Health Care Ethics

Healthcare ethics is presented as an essential aspect of quality care and professional practice for nurses.
Importance Key Definitions
 Increase awareness of health Ethos
workers of best medical
 moral duty, refers to a standard of a moral life
 Workers are able to follow the Moralis
ethical code, which sustains
 social consensus about moral conduct
healthcare
 Relevance of bioethics varies
 Morality: quality of human acts where the acts could either be
from birth to end of life.
good or right, evil or wrong (what people believe to be right or
 Healthcare ethics provides good conduct)
guidelines for medical ➢ The act is good with it is in the conformity with the dictates of
professionals regarding clinical right reason
decision-making and ➢ The act is evil when it is not in conformity with and is
advancements in medical transgression of the dictates of the right reason.
technologies. It also plays a vital
 Philosophy: knowledge of all things acquired through the use of
role in influencing policy
reasoning
changes and legislation.
➢ Greek Words: “Philos” (love), “Sophia” (wisdom) ; Love of
 Contributes to the rights and Wisdom, where person make a deliberate effort to seek the
responsibilities of patients as a truth.
person.
 Its significance replicates in Moral Philosophy
various divisions  Philosophical discussion of what is considered good or bad, right
 Ethical problems are created or wrong in terms of moral issues. (Ethics can be called Moral
because of changes in the Philosophy)
society, advances in technology,
scientific advances, confliction  Ethics: A set of principles of right or good conduct concerned with
within the nurses themselves, values and morality. The method of inquiry about the rightness or
and nurses conflicting loyalties wrongness of human actions. The science which guided one’s
and obligations judgement concerning the morality of human acts. (What should
 It is increasingly important for I do in this Situation?)
nurses to be knowledgeable
about ethical issues because Code of Ethics
advances in technology are  a declaration of faith, beliefs and ideals with the profession
leading to increasingly complex upholds and the members conform to and follow. “Statement
ethical dilemmas in client care. about what the profession itself believes and its purpose to be”
These dilemmas often become Amended Code of Ethics for The ICN - Code of Ethics for Nurse
legal issues as well. Nurses (2006)
 Familiarity with ethico-moral-  Health is a fundamental  4 Fundamentals
legal implications of nursing right of every individual. responsibilities: promote
enhances their ability to be The nurses’ primary health, restore health, prevent
client advocate. responsibility is to preserve illness, and alleviate
 Healthcare ethics is relevant health at all cost. This sufferings
throughout a person's life, from responsibility  Nursing is respectful of and
birth to death. encompasses promotion of unrestricted by consideration
health, prevention of of age, color, creed, culture,
illness, alleviation of disability or illness, gender,
suffering and restoration of sexual orientation,
health. nationality, politics, race or
social status.

 Code of Conduct: paradigm of moral action or a framework of

behavior; “a statement about how the profession considers its
members should behave towards clients, the society as a whole
and each other”
 Three Divisions of Ethics
Metaethics Normative Ethics Applied Ethics
 Where our ethical  Moral standards that regulate right and  Involves examining
principle come from, wrong conduct specific controversial
and what they mean  Involve articulating the good habits that issues, such as
 Answer to these we should acquire, the duties that we abortion, infanticide,
questions focus on the should follow, or the consequences of our animal, homosexuality,
issues of Universal behavior on other. capital rights,
truths, the will of God,  Golden Rule environmental
the role of reason in concerns punishments,
ethical judgements, and or nuclear war.
the meaning of ethical
terms themselves
 Murder is wrong
Christian Health Ethics
 Each human being is created by God in his own image and likeness, thus the worth of the person is based
on his biblical teachings
 The best way to solved ethical issues in the health care delivery system is to appeal to God since He is the
source of truth, morals and justice

Types of Ethics
Bioethics Health Ethics Nursing Ethics Professional Ethics
 The science that deals with the  Science that deals  Deals with  Related to
study of the human conduct with the study of the ethico- professional
concerning human life in all its morality of human moral behavior;
aspect from the moment of its conducts behavior in includes moral
conception to its natural end. concerning health the practice duty or
 Scope: and healthcare of nursing obligation
➢ Ethical problems associated  Health care:  Nursing which a
with medical practice medical services Professional member of the
➢ Social issues related to health, nursing care and Ethics - profession
animal welfare and other types of treats of the owes to the
environmental concern health services moral public, to his
 Significance: given by health principles, profession, to
➢ Keep members of the health care practitioner duties or his colleagues
profession aware of the do’s and who is in one way behavior of and to his
don’ts of medical practice to another engage the members clients
➢ Enhance their competence by in any duty of the
understanding the patient is a recognized form of nursing 3 Main Function
person and a holistic individual. health and care profession To reassure the
practice. toward their public
Bioethics Vs. Health Ethics co-nurses, to
their To provide
Relation Distinction profession, to guidelines for the
 Both are concerned  Health Ethics - concerned about other health profession to
about health and life life only in relation to care workers, discipline and
 Both regulate human health; regulate human conduct to the regulate in
conduct by means of in the practice of health care
patients and members
moral principle in  Bioethics - concerned not just
to the public
relation to health and about health but also about
in general To provide a
life other fields in relation to life;
➢ Nightingal framework in
 Health ethics is part of regulates human conduct not
only in the practice of health e Pledge which individual
bioethics
care but also in all aspects of members can
human life formulate their
 Bioethics is not a part of health decisions
ethics, It has encompassing
scope of discipline.
 Ethical Systems
Islamism Buddhism Communism (Karl Marx) Christianism
 A philosophy of lie, a  The Greatest Values  The Greatest Good is  Based on the
complete system of is liberation of man absolute equality. teachings and life of
living based on the from suffering The mission is the Jesus Christ. The
word of God revealed through the production of Greatest value is
to Mohammed. abandonment of all material wealth Love because God is
egoistic desires using collective Love. Christian
5 Pillars labor so that each morality is
 Confession of 4 Noble Truths would give essentially based on
Creed: there is no  Life is the root of according to his love which embraces
God but allah and all sufferings power and receive even the enemy.
Mohammed is his  Sufferings are according to his
prophet caused by desires needs. A classless
 Prayer bring man society.
 Desires can be
in the right
eliminated by
relationship with
negating life
God
 Charity  Elimination of
desires can be
 Observance of the
Ramadan achieved by
 Pilgrimage to accumulating
Mecca karma or deeds
that eventually
free the
individual.

