ETHICAL ASPECTS OF NURSING

Outline
The Human Person
The Health Care Profession
The Health Care Provider
Basic Concepts: Ethics, Bioethics, Nursing Ethics
Moral/Ethical Theories
Bioethical Principles
Professional Values
Codes of Ethics
Bioethical Issues
Framework of Ethical Decision Making
The Human Person
The subject of health care
His health is our common goal
Has dignity that must always be respected
As a rational creature, he can and should freely
choose what is best for him
Has worth and dignity, not because of what he
has or what he does but because of what he is: a
human person
Respected regardless of:
nature of health problem
social status
competence
past actions
Health decisions are aimed at the maximum
integrated satisfaction of his needs:
biological
psychological
social
spiritual
Health Care Profession
A special calling
A service characterized by a trusting and caring
relationship, a covenant relationship

The Health Care Provider
Committed to health care
Invested with authority but with corresponding
responsibilities to patients, his profession, and
the society
Patient advocate keeping patients best
interest as first priority

Competent
Guards against being arrogant and showing
undesirable bedside manner
Recognizes his limitations and asks help when
needed
Contributes to knowledge
Conducts self in ethical, professional way
A role model to colleagues
Maintains and upgrades standards of profession
Manifests a social conscience
Stands for justice for the poor
Makes health care available at reasonable price
Avoids temptation to exploit or take advantage
of the patient

Concept of Ethics
Ethics
Systematic inquiry into principles of right and
wrong conduct.
Study of the rightness of a conduct.
Deals with ones responsibilities (duties and
obligations).
Declaration of what is right or wrong; what
ought to be presented as systems of values,
behaviors & beliefs.
Serves the purpose of governing conduct to
ensure the protection of an individuals rights.
key concepts: govern and protect

Morality
behavior in accordance with custom, tradition ,
convention
personal standards of right and wrong
usually reflects personal or religious beliefs
Bioethics
The application of general ethical principles to
health care.
Division of ethics that relates to human life.
synonymous terms with health-care ethics and
encompass not only questions
concerning life and death, but also
questions of quality of life, life
sustaining and life-altering
technologies, and biologic science in
general.
Nursing Ethics
A subset of bioethics.
Principles of right conduct applied to nursing
profession.
Formal study of ethical issues that arise in the
practice of nursing and of the analysis
used by nurses to make ethical
judgments.

Ethical/Moral Theories or Frameworks
1. Consequence Based (Teleological/Utilitarian Theory-
J.S. Mill)
The rightness or wrongness of an action
depends on the consequences of an
action
Outcome of the action, and not the action itself
is the criterion for determining the
goodness of that action
Basic concept: principle of utility states that an act must
result in the greatest amount of good for the greatest
number of people involved in a situation; according to
greatest benefit.
The end justifies the means

2. Principle Based
(Deontological Theory Kant)
The act itself is the criterion for determination of
good, not the consequences.
Morality of an action is determined by whether
it is done according to objective,
impartial principles.

3. Relationship Based (Caring)
Judges action according to a perspective of
caring and responsibility
Caring is the central force in the nurse-client
relationship

Bioethical Principles
1. Autonomy
The individuals right to choose and the
ability to act on that choice.
The right to self-determination
The freedom to make choices that affect
ones life

Patients Rights
1. Considerate and respectful care
2. Obtain from his physician complete, current information
regarding his diagnosis, treatment and prognosis in terms
the patient can understand
3. Receive from his physician information necessary to give
informed consent
4. Refuse treatment
5. Every consideration of his privacy
6. Confidentiality of communications and records
regarding his care
7. Reasonable response to a requested service
8. Obtain information as to professional relationships of
those caring for him with others
9. Be advised if experimentation is performed and the
right to refuse to participate
10. Reasonable continuity of care
11. Examine and receive explanation of his bill
12. Be informed of hospital rules and regulations that
apply to his care.

Issues Related to Autonomy
Informed Consent processes by which
patients are informed of possible outcomes,
alternatives, risks of treatments, and are
required to give their consent freely.
Paternalism acting in a fatherly manner that
may restrict patients autonomy.
Non-compliance unwillingness of the
patient to participate in health care activities .

