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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. 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

ETHICS & MORALITY A. Relation  Both ethics & morality deal with human act & conduct.  Ethics studies about morality  Morality gives ethics a perspective of what to study about that is the rectitude of whether an act is good or bad  Morality provides ethics with a quality that determines and distinguishes right conduct from wrong conduct B. Distinction  Ethics pertains to the knowledge of what to study about that is the goodness or evil of a human act; Morality pertains to the application of this knowledge in the performance of human act  Ethics provides learning about the morality of a human conduct; Morality provides ways in practicing what is learned.  Ethics is the word ; Morality is the flesh  Ethics indicates the theory ; Morality indicates the practice

HUMAN ACT An act that proceeds from the deliberate free will of man Elements: 1. Knowledge act is done in the light of the agent s knowing faculty 2. Freedom act is performed in accordance with & not against the will 3. Voluntariness the act done is intentional ACT OF MAN An act that does not proceed from the deliberate free will of man Elements 1. (-) knowledge agent not aware/conscious of what he is doing 2. (-) freedom not a free act 3. (-) voluntariness no decision of the will to make the agent intend & willfully do such an act. Determinants of the Morality of Human Act The act itself - deed done ; nature of the act - primary determinant of morality Motive of the agent purpose to be achieved by means of the act. The Circumstances conditions in which the act is done affecting its morality Different Circumstances  Circumstance of Person  Circumstance of Quantity or Quality of the Act  Circumstance of Place  Circumstance of Means or Instrument  Circumstance of Manner  Circumstance of Time  Circumstance of the Motive of the Agent Moral Principles Governing the Motive of the Agent  A good act which is done for a good motive becomes doubly good  An evil act which is done for an evil motive becomes doubly evil  A good act which is done for an evil motive becomes evil  An evil act which is done for a good motive does not become good


ETHICAL CONCERNS IN HEALTHCARE y y y y y y y 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


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 y y y Issues of patient care that presents as ethical dilemmas The institution s ability to protect the rights and interests of clients in general The development of institutional policies and educational programs on ethical issues

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


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 FUNDAMENTAL CONCEPT: HEALTH IS THE FUNDAMENTAL RIGHT OF EVERY INDIVIDUAL. NURSES PRIMARY RESPONSIBILITY: PROMOTION OF HEALTH PREVENTION OF ILLNESS PRESERVE HEALTH AT ALL COST! ALLEVIATION OF SUFFERING RESTORATION OF HEALTH

Who and what is a Person? y y y y y y y y 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 y y Beliefs- ideas that one accepts as true- one that changes the least- opinions, decisions Behaviors- observable actions

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

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.


Basis of Human Dignity y 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

y y y y

Image and Likeness of God Christ redeemed us Ultimate destiny to fulfill Rational beings


y y y

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. y y y y y y 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

3 Basic Laws y y y 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 2. General Moral Principles of Relationship 3. Application of General Principles of Morality to specific situations in Life and Society Ethical Theories

 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

Utilitarianism > Concerned with the consequences or end 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 y 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 y 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 as a result of it 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 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  Virtue Ethics

 An approach that deemphasizes rules, consequences and particular acts and places the focus on the kind of person who is acting.  Virtues admirable character traits, perfection of character Vices opposite

Character traits are: y y dispositions or habit-like tendencies that are deeply entrenched or engrained. formed as a result of more or less freely selected actions of a certain kind.

Moral Virtues : y are admirable character traits; generally desirable dispositions, which contribute, among other things, to social harmony y enable us to act in accordance with reason y enable us to feel appropriately and have the right intention Theological virtues : faith, hope & charity Cardinal virtues : prudence, justice, temperance & fortitude Moral acquired virtues : fidelity, honesty, humility, compassion, justice, courage & prayfulness

CONSCIENCE  CON with ; SCIENCE knowledge  An act of judgment  Determines whether an act is good or bad To follow one s conscience is not: y To follow feelings y To follow law or custom y Blind obedience to the inspiration of God y Follow personal freedom and autonomy 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

y y

y y y

y y y

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 Pharisaical y judgmental towards other Callous y Worst type ; no sensitivity to sin

Formation of Conscience 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 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. B. C. D. Informed themselves as fully as practically possible about the facts and the ethical norms Form a morally certain judgment of conscience on the basis of this information Act according to this well formed conscience Accept responsibility for their actions

PRINCIPLE OF MORAL DISCERNMENT To make a conscientious ethical decision, one must do the following: 1. Proceed on the basis of 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

Principle of Double Effect y The directly intended object of the act must not be intrinsically contradictory to one s fundamental commitment to God & neighbor (including oneself) y y y The intention of the agent must be to achieve the beneficial effects & as far as possible to avoid the harmful effect. The foreseen beneficial effect must be equal to or greater than the foreseen harmful effects The beneficial effects must follow from the action at least as immediately as to the harmful effects.

