NCM 108 MODULE 1 PDF

 WHAT IS THE RIGHT THING TO DO?  ETHICS branch of philosophy that aims to determine the correct application of moral concepts such as good and bad, right and wrong. Timbreza (2021) defines ethics as a practical and normative science based on reason that studies human acts and provides n...

 WHAT IS THE RIGHT THING TO DO?  ETHICS branch of philosophy that aims to determine the correct application of moral concepts such as good and bad, right and wrong. Timbreza (2021) defines ethics as a practical and normative science based on reason that studies human acts and provides norms for their goodness or badness. It is, likewise, known as moral philosophy insofar as it deals with morality, moral rectitude, or the rightness or wrongness of human acts.  MORALITY refer to certain codes of conduct put forward by a society or a group (such as a religion), or accepted by an individual for her own behavior, or refer to a code of conduct that, given specified conditions, would be put forward by all rational people.  MORALITY It is the quality of human acts where the acts could either be good or right, evil or wrong. This quality indicates and determines whether the kind of human act that is performed is good or bad.  Ethics vs Morality Relation: Distinction: a) Both ethics and morality deal with human a) Ethics pertains to the knowledge of what to act or human conduct. study about – that is the goodness or evil of a b) Ethics studies about morality. human act; Morality pertains to the application c) Morality gives ethics a perspective of of this knowledge in the performance of human what to study about – that is the rectitude act. of whether an act is good or bad. b) Ethics provides learning about the morality d) Morality provides ethics with a quality of human conduct; Morality provides ways in that determines and distinguishes right practicing what is learned. conduct from wrong conduct. c) Ethics is the “word”; Morality is the “flesh”. d) Ethics indicates the “theory”; Morality indicates the “practice”. Why study Ethics in Nursing? The rapidly evolving, and complex healthcare environment amidst technological developments is often characterized by ethically challenging and difficult work situations and encounters. In the clinical setting, difficult encounters experienced by nurses involve an ethical dimension.  BIOETHICS branch of applied ethics that studies the philosophical, social, and legal issues arising in medicine and the life sciences.  BIOETHICAL ISSUES 1. Beginning of Life Issues - Abortion - Artificial Reproductive Technology - Cloning 2. End of Life Issues - Death - Euthanasia - Organ Transplantation  HEALTH CARE ETHICS the field of applied ethics that is concerned with the vast array of moral decision-making situations that arise in the practice of medicine in addition to the procedures and the policies that are designed to guide such practice. HEALTH CARE ETHICS Health care ethics (a.k.a “clinical ethics” or "medical ethics") is the application of the core principles of bioethics (autonomy, beneficence, nonmaleficence, justice) to medical and health care decisions. It is a multidisciplinary lens through which to view complex issues and make recommendations regarding a course of action.  Bioethics vs Health Care Ethics Relation: Distinction: a) Both are concerned about health and life. a) Health care ethics is concerned about life b) Both regulate human conduct by means only in relation to health; bioethics is of moral principles in relation to health and concerned not just about health but also about other fields in relation to life. life. b) Health care ethics regulates human conduct c) Health ethics is a part of bioethics. in the practice of health care; bioethics regulates human conduct not only in the practice of health care but also in all aspects of human life. The term medical ethics itself has been challenged, however, in light of the growing interest in issues dealing with health care professions other than medicine, in particular nursing. The professionalization of nursing and the perception of nurses as ethically accountable in their own right have led to the development of a distinct field known as nursing ethics. Accordingly, health care ethics has come into use as a more inclusive term.  NURSING ETHICS Nursing Ethics is the applied discipline that studies the ethica dimensions and issues in nursing practice. It is a subset of health care ethics. Nursing ethics is the basis for the professional code of ethics in nursing which specifies a system of principles and rules for resolving ethical dilemmas and issues that occur in nursing practice Professional Ethics refers to the ethics that a person must adhere to in respect of their interactions and business dealings in their professional life. Professional ethics can generally be defined as an established set of principles that govern how a professional relates with clients, fellow professionals, and the public at large.  Professional Ethics Professional ethics concern one’s conduct and practice when carrying out professional work. It is a branch of moral science concerned with the obligations that a member of the profession owes to the public.  CODE OF ETHICS FOR FILIPINO NURSES In the Philippines, every practicing nurse is guided by the Code of Ethics for Registered Nurses. It was promulgated by the Board of Nursing through Board Resolution No. 220 series of 2004. State whether the following issues belong to Health Care Ethics, Bioethics or Professional Ethics 1. Ritz Ford, took an overdose of sleeping pills because his lover broke up with him. 2. Inigo and Jan, both nurses, quarrel and start shouting at each other publicly during the PNA convention. 3. Dr. Carmela, OB Gyne, overcharges her patients. 4. Angie a nurse assigned in the ICU refused to give CPR to a dying patient because of DNR order. 