BIOETHICAL ISSUES IN NURSING

DO NOT RESUSCITATE ORDER (DNR)

Physician may order no code or do not
resuscitate for client who are in stage of
terminal, irreversible illness, or expected
death. DNR order that no effort be made to
resuscitate the client in the event of respiratory
or cardiac arrest.
ABORTION
Termination of pregnancy before the fetus
reaches the stage of viability.
EUTHANASIA
mercy killing The act of painlessly putting
to death persons suffering from incurable or
distressing disease.
HUMAN CLONING
Human reproduction / replication
SEX TRANSPLANT
Sex change
PROFESSIONAL CRIMES

NEGLIGENCE
The doing of that thing, which a reasonably
prudent person would not have done, or the failure
to do that thing which a reasonably prudent
person would have done, in like or similar
circumstance.
..Act of omission or commission
THEORIES OF NEGLIGENCE:
Respondeat Superior let the superior
answer ; let the principal answer for the acts
of his agent
Res Ipsa Loquitur the thing speaks for itself;
talks about the evidence; you cannot
deny the negligence because of the presence of
evidence.
Force Majeure irresistible or superior force. It
is a fact or accident which human prudence
can neither foresee nor prevent
MALPRACTICE
Any professional misconduct, or any
unreasonable lack of skill, or fidelity in the
performance of the professional or
fiduciary duties.
For Nurses, Malpractice refers to the
failure to follow a reasonable
professional standard of care, thereby,
resulting to injury of patient
ELEMENTS OF
NEGLIGENCE/MALPRACTICE:
Duty
Breach of Duty
Foreseeability
Causation
Harm/Injury
INVASION OF PRIVACY

Violation on the right of an individual to withhold

herself and her life from public scrutiny. Violation
on the right to remain alone and the right to
keep information.

FRAUD

False presentation of some facts with the

intention that will be acted upon by another
person.
Willful misrepresentation
DEFAMATION
Derogatory remarks about a person
Making false statements about a person that
can result to the injury of his reputation

KINDS OF DEFAMATION:
Slander oral defamation
Libel written defamation

ASSAULT
Attempt or threat or to touch another person
unjustifiably
CONSENT

KINDS OF CONSENT:
Informed Consent
Implied Consent

INFORMED CONSENT
Agreement by the client to accept a course of treatment
or a procedure after complete information, including the
risk of treatment and facts relating to it, has been
provided by the physician

ELEMENTS OF INFORMED CONSENT:

. voluntarily
. given by an individual with the capacity, competence, and
understanding.
.client must be given enough information to be the ultimate
decision maker.
 NURSES RESPONSIBILITY
Witnessing the exchange between the client
and the physician.
Establish that the client really did understand,
that is, was really informed
Witnessing the clients signature

PEOPLE WHO ARE NOT ALLOWED TO PROVIDE

CONSENT:
Minors below 18 years old; except for married
and already a parent
Mentally ill
Unconscious or injured in such a way that they
are unable to give consent.

IMPLIED CONSENT
In a life threatening situations and consent can not
be obtained from the client or relatives, the law
generally agrees that consent is assumed.
Ethics of Nursing

..Ethics includes values, codes, and principles that

govern decisions in nursing practice and
relationships

..Nursing Ethics is the discipline of evaluating the

merits, risks, and social concerns of activities in
the field of nursing

..Ethical principles are necessary to guide to

professional development
 Principles of Health Care Ethics
Beneficence: means doing or promoting good in such
a manner as to safeguard and promote the
interest and well being of patients and
clients

Nonmaleficence means to avoid doing harm, to

remove from harm, and to prevent harm

Harm can be physical and so include

pain, disability, discomfort and death
but it can also be psychological and
thus include mental stress
Autonomy and consent: Principles of self
determination

The cardinal principles of autonomy

The right to full disclosure- the right to

know
The right to privacy
The right to receive care and treatment
Justice: The principle of fairness is the basis for
the obligation to treat all clients equally
and fairly

