BIOETHICS- apply ethico-moral & legal concepts in issues affecting health care practice VIRTUE ETHICS IN NURSING

MORALITY- area of right & wrong in human behavior theory & practice VIRTUE / CHARACTER ETHICS- individual acts are based on degree of innate moral virtue
ETHICS- practical & normative science based on reason; study human acts & provides 3 criteria of virtuous character
norms for its goodness & badness 1. Virtuous acts must be chosen for their own sake (bc YOU WANT TO)
as practical science: systemized body of knowledge used, practiced, applied to action 2. Choice must proceed from a firm & unchangeable character
as normative “ : establish norm & standard for action direction & regulation 3. Virtue is a disposition to choose mean (
based on reason: doesn’t rely on divine revelation; investigate & analyze fact Florence Nightingale- virtue is an important trait of a good nurse
applied only to human act: performed w/intellectual deliberation & freedom Nightingale Pledge - virtue of character as nurse promise purity, faith, loyalty, devotion,
trustworthiness, temperance
Branches of Ethics
- Good character is cornerstone of good nursing
Health- morality study of human conduct concerning health & healthcare
- nurse w/virtue will act according to principle
Professional - applied type; deal w/certain moral precepts where persons behave
& act in exercise of their calling & profession. Aristotle - virtue can be practiced & learned, so we can learn through practice.
Bioethics- “bios” (life); ethics of life & medical care; relates to human life; ethics of life Focal Virtues
sciences & health care, both delivery & research 1. COMPASSION - ability to imagine oneself in situation of another
scope: Initial Stage- concerned w/ethical problems associated w/medical practice 2. DISCERNMENT- sensitive insight w/acute judgment & understanding, result to decisive act
Later “ - include social issues r/t health, animal welfare, env concerns 3. TRUSTWORTHINESS -confident belief in moral character of another person
4. INTEGRITY - soundness, reliability, wholeness, integration of moral character
stages of human issues & queries
1. Beginning of life (contraception & family planning) Core Nsg Values
2. Middle “ (genetic engineering & abortion) - “As actions are informed by your awareness of values, thinking, & ideas are shaped &
3. End “ (death & euthanasia) changed by one’s experiences w/those actions. (Chinn,2004)
VALUES- personal beliefs/attitude on truth, beauty, worth of thought, object or behavior.
Bioethics Evolution - action oriented & give direction & meaning to one's life'.
I. MEDICAL - oldest phase; formulation of ethical norms for conduct of health care Personal Value- internalized from society/culture in which one lives.
professionals in px treatment Professional “- acquired during socialization into nsg from codes of ethics, experiences,
- Hippocratic Oath: (Hippocrates, Father of Medicine, Greece 460-357 BC) teachers, peers.
- no prescription of fatal drugs
Core Values of Nursing
- rule out any form of abortifacient
Human Dignity- respect for inherent worth & uniqueness of individuals & populations.
- no sexual relations between doctors & patients
Integrity- adherence to moral norms sustained overtime
- moral significance of confidentiality/medical secrecy.
Autonomy- right to self-determination; criterion in judging professional status
nd
II. RESEARCH- 2 phase; Biomedical Research (use of humans as experimental specimen) Altruism- concern for welfare & wellbeing of others.
Third Reich Era (1935-1945): Friedrich Nietzsche (superman philosopher who Social Justice- act acc to fair treatment regardless of economic status, race, ethnicity, age,
strengthened Hitler’s conviction that German is superior race) citizenship, disability, sexual orientation
Nuremburg Code (1947): humanize cruel & barbaric nature of experiments other nsg values
accounts experimental objects’ consent • Safe & competent • Health & well –being • Choice • Dignity
contribution: Respect of px right by IC • Confidentiality • Justice • Accountability • Diversity
Right of px to decline/ not submit to any health care procedure
III. PUBLIC POLICY- - emphasize participatory aspect of decision making in democratic
set-up w/regards to public policy formulation UNIVERSAL BIOETHICAL PRINCIPLES
I. AUTONOMY
- marks significance of individual autonomy mandating strong sense of personal
THEORIES OF HEALTH ETHICS responsibility for one’s own life
TELEOLOGICAL/CONSEQUENTIAL ETHICS- Gk telos (“end/purpose”) elements: a. person should be respected
- emphasize end-result/goal/consequence of act as determining factor b. able to determine his personal goals
DEONTOLOGICAL / DUTY “ – Gk deontos (discourse on duty/obligation”) c. ability to decide on plans of actions
- duty as norm of moral action d. freedom to act upon his choice
UTILITARIANISM- act is right if it leads to greatest possible balance of good consequence a. PATERNALISM- Gk pater/paternos (“being fatherly”); being fatherly to their offspring
