MAJOR BIOETHICAL PRINCIPLES would probably lead to some loss of life

and increased hatred of each other by

Theories related to Healthcare Ethics whites and Negroes — or of hunting for
the guilty person and thereby allowing
CONSEQUENTIALIST ETHICS: UTILITARIANISM the anti-Negro riots to occur, while
doing the best he can to combat them.
• Consequentialists stresses that the focus of an In such a case the sheriff, if he were an
ethical matter and its ethical weight resides on the extreme utilitarian, would appear to be
person, or agent, by way of that person’s actions or committed to framing the Negro.
consequences.
CONSEQUENTIALIST ETHICS: RULE
• A broad school of thought is utilitarianism. CONSEQUENTIALISM, (RULE
Utilitarianism states that morality is about maximizing UTILITARIANISM)
the most pleasure and minimizing the most pain as • Rule consequentialism follows all the
much as possible. same ideas of consequentialism, but with a
backbone or framework of a legal system or
• Utilitarianism is an ethical theory which states that ethical code.
the best action is the one that maximizes utility.
• For example, the right action among
• Utility as the sum of all pleasure that results from an several choices has been laid out within the
action, minimizes the suffering of anyone involved in ethical system already, and therefore has
the action. States that the consequences of any action been accepted as a moral truth by the
are the only standard of right and wrong. community, because it provides the best
possible outcome.
• They reject moral codes or systems that consist of
commands or taboos that are based on customs, • This is seen a lot in lawmaking and law
traditions, or orders given by leaders or supernatural enforcement.
beings.
 An example is that a community may
think it is moral to make bank robbers
perform community service work
because it helps the community—that is,
this service work provides a societal
benefit beyond just a jail sentence.

NORMATIVE ETHICS AND DESCRIPTIVE

ETHICS “THINKING RIGHT VERSUS ACTING
RIGHT”
• Any discussion or study of ethics can be
split into two essential but different
 This is best illustrated by the Sheriff Scenario, by H. questions: “Why?” and “How?”
J. McCloskey (1975). An examination of restricted
utilitarianism. • Investigations into “why” humans act
 Suppose that a sheriff were faced with the choice cover the guiding, underlying principles of
either of framing a Negro for a rape that had ethical standards such as virtue, human
aroused hostility to the Negroes (a particular behavior, fear of consequence, and desire
Negro generally being believed to be guilty but for happiness.
whom the sheriff knows not to be guilty) — and
thus preventing serious anti-Negro riots which
• This aspect of ethics is also called normative ethics • Intention is relevant. “I am acting a certain
and it is concerned with figuring out the meat of way only if I act for the right reason”.
morality. The end goal of normative ethics is to help us
determine the proper course of action for human  A child runs away from home because
behavior, which is to say the most moral, correct, or his parents are abusive, and he seeks
just ways of thinking and acting. comfort at the home of his uncle, a
deontologist. This deontologist uncle
• One basic example of normative ethics is Immanuel may believe that abusing one’s child is
Kant’s Categorical Imperative. It states that morality is inherently wrong, but that same uncle
an outgrowth of rational thought, and it’s normative may also believe that it is morally
because it seeks to define the best way a person correct to reunite the child with his
should act. parents. Knowing full well that the child
will likely be abused again, the uncle
• The actions that result (or do not result) from sends the child home, fully confident
normative ethics fall under the banner of descriptive that his actions were moral, because the
ethics. It’s an examination of behavior itself, as action in and of itself, without any other
opposed to the ethics that lead to behavior and things considered, is the right thing to
defines good actions as ones that promote happiness do from an extremely objective stance.
or pleasure.

• Ideals and ideas are normative ethical theories, and VIRTUE ETHICS “ITS GOOD TO BE
actual actions (and the process that surrounds them) GOOD ”
are descriptive ethics. Virtues
• A highly regarded personality trait or
• Descriptive ethics are all about action—how those aspect of character (Boone, 2017).
normative ethics are used where it really counts. It’s • Excellence of intellect or character.
the study of how human beings behave in the ethical • Becomes apparent through one’s behavior
realm, whether they’re actively considering the ethical and are linked to ethical principles
ramifications of their actions or not. Descriptive ethics • Refer to specific character traits
is what humans do to one another and themselves— • Examples: compassion, fairness,
the “applied. integrity, respectfulness, courage

 To illustrate normative ethics versus descriptive Ethics

ethics (“Thinking Right Versus Acting Right”) • Based on reason
• Studies human act and provides norms for
their goodness and badness
DEONTOLOGICAL ETHICS • Deals only with human act

• Deon is the Greek word for duty. From that word  Deeply held value by a person that
comes the ethical concept of deontology. Deontology intrinsically leads him or her to behave
holds that morality is based on duties and in a certain way.
obligations—that we as humans are bound by some
unwritten code or codified system to do and say the  Virtues influence actions, feelings,
objectively right thing. desires, choices, and reactions—all of
which are predictable in a person, if that
• Deontology is a category of normative ethical value is deeply held.
theories that encompasses any theory which is
primarily concerned with adherence to certain rules or  And while these values may lead a
duties. Consequences do NOT matter! person to act out instinctively, they are
 learned behaviors that are well thought out and • To have the benefit of the autonomous
deeply felt on the level of a religious belief. practice, the nurse must be competent
enough to take charge of the situation they
VIRTUE ETHICS are responsible in.
• A virtue ethicist acts because helping another is
charitable, benevolent, or just the “right” thing to do. HUMAN DIGNITY
It’s a virtue-based, not rule-based ethic. • A basic necessity not only for patients, but
also for all human beings.
• Calls attention to the central role which such virtues • Observing human dignity is vital for
as courage, loyalty, integrity, compassion and establishing an effective nurse-patient
benevolence, along with determination and relationship.
intelligence, should play in the practices of medical
providers. INTEGRITY
• Integrity is defined as the quality of being
• Emphasizes the virtuous character of individuals who honest and fair; possessing high moral
make the choices. principles.
• Applied in healthcare profession, the
• Focuses on what makes a good person, rather than healthcare provider practices integrity when
what makes a good action. they do their duties and obligation in
accordance to the beliefs, principles and
BIOETHICS values they claim and cherish.
• Etymologically, “bioethics” means ethics of life.
HONESTY
• A discipline that deals with the ethical implications of • A vital characteristic for a nurse to be able
biological research. to build a trusting relationship.
• Honesty sharpens our perception and
• It is a branch of ethics that analyzes moral values in allows us to observe everything around us
the context of biomedical sciences. with clarity.