Veracity: telling the truth. Clients prefer to receive

accurate information about their
conditions and prognosis even when the
outlook is bleak
Privacy:
To ensure that the patients body is
appropriate covered

To establish a culture of privacy to ensure

that personal information of patients is
kept as private as possible
Confidentiality
To preserving the human dignity of patients

Discussing clients outside the clinical setting, telling

friends or family about clients, or even discussing
clients in the elevator with other workers violates
client confidentiality and must be a voided
Responsibility: A nurse, who neglects to give a
patient pain relief can be said to have
caused that patient harm

Proving negligence (i.e. that the nurse is legally

responsible)

It is not only human beings who can cause something

to happen, since conditions (e.g. staff shortages,
poor equipment, inadequate resources, and so
forth) may also cause accidents or result in a
patient being injured
Accountability

Is about justifying actions, explaining why

something was (or was not) done

The purpose of calling people to account for their

actions is therefore to establish whether they had
good enough reasons for acting in the way they did
FIDELITY

The professionals faithfulness or loyalty to

agreements & responsibilities accepted as part
of the practice of the profession
The ICN- Code of Ethics for Nurses (2006)

Nurses have four fundamental

responsibilities:
To promote health
To prevent illness
To restore health
To alleviate suffering
The ICN Code of Ethics

Nursing care is respectful of and

unrestricted by considerations
of age, color, creed, culture,
disability or illness, gender, sexual
orientation, nationality, politics,
race or social status
1. NURSES AND PEOPLE

nurses primary professional

responsibility is to people
requiring nursing care.

promotes an environment in
which the human rights, values,
customs and spiritual beliefs of
the individual, family and
community are respected.
2. NURSES AND PRACTICE

nurse carries personal

responsibility and accountability
for nursing practice, and for
maintaining competence by
continual learning.

maintains a standard of
personal health such that the
ability to provide care is not
compromised.
3. NURSES AND THE
PROFESSION
nurse assumes the major role in
determining and implementing acceptable
standards of clinical nursing practice,
management, research and education.

active in developing a core of research-

based professional knowledge.
4. NURSES AND CO-WORKERS

nurse sustains a co-operative

relationship with co-workers in nursing and
other fields.

takes appropriate action to safeguard

individuals, families and communities
when their health is endangered by a
coworker or any other person.
Legal Aspects of Nursing

Other Laws That Affect Nursing

LAWS, RESOLUTIONS,
PROCLAMATIONS AND
EXECUTIVE ORDERS
AFFECTING THE
PRACTICE OF NURSING
IN THE PHILIPPINES
Executive Orders

Executive Orders are orders issued by the

Chief Executive in order to implement a
constitutional mandate or statutory
provision
EO 51 The Milk Code; it aims to
provide safe and adequate
nutrition for infants by
protection and promotion of
breastmilk and by ensuring the proper
use of breastmilk substitutes
The labels of milk products covered by
this code shall have written important
notice such as This product is not
EO 174 The national drug policy on availability,
affordability of safe, effective and good quality
drugs for all

EO 209 The Family Code of the Philippines

 Letter of Instruction (LOI)
LOI is an order issued by the President to serve as
guide to his previous decree or order

LOI 47- directs all schools of midwifery and

nursing, social work, medicine and allied
medical profession to include family planning in
their curricula

LOI 949 which created the Primary Health Care

System

LOI 1000 which directs government agencies to

give preference to members of accredited
professional organizations when hiring employees
 Presidential Decree (PD)
PD are orders coming from the President of the
Philippines who exercised legislative powers during state
of martial law

PD 48 4 children with paid maternity leave privileges

PD 69 4 children for tax exemption

PD 442 which is the Labor Code of the Philippines

PD 491 Nutrition Program

PD 603 The Child and Youth Welfare Code of the

Philippines. It protects the right, and promotes the
welfare of the children
 Presidential Decree (PD)
PD 626 which provide for an Employee
Compensation and Insurance Fund, providing
more benefits to persons covered by SSS and GSIS
for injury, illness and disabilities

