Theories and Principles of Health Ethics PDF

ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 CONTENTS...

ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 CONTENTS He said we have an obligation to do the right thing. Duty I. INTRODUCTION TO THE COURSE II. THEORIES AND PRINCIPLES IN HEALTH ETHICS Ethics say we have a duty to achieve good. A. ETHICAL THEORIES 1. Deontology IMMANUEL KANT 2. Teleology 3. Utilitarianism He defined… B. VIRTUE ETHICS 1. did not like a morality based on laws, church laws 1. Virtue ethics in Nursing 2. Core values of a professional nurse 2. morality has its roots/foundation in the condition of C. ETHICAL PRINCIPLES goodwill among people 1. AUTONOMY 3. we have an obligation to do the right thing a. Patient’s Rights b. Patient’s Bill of Rights 4. people/actions are moral when they achieve the c. Informed Consent good/goodwill d. Proxy Content/Legally Acceptable Representative e. Confidentiality 5. morality is discovered by pure reason not by law or f. Privacy consequences 2. CONFIDENTIALITY a. Truth telling and right to information 6. Place special emphasis on the relationship between duty 3. VERACITY and the morality of human actions. 4. FIDELITY 5. JUSTICE 7. Holds that the basic standards for an action’s being 6. BENEFICENCE morally right are independent of the good and evil 7. NON-MALEFICENCE generated. 8. It holds that at least some acts are morally obligatory regardless of their consequences for human welfare. ETHICS 9. An action is considered morally good because of some characteristics of the action itself, not because the Ethics is the branch of philosophy that deals with the product of the action is good. principles of morality and the well-defined standards of right and wrong that prescribes the human character and KANT’S CONCEPTS conduct in terms of obligations, right, rules, and benefit to Reason society and fairness. o Foundation of a sound ethics (reason in itself can only be the sensible foundation of what is ethical It is divided into two different ways of looking at the for man) morality of humanity. These are: o Functions as the very effort to think through Consequential - the outcome determines the moral principles and apply what he/she knows to morality of the act. get to the right thing to do. Non-consequential- the source of morality Goodwill – source/origin of ethical obligation comes from something else such as law, God’s o What is morally binding is rooted in reasons as law, moral law, sense of duty and your definition “doable for the human person” of what is the virtuous thing to do. o the good that is relevant to the person who through his/her reason knows what one ought to do, is that which he/she can do ETHICAL THEORY and known as good. (He/she is of his/her own Is the systematic effort to understand moral concepts and doing able to carry out his/her obligation) justify moral principles. Duty – motivation for reason and goodwill of the human person DEONTOLOGY o It is that which the reason determines as our Greek: deon “duty” and logos “science” obligation Deontology is an ethical theory that uses rules to o Doable good for the human will (since it is the distinguish right from wrong. It is often associated with doable obligation for the human person, it is not a duty is it is impossible for a man to do it) philosopher Immanuel Kant. Category of normative ethical theories that encompasses RULES OF DEONTOLOGY any theory which is primarily concerned with adherence to First, act only according to that maxim (rule), which can be certain rights or duties (duty-centered theory). a universal law for all people in all circumstances. He said there’s one thing that human beings have in Second, the calls for the principle of Reversibility. It says, common, and that is the ability to reason. Pure reasoning the maxim (rule) is right if one would want to be treated is the source of morality. that way themselves. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 Third, do not use others as a (mere) means to one’s end. According to Aristotle: "Every action and purpose may be This is called Practical Imperative. said to aim at some good" Every action that we do aims on achieving as a supreme APPLICATION IN NURSING PRACTICE good and this is our general purpose Healthcare providers should act in such a way that any Example: In the human excellence, when someone strives to other provider making the same decision would be do good purpose or the supreme good they develop good justified and considered acting morally. habits out and get their virtues. A clinical-based application of Kant’s ethical theory to Happiness is another foundation of Aristotle's teaching. It client care involves disclosing medical errors to clients. can only be found in the context of the community as we Many barriers surround disclosing errors to clients, used other people to find good task to perform. including fear of litigation, shame about the error, and It is a results-oriented approach that defines ethical lack of training on how to discuss errors with clients. behaviour by good or bad consequences. These barriers and organizational culture influences may It justifies inherently what most people would call evil acts lead providers to believe that bringing the error to light by their desirable outcomes, if the good of the outcome does more harm than good. However, applying Kant’s outweighs the bad of the act. deontological theory to this type of decision clearly favours truth telling and full disclosure of errors. TYPES OF TELEOLOGY According to Gallagher, patients want their providers to 1. Natural teleology: hypothetically, the inherent purpose show respect for them by being honest about errors. Part or end of a natural entity; in Aristotle’s classic example, of the disclosure process involves issuing an apology for the oak tree is the natural purpose of the acorn. the error, which is an important move in the direction of 2. Cybernetics: the study of mechanical systems with built in soothing distress, maintaining a trusting client-provider goals, e.g. a thermostat, a self-adjusting valve, or the relationship, and restoring client dignity. human metabolism; note that robots and artificial intelligences will all incorporate cybernetics when they Pro’s Con’s eventually work. Creates a foundation for human Creates a paradox 3. Consequentialism: any philosophy claiming that “the conduct ends justify the means,” such as utilitarianism. In other Creates higher levels of Becomes useful as supernatural personal responsibility excuses words, teleological ethics. Creates moral absolutes A matter of subjective opinion Emphasizes the value of every Do not incorporate self-defense APPLICATION IN NURSING PRACTICE person ideas 1. A pregnant woman about to give birth but due to so many Provide certainty Based on actions that we take complications only one can be saved, the mother or child. Suggest You should always do As per the nurse, you need to decide which one has the the right thing no matter what higher survival rate and inform the family. Absolutist 2. Most people would agree that lying is wrong. But if telling a lie would help save a person’s life, consequentialism says TELEOLOGY it’s the right thing to do. An example of this is when we tell Greek: telos, “end”; logos, “reason” a patient or their relatives that they are going to be fine Finality when we know that they will probably not survive the Reason or explanation for something as a function of its night, we tell this things to be tactful and save the patient end, purpose, or goal. from the concern. Any philosophical account that holds that final causes -IN TEOLOGY, THE ENDS JUSTFIES THE MEANS- exist in nature, meaning that, analogous to purposes found in human actions, nature inherently tends toward UTILITARIANISM definite ends. An ethical theory that determines right from wrong by Teleology is the study of the ends or purposes that things focusing on outcomes and treats intentions as irrelevant. serve, and Aristotle's emphasis on teleology has A form of CONSEQUENTIALISM. (good repercussions throughout his consequences=good actions) philosophy. Aristotle believed that the best way to Most ethical choice=one that produces the greatest good understand why things are the way they are is to for the greatest number. understand what purpose they were designed to serve. