BIOETHICAL

PRINCIPLES
OBJECTIVES

1. Discuss different bioethical principles.

2. Explain the importance of Bioethics in Health
Care.
3. Apply bioethical principles in the care of clients.
INTRODUCTION:

 In health care delivery, basic ethical

principles assist the health professionals to
determine right or wrong in regard to value
issues involving the pursuit of health,
alleviation of suffering, and assisting
patients towards peaceful death.
BIOETHICS, defined:

 Ethics as applied to life

 It is a living science/study of the conduct of life.
 Also known as applied or practical ethics
 It relates to ethical issues that are raised because of
new technological developments in medicine and
biological sciences
ETHICAL DILEMMA

The choice between two or more equally

justifiable alternatives.
When there is only one course of action or when
conflict does not exist there is no ethical
dilemma.
Bioethical Principles

Bioethical principles are derived from ethical theories.

1. Autonomy 6. Veracity
2. Paternalism 7. Fidelity
3. Beneficence 8. Privacy and Confidentiality
4. Nonmaleficence 9. Stewardship and accountability
5. Justice 10. Respect for life/person
AUTONOMY

 From the Greek word “autos” meaning self

and “nomos” meaning governance
 It involves self-determination and
freedom to choose and implement one’s
decision, free from deceit, duress,
constraint or coercion.
Violations:

1. Actions that constrain a person’s capacity to

make decision
2. Actions that constrain a persons capacity to act
according to his decision
Non-violations

1. Waiver of consent
2. Delegation of authority to others
3. Paternalism/parentalism, in case competence to give
consent is absent /reduced and the procedure is
necessary to save the persons life
4. Person’s autonomy competes with or is overruled by
the principle of non-maleficence of other persons
(Harm Principle).
5. Required by Law or With Court order
RULES FOR THE HEALTH WORKERS

1. Provide client with information necessary to weigh benefits

and risks
2. No coercion, manipulation, undue influence or irrational
persuasion
3. Respecting the patient’s autonomous choice
4. Withdrawing from the case and helping the patient look for
another health professionals who might be more successful
in this situation when health professional feels it is
impossible to help the patient
INFORMED CONSENT

 Informed Consent/Enlightened Consent:

 One given prior to any substantial intervention or research,
where the clients concerned must have full information of what
the procedure is all about, the objectives, need, risks and
advantages of such procedure
 Implied Consent - an assumption of permission to do something
that is inferred from an individual's actions rather than explicitly
provided.
 Surrogate Consent-Someone decides in behalf of the patient
Paternalism / Parentalism

1. When the patient is in coma, unconscious or incapable of making a

decision, those closest to him such as the family or relatives may decide for the
best benefit of the patient

2. In instances when there are no close relative and decision must be made, the
health professionals with honest desires and intentions to give the best strategy or
intervention to the patient may decide for the patient (Advocacy Role for the best
outcome of the patient).

3. In case ofminority , parents and the family of the patient will assume the patient’s
autonomy and make the decision which should always be the best for the patient
BENEFICENCE

 It refers to a moral obligation to do good

and act for the benefit of others
 To prevent evil or harm/ To remove evil or harm/
To do or promote good
BENEFICENCE

 BENEFICENT RULES*:
1. Protect and defend the rights of others (Right to know what the
surgery is all about/ Right to refuse tx)
2. Prevent evil or harm from occurring to others (Eg. Use of double
gloves in caring for AIDS patients/Placing siderails)
3. Remove conditions that will cause harm to others (Eg. Removing
pills, sharp objects, hazardous materials when caring for mentally
ill)
4. Help persons with disabilities (Eg. Guide and hold hands of the
blind or deaf individual) crossing the street
5. Rescue persons in danger
* From the Principles of Biomedical Ethics, 1994
NON-MALEFICENCE

 Obligation not to inflict harm intentionally

 “Primum Non nocere”-above all do no harm to anyone
 EXAMPLES OF NONMALEFICENCE
1. Do not kill
2. Do not cause pain or suffering to others
3. Do not cause offense to others
4. Do not incapacitate others
5. Do not deprive others of the goods of life
VIOLATIONS/NON VIOLATION of the PRINCIPLE
of NONMALEFICENCE

Violations:
 Physically harming a person
 Exposing a person to physical harm
 Harming a person’s reputation, honor, property or interest
Non-violation:
 The principle of double effect justifies some actions as non-
violation of the principle of Nonmaleficence
Principle of Double Effects

