MIDTERM COVERAGE – NCM 108 HEALTH CARE ETHICS

II. BIOETHICS AND ITS APPLICATION IN VARIOUS HEALTH CARE SITUATIONS

A. SEXUALITY AND HUMAN REPRODUCTION
1.HUMAN SEXUALITY AND ITS MORAL IMPLICATION
● The significant and vital role that sex plays in an individual’s desire to be fully human has, to
some extent remained undisclosed and even sinful – due to culture or negative attitude of
Filipinos towards human sexuality.
● Traditional sex attitude is conservative and strict.
● Sex is unmentionable, not to be discussed in public and seldom between children and their
parents, between young and their elders.
● Whatever our sex attitude may be, the irrefutable fact is that every individual is born out of
human sexuality either by choice, by chance, by design or by accident.
● What is the relevance and significance of sex to ourselves? To our living with others in the
world? To what extent if at all, does sex plays a considerable role in an individual’s desire to
become authentically human?
● Is human sexuality meaningful or meaningless? Does it affirm or negate freedom and
responsibility?
● Meaning of sex to the Individual: sexual meaning permeates our bodily presence to one
another and makes us more aware of our individual existence. We become conscious of
ourselves and discover ourselves through this sexual meaning.
● Through sexual meaning, we realize that we are not alone and separate, powerless and
ignorant, helpless and weak, empty and homeless, inadequate and incomplete.
● Sexual meaning therefore, makes us realize the need for some measure of fulfillment that
only the other can give. In other words, we come to know more of our real selves.
● We need to know that we need each other to be full, complete and protected.
● Mutual experience of each other’s worth: sexual meaning reveals each one’s value to the
other. It unfolds either one’s worth or lack of it to another person. As a woman realizes the
value of the man she loves, the man who loves her also recognizes her value to him. Thus,
they become aware of their value to each other. In this mutual experience exists the
humanizing value of sexual love.
● Through sexual meaning we are thus valuable and reachable to one another. I need you to be
me, as you need me in order to be you.
● The trust which true love shows however – the defenselessness it displays – is itself an appeal
for mutual care and protection for each other.
● True love says: I GIVE YOU MYSELF TO YOU BECAUSE I TRUST YOU AND THIS PERSONAL TRUST
MAKES YOU ANSWERABLE TO ME. IF YOU DECEIVE ME, YOU LIKEWISE DECEIVE YOURSELF,
FOR YOU HAVE PRETENDED TO APPEAR AS SOMETHING YOU ARE NOT. YOU HAVE
CONTRADICTED YOURSELF AND YOUR HYPOCRISY WILL STRIKE BACK TO YOU. FOR THEN YOU
WILL LOSE MY TRUST FOREVER.
● IN OTHER WORDS, IN THE LOVE WORLD, “I CAN BE MYSELF ONLY IN YOUR PRESENCES. BUT IF
I NEED YOU IN ORDER TO BE MYSELF, YOU LIKEWISE NEED ME. EACH OF US HOLDS OUR
PERSONHOOD AS A GIFT FROM THE OTHER, SO THAT TO BETRAY THE OTHER IS ALSO TO
BETRAY ONESELF.
● Sharing each other’s being: we find a mutual sharing of selves, mutual self-realization. We
discover that we cannot be ourselves without other. Life becomes more meaningful if and
when we share it with someone we love.
● Human Sexuality becomes the language of love and it is considered as one of the deepest
forms of human communications.
● THE GIFT OF LOVE IS THE GIFT OF THE POWER AND THE CAPACITY TO LOVE AND THEREFORE,
TO GIVE LOVE WITH FULL EFFECT IS ALSO TO RECEIVE. SO LOVE CAN ONLY BE KEPT BY BEING
GIVEN AWAY, AND IT CAN ONLY BE GIVEN PERFECTLY WHEN IT IS ALSO RECEIVED.
● TYPES OF SEXUAL DEVIATION​:
1. Homosexuality: this refers to sexual relations between individuals of the same sex.
Men may engage in sexual activities with other men and women with other women.
2. Transvestism: cross-dressing or conism. An obsession of an individual to wear
clothes by the opposite sex.
3. Transsexualism: not only wish to dress the opposite but to have his/her sex organ
changed.
4. Exhibitionism: this sexual deviation refers to an individual’s desire to obtain sexual
gratification by public exposure of his/her body or sex organs.
5. Sadism: sexual gratification depends largely on the infliction of pain upon others.
6. Masochism: sexual gratification upon receiving pain or undergoing physical pain or
humiliation.
 7. Necrophilia: making love to a corpse or cadavers.
8. Necrosadism: sexual abnormality wherein an individual experiences sexual
stimulation and orgasm by mutilating corpses.
9. Sex murder: rapist and sex offenders.
10. Fetishism: sexually gratification from objects.
11. Pedophilia: which an adult is attracted to youth.
12. Gerontophilia: sexual gratification to older persons.
13. Voyeurism or Mixoscopia: sexual excitement from viewing members of the other
sex when they are nude or naked.
14. Pygmalionism: making love with a statue.
15. Bestiality: sexual intercourse with animals.