CORE VALUES OF A PROFESSIONAL NURSE BIOETHICAL PRINCIPLES

 ALTRUISM  AUTONOMY
 AUTONOMY  CONFIDENTIALITY
 HUMAN DIGNITY  VERACITY
 INTEGRITY  FIDELITY
 HONESTY  JUSTICE
 BENEFICENCE
ALTRUISM  NON- MALEFICENCE
• The act that promote someone else’s welfare, even
at risk of one’s own. ETHICAL PRINCIPLES
• A feeling that people should help one another even CONFIDENTIALITY
without the regard for reward or compensation. • Information related to patients cannot be
obtained and disclosed without their
AUTONOMY consent, and digital patient records can only
• Refers to the freedom and ability to act according to be used by related people. Information
one's knowledge and judgment, providing nursing care related to patients cannot be exchanged in
within the full scope of practice as defined by existing public spheres and in the presence of
professional, regulatory, and organizational rules. unrelated people
VERACITY APPLICATION OF ETHICAL PRINCIPLES TO
• Ethics of telling the truth. Medical personnel are THE CARE OF THE SICK
trust in their community, they are held to high PART 1
standards which promote accountability and overall
professionalism. AUTONOMY
 From the Greek word autos meaning
FIDELITY self and the word nomos meaning rule,
• Giving one’s word and keeping the promises made. governance or law.
Being faithful and true to the promises given and  With autonomy, patients have the
responsibilities tasked with by providing optimum choice and freedom to seek other
standard of care opinions to validate what the physician
advised them to do.
JUSTICE  Patients have the right to decline or ask
• The obligation to be fair to other people. Fair for alternative medical treatment.
treatment of individuals to the equitable allocation of
healthcare access and resources. MEANING OF PATIENT’S RIGHTS
 Patient’s Rights refers to the moral and
BENEFICENCE inviolable power vested in him/her as a
• To do good and do no harm. Addresses the idea that person to do, hold, or demand
a nurse’s actions should promote good. Doing good is something s his/her own.
thought of as doing what is best for the welfare of the  As the patient enjoys some rights. For
patient example, the doctor must respect these
rights.
NON-MALIFICENCE  Duty, therefore, is the correlative of
• Avoid inflicting harm or evil. Directly tied to the right.
nurse’s duty to protect the patient’s safety.  Right is something that belongs to a
person by nature.

PATIENT BILL OF RIGHTS

1. Right to Appropriate Medical Care and
Humane Treatment
2. Right to Informed Consent
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 to 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
1. RIGHT TO APPROPRIATE MEDICAL CARE AND d. When the patient is either a
HUMANE TREATMENT minor, or legally incompetent, in
 Every person has a right to health and medical which case, a third-party consent Is
care corresponding to his state of health, without required.
any discrimination and within the limits of the
resources, manpower and competence available e. when disclosure of material
for health and medical care at the relevant time. information to patient will
jeopardize the success of treatment,
 If any person cannot immediately be given in which case, third party disclosure
treatment that is medically necessary, he/she shall, and consent shall be in order.
depending on his/her state of health, either be
directed to wait for care, or be referred or sent for f. When the patient waives his right
treatment elsewhere, where the appropriate care in writing.
can be provided.
 Informed consent shall be obtained
2. RIGHT TO INFORMED CONSENT from a patient concerned if he is of legal
 The patient has a right to a clear, truthful and age and of sound mind. In case the
substantial explanation, in a manner and language patient is incapable of giving consent
understandable to the patient, of all proposed and a third-party consent is required.
procedures, whether diagnostic, preventive,
curative, rehabilitative or therapeutic.  The following persons, in the order of
priority stated hereunder, may give
 The person who will perform the said procedure consent:
shall provide his name and credentials to the i. spouse;
patient, possibilities of any risk of mortality or ii. son or daughter of legal age;
serious side effects, problems related to iii. either parent;
recuperation, and probability of success and iv. brother or sister of legal age, or
reasonable risks involved v. Guardian

