ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
SCHOOOL YEAR 2020-2021

HEALTH CARE ETHICS (NCM 108)

I. MODULE TITLE:​ HEALTH ETHICS 108 (BIOETHICS)

II. FOREWORD:

Changes in the Nursing Profession and our world today demand understanding of the virtues and
values learned from our parents, school and to our environment as well. Our student nurses’ even
professionals should practice the ethical values in the practice of Nursing. The complexities of the
roles and responsibilities and the relationship of nurses with society in their workplace and members
of the health team demand full knowledge of their ethical responsibilities and values toward work and
people. In this regard, Nurses should develop their full responsibilities of their actions and their
competencies in dealing with people and circumstances to avoid ethico-legal problems in the future.
Thus, Health Ethics/Bioethics is important in our everyday life and therefore it is included in the
Nursing curriculum.

III. TABLE OF CONTENT:

IV. INTRODUCTION:

V. ​ ​MODULE DESCRIPTION/ LEARNING OUTCOMES:

A. Module Name: Health Ethics 108 ( BIOETHICS)

B. Module Code: NCM 1O8
C. Units: 3 units (54 hours)
D. Number of Hours: 3hours
E. Term: 1​ST​ Semester 2020 -2021
F. Assessment Date:
G. Aims/ General Objectives:
H. Learning Outcomes:
I. Content:

General Objectives:​ ​At the end of the course, the students will be able to acquire knowledge about
the basic norms of morality, bio-ethical principles and issues and develop sensitiveness to ethical
consideration in making moral decisions.
Specific Objectives:​ The students will be able to:

1​. To familiarize with the various ethical issues confronting health care professionals.

2. To apply the bio-ethical principles when confronted with different issues related to Health care

3. To appreciate the importance of bioethics in delivery care to individuals, family and community.

Objectives:​ At the end of the chapter the students will be able to:

Define the different terms and theories.

Discuss the different Ethical Theories, virtues and other Ethical Principles.

Give examples of the different Ethical and other relevant Principles.

Definition of terms:

ETHICS​- comes from Greek word ​“ethos”​ characteristics way of acting which means custom

or particular behaviour.

ETHIKOS​- means Moral duty; Latin- Mos, Morrs, Moris (Way of Acting)
ETHICS​- Real definition-is Science of correct living and doing.

- Concerned with the meaning of such words as right, wrong, good, bad, ought, duty. Studies of human
acts or conduct from a moral perspective as to whether they are good or bad.

- According to Webster- the study of the standards of conduct and moral judgment. It teaches nurses to
judge accurately the moral goodness of any human actions.

- A practical and normative science based on reason which studies human acts and provides norms for
their goodness or badness.

​MORALITY​- derived from the latin word​ “moralis”​ the rightness and wrongness of an act

determined by our principles. Goodness or badness of human acts.

Moral- Latin word Mos, Moris- means customs. Identical meaning with Ethics.

UNIT I
I. THEORIES AND PRINCIPLES OF HEALTH ETHICS

A. Ethical Theories

1. Deontology

Deontological (Duty- Oriented) Theorie​s​- ​Greek word ​“​deon”​ ​, obligation, duty, and ​“​logos​”
meaning ​“​science”​ ​. Is the normative ethical theory that the morality of an action should be based on
whether that action itself is right or wrong under a series of rules rather than based on the
consequences of the action. Concept was introduced by ​Immanuel Kant​.

Example:​ Killing someone is wrong, even if it was in self-defense.

2.​. Teleology

Teleological (Consequence- Oriented) Theories​- ​Greek ​“telos”​, meaning goal or end purpose

and ​“logos”,​ meaning reason or explanation. Describe an ethical perspective that contends the
rightness or wrongness of actions is based solely on the goodness or badness of their consequences.

Examples:​ Ethical Egoism and Utilitarianism examples of teleological theories.

3. ​Utilitarianism​- Based on ​Jeremy Bentham and ​John Stuart Mill an English philosopher
describes that utilitarianism seek pleasure, avoid pain and you do things that are more beneficial to the
greater majority. ​Actions are to be judged by their consequences. It is the most common form and
more realistic describes that utilitarianism seek pleasure, avoid pain and you do things that are more
beneficial to the greater majority. ​Actions are to be judged by their consequences. It is the most
common form and more realistic.

B. Virtue Ethics
1. Virtues/Ethics in Nursing

Virtues​- refer to specific character traits. Examples: Honest, courage, kindness, respectfulness,
compassion, fairness.

Virtue Ethics​- It is in the heart and personality of the agent and in their character. Emphasizes
being a certain kind of person who will no doubt manifest their being in actions or
non-action.

The question is ​“What sort of person should I become?”

Aim​ to cultivate in gifted people their potential intellectual and moral qualities.

The ​Nightingale​ ​Pledge:​ Promise, purity, faith, love, loyalty, devotion, temperance, trustworthiness.

Good Character:​ is cornerstone of good nursing. Nurse will act according to principle.

2. Core Values of a Professional Nurse

a.​ ​Empathy and Caring

Empathy​- nurses ability to understand, be aware of, be sensitive to and vicariously experience
the feelings, thoughts and experience of the patients and their family.

Caring​- involves the planning and provision of culturally sensitive and appropriate care.
Caring, promoting health, healing and hope in response to the human condition.

b. ​Integrity​- respecting the dignity of a normal and wholeness of every person without condition
or limitation.

c.​ ​Diversity​- affirming the uniqueness and differences among persons, ideas, values and ethnics.

d.​ ​Excellence​- co-creating and implementing transformation and strategies with daring ingenuity.

