UST COLLEGE OF NURSING Michael John M.

Vallarit BIOETHICS MAM CHUA Ethics - Practical science of the morality of human conduct - Practical because it: o Applies a direction o Represents the reason which show these data to be true o Moral because it is related to the dictates of reason (how it should be) o Human conduct because it deals with human activity and how one should act Morals - Refers to human conduct itself - Internalization of what you have learned since childhood - Based on norms of conduct about right or wrong - Societys moral codes guide what people ought to do - Professional codes such as code of ethics for nurses, communicate the goals and ideals of the profession o ICN International Code for Nurses o BON Res 220 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 Professional Code of Ethics - Nurses have a contract with society to behave in accordance with rules dictated by society and the nursing profession - Nurse Practice Acts VS Code of Ethics ETHICAL PRINCIPLES Autonomy Beneficence Non maleficence Veracity Confidentiality Justice Fidelity Respect for Person - Most fundamental human right - Foundation of all ethical principles - Respecting the worth and value of a person - Imago Dei created in the image of God - The human person ought to be respected always - Every human being has an inner worth and inherent dignity. - Certain action may never be done because performing them would constitute a violation against the persons dignity 1

UST COLLEGE OF NURSING Michael John M. Vallarit

REVIEW REPRODUCTIVE HEALTH BILL AUTONOMY - Recognizing patients as persons who are entitled to such basic human rights such as the right to know, privacy and right to receive treatment - Ability of a person to make their own decisions without interference - Autonomy- self governing o Freedom to make choices about issues that affect ones life o Respect for persons o Assumes rational thinking on the part of the individual and may be challenged when the right of others are infringed upon by the individual - Auto self ; nomous governing - Who can give proxy consent: o Durable power of attorney Appointing somebody to make decisions for you; it should be in favour of the patient o Closest of kin Spouse > children legal age Adult married spouse, children of major age Below 18 parents, grandparents No spouse siblings, uncles/aunts - Advanced directives what you want to be done to you in the future if you cannot decide for yourself in the future o Living Will you say what you want to do for yourself when you are incompetent anymore o Durable power of attorney - If in emergency head trauma, waive the consent of the MD who will do the procedure/ surgery paternalism - Competent: o 18 years of old age of majority Marriage for men: until 23 years old before no need for parental consent Emancipated minor: self sufficient; self supportive; married and independent o Mentally competent - The doctor can decide: o Doctor can act as loco-parentis or substitute parent = paternalism o Matter of life and death situations o Court Jehovahs witness, 12 years old - Assent is the confirmation of the child to participate in a research - Descent disapproval of a child in a research - PATERNALISM o Deliberate restriction of peoples autonomy by healthcare professionals based on the idea that they know whats best for the clients can be justifiable at times; not all the times o Doing good should take precedence over autonomy INFORMED CONSENT

UST COLLEGE OF NURSING Michael John M. Vallarit It is a patients right to exercise freedom to make decisions for his/her health. Appropriate and necessary information are required so that medical protocols and management may be done for his interest. o To protect the basic need of every human person for health care and the persons primary responsibility for his or her own health, No physical or psychological therapy may be administered without the free and informed consent of the patient, or If the patient is incompetent, the persons legitimate guardian acting for the patients benefit and, as far as possible, in accordance with the patients known and reasonable wishes Proportionality Risks VS. Benefits o Elements of informed consent Disclosure What operation, how is it done, complications, prognosis, alternatives, cost Understanding Avoid medical terms/ jargons Voluntariness autonomy; no force or coercion Competence Consent Only for 24 hours If deferred, secure another one. File the previous consent o Who are incompetent? Comatose Below 18 yrs old Mentally incoherent - Nuremberg Code 1947 o Foundation of all research ethic codes o 10 principles o Voluntary consent, results need to be of good to the society, animal experiments first, avoid unnecessary physical and mental suffering/ injury, should not be done if it will cause death or disability - Declaration of Helskinski o Developed by WMA guidance to research no t present in Nuremberg Code; o For MD doing research on their patients - Belmont Report 1976 o Medical and behavioural research o Washington DC - Basic ethical Principles of all codes o Respect for persons Respect for autonomy and protection of persons with diminished autonomy o Beneficence and non-maleficence Maximize benefits and minimize harm o Justice Equitable distribution of both burdens and benefits of research o CONFIDENTIALITY 3