5. Miggy has a bad cold. He went to see Dr. MD and asked for a prescription of Azithromycin. Dr. MD complied with Miggy’s request knowing that antibiotics are useless against common colds and charge Miggy a high PF.  HUMAN ACTS Human acts being the object of study of ethics, are voluntary acts which proceeds from the free will. It depend on human’s judgment and choice hence entail a moral responsibility. Human acts are proper to man since it is performed by a human being. ELEMENTS: Knowledge Freedom Voluntariness  HUMAN ACTS Human acts, that is, acts that are freely chosen in consequence of a judgment of conscience, can be morally evaluated. They are either good or evil. Human Acts Examples: Studying for an exam. Giving pain medication Checking patient’s vital signs Murder Rape Cheating during exam ACTS OF MAN The actions are performed without conscious deliberation or knowledge and with the absence of a free will. Acts of man constitute unconscious and involuntary actions. Example: Digestion Breathing Reflex Seeing Hearing Somnambulism Actions done under the influence of disease or condition. NORMS OF MORALITY LAW CONSCIENCE  LAW Ordinance of reason promulgated by competent authority for the common good.  Ordinance of reason It is dictated by reason. It is not an arbitrary mandate of the one making the law. It is a prescription of that which is to be followed and a prohibition of that which is to be evaded on the basis of the dictates of reason and not on the basis of mere option or wish.  Promulgated by competent authority The law must be made publicly known to its subjects –to those who are bound by it so that corresponding obedience, as it demands, can be exercised. The law becomes unreasonable when it is not properly promulgated.  Common Good It presupposes a community or society of people who are the subjects of the law and whose public or general welfare is ensured. It is made to serve this purpose, to serve the people and not that the people are made to serve the law. Characteristics of True Law 1. Just 2. Honest 3. Possible of fulfilment 4. Useful 5. Relatively permanent 6. Promulgated  Classes of Law Eternal Law Natural Law Human Positive Law ETERNAL LAW the Divine Reason and Will commanding that the natural order of things be preserved and forbidding that it be disturbed.  NATURAL LAW the Eternal Law as known to man by his reason. By the light of his understanding, man knows the natural order in the existence of things which he recognizes as that which has to be preserved. It is obligatory, recognizable, immutable, and universal.  POSITIVE LAW is an ordinance of reason derived from natural law or making a concrete and determinate application of the natural law promulgated for the common good by a human agency in charge of a society.  CONSCIENCE It is a practical judgement of reason on the goodness of an act that has to be done and the evil of an act that has to be avoided.  Correct vs Erroneous Correct conscience is present in the Erroneous conscience is present in judgement of an act as good when it is the judgement of an act as good when truly good and an act as evil when it is it is evil and an act as evil when it is truly evil. good.  Certain vs Doubtful Certain conscience is present when there is Doubtful or Dubious Conscience is an assured and firm judgment of an act present when there is no sure judgement without any fear of being in error. The person of whether an act is good or bad. In this has a firm conviction and belief of what his state, the agent is aware of the conscience dictates on him without any possibility that what his conscience tells hesitation and awareness that he may be in him is erroneous. error.  Lax vs Scrupulous Lax conscience is a type of conscience Scrupulous conscience is a type of which perceives even morally grave evils conscience which perceives evil in as allowable. It finds and makes excuses an act when there is none. In a way, of evil acts though seriously evil by it is the opposite of laxity. rationalizing and justifying them. FORMATION OF CONSCIENCE A formed and informed conscience is that which knows how to make a proper judgement on an act as truly good to be done or truly evil to be avoided in its three moral determinants, namely: (a) the act itself; (b) the motive of an agent; and (c) the circumstances surrounding the act.  LAW, CONSCIENCE AND HEALTH CARE The practice of health care is harmoniously aligned to the mandate of natural law order to ensure and sustain the natural order of man's existence in the realm of his health condition. Health care practice is a means by which the natural order of things in the realm of health is sustained and restored. By its nature, health care practice is of the natural order of things. Thus, to keep health care practice within the precepts of the natural law, a well formed and informed conscience is necessary to make proper judgment on human action in the health care delivery system. THEORIES AND PRINCIPLES IN HEALTH CARE ETHICS  TELEOLOGY Judge the rightness or wrongness of decisions based on outcomes or predicted outcomes. “The right thing to do, is the good thing to do.” Ethical Egoism is a teleological ethical theory that posits that an action is good if it produces or likely to produce results that maximize the person’s self-interest which the person himself defines. Even at the expense of others. It is based on the notion that it is always right to promote one’s own good. Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes. It is a form of consequentialism. HEDONIC CALCULUS Eudaimonism posits that an action is good if it results in the fulfillment of goals along with the welfare of the human beings. The actions are said to be fruitful if it promotes or tends to promote the fulfillment of goals that constitute human nature and its happiness  DEONTOLOGY The word deontology derives from the Greek words for duty (deon) and science (or study) of (logos). The basic rightness or wrongness of an act depends on its intrinsic nature rather than on the situation or the consequences. “An act in itself would be either right or wrong; it could not be both.”  