Health Care Ethics

Case Scenario: Nursing Ethics VS Health Ethics patient or the potential consequences for the
colleague.

Rationale: The nurse adheres to the duty of reporting all

Ethics VS Bioethics
errors to ensure transparency and uphold ethical standards,
Ethics believing it is the right action regardless of the outcome.

General Principles that Utilitarianism in Healthcare Ethics

govern behavior and
▪ Focuses on the outcomes or consequences of
decision-making about
actions.
what is right and wrong in
▪ Choose actions that maximize overall happiness
any context.
or well-being and minimize suffering.
can apply to various ▪ In health ethics, this means making decisions that
aspects of life, including aim to produce the greatest good for the greatest
business, law, and Theories & Principles of Health Ethics number of people.
personal relationships.
Case Scenario: “Flu Shots for the Greater Good”
Teleology VS Deontology
Bioethics
Scenario: A small community with a
Teleology limited supply of flu vaccines. There are
➢ A specialized branch of ethics that deals Deontology
(Consequentialism)
specifically with issues arising from advances in 100 vaccines available, but 150 people
This ethical theory judges
This ethical theory need them. The health clinic must
biology and medicine. the rightness or
judges the morality of
➢ Addresses questions about the ethical implications wrongness of actions decide how to distribute the vaccines.
Definition an action based on the
based on their
of biological research, medical practices, and action’s adherence to
consequences or What do you think happen if they
rules or duties.
healthcare policies. outcomes.
followed the utilitarianism approach?
The means are
The end justifies the
Case Scenario: Ethics VS Bioethics important regardless
means. An action is Utilitarian Approach:
Key of the outcome. An
considered morally right if
Principles action is morally right
it results in a good
if it follows a set of ➢ Decision - The clinic decides to prioritize
outcome.
rules or duties.
vaccinating children, elderly people, and people
Results and consequences The intrinsic nature of
Focus with comorbidities.
of an action the action itself.

➢ Reasoning - Vaccinating these groups maximizes

Case Scenario: “To Tell or Not to Tell” overall benefit because:
o Children: Protecting them reduces the spread
Scenario: A nurse discovers that a of flu and prevents severe illness.
fellow nurse has made a medication o Elderly & People with comorbidities: They are
error, but no harm has come to the at higher risk of severe complications from the
patient afterwards. flu.

Nursing Ethics VS Health Ethics What do you think happen if the Virtue Ethics
nurse followed the:
Nursing Ethics ▪ Focuses on the character and virtues of a
A. Teleological Approach? person rather than specific actions.
➢ Ethical principles and standards specifically related ▪ Emphasizes being a good person and having traits
to the practice of nursing. ➢ The nurse decides not to report the error because like honesty, courage, compassion, and wisdom.
➢ Focuses on the duties and responsibilities of nurses no harm was done, and reporting it could result in ▪ The idea is that if someone develops good character
towards their patients, colleagues, and the broader disciplinary action against the colleague, which traits, they will naturally make good decisions.
healthcare environment. might affect their career and the work environment.
Case Scenario: “Honest Heart”
Health Ethics Rationale: The nurse focuses on the positive outcome of
maintaining team morale and avoiding unnecessary Scenario: A nursing student finds a wallet on
➢ A broader field that encompasses the ethical issues punishment since the patient is unharmed. the sidewalk on their way home with a large
and principles that arise in all areas of amount of cash and the owner's ID inside.
healthcare. B. Deontological Approach?
➢ Includes considerations for all healthcare What do you think happen if they applied
professionals, healthcare systems, policies, and the ➢ The nurse reports the medication error as per virtue ethics?
overall delivery of healthcare services. hospital policy, regardless of the lack of harm to the
Virtue Ethics Approach: 4. His patient's rights are protected and are not unduly by the practitioner prior to the patient’s
interfered with. participation.
➢ Action Taken - The student decides to return the 5. He cannot be constrained or forced to make 6. The right to refuse treatment.
wallet to the owner. With the help of the police, they decisions and perform actions against his will. o They may refuse treatment as long as
contact the person using the information on the ID they may considered to be capable of
and ensure the wallet is returned with all its Main Nursing Responsibility: making sound decisions, or they made
contents intact. Promoting Autonomous Behavior that choice when they were of sound
mind through written expression.
➢ Reasoning - The student's decision is guided by • Presenting all treatment options to a patient. 7. The right to make decisions about end-of-life-care.
their desire to be an honest and kind person. They • Explaining risks in terms that a patient o They may make their decisions about
believe that acting with integrity is important, not understands. how their lives will end, including life-
because of any specific rule or potential • Ensuring that a patient understands the risks and preserving decisions like the use of
consequence, but because it's part of being a good agrees to all procedures before agreeing into a feeding tubes or ventilators.
person. procedure.
Patient’s Bill of Rights
Core Values Autonomy VS Paternalism
➢ A document that provides the
➢ These are the fundamental beliefs of a person or Paternalism – defined as the overriding of individual choices patients with information on how
organization. or intentional actions to provide benefit to that individual. they can reasonably expect to be
treated during the course of their
Core Values (PNA) ➢ Is sometimes legitimate to restrict client’s treatment or hospital.
autonomy, for their own good.
1. Love of God and Country ➢ Participations in decisions is NOT EQUAL to Informed Consent
2. Caring patient’s willingness to take consequences.
3. Quality and Excellence ➢ Medical ethics remains largely paternalistic since ➢ Refers to the patient's deliberate and voluntary
4. Integrity doctors are required to protect patients from the acceptance of a health care procedure which
5. Collaboration consequences. presupposes sufficient disclosure of the nature and
goal of the procedure, its possible side-effects,
Core Values (BSN Program) Patient’s Rights risks, benefits and the available medical options.

