THEORIES AND PRINCIPLES OF HEALTH ETHICS

A. FUNDAMENTAL OF PHILOSOPHY AND ETHICS

1. History of Philosophy

B. PROFESSIONAL ETHICS

1. General Ethics

2. Social Ethics

ETHICS

 Is the philosophical study of morality, concerned with determining right from

wrong, good from bad, and establishing principles for human behavior.

 It is divided into General Ethics (fundamental principles of morality) and

Special/Applied Ethics (application of these principles to specific fields).

 Social Ethics is a key branch of applied ethics, focusing on the moral dimensions of
social structures, institutions, and community issues.

General Ethics Principles and Foundations

General ethics establishes the foundational, often universal, norms of morality.

 Definition: The systematic study of human conduct, evaluating whether actions

are right or wrong.

 Core Concepts: it focuses on human acts-actions performed with knowledge,

freedom, and voluntariness-as opposed to mere “acts of man”

 Norms of Morality: Standards that measure the goodness or badness of conduct.

Key Ethical Theories:

DEONTOLOGY (Kant)

 Focuses on duty, rules, and actions that are inherently right or wrong,
regardless of consequences.

TELEOLOGY/CONSEQUENTIALISM

 Evaluates the morality of an action based on its outcomes or consequences.

 VIRTUE ETHICS

 Emphasizes the character of the moral agent rather than just the rules or
consequences.

ETHICAL PRINCIPLES

 These include respect for persons, autonomy, beneficence (doing good), non-
maleficence (doing no harm), and justice.

SOCIAL ETHICS
- Application to Community and Institutions

 Social Ethics applies general ethical principles to the interactions, structures,

and systems within society.

 Definition:

 Systematic reflection on the moral dimensions of social issues and

institutions (e.g., family, state, economic system).

 Core focus:

 It addresses how people ought to act as members of a group and how

social conditions affect individuals.

Key Issues in Social Ethics:

 Economic DISTRIBUTION & Justice:
o Fair distribution of goods and resources.
 Human Rights & Dignity:
o Respecting the inherent worth of the person.
 Social Policy:
o Analyzing and reforming structures like education, healthcare, and law.
 Environmental Ethics/Stewardship:
o Responsibility toward the environment.
 Discrimination & Equality:
o Addressing racism, sexism, and oppression.

Principles of Social Ethics

 - Key principles include the common good, solidarity (being “our brother’s keeper”),
and the preferential option for the poor.

LEGAL LIABILITY IN NURSING

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Modern Professional Malpractice

- In modern settings, The American Philosophical Association (APA) maintains

standards to prevent professional misconduct, such as:

o Plagiarism

o Sexual harassment or discrimination in academic environments.

o Exploitation of students or research subjects.

Malpractice in Nursing

 In nursing, malpractice is a specific type of professional negligence that occurs

when a nurse’s actions (or failure to act) deviate from the established standard of
care, directly resulting in harm to a patient.

 While negligence is a general failure to exercise reasonable care, malpractice is

restricted to licensed professional who breach their specific professional duties.

 The Four Legal Elements of malpractice. To successfully prove a malpractice claim,

a plaintiff must establish four distinct elements:

1. Duty

2. Breach of Duty

3. Causation

4. Damages

Common Examples

1. Failure to Monitor/Assess

2. Medication Errors

3. Documentation Errors

4. Failure to Act as Patient Advocate

5. Improper Delegation

2. NEGLIGENCE
  Negligence in nursing ethics refers to a failure to provide the expected standard of
care, resulting in unintentional harm to a patient due to carelessness, omission, or
deviation from professional protocols.

 It differ from malpractice by lacking willful intent, often stemming from oversights
like medication errors, failure to monitor, or poor documentation.

Key Aspects of Nursing Negligence

 The deviation from the standard of care that a reasonably prudent nurse would
provide under similar circumstances.

Four Elements of Proof of Nursing Negligence

To establish negligence, a patient must prove:

1. DUTY: the nurse had a professional obligation to the patient.

2. BREACH: the nurse failed to meet that standard of care.

3. CAUSATION: The breach directly caused the injury.

4. HARM: Actual injury or damage resulted from the breach.

3. ASSUALT & BATTERY

ASSUALT:

 Threatening to do something to a patient that makes them afraid, such as “I’m

going to tie you down if you don’t stay in bed,” or threatening to give an injection
to a patient who refused.

