Bioethics Reviewer PDF

BIOETHICS REVIEWER HEALTHCARE ETHICS: the field of applied ethics that is concerned with the vast array of WEEK 1: ETHICS moral decision-making situations th...

BIOETHICS REVIEWER HEALTHCARE ETHICS: the field of applied ethics that is concerned with the vast array of WEEK 1: ETHICS moral decision-making situations that arise in - a branch of philosophy that seeks to determine the practice of medicine in addition to the how human actions may be judged right or procedures and the policies that are designed to wrong. guide such practice. - a philosophical study of morality - Health care ethics (a.k.a “medical ethics”) - comes from the Greek word Ēthika, which is an - application of the core principles of bioethics adjective that itself derives from ēthos, the Greek (autonomy, beneficence, nonmaleficence, justice) word for character to medical and health care decisions. - For Aristotle, character is of central importance - a multidisciplinary lens through which to view to ethics, and one cannot have a good character complex issues and make recommendations without having formed good ethoi or habits. regarding a course of action. - ETHICS is Greek for customs, and MORALITY * Bioethics and Health ethics are viewed as comes from mores, which is Latin for customs. synonymous, health ethics is more limited as it - MORALITY refers to human conduct and values confines itself to the moral behavior in relation to whereas ETHICS refers to the study of those. health ETHICS AND MORALITY PROFESSIONAL ETHICS The two terms are used interchangeably ▪ Division of ethics that relates to professional however: behavior. - MORALS may be perceived as prescriptions or ▪ Moral science that deals with the obligation of a rules to guide our actions and behavior professional towards his profession, the public, and to his client. - ETHICS may be perceived as a set of analytical tools or a process that helps to identify right BIOETHICS conduct and determine appropriate behavior ▪ Refers to the moral, social & political problems that arise from biology & the life sciences - MORAL: relating to character or conduct generally that involve, directly or indirectly, considered as good or evil human wellbeing - MORALITY: quality of being moral; the practice ▪ ▪ “Bioethics” emerged between 1960s to 1970s of moral duties apart from religion ▪ The word was coined in 1970 by oncologist Van - BIOLOGY: a branch of knowledge that deals Potter Conceptualized bioethics as a with living organisms and vital processes. comprehensive field of though and action BIOETHICS: a discipline dealing with the ethical Research the following and understand its implications of biological research and background that suggests to bioethics applications especially in medicine - Ethics as applied to human life or health 1. Hippocratic Oath 2. Nightingale Pledge (orig.) 3. Nurses Code of Ethics CODES OF ETHICS CLARIFYING THE NURSE’S VALUE Values ▪ Fundamental professional nursing values of human dignity, equality, and prevention of ▪ Enduring beliefs or attitudes about the worth of suffering have not varied over time or across a person, object, idea or action. groups ▪ It influence decisions & actions But still needs to reflect on the values they Nurses’ ethical decision-making hold about life, death, health, and illness ▪ Belief and attitude are related but not identical o as it may affect attitudes or outlook on different issues or situation a nurse may face Value Transmission ▪ Nurses need to identify clients’ values as they influence and relate to a particular health problem Values are learned through observation & For a more effective clientcentered care ▪ Nurse experience should never assume client’s particular values & Influenced by sociocultural environment should discuss these o Societal traditions o Culture PROCESS TO HELP CLIENT CLARIFY o Ethnic & religious groups 1. List alternatives o Family and peers 2. Examine possible consequences of choices 3. Choose freely PERSONAL VALUE 4. Feeling about the choice ▪ Internalization of accumulative values derived 5. Affirm the choice. from society and environment 6. Act with a patter ▪ A sense of individuality ETHICS PROFESSIONAL VALUES a) a method of inquiry that helps people to ▪ Values acquired during socialization into understand the morality of human behavior nursing, from code of ethics, nursing b) the practices or beliefs of a certain group experiences, teachers and peers c) the expected standards of moral behavior of a VALUES CLARIFICATION particular group as described in the group’s formal code of professional ethics ▪ A process by which people identify, examine, and develop their own individual values MORALITY: once identified, these values can either be Refers to private, personal standards of what is retained or change o no one set of values is right right and wrong conduct, character and attitude. for everyone ▪ Distinguish Morality and Law ▪ Promotes personal growth by fostering Law reflects moral values of society awareness, empathy, and insight An action can be Legal but not Moral ▪ Useful in helping individuals to become more aware of their own values and how they may ▪ Distinguish Morality and Religion influence their actions Some religions have differences in moral perspective in relation to health MORAL DEVELOPMENT CONTRACTARIAN ETHICS ▪ The process of learning to tell the difference ▪ People are primarily self-interested, and that a between right and wrong rational assessment of the best strategy for ▪ Begins from childhood & continues throughout attaining the maximization of their self-interest life will lead them to act morally (where the moral norms are determined by the maximization of joint interest) and to consent to governmental ETHICAL THEORIES authority. ▪ Moral theories provide frameworks ▪ Nurses can use moral theories in explaining ▪ We each are