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 A HEDONISTIC MORAL THEORY (good=pleasant)- we STRENGTH WEAKNESS ought morally to pursue good and happiness, and work to ✔ A possible answer for ✔ It is difficult to predict the avoid pain. every situation, it is an consequences. is a philosophy or belief suggesting that an action is absolute system. morally right if the majority of people benefit from it ✔ It gets at the substance of ✔ It is difficult to define It also advocates actions that foster happiness or pleasure morality because it has a what constitutes and opposes actions that cause unhappiness or harm material core: promoting happiness. Actions should be measured in terms of the happiness or human good and pleasure that they produce. (happiness=final end) alleviating pain. ✔ There is no defense for PROPONENT OF MODERN UTILITARIANIS minorities. JEREMY BENTHAM (1748-1832) ✔ Regarded as the founder of Modern Utilitarianism. THE GREATEST HAPPINESS PRINCIPLE “It is the greatest happiness of the greatest Actions are considered moral when they promote the number that is the measure of right and wrong.” Provided the Bentham’s Felicific/Hedonistic Calculus- utility and immoral when they promote the reverse. a method or guide to balance the pros and cons of a The main elements of this philosophy are one’s actions proposed course of action in relation to the balance and their resulting utility. of pleasures and pains it potentially produces. In order for the action to be moral, it must be the optimal choice in increasing utility and minimizing pain. FACTORS AND QUESTIONS TO CONSIDER ON BENTHAM’S FELICIFIC THE ULTIMATE SANCTION 1. Intensity: How strong is the pleasure? According to Mill: 2. Duration: How long does the pleasure last? It is man's "feeling for humility" that constitutes the 3. Certainty or Uncertainty: How likely or unlikely that the ultimate sanction of the principle of utility. pleasure will occur? 4. Propinquity or Remoteness: How soon does the pleasure External Sanction occur? One's fear of displeasing God 5. Fecundity: What is the probability that the action is Fear of disapproval from other people followed by sensations of the same kind? 6. Purity: What is the probability that it is not followed by Internal Sanction sensations of the opposite kind? Conscience is the internalization of the external sanctions 7. Extent: How many people are affected? of morality that feels remorse each time one acts without considering first the effect or consequences of one's JOHN STUART MILL (1806-1873) action in other people’s lives. ✔ His Utilitarian Theory of Morality is a development and clarification of the theory created by Jeremy Bentham. MILL’S REPLIES TO THE OBJECTIONS OF UTILITARIANISM ✔ Predominance of Pleasure over Pain. Mill’s Replies: ✔ Highlighted distinction between qualities and quantities of ❑ If the objectors define happiness as a continuity of highly pleasures and pains. pleasurable excitement, then it is true that such a life is indeed impossible. 2 TYPES OF UTILITARIANISM ❑ Those who find no happiness are generally those who care ACT-UTILITARIANISM: for no one but themselves and those who have cultivated An act is right if and only if it results in as much good as friendships and have left a lasting legacy of fellow feeling any available. for mankind retain their happiness in any circumstances. ❑ Some experience difficulties in being happy because they RULE-UTILITARIANISM: An act is right if it conforms to a valid rule if it conforms to lack mental cultivation. a valid rule within a system of rules whose acceptance ❑ Therefore, HAPPINESS is attainable if one understands it leads to greater utility for society. realistically and lives one’s life in solidarity with others and cultivates one’s deeper capacity to enjoy that which endures in the transitory. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 To the objection that UTILITARIAN MORALITY IS rights and duty. For utilitarianism, we have to follow or do things INCOMPATIBLE WITH SELF SACRIFICE and aim to create healthcare policies which promote for the Mill’s Replies: greatest number of patients. For teleology, we have to be careful of ❑ Utilitarianism does recognize the goodness of self- our actions so we can avoid bad consequences that might result sacrifice which places the welfare of others over and from our actions. above one’s own but only the extent that it is done for the One principle is not superior to the other. There should be a sake of promoting the greatest happiness of the greatest balance. number and for no other reason it is acceptable other than this. ❑ If self-sacrifice is merely done for its own sake, utilitarian ETHICAL PRINCIPLES sees it as a waste. Ethical principles are general standards of conduct that ❑ Utilitarianism upholds the belief that a truly moral person make up an ethical system. always tries to incorporate the good of others in every decision he makes. By this view, an action or decision is generally considered morally right or good when it accords with a given To the objection that SOCIAL CONCERN IS A RARE MOTIVE FOR relevant moral principle, and morally wrong or bad when it ACTION does not. Mill’s Replies: ETHICAL PRINCIPILISM ❑ Do people actually have society in mind whenever they the view that ethical decision-making and problem solving choose a course of action? is best undertaken by appealing to sound moral principles ❑ For Mill, a distinction must be made between the motives ETHICAL PRINCPLES: and the consequences of one’s actions with respect to autonomy, which of the two is the basis for judging an act to be moral non-maleficence or not. The act itself is moral so long as it promotes the beneficence good of the greatest number. justice From other references: Veracity APPLICATION IN NURSING PRACTICE Utilitarianism would assume that the core values of nursing can all Fidelity be explained by the effects that decisions have on patients, families, Confidentiality health professionals, or other stakeholders. VIRTUE ETHICS EXAMPLES: 1. In relation to the principle of utility, this states that an act Its primary focus is the heart of the moral agent making must result in the greatest amount of good for the the decision rather than the reasoning to a right action. greatest number of people involved in a situation. Often, It is primarily about personal character and moral habit individuals attempt to use utilitarian theory when they development rather than a particular action. seek to divide scarce resources such as healthcare. They Emphasizes being rather than doing. might justify the denial of a single individual access to a The term given to an approach that has a focus on heart transplant if the money could be spent on providing character. More specifically, it focuses on the character of vaccine for thousands. the actor or agent. 