CHAPTER 8

NUR 109
NURSING ETHICS
 MORALITY

 Definition: Morality refers to specific ways of behavior rooted in societal norms.

 Origin: Derived from the Greek word "moralis," meaning "manner" or "custom."
 Key Idea: Social consensus about what is considered right, wrong, proper, or
improper.
 Examples: Human decency, the distinction between right and wrong.
WHAT IS ETHICS?

 Definition: Ethics involves making choices that are best for

the individual.
 Key Concept: Ethics is about critical reflection on one's
actions and decisions.
 Moral vs. Ethics:
 Morality: What you believe is right and good.
 Ethics: Critical reflection on these beliefs.
EXAMPLES

 Morality:

Morality is about the personal beliefs or values you hold about what is right and wrong. It’s shaped by
culture, religion, upbringing, and individual experience.
Example:
Imagine you believe it’s morally wrong to lie. In a situation where you could protect someone by
telling a small lie, your belief in the wrongness of lying would guide your decision. You might choose
not to lie, based on your personal moral compass.
 Ethics:

Ethics involves the process of questioning, analyzing, and evaluating those moral beliefs. It’s a more
systematic approach to deciding what’s right, often in complex situations.
Example:
Let’s say a doctor faces a situation where telling the truth might cause harm to a patient, but lying
could lead to a better outcome. Ethics would come into play as the doctor reflects on their moral
beliefs (e.g., about honesty or harm) and the ethical principle of "do no harm" to decide the best
course of action.
 Joseph Fletcher, an ethicist, differentiates between morality and
ethics:
 Morality: What you believe is right and good.
 Ethics: The process of critical reflection on these beliefs.
 Professional Ethics refers to the ethical principles and obligations that
professionals owe to the public.
 This branch of ethics helps define the moral responsibility of
professionals in their respective fields.
 Healthcare Ethics: A division of ethics that focuses on human health.
 Incorporates human values, morals, customs, and personal
beliefs.
 Relates to the moral decisions healthcare professionals face regarding
patient care.
 Bioethics: A specific branch of ethics dealing with moral issues in
the field of healthcare.
 Evolved due to the life and death dilemmas faced by
healthcare practitioners.
 Focuses on the systematic study of human behavior in science
and healthcare.
 Scope of Bioethics
 Expanded to encompass issues in:
 Health and biological sciences.
 Environmental concerns.
 Bio-ethics helps address complex moral questions about life,
health, and science.
Independent Yet Interdependent Decision Making in Nursing
 Nurses must make independent decisions in their practice.

 These decisions are made interdependently with colleagues, patients, and families.

 Requires collaboration while maintaining individual responsibility.

Bioethical Behavior in Nursing

 Nurses are expected to exhibit bioethical behavior in their professional duties.
 Respect for patient autonomy, beneficence, and non-maleficence.
 Upholding justice and promoting ethical practice.

Nursing Ethics
 Nursing Ethics refers to all principles of right conduct as they apply specifically to the nursing
profession.
 Focuses on ethical duties and responsibilities that nurses have towards patients, families, and the
community.
 Reinforces nurses’ ideals to be effective in their service.
Johnstone's Definition of Nursing Ethics
 Johnstone defines nursing ethics as the examination of all ethical and bioethical
issues in nursing practice.
 Focus on moral dilemmas and decision-making in patient care.

Vercoe's Emphasis on Nursing Ethics

Vercoe et al. emphasizes that nursing ethics focuses on the needs and experiences of
practicing nurses.
 Explores the meaning of ethical practice in real-world healthcare settings.
 Acknowledges the challenges nurses face in making ethical decisions.

The Role of Ethics in Nursing Practice

 Nursing Ethics shapes the profession by providing a framework for nurses to navigate
complex situations.
 Ensures nurses provide care that is morally responsible, compassionate, and
respectful of patient rights.
ETHICAL PRINCIPLES AND OTHER APPROACHES
What is the Teleological Approach?
 Teleological comes from the Greek word "Telos", meaning goal or end.

 Focuses on the outcome or purpose of actions in determining their morality.

 The principle: "The right thing to do is the good thing to do."

 Involves making decisions based on their ability to achieve good outcomes.

Utilitarianism
 Utilitarianism is a form of Teleological ethics.

 Focuses on maximizing happiness and pleasure while minimizing pain.

