Principles of Ethics 2023-2024 PDF

Principles of Ethics Prepared by Dr. Heba Mostafa Mohamed 2023-2024  Outlines  Introduction  Definitions of the term ethics.  Ethics and Morality.  The principles of ethics.  A different set of principles of ethics ...

Principles of Ethics Prepared by Dr. Heba Mostafa Mohamed 2023-2024  Outlines  Introduction  Definitions of the term ethics.  Ethics and Morality.  The principles of ethics.  A different set of principles of ethics  Introduction  Every day, in all professional practice setting, nurses fight with the relationship between ethical and legal concepts, often asking themselves if they are protecting the legal rights of patients while being sensitive to individual needs for autonomy and Justice.  Definitions of Ethics:  Ethics refer to the study of ideals of right and wrong behavior. It is concerned with the study of good conduct, character and motives determining what are good or which valuable for all people.  Ethics are the rules that govern over behavior both socially and professionally.  Definition of Morals  Morals provides standards of behaviors these standards guide the behavior of an individuals or social group. The moral is established rules in situation in which decision about right and wrong must be made.  An example of moral standard is good people do work.  Principles of Ethics:  The value of life.  Goodness and rightness.  Justice or fairness.  Truth-telling or honesty.  Individual freedom.  1- The Value of life  Human being should revere life and accept death. ” Edel (1955) asks : “ to whom is life a good” Harris (1987) “ The Theory of QALY” “Quality Adjusted Life Year “  2-Goodness and Rightness  This principle demands:  That we promote goodness over badness.  That we cause no harm or badness.  That we prevent badness or harm  3-Justice or Fairness  Justice is fair, equitable and appropriate treatment. It is the basis for the obligation to treat all clients in an equal and fair way. Just decision is based on client need and fair distribution resources.  The moral assumptions underlying medical ethics are rarely in dispute It is the application of these assumptions to specific cases that the dispute arise.  4-Truth-telling or honesty (Veracity) Veracity means telling the truth, which is essential to the integrity of the client-provider relationship. Health care providers obliged to be honest with clients. The right to self-determination becomes meaningless if the client does not receive accurate, unbiased, and understandable information.  5-The principle of individual freedom  Freedom=life Use freedom to preserve life , Do right , and be good , act Justly and tell the truth if we have no freedom to do this , we have no morality therefore , neither can this principle , nor the others four stand alone  A different Set of Principles Major principles of nursing ethics are: - Autonomy is the promotion of independent choice, self- determination and freedom of action. The term autonomy implies for basic elements The autonomous person is respected The autonomous person must be able to determine personal goals. The autonomous person has the capacity to decide on a plan of action. The autonomous person has the freedom to act upon the choices.  Four factors for violations of patient autonomy  Nurses may assume that patients have the same values and goals as themselves.  Failure to recognize that individuals’ thought processes are different.  Assumptions about patients’ knowledge base.  Focus on work rather than caring.  Noncompliance may result from two factors:  When plans seem unreasonable to the patient.  Patients may be unable to comply with plans for a variety of reasons including resources, lack of knowledge, psychological and cultural factors.  Beneficence Beneficence is doing or promoting good. This principle is the basis for all health care providers. Nurses take beneficent actions when they administer pain medication, perform a dressing to promote wound healing or providing support to a client who is anxious or depressed.  The principle of beneficence has three components: Promote good Prevent harm Remove evil or harm  Non-maleficience Non-maleficience: It means to avoid doing harm. When working with clients, health care workers must not cause injury or suffering to clients. Ex. Experimental research that have negative consequences on the client.  Fidelity Fidelity means being faithful to one's commitments and promises. Nurses’ commitments to clients include providing safe care and maintaining competence in nursing practice. In some instances, a promise is made to a client in an over way. Nurse must use good judgment when making promises to client. Fidelity means not only keeping commitment but also keeping or maintaining our obligation.  Training questions 1. Ethics refer to standards of behaviors these standards guide the behavior of an individuals or social group ( ) 2. Non-maleficience means doing harm ( ) 3. Beneficence it is a basic principle for all health care providers. ( ) 4. Fidelity means being not faithful to one's commitments and promises. ( ) 5. List to five principles of ethics.  Patient’s Rights Prepared by Dr. Heba Mostafa Mohamed 2023-2024  Outlines:- Introduction. Definition Rights. Types of Rights. Patient‘s rights & responsibilities.  Introduction: Human rights are universal and indivisible rights, possessed by all people, by virtue of their common humanity. The right to health and well- being is a fundamental right that influences all aspects of life.  Definitions A set of rights, responsibilities, and duties under which individuals seek and receive health care services. Because patients' rights are often not explicit, the composition of the set varies from country to country and over time.  