2. Triage System- triage’s purpose is to save as many lives Emphasizes that character guides conduct. Lead to holiness. and prevent as much disability as possible. However, in Requires that those who wish to act good need to develop doing this, healthcare providers like nurses, sometimes good traits of character. tend to ignore bioethics that usually govern medical It means building up our character by doing the right thing practice and protect individual patients. But if they defy always BUT IN THE the bioethics and saved many lives as their action’s consequence, it would still be the right thing to do 1. Right time regardless of the action being right or wrong based on 2. Right way laws. 3. Right amount 4. Right people CONCLUSION General Principle: We should always act in accordance These three principles are very vital in nursing practice. For with the virtues or as a truly virtuous person would. deontology, we have to use our reasons in order to balance our COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 Asks the Questions: HONESTY AND TRUST AS A VIRTUE 1. “What sort of person should I be?” Honesty - one of the cornerstones of the nurse-patient 2. “If I act in such and such a way, would I be acting in a relationship. way that was virtuous?” Trust – this must be earned, because if there is distrust on the part of the patient, it could be because the nurses fail Virtue Ethics in Nursing to perform what is necessary for the patient. The least Can be viewed as an approach of ethical deliberation that nurses as moral agents acting in the situation can do about the moral character and dispositions of nurses as is not to violate this trust. moral agents that enables them, as virtuous human beings, to fulfil their purpose and function as professional PRACTICAL WISDOM AS A VIRTUE people, Enables the nurse as a moral agent to know what action is It implies a characteristic habit that allows the nurse to correct in specific situation. To this effect, virtues enable become a good practitioner who behaves well, the nurse to discover the relevant moral aspects of a An approach to moral dilemmas in nursing. On the moral dilemma and to interpret,judge and evaluate them and as well to apply the rules, principles and moral contrary, decision making about moral issues in health theories wisely to a situation in order to resolve the care demands that nurses exercise rational control over dilemma. emotions. This clearly focuses the attention on the nurse as moral agent and in particular their character, TWO KINDS OF VIRTUES Virtue is important because it reminds us that nursing is “reflective practice.” Nursing is not just delivering MORAL VIRTUE something to the patient; it is becoming a certain kind of Those that relate to a person's character ------> enables person-we do, we learn, we reflect, we become, mind-set the nurse to act in accordance with the right reason. of what is right or good to be based on duty to achieve good consequences, INTELLECTUAL VIRTUE Concerns character of individual nurses and seeks ways to Those that relate to a person’s intellect ----> enables the enable nurses to develop character traits appropriate for nurse to reason well. actions that enhance well-being; Weighing obligation and values. Core Values of Professional Nurses CHARACTER- The focus and guide when a Nurse acts. Agent-based ethics tends towards asking: ‘what sort of ALTRUISM person should I be?’ concern for the welfare and wellbeing of others; do things for other people with the other person’s well- CARE AS A VIRTUE being in mind, like a sense of duty; Care is and should be a central characteristic of nursing. In professional practice, altruism is reflected by the nurse’s 1. Natural care - refers to situations where people act voluntarily in concern and advocacy- for the welfare of patients, other the interest of others. nurses, and other healthcare providers. 2. Ethical care - arises from natural care. Requires that nurses put the needs of their patients before RESPECT AND INTEGRITY AS VIRTUES their own needs, which can be difficult at times. Respect - demonstrate sensitivity to the differences in the AUTONOMY views that people as human beings might hold and learn the right to self-determination; to understand them even if we disagree. professional practice reflects autonomy when the nurse Integrity - being faithful to one’s commitments; it focuses on nurses as people and their dedication to their patients. respects patients’ rights to make decisions about their health care; JUSTICE AND COURAGE AS VIRTUES Means that nurses should be sure patients have all the Justice – is a principle (implies fairness and equality) and a needed information that is required to decide about their virtue (enables the nurse to have an awareness of, and a medical care and are educated. The nurses do not special concern for, the vulnerability of a patient) influence the patient’s choice; Courage - a courageous nurse is capable of free thought, Also refers to nurses acting independently within their undertakes responsible actions and carries them out scope of practice. REASON AS A VIRTUE HUMAN DIGNITY Reason implies the use of abstract rules and principles to is respect for the inherent worth and uniqueness of make decisions or solve problems. Nurses as moral individuals and populations; agents also need a certain disposition to use their reason. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 is a vague, complex, multidimensional, and fundamental The principle of autonomy, however, is a little different, concept in the nursing profession; which basically means that people should be free to in professional practice, concern for human dignity is choose and entitled to act on their preferences provided reflected when the nurse values and respects all patients their decisions and actions do not stand to violate the and colleagues and treating everyone as a unique human significant moral interests of others. being; Autonomy refers to the ability of competent individuals to in moral codes, it is a duty and a human right, and in the make decisions over their own lives and in order for nurses’ workplace, amoral obligation; autonomy to be meaningful, a competent individual’s “Having respect for the inherent worth and uniqueness of decisions should be respected even when those decisions individuals, families, and communities and it characterizes conflict with what others believe to be reasonable all interactions a nurse should have with them” - the root In addition, In order to act autonomously, a patient ought of all values that nurses exemplify in their day-to-day to have full access to all information available in order to interactions with patients. be able to make a decision regarding their own welfare. This puts a heavy burden of disclosure on the physician, INTEGRITY including information that would allow the patient to is acting in accordance with an appropriate code of ethics reject treatment. and accepted standards of practice; Autonomy is the freedom and ability to act in a self- reflected in professional practice when