ETHICS

• “ETHOS” – character, behavior/custom

• DECLARATION OF R/W- process oriented, involves critical analysis of action – reflects
the “SHOULD” of human behavior.
• STUDY OF MORAL CONDUCT OR PRINCIPLES OF UNDERLYING DESIRABLE
TYPES OF HUMAN CONDUCT.
• SCIENCE OF IDEALS – guides our judgment concerning morality of human acts.

ETHICS
- a theoretical task that involves careful reflection on the nature of a human person.

Based on this reflection, one derives the normative principles which govern one’s relationship
with others, the environment, and God.

MORALS
• “MOS” – custom
• REFERS TO HUMAN CONDUCT ITSELF-APPLICATION OF ETHICS.
• FUNDAMENTAL STANDARDS OF R/W THAT AN INDIVIDUAL LEARNS AND
INTERNALIZES - USUALLY DURING EARLY STAGES OF CHILDHOOD DEVT -
REFLECTS WHAT IS DONE IN A SITUATION

Morality - measure of relation between the human act performed & its norm according to the
dictates of right reason, human nature & ultimately, God’s Eternal Law

“To cultivate morality

You must cultivate your mind on all occasions
train your mind in all situations
and elevate your mind in all places”

WHY STUDY ETHICS?

ETHICS DETERMINE:
1.) WHY ONE ACT IS BETTER THAN THE OTHER.
2.) TO HAVE AN ORDERLY SOCIAL LIFE.
3.) SEEK TO POINT OUT TO MEN THE TRUE VALUES OF LIFE

ETHICAL CONCERNS IN HEALTHCARE

• Confidentiality of Records
• Right to Privacy
• Right to Information
• Competent Consent to Treatment
• Right to Refuse Treatment
• Termination of Treatment
• Quality of Service provided for disabled or terminal patients
BIOETHICS
• APPLICATION OF ETHICAL THEORIES AND PRINCIPLES TO PROBLEMS IN
HEALTHCARE – CONCERNED WITH WHAT SHOULD BE DONE
• CHRISTIAN BIOETHICS – STUDY OF THE CONCEPTS AND PRINCIPLES
OF CHRISTIANITY

WHY STUDY BIOETHICS?

The following changes gave rise to the need of bioethics:
• Scientific Advances
“What is technologically possible is not always ethically justifiable”
• Inequalities in socio-economic, educational and political positions
• Finitude of resources
• Changes in the doctor-patient relationships
“Doctor w/o ethics is only a technician, but with ethics, he is properly called a physician”
• Rampant unethical behavior

ETHICS COMMITTEE
Functions:
• Provide ethics education programs for staff
• Advisory Function - formulate policies
• Consultative Function
should not exercise decision – making power only recommendatory
• Other functions:
In the absence of Institutional Review Board (IRB) it can review research protocols on its
ethical aspects
It can also serve as advocates for legislative development on health and contributes its
share to public debate on health care issues.

Committee Composition
• Must have a well-balanced representation from medical, nursing & administrative staffs.
• Representatives from pastoral care, social work & other areas involved in patient care
• A lawyer can be an effective committee member as long as he is careful not to put legal
concern above ethical concerns.
• A liaison from the administration should be an active member of the committee

* A committee that does not have the full support of the administration is doomed to fail

NURSING BIOETHICS COMMITTEE

• HELP NURSES INCREASE THEIR KNOWLEDGE ABOUT APPLIED ETHICS
• ASSIST NURSES IN MAKING ETHICAL JUDGMENTS AND DECISIONS
• SERVE AS NURSING REPRESENTATIVES IN THE HOSPITAL’S
MULTIDISCIPLINARY ETHICS COMMITTEE
Code of Ethics
The “Code of Ethics for Nurses” BON Resolution 220 series 2004
- provides guidance for carrying out nursing responsibilities consistent with the ethical obligations
of the profession

Who and What is a Person?

• From the time of conception till death
• Personhood- depends on the values, attitudes, beliefs and needs
• All Human beings have needs
• Anything that fulfills a need is a VALUE
• Values give direction and meaning to life and guide a person’s behavior
• Values are shaped by culture, ethnicity, family, environment and education
• Values are freely chosen, cherished and consistently incorporated into one’s behavior
• Attitudes-one’s disposition toward an object or a situation; emotional or mental mindset;
positive or negative

Beliefs- ideas that one accepts as true- one that changes the least- opinions, decisions

Behaviors- observable actions or reactions in relation to the environment

What is a Patient?
• The patient is the most important person in the hospital
• The patient is not an interruption of our work - he is the purpose of it. He gives meaning
and nobility to our profession
• The patient is not an outsider of our day to day operations. He is our concern
• The patient is a person, not a statistic
• He has feelings, emotion, wants, aspirations, and dreams
• It is our business to satisfy him
• Above all, he is an instrument of our ultimate salvation

