BioEthics 3.

Ethics is the science of human acts with

reference to right and wrong.
4. Ethics is the study of rectitude of human conduct.
Title: Introduction to Ethics Date: Aug. 27 5. Ethics is the scientific inquiry into the principles of
What is Ethics? morality.

 It is a philosophical and practical science Material Object Formal Object

that deals with the study of the morality of The subject matter  Delivers into
human acts of human conduct. with which ethics deals how human
in its study. act is to be
What is Morality? performed
 Human Acts according to
 The quality of human acts where the acts  Human what ethics
could either be good or right, evil or wrong. Conduct demands-
 This quality indicates and determines  Acts done by morality of
whether the kind of human act that is a human human act or
performed is good or bad. person in moral
which his rectitude.
rational and
ETHICS as a SCIENCE higher
faculties of
Ethics comprises data on the morality of
intelligence
human acts that are put together and arranged in and free will
order along with the causes and reasons by which are utilized
said data are held to be factual thereby making a
systematized body of knowledge.
Bioethics
ETHICS as a PHILOSOPHICAL SCIENCE
The term bioethics was first used by the
Ethics deals with the ultimacy of the biologist Von Renssalear Potter who used the term
cause, principle, truth concerning the morality of to refer to a new field devoted to human survival and
human conduct in the light of human reason alone. an improved quality of life.
Ethics can also be called moral This term came to refer to the broad terrain
philosophy. of moral problems of the life sciences ordinarily to
ETHICS as a PRACTICAL SCIENCE encompass medicine.

Ethics provide a body of knowledge that It is defined as a science that deals with the
enriches and sustains the intellect with more study of the morality of human conduct concerning
learning and which is applied in the performance of human life in all aspects from the moment of its
human conduct. conception to its natural end.

ETHICS as a PHILOSOPHICO-PRACTICAL Health Ethics

SCIENCE It is a science that deals with the study of
The science of ethics. the morality of human conduct concerning health and
health care (medical services, nursing care all other
Ethics points out the way to right living and types of health services given by health care
compels man to follow the directions to his ultimate practitioners)
destiny.
It is employed to regulate human conduct in
Other definitions: the practice of health care so that good may be done
and evil may be avoided thereby ensuring that the
1. Ethics is a natural science.
purpose of health care which delves in the alleviation
2. Ethics is not a physical science. It is a moral
of suffering, prevention of sickness, and promotion of
science.
health is being met in the light of the fundamental
principles of morality.
RELATION OF BIOETHICS AND HEALTH
ETHICS
1. Both are concerned about health and life.
2. Both regulate human conduct by means of moral
principles in relation to health and life.
3. Health ethics is part of bioethics.
DISTINCTION BETWEEN BIOETHICS & HEALTH
ETHICS
1. Health ethics is concerned about life only in
relation to health; bioethics is concerned not just
about health but also about other fields in relation to
life.
2. Bioethics is not part of health ethics. It has an
encompassing scope of discipline.
3. Health ethics regulates human conduct in the
practice of health care, bioethics regulates human
conduct not only in the practice of health care but
also in all aspects of human life.
POINTERS FOR A HEALTH CARE
PRACTITIONER
1. Be constantly aware of and learn by heart the
essential role ethics plays in the practice of health
care for which you are responsible.
2. Live the knowledge of ethics in the practice of your
profession and share it with other health care
practitioners and patients.
3. In case of doubt, seek counsel from persons in
authority so as to be enlightened and guided by
moral truth in the practice of health care.
4. Be brave in adhering to the objective norm and
standard of morality at all times even despite
contrasting advocacies in the health care milieu.
ETHICAL THEORIES
(serve as guides of human conduct provided by
ethical systems)
1. It can provide individuals with guidance in moral
thinking and reasoning and provide justification for
moral actions.
2. It can be used as a way to analyze ethical
problems.
3. No theory in and of itself can provide the correct
answer to any single ethical conflict.
