BIOETHICS - THE ETHICAL PRINCIPLES SURROUNDING HEALTHCARE

BIOETHICS
Ethical Principles
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PRINCIPLE OF HUMAN DIGNITY
Basis of Human Dignity
Human rights
- 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
Universal Declaration of Human Rights (1948)
– respects the dignity of the human person
PERSON a person is a rational, autonomous being with the
ability to know universal, objectives moral laws & the
freedom to decide to act morally

SIGNIFICANCE OF BEING A PERSON
• Has an inherent dignity which must be respected
- A person should not be destroyed; uniqueness must not be
altered; genes cant be manipulated; organs removed
without any reason; one cant be cloned
- Has an ultimate destiny- to live with God
- To fulfill this, one has needs that must be met, resources
must help one meet these needs; but he is only a steward
- Lives with other persons in the community
- -Interacts with people; helps them

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.
Human Dignity
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
Decisions about health must aim at the maximum integrated

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
Certain actions may never be done because
performing them would constitute a violation
against the person’s dignity

Autonomy
Greek word “autos” meaning self and “nomos” meaning rule/
governance/ law. self- governing or the ability to govern
self is dependent upon many factors such as
o sound mind
o sound body
o full information of the issues
o without force or coercion
“Self Rule”
Having the right to choose/Decide for himself;
An individual has the right to determine for himself
Corollary Principles- Honesty in our dealings with others and
obligation to keep promises.

- Recognizing patients as persons who are entitled to
such basic human rights such as the right to know,
privacy and right to receive treatment - State of being
self-regulating, self-defining and self-reliant
- Ability of a person to make their own decisions without
interference
- freedom to make choices about issues that affect one’s
life
- Respect for persons; unique and valuable members of
the society

KEY POINTS
This principle assumes rational
thinking on the part of the individual
and may be challenged when the
rights of others are infringed upon by
the individual

Patient’s Rights
> Right to appropriate Medical Care and Humane Treatment
> Right to Informed Consent
> Right to Information
> Right to Religious Belief
> Right to Leave
> Right to Express Grievances
> Right to Correspondence and to Receive Visitors
> Right to be informed of his Rights and Obligations as a Patient
> Right to Refuse Participation in Medical Research
> Right to Privacy and Confidentiality
> Right to Choose Health Care Provider and Facility
> Right to Medical Records

Patient’s Bill of Rights
> High quality hospital care
> A patient can expect to be treated with respect regardless of race, sex, gender,
color, religion, age, marital status, sexual orientation, disability or other state or
condition
> A patient may choose who she/he spends time with during the course of care
> Appropriate pain management will be provided to the patient
> Patients are to be free from restraints and seclusion unless completely
medically necessary
> Providers will disclose and discuss patient’s condition and provide information
about relevant medical decisions
> Providers will understand who is to make decisions for the patient if she/he is
unable to > Patients can expect access to their medical records at will
> Providers will work to obtain information from patients about their condition
and personal state
> Providers will work to understand the patient’s health care goals and personal
values

PATERNALISM
Deliberate restriction of people’s autonomy
by health care professionals based on the
idea that they know what’s best for the
clients- can be justifiable at times
Doing good should take precedence over
autonomy
The doctor can decide:
1. Doctor can act as loco-parentis
2. If it is a matter of life and death
3. Court

Informed Consent Or Enlightened Consent
 It is a patient’s right to exercise freedom to make
decisions for his/her health. Appropriate and
necessary information are required so that
medical protocols and management may be done
for his interest.
 To protect the basic need of every human person for
health care and the person’s primary responsibility for his
or her own health,
(1) no physical or psychological therapy may be administered
without the free and informed consent of the patient, or,
(2) if the patient is incompetent, the person’s legitimate
guardian acting for the patient’s benefit and, as far as
possible, in accordance with the patient’s known and
reasonable wishes.

- Autonomy and Respect for person.
- Any procedure to be done on a person may only be
administered with his free and Informed consent. This
gives valid permission for others to act in certain
specific ways.

Informed Consent therefore has 2 main functions:
a. Protective- to safeguard against intrusion of
integrity.
b. Participative- to be involved in medical decision
making.