 The best action is the one that produces the greatest good for the greatest number.

John Fletcher's View on Utilitarianism

 John Fletcher adds a unique element to utilitarianism: the concept of Agape (love for humanity).

 In Act Utilitarianism, he states that good is achieved by promoting general goodwill and love for
people.
 Fletcher also emphasizes that moral decisions should be practical, focusing on real-life consequences
and human needs.
GUIDELINES FOR MAKING ETHICAL DECISIONS (JOHN FLETCHER)
Fletcher provides guidelines to help make ethical decisions in a
practical and compassionate way:
 People as Human Beings: Treat people with inherent worth and
respect.
 Consequences Matter: Consider the impact of your actions.
 Balance Good Choices: Weigh the good outcomes against the
harm.
 Actual Needs Over Ideal Needs: Focus on what people really
need in the moment.
 Enlarge Choices: Offer more options and reduce limitations.
 Accept Consequences: Have the courage to face the outcomes of
your decisions.
Deontological Approach?
 Deontology comes from the Greek word "deon", meaning duty.

 Focuses on duty and the intrinsic rightness or wrongness of actions, regardless of the
consequences.
 In Deontological ethics, an act is morally right or wrong based on its nature, not the outcomes.

Principles of Deontological Ethics

 Duty over consequences: The rightness or wrongness of an action depends on doing one's
duty, not the results.
 Moral law: Morality is governed by rules or principles that must be followed, regardless of the
outcome.
 Actions are intrinsically right or wrong, independent of external factors like happiness or pain.
Immanuel Kant's Contribution
 Immanuel Kant, a German philosopher, is central to Deontological ethics.

 Kant's Definition: Humans are rational beings with freedom and social worth.

 Moral worth comes from performing dutiful actions that respect moral laws and treat people
as ends in themselves, not as means to an end.
Kant's Categorical Imperative
 Categorical Imperative: Kant's key concept in deontological ethics.
 "Act only according to that maxim whereby you can, at the same time, will that it should become a
universal law."
 In other words: Act in ways that could be universally applied, as if everyone followed the same
principle.

 This principle guides actions in a way that respects the inherent dignity and rights of
individuals.
Virtue Ethics?
 Virtue Ethics is also known as Aretaic Ethics (from the Greek word arête, meaning excellence or virtue).

 Focuses on the character and virtues of the person performing the act, rather than the act itself or its
consequences.
 Emphasizes having the right motivations and dispositions to act morally.

Core Ideas of Virtue Ethics

 Moral Character: The focus is on developing good character traits like courage, honesty, and justice.

 Right Motivation: It’s not just about doing the right thing, but doing it for the right reasons.

 Virtue Development: Virtues must be practiced over time to become part of one’s character.

Intellectual and Moral Virtues

 Intellectual Virtue: The ability to deliberate and make thoughtful decisions about what is good for oneself.

 Moral Virtue: Virtues like honesty, courage, and compassion that are learned through practice and
experience.
 Both types of virtues are important for living a good, moral life.
Virtue Ethics in Nursing
 Nurses must integrate virtue ethics with other ethical principles like duty.

 Nurses should develop virtues such as:

 Compassion and empathy in caring for patients.
 Courage to advocate for patient needs.
 Integrity and honesty when making clinical decisions.

 Virtues must be practiced and developed over time in real-world situations.

 Focus on character: Emphasizes the development of good moral character over time.

 Encourages moral growth: Virtues are learned and strengthened through continuous practice.

 Emphasizes intentions: It’s about having the right intentions and motivations behind actions.
What is Divine Command Ethics?
 Divine Command Ethics: A supreme or divine being (e.g., God) sets down rules or commands to
guide moral decisions.
 Guided by Sacred Texts: For example, the Ten Commandments in Christianity.

 Ethical decisions are based on following divine law, which is seen as the ultimate authority on right
and wrong.
Examples of Divine Command Ethics
 Christians: Following the Ten Commandments as moral guidelines (e.g., "Thou shalt not kill").

 Jehovah's Witnesses: Refusal of blood transfusions, as they believe it goes against divine commands
in their religious teachings.
 Abortion & Euthanasia: Some religious traditions oppose abortion and euthanasia, seeing them as
violations of divine commandments about the sanctity of life.

