Ethics For Nurses PDF

1 ETHICS FOR NURSES ETHICS  It is a principle of right or good conduct (Notter and Spalding 1976).  A science of the morality of h...

1 ETHICS FOR NURSES ETHICS  It is a principle of right or good conduct (Notter and Spalding 1976).  A science of the morality of human behavior, both of the human acts and the acts of man (De la Torre, 1993).  Ethics is the philosophical study of voluntary human acts with the purpose of determining what is good, right and to be done, and what is bad, wrong and not to be done. Human Acts are actions that involve the use of both free will intellect, these are actions performed with the use of reason. Human acts are performed consciously and knowingly. Acts of Man are actions that do not involve the use of intellect and free will, these are actions done unconsciously and without reason Elements Determining Morality 1. Act itself – object 2. Purpose – Reason for which the act is performed, intention of the person performing the act. 3. Circumstances – surrounding the act, factors distinct from the act itself and from the purpose which may affect the morality of the act. Principles of Judging Morality 1. An act is morally good if the act itself, the purpose and the circumstances are substantially good. 2. If an act is intrinsically evil (evil by its nature), the act is not morally allowable regardless of the purpose or circumstances. 3. Circumstances may create, mitigate or aggravate the immorality of an act. 4. If the act is itself good or at least indifferent, its morality will be judged by the purpose and circumstances.  2 Conditions Affecting Morality 1. Ignorance – is the absence of intellectual knowledge in man. 2. Fear – is one of the passions but a very common one so it is given special attention. It is the agitation of the mind caused by the apprehension of impending evil. It ranges from slight disturbance to actual panic. 3. Concupiscence – are the passions of man which include love, hatred, joy, grief, desire, aversion or horror, hope, despair, courage or daring, fear and anger which make man frail and prone to evil. 4. Violence – or coercion is external force applied to a person for the purpose of compelling him to perform an act which is against his will. 5. Habit – refers to operative habit which is a lasting readiness and facility, born of frequent repeated acts, for acting in certain manner. CONSCIENCE  Conscience is a practical judgment of reason upon an individual act is good, pr as evil and to be avoided. The act of reasoning out the right and wrong of a situation. LAW  It is an ordinance of reason promulgated for the common good by one who has charge of society. MORALS  Morals deals with conduct of man, the right and wrong behavior of man in his relationship with his fellowmen. MORALITY  is concerned with knowing and doing what is right, with the goodness and badness of man’s actions as they conform to some set of standards imposed by society. ETIQUETTE  Etiquette has been defined as “a set of formal rules for social conduct based on social consideration for other and designed to establish pleasant social relationships.” IDEALS  “An ideal is an idea grasped firmly in the mind, raised to a standard of action and pursued consistently.”  3 HABIT  It refers to a pattern of action which is both convenient and undeviating.  Good habits cultivates a morally upright character.  Bad habits can enslave a person and deprive him of freedom, such as the bad habit of smoking and alcoholic drinking. Basic Rules to follow in forming and good habits. 1. There must be strong desire or will power to form a habit. 2. Repetition and uninterrupted practice must be religiously observed. 3. No exceptions must be tolerated. 4. The will must be daily strengthened by small sacrifices, penitential work and all other acts which tend to strengthen the will. Four Rules of eliminating bad habits. They are: 1. There must be strong desire or will power to break the habit. 2. The breaking of the habit must be done gradually with no exceptions allowed. 3. Following the law of disuse, the person must refrain from performing the bad habit. 4. Substitute a (bad) habit for another (good habit). MORES  Mores is defined by Robles as “customs enforced by social pressure.”  They are the society’s established patterns of action to which an individual is expected to conform and risks disapproval and punishment if he goes against it. THE MORAL VIRTUES 1. Justice - “Is the virtue that allows man to give his neighbor what rightfully belongs to him.” 2. Temperance –” Is the virtue that moderates the possible over-indulgence of the concupiscible appetite.” 3. Fortitude – “Is the virtue that gives courage to a man in time of overwhelming odds.” 4. Prudence – is the virtue of knowing how things are to be done rightly and well. FUNCTION OF ETHICS  Ethics teaches as to distinguish what is right from what is wrong.  It helps us to make sound judgments and decisions, aiding us to attain a happy and fruitful life which is the goal of every human being.  