2. MARRIAGE: is
● A lifetime contract with a spouse as ministers
● A school and source of life
● An institution of the natural law, not just a social one
● A sacrament a union of three partners: man, woman and God.

CHARACTERISTICS OF CONJUGAL LOVE IN MARRIAGE:

● It is Human Love: physical and spiritual which means saying YES to someone else and no to
oneself. By it, husband and wife become one heart, one soul and together they attain their
human perfection.
● It is total: a married person loves generously and shares things without reservations or selfish
calculations.
● It is faithful and exclusive. The adjective “COMMITTED” describes how true married love
involves a pledging of oneself to another. Married love is not self-centered but looks to the
other partner.
● It is fruitful. The matrimonial consent has two essential elements; conjugal love and
ordination of children.
Sex outside marriage: issues and effects:
1. One tend to lose the partner
2. High possibility of break up
3. Affects other relationship in a negative way
4. You may become the object of gossip
5. Premarital relationship can disrupt mental health
6. Trauma in case of unwanted pregnancy
7. High risk of STI
8. Changes one’s body
9. Steps into marriage with an emotional baggage
10. One tends to take the partner for granted
11. May lead to infidelity
12. Can change outlook towards love
13. Face abandonment
14. Self-esteem takes a hit
15. Risk for spiritual damage
ISSUES ON CONTRACEPTION, ITS MORALITY AND ETHICO-MORAL RESPONSIBILITY OF NURSES:
● Contraception – ​is concerned with the rightness or wrongness of the use of various methods
by which conception can be prevented in the conjugal union.
● Sterilization – ​is a form of contraception not only the positive use of artificial methods but by
cutting off the sexual capacity in a woman and man. It is the mutilation of sexual power in a
man and woman so as to render conception impossible.
● Justification of contraception:
1. Parenthood and birth are matters of moral responsibility and intelligent choice.
2. An individual should be the one to determine his/her fertility and should be able to
control his/her fecundity. One’s procreativity should not be left to fate or the blind
forces of nature.
3. One should be able to decide how many children one is able to bear and support.
4. Contraceptive technology makes men and women persons of will and decision and
not merely inert and powerless bodies subject to church proscriptions or to the
divine will.
● ARTCILE 11, SECTION 12 OF THE 1986 CONSTITUTION provides that “the state recognizes the
sanctity of life and shall protect and strengthen the family as a basic autonomous social
institution. It shall equally protect the life of the mother and the life of the unborn from
conception.
● Despite of this position, illegal practice of abortion continues and formal complaints against
violators have yet to be filed in the Philippine courts.
● The direct and voluntary of an innocent human being is always gravely immoral even when it
is performed as a means to a good end. Respect for human life and the radical condemnation
of abortion is evil.
● Medical ethics and contraception:
What ethical issues do doctors or other medical professionals face when giving
contraceptive advice? Their primary concern should always be the welfare of the patient
concerned. This goes hand in hand with respecting the autonomy of the patient: the doctor
must respect the patient's right to make their own decisions, which means the doctor
should provide the method the patient prefers unless there is a medical reason not to do so.

