand the of medical treatment before that treatment circumstances is administered. INCAPACITATION o The patient has the right to receive all o Comatose, blind, or illiterate necessary information concerning WHEN IN EMERGENCY diagnosis and treatment in order to be able to give consent based on his/her value system. COMPETENCE: capacity for decision making BIOETHICS o Competent when: - Greek word "bios" which means "life“ ▪ Makes decision - "Ethics of Life“ ▪ Justifies choice - the application of ethics to the field of ▪ Justifies reasonably medicine and healthcare. DISCLOSURE: Refers to the content of what a - ALL LIFE ETHICS – is a science that deals patient is told or informed about during the consent with the study of the morality of human conduct negotiation concerning human life in all its aspects from the o Includes: moment of its conception to its natural end. ▪ Necessary information - A specific discipline as a result of life and death ▪ Awareness of the outcome dilemmas faced by health care practitioners. ▪ Preparation for moral decision - A continuous process of decision-making in COMPREHENSION: Refers to whether the order to save lives or enhance quality of lives information given has been understood or not. at all times as possible. VOLUNTARINESS: consent must be voluntary. o Includes: ▪ Free will HEALTHCARE ETHICS ▪ Free from pressure - Medical Ethics; Division of ethics that relates ▪ Preparation for moral decision to human health - Deals with the conduct and moral issues that WRITTEN arise in the practice of health care o A consent to be filled out and signed by a professionals patient as he/she checks in for admission in - Resides in the realm of human values, morals, a hospital customs, personal beliefs, and faith VERBAL - a formulation of ethical norms for the conduct o Is usually made after a physician has of health care professional in the treatment of briefed the patient about the medical patients. process to be undertaken. - HEALTH CARE: Is the prevention, treatment THIRD PARTY and management of illness and the o In case the patient is incapable of giving preservation of the well-being through the consent, in order of priority may give services offered by the medical and allied consent: health professions. ▪ spouse, either parent, immediate relatives, guardian. OTHER FORMS OF CONSENT: - Strives to resolve ethical issues that confront health o BY PRESUMPTION: This is reasonably care professionals. presumed to be present in the subsequent - Example scenarios: employment and series of procedures as o In a difficult delivery case, what is best for the mother and what is best for the unborn child? they are aligned with the primary procedure o What is best for the patient and his or her relative in to which explicit consent is expressed. his or her present health condition? o BY PROXY: This is done when the patient o What medical records can be disclosed and what must is not capable of giving informed consent be held in strict confidentiality?   Example: A patient requests a specific diet in the hospital according to their religious practices, and it is provided. 8. Right to Medical Records  Patients can access their medical records and - FILIPINO PATIENT’S BILL OF RIGHTS obtain copies of them. - BILL 812 (Sen. Ramon "Bong" Revilla, Jr.)  Example: A patient requests and receives a copy of their - July 3, 2007 medical history to seek a second opinion. OBJECTIVES OF THE POLICY: To ensure and protect the rights of the patient 9. Right to Leave to decent, humane and quality health care.  Patients can discharge themselves from the To adopt an integrated and comprehensive hospital against medical advice, after being approach to health and other services available informed of the risks. to the people at affordable costs.  Example: A patient chooses to leave the hospital despite To provide free medical care to pauper. doctors recommending further treatment. 10. Right to Refuse Participation in Medical Research 1. Right to Appropriate Medical Care and Humane  Patients can decline to participate in medical Treatment research without affecting their standard of  Patients have the right to receive adequate and care. humane medical care without discrimination.  Example: A patient opts out of a clinical trial for a new  Example: A patient in an emergency room receives medication but continues to receive regular treatment. immediate, respectful, and competent care regardless of their ability to pay. 11. Right to Correspondence and to Receive Visitors 2. Right to Informed Consent  Patients can communicate with others and  Patients must be given all relevant information receive visitors within the facility's policies. regarding their treatment options and must  Example: A patient receives family visits during hospital voluntarily agree to proceed. visiting hours and uses the phone to speak with friends.  Example: Before undergoing surgery, a doctor explains the risks and benefits, and the patient signs a consent form. 12. Right to Express Grievances  Patients can voice complaints or concerns 3. Right to Privacy and Confidentiality about their care without fear of retribution.  Patients' personal and medical information  Example: A patient files a complaint about poor service and must be kept confidential and only shared with it is reviewed by the hospital administration. authorized individuals.  Example: A nurse discusses a patient's condition in a 13. Right to be Informed of his Rights and private room instead of a public area. Obligations as Patient  Patients should be informed of their rights and 4. Right to Information responsibilities within the health care system.  