Health Care

Ethics-Basic
Concepts
LEC 1
NCM 108
SHEILA MARIE P. OCONER, RN MAN
Nurses are exposed to daily work and
experience exposed them to events of
birth, death and sufferings

Nurses must decide on the morality of

their own actions in ethical issues
Nurse Client Relationship
✔Support and advocate clients

✔Assist families when facing

difficulty choices

✔Nurses need to develop

sensitivity to the ethical
dimensions of the nursing
practice
VALUES
• enduring beliefs or
attitude about the worth of a
person, object, idea or action
• influence decisions and
actions including nurses
ethical decision making

Values are derived from (6)

• Work
• Family
• Religion
• Politics
• Money
• relationships
Value System
• Are basic to the ways
of life, give direction to life
and form the basis of
behavior based on decisions
and choices
• Beliefs and attitudes
are related but not identical
to values
• People have many
belief and attitudes, but
have. a smaller number of
values
Beliefs/Opinions

⮚Are interpretations or conclusions that people

accept as true. They are based on faith rather
than fact and not necessarily involve values
⮚A belief is an internal feeling that something is
true, even though that belief may be unproven
or irrational
Attitudes

• Mental positions or feelings towards, person, object, or

ideas (like acceptance, compassion, openness)
• Lasts overtime while belief last only briefly
• Often judged as good or bad, positive or negative while
beliefs correct or incorrect
• The way a person expresses or applies their beliefs
and values, and is expressed through words and
behavior
Values Transmission

Values are learned through observation and experience,

they are influenced by a person’s socio cultural environment -
that is by social traditions, culture, ethnics and religious
groups and by family and peer groups

Personal Values
Derived values from society and their individual
subgroups which were internalized

Professional Values
Nurses professional values are acquired during
socialization into nursing from codes of ethics, nursing
experience, teachers and peers.
VALUES CLARIFFICATION

⮚Is a process by which people

identify, examine and
develop their own individual
values

⮚A principle of values
clarification is that no one
set of values is right for
everyone

⮚Promotes personal growth

by fostering awareness,
empathy and insight and a
important step for nurses to
take in dealing with ethical
problems
CLARRIFYING NURSES VALUES
⮚ Nurses and nursing students need to reflect on the values
they hold about life, death, health and illness. Nurse holds
both personal and professional values

CLARRIFYING CLIENT VALUES

⮚ Plan effective client-centered care, nurses need to identify
client’s values as they influence and relate to a particular
health problems.

The following process may help clients clarify their values:

1. Lists all alternatives
2. Examine possible consequences of choices
3. Choose freely
4. Feeling about the choice
5. Affirm the choice
6, Act with a pattern
ETHICS
Refers to a method of inquiry that helps people to
understand the morality of human behavior
Study of morality
The practice of beliefs of a certain groups like
medical ethics, nursing ethics
The expected standard of moral behavior of a
particular group to describe in the groups formal
professional code of ethics

BIOETHICS
Ethics applied to human life or health decisions

NURSING ETHICS
Refers to ethical issues that occur in the nursing
practice
Health ethics Health care ethics
(a.k.a “medical ethics”) is
is the branch of ethics that deals the application of the
with ethical issues in health, core principles of
health care, medicine and science.
bioethics (autonomy,
It involves discussions about beneficence,
treatment choices and care options nonmaleficence, justice)
that individuals, families, and to medical and health
health care providers must face. care decisions. It is a
It requires a critical reflection
multidisciplinary lens
upon the relationships between through which to view
health care professionals and complex issues and
those they serve, as well as the make recommendations
programs, systems, and structures regarding a course of
developed to improve the health of
a population.
action.
MORALITY OR MORALS

Similar to ethics and many people use the

terms interchangeably

Refers to private, personal standards of what

is right or wrong in conduct, character and attitude

Its difference to Laws, Laws reflect the moral

values of the society and offer guidance in
determining what is moral
Moral Development
Process of learning to tell the difference
between right or wrong and of learning what ought
and ought not to be done

Moral Frameworks
Nurses use moral theories in developing
explanation for their ethical decisions and actions
and in discussing problem situations with others.
 THEORIES

CONSEQUENCE-BASED (TELEOLOGICAL )
THEORIES

It looks to the outcomes (consequences) of an action

in judging whether that action is right or wrong
Teleological theories focus on issues of fairness

- Utilitarianism
- One form of consequentialist theory, views
a good act as one that is the most useful -that is one
brings the most good and the least harm to the greatest
number of people. This is the principle of utility
This approach is often used in making decisions
about the funding and delivery of health care
 u·til·i·ty
Utilitarianism
- normative ethical theory that
places the locus of right and wrong the state of
solely on the outcomes (consequences) being useful,
of choosing one action/policy over other profitable, or
actions/policies. beneficial.
As such, it moves beyond the scope of
one's own interests and takes into
Worth or value
account the interests of others.

Ex
Rather spend time with friends
Better spend quality time with family
PRINCIPLE-BASED
(DEONTOLOGICAL) THEORIES

• Involve logical and formal

processes and emphasize individual
rights, duties, and obligations.

• The morality of an action is

determined not by its consequences but
by whether it is done according to an
important objective principle

The theory of deontology states we are morally

obligated to act in accordance with a certain set of
principles and rules regardless of outcome.

In religious deontology, the principles derive from

divine commandment so that under religious laws, we
are morally obligated not to steal, lie, or cheat.
RELATIONSHIP-BASED (CARING) THEORIES

• Stress courage, generosity, commitment and the

need to nurture and maintain relationships.