 The patient will not be subjected to any procedure  If a patient is a minor, consent shall be
without his written informed consent, except in obtained from his parents or legal
the following cases: guardian.
a. in emergency cases, when the patient is at  If next of kin, parents or legal guardians
imminent risk of physical injury, decline of refuse to give consent to a medical or
death if treatment is withheld or postponed. surgical procedure necessary to save the
In such cases, the physician can perform any life or limb of a minor or a patient
diagnostic or treatment procedure as good incapable of giving consent, courts,
practice of medicine dictates without such upon the petition of the physician or any
consent. person interested in the welfare of the
patient, in a summary proceeding, may
b. when the health of the population is issue an order giving consent.
dependent on the adoption of a mass health
program to control epidemic. 3. RIGHT TO PRIVACY AND
CONFIDENTIALITY
c. when the law makes it compulsory for  The privacy of the patients must be
everyone to submit a procedure assured at all stages of his treatment.
 The patient has the right to be free from  person's participation in the plan of
unwarranted public exposure, except in the care and necessary changes before
following cases: its implementation.
a) when his mental or physical condition is in  the extent to which payment maybe
controversy and the appropriate court, in its expected from Philhealth or any
discretion, order him to submit to a physical or payor and any charges for which the
mental examination by a physician patient maybe liable.
b) when the public health and safety so demand
c) when the patient waives this right in writing  The disciplines of health care
practitioners who will render the care
 The patient has the right to demand that all and the frequency of services that are
information, communication and records proposed to be furnished.
pertaining to his care be treated as confidential.
 The patient or his legal guardian has the
 Any health care provider or practitioner involved right to examine and be given an
in the treatment of a patient and all those who itemized bill of the hospital and medical
have legitimate access to the patient's record is services rendered in the facility.
not authorized to divulge any information to a
third party who has no concern with the care and  The patient or his/her legal guardian has
welfare of the patient without his consent, the right to be informed by the
 Except: physician of his/her continuing health
a) when such disclosure will benefit public health care requirements following discharge.
and safety
b) when it is in the interest of justice and upon the 5. THE RIGHT TO CHOOSE HEALTH CARE
order of a competent court PROVIDER AND FACILITY
c) when the patients waives in writing the  The patient is free to choose the health
confidential nature of such information care provider to serve him as well as the
d) when it is needed for continued medical facility except when he is under the care
treatment or advancement of medical science of a service facility or when public
subject to de-identification of patient and shared health and safety so demands or when
medical confidentiality for those who have access the patient expressly waives this right in
to the information. writing.
 The patient has the right to seek for a
4. RIGHT TO INFORMATION second opinion and subsequent
 In the course of his/her treatment and hospital opinions, if appropriate, from another
care, the patient or his/her legal guardian has a health care provider/practitioner.
right to be informed of:
 result of the evaluation of the nature and 6. RIGHT TO SELF-DETERMINATION
extent of his/her disease.  The patient has the right to avail
 any other additional or further contemplated himself/herself of any recommended
medical treatment on surgical procedure diagnostic and treatment procedures.
including any other additional medicines to be Any person of legal age and of sound
administered and their generic counterpart. mind may make an advance written
 possible complications and other pertinent directive for physicians to administer
facts, statistics or studies regarding his/her terminal care when he/she suffers from
illness. the terminal phase of a terminal illness,
 any change in the plan of care before the provided that:
change is made. a) Patient is informed of the medical
consequences of his choice.
 b) Patient releases those involved in his care relative to the consequences of his
from any obligation relative to the decision.
consequences of his decision. c) His/her decision will not prejudice
c) Patient decision will not prejudice public public health and safety.
health and safety.
 No patient shall be detained against
7. RIGHT TO RELIGIOUS BELIEF his/her will in any health care institution
 The Patient has the right to receive spiritual and on the sole basis of his/her failure to
moral comfort, including the help of a priest or fully settle his/her financial obligations.
minister of his/her chosen religion.
 He/ she also has the right to refuse medical  Republic Act (R.A.) 9439, or the Act
treatment or procedures which may be contrary to Prohibiting the Detention of Patients in
his religious beliefs, subject to the limitations: Hospitals and Medical Clinics on
a) The Patient is of legal age and is mentally Grounds of Nonpayment of Hospital Bills
competent; or Medical Expenses makes it illegal for
b) The Patient is informed of the medical “any hospital or medical clinic, (whether
consequences of his/her refusal; government or private), to detain or
c) The Patient releases those involved in his otherwise cause, directly or indirectly,
care from any obligation relative to the the detention of patients who have fully
consequences of his/her decision; and or partially recovered or have been
d) The Patient's refusal will not jeopardize adequately attended to or who may
public health and safety. have died, for reasons of nonpayment in
part or in full of hospital bills or medical
8. RIGHT TO MEDICAL RECORDS expenses.”
 The patient is entitled to a summary of his medical
history and condition.  “Detention” occurs when a person is
 He/she has the right to view the contents of restrained from leaving the hospital or
his/her medical records, except psychiatric notes medical clinic premises for nonpayment
and other incriminatory information obtained of hospital bills or medical expenses in
about third parties, with the attending physician part or in full.
explaining contents thereof.
 The health care institution shall safeguard the  Under our law, patients are granted the
confidentiality of the medical records and to right to leave the hospital or medical
likewise ensure the integrity and authenticity of facility where they are confined should
the medical records. they signify their desire to leave, subject
 The health care institution shall issue a medical to the following conditions: (a) living
certificate to the patient upon request. Any other patients who desire to leave must have
document that the patient may require for fully or partially recovered; (b) the
insurance claims shall also be made available to patient is not staying in a private room
patient within forty-five (45) days from request. (a single occupancy room or ward type
room that may accommodate not more
9. RIGHT TO LEAVE than four (4) patients); and (c) the
 The patient has the right to leave hospital or any patient executed a promissory note
other health care institution regardless of his secured by either a mortgage or by a
physical condition, Provided that: guarantee of a co- maker.
a) he/she is informed of the medical
consequences of his/her decision.
b) Patient releases those involved in
his/her care from any obligation
10. RIGHT TO REFUSE PARTICIPATION IN MEDICAL PATIENT’S RESPONSIBILITIES
RESEARCH 1. The patient shall ensure that he/she is
 The patient has the right to be advised if the fully aware of his/her rights and exercise
health care provider plans to involve him in those rights reasonably.
medical research, including but not limited to 2. The patient shall provide accurate and
human experimentation which may be performed complete information about all matters
only with the written informed consent of the concerning his/her health.
patient: Provided, That, 3. The patient shall report or voice out any
a) an institutional review board or ethical changes in his/her health condition to
review board in accordance with the guidelines his/her healthcare provider.
set in the Declaration of Helsinki be established 4. The patient shall ensure that he/she
for research involving human experimentation understands the purpose and cost of any
b) The Department of Health shall safeguard proposed treatment or procedure before
the continuing training and education of future deciding to accept it.
health care provider/practitioner to ensure the 5. The patient shall accept all the
development of the health care delivery in the consequences of the patient's own informed
country. consent.
c) The patient involved in the human 6. The patient shall ensure that financial
experimentation shall be made aware of the obligations of his/her health care are fulfilled
provisions of the Declaration of Helsinki and its as promptly as possible, otherwise, he/she
respective guidelines. shall make appropriate arrangements to
settle unpaid hospital bills.
11. RIGHT TO CORRESPONDENCE AND TO RECEIVE 7. The patient shall so behave himself or
VISITORS herself so as not to interfere with the well-
 The patient has the right to communicate with being or rights of other patients or providers
relatives and other persons and to receive visitors of health care.
subject to reasonable limits prescribed by the rules 8. The patient shall first exhaust the
and regulations of the health care institution. grievance mechanism provided in this Act
before filing any administrative or legal
12. RIGHT TO EXPRESS GRIEVANCES action.
 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.

