This presentation provides basic knowledge on nursing ethics intended for nursing students.

1. NURSING ETHICS
RYAN MICHAEL F. ODUCADO

2. Why do we study ethics?
 Providing guidelines in knowing
What is GOOD or
what is BAD?
What is RIGHT and
what is WRONG?

3. Why do we study ethics?
Ethics enables us to make correct
judgement of different types of
situations.
In order to choose the right course
of action that will help us towards
the attainment of our goals which
is to attain a happy and fruitful
life.

4. Ethics
 Refers to well based standards of right or wrong
that prescribes what human ought to do, usually
in terms of rights, obligations, benefits to society,
fairness, or specific virtues.
– Example, ethics refers to those standards that impose
the reasonable obligations to refrain from rape,
stealing, murder, assault, slander, and fraud.
– Ethical standards also include those that enjoin virtues
of honesty, compassion and loyalty.
– And, ethical standards include standards relating to
rights, such as the right to life, the right to freedom
from injury, and the right to privacy.

5.  Refers to the study and development of
one’s ethical standards.
 Came from the Greek word “ethos” which
means “moral duty”
 Provide the standards that govern human
conduct
 Study of “good life”
 Studies how people make judgement in
right to right or wrong
 Is about making choices that are best for
the individual or society at certain times
and in particular situations and then
evaluating such choices and outcomes

6.  Refers to the study and development of
one’s ethical standards.
 Came from the Greek word “ethos” which
means “moral duty”
 Provide the standards that govern human
conduct
 Study of “good life”
 Studies how people make judgement in
right to right or wrong
 Is about making choices that are best for
the individual or society at certain times
and in particular situations and then
evaluating such choices and outcomes

7.  When singular:
– is also known as “moral
philosophy”
– a field of philosophy that deals with
the study of the moral value of
human conduct and the rules and
principles that ought to govern it.

8. Ethical Theory and Moral
Philosophy
 Refer to philosophical reflection or when
we speak of morality’s nature and function.
 Purpose of theory:
– To enhance clarity, systematic order and
precision of argument in our thinking about
morality.

9.  When plural:
– pertain to social, religious or civil
code of behavior that is considered
correct, for that of a particular
group, profession, or individual.
– It also refers to the moral fitness of
a decision or course of action.

10.  Foundation of a caring, ethical person:
– The experience of a solid bonding between
child and parents.
 Foundation of bioethics is the very nature
of our human being.
 Each individual is born in love, with love
and by love.

11.  Basically, we tend to do good and right
things from birth until such time that other
influences drive us to do evil and wrong
acts.
 The experience of the pasts predicts the
events of the future
– As human beings, we are molded by
everything we have experienced in our life.

12. Morals
 Are specific ways of behavior or
accomplishing ethical practices
 Fundamental standards of right and wrong,
learned and internalized in early childhood,
often based on religious beliefs
 Moral Virtues:
– Justice
– Temperance
– Fortitude
– Prudence

13. Morality
 Derived from the Greek word “moralis”
which refers to social consensus about
moral conduct for human beings and
society.
 Refers to social conventions about right
and wrong human conduct that are so
widely shared that they form a stable,
communal consensus, in a certain
population or in a certain specific society.

14.  Refers to behavior in accordance with
custom and tradition and usually reflects
personal and religious beliefs.
 Addresses the questions of what is RIGHT
and WHAT is WRONG.
 Human tendency, right or wrong, good or
evil, proper or improper, cruel or
benevolent acts are explained in terms of
morality.

15. Elements determining Morality
1. Object: the act itself
– Example:
• To end the life of the fetus is object of abortion,
• To end the life of a terminally ill patient is the
object of euthanasia
2. End: Purpose, intension, motive, or
reason
– With out end, the act will not be carried out
at all
3. Circumstances
– Accidental aspects surrounding the act
– Include time, place, means to the act

16.  HUMAN ACT
– Actions that are deliberate and involve the use
of human intellect and reason.
 ACTS OF MAN
– Actions that does not involve the use of
intellect and freewill, these actions are done
unconsciously and without reason
– Example: An insane person who attacks a
nurse cannot be held liable for his actions

17. Morals Ethics
Principles and rules
of right conduct
Formal reasoning
process used to
determine right
conduct
Private and personal Professionally and
publicly stated
Commitment to
principles and values
are usually defended
in daily life
Inquiry or study of
principles; Process of
questioning and
perhaps changing
one’s morals

18. CONSCIENCE
 “Consciousness of an interior court of
justice of man.”
 :Inner voice
 An innate faculty that tends to acts towards
something that is good, proper and useful
to self and others.
 Suppression of libido – Freud

19.  Conscience formation
starts from the moment the child is conceived
in the womb of the mother.
PRE-FORMA FACTOR

20. What constitutes the pre-forma
factor?
1. The parent’s relationship with each
other.
– The quality of the conjugal relationship is
very important in the shaping of the child’s
innate positive traits.
2. The quality of sensory stimulation
received in infancy and childhood.
– The process of conscience formation is
shaped by events and people, and by an
individual’s response to them.

21.  Birth to 6 years of age
– Time of remote preparation for moral action,
during which the child consciously develops
an attitude toward authority, law and life.
 The reaction of the parent to a child’s
behavior serves as a conscience for the
child revealing, the acceptability of
“naughtiness” of certain acts.

22.  6-7 years old
– Age of reason
– Child exhibits concern for knowing the
rightness or wrongness of things.
– Generally given programmed instruction in a
particular system of values in daily life.

23.  9-10 years
– Child’s unconscious and instinctive behavior
patterns among his playmates and peer group
contradict those learned at home, forcing the
child to think, and raising conformity to values
from automatic reflex to conscious obedience.

24.  12 years old
– Capable of some discrimination between right
or wrong.
– Capable of making some autonomous decision
– Child-morality is only partially conscious and
is a participation in the morality of others

25.  Adolescent
– Chiefly preoccupied with personal and
subjective moral values.
– Greatly concerned about social justice and
rights of the individual, and will devote great
energy to a cause that captures his idealism
and imagination.
– Need to grow toward autonomy in order to
establish a unique and independent person
before parents and peers.  rebellion

26.  Adulthood
– Has assume responsibility not only for actions
but for the self.
– Has understanding of morality
– Has subjective norm of his actions
– Can read the exigencies of a situation
accurately
– Responds consistently with love and
generosity.

27.  The speed with which the development
of conscience is accomplished depends
upon the child’s:
1. Autonomy
2. Native intelligence
3. Emotional control
4. Self-image and moral instruction
5. Quality and variety of experiences

28.  Some specific experiences that can aid in
the gradual rationalization of behavior
are:
1. The opportunities for choice
2. The experience of different levels of law
3. The experience of deception
4. The discovery of failure and weakness in
this whom one depends

29. Conscience Situations
 Children are very observant and imitative.
 They build their own character, language,
and reactions to situations depending on
what they see, feel and experience with
adults close to them.
 HOME has a big role to play in the
formation and education of the child’s
conscience and values.

