NCM 201: HEALTH CARE ETHICS (BIOETHICS)

LESSON 1
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HEALTH CARE ETHICS GUIDING Guided by Guided by

FRAMEWORK interdisciplinary professional
Lesson 1 - Topics principles from codes such as
1. Definition and importance of Health Care Ethics philosophy, the ICN Code of
2. Theories and Principles of Health Ethics medicine, law, Ethics and
3. Ethical Theories: Deontology, Teleology Utilitarianism and and theology. national nursing
codes.
Virtue Ethics
4. Introduction to SDGs in Health Ethics KEY EXAMPLE Organ donation, Respect for
genetic patient
Bioethics engineering, autonomy,
Bioethics is the interdisciplinary field that examines ethical, euthanasia, equitable care,
legal, and social issues arising in health care, medicine, and pandemic ethics. advocacy for
life sciences. It provides a moral framework for vulnerable
patients.
decision-making in situations involving human life, dignity,
and well-being, particularly in clinical practice, research, and
public health. Why study ethics in Nursing?
1. Guide for difficult ethical encounters experienced by
Bioethics in Nursing Nurses in clinical settings
Bioethics is the study of right and wrong in health care 2. Resolution for unsupported organizational environments
decisions involving human life, guiding nurses and other 3. Moral distress or ethical dilemma by Professional Nurses,
health professionals to act responsibly and compassionately newly graduates and nursing students
in their practice.
BASIC ETHICAL CONCEPTS
Importance of Bioethics in Nursing Practice Human Act
1. Guides Ethical Decision-Making Actions done consciously and freely by agent /or by man
2. Promotes Respect for Human Dignity with Knowledge, Freedom and Voluntariness
3. Protects Patients' Rights and Safety
4. Supports Professional Integrity Acts of Man
5. Prepares Nurses for Ethical Challenges in Technology and Actions beyond one's consciousness; not dependent on the
Research intellect and will.
Elements:
Difference of Bioethics and Nursing Ethics ●​ Done without knowledge
●​ Without consent
●​ Involuntary
ASPECT BIOETHICS NURSING ETHICS
SPECIFIC ETHICAL DILEMMAS
SCOPE Broad field covering Specific to nursing
ethical issues in practice and patient 1. A young woman asking to abort her baby.
health care, care. 2. A patient with congestive heart disease would like to
biotechnology, deliver the baby normally in full term.
research, and 3. A cancer patient asking for more morphine despite being
medicine. given at the prescribed dose.
4. A middle aged couple, childless, wanting a surrogate
FOCUS Deals with moral Focuses on nurse's
mother to carry their child.
questions related to ethical
life, death, responsibilities, 5. You want to pass the exam to maintain your scholarship
technology, and conduct, and but you did not study and your classmate offer help to share
medical professional his answer.
interventions. behavior.
How to Intervene Well in Ethical Dilemmas
APPLICATION Used in areas like Applied in daily
1. Assess the Patient Holistically
cloning, stem cell nursing activities
●​ Evaluate the patient’s physical condition and
research, end-of-life like patient
care, and Al in confidentiality, assess their mental and emotional state
health care. advocacy, and (understanding of the situation, stress, fears,
consent. cultural or religious beliefs) to ensures that any
decision-making is based on a complete
understanding of the patient’s needs and capacity.
2. Provide Counseling on Law and Ethics Key Principle:
●​ Educate the patient (and family, if appropriate) "Maximize overall happiness and minimize harm."
about their rights, ethical principles, and legal - Jeremy Bentham, John Stuart Mill
options related to their situation.
●​ Clarify what is allowed by law, what is medically Application to nursing and medical practice:
safe, and what aligns with ethical standards of Government implements Universal Health Care (UHC) to
nursing. ensure that all citizens have access to basic health services,
regardless of income, location, or social status.
3. Refer to the Appropriate Specialist or Support System
●​ Referral (physician, ethics committee, social worker, VIRTUES OF HEALTH CARE PROVIDER
counselor, or chaplain) ensures the patient receives 1. Fidelity
well-rounded support—medical, ethical, legal, and ●​ Faithfulness to commitments and responsibilities.
emotional—so that decisions are informed and ●​ Keeping promises to patients, being loyal to their
safe. needs, and maintaining confidentiality and trust.
2. Honesty
NURSE RELATIONSHIP ENTAILS ETHICS ●​ Telling the truth and being transparent in all actions.
1. Nurse-patient relationship ●​ Giving accurate information to patients and
2. Nurse to self (Duties to self) families, admitting mistakes, and documenting
3. Nurse to Nurse relationship truthfully.
4. Nurse to Physician relationship 3. Humility
5. Nurse to Society or public ●​ Recognizing one’s limitations and being open to
6. Nurse to the institution learning.
7. Nurse to the Profession ●​ Admitting when you need help, respecting the
8. Nurse to the Environment expertise of others, and not letting pride get in the
way of patient safety.
THEORIES AND PRINCIPLES OF ETHICS 4. Respect
●​ Valuing the dignity, rights, and individuality of every
ETHICAL THEORIES person.
●​ Treating all patients equally regardless of
1. DEONTOLOGY background, culture, or beliefs; honoring patient
Ethical theory that focuses on the morality of actions autonomy.
themselves, rather than the consequences. It emphasizes 5. Compassion
doing what is right based on duties, rules, or principles, ●​ Deep awareness of another’s suffering with a desire
regardless of the outcomes. to relieve it.
Key Principle: ●​ Showing kindness, empathy, and understanding
"Do the right thing because it is your duty." – while providing care.
Immanuel Kant 6. Prudence
●​ Wise judgment and careful decision-making to
Application to Nursing Practice: avoid mistakes.
A nurse refuses to falsify a patient's medical record, even ●​ Double-checking medications, verifying patient
when pressured by a superior, because it is ethically and identity, and thinking ahead to prevent harm.
legally wrong, upholding honesty and professional duty, 7. Courage
regardless of the consequence to her job. ●​ Strength to do what is right despite fear, difficulty, or
opposition.
2. TELEOLOGY ●​ Speaking up about unsafe practices, advocating for
Ethical theory that focuses on the outcome or consequences patients even if it’s unpopular, and caring for
of actions. An action is considered morally right if it leads to patients in difficult or high-risk situations.
a good or desirable result.
Key Principle: SUSTAINABLE DEVELOPMENT GOALS (SDG)
"The end justifies the means."