A. TELEOLOGICAL APPROACH
Teleology comes from the Greek word
“telos” or “goal or end”
This is expressed in the maxim, “the right
thing to do is the good thing to do.”
This is also termed as act of utilitarianism
where the good resides in the promotion of
happiness or the greatest net increase of pleasure
over pain.
In recent formulation of act utilitarianism,
Joseph Fletcher, a situation ethicist, holds that good
agape, the general goodwill or love for humanity.
In the final analysis human need
determines what is or what is not ethical. If the act
helps people, then it’s a good act, and if it hurts
people, then it is a bad one.
a. UTILITARIANISM
 Holds that right action is that which has the
greatest utility or usefulness and no action
is in itself good or bad.
 Promotes the highest good that is possible
in every situation; the greatest good for the
greatest number.
 Places great emphasis on what is the best
for groups, not on individual people, the
focus is on the acts that produce the most
good in terms of most happiness.
 By aiming for the most happiness, this
theory focuses on the consequence, utility
or ends.
Jeremy Bentham: action can be considered to be
right when they increase happiness and diminish
misery.
John Stuart Mill: The only right actions are those that
produce greatest happiness. Pleasure and
happiness should be prioritized according to a
person’s intellectual ability.
Ethical theory stating that the value of a
situation is determined by its consequences.
Thus the outcome of an action (not the
action itself) is the criterion for determining the
goodness of that action.
 This theory also called the
consequentialist theory, advocated by the
philosopher, John Stuart Mill.
The principle of utility is the basic concept
of teleology.
Utility states that an act must result in the
greatest amount of good for the greatest number of
people involved in a situation.
Good refers to a positive benefit.
Any act can be ethical if it delivers good
results.
Every alternative is assessed for its
potential outcomes, both positive and negative. The
selective action is the one that results in the most
benefits and the least amount of harm for all those
involved.
GUIDELINES for making decisions according to
Fletcher
1. Consideration for people as human beings.
2. Consideration of consequences.
3. Proportionate good to come from the choices.
4. Propriety of actual needs over ideal or potential
needs.
5. A desire to enlarge choices and reduce chance;
and
6. A courageous acceptance of the consequences
of the decision.
CHO planning for their annual budget
1. To which program should they allot a bigger
budget—the modernization of the city hospital or the
nutrition and immunization programs of the poverty
stricken families of the city?
2. Will the promotion of health and prevention of
illness have priority over treatment of illness and
rehabilitation?
DEONTOLOGICAL APPROACH or DUTY
ORIENTED THEORY
The word deontology comes from the
Greek word deon which means duty.
In this theory, the ethicist feels that the
basic rightness or wrongness of an act depends on
the intrinsic nature rather than upon the situation or
its consequences.
 It is an ethical theory based on dutiful
actions, not actions based on rewards,
happiness, or consequences. (Hill & Zuerig,
2003)
 Based upon the rationalist view that the
rightness and wrongness of an act depends
upon the nature of the act, rather than the
consequences that occur as a result of the
act.
 It considers the intrinsic of the act itself as
criterion for determination of good.
 In determining, the ethics of a situation, a
person must consider the motives of the
act, not the consequences of the act.
 This theory also called formalism was
postulated by Immanel Kant.
 Kant established the concept of categorical
imperative which states that one should act
only if the action is based on a principle that
is universal (everyone would act in the
same way in a similar situation).
Immanuel Kant, a German philosopher and
ethicist in the 18th century defines a person as “a
rational human being with freedom and social
worth.”
A person is morally good and admirable if
his actions are done from a sense of duty and
reason. He states that it is only through difficult
actions that people have moral worth.
Even when individuals do not want to fulfill
their duty. Kant believes that they are required to do
so.
In his classic work, “Groundwork of the
Metaphysics of Morals,” Kant attempted to define a
person as a rational human being with freedom and
moral worth.
“A PERSON IS MORALLY GOOD AND
ADMIRABLE IF ACTIONS ARE DONE FROM A
SENSE OF DUTY.”