30. Theories
 Jean Piaget
– 2-stage process
– Cognitive development
 Lawrence Kohlberg
– 6 stages with 3 levels
– moral development is a continual process that
occurs throughout the lifespan.
 Carol Gilligan
– Stages of the Ethic of Care

31. Piaget’s Two-Stage Theory of
Moral Judgment
Younger than 10 or 11 Older children
Rules as fixed and
absolute
Relativistic view of
rules: He or she
understands that it is
permissible to change
rules if everyone agrees
Base moral judgments
more on consequence
Base judgments on
intentions

32. Heinz Steals the Drug
"In Europe, a woman was near death from a special kind of
cancer. There was one drug that the doctors thought might
save her. It was a form of radium that a druggist in the
same town had recently discovered. The drug was
expensive to make, but the druggist was charging ten times
what the drug cost him to make. He paid $200 for the
radium and charged $2,000 for a small dose of the drug.
The sick woman's husband, Heinz, went to everyone he
knew to borrow the money, but he could only get together
about $ 1,000 which is half of what it cost. He told the
druggist that his wife was dying and asked him to sell it
cheaper or let him pay later. But the druggist said: "No, I
discovered the drug and I'm going to make money from it."
So Heinz got desperate and broke into the man's store to
steal the drug-for his wife. Should the husband have done
that?" (Kohlberg, 1963).

33. Levels Stages
Level 1.
Preconventional
Morality
Stage 1 - Obedience and
Punishment
Stage 2 - Individualism
and Exchange
Level 2.
Conventional
Morality
Stage 3 - Interpersonal
Relationships
Stage 4 - Maintaining
Social Order
Level 3.
Postconventional
Morality
Stage 5 - Social Contract
and Individual Rights
Stage 6 - Universal
Principles

34. Stage 1 - Obedience and
Punishment
 Earliest stage of moral development
 Children see rules as fixed and absolute.
 Obeying the rules is important because
it is a means to avoid punishment

35. Stage 2 - Individualism and
Exchange
 Children recognize that there is not just
one right view that is handed down by
the authorities.
 Children account for individual points
of view and judge actions based on how
they serve individual needs.
 Reciprocity is possible at this point in
moral development, but only if it serves
one's own interests.

36. Stage 3 - Interpersonal
Relationships
 Often referred to as the "good boy-good
girl" orientation
 Focused on living up to social expectations
and roles.
 There is an emphasis on conformity, being
"nice," and consideration of how choices
influence relationships.

37. Stage 4 - Maintaining Social
Order
 People begin to consider society as a whole
when making judgments.
 Focus is on maintaining law and order by
following the rules, doing one’s duty and
respecting authority.

38. Stage 5 - Social Contract and
Individual Rights
 People begin to account for the differing
values, opinions and beliefs of other
people.
 Rules of law are important for maintaining
a society, but members of the society
should agree upon these standards.

39. Stage 6 - Universal Principles
 Based upon universal ethical principles and
abstract reasoning.
 People follow these internalized principles
of JUSTICE, even if they conflict with
laws and rules.

40. Carol Gilligan and the
Morality of Care
 "In a Different Voice: Psychological
Theory and Women's Development"
(1982).
 She suggested that Kohlberg's theories
were biased against women, as only males
were used in his studies.

41.  Morality of caring and responsibility is
premised in nonviolence,
 Morality of justice and rights is based on
equality.

42. Approximate
Age Range
Stage Goal
not listed Preconventional
Goal is
individual
survival
Transition is from selfishness -- to -- responsibility to
others
not listed Conventional
Self sacrifice is
goodness
Transition is from goodness -- to -- truth that she is a
person too
maybe never Postconventional
Principle of
nonviolence: do
not hurt others or
self

43. Development of Bioethics
(Kuan, 1993)
Wave
No.
Significant figures Bioethical
principle
I Creation of Hammurabi
Moses
Justice
II Hippocrates Paternalism
III New Testament; Jesus
Christ
Autonomy
IV Media, Research,
Economics, Pluralism
Compassion and
Veracity
V Poverty, Super-rich,
Migrants
Sharing and
allocation of
resources

44. Metaethics
 Involves analysis of:
1. Language
2. Concepts
3. Methods of reasoning

45. Values
 “valere” = to be strong.
 Strongly held beliefs or convictions about
what one hold’s to be important and
worthy in life.
 Freely chosen, enduring beliefs, or
attitudes about the worth of a person,
object, idea, or action.
 Person’s real values  shown by
consistent patterns of behavior.

46.  Value system
– the organization of a person’s values along a
continuum of relative importance.
 Purposive behavior
– actions that are performed “on purpose with
the intention to reach some goal
Purposive behavior  based on decisions or
choices  based on values

47. Value Transmission
 The origin of a person’s values can be
traced to:
– Culture
– Society
– Institutions
– Personality
 Greatly influenced by SOCIOCULTURAL
ENVIRONMENT  learned through
observation and experience.

48. Types of Values
1. Intrinsic value
– Relates to maintenance of life
2. Extrinsic value
– Originates outside the individual
– Not necessary for the maintenance of life

49. 1. Positive value
– A view of what is desirable
– How something should be
2. Negative value
– Undesirable
– How something not should be

50. VALUE MEANING
Religious Obtains strength from
religious beliefs
Theoretical Holds truth, rationality, and
empiricism in high esteem
Political Values power
Economic Values usefulness and
practicality
Aesthetic Values beauty, harmony and
form
Social Values human interactions, is
kind, sympathetic, and
unselfish

51. 1. Personal values
– Used to individualized themselves
2. Societal values
– Used to feel accepted
3. Professional values
– Reflection and expansion of personal values
– Acquired during socialization into nursing:
• Codes of ethics
• Nursing experiences
• Teachers
• Peers
 Nursing values: COMPETENCE AND
COMPASSION

52. Important Values in Nursing
(Watson)
1. Strong commitment to service.
2. Belief in the dignity and worth of each
person.
3. Commitment to education.
4. Autonomy.
 Nurses should be VALUE-NEUTRAL.

53. Values Clarification
 Is a process by which people identify,
examine, and develop their own individual
values.
 Principle: no one set of values is right for
everyone.
 Promotes personal growth by fostering
awareness, empathy and insight.

