Learning Outcomes

At the end of lesson, the students will be able to:

Identify the basic principles applied in nursing practice;
Explain how informed consent is derived from the
principle of autonomy; and
Evaluate patient’s right.

CONTENT:

1. Autonomy
❖ in Greek auto means
“one’s own,” and
nomos stands for “rule,
principle or law”. Thus,
autonomy would be
“living or acting
accordance to one’s
own rule, principle or
law.” Autonomy will be
taken here to refer to a
person’s choosing and
acting on the basis of
his/her [own values,
principles or ideals of
conduct, goals and
purposes.
❖ means that individuals
have a right to self-
determination, that is, to make decisions about their lives
without interference from others.
Each person is autonomous, in which case one should choose
what one wants to be and should take responsibility for that choice.
Anyone who directly carries the burden of his or her moral judgment,
such as the burden on women during pregnancy and childbirth, should
make that decision. Only the one who directly carries the burden of
responsibility should make a decision.

The concept of autonomy is an important factor in the relatively

recent focus on patients ' rights. It stresses the moral right of a person to
decide what is good for himself or herself and others.
This principle acknowledges the value of individual autonomy,
which provides a clear sense of personal responsibility. And inasmuch as
every person is self-sufficient, moral decisions should be made by and for
oneself.
Patient’s Right

Every individual must live in a group of persons in a relation such

as the family or any given place, right is necessary. As the saying goes,
'no man is an island.' Man is a being with others in the world. If only for
this reason human life is more important and worth living in the company
and support of others in fellowship with others and for the good of others.
The relationship between a doctor or nurse and a patient is a
value in itself. They enter into the human sphere of values through their
relationship. We not only need the service of others, but we need the
others itself. Much like a patient needs a doctor or nurse for his or her
own well-being, the doctor or nurse often needs a patient for self-
fulfillment of his or her own career.

The nurse-patient relationship entails such responsibilities and rights

known as the duty-right, correlates.
What is a patient's right?

A patient's right is the good and sacred force vested in him by an

individual to do hold or request something as his own. Commonly every
individual appreciates a good and sacred force (i.e., right) to do, hold,
appreciate and precise those things legitimate to one’s entire being.
Each directly in one individual includes a relating obligation in others to
regard this privilege and not to abuse it.
 In the event that a patient has the privilege to do request
something it is the obligation of the doctor or medical attendant not to
meddle with this right; rather commitment or obligation to perform or
discharge an activity relating to the patient's right.

The rights of a patient:

1. the patient has the right to a considerate and respectful care
2. the patient has the right to obtain from his physician complete
current information concerning his diagnosis treatment and
prognosis in terms the patient can reasonably be expected to
understand
3. the patient has the right to receive from his physician information
necessary to give informed consent prior to the start of any
procedure and or treatment.
4. the patient has the right to refuse treatment to the extent
permitted by law and to be inform of the medical consequences
of the action
5. the patient has the right to every consideration of his privacy
concerning his own medical care program
6. the patient has a right to expect that all circumstances and
records pertaining to his case should be treated as confidential
7. the patient has the right to expect that within its capacity the
hospital must provide a reasonable response to his or her request
for services
8. the patient has the right to obtain information regarding any
relationship of his hospital to other healthcare and educational
institutions insofar as his care is concerned
9. the patient has the right to be advice if the hospital proposes to
engage in or perform human experimentation affecting his or hair
care or treatment the patient has the right to refuse to participate
in such research projects
10. The patient has the right to expect reasonable continuity of care
the patient has the right to know in advance what appointment
schedules and physicians are available and where
11. the patient has the right to examine a receive an explanation of
the hospital bill regardless of the source of payment
12. the patient has the right to know what hospital rules and
regulations apply to his or her conduct as a patient
Limitations of a patient's right
1. Patients’ rights do does not encompass the right to be allowed to
die. Under the notion of individual paternalism, the physician can
also make the ethical choice for and in behalf of the affected
person who is no longer mentally able to make decisions, as in the
 case of a comatose patient. In light of the value of life principle of
health care ethics it is the sworn obligation of the attending doctor
to do something that is medically possible to store a patient's life.

2. A patient in a moribund prerequisite no longer possesses the

fundamental intellectual potential or emotional stability to make
a knowledgeable choice. Dying patient or one who lapses into
unconsciousness will become mentally incompetent to make
decisions. The attending medical doctor in such a situation may
additionally operate a paternalistic act for the well-being of the
patient.

3. Patients’ rights are now not absolute paternalistic issue limits the
competent or capable patients freedom of preference for his or
her personal good in order to forestall harm from befalling that
patient. Informed consent

The basis for the doctrine of informed consent has been derived from
the conflict between paternalism and autonomy. This moral and legal
doctrine is the product of the last half of the twentieth century, when
judges tried to protect the patient's right to greater freedom of choice.
Informed consent binds the practitioner to an appropriate declaration
and clarification of the procedure and of the different choices and
consequences. Simply specified informed consent ensures that, before
any dangerous or intrusive procedures can be carried out, the
healthcare provider must advise the patient of the necessary specifics
of the nature of the procedure, of its possible risk and of any appropriate
alternatives. The elements of informed consent:

✓ disclosure
✓ understanding
✓ voluntariness.
✓ competence
✓ consent

In the medical context

In authentic clinical practice in the Philippines there are two methods of
obtaining informed consent.
✓ First is a written consent the consent form to be filled up and signed
by way of a patient as she or he checks in for admission in a
hospital.
✓ Second is a verbal consent on every occasion the patient verbally
signifies his or her willingness to undergo clinical therapy informed
consent is met. Verbal consent is usually made after a physician,
 brief’s the patient the nearest kinfolk if any, about the clinical
concerns or scientific manner to be undertaken.