the nurse is honest determined manner. It represents the right of a rational and provides care based on an ethical framework that is person to express personal decisions independent of accepted within the profession; outside interference and to have these decisions honored. according to National League of Nursing, a culture of integrity is evident when organizational principles of open It can be argued that autonomy occupies a central place in communication, ethical decision-making, and humility are Western healthcare ethics because of the popularity of the encouraged, expected, and demonstrated consistently; it Enlightenment-era philosophy of Immanuel Kant. demands truthfulness and honesty; However, it is noteworthy that autonomy is not Nursing professionals must also consider the integrity of emphasized in an ethic of care and virtue ethics, and these patients. Nurses should be cognizant of the ways in which also are popular approaches to ethics today. they can violate a patient’s integrity while caring for them. Self- governing SOCIAL JUSTICE Freedom to make choices about issues that affect is acting in accordance with fair treatment regardless of one’s life economic status, race, ethnicity, age, citizenship, Respect for persons; unique and valuable members disability, or sexual orientation; of the society core nursing value and the foundation of public health Free to choose and implement one’s own decision, nursing; free from lies, restraint or coercion Its ideology requires nursing students to uphold moral, legal, and humanistic principles related to health. As such, This principle assumes rational thinking on the part of the teaching social justice requires a basis in moral individual and may be challenged when the rights of developmental theory; others are infringed upon by the individual implies that there is a fair and equitable distribution of benefits and burdens in a society; Lies, restraints, coercion = wrong decision Nurses uphold moral, legal, and humanistic principles by No matter what, we must let patients decide for himself ensuring equal treatment and health care under the law. AUTONOMY * Autonomy is NOT absolute. The term ‘autonomy’ comes from the Greek term: autos- Factors that affect decision: ‘self’, nomos- ‘rule’, ‘governance’ or ‘law’ Emotions When autonomy is used as a concept in moral discourse, Time what is commonly being referred to is: a person’s ability to make or to exercise self- Consider this: determining choice What if the patient wants to do something that will cause treating or respecting persons as ends in harm to him/herself? Under what circumstances can the themselves, as dignified and autonomous healthcare team intervene? choosers, and not as the mere means (objects or tools) to the ends of others. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 Examples: accommodate people’s personal preferences, health 1. Elsa goes to the doctor because she has a beliefs, health values and health practices. vaginal discharge. She however refuses to talk If nurses are to respond to this sense of right to health and about her personal life health care, they need to gain knowledge and 2. Mia, 16, is afraid of injections and hospitals. She understanding of their patients’ health beliefs and health has acute appendicitis and needs surgery but practices and to negotiate ways in which these can be she refuses accommodated and met appropriately. Criteria in determining the decision making capacity of an individual: 3. The right to quality care 1. the ability to comprehend information relevant to the decision at hand A right to quality care is the third sense which concerns the accountability, responsibility and competency of 2. the ability to deliberate in accordance with his or health professionals and health care providers, and about her own values and goals the standard of care that is actually delivered. 3. the ability to communicate with caregivers 4. The right to safe care PATERNALISM It is generally accepted that all people receiving health Deliberate restriction of people’s autonomy by health care care have the right to be safe. This right has been professionals based on the idea that they know what’s interpreted to mean the right to be kept free of danger or best for the clients - can be justifiable at times risk of injury while in health care domains. Not everything legal is ethical and vice versa Doing good should take precedence over autonomy B. PATIENT’S BILL OF RIGHTS The American Hospital Association presents A Patient's Bill of Rights with the expectation that it will contribute to A. PATIENTS RIGHTS What are patients’ rights? more effective patient care and be supported by the hospital on behalf of the institution, its medical staff, To put it simply, patients’ rights are a employees, and patients. subcategory of human rights. It is important to clarify that patients’ rights 1. Right to Appropriate Medical Care and Humane Treatment. statements tend to include a mixture of civil rights, legal rights and moral rights. Every person has a right to health and medical care corresponding to his state of health, without any THE RIGHT TO HEALTH AND HEALTH CARE discrimination and within the limits of the resources, In keeping with the Universal Declaration of manpower and competence available for health and Human Rights, all people have the right to medical care at the relevant time. health. The World Health Organization (WHO 2002a) has clarified that the right 2. Right to Informed Consent. to health does not entail the right to The patient has a right to a clear, truthful and substantial be healthy, but the right to the highest explanation, in a manner and language understandable attainable standard of health. to the patient, of all proposed procedures, whether 1. The right to equal access to health care diagnostic, preventive, curative, rehabilitative or therapeutic. Access to health care refers to ‘whether people who are — or should be — entitled to health care services receive 3. Right to Privacy and Confidentiality. them’ (Emanuel 2000: 8). The right to equal access to The privacy of the patients must be assured at all stages of health care raises questions of distributive justice and of his treatment. The patient has the right to demand that all how the benefits and burdens associated with health care information, communication and records pertaining to his service delivery ought to be distributed. care be treated as confidential. 