54. Values Clarification Process
(Raths, Harmon and Simon 1966)
CHOOSING Beliefs are chosen
•Freely, without outside pressure
•From among alternatives
•After reflecting and considering
consequences
PRIZING Chosen belief are prized and
cherished.
ACTING Chosen belief are
•Affirmed to others.
•Incorporated into one’s behavior
•Repeated consistently in one’s life

55. Obligations
 Refers to the demands made on an
individual, a society, a profession or
government to fulfill and honor the rights
of others

56. Types of Obligation
1. Legal obligations
– required by the law
– such as the obligation of a nurse to pay
professional tax when practicing his or her
profession
2. Moral obligations
– based on moral and ethical principles but are
not enforceable under law
– such as the moral obligation of the nurse to
go on duty when the hospital is under staffed
to ensure patient’s welfare

57. Professional Ethics
 A branch of moral science concerned with
the obligations that a member of the
profession owes to the public, to his
profession, to his brethren, and to his
clients
 Norms of behavior or Code of Ethics of
professionals to help members of the
discipline to coordinate their actions or
activities and to establish the public’s trust
on the discipline

58. Health Care Ethics
 Is the division of ethics that relates to
human health
 Deals with the conduct and moral issues
that arise in the practice of health care
professionals
 It resides in the realm of human values,
morals, customs, personal beliefs, and faith

59.  It strives to resolve ethical issues that often
confront health care professionals such as:
a. Choosing what is best for the mother and
what is best for the unborn child
b. What is best for the individual or her
relatives
c. What medical records can be disclosed and
what must be held in strict confidentiality

60. Bioethics
 Is a living study of the conduct of
HUMAN LIFE.
 It is a systematic study of human behavior
in the field of life science and health care
in the light or moral values and principles

61. Bioethics
 Is a specific domain of ethics that focuses
on moral issues in the field of health care.
 It evolved into a discipline all on its own as
a result of life and death dilemmas faced
by health care practitioners.
 Caring for people’s lives entails a
continuous process of decision-making
because we want to save lives and enhance
quality of life at all times.

62. Nursing ethics
 In limited sense, is known as, nursing
etiquette
 In general sense, it is concerned with moral
principles governing the right conduct of
nurses in her relationship with patients,
physician’s colleagues, the nursing
profession and the public.
 Examination of all ethical and bio-ethical
issues from the perspective of nursing
theory and nursing ethics (Johnston).

63. Ethical Dilemma
 Occurs when the decisions available in
making an ethical decision are equally
justifiable alternatives.
 When there is only one course of action, or
when conflict does not co-exist, there is no
ethical dilemma.
 Sometimes, it requires an individual to
make a choice between two equally
unfavourable alternatives.

64.  It occurs because people have different
ethical philosophy, follows different
philosophy in life and see life situations at
different perspectives.
 In many instances, decisions must be made
quickly because patient’s medical
condition is rapidly deteriorating.

65. Types of Ethical Problems
(Wilkinson, 1993)
1. Decision-focused problems
2. Action-focused problems

66. 1. Decision-focused problems
 Difficulty lies in deciding what to do.
 “What should I do?”
 Moral Dilemma
– Being between a rock and a hard plate
– Difficulty is internal and personal
– Addressed by: learning to make better
decisions
• Reviewing personal value system
• Attending staff development offerings and ethics
rounds.

67. 2. Action-focused problems
 Difficulty lies not in making the decision
but in implementing it.
 “What can I do?”
 “What risk am I willing to take to do what
is right?”
 Moral distress
– Nurse knows the right course of action but
cannot carry it out because of institutional
policies or other constraints.

68. Ethics Committees in Hospitals
 Composed of interdisciplinary group of
health care providers (doctors and nurses),
community representatives (government
officials, NGOs, clergy), and non medical
representatives (social workers, ethicist)

69.  They discuss sensitive issues such as:
– when to withdraw or withhold treatment for
an adult and the treatment of a severely
handicapped newborn
– Some may include topics such as the right to
die
– informal consent
– right to choose or refuse treatment
– right to know who is treating the patient.

70.  Ethics committee serves as a forum in
which nurse and other health care
professionals can challenge a treatment
decision.
 Increase communication between health
care providers, patients, and their families
in order to clarify issues, conflicts, and
expectations. With increased understanding
between them, lawsuits can be avoided.
 Formulate organizational code of ethics.

71.  Functions:
1. Give advice about policies and cases
regarding ethical issues.
2. Consultation and case review by providing a
forum for exchanging ideas in order to show
the involved people the different courses of
action available to them.
3. Formulating policies to help guide ethical
decision making and thus ensure that each
patient is treated fairly, that their decisions
are honoured and the choices made for those
who have no decision making capacity
(children, unconscious, mentally
incompetent) are for their best interest.

72. Why be Moral?
Perhaps sometimes you were told by your
classmates while doing you surgical hand
washing during your duty in the O.R.
“Why do we have to follow all these sterile
techniques when our CI won’t know
anyway because she’s out there on the
ward most of the time?” So why be moral
if there is no one to see and judge you
anyway?

73. 1. The Answer of Divine Command.
– We strive to become moral because God is
good and He commands it to us to be also
good.
2. The Answer that Morality pays.
– This means that we should act from self
interest. This emphasizes that good deeds are
rewarded. Whenever a person does the right
thing, his action is always to his advantage.

74. 3. The Fair Play or Common Interest
Argument.
– This answer proposes that life is a game with
rules and it is our mutual advantage or
common interest to play by the rules.
4. “Because It is Right” Argument.
– This view holds that a person should act
morally simply because of his ethics or
because it is right, not whether the act will
pay or be rewarded

75. A hallmark of a true
professional is their
willingness to accept a set of
professional and ethical
principles and follow these
principles in the conduct of
their daily affairs.

76. Ethical Codes
 Are systematic guides for developing
ethical behavior.
 They answer the normative question of
what beliefs and values should be morally
accepted.
 Reflects the professions values and
established standard of conduct or a written
list of acceptable behavior that every
member is expected to observe

77. Functions of Ethical Codes
(Kozier et al)
1. To inform the public about the minimum
standards of the profession and to help
them understand professional nursing
conduct.
2. To provide a sign of the profession’s
commitment to the public it serves.
3. To outline the major ethical
considerations of the profession.

78. 4. To provide general guidelines for
professional behavior.
5. To guide the profession in self-regulation.
6. To remind nurses of the special
responsibility they assume when caring
for the sick.

79. Functions of Professional Code
of Ethics (Caffery and Sugarman)
1. Set forth basic principles and regulations
to serve as guidelines
2. Serve as resource for the orientation of
new practitioners for their duties, rights
and privileges
3. Serves as guide to identify and evaluate
qualities synonymous with professional
conduct

80. 5. Provide guideline for the establishment
and operation of education programs to
prepare future members for service in the
profession
6. Identify common practices to be followed
and those to be shunned
7. Provide a guide for considering the
relationships of individuals to the
employers, co-workers, society in general
and to their won profession

81. 8. Serve as a basis for identifying standards
of quality practice
9. Provide, by implication, for legal actions
against incompetents and violators of the
code and for liability for the consequences
of their actions
10.Provide for due process under the law for
practitioners unjustly accused of
misconduct in the performance of their
duties

82. Code of Good Governance
 Promulgated by the PRC and adopted by
Professional Regulatory boards
 Set of professional and ethical principles
which should be followed in the conduct of
daily lives
 Adopted to cover an environment of good
governance in which all Filipino
Professionals shall perform their duties

83. General Principles of the Code
of Governance
1. Service to Others
– This implies a commitment to life of sacrifice
and genuine selflessness in carrying out their
duties even at the expense of personal gain.

84. 2. Integrity and Objectivity
– Professional should perform their
responsibilities with the highest sense of
integrity and imbued with nationalism and
spiritual values, maintain objectivity, be free
of conflicts, refrain from engaging in any
activity that would prejudice their abilities to
ethically carry out their abilities nor make
any representatives that would likely cause a
reasonable person to misunderstand and be
deceived.