Principle of Legitimate Cooperation y y Formal cooperation- when one concurs with the sinful act of another and gives internal consent to it. Material cooperation- one somehow externally participates in another s sinful deed, without giving internal consent to it - immediate - mediate Ethical if the following conditions are met: 1. The more remotely related the material and mediate cooperative act is to the evil act, the easier it is to justify 2. The good achieved by the material and mediate cooperation must outweigh the degree of evil and also the contribution of the cooperator to the evil. 3. The evil effects of the scandal ( the bad example) set by the mediate material cooperation should be weighed. REMEMBER: 1. Formal cooperation is always immoral 2. Material immediate cooperation is likewise immoral 3. Mediate material cooperation may be moral. Principle of Legitimate Cooperation To achieve a well-formed conscience, one should always judge it unethical to cooperate formally with an immoral act (that is, directly to intend the evil act itself), but one may sometimes judge it to be an ethical duty to cooperate materially with an immoral act (that is, only indirectly intend its harmful consequences) when only in this way can a greater harm be prevented, provided: y a. that the cooperation is not immediate and y b. that the degree of cooperation and the danger of scandal are taken into account.

Principle of Stewardship and Creativity Two gifts given to us by God: > gift of natural resources > gift of human creativity DIMENSIONS OF STEWARDSHIP y Personal: Life and Health y Social: Stewardship of Resources; the Preferential Love for the Poor. y Ecological: Stewardship of Creation y Biomedical: Research and Experimentation on Human Beings. Principle of the Totality of the Human Person To promote human dignity in community, every person must develop, use, care for, and preserve all of his or her natural physical and psychic functions in such a way that:

a. Lower functions are never sacrificed except for the better functioning of the whole person and even then with an effort to compensate for this sacrifice. b. The basic capacities that define human personhood are never sacrificed unless this is necessary to preserve life Conditions for Principle of Totality 1. That the organ, by its deterioration in function, may cause damage to the whole organism or at least pose a serious threat to it 2. That there is no other way than taking the indicated action against it or obtaining the desired good result 3. That the damage being avoided to the whole is proportional to that which is caused by the mutilation or incapacitation of the part MUTILATION y y Destruction of member, organ or part of the body (organic) or the suppression of a physical function (functional) in such a way that the organism becomes no longer basically whole Types  direct- willed in itself, as end or as means, intended and caused  indirect ( therapeutic)- caused by the exigencies of the health or survival of the patient; at times willed as means, at others tolerated as an unavoidable side effect y Reasons for Plastic Surgery:  Treatment of a physical pathologic condition  Aesthetic considerations  Psychological reasons Is Plastic Surgery Moral? 3 conditions: 1. the motive must, in the 1st place , be good 2. the preservation & protection of the patient s health, in general, from any remarkable risks & danger must be ensured along with the procedure 3. a reason sufficiently grave should exist proportionate to the gravity of the procedure involved ORGAN DONATION Criteria: 1. There is serious need on the part of the recipient that cannot be fulfilled in any other way. 2. The functional integrity of the donor as a human person will not be impaired, even though anatomical integrity may suffer. 3. The risk taken by the donor as an act of charity is proportionate to the good resulting for the recipient. 4. The donor s consent is free and informed.

5. The recipients for the scarce organs are selected justly.

Live donor- Informed consent - benefits & risks - Unforeseen adverse events Cadaver donors - brain death - Informed consent (donor, next of kin) - Proper care at death Who receives organs? - Those who will benefit - Those who will comply w/ treatment - Allocation must be just STERILIZATION y A medical or surgical intervention which causes a patient, incapacity of generation y Therapeutic- inevitably required for the survival and health of a person- sexual organsintegrating parts which must yield to the good of the whole. licit if: - sickness is grave, certainly diagnosed and definitive that it offsets the evils of sterilization - it is necessary because it is the only possible effective remedy - exclusively curative- intention is important y y Direct sterilization- the immediate effect is to render procreation impossible Types: eugenics- seeking to avoid the transmission of hereditary defects hedonistic- evade the complications & responsibilities of procreation without giving up the sexual pleasure demographic- to control the birthrate preventive- render pregnancy impossible which might aggravate sickness that already exist