​ ommunication​- the exchange of thoughts, messages or information vital importance to the

e. C
nursing process. A Nurse uses communication skills, speech, signals, writing and behaviour
during patient assessment as well as the planning, implementing and evaluating of nursing care.
Communicate with patients, families, groups and members of the health care team. Good in
oral and written forms of communication as well as in techniques of therapeutic
communication.

f. Teaching​- most important role of a nurse is to assist patients and their families with receiving
information necessary for maintaining patient’s optimal health. A nurse provides patients and
 families with information based on their assessed learning needs, their abilities, learning
preference and other readiness to learn.

g. Critical Thinking​- nurses constantly involved in making accurate and appropriate clinical
decisions. Able to think critically and can make decisions when patients present problems in
which there may not be clear, textbook solutions. It involves an active and organized cognitive
process.

h. Psychomotor Skills​- are the physical side of the nursing profession. Good motor skills can
perform the physical tasks of nursing with speed and finesse. Can use equipment properly.
Fundamental of nursing is the “ laying on of hands” to provide comfort, and the use of specific
skills to accomplish client assessment and to provide and evaluate nursing care.

i. ​Ethical and Legal Consideration- a​ nurse plans, provides and evaluates nursing care guided
by specific ethical and legal boundaries.

Code of Ethics- for nurses provides the ideal framework for safe and correct practices and
behaviour. Ethical Behaviour also involves accountability, responsibility, confidentiality,
truthfulness, fidelity and justice.

j. Professionalism​- ​involves the characteristics of a nurse that reflects his or her professional status.

​ rofessionals- ​are knowledgeable in their subject matter, conscientious in their actions and
P
responsible for themselves and others. Nurses enhance their professionalism by
understanding history, educational choice, professional organization and standards.

C. Ethical Principles

1. ​AUTONOMY​- Greek word ​“autos”​ (Self) and ​“nomos”​ (Governance/Rule) Latin for ​“Self Rule”

Having the right to choose/Decide for himself;

An individual has the right to determine for himself

Corollary Principles​- Honesty in our dealings with others and obligation to keep promises.

​Patient’s Rights
 > ​Right to appropriate Medical Care and Humane Treatment

> ​Right to Informed Consent

>​ Right to Information

>​ Right to Religious Belief

>​ Right to Leave

>​ Right to Express Grievances

>​ Right to Correspondence and to Receive Visitors

> ​Right to be informed of his Rights and Obligations as a Patient

>​ Right to Refuse Participation in Medical Research

>​ Right to Privacy and Confidentiality

>​ Right to Choose Health Care Provider and Facility

>​ Right to Medical Records

Patient’s Bill of Rights

> ​High quality hospital care

> ​A patient can expect to be treated with respect regardless of race, sex, gender, color,

religion, age, marital status, sexual orientation, disability or other state or condition
 >​ A patient may choose who she/he spends time with during the course of care

>​ Appropriate pain management will be provided to the patient

>​ Patients are to be free from restraints and seclusion unless completely medically necessary

>​ Providers will disclose and discuss patient’s condition and provide information about
relevant medical decisions

>​ Providers will understand who is to make decisions for the patient if she/he is unable to

> ​Patients can expect access to their medical records at will

>​ ​Providers will work to obtain information from patients about their condition and personal state

>​ Providers will work to understand the patient’s health care goals and personal values

Informed Consent Or Enlightened Consent

- Autonomy and Respect for person.

- Any procedure to be done on a person may only be administered with his free and

Informed consent. This gives valid permission for others to act in certain specific ways.

Informed Consent therefore has 2 main functions:

a. Protective​- to safeguard against intrusion of integrity.

b. Participative​- to be involved in medical decision making.

Shift from the Paternalism of ​“Doctor knows best and decides”​ to ​“Patient knows best and decides.”

Nursing Responsibilities:

Witness the signing of the consent.

Make sure the patient understands the procedure to be performed.

The ability to give informed consent depends on:

Adequate ​disclosure​ of information;

 Patient ​freedom​ of choice;

Patient ​comprehension​ of information;

4. And patient ​capacity for decision making.

By meeting these above requirements, three necessary conditions are satisfied:

1.​ ​That the individual’s decision is voluntary

2.​ ​That this decision is made with an appropriate understanding of the circumstances;

3. And that the patient’s choice is deliberate in so far as the patient has carefully considered
all of the expected benefits, burdens, risks and reasonable alternatives.

Legally, adequate disclosure includes information concerning the following:

Diagnosis:

Nature and purpose of treatment;

Risks of treatment;

4. Treatment alternatives

Proxy Consent/Legally Acceptable Representative

The patient’s family or guardian or representative provides it. This is ​Proxy Consent​. Decisions
by proxy should be based on what the patient would have chosen had he been competent or if
the patient’s preferences are not known, based on the patient’s interest.

Proxy Consent is the process by which people with the legal right to consent to medical
treatment for themselves or for a minor or a ward delegate that right to another person.

There are three fundamental constraints on this delegation:

1. The person making the delegation must have the right to consent.

2. The person must be legally and medically competent to delegate the right to consent.
 3. The right to consent must be delegated to a legally and medically competent adult.
Depending on the circumstances consent may take ​2 other forms.​

*Presumed- In cases where individuals are brought to the hospital in an unconscious state
or with no decision making capacity, that the procedures to be performed are necessary and
can’t be postponed until the person has regained consciousness or decision making
capacity.