Clear moral guidance: Offers clear and absolute rules for right and wrong based on divine authority.
 Provides a sense of security in moral decision-making, knowing that actions align with a higher
power’s will.
 Encourages spiritual growth through adherence to divine law.
Autonomy?
 Autonomy comes from the Greek words:
 "Autos" = self
 "Nomos" = governance or law

 Autonomy refers to the right to self-determination—the freedom to make decisions about one's
life, body, and healthcare.
Aspects of Autonomy
 Self-Determination: The freedom to choose and implement decisions without external interference.

 Freedom from Deceit & Coercion: Ensuring individuals can make decisions without manipulation or
force.
 Informed Consent:
 Providing the patient with all necessary information to make a decision.
 Ensures the patient fully understands their choices, risks, and benefits.
 Gives patients the knowledge to make informed decisions about their treatment. Includes explaining the diagnosis,
treatment options, risks, and benefits.
 Ensures patients have the understanding needed to make an autonomous decision.
Refusal of Treatment
 Allowing Patients to Refuse Treatment is a key element of Autonomy.
 A patient has the right to refuse any treatment, even if it may be life-saving.
 Example: A terminally ill patient may refuse aggressive treatment in favor of comfort care.

Restrictions on Autonomy
 may occur when there is a potential for harm to others:
 Acts of Violence: When a person may harm others, autonomy may be restricted.
 Communicable Diseases: In some cases, individuals with contagious diseases may be restricted from certain
activities to prevent harm to others.

Example of Autonomy in Healthcare

A Patient's Right to Refuse Life-Saving Treatment
 A patient diagnosed with a terminal illness chooses to refuse life-saving treatments, opting for
palliative care.
 This decision is respected because the patient has the autonomy to decide their care based on
their values and understanding.
Veracity?
 Veracity means truth-telling in healthcare.
 Healthcare professionals have a duty to provide accurate information and be
honest with their patients.
 Veracity is crucial in establishing trust between patients and healthcare
providers.
 Healthcare providers are bound to tell the truth in all aspects of patient care.
 Patients need honest communication about their condition, treatment options,
and prognosis to make informed decisions.
 Truth-telling ensures transparency and fosters trust in the healthcare system.
 Patients are responsible for providing complete and accurate information to
the best of their knowledge.
 This includes details about their medical history, symptoms, and
complaints.
 Full disclosure enables healthcare providers to make accurate diagnoses and
 If the patient is unable to provide information (e.g., due to illness or
unconsciousness), the family can provide critical information.
 This ensures the healthcare provider has accurate data to make
the correct diagnosis and treatment plan.
Benevolent Deception
 Benevolent Deception refers to the intentional withholding of
information by a healthcare provider when revealing the truth
might cause significant harm.
 For example, telling a patient the full truth about a terminal
diagnosis may cause emotional distress or worsen their condition.
 In such cases, healthcare providers may choose to withhold certain
information with the patient’s well-being in mind.
Beneficence?
 Beneficence refers to acts of kindness and mercy that aim to directly benefit the patient.

 It involves promoting health, preventing illness, and alleviating suffering.

 Healthcare providers are guided by the principle of beneficence to do good for their patients and
improve their well-being.
Aspects of Beneficence
 Prevent Illness: Healthcare providers take actions to prevent disease and improve health.

 Promotion of Health: Encouraging healthy lifestyles, behaviors, and environments.

 Alleviation of Suffering: Providing comfort and care for patients in pain or distress.
 Patient Bill of Rights

 Patient Rights are a set of principles that ensure respect, dignity, and fairness in healthcare.
 Respectful Care: Patients should receive care that respects their dignity and personal values.
 Right to Information: Patients must be given understandable and relevant information regarding:
 Diagnosis

 Treatment options

 Prognosis

 Risks and procedures

 Right to Make Decisions: Patients have the right to make decisions regarding their care plan.

 Advance Directives: The right to make decisions about future medical care, including do-not-
resuscitate (DNR) orders or other directives.
 Privacy and Confidentiality: Patients have the right to keep their medical information
private and confidential.
 Access to Medical Records: Patients can review their medical records, except when restricted by
law.
 Informed of Relationships: Patients should be informed of business relationships among hospitals,
educational institutions, or other entities that might influence their treatment.
 Right to Participate or Decline: Patients can consent to or decline participation in experimental
research affecting their care.
 Right to Continuity of Care

 Reasonable Continuity of Care: Patients have the right to expect continuous care without
unnecessary interruptions.
 Informed of Hospital Policies: Patients should be informed about hospital policies that may affect
their care.
 Considerations for Beneficence in Practice

- All healthcare activities must be conducted with deep consideration for the patient’s values, dignity,
and personal beliefs.
- The principle of beneficence requires healthcare providers to act with compassion and care in all
aspects of patient interaction.
Nonmaleficence?
 Nonmaleficence is the ethical principle that requires healthcare providers to do no harm.

