BIOETHICS (FIRST SEM) SECOND YEAR NOTES

FINALS
UNIT 6

ETHICAL ISSUE RELATED TO TECHNOLOGY IN THE DELIVERY OF HEALTH

CARE

A. DATA PROTECTION AND SECURITY

1. Data Privacy Act 2012 (RA 10173 Series of 2012)

● “An act protecting individual personal information in information and
communication systems in the government and the private sector, creating for
this purpose a National Privacy Commission, and for other purposes”
● Responsible Agencies:
○ Republic of the Philippines (1. DEPARTMENT OF INFORMATION AND
COMMUNICATION TECHNOLOGY, 2. NATIONAL PRIVACY
COMMISSION) = Country’s Privacy Watchdog
● The Philippines has a growing and important business process management
and health information technology industry.
● Total IT spending reached $4.4 billion in 2016, and expected to more than
double by 2020
● The country is also in the process of enabling free public Wi-Fi.
○ Rapid growth of the digital economy and increasing international trade of
data.
○ Filipinos are heavy social media users
◆ 67 internet users - world’s no. 1 in terms of social media usage
(Digital 2018 by hootsuite, and We Are Social Ltd.)
● Facebook users - 30m in 2013 to 67m in 2017
● The Journey of the DPA
○ The European Unions’s 1995 Data Protection Directive.
○ Electronic Commerce Act of 2000 (R.A No. 8792) - recognition and use of
electronic commercial and non-commercial transactions and documents.
○ Membership in the Asia-Pacific Economic Cooperation (APEC) - Privacy
Framework in 2005.
○ DTI Administrative Order NO.8 in 2006 - which prescribed guidelines for a
local data protection certification system.
○ The DPA was signed into law in 2012, with the local BPO sector as its
most visible endorser.
 ○Creation of Department of Information and communications Technology
(DITC) in 2015 (R.A no. 10844).
○ The activation of the National Privacy Commission (NPC) in 2016.
○ DPA’s Implementing Rules and Regulations was put in effect on September
9, 2016)
● Provision of the DPA
○ Chapter I - General Provisions
○ Chapter II - The National Privacy Commission
○ Chapter III - Processing of Personal Information
○ Chapter IV - Rights of the Data Subject
○ Chapter V - Security of Personal Information
○ Chapter VI - Accountability for Transfer of Personal Information
○ Chapter VII - Security of Sensitivity Personal Information in Government
○ Chapter VIII - Penalties
○ Chapter IX - Miscellaneous Provisions

SCOPE
● SEC. 4. Scope
○ This Act applies to the processing all types of personal information and to
any natural and juridical person involved personal information processing
including those personal information controllers and processors who,
although not found or established in the Philippines, use equipment that
are located in the Philippines, or those who maintain an office, branch or
agency in the Philippines.
○ This act does not apply to the ff:
◆ (A) information about any individual who is or was an officer or
employee of government institution that reacts to the position or
functions of the individual, including;
◆ 1. The fact that the individual is or was an officer or employee of
the government institution;
◆ 2. The title, business address and office telephone number of the
individual;
◆ 3. The classification, salary range and responsibilities of the
position held by the individual; and
◆ 4. The name of the individual on a document prepared by the
individual in the course of the employment with the government
◆ (B) Information about an individual who is or was performing
service under contract for a government institution that relates to
the services performed, including the terms of the contract, and the
name of the individual given in the course of the performance of those
services;
◆ (C) information relating to any discretionary benefit of a financial
nature such as the granting of a license of permit given by the
 ◆

government to ah individual, including the name of the individual and

the exact nature of the benefit.
◆ (D) Personal information processed for journalistic, artistic, literary
or research purposes;
◆ (E) information necessary in order to carry out the functions of
public authority which includes the processing of personal data for
the performance by the independent, central monetary authority
and law enforcement and regulatory agencies of their
constitutionally and statutorily mandated functions.
◆ (F) Information necessary for banks and other financial institutions
under the jurisdiction of the independent, central monetary authority
or Bangkok Central ng Pilipinas to comply with Republic Act NO. 9510
and Republic Act No. 9160, a amended, otherwise known as the Anti-
Money Laundering Act and other applicable laws; and
◆ (G) Personal Information originally collected form residents of
foreign jurisdictions in accordance with the laws of those foreign
jurisdictions, including any applicable data privacy laws, which is
being processed in the Philippines.

General Rights of Data Subjects

● Right to INFORMATION
● Right to ACCESS
● Right to CORRECT
● Right to REMOVE
● Right to DAMAGES
● Right to DATA PORTABILITY
○ Right TRANSMISSIBLE: The lawful heirs of the data subject invoke the
rights of the data subject for, which he or she is an heir or assignee at
any time after death of the data subject or when the data subject is
incapacitated or incapable of exercising the rights.
○ Exceptions
◆ The Rights of the Data Subject are not applicable, IF;
◆ 1. The processed personal information are used only for the needs
of scientific and statistical research AND, on the basis of such,
no activities are carried out and no decisions are taken regarding
the data subject:
◆ 2. The
Approach of the Government
● The processing of personal data shall be allowed subject to adherence to the
principles of;
○ Transparency
○ Legitimate Purpose
○ Proportionality
Data Processing and Consent
● Collection of the personal data must be;
○ Declared
○ Specified
○ Legitimate purpose
● Consent is required prior to the collection of all personal data.
○ The data subject must be informed about the extent and purpose of
processing.
○ For the “automated processing his or her personal data of profiling or
processing for direct marketing and data sharing.”
○ For sharing information with affiliates or even mother companies must be
“freely given, specific, informed,” and must be evidenced by recorded
means.
● Consent is not required for processing where the data subject is party to a
contractual agreement, for the purpose of fulfilling that contract.
○ For protection of the vital interests of the data subject.
○ To response to a national emergency.
○ For the legitimate interests of the data controller.

Agreement
● “The law requires that when sharing data, the sharing be covered by an
agreement that provides adequate safeguards fo the rights of data subjects
and these agreements are subject to review by the National Privacy
Commission”

Sensitive Personal Information

● The law defines sensitive personal information as being:
○ About an individual’s race, ethnic origin, martial status, age, color,
religious, philosophical or political affiliations:
○ About an individual’s health, education, genetic or sexual life of a
person, or to any proceeding or any offense committed or alleged to
have committed;
○ Issued by government agencies “peculiar” (unique) to an individual, such
as social security number:
○ Marked as classified by the executive order or act of Congress.
● All processing of sensitive and personal information is prohibited except in
certain circumstances.
○ Count of the data subject
○ Pursuant to law that does not require consent
○ Necessity to law that does not require consent
○ Necessity to protect life and health of a person
○ Necessity for medical treatment
 ○Necessity to protect the lawful rights of data subjects incourt
proceedings, legal proceedings or regulation
● Security of Sensitive Personal Information in Government
○ Responsibility of Heads of Agencies
◆ Information shall be secured with the most appropriate standards as
recommended by the NPC. Heads of agencies are responsible for
complying with the security requirements.
○ Requirements of Access by Agency Personnel:
◆ Online/Onsite - no employee of the government shall have access
unless the employee has received a security clearance.
◆ Offsite - information shall not be transported or accessed offsite
unless a request is approved.

Personal Information Controllers

● Personal Information Controller - refers to a person or organization who can
tools the collection, holding, processing or use of personal information,
including a person or organization to collect, hold, process, use, transfer or
disclose personal information on his or her behalf. The term excludes:
○ 1. A person or organization who performs such as functions as instructed
by another person or organization
○ 2. An individual who collects, holds, processes or uses personal
information in connection with the individual’s personal, family or
household affairs (personal interest)
● Personal Information Processor - refers to any natural or juridical person
qualified to act as such to who a personal information controller may
outsource the processing of personal data pertaining to a data subject.
● Rights of Personal Information Controllers
○ 1. Outsource the processing of personal information to processors
qualified as such;
○ 2. Invoke the defense of privileged communication.

Penalties
● Ranging from P100,000 to P5,000,000 (approximately USD2,000 to 100,000)
● Imprisonment of 1 year up to 6 years
○ Unauthorized Processing of Personal Information and Sensitive Personal
Information
○ Accessing Personal Information and Sensitive Personal Information Due to
Negligence.
○ Improper Disposal of Personal Information and Sensitive Personal
Information
○ Processing of Personal Information and Sensitive Personal Information of
Unauthorized Purposes.
○ Unauthorized Access or Intentional Breach
 ○ Concealment of Security Breaches Involving Sensitive Personal
Information
○ Malicious Disclosure
○ Unauthorized disclosure

Who Needs to Register?

● Companies with at least 250 employees or access to the personal and
identifiable information of at least 1,000 people are required to register with
the National Privacy Commission and comply with the Data Privacy Act of
2012.

Compliance of the Data Privacy

● The National Privacy Commission, which as created to enforce RA 10173, will
check whether companies are compliant based on a company having 5
elements:
○ Appointing a Data Protection Officer
○ Conducting a Privacy Impact Assessment
○ Creating a Privacy knowledge management program
○ Implementing a privacy and data protection policy
○ Exercising a breath reporting procedure

