BIO‭ETHICS IN NURSING PROFESSION (LECTURE).pptx

BIOETHICS
By: ROMMEL LUIS C.
ISRAEL III

BY: ROMMEL LUIS C. ISRAEL III
2
WHAT IS ETHICS?

3
It is a study of
Morality’s effect on
the conduct; the
study of moral
standards and how
they affect a
conduct.
It is also a branch of
philosophy
concerned with
judgements about
right and wrong;
goodness and
badness.
It also covers related
concepts such as
virtue, vice, duty and
obligation.

4
WHAT IS
BIOLOGY?

5
It is the study of Life
First used by Jean-Baptiste Lamarck(French
Naturalist)
It examines the Structure, Function, Growth,
origin, Evolution, and distribution of living things.

6
WHAT IS
BIOETHICS?

7
• It is a discipline dealing with
the ethical implications of
biological research and
applications especially in
medicine.
• It comprises the basic
principles that govern nurses
and is helpful in guiding how
to approach and engage
patients, especially when
difficult decisions about life.

8
Bioethical questions often involve overlapping
concerns from diverse fields of study including life
sciences
• biotechnology,
• public health,
• medicine,
• public policy,
• law, philosophy and theology.
They arise in clinical, research, and political
arenas, usually in response to advances in
biology, health care, and technology, particularly
biotechnology.

9
THEORIES AND PRINCIPLES
IN HEALTH ETHICS

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DEONTOLOGY
It is derived from
the Greek
words:
deon (duty)
and logos
(science)
In
deontological ethics,
an action is
considered morally
good because of
some characteristic
of the action itself,
not because the
product of the action
is good.
Deontological
ethics holds that
at least some
acts are morally
obligatory
regardless of
their
consequences
for human
welfare.

11
IMMANUEL KANT
He is the first great
philosopher to
define
deontological
principles , the 18th-
century German
founder of critical
philosophy (see
Kantianism).
Kant held that
nothing is good
without qualification
except a good will,
and a good will is
one that wills to act
in accord with the
moral law and out of
respect for that law
rather than out of
natural inclinations.
He saw the moral
law as a categorical
imperative—i.e., an
unconditional
command—and
believed that its
content could be
established by
human reason
alone.

12
TELEOLOGY
• Teleological ethics
• teleological from Greek words:
telos (end) and logos (science)
• theory of morality that derives duty or
moral obligation from what is good or
desirable as an end to be achieved.
• Also known as consequentialist
ethics.

13
BARON CHRISTIAN VON
WOLF
•"study of final causes,"
1740, from Modern
Latin teleologia, coined 1728
by German philosopher
Baron Christian von Wolff
(1679-1754)

14
CONSEQUENTIALISM
• Ethical egoism is the moral doctrine that
everyone ought to act to promote his or her
own interests exclusively.
• Ethical Altruism
(also called the ethic of altruism, moralistic
altruism, and ethical altruism is
an ethical doctrine that holds that the moral
value of an individual's actions depend solely on
the impact on other individuals, regardless of the
consequences on the individual itself.

15
UTILITARIANISM
• The doctrine that the end
of all action should be the
greatest happiness of the
greatest number.

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JEREMY BENTHAM
AND JOHN STUART
MILL
• Utilitarianism in
normative ethics, a
tradition stemming from
the late 18th- and 19th-
century English
philosophers and
economists Jeremy
Bentham and John
Stuart Mill

17
Situation 1: If a nurse
immediately and directly tells a
(CHD) patient that he have a
cancer and prognosis is not
good.
Using the Ethical Theory of
Deontology, what could be the
possible outcome of the
action?

18
Situation 2: Role-Play
with a partner
As a Gynecology
Nurse on how to tell a
Mother of a underage
girl about her
daughter’s unwanted
pregnancy. (Explain
the Ethical Theory you
apply in the situation).

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VIRTUE ETHICS

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It is another philosophical idea that has been central
to medical ethics which holds that those who are
taught to be good will do what is right.
Nurses should act, think and feel from the virtues
including honesty, kindness, trustworthiness,
respectfulness and courage.