motivated to accept morality “first ethical decisions and discussions of problematic because we are vulnerable to the depredations of situations others, and second because we can all benefit from cooperation with others” (Narveson 1988) MORAL FRAMEWORKS Three Types of Moral Theories (with emphasis ▪ Moral norms derive their normative force from on:) the idea of contract or mutual agreement (SEP, a) Consequences 2017) b) Principles & Duties c) Relationships ▪ Right acts are those that do not violate the free, rational agreements that people made. CONSEQUENCE-BASED THEORIES TELEOLOGICAL Theories SITUATION ETHICS ▪ Hold only the consequences of actions matter ▪ moral judgments must be made within the morally context of the entirety of a situation and that all ▪ Focused on outcomes of an action in judging if normative features of a situation must be viewed it’s right or wrong as a whole. UTILITARIANISM: Actions are morally right if ▪ objects to both moral absolutism (the view that and only they maximize the good (or, there are fixed universal moral principles that alternatively minimizes the bad). have binding authority in all circumstances) and moral relativism DEONTOLOGICAL theories ▪ Logical and formal process & emphasize ETHICAL EGOISM individual rights, duties & obligations ▪ An action is morally right if the consequences of ▪ Uses rules to distinguish right or wrong that action are more favorable than unfavorable Kant’s Theory: Requires people to follow rules only to the agent performing the action. (Henk & do their duty ten, 2016) ▪ claims that each person has but one ultimate ▪ Caring theories aim: his/her own welfare. ▪ It stresses courage, generosity, commitment & ▪ claims I morally ought to perform some action if the need to nurture and maintain relationships and only if, and because, performing that action ▪ Judges actions according to a perspective of maximizes my self-interest. (Stanford.edu) caring and responsibility ▪ Promote common good or welfare of the group ETHICAL ABSOLUTISM 1. Altruism: Concern for the welfare and well- being of the others ▪ Acceptance of a conduct code based on 2. Autonomy: Right to self-determination. absolute, indisputable rights and duties (springer, Respect patient’s rights 2016) 3. Human Dignity: Respect for inherent worth moral commands are true at all times and uniqueness of others true in all cultures and situations 4. Integrity: Honesty as reflected in the code of ▪ Deontological (Kant's Categorical Imperative ethics and accepted standards and the Divine Command Theory) 5. Social Justice: Acting in accordance wt fair do not consider consequences treatment regardless of status, socio-cultural, gender differences ETHICAL RELATIVISM ▪ views moral values as entirely relative to ______________________________________ different societies and contexts Morality is relative to the norms of one’s WEEK 2: ETHICAL/ MORAL PRINCIPLES context or culture & that there are no common moral principles shared by all cultures (Baker, ETHICAL/MORAL PRINCIPLES 1998) ֎ Statements about broad general, philosophical concepts ▪ Teleological (Utilitarianism and Situation Ethics) Provide the foundation for moral rules which may consider the consequences of moral are specific prescriptions for action actions when deciding if they are right or wrong Useful for ethical decisions ▪ truth and falsity, right and wrong, standards of ETHICAL/MORAL PRINCIPLES reasoning, and procedures of justification are 1. AUTONOMY products of differing conventions and frameworks - Right to make ones’ own decisions of assessment and that their authority is confined - Each cx is unique; has the right to be who that to the context giving rise to them. individual is and right to choose personal goals - Nurses must treat clients with considerations VIRTUE ETHICS ▪ an approach that focuses on character with the RESTRICTIONS/LIMITATION assumption that a person of good character will ֎ If there is potential harm to self or others tend to behave in ways that are consistent with ▪ communicable diseases or acts of violence their character. a) PATIENT’S RIGHTS VIRTUE ETHICS IN NURSING Universal Declaration of Human Rights ▪ concerned with the character of individual recognizes “the inherent dignity” and the “equal nurses and seeks ways to enable nurses to and unalienable rights of all members of the develop character traits appropriate for actions human family”. that enhance wellbeing. vary in different countries and in different jurisdictions, often depending upon prevailing 5 Essential Nursing Values cultural and social norms. (WHO) a) Right to Appropriate Medical Care and that the patient wishes to receive or not to Humane Treatment. receive. b) Right to Informed Consent. 2 Types of consent c) Right to Privacy and Confidentiality. 1. Express: Either oral or written form d) Right to Information. e) The Right to Choose Health Care Provider and 2. Implied Individual’s nonverbal behavior Facility. indicates agreement f) Right to Self-Determination. g) Right to Religious Belief. h) Right to Medical Records. 3 major elements of informed consent i) Right to Leave. 