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LEARNING OBJECTIVES
At the end of the unit the learner will be able to:
1. Discuss the concept of bioethics and other related terminologies;
2. Apply ethical concepts in order to clarify ethical issues in healthcare;
3. Utilize ethical concepts through the process of ethical reflection in order to examine personal values;
and be sensitive with ethical issues in the practice of the profession.
4. Understand the meaning of Bioethics, health care ethics and Nursing ethics
5. Recognize the importance of bioethics in the field of nursing
6. Identify the difference between deontology, utilitarianism and teleology
7. Explain the importance of virtue ethics in the field of nursing
8. Demonstrate the core values of a professional nurse

STUDY GUIDE
Introduction to Bioethics

BIOETHICS- is a field of study concerned with the ETHICS and philosophical implications of
certain biological and medical procedures, technologies, and treatments, as organ transplants,
genetic engineering, and care of the terminally ill.
A science that deals with the study of the morality of human conduct concerning human life in all its
aspects from the moment of its conception to its natural end.

HEALTHCARE ETHICS-is the field of applied ethics that is concerned with the vast array of moral
decision-making situations that arise in the practice of medicine in addition to the procedures and the
policies that are designed to guide such practice. Health ethics is employed to regulate human conduct
in the practice of health care so that the good may be done and evil may be avoided thereby ensuring
the purpose of health care.

NURSING ETHICS- can be defined broadly as the examination of all kinds of ethical and bioethical
issues from the perspective of nursing theory and practice which, in turn, rest on the agreed core
concepts of nursing, namely: person, culture, care, health, healing, environment and nursing itself

PROFESSIONAL ETHICS - Is the division of ethics that relates to professional behavior

ETHICS
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It is a PRACTICAL science of morality of human conduct that implies direction;

Science – deals with complete and systematic body of factual and empirical data and reasoning;
Moral – dictates of reason on how things should be
Human conduct – deliberate, free and how one person SHOULD ACT
Ethics - concerns the needs and values of human persons in all matters of human concern including
HEALTH; nothing is more human and personal than HEALTH;
Ethics is concern with the study of social morality and philosophical reflection on its norms and practices;
Moral issues deals with respect for life, freedom, love, issues that provokes conscience; issues that
responds to ought, should, right, wrong, good, bad and complicated

The Human Being

The PERSON
 (Biblical) Created in the image and likeness of God; differing from animals due to
possession of spiritual intelligence and free will;
 God produces the human body through the cooperation of human parents; the creation
of the human soul is direct act of God;
 Each person is unique and irreplaceable; and are called not only to maturity but to eternal
life

HUMAN ACTS & ACTS OF MAN

 Human act is an act which proceeds from the deliberate free will of man. Man knows what he is
doing and freely chooses to do what he does;
 Not all acts are Human Acts; for an act to be human it must have:
 KNOWLEDGE and FREEDOM

HUMAN ACTS & ACTS OF MAN

 KNOWLEDGE – of what it is about and what it means

 facts, information, and skills acquired by a person through experience or education; the
theoretical or practical understanding of a subject:
 awareness or familiarity gained by experience of a fact or situation
 FREEDOM – to do or leave it undone without coercion or constraint;
 it implies voluntariness which is to rationally choose by deliberate will the object
 an idea of reason that serves an indispensable practical function. Without the assumption of
freedom, reason cannot act.
 CONSCIENCE – spiritual discernment;
 The capacity to make practical judgement in matters involving ethical issues;
 It is person’s most secret sanctuary where he/she is alone with God;
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 Hence the more a correct conscience prevails the more do persons and groups turn aside from
blind choice and try to be guided by the objective standards of moral conduct (SVC 1965)

Ethical Philosophers/Bioethicists

Immanuel Kant
(1724-1804)
 A German philosopher
 was an opponent of utilitarianism
 Our emotional preferences which provides us with values, must be checked against certain
rational standards of a PURELY formal kind;
 Supreme principle of morality referred to as The Categorical Imperative (CI);
 Any choices we make must be such that we would be willing for everyone else to make the same
choices (universality).

John Bordley Rawl

 Born: February 21, 1921
 an American moral and political philosopher;
 Professorship at Harvard University, University of Oxford;
 His magnum opus, A Theory of Justice (1971
 According to English philosopher Jonathan Wolff, John Rawls was the most important political
philosopher of the 20th century
 Social Contract as a solution to Distributive Justice (the socially just distribution of goods in a
society);
 Resultant theory known as "Justice as Fairness”:
 1. Society should be structured so that the greatest possible amount of liberty is given to its
members,;
 2. Inequalities either social or economic are only to be allowed only if the worst will result under
an equal distribution;
 Finally, if there is such a beneficial inequality, this inequality should not make it harder for those
without resources to occupy positions of power, for instance public office.
St. Thomas Aquinas