BENEFITS AND CHALLENGES OF TECHNOLOGY

Benefits of Technology
● Technology has brought a number of remarkable changes to the health
industry throughout the years> It has allowed a number of cures to be created
and beneficial changes to be made in treatment and care.
● With the constant state of improvements and upgrades, it is important to
consider where we are toady in terms of beneficial healthcare technology.
● 1. Easily Accessible Medication Information
○ It has become increasingly common for the people suffering from
questionable symptoms to immediately consult the internet for an
answer to their ailments. This is great for easing worries for providing
answers when your medical provider may not be readily available.
○ It can also save you money by avoiding unnecessary doctor visits.
However, looking up upper symptoms online can leas to acuity and panic
of a simple illness, as your symptoms may be present for number of
different sicknesses. In these instances, it is important to consult your
doctor for a professional diagnosis.
● 2. A Larger Presence of Social Media
○ Physicians, hospitals and clinics have made it a standard practice to
 ○
create an avenue to the public through social media sites. This not only
grants them a larger audience, but allows people an easy way to reach out
for information from them.
○ They can offer advice or information specific to their practice, educating
followers far and wide.
○ Another great perk form this is that past patients are able to leave
feedback or a review of the service they received at the specific medical
facility, or with a specific doctor. This can greatly help potential patients
narrow down a doctor or facility that they feel could best serve their
needs.
● 3. Better Treatments, equipment and medicine
○ It is no secret that as we move further into the age of technology, number
of benefits emerging.
○ Many would consider that improved healthcare is the greatest result to
come from technology
○ Better equipment has allowed doctors to provide more comprehensive
care. Better treatments have increased the quality of life of a number of
different people suffering form one-term illnesses. And better medicine
has completely wiped out the fear of some life-threatening illnesses of the
past.
○ It also helped speed up research, as well as connect medical researchers
from around the world. This has allowed the focus to be narrowed and the
manpower to multiplied to finding answer to certain medical mysteries.
○ Procedures have been improved as well, for example. A medical spa I’m
San Mateo County uses state-of-the-art technology for plastic surgery.
The scope of qualified technicians and physicians has largely increased,
allowing more options with safe results.
○ All of these things are due to improved technology.
● 4. Faster results
○ It used fro take weeks or even a moth to get the results of medical testing
○ With improved technology, it is now possible to get results as soon as the
lab is finished with your sample.
○ Many hospitals and clinics offer web portals, allowing you ti access your
results within hours or days. This is incredible helpful in easily anxiety and
providing the answers you seek.
○ These web portals also allow you to access you last medical records,
giving you a chance to keep track of appointments, medical issues and
billing, It is a great way to add convenience for the patient.
● 5. Improved Relationships with Patients
○ Doctors can easily access a patient’s records, allowing them to provide
better, in-depth knowledge about each patient’s medial past and care.
○ Patient files used to line the halls of practices, creating larger mounts of
paperwork and eliminating the possibly of finding year-past medical
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records,
○ Now, technology has allowed medical records to be transcribed online,
easily available to both doctor and patient.
○ Patients can feel more comfortable with their doctor when he understands
their complete health picture.
● 6. It Helps To Predict Outbreaks
○ Since many people search online for answers once they begin to feel
under the weather, that data actually adds up to create a larger picture
specific to that query.
○ Yearly flu outbreaks are a great example if this. Locations can be
determined for the online searches and a database can be created that
shows the rise in possible cases as well as spread of the illness, This can
be important step in preparing for outbreaks as well as predicting the
outlook for the flue season in future years,

CHALLENGES

Challenges of Technology
● Technology has changed the way industry professionals approach the idea of
healthcare.
● While many of these innovations are positive - facilitating patient care and
ensuring traditional treatments are more effective - they also present some
unique challenges. Why? Because this technology is something the
industry has never seen before.
● 1. The Challenge of Interoperability (exchange)
○ One of the mist significant selling points of electronic health records
(EHRs) is they allow practitioners to access relevant patient data instantly.
With the adoption of this technology nearly complete - around 95 percent
of hospitals use EHRs - interoperability is providing to be a challenge.
○ To put it bluntly, interoperability is a mess. Patient identification isn’t
standardized, often making it impossible to watch a person with their
records. Nearly anyone can input information into a patient’s EHR, but
withdrawing data isn’t always possible.
○ Avoiding interoperability problems will require industrywide changes. One
solution is to implement cloud-based EHRs, which centralize the database
while still providing the necessary security.
● 2. Keeping Up with Old Tech
○ In spite of all these technological advances, many facilities still use out-
of-date technology. Outdated software creates security holes like the
one that allowed hackers to take down National Health Security’s (NHS’s)
system in 2017. Windows 7 devices are bout to be in the same boat, with
the company ending support in 2020.
 ○ IT’s easy to upgrade a computer to the next operating system in line.
However, for medical equipment running an older OS, upgrading isn’t as
straightforward. The best way to avoid problems is to upgrade when
possible. The facility’s IT department should be fluent in every operating
system that’s currently in use.
● 3. User-Unfriendly Interfaces
○ Medical technology is advancing by leaps and bounds. Yet one thing left in
the dark ages in user interface. These devices might change the world,
but it won’t matter if they’re too difficult to use. If there’s too much data
on the screen at once, or he interface doesn’t help users navigate, no one
is going to use it.
○ For medical professionals, there’s two possible courses of action to
avoid an interface problem.
◆ First engage with manufacturers during the research and development
and let them know what’s needed.
◆ Second, take the time to learn how unfriendly interfaces work. It may
be challenging but it could be the lesser of two evils.
● 4. Exacerbating Malpractice Claims
○ MedTech has made many practices easier, but it overcomplicates others.
○ One case from 2013 is an ideal example;
◆ A 16-year-old patient was supposed to take a singe dose of antibiotics
before a routine procedure. A lack of interoperability meant everyone
who saw the patient between admissions and when he complained of
anxiety - though. He needed to take another dose. Overall, he took
nearly 39 times the recommended dose of this medication.
● 5. Overall Implementation
○ Implementing technology in medicine has steep learning curve. Those who
need it most may not have time to learn how to use it. Without a
comprehensive understanding, trying to use medical technology can
lead to practitioner error and malpractice.
○ Hospitals administrators, medical professionals and IT teams need to
tackle this challenge head-on. Technology is going to change and shape
the medical industry for decades to come. Those what don’t adapt will
be left behind, struggling to keep up with the tidal wave of innovation
that’s sweeping through healthcare.

Issues of Dilemma
● Privacy and Confidentiality
○ Although controlling access to health information is important, but is not
sufficient for protecting the confidentiality. Additional security steps
such as strong privacy and security policies are essential to secure
patient’s information.
● Security Breaches
 ○Security measures such as firewalls, antivirus software and intrusion
detection software must be included to protect data integrity. Specific
policies and procedure serve to maintain patient privacy and
confidentiality. Ex. Employees must not share their ID with anyone,
always log off when leaving a terminal and use their own ID to access
patient digital records. A security officer must be designated by the
organization to work with a team of health IT experts.
○ Routine random audits should be conducted on a regular basis to ensure
compliance with hospital policy. All system activity can be tracked by audit
trails. This includes detailed listings of content, duration and the user-
generating date and time for entries and logs of all modifications to EHRs.
● Data Inaccuracies
○ Inaccurate representation of the patient’s current condition and treatment
occurs due to improper use of options such as cut and paste. This
practice is unacceptable because it increases the risk for patients and
liability for clinicians and organizations
○ Another feature that can cause a problem in the date integrity is the drop
down menu and disposition of relevant in the trash.
○ A growing problem is of medical identity theft this results in the input of
inaccurate information into the record of the victim.

CONTINUING EDUCATION PROGRAMS ON ETHICO-

MORAL PRACTICE IN NURSING
Lobbying - in politics lobbying, persuasion, or interest representation is
the act of lawfully attempting to influence, persuade, alter the actions,
policies, or decisions of government officials, most often legislators or
members of regulatory agencies.
Governments often define and regulate organized group lobbying that has
become influential.

What is healthcare lobbying?

When these issues reach point where they may be voted on, health care
lobbyists step into the space between the public and government
representatives - advocating for the interests of patients, providers,
insurance companies and others in the health care industry - to ensure
officials make educated decisions.
How does it work?
Lobbying gin the United States describes paid activity in which special
interest groups hired well-connected professional advocates, often
 lawyers, to argue for specific legislation in decision-making bodies such
as the United States Congress.
What are some examples of lobbying?
An officer Duke writes to a Member of Congress urging him or her vote
against amendment that will be offered during the debate on a bill. This
constitutes lobbying because it states a view about specific legislation
What are the advantages of lobbing
– Lobbying is an important level for a productive government. Without it,
governments would struggle to sort out the many, many competing
interests of its citizens.
– Fortunately, lobbying provides access to government legislators, acts
as an educational tool, and allows individual interests to gain power in
numbers.
How are health care and lobbying related?
– Lobbying and health care can related in that, lobbying consists of groups of
active people with political interest who are responsible for influencing
legislative decisions, acting as lobbyists.
What is the role of nurse lobbyist?
- While a U.S senator may receive hundreds of letters on an issue, the nurse
lobbyist is the person who can directly lay out concerns or opportunities and work
with the politician’s office to ensure those sentiments are addressed in legislation
What is a lobbyist in simple terms
- a lobbyist is someone hired by a business or a case to persuade legislators to
support that business or cause.
- lobbyist get paid to win favor from politician. For example, oil companies send
lobbyists to Washington to try to make life easier for oil companies.
Is lobbying unethical?
– The most obviously unethical (and illegal) practice associated with lobbying
is paying a policy maker to vote in a favorable way or rewarding him or her
after a vote with valuable considerations. If this practice were allowed, people
and organizations with money would always win the day.
What is an example of indirect lobbying?
- As an indirect tactic, lobbyists often try to manipulate public opinion which, in
turn, can sometimes exert pressure on congresspersons, who must frequently
appeal to that public during electoral companies
– One method for exerting this indirect pressure is these of mass media.

INTERNATIONAL CODE OF ETHICS

- nurses are responsible to provide their clients/patients with the high-quality
care. They are undoubtedly confronted with various ethical challenges in their
professional practice, so they should be familiar with ethical codes of conduct and
the essentials of ethical decision making.
● code of ethics are fundamental guidance for nursing as like many other
 ●
professions. Although there are authentic international codes of ethics for
nurses, the national code would be the additional assistance provided for
clinical nurses in their complex roles in care of patients, education, research
and management of some parts of health care system In the country.
● International Code of Ethics for Nurses
○ The first International code of ethics for nurses was adopted by the
International Council of Nurses (ICN) in 1953.
○ The two codes prepared by American Nurses Association (ANA) and
Canadian Nurses Association (CAN) are the examples of national codes of
ethics for nurses.
○ The codes outline how the nurses should behave ethically as a
profession, and how they should decide when encounter barriers
preventing them from fulfilling their professional obligations.
○ The codes can also support nurses in their practice and reduce their moral
distress
○ An International code of ethics for nurses was first adopted by the
International council of Nurses (ICN) in 1953.
○ It has be revised and reaffirmed at various Tims since, most recently with
this review and revision completed in 2012

Preamble
● Nurses have four (4) fundamental responsibilities:
1. To promote
2. To prevent illness
3. To restore health
4. To alleviate suffering
● The need for nursing is universal
● Inherent in nursing is a respect for human rights, including cultural rights, the
right to life and choice, to dignity and to be treated with respect.
● Nursing care is respectful of and unrestricted by considerations of age, color,
creed, disability or illness, gender, sexual orientation, nationality,
politics, race or social status.
● Nurses render health services to the individual, the family and the community
and coordinate their services with those of related groups.