KANTIAN ETHICS Immanuel Kant (1724–1804) argued that the supreme principle of morality is a principle of practical rationality that he dubbed the “Categorical Imperative” (CI). Kant characterized the CI as an objective, rationally necessary and unconditional principle that we must follow despite any natural desires we may have to the contrary. All specific moral requirements, according to Kant, are justified by this principle, which means that all immoral actions are irrational because they violate the CI. CATEGORICAL IMPERATIVE Respect of Persons Principle CATEGORICAL IMPERATIVE UNIVERSIZABILITY PRINCIPLE  RAWL’S ETHICS John Rawls (b. 1921, d. 2002) was an American political philosopher in the liberal tradition. His theory of justice as fairness describes a society of free citizens holding equal basic rights and cooperating within an egalitarian economic system. Rawls' theory is oriented toward liberalism and forms the basis for what law enforcement, and the criminal justice system, should strive for in a pluralistic and liberal society. Borrowing from some concepts of social contract theory, Rawls envisions a society in which the principles of justice are founded in a social contract. Rawls further addresses ethics in the individual, though this is not the central tenet of his theory, and is somewhat of a general statement of how moral people should behave.  Justice as Fairness Equal Liberty Principle "Each person is to have an equal right to the most extensive basic liberty compatible with a similar liberty for others". Rawls goes further by allowing each person to engage in activities, as long as he or she does not infringe on the rights of others. Difference Principle "Social and economic inequalities are to be arranged so that they are both (a) reasonably expected to be to everyone's advantage (b) attached to positions and offices open to all…". Likewise, everyone should share in the wealth of society and everyone should receive benefits from the distribution of wealth. Rawls does not argue that everyone should be paid the same, but rather that everyone should have benefit from a fair income and have access to those jobs that pay more.  ROSSIAN ETHICS Sir William David Ross was a British philosopher, college administrator, WW I veteran, civil servant, and humanities scholar best known for his important contributions to moral philosophy and the study of classical literature. Ross held that monistic ethical theories, such as utilitarianism and Kantian ethics, oversimplify morality and are counter-intuitive. As a pluralist, Ross believed that there are multiple fundamental moral principles. He called them prima facie duties. This essay introduces Ross’s theory, which is often called intuitionism.  Prima Facie Duty A prima facie duty is a duty that is binding (obligatory) other things equal, that is, unless it is overridden or trumped by another duty or duties.  PRIMA FACIE DUTIES 1. Fidelity. We should strive to keep promises and be honest and truthful. 2. Reparation. We should make amends when we have wronged someone else. 3. Gratitude. We should be grateful to others when they perform actions that benefit us and we should try to return the favor. 4. Non-injury (or non-maleficence). We should refrain from harming others either physically or psychologically. 5. Beneficence. We should be kind to others and to try to improve their health, wisdom, security, happiness, and well-being. 6. Self-improvement. We should strive to improve our own health, wisdom, security, happiness, and well- being. 7. Justice. We should try to be fair and try to distribute benefits and burdens equably and evenly.  NATURAL LAW THEORY According to natural law moral theory, the moral standards that govern human behavior are, in some sense, objectively derived from the nature of human beings and the nature of the world. While being logically independent of natural law legal theory, the two theories intersect.  7 Basic Goods 1. Life 2. Reproduction 3. Educate one’s offspring 4. Seek God 5. Live in society 6. Avoid offense 7. Shun ignorance OTHER THEORIES RELEVANT TO HEALTH CARE ETHICS  RELATIVISM Subjective Relativism Right and wrong for each person are decided by themeselves. What’s wrong for someone may be right for someone else. Cultural Relativism Right and wrong depend on society’s moral guidelines. This guidelines vary from place to place and from time to time. An action can be right in a certain soceity at one time and wrong in another soceity or at another time. VIRTUE ETHICS  VIRTUE ETHICS -Originated in Ancient Greece and associated with Plato and Aristotle -Moral conduct is not determined by universal code of conduct or an outcome of a specific action but by specific personal traits that guarantee the right choice in front of moral dilemmas. -Ethical value is determined by character which refers to virtues, inclinations and intentions that dispose a person to be ready to act ethically. The Golden Mean  What is virtue? Virtue refers to excellence in character. Purposive dispositions and character traits that are developed throughout life. These are praiseworthy traits of human character. Schools, social institutions, and families help to shape a person’s moral character. FOUR CARDINAL VIRTUES FOUR CARDINAL VIRTUES FOUR CARDINAL VIRTUES Virtues of the Health Care Provider FIDELITY COMPASSION HONESTY PRUDENCE HUMILITY COURAGE RESPECT  Virtue Based Nursing Model The model implies that as nurses go about in their day-to-day activities they are aware that this routine may give them dissatisfaction from their profession. But they are also aware that they have to focus less on their dissatisfaction instead, they need to carry on with their work.