Nursing Responsibilities:
Witness the signing of the consent.
Make sure the patient understands the procedure to be
performed.
The ability to give informed consent depends on:
Adequate disclosure of information;

Patient freedom of choice;
Patient comprehension of information;
And patient capacity for decision making.
By meeting these above requirements, three necessary
are satisfied:
1. That the individual’s decision is voluntary
2. That this decision is made with an appropriate understanding of
the circumstances;
3. And that the patient’s choice is deliberate in so far as the
patient has carefully considered all of the expected benefits,
burdens, risks and reasonable alternatives.

Legally, adequate disclosure includes information concerning the following:
What information you should give to patients?
1. Diagnosis: Current Medical status
2. Nature and purpose of treatment; procedures available
3. Risks of treatment and benefits
4. Treatment alternatives
1. Prognosis
2. Affordability
Types of consent
a. Admission agreement
b. Blood Transfusion consent
c. Surgical Consent
d. Research Consent
e. Special Consent

Functions of Informed consent
a. To avoid fraud and duress
b. To encourage self- scrutiny by professionals
c. To foster rational decision making
d. To involve the larger society in the debate

Proxy Consent/Legally Acceptable Representative
The patient’s family or guardian or representative provides it. This
is Proxy Consent. Decisions by proxy should be based on what the
patient would have chosen had he been competent or if the
patient’s preferences are not known, based on the patient’s
interest.
Proxy Consent 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. Depending on the circumstances consent may take 2 other forms.
*Presumed- In cases where individuals are brought to the hospital in an unconscious
state or with no decision-making capacity, that the procedures to be performed are
necessary and can’t be postponed until the person has regained consciousness or
decision-making capacity.
*Vicarious Consent- For incompetent or incapacitated individuals, this right and duty
of the patient to give consent is to be exercised on her behalf by a surrogate. This is
regulated by individual state and federal laws, following various standards of
surrogate decision making, including substituted judgment and best interests.

Proxy Consent/Legally Acceptable Representative
Who are incompetent?
- Comatose
- Below 18 yrs old
- Mentally incoherent
Who gives proxy consent?
1. Durable Power of attorney
2. Closest of kin
 Adult- married- spouse, children of major
age Below 18- parents, grandparents No
spouse- siblings, uncles/aunts
 Key point
In securing consent, exhaust the vertical line first
before the horizontal

Proxy Consent/Legally acceptable representatives
Legally Authorized Representative (LAR): An
individual or judicial, or other body authorized
under applicable law to grant permission on
behalf of a prospective participant in research
activities. Surrogate consent was previously
referred to as “proxy consent”.

Proxy Consent/Legally acceptable representatives
Privacy- A state of being private, withdraw from public view or
company. Privacy is justified by the principle of Autonomy. Rights
to privacy are valid claims against unauthorized access that have
their basis in the right to authorize or decline access. These rights
are justified by rights of Autonomous choice expressed in the
principle for autonomy. In this respect, the justification of the right
to privacy is parallel to the justification of the right to give an
Informed Consent.
Latin “ privatus” Patient’s right.
Invasion of Privacy – If a patient is exposed to the public personally
or thru pictures or recording, the person responsible for his/ her
exposure can be held liable if the patient has not given his
authority for the exposure. Unauthorized exposure even after
death may constitute Invasion of Privacy.

PRINCIPLE OF CONFIDENTIALITY
Confidentiality
• non disclosure of private or secret information with one is
entrusted
• Requires the non-disclosure of private or secret
information with which one is entrusted
• ICN (2000)- “ the nurse holds in confidence personal
information and uses judgment in sharing this information”
• An important component of autonomy- maintains dignity
and respect for the person
Latin word “confidere” means to trust

PRINCIPLE OF CONFIDENTIALITY
Relates to matters of professional ethics. It protects the
client/patient from the unauthorized disclosures of any sort by
the professionals without the informed consent of the client.
The purpose of confidentiality is to safeguard t he clients right
with sanctions for violations of confidentiality.
Clients must be able to assume that their private
communications with the obligation not to divulge information
without the client knowledge and authorization unless it is in the
client interest to do so

2 General Situations that may give rise to exceptions
exist:
Concern safety of other specific person, the determining
factor in justifying breaking confidentiality is whether there is
good reason to believe, specific individual are placed in
serious danger depending on the medical information at hand.
Concern for Public Welfare in most cases of limited
confidentiality. The health care practitioner is required to
report in certain communicable infectious diseases to the
public health authorities the duty to protect.