Elements of ICN Code

● The ICN code of ethics for Nurses has four principal elements that outline
the standards of ethical conduct.
○ Nurses and People
◆ The nurse’s primary professional responsibility is to people requiring
nursing care. In providing care, the nurse promotes an environmental
in which the human rights, values, customs and spiritual beliefs of the
individual family and community are respected.
 ○ Nurses and Practice
◆ The nurse carries personal responsibility and accountability for
nursing practice, and for painting competence by continual learning,
◆ The nurses maintains a standard of personal health such that the
ability to provide care is not compromised.
◆ The nurse uses judgment regarding individual competence when
accepting and delegating responsibility.
○ Nurse and the Profession
◆ The nurse assumes the major role in determining and implementing
acceptable standards of clinical nursing practice, management,
research and education
◆ The nurse is active in developing a core of research-based
professional knowledge that supports evidence-based practice.
○ Nurse and co-workers
◆ The nurse sustains a collaborative and respectful relationship with co-
workers in nursing and other fields
◆ The nurse takes appropriate action to safeguard individuals, families
and communities when their health endangered by a co-worker or any
other person.
◆ Nurses and nursing students can therefore;
◆ Study the standards under each element of the Code.
◆ Reflect on what each standards means to you. Think about how
you can apply ethics in your nursing domain: practice, education,
research or management.
◆ Discuss the code with the co-workers and others
◆ Use a specific example for experience to identify ethical dilemmas
and standards of conduct as outlined in the code. Identify how
you would resolve the dilemmas.
◆ Work in gourds to scarify ethical decision making and reach a
consensus on standards of ethical conduct,
◆ Collaborate with noir National Nurses Association, co-workers,
and others in the continuous application of ethical standards in
nursing practice, education, management and research

NATIONAL COE
● The National Code defines the values which are comprehensive and
culturally-adapted.
● Then, it classify the ethical responsibilities as five main parts (5);
○ Nurses and People
○ Nurses and the Profession
○ Nurses and Practice
○ Nurses and Co-workers
○ Nursing, Education and Research including 71 provisions in total
Conclusion
● Considering the experience in compiling national ethical codes and guidelines,
the National Code of Ethics For Nurses is developed as a guide for
performing nursing responsibilities and the ethical obligations of the
profession
● Although there are authentic International codes of ethics for nurses, the
national code would be the additional assistance provided for clinical nurses in
their complex roles in care of patients, education, research and management
of some parts of health care system in the country.
● Most nurses may be either too busy or exhausted to think about their behavior
in practice. However, accountability through meeting the obligations is
essential in nursing which is one the most-trusted precessions in all societies.

CODE OF ETHICS OF FILIPINO NURSES

REGISTERED NURSES AND PEOPLE
PREAMBLE
● SECTION 1
○ Health is fundamental right of every individual. The Filipino registered
Nurse, believing in the worth and dignity of each human being,
recognizes the primary responsibility to preserve health, prevention of
illness, alleviation of suffering, and restoration of health. However,
when the foregoing are not possible, assistance towards a peaceful death
shall be his/her obligation.
● SECTION 2
○ To assume this responsibility, registered nurses have to gain knowledge
and understanding of man’s cultural, social, spiritual, physiological,
psychological and ecological aspects of illness, utilizing the
therapeutic process. Cultural Diversity and political and socio-
economic status are inherit factoids to effective nursing care.
● SECTION 3
○ The desire for the respect and confidence of clients, colleagues, co-
workers, and the members of the community provides the incentive to
attain and maintain the highest possible degree of ethical conduct.
● SECTION 4
○ Ethical Principles
◆ Value customs, and spiritual beliefs held by individuals shall be
 ◆
respected.
◆Individual freedom to make rational and unconstrained decisions shall
be resected.
◆ Personal information acquired in the process of giving nursing care
shall be held in strict confidence.
● SECTION 5
○ Guidelines to be observed:
○ Registered Nurse must
◆ Consider the individuality and totality of patients when they administer
care
◆ Respect the spiritual beliefs and practices of patients regarding diet
and treatment
◆ Uphold the right s of individuals
◆ Take onto consideration the culture and values of patients in providing
nursing care. However, the event conflicts, their welfare and safety
must take precedence
● SECTION 5
○ Ethical Principles
◆ Human is invisible (untouchable, absolute)
◆ Quality and excellence in the care of the patients are the goals of
nursing practice
◆ Accurate documentation of actions and outcomes of delivered care is
the hallmark of nursing accountability.
● SECTION 7
○ REGISTERED NURSE MUST;
◆ Know the definition and scope of nursing practice which are the
provisions of R.A No.9173, known as the “Philippine Nursing Act
2002” and board Res. NO. 425, Series of 2003, the “Rules and
Regulations Implementing the Philippine Nursing Act. Of 2002”,
(the IRR)
◆ Be aware of duties and responsibilities in the practice of their
profession as defined in the “Philippine Nursing Act of 2002” and the
IRR.
◆ Acquire and develop the necessary competence in knowledge, skills,
and attitudes to effectively render appropriate nursing services
through varied learning situations.
◆ They are administrators, be responsible in providing favorable
environment for the growth and developments of registered nurses in
their charge
◆ Be cognizant that professional programs for specialty certification by
the BON are accredited through the Nursing Specialty Certification
Council (NSCC)
◆ See to it that quality nursing care and practice meet the optimum
 ◆
standard of safe nursing practice
Ensure that modification of practice shall considered the principles pf
◆
safe nursing practice.
◆ If in position of authority in a work environment, be normally and
legally responsible for devising a system of minimizing occurrences of
ineffective and unlawful nursing practice
◆ Ensure that patient’s records shall available only if they are to issued
to those who ate professionally and directly involved in their care and
when they are required by law
● SECTION 8
○ ETHICAL PRINCIPLES
◆ Registered nurses are the advocates of the patients; they shall take
appropriate step to safeguard their rights and privileges
◆ REGISTERED NURSE MUST
◆ Respect of the “patient’s Bill of Rights” in the delivery of nursing
care
◆ Provide the patients of their families with all pertinent information
except those which may deemed harmful to their well-being
◆ Uphold the patient’s rights when conflict arises regarding
management of their age.
● SECTION 9
○ ETHICAL PRINCIPLES
◆ Registered Nurses area aware that their actions have professional,
ethical, moral and legal dimensions. They strive to perform their work
in the best interest of all concerned.
● SECTION 10
◆ Perform their professional duties in the conformity with existing laws,
rules and regulations, measures and generally principles of moral
conduct and proper decorum
◆ Now allow themselves to be used in advertisement that should
demean the image of the profession (I.e incident exposure, violation of
dress code, seductive behavior, etc)
◆ Decline any gift, favor or hospitality which might be interpreted as
capitalizing on patients.
◆ Do not demand and receive any commission, free or emolument for
recommending or referring a patient to a physician. A co-nurse or
another health care worker; not to pay any commission, fee or other
compensations to the one. Referring or recommending a patient to
them for nursing care.
◆ Avoid any abuse of the privilege relationship which exist with patients
and of the privilege access allowed to their property, residence or
workplace.
REGISTERED NURSES AND CO-WORKERS
● SECTION 11
○ The registered nurse is in solidarity with other members of the healthcare
team in working for the patient’s best interest.
○ The registered nurse maintains collegial and collaborative working
relationship with colleagues and other health care providers
● SECTION 12
○ Maintain their professional role/identity while working with other members
of the health team
○ Conform with group as those of a health team should be based on
acceptable ethics-legal standards
○ Contribute to the professional growth and development of other members
of the health team.
○ Actively participate in professional organizations
○ Not act in any manner prejudicial to other professions
○ Honored and safeguard the reputation and dignity of the members of
nursing and other professions; refrain from making unfair and unwarranted
comments or criticisms on their competence, conduct and procedures or
not do anything that will bring discredit to a colleague and to any member
of other professions
○ Respect the rights of their co-workers
● SECTION 13
○ The preservation of life, respect of human rights, and promotion of healthy
environment shall be a commitment of a registered nurse.
○ The establishment of linkages with the public in promoting local, national,
and international efforts to meet health and social needs of the people as
a contributing member of society is a noble concern of a registered nurse.
● SECTION 14
○ Be conscious of their obligations as a citizens and, as such, be involved in
community concerns
○ Be equipped with knowledge of health resources within the community,
and take active roles in primary health care
○ Actively participate in programs, projects and activities that respond to
the problems of society.
○ Lead their lives in conformity with the principles of right conduct and
proper decorum
○ Project an image that will uplift the nursing profession at all times
● SECTION 15
○ Maintenance of loyalty to the nursing profession and preservation of its
integrity are ideal
○ Compliance with the by-laws of the accredited professional organization
(PNA), and other professional organization of which the Registered nurses
is a member is a lofty duty
 ○Commitment and growth of the profession are commendable obligations
○Contribution to the improvements of the socio-economic conditions and
general welfare of nurses through appropriate legislation is a practice and
a visionary mission
● SECTION 16
○ A members of the accredited Professional Organizations (PNA)
○ Strictly adhere to the nursing standards
○ Participate actively in the growth and development of the nursing
profession
○ Strive to secure equitable socio-economic and work conditions in nursing
through appropriate legislation and other means
○ Assert the implementation of labor and work standards
● SECTION 17
○ The certificate of Registration of Registered Nurse shall either be
revoked or suspended for violation of any provisions of this code
pursuant to Sec.2.4 (f)., ART, IV of R.A No. 9173 and Sec. 23(f) Rule III of
Board Res. NO. 425, Series of 2003, the IRR
● SECTION 18
○ The Amended Code of Ethics promulgated pursuant to R.A no. 877 and
P.D
○ No. 233 is accordingly repealed or suspended by the herein Code

SEMIFINALS
UNIT 3

NUREMBERG CODE
● Researcher must inform subjects about the study.
● Must be for the good of society
● Based on animal experiments. If possible.
● Must try to avoid injury to research subjects.
● Subjects or the researcher can stop the study if problems occur.

DECLARATION OF HELSINKI
● A set if ethical principles regarding human expirementation developed for
 ●
the medical community by the World Medical Association (WMA). It is widely
regarded as the cornerstone document on human research ethics.
● It is not a legally binding instruments under the international law, but instead
draws its authority from the degree to which it has been codified in, or
influenced, national or regional legislation and regulations.
● Declaration is morally binding on physicians, and that obligation overrides any
national or local laws or regulations, if the declaration provides for a higher
standard protection of human than the latter. Investigators still have to abide
by a local legislation but will be held to the higher standard.
● The fundamental principle is respect for the individual, right to self-
determination, and the right to make informed decisions regarding
participation in research, both initially and during the course of the research.

BELMONT REPORT
● IN 1978 The National Commission for the protection of Human Subjects of
Biomedical and Behavioral Research was formed.
● “Ethical Principles and Guidelines for the Protection of Human Subjects of
Research’
○ The Goals of this Commission were to:
◆ Identify basic ethical principles that should guide the conduct of
research involving human subjects and
◆ Develop guidelines based on principles that had been identified.
● The report published by this commission in 2979 was titled “The Belmont
Report”
○ 3 basic principles related to research subjects were identified.
1. Respect for Persons - research subjects should have autonomy and
self determination
2. Beneficence - research subjects should be protected form harm.
3. Justice - research subjects should receive fair treatment.