1. Love of God Basic rule of conduct between patients and healthcare Depends on:
2. Caring as the core of nursing personnel as well as the institutions and people that support
o Compassion them. • Adequate disclosure of information
o Competence • Patient freedom of choice
o Confidence 1. The right to be treated with respect. • Patient comprehension of information
o Conscience o All patients, regardless of their means or • Patient capacity for decision-making
o Commitment health challenges, should expect to be
3. Love of People treated respectfully. Three (3) Necessary Conditions are Satisfied:
4. Love of Country 2. The right to obtain medical records.
o This provides patients a right to obtain 1. That the individual’s decision is voluntary.

Ethical Principles their medical records, including doctors’

notes, medical test results and other
2. That this decision is made with an appropriate
understanding of the circumstances.
documentation related to their care. 3. That the patient has carefully considered all of the
The Principle of Autonomy 3. The right to privacy of medical records. expected benefits, burden, risks and reasonable
o This outline who else, besides the alternatives.
▪ Refers to one's moral patient, may obtain patient’s records,
power or right to self- and for what purpose/s. Form of Consent
governance and 4. The right to make a treatment choice.
determination to make o As long as a patient is considered to be 1. Consent by Presumption
decisions in directing of sound mind, it is both their right and
one's own life. ➢ This is reasonably presumed to be present in the
responsibility to know about the options
▪ Exercise of freedom. available for treatment of their medical subsequent employment and series of procedures
as they are aligned with the primary procedure to
condition and then make the choice they
Implications of Patient’s Autonomy feel is right for them. which explicit consent is express.
➢ Example: Though it is not utterly expressed, a
5. The right to informed consent.
1. The patient is responsible for his choices and consent to perineal flushing is reasonably presumed
o Before any tests, procedures or
decisions. after the patient is medically assisted for delivery.\
treatments an informed consent must be
2. His human dignity is upheld and recognized.
signed by the patient or their guardian.
3. His personal value and worth are affirmed.
The risks and benefits must be explained
2. Consent by Proxy
Principles of Confidentiality information if they believe there is an error or
omission.
➢ This is done when the patient is not capable of
informed consent and is legitimately represented by The Following Principles May Guide Nurses on Their 12. Nurses take action, including following
a competent surrogate who acts in his behalf. Role to Provide Confidentiality organizational policies, procedures, or restrictions,
➢ The patient may be unconscious, insane or if others inappropriately access or disclose a client’s
minor/child who is out of reason or not in the age According to National Institute of Health: personal or health information.
of reason.
➢ Example: A febrile baby is given an antipyretic 1. Nurses know which specific legislations apply to 13. Nurses ensure they do not discuss confidential
injection at the consent of his mother. their practice & follow legislated requirements. information in public areas or online forums (ex.
(Data Privacy Act) Social media and the likes)
Case Study: Canterbury VS Spence
2. Nurses collect, use & disclose personal & health
Jerry Canterbury (1939 – 2017) is a 19 years old information only as required to meet their Principles of Health Ethics
Male who developed a sharp pain in his back (due professional responsibilities and/or legislated
to ruptured disk). He underwent Laminectomy in requirements, or as authorized under the bylaws. Six (6) Principles of Health Ethics
1959 and was operated on by Dr. William T.
Spence, a well-known neurosurgeon. Dr. Spence 3. Nurses access personal and health information only ➢ Confidentiality
described the operation as “no more serious than for purposes that are consistent with their ➢ Veracity
an ordinary, everyday operation.” professional responsibilities. ➢ Fidelity
However, Jerry ended up paralyzed below the waist ➢ Justice
after the surgery. 4. Nurses ensure that clients are aware of their rights ➢ Beneficence
Canterbury sued Dr. Spence for malpractice. The concerning their personal and health information. ➢ Non-Maleficence
trial took place in 1968. The accusation/prosecution
negligently withholding the risk for surgery. ‘ 5. Nurses ensure that the clients have consented to 1. Confidentiality
Defense: the collection, use & disclosure of their personal &
o Communication of the risk to plaintiff was health information, unless the collection, use or • Refers to the privacy of information or patient’s
not good medical practice. disclosure without consent is authorized by data.