2. The right to have access to appropriate care The patient has the right to privacy and protection from The right to have access to appropriate care is a second unwarranted publicity. sense in which a right to health care can be claimed. This Include the patient's right not to be subjected to exposure, sense concerns the cultural competency and cultural private or public, either by photography, publications, safety of care as well as its ability generally to video-taping, discussion, or by any other means that would otherwise tend to reveal his person and identity and COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 the circumstances under which he was, he is, or he will be, The patient has the right to refuse medical treatment or under medical or surgical care or treatment. procedures which may be contrary to his religious beliefs: Provided, That such a right shall not be imposed by 4. Right to Information. parents upon their children who have not reached the In the course of treatment and hospital care, the patient legal age in a life threatening situation as determined by or the legal guardian has a right to be informed of the the attending physician or the medical director of the result of the evaluation of the nature and extent of the facility. disease, medicines to be administered and their generic 9. Right to Leave. counterpart including the possible complications, and the person's participation in the plan of care and necessary The patient is entitled to a summary of his medical history changes before its implementation. and condition. Right to examine and be given an itemized bill of the The health care institution shall safeguard the hospital and medical services rendered in the facility or by confidentiality of the medical records and to likewise his/her physician and other health care providers, ensure the integrity and authenticity of the medical record regardless of the manner and source of payment The patient has the right to leave hospital regardless of his Right to be informed by the physician or his/her delegate physical condition. Provided that: of his/her continuing health care requirements following ○ he is informed of the medical consequences of discharge, his/her decision The patient is entitled to a brief, written summary of the ○ he releases those involved in his/her care from course of his/her illness which shall include at least the any obligation relative to the consequences of history, physical examination, diagnosis, his decision 5. The Right to Choose Health Care Provider and Facility. ○ his decision will not prejudice public health and safety The patient has the right to seek for a second opinion and subsequent opinions, if appropriate, from another 10. Right to Refuse Participation in Medical Research. health care provider. Every patient has the right to health education that will The patient has the right to leave hospital or any other assist him/her in making informed choices about personal health care institution regardless of his physical condition health and about available health services. No patient shall be detained against hi$/her will in any 6. Right to Self-Determination. health care institution on the sole basis of his failure to fully settle his financial obligations. The patient has the right to avail himself/herself of any recommended diagnostic and treatment procedures. The patient has the right to be advised if the health care provider plans to involve him in medical research, The patient is free to choose the health care provider to including but not limited to human experimentation which serve him as well as the facility except when he is under may be performed only with the written informed consent the care of a service facility or when public health and of the patient: safety so demands or when the patient expressly waives ○ Department of Health shall safeguard the this right in writing. continuing training and education of future health care provider to ensure the development 7. Right to Religious Belief. of the health care delivery in the country. The patient has the right to refuse medical treatment or ○ The patient involved in the human procedures which may be contrary to his religious beliefs. experimentation shall be made aware of its The patient has the right to avail himself/herself of any respective guidelines. recommended diagnostic and treatment procedures. 11. Right to Correspondence and to Receive Visitors. 8. Right to Medical Records. The patient has the right to communicate with relatives The patient is entitled to a summary of his medical history and other persons and to receive visitors subject to and condition, the contents of his medical records, except reasonable limits prescribed by the rules and regulations psychiatric notes and other incriminatory information. of the health care institution. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 The Patient has the right to refuse diagnostic and medical procedure; it’s possible effects, risks, and benefits, and treatment procedures, provided that the following the available medical options. conditions are satisfied; Nurses should provide precise and simple explanations and see to it that their patients comprehend the The Patient is of legal age and is mentally competent; information by asking them questions and by letting The Patient is informed of the medical consequences of them speak their mind. his/her refusal; The goal of informed consent is to assure patient The Patient's refusal will not jeopardize public health and autonomy. safety. a. Rights of Unconscious Patients 12. Right to Express Grievances. If the patient is unconscious or otherwise unable to The patient has the right to express complaints and express his/her will, informed consent must be obtained grievances about the care and services received without whenever possible, from a legally entitled fear of discrimination. representative.In all cases, a physician always strives to save the life of a patient unless a prior explicit written The patient has the right to be advised if the health care document states otherwise (Do Not Resuscitate provider plans to involve him in medical research, including but not limited to human experimentation b. Rights of Legally Incompetent Patient which may be performed only with the written informed The consent of a legally entitled representative is consent of the patient. required. 13. Right to be Informed of His Rights and Obligations as a If a legally incompetent patient can make rational Patient. choices, decisions must be respected and he/she has the right to forbid disclosure of information to his/her legally Every person has the right to be informed of his rights and entitled representative. obligations as a patient. Also, it shall be the duty of health care institutions to inform of their rights as well as of the c. Procedures against the Patient’s Will institution's rules and regulations that apply to the Diagnostic procedures or treatments against the patient’ s will can conduct of the patient while in the care of such institution. be carried out only in exceptional cases, if specifically permitted by law and conforming to the principles of medical ethics. The patient has the right to communicate with relatives and other persons and to receive visitors subject to What is involved in an informed consent? reasonable limits prescribed by the rules and regulations of the health care institution. Legally, this requires that the patient is informed of the risks, benefits, and alternatives to a treatment. 14. Right to Express Grievances A signature on the consent form provides legal documentation of consent. The patient has the right to express complaints and Consent may be withdrawn at any time. Healthcare grievances about the care and services received without providers must accept and support refusal or withdrawal fear of discrimination or reprisal and to know about the of consent even if they disagree with the patient. disposition of such complaints. What can nurses do to improve informed consent? 