85. 3. Professional Competence
– It is their express obligation to keep up with
the new knowledge and techniques in their
field and upgrade their level of competence,
taking part in a lifelong continuing education
program.
4. Solidarity and Teamwork
– Each professional shall maintain and support
one professional organization for all its
members promoting a deep spirit of solidarity
and teamwork.

86. 5. Social and Civic Responsibility
– Professionals shall always carry out their
professional duties with due consideration of
the broader interest of the public, serve them
with professional concern consistent with
their responsibilities to society and as
Filipinos, contribute to the attainment of the
country’s national objectives
6. Global Competitiveness
– Professional shall remain open to challenges
of a more dynamic and interconnected world,
rise up to global standards and maintain
levels of professional practices fully aligned
with global practices.

87. Code of Ethics of Filipino
Nurses
 1982
– the PNA Special Committee under
chairmanship of Dean Emeritus Julita V.
Sotejo developed the Code of Ethics of
Filipino nurses, was approved but not
implemented

88.  1984
– BON adopted the Code of Ethics of the
International Council of Nurses (ICN) and
added the fifth commitment which is
“promotion of spiritual environment” through
Board Resolution No. 633 and was enforced in
1989
 1989
– Code of Ethics promulgated by the PNA was
approved by the PRC through Board
Resolution No. 1955

89.  A new amended Code of Ethics for RNs
has been promulgated by the BON in
coordination and consultation with the
PNA.
 The Code of Good Governance was
principal basis and was adopted and
integrated as they apply to the Nursing
Profession.
 Adopted under RA 9173 and promulgated
by the BON under Resolution No. 220
Series of 2004 last July 14, 2004

90.  Preamble
Health is a fundamental right of every
individual. The Filipino registered nurse
believing in the worth and dignity of each
human being recognizes the primary
responsibility to preserve health at all cost.
 Emphasizes the responsibility of the nurse
to:
1. People they serve
2. Practice
3. Co-workers
4. Society and environment
5. Profession

91. 5-FOLD ETHICAL
RESPONSIBILITIES OF THE NURSE:
1. PROMOTION OF HEALTH
2. PREVENTION OF ILLNESS
3. PROLONGING OF LIFE
4. RESTORATION OF HEALTH
5. SPIRITUAL UPLIFTMENT OF THE
PATIENTS

92. Approaches to Ethics (Beauchamp and
Childress, 1994)
1. Normative
– Actions are based on standards of society and
acts are judge by standards of what is
accepted as right or good action.
2. Descriptive
– What people believe and how they are
phenomenologically described.
3. Analytic
– People analyze concepts and methods of
ethics in the light of what they observe,
believe and practice.

93. Normative Ethics/Prescriptive
Ethics Theories or Approaches
 It is the study of moral problems which
seek to discover how one ought to act, how
one does act or how one thinks one should
act.
 Types:
1. Teleological Approach
2. Deontological Approach
3. Virtue Ethics Approach

94. Teleological Approach
 Consequencialist Theory/Situation Ethics
 Teleology comes from the Greek word
“telos” or goal or end
 Expressed in the maxim: “the right thing
to do is the good things to do”
 Based on the consequences of human
action; action is morally right if the
consequences of such action are favorable.

95.  ACT UTILITARIANISM
– we judge morality of each action by first
determining the good or bad consequences of
a particular act
 HEDONISTIC UTILITARIANISM
– good resides in the promotion of happiness or
the greatest net increase of pleasure over pain
 Holds that good is agape, the general
goodwill or love for humanity
 If the acts helps people, then it is a good
act, and if hurts people, then it is a bad one
 Often are made through risk benefit
analysis

96.  Example
– The City Health Department is planning for
their annual budget. To which program should
they allot a bigger budget? The modernization
of the city hospital or the Nutrition and
Immunization Programs of the poverty-
stricken families in the city? Will promotion
of health and prevention of illness have
priority over treatment of illness and
rehabilitation?
– Before any treatment is instituted to the
patient, we discuss all treatment options to
enable the patient to choose which treatment
will produce the greatest amount of relief and
largest amount of danger

97. Deontological Approach
 Duty-Oriented Theory/Nonconsequentialist
Theories
 Deontology came from the Greek word
“deon” which means duty
 Ethicist feels that basic rightness and
wrongness of an act depends on the
intrinsic nature rather upon the situation or
its consequences.

98.  A person is morally good and admirable if
his actions are done from a sense of duty or
reason.
 Even when individuals do not want to fulfil
their duty, Kant believes that they are
required to do so.
 Based on principles of obligation that must
be followed by all irregardless of the
consequences

99.  Example
– Suppose a nurse is assigned to care for a
patient with AIDS. Could she reasonably
refuse to care for the patient on the ground that
the patient’s condition may threaten her
health? As practitioners of the healing art,
nurses are to take care of the sick even if
patients have conditions that threaten their
personal health. Nurses, however, must
observe the necessary precautions to protect
their health.

100. Ross list the duties which believes
reflects our moral convictions:
 Fidelity: duty to keep promises
 Reparation: duty to compensate others
when we harm them
 Gratitude: duty to thank those who help us
 Justice: duty to recognize merit
 Beneficence: duty to improve the
conditions of others
 Self-improvement: duty to improve our
virtue and intelligence
 Nonmaleficence: duty not to harm others

101. Virtue Ethics Approach/Virtue
Theories
 Known as aretaic ethic from the Greek
word “arête’ is focused on primarily on the
heart of the person performing the act
 Virtues: good habits that are used to
regulate emotion, good character traits that
are natural right and useful for getting what
one wants

102.  Cardinal virtues: wisdom, courage
temperance and justice
 Christian or theological virtues: faith,
hope and charity
 Example
– a person who has developed the virtue of
courage will stand firm in response to feelings
of fear when he or she is face of danger

103. Divine Command Ethics
 Based on the theory that there is a Supreme
or Divine being that sets down the rules to
provide guidance to moral decisions.
 For Christians, these rules are found in the
Ten Commandments
 Example
– A nurse is approached by her friend who
request for an abortion. The nurse refuses but
refers the friend to a doctor who can perform
it. This is a violation of the divine command,
“Thou shall not kill.”

104. Universal Principles of
Biomedical Ethics
 Ethical Principles Used in Health Care
1. Respect for Individuals
2. Autonomy
3. Veracity
4. Beneficence
5. Nonmaleficence
6. Justice
7. Fidelity
8. Confidentiality

105. Respect for Individuals
 Overarching maxim of morality that
influences all other ethical principles

106. Autonomy
 Comes from the Greek word
– “autos” meaning self and
– “nomos” meaning governance, rule, law
 Personal liberty to determine one’s action
 Self- governance
 Individual choice
 Freedom of will
 Causing one’s behavior (Beauchamp and
Childress, 1994)

107.  It involves self-determination and
freedom to choose and implement one’s
decision, free from deceit, duress,
constraint and coercion

108.  To govern one’s self, one must have the
capacities to:
1. Understand the issue and what the
situation is all about
2. Reason out and give one’s own opinion
3. Deliberate by weighing the pros and cons
of the issue
4. Make an independent choice

109.  Examples: allowing the patient to refuse
treatment if he so decides, disclosure of his
ailments, prognosis, mode of treatment and
maintaining confidentiality, have the right
to determine what should be done to his
body.