Welfare rights.  Ethical rights.  Option rights.  Also called legal rights  Based on a legal entitlement and are guaranteed by laws (such as the bill of rights) and, if violated, can lead to punishment within the legal system.  Also called moral rights.  Are based on a moral or ethical principle.  Usually do not have the power of law behind them for enforcement Are based on a fundamental belief in the dignity and freedom of human being. Are particularly evident in free and democratic countries and much less evident in the restrictive societies. Give individuals the freedom of choice and the right to live their lives as they choose, as long as they stay within a set of prescribed boundaries.  You have the right to be treated with respect and dignity, regardless of your race, age, gender and beliefs, or sexual orientation.  All patients receive quality and comprehensive care.  Health care personnel should be interested in hearing what you feel and what questions you have about your health.  All personnel, including physicians, will introduce themselves to you and will address you according to your preference. (2) Decisional privacy is distinguished as control over the intimate decisions one makes (e.g., about contraception, abortion, and perhaps health care at the end of one’s life). (3)Informational privacy this type of privacy underlies the notion of confidentiality.  - Confidentiality “show trust by imparting secrets. - Professional codes of ethics (and conduct) will often maintaining confidentiality, but confidentiality is often qualified.  All communications and records between the Patient and the clinician are confidential information.  Patient permission must be obtained before any information can be given to any person not directly connected with Patient care.  In most instances, giving the information will help the Patient.  You have the right to know and understand any thing.  What treatment, procedure or test is being recommended and why.  The risks of the recommended treatment, test or procedure and the alternative.  You have a right to service for your health needs.  You have the right to refuse service and you must sign if recommended treatment is refused.  You have the right to a second medical opinion before making any decision.  You have the right to request the same practitioner for continuous care.  You also have the right to change practitioners if you feel you have a personality conflict or other concerns which impact your health care needs.  These rights apply to you and to anyone else who, because of your age or disability, may be responsible for your health. As a mental health (psychiatric) patient, you have rights. If you are a danger to yourself or others, a doctor can limit your rights a- Responsibilities providing information: Patients must provide, to the best of their knowledge, accurate and complete information about symptoms, past illnesses, hospitalizations, medications and other matters relating to their health. b- Respect and consideration: Patients must consider the rights of other patients and health care personnel. Patients must respect the property of other persons and the medical facility. C- Compliance with health care: Patients are strongly encouraged to comply with the medical, dental and nursing treatment plan, including follow-up care recommended by health care personnel. d- Medical records: Patients must ensure they return any medical documentation that they receive from any provider outside the hospital to the medical facility for review by his/her primary care manager, proper filing and maintenance. E- Medical facility rules and regulation: Patients must follow general medical facility rules and regulations affecting patient and visitor conduct. F- Reporting of complaints: Patients should help the medical facility commander provide the best possible care by reporting any complaint that occurs with them.  Lecture questions Human rights are universal and indivisible rights, possessed by all people ( ) Ethical rights called moral rights power by law behind them for enforcement ( ) …………………. A set of rights, responsibilities, and duties under which individuals seek and receive health care services. List types of patient Rights.  Ethical Issues in Nursing Prepared by Dr. Heba Mostafa Mohamed 2022-2023  Outlines Introduction. Definitions. Ethical issue between the nurse and the patient Patient‘s Responsibilities Nursing Role Toward Patient Introduction  Ethical and legal issues are closely related to other areas of concern for nurses. Legal and ethical issues surround the right to choose how one will live while dying and who should have the right to make decisions regarding the treatment plan. Definition  Law: is a system of rules, usually enforced through a set of institutions.  Ethics: is the systematic exploration of what is right or wrong. It is an attempt to understand or make sense of our moral experience. Definition  Clinical ethics: a structured approach to assist health care providers in identifying, analyzing, and resolving ethical issues in clinical practice. Nursing ethics: is the formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments. Definition  Right: a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service. Legal right: a right on which society agrees and has formalized into law.  Ethical issue between the nurse and the patient 1. The patient has the right to considerate and respectful care.  