The doctor should make sure the patient gets the information and advice they need to
be able to choose wisely
● The principle of ​informed consent​ requires a doctor and the nurse to make sure that the
patient is aware of, and has genuinely understood the hazards and benefits of various
methods of contraception.
● The principle of informed consent requires a doctor to make sure that the patient is aware of,
and has genuinely understood the hazards and benefits of various methods of contraception.
● For each method of birth control the patient needs to know:
● Reliability of the method
● Ease of use of the method
● Potential side-effects
● Health risks
● Doctors and Nurses should explain the methods available, and help patients weigh the
advantages and disadvantages of the methods so as to make the best choice for their
situation.
● Doctors and Nurses must make sure that that patients are able to use the chosen method
properly and can recognize and cope with side effects.
● Doctors provide continuing support for their patients' birth control needs.
● Doctors should outline the emergency contraception options that are available if there is a
problem.
● Where the method is sterilization the doctor must ensure that the patient is aware that it is
unlikely to be reversible.
● Artificial Insemination(AI):​ consists of depositing a man’s semen in the vagina, cervical canal
or uterus through the use of instruments to bring about conception unattained or
unattainable by sexual intercourse.
● Justification of AI:
1. Husband’s impotence
2. Husband is sterile
● In vitro fertilization: ​fertilization within a glass… laboratory fertilization. The ovum is placed
in a petri dish (test tube) where it is fertilized by the husband’s semen. After several days of
growth in the test tube, the fertilized ovum or embryo is implanted in the wife’s uterus and a
normal pregnancy can be carried out. ​Louise joy Brown was the first IVF baby. Born in July
25. 1978 in England.
● Surrogate Motherhood: ​means substitute in place of another. Is a biomedical technique
whereby a fertilized ovum is implanted into the uterus of another woman who will carry the
fetus to term either as a favor or for a fee. Termed a WOMB FOR HIRE OR WOMAN FOR RENT
OR UTERUS FOR RENT.
● MORALITY OF ABORTION: ​it is the expulsion of a living fetus from the mother’s womb before
it is viable. It is also defined as termination of pregnancy, spontaneously or by induction prior
viability.
● Five types of abortion:
1. Natural abortion – expulsion of the fetus through natural or accidental cause. Also
known as spontaneous abortion or miscarriage.
2. Direct or intentional abortion – deliberately induced expulsion of the fetus before it has
become viable.
3. Therapeutic abortion – deliberately induced expulsion of a living fetus in order to save
the mother from the danger of death brought about pregnancy.
4. Eugenic abortion - recommended in cases wherein defects are discovered in the
developing fetus.
5. Indirect abortion – removal of the fetus as a secondary effect of a legitimate or licit
action which is the direct and primary object of the intention.
 ● THE MORAL ISSUES OF ABORTION​: What is the moral issues of abortion? When does life
begin? Is the fetus a person? When does the human soul fuse or unite with the body? From
the moment of conception? During a certain stage of fetal development? At viability? At
birth? Or after birth?
● If the phenomenon of ensoulment occurs from the moment of conception, then the newly
fertilized ovum or conceptus is already a person. Hence to expel or abort it is to commit
murder, but if the ensoulment phenomenon occurs not from conception but a certain stage of
fetal development, then eugenic abortion as well as abortion before implantation may be
morally licit.
B. DIGNITY IN DEATH AND DYING
1. EUTHANASIA AND PROLONGATION OF LIFE:
● Everyone is destined to die, just as everyone is born in an accidental place, time and manner.
We did not choose to be born, nor did we choose our parents, the time, place and where we
were thrown sexually into this world. From this time, it is clear that there is no freedom to be
born. And ultimately too, we are going to die sometime, some place and somehow. The
difference however is that to some extent there is freedom to die, for we can choose to die
now or later, we can elect either to die with dignity or in humiliation or as a hero or as a
villain.
● EUTHANASIA is defined as the intentional killing a dependent human being by act or omission
for his or her alleged legal benefit.
● Death and Human dignity: death has become more complicated than it used to be because of
ethical conflict. The moral issue of euthanasia revolves around the preservation of human
dignity in death even to the individual’s last breath.
● Classification of Euthanasia:
1. Suicidal euthanasia: when a person subject himself, resorts to lethal means to
interrupt or suppress his life. Done with the person’s consent.
2. Ortothanasia: passive death. The person is left to die by omitting any medical
assistance.
3. Voluntary euthanasia: the person requests to be killed.
4. Non voluntary: when the person did not give consent to be killed.
5. Euthanasia by action: mean intentionally causing the person’s death by performing
an action such as giving him lethal injection.
6. Euthanasia by Omission: not providing food or water until the person dies.