 It is a negative form of beneficence. While beneficence focuses on actively doing good,

nonmaleficence reminds healthcare professionals to avoid actions that may cause harm to patients.
 "First, do no harm" is a foundational concept in healthcare.

 he principle of nonmaleficence emphasizes that healthcare practitioners must avoid causing harm or
suffering to patients.
 Human life is inviolable: Nurses and healthcare providers must respect and protect the life of every
patient, doing their best to prevent harm.

Nonmaleficence vs Beneficence
 Beneficence: Requires healthcare providers to act with kindness and mercy to benefit patients.

 Nonmaleficence: Requires healthcare providers to avoid actions that can harm patients.

 Both principles are complementary; beneficence promotes good outcomes, while nonmaleficence
ensures that no harm is caused in the process.
 Key Aspects of Nonmaleficence

 Avoiding Harm: Practitioners must take all necessary precautions to prevent harm to
patients.
 Balancing Risks: In situations where harm is unavoidable, such as with medical treatments,
healthcare providers must weigh the potential benefits against the risks.
 Patient's Safety: Ensuring the patient is not harmed during diagnosis, treatment, or recovery
processes.

example of Nonmaleficence in Action

Administering Medication Safely
 A nurse is about to administer a medication to a patient.

 The nurse checks the patient's medical history, verifies the dosage, and ensures that the patient
is not allergic to the medication.
 By taking these steps, the nurse ensures that the patient is not harmed by incorrect medication
or dosage, aligning with the principle of nonmaleficence.
Justice in Healthcare?
 Justice refers to the right to be treated justly, fairly, and equally in healthcare settings.

 Every individual has the right to equal access to health services, care, and resources.

 Healthcare providers must ensure that their actions and decisions are based on fairness, without discrimination.

Legal Framework of Justice in Healthcare

 Philippine Constitution (Article XIII):
 Guarantees that the state shall adopt an integrated approach to health development.
 The goal is to make essential goods, health services, and social services available and affordable to all.

 The priority groups for healthcare services include:

 Underprivileged individuals
 Sick, elderly, and disabled individuals
 Women and children

Health as a Basic Human Right

 According to the Department of Health (DOH), health is a basic human right.

 Every person is entitled to receive adequate healthcare, regardless of their socio-economic status, gender, or
background.
 Health as a Basic Human Right
 According to the Department of Health (DOH), health is a basic human
right.
 Every person is entitled to receive adequate healthcare, regardless of their socio-
economic status, gender, or background.
 Justice in healthcare ensures that resources are allocated fairly, and individuals
receive the care they need.
 Government Healthcare Programs
 National Health Insurance Act of 1995:
 Provides a universal, compulsory health insurance program for all citizens,
including the self-employed.
 Republic Act 7432 (Senior Citizens Act):
 Grants 20% discount on goods and services at public establishments for
senior citizens.
 Provides free medical and dental check-ups at government hospitals.
 Fair Opportunity Rule

 The Fair Opportunity Rule is rooted in egalitarian theory, which states that all
individuals should have equal access to goods and services.
 In healthcare, this means ensuring that everyone, regardless of social or economic status,
has equal opportunity to receive healthcare services and treatment.
 Triage in Hospitals

 Triage is the process used in hospitals to determine which patients should be treated first,
especially in emergency or critical situations.
 Justice in triage means ensuring that patients are treated based on medical urgency, not
on their social status or ability to pay.
Ethics Committees?
 Ethics committees are formal groups in hospitals designed to help address sensitive ethical issues.

 They are typically composed of:

 Philosophers
 Doctors
 Lawyers
 Clergy
 Social Workers

 Their role is to evaluate complex ethical situations and provide guidance on difficult healthcare
decisions.
 Ethical Issues Addressed by Committees

Ethics committees discuss sensitive topics, including:

 Withdrawing or withholding treatment (for example, in cases of severe disability or terminal illness).