15. Right to be Informed of His Rights and Obligations as a Patient Think about consent as a process to assure patient understanding and agreement, not just signing a form. It shall be the duty of health care institutions to inform of Informed consent should be a collaborative their rights as well as of the institution's rules and activity between the physician, nurse, and patient. The regulations that apply to the conduct of the patient while physician should have obtained consent before the nurse in the care of such institution. has the patient sign a form. C. INFORMED CONSENT: AN ETHICAL WAY OF NURSING Nurses can offer what we do best—patient teaching. INFORMED CONSENT However, our teaching cannot take the place of prior refers to the patient’s deliberate and voluntary physician / patient shared decision-making. acceptance of a health care procedure which presupposes To note: sufficient disclosure of the nature and the goal of the COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 Remember that informed consent is a way of nursing each of us needs This is particularly important given the often sensitive and to live out as we offer our patients ethical practice and quality nursing personal nature of the information that medical care. practitioners can acquire, and the damaging ways in which such information could be used. Confidentiality is vital when working confidential within D. PROXY CONTENT/LEGALLY ACCEPTED the healthcare sector. You are privilege to information REPRESENTATIVE Proxy consent is the process by which people with the that should only be shared with others for the benefit of legal right to consent to medical treatment for themselves the patient. or for a minor or award delegate that right to another The intent of maintaining confidentiality is to afford An individual or other body authorized under applicable protection of patients from the harms of stigma, potential law to represent the interest of an individual including embarrassment, socio-economic manifestations, and illicit providing consent on behalf of the prospective subject to use of information. the subject’s participation in a clinical test. Despite patient confidentiality being a key priority, They are individuals who can, in accordance with the law, circumstances exist where information disclosure is provide consent on behalf of the patient who is incapable demanded. In the safeguarding of children or vulnerable of giving or who has diminished capacity to give informed adults, disclosure is required to prevent harm or prevent consent. criminal activity from occurring. Disclosure must be A surrogate or proxy decision-maker is charged with approached carefully due to the continuing need to making decisions on behalf of the patient to the best of his protect patients’ personal information. or her knowledge of what the patient would have wanted Confidentiality is one of the core duties of medical had the patient been able to express his or her own practice. The obligation of confidentiality prohibits the desires. Also they are charged with deciding on behalf of health care provider from disclosing information about the patient consistent with their understanding of the the patient's case to others without permission and patient’s best interests. encourages the providers and health care systems to take Further, if a surrogate has not been appointed a situation precautions to ensure that only authorized access occurs. may arise wherein family members argue about what the Patients routinely share personal information with health best course of action is for their elderly relative, which can care providers. If the confidentiality of this information place the health care team in the unenviable position of were not protected, trust in the physician-patient having to resolve the dispute. relationship would be diminished. Creating a trusting environment by respecting patient There are three fundamental constraints on this privacy encourages the patient to seek care and to be as delegation: honest as possible during the course of a health care visit. 1. The person making the delegation must have the right It may also increase the patient’s willingness to seek care. to consent. Appropriate care often requires that information about patients be discussed among members of a health care 2. The person must be legally and medically competent to team; all team members have authorized access to delegate the right to consent. confidential information about the patients they care for and assume the duty of protecting that information from 3. The right to consent must be delegated to a legally and others who do not have access. medically competent adult. There are two types of proxy The 6 Principles of Confidentiality consent for adults. The first, the power of attorney to 1. Justify the purpose(s) consent to medical care, is usually used by patients who want medical care but are concerned about who will Every proposed use or transfer of patient identifiable consent if they are rendered temporarily incompetent by information within or from an organization should be the medical care. A power of attorney to consent to clearly defined and scrutinized, with continuing uses medical care delegates the right to consent to a specific regularly reviewed, by an appropriate guardian. person. The second type is the living will. 2. Don't use patient identifiable information unless it is absolutely E. CONFIDENTIALITY necessary Confidentiality protects the autonomy of patients by allowing them to control information about themselves. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 Patient identifiable information items should not be In Kant's theory, autonomy is a fundamental value of included unless it is essential for the specified purpose(s) being a human. If privacy constitutes an essential to of that flow. The need for patients to be identified should autonomy and autonomy cannot be understood without be considered at each stage of satisfying the purpose(s). privacy, then losing privacy poses a threat to our most fundamental values 3. Use the minimum necessary patient-identifiable information Privacy, besides being a fundamental quality of human beings and bearing an essential value in its own right, is an Where use of patient identifiable information is instrumental 'good' that enable individuals to achieve considered to be essential, the inclusion of each individual other good values. If privacy constitutes an essential to item of information should be considered and justified so autonomy and autonomy cannot be understood without that the minimum amount of identifiable information is privacy, then losing privacy poses a threat to our most transferred or accessible as is necessary for a given fundamental values. function to be carried out. Privacy is the right to autonomy and comprises the right to be left alone. It provides individuals with the right to 4. Access to patient identifiable information should be on a strict control the information related to them, including the need-to-know basis restriction of access to this information. It also involves Only those individuals who need access to patient the right to keep secrets confidential and to share them identifiable information should have access to it, and they only in private conversations should only have access to the information items that they Privacy is important as it provides a secure environment need to see. This may mean introducing access controls or for patients where they receive medical care and provide splitting information flows where one information flow is complete and accurate information, and which reinforces used for several purposes. confidence in health care and emphasizes the importance Action should be taken to ensure that those handling of respect for patient autonomy patient identifiable information - both clinical and non- clinical staff - are made fully aware of their responsibilities Confidentiality and obligations to respect patient confidentiality. Confidentiality protects the autonomy of patients by allowing them to control information about themselves. 