SUMMARY OF ETHICAL PRINCIPLES

Ethical Principles
1. Autonomy
The word come from Greek Autos (self) and Nomos ( governance)
Refers to one’s moral power or right to self-governance and determination to make
decisions in directing one’s own life. It presupposes the exercise of freedom upon which autonomy
is incumbent to determine the course of action to choose and take in pursuing that which upholds
human dignity and life.
The term self-determination is often used synonymously with autonomy.

In medicine, autonomy refers to the right of the patient to retain control over his or her body. A
health care professional can suggest or advise, but any actions that attempt to persuade or coerce
the patient into making a choice are violations of this principle. In the end, the patient must be
allowed to make his or her own decisions – whether or not the medical provider believes these
choices are in that patient’s best interests – independently and according to his or her personal
values and beliefs.

Implications of Patient’s autonomy

1. The patient is responsible for his choices and decisions
2. His human dignity is upheld and recognized
3. His personal value and worth are affirmed
4. His patient’s rights are protected and are not unduly interfered with
5. He cannot be constrained or forced to make decisions and perform actions against his will

Paternalism is the intentional limitation of the autonomy of one person by another, where the
person who limits autonomy appeals exclusively to grounds of benefit to the other person.

A. Patient’s Rights
What are the patient’s Rights?
Patient’s Rights refer to the moral power incumbent upon the dignity of the patient as a human
person which is enjoined by both natural law and positive law requiring that what is due must be
rendered to the patient as justice demands.
The patient as a dignified Human Person
Patient’s Bill of Rights
Patient’s Rights and Obligations
The patient is a person who avails himself or herself of health or medical care services or is
otherwise the subject of such services. The following are the rights that are embodied in the
proposed Magna Carta of Patient’s Rights, authored by Senator Juan M. Flavier.
1. Right to Appropriate Medical Care and Humane Treatment
2. The Right to Informed consent. Except in the following cases:
a. emergency cases
 b. when the health of the population is dependent on the adoption of a mass health
program to control epidemic
c. when the laws makes it compulsory for everyone to submit to a procedure
d. when the patient is either a minor or legally incompetent, where third party consent is
required
e. when disclosure of material information to patient will jeopardize the success of
treatment
f. when the patient waives his right in writing.
3. Right to Privacy and Confidentiality
4. Right to information
5. Right to Choose Health Care Provider and Facility
6. Right to Self Determination
7. Right to Religious Belief
8. Right to Medical Records
9. Right to Leave
10. Right Refuse Participation in Medical Research
11. Right to Correspondence and to Receive visitors
12. Right to Express Grievances
13. Right to be Informed of His Rights and Obligations as a Patient
B. Informed Consent

Informed consent in health care refers to the patient’s deliberate and voluntary acceptance of a
health care procedure which presupposes sufficient disclosure of the nature and goals of the
procedure, its possible side effects , risks and benefits and the available medical options.
The procedure can be diagnostic, preventive, curative and/or research for experimentation that
may have some effects on the patient’s bodily integrity and human dignity. That is why, informed
consent is sought in agreement with the principle of autonomy.

2. Confidentiality
Confidentiality is an important aspect of the trust that patients place in health care professionals.
If the patient felt that information in regard to his body or condition was the subject of public
conversation used to brighten the coffee break in the cafeteria or was subject to release to
publications, a great barrier between practitioner and patient would exist. This fear of disclosure
has, in the past led minors with sexually transmitted disease to suffer without care rather than
seek to aid , knowing that the system required the health care system to notify their parents.
- Keeping in confidence all that one has learned in the course of caring for the a patient
and the family is a very strong basis for an effective and working professional relationship.
 Top confide in someone like a physician or nurse , one has to feel secure that secrets are
securely guarded and kept in confidence.
- A person who without authorization enters a hospital record room or computer data bank
violates the right to privacy. Only the person or institution to whom information is given in
a confidential relationship can be charged with violating rights of confidentiality. Ones
secrets are confided they should be sealed with much respect because with confidentiality
there is trust.

3. Veracity
Binds both the health practitioner and the patient in an association of truth. This patient must tell
the truth in order that appropriate care can be provided. The practitioner needs to disclose
factual information so that the patient can exercise personal autonomy. To respect veracity in
relationships is to deal honesty with patients and colleagues as they are.
- Truthfulness
- To be true is to accept one’s self as one is.
- Veracity has a close connection to obligations of fidelity and promise keeping. When we
communicate with others, we implicitly promise that we speak truthfully and that we will
not deceive listeners. Truth- diagnosis, prognosis and other pertinent information.

