Bullets in BIOETHICS

Michael Kenneth A. Desierto R.N.

• ETHICS - Rules and principles that guide decisions or conduct in terms of

rightness/wrongness of that decision or action. Publicly announced.
• MORALITY - Personally held beliefs, opinions, and attitudes that guide our actions.
Subjective, Personal
• Lawrence Kohlberg’s Stages of Moral Development
Level 1 (Pre-Conventional)
1. Obedience and punishment orientation (2-3 y.o.)
2. Self-interest orientation (Reward Orientation) (3-6 y.o.) (Superego development)
Level 2 (Conventional)
3. Interpersonal accord and conformity (The good boy/good girl attitude) (6-10 y.o.)
4. Authority and social-order maintaining orientation (Law and order morality) (10-12 y.o.)
Level 3 (Post-Conventional)
5. Social contract orientation (12-18 y.o.)
6. Universal ethical principles (Principled conscience) (18 and above)
• UTILITARIANISM - The broader good deems to be the better good. “The end
justifies the means.”
• DEONTOLOGICAL – Argues that “good consequences may have to be set aside to
respect inalienable human rights.” “Do no harm.”
• AUTONOMY - “Independence,” “One’s ability to decide for himself”
NOTE: Only a COURT ORDER can overrule the client’s right to Autonomy.
• NONMALEFICENCE - “Do no Harm”

• BENEFICENCE - “Do good for the client’s benefit”

• What is the undesirable outcome of beneficence?

Paternalism – the health care provider decides what is best for the client and
attempts to encourage the client to act against his own choices.

• JUSTICE - “Fairness and Equality”

• FIDELITY - “Being Faithful”
• VERACITY - “Truthful”
• CONFIDENTIALITY - respect for privileged information.
Reasons to disclose Confidentiality:
a. The Public has the right to know such as in communicable diseases (Swine
Flu).
b. Criminal Cases such as wanted individual for heinous crimes.
c. Court Order
d. Cases of Abuse such as Child Abuse (RA 7610) and Abuse of Women
(RA 9262)
• Voluntary commitment – the client willfully admitted himself to the hospital.
a. Client must be released when he no longer chooses to be hospitalized.
b. Client has the right to refuse treatment.
• Involuntary commitment – client was brought and admitted to the hospital by his
folks against his will.
a. Reasons: Client is mentally ill, Poses a danger to self and others, and Unable to care for
self
b. Client may not refuse treatment.
• If a nurse suspects that a co-worker is abusing chemicals, what
must she do?
-Report it to the Nurse Manager in a confidential matter
• The goal of reporting the co-worker is?
-Treatment
• When does a nurse’s responsibility to the patient begin?
-Upon admission
• INFORMED CONSENT - Giving the client factual information about the benefits,
risks, and alternatives prior to the procedure he will undergo. Obtained by the
Physician
1
 -Role of the Nurse:
a. Witnessing the Consent.
b. Making sure that the client understood the given information.
c. Witnessing the client’s signature.

• A client advocate strongly upholds what moral principle? Fidelity

• Components of Informed Consent: VIC

a. Voluntary – free of coercion or the client was not forced.

b. Informed – client was informed by the physician and understands the procedure.

c. Competent – of legal age (18 y.o. and above), mentally stable, not under the
influence of drugs

• Minors can sign the consent only if they are EMANCIPATED MINORS:
a. Married b. in Military Service c. Self-sufficient and Independent
• Types of Informed Consent

1. Expressed Consent - Verbal or written

2. Implied – signed during hospital admission and needs no separate consent; for simple &
routine procedures.

• A client has signed the consent but he no longer wish to undergo the
procedure, what can the client do?
- Client may withdraw consent anytime!
• Informed consent is waived in EMERGENCY CASES.
• Sterilization: husband & wife must give consent (except in: abruptio placenta, ectopic pregnancy,
ruptured uterus)
• Informed Consent is Valid only for: 24 hrs
• ADVANCED DIRECTIVES – any advance declaration by a person regarding his care
and medical treatment if he becomes unable to communicate his wishes.
• Types of Advanced Directives:
o LIVING WILL (it’s a LIST of treatments and treatments to be avoided)
- LISTS the medical treatment that a client chooses to omit or refuse if the client becomes
unable to make decisions and is terminally ill.
o DURABLE POWER OF ATTORNEY (with HEALTH CARE PROXY)
- is a legal document that APPOINTS A PERSON (HEALTH CARE PROXY) chosen by the
client to carry out the client’s wishes or to make decisions on the client’s behalf when the
client can no longer make decisions.

• Valid for how long? ONE YEAR ONLY

• Must be reviewed with whom after 1 year? PHYSICIAN
• Can a nurse witness in the making of Advanced Directives? No. Any employee of the hospital
where the client is admitted can’t stand as a witness nor the client’s family members.
• DNR ORDER
- Is an order written by a physician when a client has indicated a desire to be allowed to
die if the client stops breathing or the client’s heart stops beating.
- The client or his or her legal representative must provide informed consent for the DNR
status.
• ORGAN DONATION
- Any person 18 years of age or older may become an organ donor by written consent, in
a living will, or indicated in his driver’s license.
- In the absence of appropriate documentation, a family member or legal guardian may
authorize donation of the decedent’s organ.