1. Consent must be given voluntarily j) Right to Refuse Participation In Medical 2. Consent must be given by a client or individual Research. with the capacity & competence to understand k) Right to Correspondence and to Receive 3. Client or individual must be given enough Visitors. information to be the ultimate decision maker l) Right to Express Grievances. m) Right to be Informed of His Rights and d) PROXY CONSENT Obligations as a Patient. ֎ The process by which people with the legal Source: DOH / “Magna Carta of Patient’s Rights right to consent to medical treatment for and Obligations.” Senate bill # 812 themselves or for a minor or a ward, delegate that right to another person. b) PATIENT’S BILL OF RIGHTS: A document 3 fundamental constraints that provides patients with information on how 1. The person making the delegation must have they can reasonably expect to be treated during the right to consent the course of their hospital stay. 2. The person must be legally & medically competent to delegate the right to consent ֎ Specific wording varies from hospital to 3. The right to consent must be delegated to a hospital, most bills of rights include the following legally & medically competent adult focus areas: o High-quality hospital care e) CONFIDENTIALITY o A clean and safe treatment environment ֎ keeping of another person or entity's o Involvement in care information private o Protection of patients’ privacy ▪ required by law to keep information shared by a o Help with patients’ billing and insurance client or patient private, without disclosing the claims information, even to law enforcement, except o Preparing for the end of patients’ hospital under certain specific circumstances. visits o Data Privacy Act – RA 10173, 2012 c) INFORMED CONSENT f) PRIVACY ֎ Agreement by a client to accept a course of - Refers to the right of an individual to keep his or treatment or a procedure after being provided her health information private (cdc.gov) complete information, including the benefits and ֎ The right of individuals to withhold themselves risks of treatment, alternatives to treatment option and their lives from public scrutiny ▪ right to be own actions left alone (Kozier. 2016) 7. RESPONSIBILITY ֎ the specific accountability or liability 2. NONMALEFICENCE: associated with the performance of duties of a ֎ “do no harm” particular role ֎ Not placing someone at risk of harm & unintentionally causing harm Responsibility involves having authority over one’s actions. 3. BENEFICENCE ֎ doing good” Accountability means you are liable or ֎ Implement actions that benefit clients answerable for one’s actions. In order to be 4. JUSTICE responsible, you must be accountable and vice ֎ Fairness versa. ֎ Weigh the facts carefully in order to divide time or services justly PRINCIPLE OF DOUBLE EFFECT ֎ It provide specific guidelines for determining 5. FIDELITY when it is morally permissible to perform an ֎ Loyalty action in pursuit of a good end in full knowledge ֎ Faithful to agreements and promises that the action will also bring about bad results ֎ Involves loyalty, truthfulness, promise ֎ An action that is good in itself that has two keeping, advocacy and respect effects ֎ Nurses have responsibility to clients, ֎ Guidelines for determining when it is ethically employers, government, profession, society and permissible for a human being to engage in to themselves conduct in pursuit of a good end with full knowledge that the conduct will also bring about 6. VERACITY bad results ֎ Truth telling ֎ An intended and otherwise not reasonably ֎ Having Integrity attainable good effect, and an unintended yet ֎ Professional accountability & responsibility foreseen evil effect--is SANCTIONED, provided there is a due proportion between the intended The right to information good and the permitted evil ֎ The patient has the right to be informed of hospital policies and practices that relate to Principle of double effect patient care treatment, and responsibilities. 4 BASIC MORAL CRITERIA: 1. The intervention or act itself must be good or ֎ the patient or his/her legal guardian has a at the very least, indifferent right to be informed of the result of the evaluation 2. The intent of the intervention must be good of the nature and extent of his/her disease, any 3. The good must be the result of the act and not other additional or further contemplated medical the result of the bad effect. treatment on surgical procedure 4. There must be a compelling necessity for the act- the benefits must outweigh the costs 6. ACCOUNTABILITY ֎ answerable to oneself and others for one’s Example: Research on human subjects in which researchers justified harms by the potential for PRINCIPLE OF COMMON GOOD AND greater rewards from their study SUBSIDIARITY When a pregnant woman has a cancerous womb Common good that needs to be removed, the death of a pre- o certain general conditions that are...equally to viable fetus is inevitable everyone's advantage o the sum total of social conditions which allow Principle of legitimate cooperation people, either as groups or as individuals, to This principle is aimed in helping individuals reach their fulfillment more fully and more easily. discern how to properly avoid, limit, or distance o used in various contexts to identify actions or themselves from evil in order to avoid a worse outcomes that have some definable benefit that evil or to achieve an important good. extends beyond individual gain ▪ applies to situations where an action involves more than one person, and sometimes when the Refers to those facilities—whether material, persons have different intentions. cultural or institutional—that the members of a ▪ To differentiate the action of the wrongdoer community provide to all members in order to from the action of the cooperator through two fulfill a relational obligation they all have to care major distinctions for certain interests that they have in common. ֎ portrays the Principle of the Double Effect in a scenario in which more than one person EXAMPLES: the road system; public parks; participates in the actions being evaluated police protection and public safety; courts and the judicial system; public schools; museums and When you are performing an action that is cultural institutions; public transportation; civil intertwined with evil, you can use the following liberties, such as the freedom of speech and the criteria to judge how legitimate your cooperation freedom of association; the system of property; with the evil is: clean air and clean water; and national defense. o The moral object of your action is good and you are operating