Patients have the right to obtain complete  Example: A patient receives a brochure detailing their rights information about their diagnosis, treatment, and responsibilities upon admission to a hospital. and prognosis in understandable terms.  Example: A doctor provides a clear explanation of a patient’s illness and the available treatment options. 1. Right to Health 5. Right to Choose Health Care Provider and  Every individual has the right to the highest Facility attainable standard of physical and mental  Patients can select their preferred health care health. provider and facility within the available options.  Example: A government ensures access to essential health services, clean water, and nutritious food for all citizens.  Example: A patient chooses to be treated by a specialist in another hospital for a complex medical condition. 2. Right to Access to Quality Public Health Care  Patients have the right to access 6. Right to Self-Determination comprehensive, quality health care services  Patients have the right to make decisions about provided by the public health system. their own health care, including accepting or  Example: A patient receives timely and effective treatment refusing treatment. for a chronic illness at a publicly funded clinic.  Example: A patient decides to decline a particular 3. Right to Healthy and Safe Workplace medication due to its side effects.  Individuals have the right to work in environments that do not harm their health and 7. Right to Religious Belief well-being.  Patients' religious beliefs must be respected, and they can practice their religion freely within  Example: An employee receives appropriate protective equipment and training to handle hazardous materials the medical facility. safely. 4. Right to Prevention and Education Programs 7. Relation to others.  Patients have the right to access programs  Patients should respect the rights of other aimed at preventing illness and promoting patients and health care staff, fostering a health education. considerate and cooperative environment.  Example: A community benefits from free vaccination  Example: A patient keeps noise to a minimum and follows programs and educational workshops on preventing visiting hours to respect the privacy and comfort of others infectious diseases. in the hospital. 5. Right to Participate in Policy Decisions 8. Exhaust Grievance Mechanism  Patients have the right to be involved in  Patients should use the established grievance decisions and policy-making processes that processes to resolve complaints before seeking affect their health and health services. external remedies.  Example: A local health board includes patient  Example: A patient files a formal complaint with the representatives who provide input on the development of hospital's patient advocacy department regarding poor new health policies and programs. treatment before contacting regulatory bodies. 1. Know the rights  Patients are responsible for being aware of their rights to ensure they can advocate for themselves effectively. A. Personal  Example: A patient reads the hospital's patient rights - Cultivate your character by doing virtues document upon admission to understand what they are habitually. A good person will make good entitled to. decisions. Learn from your experiences. B. Social 2. Provide accurate and complete information - Nurses can advocate for health promotion,  Patients must give their health care providers educate patients and the public in the complete and truthful information about their prevention of illness and injury. health history and current condition. C. Ecological  Example: A patient discloses all medications they are taking - As nurses, we have the skills and we can take and any past surgeries to their doctor during a consultation. the lead for a more sustainable, health communities and environments. 3. Report unexpected health changes D. Biomedical  Patients should promptly inform their health - Nurses take charge of the treatments of the care providers about any significant or patient, under collaboration with the physician. unexpected changes in their health.  Example: A patient experiencing new or worsening symptoms after starting a new medication contacts their doctor immediately. "Stewardship consists in the practical recognition that Man is not the absolute master 4. Understood purpose and cost of treatment of himself or his possessions. He has received  Patients need to understand the goals, benefits, every gift and grace from God. He must use and costs of their treatment options. them in a responsible manner to promote the  Example: Before agreeing to a medical procedure, a patient interest of God". – Hugh J. O’Connell asks questions about the expected outcomes and the STEWARDSHIP – refers to the expression of associated costs to make an informed decision. one's responsibility to take care of, nurture and cultivate what has been entrusted to him. 5. Accept consequences of own informed In Health Care, Stewardship refers to the consent. execution of responsibility of the health care  Patients must accept the outcomes of their practitioners to look after, provide necessary health care decisions made after informed health care services, and promote the health consent. and life of those entrusted to their care.  Example: A patient who opts for a non-standard treatment based on their own research acknowledges the potential risks involved. To be Just and Honest with exercise of his 6. Settle financial obligations. duties and obligations to uphold goodness of  Patients are responsible for paying for the human life as God's creation. health care services they receive, in To make all health care facilities and accordance with the terms agreed upon. technologies serve the well being of the  Example: A patient arranges a payment plan with the patients and prevent unnecessary pains. hospital's billing department to cover the cost of a surgery. To respect life from the moment of conception until its natural expiration and defend it from any unnatural proceedings meant to contradict its nature and destroy its dignity.  