HEALTH CARE ETHICS (BIOETHICS) Flashcards
Bioethics
deals with the application of ethico-moral and legal
concepts and principles to issues that affect the practice
of nursing
Nursing is not just another job, not just another way to earn
a living; Nursing is a vocation in the fullest sense of the word
(Dr. Reynaldo Padilla, Filipino Author of Business Ethics &
Social Responsibility)
Morals
personal beliefs/principles
Ethics
rules that the social system provides us
may vary between environments
ETHICS
Greek -
Latin -
Ethos; characteristic way of acting
Mos; morrs (way of acting)
IMPERATIVES OF ETHICS
The Existence of God or Supreme Being
– retribution
IMPERATIVES OF ETHICS
The Existence of Human Freedom
Presupposed idea – responsibility
IMPERATIVES OF ETHICS
The existence of afterlife – immortality
Postulate of ethics – immortality of the soul
NATURE OF ETHICS
Moral philosophy
morality, moral rectitude or the rightness and
wrongness of human acts
NATURE OF ETHICS
Practical science
systematized body of knowledge that can be used,
practiced, and applied to human action
NATURE OF ETHICS
Normative science
establishes norms or standards for the direction and
regulation of human actions
NATURE OF ETHICS
Philosophical science
deals with the study of the morality of human acts or
human conduct
NATURE OF ETHICS
Philosophical science
deals with the study of the morality of human acts or
human conduct
Bioethics began to be discussed in the
1960s
Bioethics
The term was originally coined in
America
cancer researcher, claims to
have invented the word in a book entitled Bioethics:
Bridge to the Future
Van Rensselaer Potter
Van Rensselaer Potter a cancer researcher, claims to
have invented the word in a book entitled
Bioethics:
Bridge to the Future.
Etymologically, bioethics means
“ethics of life.”
branch of applied ethics which investigates practices
and developments in the life sciences and/or
biomedical fields
bioethics
Health Ethics
science that deals with the study of morality of human
conduct concerning health and health care
Professional Ethics
branch of moral science which treats of the
obligations which a member of a profession owes to
the public, to his/her profession, and to his/her clients
Macro allocation
(which program receives the funds)
micro allocation
(which patient receives the aid
in the predominant poverty of developing countries
create no-win situations.
is a society where people from different backgrounds, religions, cultures, and beliefs live and interact together.
A pluralistic community
the quality of human acts by which we call some of
these acts evil, the quality of goodness or badness of
human acts
MORALITY
Right or wrong
which is morally binding or obligatory
Good or bad
which is in conformity or not with goa
Moral
designed to teach goodness or correctness of character
and behavior
Immoral
contrary to established morality
Amoral
having no moral sense
being indifferent to right and wrong
Non-moral
out of the realm of morality
All of morality aims at the same thing but there are
several basic ways to get there. If you prefer, each
approach is like a different tool—a pen, a paper, an
idea that needs to be written. Using the right tool for
the right job makes it easier to do your work.
-?
Arthur Dobrin
St. Paul talks about it in:
1 Corinthians 12:12-27
One Body but Many Parts all working together for the
good of the body, mind and spirit
metaphysics of morality
(what makes an action morally right
or wrong)
epistemology of morality
( an account of
how we know an action is morally right or wrong)
THEORIES OF ETHICS
Deontology
according to which the right action is the action that is
performed out of duty (or reverence for the moral law)
Deontology
derived from the Greek __and logos, “
deon, “duty,” science”
Teleology derived from 2 Greek words
telos (end, goal, purpose)
logos (science/reason/explanation)
first great philosopher to define deontological
principles (the 18th-century German)
Immanuel Kant
Teleology
account of a given thing’s purpose
Also called consequential ethics
Teleology
- Framer of Teleology
Aristotle -
Duty Theory
DEONTOLOGICAL THEORY
Utilitarianism in ___, coined by ____
1781, Jeremy Bentham
they gave an alternative formulation of
the utilitarian utility principle, known as the principle
of the greatest happiness
Bentham and Mill
Philosophers of utilitarianism
David Hume
Jeremy Bentham
John Stuart Mill
Beauchamp & Mc Cullough on their book Medical
Ethics (1984) described these Intrinsic Factors
health (prevention, elimination, or control of
diseases)
relief from unnecessary pain and suffering
amelioration of disabling conditions
prolongation of life
7 CRITERIA FOR DETERMINING
THE LEVEL OF UTILITY
Intensity – How intense was the pleasure?