5. Everyone with access to patient identifiable information should This is particularly important given the often sensitive and be aware of their responsibilities personal nature of the information that medical practitioners can acquire, and the damaging ways in which 6. Understand and comply with the law such information could be used. Confidentiality is vital when working confidential within Every use of patient identifiable information must be the healthcare sector. You are privilege to information lawful. Someone in each organization handling patient that should only be shared with others for the benefit of information should be responsible for ensuring that the the patient. organization complies with legal requirements. Confidentiality is one of the core duties of medical practice. It refers to the duty to protect privileged F. PRIVACY information and to share entrusted information privacy originates from "privatus" and "privo" in latin and responsibly. Additionally, it is the cornerstone of trust means "deprive of". The root of privacy is "priv", which between doctor and patient. As a general rule, it requires means "an opportunity in one's favor" health care providers to keep a patient's personal health information private unless consent to release the Patient privacy encompasses a number of aspects, information is provided by the patient. including personal space (physical privacy), personal data The intent of maintaining confidentiality is to afford (informational privacy), personal choices including cultural protection of patients from the harms of stigma, potential and religious affiliations (decisional privacy), and personal embarrassment, socio-economic manifestations, and illicit relationships with family members and other intimates use of information (associational privacy). Despite patient confidentiality being a key priority, Privacy has been defined as the control of a situation, circumstances exist where information disclosure is freedom of choice, mutual interaction, avoidance of demanded. In the safeguarding of children or vulnerable communication and an unreachable area. Additionally, adults, disclosure is required to prevent harm or prevent privacy may be defined as a restriction put by an individual criminal activity from occurring. Disclosure must be on access to his/her bodily and mental integrity. COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 approached carefully due to the continuing need to ICN (2000) - “ the nurse holds in confidence personal protect patients’ personal information. information and uses judgment in sharing this The principle that binds the practitioner to hold in strict information” confidence those things learned about a patient in the An important component of autonomy - maintains dignity course of medical practice. and respect for the person Confidentiality pertains to restricting the sharing of Do not the tell the diagnosis to those who are not directly involved – nurse aides and janitors sensitive patient information and only sharing information o If directly involved – needs to know dx when it is necessary either by law or professional duty. o If not directly involved – use standard This –the principle of confidentiality –is what underpins precaution the trust between patients/clients and health care No need to mention the dx workers. Breaching that trust by disclosing information about a The following are subjects of Confidentiality and should not patient/client to someone who has no right to the be revealed to anyone except for graver cause: information is one of the most serious errors a health care 1. Private Secrets worker can commit. 2. Contractual Secrets It can lead to disciplinary proceedings and, if the o Secret comes first before the promise to keep the secret individual is a registered practitioner, to formal 3. Professional Secrets professional misconduct hearings. o Understanding at the very start that you will not say Your work in health care puts you in the privileged anything before the secret comes out position of finding out a lot of information about the people you care for. Graver Cause: 1. Personal decision You’ll learn about their health problems, their 2. Reportable cause employment, their family, perhaps even their income. 3. Legal case They will speak to you about things very close to them personally – sometimes they will talk about things they Mandatory Disclosure haven’t even discussed with their family. Communicable disease And you’ll be supporting them in some of the intimate Child is physically abused aspects of daily life – washing, dressing and going to the o Report even if it is just a suspicion, report to toilet, for instance. SOCIAL SERVICES Amongst the ethical principles, another major one is o Evidence of Child Abuse and Neglect confidentiality, or the obligation of a physician/nurses to Bruises in different stages of healing – “clumsy” keep a patient's health information private. This is pretty o Black and blue – fresh important, since patients have to trust their o Yellowish - healing physician/nurses but may be afraid to honestly admit to -Bruises under the clothing illegal or dangerous activity. Maybe they don't want the -Frequent hospitalization cops to know that they were doing drugs; maybe they just -Child is guarded – withdraws from touch don't want their mom to know that they were being - Quiet when parents are around but talkative when only healthcare providers are around reckless. However, both of these things are really - Failure to thrive important for physicians to know before administering - Child is sexually abused treatment. o Familiar with vulgar/ sex language So as long as you're over 18, physicians cannot reveal o Inspect perianal area anything that you tell them about your personal health -Abusers do not usually penetrate the vagina because it is easily without your written consent. This confidentiality clause detected by police/ hospital extends beyond your death. Even if you stop seeing a -They usually penetrate the rectal area certain doctor, that doctor is bound to the confidentiality -Vulnerable adults clause. It protects your medical information and records o Elderly from being released to unauthorized people or parties. o Mental incapacity Confidentiality is the protection of personal information. Confidentiality means keeping a client’s information Example: between you and the client, and not telling others A 30-year old married man consults a physician complaining about including co-workers, friends, family, etc. his difficulty in urinating. He attributes this to what he had taken five days ago when he attended a convention. After examinations of Requires the non-disclosure of private or secret his blood and urine, he was told that he has Gonorrhea. He was information with which one is entrusted afraid that his wife might discover it. So he told the Doctor not to tell anyone, including his wife for fear the she might leave him. He COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 loves his wife and family. The wife however, after a week, asks the patient