Health Care Ethics Prelim
Health Care Ethics Prelim
Health Care Ethics Prelim
HEALTH CARE
Health Care Ethics ETHICS
Orientation By:
MARY ELEANOR N. USIS, MSN, RN
Introduction to Bioethics
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Significance in NURSING
Values, Morals and Ethics
profession
Ethics reflects the standards that govern a proper conduct in a Values Morals
particular profession. These are operational beliefs an are personal opinion or principle
For instance, the nurse on duty knows that she is obligated to act individual chooses as the basis for that a particular action or behavior
for the good of the client and to prevent any incident to harm the behavior which can change over is absolutely right or wrong in all
time. situations.
patient. Usually a person is reluctant or
This principle of doing no harm to the client is the intervention of These beliefs serve as the building
blocks of moral and ethical unwilling to change his personal
knowing the ethics in nursing. development. opinions on specific issues of a
To formulate an ethical decision, the nurse should gain knowledge Values influence not only the
moral nature.
on the situation taking a look at all angles to promote maximal behavior but also the decision
For instance, some people view
benefit to the client. abortion a totally wrong and there is
making of a person. It could be no justifiable excuse for it.
Aside from scrutinizing every possible aspect of the problem the based on the following: However, some hold the belief that
nurse should be able to understand the relationship between values, Experience, Religion, Education aborting a fetus is better rather than
morals and ethics. Culture, Professional peer group improperly rearing a child.
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Ethics
Ethics
Defined as the science of standards or principles of moral Ethics is about choices - presupposition of ethics (no
judgment or actions. choices, no ethics)
Or, A science of the morality of human conduct Ethics is about evaluation - evaluation is between good
A science - It provides a methodical system in and bad (choose the good and avoid the bad)
differentiating right from wrong basing on a certain belief. Ethics includes reasoning - faced with challenges of
Moral – because it is related to personal opinion or life, we have to figure out what is truly good for ourselves
principle that a particular action or behavior is absolutely and what is truly bad.
right or wrong in all Our traditions are not enough--they sometimes misguide us
Human conduct – deals with deliberate and free human (slavery), and they sometimes become obsolete (organ
transplants, sustaining life with machines) "All people seek the
activity and how one should act.
good, not the way of their ancestors.“
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Answer Key:
The Florence Nightingale Pledge A – Ethics D - Professional Ethics
I solemnly pledge myself before God and presence of this assembly; B – Bioethics E - Healthcare Ethics
To pass my life in purity and to practice my profession faithfully. C – Health Ethics
I will abstain from whatever is deleterious and mischievous and will not take or
knowingly administer any harmful drug.
1. Edna is failing in class. Greta is a high achiever.
I will do all in my power to maintain and elevate the standard of my profession Greta sits besides Edna during an examination and
and will hold in confidence all personal matters committed to my allows Edna to copy her answers in order for Edna to
keeping and family affairs coming to my knowledge in the practice of my pass.
calling.
2. Edmond freely choose to tell a lie to someone to
With loyalty will I endeavor to aid the physician in his work, and devote save himself from shame.
myself to the welfare of those committed to my care.
3. Ethics that relates to human life.
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4. Moral issues that relate to health care professionals 8. Philippe comes to work on time.
5.A student nurse participates in the conduction of
9. Anna was asked to administer blood transfusion to
research of a new medicine that proves to be fatal.
her client but, refuses to follow and told her supervisor
6.The nurse fails to discuss procedures before that it was against her religion.
administering treatments.
10. Nurse Amy failed to administer the 4PM medication
of her client
7. Nursing students become noisy during duty hours.
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Teleology Utilitarianism
• “Telos” = Greek for goal. • An ethical theory that holds that an action is right if
it tends to produce the greatest amount of good for
• Begins with intuitions about “the good life” and what
the greatest number of people affected by the action.
it means to be an ideal human being
Otherwise, the action is wrong.
• Emphasizes the virtues, the capacity for always
knowing how to act well in a given situation.
• Adopts a teleological approach to ethics and claims
that actions are to be judged by their consequences.
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Virtue Ethics
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Dignity of MAN
Nurses should recognize and respect the intrinsic worth of
each person. Common good
This is the basis for human rights
The source of human dignity is rooted in the concept of
Imago Dei, in Christ’s redemption and in our ultimate
destiny of union with God.