110. Application of Autonomy
• Informed consent
– Nurses do not give advice to what
course of action but their primary
task is to provide all information

111. Paternalism
 The principle and practice of paternal
administration: government as by a father,
the claim or attempt to supply the needs or
to regulate the life of a nation or
community in the same way a father does
of the children.” - (Immanuel Kant and
Stuart Mill, 1880s)

112.  Principle of Paternalism/Parentalism
– Means acting in a fatherly manner which
involves engaging in behaviors associated
which those of the traditional father of the
family such as leadership, decision-making,
discipline and protection.
– Should assist others in pursuing their best
interest when they cannot do themselves
– In health care, the concept of paternalism is
applied when health care givers, especially
physicians, assume the authority to make
decisions for the patients.

113. – Thought of as a violation of the patient’s right
for autonomy or freedom to choice
– Applied in instances where patient’s have
diminished decision making capacity such as
mentally incompetent, delirious, unconscious
or under the influence of drug
– Nurses can make the decision for the patient to
promote patient’s well being or to be protected
from harm or injury (Justified only to prevent
harm to the patient)
– The role of nurses as patients advocate is
related to this concept

114.  Example:
– The nurse capacity to restrain a violent patient
(without need of asking for the patient’s
consent) who may harm himself or other
persons around him
– An unconscious patient brought to the
emergency room who receives medical
treatment without him being made to sign
consent for medical treatment first

115. Standard of Best Interest
 Pertains to health care providers making
decisions about the a client’s health care
when they are unable to make decisions
about their own care
 The health care provider must decide what
the best course of action for the patient is
and carry it out

116.  Restrictions on autonomy may occur when there
is potential harm to others such as communicable
diseases or acts of violence.
– For example: a person in the acute stage of
contagious disease must be isolated, even
against his will, in order to prevent the spread
of disease and protect the greater public.
 Therapeutic privilege is the legal exception
of the rule of informed consent,
– which allows the caregiver to proceed with
care in case of emergency, incompetence,
waiver, or implied consent

117. Liberty-limiting Principle
(Justification for overriding autonomy)
 Harm principle
– A person’s liberty is justifiably restricted to
prevent that person from harming others
 Offense principle
– A person’s liberty is justifiably restricted to
prevent that person from offending others
 Principle of paternalism
– A person’s liberty is justifiably restricted to
prevent that person from harming himself or
herself

118.  Principle of extreme paternalism
– A person’s liberty is justifiably restricted to
benefit that person
 Principle of legal moralism
– A person’s liberty is justifiably restricted to
prevent harm to that person from acting
immorally
 Social welfare
– A person’s liberty is justifiably restricted to
benefit others

119. Veracity
 Telling the truth
 The physician tells the patient and his
family his diagnosis, plan of care,
treatment and possible risks involved,
length of treatment, possible expenses and
other options they may take if there be any
 Applied in the nurse’s responsibility never
to mislead or deceive a patient

120. 3 Elements for Communication
to be Credible
1. Logia
– Substantial views of world truth.
2. Pathos
– Element of empathy
– Ability to put one’s self in a true situation
3. Ethos
– Morally correct and true to the event.

121. Veracity is necessary in Professional-
Patient Relationships for three
reasons:
 1. The obligation of veracity is based on
respect owed to others.
– In asking patients their consent, for any
deemed necessary intervention, the validity of
the consent depends on the thorough
information, full disclosure, and enlightenment
given to the patient regarding the procedures
to be done.

122.  2. Veracity has a close connection to
obligations of fidelity and promise-
keeping.
– When we communicate with others, we
implicitly promise that we well speak
thrutfully and that we will not deceive out
listeners.
– Example, relationship is entered into a
contract, thereby gaining a right to the truth
regarding diagnosis, prognosis and all other
pertinent information.

123.  3. Relationship of trust between persons
are necessary for fruitful intervention
and cooperation.
– At the core of these relationships is confidence
in and reliance on others to be truthful.
– Truth telling is necessary to foster trust.
– Lying and inadequate disclosure show
disrespect for persons, violate implicit
contracts and threaten relationships.

124. In Filipino culture, the two traits
that affect truth telling are:
1. Family orientation to illness
– Means members are often informed of serious
diagnosis before the patient is told.
2. Nonconfrontational attitude
– Prevents us from disclosing unpleasant views
– Most physicians still subscribe to death
denial culture.
– Fear of hurting otherz

125.  How we say the information oftentimes
makes them acceptable or not
 Example:
– The physician or health practitioner is
requested not to tell the relative the exact
nature of the patient’s illness: A young
married male who was diagnosed to have
AIDS request the doctor not to tell his
diagnosis to his wife.
• Telling the wife would be far more advantageous
so that she can be examined, protected or treated as
the case may be. She would be able to use proper
precautionary measures for herself, understand the
husband’s illness, and participate in his case

126. – Relative request the physician not to tell the
patient his condition or diagnosis: The
children of an aged mother suffering from
metastatic cancer request the doctor not to tell
their mother her diagnosis and instead to
proceed with the chemotherapy.
• Gently telling her the truth would help convince
her to participate in the treatment plan and
including spiritual preparation towards peaceful
death.
– Physician intentionally withholds information
according to his sound judgement when such
revelation would do more harm to an
emotionally unstable or depressed person.
• This is called benevolent deception.

127. Beneficence
 Latin words “Bene” = good
 “fiche” = to act or do
 All forms of action done for the benefit of
others.
 To do good and what is best for the patient.
 Promoting acts of kindness and mercy that
directly benefit the patient.
 Charity, altruism, love, humanity

128.  Includes:
– Nonmaleficence
– Attentiveness
– Prevenance (anticipating one’s needs)
– Positive reinforcement
– Helpfulness
– Positive paternalism
– Sharing
– Truth-telling

129.  BENEVOLENCE
– Refers to the character trait or virtue of being
disposed to act for the benefit of others
 PRINCIPLE OF BENEFICENCE
– Refers to the moral obligation to act for the
benefit of others.
– Asserts obligation to help others

130. Principle of Benevolence
 Should help those in need

131.  Ideal Beneficence
– is a benevolent act that involves going out of
one’s way to do good to others.
 Obligatory Beneficence
– Is a mandatory act to do good, to give aid to
those who are in need.

132. Five Rules of Beneficence from
Principles of Biomedical Ethics
1. Protect and defend the rights of others.
2. Prevent harm from occurring to others.
3. Remove conditions that will cause harm
to others.
4. Help persons with disabilities.
5. Rescue persons in danger.