o Plaintiff’s paralysis resulted from the legislation or under the bylaws. • Legally limits access to only those who have a
original spine injury. “need to know”.
o Plaintiff lacked expert testimony 6. Nurses share relevant personal and health • Main nursing responsibility: Nurses should never
(Conspiracy of Silence) information with the health care team. They explain discuss patients with others who do not have the
Court ruled in favor of the Defense, granted a to clients how this information is shared with other “need to know”.
motion for a directed verdict in Spence’s favor. members of the healthcare team. o Other ex: Not responding to phone or
Canterbury appealed and 2nd trial took place. email inquiries about patients, posting on
Court in Washington declared that before a patient 7. When disclosure of personal & health information is social media (pics, videos, any info)
provides informed consent to surgery, the doctor required, nurses restrict the information disclosed about the patients are prohibited.
must disclose the risks, benefits and alternatives and the number of people informed to the minimum • Healthcare facilities have regulations, policies
that a reasonable person would consider relevant to necessary to fulfill legal, professional and ethical procedures related to confidentiality & accessing
their situation. obligations. client records.
• Personal privacy including private visits &
Reasonable Patient Standard – the amount of information 8. Nurses disclose a client’s personal & health conversations, personal care such as hygiene &
that a rational patient would want before making a choice to information to the appropriate authority if there is bathing must be upheld and maintained.
pursue or reject a treatment or procedure. a substantial risk of signified harm to the health or
2. Veracity
safety of the client or others.
Case Study # 2:
• Being honest and telling the truth.
9. Nurses comply with any legal obligation to disclose
A nurse is told by the hospital administrator to omit a blood • Basis of trusting relationship established between a
confidential information imposed by legislation or
transfusion ordered by the doctor because the patient is going patient & a health care provider.
required under a warrant, court order or subpoena.
to die eventually anyway and is so sick that he will not know • Patients will be informed of their medical condition
the difference. The hospital in this way will make some needed regardless of the severity
10. Nurses safeguard personal & health information
money, since the family can be charged for the blood. The • or prognosis.
learned in the context of the nurse-client
nurse know that it is wrong, but fears that she will lose her • How easy it is to be honest?
relationship, and disclose this information outside
job if she does not cooperate. She obeys the orders of the
of the healthcare team only with the client’s consent 3. Fidelity
administrator.
or when there is an ethical or legal obligation to do
so. • Nurses must be loyal & faithful to the promises they
made as professionals to provide competent care to
11. Nurses respect client’s right to access their own their patients.
client records and to request correction of the
 • Basis of accountability & the promise to fulfill all 7. Nonmaleficence B. Social
commitments to patients.
• Nurses must do no harm intentionally. • Nurses advocate for health promotion, educate
Roles of Fidelity in Healthcare: • Nurses must provide a standard of care patients and the public on the prevention of illness
and injury, provide care and assist in cure,
1. That you treat them with basic respect. The Principle of Nonmaleficence Supports the ff Rules: participate in rehabilitation, and provide support.
2. That you, the caregiver or other health care or other • No other health care professional has such a broad
health care professional, are competent and ➢ Do not kill. and far-reaching role.
capable of performing the duties requires of your ➢ Do not cause pain or suffering.
professional role. ➢ Do no incapacitate. Case Scenario: Social Stewardship
3. That you adhere to a professional code of ethics. ➢ Do not cause offense.
4. That you follow the policies and procedures of your Maria works in a community clinic. She spends her day:
organization and applicable laws. Principles of Stewardship & Role of Nurses as Stewards
5. That you will honor agreements made with the Health Promotion: Giving a workshop to the
patient. community about healthy eating and exercise to
Stewardship
prevent heart disease.
5. Justice Patient Education: Teaching a diabetic patient how
➢ Refers to the expression of one’s responsibility to
to manage their blood sugar levels.
take care, nurture, and cultivate what has been
• Requires nurses to act in ways that treat people Providing Care: Administering medication to a
entrusted to them.
equitably and fairly. patient with an infection.
• Distributive justice - “economic justice” - In Health Care Practices: Assisting in Cure: Helping a patient recover after