He states that it is only through difficult
actions that people have moral worth. Because
human beings are rational, they have the freedom
to make moral judgments.
 Kant had stated, “People ought to follow a
universal framework for moral maxims or rules to
guide right actions and duties because it is only
through dutiful actions that people have moral
worth.”
Even when individuals do not want to act
from duty, it is Kant’s belief that they are required to
do so.
Maxims apply to everyone universally and
become the laws for guiding conduct.
Kant emphasized that people should regard
everyone with dignity and respect and when they do
not, individuals feel used and demoralized.
Kantianism-duty oriented  ethics derived from
fulfilling duties.
2 TYPES OF DUTIES
a. Hypothetical imperative
 Kant meant – “do not accept exceptions”
 Duties or rules that people ought to
observe if certain ends are to be achieved.
 Sometimes called “if-then” imperatives
which are conditional.
 Example: If I want to show compassion
toward my patient then I should perform
compassionate action for my patient.
 Requires that one treats others as ends
and never as means.
 Acting forward another as you would
toward yourself.
b. Categorical imperative (an action could be
known to be right when it was in accordance with a
rule that satisfied a principle)
 A command derived from a principle.
 Requires that no action can be judged as
right which cannot reasonably become a
law by which every person should always
abide. (one should act as if one’s actions
could become universal law for all people)
 Moral actions must be based on reason
where moral actions are concerned, duties
and laws are absolute, unconditional and
universal.
 According to Kant, “No action can ever be
judged as right if the action cannot have
the potential to become a binding law for
all people.”
 One can never tell a lie for any reason,
because if a person lies in any instance,
the person cannot rationally wish that
permission to lie become a law for
everyone in the universe.
 Suicide is never acceptable. A person
committing suicide cannot rationally wish
that all people should feel free to commit
suicide, the world would become chaotic.
These imperatives were formulated by finding a
maxim that could be understood as universal law.
3 ELEMENTS
1. Universal application-bind upon every individual
2. Unconditionally
3. Demanding action
(still under deontological approach)
As practitioners of the art of healing, nurses
are to take care of the sick even if patients have
conditions that threaten their personal health.
Nurses, however, must observe the
necessary precautions to protect their health.
W.D. Ross’s Seven Prima Facie Duties
Ross’s book, the Right and the Good, is
based on his connection of ethical intuitionism to
prima facie duties.
Ross’s theory was deontological or rule-
based in nature, as opposed to Kant, considered
consequences to have value in his theory of prima
facie duties.
Ross believed in 2 moral principles:
1. Rightness
2. Goodness
He outlined the 7 prima facie duties (set of moral
rules that should guide a person’s universal
principles).
 A prima facie duty is one that dictates
what one should do when relevant factors in a
situation are not considered.
Actual duties are those duties real duties
that a person is obligated to perform.
Prima facie duties are morally significant
duties as they relate to individual circumstances at
first sight.
If two duties come into conflict, only one
duty can become the actual duty.
Prima facie duties are NOT ABSOLUTE but
are CONDITIONAL,
------Prima Facie Duties-----
1. Duties of FIDELITY: telling the truth; keeping
actual and implicit promises.
2. Duties of REPARATION: righting the wrongs we
have done to others.
3. Duties of GRATITUDE: recognizing the service
others have done for us.
4. Duties of JUSTICE: preventing a distribution of
pleasure or happiness that is not in keeping with the
merit of the people involved.
5. Duties of BENIFICENCE: helping to better the
condition of other beings.
6. Duties of SELF-IMPROVEMENT: bettering
ourselves with respect to virtue or intelligence.
7. Duties of MALEFICENCE: avoiding or preventing
injury to others.
VIRTUES ETHICS APPROACH
Doing the right thing is not all that is
needed. One must have the right motivation,
disposition and traits for being good and doing right
such as courage, magnanimity, honesty, justice, and
beneficence.
Intellect virtue is the power to deliberate
about things good for oneself.
