UNIVERSITY OF THE CORDILLERAS

College of Nursing
NCM 108: HEALTH CARE ETHICS (Additional Notes)

MODULES 1: WHAT IS ETHICS AND ITS IMPORTANCE TO NURSING. TERMS RELATED TO

HEALTH CARE ETHICS.
Learning Objectives: (Modules 1 & 2)
1. Know the definition of some terms related to Health Care Ethics
2. Discuss why is it important to have a correct understanding of the terms commonly
used in discussions and debates about ethics and ethical issues in nursing and health
care.
3. Understand the importance of Ethics to nursing
4. Describe the basic ethical principles and major bioethical principles and their
application
5. . Identify and understand some common ethical dilemmas encountered as a nursing
student.
A. DEFINITION OF TERMS
ETHICS - It came from the Greek word “ethicos”, which pertains to ethos translated as
“custom” or ‘character”.
 It is defined as generic term that is used for referring to various ways of thinking
about, understanding and examining how best to live a’ moral life’. (Beauchamp and
Chidress, 2001)
 It deals with the study of the morality (goodness or badness) of human acts or
human conduct. (Moral Philosophy)
 ETHICS is a practical and normative science (based on reason)
 ETHICS as a Science because it is a systematized body of knowledge.
 ETHICS is based on well-founded standards of right and wrong that prescribes what
humans ought to do, usually in terms of rights, obligations, benefits to society,
fairness, or specific virtues.
 As a Practical Science – it provides a body of knowledge which is not only a body
that enriches and sustains the intellect with more learning but a body of knowledge
which, by nature of its learning, is applied in the performance of human conduct.
 As a Normative Science, ethics establishes norms for the direction and regulation of
human actions
 It is prescriptive, (what ought to be done)
 It only deals with HUMAN acts as these acts are performed with intellectual
deliberation and freedom (irrational animals and insane persons are devoid of moral
significance.)
OBJECTIVES OF ETHICS

 To make clear why one act is better than the other

 To allow persons to live an orderly social life

 To appraise and criticize intelligently the moral conduct and ethical systems of
society

MORAL PHILOSOPHY is the branch of learning that deals with the nature of morality
and the theories that are used to arrive at decisions about what one ought to do and
why.
MORALITY - The quality of human acts where the act could be good or right, evil or
wrong. This quality indicates and determines whether the kind of human act that is
performed is good or bad.
NORMS – (pamantayan) The rules that a group uses for appropriate and
inappropriate values, beliefs, attitudes and behaviors.
- an accepted or expected standard or a way of behaving or doing things that most
people agree with.
Ex. Covering your mouth and nose when sneezing, shaking hands when you meet
someone, saying 'sorry' when you bump into someone, not talking with your mouth
full.
CHARACTER is defined as a trait, quality or high moral code.
Ex. Being trustworthy, kind
- It is the mental and moral qualities distinctive to an individual. (what makes you
who you are)
CUSTOM is an action or way of behaving that is usual and traditional among the people
in a particular group or place.
- Tradition, practice
- A custom is a commonly accepted manner of behaving or doing something in a
particular society, place or time. A tradition is the transmission of customs or
beliefs from generation to generation.
ETIQUETTE
- The rules indicating the proper & polite way to behave.
- Etiquette is defined as the formal manners and rules that are followed in social
or professional settings.
- Ex. Saying sorry and thank you appropriately, being punctual, table manners,
etc. are some common acceptable social behavior or etiquette.

LAW
- an ordinance of reason promulgated by the common good by one who has
legitimate authority. It is an authoritative order that should be just and honest.
- It has a binding and legal force (with penalty)
 Ex. Laws on smoking in public places.
IMPORTANT CLASSES OF LAW
a. Eternal Law - God’s eternal plan for the Universe (10 commandments)
b. Natural Law - is the eternal law as known to man through reason. (to live,
reproduce, learn, love & seek affection)
c. Positive law - Human made law that is enacted and promulgated by proper
authority (anti-smoking)
BIOETHICS
- A science that deals with the study of the morality of human conduct concerning
human life in all its aspect from the moment of its conception to its natural end.
- All aspects should be respected from existence to the time it naturally ends
HEALTH ETHICS
- A science that deals with the study of the morality of human conduct concerning
health and health care.
- It is employed to regulate the human conduct in the practice of human care so that
good may be done and evil may be avoided thereby ensuring the purpose of health
care is being met in the light of the fundamental principles of morality.
- It is part of bioethics.