fairness in what people receive. Health services be surgery
accessible to individuals according to need & within ➢ Refers to the execution of responsibility of the by monitoring their wound and providing pain relief.
the context of resource availability. healthcare practitioners to look after, provide
necessary health care services and promote the Her role covers a wide range of activities that help people stay
Methods for the Distribution of Goods and Services: health and life of those entrusted to their care. healthy, recover from illness, and feel supported throughout
their healthcare journey.
➢ To each person on equal share Role of Nurses as Stewards
➢ To each person according to individual need C. Ecological
➢ To each person according to acquisition in free ➢ Personal
market (ability to pay) ➢ Social • The nursing profession is well positioned to tackle
➢ To each person according to individual effort ➢ Ecological the challenges of waste reduction with hospital
(benefits) ➢ Biomedical systems.
➢ To each person according to societal contributions • The healthcare sector generates a massive amount
(retirement system) A. Personal of waste, contributing to environmental issues,
➢ To each person according to merit (jobs and such as air and water pollution.
promotion) • A nurse who practices stewardship, meaning they
take responsibility and care in their role , and Case Scenario: Ecological Stewardship
6. Beneficence who follows MacIntyre's Theory of Virtue Ethics, will
help other nurses understand and justify their Tom works in a large hospital. He notices that a lot
• Addresses the idea that a nurse’s actions should shared values and priorities. of medical supplies are being thrown away even
promote good. though they are still usable, like unopened
• Defined as kindness & charity on the part of the Care Scenario: Personal Stewardship bandages and gloves.
nurse to their patients. He suggests changes to his team, such as only
• “act of doing good” Sarah works in a busy hospital. One day, a patient opening supplies when they are needed and
refuses a life-saving treatment. The patient’s choice recycling materials where possible. He also
There are Two (2) Aspects of Beneficence: is based on their personal beliefs, even though it encourages the hospital to switch to eco-friendly
goes against what the healthcare team thinks is products. By making these small changes, Tom
1. Providing benefits. best. helps the hospital reduce waste, which in turn helps
2. Balancing benefits and risks/harms. Sarah, who believes in the importance of respecting protect the environment from pollution.
patients' autonomy, discusses the situation with her
The Principle of Beneficence Supports the Following Moral team. She helps the team understand that, while D. Biomedical
Rules or Obligations: they may disagree, the patient’s choice must be
respected. Her actions show stewardship because • Bioethics is a branch of applied ethics that refers
➢ Protect and defend the rights of others. the discipline dealing with the ethical implications
she guides her team in respecting the shared value
➢ Prevent harm from occurring to others. of biological research and applications, especially in
of patient autonomy, even when it’s difficult.
➢ Remove conditions that will cause harm. the medicine. It involves issue relating to the
➢ Help persons with disabilities. beginning of end of human life.
➢ Rescue persons in danger.
Case Scenario: Biomedical Stewardship Types of Sterilization: success. The treatment would involve significant side
effects, severe pain, and enormous financial cost. The
A patient is very sick and on life support. The ▪ Direct - Willed, as end or as means, intended and patient chooses to forgo the treatment because it is
doctors tell the patient’s family that there is no hope caused intrinsically wrong. considered extraordinary means, as the burdens
for recovery and ask whether they should continue ▪ Indirect – Inevitably required for the survival and greatly outweigh the potential benefits.
life support or not. health of a person, sexual organs, integrating parts
which must yield to the good of the whole.
This situation involves bioethics because the family
o Ex. Eugenics, Demographic, Preventive etc.
Principles of Personalized Sexuality
and doctors must make a tough decision about
ending life support, which has deep moral and C. Organ Donation Sexuality
ethical implications. Bioethics helps guide these
decisions by considering the patient's wishes, the • A person may will to dispose of his body and to destine ➢ Is a complex aspect of our personality and self.
family's beliefs, and what is ethically right in such a it to ends that are useful, morally irreproachable. ➢ Our sexuality is defined by sexual thoughts, desires and
difficult situation. longings, erotic fantasies, turn-ons and experiences.
Criteria for Organ Donation:
Principles of Totality and Its Integrity 1. There’s a serious need on the part of the recipient that
Personalized Sexuality