PD 651 Birth and Death Registration law

PD 925 which provided penalty for improper garbage

disposal and other forms of uncleanliness

PD 856 Code on Sanitation

PD 965 required marriage license applicants to

receive instruction on Family Planning and
Responsible Parenthood prior to the issuance of
marriage license
 Presidential Decree (PD)
PD 996 which provided for compulsory
basic immunization for children and
infants below eight years of age
PD 1519 revised medicare benefits; which
provided for medical benefits of
government employees regardless of
status of appointment
PD 1636 which requires compulsory
membership to SSS or GSIS retirement
fund
 PROCLAMATIONS
These are official declaration by the Chief
Executive of Office of the President on
certain programs, projects or situations

Proclamation # 6 declaring that UNs goal of

Universal Child Immunization , involved
NGOs in the immunization program
Proclamation # 499 which declares December
1 as the National AIDS Awareness Day
Proclamation # 539 Last week of October as
Nurses Week
 Republic Acts (RA)
These are acts or laws passed by the Congress of the
Philippines

RA 1080 which declared that professionals who

passed the board and bar exams are civil service
eligible (Civil Service Eligibility)
RA 1082 which is The Rural Health Act, creating
RHU all over the country with the goal of promoting
the health and well being of the rural population
RA 1612 which provides that a privilege tax
ta shall
be paid before any business or occupation can be
lawfully begun or pursued
To be paid before January 31 of each year
Professionals working in govt agencies are exempted from
this
 Republic Acts (RA)
RA 1636 Compulsory membership to SSS of
the self employed individual
RA 2382 which is the Philippine Medical
Act regulating the practice of medicine in
the Philippines
RA 3573 the law on the reporting of
communicable diseases to the nearest
health station and that any person may be
inoculated, administered or injected with
prophylactic injections
RA 4226 which is the Hospital Licensure Act,
requiring all hospitals to be licensed
before they can operate
 Republic Acts (RA)
RA 5181 this act prescribes permanent
residence and reciprocity qualifications for
any examination or registration for the practice
of any profession in the Philippines
RA 5901 working hours and compensation of
hospital and clinical personnel
RA 6111 which is the Philippine Medical Care
Act of 1969 (MEDICARE) providing for
hospitalization benefits for employees who
are members of the GSIS and SSS
 Republic Acts (RA)
RA 6675 which is the Generic Acts of 1988
RA 6713 which is the Code of Conduct and
Ethical Standards for Public Officials and
Employees
RA 7170 the law that governs organ donation
RA 7305 which is the Magna Carta of Public
Health Workers
RA 7600 which is the Rooming-in and
Breastfeeding Act of 1992
RA 7610 which is The Special Protection of
Children Against Child Abuse,
Exploitation and Discrimination Act
 Republic Acts (RA)
RA 7875 which is the National Health Insurance Act of
1995.
It is an act instituting a national health insurance
program for all Filipinos and establishing the PHIC for
the purpose
RA 7877 which is The Anti-Sexual Harassment Act of
1995
It is an act declaring sexual harassment unlawful in
the ff environment: 1. employment 2. education 3.
training
RA 8749 The Philippine Clean Air Act of 1999

RA 8981 The PRC Modernization Act of 2000

RA 9211 No smoking act

 LAWS THAT
PROMOTE THE
WELFARE AND
WELL-BEING OF
NURSES
 LAWS THAT PROMOTE THE
WELFARE AND WELL-BEING OF
NURSES
LABOR CODE (PD 442)
- defines among other things,
hours of work, contract
( including termination of
contract) and nurse staffing in
industrial clinics
 LAWS THAT PROMOTE THE
WELFARE AND WELL-BEING OF
NURSES
CIVIL SERVICE LAW ( PD 807)
- provide for the recruitment and
selection of employees in government
service; qualification standards;
personnel evaluation system; and
personnel discipline). Also provides
that no employee of the Civil service
can be suspended except for cause as
provided for by law and after due process
 LAWS THAT PROMOTE THE
WELFARE AND WELL-BEING OF
NURSES
EXECUTIVE ORDER No. 180
- uphold the exercise of the right to
organize of government employees.
This is in accordance with the 1987
constitution that states; the right of
people..to form unions, associations,
or societies for purposes not contrary
to law shall not be abridged.
 LAWS THAT PROMOTE THE
WELFARE AND WELL-BEING OF
NURSES
MAGNA CARTA OF PUBLIC HEALTH
WORKERS ( RA 7305)
- has provisions on benefits (financial and non
financial), rights and responsibilities of public
health workers. Public health workers include
everybody who works in government health
institutions such as hospitals and laboratories.
 LAWS THAT PROMOTE THE
WELFARE AND WELL-BEING OF
NURSES
SALARY STANDARDIZATION LAW (RA
6758)

