HEALTH EDUCATION

MODULE 3: ETHICAL, LEGAL AND ECONOMIC FOUNDATIONS OF THE EDUCATIONAL PROCESS

ETHICS ETHICS
is the study of ideas,ETHICAL,
ideas about right and wrong, and refersOF
LEGAL AND ECONOMIC FOUNDATIONS toTHE
the EDUCATIONAL
guiding principles of behavior.
PROCESS
these ideas are couched in terms and concepts, which
required definition and understanding. ETHICAL
refers to norms or standards of behavior.
NOTE:
Due to the complexities of modern day living & the MORALS
heightened awareness of an educated public, ethical refers to an internal value system (the moral fabric of
issues related to health care have surfaced as a major one’s being).
concern of both healthcare providers and recipients of MORALITY
these services. Thus, it is a widely held belief that the the values system which is expressed externally through
client has the right to know his or her medical diagnosis, ethical behavior.
the treatment available, and the expected outcome.
LEGAL RIGHTS AND DUTIES
▪ Ethical Principles of Human Rights
are rooted in natural laws, which, in the absence of refer to rules governing behavior or conduct that are
any other guidelines, are binding on human society. enforceable under threat of punishment or penalty, such
Inherent in these natural laws are, for example: as a fine, imprisonment, or both.
Principles of respect for others, Truth telling, The intricate relationship between ethics and the law
Honesty and Respect of Life. explains why ethics terminology, such as informed
▪ Ethics as a discipline consent, confidentiality, non- malfeasance, and justice,
interprets these basic principles of behavior in can be found within the language of the legal system. In
broad terms that guide moral decision making all keeping with this practice, nurses may cite professional
realms of human activity. commitment or moral obligation to justify the education
Immanuel Kant (German Philosopher) of clients as one dimension of their role.
Proposed that individual rights prevail and
openly proclaimed the deontological notion The legitimacy of this role stems from the nurse practice
of the “Golden Rule.” Deontology (from the act that exists in the particular state where the nurse
Greek word deon, which means duty) is the resides, is licensed, and is employed. In essence, the
ethical belief system that stresses the nurse practice act is not only legally binding, but it is also
importance of doing one’s duty and protected by the police authority of the state in the
following the rules. interest of protecting the public.

TAKE NOTE: Respect for individual rights is key and one EVALUATION OF ETHICAL AND LEGAL PRINCIPLES IN
person should never be treated merely as a means of HEALTH CARE
another person’s benefit or a group’s well-being.
In the past, ethics was relegated almost exclusively to the
John Stuart Mill (English Scholar) philosophical and religious domains. Medical and nursing
Proposed the teleological notion or care was considered a humanitarian, if not charitable,
utilitarian approach to ethical decision endeavor. Often it was provided by members of religious
making that allows for the sacrifice of one or communities and others considered to be generous of
more individuals so that a group of people spirit, caring in nature, courageous, dedicated, and self-
can benefit in some important way. sacrificing in their service to others. In the same manner,
healthcare practitioners in the past—who were primarily
The legal system and its laws are based on ethical and physicians and nurses—were usually regarded as Good
moral principles that, through experience and over time, Samaritans who acted in good faith.
society has accepted as behavioral norms.