To recognize dependency not so much on its own capacity but on God - the Giver of that capacity and to God ambassador of service for the Sick. *Continuation of Principles of Bioethics Golden Rule - So whatever you wish that others would do to you, do also to them. A. Properly applied to the individual or the human person who is an embodied spirit with all the The Principle of Totality functions and capacities he naturally possesses. - The whole is greater than its parts. Epikia a. Principle of Proportionate and Disproportionate - There is always an exception to the rule. Means" b. an important approach to the analysis of ethical The One Who Acts Through as Agent Is Herself questions arising from the general obligation to Responsible. preserve human life and the limits of that obligation. - The instrument to a crime is part of the crime. No One Is Obliged to Betray Herself a. Ordinary means “of preserving life are all - You cannot betray yourself. medicines, treatments, and operations, which offer a reasonable hope of benefit for The End Does Not Justify the Means the patient, and which can be obtained - The method is as important as the goal. without excessive expense, pain, and other inconveniences” (Ramsey, 122) Defects of Nature May Be Corrected - Given the proper means and resources we may be able to repair a natural defect. b. Ordinary means “of preserving life are all If One Is Willing to Cooperate in The Act, No those medicines, treatments, and Injustice Is Done to Him operations, which can be obtained without excessive expense, pain, or other - The method is as important as the goal. inconveniences, or which, if used, would A Little More or A Little Less Does Not Change not offer a reasonable hope of benefit.” the Substance of An Act. (Ramsey, 122) - The act defines itself not the “amount”. No One Is Held to Impossible A. Sexuality - a person's sexual feelings, thoughts, - Not a false promise attractions, and behaviors towards other people; diverse and personal. B. Personalized Sexuality - takes note of a humanized sexuality, one that represents fulfilment TOTALITY or physical and sensual need but also evidenced - Refers to the duty to preserve intact the with love and sacramental mystery. physical component of the integrated bodily and spiritual nature of human life. INTEGRITY - Refers to each individuals duty to preserve a view of the whole human person. A. SURGERY - Is a medical or dental procedure that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, (2) to help improve bodily function, appearance, or (3) to repair unwanted ruptured areas The Registered Nurse (RN) has ethical and moral responsibility to represent the patient's interests, to respect and protect patient’s autonomy and preserve ▪ CONTRACEPTIVE patient’s dignity (ICN, 2013). STERILIZATION: Intentional prevention of conception through sterilization. If a patient who has cancer of the uterus submits to hysterectomy, ▪ EUGENIC AND SOCIAL she will not be able to bear a child. If she does not have the operation, STERILIZATION: are performed she will die. It is the gynecologist’s intention to help the mother and to hinder the conception and not to harm her. The surgeon’s action is morally good since saving the mother’s life is of primary importance. Also, the doctor did not will that undesirable and physically and the patient lose her child-bearing function. mentally unfit offspring. ▪ PUNITIVE STERILIZATION: isa form of penalty or punishment B. MUTILATION usually ascribed to sex related - Refers to the procedure that diminishes or crimes particularly rape. destroys the functional integrity of the human body. TYPES OF MUTILATIONS: ▪ MAJOR MUTILATION: Refers to the procedure that destroys the functional integrity of the human body so that it becomes incapacitated of its natural functions. ▪ MAJOR MUTILATION: Refers to the procedure that destroys the functional integrity of the human body so that it becomes incapacitated of its natural functions. FUNCTIONAL INTEGRITY: Is the degree of completeness necessary for the performance of functions to the human body. 1. That the preservation or functioning of a particular organ provokes a serious damage or constitutes a threat to the whole body. 2. That the damage cannot be avoided or at least notably diminished, EXCEPT by the amputation or mutilation in question and that its efficacy is well assured. 3. That it can reasonably foresee that the negative effect will be compensated by the positive effect, exclusion of a damage to the whole body, mitigation of the pain etc. C. STERILIZATION - Refers to any technique that renders one sterile or unable to exercise the power to reproduce during the sexual intercourse. TYPES OF STERILIZATION: ▪ VOLUNTARY OR DIRECT STERILIZATION: A person wills and requests that the procedure be done on him/herself. ▪ INVOLUNTARY OR INDIRECT STERILIZATION: It is done by the order of a public authority or a state. ▪ THERAPEUTIC STERILIZATION: The removal or a portion of a reproductive organ to save one's life or to promote bodily integrity.  