COMPILATION OF BIOETHIC

OBJECTIVES
*At the end of the course, the student will:
*1. Demonstrate the ability to relate knowledge of social, natural, health science and
humanities in the practice of nursing and health-related situations.
*2. Demonstrate sensitivity for ethical considerations in dealing with individuals or groups on health
issues and in engaging with processes and activities in healthcare delivery and health development. 

*3. Display the behaviors and attributes worthy of a healthcare professional.

 Definition of Terms
Ethics-the branch of knowledge that deals with moral principles."neither metaphysics nor
ethics is the home of religion”
 moral principles that govern a person's behavior or the conducting of an activity.
Biology -he study of living organisms, divided into many specialized fields that cover their
morphology, physiology, anatomy, behavior, origin, and distribution.
BioEthics-is the study of the ethical issues emerging from advances in biology and medicine. It
is also moral discernment as it relates to medical policy and practice. Wikipedia
Health Ethics-promotes the consideration of values in the prioritization and justification of
actions by health professionals, researchers and policymakers that may impact the health and
well-being of patients, families, and communities.
Professional Ethics -are principles that govern the behaviour of a person or group in a business
environment. Like values, professional ethics provide rules on ..
 Bio –life

BIOETHICS Ethos –deals with morality of human conduct

defined by Merriam-Webster, is
"a discipline dealing with the ethical
implications of biological research and
applications especially in medicine."
It comprises the basic principles that
govern nurses and is helpful in guiding
how to approach and engage patients,
especially when difficult decisions about ...
 BIOETHICS
 Is a discipline that deals with the ethical implications of biological research .
(www.biotech.ca/EN/glossary.htm)
 Is the study of ethical issues that emanate from the changes and developments in the
life science technologies (www.bcs.org/onco/glossary.htm)
 It is a branch of ethics that deals with the life sciences and their impact in society.
 It is a branch of ethics that analyzes moral values in the context of biomedical sciences(
www.wordnet.Princeton.edu/pert/webwn)
 Cont’
 It is a branch of the ethics of biological science and medicine
(www.en.Wikipedia.org/wiki/Bioethics)
 It is a systematic study of the human conduct in the areas of the life sciences and health
care(Miranda,pagkamabuhay.1994:19 )
 It belongs to the auspices of medical ethics and is loosely anchored in the avenues of life
sciences(Babor,Ethics.2006:252-253;and
 It is the study of the moral problems in medicine and biological technology
(htpp:/www.cuw.ed/Academics/institutes/pdfs/defending_defenseless.pdf)
 Health Care Ethics 
 is the branch of ethics that deals with ethical issues in health, health care, medicine and
science. It involves discussions about treatment choices and care options that.
individuals, families, and health care providers must face.
WHAT IS HUMAN BEINGS?
From the Bible:
 The Supreme Court can define "person" to include all human beings, born and
unborn. ... The legal test used to extend constitutional personhood to corporations,
which are artificial "persons" under the law, is more than met by the unborn,
demonstrating that the unborn deserve the status of constitutional personhood.
 The human is person because God is person. It is apparent in Christian claims that the
concept of the human as “being-as-person” is the real seal of that human as “being-as-
the-image-of-God,” and therein lies the true nobility that distinguishes human
beings from all other creatures.
 5 Principles of Bioethics
 1. Non-Malfeasance= Do NO Harm!! Cause no needless harm or injury according to
reasonable standards of performance.
 Observe DUE CARE . This does not mean that there must be no risk of injury but only
that there be no more than acceptable risks.
 n criminal court, malfeasance can apply to cases that cause financial damage or physical
injury to another person. For example, medical malpractice is an act of
criminal malfeasance. If someone died after poor treatment by a licensed doctor, the
doctor can be charged in criminal court for negligent homicide.
 2. Beneficence
 Promote the welfare of others. This is inherent in the relationship of a health care
provider (HCP) and the recipient of care.
 The principle of beneficence is the obligation of physician to act for the benefit of the
patient and supports a number of moral rules to protect and defend the right of others,
prevent harm, remove conditions that will cause harm, help persons with disabilities,
and rescue persons in danger
 E.g. the doctor-patient relationship. However, what exactly is the duty of the HCP?
 An example of a nurse demonstrating this ethical principle is by holding a dying patient's
hand
 two components of the principle of beneficence?
 The principle of beneficence is a moral obligation to act for the benefit of others.
There are 2 aspects of beneficence:
 Balancing benefits and
risks/harms.
 3. Utility
*Attempt to bring about the greatest
amount of benefit to as many people
involved as is possible and consistent
with the observance of other basic moral
principles. Greatest Benefit and Least
harm.
 4.Distributive Justice-