133. Patient’s Rights
A. Right to Medical Care and Human
Treatment
B. Right to Informed Consent
C. Right to Privacy
D. Right to Information
E. Right to Privilege Communication
F. Right to Choose Physician
G. Right to Self-determination

134. A. Right to Religious Belief
B. Right to Medical Records
C. Right to Leave
D. Right to Refuse Participation in Medical
Research
E. Right to Correspondence and Receive
Visitor
F. Right to Express Grievances
G. Right to be Informed of His Rights and
Obligations as a Patients

135. Nonmaleficence
 An admonition in the negative form to
remind health practitioners to do no harm
 Obligation to avoid injuring another
individual
 The legal requirements of duty of care and
accountability clearly arise from this
principle
 “Prinum non nocere” = above all do no
harm to anyone

136.  The principle affirms the need for
professional competence.
 Expressed in the Hippocratic oath:
– “I will use treatment to help the sick
according to my ability and judgment, but will
never use it to injure or harm them.”
 An extension of this is the obligation of
health care providers to protect from harm
those who cannot protect themselves such
as children, mentally incompetent, and
unconscious client

137.  In 1988, Gert, a bioethicist working in
moral-oriented disciplines, gave the
following typical examples of
nonmaleficence:
1. “Do not kill.”
2. “Do not cause pain or suffering to others.”
3. “Do not cause offense to others.”
4. “Do not incapacitate others.”
5. “Do not deprive others of the goods of
life.”

138.  Example:
– Not assisting in performing abortion
– Not assisting to commit suicide
– Not performing euthanasia or mercy killing
– Not wilfully subjecting patients to
experimental drugs whose potential harm may
be greater than the benefit
– Not harming a person’s reputation by
revealing confidential information
– Not participating in treatments or procedures
that will harm the patient
– Not able to perform skin test prior to
administration of allergic medications

139.  The principle may justly be violated in
some medical situations.
– When a pregnant women with advanced
cardiac disease must have abortion
– When you insert intubate a patient
– Violated in short term to produce greater good
for the patient in the long term such when
painful and disfiguring surgery is performed
like radical neck dissection for the purpose of
prolonging life in a patient with advanced
laryngeal cancer
– When a gangrenous limb of a diabetic patient
must be amputated in order to prevent the
spread of infection to the other parts of the
body

140. Justice
We give what is due and we get
what we merit for our conduct
in life.
FAIRNESS
EQUITABLE
DESERVED
APPROPRIATE

141.  If an individual need care, he/she has the
right to be cared for because care is his/her
due.
 No one therefore has the right to refuse
health care to someone who is in need.
 Emergency: regardless of the individual’s
capacity to pay, health care must be given
to the person needing care because as
health care professionals, out first duty is
save lives.

142. Justice
 The right to demand to be treated justly,
fairly and equally
 Fair opportunity rule is based on the
EGALITARIAN PRINCIPLE that
emphasizes equal access to goods and
services
 Underlies the nurse commitment to provide
services with respect for human dignity
and render nursing care to the best of her
ability to every patient irregardless of
religion, sex, race, economic status, and

143.  Basis of the law that provides for equal
access to health care for all.
 Example: The hospital put up triage
schemes to determine who should be
served first

144. Injustice
 Involves a wrongful act or omission that
denies people benefits to which they have a
right
 Sharing of responsibility is not equal
among responsible people.
 Exploitation of nurses to unpaid overtime
 Overcharging of government for patient
services which are not done.

145. Types of Justice (Beauchamp and Childress (1994)
1. Distributive justice
– Fair, equitable, and appropriate distribution
of responsibilities, or share of rights and
roles.
2. Criminal justice
– Just infliction of punishment or penalty
proportionate to the crime committed.
3. Rectificatory justice
– Just compensation for transactional problems
such as breaches of contract and practice
based on civil law

146.  When the supply is limited, distributive
justice requires that more should be given
to the one who needs most and the one
who will most benefited to attain quality
life.
 When the available supply is too limited,
and there are just too many who desire to
avail of the limited supply, sometimes it is
resolve by lottery, giving each one a fair
probability of being selected.

147.  Engelhardt, Keusch, Wildes (1995) and
others have suggested the following
principles as valid material principles of
distributive justice:
1. To each person an equal share.
2. To each person according to need.
3. To each person according to effort.
4. To each person according to contribution.
5. To each person according to merit.
6. To each person according to free-market
exchanges.

148. Some influential theories that go
with the principles of justice:
1. Utilitarian
– Emphasizes a mixture of criteria for the
purpose of maximizing public utility.
2. Libertarian
– Emphasizes rights to social and economic
liberty, invoking fair procedures rather than
substantive outcome.

149. 3. Communitarian
– Stresses the principles and practices of justice
that evolve through traditions in a
community.
4. Egalitarian
– Emphasizes equal access to goods in life that
every rational person values.

150. Allocation of Scarce Resources
 To allocate = to distribute by allotment.
 Macroallocation decisions
– Determine funds to be expended and the goods
to be made available, as well as the methods of
distribution.
 Microallocation decisions
– Determine who will receive particular scarce
resources.

151.  Justice in health care implies that every
individual should:
1. Receive benefits due him or her by right;
2. Receive benefits he or she deserves after
balancing competing claims of other
persons against his/hers
3. Share in the burden of paying for the cost
of health care and health research.

152. Southeast Asia Center of
Bioethics (1995) recognizes:
1. Every human being has a fundamental
right to health.
2. Individuals have the primary
responsibility to promote their own
health.
3. As independent social beings, people have
a right to seek the help of others in
fulfilling this responsibility. Reciprocally,
people have the duty to give the same
help to others

153. Fidelity
 Obligation of a person to be faithful to
agreements, responsibilities and
commitments that he has made to himself
and to others..
 It is the main principle that supports the
concept of accountability of nurses and
other professionals

154.  Fiduciary responsibility
– Refers to the contract of relationship we enter
into with the patient.
– Bank in trust and confidence
 Model of fidelity is:
– Keeping one’s word of honor
– Loyalty to commitments and oaths
– Reliability

155.  ABANDONMENT is a breach of fidelity
and infidelity amounting to disloyalty. –
Council of Ethical and Judicial Affairs on
Health Care (1992)

156. Confidentiality
 Confidential communication is termed as
privilege communication or professional
secrecy because it is given based on trust.
 Both legal and moral obligation of health
care providers
 The patient and his/her family are entitled
to known information or facts within the
limits determined by the physician.

157.  Nurse may only repeat what the doctor
wishes to disclose
 Any information gathered by the nurse
during the course of caring for the patient
should always be treated confidential until
the patient’s death
 Nurses reassures the patient that
information gained in the interview will be
treated confidential

158.  Persons required to observe
confidentiality:
a. Physicians who deal with the patient even
for a briefest times at various phases of the
patient’s illness or treatment
b. Pharmacist who prepares and dispenses the
medication prescribed to the patient
c. All other health care professionals involved
in the care of the patient such as nurses,
medical technologist, hospital chaplain,
student nurses and social workers
d. All other personnel who attend to the care of
the patient such as janitors, hospital
receptionists, secretaries, accountant,
treasurer, etc.