4 ETHICAL PRICIPLES The Golden Rule which means “Do unto others what you would want others do unto you.” The two Fold Effects. When a nurse is faced with an ethical dilemma and could not decide on what to do, she can apply the principle of the two-fold effects: 1. The action must be morally good; 2. The good effect must be willed and the bad effect merely allowed. 3. The good effect must not come from an evil action but must come from the initial action itself directly; and 4. The good effect must have a greater effect than the bad effect. A little more or less does not change the substance of an act. Principle on the origin and destruction of life. No one is held to the impossible. The utilitarian Principle which is the greatest good for the greatest number. Meeting other halfway. Defects of nature may be corrected. PROFESSIONAL ETHICS  Professional ethics are basic principles of conduct or right actions that a licensed practitioner must at all times observe and uphold in the practice of his profession.  They are a set of guidelines for one’s professional activity. Professional ethics establish standards of acceptable behavior for professionals. Cafferty and Sugarman list nine functions of a professional code of ethics. They are: 1. Set forth basic principles and regulations to serve as guidelines; 2. Serve as resources for the orientation of new practitioners for their duties, rights and privileges. 3. Serve as guides to identify and evaluate qualities synonymous with professional conduct; 4. Provide guidelines for the establishment and operation of education programs to prepare future members for service in the profession; 5. Identify common practices to be followed and those to be shunned; 6. Provide a guide for considering the relationships of individuals to their employers, co- workers, society in general, and to their own profession;  5 7. Serves as a basis for identifying standards of quality practice consistent wit actions of the qualified, competent practitioner; 8. Provide, by implication, for legal actions against incompetents and violators of the code and for liability of the consequences of their actions; and 9. Provide for due process under the law for practitioners unjustly accused of misconduct in the performance of their duties. NURSING ETHICS  Nursing ethics are principles of right conduct that a nurse must observe in the practice of her profession.  It is concerned with the moral responsibilities of the nurse towards her profession, patients, physician and superiors, co-workers and herself.  6 CODE OF ETHICS FOR NURSES The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your clients. A code of ethics is a set of guiding principles that all members of a profession accept. It is a collective statement about the group’s expectations and standards of behavior. Codes serve as guidelines to assist professional groups when questions arise about correct practice or behavior. The nurse’s code of ethics came about as early as the time of Florence Nightingale. A highlight on the creation of Nurses Code of Ethics was composed by a nursing instructor Lystra Gretter in 1893. She was the one who wrote the following words that best describes the code of ethics of nurses in the oath for nurses: “to abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug.”  7 Basic concepts of the Code of Ethics 1. Rights – According to the Webster dictionary, a right means “something to which one has a just claim or the power or privilege.” 2. Autonomy – The concept of autonomy can be seen during the decision-making of undergoing such procedures whether invasive or not. Informed consent is one example of how a nurse can practice the concept of autonomy. 3. Beneficence and nonmaleficence – These concepts can be seen during rendering nursing care. It is very important that nursing care must do not harm (beneficence) but rather be safe for the patient. Likewise, nursing care must also be sure enough that it cannot lead to intentional harm (nonmaleficence).. 4. Fidelity – nurses should have fidelity towards four major parts of her profession: patient, company, community, and environment. Fidelity is being accountable for your actions towards each individual or group you encounter. Basic Principles to Maintain 1. Advocacy – refers to the support of a cue. As a nurse, you advocate for the health, safety and rights of the clients. 2. Responsibility – refers to a willingness to respect obligations and to follow through on promises. 3. Accountability - refers to the ability to answer for one’s own actions. 4. Confidentiality – protection of client’s personal health information. The legislation defines the rights and privileges of clients for protection of privacy without diminishing access to quality care FILIPINO PATIENT’S BILL OF RIGHTS 1. The patient has the right to considerate and respectful care irrespective of socioeconomic status. 2. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected to understand. 3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment.. 4. The patient has the right to refuse treatment/life – giving measures, to the extent permitted by law, and to be informed of the medical consequences of his action. 