BY: MARHEA ELSIE MAE PONGAN REYES ਏਓ PAGE 1

According to Reising & Allen (2007) there are inhumane This code represents an articulation of professional values
and often torturous treatment of prisoners, the mentally and moral obligations in relation to the nurse-patient
infirm, the disabled, and the poor, there was limited focus relationship and in support of the profession and its
in the past on ethical aspects of that care. In turn, there mission.
was little thought of legal protection for the rights of such
mentally, physically, or socioeconomically challenged The Code of Ethics for Registered Nurses in the
Philippines is promulgated by the Board of Nursing (BON)
people.
and was consulted with accredited professional
1914 Justice Benjamin Cardozo organizations like the Philippine Nurses Association. On
October 23, 2013, at Iloilo City. It also coincides with the
He established the informed consent, which is a basic ideals of Republic Act No. 9173 or the “Philippine
tenet of ethical thought in the court. Cardozo determined Nursing Act of 2002”.
that every adult of sound mind has the right to protect his
Republic Act No. 9173 or the “Philippine Nursing Act of
or her own body and to determine how it shall be treated.
2002”
WORLD WAR II
Article II Section 4. Ethical Principles
• There were violations of human rights made by the
Nazis in the name of biomedical research. Registered Nurses & People
• On U.S. soil, for example, the non-treatment of
1. Values, customs, & spiritual beliefs held by individuals
syphilitic African in Tuskegee, Alabama; the injection shall be respected.
of live cancer cells into uninformed, nonconsenting
older adults at the Brooklyn Chronic Disease 2. Individual freedom to make rational and unconstrained
Hospital decisions shall be respected.
• The use of institutionalized mentally retarded 3. Personal information acquired in the process of giving
children to test hepatitis vaccines at Willow brook nursing care shall be held in strict confidence.
Development Center on Staten Island, New York,
Section 5. Guidelines to be observed:
shocked the nation and raised a critical
consciousness of disturbing breaches in the RN must:
physician– patient relationship.
1. Consider the individuality and totality of patients when
Stirred to action by these disturbing phenomena, in they administer care.
1974 Congress moved with all due deliberation to
2. Respect the spiritual beliefs and practices of patients
create the NATIONAL COMMISSION FOR THE regarding diet and treatment.
PROTECTION OF HUMAN SUBJECTS OF BIOMEDICAL
AND BEHAVIORAL RESEARCH to this day, the primary 3. Uphold the rights of individuals.
emphasis of these review boards is on. 4. Take into consideration the culture and values of
❖ Confidentiality patients in providing nursing care. However, in the event
❖ Truth telling of conflicts, their welfare and safety must take
precedence.
❖ Informed consent (vulnerable pop. – infants’
children, prisoners and mentally ill) Article III Section 6. Registered and Practice
Ethical Principles:
Every proposal for biomedical research that involves
human subjects must be submitted to a local IRBPHS for 1. Human life is inviolable.
intensive review and approval before proceeding with a
proposed study. 2. Quality and excellence in the care of the patients are
the goals of nursing practice.
The American Nurses Association (ANA) developed and
adopted an ethical code for professional practice. CODE 3. Accurate documentation of actions and outcomes of
OF ETHICS FOR NURSES WITH IMPERATIVE STATEMENTS delivered care is the hallmark of nursing accountability.
was released in 2001 for implementation in the new
millennium.
BY: MARHEA ELSIE MAE PONGAN REYES ਏਓ PAGE 2
Section 7. Guidelines to be observed: 4.Contribution to the improvement of the socio-economic
conditions and general welfare of nurses through
RN must:
appropriate legislation is a practice and a visionary
1. Know the definition and scope of nursing practice mission.
which are in the provisions of R. A. No. 9173, known as
the “Philippine Nursing Act of 2002” and Board Res. No. Section 16. Guidelines to be observed:
425, Series of 2003, the “Rules and Regulations RN must:
Implementing the Philippine Nursing Act. of 2002”,
1. Be members of the Accredited Professional
2. Be aware of their duties and responsibilities in the Organization (PNA)
practice of their profession as defined in the “Philippine
Nursing Act of 2002.” 2. Strictly adhere to the nursing standards.