 All involved should have equal entitlements, equal access to benefits and burdens.
Similar cases should be treated in a similar fashion. People should be treated alike
regardless of need, contributions or effort.
The formal principle of Justice as Fairness (Rawls’ Theory) similar cases are to receive the same
treatment. However, in what ways are the cases similar? In what relevant ways? Equal in need?
Equal in contributions to society? to the Health Care institution? Equal in effort?
 V. Autonomy
 People are rational, self -determining beings who are capable of making judgments and
decisions and should be respected as such and permitted to do so and supported with
truthful and accurate information and no coercion.
 They should have their decision making and actions: a) free of duress of any type, (b)
based upon options that are clearly explained and that are genuine possibilities and (c)
given the information needed for decision making.
There are four principles cited to justify restrictions
on AUTONOMY
 1. HARM Principle- stop an individual whose autonomy is restricted or violated from
causing harm to others
 2. PATERNALISM Principle-  There are two forms:
a. Weak -to stop a person whose autonomy is restricted or violated from self- harm
b. Strong -to benefit the person whose autonomy is restricted or violated
 3. LEGAL MORALISM Principle- legislated morality
 Acts of legislation impose restrictions upon all, presumably for the benefit of all
 4. WELFARE Principle- restrictions or violations of the autonomy of an individual for the
benefit of all.
 EXAMPLES: Harm- if a person has a highly contagious and life threatening disease that
person could be confined against that person's will
 Examples
 EXAMPLES:
 Harm- if a person has a highly contagious and life threatening disease that person could
be confined against that person's will
 Paternalism-weak- a person attempting suicide by ingesting poison could have the
stomach cleared of the poison in the ER even though refusing treatment.
 Paternalism-strong- a 22 year old person could have a gangrenous leg amputated even
against a refusal of treatment.
 Legal Moralism - children can be inoculated against disease despite their refusal and
that of their parents.
 Welfare- a person with a rare anti-body to a deadly incurable disease threatening the
general population could be made to give a specimen of their blood or bone marrow or
other tissue for the sake of the benefit of the entire society.
 4 Ethical rules covers the following:
 1. Veracity – telling truth, respecting autonomy and informed consent.
 2. Privacy – it's the right of person to remain private and not to disclose information.
 3. Confidentiality – this is sharing private information on a 'need to know basis' only.
 4. Fidelity – is maintaining the duty to care for all no matter who they are or what they
may have done.
 PATIENT’s RIGHT
 Patient’s Right means the moral and inviolable power vested in him as a person to do,
hold , or demand something as his own.
1. Right to Self-Determination –related to the principle of autonomy which states that a
patient ,as an autonomous individual , has the moral right to determine what is good for
himself , usually upon the advice of a health care professional . One is in charge of himself , of
his direction in life , and this responsibility is every individual’s task that should not not be left
to the stars or to the blind forces of nature.
 Right to Informed Consent
 Right to Informed Consent – the patient has the right to receive all necessary
information concerning diagnosis and treatment in order to be able to give consent
based on his sense of values. “Informed consent” refers to the knowledge or
information about , and the consent to, a particular form of medical treatment , before
that treatment is administered . The information should include the risks , expenses ,and
advantages of any medical treatment that concerns the patient.
4 elements of the patient’s consent must be observed:
a. Competence. B. disclosure. C. comprehension D. voluntariness
 2 ways of obtaining informed consent
 1. Written Consent –is a consent form to be filled up and signed by a patient as he
checks in for admission in a hospital.
2. Verbal consent – whenever the patient verbally signifies his willingness to undergo medical
treatment ,informed consent is met . Verbal consent is usually made after a physician ha
briefed the patient ( together with the nearest of kin , if any) about medical process to be
undertaken.
 Right to Informed Decision
 Refers to the necessary information of and decision on , a medical treatment before it is
to be carried out . Information and understanding are necessary for genuine
deliberation. The patient must be informed about the whole process and must
understand what this information pertains to so that an appropriate moral decision can
be arrived at.
In emergency cases, however , the following types
of patient need NOT require informed consent:
 1. Comatose or obtunded patients,
 2. blind or illiterate patients
 3. underage patients , or those unable to understand the circumstances
 4. language-barrier patients
 Right to Informed Choice
 Refers to the necessary information a patient should know about a medical treatment or
experiment so that a moral choice can be made . The patient has the right to be