21
ETHICAL
PRINCIPLE -
AUTONOMY
• Respecting each
persons rights, decision
and beliefs
Is an ancient notion (the
term is derived from
the ancient
Greek words autos,
meaning “self,” and nomos,
meaning “rule”)

22
AUTONOMY
Right to Appropriate Medical Care and Humane Treatment.
Every person has a right to health and medical care corresponding to his state of health,
without any discrimination and within the limits of the resources, manpower and competence
available for health and medical care at the relevant time.
Right to Informed Consent.
The patient has a right to a clear, truthful and substantial explanation, in a manner and
language understandable to the patient, of all proposed procedures, whether diagnostic,
preventive, curative, rehabilitative or therapeutic, wherein the person who will perform the said
procedure shall provide his name and credentials to the patient, possibilities of any risk of
mortality or serious side effects, problems related to recuperation, and probability of success
and reasonable risks involved.

23
The patient will not be subjected to any procedure without his written informed
consent, except in the following cases:
• In emergency cases, when the patient is at imminent risk of physical injury,
decline or death if treatment is withheld or postponed. In such cases, the
physician can perform any diagnostic or treatment procedure as good
practice of medicine dictates without such consent;
• When the health of the population is dependent on the adoption a mass
health program to control epidemic;
• When the law makes it compulsory for everyone to submit to a procedure;

24
When the patient is either a
minor, or legally
incompetent, in which case,
a third party consent is
required;
When disclosure of material
information to patient will
jeopardize the success of
treatment, in which case,
third party disclosure and
consent shall be in order;
When the patient waives his
right in writing.

25
Informed consent shall be obtained from a patient concerned if he is of legal age
and of sound mind. In case the patient is incapable of giving consent and a third party consent
is required, the following persons, in the order of priority stated hereunder, may give consent:
Spouse;
Son or daughter of legal age;
Either parent;
Brother or sister of legal age, or
Guardian

26
When his mental or physical
condition is in controversy
and the appropriate court, in
its discretion, orders him to
submit to a physical or
mental examination by a
physician;
When the public health and
safety so demand; and c)
when the patient waives this
right.

27
If a patient is a minor, consent shall be
obtained from his parents or legal
guardian.
If next of kin, parents or legal
guardians refuse to give consent to a
medical or surgical procedure
necessary to save the life or limb of a
minor or a patient incapable of giving
consent, courts, upon the petition of
the physician or any person interested
in the welfare of the patient,
in a summary proceeding, may issue
an order giving consent.

28
Right to Privacy and Confidentiality.
• The privacy of the patients must be assured at all stages of
his treatment. The patient has the right to be free from
unwarranted public exposure, except in the following cases:
• The patient has the right to demand that all information,
communication and records pertaining to his care be treated
as confidential. Any health care provider or practitioner
involved in the treatment of a patient and all those who have
legitimate access to the patient's record is not authorized to
divulge any information to a third party who has no concern
with the care and welfare of the patient without his consent,
except:
• When such disclosure will benefit public health and safety;
• When it is in the interest of justice and upon the order of a
competent court.

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• When the patients waives in writing the confidential nature of
such information;
• When it is needed for continued medical treatment or
advancement medical science subject to de-identification of
patient and shared medical confidentiality for those who have
access to the information.
• Informing the spouse or the family to the first degree of the
patient’s medical condition may be allowed; provided, that
the patient of legal age shall have the right to choose on
whom to inform. In case the patient is not of legal age or is
mentally incapacitated, such information shall be given to the
parents, legal guardian or his next of kin.

30
Right to Information.
• In the course of his/her treatment and hospital
care, the patient or his/her legal guardian has a
right to be informed of the result of the
evaluation of the nature and extent of his/her
disease, any other additional or further
contemplated medical treatment on surgical
procedure or procedures, including any other
additional medicines to be administered and
their generic counterpart including the possible
complications and other pertinent facts,
statistics or studies, regarding his/her illness.

31
Any change in the plan of care before the
change is made, the person’s participation
in the plan of care and necessary changes
before its implementation, the extent to
which payment maybe expected from
Philhealth or any payor and any charges for
which the patient maybe liable, the
disciplines of health care practitioners who
will furnish the care and the frequency of
services that are proposed to be furnished.
The patient or his legal guardian has the
right to examine and be given an itemized
bill of the hospital and medical services
rendered in the facility or by his/her
physician and other health care providers,
regardless of the manner and source of
payment. He is entitled to a thorough
explanation of such bill.

32
• The patient or his/her legal guardian
has the right to be informed by the
physician or his/her delegate of
his/her continuing health care
requirements following discharge,
including instructions about home
medications, diet, physical activity
and all other pertinent information to
promote health and well-being.