In emergency instances however the following sorts of patients needs

not require informed consent:

1. comatose or obtunded patients;

2. blind or illiterate patients;
3. underage patients or those unable to apprehend the situations;
and
4. language barrier patients.
In precept the dad and mom immediate family guardians or the
next-of-kin ought to be informed when the affected person is comatose
blind or illiterate underage or unable to understand the language of the
physician.
PROXY CONSENT
Proxy consent is the system by which human beings with the legal
right to consent to medical cure for themselves or for a minor or a ward
delegate that right to any other person. There are three fundamental
constraints on this delegation:
1. The person making the delegation should have the right to consent.
2. The individual must be legally and medically in a position to delegate
the right to consent.
3.The right to consent need to be delegated to a legally and medically
capable adult.
There are two sorts of proxy consent for adults.
✓ The first, the power of attorney to consent to medical care, is
commonly used with the aid of patients who choose medical care
however are worried about who will consent if they are rendered
temporarily incompetent by way of the medical care. A power of
lawyer to consent to medical care delegates the right to consent
to a particular person.
✓ The second kind is the living will.

2. Confidentiality

This ethical principle relates to privacy and confidentiality. Privacy

belongs to every individual and, as such, it can't be taken away from
that person unless he/she desires to share it. Confidentiality, on the other
hand, means that the data
shared with different humans
will not be unfold abroad and
will be used solely for the
purposes intended. A
patient's sharing of personal
facts imposes a duty of
confidentiality on health care
providers. That obligation
means providers will share
records solely on a need-to-know basis.

There already exists a hesitancy for patients to share information with

health care providers. Too many reported breaches of confidentiality
have appeared in the media. "High risk" patients with HIV or AIDS,
genetic diseases, or mental sickness might also feel particularly
vulnerable. As a result, patients are limiting facts shared with health care
providers, hence protecting privateness at the price of impairing their
health. We need to forestall any grass roots efforts, inside or among
states, in which patients embrace a "don't ask, do not tell" philosophy
about their health.

Confidentiality is such a major issue that these days two health care
oversight organizations — took a proactive stance in opposition to
practicable breaches in patient confidentiality. Their 1998 file "Protecting
Personal Health Information: A Framework of Meeting the Challenges in
a Managed Care Environment" focuses on such techniques as clear
policies and tactics for ensuring confidentiality and on periodic audits to
guarantee compliance with such policies and procedures. This
document is both vital and timely, specifically in light of the conceivable
for an increased breach of patient confidentiality with interstate nursing
practice.

The second challenge with privateness and confidentiality focuses on

nurses. The National Council for State Boards of Nursing has developed
a centralized data base (NURSYS) particularly designed for interstate
nursing practice. This records base, which consists of private and
sensitive statistics such as nurses' licensures and revocations can be used
to ensure best care or to harm nurses' reputations if it falls into the
incorrect hands.
 3. Veracity

The principle of veracity, a term

regularly used in the medical
profession, refers to the ethics of
telling the truth and is one guide of
the behavior of medical
practitioners. While this principle is
not a law, violation of ethical principles, along with veracity, will end
result in a loss of credibility and respect with different professionals and
patients alike. Because medical personnel keep a role of trust in the
community, they are held to high standards which promote
accountability and general professionalism.
❖ Ethical Principles - Because of the facts involved, and the personal
nature of the medical field, ethical concepts are an essential part
of the medical profession. Medical personnel are exposed to
patient vulnerability and existence and demise issues on an
everyday basis. In addition to veracity, these ethical concepts
include autonomy, beneficence, non-maleficence, justice and
fidelity. The delicate relationship between these principles means
that the needs of the patient need to be prioritized when
identifying which precept ought to be honored first.

❖ Considerations in Medicine - Medical personnel need to

communicate honestly to the best of their capabilities and
prevent misunderstandings whenever possible. The medical
expert should absolutely represent the client's point of view and
wishes. Extensive documentation enhances the credibility of
medical personnel as it relates to the concepts of veracity.

❖ Informed Consent - The first application of the principle of veracity

relates to informed consent and the autonomy of the patient to
make choices primarily based on all accessible information.
Patients need to be aware of the reality about their medical
scenario and their options. However, some patients or their
families may also not prefer the full fact disclosed to them. Family
dynamics are an extra consideration as well.

❖ Professional Ethics - Veracity in conjunction with professional ethics

relates to integrity in general standards such as billing,
documentation, certification, health standards, overall
compliance and peer relationships. These do not address the
medical professional's personal interaction with the patient
 however rather address general behavior in areas which have an
impact on the patient indirectly.