 Born 1225; Sicily, Italy

 Proclaimed Doctor of the Catholic Church } Joined the Dominican Order
 (Order of Preachers – OP)
 Thomas's ethics - "first principles of action.“ } Summa theologiae , he wrote:
 Virtue denotes a certain perfection of a power;
 Now a thing's perfection is considered chiefly in regard to its end;
 But the end of power is act. Wherefore power is said to be perfect, according as it is determinate
to its act.[82] St. Thomas Four Cardinal Virtues
 Prudence
 Temperance
 Justice
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 Fortitude
 The object of the theological virtues is GOD Himself, Who is the last end of all, as surpassing
the knowledge of our reason;
On the other hand, the object of the intellectual and moral virtues is something comprehensible to human
reason. Wherefore the theological virtues are specifically distinct from the moral and intellectual virtues

William David Ross

• Born: April 15, 1877; Thurso, Scotland
• Scottish philosopher
• Education: University of Edinburgh
• The moral order...is just as much part of the fundamental nature of the universe (and...of any
possible universe in which there are moral agents at all) as is the spatial or numerical structure
expressed in the axioms of geometry or arithmetic;
• "moral intuitionist" theory,
• According to W. D. Ross (1877-1971), there are several prima facie duties that we can use to
determine what, concretely, we ought to do.
• A prima facie duty is a duty that is binding (obligatory)
• "Unless stronger moral considerations outweigh, one ought to keep a promise made."

Theories and Principles of Health Care Ethics

Moral philosophy is the branch of philosophy that examines beliefs and assumptions about certain human
values. Ethics is the practical application of moral philosophy; that is, given the moral context of good or
bad, right or wrong, “What should I do in this situation?” The philosopher reveals an integrated global
vision in which elements, like pieces of a puzzle, have a logical fit. By developing theories of ethics, the
philosopher hopes to explain values and behavior related to cultural and moral norms. Each theory is
based upon the particular viewpoint of the individual philosopher, and maintains, within itself,
philosophical consistency.

1. Deontology- Deontological theories of ethics are based upon the rationalist view that the
rightness or wrongness of an act depends upon the nature of the act, rather than its consequences. The
term deontology is taken from the Greek word for duty. Occasionally, deontology is called formalism;
some writers refer to this type of ethical theory as Kantianism. Kantianism is based upon the writings of
the German philosopher Immanuel Kant, who shaped many deontological formulations.

• Act only according to that maxim by which you can at the same time will that it should become a
universal law.
• Act so that you treat humanity, whether in your own person or that of another, always as an end
and never as a means only.

Deontology also implies that ethics are derived from fulfilling duties. One must act for the sake of duty or
obligation. Most professional codes of ethics are based upon Kantian principles. Nurses’ codes of ethics
stress both the importance of fulfilling duties that are inherently owed to patients and the importance of
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preserving the dignity and autonomy of each individual patient. For example, section 1.2 of the ANA Code
of Ethics for Nurses (Appendix A) notes that, “The nurse establishes relationships and delivers nursing
services with respect for patient needs and values, and without prejudice.” This statement presumes that
the nurse has a duty to respect and care for the patient in terms of the patient’s own needs and values.
It demonstrates the principles of respect for person, beneficence, and autonomy. These principles are so
pervasive in the profession that they often go unnoticed. When you maintain confidentiality, when you
advocate for a patient, when you keep your promises, when you tell the truth, and when you practice with
expert skill, you are utilizing deontic principles.

2. Utilitarianism- Utilitarianism is a pivotal form of moral philosophy for health care delivery.
Sometimes called consequentialism, utilitarianism is a type of teleological theory. Telos comes from the
ancient Greek language and literally means end: Utilitarianism is the moral theory that holds that an
action can be considered good or bad in relation to its end result. Utilitarianism is an important ethical
philosophy that has its basis in naturalism. According to the utilitarian school of thought, the right action
is that which has the greatest utility or usefulness. No action is, in itself, either good or bad. Utilitarian
hold that the only factors that make actions good or bad are the outcomes, or end results, that are derived
from them.

• The end justifies the means

Utilitarianism is widely used in the health care system. It is the basis for many policy-level decisions about
the distribution of health care services and can be integral to medical emergency triage decisions. Policy
makers attempt to wisely appropriate public funds. The debates about funding are often in the news and
include topics on a variety of public programs, such as Medicare, Medicaid, managed care, family
planning, pediatric services, mental health, and others. As these programs focus on delivering cost-
effective health care to large numbers of people, they serve very specific narrow populations (denying
resources to others) and provide or deny very specific services—all based upon utilitarian principles. In
emergency situations such as war or natural disasters, utilitarianism may become the default method of
making these types of decisions.

3. Consequentialism/Teleology- Consequentialist moral theories evaluate the morality of actions

in terms of progress toward a goal or end. The consequences of the action are what matter, not their
intent. This is in contrast to previously noted theories (e.g., deontology, virtue ethics, and natural law)
that consider intent. Consequentialism is sometimes called teleology, using the Greek term telos, which
refers to “ends.” Thus, one finds that the goal of consequentialism is often stated as the greatest good
for the greatest number.