Somera Case
 This is where a nurse fails to question a doctor’s order and is often cited as proof of nurses’ independent
accountability.
➢ In 1929,in Manila Lorenza Somera (a nurse), was found guilty of manslaughter, sentenced to a year in
prison, and fined one thousand pesos for following a physician’s orders. (Somera assisted a physician
in a tonsillectomy. The physician ordered an injection of cocaine to be prepared. Somera prepared it,
the physician administered it, and the patient died. The drug he meant to ask was “procaine”.) She was
found guilty (while the doctor was acquitted) because when the doctors said cocaine, she did not
question his orders.
Ethics in Nursing
 It is not enough for today’s nurses to be technically competent byt they also gave to be morally and
ethically grounded
 Nursing Ethics is the discipline of evaluating the merits, risks, and social concerns of activities in the
field of nursing
 Some people define nursing ethics as part of bioethics since the same knowledge base is often used;
Others in nursing define nursing ethics as separate from Bioethics since the usually applied ethics does
not help nurses deal with the ethical issues that they often face. That is one reason why Caring Ethics and
Feminist Ethics have developed.
Code of Ethics for Nursing Students
 Advocate the rights of all clients
 Maintain client confidentiality
 Take appropriate action to ensure the safety of clients, self, and others
 Provide care for the client in a timely, compassionate, and professional manner
 Communicate client care in a truthful manner
 Promote excellence in nursing by encouraging lifelong learning and professional development
 Treat others with respect and promote an environment that respects human rights, values, a choice of
cultural and spiritual beliefs
 Collaborate in every reasonable manner with the academic faculty and clinical staff to ensure the highest
quality of client care
 Use every opportunity to improve faculty and clinical staff's understanding of the learning needs of
nursing students
 Encourage faculty, clinical staff, and peers to mentor nursing students
 Refrain from performing any technique or procedure for which the student has not been adequately
trained
 Assist in ensuring that there is full disclosure and that consent is obtained from clients regarding any
form of treatment or research
 Abstain from the use of alcoholic beverages or any substances in the academic and clinical setting that
impair judgment
 Refrain from any deliberate action or omission of care in the academic or clinical setting that creates an
unnecessary risk of injury to the client, self, or others

Code of Academic and Clinical Conduct

 The code of Academic and Clinical conduct is based in an understanding that to practice nursing as a
student is an agreement to uphold the trust with which society has placed in us

Morality
Determining Elements Ethics vs. Morality
 Act itself
Relation Distinction
 Purpose: reason for which the act is performed
 Circumstances: factors distinct from the act  Ethics  Ethics pertains to the
itself and from the purpose which may affect the studies knowledge of what to
morality of an act about study about goodness or
morality. evil of human act,
 Morality Morality pertains to
gives ethics a application of this
perspective knowledge in the
of what to performance of human
study about act.
(goodness or  Ethics provide learning
badness of about the morality of a
an act) human conduct, Morality
 Both deal provide ways in
with human practicing what is
act or learned
conduct.  Ethics indicates the
 Morality theory; morality indicates
provides practice.
ethics with
quality that
determines
and
distinguishes
right conduct
from wrong.

Type of Ethical School of Thought

Kantian Ethics Rawl’s Ethics Ross’s Theory St. Thomas Aquinas
 This theory  This theory centers  This theory  This theory is based
emphasizes duty on the concept of acknowledges that on the idea that
and motives. It fairness and ethical decision- there is a natural
argues that an equitable making often order to the world,
action is right if it is distribution of involves navigating and humans have a
done from a sense resources. conflicting duties. natural inclination to
 of duty, regardless  Referred to as the  Referred to as the do good and avoid
of its consequences. “Principle of Justice” “Moral Intuitionist” evil.
 Referred to as the  Giving each other Theory  The highest good
“respect for that which is his due  several moral consists of a beatific
persons” Theory of – Aristotle obligations and vision of God. No
Morality  Motivation for the reflects common- Earth good can fully
 To be a good person, reform of our sense moral satisfy human desire
you must be good healthcare system commitments.
 “Do good, avoid evil”
for goodness sake  Justice in nursing
 Moral rules serve as
relates to  Synderesis - the
Principles moral guidelines in
impartiality inherent capacity of
 It is always wrong such a way that
regarding a patient’s an individual to
to lie, no matter age, ethnicity, they must be
determine what is
what the economic status, adjusted and
right from what is
consequences religion, or sexual modified.
wrong or good from
may be orientation.  The distinction bad.
 We must always Assigning clinical or between an actual
treat people prioritizing care
(including duty and a prima
Principle of Double
ourselves) as facie (at first view,
Distributive Justice Effect
ends not only as as it appears)
 some goods and  “Nothing hinders
means one act from
services are in 7 Prima Facie Duties
 An action is right having two effects,
short supply,  Duty of Fidelity:
and legitimate only one of which
there is not duty to keep
insofar as is intended, while
enough to go promises, telling
it satisfies the the other is beside
around, thus the truth
categorical the intention.”
some fair means
imperative (moral  Duty of Gratitude:  Virtue ethics in
of allocating
dictate forbids the duty to thank nursing can be
scarce resources
lying, stealing, those who help us; viewed as an
must be
killing, breaking recognizing the approach of ethical
determined.
of promises service deliberation about
 Persons who are others have done
under any & all the moral
equal should for us
circumstances) character and
qualify for equal
 The distinction  Duty of Justice: dispositions of
treatment
between perfect the duty to nurses as moral
Factors: recognize merit
& imperfect agents that
duties suggests  To each person an  Duty of enables them, as
that some rights equal Beneficence: duty virtuous human
should be share (Education to improve the beings, to fulfill
recognized. ) conditions of their purpose and
 To each person others; function as
according to need ➢ helping to better professional
(aid to the needy) the condition of people.
 To each person beings with
according to respect to virtue,
effort intelligence, and
(employment comfort.
opportunity)  Duty of
 To each person Improvement: the
according to duty to improve
contribution our virtue or
(retirement intelligence
benefit)  Duty of Non-
 To each person maleficence: duty
according to to not injure others
merit (jobs &  Duty of
promotion) Reparation: the
 To each person duty to
according to free- compensate others
 market exchange when we harm
s (the greatest them
good for the ➢ righting the
greatest number) wrong we have
done to others
 Duty of
Compensation: to
do good to make
up for the repair to
the damage done

Basic Bioethical and Moral Principles

Principle Moral Principles
 a comprehensive and fundamental law or  a fundamental rule of moral law containing
doctrine certain truth from which knowledge of a definite
moral action for performance proceeds along
with the provision of solution to specific moral
problems or issues.