• Consists of all the conditions of society
One direct normative implication of human dignity is that and the goods secured by those
every human being should be acknowledged as an inherently conditions, which allow individuals to
valuable member of the human community and as a unique
expression of life, with an integrated bodily and spiritual achieve human and spiritual flourishing.
nature.
This principle is foundational for the understanding
of distributive justice, the common good, the right to
life and the right to health care
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• This he possesses not because of what he has or what he 2. Newborn, healthy adult, senile elderly
does but because of what he is: a human person 3. Comatose patient, crazy individual
• As a human person he must be respected regardless of the 4. Illiterate man, university president, uneducated
nature of his health problem, social status, competence, housemaid, convicted killer
past actions, etc. Guiding questions:
• To be a person is to have moral value and intrinsic worth. 1. Are they all persons?
• Being a person is to be a subject, and deserve to be treated 2. Do they have equal human dignity?
as a subject, and not merely as an object.
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• "That’s kind of an odd name for an older man. How • As she walked around the bed to the left side, Mr L
do we know that’s what he likes to be called?" Marta became calmer. Marta checked his pupils and noticed
said. that his right eye was completely clouded but that his
• "I’m not sure; that’s what I was told to call him," the left eye was not. When Marta moved into Mr L’s field
other nurse replied. of vision, he focused on her face, indicating that he
had partial vision in his left eye.
• As Marta walked into Mr L’s room, she noted a sign
over the bed that read "Legally Blind." Mr L was lying • Not feeling comfortable with calling an elderly man
on his left side with his back to the door, his wrists Jakey, Marta asked Mr L how he would like to be
restrained, eyes open. Marta walked up to the bed with addressed. Because he could not speak, Marta listed 3
Mr L’s back to her and said good morning. options: Mr L, Jakey, and Jacob. He indicated his
Immediately Mr L became agitated, pulling at his preference for Jacob by nodding.
restraints and motioning with his head for Marta to
move to the left side of the bed.
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True or False:
1. The source of Human Dignity is rooted in the
concept of Imago Dei, in union with God.
2. A man who is doing an act based on a situation
that he does not truly knows or is innocent about
it, is called a human act.
3. An act of man is an act that shows this: Shirley
Basic Ethical Principles
drinks water every time she gets thirsty.
4. A nurse is a moral agent if she follows the Code of
Ethics
5. Good habits of a person reflect the principle of
Stewardship.
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Principles of Totality
Principles of Totality This Suggests that:
• Refers to the duty to preserve intact the A part of the human body may be sacrificed if that
physical component of the integrated sacrifice means continued survival for the person.
bodily and spiritual nature of human life Sacrifices are normally justifiable under the principles of
integrity and totality, and may sometimes be forgone
• Whereby every part of the human body under the Principle of Disproportionate Means
"exists for the sake of the whole as the
imperfect for the sake of the perfect" (St.
Thomas Aquinas)
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Principles of Totality
Principle of Disproportionate Means Principles of Double EFFECT
• Any treatment that, in the given circumstances and in
the judgment of the patient or the caregiver,
either offers no reasonable hope of benefit (taking into • An action that is good in itself that has two
account the well-being of the whole person) or is too effects:
burdensome for the patient or others 1. An intended and not reasonably good
• i.e., the burdens or risks are disproportionate to or effect
outweigh the expected benefits of the treatment. Note: 2. Unintended and yet foreseeable evil effect
these determinations should be patient specific and take
into consideration the patient’s personal, financial, familial,
and social circumstances. Or….. An intended good : permitted evil
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CASE STUDY: Foregoing Ventilator Treatment • If the caregiver is correct, then the caregiver could use the
He must use the reasonable treatment standard for his decision-making. following argument.
The treatment (ventilation) is not going to cure Karen; it has • Option (a) does no good for Karen (she cannot
no medical (curative) advantage at all. experience good or bad), no good for the family (it makes
So, the reasonable treatment only is if you can justify its major purpose, no sense—he would know this best) no good for society
which is keeping Karen alive. or the common good—in other words, there is nothing
So, the "burden of proof" lies on those who say continue treatment, not on gained by the treatment—it is unreasonable treatment. In
those who say it should be discontinued—default is no medical treatment fact, it undermines the common good by its unreasonable
unless we have reason to use it. use of financial resources contributed by others. Option
• He cannot justify his belief by (a) therefore causes harm.