159.  Confidential information may be revealed
when:
a. The patient himself/herself permits
b. The case is medico-legal
c. The patient is ill of communicable or
highly contagious disease and public safety
may be jeopardized
d. Given to the members of the health team if
information is relevant to his care
e. Upon order of the court or when public
safety and order require otherwise ( Article
IV, Section 4(1) of the New Constitution

160. Privacy
 Defined as the individual’s control over
access to himself or herself extending to
physical or informational inaccessibility.
 Person has the right to control access.
 Libel
– written defamation
 Slander
– oral defamation

161. What counts as a loss of
privacy and what affects
an individual’s sense of
loss of privacy = to what
one values as strictly
personal or very private.

162.  Hospital settings
– Territorial inaccessibility and non-exposure to
others
 Privacy is a necessary condition, the
necessary atmosphere for maintaining
intimate relationships of respect, love,
friendship and trust.” – Charles Fried
(1990)

163.  Privacy certainly has such instrumental
values.
 We grant access to ourselves in order to
have and maintain such relationships.
 Whether we grant someone else access to
some aspects of our lives will depend on
the kind of relationship we want in pursuit
of our goals.
– Example: we allow physicians access to our
bodies in order to protect our health.

164.  “I need breathing space.”
 In relationships, this means a need to with
one’s elf, to be private in order to
decongest the self from the other’s
shadowing.
 In any relationship, we have to provide
time for being alone, for being private, and
to be just ourselves and be inaccessible to
others.
 In health care, each person is unique and
private. Let us respect out patients’ needs
for privacy, for moments of silence.

165.  Distinction between infringement of
privacy and infringement of
confidentiality,
– Only a person or institution to whom
information is given in a confidential
relationship can be charged with violating
rights of confidentiality.

166. Filipino Primary Principles of
Bioethics
1.Goodness
2.Beneficence
3.Family

167. Goodness
 Demonstrated through the practice of
justice, respect for autonomy, compassion,
veracity, fidelity, and confidentially.
 Filipinos: delicate and generous
HOSPITALITY
 Sharing of goods
– Lending money, materials, equipment, and
even human resources

168.  “Utang na loob” (indebtedness or
gratitude)
– Belief that good favors done to one member
should be perpetuated in acts of gratefulness
forever.
 Extends to keeping secrets even it would
have been more charitable to reveal the
secret.
 Confrontative dialogues are avoided
because of the guise of being good and not
hurting the feelings of others.

169. Family
 Solid bank one can rely on where
withdrawal of help and support is endless
and the resources is never exhausted.
 All principles of human conduct of life
begin and end in the family.
 Visayan: “Ginikanan” = source of
everything
 Source of all right conduct.

170. The Beginning of Life
 Life begins at the moment human sperm
fertilizes a mature human ovum.
 Respect to an unborn human being starts at
the moment fertilization takes place.
 WRONG AND BAD any means or
procedures that arrest the right to life and
care due to this growing, living, human
being.

171.  It is unjust because the innocent, helpless,
developing human being is deprived of the
human right to be cared for, to be borne
and to live.
 ABORTION = always regarded as
bioethically a violation of the unborn
child’s right to live and grow with dignity.
 “WHAT IS LEGAL IS NOT ALWAYS
MORALLY CORRECT.”

172. 2 Significant things to remember
in caring for the unborn
1. Physical environment
– Receive all the necessary nutrition
– Clean surroundings and sufficient sleep
2. Psycho-emotional-spiritual ecology
– Refers to love and spirituality of the mother
and father of the child
– Child must be loved, wanted and prayed over

173. Virtues of Professional Life
TRADITIONAL
MODEL
CONTEMPORARY
MODEL
Obedience Autonomy
Submission Justice
Persistence
Courage

174. 1. Compassion
 Is a trait that combines a attitude of active
regard for another’s welfare with an
imaginative awareness and an emotional
response for deep sympathy, tenderness
and discomfort at the other’s misfortune or
suffering.
 Resembles CARE.

175. 2. Discernment
 Rests on sensitive insight involving acute
judgment and understanding and it results
in decisive action.
 Includes the ability to make judgments and
reach decisions without being unduly
influenced by extraneous considerations,
fears and personal attachments.
 Pairs in action with courage and fidelity to
one’s duty and prudence.

176. 3. Trustworthiness
 Shown when someone you believe to be
solidly true, loyal, and good will stand by
you through thick and thin.
 Trust entails confidence that another will
act with the right motives in accord with
moral norms.

177. 4. Integrity
 Soundness, reliability, wholeness, and
integration of moral character,
 Coherence of the person’s words,
actuations, and his or her way of life.

178.  Describes two aspects of a person’s
character:
1. coherent integration of aspects of the self
– emotions, aspirations and knowledge so
the each complements and does not
frustrate others
2. Character trait of being faithful to moral
values and standing up in their defense
when they are threatened or under attack.

179. Guidelines, Moral Principles or
Theories for the Nurses
 to use to be able to respond to a given
situation with sound moral judgement
 Moral principles
– Are statements about broad

180. 1. God is the author of life; therefore, no
one has the right to take it except Him
2. Health is wealth.
3. The golden rule: Do unto others what
you want would like others do unto you.

181. 4. Theory of double or two-fold effect
– A situation which may both have good and
bad effects
– Choose the lesser evil, which may produce
greater good effects
– The basis of action may be the following:
1. That action must be morally good
2. That the good effect must be willed and that the
bad effect merely allowed
3. That the good must not come from evil action but
from the initial action itself directly
4. That the good effect must be greater than the bad
effect

182.  Example:
– It is not morally good if a boy steals in order
to alleviate his hunger because the action itself
is already bad.
– On the other hand, if the patient who has
cancer of the uterus submits to hysterectomy,
she will not be able to bear a child. If she does
not have the operation, she will die. It is the
gynaecologist’s intention to help the mother
and not harm her. The surgeon’s action is
morally good since saving the mother’s life is
the primary importance. Also the doctor
himself did not will that the patient lose her
child-bearing.

183. 5. The principle of totality
– The whole is greater than the sum of its
parts.
– Example: a man who has a gangrenous foot must be
amputated so as to save his life and he can still walk
through aid of crutches or artificial limbs
6. The greatest good for the greatest
number
– The result should be one that benefits the
most number of people
– During epidemic, immunization against
communicable diseases is administered to people.
Although some may have some slight reactions to
the vaccine, the greater majority of the population
shall be considered rather than the isolated few

184. 7. One who acts as through an agent may
be himself responsible.
– Example: a nurse recommends a doctor to an
unwed pregnant adolescent for abortion
8. The end does not justify the means
– If the action taken is bad, the result, no matter
how good, is not enough for his bad action.
– Giving a sedative to a chronically ill person so
he/she can die in peace is morally wrong. A
physician assisted a woman diagnosed as
having Alzheimer’s disease in committing
suicide is both legally and morally wrong

185. 9. Epikia
– Exception to the general rule
– Example: if a mental patient went out of
control and the doctor could not be contacted,
the patient may be restrained by the virtue of
epikia. Another is allowing a relative to see a
seriously ill patient who expresses the desire
to see the former although it is not yet
visiting hours
10.No one is obliged to betray himself or
herself
– In testifying in court, no one can force any
person to answer a question if such will
incriminate him/her

