Ethical%20Principles%20-%20Module%202.pdf

Ethical Principles Learning Objective: Identify the sources of the Ethical Principles Deliberate on the basic ethical principles reflected in the natural law Explain the universal ethical principle in terms of its application to a particular scenario. Describe how eth...

Ethical Principles Learning Objective: Identify the sources of the Ethical Principles Deliberate on the basic ethical principles reflected in the natural law Explain the universal ethical principle in terms of its application to a particular scenario. Describe how ethical principles are applied in nursing settings. Enumerate the patient’s bill of rights Identify components of informed consent. Sources of Ethical Principles These are directives or guides in making decisions on what we ought to do or to be. a. Law – an ordinance of reason, promulgated for the common good by one who has legitimate authority. It is an authoritative order that should be just, honest, possible of fulfilment, useful, to a certain degree of permanency and promulgated or made known to the subject. b. Conscience – the practical judgment of reason upon an individual act as good and to be performed or as evil and to be avoided. IMPORTANT CLASSES OF LAWS a. Eternal Law – It is God’s eternal plan and providence for the universe. It is the diverse reason or will commanding the preservation of the natural order of things and forbidding its disturbance. According to St. Thomas, it is the plan flowing from God’s wisdom directing all acts and movements. a. Natural Law – it is the eternal law as known to human through reason. It is nothing than the rational creatures’ participation in the eternal law of God and Human comes to the knowledge of this law by natural light of his/her reason. e.g. do good and avoid evil. (St. Thomas) PROPERTIES OF NATURAL LAW a. Universality – the natural moral law binds every person at all times and in all places or its basis is the very nature of human. based on what it means to be human, so it affects all people. b. Immutability – as soon as the human being has the capacity of using his/her reason, certain fundamental norms will become self-evident to humans.. These fundamental norms are imprinted in human nature, so that they exist as long as human nature exists. c. Indispensability – no one is dispended or excused in the observance of the natural law. No one is exempt from following the natural moral law. Everyone must follow it, no matter who they are. ON CONSCIENCE Once a person can think for themselves, some basic moral rules become obvious to them. These rules are a part of human nature and remain the same as long as humans exist.  Conscience is the practical judgment of reason upon individual act as either good and to be performed or as evil and to be avoided. It follows personal freedom and autonomy. It is the capacity to make practical judgments in matters involving ethical issues. It involves reasoning about moral principles Must be rooted in reality and truth and not on mere will or desire or blind choice. CONSCIENCE FORMATION Diligently learning the laws of moral life Seeking expert advice on difficult cases Asking God for light through prayer Removing the obstacles to right judgment Personal examination of conscience “ My conscience is my guide” “ What I don’t know can’t hurt me” “ It is God’s will” Principle of Well-Formed Conscience To attain the true goals of human life by responsible actions, in every free decision involving an ethical question, people are morally obliged to do the following: A. Inform themselves as fully as practically possible about the facts and the ethical norms B. Form a morally certain judgment of conscience on the basis of this information C. Act according to this well-formed conscience D. Accept responsibility for their actions Key Points on Conscience Formation 1.Making moral decisions demand mature responsibility 2.A fully mature and responsible conscience should be free, correct, clear and certain 3.Discern what is right and what is wrong 4.We must follow our decision only after we have done our best to search for the truth regarding the issues facing us Qualities of Conscience 1. Personal Freedom- should be free from some obstacles such as fear and anger. refers to how our personal views (subjective) match or 2. Objective value – don't match with moral truths (objective) correct – subjective conforms to the objective moral values personal view agrees with true moral values. objective – norms of morality actual moral rules that apply to everyone.  personal view doesn't agree with true moral values. erroneous – lack of conformity to the objective normas of morality culpable – one is in error and therefore responsible made a mistake and are responsible for it. Inculpable – has erred in good faith made a mistake, but it was an honest one made with good intentions. 3. Moral Attitude – describes different ways people approach moral choices Lax – careless in its effort to seek the truth Doesn't try hard to figure out what's right or wrong Strict – follow to the letter Follows moral rules very strictly, without flexibility. Scrupulous – tends to judge sin to be present when there is none. Sees sin or wrongdoing even when there isn't any. Pharisaical – judgmental towards others Quick to judge others harshly Clear – Understands moral choices well and makes good judgments. Callous – worst type – no sensitivity to sin. 4 Degree of certitude – refers to how sure someone is about a moral choice: Feels stuck—wrong if you do something, but wrong if you don’t. Perplexed – wrong if you don’t do; wrong if you did. Doubtful – lack of sufficient evidence Probable – made a decision already but still admitting the possibility that the opposite is true. Certain – sure. With sufficient factual evidence. BASIC ETHICAL PRINCIPLES REFLECTED IN THE NATURAL LAW 1.Principle of the Inviolability of Human Life – also synonymous to the Principle of the Defense of Human