informed about all possible alternative course of action ( or other forms of treatment) to
be taken , with the possible consequences.
 Right to Refusal of Treatment
 The patient has the right to refuse medical treatment because his religious convictions
prohibit him from doing so .Many regard the right to refuse treatment as fundamental
in a free society,especially among those who advocate the freedom or right to die if and
when the prevailing circumstances warrant it . Moreover, the invasion of a patient ‘s
body without valid consent is an assault and health care professionals maybe subjected
to legal sanctions.
 In the International Council of Nurses Code of Ethics, it is specifically provided: ” in
providing care ,the nurse promotes an environment in which the human
rights,values,customs and spiritual beliefs of the individual,family ,and community are
respected” (
 Limitations of a Patient’s Rights
1.Patient’s rights do not include the right to be allowed to die.
Ex: It is the sworn duty of the attending physician to do whatever is medically possible to save
the patient’s life.
2. A patient in a moribund condition does not possess the necessary mental capacity or
emotional stability to make an informed choice. A dying patient ,or one who lapses into
unconsciousness , becomes mentally incompetent to make a decision.
3. Patient’s right are not absolute . Paternalistic concern limits the competent or capable
patient’s freedom of choice( e,g refusal of treatment ) for his good in order to prevent harm
from befalling that patient .Moreover ,this precept is enshrined in the Hippocratic Oath: I will
apply dietetic measures for the benefit of the sick according to my ability and judgement; I will
keep them from harm and injustice.
 The Rights of Patients
( 12 Rights)
 1. The patient has the right to a considerate and respectful care.
 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 the start of any procedure and/ or treatment.
 4.The patient has the right to refuse treatment to the extent permitted by law and to be
informed of the medical consequences of the action.
 The Rights of Patients
( 12 Rights)
 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 circumstances and records pertaining to his
case should be treated as confidential.
 7. The patient has the right to expect that within its capacity ,the hospital must provide
a reasonable response to his request for services.
 8. The patient has the right to obtain information regarding any relationship of his
hospital to other health care and educational institutions in so far as his care is
concerned.
 9. The patient has the right to examine and receive an explanation of the hospital bill ,
regardless of the source of payment.
 The Rights of Patients
( 12 Rights)
 10. The patient has the right to be advised if the hospital proposes to engage in or
perform human experimentation affecting his treatment . The patient has the right to
refuse to participate in such research projects.
 11. The patient has the right to expect reasonable continuity of care .( The patient has
the right to know in advance what appointment schedules and physicians are available
and where.)
 12.The patient has the right to know what hospital rule and regulations apply to his
conduct as a patient.
What. Is paternalism?
( Latin Pater ‘ Father” & paternus “ Fatherly”
 Means the act of being fatherly to someone ,as if the latter were one’s own child or
sibling .The health care professional performs a paternalistic act or intervention by
acting or deciding for and in behalf of the patient for the latter’s well-being.
 In the application in the medical context:
a. Personal paternalism is one in which an individual decides on the basis of one’s best
knowledge of what is good for another person.
b. State paternalism refers to the control exerted by the legislature ,an agency ,or other
governmental bodies over particular kinds of practices and procedures in medicine.
Justifications for personal Paternalism
 1. The patient is sick and consults the health care professional seeking medical expertise
and assistance.
 2. The patient has some incapacity which prevents him from making a decision ; in other
words ,the patient is not mentally competent to make an autonomous choice.
 3. To the best health care professional’s knowledge and training ,there is probability of
greater harm unless a paternal decision is made ; here one needs to determine if all
harms are equal(e.g., physical, mental , and social)
 4. The probable benefit of paternal intervention outweighs the probable risk or harm
from noninterference.
 5. The health care professional has an obligation to act in the best interest of the
patient.
 6. The patient upon consulting the health care professional voluntarily transfers part of
his autonomy to the latter based on faith & trust in the health care professional.
 Justifications for State paternalism
 1. To improve the good quality of medical education (e.g., issuing a set of policies or
practices ,national guidelines for biomedical and behavioral research).
 2. To upgrade a high standard of medical or health care(e.g., rigorous standard and strict
law & to improve and enhance medical practice.)
 3. To control drug addiction ,other drug abuses,or the spread of AIDS and other sex-
related disease.
 4. To set a high standard of medical policies and practices that will emulate medicine as
a respectable and honorable profession.