BioEthics (NGCM108)

Rolando De Guzman III

RN, RM, MAN, Dsped
Instructor
Nice to meet you
 Tell us your name

 What are your expectations in this Course?

 Introduce the next person to speak

Pre Test
Get ¼ sheet of paper and write your name and level

Answer the following questions in 5 minutes.

What is Ethics?

What is Biology?
Ethics
 A study of Morality’s effect on the conduct; the study of
moral standards and how they affect a conduct.

 It is also a branch of philosophy concerned with

judgements about right and wrong; goodness and
badness.

 It also covers related concepts such as virtue, vice, duty

and obligation.
Biology

It is the study of Life

First used by Jean-Baptiste Lamarck(French Naturalist)

It examines the Structure, Function, Growth, origin, Evolution,

and distribution of living things.

Bioethics;Dr.Jose Mary Estoesta & Dr.Romeo R. Javines First Ed.2009 P3

 Bioethics
 is "a discipline dealing with the ethical implications of biological research and applications
especially in medicine."

 It comprises the basic principles that govern nurses and is helpful in guiding how to approach
and engage patients, especially when difficult decisions about life.
 Bioethics
Bioethical questions often involve overlapping concerns from diverse fields of
study including life sciences

biotechnology,
public health,
medicine,
public policy,
law, philosophy and theology.

They arise in clinical, research, and political arenas, usually in response to

advances in biology, health care, and technology, particularly biotechnology.

https://bioethics.jhu.edu/about/what-is-bioethics/
Theories and Principles in Health Ethics
Ethical Principles / Theories
 Deontology

The term deontology is derived from the Greek deon, “duty,” and logos, “science.”

In deontological ethics an action is considered morally good because of some characteristic

of the action itself, not because the product of the action is good.

Deontological ethics holds that at least some acts are morally obligatory regardless of their
consequences for human welfare.
Deontology
 The first great philosopher to define deontological principles was Immanuel
Kant, the 18th-century German founder of critical philosophy (see
Kantianism).

 Kant held that nothing is good without qualification except a good will, and a
good will is one that wills to act in accord with the moral law and out of
respect for that law rather than out of natural inclinations.

 He saw the moral law as a categorical imperative—i.e., an unconditional

command—and believed that its content could be established by human
reason alone.

 https://www.britannica.com/topic/deontological-ethics
Teleology

 Teleological ethics, (teleological from Greek telos, “end”;

logos, “science”), theory of morality that derives duty or
moral obligation from what is good or desirable as an
end to be achieved.

 Also known as consequentialist ethics.

 "study of final causes," 1740, from Modern

Latin teleologia, coined 1728 by German philosopher
Baron Christian von Wolff (1679-1754)
Consequentialism
 Ethical egoism is the moral doctrine that everyone ought to act to promote his or her own
interests exclusively.

 Ethical Altruism 
(also called the ethic of altruism, moralistic altruism, and ethical altruism is an ethical doctrine that
holds that the moral value of an individual's actions depend solely on the impact on other individuals,
regardless of the consequences on the individual itself.
 Utilitarianism

 The doctrine that the end of all action should be the

greatest happiness of the greatest number.

 Utilitarianism in normative ethics, a tradition stemming from

the late 18th- and 19th-century English philosophers and
economists Jeremy Bentham and John Stuart Mill
Lets apply our learnings

Situation 1: If a nurse immediately and directly tells a (CHD) patient that

he have a cancer and prognosis is not good.

Using the Ethical Theory of Deontology, what could be the possible

outcome of the action?
 Situation 2: Role-Play with a partner (5 minute skit)
 As a Gynecology Nurse on how to tell a Mother of a underage girl about
her daughter’s unwanted pregnancy. (Explain the Ethical Theory you
apply in the situation).
Virtue Ethics
 Virtue Ethics

Another philosophical idea that has been central to medical ethics

which holds that those who are taught to be good will do what is
right.