The right of respectful care has direct meaning for nursing, as nurses have the most contact with patients in a hospital setting. Ethical issue between the nurse and the patient 2.The patient has the right to obtain from his physician complete, current information concerning his diagnosis, treatment, and prognosis. In terms that for the patient be reasonably expected to understand. 3. The patient has the right to receive from his physician the information necessary to give informed consent: Explaining that it is the person‘s right to know the risks as well as the benefits of treatment helps people to understand why the physician's explanation was in such details. 4. The patient has the right to refuse the treatment to the extent permitted by law and to be informed of the medical consequences of his action. Usually the reason a person refuses treatment is that he doesn‘t fully understand its importance or effect.  The patient has the right to every consideration of his privacy (confidentiality): Privacy is an easy right to forget in a busy hospital unit, it means that a discussion between you and the patient must be conducted in a private area, not a public hallway.  5. The patient has the right to expect that all communications and records pertaining to his care should be treated as confidential.  To protect the right of confidentiality, be careful that you don‘t leave patients chart in place where it could be read by someone other than the patient or authorized personnel.  6. The patient has the right to expect that within its capacity a hospital must make reasonable response to the request of a patient for services.  As a nurse, you are the person who will be coordinating services for the patients such as occupational therapy appointments, x-ray, and diagnostic studies. 7. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment, he has the right to refuse to participate in such research projects. The patient must be asked to sign a separate consent in addition to his consent of care if an experimental therapy or drug is proposed for him. 8. The patient has the right to expect reasonable continuity of care.  The patient's right to continuity of physician care indirectly refers to nursing care as well. 9. The patient right to know the cost of hospitalization and follow up his bill even if; he was treated by health insurance. 11.The patient has the right to know what hospital rules and regulations apply to his conduct as a patient. Most health care agencies give patients an information booklet on admission that details such policies as smoking, visiting hours, and dietary services.  Patient’s Responsibilities: 1. Responsible for providing as much information as possible about his or her health and medical history. 2. Responsible for asking the care provider when do not understand medical words or instructions about plan of care. 3. Responsible for following plan of care.  Patient’s Responsibilities: 4. Responsible for acting in a manner that is respectful of other patients, staff. 5. Report changes in his/her condition or symptoms including pain to a member of the health care plan. 6. Accept responsibility for his/her health outcome, if choose not to follow treatment.  Patient’s Responsibilities: 7. Follow the rules and regulations of the hospital. 8. Assist in providing a safe environment. 9. Provide information about his/her insurance and to work with the hospital to arrange payment, when needed including correct home address, telephone number.  Nursing Role Toward Patient 1. Right to provide professional standards of health care, Regardless of setting. 2. Right to provide health care that is equitable, human, and given without discrimination as to race, color, creed, sex, national origin source of payment, or ethical or political beliefs.  Nursing Role Toward Patient: 3. Right to provide complete information about their diagnosis, prognosis, and treatment, including alternatives to care and risk involved. 4. Right to information about the qualifications, names, and titles of healthcare personnel. 5.Confidentiality of all records and all communication written or oral between patients and healthcare providers. 10/23/2023 Nurses Right and Responsibility Prepared by Dr. Heba Mostafa Mohamed 2023-2024  outlines Define responsibility & rights. List responsibility aspects. Identify rights types. List institution duties & responsibilities. Discuss nurse‘s rights & responsibilities. Discuss patient‘s rights & responsibilities.  Introduction We hear a great deal these days about rights, But We hear much less about responsibilities, Yet the two go hand in hand. Responsibility is an ethic of caring is based on a basic relationship. It is the ability to respond in order to be able to care.  Definition of Responsibility Responsibility - It is the duty or obligation to satisfactorily or complete a task (assigned by someone) that one must fulfill, and which has a consequent penalty for failure. - It is the ability to respond in order to be able to care.  Items of Responsibility  Doing my job  Caring  Trying my best  Helping others when they need help  Helping to make the better  Doing share in work  Being faire  Aspect of responsibility Having responsibility: It means to be answerable to someone or something specifically usual defined by contract. The contract helps to know what the parameters (limits) of this thing are. Right to an established salary, week’s holidays, and the right to sick leaves and paid person.  Being responsible  A person who feels involved is a person who is responsible.  Aware of what is happening and prepared to engage with it and work for its positive advance.  It is an active taking part and interest in a cause.  To be responsible is a truly ethical act.  