Application to nursing practice:

Nurse prioritizes the most critically ill patients with life
threatening condition first, even if others arrived earlier,
choosing actions based on the best outcome for patient
survival.

3. UTILITARIANISM
A type of teleological theory that determines the rightness of
an action based on its ability to produce the greatest good
for the greatest number of people.
NCM 201: HEALTH CARE ETHICS (BIOETHICS)
LESSON 2 - PRELIM
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CORE ETHICAL PRINCIPLES IN NURSING PRACTICE OTHER RELEVANT ETHICAL PRINCIPLE

1. Autonomy 1. PRINCIPLE OF DOUBLE EFFECT

●​ Respecting a patient's right to make their own ●​ An action with both good and bad effects may be
decisions. morally permissible if the intent is the good effect.
●​ Nurses must support patients in making informed ●​ Example: Administering high doses of opioids in
choices about their care, even if those choices palliative care may hasten death but is intended to
conflict with medical advice. relieve severe pain.
●​ Example: A competent patient with cancer
refuses chemotherapy. The nurse educates but Conditions:
ultimately respects the patient decision. 1. The act itself is morally good or neutral.
2. The intention is the good effect.
2. Confidentiality 3. The bad effect is not the means to the goop effect.
●​ Keeping patient information private and secure. 4. The good effect outweighs the bad effect.
Nurses must not disclose any patient data
without consent, except when required by law or 2. PRINCIPLE OF LEGITIMATE COOPERATION
to prevent harm. Assisting in another's actions can bе ethically permissible
●​ Example: A teenager confides in a nurse about depending on the role and intention. Cooperation can be
early pregnancy. The nurse respects formal (agreeing with the immoral act, thus unethical) or
confidentiality unless there is a risk of harm. material (indirect involvement, sometimes acceptable).

3. Veracity Morally Acceptable (Material) Cooperation:

●​ Obligation to tell the truth. Honesty fosters trust in ●​ Scenario: A nurse is assigned to a surgical unit
nurse-patient relationships. Deception, even with where some patients undergo gender
good intent, can damage credibility. reassignment surgeries, which may conflict with
●​ Example: A nurse honestly informs a patient the nurse's personal or religious beliefs.
about a medication error and the steps being ●​ Application: The nurse assists in general
taken to correct it. post-operative care (e.g., monitoring vital signs,
managing pain, preventing infection) but does not
4. Fidelity directly participate in the surgical procedure itself.
●​ Being loyal and keeping promises or
commitments. Nurses must honor their Unethical (Formal) Cooperation:
professional duties and responsibilities, including ●​ Scenario: A nurse personally disagrees with
following through with care and being trustworthy. physicianassisted suicide but agrees to prepare
●​ Example: A nurse tells a patient she will return in and administer the medication because the
30 minutes to check pain levels and does so. doctor requests it.
●​ Why it is not legitimate? The nurse is directly
5. Justice involved and shares the intention of the act
●​ Fair and equitable treatment of all patients. (helping to end the patient's life), making this
Nurses must ensure equal access to care and formal cooperation which is ethically
resources, without discrimination. impermissible under most ethical and religious
●​ Example: In a busy ER, triage is based on severity frameworks.
of illness, not social status or ability to pay.
3. PRINCIPLE OF COMMON GOOD AND SUBSIDIARITY
6. Beneficence Common Good:
●​ Promoting good and acting in the patient's best ●​ Social conditions that allow individuals and
interest. Nurses should take actions that improve communities to flourish.
the health and well-being of patients. ●​ Example: Advocating for vaccination programs to
●​ Example: Providing emotional support to a dying protect vulnerable populations.
patient to ensure comfort in their final moments.
Subsidiarity:
7. Non-maleficence ●​ Decisions should be made at the most local level
●​ "Do no harm." possible, empowering individuals and small
●​ Avoiding actions that cause unnecessary groups.
suffering or injury to patients. ●​ Example: Nurses involving families in end-of-life
●​ Example: A nurse refuses to follow an unsafe care decisions, respecting cultural and personal
medication order and consults the physician. values.
NCM 201: HEALTH CARE ETHICS (BIOETHICS)
LESSON 3 - PRELIM
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I. PRINCIPLE OF STEWARDSHIP AND ROLE OF II. PRINCIPLE OF TOTALITY AND INTEGRITY