5. The patient has the right to every consideration of his privacy concerning his own medical care program. 6. The patient has the right to expect that all communications and records pertaining to his care should be treated as confidential.  8 7. The patient has the right that within its capacity, a hospital must make reasonable response to the request of patient for services. 8. The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. 9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. 10.The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. 11.The patient has the right to examine and receive an explanation of his bill regardless of source of payment. 12.The patient has the right to know what hospital rules and regulation apply to his conduct as a patient.  9 LAWS EVERY NURSE SHOULD KNOW LAW  “A rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority.” (Webster’s Ninth Collegiate Dictionary USA 1983).  It is any rule of action or any system of uniformity.  It is an ordinance of reason promulgated for the common good.” CLASSIFICATION OF LAW I. Natural Law  refers to the law not enforced by the State but determines man’s action through internal dictate of reason and conscience. A. Natural Moral Law  is the law that applies to man’s free will and intellect.  It includes the moral norms of the community which determines the people’s way of life and which every member of the community is expected to follow.  Moral law is not absolute but varies with time and place. B. Law of Nature applies to the order and regularity of nature. II. Positive Law- these are the law promulgated expressly and directly. A. Divine Laws – Divine laws are those authored and promulgated by God and made known to man by means of revelation. This is the law of religion and faith. If a person disobeys the laws of his religion, he commits a sin. B. Divine-Human Law – These are laws promulgated by man in accordance with the Divine Law. C. Human Laws – These are laws authored and enacted by man. According to Justice Bradley of the U.S Supreme Court it “It is the science of principle by which civil society is regulated and held together, by which right is enforced and wrong is detected and punished. The different kinds of human to follow it. 1. Public Laws – Laws that govern the relationship between the state and its citizenship. Public laws are classified into: a. Criminal Law b. Political Law  Constitutional Law  Administrative Law  Law of Public Officers  10  Law of Public Corporations  Election Law c. International Law  Public International Law  Private International Law 2. Private laws – Laws that govern the relationships between the citizens of the State. Private Laws are classified into: a. Civil Law b. Commercial Law c. Remedial Law CHARACTERISTICS OF LAW 1. It is a rule of conduct or section which determining what can be done and what cannot be done. 2. Law is obligatory which means that every person is obliged to follow the law. 3. It is promulgated by legitimate authority. 4. It is of common observance and benefit. RIGHTS “Right is a moral power residing in a person of doing, possessing, or requiring something, which power all other are bound to respect” (Asprer, 1990). Webster has the following descriptions of rights:  Something to which one has just claim  The power or privilege to which one is justly entitled  The cause of truth or justice Legal rights are rights of a person conferred or protected by the State and which other persons in the community must respect. These rights can be enforced by legal means. SOURCES OF LAWS In the Philippines, the principal sources of laws are the Constitution, Legislative enactments of the Congress, administrative rules and regulations, judicial decisions and customs.  11 Constitution The Constitution of the Republic of the Philippines is the fundamental law of the land, it is the supreme law or the highest law to which all the other law must conform. The Constitution has the following purposes: 1. To prescribe the permanent framework of a system of government. 2. To assign to the several departments their respective powers and duties. 3. To establish certain fixed first principles on which government is founded. The 1987 Constitution consist of the following parts: PREAMBLE Article I. National Territory Article II. Declaration of Principles and State Policies Article III. Bill of Rights Article IV. Citizenship Article V. Suffrage Article VI. The Legislative Department Article VII. The Executive Department Article VIII. The Judicial Department Article IX. Constitutional Commission Article X. Local Governments Article XI. Accountability of Public Officers Article XII. National Economy and Patrimony Article XIII. Social Justice and Human Rights Legislation  Consists of laws enacted by the Congress and local legislative bodies  12 Administrative Orders Consist of administrative orders, regulations and rulings, rules and regulations issued by administrative officials under legislative authority. Administrative rules and regulations are intended to clarify and explain the law and carry into effect its general provisions. Judicial Decision and Jurisprudence The legal system of the Philippines is formed is part by the decision of the courts, particularly the Supreme Court. The decisions of the Supreme Court are binding on all the subordinate courts ad are used as bases for the decisions of the lower courts. Customs “It consists of those habits and practices which, through long and uninterrupted usage, have become acknowledged and approved by society as binding rule of conduct” (Gamboa, 16th Edit). JURISPRIDENCE  Jurisprudence is the science of laws (Webster, 1981).  