in world as whole - VIOLATES autonomy principle; you DECIDE for px instead of themselves
condition: Principle of Utility- maximize good Theory of Value- standard of goodness types:
Consequentialism- whatever its precise value theory 1. With regards to recipient’s welfare
Impartiality (Universalism)  pure paternalism – justifies interv into a person’s life for their sole welfare
THOMISTIC “ – St Thomas Aquinas (1225-1274); Christian/Roman Catholic Ethics,  impure “– welfare of that person & others
Natural Law Ethics, Scholastic Ethics 2. with regards to recipient’s defects & safety
synderesis- -inherent capacity of lettered/unlettered person, to distinguish good/bad  restricted “– support interv which overrides & individual’s action bc of defects/weakness
- voice of right reason/voice of conscience  extended “ – person is restricted from doing something bc of risk/danger
3. with regards to promotion of good and prevention of harm
Man’s Threefold Natural Inclination: self-preservation
 positive “ – for promotion of good
just dealings w/others
 negative “ – for prevention of harm
species propagation
determinant of moral action 4. with regards to patient’s sense of values
 soft “– patient’s values justify interv
1. Object- which will intends directly & primarily; procedure; ACT ITSELF; substance
 hard “ – “ “ are not used to justify paternalistic acts
2. Circumstance- conditions affecting morality when superadded to moral act’s nature
- mitigating/aggravating circumstance 5. with regards to the recipient of the benefit
 direct “ – one who receive benefit is one whose values are disregarded for his own good
who- event has something to do w/person’s special quality, prestige, rank,  indirect “ – individual will benefit if he is restricted from doing something
excellence involved in moral act
what- event refer quantity/quality of moral object 6. personal paternalism- decide based on best knowledge & capacity for good of another
where- “ denote place where act occurs 7. state paternalism- control by legislature, agency, gov’t body over practice & procedure
by what means- means used to carry out act
how- manner in which action is done PATIENT’S RIGHTS- moral & inviolable power vested to do, hold, demand as his own.
when- time of action (quantity/quality) -- something that by nature belongs to a patient
3. End/Purpose- take end in sense of end/purpose of doer/agent
- affect goodness/badness of action/decision in many ways
types
1. Right to informed consent – px are informed of possible outcomes, alternatives, risks
of treatments; px required to give their consent freely.
IC types: - Admission agreement - Blood Transfusion consent
- Surgical Consent - Research Consent
- Special Consent
IC fx: - avoid fraud & duress - encourage self- scrutiny by professionals
- foster rational decision making
- involve the larger society in debate
IC elements:
 Competence- px capacity for decision-making
` - competent person is: Can make decision
justify the decision
justify decision in a reasonable manner
 Disclosure- content of what px is informed about during consent negotiation
 Comprehension- whether info given has been understood
 Voluntariness- consent must be from own free will w/o being forced
2. Right to informed decision- info & understanding so there’s genuine deliberation
before making moral decision on a medical treatment
3. Right to informed choice- informed about all possible alternative action &
consequence to be taken
4. Rights to refuse treatment- to extent permitted by law & be informed of medical
consequences of his action.
5. Right to Self-determination- px as autonomous person has moral right to determine
what’s good for himself, upon advice of a healthcare provider
Limitations to Px Rights
1. Don’t include px rights to be allowed to die
2. Px in a moribund condition doesn’t possess mental, physical, emotional stability to
make decision
3. Px rights aren’t absolute

Patient’s Bill of Rights from DOH

1. Right to appropriate Medical care & Humane treatment
2. Right to informed consent 3. Right to privacy and confidentiality
4. Right to information 5. Right to choose health care provider & facility
6. Right to self-determination 7. Right to religious belief
8. Right to medical records 9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence & receive visitors
12. Right to express grievances
13. Right to be informed of his rights & obligations as a patient

Proxy Consent- people w/legal right to consent to treatment for themselves/minor/ward

delegate that right to another person
constraints: • person making delegation must have right to consent
• “ must be legally & medically competent to delegate right to consent
• right to consent must be delegated to legally & medically competent adult
Confidentiality & Privacy are Interrelated
CONFIDENTIALITY- nondisclosure of private/secret info about another person w/which
one is entrusted; requires one maintain privacy of another
PRIVACY- right to control personal info/ secrets disclosed to others
- fundamental right of individuals