186. 11.Defects of nature can be corrected.
– Patients with cleft palate may have their
defects corrected by plastic surgery.
12.If one is willing to cooperate in the act,
no injustice is done to him/her.
– Example: suppose a patient subjects
himself/herself willingly to an experimental
drug and he/she has been told of the possible
effects, is of right age and is sane, there is no
violation to human rights

187. 13.A little or less does not change the
substance of an act
– If a nurse gets medicine from a hospital
stock without permission or without
prescription, he or she is guilty of theft even
if she got only one tablet
14.No one is held to the impossible
– To promise that a patient with heart
transplant will live may be impossibility. Yet
such procedures are done in the hope of
saving or prolonging a patient’s life. The
doctor or the nurse cannot be held if they
have done their best to take care of the
patient and the latter dies

188. 15.The morality of cooperation
– Man is morally responsible not only for his
own actions but also to the effect of his actions
to other people as well as his reaction to others
men’s action
– Formal cooperation in an evil act is never
allowed
 Types of Cooperation with Evil:

189. 1. Positive Cooperation:
– Voluntarily doing an act which contributes to
the evil act of another
– Example: A nurse who assist in abortion
(Immoral operations such as abortion shall not
be participated upon by a nurse even if the
doctor commands it)
2. Negative Cooperation:
– Cooperation by omission in which the person
did not do anything to prevent another person
from committing the evil act
– Example: A nurse who saw another nurse
stealing medical supplies and does not stop the
said nurse or report the incident to her supervisor

190. 3. Direct/Immediate Cooperation:
– happens when a person’s cooperation occur
while the act is being performed
– Example: A nurse who acts as a “watch”
while the doctor injects a fatal dose of
sedative to un unconscious patient
4. Indirect/Mediate Cooperation:
– committed before and after the evil act;
however, cooperation is not necessarily to the
evil act itself
– Example: A nurse destroys all evidence of an
abortion although he did not assist while the
surgical procedure was being performed

191.  Medical situations in which a nurse may
commit immoral act by cooperation
– IUD insertion
– Abortion
– Sterilization
– Infertility studies in which a male patient may
be require to collect semen specimen by
masturbation
– IVF
– End of life issues: “DNR order”
– Euthanasia

192. 15.Principle relating to the origin and
destruction of life.
– One of God’s Commandments: Thou shall not
kill
– Example: euthanasia

193. INFORMED CONSENT
 Is the client’s approval (or that of the
client’s legal representative) to have his or
her body touched by a specific individual.
 It indicate the client’s participation in the
decision making regarding health care

194. Informed Consent
 Originates from the legal and ethical right
of the patient to direct what happens to her
body
 Based on principle of autonomy.
 The nurse’s responsibility is to WITNESS
the giving of informed consent.

195. Witnessing involves the FF:
1. Witnessing the exchange between the client
and the physician
2. Establishing that the client really did
understand, and was really informed
3. Witnessing the client’s signature
 “Witnessing only signature”: if a nurse
witnesses only the client’s signature and not
the exchange between client and physician

196. Requisites of Informed consent
1. Informed
2. Voluntary
3. Competent

197. Elements of Informed Consent
1. Threshold elements
a. Competence (to understand and decide
b. Voluntariness (in deciding)
2. Information elements
a. Disclosure (of material information)
b. Recommendation (of a plan)
c. Understanding (of the information and plan)
3. Consent elements
a. Decision (in favor of the plan)
b. Authorization (of the chosen plan)
c. Signature (execution of the consent through
signature)

198. 3 major elements of informed
consent
1. The client must be given enough
information to be the ultimate decision
maker
2. The consent must be given voluntarily
3. The consent must be given by an
individual with the capacity and
competence to understand
– COMPETENT AND AN ADULT
– Over 18 years old, conscious and oriented

199.  INFORMED consent requires that patient
has the right to:
a. clear explanation, in lay person’s terms, all
proposed procedures, including identity of
the person who will perform the said
procedure
b. possibilities of any risk or side effects
c. problems related to recuperation, and
d. the probability of the risk involved and
e. how he will be subjected to any procedure
without his informed consent.”

200.  VOLUNTARY
– That the decision is of his own free will and he
is not coerced or put under duress to do so. He
must be allowed to make decisions even if the
choices may have harmful consequences as
long as he does not cause harm to others.
• Example: Patient is allowed to refuse the more
effective chemotherapy and chooses alternative
treatments such as herbal medication
– Nurses must make certain precautions and assess the
patient’s ability to understand his situation, understand
the risk associated and at hand to communicate a
decision based on that understanding
– If possible, it would be better if the patient can
verbalize full understanding of the procedure before
he is asked to sign a consent form.

201.  COMPETENT
– He must have the intellectual capacity to
make a rational decision
– Mentally and emotionally
– Must be of legal age

202. 2 Functions of Informed
Consent
1. Protective
– To safeguard against tension of integrity
2. Participative
– To be involved in the health care decision
making

203. Persons who cannot provide
consent
1. Minors
2. Unconscious or severely injured
3. Mentally ill/chronic dementia other
mental deficiency
4. Under the influence of drugs and alcohol

204.  Informed consent of Minors
– Parents or guardians have the authority to give
consent on the behalf of minors and children
under 18 years old
– Parents are ethically and legally responsible
because they are considered to be one who
care most of their children and as well
treatment and diagnosis will have impact of
the family
– The right to make decisions on behalf of their
children includes
1. Right to give consent
2. Right to refuse and discontinue treatment even
those life sustaining

205.  Minors and children can make their own
informed consent if they are:
Emancipated minor
– Has established independence from parents
through/by:
• Self-supporting and not living at home
• Marriage
• A parent
• Service in the armed forces
• By a court order

206.  Informed consent of
a. Mentally Incapacitated
b. Declared incompetent
c. Unconscious
d. Chronic dementia or other mental deficiency
e. Under the influence of alcohol or dugs
– If a client is declared mentally or emotionally
incompetent, the next of kin, legal gaurdain
(appointed by the court), or the durable
power of attorney has the legal authority to
give consent.

207. REFUSAL TO CONSENT
 A patient who is mentally and legally
competent (sane mind and of legal age) has
the right to refuse the touching of his body
or to submit to a medical and surgical
procedure no matter how necessary, nor
how imminent the danger to his life or
health if he fails to submit to treatment.

208. CONSENT FOR
STERILIZATION
 Sterilization is the termination of the
ability to produce offsprings.
 HUSBAND and WIFE must consent to the
procedure if the operation is primarily to
accomplish sterilization.
 Medically necessary and an incidental
result = PATIENT’s CONSENT ALONE
is sufficient.

209. Implied consent
 Presumed consent and need not to be
obtained during emergency situations when
the patient is unconscious or incompetent
and no surrogate decision maker is
available.
 Based on the principle of beneficence
when health care providers are obliged to
act on the patient’s behalf when the life of
the latter is at stake.