PROFESSIONAL ETHICS
- Ethics that deals with certain moral precepts or rules by which persons behave
and act in the exercise of their calling or profession.
- It discusses the obligations which a member of a certain profession owes to the
public, to his profession, to the society, and to his clients.
- It expresses responsibility and accountability in the practice of one’s profession.
NURSING ETHICS
- Is concerned with moral principles that govern the conduct of a nurse in his or
her relationship with patients, and the community.
ETHICAL DILEMMA
- a situation in which two moral principles conflict with one another.
situations in which there is a difficult choice to be made between two or more options,
neither of which resolves the situation in a manner that is consistent with accepted ethical
guidelines. When faced with an ethical dilemma, a person is faced with having to select an
option that doesn’t align with an established code of ethics or societal norms, such as codes
of law and religious teachings, or with their internal moral perceptions of right and wrong.
MODULE 2: BASIC ETHICAL PRINCIPLES AND MAJOR BIOETHICAL PRINCIPLES
The following are some of the basic ethical principles that may assist us in the whole
process of practical moral discernment, geared towards making a correct moral decision.

BASIC ETHICAL PRINCIPLES

1. PRINCIPLE OF STEWARDSHIP
 A steward takes charge of representing and protecting another’s interest, and
sees to it that the service is carried out faithfully
 The principle of stewardship entails concomitant values and virtues of
responsibility and accountability
 RESPONSIBILITY – is the duty involved when one accepts the task of
management. It is the ability of one to respond freely to a call for quality
service. This response is characterized by the values/virtues of dependability,
perseverance, initiative, and effort, and being a worthy, good servant which
implies reliability and trustworthiness as a steward.
 ACCOUNTABILITY - Is the obligation to explain, justify, and take responsibility
for one's actions. It is the state of being answerable or liable for carrying out
one’s right and duty.
 * Both go hand in hand.
 By virtue of their chosen profession, health care providers are charged as
stewards in the health care services
 They are mandated to take care of and look after the well-being of the sick,
disabled, and other people suffering from physical and psychological
infirmities
 Equipped with knowledge, skills, right attitude, and values, they are tasked to
sustain good health of those people whom they are charged to serve.
2. THE PRINCIPLE OF DOUBLE EFFECT
 The principle contemplates on two effects or outcomes arising from the
performance of an action; one is good, one is evil.
The following are 4 principles that merit the application of the principle of
double effect
 The act must not be evil in itself
 Both effects the good and the bad must proceed directly and equally from
the act, or the immediate effect of the act must be good, while the evil effect
is more remote
 The intention of the one performing the act must be good and evil must not
be directly intended
 A proportionally grave reason must be present in order to justify the
toleration of the indirect evil effect

3. THE PRINCIPLE OF COOPERATION
 Cooperation in this context means any physical or moral concurrence with
the principal agent in an immoral act.
 The one who cooperates somehow assists in the carrying out of the immoral
act by giving advice, providing necessary information, making necessary
means available or doing anything in which in one way or another makes the
immoral act possible or at least, facilitates it.
 Formal cooperation is present when one concurs with the sinful deed of
another and gives internal consent to do it
 It is never morally permissible for it always involves participation in the
immoral intent of the person.
 Material cooperation means that one somehow participates in another’s
sinful deed without giving it any internal consent
4. PRINCIPLE OF TOTALITY
 The term totality connotes wholeness, completeness or entirety
 It applies to any entity that is made up of parts that together constitute a
whole, remembering that the whole is greater than any of its parts.
5. THE PRINCIPLE OF SOLIDARITY
 To be solid means to be firmly united
 It follows that solidarity implies unity or fellowship arising from common
responsibility or interests
 It relates to the ability of its members to organize and standardize the
professional values of competence, autonomy, authority, and accountability
 There is the need for the members of a health team to work together to
meet the health care needs of society
6. PRINCIPLE OF EPIKEIA
 Epikeia is a Greek word meaning “reasonableness”.
 There is an exception to the rule.
 “Sometimes, it is necessary to set aside the law in order to protect justice and
the common good.