Privacy – non exposure of a body part
The following are subjects of Confidentiality and should not
be revealed to anyone except for graver cause:
1. Private Secrets
2. Contractual Secrets
3. Professional Secrets

Privileged Communication
 a confidential communication that one cannot
be forced to divulge
Husband & wife
priest & penitent
doctor & patient
lawyer & client
To qualify for privileged status,
communication must generally be made in
private setting (that is, in a context where
confidentiality could reasonably be
expected).
Are there any situations in which a medical
professional justified in revealing
embarrassing or damaging information about
a patient to a third party?
GRAVE CAUSE
abuse (child/ elder abuse)
intent to kill self or someone
communicable disease
statuses require the disclosure of certain
happenings e.g. rape, abuse, incest, other crimes
Personal decision
Reportable cause
Legal case
KEY POINTS
The public good outweighs the individual’s right
to privacy and confidentiality
protective privileged ends where the public
perils begins
duty to warn is the duty to disclose confidential
information to protect identifiable victim and
warn appropriate authority targeted by threat

VERACITY/TRUTH
 truthfulness, document accurately
 Duty to tell the truth
 Fundamental to the development and continuance of
trust among human beings- truth telling, integrity and
honesty
 Truth telling
Definition: a nursing intervention from the Nursing
Interventions Classification (NIC) defined as the use of
whole truth, partial truth, or decision delay to promote the
patient’s self determination and well being.

VERACITY/TRUTH
Thoughts corresponds to action
“ We should declare what we think and not lie”.
*Lying – intention of deceiving
*Lie - “intrinsically evil and can never be considered
*Truth – Concealing the truth when:
Mental Reservation- act of the mind limiting the
phrase.
Not bearing the full sense of the phrase.
Example: Supposed to know but not to tell like- Cancer
patient.

VERACITY/TRUTH
Mental Evasion- limiting the right of the patient to know about
his condition.
Avoid in answering questions.
Never, tell a lie but tell them with Mental Reservation and Evasion
*Conceal the truth when:
you have no right to disclose the truth
*The person has no right to know the truth
Considerations in concealing truth when:
*It must not injure the right of another person to know the
truth
*There must be a good reason for concealing the truth
*The intention for concealing the truth must be good

FIDELITY
It’s keeping one’s promises. The nurse must be
faithful and true to their professional promises and
responsibilities by providing high quality, safe in a
competent manner.
 faithfulness, promises and loyalty
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

JUSTICE
Latin word “justitia” – “jus” From “ justus” means lawful and rightful
Fairness; Equal distribution of resources
“Giving each one what is his due”
JUSTICE = EQUITY
EQUITY vs UNIFORMITY
Preferential option for the poor
X- has a right to his due
Y- has the obligation not to deprive X of his due.
Justice also means to treat equals equally X and Y are
equal: X and Y should have equal benefits/burdens

JUSTICE
IMPLICATIONS OF THE PRINCIPLES OF JUSTICE
1. each individual should receive what is due to right such as
a. Life
b. Information needed for decision making
c. Confidentiality of private information
2. 2. benefits should be justly distributed among individuals such as
a. minimum health care
b. equal opportunities for scarce resources
3. 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
VIOLATIONS OF THE PRINCIPLES OF JUSTICE
1. Denying/ withholding a benefit to which a person has a right
2. Distributing a minimum health benefit unequally
3. Imposing an unfair burden on an individual

NON VIOLATIONS OF THE PRINCIPLES OF JUSTICE
1. the patient chooses to give up what is due
2. unjust outcome results or just process
Distributive Justice- the aspects of justice that
pertains to a fair scheme of distributing a society’s
benefits and burdens to its members, fair and just
distribution, should have equal opportunities to all
people, fairness of outcome distribution(pay,feedback)
-Ex: public programs that provides social security or
medical care to all elderly and retired persons, public
schools which all children have an equal opportunity
to attend,
PROBLEMS OF DISTRIBUTIVE JUSTICE
a. macro-allocation-to distribute resources across
population
b. meso-allocation-concerns policy that is implented