It embraces all the enacted by the legislative body of the State (Senate and Congress), all rules and regulation promulgated by those in authority, court decisions and formal principles upon which laws are based (Asprer 1990). Nursing Jurisprudence includes all laws, court decisions, legal principles and doctrines, rules and promulgations which regulates the practice of midwifery. The practice of nursing is regulated by the following:  The Nursing Law  The Constitution of the Republic of the Philippines  Rules and regulations promulgated by the Board of Nursing and Professional Regulation Commission  Decision of the Board of Nursing and PRC which has a bearing on the practice of nursing  Decisions of the Supreme Court on cases relevant to Nursing practice  The Revised Penal Code  The New Civil Code of the Philippines  The Revised Rules of Court  The National Internal Revenue Code  Other laws which affects the practice of nursing  The Labor Code  Amendments of previous laws relevant to nursing practice  13 STATE  Is the community of persons, more or less numerous, permanently occupying a definite territory and having a government of their own and enjoying freedom from external control.  Take note that State refers not to the territory but to a group of persons. Elements of the State 1. People- Refers to the mass of population inhabiting the territory of the State. 2. Territory- The fixed portion of the surface of the earth inhabited by the people of the State. 3. Government- The agency or instrumentality through which the will of the people is formulated, expressed and realized. 4. Sovereignty- The supreme and uncontrollable power by which the State is governed. This includes freedom of the State from external control. The State exercises sovereignty when it enacts laws. The Three Inherent Powers of the State 1. Police Power- This refers to the power of the State to interfere with rights and properties for the promotion of the general welfare. 2. Power of Eminent Domain- The power to take personal property for public use, provided the owner is paid fairly. 3. Taxation- The power of the State to demand contribution from the people in exchange for the protection and service they service. The Three Main Branches of the Government The Legislative Branch is the branch that exercise legislative power. Legislative power refers to the power to enact laws. The Legislative Department is composed of the House of Congress The Executive Branch is the branch of the government which enforces or executes the laws enacted by the legislative branch. This department is headed by the President, who is therefore known, as the Chief Executive. The Judicial Department is the branch of the government which applies and interprets the laws of the land. This department is composed of the Supreme Court and the lower courts.  14 LAWS AFFECTING NURSING PRACTICE EXECUTIVE ORDER- An order issued by the executive branch of the government in order to implement a constitutional mandate or a statutory provision. EXECUTIVE ORDER No. 51- The Milk Code or The National Code on the Marketing of Breastmilk Substitutes, Breastmilk Supplement and Other Related Products. This Laws aims to provide safe and adequate nutrition for infants by the protection and promotion of breastmilk and by ensuring the proper use of breastmilk substitutes. Executive Order No. 180- Government Workers Collective Bargaining Rights. Executive Order No. 174- National Drug Policy on Availability, Affordability of Safe, Effective and Good Quality Drugs for All. Executive Order No. 209- The Family Code Family relations include those: a) Between husband and wife b) Between parents and children c) Among other ascendants and descendants; and d) Among brothers and sisters, whether of the full or half-blood. Legitimate children are a) Those conceived and born during the marriage of the parents; b) Conceived as a result of artificial insemination of the wife with the sperm of the husband or that of a donor or both, provided, that both of them authorized such insemination in a written instrument executed and signed by them before the birth of the child. Legitimate children shall enjoy the following rights: a) To bear the surnames of the father and mother. b) To receive support from them, from their ascendants, and in a proper case, from their brothers and sisters. c) To the legitime and other successional rights which the law recognizes in their favor. Illegitimate children are those conceived and born outside a valid marriage. Illegitimate children shall use the surname and shall be under the parental authority of their mother. Executive Order No. 857- Compulsory Dollar Remittance Law LETTER OF INSTRUCTION- An order issued by the President to serve as a guide to his previous decree or order.  