ETHICAL ISSUES IN EVIDENCED BASED PRACTICE

● Evident-based practice is a conscientious, problem-solving approach to
clinical practice that incorporates the best evidence from well-designed
studies, patient values and preferences and a clinician’s expertise in making
decisions about a patient’s care.
● Is roughly the use of current best evidence in making decisions about the care
of patients (Sackett)
● At least two ethical concerns are found in the literature on EBP.
●
1. Some types of knowledge are not included in EBP.
A. EBP downgrades or discounts types of knowledge that are used by
practitioners and which are important for good practice, the include experience ,
intuition and anecdote.
B. In health care, EBP fits best with tightly defined areas of practice, particularly
pharmacology, but is ill suited for the more craft-like areas, such as surgery and
nursing.
C. In these areas, experience counts for a great deal, and patient would be better
served by an experienced practitioner rather than one well-versed in recent
research evidence.
D. However, the point is rather that experience and intuition can point in directions
counter to those suggested by EBP.

Example ;
– Whilst guidelines based on EBP might suggest a new treatment for all patients,
a practitioner might believe that overall, some patients who are well
established on the old treatment would be best left on it (for examples, those
who would find it difficult to establish new routines.
– A surgeon during a procedure might decide to try something new on the basis
of a hunch, even though little r no EBP-evidence to support it.
2. EBP runs counter to patient-centered care
A. Patient-centered care - which requires case-specific knowledge and intuition,
is undermined.
B. Patient lose choice - they are constrained to have what the evidence tells them
to a phenomenon that has been described a evidence-based paternalism.
ex. EB judgment includes cost effectiveness; for example, an individual
patient might prefer a treatment of only marginally efficacy but much greater cost.
C. Practitioner lose choice - they can no longer make choices that fit individual
patient but which run counter the guidelines of EBP.

ETHICO-MORAL OBLIGATIONS IF THE NURSE IN EVIDE-BASED PRACTICES

● The principal means for ensuring that the rights of research subjects are
protected is through informed consent.
● Informed Consent concern subjects’ participation in research in which they
have full understanding of the study before the study begins.

MAJOR ELEMENTS OF INFORMED CONSENT

● Researcher is identified and credentials presented.
● Subjects selection process is described.
○ How they were chosen to participate
○ Information should be provided
○ Meet the criteria to be eligible
● Purpose if study described.
○ Clearly stated.
○ Subjects’ preferred language
 ○ Printed material at subjects’ reading level.
● Study procedure are discussed
○ Fully explained
○ Inform when and where the study will take place.
○ Informed consent
● Potential risks are described
○ Inform possible discomforts
○ Discuss possible invasion. Of privacy,
● Potential benefits are described
● Compensation, if any, discussed
● Alternative procedure, if any, are disclosed
● Anonymity if confidentiality’s assured.
○ Anonymity no one can identified the subjects in the study
○ Confidentiality the researcher will protect the subjects’ identities.
● Rights to refuse to participate or to withdraw form study without penalty is
assured.
○ Voluntary participation
◆ Offer to answer all questions is made
◆ Means of obtaining study results is presented

THE NURSE RESEARCHER AS A PATIENT ADVOCATE

● The nurse researcher has the responsibility to protect the privacy and the
dignity of the people involved in the research.
● The researcher has an obligation tor refrain from conducting such researcher
study involving undue physical risks, psychological risks, or both.
● The nurse researcher must assume responsibility for study conditions.

CLINICAL TRIALS
● Are research studies conducted to evaluate new treatments, new drug and
new or improved medical equipment.
● Nurses should be able to answer patients’ questions studies, particularly
clinical trials

VULNERABLE RESEARCH SUBJECTS

● Certain special groups of people are considered particularly vulnerable
research subjects because they are either unable to give informed consent or
because the likelihood of coercion to participate is strong.
● Special precautions must be taken to ensure that the study has low risks
potential for these vulnerable people.

VULNERABLE RESEARCH SUBJECTS

● These groups include:
○ Children
 ○ Geriatric clients
○ Prisoners
○ People with AIDS
○ Homeless
○ Unconscious
○ Sedated patients

ASSENT
● When children are younger than 7 Years, parental consent is sufficient.
● If a child is older than 7 years, not only must the parent consent to the
child’s participation but the child must also agree to be in the study bu giving
assent to participate in a study.
● Assent means that an underage child or adolescent freely chooses to
participate in a study.

GUIDELINES OF CRITIQUING THE ETHICA; ASPECTS OF A STUDY

● Was the study approved by an Institutional Review Board (IRB)?
● Was informed consent obtained form the subjects?
● Is there information about provisions for anonymity or confidentiality?
● Were vulnerable subjects used?
● Does it appear that subjects might have been coerced into acting subjects?
● It sit evident that the benefits of participation in the study outweighed the
risks involved?
● Were subjects provided the opportunity to ask questions about the study and
told how to contact the researcher if other questions arose?
● Were the subjects told how they could get the results of the study?

UNIT 4

GUIDELINES AND PROTOCOL IN DOCUMENTATION AND

HEALTH CARE RECORD

DOCUMENTATION
● All professional persons need to be accountable for the performance of their
duties to the public.
● Since nursing has been considered as profession, nurses need to record their
work on completion.
● Records are a practical and indispensable and to the doctor, nurse and
paramedical personnel in giving the best possible service to the clients
 ● Report summarizes the services of the person or personnel and of the agency.

RECORDS VS REPORTS
● RECORD is a permanent written communication that documents information
relevant to a client’s health care management.
● RECORD is a clinical, scientific, administrative and legal document relating to
the nursing care given to the individual family or community.

● REPORTS are oral or written exchanges of information shared between

caregivers or workers in a number of ways.
● Report is the summary of the services if person or personnel and of the
agency.

● Records are practical and indispensable aid to doctor, nurse and paramedical
personnel on giving the best possible service to their clients.
● Recorded Facts have value and scientific, accuracy for more than mere
Impression of memory and there are guidelines for better administration go
health services.

PURPOSE OF RECORDS
● Supply data that are essential for programme planning and evaluation.
● Provide the practitioner with data required for the application of professional
services for the improvement of family’s health.
● Tools of communication between health workers, the family and other
development personnel.
● Effective health records show the health problem in the family and other
factors that affect health.
● Indicates plans for future.
● Help in the research for improvement of nursing care.

PRINCIPLES OF RECORD WRITING

● Nurses should develop their own method of expression and form in record
writing.
● Written clearly, appropriately and adequately.
● Contains facts based on observation, conversation and action.
● Select relevant facts and the recording should be neat, complete and uniform.
● Valuable legal documents and so it should be handled carefully and accounted
for.
● Records should be written immediately after an interview.
● Records are confidential documents.
● Accurately dated, timed and signed.

VALUES AND USES OF RECORDS IN HOSPITAL OF HEALTH CENTERS.

 ● For the individual and Family
– Records serve to document the history of the client.
– Records assist in the continuity of care.
– Records serve as evidence to support or to manage or face the legal
questions that arise.
– Records serve to recognize the health needs and can be used as a
research and teaching tool
● For the Doctor
– Serves as guide for diagnosis, treatment, follow up and evaluation of
services.
– Indicates progress and continuity of care.
– Help self evaluation of medical practice.
– Protect the doctor in case of legal issues.
– Records may be used for teaching and research.
● For the nurse
– Provide with documentation of services rendered, I.e. shows health
condition of the client.
– Provide data essential for planning and evaluation of services for further
improvement.
– Serve as guide for professional growth
– Enable to judge the quality and quantity of work done.
– Serve as communication tool between staff and other members involved in
care.
– Indicate plans for future.
For Authorities
– Provide the management with statistical information necessary for
decision in regard to utilization of resources, planning for administrative
control and future references.
– Help the supervisor evaluate the services rendered, teaching done and a
person’s actions and reactions.

TYPES OF RECORDS
● Cumulative or Continuing Records
– This is found to be time saving, economical and also it is helpful to review
that total history of an individual and evaluate the progress of a long
period.
● Family Records
– All records, which relate to member of family, should be placed in a single
family folder. Gives the picture of the total services and helps to give
effective, economic service the family as a whole.
– Separate record forms may be needed for different types of service such
as TB, maternity etc. all such individual records which relate to members
 –

of one family should be place in a single family folder.

Records Maintained In Community Settings

1.
– Family Record
– Eligible couple and child register
– Sterilization and IUD register
– MCH Card/Register
– Child Cared/Register
– Birth and Death Register
– Sub Centers/PHC/clinic register
– Stock and Issue Register
– Reports of Blood Test Of Malaria and Filaria
– Malaria parasite positive case register and others.
2. DIARIES
– Diary of Health Assistants
3. RETURN-MONTHLY report of Health Workers
– Complication Report
– Public Health Care

In addition, each organization should maintain;

– Cumulative Research
– Family Records

RECORDS MAINTAINED IN THE HOSPITAL

● The patient’s clinical research
● Records of nurses’ observations Nurses’ Notes
● Records of order carried out
● Records of treatment
● Records of admission and discharge
● Records of equipment loss and replacement (inventory)
● Records of personal performance

PATIENT’S CLINICAL RECORD

● Head Nurse’s Responsibility for Clinical Record

– Protection from the loss
◆ The head nurse is responsible for safeguarding the patient’s record
from loss or destruction. No individual sheet is separated from the
complete record unless, as with the doctor’s order sheet, it is kept in a
special place where its safety is guarded.
– Safeguarding its content
◆ The hospital administration usually has procedure with which the head
 ◆
nurses should be familiar for handling legal matter of this kind. Patient
has the right to insist that his record be confidential.
– Completeness
– Compile records with complete identifying data on each page in the
form approved by the hospital. The two parts of the record for which
the nursing service is universally wholly responsible are the vital sign,
graphic sheet and nurses’ observation or nurses’ notes.
– Responsibility for the Nurses’ Notes
– The form for nurses’ notes which has been established by the hospital
should be used by all nurses.

EVALUATION PRINCIPLES IN KEEPING RECORDS

● What information is essential to record?
● What useful purposes will it serve?
● Is the information obtained in other way or is it recorded elsewhere?
● Can two be easily filled?
● Is the form uniform throughout the hospital?

HOW TO IMPROVE RECORD-KEEPING

● Get into habit of using factual, consistent, accurate, objective and
unambiguous patient information.
● Use your senses to record what you did.
● Ensure there is reasoned rationale (evidence) for any decision recorded.
● Ensure notes are accurately dated, timed and signed with the name printed
alongside the entry.
● Write the notes, where possible, with the involvement and understanding of
the patient or care taker.
● Errors should be corrected by putting a single line through the incorrect
statement and signing and dating it.
● Follow the SMART model (specific, measurable, achievable, realistic and
Time-based) or similar when planning care.
● Write up notes as soon a s possible after an event and, by law, within 24
hours, making clear any subsequent alterations or additions
● Do. Not include jargon, meaningless phrases (ex. Awol) ; offensive
subjective statements.
● It must be clear what was originally written and why it was changed, therefore
correction fluids should be not be used.
● The mmc’s position on abbreviations is that they should no be used (NMC,
2002c) eg. ‘PT’ could mean patient, physiotherapist or yartname

GUIDELINES AND PROTOCOL IN DOCUMENTATION

REPORTING
● Reports can be daily, weekly, monthly, quarterly and annually.
● Report summarizes the services of the nurse and/or the agency.
● Reports may be in the form of an analysis of some aspects of a service.
These are based on records and registers and so it is relevant for the nurses to
maintain the records regarding their daily loadmaster service land and activities.