Other examples of application of the principle of
nonmaleficence (Kuan, 2006)
1. Do not kill
2. Do not cause pain or suffering to others
3. Do not cause offense to others
4. Do not deprive others of the good of life

3. Beneficence
Doing good
Duty to promote good and prevent harm
Elements:
Providing benefit
Balancing benefits and harms (principle of
double effect benefit should
outweigh harm)
Nursing Application
Commit self to actively promote patients
benefit (health and well being).
Be sensitive to the fact that clients may identify
benefits and harm differently
Be wary of practicing paternalism towards
patients
Other examples (Kuan, 2006)
o Protecting and defending the rights of others
o Preventing harm from occurring to others
o Removing conditions that will cause harm to
others
o Helping persons with disabilities
o Rescuing persons in danger

The Material Principle of Justice states that materials
should be distributed:
Equally
According to need
According to effort
According to merit
According to individuals contribution to society
Nursing Application
Honor contracts, agreements, relationships
Be faithful to the promise you made to the
public
Use competence to benefit clients
Do not abandon a client entrusted to your care
without providing for her needs
Act as client advocate inform and support
Nursing Application
Respect clients privacy
Do not disclose information obtained
Limitation: when the health of the public is
endangered
Value clarification process by which people
identify, examine, and develop their
own individual values
Importance:
When we are able to identify our values, we are able to act
on freely chosen values rather than on unconscious values,
promote personal growth by fostering awareness,
empathy, and insight.





Professional Nursing Values
Extension and reflection of personal value
Acquired during socialization into nursing, from
code of ethics, nursing experience, teachers, and
peers.
Other desirable values
Commitment to education values lifelong
learning,
Strong commitment to service recognizes
nursing as a helping, humanistic service.

Code of Ethics
A formal statement of a groups ideals and
values
A set of ethical principles that is shared by the
members of a group/profession
Reflective of moral judgment
Serves as standard for a groups professional
action

ICN Code of Ethics
Preamble
The fundamental responsibility of the nurse is
fourfold: to promote health, to prevent illness, to restore
health, and alleviate suffering
The need for nursing is universal. Inherent in
nursing is respect for life, dignity and rights of man. It is
unrestricted by considerations of nationality, race, creed,
color, age, sex, politics, or social status.
Nurses render health services to the individual, the family,
and the community and coordinate the services with those
of related groups.

Nurses and the People
The nurses primary responsibility is to those
who require nursing care.
The nurse, in providing care, promotes an
environment in which the values, customs, and
spiritual beliefs of the individual are respected.
The nurse ensures that the individual receives
sufficient information on which to base consent
for care and related treatment
The nurse holds in confidence personal
information and uses judgment in sharing this
information
The nurse shares with the society the
responsibility for initiating and supporting action
to meet the health and social needs of the
public, in particular those of vulnerable
populations.
The nurse also shares responsibility to sustain
and protect the natural environment from
depletion, pollution, degradation, and
destruction




Nurses and Practice
The nurse carries responsibility for nursing
practice and for maintaining competence by
continual learning.
The nurse maintains the highest standards of
nursing care possible within the reality of a
specific situation.
The nurse uses judgment in relation to individual
competence when accepting and delegating
responsibilities.
The nurse when acting in a professional capacity
should at all times maintain standards of
personal conduct which reflect credit upon the
profession.
Nurses and Society
The nurse shares with other citizens the
responsibility for initiating and supporting action
to meet the health and social needs of the
public.
Nurses and Coworkers
The nurse sustains a cooperative relationship
with coworkers in nursing and other fields. The
nurse takes appropriate action to safeguard the
individual when his care is endangered by a
coworker or any other person.
Nurses and the Profession
The nurse plays the major role in determining
and implementing desirable standards of nursing
practice and nursing education.
The nurse is active in developing a core of
professional knowledge.
The nurse, acting through the professional
organization, participates in establishing and
maintaining equitable social and economic
working conditions in nursing.