13. 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
heath 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.
APPLICATION OF ETHICAL PRINCIPLES TO THE CARE treatment to be undertaken so that the
OF THE SICK moral decision can be made.
PART 2
COMPREHENSION
INFORMED CONSENT  This refers to whether the information
 Client’s approval (or that of the client’s legal given has been understood. The
representative) to have his or her body touched by disclosure of information is not enough.
a specific individual.  If the patient does not understand what
 The patient's choice to have a treatment or he/she has been told, then information
procedure which is based on their full has not been relayed at all.
understanding of the treatment or procedure, its  Health care professionals have a
benefits, its risks, and any alternatives to the professional language and so they are
particular treatment or procedure. expected to translate their jargon so
that it will be intelligible to their
FUNCTIONS OF INFORMED CONSENT patients.
1. Protective
 Protects individual autonomy VOLUNTARINESS
 Protects the patient’s status as a human being  This means that consent must be
 Avoids fraud and duress voluntary. The patient must be of
his/her own free will to agree to a
2. Participative research or undergo a medical
 Encourages doctors to carefully consider their procedure or intervention.
decisions  He/she must make a choice without
 Fosters rational decision making by the patient. being unduly pressured by anyone else.
 Involves the public generally in medicine.
TYPES OF CONSENT
4 Major Elements of Informed Consent (a) Implied consent - agreement is given
1. Competence by cooperating with a healthcare
2. Disclosure professional’s instructions for routine
3. Comprehension procedures.
4. Voluntariness  Implied consent is based on asking a
specific question and waiting until
COMPETENCE permission (or affirmative consent)
 Refers to patient’s capacity for decision-making. is given or by the observation of a
 A patient is considered competent when: person's behavior that implies that
(a) One has made a decision. they agree to the intervention.
(b) One has the capacity to justify one’s choice.
Requires deliberation, justification and (b) Verbal consent- agreement is given
articulation of why one made such choice. verbally for a treatment or procedure that
(c) One does not only justify one’s choice but doesn’t carry a significant risk.
does so in a reasonable manner.  A verbal consent is where a patient
states their consent to a procedure
DISCLOSURE verbally but does not sign any
 This refers to the content of what a patient is told written form. This is adequate for
or informed about during the consent negotiation. routine treatment such for
If there is a language barrier, an interpreter might diagnostic procedures and
be consulted. prophylaxis, provided that full
 The patient must be informed and must records are documented.
understand the information concerning medical
(c) Written consent- agreement is given by signing  Chronic dementia or other mental
a document for a treatment or procedure that is deficiency that impairs thought
complex or carries a higher risk. processes and ability to make decisions
 Written consent- agreement is given by signing
a document for a treatment or procedure that IN THE MEDICAL CONTEXT
is complex or carries a higher risk.  In the Philippines, there are two
methods of obtaining informed consent,
LIMITATIONS OF PATIENT’S RIGHTS first is (a) written consent (i.e., consent
1. Patients’ rights do not include the right to be form to be filled out and signed by a
allowed to die. Under the concept of personal patient as he/she checks in for
paternalism, the physician may make the moral admission in a hospital).
decision for and on behalf of the patient who can no  Routine only because the clerk or
longer decide a sin the case of comatose patient. admission personnel does not bother to
2. A patient in a moribund condition does not posses explain the content and the patient
the necessary mental or emotional stability to make usually just signs it) however invasive
informed choice. procedures require an explanation from
3. Patients’ rights are not absolute the physician before signing.
 The second is a (b) verbal consent.
EXCEPTIONS Whenever the patient verbally signifies
Who cannot provide consent? willingness to undergo medical
 Minors treatment, informed consent is met.
 Unconscious or injured patients Usually made after physician briefs the
 Mentally-ill patients patient about medical process to be
undertaken.
Several exceptions to the requirement for informed
consent include: NURSES’ ROLE ON INFORMED CONSENT
 the patient is incapacitated,  NOT responsible for explaining the
 life-threatening emergencies with inadequate time procedure, but for witnessing the
to obtain consent, and client’s signature on the form.
 voluntary waived consent.  The nurse’s signature confirms three
things:
 In emergency cases, the following types of 1. The client gave the consent
patients need not require informed consent: voluntarily.
 Comatose or obtunded patients, 2. The signature is authentic.
 Blind or illiterate patients 3. The client appears competent
 Underage patients or those unable to understand to give the consent
the circumstances, and  Proxy consent is the process by which
 Patients limited by language barriers people with the legal right to consent to