Key Concepts
• All human interactions are value based
• Nurses must clarify and respect the values of others and examine their own values
• Values are enhanced and refined by experiences that cultivate values development such
as interactions with people of differing values and viewpoints and experiences that
challenge one’s way of thinking
Maslow’s Hierarchy of Needs (Biological, psychological, social and spiritual and creative needs)

St Thomas Aquinas-need to preserve life; need to procreate; need to know the truth and the
need to live in society

Ethical problems exist when we must make decisions so that all these needs will be satisfied in
an integrated and consistent manner

Values and Value Clarification

• Ethical problems results from changes in society, advances in technology and the nurse’s
conflicting loyalties and obligations
• Nurse’s ethical decisions will be influenced by their moral theories and principles, levels
of cognitive development and personal and professional values
• The goal of ethical reasoning is to reach a mutual, peaceful agreement that is in the best
interests of the patient.

RESPECT FOR PERSON

• MOST FUNDAMENTAL HUMAN RIGHT
• FOUNDATION OF ALL ETHICAL PRINCIPLES
• RESPECTING THE WORTH AND VALUE OF A PERSON = HUMAN DIGNITY

“Human Dignity is used to indicate that persons should always be treated as ends in themselves
and never merely as a means” - Thomas Aquinas & Emmanuel Kant

Basis of Human Dignity

Salvation History
1. Creation of man
2. Fall of Man
3. Promise of a Savior
4. Preparation for the Coming
5. Fulfillment of the Promise
6. Establishment of the Church
7. Heavenly Kingdom

Image and Likeness of God

Christ redeemed us
Ultimate destiny to fulfill
Rational beings

SIGNIFICANCE OF BEING A PERSON

• Has an inherent dignity which must be respected
• Has an ultimate destiny- to live with God
• Lives with other persons in the community
PRINCIPLE OF HUMAN DIGNITY
All ethical decisions (made by patients and healthcare givers) must aim basically and
ultimately at human dignity.
• They must protect, defend, enhance, and enable the person’s worth.
• They must aim for the maximum and integrated satisfaction of every person’s needs, as
an individual and members of his community.

✓ Every human being has an inner worth and inherent dignity. These he possesses not
because of what he has or what he does but because of what he is: a human person
✓ As a human person, he must be respected regardless of the nature of his health problem,
social status, competence, past actions
✓ Decisions about health must aim at the maximum integrated satisfaction of his needs:
biological, psychological, social and spiritual
✓ Certain actions may never be done because performing them would constitute a violation
against the person’s dignity

Human rights
- needs and values as it relates to other human beings
- it is universal
- equal among everybody
- not a product of human creativity but inherent to us

Universal Declaration of Human Rights (1948)

– respects the dignity of the human person

Newborn, healthy adult, senile elderly

Comatose patient, crazy individual
Illiterate slum dweller, university president, uneducated housemaid, convicted killer

Are they all persons?

Do they have equal human dignity?
How is respect for this dignity manifest?
3 Basic Laws
• Eternal law- “the divine will or command that directs all actions & movements in the
universe. It commands that the natural order of things be preserved & forbids that it be
disturbed”.
• Natural law- commands that nature must be respected in its integrity & it prohibits the
destruction of such nature – nature of human being
• Positive law- dictated by the authority of the church or state

NATURAL LAW
Properties of Natural Law
1. Universal 3. Recognizable
2. Obligatory 4. Unchangeable

Contents:
1. Fundamental Principles of Action
“Good is to be done and evil to be avoided”
“Never do to others what you would not want them done unto you”
2. General Moral Principles of Relationship
“Adore God, honor your father and mother”; Preserve life
3. Application of General Principles of Morality to specific situations in Life and Society

Ethical Theories
• Teleology
Utilitarianism
• Deontology
• Virtue Ethics

Teleological- -telos- “end”; “goal”

- consequentialism- action is judged as good or bad in relation to the consequence,
outcome or end that is derived from it
- “the end justifies the means”- sometimes it is possible to do wrong to achieve “right”
- the only right action is those that produce the greatest happiness to majority concerned
- right action is that which has the greatest utility and no action is in itself either good or
bad

Utilitarianism
• Concerned with the consequences or product of our actions. An action is right if it brings
increased happiness or benefit for those concerned; an action is wrong if it decreases
people’s happiness or benefit

“Primary responsibility is to support the interest of the group”

“the greatest good for the greatest number of people”
“the greatest happiness principle”