Importance of Reports
● Good reports save duplication of effort and eliminate the need for
investigation to learn the facts in a situation.
● Full reports often save embarrassment due to ignorance of situation
● Patients receive better care when reports are thorough and give all pertinent
data.
● Complete reports give a sense of security which comes form knowing all the
factors in the situation.
● It helps in efficient management of the ward.

Criteria for good reports

● Reports should be made promptly if they are to serve their purpose well,
● A good report is clear, complete, concise.
● If it is written all pertinent, identifying data includes - the date and time, the
people concerned, the situation, the signature of the person making the
report.
● It is clearly stated and well organized for early understanding.
● No extraneous material is included
● Good oral reports are clearly expressed and presented in an interesting
manner, important points are emphasized.

TYPES OF REPORTS
● Oral reports - are given when the information is for immediate use and not for
permanency. E,g it is made by the nurse who is assigned to patient care, to
another nurse who is planning to receive her (endorsement).
● Written reports - reports are ti be written when the information to be used by
several personnel, which is more or less permanent value, e.g day and night
reports, census, interdepartmental reports, needed according to situation,
events and conditions.

REPORTS USED IN HOSPITAL SETTING

● Change-of-shift reports or 24 hours report
○ Provide only essential background information about client (name, age,
sex, diagnosis and medical history) but fo not review all routine care
procedures or task.
○ Identify clients’ nursing diagnosis or health care problems and other
 ○
related causes.
○ Describe objective measurements or observations about clients’ condition
and respond to health problems. Stress recent change, but do not use
critical comment about clients’ behavior.
● Transfer reports
● A transfer reports involve communication of information about clients form the
nurse on sending unit to the nurse on the receiving unit. Nurse should be
include the following information.
○ Client’s name. Age, primary doctor and medical diagnosis
○ Summary of medical progress up to the time of transfer
○ Current health status - physical and psychological
○ Current nursing diagnosis or problems and care plan
○ Any critical assessment or interventions to be completed shortly
○ Needs for any special equipments etc.
● Incidents Reports
○ The nurse who witnessed the incident or who found the client at the time
of incident should file the report
○ The nurse scribes in concise what happened specifically objective terms
○ Nurse does not interpret or attempt to explain the cause of the incident
○ The nurse describes objectively clients, conditions when the incident was
discovered
○ Any measures taken by the nurse, other nurses, or doctors at the time of
the incident are reported.
● Census Report
○ This is report compiled daily for the number of patients.
○ Very often it is done at midnight and the norms are collected by the
night supervisor.
○ The report will how the total number of patients, the number of
admissions, discharges, transfer, births and deaths.
○ The nurses should remember that a single mistake in the census figures
made buy one of the nurses make the census report of the entire
institution incorrect.
● Birth and death Report
○ The nurses are responsible for sending the birth and death reports to
governmental authorities for registration within specified time.
● Anecdotal Report
○ Brief account of some incident, incidents reports and report on accidents,
mistakes and complaints are legal in nature. A written record concerning
some observation about a person or about her work is called an
anecdote note

HOW TO WRITE A BETTER REPORT

● Before anything van be bitten clearly, it must be clear in one’s own mind.
 ● Report, lacking facts, may be biased or worthless.
● Conciseness, accuracy and completeness are essential to good reports
● Observes mechanics of good writing
○ Use good sentences and paragraphs
○ Observe margins
○ Spell properly; avoid abbreviation except in clinical charting
○ Use correct pronoun
○ Don’t forget punctuation
○ Be neat
● Write report in a conversational manner
● Data reports
● If report is typed by someone else, check it before signing it.

NURSES RESPONSIBILITY FOR RECORD KEEPING AND REPORTING

● The patient has a right to inspect and copy the record after being discharged.
● Failure to record significant patient information on the medical record makes a
nurse guilty of negligence
● Medical record must be accurate to provide a sound basis for care planning
● Errors in nursing charting must be corrected promptly in amber that leaves no
doubts about the facts
● In reporting information about criminal acts obtained during patient care, the
nurse must reveal such information only to the police, because it it considered
a privileged communication
● FACTS
○ Information about clients and their care must be functional, a record
should contain descriptive, objective information about what a nurse sees,
hears, feels and smells.
● ACCURACY
○ A client record must be reliable. Information must be accurate so that
health team members have confidence in it.
● COMPLETENESS
○ The information within a recorded entry or a report should be complete,
containing and thorough information about a client care or any event or
happening taking place in the jurisdiction of manger.
● CURRENTNESS
○ Delays in recording or reporting can result in serious omissions and
untimely delays for medical care or action legally, a late entry in a chart
may be interpreted on negligence.
● ORGANIZATION
○ The nurse or nurse manager communicates information in a logical format
or order. Health team members understand information better When it is
given in the to given in order in which it is occurred.
 ● CONFIDENTIALLY
○ Nurse are legally and ethically obligated to kept information about client’s
illnesses and treatments confidential

ETHICAL CONSIDERATION IN LEADERSHIP AND

MANAGEMENT
UNIT 5

MORAL DECISION MAKING

1. Principle of Moral Discernment
○ Significant human trait.
○ “Deciding for Yourself, not by Yourself”
○ This is the ability to perceive and evaluate the quality of actions and
behaviors form the perspective of good and evil.
○ To observe and make sense of meaning-is central to one’s ability to
make ethical choices and to take moral action.
○ Discernment is defined as the ability to notice the fine-point details, the
ability to judge something well or the ability to understand and
comprehend something.
◆ Ex. Noticing the distinctive details in a painting and understanding
what makes art good and bad is an example of discernment.

○ Theory of Moral Discernment

◆ Emotivism
◆ Based on feeling and emotions.
◆ Moral judgements are seen exclusively as expressions of
sentiments.
◆ Rationalism-based
◆ Deontologism, which duties are central, and consequentialism,
especially the version known as utilitarianism, which focuses the
external effects of an action, balancing them in terms of pleasure
 ◆

and pain, satisfaction or disssatisfaction.

◆ Virtue-based
◆ Aligned with the Aristotelian tradition
◆ Here virtues are central and are often related to human flourishing
ore excellence.

2. Principle of Well-Formed Conscience

○ The formation of a well-formed conscience must take into consideration
the complementarity of faith and reason.
○ It is reason compatible with Catholic faith the reinforces the Church’s
claim to teach and to proclaim the Gospel to the faithful and all people of
good will.

● Conscience
○ It is the inner voice summoning us to love the good and avoid evil, by
applying objective moral norms to our particular acts, and thus
commanding: “do this, don’t do that”.
○ Basic tendency toward the good.
○ Conscience is man’s most secret core, and his sanctuary. There he is
alone with God whose voice echoes in his depths.
○ A Judgment of Reason by which the human person recognizes the moral
quality of a concrete act.
○ Through the process of reasoning, based on moral principles, Conscience
judges an act as Good or Bad.
○ Feeling of guilt, worry, dissatisfaction, restlessness or feeling of “hiya”
when they do something wrong.
○ Sincerity: to be “true to one’s self”: “I can do anything as long as it does
not hurt anybody”
○ What “authorities” tell them to do; the laws of the government, the
Church, the parents, the “barked”.
◆ SINCERITY and CORRECTNESS
◆ It is not enough to be sincere
◆ It is important to be correct.
○ As s Subjective Norm of Morality
◆ Conscience has the final say in the making moral decisions. It helps a
person make the final judgement on how to act in a given situation.
◆ Along with LAW, which is the objective norm of morality, conscience
helps a person determine whether on his doing the right or the wrong.
○ 2 Basic Elements of Conscience
1. Moral judgement that discerns what is right and wrong.
2. Obligation or command to do good and avoid evil.

● Moments
 ○ Antecedent - Conscience which discerns
○ Concomitant - Conscience in action
○ Consequent - conscience which reviews, evaluates an action which has
already been done.

● Level of Conscience
○ Instinctive Level - Dominated by fear of punishment and desire for
approval or reward.
◆ Nature levels normal for children.
○ Moral/Philosophical - operates on the ethical level, that is not just on
what it commanded by some “authority” but now from awareness of the
inner good or evil of an act.
○ Christian Level - One’s Christian Faith illumines, clarifies and deepens
what we perceive as truly worthy of being a person. It places moral
striving as a personal call to wholeness and holiness.
○ “We become conscious of the healing and liberating grace present in out
very moral struggle and striving, as we are called to greater and fuller
conversion into persons that God has created us to become.”

● Ways by Which our Conscience is Formed

○ Through the natural education agents of family upbringing.
○ Our school training
○ Parish catechist
○ Influence of friends and social contacts.
● Formation of Christian Conscience
○ Well-formed conscience is upright and truthful,
○ The education of Conscience is a lifelong task
◆ Formed gradually in faith and through personal and ecclesial
◆ PRAYER LIFE:
◆ Studying the WORD of GOD and the Teaching of the Church (Seek
the moral guidance of the Church)
◆ Responsiveness to the indwelling Holy Spirit.
◆ Examination of one’s conscience which is a a critical reflection on
our concrete moral choices and experiences in daily life.

● Type of Conscience
○ Correct or True Conscience - corresponds to objective moral values
precept
◆ “A good and pure conscience is enlightened by true faith, for charity
proceeds at the same time from a pure heart and a good conscience
and sincere faith”
○ False or Erroneous Conscience - one which mistakenly judges
something as morally good which is objectively evil.
 ● Work of Conscience
○ To judge the good or evil of an act, by deciding on its three essential
aspects:
◆ The nature or object of the act
◆ Our intention as agents or doers of the act, and
◆ The circumstances which affect the morality of the act.

STRATEGIES OF MORAL DECISION MAKING PROCESS

● Ethical dilemma
○ Or ethical paradox is decision-making problem between two possible
moral imperatives, neither or which is unambiguously acceptable or
preferable.
○ The complexity arises out of the situational conflict in which obeying
would result in transgressing another.
○ On the other hand, ethical dilemmas are extremely complicated challenge
es that cannot be easily solved. Therefore, the ability to find the optimal
solution in such situations is critical to everyone.
○ Every person may encounter an ethical dilemma in almost every aspects of
their life, including personal, social, and professional.
○ Solving an Ethical Dilemma
◆ Refute the paradox (dilemma): The situation must be carefully
analyzed. In some cases, the existence of the dilemma can be logically
refuted (confirmed).
◆ Value theory approach: Choose the alternative that offers the
greater good or the lesser evil.
◆ Find alternative solutions ; in some cases, the problem can be
reconsidered, and new alternative solutions may arise.
○ Example of Ethical Dilemma
◆ Taking credit for other’s work.
◆ Offering client a horse product for your own profit
◆ Utilizing inside knowledge for your own profit.