Life or Principle of the Sanctity of Human Life. – Principle of Stewardship, Respect for Human Dignity, Principle of Legitimate Cooperation, principle of ordinary and extraordinary means 2.Principle of Freedom and Responsibility – Principle of Personalized Sexuality 3.Principle of Totality and Bodily Integrity 4.Principle of Subsidiarity and Sociality- Principle of Fidelity A. Principle of the Inviolability of Human Life Dimnsions of Stewardship: Call for 3 responsibilities: Personal Social Ecological  1. Personal / Social Responsible Stewardship of Available Resources You should use your resources wisely, being careful not to waste them. Managing resources with prudence and moderation Managing what you have with care and moderation is important. Wasting or squandering of scarce resources is unethical Wasting resources, especially when they are limited, is wrong. Not to fall into the trap of the technological imperative Don't be obsessed with always having the newest technology if it's unnecessary. 2. Ecological and Biomedical Dimension Our bodies, our life, our human nature and everything in this earth are gifts we have dominion over. This means we are responsible for them. We should not as faithful stewards, harm but rather improve and care for them. We have to treat them with utmost respect, use originality and creativity to cultivate them, know and respect their limits. We cannot contradict human nature. A.1 Principle of Respect for Human Dignity Respect for Human rights - pertains to the needs and values as it relates to other human beings; it is universal ; equal among everybody; not a product of human creativity but inherent to us ex. Universal Declaration of Human Rights (1948) – respects the dignity of the human person A.2 Respect for Person Every human being has an inner worth and inherent dignity. These he possesses not because of what he has or what he does but because of what he is: a human person As a human person, he must be respected regardless of the nature of his health problem, social status, competence, past actions Harming a person would constitute a violation against the person’s dignity Keypoints on human dignity All ethical decisions (made by patients and healthcare givers) must aim basically and ultimately at human dignity. They must protect, defend, enhance and enable the person’s worth. They must aim for the maximum and integrated satisfaction of every person’s needs, as an individual and members of his community. B. PRINCIPLE OF FREEDOM AND RESPONSIBILITY B.1 Principle of Personalized Sexuality The gift of sexuality must be used in keeping with intrinsic, indivisible, specifically human teleology. It must be a loving, pleasurable, expression of the complementary,  permanent self giving of a man and a woman to each other which is open to fruition in the perpetuation and expansion of this personal communion through the family they responsibly beget and educate. Basic Concepts/Values recognized in Sexuality sex is a search for sensual pleasure & satisfaction, releasing physical & psychic tensions sexuality = male and female = genitals (with natural tendencies) sex is a search for the completion of the human person through an intimate personal union of love expressed by bodily union sex is a social necessity for the procreation of children sex is symbolic mystery, somehow revealing the cosmic order Key points on personalized sexuality Sex is not always a proof of love, although often is demanded as such There is inseparable connection established by God, which man in his own initiative may not break, between the (1) unitive significance and the (2) procreative significance, both inherent to marriage act. any use of sex outside marriage is ethically unacceptable 1.It is selfish pursuit of pleasure apart from love = masturbation, prostitution, casual or promiscuous relations 2.It expresses love, but not a committed love involving true self –giving = adultery or premarital sex 3.It is committed but practiced in a way contradictory to it natural fulfillment in the family = use of artificial contraceptive methods, relations of committed homosexuals C. PRINCIPLE OF TOTALITY AND INTEGRITY OF A HUMAN PERSON Totality and Integrity posits that every person must develop, use, care for and persevere all of his or her natural physical and psychic functions in such a way that KEYPOINTS The good of the parts is essentially subordinate to the good of the whole In case of danger to itself the whole can dispose the part for its own benefits For the unitary and subsistent life of the organism, the parts considered separately have no meaning or purpose. THE BASIC CAPACITIES  - That define human personhood are never sacrificed unless this is necessary to preserve life Non justifiable – TAHBSO because you don’t want to have a child, cosmetic reason addiction for vanity purposes Justifiable – matter of life and death, mastectomy, organ donation KEY POINTS üA person may will to dispose of his body and to destine it to ends that are useful, morally irreproachable and even noble, among them the desire to aid the sick and suffering. One may make a decision of this nature with respect to his own body with full realization of the reverence which is due it … This decision should not be condemned but positively justified. D. Principle of Subsidiarity and Sociality Human communities exist only to promote and share the common good among all their members “from each according to ability, to each according to need” in such a way that: 1.Decision making rests vertically first with the person then with the lower social levels and horizontally with the functional social levels 2.The higher social needs intervene only to supply the lower units what they cannot achieve by themselves while at the same time working to make it easier for lower units and individuals to satisfy these needs by their own efforts. Universal Ethical Principles: The North American Center for Bioethics recommends 4 Universal Ethical Principles that are applicable and appropriate to all regardless of race, creed and nationality. These are thought to guide professional code of ethics and social norms. 