 Right to die: Decisions related to end-of-life care.

 Informed consent: Whether patients have the right to choose or refuse treatment.

 Who should treat the patient?: Ethical dilemmas about care providers and decision-makers.

 Research proposals: Ethics of conducting research involving human subjects.

 Role of a Medical Ethicist

 A medical ethicist is a professional trained to apply ethical principles to healthcare practices.

 They provide advice and guidance on:

 Patient rights and autonomy
 Confidentiality
 End-of-life decisions
 Informed consent

 Medical ethicists help resolve moral dilemmas and ensure that medical decisions are made ethically and
compassionately.

Famous Cases Involving Ethics Committees

Several well-known legal and ethical cases have been addressed by ethics committees:
 Terri Schiavo (2005)
 Issue: Removal of Terri Schiavo’s feeding tube after 15 years in a vegetative state at her husband’s request.
 Ethical Issue: Right to die and decision-making authority.
 Nancy Beth Cruzan (1990)
 Issue: Right to withdraw life-sustaining treatment for a woman in a persistent vegetative state.
California Couple’s Decision (1990s)
•Issue: A couple conceived a child to be a bone marrow donor for their 17-year-old daughter.
•Ethical Issue: Ethics of using reproductive technology for medical purposes.

Manslaughter Case (2009)

•Issue: A couple convicted for manslaughter after failing to seek medical care for their 2.5-year-old child.
•Ethical Issue: Parental responsibility and neglect.

Doctor-Assisted Suicide Case

•Issue: A doctor assisted a woman suffering from Alzheimer’s disease in committing suicide.
•Ethical Issue: Physician involvement in assisted suicide and euthanasia.

 Decision-Making and Ethics Committees

 Ethics committees play a critical role in decision-making when it comes to:

 End-of-life care
 Informed consent in complex treatments or experimental research
 Balancing patient autonomy with medical advice and legal considerations

 They help healthcare providers make ethical decisions in situations where the patient’s well-
being and
RESPONSIBILITIES OF NURSES TO PATIENTS
 Equal and Kind Care for All

 Nurses must provide kind, compassionate care to all patients, regardless of:
 Race
 Color
 Nationality
 Status

 Every patient deserves respect and dignity in the healthcare setting, no matter their
background.
 Patient Needs and Physician Orders

 Nurses should always base their care on:

 Patient needs: Assessing and understanding each patient's unique physical, emotional, and psychological
needs.
 Physician orders: Following the doctor's instructions for treatment, medication, and care plans.
 Ailments: Addressing the specific medical conditions or concerns of the patient.
 Familiarity with the Patient Bill of Rights

 Nurses should be well-versed in the Patient Bill of Rights, which outlines the rights patients have
regarding their care.
 Compensation and Accepting Gifts

 Nurses are entitled to fair compensation for their work, as stipulated by their employment contract.

 Nurses should never accept gifts or personal favors from patients, as this could create conflicts of
interest or compromise professional ethics.
 Completing the Contracted Service

 Nurses are responsible for fulfilling the terms of their employment contract, including providing care
for the specified length of time.
 Nurses should always strive to:
 Commit fully to patient care and ensure quality service.
 Follow the standards of practice outlined in their contract

 Commitment to Patient Welfare

 Nurses are dedicated to the welfare of those entrusted to their care.

 This involves providing safe, competent, and compassionate care.
 Nurses must act in the best interest of the patient, promoting their health and well-being at all times.
Confidentiality?
 Confidentiality is also known as privileged communication because it is based on the trust between the
patient and healthcare provider.
 Any information gathered by nurses during the course of treatment should be considered confidential and
protected.
 Nurses have a legal and ethical obligation to protect patient privacy.

When Can Confidential Information Be Revealed?

 Confidential information may only be disclosed under certain conditions:

 Patient Permission
 When the patient gives consent, such as for hospitalization claims or insurance benefits.
 Medico-Legal Cases
 If the information is required by law to be reported to local police or authorities (e.g., injuries related to criminal acts).
 Communicable Diseases
 Information about patients with communicable diseases may be revealed for public safety if there is a risk of spreading the
disease.
 Relevant Information to Healthcare Team
 If relevant, confidential information may be shared with other members of the healthcare team for effective patient care, while
maintaining confidentiality within the team.
Nurses' Bill of Rights?
 The Nurses' Bill of Rights is a set of principles designed to protect the professional and personal
rights of nurses.
 It ensures that nurses have the resources and environment needed to deliver high-quality patient
care while also upholding their own rights and well-being.
 Right to Practice and Fulfill Obligations

 Nurses have the right to practice in a way that allows them to:
 Fulfill their professional obligations.
 Provide safe, effective care to patients.
 Work according to their scope of practice and competency.