33
•At the end of his/her confinement, the
patient is entitled to a brief, written
summary of the course of his/her illness
which shall include at least the history,
physical examination, diagnosis,
medications, surgical procedure, ancillary
and laboratory procedures, and the plan of
further treatment, and which shall be
provided by the attending physician.

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• He/she is likewise entitled to
the explanation of, and to
view, the contents of the
medical record of his/her
confinement but with the
presence of his/her attending
physician or in the absence of
the attending physician, the
hospital’s representative.

35
Notwithstanding that he/she may not be
able to settle his accounts by reason of
financial incapacity, he/she is entitled to
reproduction, at his/her expense, the
pertinent part or parts of the medical record
the purpose or purposes of which he shall
indicate in his/her written request for
reproduction. The patient shall likewise be
entitled to medical certificate, free of
charge, with respect to his/her previous
confinement.
The patient has likewise the right not to be
informed, at his/her explicit request.

36
The Right to Choose Health Care
Provider and Facility.
• The patient is free to choose the health care
provider to serve him as well as the facility except
when he is under the care of a service facility or
when public health and safety so demands or when
the patient expressly or impliedly waives this right.
• The patient has the right to discuss his condition
with a consultant specialist, at the patient’s request
and expense. He also has the right to seek for a
second opinion and subsequent opinions, if
appropriate, from another health care
provider/practitioner.

37
Right to Self-Determination.
• The patient has the right to avail himself/herself of any
recommended diagnostic and treatment procedures.
Any person of legal age and of sound mind may make
an advance written directive for physicians to
administer terminal care when he/she suffers from the
terminal phase of a terminal illness: Provided, That
• He is informed of the medical consequences of his
choice;
• He releases those involved in his care from any
obligation relative to the consequences of his decision;

38
• His decision will not prejudice public health
and safety.
• He/she is informed of the medical
consequences of his/her decision;
• He/she releases those involved in his/her
care from any obligation relative to the
consequences of his decision;
• His/her decision will not prejudice public
health and safety.

39
Right to Religious Belief.
• The patient has the right to refuse medical treatment
or procedures which may be contrary to his religious
beliefs, subject to the limitations described in the
preceding subsection:
• Provided, That such a right shall not be imposed by
parents upon their children who have not reached the
legal age in a life threatening situation as determined
by the attending physician or the medical director of
the facility.

40
Right to Medical Records.
• The patient is entitled to a summary of
his medical history and condition, He
has the right to view the contents of
his medical records, except psychiatric
notes and other incriminatory
information obtained about third
parties, with the attending physician
explaining contents thereof.
• At his expense and upon discharge of
the patient, he may obtain from the
health care institution a
reproduction of the same record
whether or not he has fully settled his
financial obligation with the physician
or institution concerned.

41
The health care institution shall
safeguard the confidentiality of
the medical records and to
likewise ensure the integrity and
authenticity of the medical
records and shall keep the same
within a reasonable time as may
be determined by the Department
of Health.
The health care institution shall
issue a medical certificate to the
patient upon request. Any other
document that the patient may
require for insurance claims shall
also be made available to him
within a reasonable period of time.

42
Right to Leave.
• The patient has the right to leave a hospital or any
other health care institution regardless of his
physical condition: Provided, That
• No patient shall be detained against his/her will in
any health care institution on the sole basis of his
failure to fully settle is financial obligations. However,
he/she shall only be allowed to leave the hospital
provided appropriate arrangements have been
made to settle the unpaid bills: Provided, farther,
that unpaid bills of patients shall be considered as
lost income by the hospital and health care
provider/practitioner and shall be deducted from
gross income as income loss for that particular year.

43
Right to Refuse Participation in Medical
Research.
• The patient has the right to be advised if the health care
provider plans to involve him in medical research, including
but not limited to human experimentation which may be
performed only with the written informed consent of the
patient.
• Provided, further, That, an institutional review board or ethical
review board in accordance with the guidelines set in the
Declaration of Helsinki be established for research involving
human experimentation:
• Provided, finally, That the Department of Health shall
safeguard the continuing training and education of future
health care provider/practitioner to ensure the development of
the health care delivery in the country.

44
RIGHT TO REFUSE
PARTICIPATION IN
MEDICAL RESEARCH

45
RIGHT TO REFUSE
PARTICIPATION IN
MEDICAL RESEARCH

46
Right to Correspondence and to
Receive Visitors.
• The patient has the right to communicate
with relatives and other persons and to
receive visitors subject to reasonable limits
prescribed by the rules and regulations of
the health care institution.