4 Different Types of Justice
1. Commutative Justice- refers to that which is
owed between individuals
- giving people what they deserve
Example:in conducting business transactions
- buying and selling and trading relationships
- agree to the offer
2. Contributive Justice- which refers to what
individuals owe to society for the common good, a
contribution a person makes to his or her society.
- being partly responsible for
- Ex: donation for breast cancer research, giving
time, fund raising

4 Different Types of Justice
3. Legal Justice- which refers to rights and responsibilities of citizens to
obey and respect the rights of all the laws devised to protect peace and social
order.
- it ensures that everyone is protected by the law, the law applies equally to
all, that all men are equal before the law.
- the law makes no distinction between the wealthy and the destitute
Ex: charity, homeless shelters, emergency services
4. Distributive justice- which refers to what society owes to its individual
members.
Example: the just allocation of resources.
> Creating a health care policy helps decide how limited resources are to be
distributed . It should consider the principles of equality (distributive justice),
social justice and solidarity.
The policy should state in clear terms the criteria for consideration, rank
ordering, etc. and this should be made public. The process must be just,
though sometimes outcomes do not appear Just.

JUSTICE
A. Utilitarian alternatives
promotes the highest good that is possible in every situation (the
greates good for the greatest number)
Principle of Immediate Usefulness
o gives priority to the candidate who is at greater immediate service
to the larger group under the circumstances
Medical Success Principle
o give priority to those whom treatment has the highest probability
of success
Principle of Conservation
o gives priority to those candidates who requires proportionally
smaller amount of resources and therefore more lives would be saved
Parental Role Principle
o gives priority to those who have the largest responsibilities to
dependents
Principle of General Social Value
o gives priority to those believed to have the greatest general social

JUSTICE
B. Egalitarian Alternatives
- restoring the equality of the persons in need
Principle of Saving No One
= gives priority to no one because not all can be saved
Principle of medical Neediness
= with the most pressing medical needs
Principle of General Neediness
= gives priority to the most helpless or generally neediest in an
attempt to bring them as nearly as possible to a level of well
being equal to that enjoyed by others.
Principle of Queuing the line
= gives priority to those who arrived first
Principle of Random Selection
= gives priority to those selected by chance or random

PRINCIPLE OF BENEFICENCE
Beneficence
Comes from the LT. word “bene” meaning
good and “fiche” meaning to act or do.
Beneficentia
An act of or goodness, kindness, an action
done for the good and benefit of others.
Practice of doing acts of goodness, kindness and charity; suggests acts of Mercy and
Charity.
Is the positive pole of non –maleficence. It means to do good, to
provide a benefit.
“ Do good and do no harm”

PRINCIPLE OF BENEFICENCE
Action that brings the most benefits and the least burden to
those affected, this is the Principle of Utility.
X- has a duty to benefit Y provided Y- is at significant risk
X’s action is needed; X’s action is likely to succeed;
There is No significant risk for X. The benefit to Y outweighs any
harm for X.
Example: Do overtime, during emergency, Stay and help or No
help at all.

PRINCIPLE OF NONMALEFICENCE
• the obligation of a physician not to harm the patient
it is related to the following human rights
Right not to be killed
Right not to have bodily injury or pain inflicted to oneself
Right not to have one’s confidence revealed to others

Violations of nonmaleficence
1. Physically harming a person as in suicide,
abortion, infanticide, torture and violence
2. Exposing a person to physical harm as in
subjecting a person to unnecessary
treatment or to dangerous procedure without
a commensurate important goal.
3. Harming a person’s reputation, honor,
property or interests as by revealing
confidential information
KEYPOINTS
1. BOTH the principles of BENEFICENCE and
NONMALEFICENCE focus on doing good to
others.