GENERAL PRINCIPLES OF CODE OF GOOD GOVERNANCE Service to others Integrity and objectivity Professional competence - is a specific learning activity generally characterized Solidarity and teamwork by the issuance of a certificate or Continuing Social and Civic Responsibility Education Units (CEU). This certificate is for the purpose of documenting attendance at a Global Competitiveness designated seminar or course of instruction. Equality of all professions PURPOSE AND OBJECTIVE: to meet high performance level of nurses by CODE OF ETHICS FOR FILIPINO NURSES updating knowledge, enhancing skills and Promote Health developing positive attitude. Alleviate Suffering SCOPE: Prevent Illness for professional and personal growth; these Restore Health developments relate to the professional and Promotion of Spiritual Environment organizational development. AMENDED CODE OF ETHICS FOR FILIPINO BOARD OF NURSING NURSES Encourages continuing education requirements on “Philippine Nursing Law” members who hold licenses to practice. o Act that regulates the practice of nursing in These requirements are intended to encourage the Philippines professionals to expand their knowledge and stay o SECTION 3, REPUBLIC ACT NO. 877 up to date on new trends and development. June 19, 1953 Amended Code of Ethics for Nurses was adopted NURSING ETHICS o SECTION 6, PRESIDENTIAL DECREE a branch of moral science that refers to the conduct NO. 233 June 22, 1973 and behavior of nursing practitioners which by In October 23, 2003, Iloilo City, a consultation was reason of public approval has become customary done together with the accredited professional among professional nurses. organization of RN, PNA and other affiliate organizations of RN's deciding to adopt a NEW CODE OF ETHICS Code of Ethics under R.A. 9173 A written list of profession's values and standards of July 14, 2004, a new Code of Ethics for Filipino conduct and framework of decision making for Nurse was adopted under R.A. 9173 and was nursing profession. promulgated by the Board of Nursing. The Code of Ethics for Filipino Nurses embodies ethical INTERNATIONAL COUNCIL OF NURSES principles and guidelines to be observed. Operated by nurses and leading nurses “Philippine Nursing Act of 2002” internationally. o Act that provides a comprehensive Founded in 1899, ICN is the world’s first and widest definition and understanding of the nursing reaching international organization for health profession. professionals and is headquartered in Geneva, o REPUBLIC ACT NO. 9173 Switzerland. 1. To ensure quality nursing care for all. 2. A sound health policies globally. 3. The advancement of nursing knowledge. 4. The presence worldwide of a respected nursing profession. 5. A competent and satisfied nursing workforce. ETHICAL CONDUCT ✓ Essential to the practice of professional nursing ✓ Described in the nursing code of ethics ✓ Formal statement that determines the standards of FILIPINO NURSES CODE OF ETHICS conduct of a professional nurse ARTICLE 1: PREAMBLE CODE OF GOOD GOVERNANCE Section 1: Health is a fundamental right of every Promulgated by the PRC on July 23, 2003: individual. The hallmark of all professionals is their willingness to accept a set of professional and Section 2: Nurses have to gain knowledge and ethical principles which they will follow in the understanding of man's cultural, social, conduct of their daily lives. spiritual, psychological, and ecological aspects of nursing services through varied learning illness, utilizing the therapeutic process. situations. if they are administrators, be responsible in Section 3: The desire for respect and confidence for providing favorable environment for the clientele, colleagues, co-workers, and the growth and developments of Registered members of the community provides incentive Nurses in their charge. to attain and maintain the highest possible be cognizant that professional programs for degree of ethical conduct. specialty certification by the BON are accredited through the Nursing Specialty ARTICLE 2: REGISTERED NURSES & PEOPLE Certification Council (NSCC). see to it that quality nursing care and practice Section 4: meet the optimum standard of safe nursing Ethical Principles: practice. Values, customs, & spiritual beliefs are to be respected Freedom to make rational and unconstrained ARTICLE 4: REGISTERED NURSES & CO- decisions will be respected WORKERS Personal information acquired shall be held in strict confidence. Section 12: Ethical Principles: Section 5: RNs are in solidarity with other members of Guidelines to be observed: the healthcare team in working for the REGISTERED NURSES must patient's best interest. consider the individuality and totality of RN maintains collegial and collaborative patients when they administer care. working relationship with colleagues and respect the spiritual beliefs and practices of other healthcare providers patients regarding diet and treatment. uphold the rights of individuals. Section 13: take into consideration the culture and values Guidelines to be observed: of patients in providing nursing care. REGISTERED NURSES must However, in the event of conflicts, their maintain their professional role/identity while welfare and safety must take precedence. working with other members of the health team. ARTICLE 3: REGISTERED NURSES & PRACTICE conform with group activities as those of a health team should be based on acceptable, Section 6: ethico-legal standards. Ethical Principles: contribute to the professional growth and Human life is inviolable development of other members of the health Quality and excellence in care are the goals team. of nursing practice. actively participate in professional Accurate documentation of actions and organizations. outcomes is the hallmark of nursing not act in any manner prejudicial to other accountability. professions. honor and safeguard the reputation and Section 7: dignity of the members of nursing and