medical treatment for themselves or for
 Normally, parents, immediate relatives, guardians a minor. To delegate that right to
or next of kin should be informed, but may not another person.
have time to consult them during emergencies  Three fundamental constraints on this
when time is the essence. delegation:
1. The person making the delegation
MENTALLY OR EMOTIONALLY INCOMPETENT CLIENTS must have the right to consent.
 Unconcious 2. The person must be legally and
 Under the influence of chemical agents such as medically competent to delegate the
alcohols or drugs right to consent.
 3. The right to consent must be delegated to a APPLICATION OF ETHICAL THEORIES:
legally and medically competent adult. KANTIAN ETHICS
Kant’s ethical principle – one must always
LEGALLY AUTHORIZED REPRESENTATIVE (LAR) be treated as ends and never only as means.
 An individual or judicial body authorized under Patients must not be deceived by physicians
applicable law to consent on behalf of another no matter how good the intention.
person.  Patients have the right to be told what
 The LAR may be a parent, grandparent, caregiver they are getting into and decide
who has the legal authority to grant consent on whether they want to go or not.
behalf of another who has been invited to  According to Kantian account of
participate in research. autonomy, informed consent means
 If the individual has appointed a health care agent obtaining honest permission by avoiding
(sometimes referred to as a health care power of deception and coercion, without
attorney), or if there is a judicially-appointed necessarily promoting personal
guardian, that individual would generally be deliberation and decision-making.
considered the legally authorized representative.
APPLICATION OF ETHICAL THEORIES:
ADVANCE DIRECTIVES UTILITARIANISM
 Written instructions that is recognized under state Utilitarianism’s principle of utility– requires
law and is related to the provision of such care healthcare professionals to design medical
when the individual is incapacitated. treatment in a way that minimize suffering
and harm.
1. Living Will- a document prepared by a competent  As far as informed consent is concerned,
adult that provides direction regarding medical care in utilitarianism does not seem to require
the event the person becomes unable to make the it. If more social good is to be gained my
decisions personally. making patients research subjects
without receiving their consent, then it
2. Durable Power of Attorney (health care proxy) -an is morally legitimate.
authorization that enables any competent individual to
name someone to exercise decision- making authority, APPLICATION OF ETHICAL THEORIES:
under specific circumstances, on the individual’s behalf. RAWLS’ PRINCIPLE
Rawls principle of justice – do not allow
3. Advance Care Medical Directive -A document in medical treatments or experiments that
which an individual, in consultation with the physician, violate freedom, which a patient is entitled
relatives or other personal advisers provides precise to by virtue of being a member of society.
instructions for the type of care the client want or does  All experiments and medical treatments
not want in various clinical scenarios. that make use of coercion and
deception are ruled out. Voluntary
APPLICATION OF ETHICAL THEORIES: NATURAL LAW informed consent is required of all
Natural law ethics – regards the right to informed subjects of research.
consent as morally legitimate. Consent must be given
freely and not by intimidation, deception or coercion. NURSES AND CRIMINAL LIABILITY
Felonies
 Seems to be against the principle of stewardship  Acts or omissions punishable by law.
and inviolability of life if the latter means act of  Elements:
commission/omission resulting in self- killing or  Deceit (Dolo)- Committed with intent.
euthanasia.  Fault (Culpa)- Due to imprudence,
negligence or lack of foresight/skill.
STAGES OF FELONIES  Lack of sufficient provocation
1. Consummated
Element: Yes 2. Defense of relative
Result: Yes  Unlawful Aggression
2. Frustrated  Reasonable necessity of the means
Element: Yes employed to prevent or repel it.
Result: No  One making the defense had no part
3. Attempted therein
Element: No
Result: No 3. Defense of stranger
 Unlawful Aggression
DEGREE OF FELONIES  Reasonable necessity of the means
 Grave- Capital punishment, penalty of above 6 employed to prevent or repel it.
years and one day, or fine of more than 6  One making the defense be not induced
thousand pesos. with revenge, resentment or other evil
 Less Grave- Penalty of one month and 1 day- 6yrs, intent.
or fine of not more than 6 thousand pesos.
 Light- Penalty of 1 day to 30 days, or fine of not 4. Fulfillment of Duty or Lawful Exercise
more than 200 pesos. 5. Avoidance of greater evil/ injury
6. Obedience to a lawful order of a superior
CLASSIFICATIONS OF PERSONS WHO ARE CRIMINALLY  Legal lawful order
LIABLE  Lawful means employed
Principal 7. Battered woman syndrome RA 9262
 By direct participation
 By inducement EXEMPTING CIMCUMSTANCES
 By indispensable cooperation 1. Imbecile/ Insane; except during lucid
Accomplice interval
 Accessory before the act 2. Persons under 15 y/o
Accessory Periods of criminal responsibility from RA
 Accessory after the act 9344
 Profiting themselves or assisting others to  15 yrs below- Absolute responsibility
profit  15 yrs 1 day- 18 yrs- Mitigated