PRINCIPLE OF NONMALEFICENCE
Make sure patient is safe and not harmed
“ Do not inflect harm’’ means to do No, to prevent, to remove
or not to risk harm.
X- has a right Not to be harmed;
Y- has an obligation, Not to harm X
Harm maybe physical, mental, psychological, social, financial,
spiritual etc.
Example: Hippocratic Oath-“ I will never use treatment to injure
or wrong the sick”

Other Relevant Ethical Principles
Principle of Double Effect
From a common cause – an action- two effect are produced:
 A good effect and an evil effect
Determinants of the Morality of Human Act
 The ACT itself
 The INTENTION
 CIRCUMSTANCES
No amount of good intention or difficult circumstance can make a
wrong action correct.

• is a set of ethical criteria which Christian philosophers, and
some others have advocated for evaluating the permission of
acting when one’s otherwise legitimate act (for example,
relieving a terminally ill patient’s pain) may also cause an
effect one would otherwise be obliged to avoid (Sedation and
a slightly shortened life).
An action done with two results: good or bad

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

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.

Considerations
1. INTE
NTION isfocused on the
Beneficial E
ffect
2. INTE
NTION must be good
3. B
.E= H.E
. or if possible BE> HE
> 4.
OR
DE
ROFTIME
BEmust come
BEcomessimultaneously with
the HE

An action done with two
results: good or bad

4 Conditions of Double Effect:
I. The act must be good in itself
II. The intention must be good
III. Proportion of graveness must be
weighed (the good must outweigh the
bad effects)
IV. Good effects must follow from the
action as immediately as do the harmful
effects

Principle of Legitimate
Cooperation
 to assist in performing an evil act.
COOPERATION
Working with anther in the performance of an action.
2 Types of Cooperation:
a. Formal Cooperation
Involvement
Intention/Knowledge
b. Material Cooperation
Involvement
Intention

Types of cooperation:
I. FORMAL COOPERATION - Cooperator
wills the evil either by an explicit act of will
or actual sharing in the evil act itself -
Formal cooperation in evil is never allowed.
Identification with the “purpose”
Directly intend the evil action
Legitimate cooperation
 A nurse must never formally cooperate in
immorality either by explicitly willing the
evil or by directly sharing in the immoral
act.

II. MATERIAL COOPERATION
Cooperator performs an act which in itself is not
wrong though it is used by the principal agent to
help commit the evil action -It consists in
performing morally indifferent actions which make
the operation possible.
You cooperate in the act but not in purpose
indirectly intend the evil action
KEY POINTS:
1. Formal cooperation is always immoral
2. Immediate material cooperation is likewise
immoral
3. Mediate material cooperation may be moral

Sample Case Scenario
“Angely attempted abortion because her
boyfriend Dickson does not want to marry
her and he bought Cytotec and bottled
herbal medications from Quiapo and
suggested that she removed the baby. In her
attempt she was bleeding profusely and her
relatives, unaware of her intention, rushed
her to the hospital. The doctors completed

Sample Case Scenario
“Angely attempted
abortion because her
boyfriend Dickson does
not want to marry her
and he bought Cytotec
and bottled herbal
medications from
Quiapo and suggested
that she removed the
baby. In her attempt
she was bleeding
profusely and her
relatives, unaware of
her intention, rushed
her to the hospital. The
doctors completed the
procedure even if there
is FHT.
1. Angely- formal cooperation; intends to terminate
pregnancy and the evil action
2. Dickson : formal cooperation; intends evil action, advices
to abort the baby, bought abortifacients such as
bottled herbal medications and Cytotec
3. Relatives: material cooperation: not included in the evil
plan, rushes to the hospital unaware
4. Doctors: formal cooperation; intends evil action by the
expulsion and aborting the fetus even though there is a
FHT
5. The janitor in paternal leave: knows what’s happening
in the hospital: material cooperation: because even
though he is aware on what the institution is doing, he
remains quiet and doesn’t do anything to stop the evil
action
6. Nurse on duty during the procedure, nursing aide and
janitor on duty: formal cooperation: knows the evil

Principle of Common Good and Subsidiary
Vatican II defined the common Good as “sum total of social
conditions which allows people, either as groups or as individuals,
to reach their fulfillment more fully and more easily.” It is about the
progress of persons.
A society that wishes and intends to remain at the service of the
human being at every level is a society that has the common good.
the good of all people and of the whole person as its primary goal.
The common good comes into existence in a community of
solidarity among active, equal agents.