*Vicarious Consent- For incompetent or incapacitated individuals, this right and duty of
the patient to give consent is to be exercised on her behalf by a surrogate. This is regulated
by individual state and federal laws, following various standards of surrogate decision
making, including substituted judgment and best interests.

Proxy Consent/Legally acceptable representatives

Legally Authorized Representative (LAR): An individual or judicial, or other body

authorized under applicable law to grant permission on behalf of a prospective participant
in research activities. Surrogate consent was previously referred to as ​“proxy consent”.​

Privacy- ​A state of being private, withdraw from public view or company. Privacy is justified
by the principle of Autonomy. Rights to privacy are valid claims against unauthorized access
that have their basis in the right to authorize or decline access. These rights are justified by
rights of Autonomous choice expressed in the principle for autonomy. In this respect, the
justification of the right to privacy is parallel to the justification of the right to give an
Informed Consent.

Latin ​“ privatus”​ Patient’s right.

Invasion of Privacy – If ​a patient is exposed to the public personally or thru pictures or

recording, the person responsible for his/ her exposure can be held liable if the patient has not
given his authority for the exposure. Unauthorized exposure even after death may constitute
Invasion of Privacy.​

2. ​CONFIDENTIALITY- ​Latin word ​“confidere”​ means to trust

 Relates to matters of professional ethics. It protects the client/patient from the unauthorized
disclosures of any sort by the professionals without the informed consent of the client. The
purpose of confidentiality is to ​safeguard t​ he clients right with sanctions for violations of
confidentiality. Clients must be able to assume that their private communications with the
obligation not to divulge information without the client knowledge and authorization unless it
is in the client interest to do so.

2 General Situations that may give rise to exceptions exist:

Concern safety of other specific person, the determining factor in justifying breaking
confidentiality is whether there is good reason to believe, specific individual are placed in
serious danger depending on the medical information at hand.

Concern for Public Welfare in most cases of limited confidentiality. The health care
practitioner is required to report in certain communicable infectious diseases to the public
health authorities the duty to protect.

3. VERACITY/TRUTH

Thoughts corresponds to action

“ We should declare what we think and not lie”.

*Lying – ​intention of deceiving

*Lie - ​“intrinsically evil and can never be considered lawful”

*Truth ​– Concealing the ​truth when:

Mental Reservation- ​act of the mind limiting the spoken phrase.

Not bearing the full sense of the phrase.

​ Example:​ Supposed to know but ​not​ to tell like- Cancer patient.

2. ​Mental Evasion-​ limiting the right of the patient to know about his condition.
Avoid in answering questions.

Never, tell a lie but tell them with Mental Reservation and Evasion

Conceal the truth when:

 *​You have no right to disclose the truth

*​The person has no right to know the truth

​Considerations in concealing truth when:

*It must not injure the right of another person to know the truth

*There must be a good reason for concealing the truth

*The intention for concealing the truth must be good

4. FIDELITY- ​It’s keeping one’s promises. The nurse must be faithful and true to their
professional promises and responsibilities by providing high quality, safe in a competent
manner.

5. JUSTICE- ​Latin word ​“justitia”​ – ​“jus”​ From ​“ justus” ​means lawful and rightful

Fairness; Equal distribution of resources

“Giving each one what is his due”

JUSTICE = EQUITY

EQUITY vs UNIFORMITY

Preferential option for the poor

X​- has a right to his due

Y​- has the obligation not to deprive ​X ​of his due.

Justice also means to treat equals equally

X ​and ​Y ​are equal: ​X ​and ​Y ​should have equal benefits/burdens

​4 Different Types of Justice

Commutative Justice- ​refers to that which is owed between individuals

Example:​ in conducting business transactions

 Contributive Justice- ​which refers to what individuals owe to society for the
common good

Legal Justice​- which refers to rights and responsibilities of citizens to obey and
respect the rights of all the laws devised to protect peace and social order and

Distributive justice​- which refers to what society owes to its individual members.

Example: ​the just allocation of resources.

Creating a health care policy helps decide how limited resources are to be distributed . It
should consider the principles of equality (distributive justice), social justice and solidarity.
The policy should state in clear terms the criteria for consideration, rank ordering, etc. and
this should be made public. The process must be just, though sometimes outcomes do not
appear Just.

​ eans good; ​“facere” m

​ 6. BENEFICENCE- ​Latin ​“bene” m ​ eans to do; ​Beneficentia

​Practice of doing acts of goodness, kindness and charity; suggests acts of Mercy and Charity.

Is the positive pole of non –maleficence. It means to do good, to provide a benefit.

“ Do good and do no harm”

Action that brings the most benefits and the least burden to those affected, this is the
P​rinciple of Utility.​

X- ​has a duty to benefit ​Y ​provided ​Y​- is at significant risk

X’s ​action is needed; ​X’s ​action is likely to succeed;

There is No significant risk for ​X​. The benefit to ​Y ​outweighs any harm for ​X​.

Example:​ Do overtime, during emergency, Stay and help or No help at all.

NON- MALEFICENCE

Make sure patient is safe and not harmed

 “ Do not inflect harm’’ ​means to do No, to prevent, to remove or ​not​ to risk harm.

X​- has a right Not to be harmed;

Y​- has an obligation, Not to harm ​X

Harm maybe physical, mental, psychological, social, financial, spiritual etc.

Example: ​Hippocratic Oath-​“ I will never use treatment to injure or wrong the sick”

D. Other Relevant Ethical Principles

1. ​Principle of Double Effect​- is a set of ethical criteria which Christian philosophers, and some
others have advocated for evaluating the permission of acting when one’s otherwise legitimate act
(for example, relieving a terminally ill patient’s pain) may also cause an effect one would
otherwise be obliged to avoid (Sedation and a slightly shortened life).