• trying to re-describe his action as good. • Option (b) would also cause harm, i.e., it would kill
• trying to camouflage his action as an omission (I am not doing Karen. However, what is the magnitude of the harm? Do
something that will lead to Karen’s death, but only "omitting the all deaths cause equal harm?
technology necessary to support her life.")
• appealing to his feelings
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Beneficence
Implies that all individuals have some moral obligation to
Specific Ethical benefit others
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Baby Fae
Baby Fae
• Among the ethical issues raised by the Baby Fae case are:
• The case of Baby Fae raises important issues in the area
of human experimentation. • The risk/benefits ratios for the human subject
• On October 26, 1984, Dr. Leonard Baily and the transplant • Experimentation
team of Loma Linda University Medical Center in California • Quality of informed consent
removed the defective heart (hypoplastic left heart syndrome, • Surrogate decision-making
in which the left side is much smaller than the right) of a five
pound baby girl (known as Baby Fae).
• Exploration of other options
• Introduction of expensive and untested technology
• It was replaced with the heart of a baboon, a procedure
known as xenotransplantation (cross-species transplantation).
• Twenty days later, on November 15th, the baby died of Regarding other options, the doctors at Loma Linda never
complications caused when her body began to reject the sought a human heart and the chances for a successful
xenograft were very slim.
transplanted heart.
• Principles & Concepts: beneficence, benefit and
burdens, disproportionate means, best interests.
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Nonmaleficence
Implies that we have a moral obligation not to harm others
Autonomy
• Primum non nocere, commonly translated as "first, do no • The right to participate in and decide on a
harm” course of action without undue influence
• In this respect, it shares the same characteristics of beneficence (free from coercion in deciding to act)
• Self-Determination: which is the freedom to
and is considered as a middle principle.
• Is sometimes interpreted to imply that if one cannot do good
without also causing harm, then one should not act at all (in
act independently. Individual actions are
that particular circumstance). directed toward goals that are exclusively
• The difficulty with this rigorist interpretation, however, is that
one’s own.
it makes action almost impossible in a world where even the
best actions may have some harmful results
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Autonomy
•This also implies that one should is Autonomy
obligated to protect confidentiality, respect
privacy, and tell the truth. Three Basic Elements in Autonomy:
•In the practice of health care, a person’s 1. The ability to decide
autonomy is exercised through the process 2. The power to act upon your decision
of obtaining informed consent. 3. Respect for the individual autonomy of
others
•The principle of respect for autonomy,
however, does not imply that one must
cooperate with another’s actions in order to
respect that individual’s autonomy.
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Autonomy Justice
encompasses fairness and equality
Respect for autonomy involves not only refraining
others from interfering with other person’s choices,
but sometimes it entails providing them with
necessary conditions:
Protect confidentiality (protection of information Fairness Equality
revealed by the patient)
Obtain Informed Consent- the right and
responsibility of every competent individual to
advance his own welfare.
Prerequisite: 1) adequate disclosure of information;
2) patient freedom of choice; 3)
patient comprehension of information; and 4)
patient capacity for decision making
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Justice
Justice • This relates to the provisions of equal access to health care
The principle that deals with fairness, to all and equitable allocation or in equal proportion to:
equity and equality and provides for an
individual to claim that to which they
are entitled.
2 Types: 1. The individual’s needs, contribution and
• Comparative Justice - Making a responsibility
decision based on criteria and outcomes. 2. The resources available to the society or
ie: How to determine who qualifies for one organization (market considerations would be
available kidney. 55 year old male with included under this, as well as other financial
three children versus a 13 old girl. considerations)
• Noncomparative Justice: ie: a method 3. The society’s or organization’s responsibility to the
of distributing needed kidneys using a common good.
lottery system.
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inviolability of Life
In general, justice refers to what is owed • Therefore, not to be violated, opposed or destroyed, but to
affirm, cherished, respected, defended and preserved.
or due to the individual members of • A commitment to choosing life and fighting to protect it.
society. • Being against to violence, pollution of environment, drug
addiction and treachery
• Measures for survival of human and freedom to have children.
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Questions?
Thank You!!!!
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