 The duty of all is to make the sacrifices necessary so that those who are
marginalized can also become active participants. “It is not enough to
draw on surplus goods which in fact our world abundantly produces;
requires above all a change of lifestyles, of modes of production and
consumption, and of established structures of power which today
societies.”
• We must be interested in the good of all, even of people
nobody thinks about because they have no voice and no power.
The goods of the earth are there for everyone. The common
good consists not only of the material or external good of all
human beings; it also includes the comprehensive good of the
human being, including even the spiritual good.

The common good of society is not an end in itself. It is only part of a bigger picture,
the ultimate end which is God. The common good, as a mere materialistic social
economic ideal, would count for little without any transcendental goal.
Subsidiarity- Often considered a corollary of the principle of the common good,
subsidiarity requires those in positions of authority to recognize that individuals have a
right to participate in decisions that directly affect them, in accord with their dignity
and with their responsibility to the common good.
Every task of society should be assigned to the smallest possible group that
perform it. Only if the smaller group is unable to resolve the problem itself should a
group at a higher level assume responsibility. This idea is summed up in the principle
of subsidiarity.
Example: if a family is experiencing problems, the state can intervene only if the
family or the parents are overburdened and cannot resolve them. It helps to avoid too
much centralization. Being able to help oneself is an important component of the
dignity of the human person.

Principles of Bioethics
Principle of Stewardship and Role of Nurses
as Stewards

Stewardship
- An act of delegation of responsibility. Assumes
responsibility for providing necessary physical for the
patients needs. The nurse presents information to the
patient that will help illness and will assist with
possible regaining health status.
EX: manage something on someone’s behalf, taking
care of something entrusted to one’s care

Steward-
May be characterized as a person who preserves and
promote intrinsic value of a situation, as well as
engage others in solutions and actions. Means
keeper; Responsible for the care of the body of
oneself and of others. “The Lord God took the men
and settled him into the Garden of Eden to cultivate
and care for it” (Genesis 2:15)

Accountability-
- related to both responsibility and answerability.
According to the American Association (1985) it refers to
being answerable to someone for something one has done.
It is grounded in the moral principles of fidelity and respect
for the dignity, worth and self – determination of clients.
Safe, autonomous practice is ensured thru various
processes of nursing accountability.

Personal-
 Involves valuing and respecting patient’s priorities and self- determination. Nurse
becomes stewards or teachers to patient who may have not expertise or experiences in
the disease process but who understand the consequences of their illness. The primary
role of a nurse is to advocate and care for individuals of all ethnic origins and religious
backgrounds and support them through health and illness. However, there are various
other responsibilities of a nurse that form a part of the role of a nurse, including to:
*Record medical history and symptoms
*Collaborate with team to plan for patient care
*Advocate for health and well being of patient
*Monitor patient health and record signs
*Administer medications and treatments
*Operate medical equipment *Perform diagnostic tests
*Educate patients about management of illnesses
*Provide support and advice to patients

Social-
is a concept that offers nurse to be a leader in critical insight how they can assist and
extend their practice of bearing witness.
*Nurses role play a dynamic and crucial role in health care. A nurse is usually the first
person a patient interacts with. Nurses are responsible for assessing patients’ needs
and diagnosing illnesses. As such, nurses are an integral part of the comprehensive
standards of care and health promotion.
*Nurses can teach their patients education regarding the disease process that maybe
affecting the patient at that time.
*Nurses give patients resources to improve their lives and disease outcomes.
*Nurses pass medications and teach procedures to patients to help them achieve
compliance with their health related needs.

Ecological-
nurses give patients resources to improve their lives and disease
outcomes. Nurses pass medications and teach procedures to
patients to help them achieve compliance with their health
related needs. Expanding Role for Nurses with New Global Health
Challenges. Nurses have long taken a lead in helping patients
address the physical impact of aging and chronic disease, as well
the psychological factors that affect how patients manage their
conditions. Nurses have the ability to use their trusted skill sets
and lead the way for sustainable healthy communities and
environments in which they serve.