An action done with two results: ​good or bad

4 Conditions of Double Effect:

The act must be good in itself

The intention must be good

Proportion of graveness must be weighed (the good must outweigh the bad effects)

Good effects must follow from the action as immediately as do the harmful effects

2. ​Principle of Legitimate Cooperation- ​to assist​ ​in​ ​performing an evil act.

2 Types of Cooperation​:

a. ​Formal Cooperation

Involvement

Intention/Knowledge
 b. ​Material Cooperation

Involvement

Intention

Cooperation is permissible and obligatory if:

Refusal to cooperate would result in a greater evil than if we cooperate

The cooperation is not immediate and is more remote than the greater evil involved Material
Cooperation and Cooperation and Scandal

Example: A nurse who disapproves yet takes an active part in the procedure cooperates
immediately and her action is not justified, yet a nurse who cares for the patients after the
abortion cooperates only materially and remotely.

Such cooperation might be justified if her refusal would imperil her ability to continue in her
profession and scandal can be avoided. This would not justify, however working in a facility
devoted exclusively to abortion , since this would certainly give scandal.

3.​ Principle of Common Good and Subsidiary

Vatican II defined the common ​Good ​as ​“sum total of social conditions which allows people, either
as groups or as individuals, to reach their fulfillment more fully and more easily.” It is about
the progress of persons.

A society that wishes and intends to remain at the service of the human being at every level is a
society that has the common good. the good of all people and of the whole person as its primary
goal.

The common good comes into existence in a community of solidarity among active, equal agents.

The duty of all is to make the sacrifices necessary so that those who are marginalized can also
become active participants. ​“It is not enough to draw on surplus goods which in fact our world
abundantly produces; It requires above all a change of lifestyles, of modes of production and
consumption, and of established structures of power which today govern societies.”

We must be interested in the good of all, even of people nobody thinks about because they have no
voice and no power. The goods of the earth are there for everyone. The common good consists
 not only of the material or external good of all human beings; it also includes the comprehensive
good of the human being, including even the spiritual good.

The common good of society is not an end in itself. It is only part of a bigger picture, the ultimate
end which is God. The common good, as a mere materialistic social economic ideal, would count
for little without any transcendental goal.

Subsidiarity- ​Often considered a corollary of the principle of the common good, subsidiarity
requires those in positions of authority to recognize that individuals have a right to participate
in decisions that directly affect them, in accord with their dignity and with ​their responsibility
to the common good.

Every task of society should be assigned to the smallest possible group that perform it. Only
if the smaller group is unable to resolve the problem itself should a group at a higher level
assume responsibility. This idea is summed up in the ​principle of subsidiarity.​

Example: if a family is experiencing problems, the state can intervene only if the family or
the parents are overburdened and cannot resolve them. It helps to avoid too much
centralization. Being able to help oneself is an important component of the dignity of the
human person.

Principles of Bioethics

Principle of Stewardship and Role of Nurses as Stewards

Stewardship​- An act of delegation of responsibility. Assumes responsibility for providing

necessary physical for the patients needs. The nurse presents information to the patient that will help
illness and will assist with possible regaining health status.

Steward- ​May be characterized as a person who preserves and promote intrinsic value of a
situation, as well as engage others in solutions and actions. Means keeper; Responsible
for the care of the body of oneself and of others. ​“The Lord God took the men and
settled him into the Garden of Eden to cultivate and care for it”​ (Genesis 2:15)

Accountability​- related to both responsibility and answerability.

 According to the American Association (1985) it refers to being answerable to someone for
something one has done. It is grounded in the moral principles of fidelity and respect for the
dignity, worth and self – determination of clients. Safe, autonomous practice is ensured thru
various processes of nursing accountability.

Personal- ​Involves valuing and respecting patient’s priorities and self- determination. Nurse
becomes stewards or teachers to patient who may have not expertise or experiences in the disease
process but who understand the consequences of their illness. The primary role of a nurse is to
advocate and care for individuals of all ethnic origins and religious backgrounds and support them
through health and illness. However, there are various other responsibilities of a nurse that form a
part of the role of a nurse, ​including to:

​ ecord medical history and symptoms

*R

*Collaborate with team to plan for patient care

*Advocate for health and well being of patient

*Monitor patient health and record signs

*Administer medications and treatments

*Operate medical equipment

*Perform diagnostic tests

*Educate patients about management of illnesses

*Provide support and advice to patients

Social- ​is a concept​ ​that offers nurse to be a leader in critical insight how they can assist and extend
their practice of bearing witness.

*Nurses role play a dynamic and crucial role in health care. A nurse is usually the first person a
patient interacts with. Nurses are responsible for assessing patients’ needs and diagnosing illnesses.
As such, nurses are an integral part of the comprehensive standards of care and health promotion.

*Nurses can teach their patients education regarding the disease process that maybe affecting the
patient at that time.

*Nurses give patients resources to improve their lives and disease outcomes.

*Nurses pass medications and teach procedures to patients to help them achieve compliance with
their health related needs.
Ecological- ​nurses give patients resources to improve their lives and disease outcomes. Nurses pass
medications and teach procedures to patients to help them achieve compliance with their health
related needs. Expanding Role for Nurses with New Global Health Challenges. Nurses have long
taken a lead in helping patients address the physical impact of aging and chronic disease, as well
the psychological factors that affect how patients manage their conditions. Nurses have the ability
to use their trusted skill sets and lead the way for sustainable healthy communities and
environments in which they serve.