Moral virtues must be lived over time in
order to be learned.
Nursed, when faced with a particular
situation must be able to know what to do. They must
be able to integrate virtue ethics with duty.
Ex. A student letting her best friend copy her answer
during exam-formal cooperation is an evil act.
DIVINE COMMAND ETHICS
This is based on the theory that there is a
Supreme or Divine being that wets down the rules to
provide guidance to moral decisions.
For example: for Christians, these rules are found in
the Ten Commandments.
Differences in religion pose problems such
as what to do when the decision would conflict with
one’s religious beliefs.
CORE COMPETENCY STANDARDS FOR
NURSING PRACTICE IN THE PHILIPPINES
 Safe & Quality Nursing Practice
 Management of Resources & Environment
 Health Education
 Legal Responsibility
 Ethico – Moral Responsibility
 Personal & Professional Development
 Quality Improvement
 Research
 Record Management
 Communication
 Collaboration & Teamwork
LEGAL BASES
Article 3 Sec. 9 © of R.A. 9173 / “Philippine
Nursing Act 2002”
The board shall monitor and enforce quality
standards of nursing practice necessary to ensure
the maintenance of efficient, ethical and technical,
moral and professional standards in the practice of
nursing taking into account the health needs of the
nation.
Program outcomes:
1. Apply the knowledge of physical, social, natural
and health sciences and humanities in the practice
of nursing.
2. Provide safe, appropriate and holistic care to
individuals, families, population group and
community utilizing nursing process.
THE PRINCIPLES
1. Principle of AUTONOMY
2. Principle of NON-MALEFICENCE
3. Principle of BENEFICENCE
4. Principle of VERACITY
5. Principle of FIDELITY
6. Principle of JUSTICE
I. PRINCIPLE OF AUTONOMY
It refers to one’s moral power or right to self-
governance and determination to make decisions in
directing one’s own life.
Implies the ff:
 The patient is responsible for his choices
and decisions.
 His human dignity is upheld and
recognized.
 His personal value and worth are affirmed.
 His patient’s rights are protected and are
not unduly interfered with.
 He cannot be constrained or forced to make
decisions and perform actions against his
will.
 It is moral right to choose and follow one’s
own plain of life.
 It is based on respect for person which is
the recognition of the equality possessed by
every human being as unique, worthy,
rational, creative having the capacity and
right to determine his destiny, deliberate on
plans, decide what is best for him according
to his own values and act accordingly.
 Autonomous decisions and actions should
not be constrained by others.
The statements listed in the previous slide carry the
following implications:
 X has a right to determine what will be done
to him (self-governance)
 Y has a duty not to contain X’s autonomous
choices and actions (non-interference)
Importance:
1. Autonomy enhances a person’s personal worth.
2. It protects from being used by others.
3. In health care, it helps develop a mature
therapeutic alliance between health professionals
and patient.
Violations:
1. Actions performed that constrain a person’s
capacity to make a decision.
Example:
 Not telling a patient the risks involved in an
intervention recommended and therefore
preventing him from properly weighing risks
and benefits.
 Using words not understood by the patient.
II. PRINCIPLE OF NNON-MLALEFICENCE
Implications:
X should not harm Y.
X has to give “Due Care” in dealing with Y
so that no harm is inflicted on Y.
Harm may be physical, mental,
psychological, social, financial, spiritual, etc.
Violations:
1. Physically harming a person as in assisted in
suicide, abortion, infanticide, mutilation, torture and
violence.
2. Exposing a person to physical harm as in
subjecting a person to disease, to unnecessary
treatment or to a dangerous procedure without a
commensurate important goal.
3. Harming a person’s reputation, honor, property or
interests as by revealing confidential information.
The principle of indirect or double effect justifies
some actions as non-violations of the principle of
non-maleficence.
Following this principle, when an action is seen to
have both beneficial and harmful consequences four
conditions must be met to justify what otherwise
would appear ass violations.
