NLM MIDTERMS REVIEWER
must merely be allowed
I. Moral Ethical Responsibilities of Nurses and their
2. The two-fold effect/ Double effect
Code of Ethics
 Moral – specific ways of behavior in
accomplishing ethical practices
 Morality – private personal standard of what is
right and what is wrong in conduct, character,
and attitude.
- Behavior in accordance with customs or
tradition and usually reflects personal or
religious beliefs
 Personal morality – set of beliefs about the
standards of right or wrong that help a person
determine the correct or permissible action in a
given situation.
Moral Development – the process of learning to tell the
difference between right and wrong of learning, what
ought and not ought to be done.
Well known Theories of Moral Dev’t
 Lawrence Kohlberg
- Emphasize right and formal reasoning
 Carol Gilligan
- Emphasize care and responsibility
3 types of Moral Theories
1. Teleological (consequences)
- Look to the consequences of an action in
judging whether the action is right or wrong
2. Relationship (caring)
- Judge actions according to a perspective of
caring and responsibility
3. Principles and Duties (Deontological – duty)
- Morality of an action is determined not by
its consequences but whether it is done
according to an impartial, objective
principle.
Moral Principles
1. The Golden Rule
- “DO unto others what you would like others
do unto you
- Action must be morally good
14. The morality of cooperation
- Good effect must be willed and the bad
- An action is done with two effects: one is
good and the other is evil (Mass
Immunization)
- Good effect must not come from evil action
but from the initial action itself
- Good effect must be greater than the bad
effect
3. The Principle of Totality
- The whole is greater than any of its parts.
4. Epikia
- Exception to the general rule
5. One who acts through an agent is Himself
responsible
- An accomplish/accessory/ part to the crime
6. No one is obliged to betray himself/herself
- no one can force a person to answer a
question
7. The end does not justify the means.
- ex. Giving a sleeping tablet to a chronically
ill person so she/he can die in peace.
8. Defects of nature may be corrected
- ex pts. With harelip may have their defects
corrected through plastic surgery.
- withholding nutrition can constitute nursing
neglect.
9. If one is willing to cooperate in the act, no
injustice is done to him/her
- ex. Human research
- pts. Subjects himself to an experimental
drug.
10. A little more or less does not change the
substance of an act.
11. The greatest good for the greatest number
- Mass immunization because of an
epideminc. If one had a reaction to it the
greater majority shall be considered.
12. Principle relating to the origin and destruction
of life.
Ex. Euthanasia
13. No one is held for the impossible
- The doctor or the nurse cannot held to the
impossible if they have done their best to
take care of the patient and the later dies
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 Good Samaritan Law
 Generally, a nurse is not liable for injury that
occurs as a result of emergency treatment
provided that:
1. Standard care is provided at the scene of the
emergency
2. The care is not grossly negligent
3. Act in good faith
The Moral Decision-Making Model (Crisham, 1985)
M – Massage the dilemma
O – Outline Options
R – Review criteria and resolve the problem
A – Affirm position and act
L – Look back. Evaluate the decision
Nursing Ethics
- A standard for professional behavior
- A guide to identify our conduct in relation to
 Patients
 Fellow nurses
 Health care team
 Our community
 Our profession
- Practicing nurses are required to be registered
nurses duly licensed by the PRC
- Best guides that the nurses may use in their
performance of their duties are:
a) Phil. Nursing Act of 2002, RA 9173 which defines
the scope of nursing practice
b) Standards of Safe Nursing Practice developed by
the ANSAP (Association of Nursing Services
Administration of the Philippines) with the Board
of Nursing
c) Code of Ethics for Nurses
d) Job descriptions
Ethics
- The systematic study of what a person’s conduct
and actions ought to be with regard to him or
herself
- Justification of what is right or good
- What person’s life and rel. ought to be, not
necessary what they are
Types:
1. Clinical Ethics
- Literally concerned with the ethical
problems “at the bedside”
- E.g: informed consent
2. Bioethics
- moral issues in the field of healthcare
- systematic study of human behavior
3. Nursing ethics
- Study of the historical and contemporary
foundation of professional nursing actions
in order to understand what “the good” the
nursing provides for the individual and
society
- Refers to the ethical issues that occur in the
nursing practice
4. Healthcare ethics
- Pertain to how professionals fulfill their
responsibilities and provide care to clients
- The division of ethics that relates to human
health
- Fundamental principles of ethics serve as a
basis for interpreting and analyzing clinical
situations in decision making, when no set
of absolute guidelines are available to
answer a problem.
Ethical approaches (THEORIES)
1. Teleological approach (Utilitarianism)
- Greek: Telos means goal or end
- Look to the consequences of an action in
judging whether the action is right or
wrong.
- UTILITARIANISM: the greatest good for the
greatest number and the end justify the
means
2. Deontologic –duty
3. Virtue Ethics Approach
- Known as aretaic ethics, focused primarily
on the heart of the person performing the
act.
 Intellectual Virtue – power to deliberate
about things good for oneself
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  Moral Virtue – must be lived overtime in - Documents that individual formulate
order to learned indicating the type and kind of care they
4. Divine Command ethics desire
- There is a supreme or divine being that sets - Allow the competent person to make choice
down the rules to provide guidance to 2. Living Will
moral decisions - Document signed by a competent adult
indicating what health care or kind of
treatment wishes in the future
Universal Ethical Principles
- Terminally ill
1. Autonomy (informed consent) 3. DNR
- Greek autos meaning self and nomos 4. Durable power of attorney for health care
meaning governance - Proxy derivative: allows an individual to
- Involves self-determination and freedom to designate another person to make decisions
choose and implement if client becomes incapacitated.
2. Veracity - Also called SUROGATE decision
- truth
3. Beneficence b) Right and Cultural relativism
- Doing good - Must be able to be applied to all cultures
- Promotes doing act of kindness and mercy c) Right of the Unborn
4. Non-maleficence d) Right of Privacy and Confidentiality
- Do no harm e) Right to competent care
5. Justice - Freedom from harm
- Fairness of Equity - Should be a balance between potential
6. Confidentiality of Information benefits of the patient’s medical regimen
- Termed as privilege communication and the risk assumed by the patient
7. Fidelity f) Right to informed consent
- Faithfulness - Informed of possible outcomes,
8. Paternalism alternatives, and risk of the treatments and
- Allow one to make decisions for another, are required to give their consent feeling
limits freedom of choice, and is seen as g) Inviolability of life
undesirable - Life is sacred; nobody can take it away
9. Respect for others except GOD
- Is considered the highest principle that h) Stewardship
incorporates all other principles
BILL Right of the patients
- Respect for others acknowledges the right
of people to make their own decisions and 1. Information to know about his/her conditions
to live by their decisions 2. Make decisions about his/her own care
10. Utility a. Informed consent (sound mind and legal
- What is best for the common good age)
11. Rights b. Surrogate consent (legally competent
- Just claim and entitlement person)
3. Privacy and confidentiality; privilege
a) Autonomy communication, trusting rel. with clients
- The right to be respected
- Right to self-determinations When to break:
1. Advance Directives - For patient welfare
- Public welfare

