NCM 108 A

Health Care Ethics

Mary Beth Paypon Diva
 Unit 1
Theories and
Principles of Ethics:
Ethics defined:
is a system of moral principles. They affect
how people make decisions and lead
their lives.
is concerned with what is good for
individuals and society and is also
described as moral philosophy.
is derived from the Greek
word ethos which can mean custom,
habit, character or disposition.
Ethics covers the following dilemmas:
how to live a good life
our rights and responsibilities
the language of right and wrong
moral decisions - what is good and bad?

Our concepts of ethics have been derived from

religions, philosophies and cultures. They infuse
debates on topics like abortion, human rights and
professional conduct.
Approaches to ethics:
Philosophers divided ethical theories into three areas:
Meta-ethics deals with the nature of moral
judgement. It looks at the origins and meaning of
ethical principles.
Normative ethics is concerned with the content of
moral judgements and the criteria for what is right or
wrong.
Applied ethics looks at controversial topics like war,
animal rights and capital punishment
If ethical theories are to be useful in practice, they
need to affect the way human beings behave.
Some philosophers think that ethics does do this.
They argue that if a person realises that it would be
morally good to do something then it would be
irrational for that person not to do it.
But human beings often behave irrationally - they
follow their 'gut instinct' even when their head
suggests a different course of action.
However, ethics does provide good tools for thinking
about moral issues.
 Introduction: What is ethics?
Ethics or moral philosophy is a branch of philosophy
that "involves systematizing, defending, and
recommending concepts of right and wrong behavior."
The field of ethics, along with aesthetics, concerns
matters of value, and thus comprises the branch of
philosophy called axiology
promote the values essential to good communication,
such as trust, accountability, mutual respect and fair
medical care.
moral principles that govern a person's behavior or the
conducting of an activity.
Ethics is two things:
 First, ethics refers to well-founded standards of
right and wrong that prescribe what humans
ought to do, usually in terms of rights,
obligations, benefits to society, fairness, or
specific virtues. ...
 Secondly, ethics refers to the study and
development of one's ethical standards.
Ethics is about the ‘other’
At the heart of ethics is a concern about something
or someone other than ourselves and our own
desires and self-interest.
is concerned with other people's interests, with the
interests of society, with God's interests, with "ultimate
good", and so on.
So when a person 'thinks ethically' they are giving at
least some thought to something beyond
themselves.
 Where does ethics come from?
Philosophers have several answers to this question:
God and religion
human conscience and intuition
a rational moral cost-benefit analysis of actions
and their effects
the example of good human beings
a desire for the best for people in each unique
situation
political power
 Nursing ethics and Medical ethics:
Nursing is concerned with health,
whereas medicine focuses on cure.
Also, there is a functional difference between
care and healing.
It is useful here first to consider the history
of nursing as it pertains to ethics. The historical
influence on ethics might begin by considering
Florence Nightingale's 1893 paper.
 Nursing ethics:  Medical ethics:
1. Care 1. Healing
2. Treating of person 2. Treat disease
3. Concerned with health 3. Focuses-Curing as response
4. Focus on patient’s active to occurrence of disease
participation condition
5. Health oriented profession 4. Illness oriented profession
6. Locus of care- compassionately 5. Consultative- physical patient
aids individuals encounter
7. In depth and personal values 6. Hospital as center for best
and adoptive/ restorative
medicine
process
8. Nurses’ ever presence 7. Episodic in nature- complex
surgical, biochemical and
9. Trusting relationship technical interventions.
10.Advocacy
11.NURSING ITSELF.
Ethical theories
deontology
is a modern combination of Classical Greek terms,
and means the study or science (logos) of duty, or
more precisely, of what one ought to do (deon).
 In contemporary moral philosophy, “deontology”
is used most commonly to refer to moral
conceptions which endorse several theses
regarding the nature of duty (the right), the
nature of value (the good), and the relationship
between the primary ethical concepts of the right
and the good.
teleology
comes from the Greek word telos for
goal or aim.
teleological ethics in recent usage
has been understood, most
fundamentally, as standing in
contrast with “deontological”
approaches to ethics.
utilitarianism
A prominent, compelling, and
controversial theory about the
fundamental basis of morality,
utilitarianism holds that human
conduct should promote the interests
or welfare of those affected.
Other ethical theories:
Kantian ethics
 ethical theory of Immanuel KANT (1724-1804)
 Kant's central ideas, including the good will, the moral law, moral
obligation, acting from duty.

Duty and Obligation

 certain acts are required, or ought to be done,
 as obligations or duties.
 “obligation” is used for more abstract claims (e.g., we would
speak more readily of “principles of obligation” than of
“principles of duty”)
 “duty” for more specific demands.
 Virtue ethics:
are normative ethical theories which emphasize virtues
of mind, character and sense of honesty.
discuss the nature and definition of virtues and other
related problems that focus on the consequences of
action.
Virtue ethics is a philosophy developed by Aristotle and
other ancient Greeks. ... This character-based approach
to morality assumes that we acquire virtue through
practice.
practicing being honest, brave, just, generous, and so
on, a person develops an honorable and moral
character.
Theorists:
Plato is one of the founding fathers of philosophy and has
had a massive impact on the history of western thought.

Aristotle a Greek philosopher and protégé of Plato, is

considered the Father of the Scientific Method, the
creator of formal logic, and one of the greatest thinkers in
the history of the Western world.