out of good intentions. NURSES’ DEFIANCE o Your cooperation is only material cooperation, ֎ Protests and strikes of health personnel who not formal refused to do their work because they had not o Your cooperation is remote rather than been provided with the necessary protections by proximate so it causes minimal evil effects the competent institutions (or even had not o Your action does not cause scandal managed to obtain them personally on the market), must be considered as a legitimate EXAMPLE: Paying taxes in a society that defense of personal rights to safety. engages in an enterprise that is construed as ▪ Defiance is not a moral obligation of single being morally wrong. Such a situation can arise individuals in some nations that build and threaten the use of ▪ An ethical obligation to promote “Common nuclear weapons. Good” SUBSIDIARITY ▪ the doctrine holds that nothing should be done by a larger and more complex organization which can be done as well by a smaller and simpler organization. ▪ activity which can be performed by a more decentralized entity should be ▪ The principle states that only those decisions and tasks that cannot be effectively decided upon or performed by a supported or subsidized lower level authority ought to be relegated to a more central or higher authority.  NP8-Bioethics in Nursing ETHICAL ASPECTS OF NURSING * We can be taught ethics but morality is always up to us Morals ▪ Based on norms of conduct about right or wrong PRINCIPLE OF AUTONOMY ▪ Society’s moral codes guide what people ought to do Autonomy ▪ Professional codes such as the code of ethics for nurses, ▪ Self- governing communicate the goals and ideals of the ▪ Freedom to make choices about issues that affect profession one’s life ▪ Respect for persons; unique and valuable members of Ethics the society ▪ Science of ideals – what a person should do because it ▪ Free to choose and implement one’s own decision, is the right thing to do free from lies, restraint or coercion Morality ▪ This principle assumes rational thinking on the part of ▪ Application of Ethics the individual and may be challenged when the rights of others are infringed upon by the individual Code of Ethics ▪ The “Code of Ethics for Nurses” BON Resolution 220 * Lies, restraints, coercion = wrong decision series 2004 * No matter what, we must let patients decide for o Provides guidance for carrying out nursing himself responsibilities consistent with the ethical obligations * Autonomy is NOT absolute. of the profession o If you violate any provisions in terms of the Code of Factors that affect decision: Ethics, sanctions could be suspension or revocation o Emotions of license o Time o Always be on the safe side = respect of the person Consider this: Professional Code of Ethics What if the patient wants to do something that will cause harm ▪ Nurses have a contract with society to behave in to him/herself? Under what circumstances can the healthcare accordance with rules dictated by society and the team intervene? nursing profession ▪ Nurse Practice Acts vs Code of Ethics Examples: ▪ Delineates nursing’s moral ideals, provides guidelines for ▪ Elsa goes to the doctor because she has a vaginal ethically principled behavior and holds nurses discharge. She however refuses to talk about her morally accountable for their actions personal life ▪ Mia, 16, is afraid of injections and hospitals. She has Ethical Principles acute appendicitis and needs surgery but she refuses Autonomy Beneficence PATERNALISM Non-maleficence ▪ Deliberate restriction of people’s autonomy by health Veracity care professionals based on the idea that they know Confidentiality what’s best for the clients - can be justifiable at times Justice o Not everything legal is ethical and vice versa Fidelity ▪ Doing good should take precedence over autonomy RESPECT FOR PERSON ▪ Most fundamental human right PRINCIPLE OF AUTONOMY ▪ Foundation of all ethical principles Competent for Decision Making ▪ Respecting the worth and value of a person ▪ 18 y/o and above ▪ Imago Dei (Created in the Image of God) ▪ Emancipated minor – self- supported, financially ▪ “The human person ought to be respected always.” independent o Female – 18 ▪ Every human being has an inner worth and inherent dignity. o Male – 24 and below – parental consent These he possesses not because of what he has or what he ▪ Mentally coherent does but because of what he is: a human person o 90 y/o – depends if mentally competent or not ▪ As a human person, he must be respected regardless of the o Illiterate – CAN give consent nature of his health problem, social status, competence, ▪ Thumb mark and initials are NOT used as a past actions signatures ▪ Certain actions may never be done because performing ▪ For + initials – not allowed them would constitute a violation against the person’s o Signed by closest relative, patient gives dignity the consent * What we do in the hospital has legal and ethical implications * Everybody must be treated equally MARILANE M. FERRER, MSN, RN NP8-BIOETHICS-HEALTH CARE ETHICS  NP8-Bioethics in Nursing Consent – immediate family PRINCIPLE OF FREE AND INFORMED CONSENT o Adult – Patient, spouse if married, children of major age ▪ It is a patient’s right to exercise freedom to make o Below 18 – Parents, siblings, grandparents decisions for his/her health. Appropriate and necessary information are required so that medical protocols and Who gives proxy consent? management may be done for his interest. 