Stewardship Beneficence Non-maleficence Double Effect

 This principle  This principle  This principle  This principle
emphasizes the mandates that dictates that recognizes that
responsibility of healthcare providers healthcare providers some actions may
healthcare do good and act in should avoid have both good and
professionals to the best interests of causing harm to bad consequences. It
care for and nurture their patients. It their patients. It allows for such
the health and life involves promoting involves refraining actions only if the
entrusted to them. good, preventing from actions that good effect is
harm, and removing cause intentional intended, the good
harm. harm and avoiding effect does not result
 To do good and not harm as a from the bad effect,
to do harm, one consequence of the harm is not
ought to doing good. intended but merely
prevent/remove evil  Do no harm, avoid tolerated, and the
and harm harm as a good outweighs the
consequence of harm.
doing good.  Act must be good in
itself or at least
morally neutral,
harm is never
intended (good
intended) ; good
must outweigh the
harm
Cooperation Solidarity Veracity Confidentiality
 This principle  This principle  This principle  This principle
addresses the emphasizes the highlights the centers on the
ethical implications importance of unity, importance of protection of patient
of working with collaboration, and truthfulness in privacy. It requires
others when their shared healthcare. It healthcare providers
actions may be responsibility mandates that to keep patient
morally wrong. among healthcare healthcare providers information
providers and be truthful with their confidential and only
between providers patients and refrain disclose it when
and patients. It calls from deception. necessary for the
for providers to work patient's benefit or
together for the
 patient's best  Obligation to tell the to protect the public
interests and to truth, Respect for good.
promote justice and other.
peace in healthcare.
Principle
 Core respect for all
persons by being
truthful. Opposite of
the concept of
paternalism.

Nursing Malpractice vs. Nursing Negligence

 Nursing Standard of Care Violation - A violation of the nursing standard of care occurs when a nurse
fails to provide the level of care that a reasonably prudent nurse would deliver under similar
circumstances.
 Medication Error, Failure to Monitor, Infecion Control, Failure to Communicate, Patient Falls and Injuries.
Malpractice Negligence
 Malpractice is professional misconduct or a lack  Negligence is a breach of the standard of care
of skill or fidelity in performing professional that results in harm to the patient. It doesn't
duties. It applies to a situation in which a nurse necessarily involve a violation of established
fails to meet the expected standard of care, standards of care.
resulting in harm to the patient.
 Failing to follow a physician’s orders or
 Failing to turn or reposition a patient, leading treatment plan, Failing to properly supervise
to pressure ulcers, Administering the wrong nursing assistants or other staff members.
medication or dosage, leading to adverse
reactions or harm.

Human Person
 inherent dignity and worth of every human person, emphasizing that this is not earned but intrinsic to
their being. Decisions about health must consider and address the biological, psychological, social, and
spiritual needs of the person.
Human Acts and Acts of Human
Human Acts Acts of Human
 Those performed knowingly, freely, and  Actions that are not dependent on intellect and
voluntarily, involving conscious knowledge and free will. They are instinctive and not within the
the control of the will. An example is a nurse control of the will. These actions are done
administering medication to a patient as without knowledge, consent, or voluntary control.
instructed. An example is a man walking in his sleep or
 Subject to moral evaluation because humans, by under hypnosis. Acts of man can become human
nature, act towards an end, and their lives have a acts when intellect and will are employed in
purpose performing them.

Elements
Knowledge Freedome Voluntaries
The act is The agent This element
performed with performs the requires the
awareness and act under the presence of
understanding control of their both knowledge
will. and freedom.

Conscience
 Conscience is described as a subjective norm of human acts, an inner sense or feeling that helps
individuals make the right choice. It is considered an innate force that is the cornerstone of ethics, often
referred to as the "personal self" or the "little voice" inside our minds
Types
Correct or True Erroneous or False Certain Doubtful Scrupulous
Conscience Conscience Conscience Conscience Conscience
 Judges  Judges incorrectly,  The person is  A vacillating  Rigorous
good as perceiving bad as good subjectively conscience and fearful
good and and good as bad. An sure of the unable to of
evil as evil, example is believing that lawfulness or form a committing
aligning having an extramarital unlawfulness definite evil, seeking
with affair is acceptable of an act, judgment, incontrovert
objective because it's considered though it requiring the ible proof
moral law. "macho". may not resolution of before
An example align with doubt before acting and
is Culpable Inculpable objective acting. often
understand Conscience Conscience truth. judging sin
ing that (Voluntary (Involuntary where there
stealing is Error) Error or is none.
wrong. Honest
Mistake)

The error is The error is

due to not
neglect or intentionally
malice. An made. An
example is example is
believing unknowingly
that using
cheating is counterfeit
acceptable money.
because it
helps pass
exams and
is a
common
practice.

Lax Conscience Strict Conscience Pharisaical Clear Conscience Callous Conscience

Conscience
 Indifferent to  Judges moral  Self-righteous  Acts  Described as
the distinction obligations about one's confidently the worst type,
between good harshly, own moral and freely, exhibiting low
and evil, quick adhering more evaluation perceiving, sensitivity to
to justify to the letter while being appreciating, sin and God, as
actions, and than the spirit judgmental and if the person
often of the law towards internalizing has no
characterized others. true values, conscience.
by a "bahala and adapting
na" attitude. to moral
decisions
Conscience Formation
 conscience is not static but rather a dynamic process of formation. It is a personal sense of the moral
content of one's own conduct, intentions, and character.
Acculturation and Personal Reflection Objective Moral The Word of God
Instruction Standards
Learning from societal Examining one's own Guiding conscience A principal tool for
norms, values, and values, principles, and development with conscience formation
teachings actions. external principles of through study, prayer,
right and wrong. and practice.