identifiable information should have access to it, and they doctor as to the condition of her husband because she was a bit should only have access to the information items that they need to worried why her husband does not want to make love with her. If see. This may mean introducing access controls or splitting you are the doctor, should you confide to the wife about her information flows where one information flow is used for several husband’s condition knowing that you know the obligation attached purposes. Action should be taken to ensure that those handling to the Principle of Confidentiality? patient identifiable information - both clinical and non- clinical staff - are made fully aware of their responsibilities and obligations to respect patient confidentiality. Maintaining Confidentiality Include: -individual files are locked and secured 5. Everyone with access to patient identifiable information should -support workers do not tell other people what is in a client’s file be aware of their responsibilities. Everyone with access to patient unless they have permission from the client identifiable information should be aware of their responsibilities -information about clients is not told to people who do not need to know 6. Understand and comply with the law. Every use of patient -clients’ medical details are not discussed without their consent. identifiable information must be lawful. Someone in each -adult clients have the right to keep any information about organization handling patient information should be responsible for themselves confidential, which includes that information being kept ensuring that the organization complies with legal requirements. from family and friends. -Respecting the client's right to keep private information about his What can be considered as confidential information? or her mental and physical care and related care. Any information that an individual wishes not to make public is -Allowing only those dealing with client's care to have access to the considered as confidential information. information that the client divulges. Information that is considered confidential can include: -Only under precisely defined conditions can third parties have name, date of birth, age, sex and address access to this information. current contact details of family, guardian, etc. -Adult clients can decide which family members, if any, may be bank details involved in treatment and may have access to clinical information. medical history or records personal care issues Breach of confidentiality service records and file progress notes A breach of confidentiality occurs when a patient's private individual personal plans information is disclosed to a third party without their assessments or reports consent. There are limited exceptions to this, including 9 guardianship orders disclosures to state health officials and court orders requiring medical records to be produced. Truth-telling Computerization of Medical Records Truth-telling or honesty is seen as a basic moral principle, rule or Access to hospital patient charts value. Truth-telling, the act of sharing one's knowledge and the Patients discussed by colleagues limitation of one's knowledge with accuracy and sensitivity to the clinical impact of the disclosure, is also an ethical imperative in medicine as practiced in this country. The truth-telling duty derives The 6 Principles of Confidentiality from the philosophical principle of respect for the truth. It entails 1. Justify the purpose(s)- Every proposed use or transfer of patient that information must be trustworthy and conveyed in a manner identifiable information within or from an organization should be that can be understood and meaningfully applied by the patient. clearly defined and scrutinized, with continuing uses regularly reviewed, by an appropriate guardian. The value of telling the truth in health care 1. Respect for the patient as a person who is able to make decision. 2. Don't use patient identifiable information unless it is absolutely - To consent to any health intervention, necessary. Patient identifiable information items should not be a person requires sufficient and included unless it is essential for the specified purpose(s) of that truthful information to make an flow. The need for patients to be identified should be considered at each stage of satisfying the purpose(s). informed and conscious choice; arguably, patients cannot make 3. Use the minimum necessary patient-identifiable information. effective decisions without truthful Where use of patient identifiable information is considered to be information. essential, the inclusion of each individual item of information should be considered and justified so that the minimum amount of 2. The duty and trust; where everyone has a strict duty to tell the identifiable information is transferred or accessible as is necessary truth even if it might be harmful. According to Kant. for a given function to be carried out. - Kant further supposes that telling the truth is always a duty, whether it relates to the other’s 4. Access to patient identifiable information should be on a strict right to know or results in innocent people being need-to-know basis. Only those individuals who need access to severely harmed. In other words, from a COURSE CODE:Topic Page PAGE \* ST. PAUL UNIVERSITY PHILIPPINES ST. RITA OF CASCIA 2023 SCHOOL OF NURSING 1ST SEMESTER, A.Y. 2020-2021 deontological point of view, competent patients Consider this: should be told the truth regardless of the Is lying to a patient ever justified? If a patient finds out that you consequences. have lied to them, will they have reason to trust you? 3. The physical and psychological benefits of telling the truth. - One of which is the positive benefit on the patient; those who are well informed tend to collaborate with health professionals and seek Veracity in the Health Care Setting to be treated. It refers to comprehensive, accurate, and objective transmission of information, as well as to the way the professional fosters the - In terms of psychological benefit, knowing one’s patients or subjects understanding. prognosis and diagnosis is far less debilitating than worrying about the unknown because Importance of Ethics of Veracity in the Medical/ Health care patients who are not given the opportunity to Patients place a great deal of trust in their physician, and reveal their own fears and worries may be left may feel that trust is misplaced if they discover or anxious and convinced that they have the most perceive lack of honesty and candor by the physician. horrible fate ahead. Patients have the right to know their health information, The Challenge of telling the truth and physicians are obliged to provide it. ✓ Respect for patient as a person to be told the truth may It is very important while sharing medical information that possibly contradict with a patient’s right not to know such nothing remains uncertain. truth. Telling the patient the truth ensures that the correct ✓ In some cases, patients prefer not to be told or have full information is given and correct choice for the patient is information of their health conditions, of a serious made. diagnosis, but would rather wish a family member be informed. Truth telling fosters trust in the medical profession and rests on the respect owed to patients as persons. ✓ In any health care codes of ethics, it is generally established th