Nurses should act, think and feel from the virtues including
honesty, kindness, trustworthiness, respectfulness and courage.
 Ethical Principle - Autonomy

 Respecting each persons rights, decision and beliefs

Is an ancient notion (the term is derived from the ancient

Greek words autos, meaning “self,” and nomos, meaning “rule”)
 Autonomy
(1) Right to Appropriate Medical Care and Humane Treatment.
Every person has a right to health and medical care corresponding to his state of health,
without any discrimination and within the limits of the resources, manpower and competence
available for health and medical care at the relevant time.

(2) Right to Informed Consent.

The patient has a right to a clear, truthful and substantial explanation, in a manner and
language understandable to the patient, of all proposed procedures, whether diagnostic,
preventive, curative, rehabilitative or therapeutic, wherein the person who will perform the
said procedure shall provide his name and credentials to the patient, possibilities of any risk
of mortality or serious side effects, problems related to recuperation, and
probability of success and reasonable risks involved.
The patient will not be subjected to any procedure without his written informed consent,
except in the following cases:

 In emergency cases, when the patient is at imminent risk of physical injury, decline or
death if treatment is withheld or postponed. In such cases, the physician can perform any
diagnostic or treatment procedure as good practice of medicine dictates without such
consent;

 When the health of the population is dependent on the adoption a mass health program to
control epidemic;

 When the law makes it compulsory for everyone to submit to a procedure;

 When the patient is either a minor, or legally incompetent, in which case,
a third party consent is required;

 When disclosure of material information to patient will jeopardize the

success of treatment, in which case, third party disclosure and consent
shall be in order;

 When the patient waives his right in writing.

Informed consent shall be obtained from a patient concerned if he is of legal age and of sound
mind. In case the patient is incapable of giving consent and a third party consent is required,
the following persons, in the order of priority stated hereunder, may give consent:

 Spouse;
 Son or daughter of legal age;
 Either parent;
 Brother or sister of legal age, or
 Guardian
 When his mental or physical condition is in controversy and the appropriate court, in its
discretion, orders him to submit to a physical or mental examination by a physician;

 When the public health and safety so demand; and c) when the patient waives this right.

 If a patient is a minor, consent shall be obtained from his parents or legal guardian.

 If next of kin, parents or legal guardians refuse to give consent to a medical or surgical

procedure necessary to save the life or limb of a minor or a patient incapable of giving
consent, courts, upon the petition of the physician or any person interested in the welfare
of the patient, in a summary proceeding, may issue an order giving consent.
 (3) Right to Privacy and Confidentiality.

 The privacy of the patients must be assured at all stages of his treatment. The patient has
the right to be free from unwarranted public exposure, except in the following cases:

 The patient has the right to demand that all information, communication and records
pertaining to his care be treated as confidential. Any health care provider or practitioner
involved in the treatment of a patient and all those who have legitimate access to the
patient's record is not authorized to divulge any information to a third party who has no
concern with the care and welfare of the patient without his consent, except:

 When such disclosure will benefit public health and safety;

 When it is in the interest of justice and upon the order of a competent court.
 When the patients waives in writing the confidential nature of such information;

 When it is needed for continued medical treatment or advancement medical science

subject to de-identification of patient and shared medical confidentiality for those who
have access to the information.

 Informing the spouse or the family to the first degree of the patient’s medical condition
may be allowed; provided, that the patient of legal age shall have the right to choose on
whom to inform. In case the patient is not of legal age or is mentally incapacitated, such
information shall be given to the parents, legal guardian or his next of kin.
(4) Right to Information.

 In the course of his/her treatment and hospital care, the patient or his/her legal guardian has a
right to be informed of the result of the evaluation of the nature and extent of his/her disease,
any other additional or further contemplated medical treatment on surgical procedure or
procedures, including any other additional medicines to be administered and their generic
counterpart including the possible complications and other pertinent facts, statistics or studies,
regarding his/her illness.
Any change in the plan of care before the change is made, the person’s participation in the
plan of care and necessary changes before its implementation, the extent to which payment
maybe expected from Philhealth or any payor and any charges for which the patient maybe
liable, the disciplines of health care practitioners who will furnish the care and the frequency
of services that are proposed to be furnished.