Conscience Vs. Morality

 Conscience and morality are interconnected but distinct, both playing roles in ethical decision-making.

Conscience Morality
 An individual's internal sense of right and wrong.  A broader set of principles and values that guide
ethical behavior, often reflecting societal norms.
Conscience in Nursing
 In nursing, conscience is seen as a personality-related component of professional competence,
promoting nurses' sense of responsibility and guiding the application of knowledge and skills in patient
care.
The Calling of the Health Care Provider
Health Care Practitioner The Patient/Client Other Members of the Health Care
Team
 Health care practitioners are  The patient or client is the  Collaborative nature of
those who have acquired recipient of therapy or care. healthcare, involving various
advanced training and They have a health problem or healthcare providers working
experience in healthcare. They need that requires together to administer health
are responsible for identification and attention. care services. Effective
determining appropriate The sources highlight the communication and a
therapy or care, adjusting importance of patients taking collegial approach are
healthcare measures to meet an active role in their care, essential for successful
client needs and engaging being open, amenable, teamwork.
with and working with clients cooperative, and submissive
throughout the therapeutic to healthcare instructions.
process.

Building Health Care Practitioner-Client Relationships

 Develop trust and confidence: Be credible, reliable, consistent, and honest.
 Inspire openness and transparency: Convey acceptance, appreciation, and acknowledgment of the client's
uniqueness.
 Show positive regard and respect: Recognise the client's worth, human dignity, and rights.
 Provide empathic listening and responding: Understand and share the client's perspective and feelings.
Nursing as a Profession
 Nursing is described as a profession requiring special knowledge, skills, attitude, and preparation.
Nurses have a responsibility to promote health, prevent illness, and collaborate with other healthcare
providers to provide curative, preventive, and rehabilitative care.
Virtues of Health Care Providers
Intellectual virtues Moral virtues
 pertain to acquiring knowledge and perfection  relate to the will and help individuals acquire
through intellect, including understanding, proper conduct and build character, including
science, wisdom, art, and prudence. justice, fortitude, and temperance.

Vices of Health Care Providers

 Vices are presented as habits of doing evil. Example of pride and greed as vices.
Definition of Terms
 Values: Enduring beliefs or attitudes about worth.
 Value Systems: Guiding principles that form the basis of behaviour.
 Beliefs (or Opinions): Interpretations or conclusions accepted as true, based on faith rather than fact.
 Attitudes: Mental positions or feelings towards a person, object, or idea, often judged as good or bad.
Values Transmission
 Values are learned through observation and experience, influenced by sociocultural environments,
including societal traditions, cultural and religious groups, and family and peer groups.
Personal Values
 Individuals internalize values from society and subgroups, forming their own personal values, which
contribute to their sense of individuality.
Moral Development
 Moral development is the process of learning right from wrong and understanding what should and
should not be done. It is a lifelong process that starts in childhood.
Moral Frameworks
Consequence-based (teleological) theories Principles-based (deontological) theories
 Judge actions based on their outcomes.  Focus on individual rights, duties, and
Utilitarianism is an example. obligations, with the morality of an action
determined by adherence to impartial, objective
principles.
Virtues Specific to Healthcare
Service-orientedness Intellectual, Moral, and Clinical Wisdom
 A deep-rooted commitment to serving others.  Combining intellectual knowledge, ethical
principles, and practical experience.
Professional Boundaries
 Maintaining professional boundaries is crucial for healthcare providers to avoid misunderstandings and
inappropriate relationships. Violations can lead to serious consequences.

Receiving/Giving Coercing Patients Showing Sharing Personal Using Social Media

Gifts Favoritism Information
 Avoid personal  Forcing  Avoid actions Maintain  Adhere to
gifts to prevent patients to act that create professional institutional
unrealistic against their dependence or distance and avoid policies,
expectations. will is suggest over- disclosing personal protect patient
unethical and involvement details privacy and
potentially with a patient. confidentiality,
illegal. and avoid
posting
negative
comments
about
colleagues or
content that
reflects poorly
on the nurse's
character.

Issues / Cases of Bioethical Concerns

Abortion
 the expulsion of a living fetus from the mother's womb before it is viable, either occurring naturally
(spontaneous abortion) or induced through surgery or medication. Viability refers to the fetus's ability to
survive outside the uterus, generally considered to be before 20 or 24 weeks of gestation.
Types of Abortion
Spontaneous Abortion Indirect Abortion Direct or Induced Abortion
 This type occurs naturally  Refers to the unintended but  This is the deliberate
without artificial means, foreseen loss of the fetus termination of pregnancy
typically resulting in fetal loss following a medical procedure through artificial or
during the first trimester necessary to preserve the mechanical means or
mother's life or health, such voluntary human intervention.
Types: as an appendectomy for a
ruptured appendix, treatment Types:
  Threatened Abortion - for an ectopic pregnancy, or  Criminal Abortion -
Characterized by bleeding, removal of a cancerous Performed solely because
cramping, and backache, uterus. the child is unwanted,
with a closed cervix. Bed considered murder and
rest and medication are legally punishable.
typically the indicated  Therapeutic Abortion -
treatment, with Performed to save the
procedures like a D&C mother from death or
considered immoral. illness, considered morally
 Imminent Abortion - equivalent to criminal
Marked by increased abortion because it
bleeding and cramping, involves a direct attack on
cervical dilation, and an innocent life.
possible membrane
rupture. This is considered
an inevitable abortion.
 Incomplete Abortion -
Occurs when parts of the
products of conception,
often the placenta, are
retained, and the cervix is
dilated.
 Complete Abortion - All
products of conception
are expelled.
 Missed Abortion - The
fetus dies inside the
uterus but is not expelled,
with a closed cervix.
 Habitual Abortion - Occurs
in three or more
consecutive pregnancies.

Legal, Moral, and Ethical Considerations of Abortion

 asserting that it destroys life, violates the right to life, and is morally evil. The direct killing of an innocent
human being is considered gravely immoral, regardless of the intended good outcome.