4. Fidelity
By fidelity, we mean the obligation to act in good faith and to keep vows and promises, fulfill
agreements, maintain relationships and fiduciary responsibilities.
Fiduciary responsibility refers to the contract of relationship we enter into with the patient.
Fiduciary responsibility bank on trust and confidence. This means that once the physician or nurse
enters into a relationship with the patient, these professionals become the trustees of the patient
health and welfare. Hence both the physician and the nurse are obligated to maintain the contract
of care. They cannot withdraw their care without
The model for fidelity is keeping one’s word of honor, loyalty to commitments and oaths , and
reliability.
The model of fidelity leans on the values of loyalty and trust as well as standing true to one’s
word . In popular Spanish parlance, known as palabra de honor. With fidelity goes the traits of
maturity and commitment of the person.
- We mean obligation to act in good faith and to keep vows and promises, fulfill
agreements, maintain relationships and responsibilities.
- Keeping one’s word of honor, loyalty to commitments and oaths and reliability.

5. Justice/ fairness

The principle of justice states that there should be an element of fairness in all medical decisions:
fairness in decisions that burden and benefit, as well as equal distribution of scarce resources
and new treatments, and for medical practitioners to uphold applicable laws and legislation when
making choices.

Aristotle: equals must be treated equally and un-equals must be treated unequally.in health care
we are confronted by distribution problems that seem to provide better care to he rich than to the
poor, the urban dweller over the rural, the middle aged over the child or elderly.
Compensatory justice- in which individuals seek compensation for a wrong that has been done.
Recent cases where cigarette smokers have received compensation from tobacco companies for
their lung cancer or emphysema suggest how large an issue this may become. Fines or
compensation for injury, are requested.
Retributive justice- an eye for an eye and a tooth for a tooth. Requires equal suffering.
 - Means deserved, due, equitable or appropriate in society determined by norms that
structure the term of social cooperation

6. Beneficence benefactor- good deed

The common English usage of the term beneficence suggest acts of mercy and charity, although
it certainly may be expanded to include any action that benefits another. Most health care
professions have statements that echo the Hippocratic oath, which states that “the physician will
apply means for the benefit of the sick”. In the pledge of American nurses association this is
clearly stated the nurse’s primary commitment is to health, welfare and safety of the client.
One ought to prevent evil or harm, one ought to remove evil or harm , one ought to do or promote
good.

This principle states that health care providers must do all they can to benefit the patient in each
situation. All procedures and treatments recommended must be with the intention to do the most
good for the patient. To ensure beneficence, medical practitioners must develop and maintain a
high level of skill and knowledge, make sure that they are trained in the most current and best
medical practices, and must consider their patients’ individual circumstances; what is good for
one patient will not necessary benefit another.
- Done for the good of others It is associate this with acts of mercy, kindness, and charity
-Parable of Good Samaritan
- refers to action done for the others
- based some ethical theories like utilitarianism
- one ought to prevent evil or harm
-One ought to remove evil or harm
- one ought to do or promote good
- protect and defend the rights of others
-prevent harm from occurring to others
-remove conditions that will cause harm to others
-Help persons with disabilities
-Rescue person in danger

7. Non- maleficence
Most health care professional pledges or codes of care echo the principle paraphrased from the
Hippocratic oath statement- I will never use treatment to injure or wrong the sick.
One ought not to inflict evil or harm.
- Not to inflict harm intentionally
- The maxim of medical ethics “ PRIMUM NON NOCERE” which means Above all, do no
harm to anyone”

All the statements of the beneficence involved positive action toward preventing or removing
harm, and promoting the good.in the nonmaleficence statement, the admonition is stated in the
negative, to refrain from inflicting harm.