MEANING AND SERVICE VALUE OF MEDICAL CARE

1. Allocation of Health Resources

2. Issues involving Access to Care

○ Macro-allocation
◆ Provide of Congress, state legislatures, insurance companies, private
 ◆
foundations, and health organizations
○ Micro-allocation
◆ More personal determination of who will receive scarce resources.
○ Two-Tier System
◆ Everyone guaranteed coverage for basic care and catastrophic health
needs.
○ Cultural and Social Barriers bar the way for many citizens to receive
health care.

MICRO-ALLOCATION
○ Lifeboat Ethics
◆ Who shall be saved from drowning, and what will be the criteria for our
selection?
○ Triage
◆ Allocating scarce resources practiced and justified in crises of war or
disaster.
○ Medical Utility
◆ Which patient has best prognosis?
◆ Often difficult to assess.
○ Social Utility
◆ Which patient has greatest social worth?
◆ Invites problems of racism, ageism, sexism, bias against retarded and
mentally ill
○ First Come, First Served
◆ Random selection treats all patients as equal.

● Theories of Justice
○ Egalitarian
○ Ultilitarian
○ Libertarian

● Egalitarian Theories
○ Emphasize equal access to goods and services
○ Advocates of a right to health care.
○ Socialistic universal access health care systems
○ Daniel’s Veiled Prudence
◆ Prudent planner does not know her age.
◆ Prudent planner ignorant of her conception of the good.
◆ Prudent planner guided by a time neutral concern for her well-being
over the lifespan
◆ Prudent planner has to plan for each stage of her life under
assumption she will live through it.
○ Fair Innings (turns) Argument
 ◆ Finite span of years considered reasonable lifetime
◆ Everyone equal chance to have a full set of fair innings, to reach
appropriate life expectancy.
◆ Injustice when one who has not had full opportunity to reach full
allotment of innings.

● Utilitarian Theories
○ Criteria so public utility us maximized
○ Public utility: greatest good for greatest number
○ Political planning and intervention methods of redistributing goods and
wealth.
○ QALY: quality adjusted life years
◆ Measure cost-benefit if applying a medical procedure.
○ Callahan Natural Life Span Argument
◆ After a person has lived normal life span, medical care no longer
oriented to resisting death.
◆ Medical care following natural life span limited to relief of suffering
◆ Technologies capable of extending life beyond normal life span create
no technical imperative for its use.

● Libertarian Theories
○ Emphasize personal rights to social and economic liberty.
○ Choice or allocation system freely chosen
○ Free-market system operates on material principle of ability to pay.

● Health Care Crisis

○ Society spends 17.4 percent of gross domestic product on health care
○ $2.9 trillion or $9,255 per person
○ Per capita medical cost s increased 1,000 percent
○ Aging population places great burden on stressed system
○ Use of high technology in medicine

● World Health Care Models

○ Beverage Model
○ Bismarck Model
○ National Health Insurance
○ Out of Pocket

● Beverage Model
○ Model originated in Great Britain
○ Health care financed by government and taxed based rather than
insurance based.
○ No medical bills? Health care treatment public service.
 ○ Strong emphasis on primary care.
○ Cost controlled by rationing
○ Long wait times for non-acute secondary and tertiary care.
○ Newest Technologies not easily available
○ Low costs per capita
○ Government, as sole payer, controls what doctors can do and what they
will charge.

● Bismarck Model
○ Germany, France, Japan, Belgium, Switzerland
○ Care providers and payers private entities
○ Private not-for-health insurance (“sickness funds”) financed jointly by
employees and employers through payroll deductions
◆ Basically charities and cover everybody.

● National Health Insurance

○ Canada, Australia, Taiwan, South Korea.
○ Health care providers private.
○ Payer is government-run insurance program all citizens pay into
○ Insured residents entitled to same level of care.
○ No profit motive, no need to advertise no expensive underwriting
○ National System great leverage and market power to negotiate lower
prices

● Out of Pocket
○ Majority of world’s nations do not have resources to provide health care
services for their citizens.
○ Well connected and rich get medical care
○ Poor do without
○ Rural Africa, India, China, South America.

● Patient Protection and Affordable Care Act

○ Law requires Americans to purchase health insurance.
○ Expands Medicaid rolls
○ Establishes health-insurance exchanges to provide more competitive
rates.
○ Provides subsides to the poor and middle-class to assist them in
purchasing a private plan.
○ Imposes billions in new taxes, mainly on the rich and health care industry.
○ Still most complicated, expensive, and inequitable health care system
developed nations.

● The Quality Improvement Movement and Standard of Care

 ○ Medical Errors: top 10 causes of deaths
○ Health care quality assessment top priority for health care providers
○ Health care providers conform to specific standard of care to protect
others;
○

MIDTERMS
Evidence -guidlelines, principles and proofs for an intervention

SEXUALITY AND HUMAN PRODUCTION

1. MORAL SEXUALITY AND ITS MORAL EVALUATION

HUMAN SEXUALITY
● Makes us realize the need for some measure of fulfillment that only the other
can give.
● One haas to be free form self-centeredness by opening one to other person.
● Giving and giving of the best, a giving to self.
● Giving until nothing more is to give.
● A happiness that is sought for ourselves alone can never be found.
● Making someone happy.
● Right of Freedom of Sexuality
○ Your right to sex involves a duty in others to respect it
○ Sex implies moral discipline
○ “It is better to be a human being dissatisfied than a pig satisfied” - John
Stuart Miller
● Human Sexuality = commitment:
○ Care
○ Concern
○ Responsibility
○ Safeguarding the other’s value
○ Responsibility to and for one another
○ Humanizing
○ Dehumanizing if and when it destroys a person’s honor and becomes a
 ○
degradation of the other.
● Natural Law
○ Human sexuality is sacred and a God-given Gift.
● Kant
○ Act as treat human as always an end, never means.
● Rawls
○ Justice is fairness
○ Never take advantage of persons for own personal gains and satisfaction
● Fletcher
○ Prostitution out of necessity and survival may be legitimate.

2. MARRIAGE

● Marriage may be defined as “formal and durable sexual union of one or more
women to one or more men, which is conducted within a set of designed
rights and duties.
According to Family code of the Philippines
● Special contract of permanent union between a man a woman.
● Foundation of family and an inviolable social institution whose nature.
● Importance of marriage
○ To have a permanent relationship with the person you love.
○ To beget children and have happy family
○ For economics and social upliftment or insurance

Forms of Marriage

● Monogamy
○ One-union marriage wherein main marries one woman
● Bigamy
○ As provided by Philippine law, when a main marries more than one woman
at a give time, which is considered a crime.
● Polygamy
○ Practice of marrying multiple spouses
○ Polygyny - marriage uniting one man to two ore several woman.
○ Polyandry - marriage uniting one woman to many men.
● Endogamy
○ Requires a person to marry someone from his own locality, race, social
class and religion.
● Exogamy
○ Mandates marriage between people of different social categories.

Issues on Sex Outside Marriage

 ● Premarital Sex
○ Sexual activity practiced by people before they are married>
○ Considered a moral issue which was taboo in many cultures and
considered a sin by a number of religions.
○ Generally consensual sexual intercourse between two people not married
to each other.
● Premarital Sex Should be Discouraged
○ Causes one’s emotional, social, spiritual and physical being to become
corrupted.
○ Premarital pregnancy
○ HIV/AIDS, STDs

HOMOSEXUALITY
● Means that men are sexually and emotionally attracted to men, and women are
sexually and emotionally attracted to women. Also called same-sex
attraction.
● A sexual attraction or sexual relations with persons of the same sex.
● Heterosexual
○ Sexually attracted to people of the opposite sex.
● Homosexual
○ Sexually attracted to people of their own sex.
● Bisexual
○ Sexually attracted to both men and women
● Transgender
○ People who are born with typical male or female anatomies but feel as
though they’ve been born into the “wrong body”

Neurobiologist, Dick Swaab

○ Pre-birth exposure to both nicotine and amphetamines increases the
chance of lesbian daughters.
○ Pregnant women suffering from stress are also more likely to have
homosexual children of both genders because their raised level of the
stress hormone cortisol affects the production of foetal sex hormones.

Why Homosexuality is a Social Problem?

○ Homosexuals experience abuses
○ We live in a Christian world
○ “If there is a man…..” Lev. 20:13
○ Homosexual marriage violates the natural law
○ Homosexuality gives disease which is difficult to cure

Ph - bayot/bading/bakla
 ● Effeminate gays - They used make-up and dressing in woman’s cloth. They
tend to be concentrated in certain profession.
● Straight acting gays - these men are not effeminate. They are found outside
of the stereotype gay profession. Sexually; preferences vary with some willing
to have sex with other straight acting guys or men.
● Bisexual (paminta/Maya) - attracted to both sexes.

● Is it possible to legalized same sex marriage in the Philippines?

○ YES - Supreme Court associate, Jose Vitug “same sex marriage in the
country has a long way to go”
○ NO - article 1 “marriage is special…

CONTRACEPTION
○Voluntary prevention of conception
○ Uses artificial means that prevents the union of sperm and egg
○ Synonymous with Family Planning
○ Planned parenthood
○ Responsible parenthood
○ Birth control
● Sterilization
○ Positive use of artificial method
○ Cutting off the sexual capacity in a man or woman
○ Usually done surgically
○ Types according to willingness;
◆ Voluntary
◆ Involuntary
○ Types according to purpose or ends;
◆ Therapeutic
◆ Contraceptive
◆ Eugenic - reduce human suffering by “breeding out” disease,
disabilities, undesirable characteristics
◆ Social
◆ Punitive - corrective, disciplinary punishment

ARTIFICIAL REPRODUCTION, ITS MORALITY AND ETHICO-MORAL

RESPONSIBILITIES OF NURSES

ARTIFICAL INSEMINATION
● Consist 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.
● Intravaginal
○ Placing the semen in the vaginal vault
● Intracervical
○ Cervical cavity
● Intrauterine
○ Inside the uterus itself

● Methods of Extraction
○ Masturbation
○ After a short period abstinence from ejaculation 3 to 12 days
○ Condomistic intercourse
○ Coitus interruptus
○ Anal massage of the prostate gland
○ Direct puncture of the epididymis (excretory duct of the testicle)

TYPES
● Homologous or Artificial Insemination by Husband (AIH)
○ Collecting the husband’s sperm and injecting it into his wife’s reproductive
tract via the vagina at the appropriate stage of the menstrual cycle period.
○ DIY
● Heterologous or Artificial Insemination by Donor (AID)
○ Semen from other person other than husband

● REASONS:
○ The husband may be fertile but unable to participate in normal sexual
relations (impotent)
○ Husband may be have a low sperm count (oligospermia) or no sperm int
he semen (azoospermia)
○ Husband may use AIH as precautionary measure eg. Spinal injury
○ Vasectomy
○ Physiologic obstructions of genital organs of wife
● AIH (donor)
○ Genetic disease
○ Sterile, disease or accident
○ Antibody reaction form mother

APPLICATION OF ETHICAL THEORIES

 ● Natural Law ethics/Roman Catholic
○ Immoral
● Situational Ethics
○ Moral
○ Our right overcome childlessness
● Utilitarianism
○ Moral since it produces more happiness
● Pragmatism
○ Moral since it is practical, beneficial and useful and workable
● Immanuel Kant
○ Principle of autonomy
○ It is moral only if couple is voluntary and mutually agreed.