The patient or his legal guardian has the right to examine and be given an itemized bill of the
hospital and medical services rendered in the facility or by his/her physician and other health
care providers, regardless of the manner and source of payment. He is entitled to a
thorough explanation of such bill.
 The patient or his/her legal guardian has the right to be informed by the physician or his/her delegate of
his/her continuing health care requirements following discharge, including instructions about home
medications, diet, physical activity and all other pertinent information to promote health and well-being.

 At the end of his/her confinement, the patient is entitled to a brief, written summary of the course of
his/her illness which shall include at least the history, physical examination, diagnosis, medications,
surgical procedure, ancillary and laboratory procedures, and the plan of further treatment, and which
shall be provided by the attending physician.

 He/she is likewise entitled to the explanation of, and to view, the contents of the medical record of
his/her confinement but with the presence of his/her attending physician or in the absence of the
attending physician, the hospital’s representative.
 Notwithstanding that he/she may not be able to settle his accounts by reason of
financial incapacity, he/she is entitled to reproduction, at his/her expense, the pertinent
part or parts of the medical record the purpose or purposes of which he shall indicate in
his/her written request for reproduction. The patient shall likewise be entitled to medical
certificate, free of charge, with respect to his/her previous confinement.

 The patient has likewise the right not to be informed, at his/her explicit request.
(5) The Right to Choose Health Care Provider and Facility.

 The patient is free to choose the health care provider to serve him as well as the facility
except when he is under the care of a service facility or when public health and safety so
demands or when the patient expressly or impliedly waives this right.

 The patient has the right to discuss his condition with a consultant specialist, at the patient’s
request and expense. He also has the right to seek for a second opinion and subsequent
opinions, if appropriate, from another health care provider/practitioner.
(6) Right to Self-Determination.

 The patient has the right to avail himself/herself of any recommended diagnostic and
treatment procedures. Any person of legal age and of sound mind may make an advance
written directive for physicians to administer terminal care when he/she suffers from the
terminal phase of a terminal illness: Provided, That

 He is informed of the medical consequences of his choice;

 He releases those involved in his care from any obligation relative to the consequences of
his decision;
 His decision will not prejudice public health and safety.

 He/she is informed of the medical consequences of his/her decision;

 He/she releases those involved in his/her care from any obligation relative to the consequences
of his decision;

 His/her decision will not prejudice public health and safety.

(7) Right to Religious Belief.

 The patient has the right to refuse medical treatment or procedures which may be contrary
to his religious beliefs, subject to the limitations described in the preceding subsection: 

 Provided, That such a right shall not be imposed by parents upon their children who have
not reached the legal age in a life threatening situation as determined by the attending
physician or the medical director of the facility.
(8) Right to Medical Records.

 The patient is entitled to a summary of his medical history and condition, He has the right to
view the contents of his medical records, except psychiatric notes and other incriminatory
information obtained about third parties, with the attending physician explaining contents
thereof.

 At his expense and upon discharge of the patient, he may obtain from the health care
institution a reproduction of the same record whether or not he has fully settled his financial
obligation with the physician or institution concerned.
 The health care institution shall safeguard the confidentiality of the medical records and
to likewise ensure the integrity and authenticity of the medical records and shall keep the
same within a reasonable time as may be determined by the Department of Health.

 The health care institution shall issue a medical certificate to the patient upon request.
Any other document that the patient may require for insurance claims shall also be made
available to him within a reasonable period of time.
(9) Right to Leave.

 The patient has the right to leave a hospital or any other health care institution
regardless of his physical condition: Provided, That

 No patient shall be detained against his/her will in any health care institution on the
sole basis of his failure to fully settle is financial obligations. However, he/she shall only
be allowed to leave the hospital provided appropriate arrangements have been made
to settle the unpaid bills: Provided, farther, that unpaid bills of patients shall be
considered as lost income by the hospital and health care provider/practitioner and
shall be deducted from gross income as income loss for that particular year.
(10) Right to Refuse Participation in Medical Research.

 The patient has the right to be advised if the health care provider plans to involve him in medical
research, including but not limited to human experimentation which may be performed only with
the written informed consent of the patient. 

 Provided, further, That, an institutional review board or ethical review board in accordance with

the guidelines set in the Declaration of Helsinki be established for research involving human
experimentation:

 Provided, finally, That the Department of Health shall safeguard the continuing training and
education of future health care provider/practitioner to ensure the development of the health care
delivery in the country.
Right to Refuse Participation in Medical
Research
Right to Refuse Participation in Medical
Research
(11) Right to Correspondence and to Receive Visitors.