Rights Rights: Requirements of individual during his life and should be protected. A person‘s rights are based on human needs. One person‘s rights are depend on another‘s duty. A nurse's rights are the employer‘s duties. A patient's rights are the nurse‘s duties.  An institution’s Duties  A hospital or health authority as an institution has first of all a duty to care for its patients  The nurses‘ rights are the institution‘s duties  It should act ethically acts in such a way that it to be humanize (prevent dehumanization).  It should promote an environment which is physically, psychologically, emotionally, and spiritually healthy.  Maintain high standards of patient care by promoting policies.  An institution’s Rights The rights of an institution are that it can expect its employees to respect such policies and measures, and help others to respect them.  Nurse’s rights Nurses' Bill of Rights: The Nurses' Bill of Rights was adopted by the American Nurses Association (ANA) 2001. "a powerful statement of the rights that:-  Every nurse must have to provide high quality patient care in a safe environment.  They work to alleviate the suffering experienced by individuals, families, groups and communities.  Nurses have the right to freely and openly advocate for themselves and their patients, without fear.  Nurse’s rights  Nurses provide services that maintain respect for human dignity and respect the uniqueness of each patient and the nature of his or her health problems, without restriction with regard to social or economic status.  Practice in environments that allow them to act in accordance with professional standards and legally authorized and with the Code of Ethics.  Compensate for their work, consistent with their knowledge, experience, and professional responsibilities.  Nurse’s rights  Not to be abused in any form by physicians, pharmacists, administrators or nursing directors. Any abuse that occurs should be dealt with in a professional and in partial manner by the nurse's employer.  Refuse any assignment that they feel is unsafe. Such as when a nurse is assigned a patient load the feels is unsafe.  Ethics and Low Prepared by Dr. Heba Mostafa Mohamed 2023-2024  Outlines  Identify ethic and low.  Explain relationship of Ethics and the Law  Apply confidential issues while dealing with patients.  Integrate legal services provided by nurse among patients.  Assess the issues that have both ethical and legal components include.  Apply the documentation content in patient care.  Use incident reporting in caring of patients.  Introduction Nursing as a career requires more than the course work and certificates to understand fully. Besides the academic work and extensive tests that are needed into becoming a nurse, there is also a need for training to understand the ethical and legal implications of actions involved in the field.  Definitions of Ethics  Ethics: is a branch of philosophy that deals with right and wrong.. It is a system of principles and rules of conduct recognized and accepted by a specific group or culture.  Definitions of Bioethics Bioethics: covers a broad set of possible topics, such as ethical standards and moral problems created by the practice of medicine. ethical issues in neuroscience, and protection of research participants, privacy issues raised by genome sequencing, and research with children.  The Relationship of Ethics and the Law Ethics has been described as beginning where the law ends (correlated). Both share the goal of creating and maintaining social good. Ethics never stands alone, nor does the law. Some issues that have both ethical and legal components include:  Access to medical care.  Informed consent.  Confidentiality and exceptions to confidentiality.  The Relationship of Ethics and the Law  Mandatory reporting.  Mandatory drug testing.  Privileged communication with healthcare providers.  Reproductive rights/abort.  Physician-assisted suicide.  Nurse Standards The highest nurse standards is based on the legal and ethical framework. should be practiced in nursing. The nurse is required to practice and maintain standards of professional conduct and personal conduct which will be reflective of the public confidence and profession at large.  Medical-Legal & Ethical Issues in Nursing Current and future healthcare trends: Role of nurse continues to expand & is influenced by many aspects. Best Practices: that protect your license, influence quality of care and reduce risk. Medications: 1-Giving meds on time – not when convenient for nurse (Heparin, Antibiotics, and etc.) 2- Giving med and scanning med at a later time. 3-Proper wasting of narcotics  Patient confidentiality Never leave paper chart/computer screen in a public place 2- Discuss contents only with persons directly involved in patient’s care or those authorized by the patient. They should be listed by name. (Don’t assume partners have access to information). 3- Ask for ID prior to providing information 4-Do not discuss patients information in public, places, elevators, cafeteria, or at parties. 5-Don’t view patient’s information not in your care: family;  Patient Falls & Restraints -Falls represent the 5th leading cause of death, and the mortality rate from falls increases significantly with age. -Cases: -Failure to follow policy. -Failure to raise bedrails.  Incident Reporting -Should be completed for any usual, unexpected, or unanticipated occurrences, and for any event which has or may have an adverse patient outcome. 1-Patient falls. 2-Medication error. 3-Loss of valuables, belongings.  