ADVANCE DIRECTIVES:
● An advance directive is a legal document that explains how you want medical decisions about
you to be made if you cannot make the decisions yourself. An advance directive lets your
health care team and loved ones know what kind of health care you want, or who you want to
make decisions for you when you can't. An advance directive can help you think ahead of time
about what kind of care you want. It may help guide your loved ones and health care team in
making clear decisions about your health care when you can't do it yourself.

● An advance directive is meant to help you plan ahead and let others know what kind of care
you want. It is used to guide your loved ones and health care team in making clear decisions
about your health care if you can’t make medical decisions by yourself. These medical
decisions may include special actions or emergency care from your health care team.

● Living wills and other advance directives are written, legal instructions regarding your
preferences for medical care if you are unable to make decisions for yourself. Advance
directives guide choices for doctors and caregivers if you're terminally ill, seriously injured, in
a coma, in the late stages of dementia or near the end of life.

● Advance directives aren't just for older adults. Unexpected end-of-life situations can happen
at any age, so it's important for all adults to prepare these documents.

● By planning ahead, you can get the medical care you want, avoid unnecessary suffering and
relieve caregivers of decision-making burdens during moments of crisis or grief. You also help
reduce confusion or disagreement about the choices you would want people to make on your
behalf.
 ● Choosing a person to act as your health care agent is important. Even if you have other legal
documents regarding your care, not all situations can be anticipated and some situations will
require someone to make a judgment about your likely care wishes. You should choose a
person who meets the following criteria:

● A living will​: is a written, legal document that spells out medical treatments you would and
would not want to be used to keep you alive, as well as your preferences for other medical
decisions, such as pain management or organ donation.

● An advance directive​ is a set of instructions someone prepares in advance of ill health that
determines his healthcare wishes. A living will is one type of advance directive that becomes
effective when a person is terminally ill.

● In determining your wishes, think about your values. Consider how important it is to you to be
independent and self-sufficient, and identify what circumstances might make you feel like
your life is not worth living. Would you want treatment to extend your life in any situation? All
situations? Would you want treatment only if a cure is possible?

● You should address a number of possible end-of-life care decisions in your living will. Talk to
your doctor if you have questions about any of the following medical decisions:

1. Cardiopulmonary resuscitation (CPR​) restarts the heart when it has stopped beating. Determine
if and when you would want to be resuscitated by CPR or by a device that delivers an electric
shock to stimulate the heart.
2. Mechanical ventilation​ takes over your breathing if you're unable to breathe on your own.
Consider if, when and for how long you would want to be placed on a mechanical ventilator.
3. Tube feeding​ supplies the body with nutrients and fluids intravenously or via a tube in the
stomach. Decide if, when and for how long you would want to be fed in this manner.
4. Dialysis​ removes waste from your blood and manages fluid levels if your kidneys no longer
function. Determine if, when and for how long you would want to receive this treatment.
5. Antibiotics or antiviral medications​ can be used to treat many infections. If you were near the
end of life, would you want infections to be treated aggressively or would you rather let
infections run their course?
6. Comfort care (palliative care​) includes any number of interventions that may be used to keep
you comfortable and manage pain while abiding by your other treatment wishes. This may
include being allowed to die at home, getting pain medications, being fed ice chips to soothe
mouth dryness, and avoiding invasive tests or treatments.
7. Organ and tissue donations​ for transplantation can be specified in your living will. If your organs
are removed for donation, you will be kept on life-sustaining treatment temporarily until the
procedure is complete. To help your health care agent avoid any confusion, you may want to
state in your living will that you understand the need for this temporary intervention.
8. Donating your body​ for scientific study also can be specified. Contact a local medical school,
university or donation program for information on how to register for a planned donation for
research.
9. Do not resuscitate and do not intubate orders

● You don't need to have an advance directive or living will to have do not resuscitate (DNR)
and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your doctor about your
preferences. He or she will write the orders and put them in your medical

● Advance directives need to be in writing. Each state has different forms and requirements for
creating legal documents. Depending on where you live, a form may need to be signed by a
witness or notarized. You can ask a lawyer to help you with the process, but it is generally not
necessary.