• Caring theories judge actions according to

perspective of caring and responsibility

• Caring theories promote the common good or the

welfare of the group
MORALE PRINCIPLES are statements about broad, general,
philosophical concepts and provide the foundation for moral
rules which are specific prescription for actions

9 Ethical principles that nurses must adhere to

1. Justice is fairness. Must be fair when they
distribute care. Care must be fairly, justly, and
equitably distributed among a group of patients.

2. Beneficence is doing good and the right thing for

the patient.

3. Nonmaleficence is doing no harm, as stated in

the historical Hippocratic Oath. Harm can be
intentional or unintentional.
4. Accountability - accepting responsibility for one's own
actions. Nurses are accountable for their nursing care and
other actions. They must accept all of the professional and
personal consequences that can occur as the result of their
actions.

5. Fidelity - keeping one's promises. Nurse must be faithful

and true to their professional promises and responsibilities
by providing high quality, safe care in a competent manner.

6. Autonomy and patient self-determination - nurse accepts

the client as a unique person who has the innate right to
have their own opinions. Nurses encourage patients to
make their own decision without any judgments or coercion
from the nurse. The patient has the right to reject or accept
all treatments.
7. Veracity - being completely truthful with
patients; nurses must not withhold the whole
truth from clients even when it may lead to
patient distress

8. Confidentiality - prevents the unauthorized

use or disclosure of information, ensuring that
only those who are authorized to access
information can do so.

9. Privacy - closely related concept that's most

often associated with personal data. Objective
of privacy is the confidentiality of personal data
Patients' rights - vary in different countries and in different
jurisdictions, often depending upon prevailing cultural and social
norms.

Patient's bill of rights - list of guarantees for those receiving medical

care. May take the form of a law or a non-binding declaration.
Typically a patient's bill of rights guarantees patients information,
fair treatment, and autonomy over medical decisions, among other
rights

Informed consent - process of communication whereby a patient is

enabled to make an informed and voluntary decision about accepting
or declining medical care.

- most important goal of informed consent is that the patient has

an opportunity to be an informed participant in her health care decisions.
... The nature of the decision/procedure. Reasonable alternatives to the
proposed intervention. The relevant risks, benefits, and uncertainties
related to each alternative.
PROXY
A legally authorized representative as “any individual
person, judicial body or other body of individuals who
are legally authorized under state and federal law to
consent to research participation on behalf of a
designated person.”

A proxy is a person who is designated by another to

represent that individual at a meeting or before a
public body. It also refers to the written authorization
allowing one person to act on behalf of another.
Living wills - are written, legal instructions regarding
preferences for medical care if the person are unable to
make decisions for him/herself.

Advance directives
- guide choices for doctors and caregivers if the client
is terminally ill, seriously injured, in a coma, in the late
stages of dementia or near the end of life.
- aren't just for older adults. Unexpected end-of-life
situations can happen at any age at any time so it's
important for all adults that this document are prepared
ahead of time.
- client get the medical care they want and avoid
unnecessary suffering and relieve caregivers of decision-
making burdens during moments of crisis or grief. It also
help reduce confusion or disagreement about the choices
chosen behalf of the client
Power of attorney
- medical or health care power of attorney is a
type of advance directive in which designates a
person to make decisions in behalf of the person
and he/she can not do so. May also be called a
durable power of attorney for health care or a health
care proxy.
Person chosen may be one of the following:
• Health care agent
• Health care proxy
• Health care surrogate
• Health care representative
• Health care attorney-in-fact
• Patient advocate
The person to be designated may be a spouse,
other family member, friend or member of a faith
community or may also choose one or more
alternates in case the person you chose is unable to
fulfill the role.

Living will
A living will is a written, legal document that states
medical treatments that the patient would and
would not want to be used to keep him/her alive,
as well as preferences for other medical decisions,
such as pain management or organ donation.
Address a number of possible end-of-life care decisions in
the living will

• Cardiopulmonary resuscitation (CPR) restarts the heart when it has

stopped beating

• Mechanical ventilation takes over your breathing if unable to breathe

on your own..

• Tube feeding supplies the body with nutrients and fluids intravenously
or via a tube in the stomach..

• Dialysis removes waste from your blood and manages fluid levels if the
kidneys no longer function..

• Antibiotics or antiviral medications can be used to treat many

infections. If in near the end of life, how would infections be treated
aggressively or would rather let infections run their course?
• Comfort care (palliative care) includes any number of
interventions that may be used to keep patient
comfortable and manage pain while abiding by other
treatment wishes.

• Organ and tissue donations for transplantation can be

specified in the living will. If organs are removed for
donation, while patient u will be kept on life-sustaining
treatment temporarily until the procedure is complete..

• Donating your body for scientific study also can be

specified. Contact a local medical school, university or
donation program for information on how to register for a
planned donation for research.
Do not resuscitate and do not intubate orders
- This does not included or needed to be written in
an advance directive or living will to have do not resuscitate
(DNR) and do not intubate (DNI) orders. To establish DNR or
DNI orders, inform the doctor about this preferences. The
doctor will write the orders and include them in the
medical record.

- Even there is a establish living will that includes

the patient’s preferences regarding resuscitation and
intubation, it is still a good idea to establish DNR or DNI
orders each time the patient is admitted to a new hospital
or health care facility.