health care ethics lec

8/4/2019 Health Care Ethics Lec.

http://slidepdf.com/reader/full/health-care-ethics-lec 1/39

Luzviminda M. Quinivista RN,RM,MSN,MANc



- Deals with the conduct and moralissues that arise in the practice ofhealth care professionals, nursesincluded.

- It is concerned with health care

values, obligations, rights andneeds.



It is derived from ethical theories1. Respect for individuals2. Autonomy

3. Nonmaleficence4. Beneficence5. Justice

6. Confidentiality7. Fidelity8. Veracity



Is an overarching maxim of morality thatinfluences all other ethical principles.

Is fundamental to recognition of the

autonomy of individuals as it incorporatesethical convictions that individuals shouldbe treated as autonomous agent and that

person with diminished autonomy (suchas mentally insane and children) areentitled to protection.



Individuals are to be permitted personalliberty to determine their own actions (Fowler and Fry 1988) of Autonomy are:

According to Miller the Characteristics1. Autonomy as free action

2. Autonomy as authenticity3. Autonomy as effective deliberation4. Autonomy as moral reflection



To be considered as free action, it must be theintentional and conscious choice of the person Right to free action is violated by any suggestion

of coercion, duress, undue influence or with

holding of information Eg when a nurse influences the client to decide

in favor of specific treatment by misinformingthe client that all other treatment is not aseffective and safe, the client is unable toexercise his autonomy fully.



Means that the action of the individualis consistent with his attitudes, values,dispositions and life plans.

The decision is aligned with his pastusual pattern of behavior and theirmotivation



This pertains to action that is done only aftergiving it clear thought, giving properconsiderations to the alternatives and theirconsequences

Eg when a person who acts out of impulse, heengages in thoughtless action for there is noopportunities to think, an action is considered

an effective deliberation, when all informationis available



This is the deepest and most demanding senseof autonomy for as miller pointed out, itinvolves a deeper level of self introspectionwhich involves the ability for rigorous selfanalysis, awareness of alternatives set ofvalues (personal values of an individual),commitment to a method of them assessing and

an ability to put them in place.



Reflection – will determine thesort of a person one will be.

Authenticity - can be judged byacts conforming to deliberatedvalues.



Informed consentIt obliges doctors and nurses to seek a valid

consent because the consenting party is an

autonomous person.The respect for autonomy of the patient

means that the patient has the capacity to actintentionally, with understanding, and with out

controlling influences that would act against afree and voluntary act such as Coercion orundue influence



Ex. A person in acute stage ofcontagious disease must beisolated, even against his/her will,in order to prevent the spread ofthe disease and protect thegreater public.



It means acting in a fatherlymanner which involves in engaging inbehaviors associated with those ofthe traditional roles of the fatherof a family such as leadership,decision making, discipline, andprotection.



Assumes the authority to make decisions forthe patients

many are against Paternalism as it limits thefreedom of choice

It is often thought of a violation of the client’sautonomy or the right to make his owndecisions



Mentally incompetent

Delirious or unconsciousUnder the influence of substance



Nurses/ doctors can make decisionfor the patient to promotepatient’s well being or to protectthem from harm or injury



Is justified only to prevent harm to thepatient

The role of the nurse as patient’sadvocate is related to the concept ofpaternalism.

Nurses as patient’s advocates can decidefor the incompetent patient what shebelieves the patient will decide forhimself



Ex. The nurse capacity to restrain a

violent patient (with out need of askingfor the patient’s consent) who may harmhimself or other persons around him.

Unconscious patient brought to ER whoreceives medical treatment without himbeing made to sign a consent formedical treatment first.



He/she must be allowed to make his owndecisions even if his/her choices mayhave harmful consequences as long as he

does not cause harm to others. Ex. Cancer patient- Who is allowed to refuse the more

effective chemotherapy and choosesalternative treatments such as herbalmedicines



Pertains to health care providersmaking decisions about a client’shealth care when they are unable tomake informed decisions abouttheir own care, in this situation thehealth care provider must decidewhat the best course of action forthe patient is and carry it out.