1. Durable Power of Attorney o Designating somebody else to make a decision Assent for me ▪ Approval of the person of anybody below 18 y/o o Authorization ▪ Aged 7 - 17 y/o 2. Closest of kin ▪ Example: circumcision o Adult – married - spouse, children of major age o Below 18 - parents, grandparents To protect the basic need of every human person for health care o No spouse - siblings, uncles/aunts and the person’s primary responsibility for his or her own health 1. No physical or psychological therapy may be Advance Directives administered without the free and informed consent of ▪ Definition: an advance declaration by a person of the patient, or treatment preferences if he or she is unable to 2. If the patient is incompetent, the person’s legitimate communicate his or her wishes. guardian acting for the patient’s benefit and, as far as ▪ Instructions for the future possible, in accordance with the patient’s known and reasonable wishes. ▪ Living Will o Document that tells you what I want in the future in Examples: case I cannot make a decision anymore ▪ Mikee’s parents chose her career and the school she is o Both oral and written are acceptable in the court of to study in law – needs to be proved ✓ Depends on Mikee’s age ▪ Dalia, a 21-year-old daughter, is asked to donate her ▪ Durable Power of Attorney kidney to her dying mother o Designates somebody else to make the decision for ✓ Not a violation if voluntarily given me in case in the future I cannot make a decision ▪ Leah, a 6year old girl, is asked if she wants her painful anymore tooth pulled out o Authorization letter ✓ No need to ask for assent o Specific and with proof ▪ Health Care Proxy Elements of Informed Consent ▪ Disclosure o Procedure The doctor can decide: o Reason 1. Doctor can act as loco-parentis o Risks vs Benefits o Substitute parent o Prognosis o The doctor knows what’s best for you o Cost 2. If it is a matter of life and death o Alternatives 3. Court ▪ Understanding o Both oral and written are acceptable in court o Do not use medical jargons o If you want something to be respected, have it written ▪ Voluntariness o E.g. Jehovah’s witness 12 years old o Patient if mentally competent ▪ Competence There are people who die because of their religious beliefs ▪ Consent ▪ They’d rather die than go to hell ▪ Respect their values Nazi Experiments (WWII) ▪ Experiments on twin children in concentration camps Examples: were created to show the similarities and differences in ▪ Carlo, 30-year-old Jehovah’s Witness is admitted with the genetics and eugenics of twins, as well as to see if massive GI bleeding. The attending staff tells him blood the human body can be unnaturally manipulated. transfusion will save his life. He refuses because his ▪ Dr. Josef Mengele, who performed experiments on over religion does not allow it 1,500 sets of imprisoned twins, of which fewer than 200 ✓ Respect autonomy individuals survived the studies. ✓ There are people who die because of their ▪ The twins were arranged by age and sex and kept in religious beliefs barracks in between the test, which ranged from the ▪ Ernie enjoys listening to music. He plays his music loud injection of different chemicals into the eyes of the even if his dorm mates are studying twins to see if it would change their colors to literally ✓ If it causes harm to others, stop the autonomy sewing the twins together in hopes of creating conjoined twins. MARILANE M. FERRER, MSN, RN NP8-BIOETHICS-HEALTH CARE ETHICS  NP8-Bioethics in Nursing Hypothermia Experiments ▪ Justice ▪ In 1942 the Luftwaffe conducted experiments to learn o Equitable distribution of both burdens and benefits how to treat hypothermia. One study forced subjects to of research endure a tank of ice water for up to three hours ▪ Another study placed prisoners naked in the open for MEDICAL RESEARCH several hours with temperatures below freezing. The Declaration of Helskinski (1964, 1975, 1983, 1989, 1996, 2000, experimenters assessed different ways of rewarming 2008) survivors. ▪ Developed by WMA - guidance to research not present in Nuremberg Code; for doctors doing Infected Wounds research ▪ July 1942-Sept 1943- experiments to investigate the on their patients effectiveness of sulfonamide, a synthetic antimicrobial agent, were conducted at Ravensbrück. Belmont Report (1976) ▪ Wounds inflicted on the subjects were infected with ▪ Medical and Behavioral Research bacteria such as Streptococcus, gas gangrene, and ▪ Practice vs Research tetanus. Circulation of blood was interrupted by tying off blood vessels at both ends of the wound to create a condition similar to that of a battlefield wound. PRINCIPLE OF CONFIDENTIALITY Infection was aggravated by forcing wood shavings ▪ Requires the non-disclosure of private or secret and ground glass into the wounds. The infection was information with which one is entrusted treated with sulfonamide and other drugs to determine ▪ ICN (2000) - “the nurse holds in confidence personal their effectiveness. information and uses judgment in sharing this information” Tuskegee Syphilis Study ▪ An important component of autonomy - maintains ▪ The Tuskegee Study of Untreated Syphilis in the Negro dignity and respect for the person Male was a clinical study, conducted between 1932 and 1972 in Tuskegee, Alabama, in which 399 (plus 201 ▪ Do not the tell the diagnosis to those who are not control group without syphilis) poor — and mostly directly involved – nurse aides and janitors o If directly illiterate — African American sharecroppers were involved – needs to know dx o If not directly denied treatment for Syphilis. involved – use standard precaution ▪ By the end of the study, only 74 of the test subjects ▪ No need to mention the dx were still alive. Twenty-eight of the men had died directly of syphilis, 100 were dead of related The following are subjects of Confidentiality and should not be complications, 40 of their wives had been infected, revealed to anyone except for graver cause: and 19 of their children had been born with congenital 1. Private Secrets syphilis. 