Euthanasia
 the intentional act of ending a person's life to alleviate their pain and suffering. It is often referred to as
mercy killing, assisted suicide, or doctor-assisted suicide.
 “good death”
Moral and Ethical Considerations of Euthanasia
 Euthanasia as a violation of God's sovereignty over life, arguing that only God has the right to determine
when a life should end. Intentionally terminating a human life is deemed a serious moral transgression
that cannot be justified by legislation.

Classifications of Euthanasia
Voluntary Euthanasia Non-voluntary Euthanasia Involuntary Euthanasia
 Conducted with the patient's  Performed when the patient's  Conducted against the
informed consent. consent is unavailable, and patient's will, often due to
the act is not regretted. ignorance and regretted by
the individual who performed
the act.
Procedural Decisions in Euthanasia
Passive Euthanasia Active Euthanasia
 Withholding common treatments necessary for  Using lethal substances or forces to end the
life, such as antibiotics patient's life.
Suicide
 defined as the act of intentionally causing one's own death.
 Latin: Sui Caedere – “to kill oneself”
Forms of Suicide
Unassisted Suicide Facilitated Suicide Assisted Suicide
 The individual commits  The individual commits  A clinician, with the
suicide without confiding in suicide while under the care individual's consent and
or seeking help from a of a clinician who was aware knowledge of their wishes,
clinician. When the individual of the risk but failed to take provides the means and
was not under the care of a appropriate preventative guidance for the individual to
clinician and when the measures. This suggests a end their life. The sources
individual was under care for breach of duty and negligence highlight ethical concerns
a condition unrelated to on the part of the clinician. regarding capacity and
suicidality.  Involuntary Action rationality, particularly in
 Non-voluntary Action cases of extreme stress or
chronic pain, as enabling
suicide in such situations is
considered unethical.
 Voluntary Action
Determination of Death in Suicide
Clinical Death Biological Death
 Occurs when a person stops breathing, leading  A more severe state where brain cells die due to
to a lack of oxygen and eventual cardiac arrest. lack of oxygen (hypoxia) following clinical death.
The sources indicate that all clinically dead Early response to clinical death and prompt
patients should receive resuscitative measures medical help are crucial in preventing biological
unless contraindications exist. death.

In Vitro Fertilization (IVF)

 IVF is a process where an egg and sperm are combined in a laboratory setting ("in vitro" meaning "in
glass"). It involves monitoring and stimulating ovulation, retrieving eggs from the ovaries, and fertilizing
them with sperm in a culture medium. The resulting embryos are then transferred to the uterus for
potential pregnancy
 One Full Cycle: 2 to 3 weeks
 Test-tube baby

 IVF intended for Experimentation and Research

 Do not acord them title of human persons
 Without having to be disturbed by their conscience
 Embryos have human lives
Applicability of IVF Relevant Issues in IVF
 IVF is a method primarily used to address Pregnancy Reduction Experimentation and
infertility, allowing couples to use donor sperm Research
or eggs if necessary. Additionally, IVF embryos  In IVF, multiple  Many IVF embryos
can be submitted for scientific research, such as embryos are often are frozen for
laboratory studies, experimentation, and stem implanted to potential future use.
cell research. If embryos are left over after these improve pregnancy They may be
purposes, they may be destroyed, donated to chances, which can implanted for
other infertile couples, or used in research, result in multiple couples seeking
depending on the consent of the producing pregnancies. This children or used in
couples. can overcrowd the scientific research,
uterus, risking though this raises
premature delivery, ethical concerns
stillbirths, brain about the moral
damage in babies, status of embryos.
and health risks for
 the mother.
Pregnancy reduction
may be considered
to lessen these
risks.
Moral Considerations of IVF
Violation of God's Will Usurpation of God's Power Abuse of Stewardship
 In vitro fertilization (IVF) is  IVF, like artificial  IVF is criticized for altering the
seen as a violation of natural insemination (AI), is viewed natural process of life
law because it creates life as an attempt to take control creation. It represents a
outside of the marital sexual over the creation of life, a misuse of humanity's role as
relationship, deviating from power that belongs only to stewards of God's creation by
the natural process of God. The creation and replacing natural processes
procreation. destruction of embryos for with technological means,
purposes like stem cell which is seen as morally
research further emphasize wrong and an abuse of the
this attempt to usurp divine inherent design of life.
authority over life and death.
Stem Cells
Stem cells are undifferentiated cells with the ability to develop into various specialized cell types, such as
muscle or brain cells. They serve as the body's raw materials, generating all other specialized cells. These cells
can divide and differentiate to repair and replenish diseased cells, tissues, or organs, helping restore their
normal function.
Types
Totipotent Capacity Pluripotent Capacity
refers to the ability of stem cells to differentiate into refers to stem cells' ability to be directed into
any type of bodily cell. For example, blood cells from producing specific types of cells, such as umbilical
bone marrow can transform into nerve cells. cord stem cells generating blood cells, brain cells, and
others.
Stem Cell Technology
Stem cell research involves the study of human and animal stem cells, which are essential for growth and
regeneration. While stem cells are already used for therapeutic purposes, research suggests potential future
benefits in medicine. However, the use of human embryos in some stem cell research has sparked ethical
controversy, focusing on the creation, use, and destruction of embryos
Ethical Concerns
The basic ethical issue arises from the tension between two moral principles: the desire to alleviate suffering
through medical advancements and the respect for the value of human life. Embryonic stem cell research, in
particular, raises concerns because it could lead to the destruction of embryos, despite its potential to help
treat debilitating medical conditions.
Application of Bioethical Principles to Patient Care
Informed Consent
Informed consent is a fundamental aspect of ethical healthcare, grounded in the principle of patient
autonomy, which asserts that patients have the right to make decisions about their own health and medical
care. Physicians are ethically and legally obligated to obtain informed consent before proceeding with
treatment, ensuring that patients understand the nature, risks, and benefits of the proposed interventions.
This practice not only aligns with good clinical care by actively involving patients in their treatment decisions
but also serves as a key component of effective risk management. By obtaining informed consent, both the
physician and the patient share responsibility for the treatment outcomes, fostering a collaborative approach
to healthcare.
Functions Key Elements Exceptions
 Supports patient decision-  The nature of the proposed  Emergencies - When
making and self- treatment immediate treatment is
determination  The risks and benefits of the necessary to save a life or
 Promotes communication proposed treatment prevent serious harm.
between patients and  Legal Mandate - Certain
healthcare providers situations may be mandated
  Shares responsibility for by law, such as mandatory
treatment outcomes reporting of child abuse.
 Provides a fair explanation of  Waiver - Patients can choose
the proposed treatment to waive their right to
 Helps ensure realistic patient informed consent.
expectations  Therapeutic Privilege - In rare
 Protects physicians from cases, a physician may
allegations of misconduct withhold information if
disclosure would severely
harm the patient.