 Concealing/ destroying the evidence of the Responsibility
crime  18 yrs- 70 yrs- Full responsibility
 Assisting the escape of the principal 3. Minority (over 15 but below 18)
4. Irresistible Force
CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY 5. Uncontrollable Fear 6. Performance of a
I. Justifying Circumstance lawful act
II. Exempting Circumstance
III. Mitigating Circumstance MITIGATING CIRCUMSTANCES
IV. Aggravating Circumstance 1. Below 18 y/o or over 70 y/o
V. Alternative Circumstance 2. No intention
3. Offender is deaf, dumb, blind or with
JUSTIFYING CIMCUMSTANCE physical defect - Applies if deformity is
1. Lawful Self-defense connected to the crime.
Elements: 4. Voluntary Surrender
 Unlawful Aggression 5. Neurologic Disorder - Illness diminishing
 Reasonable necessity of the means employed to exercise of will power.
prevent or repel it.
AGGRAVATING CIMCUMSTANCES 3. Homicide
1. Take advantage of Public position  Unjustified killing of another human
 Greater perversity of offender springing from his being which is neither infanticide,
personal circumstance and the means used in parricide nor murder.
committing it.  Reclusion Temporal or a minimum of 12
 Elements years and 1 day up to a maximum of 20
2. Committed with abuse of confidence or obvious years
3. Occasion of a conflagration, shipwreck, earthquake,
epidemic or other calamity or misfortune. 4. Infanticide
 The time of the commission of the crime.  The killing of any child less than 3 days
4. Consideration of a price, reward, or promise. or 72 hours.
5. Fire, poison or explosion  Reclusion Perpetua in its maximum
6. Craft, Fraud or Disguise period to death.
7. Treachery
 The offender commits any of the crimes against 5. Simulation of Birth
the person, employing means, methods or forms  The tampering of the civil registry to
in the execution thereof which tend directly and make it appear in the record of birth
specially to ensure its execution, without risk to that a child was born to a person who is
himself arising from the defense which the not such child's biological mother,
offended part might make. causing such child to lose his or her true
 The offended party was not given an opportunity identity and status.
 PD 651
ALTERNATIVE CIRCUMSTANCE
• Either aggravating or mitigating according to the 6. Theft
nature and effects of the crime and other conditions  Committed by any person who, with
attending its commission. intent to gain but without violence
a. Relationship against or intimidation of persons nor
b. Intoxication force upon things, shall take personal
c. Degree of instruction/education property of another without the latter’s
consent.
CRIMES CONCERNING NURSES
The intentional felonies which nurses could frequently 7. Robbery
encounter , but not necessarily commit, in the practice  Any person who, with intent to gain,
of their profession are: shall take any personal property
belonging to another, by means of
1. Parricide violence or intimidation of any person.
 Deemed the highest form of destruction of human
life. 8. Assault
 Killing of family member.  Imminent threat
 Intentional act that puts another
2. Murder individual in apprehension of immediate
 A crime committed by a person who kills another, harm.
other than his/her family member, whether  The act of causing physical or
legitimate or illegitimate, which killing is attended psychological harm which causes the
by any aggravating circumstance. victim to be fearful.
 Reclusion Temporal in its maximum period to
death. 9. Battery
 The intentional act of causing physical
harm to someone.
 Performing any procedure without any form of 2. Doctrine of “Respondent Superior”
consent is battery even if it is done with good  Let the principal answer for the acts of
intention. his agent
 Embodies the general rule that an
10. Illegal Detention/ False Imprisonment - employer is responsible for the
 Deprive another of his freedom of movement or negligent acts or omissions of its
space. employees within the course of
employment.
11. Defamation  “Captain of the Ship Doctrine” -
 A statement that injures a third party's reputation. Applied inside the OR for head surgeon.
 Character assassination
a. Slander - oral/ spoken statements 3. Effect of Force Majeure
b. Libel -Written statements  Act of God; Irresistible or superior force
 5 Key Elements  A doctrine that essentially frees both
1) Plaintiff must prove that the information was parties from liability or obligation to
published perform when an extraordinary event or
2) Plaintiff was directly or indirectly identified circumstance beyond the control of the
3) Remarks were defamatory towards the parties occurs.
plaintiff's reputation
4) Published information is false THE NURSE AND THE DOCTOR’S ORDERS
5) Defend is at fault  It is expected that the nurse exercise
reasonable judgement/sound discretion
NEGLIGENCE in carrying out doctor’s orders.
 Occurs when a healthcare professional fails to take  If life is endangered due to the
a reasonable action or intervention to prevent loss intervention, liable for criminal
or injury to patient. negligence or reckless imprudence.
 SOMERA CASE
3 ESSENTIAL CONDITIONS FOR ACTIONABLE
NEGLIGENCE MALPRACTICE
1. Existence of a duty on the part of the person  Any professional misconduct or any
charged to protect the complaining party from the unreasonable lack of skill or fidelity in
