Basic Ethical Principles

1. STEWARDSHIP Our bodies, our life, our human nature and everything in this earth are gifts we have dominion over. This means We are responsible for them; As faithful stewards, we should not harm but rather improve and care for them We have to treat them with utmost, respect, use originality and creativity to cultivate them; Know and respect their limits We cannot contradict nature

Learning Activity: 1. Differentiate between ownership and stewardship 2. How one should care for ones health? Example: Good Habits and Bad Habits 1. Are wearing tooth braces, eyeglasses, having a facelift, signs of good stewardship? 2. Budget for Health?

2. TOTALITY The totality refers to the whole. Every person must develop, use, care for and preserve all his parts and functions for themselves as well as for the good of the whole. If a part or lower function harms the whole, this part or lower function may be sacrificed for the good or better function of the whole. The basic capacities which define human personhood, however, are sacrificed only when there is need to preserve life. Learning Activity: 1. What is meant by wholeness? (Physical, mental, spiritual, psychological)? (Individual/community)? 1. May a disease organ be removed? May a healthy organ be removed? The principle of totality in relation to organ donation.

3. DOUBLE EFFECT

4. COOPERATION Cooperation is the participation of one agent with another agent to produce particular effect or joint effect. Cooperation becomes a problem when the action of the primary agent is morally wrong. Cooperation may be: 1. Formal when the secondary agent willingly participates as when one agrees, advices, counsels, promotes or condones. 2. Material when the secondary agent does not willingly participate 3. IImmediatemediate when the action of the secondary agent is inherently bound to the performance of the evil action 4. Mediate when the action of the secondary agent is not inherently bound to the performance of the evil action

Learning Activity: 1. Discuss the type of cooperation and the responsibility of the agent 1.1. a nurse assist a doctor before/after an abortion 1.2. a person gives a present to a clerk to facilitate approval of his paper

5. SOLIDARITY Solidarity means to be one with others. In the provision of healthcare, it is most important for the provider to be in solidarity with patient seeking, always, the latters best interest. In our country this is most important while dealing with the poor, the uneducated, the disadvantaged and the marginalized. They are the ones least provided with adequate healthcare. They are the ones most in need of the concerned healthcare provider Learning Activity: 1. Should the strong help the weak? The rich help the poor? How can the poor help the rich? 1. Should members of the team be in solidarity with each other? Explain Evaluation Is there a lack of solidarity today? Explain

MAJOR ETHICAL PRINCIPLES USED IN HEALTH CARE

1. RESPECT FOR PERSON Respect for person is the recognition of the equality possessed by every human being as a unique, worthy, rational, self-determining creature, having the capacity and right to decide what is best for himself. Respect for person is the responsibility of all to treat persons as an end and never as a means. A person should be allowed to determine his own destiny, to deliberate about his plans, choose according to his own values and to act accordingly. He should be allowed to be his own person without constraints from the actions of others or from physical psychological limitations Example: X has right to determine his course of action Y has an obligation not to constrain X

2. JUSTICE Creating a healthcare policy helps decide how limited resources are to be distributed. It should consider the principles of equality (distributive justice), social justice, and solidarity. The policy should state in clear terms the criteria for consideration, rank ordering, etc. and this should be made public. The process must be just, though sometimes outcomes do not appear just

3. THE INVIOLABILITY OF LIFE The principle of the inviolability of life is also proposed as the sanctity, the dignity, or respect for human life. The principle of the inviolability of human life means that life, in itself is sacred. It is not to be violated, opposed or destroyed but it is to be affirmed, cherished, respected, defended and preserved Commitment The principle of the inviolability of human life means choosing life and fighting to protect it. Commitment to life overcomes commitment to death It is to be against violence, pollution of environment, drug and alcohol addiction, treachery in human relations. Example: X has a right to life Y has a duty NOT to kill X

4. NON MALEFICENCE Non Maleficence means to do no, to prevent, to remove or not to risk harm Harm may be physical, mental, psychological, social, financial, spiritual, etc. REVIEW: Y has a right not to be harmed Y has an obligation not to harm X

5. BENEFICENCE Beneficence is the positive pole of Nonmaleficence It means to do good, to provide a benefit REVIEW: X has a duty to benefit Y provided