Code of Ethics for Registered Nurses
Article 1: PREAMBLE
Section 1 - Health is a 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 at all cost. This
responsibility encompasses promotion of 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 nurse
have to gain knowledge and understanding of mans
cultural, social, spiritual, physiological, psychological, and
ecological aspects of illness, utilizing the therapeutic
process. Cultural diversity and political and socio-
economic status are inherent factors to effective nursing
care.
Section 3 The desire for the respect and confidence of
clientele, colleagues, co-workers, and members of the
community provides the incentive to attain and maintain
the highest possible degree of ethical conduct.

Article II: REGISTERED NURSES & PEOPLE
Section 4 Ethical Principles
1. Values, customs, and spiritual beliefs held by
individuals shall be respected.
2. Individual freedom to make rational and
unconstrained decisions shall be respected.
3. Personal information acquired in the process
of giving nursing care shall be held in strict confidence.
Section 5 Guidelines shall be observed:
Registered nurses must
A. Consider the individuality and totality of
patients when they administer care.
B. Respect the spiritual beliefs and practices of
patients regarding diet and treatment.
C. Uphold the rights of individuals.
Section 6 Ethical Principles
1. Human life in inviolable.
2. Quality and excellence in the care of the
patients are the goals of nursing practice.
3. Accurate documentation of actions and
outcomes of delivered care is the hallmark of nursing
accountability.
Section 7 Guidelines to be observed
Registered nurses must
A. Know the and scope of nursing practice which
are in the provisions of RA No. 9173, known as the
Philippine Nursing Act of 2002 and Board Res. No. 425,
Series of 2003, the Rules and Regulations Implementing
the Philippine Nursing Act of 2002, (the IRR).
B. Be aware of their duties and responsibilities in
the practice of their profession as defined in the Philippine
Nursing Act of 2002 and IRR.
C. Acquire and develop the necessary in
knowledge, skills, and attitudes to effectively render
appropriate nursing services through varied learning
situations.
D. If they are administrators, be responsible in
providing favorable environment for the growth and
developments of Registered Nurses in their charge.
E. Be cognizant that professional programs for
specialty certification by the BON are accredited through
the Nursing Specialty Certification Council (NSCC).
F. Insure that modification of practice shall
consider the pronciples of safe nursing practice.
G. 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.
H. Ensure that patients records shall be
available only if they are issued to those who are
professional and directly involved in their care and when
they are required by law.
Section 8 Ethical Principle
4. Registered nurses are the advocates of the
patients: they shall take appropropriate steps to safeguard
their rights and privileges.

Guidelines to be observed
Registered nurses must
A. Respect the Patients Bill of Rights in the
delivery of nursing care.
B. Provide the patients or their families with all
pertinent information except those which may be deemed
harmful to their well-being.
C. Uphold the patients rights when conflict
arises regarding management of their care
Section 9 Ethical Principle
5. Registered nurses are 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 Guidelines to be observed
Registered Nurses must
A. Perform their professional duties in
conformity with existing laws, rules, regulations,
measures, and generally accepted principles of moral
condct and proper decorum.
B. Not allow themselves to be used in
advertisement that should demean the image of the
profession (i.e. indecent exposure, violation of dress code,
seductive behavior, etc).
C. Decline any gift, favor, or hospitality which
might be interpreted as capitalizing on patients.
D. Not demand and receive any commission, fee,
or emolument for recommending or referring a patient to
a physician, a co-nurse, or another health worker; not to
pay any commission, fee, or other compensations to the
one referring or recommending a patient to them for
nursing care.
E. Avoid any abuse of the privilege relationship
which exists with patients and of the privilege access
allowed to their property, residence, or workplace.

Article IV: REGISTERED NURSES & CO-WORKERS
Section 11 Ethical Principles
1. The Registered Nurse is in solidarity with other
members of the healthcare team in working for the
patients best interest.
2. The Registered Nurse maintains collegial and
collaborative working relationship with colleagues and
other healthcare providers.
Section 12 Guidelines to be observed
Registered Nurses must
A. Maintain their professional role/identity while
working with other members of the health team.
B. Conform with group activities as those of a
health team should be based on acceptable, ethico-legal
standards.
C. Contribute to the professional growth and
development of other members of the health team.
D. Actively participate in professional
organizations.
E. Not act in any manner prejudicial to other
professions
F. Honor and safeguard the reputation and
dignity of the members of nursing and other professions;
refrain from making unfair and unwarranted comments or
criticisms ontheir competence, conduct, and procedures;
or not do anything that will bring discredit to a colleague
and to any member of other professions.
G. Respect the rights of their co-workers.