BATTERY:

 Physically carrying out the threat, such as forcing a medication into a patient who
has refused, or any unauthorized touching.

Difference:

- Assault is the threat of harm; Battery is the actual, unauthorized physical contact.

Legal and Ethical Implications

Consent:

- Patients have the right to refuse treatment; ignoring this can constitute battery.

Exceptions:
 - Forcible administration of medication might be justified in emergencies to prevent
imminent harm to the patient or others.

Consequences:

- These acts can lead to legal action for damages, including pain, suffering, and
medical costs.

Key Aspects of Restraints and Seclusion

Types:

1. Physical (manual hold)

2. Mechanical (straps, vests, mitts)

3. Chemical (medication for control)

4. Environmental (locked seclusion)

Indications:

- Immediate danger to self or others (violent/self-destructive behavior) or to prevent

interruption of necessary medical treatment (non-violent, e.g., pulling out tubes).

Alternatives First

- Before using restrains, nurses should attempt de-escalation, environmental

changes, redirection, and family involvement.

Safety Monitoring:

- Patients in restrains/seclusion require close observation (e.g.,1:1, or 15 minute

visual checks).

Legal and Ethical Requirements

Orders:

- Must be ordered by a provider, usually within a short timeframe in emergencies

(e.g., immediately or within 1 hour).

Time Limits:

- Orders are limited in duration (e.g., 4 hours for adults) and require renewal.

Removal:
 - Restrains must be removed at the earliest possible time when the patient is no
longer a danger.

Risks

- Use of these methods can cause serious physical (e.g., death, injury, falls and
psychological harm

Nursing Responsibility

Responsibility

- Nurses are accountable for ensuring that any use of restraint complies with legal,
ethical, and employer policies to ensure patient safety and dignity.

Health care resource

 Healthcare quality is a level of value provided by any health care resource.

 As with the quality in other fields, it is an assessment of whether something is

good enough and whether it is suitable for its purpose.

ETHICS OF CARE
 Care ethics countenances caring for particular others with whom one shares a
relationship, and recognizing the ways in which the unique character of such
relationships impacts the ethical issues at stake in each circumstance’s.

 The ethics of care is a distinctive approach to moral theory that emphasizes the
importance of responsibility, concern, and relationship over consequences or rules.

 ANNETTE BAIER (1929-present) she is moral philosopher, believes that men and
women make decisions about right and wrong based on different value systems:

o Men follow an idea of justice

o Women follow a sense of trust or caring

FOUR PRINCIPLES OF HEALTH CARE ETHICS

1. AUTONOMY – respect a person’s freedom to choose what’s right for them.

 2. BENEFICANCE – all choices for a patient are made with the intent to do good.

3. NONMALIFICENCE – do not harm

4. JUSTICE – treat and provide care fairly to all patience.

Why healthcare is important?

- High-quality care builds trust in the health system, nourishes a culture of respect
towards individuals, improves patients safety and produces better patient
outcomes.

How to provide quality health care?

 Show respect

 Express gratitude

 Enable access to care

 Involve patient’s family members and friends

 Coordinate patient care with other providers

 Engage patients in their care plan

 Address your patients physical needs.

CHARACTERISTICS OF QUALITY HEALTHCARE

SAFE Avoiding injuries to patients from the care that is intended to help
them.

EFFECTIVE Providing services based on scientific knowledge to all who could

benefit and refraining from providing services to those not likely to
benefit.

PATIENT- Providing care that is respectful of and responsive to individual

CENTERED patient preferences, needs, and values and ensuring that patient
values guide all clinical decisions

TIMELY Reducing waits and sometimes harmful delays for both those who
give care

EFFICIENT Avoiding waste including waste of equipment, supplies, ideas, and

energy

EQUITABLE Providing care that does not vary in quality because of personal
characteristics such as gender, ethnicity, geographic location, and
socioeconomic status