Biomedical- ​nurses lead in the establishment of value–based practices that affect health care
organization and may facilitates in their value priorities . Nurse stewardship embraces character,
dialogue and shared values.

Role of the Nurse in Biomedical Waste Management

Visit all wards and high risk units regularly. Ensuring that samples (Blood, stool,
urine, etc.) are collected and dispose safely. Monitoring and supervising the staff
weather they are doing safe disposal of waste as color coded. Prevention of hospital
acquired infections by following universal precautions.

Principles of Totality and its Integrity

Latin word “​ totalis” ​means Removal/Structural change of body part(s) to promote

optimal functioning of total body.

“ The whole is more important than the parts”

Totality- ​refers ​to the whole every person must develop, use, care for and preserve all his parts
and functions for themselves as well as for the good of the whole. If a part or lower function
harms the whole, this part or lower function maybe sacrificed for the good or better function of
the whole. The basic capacities which define human person hood, however, are sacrificed only
when there is a need to preserve life.

2 Types of Totality/ Wholeness

Functional wholeness​- ability to perform tasks optimally.

Structural wholeness- ​anatomical completeness

Integrity​- refers to each individual’s duty to preserve a view of the whole human person in which
the values of intellect, will, conscience and fraternity are preeminent. Integrity is being honest
even when no one else is looking. It is doing the right thing even when no one is around to see
 you do it. Integrity is doing things the way they should be done, when no one is looking, instead
of doing short cuts.

A. Ethico-Moral Responsibility of a Nurse in Surgery

Aspects In Nursing Mora​l- personal/private interpretation from what is good and bad.

Ethical Principles:​ Autonomy- the right/freedom to decide

(the patient has the right to refuse despite the explanation of the nurse)

Example:​ Surgery or any procedure

Sterilization/ Mutilation

Sterilization- is any number of medical methods of birth control that intentionally leaves a person
unable to reproduce. Sterilization methods include surgical and non –surgical, and exist for both
males and females. It refers to any process that effectively kills or eliminates communicable
agents as fungi, bacteria, viruses, spore forms, etc. from a surface, equipment, article of food or
medication or biological culture medium.
 Sterilization is a surgical technique leaving a male or female unable to reproduce.

It is a method of birth control.

Male​- Vasectomy; ​Female- ​Tubal Ligation

Sterilization is a simple operation to tie up the vas deferens of male (Vasectomy) or by tying or

cutting off the Fallopian tube of the females (Tubal Ligation) so that the sperm and the egg would

not be able to meet each other. No organs are removed.

Sterilization may be therapeutic or non therapeutic, voluntary or involuntary.

Therapeutic Sterilization ​implies the removal of all or part of the reproductive organs to
protect the health and the life of the client.
Non therapeutic sterilization, often called Convenience Sterilization ​is the purpose of
destroying the removal of all or part of the reproductive organs for the purpose of
destroying the reproductive function.
Voluntary Sterilization ​is a term synonymous with non therapeutic and ​convenience sterilization.
Involuntary Sterilization ​is compulsory sterilization of individual reasons for Eugenic reasons.

Mutilation-​ Latin word ​“mutilus”

Mutilation or Maiming is cutting off or injury to a body part of a person so that the part of the
body is permanently damaged, detached or disfigured.
Mutilation maiming is an act or physical injury that degrades the appearance or function of
the (human) body, usually without causing death.

C . Preservation of Bodily Functional Integrity

 The functional integrity of the person may be sacrificed to maintain the health or life of the
person when no one other normally permissible means is available. The principle of
totality is based on the natural law which says that life is to be preserved and maintained.

Artificial means of preservation comprise the application of simple heat or cold, powders
such as a sawdust bed mixed with zinc sulphate, evisceration combined with immersion,
drying, local incision and immersion, arterial injections, cavity injections. Furthermore,
simple immersion in alcohol, brine etc., and sole arterial injection, which can be
combined with cavity treatment and/ or immersion were used.

Issues on Organ Donation

Human sexuality and its Moral Evaluation

SEXUAL meaning makes us realize the need for some measure of fulfilment that only the
other can give.

One has to be free from self-centeredness by opening one to the other person.

Human sexuality is giving until nothing more is to give.

A happiness that is sought for ourselves alone can never be found. For happiness that is
diminished by being shared is not big enough to make us happy

Making someone happy

MARRIAGE

Marriage is also called matrimony or wedlock. It is a culturally recognised union between

people called spouses, that establishes rights and obligations between them and their
children and between them and their in-laws.

FUNDAMENTALS OF MARRIAGE

Love/Commitment - Marriage is a decision to be committed through the ups and downs, the
good and the bad. When things are going well, commitment is easy. But true love is
displayed by remaining committed even through trials of life.
Sexual faithfulness - Includes your eyes, mind, heart and soul. When we devote our minds to
sexual fantasies about another person, we sacrifice sexual faithfulness to our spouse. It
requires self-discipline and an awareness of the consequences.

Communication - they certainly discuss kid’s schedule, grocery list, and utility bills but they
don’t stop here. They also communicate hopes, dreams fears and anxieties. They don’t just
discuss the changes that are taking place in the kids life they also discuss changes that are
taking place in their own hearts and souls​.

4. Selfishness – Although it will never show up on any survey, more marriage are broken
up by selfishness than any other reason. Surveys blame it on finance, lack of commitment,
infidelity or incompatibility but the root cause for most of these reason is selfishness

5. Humility- An essential building block of a healthy marriage is the ability to admit that
you are not perfect , that you will make mistakes and that you will need forgiveness.