1. The action itself is good or indifferent.
2. The good effect and not the evil effect is
the one directly intended by the agent.
3. The good effect is not produced by
means of the evil effect. The good effect must follow
from the action at least immediately is the harmful
effect.
4. There is a proportionate reason for
permitting the foreseen evil effect to occur.
Classical Example (Right to Live)
The case of a woman with non-viable
stage of pregnancy, with cancer of the uterus.
Immediate hysterectomy is indicated to sae
woman’s life. At the same time would result in death
of a fetus.
The surgery will produce 2 effects:
1. Good effect: Saving the life of the mother
2. Bad effect: death of the fetus/.
Operation is morally permissible by reason
of the principle of double-effect nurse may assist.
Role of the Health Professional:
 The health professional must possess
knowledge, skill and diligence.
 Nurse should remember that human life is
inviolable. They should do what is best for
the patient.
III. PRINCIPLE OF BENEFICENCE
 Means the duty to promote good and
prevent harm.
 Similar to non-maleficence
 Stated in a positive form while non-
maleficence is stated as an admonition in
the negative form.
Elements:
1. Providing benefit
2. Balancing benefits and harms
IV. PRINCIPLE OF VERACITY
 The health care providers are bound to tell
the truth.
 In nursing, veracity is applied in the nurse’s
responsibility never to mislead of deceive a
patient.
 Observed when providing informed
consent, health teachings and answering
questions of patients.
 Veracity is difficult to achieve. It may not be
hard to tell the truth but it can be very hard
to decide how much to tell the truth.
Means the principle of truthfulness – neither lying nor
deceiving others.
Forms:
 Intentional lying
 Non-disclosure of information
 Partial disclosure of information
Benevolent deception:
When the practitioner himself intentionally
withholds information according to his sound
judgment when such revelation would do more harm
to an emotionally unstable or depressed person.
Ex.
1. A young married male who was diagnosed to have
AIDS requests the doctor not to tell his diagnosis to
his wife.
V. PRINCIPLE OF FIDELITY
 Ethical foundation of nurse-client
relationship
 Means faithfulness and keeping promises
Fidelity is demonstrated when the nurse:
1. Represent the client’s viewpoint to other members
of the health care team.
2. Avoid letting their own personal values influence
their advocacy of clients.
3. Support client’s decision even when it conflicts Implications:
with the nurse’s preferences of choices.
1. Each individual should receive what is his
due by right such as
VI. PRINCIPLE OF JUSTICE a. life
b. information needed for decision making
 Incorporated in the general principle “to
c. confidentiality of private information.
each according to his desert”.
 Giving one his due. 2. Benefits should be justly distributed among
 Acts justly towards a person when he individuals such as
gives that person what is due.
a. minimum health care
 The right to demand to be treated just,
b. equal opportunities for a scarce resource
fairly and equally.
 It is equally unjust to burden or reward 3. Each individual should share in the burden
someone for something that is no his due. of health and science as
(ex. To oblige an individual to be a subject
for research which is of no direct benefit to a. caring for his own health.
himself) b. caring for the health of others.
 Equals are ought to be treated equally and c. participating in the health/science progress.
unequals may be treated unequally. Violations:
What is due an individual is determined by any or
all of the following:
1. What he deserves by right, either his natural
rights or rights granted him by law or prior
undertakings, independent of the claims of others
(non-comparative justice)
Ex. Right to Life
2. Balancing competing claims of other persons
against an individual’s claim according to some
morally relevant property or merit (comparative
justice, fairness)
Ex. Giving a donated kidney to the one who needs
it most.
3. Acting uprightly in any action bearing on others.
Paradigms of Justice
Tobin describes 4 paradigms of Justice as:
1. Utilitarian: Justice as whatever brings about the
greatest good of the greatest number
2. Egalitarian: Justice as the equal distribution of
goods and services.
3. Libertarian: Justice as the lack of restraints on
individual liberty.
4. “Natural Law”: Justice as doing to others what
one would have them to oneself.