6. THE PRINCIPLE OF AUTONOMY According to Miller (Miler 1995) characteristics of autonomy are: 1. Autonomy as Free Action. There must be the intentional and conscious choice of the actor Right to free action is violated by any suggestion of coercion, duress, undue influence or withholding of information 2. Autonomy as Authenticity. This means that the action of individual is consistent with his attitudes, values, dispositions and life plans 3. Autonomy as effective deliberation. To be able to exercise effective deliberation, the patient must be informed of all information necessary for him to make a decision. 4. Autonomy as moral reflection. This is the deepest and most demanding sense of autonomy for as Miller pointed out, it involves a deeper level of self-introspection which involves the ability for rigorous self analysis, awareness of alternative set of values, and an ability to put them in place.

7. FIDELITY This refers to the obligation of a person to be faithful to agreements, responsibilities and commitments that he has made to himself and to others It is the main principle that supports the concept of accountability of nurses and other health professionals

8. VERACITY This refers to the principle of truthfulness In nursing, veracity is applied in the nurses responsibility never mislead or deceive a patient

9. CONFIDENTIALITY According to moral theology, there are 3 classes of secrets: 1. Natural Secret. These are secrets which must remain hidden even if there is no obligation or promise to keep it that way, for the revelation of it could harm individual or society. Example: National leaders may withhold information that their country is in threat of nuclear attack for releasing information could cause panic 1. Promised Secret. These are secrets that a person confides to another in exchange of a promise not to reveal it to others 2. Confided Secret. Example: Information provided by a patient to a nurse during interview, The nurse reassures the patient that any information gained is treated confidential

Persons Required to Observe Confidentiality 1. Physicians who deal with the patient even for a briefest time at various phases of the patients illness or treatment 2. Pharmacist who prepares and dispenses the medication prescribed to the patient 3. All other health care professionals involved in the care of the patient such as: nurses, medical technologists, hospital chaplain, students nurses and social workers 4. All other personnel who attended to the care of the patient

When Confidentiality May End: 1. After the patient gives his consent to reveal information about him or his health care. 2. When its revelation is for common good. Example: If the patient is sick with highly contagious disease, the physician has the obligation to report the patient to proper authorities in order to take measures to protect other people

APPLICATION OF BIOETHICAL PRINCIPLES TO THE CARE OF THE SICK Informed Consent is an ideal connected to the principles of autonomy and respect for person. Recognizing that every person is primarily responsible for his own body, informed consent was introduced into patient care as a means of protecting a patients personal integrity and enhancing the patients active role in his own care With the introduction of informed consent in health care, there has been a shift from the paternalism of Doctor knows Best and Decides to Patient knows Best and Decides FUNCTIONS OF INFORMED CONSENT: 1. Protective to safeguard against intrusion of integrity 2. Participative to be involved in medical decision making

ELEMENTS OF INFORMED CONSENT: 1. Knowledge a. Information disclosure by the healthcare giver: The truth of the proposed action, its nature, probable benefits, possible risks and other alternative options or all information relevant to a meaningful decision making process must be given to the patient b. Comprehension by subject: The information must be given in words and manner that can be easily understood by the subject. Distorted, unfamiliar and unsuitable information, poor information processing, overload, selective perception must be avoided 2. Consent a. Subject competence. The subject must be able to make decisions based on rational reason b. Subject freedom. The subject must be able to choose and act without pressure of time, emotional upset, confusion, persuasion, coercion, threat, deception, manipulation, fear of other forms of control by others

RIGHTS OF PATIENTS: The Patients Bill of Rights within the scope of the proposed Magna Carta of Patients Rights are: 1. Right to Medical Care and Humane Treatment 2. Right to Informed Consent 3. Right of Privacy 4. Right to Information 5. Right of Privileged Communication 6. Right to Choose Physician 7. Right to Self Determination 8. Right to Religious Belief 9. Right to Medical Records 10. The Right to Refuse Participation in Medical Research 11. The Right to Correspondence and Receive Visitor 12. Right to Express Grievances 13. Right to be Informed of his Rights and Obligations as a Patient