Mass immunization of children- voluntary or involuntary

- Random drug testing for hospital workers
Utilitarianism
Advantages:
- easy to use
- can justify many decisions based on the happiness principle
Disadvantages:
- average happiness of all or total happiness for few
- harm can be done to the minority
- what constitutes happiness? Who determines what is good?
- end justifies the means

Deontology
“duty”- “duty oriented”
- rationalist view that the rightness or wrongness of an act depends upon the nature of
the act rather than the consequences that occur because of it
- human beings have the freedom, thoughtfulness, and sensibility to act in a moral
manner- knows what he/she ought to do
- Respect for person worth/dignity
- Person’s action right if it follow moral rules-fair, honest, doing good
- A person’s action is wrong, without exception, if it violates these rules

Deontology
Consequences (-), action still ethically right if the original motive is consistent with moral precepts
Nurses code of ethics- importance of fulfilling duties that are inherently owed to patients
Advantages
- provides clear guidelines for judging the rightness and wrongness of an act
- recognizes the dignity and autonomy of individuals and allows all people equal
consideration
Disadvantages
- problem with disregard for consequences
- all ethical precepts are viewed as equally important
- exceptionless and rigid

Deontology
The nurse is duty bound to act under moral rules that establish the right or wrong:
a. duty to honor a patient’s autonomy
b. duty to promote good and well-being
c. duty to be just and fair
d. duty to do no harm
e. duty to tell the truth
f. duty to keep promises and confidentiality
A person has free will and self-determination and can refuse any medical or nursing treatment
or procedure
A right action is only right if it is done out of sense of duty
Virtue Ethics
• An approach that deemphasizes rules, consequences and acts and places the focus on
the kind of person who is acting.
• Virtues – admirable character traits, perfection of character
Vices – opposite

Virtue Ethics
Theological virtues: faith, hope & charity
Cardinal virtues: prudence, justice, temperance & fortitude
Moral acquired virtues: fidelity, honesty, humility, compassion, justice, courage & prayerfulness

VIRTUE ETHICS
• Fidelity
Faithfulness to trust & promise
• Honesty
Truthfulness & integrity
• Humility
Recognizing one’s capabilities & limitations
• Compassion
Feeling for the loss/suffering of another with an attempt to help or avoid that
loss/suffering
• Justice
Constant will to give another his due
• Courage
Doing what is right without undue fear
• Prayerfulness
Inclines one to seek God’s help in everything one does.
CONSCIENCE
• CON – with
• SCIENCE – knowledge
• An act of judgment

Determines whether an act is good or bad

“To follow one’s conscience “
• To follow feelings
• To follow law or custom
• Blind obedience to the inspiration of God
• Follow personal freedom and autonomy
•
“The capacity to make practical judgments in matters involving ethical issues”

Types of Conscience
• Correct
judgment of an act as good when it is truly good and an act as evil when it is truly evil.
• Erroneous
Judgment of an act as good when it is evil and an act as evil when it is good.
• Inculpable – one who has an erroneous conscience through no fault of his own & w/o any
knowledge about being in error
• Culpable – one who has an erroneous conscience through his own fault and neglect.

• Certain
An assured & firm judgment of an act w/o any fear of being in error
• Doubtful or Dubious
No sure judgment of whether an act is good or bad.
• Lax
Perceives even morally grave evils as allowable; makes excuses of evil acts though
seriously evil by rationalizing & justifying them.
• Scrupulous
Perceives evil in an act when there is none
• Callous
Worst type; no sensitivity to sin

A formed & informed conscience is that which knows how to make a proper judgment on an act
as truly good to be done or truly evil to be avoided in its three moral determinants: act itself,
motive of the agent & circumstances surrounding the act

How do we know what is ethical?

Religious Answers:
Revelation
Scriptures
Church tradition
Experience
Secular Answers:
Reason
Experience and Observation
Intuition
Social agreement or contract

Principle of Well-Formed Conscience

• To attain the true goals of human life by responsible actions, in every free decision
involving an ethical question, people are morally obliged to do the following:
A. Inform themselves as fully as practically possible about the facts and the ethical norms
B. Form a morally certain judgment of conscience based on this information
C. Act according to this well-formed conscience
D. Accept responsibility for their actions

PRINCIPLE OF MORAL DISCERNMENT

To make a conscientious ethical decision, one must do the following:
1. Proceed based on a fundamental commitment to God and to human persons (including
oneself) according to their God-given and graced human nature
2. Among possible actions that might seem to be means of fulfilling that commitment,
exclude any that are contradictory to it (intrinsically evil)
3. Also consider how one’s own motives and other circumstances may contribute to or nullify
the effectiveness of these other possible actions as means to fulfill one’s fundamental
commitment
4. Among the possible means not excluded or nullified, select one by which one is most
likely to fulfill that commitment and act on it