1.Principle of Beneficence – covers the Principle of Double Effect, Consequentialist/Utilitarianism, 2.Principle of Non-maleficence 3.Principle of Autonomy – Respect for persons, Principle of Human Dignity, Principle of Confidentiality, Informed Consent, Principle of Veracity, Principle of professional communication 4.Principle of Justice 1. Principle of Beneficence Beneficence  Comes from the LT. word “bene” meaning good and “fiche” meaning to act or do. An act of or goodness, kindness, an action done for the good and benefit of others. 2. Principle of Non Maleficence “Do no harm” it is related to the following human rights 1.Right not to be killed 2.Right not to have bodily injury or pain inflicted to oneself 3.Right not to have one’s confidence revealed to others What is harm in the clinical setting? In the clinical setting, harm is that which worsens the condition of the patient. However, deciding what harm or worsen means is no simple matter. Much of health care involves pain, discomfort, inconvenience, expense, and perhaps even disfigurement and disability. Principle of Double Effect This principle aims to provide specific guidelines for determining when it is morally permissible to perform an action in pursuit of a good end in full knowledge that the action will also bring about bad results. An action that is good in itself that has two effects----an intended and otherwise not reasonably attainable good effect, and an unintended yet forseen evil effect---is licit, provided there is a due proportion between the intended good and the permitted evil. From a common cause – an action- two effect are produced: A good effect and an evil effect Review of the Determinants of the Morality of Human Act The ACT itself The INTENTION/the intended effect CIRCUMSTANCES No amount of good intention or difficult circumstance can make a wrong action correct. From a common cause – an action- two effect are produced: A good effect and an evil effect Review of the Basic Axioms of Morality  Majority opinion is not the norm of morality Widespread custom or the conventional wisdom is not the norm of morality A good end does not justify an evil means If an act is evil by its nature, nothing can make it good We cannot allow our emotions to warp our moral judgment Criteria for decisionmaking: Act itself must be morally good or at least indifferent. The motive behind the act must be to achieve the good effect never the evil effect, even though it is foreseen and permitted The good effect of the act must precede the evil effect or at least simultaneous with it. The good effect must be sufficiently desirable to outweigh the evil effect. Principle of Legitimate Cooperation Cooperation in the ethical sense is defined as the participation of one agent in the activity of another agent to produce a particular effect or share in a joint activity. This becomes ethically problematic when the action of the primary agent is morally wrong. Legitimate The term “legitimate” refers to moral acceptability, not the legal meaning of conforming to a set of standards and requirements to be acceptable. focuses on whether the action is ethically right, not just legally allowed. When you are performing an action that is intertwined with evil, you can use the following criteria to judge how legitimate your cooperation with the evil is: ✔The moral object of your action is good and you are operating out of good intentions. ✔The evil is only tolerated as a side effect of your action. ✔Your cooperation is only material cooperation, not formal. ✔Your cooperation is remote rather than proximate, so it causes minimal evil effects. ✔Your action does not cause scandal. 3. Principle of Autonomy 1. Principle of Autonomy deduced from the Greek word “autos” meaning “self” and “nomos” meaning “rule,” “governance,” or “law” (Morrison, E. and Furlong, B. 2019, p.44).  Autonomy refers to freedom from external control (Morrison, E. and Furlong, B. 2019, p.45). Patient autonomy is the right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for healthcare providers to educate the patient but does not allow the healthcare provider to decide for the patient Patient’s Rights The right to be treated with respect. The right to obtain medical records. The right to privacy of medical records. The right to make a treatment choice. The right to informed consent. The right to refuse treatment. The right to make decisions about end-of-life care. Patient’s Bill of Rights A Patient’s Bill of Rights is a document that provides patients with information on how they can reasonably expect to be treated during the course of their treatment or hospital stay. These documents are, in almost all cases, not legally-binding. They simply provide goals and expectations for patient treatment. The Patient’s Bills of Rights was recently renamed the Patient Care Partnership. Patient’s Bill of Rights in the Philippines (https://www.gov.ph) Informed Consent ✔The “Principle of Informed Consent” advocates that it is the right and responsibility of every competent individual to advance his/ her welfare. This right and responsibility is exercised by freely and voluntarily giving consent, designating agreement or refusal to undergo any procedures or treatments, based on a sufficient knowledge of the benefits, burdens, and risks involved. Fundamentally, the primary function of informed consent, is the protection of the patient’s right of self-determination to accept the proposed treatment. This right is  contingent on the assumption that the patient is free to decide what will be done with their body. The four Principles or Requirements of Informed Consent are as follows: 1.decision- making capacity; 2.documentation of consent; 3.disclosure of information; 4.comprehension of information. Upon meeting the four requirements