Biomedical-
nurses lead in the establishment of value–based
practices that affect health care organization and may
facilitates in their value priorities . Nurse stewardship
embraces character, dialogue and shared values.

Role of the Nurse in
Biomedical Waste
Management
Visit all wards and high risk units regularly. Ensuring that
samples (Blood, stool, urine, etc.) are collected and
dispose safely. Monitoring and supervising the staff
weather they are doing safe disposal of waste as color
coded. Prevention of hospital acquired infections by
following universal precautions.

Principles of Totality and its
Integrity
 Latin word “ totalis” means
Removal/Structural change of body part(s) to
promote optimal functioning of total body.
 “ The whole is more important than the
parts”

Totality-
• refers to the whole every person must develop,
use, care for and preserve all his parts and
functions for themselves as well as for the good of
the whole. If a part or lower function harms the
whole, this part or lower function maybe
sacrificed for the good or better function of the
whole. The basic capacities which define human
person hood, however, are sacrificed only when
there is a need to preserve life. Ex: amputation

2 Types of Totality/
Wholeness
• Functional wholeness- ability to
perform tasks optimally.
• Structural wholeness- anatomical
completeness

Integrity
• - refers to each individual’s duty to preserve a view of the whole
human person in which the values of intellect, will, conscience
and fraternity are preeminent. Integrity is being honest even
when no one else is looking. It is doing the right thing even when
no one is around to see you do it. Integrity is doing things the
way they should be done, when no one is looking, instead of
doing short cuts.

A. Ethico-Moral
Responsibility of a Nurse in
Surgery

Aspects In Nursing Moral-
 personal/private interpretation from what is good and bad.
Ethical Principles: Autonomy- the right/freedom to decide (the
patient has the right to refuse despite the explanation of the
nurse)
Example: Surgery or any procedure

Sterilization/ Mutilation
Sterilization- is any number of medical methods of birth control that intentionally
leaves a person unable to reproduce. Sterilization methods include surgical and non –
surgical, and exist for both males and females. It refers to any process that effectively
kills or eliminates communicable agents as fungi, bacteria, viruses, spore forms, etc.
from a surface, equipment, article of food or medication or biological culture medium.
Sterilization is a surgical technique leaving a male or female unable to reproduce. It is a
method of birth control.
Male- Vasectomy; Female- Tubal Ligation
Sterilization is a simple operation to tie up the vas deferens of male (Vasectomy) or by
tying or cutting off the Fallopian tube of the females (Tubal Ligation) so that the sperm
and the egg would not be able to meet each other. No organs are removed.

Sterilization may be therapeutic or
non therapeutic, voluntary or
involuntary.
Therapeutic Sterilization implies the removal of all or part of the reproductive organs
to protect the health and the life of the client.
Non therapeutic sterilization, often called Convenience Sterilization is the purpose of
destroying the removal of all or part of the reproductive organs for the purpose of
destroying the reproductive function.
ex:
Voluntary Sterilization is a term synonymous with non therapeutic and convenience
sterilization.
Involuntary Sterilization is compulsory sterilization of individual reasons for Eugenic
reasons.

Mutilation- Latin word “mutilus”
Mutilation or Maiming is cutting off or injury to a
body part of a person so that the part of the body is
permanently damaged, detached or disfigured.
Mutilation maiming is an act or physical injury that
degrades the appearance or function of the (human)
body, usually without causing death.
EX: removing or damaging a finger

C . Preservation of Bodily Functional
Integrity
The functional integrity of the person may be sacrificed to maintain the health or
life of the person when no one other normally permissible means is available. The
principle of totality is based on the natural law which says that life is to be
preserved and maintained.
Artificial means of preservation comprise the application of simple heat or cold,
powders such as a sawdust bed mixed with zinc sulphate, evisceration combined
with immersion, drying, local incision and immersion, arterial injections, cavity
injections. Furthermore, simple immersion in alcohol, brine etc., and sole arterial
injection, which can be combined with cavity treatment and/ or immersion were
used.

Issues on Organ Donation
END OF PRELIMS

BIOETHICS - THE ETHICAL PRINCIPLES SURROUNDING HEALTHCARE

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