injury received. the performance of professional
2. Failure to perform that duty. practice.
3. Injury resulting from such failure.  Biggest difference between medical
negligence and malpractice suits is that
DOCTRINES UNDER NEGLIGENCE: a medical malpractice suit aims to prove
1. Doctrine of “Res Ipsa Loquitur” that the professional’s actions were
 The thing speaks for itself intentionally reckless.
 3 Conditions
a) Injury/ accident would not have ordinarily 3 MOST COMMON MALPRACTICE FOR
occurred but for the defendant's negligence. NURSES
b) The accident must be caused by an agency or 1. Giving out prescription
instrumentality within the exclusive control of 2. Diagnosing
the defendant. 3. No suturing
c) Not have been due to any voluntary  Allowed to do episioraphy
action/contribution on the part of the injured  Only with special training
party.
SALIENT POINTS OF RA 9173 3. Monitor and enforce quality
 An act providing for a more responsive nursing standards of nursing practice
profession, repealing for the proposed RA9176. 4. Ensure quality nursing education
 “State guarantees the delivery of quality basic  Quasi-judicial function
health services through an adequate nursing 5. Conduct hearings and
personnel system throughout the country.” investigations to resolve complaints
 Revised on October 21, 2002 against nurse practitioners.
 Quasi-legislative function
BOARD OF NURSING 6. Promulgate a code of ethics
a) Composition- a chairperson and six members 7. Recognize nursing specialty
b) Appointment: organizations in coordination with
i. Nominating Body the accredited professional
ii. Recommending Body organization
iii. Appointing Body 8. Prescribe, adopt, issue and
c) Term of Office promulgate guidelines, regulations,
- The Chairperson and Members of the Board shall measures and decisions as maybe
hold office for a term of three (3) years and until their necessary
successors shall have been appointed.
- may be re-appointed for another term. g) Grounds for removal or suspension of a
- Any vacancy in the Board occurring within the term of member (3 I’s)
a member shall be filled for the unexpired portion of 1. Continued neglect of duty or
the term only. incompetence
d) Requirements upon Qualification: 2. Commission or tolerance of irregularities
i. Immediately resign from any teaching in the licensure examination
position in any institution offering BSN and/ or 3. Unprofessional immoral and dishonorable
review program. conduct
ii. Immediately resign from any government or
private employment. NURSING PRACTICE
iii. Not have pecuniary interest in, or SCOPE OF NURSING PRACTICE (3P, 1C)
administrative supervision in any institution 1. Performs nursing services to individuals,
offering BSN or review class families and communities.
e) Qualification: 2. Provide nursing care from delivery up to
i. Natural born citizen and resident of the old age.
Philippines 3. Practitioner, primarily responsible for the
ii. Member of good standing in an accredited promotion of health and prevention of
Professional Organization in the Philippines illness
iii. Be a registered nurse and holder of master’s 4. Collaborates with other members of
degree in nursing, education and allied medical health team
profession.
iv. Ten years of continuous practice, last 5 years DUTIES OF NURSE
in the Philippines. D – o utilize nursing process
v. No conviction of any offense involving moral U – ndertake training and research
turpitude T – each, guide, and supervise nursing
f) Powers, functions and Duties student
 Regulatory function I – nterlinkages with community resources
1. Conduct licensure exam for nurses and health care team
2. Issue, suspend or revoke certificates of E – ducate individual, family, and community
registration in the practice of nursing S – trict observance of code of ethics
EXAMINATIONS AND REGISTRATION 6. Violation of RA 9173, code of ethics for
License – a legal document given by the government nurses (BR 220)
that permits a person to offer to the 7. Practicing profession during suspension
public his or her skills and knowledge in a particular
jurisdiction  Suspension- nurse is not allowed to
Registration – recording of names of persons who practice temporarily until the final
have qualified under the law to practice judgment of the case against him or her
their respective profession is rendered.
 Revocation- the license to practice is
PURPOSE FOR REGISTRATION/NEED FOR LICENSURE confiscated either temporarily or
1. Protect the health of the people by establishing permanently
minimum standards which
qualified practitioners must meet. REQUIREMENT FOR RE-ISSUANCE OF
2. Discourage certain person who may be tempted to REVOKED CERTIFICATE OR REPLACEMENT
misrepresent themselves as OF LOSS CERTIFICATE
nurses. 1. Expiration of a maximum of four years
3. Tool for legal control and enforcement of nursing from date of revocation
practice. 2. Cause of revocation has disappeared or
4. Used to gather statistical data about nurses and has been corrected
nursing in the country. 3. Request is to replace lost destroyed or
mutilated cert license
QUALIFICATION FOR ADMISSION TO THE LICENSURE 4. Proper application
EXAM 5. Payment of required fees
1. Citizen of the Philippines or by reciprocity
2. Good moral character
3. Holder of a Bachelor's Degree in Nursing from a
college or university that
complies with the standards of nursing education duly
recognized by the
proper government agency.