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 - Patient consented RN’S Responsibilities in Research (Human Subjects)
- Court order
 Helsinki Declaration of 1964
4. Quality care
o Emphasizes that research subjects must
5. Considerate/ respectful care
be informed when a clinical/non-clinical
6. Relevant, current, and understandable
will be of no personal benefit to them
information
7. Make decisions regarding their plan of care  2 types of research
8. Have advantage directive o Essentially therapeutic
o Directed toward developing scientific
knowledge
Responsibilities of RN  Basic human rights
o Right to informed consent
1. To give the kind of care the patient needs
o Right to refuse/withdraw from
regardless of who they are
participation
2. Pt. care shall be based on needs
o Right to privacy
3. When engage by any pt. or agency, they shall
o Right to confidentiality
complete such services on the length of time
o Right to be protected from any harm
stipulated in their contract
 Risk benefit ratio
4. Shall not leave their pt. without proper
 Experimental subjects bill of right
permission/resignation or w/o relief
o Be told what the study is trying to find
5. Should commit themselves to the welfare of
out
those entrusted to them
o The frequent/important risk, side
6. RN’s shall be loyal to their sworn duty (role
effects/discomforts that will happen for
fidelity)
research purposes
Patient’s Responsibilities o Told of other choices
o Be allowed to ask any questions
1. Provide accurate information
o Be told what sort of treatment is
2. Complying the instructions
available
3. Informing the physician of refusal of treatment
o Refuse to participate
4. Paying hospital charges
o Receive a copy of the signed and dated
5. Following hospital rules and regulations
consent form
6. Sharing respect and consideration
o Be free from pressure
Bill of Rights of RN
Code of ethics for nurses:
1. Nurses have the right to practice in an
 Lystra Gretter
environment that allow them to act in
o Author of the 1st generally accepted
accordance with professional standards and
code of ethics in the US (1893)
legally authorized scope of nursing practice
o Patterned it in the Hippocratic Oath and
2. RN have the right to work environment that
named it after Florence Nightingale
supports and facilitate ethical practice in
o 1st code has been used in Hollywood for
accordance with the code of ethics for nurses
film showing
and interpretative statements.
 Isabel Hampton Robb
3. RN have the right to fair compensation for their
o Wrote the 1st book on nursing ethics for
work, consistent with their knowledge,
Hospital and Private use (1900)
experience, and professional responsibilities
o Patterned on Nursing Environment
4. RN have the right to negotiate the conditions of
their employment  Marcia Sue De Wolf Bosek
o 2007

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 o Code of Ethics should be modified and
revised as the profession is faced with
new situations
Code of ethics for Filipino nurses
 Systematic guides for developing ethical
behavior and provides direction for the
nurses to act morally
 Emphasizes the 4-fold responsibility of
nurses
o To promote health
o To prevent illness
o To restore health and
o To alleviate suffering
 Dean Julita Sotejo
o Developed the 1st Code of Ethics for
Filipino Nurses
 Mrs. Anastacia Giron Tupas
o Instrument for the FNA to be accepted
in ICN held in Canada
o PNA has approx. 780,000 RNs
Article 1 Preamble:
 Health is a fundamental right of every individual
 Primary responsibility to preserve health at all
cost
Elements of the Code

International Council of Nursing (ICN)  Nurses and the Profession

1. Loyalty and preservation
 Organization through which nurses all over the 2. Comply with the bylaws
world collaborate in strengthening nursing 3. Continual learning and active participation
service 4. Contribute to the improvement
 Phils. Became a member since 1929 at the ICN
Code of Governance
Congress in Montreal, Canada
 Objective:
o To provide a medium through which
national nurses associations may share
their common interest:
 Working together
 Promoting health
 Caring of the sick
o ICN’s Code of Ethics
 4 principal elements
 Nurses and people
 Nurses and practice
 Nurses and the
profession
 Nurses and co-workers
 Nurses, Society, and
Environment
o 4 basic ethical principles applied to
nursing
 Four-fold
 Renders service regardless of
race, creed, nationality, and
political belief
 Protects life and respects
dignity
 Collaborates with other
members of health team
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