2. Contractual Secrets o Secret comes first before the promise to keep the secret NUREMBERG CODE 3. Professional Secrets o Understanding at the very ▪ Nuremberg Code (1947)- foundation of all research start that you will not say anything before the secret ethics codes comes out ▪ 10 principles Graver Cause: ▪ Voluntary consent, results need to be of good to the 1. Personal decision society, animal experiments 1st, avoid unnecessary 2. Reportable cause physical and mental suffering/ injury, should not be 3. Legal case done if it will cause death/disability ▪ Risk vs benefits, proper preparations and adequate Breaches of Confidentiality facilities, only on qualified patients, free to end ▪ Computerization of Medical Records participation, researcher must be prepared to ▪ Access to hospital patient charts terminate experiment at any time ▪ Patients discussed by colleagues ▪ Placebo Mandatory Disclosure ▪ Practice - NOT acceptable Communicable disease ▪ Research - Acceptable as long as with consent Child is physically abused o Report even if it is just a suspicion, report to SOCIAL BASIC ETHICAL PRINCIPLES SERVICES ▪ Respect for Persons o Evidence of Child Abuse and Neglect o Respect for autonomy and protection of persons ▪ Bruises in different stages of healing – with diminished autonomy “clumsy” o Black and blue – fresh ▪ Beneficence and Non-Maleficence o Yellowish - healing o Maximize benefits and minimize harm ▪ Bruises under the clothing ▪ Frequent hospitalization MARILANE M. FERRER, MSN, RN NP8-BIOETHICS-HEALTH CARE ETHICS  NP8-Bioethics in Nursing ▪ Child is guarded – withdraws from touch ▪ Jay brings her lunch to school every day. One day, she ▪ Quiet when parents are around but talkative when only saw a thin boy watching her eat. The boy extends his healthcare providers are around hands asking for food ▪ Failure to thrive Child is sexually abused Non-Maleficence o Familiar with vulgar/ sex language ▪ Duty to prevent or Avoid Harm Whether Intentional or o Inspect perianal area Unintentional Abusers do not usually penetrate the vagina ▪ Does not mean avoidance of harm altogether… because it is easily detected by police/ avoidance of harm unless the action promises a hospital greater good They usually penetrate the rectal area ▪ Different issues on euthanasia, withholding and Vulnerable adults withdrawing treatment and the use of artificial nutrition o Elderly o Mental incapacity and hydration Example: A 30-year-old married man consults a physician Consider this: complaining about his difficulty in urinating. He attributes this to ▪ Is it harmful to accept an assignment to “float” to an what he had taken five days ago when he attended a unfamiliar area that requires administration of unfamiliar convention. After examinations of his blood and urine, he was medications? told that he has Gonorrhea. He was afraid that his wife might ▪ Is it acceptable to refuse an assignment? discover it. So, he told the Doctor not to tell anyone, including his wife for fear the she might leave him. He loves his wife and ✓ Go but choose patients that you could handle family. The wife however, after a week, asks the doctor as to the ✓ Only do something within your capability condition of her husband because she was a bit worried why her ✓ General Rule: If what you did is what a prudent nurse husband does not want to make love with her. If you are the have done in the same situation, you are covered – doctor, should you confide to the wife about her husband’s Nursing Jurisprudence condition knowing that you know the obligation attached to the Principle of Confidentiality? Examples: ▪ Tony has AIDS. He is bedridden and emaciated. He asks PRINCIPLE OF BENEFICENCE AND NON-MALEFICENCE the doctor to give him medicine to end his life ▪ Perla has a lump in the breast. When she consults at a * If stated in a positive manner, BENEFICENCE public hospital, the doctor asks 8 medical students to * If stated in a negative manner, NON-MALEFICENCE feel the lump ▪ Avoid, prevent, not ▪ Ben has a urethral secretion, which reveals gonorrhea. Clara, the clinic nurse on duty, is a good friend of Fe, Healthcare Worker duties in Patient Care: Ben’s wife. Fe asks Clara for the result of the test 1. Duty to do or promote good 2. Duty to remove or prevent evil or Case: harm. Nino, a 52-year-old male is in coma in the ICU with a massive inoperable intracranial bleed. His attending physician BENEFICENCE orders IV fluid, medications, intubation and respirator support. He ▪ Duty to actively do good for patients talks to the family to inform them of the poor prognosis and ▪ Primary goal of healthcare is to do good for patients probability the patient is going to die in 1 week. The wife insists under their care that all aggressive measures be done. She has 7 children but no means of support. What should the doctor do? Consider this: ▪ Deciding what interventions should be provided for A. Do as the wife insist patients when some of those interventions may cause B. If treatment is useless and impose excessive burden, pain recommend stopping the tx ▪ Burn clients receiving mafenide acetate C. Transfer the patient to another MD o Give analgesics prior to wound care D. Transfer patient to the Service ward o Stinging sensation when applied PRINCIPLE OF PROPORTIONALITY This principle may create a duty when the law doesn’t - Doing ▪ Do all available means have to be used all the time? something out of duty at times ▪ How long these means should be used? ▪ Often conflicts with the principle of autonomy ▪ Is treatment effective? ▪ Beneficent act: A nurse prevents a patient from acting ▪ Will it impose unacceptable burden? on suicidal impulses ▪ Good Samaritan Act Euthanasia & Assisted Suicide ▪ Orthothanasia – letting the incurably diseased person Examples: “die his own death’ while making no extra efforts to ▪ Mon, a so-so swimmer, sees Marco drowning prolong his life. MARILANE M. FERRER, MSN, RN NP8-BIOETHICS-HEALTH CARE ETHICS  NP8-Bioethics in Nursing ▪ Passive Euthanasia – refraining of any medical ✓ Patient’s record – about the patient but owned