Types of Advance Directives

1. The living will. ...
 2. Durable power of attorney for health care/Medical power of attorney. ...
3. POLST (Physician Orders for Life-Sustaining Treatment) ...
4. Do not resuscitate (DNR) orders. ...
5. Organ and tissue donation.

NURSING ROLE AND RESPONSBILITIES IN ETHICAL DECISION MAKING:

● An ethical principle that involves the nurse's willingness to respect patients' rights to make
decisions about and for themselves, even if the nurse does not agree with the patients'
decisions. Beneficence: The duty to do good; prevent harm and remove harm.
● A nurse must respect the dignity and value of patients and colleagues, and treat all persons
equally regardless of personal attributes or medical condition. Related to this is the
responsibility to always respect the patient's right to self-determination in her medical care.

QUESTIONS THAT WE NURSES ENCOUNTER:

1. What are the nurses responsibilities in legal and ethical aspect of nursing?
● Nurses are advocates for patients and must find a balance while delivering patient care. There
are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence. Each
patient has
2. What is ethical decision making in nursing?
● Ethical principles are a set of standards that help nurses make informed decisions when
evaluating the consequences of their actions. ... They must also give patients autonomy,
meaning patients must be allowed to make their own decisions about treatment even if it is
not in their best interest the right to make their own decisions based on their own beliefs and
value.
3. What is the role of ethics in decision making?
● Ethical decisions generate and sustain trust; demonstrate respect, responsibility, fairness and
caring; and are consistent with good citizenship. These behaviors provide a foundation for
making better decisions by setting the ground rules for our behavior.
4. What are the 7 ethical principles in nursing?
● Ethical principles provide a framework for nurses to engage in ethical decision making. Ethical
principles include ​beneficence, nonmaleficence, autonomy, justice, veracity, fidelity, and
integrity.
5. What is the role and responsibility of a nurse?
● Nurses plan and provide medical and nursing care to patients in hospital, at home or in other
settings who are suffering from chronic or acute physical or mental ill health. A caring and
compassionate nature, and the ability to deal with emotionally charged and pressured
situations are important traits of a nurse.
6. What are the 5 steps to ethical decision making?
● GATHER THE FACTS. □ Don't jump to conclusions without the facts. ...
● DEFINE THE ETHICAL ISSUE(S) ...
● IDENTIFY THE AFFECTED PARTIES. ...
● IDENTIFY THE CONSEQUENCES. ...
● IDENTIFY THE RELEVANT PRINCIPLES,
● CONSIDER YOUR CHARACTER &
● THINK CREATIVELY ABOUT POTENTIAL.
● CHECK YOUR GUT.
7. Why is it difficult to make ethical decisions?
WHAT MAKES ETHICAL DECISIONS SO DIFFICULT? Ethics is often a problem because the
situations we face as managers are hardly ever clear-cut. People have different worldviews
that they bring into their decision-making processes, which causes individuals to see and
interpret situation in different ways.
8. How do values influence ethical decision making?
● Personal values have long been associated with individual decision behavior. ... We found a
significant positive contribution of altruistic values to ethical decision making and a significant
negative contribution of self-enhancement values to ethical decision making.
9. What are the 5 core values of nursing?
 ● 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.

Ethics in Medical Decision Making: END OF LIFE CARE

● Ethics is a branch of philosophy that is focused on understanding the moral principles of
people and how they make decisions based on what is considered morally right or wrong
(Merriam-Webster, 2014). There are often ethical issues that can arise in the context of
end-of-life care, particularly when patients and families make decisions regarding the care
they will accept or not accept. As nurses, sometimes our morals and values are in conflict with
those that our patients have, and this can cause some distress for the nurse. By having an
understanding about some of the issues that can arise during end of life decisions, the nursing
student or novice nurse can be better prepared for what to expect and how best to handle
ethical issues.
● Patients’ goals of care are what patients place highest value on and would hope to achieve in
regard to their illness. These goals are based on the patient’s moral principles and values.
These are the goals the patient wishes for in terms of their illness. Often as patients near the
end of life, many difficult decisions will have to be made. Some of these are related to what
kinds of medical treatments they would want to have if they were no longer able to make
their own decisions. In the clinical setting, it is not uncommon to witness conflicts between
the patient’s wishes and those of their family. Sometimes, there can be conflicts between
what the clinicians believe to be best for the patient and what the patient and family want to
have done.