Duration – How long does the pleasure last?
Certainty – How certain are you that the pleasure will
occur?
Proximity – How soon will the pleasure be
experienced?
Fecundity – How many more pleasures will happen as
a result of this one?
Purity – How free from pain is this pleasure?
Extent – How many will experience the pleasure?
UTILITARIANISM IN HEALTH & NURSING CARE
Expressed in the ICN code of Ethics in 4 areas:
promotion of health
prevention of illness,
restoration of health
alleviation of suffering
Triage – (by 3’s for medical emergencies) a specific
policy
Wherein the victims will be divided into categories.
Those who must be left to die because they
are beyond help
Those who can wait for treatment later
Those who are attended first because they
needed treatment urgently and stand to benefit
from it
“Nobody would call a man just who does not enjoy acting
justly, nor generous who does not enjoy generous actions,
and so on..”
.(Aristotle, Nichomachean Ethics).
In posing the problem Aristotle is following not duty or
consequence-oriented traditions but a third path known
as
aretaic ethics
aretaic ethics from the Greek word
-arete (meaning virtue or
excellence).
known as Character Ethics
Virtue Ethics
aretaic ethics
Philosophers
Aristotle (384-322 BCE)
Alasdair MacIntyre (1929)
Profession comes from the Latin word “profession”
which means a public declaration with the force of a
promise.
CORE VALUES OF A PROFESSIONAL NURSE
Altruism
Accountability
Excellence
Duty
Honor & integrity
Respect for others
CORE VALUES OF A PROFESSIONAL NURSE
Altruism
– obligated to attend to the best interest of
patients rather than self interest
Accountability –
accountable to their patients, to
society on issues of public health and to their
profession
Excellence
obligated to make a commitment to lifelong learning
Duty
– should be available and responsive,
accepting a commitment to service within the
profession and the community
Honor & integrity
– should be committed to being
fair, truthful and straightforward in their interactions
with patients and the profession
Respect for others
– should demonstrate respect for
patients and their families and to the other members
of the team
HIERARCHY OF REASONING BY VALUES
WORLD VIEW
BASIC PRINCIPLES
RULES CODES
DECISIONS
AUTONOMY From Greek word
autos - self and nomos - governance
AUTONOMY
Synonymous with
self-determination
Paternalism
intentional limitation of the autonomy of one person by
another
BASIC RIGHT OF THE PATIENT
Right to information
Right to make decisions about one’s own
care/autonomy
Right to privacy and confidentiality
Right to quality care
Legally Authorized Representative (LAR)
An individual or judicial, or other body authorized
under applicable law to grant permission on behalf
of a prospective participant for their participation in
research activities
Surrogate consent was previously referred to as
“proxy consent”
in which the practitioner is
allowed to intentionally withhold information based on
his sound medical judgment that to divulge the
information might potentially harm a depressed and
unstable patient.
benevolent deception
Natural secret
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
Promised secret
a person confides to another in exchange of a
promise not to reveal it to others
Confided secret
confided to another person only after that person
has made the commitment that it will not be made
known to others
VERACITY
or Truth Telling
VERACITY Lain ___ means
“vera”,. truth
fiduciary (ethical) relationship, thus patients have a right
to expect a
higher level of truthfulness from us than with
others
FIDELITY Latin word
fideles meaning “faithful”
FIDELITY
Duty or obligation to be faithful to agreements,
responsibilities and commitments that are made to
oneself and to others
the most important of the ethical principles because it
governs the other 6.
FIDELITY
JUSTICE from Latin
justitia, “righteousness, equity”
JUSTICE
duty to treat all patients fairly, without regard to age,
socioeconomic status, or other variables
Distributive Justice
Requires an equitable distance of benefits and
burdens
Equitable means that the amount will vary according
to different levels of need or merit given the situation,
as in prioritizing
Compensatory Justice
Concerns compensation for wrongs that has been
done
Procedural Justice
Arise in processes that requires ordering
the idea of fairness in the processes that resolve
disputes and allocate resources.