 The patient has the right to communicate with relatives and other persons and to receive
visitors subject to reasonable limits prescribed by the rules and regulations of the health
care institution.
Right to Correspondence and to Receive Visitors.
(12) Right to Express Grievances.

 The patient has the right to express complaints and grievances about the care and services
received without fear of discrimination or reprisal and to know about the disposition of such
complaints.

 The Secretary of Health, in consultation with health care providers, consumer groups and

other concerned agencies shall establish a grievance system wherein patients may seek
redress of their grievances.

 Such a system shall afford all parties concerned with the opportunity to settle amicably all
grievances.
(13) Right to be informed of His Rights and Obligations as a Patient. 

 Every person has the right to be informed of his rights and obligations as a patient. The
Department of Health, in coordination with health care providers, professional and civic groups,
the media, health insurance corporations, people’s organizations, local government
organizations, shall launch and sustain a nationwide information and education campaign to
make known to people their rights as patients, as declared in this Act. (Senate no.812)

 Such rights &d obligations of patients shall be posted in a bulletin board conspicuously placed
in a health care institution.

 It shall be the duty of health care institutions to inform patients of their rights as well as the
institution's rules and regulations that apply to the conduct of the patient while in the care of
such institution.
Core Values of a Professional Nurse
Principle of Beneficence

Helping others as the primary goal.

Beneficence holds that they should aim to do good—i.e., to promote the interests of their
patients.
Principle of Non-Malificence

 Non-maleficence states that a medical practitioner has a duty to do no harm or allow

harm to be caused to a patient through neglect.
Principle of Justice
 Distributing burdens and benefits fairly.
offering the same treatment options to two patients.
Principle of Veracity

 Veracity is defined as being honest and telling the truth and is related to the principle
of autonomy.

 It is the basis of the trust relationship established between a patient and a health
care provider. This allows patients to use their autonomy to make decisions in their
own best interest.
Principle of Fidelity

 Fidelity basically means trust and faithfulness implies a trust. It is important for a nurse to
gain the loyalty of the patients, co-workers and hospital administration.

Fidelity or loyalty is an important ethical principle and is a vital component of the nursing
profession.

Fidelity is considered by many nurses to be the most common source of ethical conflict. Health
care professionals may find themselves caught between what they believe is right, what the
patient wants, what other members of the health care team expect, and what is required by
organizational policy and the law.
Other relevant Ethical Principles

Principle of Double-Effect

The principle allows the action as morally permissible in those circumstances in which the
harmful effect is not intended, but is a side-effect of the action.

Acts of self-defense, for example, are often justified using this principle. 
 The New Catholic Encyclopedia provides four conditions for the
application of the principle of double effect:

 The act itself must be morally good or at least indifferent. (NO other option)

 The agent may not positively will the bad effect but may permit it. If he could attain the
good effect without the bad effect he should do so. The bad effect is sometimes said to be
indirectly voluntary.

 The good effect must flow from the action at least as immediately (in the order of causality,
though not necessarily in the order of time) as the bad effect.
The Principle of Legitimate Cooperation

It portrays the Principle of the Double Effect in a scenario in which more than one person
participates in the actions being evaluated.

 In order to attain a well-formed conscience, a nurse should always judge it unethical to

formally involve or participate in an immoral act.

 A nurse may decide to participate in an immoral act, when only it is to prevent a more
greater evil.
 The Principle of Common Good and Subsidiarity
Subsidiarity to make common decisions at the lowest practical level-every person,
family and intermediate group has something original to offer to the community.
‘Every person’s contributions should count’.
Sources

Printed references:
Bioethics with contemporary readings and issues 1st Edition 2009 pp.17-39
Dr. Rose Mary D. Estoesta
Dr. Romeo R. Javines

Online referrences
 https://www.britannica.com/topic/deontological-ethics
 https://www.britannica.com/topic/teleological-ethics
 https://tdh.doh.gov.ph/index.php/patient-s-corner/patient-s-rights