NURSES AS STEWARDS
The human body should be preserved in its wholeness and
➥ Stewardship in bioethics refers to responsible functional integrity unless a part must be removed to save
management and care of resources whether personal the whole or prevent greater harm.
health, community health, environmental health, or medical
resources entrusted to one's care. Nurses act as stewards Ethico-Moral Responsibilities of Nurses
by promoting well-being while safeguarding the health 1. Surgery
system, environment, and society. ●​ Nurses must ensure informed consent, and
➥ The principle is grounded in the presupposition that God advocate for the patient's dignity.
has absolute dominion over creation, and that, insofar as ●​ Example: Advocating for patient autonomy in
human beings are made in God's image and likeness, we cases of surgical interventions.
have been given a limited dominion over creation and are
responsible for its care. Responsibility of Nurses in Surgery:
●​ Ensure that the patient is not exposed to risk
A. Dimensions of Stewardship ●​ To protect the patient body
1. Personal Stewardship ●​ Organize work in surgical team
●​ Taking responsibility for one's own health, ●​ Confirm the patient as a person
knowledge, skills, and conduct as a nurse. ●​ To feel in and be responsive in the situation
●​ Application: A nurse attending regular CPD ●​ To care for the patient
(Continuing Professional Development) to remain ●​ To preserve the patient's dignity
competent and safe in nursing practice. ●​ Preservation of bodily functional integrity
●​ Freedom of movement
2. Social Ecological Stewardship ●​ Security of person
●​ Understanding the interconnectedness of human ●​ Reproductive and sexual rights
health and the environment. ●​ Women's health
●​ Application: Community health nurses promoting
vaccination, clean water initiatives, and air quality 2. Sterilization / Mutilation
improvement. ●​ Any permanent alteration of body functions (e.g.,
sterilization procedures) should be ethically
3. Biomedical Stewardship justified.
●​ Ethical use of medical technologies, ●​ Application: Ensuring patient autonomy and
pharmaceuticals, and equipment to avoid waste understanding in sterilization decisions.
and misuse.
●​ Application: Ensures that all equipments were 3. Preservation of Bodily Functional Integrity
being used appropriately and conduct periodical ●​ Protecting the patient's unnecessary harm during
maintenance. care. body from
●​ Application: Following the standard of care in
4. Hospital Waste Ethics nursing procedures.
●​ Safe and responsible segregation, disposal, and
reduction of hospital waste to minimize harm. 4. Organ Donation Issues
●​ Application: Proper sharps disposal to prevent ●​ Ethical considerations in living and cadaveric
needle-stick injuries and infections. organ donation voluntariness, consent, absence
of coercion.
5. Climate-Smart Nursing Practice ●​ Application: Educating families on organ donation
●​ Integrating environmental sustainability into laws and rights.
nursing care.
●​ Application: Reducing single-use plastics in
hospitals, supporting energy-efficient practices, III. PRINCIPLE OF ORDINARY AND EXTRAORDINARY
and educating patients on health effects of MEANS
climate change.
Application in Nursing:
●​ In palliative care, advocating for comfort-focused
ordinary means rather than burdensome
extraordinary measures when recovery is unlikely.
●​ Example: Choosing pain management over
aggressive chemotherapy in a terminal patient.
 IV. PRINCIPLE OF PERSONALIZED SEXUALITY

Sexuality is a holistic integration of physical, emotional,

psychological, and spiritual dimensions of a person's
identity. Ethical nursing care respects a patient's dignity,
privacy, and informed choices regarding sexuality. IV.

Application in Nursing:
●​ Providing sexual health education without
discrimination.
●​ Supporting reproductive health decisions
consistent with ethical standards.
●​ Addressing sexual health concerns patients with
chronic illness or disability.