6. Patience/Forgiveness- Because no one is perfect, patience and forgiveness is always

required in a relationship​.

7. Time- Relationship don’t work without time investment.

8. Honesty and Trust- Honesty and trust become the foundation for everything in a
successful marriage.

PREMARITAL SEX

Is a sexual activity practiced by people before they are married.

Was considered a moral issue which was taboo in many cultures and considered a sin by a
number of religions.

HOMOSEXUALITY

Romantic attraction, sexual attraction, or sexual behavior between members of the same
sex or gender. As a sexual orientation homosexuality is an enduring pattern in emotional,
romantic and or sexual attractions to people of the same sex.

Bisexuality

Bisexuality​ is romantic attraction, sexual attraction, or sexual behaviour toward both males
and females, or to more than one sex or gender. It may also be ​defined​ as romantic or
sexual attraction to people of any sex or gender identity, which is also known as pan
sexuality.

Heterosexual

A ​heterosexual​ person is attracted to people of the opposite sex. Boys who like girls and
women who like men are ​heterosexual​. Being ​heterosexual​ has long been considered
"normal" in our society. However, being ​heterosexual​ is only one sexual orientation. Other
people are gay, or homosexual.

Issues on Contraception , its Morality and Ethico-Moral Responsibility of Nurses

The main issues that raise ethical dilemmas following the development of assisted
reproduction techniques are:

The right to procreate or reproduce

The process of in vitro fertilization itself- is it morally acceptable to interfere in the

reproduction process?

The moral status of the embryo

The involvement of a third party in the reproductive process by genetical material donation

The practice of surrogacy, cryopreservation of embryo’s

Assisted reproduction can raise complicated ethical changes for the individuals involved
health care professionals and the greater society. One ethical dilemma associated with ARTs
involve:

The politics of embryo’s and what to do with unused embryos. For both clinical reasons,
clinics are reluctant to dispose of embryos without a couple’s consent.

Third-party reproduction, in which another person enters into the baby-making mix also
involves risks and raises many important ethical concerns.

Artificial Insemination

Is the deliberate introduction of sperm into a female’s cervix or uterine cavity for the
purpose of achieving a pregnancy through in vivo fertilizations by means other than sexual
interactions.

In Vitro-fertilization
In vitro fertilization is a process of fertilization where an egg is combined with the sperm
outside the body, in vitro. The process involves monitoring and stimulating a woman’s
ovulatory process, removing an ovum or ova from the woman’s ovaries and letting sperm
fertilize them in a liquid in the laboratory.

SURROGATE MOTHERHOOD

Practice in which woman bears in child for a couple unable to produce children in a usual
way, usually because the wife is interfile or otherwise unable to undergo pregnancy. In so
called traditional surrogacy, the surrogate mother is impregnated through artificial
insemination with the sperm of the husband.

Morality of abortion

Abortion is used in this discussion to refer to deliberate removal of a fetus from the womb
of a human female, at the request or through the agency of the mother,so as in fact to
result in the death of the fetus but with insignificantly small risk to the life or health of the
mother.

Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus before

it can survive outside the uterus. Abortion that occurs without intervention is known as a
miscarriage or spontaneous abortion.

MORALITY OF RAPE

Rape act of sexual intercourse with an individual without his or her consent, through force
or the threat of force. In many jurisdictions, the crime of rape has been subsumed under
that sexual assault, which also encompasses acts that fall short of intercourse. Rape was
long considered to be caused by unbridled sexual desire but it is now understood as a
pathological assertion of a power over a victim.

Presentation to bioethics
DIGNITY IN DEATH AND DYING

Euthanasia and prolonging of life

Inviolability of human life

Euthanasia and suicide

Dysthanasia
Orthothanasia

Administration of drugs to the dying

Advance to directives

DNR or END Of Life

NURSING ROLES AND RESPONSIBILITIES

ETHICAL DECISION MAKING PROCESS

DIGNITY IN DEATH AND DYING

Dying with dignity is a movement that promotes the ability to meet death on your own
terms. Dying with dignity involves offering options to terminally ill patients, like Sarah, other
than just waiting for the illness to kill them slowly.

TWO MAJOR WAYS TO DIE WITH DIGNITY

SUICIDE

EUTHANASIA

Principle of Ethics in Research

First Provision of Nuremberg Code:

“voluntary consent of human subjects absolutely essential”

Subject are made fully aware of nature and purpose of research

Consent is voluntary given
Person involved have the legal capacity to give consent
Responsibility for obtaining consent rests with the researcher

The Declaration of Helsinki

The well -being of the human subject should take precedence over the interest of science
and society.
Consent should be in writing.
Use caution if participant is in dependent relationship with researcher.
Limit use of placebo
Participants benefits from researcher.

Belmont Report
Respect for person​: treating people as autonomous agents and protecting those with
diminished autonomy.
Beneficience:​ minimizing potential harms and maximizing benefits of participation
Justice:​ distributing benefits/risk fairly.

Ethico- Moral Aspect In Nursing

Ethics
Ethos​-comes from the Greek word which means character/culture.
Branch of philosophy which determines or study morality (right and wrong).
Systematic inquiry into principles of right, from good & evil as they relate to
conduct
Moral-​personal/private interpretation from what is good and bad.