VITRO FERTILIZATION
● Eggs removed from a woman and fertilized in a laboratory dish (by husband or
another man)
● Embryos implanted in a woman (donor or other woman, where egg brought to
term
● Extra, spare, embryos
● Implantation process may fail and be repeated
● Freezing of embryos
● Rating them for quality
● Thawing them and disposing of them
○ What happens tp excess embryos can be a moral dilemma and
controversial
● Discarding those that hold genetic defects
● Woman could postpone pregnancy without risking infertility or diseases of
pregnancy
● Identifying genetic abnormalities
● Embryonic tissue in medical research
○ Embryo: mitochondria, cytoplasm, DNA

Surrogacy
○ When a woman agrees to carry a baby to term and give it. Up to another
set of parents to raise
○ Sometimes done for money, favor
◆ Pregnancy a deeply personal experience that should never be
undergone for the sake of others
◆ Very reason surrogacy supreme gift to another
○ Kantians: surrogacy problematic since birth mother is being used as
incubator and not regarded as a rational actor
 ○ Utilitarians; faced with very complicated utility calculations
○ Well-accepted practice in spite of misgivings of some people

MORALITY OF ABORTION, RAPE AND OTHER PROBLEMS RELATED

TO DESTRUCTION

ABORTION
● STATISTICS
○ More than half of American women receiving abortions re in their 20s
○ 60 percent of women already have a child
○ 37 percent have two children
○ No racial or ethnic group makes up majority of women having abortions
○ 70 percent of women reported religious affiliation
○ Pro-choice advocates favor intact dilation and evacuation
◆ Believes decision to abort is one of personal liberty and should be
legal
○ Pro-life advocates use term partial birth abortion
◆ Anti-abortion, believes abortion is murder and should be stopped
○ Fewer than a thousand third-trimester abortions performed each year
○ LEGAL DEBATE:
◆ 1973: ROE v. WADW
◆ Right not considered to be unrestricted
◆ Balanced the interests of the woman and the state
◆ Term person used only postnatally
◆ 28th week: allowed state to shift to protection o the fetus
◆ 1976: Hyde amendment restricted availability of medicare funding for
abortons
◆ Modified to allow funding in which mother’s life threatened by carrying
fetus full term or in cases of incest or rape
◆ It does primarily affect poor women

Moral issues
● Personhood
● Sanctity of life
○ Fetus is a live human
○ Killing him/her is wrong
○ Human life is sacred
● Quality of life
● Autonomy
● Mercy
● Freedom
● Social stability
FACTS OF FETAL DEVELOPMENT
● Conceptus - union of sperm and egg
● Zygote - full genetic code will determine sex, attributes
● Embryo - zygote settles into uterine wall
● 8 weeks; entity is a fetus
● Second trimester - fetus will have begun to move (quickening)
● 5th month: neurologically, fetus can feel pain
● Third trimester - fetus develops minimal consciousness
● Birth occurs after nine months

KILLING AND SELF-DEFENSE

● If someone is about to kill you, and the only way to save yourself is to kill the
other person first, then killing is permissible
● Doctrine of double effect: distinguish intended affect of an action form other
unintended affects

“HUMAN “ OR “PERSON”
● Traits Central to Personhood
○ Member of the moral community
○ Consciousness of objects and events
○ Ability to feel pain
○ Reasoning
○ Concept of the self

VIABILITY ARGUMENT
● Viability; characteristic of biological independence
● Some argue a fetus has standing only when it becomes viable outside the
mother

WOMEN’S LIBERTY AND PRIORITY OF LIFE PLAN

● Pro-choice; crucial a woman have control over her life span in the way a man
has control
● Pro-life: root of abortion problem is modern attitude toward sex

TRADITIONALISM vs. MODERNISM

● Pro-life activist
○ Tend to be more traditional and religious
○ Sex should be reserved for marriage
● Pro-choice activist
○ Tend to be less traditional
○ More career oriented with higher incomes
 ○ Sex is a natural expression of oneself

ABORTION AND THE FREEDOM OF RELIGION

● Pro-life:
○ Rejects the idea their views on abortion
○ Result of basic moral reasoning
○ Not absolute
● Pro-choice:
○ Reflect one’s most deeply held beliefs
○ Tolerance

ENVIROMENTAL PERSPETIVE
● See humans a members of biotic community
● Aggressive attitude toward family planning

FAMILY PLANNING PERSPECTIVE

○ Asks why we should favor accidental babies over planned babies
○ Pro-life: family planning example of decadent culture of permissiveness
○ Abortion issue not a health issue but a social issue

RAPE
● Forced, unlawful sexual intercourse.
● Without the victim’s “consent”.
● It can happen to both men and women of any age.
● Sexual harassment
○ Victims are physically harmed which showcases male dominances
● Rape
○ Victim are ravished like an animal for the fulfillment of desire and lust of
another.

Types of rape:
● Acquaintance rape/ date rape
○ When the victim and the rapist know each other
● Spousal rape
○ Rape between a married or married-like
● Gang rape
○ Group of people
● Minor rape
○ Child
● College campus rape
○ College
● Statutory rape
○ Adults engaging Sexually mature minors, consent
 ● Prison rape
○ Prison
● War rape
○ During war
● Corrective rape
○ Rape lesbian women
● Rape within military

DIGNITY IN DEATH AND DYING

EUTHANASIA AND PROLONGATION OF LIFE

Dying with Dignity

● Movement that promotes the ability to meet death on your own terms
● “Dignity” - “dignities” means worthiness and nobility. It may be attributed to a
broad range of things
● Dignity appears to have two words that function as opposites.
○ Undignified, indignity
● Euthanasia eu good, thanatosis (DEath) , means good death, gentle and easy
death. “Mercy killing”
● Act or practice of ending a life of a person either by a lethal injection or
suspension of medical treatment.
● Was first sued in a medical context by Francis Bacon
● Types
○ Passive
◆ Brought by omission, when someone lets person die
◆ Withdrawing treatment: switching off machine, that keeps person alive
◆ Withholding Treatment: Not carrying out a surgery that will extend life
○ Active
 ◆ When death is brought by an act. Eg taking a high dosage of drugs
◆ Use of drugs
○ Voluntary
◆ Committed with the willing or autonomous cooperation of the subject
○ Involuntary/non voluntary
◆ Patient is unconscious or unable to make a meaningful choice
between living and dying, appropriate person takes that decision
◆ Usually called murder
○ Assisted
◆ Persons who are going to die need help to kill themselves ask for it.
◆ May be something as simple as getting drugs for the person
○ Indirect
◆ Means providing treatment mainly to reduce pain, that has side effect
of shortening the patient’s life.
◆ Primary intent wasn’t to kill

Ethical issues
● Moral
○ Refers to an individual’s own principle regarding right and wrong
● Ethics
○ Moral principles or rules of conduct respect to a particular class of human
particular group of culture
○ Hippocratic oath: that doctors take state
○ Do not harm
○ Nuremberg Code: se of research principles for human experimentation
○ Belmont Report
◆ Respect for person
◆ Beneficence
◆ Justice

Patients
● Frail aged
● Dementia
● Survivors of severe head injury
● Serious physical illness
● Incurable mental illness
● Impaired children or adults

Euthanasia is fundamentally upsets the balance between doctor and patient

● Legislative support for euthanasia

○ Erodes standards of end-of-life care
○ Becomes available to a wider group than those with terminal cancer
 ○ Upsets the doctor-patient relationship
● Legislating in favor of euthanasia is no subtitle for
○ Better are improved pain and symptom management
○ Better teamwork
○ Better research

Arguments for euthanasia

● In favor
○ Freedom of choice
○ Dignity
○ Painless death
○ Saves family’s money
○ Shorten the grief and suffering of the patient’s loved ones
● Against
○ Professional roles compromised
○ Moral religious argument
○ Rejection of the importance and value of human life
○ Destroys life which has potential that is yet unknown to the patient, doctor
or the family members

Euthanasia and Religion

○ Christianity
◆ Catholicism
◆ Based on principles of sanctity of human life “crime against God”
◆ Protestantism
◆ Physician assisted dying has obtained greater legal support
◆ Hinduism
◆ Helping to end painful life a person performing good deed
◆ Judaism
◆ Increasing support for certain passive euthanasia options
◆ Jainism
◆ “Sailekhana”
◆ Person allowed to fast unto death

INVIOLABILITY OF HUMAN LIFE

● Important tie between ethics of religion and the ethics of law
● Ethics of religion, inviolability or sanctity of life is a principle of implied
protection regarding aspects of sentiment of life
● Sanctity, idea that human life is sacred, holy and precious
● Life
○ As a gift
 ◆Gift from god
◆Everyone is responsible for his life before God who has given it to him
○ As sacred
◆ We are created in GOd’s image and likeness
◆ God continues to sustain our life
○ As inviolable
◆ Reflection of the absolute inviolability of God
◆ We are all called to protect our life
○ We are Stewards Not Owner
◆ Life must be protected with the outmost care
◆ Ways to remain Steward of Life
◆ Choose your company
◆ Curiosity kills the cat
◆ Be wary/careful
◆ Develop friendship with Jesus

EUTHANASIA AND SUICIDE

● Physician-assisted Suicide (PAS)
● When doctor gives a person the means to commit suicide when requested for
● Writing a prescription for a lethal dose of drugs
● Jurisdictions, crime
● Doctor os allowed by law to end a persons life by a painless means as long a s
the patient and their family agreed

DYSTHANASIA
● Term generally used when a person is seen to be kept alive artificially in a
condition where, otherwise, they cannot survive; sometimes for some sort of
ulterior
● Therapeutic obstinacy practiced with the aim to postpone death

ORTHOTHANASIA
● Normal or natural manner of death and dying
● Stopping of artificial or heroic means of maintaining life
● Art of promoting a humane and correct death

ADMINISTRATION OF DRUGS TO DYING

● Palliative sedation is practice of relieving distress in a terminally ill person in
the last hours or days of a dying patient’s life
● Palliative sedation, option of last resort for patients whose symptoms cannot
be controlled by any other means
● Not form of euthanasia
ADVANCE DIRECTIVES
● Legal documents that allow you to spell out your decisions about end-of-life
care ahead of time
● They give you a way to tell your wishes to family, friends
● Living will
○ Legal document used to state certain future health care decisions only
when a person becomes unable to amen the decisions and choices on
their own
● Durable Power of Attorney for health care/Medical power of Attorney
○ Legal document in which you name a person to be a proxy (agent) to make
all your health care decisions if you become unable to do so.