This presentation discusses various bioethical theories and principles that are important for nurses to consider
when making decisions about patient care.
Bioethical Theories
• Teleology:
o This theory focuses on the consequences of actions to determine whether they are right or wrong.
It is a consequentialist theory because it suggests that the ends justify the means.
o Teleology emphasises utilitarianism which determines an act to be right if it brings about the
best consequences overall.
o For example, a family stranded on a desert island with their dogs might choose to kill and eat the
dogs to survive. This would be considered a moral choice under utilitarianism because it brings
about the greatest good for the greatest number of people (the family).
o In healthcare, teleology can be used to justify a nursing action based on the overall benefit or
harm it produces. For example, a nurse might decide to administer a particular medication based
on whether its benefits outweigh its harms for the patient.
• Deontology:
o This theory focuses on the intrinsic nature of an act rather than its consequences to determine
whether it is right or wrong.
o Deontologists believe that people should act from a sense of duty and reason. They follow moral
rules, such as "it is wrong to kill innocent people," regardless of the situation or consequences.
o Examples of deontological ethics include paying taxes, obeying the law, serving in the military,
and obeying the Ten Commandments.
• Utilitarianism:
o This theory views a good act as one that brings the least harm and the most good to people. It
focuses on promoting happiness and pleasure while minimising pain.
o There are two basic types of utilitarianism:
▪ Act-utilitarianism: people choose actions that will increase the overall good in any given
circumstance, allowing for different actions in different situations.
▪ For example, releasing drugs with minor side effects that help many people would
be justified.
▪ Other examples include promoting kindness and supporting education.
▪ Rule-utilitarianism: an action is right if it conforms to a rule that leads to the greatest
good for society.
▪ Examples include adhering to traffic regulations and considering murder morally
wrong.
• Autonomy:
o Autonomy refers to an individual's right to self-governance and self-determination. This means
that individuals should be free to make their own choices without coercion.
o The three basic elements of autonomy are: the ability to decide, the power to act on one's
decisions, and respect for the autonomy of others.
o Respect for autonomy means believing in a person's unconditional value, recognising their
capacity to determine their own destiny, and acknowledging their right to hold their own views
and make their own choices.
o However, autonomy may not apply in certain situations, such as when a patient waives their
consent, is incompetent to make decisions, or might harm themselves or others.
Bioethical Principles
• Beneficence:
 o Beneficence means acting in ways that benefit others and promote their well-being. It involves
doing good, promoting health and welfare, and preventing or removing harm.
o The ICN Code of Ethics states that nurses should take appropriate action to safeguard individuals
when their care is endangered.
o Examples of beneficence include: providing all patients with equal care, organ donation, and
treating every patient with respect.
• Non-maleficence:
o Non-maleficence means "do no harm". It involves avoiding actions that cause deliberate harm or
harm as a consequence of doing good.
o Examples include experimental research and immunisation of infants.
• Justice:
o Justice deals with fairness and entitlements in the distribution of goods and services.
o Examples include treating patients equally regardless of their background and knowing the laws
on abuses.
o There are different theories of justice:
▪ Egalitarianism: everyone should have equal access to goods and services.
▪ Utilitarianism: resources should be distributed to maximise the greatest good for the
greatest number.
▪ Libertarianism: individuals have personal rights to social and economic liberty.
Moral and Spiritual Principles
The presentation lists several moral and spiritual principles that can guide nurses' moral judgments. These
include:
• The Golden Rule: treating others how you would like to be treated.
• The Two-fold Effect (not explained in the source).
• The Principle of Totality: sacrificing a part of the body for the good of the whole body is permissible.
• Epikeia: a law can be broken to achieve a greater good.
• One who acts through an agent is himself responsible: a person is responsible for the actions of
someone they instruct to act on their behalf.
• No one is obliged to betray himself/herself: a person cannot be forced to answer a question that would
incriminate them.
• The end does not justify the means: even if the outcome is good, a bad action is still wrong.
• Defects of nature may be corrected: it is morally acceptable to correct physical defects through medical
intervention.
• If one is willing to cooperate in an act, no injustice is done to him/her: a person who willingly consents to
an action, such as participating in a medical trial, is not being treated unjustly.
• A little more or less does not change the substance of the act: the severity of a wrong act is not
determined by the amount.
• The greatest good for the greatest number: it is acceptable to prioritise the well-being of the majority over
the needs of a few.
• No one is held to the impossible: a person cannot be held responsible for something that is impossible
to achieve.
• The morality of cooperation: it is never permissible to formally cooperate in an evil act.
• The principle of relating to the origin and destruction of life: taking a human life is morally wrong.
Patient's Rights
The presentation outlines several patient rights, including:
• Right to appropriate medical care and humane treatment.
• Right to information: including information about diagnosis, treatment, and prognosis.
• Right to informed consent: receiving information necessary to give informed consent before any
procedure or treatment.
• Right to self-determination: refusing treatment as permitted by law and being informed of the medical
consequences.
• Right to privacy and confidentiality.
• Right to choose health care provider and facility.
• Right to religious belief: refusing treatment that conflicts with religious beliefs.
• Right to medical records: including the right to examine bills and medical history.
• Right to be informed of rights and obligations as a patient: including hospital rules and regulations.
• Right to refuse participation in medical research.
 • Right to correspondence and to receive visitors.
• Right to express grievances: without fear of reprisal.
• Right to leave: regardless of physical condition.
Duties and Responsibilities of the Client
• Pay hospital charges/bills
• Follow hospital rules and regulations
• Show respect and consideration
The Human Person
• The presentation highlights the inherent dignity of every human person, which should be respected
regardless of their health, social status, competence, or past actions.
• Healthcare decisions should aim to meet a person's biological, psychological, social, and spiritual needs.
Human Acts and Acts of Man
The presentation differentiates between human acts and acts of man:
• Human acts are performed knowingly, freely, and voluntarily. They involve conscious knowledge and are
controlled by the will. For example, a nurse administering medication to a patient following instructions
is performing a human act.
• Acts of man are actions that are not dependent on intellect and free will. They are instinctive and not
within the control of a person's will. Examples include walking in one's sleep and actions performed by
infants.
• Acts of man can become human acts when a person employs their intellect and will.
Conscience
The presentation provides an in-depth discussion of conscience, which is defined as:
• A subjective norm of human acts.
• An inner sense that helps individuals make the right choice.
• An innate force that is the cornerstone of ethics.
It describes various types of conscience, including:
• Correct or true conscience: judges good as good and evil as evil.
• Erroneous or false conscience: judges something incorrectly. It has two kinds:
o Culpable conscience: an erroneous conscience due to neglect or malice.
o Inculpable conscience: an erroneous conscience that is not willfully intended.
• Certain conscience: a subjective assurance of the lawfulness or unlawfulness of an act.
• Doubtful conscience: a vacillating conscience unable to form a definite judgment.
• Scrupulous conscience: a rigorous conscience afraid of committing evil.
• Lax conscience: a conscience that refuses to be bothered about the distinction between good and evil.
• Strict conscience: judges moral obligations harshly, adhering to the letter rather than the spirit of the
law.
• Pharisaical conscience: self-righteous and judgmental towards others.
• Clear conscience: confidently and freely acts with regard for true values.
• Callous conscience: has low sensitivity to sin and God.
Finally, the presentation explains that conscience is formed through acculturation, instruction, and personal
reflection, and it requires lifelong formation guided by objective moral standards.
The presentation emphasises that, in the nursing profession, conscience is a key component of professional
competence, promoting responsibility and requiring nurses to use their knowledge and skills ethically in patient
care.