Types of ethics

Bioethics​- branch of ethics that studies moral values in the biomedical sciences

Clinical Ethics-​concerned with ethical problems at the bedside that arise within the context
of caring for actual patients.
Nursing Ethics​-study of ethical issues that arise in the daily practice of nursing & of the
analysis used by nurses to make ethical judgement.
Ethical Principles:

Autonomy​-- the right/ freedom to decide ( the patient has the right to refuse despite the
explanation of the nurse).
Nonmaleficence​- the duty not to harm or inflict harm to others ( harm maybe physical
,financial or social.)
Beneficence​- for the goodness and welfare of the client.
Justice​- equality/ fairness in terms of resources/personal.
Veracity​- the act of truthfulness
Fidelity​- faithfulness/loyalty to client.

Moral Principle:

Golden rule
The principle of Totality- The whole is greater than its parts.
Epikia​- There is always an exemption to the rule.
One who acts through as agent is herself responsible-(instrument to the crime).
The end does not just justify the means
Defects of nature maybe corrected.
No one is obliged to betray herself- You cannot betray yourself
If one is willing to cooperate in the act, no justice is done to him
A little more ora little less does not change the substance of an act.
No one is held to impossible

Law​-rule of conduct commanding what is right and what is wrong.

Derived from an Anglo-Saxon term that which is laid down or fixed.
Court​- body/agency in government wherein the administration of
justice is delegated.
Plaintiff​- complainant or person who flies the case ( accuser).
Defendant​- accused/ respondent or person who is the subject of
complaint
Witness​ – individual held upon to testify in reference to a case
either for the accused or against the accused.

Written orders of cour​t:

Writ-​ legal notes from the court
 Summon​- notice to a defendant/accused ordering him to appear in
court to answer the complaint against him
Warrant of Arrest​- court order to arrest or detain a person
Search Warrant​- court order to search for properties
Private/Civil Law​-body of law that deals with relationship among
private individuals.
Public Law​-body of law that deals with relationship between
individuals and the state/governments and government agencies.
Tort Law​- is a civil wrong committed against a person or a person
property.

6 Elements of Nursing Malpractice:

Duty​- the nurse must have relationship with the client that involves providing care and
following a standard of care.
Breach of duty​- the standard of care expected in a situation was not observed by the nurse.
Foreseeability-​a link must exist between the nurse act and the injury suffered.
Causation-​it must be proved that the harm occurred as a direct result of the nurse failure to
follow the standard of care and the nurse should or could have know that the failure to
follow the standard of care could result in such harm.
Harm/injury​- physical, financial, emotional, as a result of the breach of duty to the client.
Damages-​amount of money in payment of damage /harm/injury.

Ethico-Moral Aspect Of Nursing Practice:

Values
-enduring beliefs or attitudes about the worth of a person,
objects, idea, or action.

Beliefs (Opinions​)
-interpretations or conclusions that people hold as true.
Based on faith that fact & may not be true.

Attitude
-mental positions/feelings toward a person object or idea.

Values Clarification
-process by which people identify, examine & develop their
own individual values.
 5 Attribute of Caring
Compassion​- sorrow for the suffering or trouble of another with an urge to help.
Competence​- condition in qualification of being able to perform according to standard.
Commitment-​ dedication to a long term course of action, engagement or involvement.
Confidence​- beliefs in one own abilities, to
feel certain
Conscientious​- doing things according to what is right, showing care or precision, honest.

Guidelines and Protocol in Documentation and Health

Care Records

Key Point Summary

Documentation includes all forms of documentation by a doctor, nurse or allied health

professional
(physiotherapist, occupational therapist, dietician etc.) recorded in a professional
capacity in relation to
the provision of patient care.
Documentation and record keeping is a fundamental part of clinical practice. It demonstrates
the
clinician’s accountability and records their professional practice.
Documentation is the basis for communication between health professionals that informs of
the care
provided, the treatment and care planned and the outcome of that care as a continuous
and
contemporaneous record.
Documentation is a record of the care and the clinical assessment, professional judgement
and critical
thinking used by a health professional in the provision of that care
Documentation should be clear, concise, consecutive, correct, contemporaneous, complete,
comprehensive, collaborative, patient-centred and confidential.
Documentation must be patient focused and based on professional observation and
assessment that
does not have any basis in unfounded conclusions or personal judgements.
Clinical staff must able to competently communicate effectively with individuals and groups
using formal
and informal channels of communication and ensuring documentation is accurate and
maintains
confidentiality.
Clinical staff are required to make and keep records of their professional practice in
accordance with
standards of practice of their profession and organisational policy and procedure.
Documentation is often used to evaluate professional practice as a part of quality assurance
mechanisms such as performance reviews, audits and accreditation processes, legislated
inspections
and critical incident reviews.
Documentation systems should promote appropriate sharing of information amongst the
multidisciplinary
and teams.
Accurate and comprehensive documentation is a valuable source of data for data coding,
health
research and a valuable source of evidence and rationale for funding and resource
management.
Documentation should record both the actions taken by clinical staff and the patient’s needs
and/or their
response to illness and the care they receive.
Clinical staff have legislative, professional and ethical obligations to protect patient
confidentiality. This
includes maintaining confidential documentation and patient records.
Precautions must be taken to ensure that clinicians are fully informed of appropriate, safe
and secure
use of electronic information systems and the potential risks involved in using such
systems in ensuring
and maintain confidentiality.
It should be assumed that any and all clinical documentation will be scrutinised at some
point

These guidelines support employers, policy makers, managers and clinical staff in
documentation practices and policies
that demonstrate the professional obligation, accountability and legal requirements to
communicate
patient health information and clinical interventions in the public interest. It should be
assumed that any and all
clinical documentation will be scrutinized at some point.