 Right to Practice in a Supportive Environment

 Nurses are entitled to work in an environment that supports them in:

 Acting in accordance with professional standards.
 Practicing within the scope of their role.
 Delivering care that is both ethical and effective.
 Right to Ethical Practice

 Nurses should have the ability to:

 Support and facilitate ethical practice.
 Act in accordance with the nursing code of ethics, which guides their professional actions and decisions.
 Work in environments where ethical dilemmas are addressed and supported.

 : Right to Advocate for Themselves and Patients

 Nurses have the right to openly advocate for themselves and their patients without fear of:
 Retribution or punishment.
 Intimidation or professional backlash for speaking out about care issues or concerns.

 Right to Fair Compensation

 Nurses are entitled to fair compensation for their work, ensuring:

 Adequate pay that reflects their skills, experience, and professional responsibilities.
 Fair benefits, including healthcare, retirement, and other workplace protections.
 Right to Work in a Safe Environment

 Nurses should work in safe environments, where:

 Patient and staff safety are prioritized.
 Proper workplace safety measures are in place.
 The physical and mental well-being of the nurse is supported.

 Right to Negotiate Employment Conditions

 Nurses have the right to negotiate the conditions of their employment, either:
 Individually or collectively (through unions or other groups).
 In all practice settings, ensuring fair terms of employment, benefits, and work-life balance.
Research on Human Subjects
 Nurses play a critical role in medical research involving human subjects.

 Ethical guidelines are essential to ensure patient safety and human rights.

 Nurses are responsible for adhering to ethical standards and regulatory guidelines
throughout the research process.
Helsinki Declaration of 1964
 The Helsinki Declaration provides ethical guidelines for conducting medical research involving
human participants.
It emphasizes:
 Respect for human rights.
 Informed consent.
 Ensuring safety and well-being of participants.

 It serves as a foundational document for the ethical conduct of research globally.

 Types of Research (1975 Guidelines)

Research can be categorized into two major types:

 Essentially Therapeutic Research
 Direct benefit to participants (e.g., clinical trials to improve treatment).
 Aimed at advancing care or treatments that benefit the subjects.

 Non-Therapeutic Research
 Directed at developing scientific knowledge.
 Has no direct therapeutic value for the subjects involved.
 Includes studies like drug trials or biological studies with no immediate benefits to participants.
 ANA Human Rights Guidelines for Nurses in Research

 Provides guidelines for nurses involved in research:

1. Employment in Research Settings

 Nurses should be employed in settings where research is conducted with a focus on ethics and safety.

2. Protection of Human Rights

 Nurses have a responsibility to vigilantly protect the rights of human subjects.
 Ensure participants' dignity, privacy, and confidentiality are respected.

3. Scope of Application
 Nurses are responsible for upholding ethical standards in all forms of research, from clinical trials to
laboratory studies.

4. Supporting Knowledge Accrual

 Nurses must support the accumulation of scientific knowledge by:
 Ensuring research is conducted ethically.
 Contributing to advancements that benefit public health and patient care.
 Ethical responsibility to make research outcomes transparent and beneficial.
5. Informed Consent
 Nurses play a crucial role in the informed consent process, which includes:
 Ensuring that participants are fully informed about the study.
 Ensuring voluntary participation without coercion.
 Clarifying risks, benefits, and study procedures.
 Ensuring comprehension by participants of all study details.
 Human Rights in Research

 Ethical guidelines and laws are in place to protect human subjects during research.

 Every research participant has fundamental human rights that must be respected and upheld.

 These rights ensure that individuals are treated with dignity, respect, and fairness in any research process.

1. Right to Informed Consent

ensures that individuals are fully aware of the study's details before participating.
 Participants must be given clear, understandable information about the research purpose, procedures, risks, and benefits.
 Free consent is required—there should be no deception or coercion.
 It is the recognition of self-determination—the participant has the right to make an informed decision about participation.