DO NOT RESUSCITATE OR END OF LIFE CARE PLAN

● End of life care includes palliative care
● If you have illness that can’t be cured, based on the understanding that death
is inevitable
● Palliative care makes you comfortable as possible, by managing your pain and
other distressing symptoms
● Involves psychological, social and spiritual support for you and your family

Helsinki set of ethical principles regarding human experimentation

● Morally binding on physician
● Respect for the individual
● Right to make informed decisions

PRELIMS

“ETHICS”

ETHICS is critical reflections about morality.

Involves the set of rules that society have agreed .
Moral
concerned with the principles of right and wrong behavior and the goodness or
badness of human character.

PROFESSIONAL ETIQUETTE
-Avoid talking badly.
-Maintenance of appropriate relationship.
-Stay within the boundaries.

BIOETHICS
Interdisciplinary study of problems. (Biological medical)
Preceded by medical ethics.
Ancient Hippocratic literature enjoins medical practitioners to use their knowledge
and power to benefit the sick.
Second World War - old medical ethics was not sufficient to meet contemporary
challenges.

Van Rensselaer Potter - coining the word Bioethics.

“Aiding the individual practitioner to make decisions and to live with them.”

Warren Thomas Reich “the systematic study of the moral dimensions including
vision, decisions, conduct, and policies of the life sciences and health care,
employing a variety of ethical methodologies in an interdisciplinary setting.”

DEONTOLOGICAL (DUTY-ORIENTED) THEORIES

● Greek word deontos means duty.

● Sometimes called imperativism.
● Basic rightness or wrongness of an act naturally.
● Act itself either right or wrong.
● Emphasis on moral laws, duties, obligations, prohibitions.
Ex. Don’t lie, cheat. People commands, and you follows.
Set rules.

CRITICISMS OF IMMANUEL KANT 1724-1804 (DUTY-ORIENTED)

● Morality derived from rationality.
● Obligation grounded in pure reason.
● Categorial Imperative: do not admit exceptions.
● Non-human like animals feel pain but they don’t have independent moral.

● Imperative derived from a principle.

 ○ “Duty ethics”
○ Maxim understood as universal law.
○ 3 elements
1. Universal application
2. Unconditionally
3. Demanding an action.

Maxim Relevant to Health Ethics.

“We must always treat others as ends and not as means only”
“The end justify the means.”

TELIOLOGICAL (CONSEQUENCE-ORIENTED)
THEORIES

● Greek word telos means end.

● Judge the rightness or wrongness based on outcomes.
● The right thing to do is the good thing to do.

UTILITARIANISM

Proponents: Jeremy Bentham, John Stuart Mill

● Most common form of consequence-oriented reasoning.
● Also known as Principle of Greatness Happiness
● Pleasure over pain.
● Happiness as higher-order pleasures: intellectual, aesthetic and social
enjoyments.

2 FORMS
1. Act Utilitarianism
-purest form of reasoning
-it asks a person to assess the effects.
-rejects the view that actions can be classified as right or wrong.
-An action is good if its benefits exceed its harms.
– Acts are right if they produce the greatest happiness for the greatest number.

2. Rule Utilitarianism
-set of rules, general rules
-Does not accept an action as right if it maximizes net benefits only once.
– Acts are right if they produce the greatest happiness for the greatest number.
–
Happiness for Bentham and Mill is INTRINSIC.
Happiness is intended pleasure and absence of pain.
Pain - unhappiness.
Pleasure - calculus of Bentham.

PLEASUREPAIN CALCULUS (BENTHAM)

● Intensity the more intense the pleasure, the better

● Duration the longer it lasts, the better.
● Purity the pure the pleasure
● Extent the greater the number of benefited.

PRIVATE LAW
● Recognition and enforcement of rights and duties of private citizens and
organizations.
● Tort action - wrongful act producing damages.
○ Existence of legal duty from defendant and plaintiff.
○ Breach of that duty.
○ Damages which are proximate result.

● TORT CATEGORIES
○ Negligent Torts (car accidents, malpractices)(failing to take proper care.)
○ Intentional Torts (fraud, defamation)
○ Liability assessed irrespective of fault (manufacturer’s defective
medical products).

● NEGLIGENCE
○ Unintentional commission or omission of act a person would or would not
do under same or similar circumstances.

COMMON FORMS OF NEGLIGENCE

● Malfeasance: execution of unlawful act
● Misfeasance improper performance of act that leads to injury.
● Nonfeasance failure to perform act
● Criminal negligence reckless disregard for safety of another.

4Ds of Negligence Case

1. Duty
2. Dereliction/failure of Duty Obligation
3. Direct Cause
4. Damage

Assault - verbal cursing

Battery - requires physical contact

DEFAMATION OF CHARACTER
Libel - written communication
Slander - spoken defamation

VIRTUE EThics
Characters, characteristics, (of a person should have)
Personal character, moral habit development

ARISTOTLE 12 VIRTUES
1. Courage - Bravery
2. Temperance - Moderation
3. Liberality - spending
4. Magnificence - charisma, style
5. Magnanimity - Generosity
6. Ambition - pride
7. Patience - temper, calm
8. Friendliness - social iq
9. Truthfulness - honesty, candidness
10. Wit - humor, joy
11. Modesty - ego
12. Justice- sense of right

THE VIRTUES
DEFICIENCY - MEAN - EXCESS

ARISTOTLE TRAITS OF VIRTUOUS CHARACTER

OWN SAKE
FIRM AND UNCHANGEABLE CHARACTER
CHOOSE THE MEAN

HEART - MORAL AGENT

DESCRIBE THE PROBLEM - LIST SOLUTIONS - COMPARE SOLUTIONS WITH

TRADITIONS - ARRIVES AT THE CORRECT ANSWER

CORE VALUES OF PROFESSIONAL NURSE

ETHICAL PRINCIPLES
● AUTONOMY-(liberty) form of personal liberty, self-determinatioN
Informed consent
If minor, obtained from guardian/parent.
Paternalism - intentional limitation, father, bond(fiduciary relationship)

● VERACITY - patient must tell the truth

● CONFIDENTIALITY individual’s right to privacy in health care.

● BENEFICENCE - mercy
Prevent evil or harm
Hippocratic oath ; physician will apply measures for the benefit of the sick.
Benefits another.

● NONMALIFICENCE not to inflict evil or harm.

● JUSTICE
○ Due process - disputes between individual
○ Distributive Justice - distribution of scarce resources.
○ Compensatory justice - seek compensation.

● ROLE FIDELITY faithfully

Modern health care is the practice of a team.
Prescribed by scope

PATIENT’S BILL OF RIGHTS

● RIGHT TO APPROPRIATE MEDICAL CARE AND HUMANE TREATMENT

Without any discrimination, cannot immediately be given treatment, appropriate
care can be provided.
Without any deposits, pledge, mortgage or any form of advance payment for
treatment.
Patient has to wait for care, he shall be informed.
Self-determination often used synonymously with autonomy.

● RIGHT TO INFORMED CONSENT

Substantial explanation.
Right to a clear, truthful explanation.

● RIGHT TO PRIVACY AND CONFIDENTIALITY

The privacy of the patients must me assured at all stages of his treatment.

Unwarranted public exposure

Right to demand
Any health care provider or practitioner
Spouse is the first degree, legal age.

● RIGHT INFORMATION
Right to be informed of the result of the evaluation.

● RIGHT TO CHOOSE HEALTH CARE PROVIDER AND FACILITY

Patient is free to choose the health care provider to serve him.
Right to discuss his condition with a consultant specialist.
Right to seek second option.

● RIGHT TO SELF-DETERMINATION
◆ Right to avail himself of any recommended diagnostic and treatment
procedures.
Advance written directive.

● RIGHT TO RELIGIOUS BELIEF

Beliefs

● RIGHT TO MEDICAL RECORDS

Right to view the contents.

● RIGHT TO LEAVE
Right to leave hospital
No patient shall detained against her will.

● RIGHT TO REFUSE PARTICIPATION IN MEDICAL RESEARCH

Patient has the right to be advised if the health care provider plans to involve him
in medical research.

● RIGHT TO CORRESPONDENCE AND TO RECEIVE VISITORS

Right to communicate with relatives and other persons and to receive subject to
reasonable limits.

● RIGHT TO EXPRESS GRIEVANCES

Express complaints and grievances.

● RIGHT TO BE INFORMED OF HIS RIGHTS AND OBLIGATIONS AS A PATIENT

Information and education campaign

● PRINCIPLE OF DOUBLE EFFECT

Ethically permissible
Never be intended outcomes
Intention of the agent - beneficial effect or harmful effect.
Order of time - beneficial effect, harmful effect, it could happen in the same time.

● PRINCIPLE OF LEGITIMATE COOPERATION

Working with another
○ Formal - agent identifies itself with purpose of evil act, morally wrong

○ Material - act itself but not the purpose.

● PRINCIPLE OF COMMON GOOD AND SUBSIDIARY

SUBSIDIARY- supports the internal life of the local communities.

● PRINCIPLE OF STEWARDSHIP AND ROLE OF NURSES AS STEWARDS,

“DUTIES, OBLIGATION”
Refers to the expression of one’s responsibility to take care of nurture.

● PRINCIPLE OF TOTALITY AND ITS INTEGRITY

The whole implies the existence of its parts.
Existence of the whole.
Ex. Amputation

POSSIBLE TO TRANSPLANT
 1. Hearts
2. Lungs
3. Kidneys
4. Livers
5. Bone marrow
6. Skin
7. Corneas
8. Pancreases

ISSUES ON ORGAN DONATION

Need to obtain family consent in time of grief

PRINCIPLES OF ORDINARY AND EXTRAORDINARY MEANS

Extraordinary - Refers to intervention that does not offer any reasonable hope of
recovery.
Cannot be used without any excessive expenses.
Ordinary - refers to any treatment or intervention that reasonable hope of
recovery.
All medicines
Offers reasonable hope of benefits