Marriage: A Sacred and Legal Union

The sources define marriage as a multifaceted institution with profound implications for individuals, families,
and society. It is described as:
• A lifetime contract between spouses: Emphasizing the permanence and commitment inherent in the
marital bond.
• A school & source of life: Highlighting its role in personal growth, development, and the creation of new
life.
• An institution of the natural law: Grounding marriage in a fundamental order understood as inherent to
human nature.
• A sacrament; a union of 3 partners: man, woman & God: For those who adhere to a religious
perspective, marriage is elevated to a sacred covenant, involving a spiritual dimension.
 • A moral and legal contract between a man and a woman: Recognising both the ethical commitment
and the legal framework within which marriage operates.
Requirements for Marriage
The sources outline specific conditions that must be met for a marriage to be considered valid:
1. Contracting Parties: The individuals entering into marriage must be a male and a female, both of legal
age (18 years old and above). This stipulation underscores the traditional understanding of marriage as a
union between a man and a woman.
2. Absence of Legal Impediments: Certain factors can prevent a valid marriage:
o Existing previous marriage: Polygamy is generally not legally recognised.
o Mental or psychological incapacity: A lack of understanding or ability to consent to the marriage.
o Blood or legal relationship: Incestuous relationships, such as between siblings or between an
adopter and adopted child, are prohibited.
o Treachery or deceit: Misrepresentation or fraud that undermines the free and voluntary consent of
one or both parties.
3. Free and voluntary consent: Both individuals must willingly and without coercion agree to enter into the
marriage. This consent must be expressed in the presence of a legally authorised solemnizing officer.
Purposes of Marriage
The sources articulate two fundamental purposes of marriage:
1. Establish a conjugal life (companionship): Highlighting the importance of mutual support, intimacy,
and shared experiences between spouses.
2. Establish a family (procreation & support of children): Emphasising the role of marriage in the
continuation of the human race and the nurturing of children.
Truths About the Marital Bond
The sources present three crucial truths about the bonding of man and woman in marriage:
1. That man and woman are equally persons: Affirming the equal dignity and worth of both spouses.
2. That GOD is the author of marriage and the one who gives its defining characteristics: This
perspective reflects a belief in a divine origin and purpose for marriage.
3. That men and women are persons with body and soul, not merely spirit persons: Acknowledging the
holistic nature of human beings, encompassing both physical and spiritual dimensions.
Conjugal Love
The sources describe conjugal love as a distinctive form of love that is central to marriage:
• Faithful and exclusive love: It is a commitment to one's spouse, excluding romantic or sexual
involvement with others.
• Unites the spouses according to their truth as images of GOD: Reflecting a belief that the marital
union mirrors a divine love.
• An act of the total person and not an instinctive impulse: Emphasising the deliberate and intentional
nature of conjugal love, transcending mere physical attraction.
Characteristics of Conjugal Love
The sources outline key features of conjugal love:
1. It is human love: Husband and wife become deeply connected, sharing their lives and striving for mutual
growth.
2. It is total: Spouses give themselves generously to each other, without reservation.
3. It is faithful and exclusive: It is centred on the well-being and happiness of the spouse, not driven by
selfishness.
4. It is fruitful: This characteristic encompasses both the desire for children and the overall growth and
flourishing of the marital relationship.
Causes of Marriage
The sources discuss the causes of marriage in philosophical terms:
1. Final cause: The ultimate purpose of marriage, which is the begetting and upbringing of children.
2. Efficient cause: The free decision of the spouses to love each other for life, leading to a public
declaration of their commitment.
3. Formal or constitutive cause: The mutual self-giving of the spouses, expressed in their vows and
ongoing actions.
4. Material cause: The physical bodies of the spouses, through which they experience intimacy and express
their love.
Essential Properties of Matrimony
The sources highlight two essential properties of marriage:
 1. Unity: Reflecting the biblical idea of "two becoming one flesh," this property emphasizes the profound
bond and interconnectedness of the spouses.
2. Indissolubility: Marriage is seen as an enduring bond that cannot be broken, except under specific
circumstances determined by law or religious doctrine.
Ends of Marriage
The sources distinguish between primary and secondary ends of marriage:
1. Primary: The procreation and education of children, raising them in a loving and supportive environment.
2. Secondary: Mutual assistance and support between spouses, encompassing emotional, practical, and
spiritual dimensions.
Rights and Duties of Husbands & Wives (Family Code)
The sources outline the legal framework governing the relationship between spouses, emphasizing their mutual
responsibilities:
1. Obligation to live together: Spouses are expected to share a residence and build a life together.
2. Mutual love, respect and fidelity: Maintaining a loving, respectful, and faithful relationship is essential
to a healthy marriage.
3. Mutual help and support: Spouses are expected to provide emotional, practical, and financial support to
each other.
4. Joint responsibility for the support of the family: Both spouses contribute to the financial well-being of
the family unit.
5. Joint responsibility for the management of the household: Decisions about household matters are
made collaboratively.
6. Right to legal relief: If one spouse neglects their duties or engages in harmful behaviour, the aggrieved
party can seek legal intervention.
7. Right to exercise a profession: Each spouse can pursue their chosen career or occupation without
requiring the consent of the other.
Grounds for Legal Separation (Family Code)
