Bioethics – MIDTERMS REVIEWER #1

Teleological Approach

 Greek; telos (end or purpose).

 Also called consequential ethics.
 Stresses the end result of the act as a determining factor of its rightness and wrongness.
 Focuses on the issues of fairness.
 E.g. If the consequences of my action give comfort to the patient, then it is right.

Forms

1. Ethical Relativism or Moral Relativism

 No universal or absolute moral principles.
 Standard of right or wrong are always relative to a particular culture or society.
 Depends on the prevailing view of a particular individual.
 E.g. Some ethnic groups practice cultural activities to cleanse the patient from sickness.
2. Situation Ethics
 The moral norm depends on a given situation, whatever this may be, one must act in the
name of Christian love.
 Consider the context of an act when evaluating it rather than judging it according to moral
standards.
 E.g. A patient wants to be discharged and it is against medical advice. Instead of judging
them, the nurse must come up with a discharge plan and discuss it with the patient.
3. Pragmatism
 Considers the workability, practicality or usefulness of an idea as the criterion of true
knowledge.
 A word may have a different meaning in different settings.
 Promotes respect for the individual, as it appreciates that each person has unique needs.
 E.g. Some patients accept the use of herbal medicine while others say it is used by quack
doctors.
4. Utilitarianism “Moral Calculus”
 Theory of moral philosophy based on the principle that an action is morally right if it
produces greater quantity of good or happiness than any other possible actions (Principle of
Utility).
 Usefulness of an act is determined by the extent to which it promotes happiness rather than
its reverse. “The greater good for the greatest number.”
 E.g. When you’re a public health nurse, you are required to choose which program should be
allotted a bigger amount of money, prioritize which program gives the most good to people.

Guidelines for Making Ethical Decisions

a. Consideration for people as human beings.

b. Consideration of consequences.
c. Proportionate good to come from the choices.
d. Propriety of action needs over ideal or potential needs.
 e. A desire to enlarge choices and reduce chance.
f. A courageous acceptance of the consequence of the decision.

Deontological Approach

 Greek; deon (duty) and logos (study of)

 Falls within the domain of moral theories that guide and assess our choices of what we ought to do.
 Embraces duty-oriented or principle-based theories.
 A person is morally good if his actions are done from a sense of duty and reason.
 E.g. A nurse must take care of the sick since it is our sworn duty but must observe necessary precautions
to protect their health.

Virtue Approach

 Greek; aretal (virtue or excellence)

 Also known as normative ethical theory.
 Primarily focuses on the heart of a person performing the act. Not only by doing the right thing but also
to develop the traits and qualities of a good person.
 E.g. A nurse who has developed the virtue of being punctual is often referred to as a punctual person.

Universal Principles of Biomedical Ethics

1. Autonomy
 Greek; autos (self) and nomos (governance)
 Expression of self-determination and freedom to choose and implement one’s own decision
free from deceit.
a. Right to Informed Consent
Major Elements
 Competence – patient’s capacity in decision making.
 Disclosure – accurate content of what a patient is told.
 Comprehension – patient’s understanding of the information told.
 Voluntariness – signing a consent to a certain treatment or procedure.

Therapeutic Privilege

 In case of emergency
 Incompetence
 Waiver
 Implied Consent
b. Right to Informed Decision
Client must be;
 Competent
 Has intellectual capacity to make a rational decision.
 Legal age of 18 years old
 Decision is of their free will and not coerced.
c. Right to Informed Choice
d. Right to Refusal of Treatment
2. Veracity
 Obligation to tell the truth.

Patient’s Responsibilities (Venzon, 2005)

a. Providing Information
b. Complying with Instructions
c. Informing the Physician of Refusal of Treatment
d. Paying Hospital Bills
e. Following Hospital Rules and Regulations
f. Show Respect and Consideration
 Benevolent Deception; Withholding of temporary information based on the judgment that it
may harm a depressed or unstable patient.
 Confidentiality; Nondisclosure of personal information (ANA, 2014)

Confidentiality of Information Based on the 5Cs

a. Consent
b. Complying with Existing Law and Regulations
c. Communicate a Threat
d. Care
e. Court Order
 Breach of Confidentiality; Occurs when a patient’s information is disclosed to a 3rd party
without their consent.
3. Beneficence
 Act of kindness and mercy.

Patient’s Bill of Rights

a. Right to considerate and respectful care.

b. Right to relevant, current, and understandable information concerning their health.
c. Right to make decisions regarding their plan of care.
d. Right to have advance directive.
e. Right to every consideration of their privacy.
f. Right to confidentiality of communications and records.
g. Right to review their records concerning their medical care.
h. Right to be informed of business relationship among the hospital.
i. Right to consent or decline to participate in experimental research.
j. Right to reasonable continuity of care when appropriate.
k. Right to be informed of hospital policies and practices.
4. Nonmaleficence
 Stated as an admonition (warning) in the negative form to remind practitioners to do no
harm.
 To maintain the ethical position of nonmaleficence, mostly practitioners explain their actions
through the principle of double effect.
 Principle of Double Effect

 The act itself must be morally good or neutral.

 The person must directly intend the good effect and only tolerate the evil effect.
 The good effect must be greater than or equal to the evil effect.
 The good effect must not be obtained by means of the evil effect.
5. Justice
 The right to demand to be treated justly, fairly, and equally.
 National Health Insurance Act of 1995.
 Republic Act 7432: The Senior Citizen Act 20% Discount

Bills of Rights for Registered Nurses (Venzon, 2005)

a. Right to practice in a manner that fulfills their obligations.

b. Right to practice in an environment that allows them to act in accordance with
professional standards.
c. Right to a work environment that supports and facilitates ethical practice.
d. Right to freely and openly advocate for their patients.
e. Right to fair compensation for their work consistent with their knowledge.
f. Right to a work environment that is safe for themselves and their patients.
g. Right to negotiate the conditions of their employment.

Moral Principles (Venzon, 2005)

1. The Golden Rule

 “Do unto others what you would like others do unto you.”
2. The 2 Fold Effect or The Double Effect
a. Action must be morally good.
b. Good effect is willed and bad effect is merely allowed.
c. The foreseen evil effects may not be intended or approved but merely permitted to occur.
d. Good effect must be greater than the bad effect.
3. The Principle of Totality
 The whole is greater than any of its parts.
4. Epikia
 A law can be broken to attain a greater good.
 E.g. Restriction of a patient that has gone berserk.
5. One who acts through an agent is himself responsible
6. No one is obligated to betray themselves
7. The end does not justify the means
8. Defects of nature may be corrected
9. If one is willing to cooperate in the act, no injustice is done
10. A little more or less does not change the substance of an act
11. The greatest good for the greatest number
12. No one is held to the impossible
13. The morality of cooperation
14. Principle relating to the origin and destruction of life
Spiritual Commitment of Nurses

 One of the responsibilities of nurses is the provision of spiritual environment regardless of religion.

Good Samaritan Law

 Law that protects the rescuer (Samaritan) who rendered aid in an emergency to an injured person on a
voluntary basis.
 It is a legal protection for those who assist a person who is injured or in danger.