other Guidelines to be observed: professions; refrain from making unfair and REGISTERED NURSES must unwarranted comments or criticisms on their know the definition and scope of nursing competence, conduct, and procedures; or practice which are in the provisions of R. A. not do anything that will bring discredit to a No. 9173, known as the “Philippine Nursing colleague and to any member of other Act of 2002” and Board Res. No. 425, Series professions. of 2003, the “Rules and Regulations respect the rights of their co-workers. Implementing the Philippine Nursing Act. of 2002”, (Implementing Rules and Regulations {IRR}). be aware of their duties and responsibilities ARTICLE 5: REGISTERED NURSES, SOCIETY & in the practice of their profession as defined ENVIRONMENT in the “Philippine Nursing Act of 2002” and the IRR. Section 14: acquire and develop the necessary Ethical Principles: competence in knowledge, skills, and Preservation of life, respect for human rights, attitudes to effectively render appropriate and promotion of healthy environment shall be a commitment of a RN.  Establishment of linkages with the public in ARTICLE 7: ADMINISTRATIVE PENALTIES, promoting local, national, and international REPEALING CLAUSE, AND EFFECTIVITY efforts to meet health and social needs of Section 18: people as a contributing member of society The Certificate of Registration of Registered is a noble concern of a RN. Nurse shall either be revoked or suspended be conscious of their obligations as citizens for violation of any provisions of this Code and, as such, be involved in community pursuant to Sec. 23 (f), Art. IV of R. A. No. concerns. 9173 and Sec. 23 (f), Rule III of Board Res. be equipped with knowledge of health No. 425, Series of 2003, the IRR. resources within the community, and take active roles in primary health care. Section 19: The Amended Code of Ethics promulgated Section 15: pursuant to R. A. No. 877 and P.D. No. 223 Guidelines to be observed: is accordingly repealed or superseded by the REGISTERED NURSES must herein Code. actively participate in programs, projects, and activities that respond to the problems of Section 20: society. This Code of Ethics for Nurses shall take lead their lives in conformity with the effect after fifteen (15) days from its full and principles of right conduct and proper complete publication in the Official Gazette decorum. or in any newspapers of general circulation. project an image that will uplift the nursing profession at all time NEGLIGENCE - commission or omission of an act, pursuant to a ARTICLE 6: REGISTERED NURSES & THE duty PROFESSION SPECIFIC EXAMPLES OF NEGLIGENCE: o REPORT: Failure to report observation Section 16: to attending physicians. Ethical Principles: o DILIGENCE: Failure to exercise the Maintenance of loyalty to the nursing degree of diligence which the profession and preservation of its integrity circumstances of the particular case are ideal. demands. Compliance with the by-laws of the o IDENTITY: mistaken identity accredited professional organization (PNA), o DOSE: Wrong medicine, wrong and other professional organizations of concentration, wrong route, wrong which the Registered Nurse is a member is a dose. Administration of medicine lofty duty. without a doctor's prescription. Commitment to continual learning and active o DEFECTS: Defects in equipment such participation in the development and growth as stretchers and wheelchairs may of the profession are commendable lead to falls thus injuring the patients. obligations. o ERRORS: Errors due to family Contribution to the improvement of the socio- assistance. economic conditions and general welfare of nurses through appropriate legislation is a THE DOCRINE OF RES IPSA LOQUITUR practice and a visionary mission. - The thing speaks for itself. CONDITIONS OF RES IPSA LOQUITUR: o nature of injury was that it would not Section 17: normally happen or occur unless there Guidelines to be observed: was a negligent act on the part of REGISTERED NURSES must someone be members of the Accredited Professional o injury caused by an agency within Organization (PNA). control of the defendant. strictly adhere to the nursing standards. o plaintiff himself did not engage in any participate actively in growth and manner that would tend to bring about development of nursing profession. injury. strive to secure equitable socio-economic and work conditions through appropriate MALPRACTICE legislation and other means. - improper or unskillful care of a patient by a nurse; assert for the implementation of labor and stepping beyond one's authority with serious work standards. consequences. DOCTRINE OF FORCE MAJEURE - irresistible force; unforeseen or inevitable. TOTALITY - no person shall be responsible for those events - Refers to the duty to preserve intact the (floods, earthquakes, fire, accidents) which cannot physical component of the integrated bodily and be foreseen, or which though foreseen, are spiritual nature of human life. inevitable except in cases specified by law. INTEGRITY DOCTRINE OF RESPONDEAT SUPERIOR - Refers to each individuals duty to preserve a - let the master answer for the acts of the subordinate view of the whole human person. - Although the subordinate is fully responsible, the liability is expanded to include the master as well as the employee and not a shift of liability from the D. SURGERY subordinate to the master. - Is a medical or dental procedure that uses operative manual and instrumental techniques INCOMPETENCE on a person - lack of ability, legal qualifications and fitness to to investigate or treat a pathological discharge the required duty. condition such as a disease or injury, (2) to help