MAJOR BIOETHICAL PRINCIPLES

1. THE PRINCIPLE OF AUTONOMY
 The term autonomy comes from 2 Greek words, AUTOS which means self and
NOMOS which means rule of governance
 The principle of respect for autonomy means acknowledgement of the
person’s right to hold views and opinions, make decisions and choices and to
take action based on personal values beliefs, virtues and traditions.
 It stresses the right of an individual decision maker to determine for himself
what will be done to his body
 As applied to health care services, this right of self-determination may limit
what physicians, nurses, and other health care providers can do to their
patients
 This autonomy gives rise to the notion of informed consent.
INFORMED CONSENT
 Informed consent means that the patient is given the opportunity to autonomously
choose a course of action in regards to plans of health care.
 The choice includes the right to refuse interventions or recommendations about care
and to choose from other available therapeutic alternatives
 Informed consent also serves as a significant protection to you against possible
litigation.
 Consent may be expressed or implied;
 Expressed- (e.g. via a signed consent form) typically occurs in hospitals and relates to
specific procedures.
 It is not a contract, however, and the patient can withdraw consent at any time.
 Implied- if the patient comes voluntarily to the doctor’s office for a check-up.
Ex. For routine procedures such as a blood pressure check, vital signs taking etc.
 For consent to be ‘informed’ the patient must receive a full description of the
procedure, its risks and benefits, the prognosis with and without treatment, and
alternative treatments.
 The patient must have the mental competence to comprehend the information, and
must give specific authorization for the doctor to proceed with the plan. The onus is
not exclusively on the doctor: the patient should ask questions when they are
uncertain and should think carefully about their choices.
2. THE PRINCIPLE OF NON- MALEFICENCE
 duty to do no harm
 As a principle it requires health care professionals to act in such a manner as to
avoid causing harm to patients
 It includes deliberate harm, risk of harm, and other unintended harms that
may happen during procedures done for the patient
 It prohibits experimental research that assumes negative impact on
participants and the performance of unnecessary procedures for economic
gain or self interest
3. THE PRINCIPLE OF BENEFICENCE
 The term beneficence comes from 2 latin words: bene which means well or
good, and facere which means to do or make.
 Beneficence therefore means doing what is good
 It implies the duty to actively do good for patients
 It is associated with the concept or virtues of kindness and humanitarianism
The principle of beneficence has 3 components:
 When one promotes good he is an agent of goodness and an ambassador of
good will
  Prevention of harm is a proactive disposition, it implies planning and foresight
of health care providers who take appropriate actions to safeguard and sustain
their patient’s well-being.
 Removal of harm or evil is a reactive disposition. It requires health care
professionals to do all they can to restore or bring back their patient’s good
health.
4. THE PRINCIPLE OF JUSTICE
 The concept of justice is associated with the concept of fairness, rightfulness,
deserved reward or punishment and equity
 It implies a sense of duty to treat people without bias to age, socio economic
status, race, or gender
 It applies provision of necessary treatment to those in need even though they
may not have the means to pay for such treatment

5. THE PRINCIPLE OF CONFIDENTAILITY

 Confidentiality forms a cornerstone of the nurse-patient relationship, but it is
increasingly hard to maintain with the growth of electronic data.
 In order to protect the trust between nurse and patient, the nurse should not
release personal medical information without the patient's consent.
 Like other ethical duties, however, confidentiality is not absolute.
 It can be necessary to override privacy in the interests of public health, as in
contact tracing for partners of a patient with a sexually transmitted disease.
 Note that you are legally obligated to report a possibly HIV infected patient to
the public health authorities.
 However, this should always be done in a way that minimizes harm to the
patient.
6. THE PRINCIPLE OF VERACITY
 Communicating honestly. Veracity is the ethical principle that obligates you to
tell the truth. At times the truth may be painful for the patient or his family to
hear, but honesty is a core virtue; only under unusual circumstances is violating
it acceptable.
 There are some circumstances under which you may choose not to disclose
information to a patient, including when the patient specifically asks not to be
told (you should still offer them the chance to know the truth);
 When a patient is incapacitated (here you typically inform the family);
 during an emergency when the patient's condition is unstable and immediate
care is required; and the controversial notion of 'therapeutic privilege', which
means that the doctor deems that the risk of informing the patient is worse
than not doing so
(e.g., they might attempt suicide, or refuse necessary treatment)
“Therapeutic privilege,” also known as “therapeutic nondisclosure,” is defined as the
withholding of relevant health information from the patient if nondisclosure is believed to
be in the best interests of the patient (President’s Commission, 1982; Berger, 2005). The
two most common justifications for such nondisclosure are that the disclosure would create
incapacitating emotional distress and that disclosure would violate a patient’s personal,
cultural, or other social requirements (Crawley et al., 2001; Berger, 2005).

ACTIVITY
Discussion: TOPIC
A teenage patient requests an abortion but asks you not to tell her parents. How do you
balance protection of the patient's confidentiality against the rights of her parents?