Luzviminda M.

Quinivista RN,RM,MSN,MANc

- Deals

with the conduct and moral issues that arise in the practice of health care professionals, nurses included. - It is concerned with health care values, obligations, rights and needs.

It is derived from ethical theories 1. Respect for individuals 2. Autonomy 3. Nonmaleficence 4. Beneficence 5. Justice 6. Confidentiality 7. Fidelity 8. Veracity

Is an overarching maxim of morality that influences all other ethical principles. Is fundamental to recognition of the autonomy of individuals as it incorporates ethical convictions that individuals should be treated as autonomous agent and that person with diminished autonomy (such as mentally insane and children) are entitled to protection.

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

According to Miller the Characteristics 1. Autonomy as free action 2. Autonomy as authenticity 3. Autonomy as effective deliberation 4. Autonomy as moral reflection

To be considered as free action, it must be the intentional 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 misinforming the client that all other treatment is not as effective and safe, the client is unable to exercise his autonomy fully.

Means that the action of the individual is consistent with his attitudes, values, dispositions and life plans. The decision is aligned with his past usual pattern of behavior and their motivation

This pertains to action that is done only after giving it clear thought, giving proper considerations to the alternatives and their consequences Eg when a person who acts out of impulse, he engages in thoughtless action for there is no opportunities to think, an action is considered an effective deliberation, when all information is available

This is the deepest and most demanding sense of autonomy for as miller pointed out, it involves a deeper level of self introspection which involves the ability for rigorous self analysis, awareness of alternatives set of values (personal values of an individual), commitment to a method of them assessing and an ability to put them in place.

 Reflection

will determine the sort of a person one will be. Authenticity - can be judged by acts conforming to deliberated values.

Informed consent It 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 act intentionally, with understanding, and with out controlling influences that would act against a free and voluntary act such as Coercion or undue influence

Nurses do not provide advise or recommendations as to what course of action the client and his family must resort to, instead, the nurse primary task is to inform them with all the information there is about the options available, including their cost, procedure, benefits and risks, and it is the patient and his family who shall make their own their own voluntary choice and decision and clients decision must be complied with even the nurse/ doctor disagree with her/him

 Ex.

A person in acute stage of contagious disease must be isolated, even against his/her will, in order to prevent the spread of the disease and protect the greater public.

 It

means acting in a fatherly manner which involves in engaging in behaviors associated with those of the traditional roles of the father of a family such as leadership, decision making, discipline, and protection.

 Assumes

the authority to make decisions for the patients many are against Paternalism as it limits the freedom of choice It is often thought of a violation of the clients autonomy or the right to make his own decisions

Mentally

incompetent Delirious or unconscious Under the influence of substance

 Nurses/

doctors can make decision for the patient to promote patients well being or to protect them from harm or injury

Is justified only to prevent harm to the patient The role of the nurse as patients advocate is related to the concept of paternalism. Nurses as patients advocates can decide for the incompetent patient what she believes the patient will decide for himself

Ex. The nurse capacity to restrain a violent patient (with out need of asking for the patients consent) who may harm himself or other persons around him. Unconscious patient brought to ER who receives medical treatment without him being made to sign a consent for medical treatment first.

He/she must be allowed to make his own decisions even if his/her choices may have 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 chooses alternative treatments such as herbal medicines

 Pertains

to health care providers making decisions about a clients health care when they are unable to make informed decisions about their own care, in this situation the health care provider must decide what the best course of action for the patient is and carry it out.

Is based on a persons rigorous obligation to avoid injuring another individual. The legal requirements of duty of care and accountability clearly arise from this principle. This principles obliges health care providers to DO NO HARM An extension of this principle is the obligation of health care providers to protect from harm those who can not protect themselves such as children, mentally incompetent, and unconscious patient

Requires that health care providers do not intentionally create a needless harm or injury to the patient, either through negligent acts or commission or omission. Ex. a nurse fail to perform skin test prior to administration of highly allergenic medications, Providing a proper standard of care that avoids or minimize the risk of harm is supported not only by our commonly held moral convictions, but by the laws of society as well.

One may be morally and legally accountable if one fails to meet the standards of due care. This principles affirms the need for professional competence The principle may justly violated in some medical situation Ex. 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 ones safety in order not to cause harm to others, whereas acceptance of even moderate risk is not generally required to benefit others in Beneficence

Individual should do only good and contribute to the welfare of others Ex. Providing wound treatment to a particular patient Prevention of disease through Research and immunization

 Obligation

to be fair to all This principles requires that social benefits ( EG. HEALTH CARE SERVICES) 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 right to the comprehensive system of Liberty offered by 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.

To each person an equal share Ex. Immunization (given free to all children under 7yr. Old) 2. To each person according to need Ex. When there is shortage of Hepa B vacc. Provided only to high risk grp. Like wise only those assigned in high risk areas are provided with free check up, medication, including treatment and immunization 3.
1.

3. To each person according to contribution - Only members of Phil health can avail of the services 4. To each person according to merit Ex. PCSO (only those who meet the criteria will be provided the services needed) 5. To each person according to free market exchange Ex. Cosmetic surgery 6. To each person according to effort Ex. 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 to agreements, responsibilities, and commitments that he ahs made to himself and to others It is the main principle that support the concept of accountability of nurses and other professional

 Refers

to the principles of truthfulness This is observed when providing informed consent, health teaching, and treatment as truthfully and honestly as possible.

According to moral theology there are 3 classes of secrets

1. 2. 3.

Natural secret Promised secret Confided secret

These are secrets which must remain hidden even if there is no obligation or promise to keep it that way, for the revelation of it could harm the individual or society Ex. National leaders may with hold information that their country is in threat of nuclear attack for releasing such info in public can cause panic , economic and political problem

 These

are secret that a person confides to another in exchange of a promise not to reveal it to others

These secrets are confided to another person only after that person has made the commitment that it will not be known to others.

1.

2. 3.

The physicians who deal with the patient even for a briefest time at various phases of the patients illness or treatment Pharmacists who prepare the meds. All other heath care professionals involved in the care of the client such as nurses, doctors

1.

2.

After the client gives his/her consent to reveal info. About him/her of health care When its revelation is for the common good