47
RIGHT TO CORRESPONDENCE
AND TO RECEIVE VISITORS.

48
Right to Express Grievances.
• The patient has the right to express complaints and
grievances about the care and services received
without fear of discrimination or reprisal and to know
about the disposition of such complaints.
• The Secretary of Health, in consultation with health
care providers, consumer groups and other
concerned agencies shall establish a grievance
system wherein patients may seek redress of their
grievances.
• Such a system shall afford all parties concerned with
the opportunity to settle amicably all grievances.

49
Right to be informed of His Rights and Obligations as a
Patient.
• Every person has the right to be informed of his rights and obligations
as a patient. The Department of Health, in coordination with
health care providers, professional and civic groups, the media, health
insurance corporations, people’s organizations, local government
organizations, shall launch and sustain a nationwide information and
education campaign to make known to people their rights as patients,
as declared in this Act. (Senate no.812)
• Such rights &d obligations of patients shall be posted in a bulletin
board conspicuously placed in a health care institution.
• It shall be the duty of health care institutions to inform patients of their
rights as well as the institution's rules and regulations that apply to the
conduct of the patient while in the care of such institution.

50
CORE VALUES OF
A PROFESSIONAL
NURSE

51
PRINCIPLE OF BENEFICENCE
HELPING OTHERS AS THE
PRIMARY GOAL.
BENEFICENCE HOLDS THAT
THEY SHOULD AIM TO DO
GOOD—I.E., TO PROMOTE
THE INTERESTS OF THEIR
PATIENTS.

52
PRINCIPLE OF
NON-
MALEFICENCE
• Non-maleficence states that
a medical practitioner has a
duty to do no harm or allow
harm to be caused to a
patient through neglect.

53
PRINCIPLE OF JUSTICE
• Distributing burdens and
benefits fairly.
• offering the same treatment
options to two patients.

54
PRINCIPLE OF VERACITY
Veracity is defined as being honest
and telling the truth and is related to
the principle of autonomy.
It is the basis of the trust relationship
established between a patient and a
health care provider. This allows
patients to use their autonomy to
make decisions in their own best
interest.

55
PRINCIPLE OF FIDELITY
Fidelity basically means trust and
faithfulness implies a trust. It is
important for a nurse to gain the
loyalty of the patients, co-workers
and hospital administration.
Fidelity or loyalty is an important
ethical principle and is a vital
component of the nursing profession.
Fidelity is considered by many nurses
to be the most common source of
ethical conflict. Health care
professionals may find themselves
caught between what they believe is
right, what the patient wants, what
other members of the health care
team expect, and what is required
by organizational policy and the law.

56
OTHER
RELEVANT
ETHICAL
PRINCIPLES

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Principle of Double-Effect
The principle allows the action as
morally permissible in those
circumstances in which the harmful
effect is not intended, but is a side-
effect of the action.
Acts of self-defense, for example,
are often justified using this
principle.

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THE NEW CATHOLIC ENCYCLOPEDIA PROVIDES FOUR CONDITIONS FOR THE APPLICATION
OF THE PRINCIPLE OF DOUBLE EFFECT:
• The act itself must be morally good or at least
indifferent. (NO other option)
• The agent may not positively will the bad effect but
may permit it. If he could attain the good effect
without the bad effect he should do so. The bad
effect is sometimes said to be indirectly voluntary.
• The good effect must flow from the action at least
as immediately (in the order of causality, though
not necessarily in the order of time) as the bad
effect.

59
The Principle of Common Good
and Subsidiarity
Subsidiarity to make common
decisions at the lowest practical
level-every person, family and
intermediate group has something
original to offer to the community.
‘Every person’s contributions should
count’.

60
REFERENCES
Estoesta, R. M., & Javines, R. (n.d.). Bioethics with Contemporary Readings
and Issues (1st ed., pp. 17–39) [Review of Bioethics with Contemporary
Readings and Issues ]. Educational Publishing House.
‌
Britannica (2024). Deontological ethics . In: B. Duignan, ed., Encyclopædia
Britannica. [online] Available at:
https://www.britannica.com/topic/deontological-ethics.
‌
The Editors of Encyclopaedia Britannica (2019). Teleological ethics |
philosophy. In: Encyclopædia Britannica. [online] Available at:
https://www.britannica.com/topic/teleological-ethics.
‌
Super User (2014). Patient’s Rights. [online] Doh.gov.ph. Available at:
https://tdh.doh.gov.ph/index.php/patient-s-corner/patient-s-rights.
‌

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