15 Letter of Instruction No. 47- Directs all schools of midwifery, social work, nursing, medicine and allied medical profession to include family planning in their curricula. Letter of Instruction No. 1000- Directs government agencies to give preference to members of accredited professional organizations when hiring employees. Letter of Instruction No. 949- The law that created Primary Health Care system. PRESIDENTIAL DECREE- An order of the president. This power of the president which allows him to act as a legislators was exercised during the Martial Law period. Presidential Decree No. 825- Provides penalty for improper garbage disposal and other forms of uncleanliness. Presidential Decree No. 996- Provides for compulsory basic immunization for children and infants below eight (8) years of age. Presidential Decree No. 965- A decree requiring applicants for the marriage license to receive instruction on Family Planning and Responsible Parenthood. Such instruction or information may be in the form of personal instruction and/ or handbook, pamphlets or brochures. Furthermore, such instructions and information shall be consistent with the policies of the Commission on Population. Presidential Decree No. 651- Birth and Death Registration Law. Presidential Decree No. 856- The Code on Sanitation Presidential Decree No. 79- The Law that created the Population Commission or POPCOM. Amended by Presidential Decree No. 16. Presidential Decree No. 541- Allowing former Filipino professionals to practice their respective professions in the Philippines. Presidential Decree No. 69- Limits the number of children to four for tax exemption purposes. Presidential Decree No. 223- Created the Professional Regulation Commission. Presidential Decree No. 148- Woman and Child Labor Law. Provides for the privileges of working women and states that no child below 14 years old shall be employed. Presidential Decree No. 48- Limits maternity leave benefits to four children. Presidential Decree No. 603- Child and Youth Welfare Code which protects the rights and promotes the welfare of children. Presidential Decree No. 1519- Provides medical benefits to all government employees regardless of status of appointment.  16 Presidential Decree No. 166- Amends Presidential Decree No. 79. Strengthened family planning program by promoting participation of private sector in the formulation and implementation of program planning policies. Presidential Decree No. 1636- Requires compulsory membership to the SSS of self- employed persons. Presidential Decree No. 626- Employee Compensation and Insurance Fund. Provides benefits to persons covered by SSS and GSIS for immediate injury, illness or disabilities. Presidential Decree No. 147- Declares April 21 and May 19 as National Immunization Day. Presidential Decree 1146- New GSIS Law which covers government employees. Presidential Decree 1519- New Medicare Law Benefits including episiotomy of primigravida. Presidential Decree No. 568- Role of Public Health Midwives are expanded under the RHCDS. Presidential Decree No. 169- Requiring Attending physicians and/ or persons treating injuries resulting from any form of violence, to report such fact by the fastest means of communication to the nearest Philippine Constabulary Unit without delay, to enable law enforcement agencies to keep tract of all violent crimes, conduct timely investigations thereon and effect the immediate arrest of the perpetrators. Presidential Decree No. 46- An Act making it punishable for any public official or employee, whether of the national or local governments, to receive, directly or indirectly, and for private persons to give, offer to give, any gift, present or other valuable thing on any occasion, including Christmas when such gift, present or other valuable thing is given by reason of his official position, regardless of whether or not the same is for past favors, or the giver hopes or expects to receive a favor or better treatment in the future from the public official or employee concerned in the discharge of his official functions. Included in this provision is the throwing of parties or entertainment in honor of the official or employee or his immediate relatives. This Decree aims to wipe out all conceivable forms of graft and corruption in the public service and is s concrete step in the administration program of reforms for the development of new moral values in the social structure of the country. Presidential Decree No. 3200- Professional Regulatory Code in the Philippines. Presidential Decree No. 1359- A law allowing applicants for Philippine citizenship to take Board exams pending their naturalization. Presidential