improve bodily function, appearance, or (3) to repair unwanted ruptured areas The Registered Nurse (RN) has ethical and moral responsibility to represent the patient's interests, to respect and protect patient’s autonomy and preserve Golden Rule patient’s dignity (ICN, 2013). - So whatever you wish that others would do to you, do also to them. If a patient who has cancer of the uterus submits to hysterectomy, The Principle of Totality she will not be able to bear a child. If she does not have the operation, - The whole is greater than its parts. she will die. It is the gynecologist’s intention to help the mother and not to harm her. The surgeon’s action is morally good since saving the mother’s life is of primary importance. Also, the doctor did not will that Epikia the patient lose her child-bearing function. - There is always an exception to the rule. The One Who Acts Through as Agent Is Herself E. MUTILATION Responsible. - Refers to the procedure that diminishes or - The instrument to a crime is part of the crime. destroys the functional integrity of the human body. No One Is Obliged to Betray Herself TYPES OF MUTILATIONS: - You cannot betray yourself. ▪ MAJOR MUTILATION: Refers to the procedure that destroys the The End Does Not Justify the Means functional integrity of the human - The method is as important as the goal. body so that it becomes incapacitated of its natural Defects of Nature May Be Corrected functions. - Given the proper means and resources we may ▪ MAJOR MUTILATION: Refers to be able to repair a natural defect. the procedure that destroys the functional integrity of the human If One Is Willing to Cooperate in The Act, No body so that it becomes Injustice Is Done to Him incapacitated of its natural - The method is as important as the goal. functions. FUNCTIONAL INTEGRITY: Is the degree of A Little More or A Little Less Does Not Change completeness necessary for the performance of the Substance of An Act. functions to the human body. - The act defines itself not the “amount”. No One Is Held to Impossible - Not a false promise 4. That the preservation or functioning of a particular organ provokes a serious damage or constitutes a threat to the whole body. 5. That the damage cannot be avoided or at least notably diminished, EXCEPT by the amputation or  mutilation in question and that its efficacy is well SECTION 3 OF RA 10173: assured. PROCESSING OF PERSONAL 6. That it can reasonably foresee that the negative INFORMATION effect will be compensated by the positive effect, o "Processing refers to any operation or exclusion of a damage to the whole body, mitigation any set of operations performed upon of the pain etc. personal information including, but not limited to, the collection, recording, F. STERILIZATION organization, storage, updating or - Refers to any technique that renders one sterile modification, retrieval, consultation, or unable to exercise the power to reproduce use, consolidation, blocking, erasure, during the sexual intercourse. or destruction of data." TYPES OF STERILIZATION: Personal Information ▪ VOLUNTARY OR DIRECT o "Personal Information refers to any STERILIZATION: A person wills information whether recorded in a and requests that the material form or not, from which the procedure be done on him/herself. identity of an individual is apparent or ▪ INVOLUNTARY OR INDIRECT can be reasonably and directly STERILIZATION: It is done by the ascertained by the entity holding the order of a public authority or a information, or when put together with state. other information would directly and ▪ THERAPEUTIC STERILIZATION: certainly identify an individual." The removal or a portion of a o SENSITIVE PERSONAL reproductive organ to save one's INFORMATION: life or to promote bodily integrity. ▪ Person's race, ethnic origin, ▪ CONTRACEPTIVE marital status, age, color, STERILIZATION: Intentional religious, philosophical, and prevention of conception through political affiliations. sterilization. ▪ Person's health, education, ▪ EUGENIC AND SOCIAL genetic or sexual life, past STERILIZATION: are performed offenses committed or to hinder the conception and allegedly committed by a undesirable and physically and person, or a court cases. mentally unfit offspring. ▪ Social security numbers, ▪ PUNITIVE STERILIZATION: isa health records, licenses, form of penalty or punishment suspensions, tax returns. usually ascribed to sex related ▪ Information established to be crimes particularly rape. kept private by law. Has your privacy ever been breached? How did you feel about it? DYK? Filipinos spend an average of 10 hours and 2 minutes each day online. PRIVILEGED INFORMATION o "Privileged information refers to any and all forms of data which under the Rules of Court and other pertinent laws DATA PRIVACY ACT of 2023 (DPA) constitute privileged communication. - "to protect the fundamental human right to privacy of communication while ensuring free The Data Privacy Act explicitly states that its flow of information to promote innovation and provisions are not applicable in the following cases: growth.... inherent obligation to ensure that a) Person who IS or WAS an officer or an personal information in information and employee of a government institution that communications systems in government and relates to the position or functions of the private sectors are secured and protected." individual. - To protect all forms of information, be it private, b) Information about an individual who is or was personal, or sensitive. performing service under contract for a To cover both natural and juridical persons involved government institution that relates to the in the processing of personal information. services