Friedrich Nietzsche has emerged as perhaps the most

influential thinker of the recent past. To a significant
degree, this is due to the fact that he took time seriously in
terms of both cosmology and ethics.
Immanuel Kant, like Plato and Aristotle, counts
as one of the most influential philosophers of all
time.
Jeremy Bentham is known today chiefly as the
father of utilitarianism.
John Stuart Mill (1806–73) changed the way in
which the modern world views, and legal
systems address, the issues of individual liberty
of thought, expression, lifestyle, and action. His
ideas remain both influential and controversial
to this day.
Ethical principles:
Others:
CONFIDENTIALITY
is a fundamental principle in healthcare,
and nurses must understand how this
applies to their practice.
pertains to restricting the sharing of
sensitive patient information and only
sharing information when it is necessary
either by law or professional duty.
Applied Ethics:
 General worldviews that we developed our social moral
principles and legal rights. Are still in continual state of evolution.
 Illustration: History at one point embraced slavery then rejected
it, oppressed women and disregard the disabled and eventually
struggled to create a legitimate space for everyone.
 Society evolved as reactions to vague concepts as “do good
and avoid evil”, or “inherent dignity of the individual”.
 Morality and ethics still in constant reinterpretation for every age
and time.
 Professional ethics, are applied ethics designed to bring about
the ethical conduct of the profession.
 In health care delivery: pursuit for health, prevention of death,
and alleviation of suffering as secondary goal.

.
Principles of Bioethics:
The principles of stewardship.
Life comes from God, and humans are
"stewards" responsible for the care of the
body. ... A part of the body exists for the
good of the whole, and therefore limbs,
for example, may be amputated if it is
necessary to protect the rest of the body.
Roles of Nurses as Stewards:
Stewardship is an ethic that
embodies the responsible planning
and management of resources.
The concepts of stewardship can be
applied to the environment and
nature, economics, health, property,
information, theology, cultural
resources etc.
Personal, social, ecological and
biomedical.

There are 3 main types of

ecological stewardship. A person can
take action, donate money, and practice
good stewardship on a daily basis.
Principle of Totality and Integrity:
The human body is an integral part of the human
person and is therefore worthy of human dignity. It
must be kept whole. No body part should be
removed, mangled or dibilitated unless doing so is
necessary for the health of a more essential body
part or the body of a whole.
Explanation
 Human nature is an integration of body and spirit. These
two dimensions can never be separated (in fact,
separation of the spirit from the body is the definition of
death).
 The human body shares in the dignity of the human
person.
Applications
 Surgeries that needlessly remove body parts or organs are immoral
 Tattoos and piercings are not inherently immoral but they may be
immoral if they deface the body by quantity or content.
 Torture is a moral evil because it seeks to dis-integrate the body
and the spirit
 Self-mutilation is self-hatred expressed through spite of the body
 That chemical contraception effectively shuts down a healthy
bodily system is part of what makes it immoral.
 Even if the pro-choice argument that an embryo is part of the
woman’s body rather than an independent human person is true, it
should not be removed except when its presence endangers the
woman’s life.
Principle of Ordinary and
Extraordinary Means:
Ordinary Means
 Ordinary means = reasonable hope of benefit/success;
not overly burdensome;
does not present an excessive risk and are financially
manageable
Proportionate to the state of the patient • “Ethically
indicated” (Strong 1981 p. 84).
Extraordinary Means
Extraordinary means = no reasonable hope of
benefit/success;
overly burdensome;
excessive risk and are not financially manageable
 No obligation to use it/morally optional
Principle of personalized
Sexuality:
Personalized sexuality
is based on an understanding of sexuality as
one of the basic traits of a person and must be
developed in ways consistent with enhancing
human dignity. ...
Hence, sexuality is not only a private matter,
although it involves the most intimate of
relationships.
For secular humanist: Reasonable uses of sex
2 Norms of Sexual Morality:
 Unit 2
The Informed Consent:
Informed consent
 the process in which a health care provider educates a patient
about the risks, benefits, and alternatives of a given procedure
or intervention.
 The patient must be competent to make a voluntary decision
about whether to undergo the procedure or intervention. (Jun
1, 2020)

 Obtaining informed consent in medicine is process that should

include:
 (1) describing the proposed intervention,
 (2) emphasizing the patient's role in decision-making,
 (3) discussing alternatives to the proposed intervention,
 (4) discussing the risks of the proposed intervention and
 (5) eliciting the patient's
 Provided, That the patient will not be subjected to any
procedure without his written informed consent, except in the
following cases:
 a) in emergency cases, when the patient is at imminent risk of
physical injury In such cases, the physician can perform any
diagnostic or treatment procedure as good practice of
medicine dictates without such consent;
b) when the health of the population is dependent on the
adoption of a mass health program to control epidemic;
c) when the law makes it compulsory for everyone to submit a
procedure;
d) When the patient is either a minor, or legally incompetent, in
which case. a third party consent Is required;
e) when disclosure of material information to patient will jeop
ardize the success of treatment, in which case, third party
disclosure and consent shall be in order;
f) When the patient waives his right in writing.
Elements of an Informed Consent:
Information – sufficient info.
Volunteerism – autonomy.
Competence – decision making capacity.
Right to Refuse Treatment.

Nurses’ domain of Responsibility:

Nurses typically are assigned the task of obtaining
and witnessing written consent for healthcare
treatment. ...
The goal of informed consent is to assure patient
autonomy.
the following persons, in the order of priority stated
hereunder, may give consent, in patient’s behalf:
 spouse;
 son or daughter of legal age;
 either parent;
 brother or sister of legal age, or
 guardian