Decree No. 4226- Hospital Licensure Act  17 PROCLAMATION- Is an official declaration by the Chief Executive/ Office of the President of the Philippines on certain programs/ projects/ situations. Proclamation No. 118- Professional Regulation Week is June 16 to 22 Proclamation No. 6- UN’S goal of Universal Child Immunization, involved NGOs in the immunization program. Proclamation No. 499- National AIDS Awareness Day REPUBLIC ACT- An Act passed by the Congress of the Philippines, while the form of the Government is a Republic state. Republic Act No. 6511- Amended Republic Act No. 456 Standardized the examination and registration fees charged by the regulatory boards. Republic Act No. 1612- Privilege tax or professional tax or Omnibus tax should be paid before any business or occupation can be pursued. Republic Act No. 1080- Declared that professionals who passed the board and bar exams are civil service eligible. Republic Act No. 2644- The old Midwifery Law Republic Act No.2382- The Philippine Medical Act which regulates the practice of medicine in the Philippines. Republic Act No. 5181- An Act prescribing permanent residence and reciprocity as qualifications for any examination or registration for the practice of any profession in the Philippines. Republic Act No. 6425- The Dangerous Drugs Act of 1972 Republic Act No. 1082- Rural Health Act. Creation of Rural Health Units all over the country with the goal of promoting the health and well-being of the rural population. This act calls for the employment of more physicians, nurses, midwives, and sanitary inspectors who will live in their area of assignment and help raise the health condition of the barrio people. Republic Act No. 4073- Liberalizes the treatment of leprosy, except when certified by the Secretary of Health or his authorized representatives that the stage of the disease requires institutional treatment, no persons afflicted with leprosy shall be confined in a leprosarium; Provided, that such person shall be treated in any government skin clinic, rural health unit or by a duly-licensed physician. Republic Act No. 6713 – Code of Conduct and Ethical Standards for Public Officials and Employees.  18 Republic Act No. 6758- Revised Compensation and Position Classification System in the Government. Republic Act No. 5821 – The Pharmacy Act. Requires that all prescription must contain the following information: a. Name of prescriber, office address, professional registration number, professional tax receipt number. b. Client’s name with age and sex c. Date of prescription Republic Act No. 6675- The Generic Acts of 1988 Republic Act No. 6111 – Philippine Medical Care Act of 1969 (MEDICARE). Hospitalization benefits for employees who are members of the GSIS and SSS. Republic Act No. 3573 – Law on the reporting of communicable diseases. Republic Act No. 4226- It shall be the duty, of the owner, lessee or operator of any shop, factory, estate, or commercial, industrial or agricultural establishment or branch thereof, whether the same be an individual, corporation, or partnership, or government owned or controlled corporation, or the National Government, or a provincial or municipal government, or the government of any political subdivisions whatsoever, who habitually employs in any locality employees or laborer to furnish free emergency medical and dental attendance to his employees and laborers. Republic Act No. 6365- National Policy on Population. Created the Commission on Population or POPCOM. Republic Act No. 7600- Rooming- in and Breastfeeding Act of 1992 Republic Act No. 7610- Special protection of children against child abuse, exploitation and discrimination act. Republic Act No. 7658- An act prohibiting the employment of children below 15 years of age and amend Section 12, Article VIII of R.A 7610 Republic Act No. 7160- Local Autonomy Code Republic Act No. 7641- New Retirement Law Republic Act No. 7305- Magna Carta of Public Health Workers Republic Act No. 6727- Wage Rationalization Act Republic Act No. 7277- Magna Carta of Disabled Persona Republic Act No. 7624- Drug Education Law  19 Republic Act No. 7170- Law that governs organ donation. Republic Act No. 6809- Majority age is 18 years old. Republic Act No. 6727- Provides Day Care Centers for every barangay. Republic Act No. 349- Amended by Republic Act 1056 legalizes the use of human organs for surgical, medical and scientific purposes. Republic Act No. 1891- Amended Section two, three, four, seven and eight of Republic Act No. 1082. An Act strengthening health and dental services in the rural areas. Republic Act No. 6725- An act strengthening the prohibition on discrimination against women with respect to terms and conditions of employment. Republic Act 7875- National Health Insurance Act of 1995. An act instituting a national health insurance program for all Filipinos and establishing the Philippine Health Insurance Corporation for the purpose. This law repealed the Executive Order No. 119, Presidential Decree No. 1519 and other laws which applies to the administration of MEDICARE.