performed, including the terms of  contract, and the name of the individual given COMMUNICATION: in the course of the performance of those o Benefits: Messaging is easy and there are services. plenty of options for these easy ways. (Not c) Information related to any discretionary benefit to mention, cheap.) of a financial nature such as the granting of a o Challenges: Some things get lost in license or permit given by the government to an translation. Communication becomes more individual, including the name of the individual distant, cold, and it can be easily and the exact nature of the benefit. misunderstood. It has made people d) Personal information processed for journalistic, impatient. artistic, literary, or research purposes DATA COLLECTION: e) Information necessary for banks and other o Benefits: For sellers, it's easy to get data financial institutions under the jurisdiction of the from customers and potential customers. independent, central monetary authority or Social media also makes it easy for sellers Bangko Sentral ng Pilipinas to comply with to get to know their market and make it Republic Act No. 9510 and Republic Act No. easier to reach out. Anybody can make a 9160, known as the Anti-Money Laundering Act form now that asks to fill up your name, and other applicable laws. address, age, birthday, etc. f) Personal information originally collected from o Challenges: There is lesser privacy. We've residents of foreign jurisdictions in accordance heard of data breaches or scams wherein with the laws of those foreign jurisdictions, people can make their own website that including any applicable data privacy laws, looks like a legit bank website. It pays to be which is being processed in the Philippines. vigilant! We also have hackers, not only social media accounts, but even banks and R. A. NO 10173 (DPA) applies to: big companies can be hacked. If the person, either an individual or an INFORMATION ACCESS institution, involved in the processing of o Benefits: It's not only a person's data that personal data is located in the Philippines. is easy to acquire, but Google has also The act or practice involves personal data of a made it easier for everyone to learn and Philippine citizen or Philippine resident. search for things. The processing of personal data is done in the o Challenges: Misinformation can easily Philippines. spread. Patients nowadays can easily The act, practice or processing of personal data search their symptoms or research about a is done by an entity with links to the Philippines, subject which leads to some to just self- subject to international law and comity. diagnose and don't get immediate treatment. Also misinformation about certain medications and vaccines which is of course, potentially dangerous. MISSION: We shall continuously deliver services to: DISTANCE WORK AND SCHOOL FROM HOME o (1) Be the authority on data privacy and o Benefits: Attending classes or meetings protection, providing knowledge, know- through Zoom or Microsoft Teams has how, and relevant technology. been the new classroom. It made us more o (2) Establish a regulatory environment that creative and forced us to work smarter. ensures accountability in the processing of o Challenges: It has become more stressful personal data and promotes global because there is now no boundary between standards for data privacy and protection. school, work and home. Most people right o (3) Build a culture of privacy, through now report fatigue of being online almost 18 people empowerment, that enables and hours a day. upholds the right to privacy and supports PATIENT CARE free flow of information. o Benefits: Technologies help us keep track VISION: A world-class regulatory and enforcement of our health. Tele-health or E-Health agency upholding the right to privacy and data provides doctors that can hold virtual protection while ensuring the free flow of consultations, allowing the patient to be information, committed to excellence, driven by a safe at home. Modern technology also workforce that is highly competent, future-oriented, allows us to provide better patient service. and ethical, towards a competitive, knowledge- o Challenges: Less physical assessment of based, and innovative nation. the patient Some information gets lost in the call. DATA STORAGE  TECHNOLOGY: the application of scientific o Benefits: A large like a terabyte of knowledge to the practical aims of human life or, as information can be hand carried. It saves it is sometimes phrased, to the change and space as well. Digital information is also manipulation of the human environment. easier to find, all you need is a search bar and a click of a mouse. It saves you time! If  a hospital has a universal data system, one doctor can input in program and another doctor can see his input in real time from another venue. Easy data transfer and passing it on to another health care worker. o Challenges: Personal data nowadays is very attractive to hackers. There have been multiple cases wherein big companies, even Facebook, experienced a data breach. It has been said that these stolen personal data are being sold online in the deep web for who knows what purpose! If your computer gets wet and if you didn't back up your data, it could be gone in a flash especially in cases wherein it gets wet or a virus corrupts it. Health Information Technology Supports decision-making and promotes quality health care delivery. INCREASED CYBER ATTACKS o Hacker will lock up the data, making it inaccessible. o There are also some medical devices which are vulnerable due to manufacturer negligence when it comes to providing adequate security protections and the use of legacy equipment by health care providers. LACK OF KNOWLEDGEABLE STAFF o Those in charge of healthcare IT systems/programs/applications have to manage a lot, and also there's only a number of limited staff who are knowledgeable about this area. o Experienced/knowledgeable staff require higher salaries which makes it harder for hospitals to retain the staff to help them achieve their IT goals. NON-TRADITIONAL HEALTH CARE DELIVERY TELEHEALTH o The hospital and the patient’s home should both have high-speed internet to be able to provide/send excellent video/photos/diagnostic data transmission between the two. It should also be affordable especially for the patient.  