Proper handoff communication Required to properly “handoff” your patients to another qualified professional. Tool SBAR: S=Situation: patient name, DOB, & medical provider. B=background: date of admission, diagnosis & current condition including test results A=Assessment: summary of recent events/changes in condition or treatment and any anticipated changes in condition or treatment. R=Recommendations: state your nursing recommendations with any new treatment in the plan of care by the medical provider.  Abandonment Termination of patient care without assuring the continuation of care. at the same or higher level. In various medical venues (office/clinic practice; walking off the job; leaving pt without transferring pt to another nurse; refusing overtime).  Documentation 1-Nursing procedures (procedure name; when performed; who performed; how performed; client tolerated; adverse reactions) 2-Phone calls 3- Health care team visits 4-Client refusals 5-Client’s subjective data 6-Medication omission 7-Late entry  Medical Malpractice Malpractice occurs when improper, injurious, or faulty treatment of a client that results in illness or injury. * Responsible & Accountable: you are responsible and accountable for your actions based on a. Your clinical training b. Standard of care guidelines c. Policies and procedures of your health care facility  Negligence a. Failure to use equipment in a responsible manner b. Failure to assess and monitor. c. Failure to communicate d. Failure to document e. Failure to act as a patient advocate f. Performing nursing procedures incorrectly.  Legal Role of the Nurse  Provider of service  Ensure that client receives competent, safe, & holistic care  Supervise/evaluate that which has been delegated  Documentation of care  Maintain clinical competency. Ethics and Decision making process Prepared by Dr. Heba Mostafa Mohamed 2023-2024  Outlines  Define the term of Ethical dilemma.  Enumerate the steps of ethical decision making process.  Collect and evaluate information, develops alternatives, and foresees potential consequences and risks  Apply ethical decision making process in all practice setting  Introduction  Nurses are constantly faced with the need to make ethical decisions. The current health care environment, with the rapid advances in science and technology, has created numerous ethical problems for the practice of nurses as well as an increase in these problems.  Definitions of Ethical dilemma  Is a complex situation where ethical principles or values are in conflict. When faced with a difficult ethical dilemma, we need ethical decision making ability for resolve it. It helps one determine the right course of action or the right thing to do and also enables one to analyse whether another’s decisions or actions are right or good.  Definition of decision making In general is the process of deciding about something important, especially in a group of people or in an organization.  Definition of decision making in nursing Ethical decision making is a logical process which involves making the best moral decisions through systematic reasoning in a situation that brings about conflicting choices.  Requirements of items of ethical decisions making process  Commitment: The desire to do the right thing regardless of the cost.  Consciousness: The awareness to act consistently and apply moral convictions to daily behaviour.  Competency: The ability to collect and evaluate information, develops alternatives, and foresees potential consequences and risks  Factors affecting ethical decision- making in nursing  External factors of the ethical decision-making Organizational Factors: the organization’s values often have greater influence on decisions than a person’s own values. The more ethical employees perceive an organization’s culture to be; the less likely they are to make unethical decisions.  Factors affecting ethical decision- making in nursing  Individual factors of the ethical decision making :- Gender―women are generally “more ethical” than men. Education or work experience―the more education or work experience that one has, the better he or she is at ethical decision making. Nationality―cultural appears to be significant in effect of ethical decision making.  Factors affecting ethical decision- making in nursing  Individual factors of the ethical decision making :- Age―the older you are, the more ethical you are. Locus of control― external control vs. internal control. – External control, see themselves as going with the flow because that’s all they can do. – internal control, believe that they control the events in their lives by their own effort and skill  Steps of ethical decision making process This framework consists of five steps:  Assessment  Reflecting and review  Maximize good  Ethical action  Evaluation  Step 1: Assessment  Use this step to clarify and focus the ethical decision 1. Identify what you know and what you need to know to make an ethical decision. 2. Gather as much information as possible including all relevant factors. 3. Identify all those who should be involved (healthcare team, client, family). 4. Determine the decision that needs to be made and by whom.  Step 2: Review and Reflect Use this step to identify and examine all possible options for the ethical decision. This step includes the following:- 1. Identify all the alternatives available. 2.Examine the various options that could be implemented.  Step 3: Maximize Good This step will assist in understanding professional obligations while choosing an ethical action. This step includes the following:- 1. Examine relevant legislation and professional standards. 2. Consider you and your colleagues experience and judgment. 3. Identify and utilize other available resources to support your decision making.  Step 4: Ethical Action Use this step to assist in taking action 1. Select the best alternative- all things considered. 