- provides for the standardization of salaries

of those working in government. One of the
benchmark positions is Nurse 1 which is
assigned salary grade 10. (RA 9173 upgrades
the entry salary of nurses in government to
grade 15)
 LAWS THAT PROMOTE THE
WELFARE AND WELL-BEING OF
NURSES
RA 7041 (An Act Requiring Regular
Publication of Existing Vacant
Positions in Government Offices)
- the intention of this law is for government offices to
be transparent in their recruitment practices. By
publishing presence of vacant positions, applicants
are less likely to be subjected to unethical practices in
government practices
 LAWS THAT PROMOTE THE
WELFARE AND WELL-BEING OF
NURSES

ANTI- SEXUAL HARASSMENT ACT

(RA 7877)
- protects employees against sexual harassment. Sexual
harassment is committed by any person who exercises
authority, influence or moral ascendancy over
another..by demanding, requesting or requiring sexual
favor regardless of whether or not.. Is accepted by the
object of sexual solicitation
LAWS THAT SPELL OUT
THE RESPONSIBILITIES
OF EMPLOYEES
(INCLUDING
NURSES)
CODE OF CONDUCT AND ETHICAL STANDARDS
FOR PUBLIC OFFICIALS AND EMPLOYEES ( RA
6713)
Provides that public officials and
employees shall at all times be
accountable to the people and shall
discharge their duties with utmost
responsibility, integrity, competence,
and loyalty, act with patriotism and
justice, lead modest lives and uphold
public interest over personal interest.
CIVIL SERVICE RULES AND
REGULATIONS (PD 807)
Promote morale and highest degree of responsibility,
integrity, loyalty, efficiency, and professionalism. Public
office is a public trust.
This law spells out the grounds of disciplinary action.
Some of these are: dishonesty, neglect of duty,
oppression, misconduct, disgraceful and immoral
conduct, being notoriously undesirable, discourtesy in
the course of official duties, inefficiency and
incompetence in the performance of official duties,
conviction of a crime involving moral turpitude,
falsification of documents, frequent unauthorized
absences or tardiness, gambling, insubordination,
nepotism and refusal to perform official duty or render
overtime service
RA 8344 ( AN ACT PENALIZING THE REFUSAL OF
HOSPITALS AND MEDICAL CLINICS TO ADMINISTER
APPROPRIATE INITIAL MEDICAL TREATMENT AND
SUPPORT IN EMERGENCY CASES )
In emergency cases, it is unlawful for anybody
(including the nurse) in a hospital or medical
clinic to request, solicit, demand or accept any
deposit or any other form of advance payment
as a pre requisite for confinement or medical
treatment of a patient or to refuse to administer
medical treatment and support as dictated by
good practice of medicine.
Trends in nursing
Nursing Informatics
Is a specialty that integrates
nursing science, computer science
and information science in
identifying, collecting, processing
and managing data and
information to support nursing
practice, administration,
education, research and the
expansion of nursing knowledge
 Nursing Informatics
Goal: is to improve the health of populations,
communities, families and individuals
by optimizing information management
and communication. This includes:

Using technology in the direct provision of health

care
Establishing administrative systems
Managing and delivering educational experiences
Supporting life-long learning and
Supporting nursing research.
Filipino Bill of Rights
1. The patient has the right to considerate &
respectful care, irrespective of socio-
economic status.