cannot be fulfilled in any other way. ➢ Element of human character that often leads to a loss
Totality 2. The functional integrity of the donor with a human of human dignity and an inability to pursue the truly
person will not be impaired even though anatomical fulfilling goals of human life.
• Refers to the duty to preserve intact the physical integrity may suffer.
component of the integrated bodily and spiritual 3. The risk taken by the donor as an act of charity is Case Scenario: Personalized Sexuality
nature of human life, whereby every part of the proportionate to the good resulting to the recipient.
4. The donor’s consent is free and informed. Emily works in a hospital. She becomes romantically
human body “exists for the sake of the whole as the
5. The recipients for the scarce organs are selected justly. involved with a patient, prioritizing this relationship
imperfect for the sake of the perfect”.
over her professional responsibilities. She starts
• “The Whole Is Greater Than Any of Its Parts” D. Cadaver Donation spending extra time with the patient, giving them
special treatment, and even neglecting her duties to
Considerations for Principle of Totality and It’s Integrity:
• When a body is being donated, a responsible staff other patients.
member must complete a death certificate. This situation reflects personalized sexuality, where
1. That the organ by its deterioration in function may
Emily’s focus on her own desires leads her to cross
cause damage to the whole organism or at least pose a Conditions on Donation: professional boundaries. As a result, she compromises
serious threat to it.
her integrity as a nurse, and her actions might even
2. That there is no other way than taking the indicated 1. Donor must be verbally and legitimately dead. harm her patient's care.
action against it or obtaining the desired good result. 2. Informed consent.
3. That the damage being avoided to the whole is 3. Remains must be treated with respect.
proportional to that which is caused by the mutilation
or incapacitation of the part.
Principles of Ordinary and Extraordinary Care
Ethical Issues
Principles of Ordinary Care
➢ Mutilation
➢ Sterilization
➢ Morally obligatory as they are likely to help the
➢ Organ Donation
patient. Hope of benefit is high, and cost is low.
➢ Cadaver Donation
Simple Case Scenario:
A. Mutilation
An elderly woman with pneumonia is hospitalized.
• Destruction of member, organ/ part of the body Antibiotics, oxygen, and fluids are administered to treat
(organic) or the suppression of a physical functional in
her condition. These treatments are considered
such a way that the organism becomes no longer ordinary means because they are standard, readily
basically whole. available, likely to improve her condition, and not
overly burdensome.
Types of Mutilation:
Principles of Extra Ordinary Care
▪ Direct - Willed, as end or as means, intended and
caused intrinsically wrong.
➢ Not morally obligatory because they are excessively
▪ Indirect – Necessary for the survival of the patient or
burdensome, unlikely to provide significant benefit, or
to free them from their suffering.
are experimental.
B. Sterilization
Simple Case Scenario:
• A medical or surgical intervention, which causes a
A terminally ill patient with advanced cancer is offered
patient incapacity of reproducing.
an experimental treatment with a very low chance of