by the treatment aimed at retarding death hospital ▪ Active Euthanasia – terminating a person’s life in a o Doctor’s permission painless way, at his request & with the intention to o Medical records’ permission prevent person from suffering Case: ▪ Withholding treatment is an act of omission while The parents of 9-year old Kevin who is suffering from a withdrawing treatment is an act of commission. metastatic bone cancer request that the child not be told of the ▪ Treatment is not only in terms of medications but also illness. Should the attending doctor comply? utilization of equipment, intubation, ventilators and feeding tubes Dr. E. Kubler Ross, the question: ▪ “Should we tell the child?” PRINCIPLE OF BENEFICENCE AND NON-MALEFICENCE (Patient Benefit and Avoidance of Harm) Should not be an issue, rather we should ask: Prologue of Hippocratic Oath ▪ “How do I share this with the patient?” “I will use treatment to help the sick according to my ability and judgment, but will never use it to injure or A. The physician should comply wrong them.” B. Parents should have full decision control JUSTICE C. The physician knows what is the best for the child ▪ The duty to treat all patients fairly D. Parents should be allowed considerable time to accept ▪ Equal treatment of equal cases and equal distribution seriousness of child’s condition and to be of benefits - no discrimination on the basis of sex, race, honest to their children religion, age and socioeconomic status ▪ Involves allocation of scarce and expensive health ETHICAL PRINCIPLES AND NURSING CARE care resources Respect for human life in all stages Triage Safe, competent and compassionate care ▪ Medical screening of patients to determine their priority Cooperation with fellow-workers of treatment Responsible management of resources ▪ Colors o Red o Yellow o Green Black Finite Resources ▪ Limited fund, medical supplies, healthcare services The needs of everyone, even if it’s due, cannot all be served. VERACITY ▪ Duty to tell the truth ▪ Fundamental to the development and continuance of trust among human beings - truth telling, integrity and honesty Consider this: ▪ Is lying to a patient ever justified? If a patient finds out that you have lied to them, will they have reason to trust you? FIDELITY ▪ Obligation of an individual to be faithful to commitments to him/herself and also to others ▪ Main support for the concept of accountability ▪ Keeping information confidential and maintaining privacy and trust Consider this: To whom to do we owe fidelity? Who has the right to access patient medical records? When should we “blow the whistle” on unsafe staffing patterns? ✓ Have continuing education – Professional Development MARILANE M. FERRER, MSN, RN NP8-BIOETHICS-HEALTH CARE ETHICS  Code of Ethics for Filipino Nurses THE CODE OF ETHICS FOR FILIPINO NURSES What are CODES OF ETHICS? ✓ These are systematic guides for developing ethical behavior ✓ They answer normative questions of what beliefs and values should be normally accepted Code of Good Governance ✓ Promulgated by the Professional Regulation Commission, July 23, 2003. ✓ States that: The hallmark of all professionals is their willingness to accept a set of professional and ethical principles which they follow in the conduct of their daily lives. The acceptance of these principles requires the maintenance of a standard of conduct higher than what is required by law. ✓ This code is adopted by the Professional Regulation Commission and the 42 Professional Regulatory Boards to cover an environment of good governance in which all Filipino professionals shall perform their duties. General Principles: ✓ Service to Others ✓ Integrity and Objectivity ✓ Professional Competence ✓ Solidarity and Teamwork ✓ Social and Civic Responsibility ✓ Global Competitiveness ✓ Equality of All Professions After consultation on October 23, 2003 at Iloilo City with the accredited professional organization of registered nurses, the code was adopted under the Republic Act 9173 and promulgated by the Board of Nursing under Resolution No. 220 Series of 2004 last July 14, 2004. ARTICLE I Preamble Sec. 1. Health is a fundamental right of every individual. The Filipino registered nurse believes in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all cost. The Filipino registered nurse believes in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all cost. MARILANE M. FERRER, MSN, RN Page 1  Code of Ethics for Filipino Nurses Sec 2. To assume this responsibility, registered nurses have to gain knowledge and understanding of a man’s cultural, social, spiritual, psychological, and ecological aspects of illness, utilizing the therapeutic process. Cultural diversity and political and socio-economic status are inherent factors to effective nursing care. Sec 3. The desire for the respect and confidence of clientele, colleagues, co-workers, and the members of the community provides, the incentive to attain and maintain the highest possible degree of ethical conduct. ARTICLE II REGISTERED NURSES AND PEOPLE Sec.4 Ethical Principles Values, customs, and spiritual beliefs held by individuals shall be represented. Individual freedom to make rational and unconstrained decisions shall be respected. Personal information acquired in the process of giving nursing care shall be held in strict confidence. Sec 5. Guidelines to be observed REGISTERED NURSES MUST: ✓ Consider the individuality and totality of patients when they administer care; ✓ Respect the spiritual beliefs and practices of patients regarding diet and treatment; ✓ Uphold the rights of individuals; and ✓ Take into consideration the culture and values of patients in providing nursing care. However, in the conflicts, their welfare and safety must take precedence. ARTICLE III REGISTERED NURSES AND PRACTICE Sec. 6. Ethical Principles 1. Human life is inviolable. 