3. Acquire and develop the necessary competence in 3. Participate actively in the growth and development of
knowledge, skills, and attitudes to effectively render the nursing profession.
appropriate nursing services through varied learning
4. Strive to secure equitable socio-economic and work
situations.
conditions in nursing through appropriate legislation and
4. If they are administrators, be responsible in providing other means.
favorable environment for the growth and developments
5. Assert for the implementation of labor and work
of Registered Nurses in their charge.
standards.
5. Be cognizant that professional programs for specialty
Patient’s Bill of Rights (Philippines)
certification by the BON are accredited through the
Nursing Specialty Certification Council (NSCC). ❖ Right to appropriate Medical Care and Humane
Treatment. – every person has a right to health
6. See to it that quality nursing care and practice meet the
optimum standard of safe nursing practice. and medical care corresponding to his state of
health, without any discrimination and within the
7. Ensure that modification of practice shall consider the limits of the resources, manpowered competence
principles of safe nursing practice. available for health & medical care at the relevant
8. If in position of authority in a work environment, be time.
normally and legally responsible for devising a system of ❖ Right to Informed Consent. – the patient has a
minimizing occurrences of ineffective and unlawful right to a clear, truthful and substantial
nursing practice. explanation, in a manner and language
understandable to the patient, of all proposed
9. Ensure that patients’ records shall be available only if
procedures, whether diagnostic, preventive,
they are to be issued to those who are professionally and
directly involved in their care and when they are required curative, rehabilitative or therapeutic.
by law. ❖ Right to Privacy & Confidentiality. – the privacy of
the patients must be assured at all stages of his
Article VI Section 15. Registered Nurses and the treatment.
Profession ❖ Right to Information. – in the course of his/her
Ethical Principles: treatment and hospital care, the patient or his/her
legal guardian has a right to be informed of the
1. Maintenance of loyalty to the nursing profession and result of the evaluation of the nature and extent
preservation of its integrity are ideal. of his/her disease.
2. Compliance with the by-laws of the accredited ❖ Right to Choose Health Care Provider and Facility.
professional organization (PNA), and other professional – the patient is free to choose the healthcare
organizations of which the RN is a member is a lofty duty. provider to serve him as well as the facility except
when he is under the care of service facility or
3. Commitment to continual learning and active
when public health and safety so demands or
participation in the development and growth of the
when the patient expressly waives this right in
profession are commendable obligations.
writing.
BY: MARHEA ELSIE MAE PONGAN REYES ਏਓ PAGE 3
❖ Right to Self-Determination. – the patient has the rules and regulations that apply to the conduct of
right to avail himself/herself of any recommended the patient while in the care of such institution.
diagnostic and treatment procedures.
Application of Ethical and Legal Principles to Patient
❖ Right to Religious Belief – the patient has the right
Education
to refuse medical treatment or procedures with
may be contrary to his religious beliefs, subject to In considering the ethical and legal responsibilities
the limitations described in the preceding inherent in the process of patient education, six major
subsection: provided, that such a right shall not be ethical principles are intricately woven throughout the
imposed by parents upon their children who have Code of Ethics, & Patient’s Bill of Rights.
not reached the legal age in a life-threatening
situation as determined by the attending physician • Autonomy: derived from the Greek words auto
or the medical director of the facility. (self) and nomos (law) and refers to the right of
❖ Right to Medical Records – the patient is entitled self-determination. Laws have been enacted to
to a summary of his medical history and condition. protect the patient’s right to make choices
He has the right to view the contents of his independently.
medical records, except psychiatric notes and The Patient Self- Determination Act (PSDA) a clear
other incriminatory information obtained about example of the principle of autonomy enacted law. The
third parties, with the attending physician law requires, either at the time of hospital admission or
explaining contents thereof. prior to the initiation of care or treatment in a community
❖ Right to leave – the patient has the right to leave health setting, “that every individual receiving health care
hospital or any other healthcare institution be informed in writing of the right under state law to
regardless of this physical condition: provided make decisions about his or her health care, including the
that: right to refuse medical and surgical care and the right to
▪ he/she is informed of the medical initiate advance directives.”
consequences of his/her decision.