Basic Ethical Principles and Concepts

● Nurses need to possess a basic understanding about the scope of practice and standards of
care.
● Autonomy, beneficence, nonmaleficence, and justice are four of the basic ethical principles
used to guide nurses and clinicians in the care and decision making of patients. Many of these
same standards apply for nurses who are involved in clinical research as they are a way to
ensure that people’s rights are protected as guided by specific moral principles.
1. Respect for autonomy
● This principle is described as an agreement to respect another’s right to self-determine a
course of action and to support another’s independent decision making). Sometimes it can be
difficult to see a patient make a decision about their health that the nurse does not personally
agree with or that the nurse does not feel is the best decision for that patient’s individual
circumstances. As nurses, we must support and advocate for our patients’ rights, including
their right to make decisions. While a nurse might not agree with a patient’s decision, they
must support it. For example, a nurse has been caring for an elderly gentleman for several
months as he has been receiving treatment for cancer. This patient has decided to stop his
cancer treatments and focus on spending time enjoying his family for the time he has left.
While the nurse has grown fond of this patient and would not want him to die, they must
respect the patient’s wishes and choices for his own medical care.

2. Beneficence
● Beneficence is the principle of “doing good” and has been suggested as having four distinct
parts. These include:
Not to inflict evil or harm.
To prevent evil or harm.
To remove evil or harm.
To do good or promote good.

● Sometimes it might be difficult to differentiate between doing good and doing no harm, which
is nonmaleficence, because it is often easier to determine what is clearly bad or harmful more
than what might be good or a benefit. It is recommended that there is a greater obligation to
not cause harm than there is to do something that might benefit the patient. Nurses should
keep that in mind when assisting patients with difficult decisions.
 3. Nonmaleficence
● Nonmaleficence is the principle of refraining from causing unnecessary harm. Although some
of the interventions that patients receive might cause pain or some harm, nonmaleficence
refers to the moral justification behind why the harm is caused. Sometimes harm may be
caused to a patient in order to prevent them from further harm. If the act is for a greater good
for the patient and is not meant to deliberately harm them, it is justifiable
4. Justice
● Justice is the principle that governs social fairness. It involves determining whether someone
should receive or is entitled to receive a resource. The Code of Ethics for Nurses (ANA, 2015)
states that nurses’ commitment is to patients regardless of their “social or economic status.”
In healthcare, sometimes the benefits must be balanced with the burdens to determine who
is eligible to receive some type of care. As mentioned in the beginning of this chapter, medical
futility is continuing to provide a medical intervention or treatment that would not provide a
cure or benefit to the patient.

Difficult Decisions in End-of-life care

- Caring for patients who are nearing or at the end of life often enables nurses to bear witness to
the complicated and difficult decisions that patients and families must make surrounding many
sensitive issues. Although nurses have their own morals, values, and beliefs, they sometimes do
not correspond with the patients’ values, beliefs, or wishes, and an internal conflict for the
nurse can ensue. Withholding/withdrawing of medical interventions
- Medical order for life sustaining treatment (MOLST)
- Sometimes also referred to as physician order to life-sustaining treatment (POLST), these newer
forms of advance directives were developed in order to improve the communication of a
patient’s wishes about life-sustaining treatments among healthcare providers and settings.-

What We Nurses Should Know:

1. Nurses caring for patients at the end of life have a moral and professional obligation to follow
the guidelines depicted in their professional and ethical standards.
2. The absence of an advance directive can make end of life decision-making difficult for
families of dying patients who are no longer able to speak for themselves.
3. Nurses need to advocate to ensure that their patients’ goals of care are met while following
ethical principles.

What are some important issues in caring for a dying patient?

Generally speaking, people who are dying need care in four areas—physical comfort, mental and
emotional needs, spiritual issues, and practical tasks.