of informed consent, three essential conditions are fulfilled 1.that the individual’s decision is voluntary; 2.that this decision is made with an appropriate understanding of the circumstances; and 3.that the patient’s choice is deliberate insofar as the patient has carefully considered all of the benefits, burdens, risks, and reasonable alternatives. PATERNALISM: WEAK AND STRONG ✔Paternalism allows one person to make decisions for another; assists person to make decisions when they do not have sufficient data or expertise. For example, the health care provider decides what is best for the patient The conflict between respect for autonomy and the desire to help the patient brings us to the issue of paternalism. Proxy Consent (Legally Acceptable Representative) ✔Is the process by which people with the legal right to consent to medical treatment for themselves or for a minor or a ward, delegate that right to another person. There are three fundamental constraints on this delegation: 1.The person making the delegation must have the right to consent. 2.The person must be legally and medically competent to delegate the right to consent. 3.The right to consent must be delegated to a legally and medically competent adult. Confidentiality and Privacy oConfidentiality in health care refers to the obligation of professionals who have access to patient records or communication to hold that information in confidence.  Surbhi (2018), defines confidentiality as a state when it is intended or expected from someone to keep the information secret. The term confidentiality is extracted from the word ‘confidence’ which means ‘trust.’ The information which is told in confidence to someone, will be kept secret from the reach of unauthorized people until the parties agree to uncover the information Privacy. - is the state when an individual is free from public interruption and intrusion. The word privacy is derived from the word ‘private’ which means the role of the public is limited, so the term privacy refers to a condition where a person is apart from public attention and observation. He can draw a boundary on the access of his information from the use of others. Moreover, it is a human tendency to hide certain facts about himself or else people will use them against him.(Surbhi, S., 2018). Fried (1990. Cited in Lukacs, A., 2016) advocates that, “Privacy is a necessary condition, the necessary atmosphere for maintaining intimate relationships of respect, love, friendship, and trust.” Furthermore, Fried (1990) argues that, “Without privacy, these relationships are inconceivable.” 1.Veracity Truth Telling and Right to Information Zolkefli (2018) and Amer (2019) share the following views on veracity: Veracity pertains to the ethics of telling the truth. To respect veracity in relationships is to deal honestly with patients and colleagues as they are. The ordinary ethics of truthfulness is generally summed up in two commands. First, do not lie. Second, you must communicate with those who have a right to the truth. Veracity in the Health Care Setting It refers to comprehensive, accurate, and objective transmission of information, as well as to the way the professional fosters the patients’ or subjects’ understanding. In this regard, veracity is closely connected to respect of autonomy [Beauchamp, T.L. and Childress, J.F. (2009)]. Veracity is necessary in professional-patient relationships for three reasons, namely: 3. The obligation of veracity is based on respect owed to others. 4. Veracity has a strong association with obligations of fidelity and promise-keeping.  5. Relationship of trust between persons are necessary for successful intervention and cooperation. At the core of these relationships, is confidence in and reliance on others to be truthful. Truth Telling Baillie, H., et al. (2013) assert the following statements on truth telling: oEvery competent person has a right to information about himself or herself, and about what is planned for him or for her. All information must be disclosed in order to make correct decisions both for the moment and for the future. In the Filipino culture, traits of family orientation to illness and the non- confrontational attitude affect truth telling. 4. Principle of Justice Morrison and Furlong (2019) assert the following statements on justice: -Justice is the principle that governs social fairness. It involves determining whether someone should receive or is entitled to receive a resource. Justice connotes giving each one his/ her due, entitlement, benefits one has a right to. Universal Ethical Principles -Justice usually comes in two major categories, procedural and distributive. Procedural Justice Procedural justice can be defined as due process. For example, in the legal system, we speak of being equal before the law as part of procedural justice. Distributive Justice The concept of distributive justice relates to determining what is fair when decision makers are determining how to divide burdens and benefits. IMPLICATIONS OF THE PRINCIPLES OF JUSTICE -each individual should receive what is due such as a.Life b.Information needed for decision making c.Confidentiality of private information -benefits should be justly distributed among individuals such as a.minimum health care b.equal opportunities for scarce resources -each individual should share in the burden of health and science such as a.caring for his own health b.caring for the health of others c.participating in health/science progress. IN CONCLUSION: There are basic ethical principles that are reflected in the natural law. These basic ethical principles were also reflected in the four universal ethical principles recommended by The North American Center for Bioethics. As nurses, we ascribe to the universal ethical principles and refrain from imposing our own beliefs to our patients. It is important though that we understand how these ethical principles are practiced in real life nursing situations.