One aspect of procedural justice is related to
discussions of the administration of justice and legal
proceedings
Retributive Justice
theory of punishment that when an offender breaks
the law, justice requires that they suffer in return, and
that the response to a crime is proportional to the
offence.
An eye for an eye and a tooth for a tooth
equal suffering
not suitable for health care
Social utility
a service, or characteristic, that benefits the majority of
population of any given society
BENEFICENCE Latin word
benefactum, “good deed”
BENEFICENCE
Acts of mercy and charity
Prevent harm: remove harm when it is being inflicted:
bring about positive good
Duty to promote the health and welfare of the patient
above other considerations, while honoring autonomy
PRINCIPLE OF DOUBLE EFFECT
Good effect outweighs or is equal to bad effect
euthanasia,
is the practice of intentionally ending life to eliminate pain and suffering. Different countries have different euthanasia laws.
also known as the Principle of Material Cooperation
PRINCIPLE OF LEGITIMATE COOPERATION
comprehensively explains what it means to cooperate or
participate in evil in a morally acceptable way
PRINCIPLE OF LEGITIMATE COOPERATION
Material cooperation
2 types:
Immediate
- participating in a way that
completes the act
Material cooperation
2 types:
Mediate
participating in a way that’s not
essential to the act
Material cooperation
You do not share the other person’s evil intent, but
you still cooperate.
Formal Cooperation
Agent or person or organization identifies itself
with purpose of the act or intention
Positive Cooperation
voluntarily doing an act which contributes to the evil
act of another.
A nurse assists an obstetrician perform an abortion is
committing positive cooperation
Negative Cooperation
the person did not do anything to
prevent another from committing an evil act.
A nurse saw another nurse stealing medical supplies
but did not do anything
Direct Cooperation
a person’s cooperation occur while the act is being
performed
A nurse acts as a “watch” while the doctor injects a
fatal dose of sedative to an unconscious patient
Indirect Cooperation
committed before or after the evil act, however the
cooperation is not necessary to the evil act itself
A nurse destroys all evidence of an abortion although
did not assist while the abortion was being
performed.
PRINCIPLE OF COMMON GOOD AND SUBSIDIARITY
Common Good as “the sum total of social conditions
which allows people, either as groups or as individuals, to
reach their fulfilment more fully and more easily.”
Subsidiarity
Every task of society should be assigned to the smallest
possible group that can perform it. Only if the smaller
group is unable to resolve the problem itself should a
group at a higher level assume responsibility. This idea is
summed up in the principle of subsidiarity
PRINCIPLES OF STEWARDSHIP from Old English
stig meaning house, + weard = steward –
meaning housekeeper or guardian
Steward
a person whose job is to manage the land and property
of another person
SOCIAL STEWARDSHIP
Impacting the community
Ecological (Environmental) Stewardship
refers to the responsible use and protection of the natural environment through conservation, sustainable practices, and ethical decision-making. It involves taking care of natural resources to ensure a healthy planet for future generations.
BIOMEDICAL STEWARDSHIP
thical and responsible use of medical resources, technologies, and treatments to improve healthcare while ensuring sustainability, safety, and fairness.
PRINCIPLE OF TOTALITY & ITS INTEGRITY
The human body is an integral part of the human person
and therefore worthy of human dignity
it must be kept whole
no body part should be removed, mangled or debilitated
unless doing so is necessary for the health of a more
essential body part or the body of a whole
PRINCIPLE OF ORDINARY
& EXTRAORDINARY MEANS
Ordinary measure
directly available and can be applied without incurring
severe pain
costs or other inconveniences, but which give the patient
in question justified hope for a commensurate
improvement in his health.
obligatory
PRINCIPLE OF ORDINARY
& EXTRAORDINARY MEANS
cannot be applied without incurring severe pain
costs or other inconveniences
their application, however, would not give the patient
any justified hope for a commensurate improvement in
his health
Not morally obligatory
