NURSING ETHICS

Some cases that have reached worldwide attention are:

1.      Terri Schiavo'S stomach feeding tube was removed upon his husband's request to the court as she was in persistent vegetative state

2.      A couple who conceived a child in the hope that the baby would be a bone marrow donor for his seven year old sister who is acutely ill for leukemia

3.      A couple convicted of manslaughter for the death of their 2 ½ year-old son because they failed to seek medical attention and the baby died of intestinal obstruction

Morality – Behavior in accordance with the gen. ethical principles of health care; personally held beliefs, opinions that guide our actions.

Principles of morality

1.      The golden rule – do not do unto others what you do not want to do unto you

2.      Two-fold effect – an act is foreseen to have both good and bad effects

Þ   That the action must be morally good

Þ   That the good effect most be willed and the bad effect merely allowed

Þ   That the good effect must not come from an evil action but from the action itself directly

Þ   That the good effect must be greater than the bad effect

3.      Principle of totality - The whole is greater than any of its parts.

Þ   Ex. If an organ is diseased and endangering the whole, the organ may be removed

4.      Epikia – exception to the general rule

5.      Ordinary means – basic duty of a person in case of serious illness to take necessary means to preserve life and health

6.      Subsidiarity – making the highest authority respect and protect the common good

7.      One who acts under an agent is himself responsible

Þ   Ex: No one can force any person to answer a question if such will incriminate him/her

8.      No one is obliged to betray himself - No one can force any person to answer a question if such will incriminate him/her

9.      The end does not justify the means

Þ   Ex: Giving sleeping tablets to someone who has chronic illness

10. Defects of nature may be corrected

Þ   Ex: Corrected by plastic surgery

11. If one is willing to cooperate in an act, no injustice is done

Þ   Ex: With patient’s consent

12. A little more or less does not change the substance of an act

Þ   Ex: Stealing

13. The greatest good for the greater number

Þ   Ex: Have more good effects for more people than a smaller group

14. No one is held to the impossible

Þ   Ex: Do not promise impossible things

15. The morality of cooperation

Þ   Ex: Formal cooperation is an evil act and never allowed

16. Principle relating to the origin and destruction of human life – no person has the right take someone’s life because it is inviolable

17. The Good Samaritan law (“Love Article”) – if one does not act, you will be responsible for moral negligence.  Courage is doing exactly what one believes in.

18. Nurses have the right to appeal to conscience, refuse to participate in act for they violate the right to freedom of thought, conscience and belief.

Ethics – rules, principles that guide nursing decisions or conduct in terms of the rightness or wrongness of that decisions or actions. Serves the purpose of governing conduct to ensure the protection of individual’s rights.

Importance

ð Makes clear why one act is better than another

ð Keep an orderly social life by having agreement, understanding, principles or rules of procedure

ð Moral conduct and ethical system must be intelligently appraised and criticized

BIOETHICS

ü Bioethics – synonymous term with healthcare ethics and encompass not only questions of equality of life, life-sustaining and a life-altering techniques

ü Principles that govern rights and proper conduct of a person regarding life, biology, & with health professionals

ü Ethical Dilemma – problem in decision making because there is no correct or wrong choice. This may result in having to choose an action that violates one’s principle or value in order to promote another

ü Human acts – voluntary, full knowledge, will to do it

ü Acts of man – involuntary actions of man

Theories

ð Utilitarian or Telelogical – the end justifies the means; "The right thing to do is the good thing to do"; Comes from the Greek word telos or "goal or end"; If the act helps people, then it is a good one, and if it harm people, then it is a bad one (Joseph Fletcher)

ð Deontological – Comes from the Greek word deon which means duty; the ends DOES NOT justify the means; the acts are the criterion for the determination of good and not the consequence.

ð Intuitionism – people inherently knows what is right and what is wrong

Principles of nursing ethics:

1.      Autonomy - states that a person has unconditional worth and has the capacity to determine his own destiny. It involves self determination and freedom to choose and implement one's decision, free from deceit, duress, constraint or coercion.

Ex: Informed consent; allowing the patient to refuse treatment if he decides so

Consent

ð admission

ð blood transfusion                         

ð surgical consent

ð research consent

ð special consent like restraints, photographing the client, disposal of body parts during surgery, organ donation or autopsy  

Informed consent

ð Patient’s bill of rights

ÖConsiderate and respectful care

ÖRelevant, current and understandable information

ÖMake decisions regarding his care plan

ÖHave advance directive (living will)

ÖEvery consideration of his privacy

ÖConfidentiality of communications and records

ÖReview his records concerning his medical care

ÖBe informed of business relationship among the hospital educational institution

ÖConsent or decline to participate experimental research affecting his care

ÖReasonable continuity of care when appropriate and be informed of other care options

ÖBe informed of hospital policies and practices

ð Illegal detention/false imprisonment (RA 9439)

ð Arbitrary detention

ð Restraints

   

Death and dying

ð right to informed refusal

ð care of the body

ð organ donation (RA 7170)

ð autopsy

ð assisted suicide

ð unauthorized patient’s discharge

Do Not Resuscitate/DNR (no code order) an order by the patient’s physician instructing the w/holding of CPR if the patient goes into cardiac or respiratory arrest.

    Duties of the nurse:

1.      assure that everyone in the process understands the meaning of DNR

2.      In case of conflict nurse will often act as mediator & help participants reach some shared understanding.

3.      ensure that the following information are documented

a.      patient’s condition

b.      prognosis

c.      summary of decision making

d.      parties involved in the decision making

e.      future date to review the DNR order

2.      Paternalism – giving care like a good father/mother of a family

3.      Non-maleficence – do not harm; remove harm; prevent harm

               - Medication rights

ü RA 6675 – Generics Act 1988/Medication ; Orders, Drugs & Medication

ü RA 6425 – Dangerous Drug Act 1972

ü RA 953 –   Narcotics Drug Law

ü RA 5921 – Pharmacy Act

ü BON Res. No. 8 s. 1994 (Sec. 27 Art. V RA 7164)      

ü RA 9502 -  Cheaper Medicine Bill

4.      Beneficence – to do good; client advocate

5.      Justice – allocation of goods & services & how or to whom they are distributed

a.      equality – everyone receives the same

b.      need – greater services go to those with greater needs

c.      merit – services go to more deserving (used as a criterion for transplant recipients). 

6.      Veracity – telling the truth

a.      Fraud – deliberate  deception intended to produce unlawful gain

b.      Defamation – character assassination verbal or written

c.      Libel – written

d.      Slander – verbal/oral

e.      Medical record

7.      Fidelity – loyalty/faithfulness and keep promises

8.      Confidentiality – observing the seal of secrecy

a.      Privileged communication

b.      Invasion of privacy

c.      Hearsay evidence

d.      Dying declaration or ante mortem statement

e.      Nurses as witness

Þ   When prohibition applies

Þ   Duration of the seal of secrecy

Nurses Code of Ethics

Four-fold responsibility of a nurse

ð BON Res. # 633 s. 1984 ICN Code of Ethics

1.         Promotion of health

2.         Prevention of illness

3.         Alleviation of suffering

4.         Restoration of health

ü Spiritual health –holistic care

ü self-transcendence - going beyond self to help others reach self-actualization (5th Declaration) 

ð BON Res # 1995 s. 1989 PNA Code of Ethics was promulgated