QUESTION: Should we be allowed to cut life when the weight of pain, suffering, and hopelessness becomes  Dignity unbearable? - The quality of a person that makes him or her - NO. It is murder. deserving of respect, sometimes shown in - It is legitimate under certain circumstances. behavior or appearance; a state or a quality of being worthy of honor or respect.  Most common drug used to end life: BARBITURATES (secorbarbital, Nembutal)  Death - The total cessation of life processes that  ADVANCED DIRECTIVES eventually occurs in all living organisms. o Written Will: a written statement of the patient’s wishes regarding medical  Dying treatment, often including a living will, made - Approaching death to ensure those wishes are carried out - Signs of Death: should the person be unable to o Algor Mortis: cooling of the body communicate them to a doctor. o Rigor Mortis: stiffening of the muscles o DNR (Do Not Resuscitate): This is a o Livor Mortis: purple discoloration medical order by a doctor according to the wishes of the patient or the patient’s family. Principle: Life is inviolable. This is usually included in the patient’s 1. It is never to be broken. advanced directives. Signed by the doctor, 2. It is never to be infringed. and the patient. The patient’s family 3. It is never to be dishonored. members are aware of a DNR form.  Euthanasia - Easy death - Making good ethical decisions requires a trained - In theory, this affirms the individual’s right to die sensitivity to ethical issues and a practiced method in a painless and peaceful manner. for exploring the ethical aspects of a decision and - Two Types of Euthanasia: weighing the considerations that should impact our o Self-administered: carried out by the choice of a course of action. patient himself. o Other-administered: person other than the patient carries out the means of death. A. IDENTIFY THE ETHICAL ISSUES ▪ Safeguards and Guidelines - Could this decision or situation be damaging to for Assisted Death: someone or to some group, or unevenly 1. Illness must be terminal. beneficial to people? Does this decision involve 2. All measures have been a choice between a good and bad alternative, tried. or perhaps between two “goods” or between 3. Patient repeatedly two “bads”? requests without being - Is this issue about more than solely what is legal coerced. or what is most efficient? If so, how? 4. Doctor ensures patient’s judgment is not distorted. B. GET THE FACTS 5. Procedure is carried in a - What are the relevant facts of the case? What meaningful physician- facts are not known? Can I learn more about patient relationship. the situation? Do I know enough to decide? 6. Other physicians are - What individuals and groups have an important considered in the decision. stake in the outcome? Are the concerns of 7. Documentation to assure some of those individuals or groups more of the previous steps. important? Why? - What are the options for acting? Have all the  Dysthanasia relevant persons and groups been consulted? - Difficult death Have I identified creative options? - In theory, this affirms taking all means to preserve life even beyond recovery. C. EVALUATE ALTERNATIVE ACTIONS - Which option best respects the rights of all who  Orthothanasia have a stake? - Natural death - Which option treats people fairly, giving them each what they are due?  - Which option will produce the most good and do fruit to advance medicine and not for self- the least harm for as many stakeholders as interest. possible? 3. Prior animal experimentation: history of - Which option best serves the community as a problem under study to justify performance whole, not just some members? experiment. - Which option leads me to act as the sort of 4. Avoid Unnecessary Pain: conduct person I want to be? experiment by all means avoiding - Which option appropriately takes into account necessary physical and mental suffering or the relationships, concerns, and feelings of all injury. stakeholders? 5. Not When Death May Occur: No experiment should be conducted where D. CHOOSE AN OPTION FOR ACTION AND TEST there is a prior reason to believe that death IT or disabling injury will occur; except, - After an evaluation using all of these lenses, perhaps, in those experiments where the which option best addresses the situation? experimental physicians also serve as - If I told someone I respect (or a public audience) subjects. which option I have chosen, what would they 6. Degree of Risk: Should not exceed that say? which is determined by the humanitarian - How can my decision be implemented with the importance of the problem to be solved by greatest care and attention to the concerns of the experiment. all stakeholders? 7. Preparations: Proper preparations should be made and adequate facilities be E. IMPLEMENT YOUR DECISION AND REFLECT provided to protect the experimental ON THE OUTCOME. subject against even the remote - How did my decision turn out, and what have I possibilities of injury, disability, or death. learned from this