▪ he/she releases those involved in his/her care • Veracity: or truth telling is closely linked to
from any obligation relative to the informed decision making and informed consent.
consequences of his decision. Specified an individual’s fundamental right to
▪ his/her decision will not prejudice public make decisions about his or her own body. This
health and safety. ruling provided a basis in law for patient
❖ Right to refuse Participation in Medical Research education or instruction regarding invasive
– the patient has the right to be advised if the medical procedures.
health care provider plans to involve him in
4 ELEMENTS making up the notion of INFORMED
medical research.
CONSENT that is such vital aspects of patient
❖ Right to Correspondence and to Receive Visitors –
education.
the patient has the right to communicate with
relatives and other persons and to receive visitors o Competence. refers to the capacity of the patient
subject to reasonable limits prescribed by the to make a reasonable decision.
rules and regulations of the health care institution. o Disclosure of Information. which requires that
❖ Right to express Grievances. – the patient has the sufficient information regarding risks and
right to express complaints and grievances about alternative treatments be pro- vided to the
the care and services received without fear or patient to enable him or her to make a rational
discrimination or reprisal and to know about the decision.
disposition of such complaints. o Comprehension. which speaks to the individual’s
❖ Right to be informed of His Rights and Obligations ability to understand or to grasp intellectually the
as a Patient. – every person has the right to be information being provided. A child, for example,
informed of his rights and obligations as a patient. may not yet be of an age to understand any
It shall be the duty of the healthcare institution to ramifications of medical treatment and must,
inform of their rights as well as of the institutions therefore, depend on his or her parents to make
a decision that will be in the child’s best interest.
BY: MARHEA ELSIE MAE PONGAN REYES ਏਓ
 o Voluntariness. which indicates that the patient o skilled and echnical services” Malpractice has
has made a decision without coercion or force been specifically defined as “negligence,
from others. misconduct, or breach of duty by a professional
person that results in injury or damage to a
TAKE NOTE: While all four of these elements might be
patient.”
satisfied, the client might still choose to reject the
regimen of care suggested by healthcare providers. This
• Beneficence: is defined as “doing good” for the
decision could be due to the extremely high cost of a
benefit of others. It is a concept that is legalized
treatment or to certain personal or religious beliefs.
through adherence to critical tasks and duties
Whatever the case, it must be recognized by all
contained in job descriptions; in policies,
concerned that a competent, informed client cannot be
procedures, and protocols set forth by the
forced to accept treatment as long as he or she is aware
healthcare facility; and in standards and codes of
of the alternatives as well as the consequences of any
ethical behaviors established by professional
decision.
nursing organizations. Promote patient “Best
• Confidentiality: refers to personal information Interest.”
that is entrusted and protected as privileged • Justice: speaks to the fairness and equal
information via a social contract, healthcare distribution of goods and services. The law is the
standard or code, or legal covenant. justice system. The focus of the law is the
protection of society; the focus of health law is
Under special circumstances may secrecy be ethically the protection of the consumer.
broken (breach confidentiality)
TAKE NOTE: In today’s healthcare climate, professionals
o When a patient has been the victim or subject of
must be as objective as possible in allocating scarce
a crime to which the nurse or doctor is a witness medical resources in a just manner. Decision making for
o When professionals suspect or are aware of child the fair distribution of resources includes the following
or elder abuse
criteria as defined by Tong (2007):
o Narcotic use
o Communicable diseases o To each, an equal share
o Gunshot or knife wounds o To each, according to need
o Threat of violence toward someone o To each, according to effort
o Patient tests positive for HIV/AIDS and has no o To each, according to contribution
intention of telling his/her family about his o To each, according to merit
diagnosis. o To each, according to the ability to pay.

• Non – malfeasance means “do no harm” and

constitutes the ethical fabric of legal
determinations encompassing negligence and/or
malpractice.
o Negligence- is defined as “conduct which
falls below the standard established by
law for the protection of others against
unreasonable risk to harm” involves the
conduct of professionals (e.g., nurses,
physicians) that fall below a professional
standard of due care.
o Malpractice- refers to a limited class of
negligent activities committed within the
scope of performance by those pursuing
a particular profession involving highly

BY: MARHEA ELSIE MAE PONGAN REYES ਏਓ PAGE 5