Is based on a person’s rigorous obligation toavoid injuring another individual. The legal requirements of duty of care and

accountability clearly arise from this principle.

This principles obliges health care providers toDO NO HARM

An extension of this principle is the obligationof health care providers to protect from harm

those who can not protect themselves such aschildren, mentally incompetent, and unconsciouspatient



Requires that health care providers do notintentionally create a needless harm or injuryto the patient, either through negligent acts orcommission or omission.

Ex. a nurse fail to perform skin test prior toadministration of highly allergenic medications,

Providing a proper standard of care that avoids

or minimize the risk of harm is supported notonly by our commonly held moral convictions,but by the laws of society as well.



One may be morally and legally accountable ifone fails to meet the standards of due care.

This principles affirms the need forprofessional competence

The principle may justly violated in somemedical situationEx. Pregnant woman with cardiac disease have

abortion

- Advanced laryngeal cancer- Pt with DM and with Gangrene



In Non maleficence “ one must

accept substantial risk to one’ssafety in order not to cause harmto others, whereas acceptance of

even moderate risk is not generallyrequired to benefit others” inBeneficence



Individual should do only good and contribute tothe welfare of others

Ex.-

Providing wound treatment to a particularpatient- Prevention of disease through Research and

immunization



Obligation to be fair to all This principles requires that socialbenefits ( EG. HEALTH CARESERVICES) and Social burdens (eg.Taxes)be distributed in accordance

with the demands of justice



Great Philosopher Aristotle – said Justice involves“giving to each that which is his due” Johnstone – Justice as an ethical principle can be

examined in terms of “fairness”, “desert”, and

“entitlement” Rawls – “Justice as fairness in terms of

impartiality” Impartiality being that all persons considered free

and equal, with each person having an equal rightto the comprehensive system of Liberty offeredby society. Therefore, persons who are equal should qualify for equal treatment



Justice underlies the nurse

commitment to provide services with respect for human dignity and render nursing care to the

best of her ability to every patient disregardless of religion,sex, race, economic status, and

political beliefs.



1. To each person an equal shareEx. Immunization (given free to all children

under 7yr. Old)

2. To each person according to needEx. When there is shortage of Hepa B vacc.Provided only to high risk grp. Like wise onlythose assigned in high risk areas are

provided with free check up, medication,including treatment and immunization

3.



3. To each person according to contribution- Only members of Phil health can avail of the

services4. To each person according to meritEx. PCSO (only those who meet the criteria will

be provided the services needed)5. To each person according to free market

exchangeEx. Cosmetic surgery

6. To each person according to effortEx. A DM pt – has the choice to comply or not to

comply with his/her medication nd diet regimen



Obligation of a person to be faithful toagreements, responsibilities, and commitmentsthat he ahs made to himself and to others

It is the main principle that support theconcept of accountability of nurses and otherprofessional



Refers to the principles oftruthfulness

This is observed when providinginformed consent, health teaching,and treatment as truthfully and

honestly as possible.



According to moral theology there are 3 classes of secrets

1. Natural secret2. Promised secret3. Confided secret



These are secrets which must remainhidden even if there is no obligation orpromise to keep it that way, for therevelation of it could harm the individualor society

Ex. National leaders may with holdinformation that their country is in threat

of nuclear attack for releasing such info inpublic can cause panic , economic andpolitical problem



These are secret that a personconfides to another in exchange

of a promise not to reveal it toothers



These secrets are confided toanother person only after

that person has made thecommitment that it will not

be known to others.



1. The physicians who deal with thepatient even for a briefest time atvarious phases of the patient’s illness

or treatment2. Pharmacists who prepare the meds.3. All other heath care professionals

involved in the care of the client suchas nurses, doctors



1. After the client gives his/herconsent to reveal info. About

him/her of health care2. When its revelation is for the

common good

health care ethics lec

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