2. Formulate a choice as a general maxim for all similar situations- is there a time when this may not apply? 3. Develop a clear implementation plan-with the appropriate rationale. Clearly communicate this to all those who may be affected.  Training questions 1. Ethical dilemma is the process of deciding about something important ( ) 2. Commitment means awareness to act consistently and apply moral convictions to daily behaviour ( ) 3. List items of ethical decisions making process. 4. List Steps of ethical decision making process  Informed consent Prepared by Dr. Heba Mostafa Mohamed 2023-2024 Outlines:- Define informed consent List Challenges in informed consent process Mention Requirements for obtaining informed consent  Definitions Informed consent is an ethical and legal requirement involving human participants. It is the process where a participant is informed about all aspects of the trial. 1. For all routine treatment. 2. For hazardous procedures such as surgery. 3. For some treatment programs such as chemo-therapy. 4. Before beginning any invasive procedure. 5. Administrating an experimental drug. 6. Placing a client in a research study. 1. Implied consent: Implied consent refers to when a patient passively cooperates in a process without discussion or formal consent. The principles of good communication apply in these circumstances and health professionals need to provide the patient with enough information to understand the procedure. 2. Verbal consent: A verbal consent is where a patient states their consent to a procedure verbally but does not sign any written form. This is adequate for routine treatment such for diagnostic procedures and prophylaxis, provided that full records are documented. 3. Written consent: A written consent is necessary in case of extensive intervention involving risks where anesthesia or sedation is used, restorative procedures, any invasive or surgical procedures, administering of medications with known high risks, and so on. 1. A statement that the study involves research. 2. An explanation of the purpose of research and the expected duration of the subject’s participation; 3. A description of the procedures to be followed and identification of any procedures that is experimental. 4. A description of any risks or discomforts to the subject. 5. A description of any benefits. to the subject or to others that may reasonably be expected from the research. 7. A statement describing to what extent records will be kept all data and records confidential 8. A statement that participation is voluntary and aright of refusal to participate or discontinuing participation at any time. will involve no penalty or loss of benefits to which the subject is otherwise entitled. 1. Language Barriers: It is assumed that the individual who signs the consent form does so with full understanding of what is stated on the consent form. However, it is very difficult to evaluate their viewpoint about trial since there is no established method to measure the level of understanding that a participant has about the information given 2. Religious Influence: The informed consent process is designed to give every participant the liberty to decide whether to accept or refuse the recommended medical treatment. Sometimes their decision for participating in researcher projects is influenced by the religious beliefs.  3. False Expectations: Even when there are no language barriers or religious impediments to hinder the communication relationship between researcher and participant, misunderstanding can still occur due to participants false expectations of the experiment outcome. 4. Patient Perceptions: Most patients believe that, trials will put extra burden on them. They assume that the conventional treatment is best and they are afraid of the unknown side-effects of new treatment.  Lecture questions All routine treatment is indication or Facility for informed consent. ( ) The informed consent process is influenced by the religious beliefs.( ) False Expectations is one of Challenges in informed consent process due to understanding of information …………………. , …………………….From types of informed consent. List types of patient Rights.  Thinking and feeling ethical committee Prepared by Dr. Heba Mostafa Mohamed 2023-2024  Definitions Ethical committee Is a body responsible for ensuring that medical experimentation and human subject research are carried out in an ethical manner in accordance with national and international law. A healthcare ethics committee or hospital ethics committee is a body of persons established by a hospital or health care institution and assigned to consider, debate, study, take action on, or report on ethical issues that arise in patient care. Normativity: Active ethical thinking is always progressive: it seeks to improve current conditions and prevent problems by developing better policies measures. An important dimension of normative ethics is justifying policies or actions. As a rule of thumb, ethical justification is usually based on prevention of harm or protection of rights of a person. Interpersonally: The object of ethical assessment is interpersonal activity: Thus self-harming or other non-prudential acts cannot be used as justification for intervention unless there are other pressing ethical duties present (like the duties of a parent or a care-giver Rationality: Ethical claims should always be logically consistent, compatible with the facts concerning the situation and well grounded in evidence Universality and circumstances: Ethical rules and principles should be as universal as possible. There are no different ethics for different nations, religions or genders.