In short, it means, “to do no harm.” This principle is intended to be the end goal for all of a
practitioner’s decisions, and means that medical providers must consider whether other people
or society could be harmed by a decision made, even if it is made for the benefit of an individual
patient.
- Refers to prevention of harm and the removal of harmful conditions.
- one ought not to inflict evil or harm
 - do not kill
- Do not cause pain/suffering to others
- Do not cause offense to others
- Do not incapacitate others
- Do not deprive others of the good of life.
-
D. Other Relevant Ethical Principle
1. Principle of Double Effect
Steroids are administered to asthmatic patients to relax smooth muscles of the airway, often the
side effect is Cushing syndrome, some of newer antibiotics given to fight infections have
ototoxicity and nephrotoxicity side effects. Analgesics such as morphine given for pain may lead
to suppression of respiration. With this concept the secondary effects may be foreseen, but can
never be the intended outcomes.
Guiding elements
a. the course chosen must be good or at least morally neutral
b. the good must not follow as a consequence of the secondary harmful effects
c. the harm must never be intended but merely tolerated as casually
d. the good must outweigh the harm
2. Principle of Legitimate Cooperation
The Principle of Legitimate Cooperation portrays the Principle of the Double Effect in a scenario
in which more than one person participates in the actions being evaluated.

3. Principle of Common Good and Subsidiarity

Regulating the movement from marginalization to participation for the sake of the common good
is the principle of subsidiarity. This principle warns about the tendency of the state and other large
scale institutions to usurp authority to control persons, thereby destroying individual liberty and
initiative. The principle of subsidiarity protects people from abuses by higher-level social authority
and calls on these same authorities to help individuals and intermediate groups [families, cultural,
recreational and professional associations, unions, political bodies, neighborhood groups] to fulfill
their duties.
4. Principle of Stewardship and Role of Nurses as Stewards

The gifts of multi-dimensional human nature and its natural environment should be used with
profound respect for their intrinsic teleology and especially the gift of human creativity should be
used to cultivate nature and environment with a care set by the limits of actual knowledge and the
risks of destroying these gifts.

This principle requires us to appreciate the 2 great gifts that a wise and loving God has given, the
earth, with all its natural resources and our own human nature (embodied intelligent freedom) with
its biological, psychological, ethical, and spiritual capacities.
5. Principle of Totality and its Integrity

To promote human dignity in community , every person must develop , use care for and preserve
all of his/ her natural physical psychic functions in such a way that lower functions are never
sacrificed except for the better functioning of the whole person and even then with an effort to
compensate for this sacrifice. The basic capacities that define human personhood are never
sacrificed unless this is necessary to preserve life. This principle makes explicit another aspect of
the principle of human dignity by requiring self-respect as well as respect for others, unless a
person respects his or her own integrity and seeks to preserve and perfect one’s own gifts , that
person cannot expect the community’s respect. This principle and the principle of the common
good maintains that community and the person are complex systems of mutual interdependence
of parts of a whole.

6. Principle of Ordinary and Extraordinary Means

Ordinary means - reasonable hope of benefit/success; not overly burdensome; does not present
an excessive risk and are financially manageable, Proportionate to the state of the patient

Ordinary means = “all medicines, treatments, and operations, which offer a reasonable hope of
benefit for the patient and which can be obtained and used without excessive expense, pain, or
other inconvenience”

-normally one is held to use only ordinary means – according to circumstances of persons,
places, times and culture – that is to say, means that do not involve any grave burden for
oneself or another”

“the doctor, in fact, has no separate or independent right where the patient is concerned. In
general, he can take action only if the patient explicitly or implicitly, directly or indirectly, gives
him permission”

Elements of Ordinary Means

1) Reasonable/proportionate hope of benefit/success
2) Common diligence
3) Proportionate – physical/social/financial
4) Not unreasonably demanding
• In sum: what is reasonable!

Extraordinary means = no reasonable hope of benefit/success; overly burdensome; excessive

risk and are not financially manageable

• No obligation to use it/morally optional

“All medicines, treatments, and operations, which cannot be obtained or used without excessive
expense, pain, or other inconvenience, or which, if used, would not offer a reasonable hope of
benefit”

Elements of Extraordinary Means

1) “Certain impossibility” – physical or a moral
2) Great effort – excessive
3) Pain
4) Exquisite and extraordinarily expensive
 5) Severe dread or revulsion
• In sum: what is inappropriate!

7. Principle of Personalized Sexuality

Sex is a social necessity for the procreation of children and their education in the family so as to
expand the human community and guarantee its future beyond the death of individual members.
Teaches that God created persons as male and female and blessed their sexuality as a great and
good gift.

Generally recognized values: Sex is a social necessity for the procreation of children and their
education in the family so as to expand the human community and guarantee its future beyond
the death of individual members. Teaches that God created persons as male and female and
blessed their sexuality as a great and good gift. Sex is a search for the completion of the human
person through an intimate personal union of love expressed by bodily union. As the image of
God, man is created for love.