RATINGS
 General average of at least 75% with a rating of
not below 60% in any subject.
 If above 75% but with a subject below 60% must
repeat that subject with a rating above 75%

Oath taking – priority action of a board passer.

GROUNDS FOR REVOCATION AND

SUSPENSION OF PROFESSIONAL LICENSE:
1. Conviction by final judgement of any criminal
offense involving moral turpitude, immoral or
dishonorable conduct, having unsound mind.
2. Unprofessional or unethical conduct
3. Gross incompetence or serious ignorance
4. Malpractice or negligence
5. Use of fraud deceit or false statement in obtaining a
cert of registration
PRINCIPLES OF ETHICS IN RESEARCH told they had syphilis, and were never
treated for it even when an effective
ELEMENTS OF ETHICAL RESEARCH treatment (penicillin) became readily
1. Protecting human rights. available to the researchers. Several of the
2. Understanding informed consent. men died because of their untreated disease.
3. Understanding institutional review of research.
4. Examining the balance of benefits and risk in a study. THE WILLOWBROOK STUDY
In 1956 researchers began a study of the
natural course of hepatitis in children,
HISTORICAL UNETHICAL EXPERIMENTAL PROJECTS hoping to understand the disease better and
❑ The Nazi Medical Experiments to test a vaccine. Their experimental
❑ The Tuskegee Syphilis Study subjects were several hundred children
❑ The Willowbrook Study housed at Willowbrook State Hospital in
❑ The Jewish Chronic Disease New York, the state’s largest facility for
Hospital Study retarded persons. The researchers infected
the children with hepatitis when first
admitted and monitored their bodies’
THE NUREMBERG MEDICAL EXPERIMENTS
responses. They were condemned for using
During World War II, Nazi physicians performed
children—especially retarded children—in
horrifying experiments on prisoners of war and
their study and for the methods they used to
civilians against their will which killed and maimed
obtain consent from the children’s parents.
many.
❑ Infected with cholera, smallpox, typhus, malaria, THE JEWISH CHRONIC DISEASE HOSPITAL
and other diseases. STUDY
❑ Given poisons to evaluate the deadly results The study involved the injection of foreign,
❑ Shot to simulate battle wounds live cancer cells into 22 senile patients who
❑ Frozen to death were hospitalized with various chronic
❑ Starved to death debilitating diseases. Patients were not told
❑ Sterilized and mutilated that they would receive cancer cells because
the researchers felt it would unnecessarily
JOSEF MENGELE frighten them. Researchers defended this
“...the infamous Nazi doctor who liked to view with the assertion that they had good
study twins...collected children from the cause to predict that the cancer cells were
camps, measured their physical features, going to be rejected. The researchers were
performed cross-transfusions, found guilty of fraud, deceit, and
transplanted genitals, and other organs, unprofessional conduct.
and even created artificial Siamese twins.
He also used his twin collection for THE NUREMBERG CODE (1947)
comparative studies, infecting one child Nuremberg Code, a set of minimal ethical
and then killing both for autopsy”. principles meant to govern all scientific
experiments involving humans as a result of
THE TUSKEGEE SYPHILIS STUDY the subsequent Nuremberg trial at the end
In 1932 the U.S. Public Health Service began a 40- of the Second World War. The Nuremberg
year experiment to study the damaging effects of Code served as the first set of principles
untreated syphilis in human beings. The research, outlining professional ethics for medical
known as the Tuskegee Study, involved around 600 researchers. The Code is comprised of ten
poor black men, about 400 of whom had syphilis points including the statement that
when they entered the experiment. The men were "voluntary consent of the human subject is
deceived about the nature of the study, were never absolutely essential.
NUREMBERG CODE 3. Allow them to withdraw from the study at
❑Aimed to protect human subjects from enduring the any time without penalty
kind of cruelty and exploitation the prisoners endured
at concentration camps after the World War II. VIOLATION OF THE RIGHT TO SELF-
❑A set of ten ethical principles for human DETERMINATION
experimentation. ❑ Coercion
Occurs when one person intentionally
DECLARATION OF HELSINKI presents an overt threat of harm or an
• Set of ethical principles excessive reward to another to obtain
• Developed by WMA for medical community – human compliance.
experimentation ❑ Covert data collection
• Followed Nuremberg Code (1947) Subjects are unaware that research data are
• Regarded as cornerstone document of human being collected
research ethics ❑ Deception
• Included within clinical trial protocols Actual misinforming of subjects for research
purposes
BELMONT REPORT
Belmont Report published in 1979 in response to PERSONS WITH DIMINISHED AUTONOMY
unethical studies in psychology & medicine. Further Vulnerable and less advantaged because of
articulated in Common Rule legislation. legal or mental incompetence, terminal
Three main principles: illness or confinement to an institution
1. Respect for persons: participants know about and Acceptable if the following are true:
consent to research ❑The research is therapeutic, that is, the
2. Beneficence: do no harm; maximize benefits, subjects might benefit from the
minimize risks experimental process
3. Justice: fair distribution of costs/benefits to all ❑The researcher is willing to use both
potential participants vulnerable or non vulnerable people as
subjects
PROTECTING HUMAN RIGHTS ❑The risk is minimized in the study
❑ Claims and demands that have been justified in the ❑The consent process is strictly
eyes of an individual or by the consensus of a group followed to ensure the rights of the
of people prospective subjects
❑ Human rights that require protection in research:
1. Right to self-determination PATIENT FALLS
2. Right to privacy ✓Do proper nursing assessment
3. Right to anonymity and confidentiality ✓Appropriate assistance is given
4. Right to fair treatment ✓Use protective measures
5. Right to protection from discomfort and harm ✓Document all nursing intervention
✓Morse Fall Scale
RIGHTS TO SELF-DETERMINATION
❑ Based on the ethical principle of respect for persons The Morse Fall Scale (MFS) is a rapid and
❑ Indicates that humans are capable of controlling simple method of assessing a patient's
their own destiny likelihood of falling. A large majority of
❑ Humans are “autonomous agents”, having the nurses (82.9%) rate the scale as “quick and
freedom to conduct their lives as they choose without easy to use,” and 54% estimated that it took
external controls less than 3 minutes to rate a patient.
❑ Researchers should:
1. Inform the participants about the study
2. Allow them to choose whether to participate, and
MEDICATION ERROR
• Observe 10 Rights of drug administration
• Check for doctor’s order
• Consult drug handbook/pharmacy
• Not exempted from liability for following doctor’s
order

EQUIPMENT INJURIES
• Refuse to use a devise you don’t know how to
operate.
• Report adverse events to superior.
• Monitor patient regularly.