2. The patient has the right to obtain from

his physician complete current information
concerning his diagnosis, treatment and
prognosis in terms the patient can
reasonably be expected to understand.
3.The patient has the right to receive from
his physician information necessary to give
informed consent prior to start of any
procedure and or treatment.

4.The patient has the right to refuse

treatment / life- giving measures, to the
extent permitted by law and to be
informed of the medical consequence of his
action.
5. The patient has the right to every
consideration of his privacy concerning his
own medical care program.

6. The patient has the right to expect that all

communication and records pertaining to
his care should be treated as confidential.
7.The patient has the right that within its
capacity, a hospital must make
reasonable response to the request of
patient for services.

8.The patient has the right to obtain

information as to any relationship of the
hospital to other health care and to other
health care and educational institutions
in so far as his care is concerned.
9.The patient has the right to be advised if
the hospital proposes to engage on or
perform human experimentation affecting
his care or treatment.

10.The patient has the right to expect

reasonable continuity of care; he has the
right to know in advance what
appointment times the physicians are
available and where.
11.The patient has the right to examine and
receive an explanation of his bill regardless
of source of payment.

12.The patient has the right to know what

hospital rules and regulations apply to his
conduct as a patient.
DOCUMENTATION

.also referred to as charting

.involves entering data in the clients record
.requires the use of clear and complete words
.the clients chart is owned by the
hospital/institution
 Purposes of documentation
1. Communication- ensures continuity of
care
2. Education- enhance students learning
thru review of clients records
3. Research-serves as data source of
researchers
4. Legal documentation- serves to provide
proof what exactly happened to a
patient
5. Auditing-Monitoring- used to determine
the degree to which nursing care
standards are met
 Characteristics of good
documentation
1. Factual- Contains descriptive,
objective information

.Incorrect: The client has fever

.Correct: The client says, Im
beginning to hear voices
again.
2. Accurate- uses clear and exact
measurements
Incorrect: The client has fever
Correct: The client has an oral
temperature of 38.6 degree Celsius
3. Complete- Includes updated chart
entries based on the facilitys
standards
ex.7:30 a.m. client verbalizes chest pain
described as pressing client rates pain as
7 on a scale of 0-10.Nitroglycerine 10mg
PRN, administered. Client verbalizes pain
relief after 10 min, rates pain as 0 on a
scale of 0-10.Physician notified.
4.Current- Includes updated chart entries
based on the facilitys standards
5. Organized -contains data categorized or
organized in a local manner
ex. SOAP
6. Properly signed-includes nurses full named
and credential

7. Properly corrected errors- corrected data

entries are properly labeled
ERROR
Common record-keeping form
Admission nursing history forms
-guides the nurse to facilitate
assessment and identification of
nursing diagnosis

Flow sheets- enable health team

members to assess clients status and
treatment (e.g
vs,weight,measurements)
2. Kardex - contains routine information on
the clients activity and treatment

3. Acuity records- guide for determining the

duration of care and the number of
staff needed to provide care to group of
clients
4. Standardized care plans- facilitates the
establishment of guidelines which are
used for clients with similar health
problems
5. Discharge summary forms- provides a
summary of instructions for the client and
family, on various aspects of the clients
health status
Methods of Documentation
1. Narrative Charting- descriptive account
written chronologically in paragraphs that
contains details of:

a. the clients condition

b. interventions and treatments
c. the clients response to
treatments
2. Source oriented charting- narrative
recording of each member of the health
team using separate sheets

3. Problem-oriented charting- Logical method

of documentation composed of:
1. Database
2. problem list
3. Plan of care
4. Progress notes
can be written in SOAP, SOAPIE ,or SOAPIER
6. Charting by exception- narrative form of
charting in which only the significant findings
are documented

7. Computerized charting-Utilizes nursing

information system the facilitates documentation
thru the use of computers
8. Point-of-care-charting- A portable bedside
computer facilitates immediate input and
retrieval of client data