Ethical Issues Related to Technology in the Delivery of

Health care
The work of Marckmann and Goodman states that not only has computer-based
information and communication technologies served in transforming health care delivery but
as well it has transformed “the conception and scientific understanding of the human body
and the disease that afflict I”.

Data Protection and Security

Data protection

The purpose of data protection (also known as information privacy and data privacy) is to
define when and on what conditions personal data can be processed. All data related to an
identified or identifiable natural person (the data subject) is personal data.

A controller is a person, company, authority or community that defines the purposes and
methods of processing personal data whereas a processor is a third-party processing
personal data on behalf of a controller.

Principles of data protection

The key principles of data protection are to s

​ afeguard​ and m​ ake available data
under all circumstances.​ The term d ​ ata protection​ is used to describe both the
operational backup of data and business continuity/disaster recovery (BC/DR).
Data protection strategies are evolving along two lines: ​data availability and data
management.

Data availability- e​ nsures users have the data they need to conduct business even
if the data is damaged or lost.
Data management- h ​ as come to include finding ways to unlock business value
from otherwise dormant copies of data for reporting, test/dev enablement, analytics
and other purposes.

There are two key areas of data management

Data lifecycle management- i​ s the process of automating the movement of

critical data to online and offline storage.
Information lifecycle management-​ is a comprehensive strategy for valuing,
cataloging and protecting information assets from application and user errors,
malware and virus attacks, machine failure or facility outages and disruptions.

Security
 Information security means protecting the confidentiality, integrity and availability of
any data that has business value. The requirements for information security can be legal
and regulatory in nature, or contractual, ethical, or related to other business risks.

Classification of information and compliance\

Classifying information is about identifying information assets that are sensitive to
the business, individuals and/or subjects to legal requirements. This allows an
organisation to focus and prioritise security investments.

In practice, this means keeping information classes to a minimum (e.g. open,

confidential, secret) and binding these classes to simple rules.

Addressing security within supplier agreements

Developing innovative, scalable and user-friendly services typically means working with
partners. In today’s world, organisations share data and parts of their business with third
parties ranging from cloud and IT suppliers, advisors, sponsors, competitors to start-ups.
Maintaining trust and ensuring business continuity, means also ensuring that the partners
also share the same security principles.

The main difference between protection and security is that the protection focuses
on internal threats in a computer system while security focuses on external threats to
a computer system.

REPUBLIC ACT NO. 10173

A
​ N ACT PROTECTING INDIVIDUAL PERSONAL INFORMATION IN INFORMATION
AND COMMUNICATIONS SYSTEMS IN THE GOVERNMENT AND THE PRIVATE
SECTOR, CREATING FOR THIS PURPOSE A NATIONAL PRIVACY COMMISSION, AND
FOR OTHER PURPOSES.

How do I remain in compliance of the Data Privacy Act?

The National Privacy Commission, which was created to enforce RA 10173, will check
whether companies are compliant based on a company having ​5 elements:

Appointing a Data Protection Officer

Conducting a privacy impact assessment
 Creating a privacy knowledge management program
Implementing a privacy and data protection policy
Exercising a breach reporting procedure

The benefits of IT in healthcare

Increase in financial benefits
Research has revealed that large hospitals implementing electronic health records
have earned between $37M and $59M in a period of five years.
Faster turnaround time
IT systems enable the auditing of patient records to happen in 1.4 hours as opposed
to the 3.9 hours it would take using a paper-auditing system.

Improved patient care

Medical practitioners regularly use tablets and handheld devices to record real-time
patient data and then share it instantly within their updated medical history, storing
it in one centralised area – which increases the effectiveness and efficiency of patient
care.
Improvement of healthcare and disease control
Software programs that classify illnesses, their causes and symptoms, into massive
databases, allow medical professionals and researchers to find and retrieve valuable
information that can be used to fight disease and improve healthcare.
The implementation of value-based care
Value-based care is about considering the patients and giving them safe,
appropriate, and effective care with enduring results, at a reasonable cost. But an
important way to understand value is through measurement. IT in healthcare allows
medical professionals to track and record the necessary data in order to ensure they
can provide value-based care that works.

The challenges of IT in healthcare

An insufficient data storage capacity

Data storage needs for healthcare double approximately every 18 months. Improving
the storage capacity of data will require more effective software solutions to accommodate
this massive influx of information.

Cybersecurity concerns and data breaches

The Health Insurance Portability and Accountability Act (HIPAA) has set a high standard
for encryption technology with the increased threat of repercussions and fines for data
breaches of personal health information. Security breaches could cause incidents ranging
from lost patient data to lost revenue and reputational damage, and potentially
life-threatening incidents.

The growing cost of IT in healthcare

Government regulations, growing energy needs and pressure to coordinate with the
insurance requirements proves to be increasingly costly to healthcare organisations.

Current Technology: Issues and Dilemma

Helix and DNA Tests

Helix i​ s an online platform hosting deals and packages for DNA tests, essentially
trivializing your genetic material into something of a party game, or conversation starter.

Social Credit Systems

The Chinese government is currently compiling data on everything from
shopping habits, credit ratings, online behavior, friend connections and more for
each of its citizens and businesses.

Ransomware
Ransomware is like a virus. It allows hackers to seize control of your computer or
device and lock you out, while threatening to steal or delete your important files.
Sometimes it masquerades as a government entity seizing your device. Most often,
the criminals behind the attack demand the victim to pay a hefty fine.