The sources acknowledge that while marriage is intended to be a lifelong commitment, certain circumstances
can justify legal separation:
1. Repeated physical violence or grossly abusive conduct: Protecting the safety and well-being of the
abused spouse or children.
2. Physical violence or moral pressure to compel a change in religious or political affiliation:
Respecting the individual's freedom of conscience and belief.
3. Attempt to corrupt or induce prostitution: Safeguarding the moral integrity of the spouse and children.
4. Final judgment sentencing the respondent to imprisonment of more than 6 years: Recognising the
significant disruption to the marital relationship.
5. Drug addiction or habitual alcoholism: Addressing the destructive impact of addiction on the marriage.
6. Lesbianism or homosexuality of the respondent: This ground reflects the traditional understanding of
marriage as a union between a man and a woman.
7. Subsequent bigamous marriage: Upholding the principle of monogamy.
8. Sexual infidelity or perversion: Addressing breaches of trust and the violation of marital vows.
9. Attempt against the life of the petitioner: Ensuring the safety and protection of the threatened spouse.
10. Abandonment without justifiable cause for more than a year: Recognising the importance of presence
and support within the marital relationship.
The Family: A Foundation of Society
The sources shift focus to the broader concept of family, describing it as:
• The basic unit of society: Emphasising its fundamental role in social structure and stability.
• Composed of one or more individuals closely related by blood, marriage or friendship: Expanding the
traditional definition of family to encompass diverse forms of kinship and connection.
Types of Families
The sources acknowledge the evolving nature of family structures, presenting various types:
1. Nuclear family: Consisting of parents and their offspring, this is often considered the traditional family
model.
2. Extended family: Includes grandparents, aunts, uncles, and other relatives living together or in close
proximity, providing a wider network of support.
3. Two-career family: Both husband and wife are employed, reflecting changes in societal norms and
economic realities.
 4. Single-parent family: Resulting from factors like death, separation, or birth outside of marriage, single-
parent families often face unique challenges, including childcare concerns, financial strain, role
overload, and social isolation.
5. Adolescent family: When infants are born to adolescent parents, both the parents and children may face
difficulties due to a lack of preparedness for the responsibilities of parenthood.
6. Blended family (stepfamilies): Formed when existing family units merge, blending families require time
and effort to integrate, respect differences, and establish new patterns of behaviour.
7. Cohabiting families: Unrelated individuals living together, often driven by needs for companionship, a
sense of family, relationship testing, or shared expenses.
8. Gay and Lesbian families: Based on the same goals of caring and commitment found in heterosexual
relationships, these families often challenge traditional definitions of family.
9. Single adults living alone: This category includes young adults establishing independence and older
adults who may be single due to divorce, separation, or death of a spouse. These individuals often
maintain connections with family members.
Major Roles of the Family
The sources highlight the essential functions of the family:
• To protect its members: Providing a safe and supportive environment.
• To socialize with its members: Teaching values, norms, and appropriate behaviours.
• To provide emotional support and security to its members through love, acceptance, concern and
nurturing: Fostering a sense of belonging and well-being.
Rights and Duties of Parents (Family Code)
The sources outline the legal and moral responsibilities of parents towards their children:
1. Keep children in their company, support, educate, and instruct them: Providing for their physical,
emotional, and intellectual development.
2. Give them love and affection, advice and counsel, companionship and understanding: Nurturing their
emotional and social growth.
3. Provide moral and spiritual guidance: Helping children develop a sense of ethics and values.
4. Enhance, protect, preserve and maintain their physical and mental health: Ensuring their well-being.
5. Furnish them with good and wholesome educational materials: Supporting their education and
development.
6. Supervise their activities, recreation, and association with others: Guiding their social interactions
and protecting them from harmful influences.
7. Represent them in all matters affecting their interests: Acting as advocates for their children's rights
and needs.
8. Demand from them respect and obedience: Setting appropriate boundaries and expectations.
9. Impose discipline as required under the circumstances: Guiding their behaviour and teaching
responsibility.
10. Perform other duties imposed by law upon parents and guardians: Fulfilling legal obligations related
to parenthood.
Duties of Children
The sources also address the responsibilities of children towards their parents:
1. Love, revere, and obey their parents: Showing respect and appreciation.
2. Obey all lawful commands of the parents: Adhering to parental authority.
3. Submit to the parents’ authority and decisions: Acknowledging the parents' role in guidance and
decision-making.
4. Honour their parents at all times: Treating them with respect and consideration.
5. Never harm their parents physically or morally: Protecting their parents from harm.
6. Consult and seek the advice of their parents in their activities: Seeking guidance and involving
parents in their lives.
7. Help and support their parents in times of need: Providing assistance and care when parents are in
need.
This comprehensive discussion aims to provide you with a deeper understanding of the key concepts presented
in "2024 SF Student Copy 2.pdf", connecting them to our earlier conversation about ethical principles and the
human person. By exploring these ideas, we gain insights into the complex and multifaceted nature of marriage
and family, their legal and moral dimensions, and their vital role in society.