Virtue Ethics in Nursing

Virtue ethics, sometimes called character ethics, represents the idea that individuals’ actions are based
upon a certain degree of innate moral virtue. First noted in the writings of Plato, Aristotle, and early
Christian thinkers, there has been a contemporary resurgence of interest in virtue ethics. Western
moralism emerged with the idea of the cardinal virtues of wisdom, courage, temperance, justice,
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generosity, faith, hope, and charity (Kitwood, 1990). Modern and contemporary writers also include such
virtues as honesty, compassion, caring, responsibility, integrity, discernment, trustworthiness, and
prudence. Though nearly absent in nursing ethics texts in the past 20 years, virtue ethics is re-emerging
as an important framework for examining moral behavior.

Focal Virtues

In the discussion of virtue as related to biomedical ethics, Beauchamp and Childress (2008) define
character as being made up of a set of stable traits that affect a person’s judgment and action. Like
Aristotle, these authors suggest that although people have different character traits, all have the capacity
to learn or cultivate those that are important to morality. Beauchamp and Childress propose that there
are four focal virtues that are more pivotal than others in characterizing a virtuous person: compassion,
discernment, trustworthiness, and integrity.

Virtue Ethics in Nursing

How does the concept of virtue or character ethics fit with nursing as a principled profession? It is likely
that principled behavior, while not the sole domain of a good moral character, is more likely to occur in
the presence of one. Certainly, Florence Nightingale thought virtue was an important trait of the good
nurse. Nightingale learned Greek as a child. She was inspired by Plato and translated parts of Phaedo,
Crito, and Apology. Nightingale was intrigued by Plato’s description of elite people with rare gifts who
command many kinds of knowledge. The characteristics, or virtues, of these people resonated with
Nightingale and were reflected in her writings throughout her life (Dossey, 2000). She believed that one
of the aims of philosophy was to cultivate in gifted people their potential intellectual and moral qualities.
The Nightingale Pledge, composed by Lystra Gretter in 1893 and traditionally recited by graduating
nurses, implies virtue of character as nurses promise purity, faith, loyalty, devotion, trustworthiness, and
temperance. It is reasonable to say that good character is the cornerstone of good nursing, and that the
nurse with virtue will act according to principle. If Aristotle was correct in his belief that virtue can be
practiced and learned, then we can learn, through practice, those acts that, by their doing, create a
virtuous person.

Core Values of a Professional Nurse

Nursing is a caring profession. Caring encompasses empathy for and connection with people. Teaching
and role-modeling caring is a nursing curriculum challenge. Caring is best demonstrated by a nurse's
ability to embody the five core values of professional nursing. Core nursing values essential to
baccalaureate education include human dignity, integrity, autonomy, altruism, and social justice.
The caring professional nurse integrates these values in clinical practice. Strategies for integrating and
teaching core values are outlined and outcomes of value-based nursing education are described.
Carefully integrated values education ensures that the legacy of caring behavior embodied by nurses is
strengthened for the future nursing
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TERMINOLOGIES
Ethics- Moral principles that govern a person's behavior or the conducting of an activity.
Autonomy- The capacity of an agent to act in accordance with objective morality rather than under the
influence of desires
Altruism – unselfish concern for other people

FURTHER READINGS
Overview and Summary: Ethics in Healthcare: Nurses Respond:
https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofConte
nts/ Vol-23-2018/No1-Jan-2018/O-S-Ethics-in-Healthcare.html

UNIT TASKS TASK

Question:
During the 90's a slum in Metro Manila became popular in the medical world because it has become a
place to harvest kidneys. For a good amount of money residence in that area allowed themselves to
become donor to "help" patients with renal failure get a transplant. Do you think it is unethical? Why or
why not? What is your stand?
Instructions:
Write your essay minimum of 150 words and maximum of 200 words.
*Follow the format, type your answer on the next page

REFERENCES
Ethics of Healthcare: A Guide for Clinical Practice Fourth Edition- Raymond S. Edge; J. Randall Roves
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Name: Gertrude Bagiw

Year and Section: BSN 3B
Class Code & Time:

Question:
During the 90's a slum in Metro Manila became popular in the medical world because
it has become a place to harvest kidneys. For a good amount of money residence in
that area allowed themselves to become donor to "help" patients with renal failure get
a transplant. Do you think it is unethical? Why or why not? What is your stand?

→ As long as the person is willing to help the patient or very well in need for his/her
family member for me this is ethical. But when the donor just needs money and will
commit crime this is unethical. According to human rights as long that the donor is
doing good not for doing crimes like human trafficking, kidnapping (to get their internal
organs) and etc. this may be possible. Organ trafficking the deal and buy of human
organs for transplantation could be a broad wrongdoing. Gauges put the around the
world number of commercial transplantations that include installment for the organ
at approximately 10,000 every year, generally 10 percent of all transplantations
according from DOH news. In most cases, the organ may be a kidney, sold by a
living individual wrongfully. Numerous nations have laws
that disallow the offering and buying of organs and boycott doctors from transplanting
organs obtained through installment. This hone is additionally prohibited by the
World Wellbeing Organization, which needs organ gift to be benevolent. Overall as
long as the donor will do Utilitarianism for me this is ethical but commit crime to make
money is very unethical and brutality.