❖ Violations of Veracity - Veracity can be violated in quite a few

ways. Omission capacity that integral applicable information is
deliberately left out when disclosing the patient's scientific
information. Commission ability that scientific personnel
intentionally inform the patient, or her family, a lie. A third, extra
delicate way to violate the principle of veracity is to cloak the truth
in so much scientific jargon that the patient or her household will
be unable to understand it.

4. Fidelity

Fidelity in nursing means that nurses

must be devoted to the promises they
made as professionals to furnish
competent, quality care to their
patients.
The moral principle of fidelity directs
us to model care delivery with altruism,
loyalty, caring, and honesty. For example, when an older patient with
intact cognitive function is diagnosed with a terminal sickness and he or
she doesn't prefer to share that records with immediate family, it can
create a moral dilemma. To hold the trust set up in the nurse-patient
relationship, don't share any healthcare data without the patient's
consent. Consult with other interdisciplinary group members, such as
case managers, social workers, and clergy, to help perceive supportive
services that the patient may also need as his or her ailment progresses.

5. Justice

- Ability the rendering of what

is due or merited. For instance
one act justly whenever one
offers other their due
however one acts unjustly
every time one with holds
what others deserve in the
medical context a
healthcare professional be it a doctor or a nurse) act justly or
performs an act of justice if and when the rights of the patient are
respected on the other hand an act of injustice is carried out
 instance the healthcare specialists unjustly every time is one's
obligation to the patient is neglected.

- In the nurse-patient relationship, therefore, justice is done if when

the nurse performs his/her duty as such to the patient otherwise
injustice is committed in ways as the patient's right to be attended
to is no longer respected or recognized. The patient is no longer
given what one deserves as a patient because the nurse fails to
operate her obligation as such in this sense. The nurses’
negligence or tacit non-performance of her obligation is not only
unjust but wrong as well inasmuch as she feels to do what she has
to achieved in relation to the patient

Healthcare professional speaks of the two kinds of justice in this regard

specifically comparative and non-comparative justice.

- Comparative justice is one in which what an individual patient or

group receives is decided by means of balancing the competing
claims of other individuals or groups. That is to say what a specific
patient receives is decided by means of the gravity of the
condition or need.

- Non comparative justice on the other hand is one in which a

distribution of medical items or sources is decided by a certain
standard rather than through the needs or claims of individuals. In
other phrases the medical treatment is it a meant by using
principal rule or policy not via need a principal of treatment or
policy of distribution is formulated which prescribes as a strict
numerical equality of treatment irrespective of the need of an
individual.

Procedure or system to be observed in distributing remedy is that

made specifically if medical sources are scarce or confine. To cope with
the problem as certain policy maybe device such as first come first
serve, senior citizen first, pregnant women first and the like.

6. Beneficence

The principle of beneficence is

at the heart of daily nursing
practice. The following three
forms of beneficence require
action by helping — preventing
harm, eliminating harm, and
promoting good. The principle of
beneficence may give rise to
ethical issues when there is a clash between what is good between the
nurse and the patient, between the patient and the organization,
between the patients themselves or between States engaged in
interstate practice. Differences that may have ethical implications
include: financial reimbursement, approved services, different laws on
reporting or abuse of sexually transmitted diseases, and protocols by
which nurses may accept orders.

While most agree in principle that a patient's good comes earlier than
the organization's or nurse's good, nurses regularly confuse what is good
for the patient with what the nurse believes is good for the patient. At
debate is what constitutes good for
a patient without infringing on the
patient's autonomy or letting the
affected person come to serious
harm. Weak paternalism infers that
the health care issuer is protecting
the patient when the affected
person is unable to make choices
due to issues such as depression or
the influence of medications. On
the different hand, strong paternalism involves interactions supposed to
benefit an individual regardless of the truth that the person's risky
selections and moves are informed, voluntary, and autonomous, that
the person's risky choices and actions are informed, voluntary, and
autonomous".

7. Nonmaleficence

The principle, nonmaleficence, or do no harm, is directly tied to the

nurse's responsibility to guard the patient's safety. Born out of the
Hippocratic Oath, this principle dictates that we do not cause harm to
our patients.

How do interstate exercise and nonmaleficence interrelate? With

interstate practice, it may now not seem self-evident how nurses can
injure patients with whom they have no bodily contact. Consider the
interstate nurse, however, who does not return a phone call to a patient
who is viewed a malingerer. In refusing to return the call, perhaps the
patient suffers needless bodily or emotional trauma. Therefore, a way
that harm can occur to patients is via communication failures. These
failures can be intentional as simply described or as a end result of
electronic or human error. Failing to bring correct information, giving
wrong messages, and breaking down of equipment, can cause
damage to patients. This damage could be life-threatening such as in
instances of strokes and coronary heart attacks.
 Some of these conversation issues may virtually happen whether a
patient is at a neighborhood health facility or five hundred miles away,
but distance and excessive reliance on electronic medium make close
examination of communication and ethical issues vital.

The precept of nonmaleficence is regarded before new treatment

tactics are tried on patients.