2. Right to Refuse or Withdraw Participation

 Right to refuse or withdraw from the study at any point, without any penalty or loss of benefits.
 There should be no pressure to continue participation once the decision is made.
 Withdrawal should not affect the care or treatment participants are receiving.
Right to Privacy
3. Privacy is a fundamental human right that must be respected during research:
 Participants' personal identifying information should be protected.
 Anonymity should be maintained whenever possible.
 Sensitive data, especially regarding health or personal issues, should be handled with the utmost care.

4. Right to Confidentiality
 ensures that personal and medical information shared during research remains protected:
 Information gathered during the research should only be shared with those directly involved in the study.
 Data should be stored securely and accessible only to authorized personnel.
 Breaching confidentiality can cause harm to the participant's reputation, privacy, or safety.

 Right to Protection from Harm

 Research participants have the right to be protected from harm:

 This includes physical, emotional, legal, financial, and social harm.
 Risk-benefit ratio must be considered—potential risks to the participant should be minimized and outweighed
by the potential benefits of the research.
 The research must ensure that the participant's welfare is prioritized over the research outcomes.
Vulnerable Subjects
 Mentally ill or legally incompetent

 Minors

 Students

 Pregnant women

 Low income status

Investigative Studies and Medical Regimen

 Investigative studies (clinical trials or research studies) must always align with the patient's medical
regimen.
 Ethical guidelines dictate that research should not conflict with the patient's ongoing medical care or
interfere with their current treatments.
 The primary goal is to ensure the well-being of the patient while advancing knowledge through
research.
Experimental Subject's Bill of Rights
 The Experimental Subject's Bill of Rights outlines the ethical responsibilities researchers
have toward individuals participating in research.
 It ensures that participants are well-informed, free from coercion, and fully aware of the risks,
benefits, and alternatives to participation.
The Right to be Informed
 Right to Understand the Study

Right to Know
 Potential risks and side effects of participation must be communicated thoroughly.

Knowing the Expected Outcomes

 Right to Know the Expected Outcomes:

Right to Explore Alternatives

 Right to Know Other Choices:
Right to Ask Questions
 Participants have the right to ask any questions they have about the study.
 Researchers must provide clear answers and ensure participants understand what is being asked of them.

Right to Know Treatment for Complications:

 If any complications arise from the research, participants have the right to know what treatments are available
to address those issues.

Right to Refuse or Withdraw:

 Participants have the right to refuse participation or withdraw at any point without any penalty or loss of
benefits.

Right to a Copy of the Consent Form:Participants are entitled to receive a copy of the consent form after
signing it. This serves as a record of their informed consent.

Right to Free and Unpressured Decision: Participants must be free from pressure or
coercion when deciding to join a study.
 They should feel empowered to make their own choice, whether it’s to participate or not,
without any external influence.
SAMPLE OF CONSENT LETTER
RESPONSIBILITIES OF THE NURSE TO THE PHYSICIAN

Sec. 28 (a) of RA 9173 states:

 Nursing care through utilizing the use of nursing process and the use of traditional and
innovative approaches.
 Executing healthcare techniques.

 Carry out docs. Order but also help plan and implement patient care.

 Clinical judgement. Clarify misconception.

 Familiar with idiosyncrasies of Physician.

RESPONSIBILITIES OF NURSES TO THEIR COLLEAGUES

 Expected to get along. Mature person may be easily blends in any situation.
 Adjust to the organization and know policies and procedures.
 When nurses see their colleagues neglect their duties and or incompetent shall be
brought to attention.
 Constructive criticism is welcome but not fault-finding.
RESPONSIBILITIES OF NURSES TO THEMSELVES

 Develop skills.

 Conduct must bring to the profession.

 Neat and attractive. Females with moderate make up and neat hairstyle.

 Proper uniforms as prescribed.

 Hygiene.

 Male nurses to have clean shaven.

 Nurses cap should be worn only during duty

 Jewelry must not be worn except for wedding and school ring and school pins.
LIVING WILLS OR ADVANCE DIRECTIVES

 Proxy forms or called as living wills and advance directives and is

signed by the patient with 2 witness (must be 10 year old or older)
- Sound of mind, free of duress or undue influence.
 Designates a healthcare representatives, a member of the family,
friend, or family physician. To make decisions.
Includes: To accept or refuse any treatment, service or procedures.
 Attached to patient chart.
 The directive has a force of law.