2. Quality and excellence in the care of patients are the goals of nursing practice. 3. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability. MARILANE M. FERRER, MSN, RN Page 2  Code of Ethics for Filipino Nurses Sec.7. Guidelines to be observed Registered Nurses must: a. Know the definition and scope of nursing practice which are in the provisions of R.A. No. 9173, known as the “Philippine Nursing Act of 2002” and Board Res. No. 425, Series of 2003, the “Rules and Regulations Implementing the Philippine Nursing Act of 2002”, (the IRR); b. Be aware of their duties and responsibilities in the practice of their profession as defined in the “Philippine Nursing Act of 2002” and the IRR; c. Acquire and develop the necessary competence in knowledge, skills and attitudes to effectively render appropriate nursing services through varied learning situations; d. If they are administrators, be responsible in providing favorable environment for the growth and development of Registered Nurses in their charge; e. Be cognizant that professional programs for specialty certification by the BON are accredited through the Nursing Specialty Certification Council (NSCC); f. See to it that quality nursing care and practice meet the optimum standard of safe nursing practice; g. Ensure that patient’s records shall be available only if they are to be issued to those who are professionally and directly involved in their care and when they are required by law. h. Insure that modification of practice shall consider the principles of safe nursing practice; i. If in position of authority in a work environment, be normally and legally responsible for devising a system of minimizing occurrences of ineffective and unlawful nursing practice. Sec. 8. Ethical Principle 4. Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and privileges. Sec. 9. Guidelines to be observed Registered Nurses must a. Respect the “Patient’s Bill of Rights” in the delivery of nursing care; b. Provide the patients or their families with all pertinent information except those may be deemed harmful to their well-being and c. Uphold the patient’s rights when conflict arises regarding management of their care. Sec. 10. Ethical Principle 5. Registered Nurses are aware that their actions have professional, ethical, moral and legal dimensions. They strive to perform their work in the best interest of all concerned. Sec. 11. Guidelines to be observed Registered Nurses must a. Perform their professional duties in conformity with existing laws, rules, regulations, measures, and generally accepted principle of moral conduct and proper decorum; MARILANE M. FERRER, MSN, RN Page 3  Code of Ethics for Filipino Nurses ARTICLE IV REGISTERED NURSE AND CO-WORKERS Sec.12. Ethical Principles 1. The Registered Nurse is in solidarity with other members of the healthcare team in working for the patient’s best interest. 2. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care providers. Sec.13. Guidelines to be observed Registered Nurse must a. Maintain their professional role/identity while working with other members of the health team; b. Conform with the group activities as those of a health team should be based in acceptable, ethico-legal standards; c. Contribute to the professional growth and development of other members of the health team; d. Actively participate in professional organization; e. Not act in any manner prejudicial to other professions; f. Honor and safeguard the reputation and dignity of the members of nursing and other profession; refrain from making unfair and unwarranted comments or criticisms on their competence, conduct, and procedures; or not do anything that will bring discredit to a colleague and to an member of other professions; and g. Respect the rights of their co-workers. ARTICLE V REGISTERED NURSE, SOCIETY AND ENVIRONMENT Sec.14. Ethical Principles 1. The preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment of a Registered Nurse. 2. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse. Sec.15. Guidelines to be observed Registered Nurse must a. Be conscious of their obligations as citizens and, as such, be involved in community concerns; b. Be equipped with knowledge of health resources within the community, and take active roles in primary health care; c. Actively participate in programs, projects, and activities that respond to the problems of society; d. Leads their lives in conformity with the principles of right conduct and proper decorum; and e. Project an image that will uplift the nursing profession at all times; MARILANE M. FERRER, MSN, RN Page 4  Code of Ethics for Filipino Nurses ARTICLE VI REGISTERED NURSE AND THE PROFESSION Sec.16. Ethical Principles 1. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal. 2. Compliance with the by-laws of the accredited professional organization (PNA) and other professional organizations of which Registered Nurse is a member is a lofty duty. 3. Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations. 4. Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and visionary mission. Sec.17. Guidelines to be observed Registered Nurse must a. Be members of the accredited professional organization which is the PNA. b. Strictly adhere to the nursing standards; c. Participate actively in the growth and development of the nursing profession; d. Strive to secure equitable-economic and work conditions in nursing through appropriate legislation and other means; and e. Assert for the implementation of labor and work standards. ARTICLE VII ADMINISTRATIVE PENALTIES, REPEALING CLAUSE AND EFFECTIVITY Section 18. The Certificate of Registration of the Registered Nurse shall either be revoked or suspend for violation of any provisions of this Code pursuant to Sec. 23 (f), Art.IV of R.A. No. 9173 and Sec.23 (f), rule III of Board Res. No. 425, Series of 2003, the IRR. MARILANE M. FERRER, MSN, RN Page 5