UST COLLEGE OF NURSING Michael John M. Vallarit Requires the non disclosure of private or secret info with which one is entrusted ICN (2000) the nurse holds in confidence personal information and uses judgment in sharing this info An important component of autonomy- maintains dignity and respect for the person Only with directly involved in the care of the client The ff are subjects of confidentiality and should not be revealed to anyone except for graver cause: o Private secrets o Contractual secrets o Professional secrets Graver cause: o Personal decision o Reportable cause communicable diseases SARS, AH1N1, HIV; child abuse and neglect Abused children Bruises in different stages of healing Remove the clothes to assess If it is only a suspicion, REPORT! o If MD does not support, report to supervisor. She will report it to social services. o Legal cause Breaches of confidentiality o Computerization of medical records o Access to hospital patient charts o Patients discussed by colleagues Mandatory disclosure o Communicable diseases o Child abuse and neglect o Vulnerable adults

PRINCIPLE OF BENEFICENCE AND NON MALEFICENCE - Beneficence o Duty to actively do good for patient o Positive form o Primary goal of health care is to do good for patients under their care o Consider: Deciding what interventions should be provided for patients when some of those interventions may cause pain Burn clients receiving mafenide acetate Before giving, provide pain relief measures; analgesics 15 minutes prior to administration of drug o May create a duty when the law does not doing something out of duty at times Often conflicts with principle of autonomy Im doing you good, but you dont want it. Beneficent Act: A nurse prevents a patient from acting on suicidal impulses Good Samaritan Act: what a prudent nurse could do in a certain situation o - Non maleficence o Negative form 4

UST COLLEGE OF NURSING Michael John M. Vallarit o o o o Preventing, avoiding Duty to prevent or avoiding harm whether intentional or unintentional Does not mean avoidance of harm altogether... avoidance of harm unless the action promises a greater good Consider this: Is it harmful to accept an assignment to float to an unfamiliar area that requires administration of unfamiliar medications? Float but you take care patients of you know you can take care of prioritization.

Death and Advance Refusals of Treatment - Apparent Death the cessation of life as indicated by the absence of all vital functions - Clinical Death death of all organs wherein vital signs are absent o Declared dead by MD - Biological Death with signs of death o Rigor mortis after 1 hour - Brain Death absence of all electrical activity of the brain including cerebral perfusion o Only criteria for harvesting organs for organ donation Orthothanasia acceptable; allowing patient to die in normal causes Euthanasia mercy killing o Active / Commission o Passive / Omission Dysthanasia Prolonging suffering

JUSTICE - The duty to treat all patients fairly - Equal treatment of equal cases and equal distribution of benefits- no discrimination on the basis of sex, race, religion, age and socioeconomic status - Involves allocation of scarce and expensive health care resources VERACITY - Duty to tell the truth - Fundamental to the development and continuance of trust among human beings- truth telling, integrity and honesty - Consider this: o Is lying to a patient ever justified? If a patient finds out that you have lied to them, will they have a reason to trust you? FIDELITY - Obligation of an individual to be faithful to commitments to him/herself and also to others - Main support for the concept of accountability - Keeping information confidential and maintaining privacy and trust - Consider this: o To whom do we owe fidelity? Who has the right to access patient medical record? When should we blow the whistle on unsafe staffing patterns? Tell to supervisor > Go to higher persons/ Chief Nurse > Medical Director > Outside media / DOH 5