Article V: REGISTERED NURSES, SOCIETY, &
ENVIRONMENT
Section 13 Ethical Principles
1. The preservation of life, respect for human
rights, and promotion of healthy environment shall be a
commitment of a Registered Nurse.
2. 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 Guidelines to be observed
Registered Nurses must
A. Be conscious of their obligations as citizens
and, as such, be involved in community concerns.
B. Be equipped with knowledge of health
resources within the community, and take active roles in
primary health care.
C. Actively participate in programs, projects, and
activities that respond to the problems of society.
D. Lead their lives in conformity with the
principles of right conduct and proper decorum.
E. Project an image that will uplift the nursing
profession at all times.

Article VI: REGISTERED NURSES & THE PROFESSION
Section 15 Ethical Principles
1. Maintenance of loyalty to the nursing
profession and preservation of its integrity are ideal.
2. Compliance with the by-laws of the accredited
professional organization (PNA) and other professional
organizations of which the Registered Nurse is a member
is a lofty duty.
3. Commitment to continual learning and active
participation in the development and growth of the
profession are commendable obligations.
4. Contribution to the improvement of the socio-
economic conditions and general welfare of nurses.
Section 16 Guidelines to be observed
Registered Nurses must
A. Be members of the Accredited Professional
Organization (PNA)
B. Strictly adhere to the nursing standards.
C. Participate actively in the growth and
development of the nursing profession.
D. Strive the secure equitable socio-economic
and work conditions in nursing through appropriate
legislation and other means.
E. Assert for the implementation of labor and
work standards.

Article VII: ADMINISTRATIVE PENALTIES, REPEALING
CLAUSE, AND EFFECTIVITY
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. 23 (f), Art. IV
of RA No. 9173 and Sec. 23 (f), Rule of Board Res. No. 425,
Series of 2003, the IRR.
Section 18
The Amended Code of Ethics promulgated
pursuant to RA No. 877 and PD No. 223 is accordingly
repealed or superseded by the herein code.
Section 19
The Code of Ethics for Nurses shall take effect
after fifteen (15) days from its full and complete
publication in the Official Gazette or in any newspapers of
general circulation.
Bioethical Issues
Caring for an HIV infected client
Moral obligation vs. moral option
Abortion
Sanctity of human life vs. autonomy
and the womans right to control her
own body
Termination of life-sustaining treatment
Moral obligation to prolong life vs.
autonomy of the client
Advance directives:
Living Will - written document that
specifies what types of
medical treatment are
desired
Health Care Proxy - designates another
person to make health care
decisions if he or she is
rendered incapable of
making their wishes known
Power of Attorney - Individuals may
draft legal documents
providing power of attorney
to others in the case of
incapacitating medical
condition
Ethical Decision Making
1. Assess the situation
2. Identify ethical problem
3. Plan
identify options/outcome
think ethical problem through
make decision
4. Implement and evaluate.

Strategies to Enhance Ethical Decision and Practice
1. Become aware of own values and the ethical aspects of
nursing
2. Be familiar with nursing codes of ethics
3. Respect the values, opinions, responsibilities of other
HCPs that may be different from your own.

Core Competency- Ethico Moral Responsibility
1. Respects the rights of individuals/groups
Indicators:
Renders nursing care consistent with the
patients bill of rights

2. Accepts responsibility and accountability for own
decisions and actions
Indicators:
Meets nursing accountability
requirements as stated in job description

Justifies basis for nursing actions and judgment
Projects positive image of the profession
3. Adheres to national and international code of ethics for
nurses
Indicators:
Recites the code of ethics for nurses and abides
by its provisions
Reports unethical and immoral incidents to
proper authorities

Virginia Anderson on
Excellence in Nursing
The complete, mature, or excellent nurse.. Is the one who
remains compassionate and sensitive to patients, who has
thoroughly mastered nursings technical skills, but who
uses and has the opportunity to use her emotional and
technical responses in a unique design that suits the
peculiar needs of the person she serves and the situation
in which she finds herself.