For example, a dying person can be uncomfortable because of:

1. Pain.
2. Breathing problems.
3. Skin irritation.
4. Digestive problems.
5. Temperature sensitivity.
6. Fatigue.

Dysthanasia means​ : "bad death" and is considered a common fault of modern medicine. Dysthanasia
occurs when a person who is dying has their biological life extended through technological means
without regard to the person's quality of life. Technologies such as an implantable cardioverter
defibrillator, artificial ventilation, ventricular assist devices, and extracorporeal membrane oxygenation
can extend the dying process. Dysthanasia is a term generally used when a person is seen to be kept
alive artificially.
What is meant by the sanctity of life?
● The term sanctity of life means the extent to which human life is considered precious. Jews
believe that humans were made as part of God's creation and in God's image. Therefore,
human life should be valued and considered as sacred and God-given
● For Christians, human life is sacred and is a gift from God which is to be respected and
protected. This teaching is called the sanctity of life. The Bible teaches that human beings are
created in the image of God. It also teaches that murder is forbidden
● Life issues are common problems, issues and/or crises that happen to normal people living
normal lives. Examples include managing one's relationships so that they are healthy and
functional, surviving disabilities, coping with grief, loss and self-esteem issues.

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NURSE’S BILL OF RIGHTS:

1. Nurses have the right to practice in a manner that fulfills their obligations to society and to
those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in accordance with
professional standards and legally authorized scopes of practices.
3. Nurses have the right to a work environment that supports and facilitates ethical practice, in
accordance with the Code of Ethics for nurses and its interpretive statements.
4. Nurses have the right to freely and openly advocate for themselves and their patients without
fear of retribution.
5. Nurses have the right to fair compensation for their work consistent with their knowledge,
experience and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and their patients.
7. Nurses have the right to negotiate the conditions of their employment, either as individuals or
collectively in all practice settings.

NURSES’ RESPONSIBILITIES IN RESEARCH ON HUMAN SUBJECTS

The ​HELSINKI DECLARATION OF 1964​ issued guidelines on medical research. In 1975 it differentiated
two types of research: that which is essentially therapeutic and that which is directed toward developing
scientific knowledge and has no therapeutic value for the subjects. The declaration emphasizes that the
research subjects must be informed when a clinical or non-clinical study will be of no personal benefit to
them to avoid any suspicion to the contrary.

Guidelines:
1. Employment in settings where research is conducted.
2. Vigilant protection of Human Subject’s rights.
3. Scope of application
4. Supporting accrual of knowledge
5. Informed consent
6. Representation of Human Rights committee

BASIC HUMAN RIGHTS OF RESEARCH SUBJECTS:

1. Right to informed consent

2. Right to refuse and/or withdraw from participation
3. Right to privacy
4. Right to confidentiality or anonymity of data
5. Right to be protected from harm

VULNERABLE SUBJECTS:​ subjects who are mentally ill or legally incompetent such as the: unconscious
or are in unique situations like fetuses, require special attention. Mentally ill, retarded, unconscious
patients and minors are incapable of evaluating the risks involved and cannot be given consent in their
own behalf. Consent of parents or guardians are required.

EXPERIMENTAL SUBJECT’S BILL OF RIGHTS:

1. To be told what that study is trying to find out.

 2. To be told what will happen to himself/herself and whether the procedure, drugs or devices are
different from what are used in standard practice.
3. To be told of the frequent or important risks, side effects or discomforts of the things that will
happen to himself/herself for research purposes.
4. To be told if he/she expect any benefits from participating and if so, what the benefits may be
5. To be told the other choices he/she has and how may become better or worse than being in the
study.
6. To be allowed to ask any questions concerning the study both before agreeing to be involved
and during the course of the study.
7. To be told what sort of treatment is available if any complications arise.
8. To refuse to participate at all or to change his/her mind about participation after the study is
started.
9. To receive a copy of the signed and dated consent form
10. To be free from pressure when considering whether he /she wishes to agree to be in the study

THE CODE OF ETHICS OF FILIPINO NURSES

1. Service to others
2. Integrity and objectivity
3. Professional competence
4. Solidarity and teamwork
5. Social and civic responsibility
6. Global competitiveness
7. Equality of all professions

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Maam pen 2020