 Applies when a nurse is faced with a situation that has both

good and bad effects.
 Requisites:
1. The action must be morally good
2. The good effect must be willed and the bad effect merely allowed
3. The good effect must not come from an evil action but from the
initial action itself directly
4. The good effect must be greater than the bad effect
Beneficence vs. Nonmaleficence

 Similarities:
1. Both orient its focus of action on doing good to
others

2. Both are turned altruistically to act on kindness

towards self and others
Beneficence vs. Nonmaleficence

 Difference: lies on the nature of execution

1. Beneficence starts with prevention that no harm will
happen to anyone-physical, emotional, psychological
and spiritual sense, WHEREAS,
2. Nonmaleficence focuses mainly on the subject of not
inflicting harm
JUSTICE
 JUSTICE means giving each one his due
 What is due an individual is determined by either or
both of the following:
1. Criterion of what he deserves by right independent of
the claims of others (Non-comparative Justice) e.g. Right
to life; and
2. Balancing of competing claims of others against an
individual’s claim according to some morally relevant
property or merit (Comparative Justice) eg. Donation of
an organ to the one who needs most
JUSTICE

 The terms fairness, desert and entitlement have

been raised in an attempt to explain the term justice

 INJUSTICE involves a wrongful act or omission that

denies people benefits to which they have a right or
failure to distribute burdens
VIOLATIONS of the PRINCIPLE OF JUSTICE

1. Denying or withholding a benefit to which a person has a

right (e.g. Denying use of medical facility)
2. Distributing a minimum health benefit unequally (eg. Giving
health care to those who voted for a certain government
official)
3. Imposing an unfair burden on an individual (eg. Health
professional charges poor patient more than rich patients)
TYPES of JUSTICE

1. Distributive Justice*
 It refers to fair, equitable and appropriate distribution of
responsibilities, or share of rights and roles
 Fair scheme of distributing society’s benefits and burdens to its
members
2. Criminal Justice
 It refers to the just infliction of punishment, or to penalty commensurate
with the crime committed
3. Rectificatory Justice
 It refers to just compensation for transactional problems such as
breaches of contracts and practice based on civil law
NON-VIOLATION of the PRINCIPLE OF JUSTICE

1. Patient chooses to give-up what is due (e.g. Waiver of the right to

be informed)
2. Patient loses his right to what is due (e.g For failure to pay health
insurance premium, patient loses the right to avail of free check-
up)
3. Patient chooses to accept an additional burden (e.g. One
volunteers to be a research subject for study not directly
beneficial to him)
4. When what appears to be an unjust outcome results from a just
process (e.g. lottery which benefited rich recipient)
ROLE of the HEALTH PROFESSIONAL

1. Give each patient what is due: the available care he needs,

information and confidentiality
2. Provide equal health care without discrimination
3. Work towards just health care facilities according to their
needs
4. Avoid giving undue burden to individuals
VERACITY or TRUTH TELLING

- Veracity in its basic meaning is TRUTHFULNESS.

 To respect veracity in relationship is to deal honesty
with patients and colleagues
 With VERACITY goes CANDOR (frankness) and
TRUTHFULNESS, and these are the widely-praised
character traits of health professionals.
THREE REASONS why VERACITY is NECESSARY in
PROFESSIONAL-PATIENT RELATIONSHIPS

1. The obligation of veracity is based on RESPECT OWED TO

OTHERS;
2. Veracity has a close connection to obligations of FIDELITY
and PROMISE KEEPING
3. Relationships of trust between persons are necessary for
fruitful intervention and cooperation. At the core of these
relationship is CONFIDENCE IN and RELIANCE on others to
be TRUTHFUL.
TRUTH-TELLING

 Every competent person has a right to information

about himself or herself and about what is planned
for him or her. All information must be disclosed so
that correct decisions are arrived at both for the
moment and for the future.
 General Rule: TRUTH TELLING [then] is the right of
every individual to know what the information is all
about for him or her.
TRUTH-TELLING

Exception to the rule of truth-telling:

1. TT will harm the patient

2. TT will harm others
 because the coping mechanisms to accept the facts are weak
 Family’s orientation to illness (family members is often
informed first b-4 the patient)
 Non-confrontational attitude
PRIVACY

 It is individual’s control over access to himself or herself extending

to (1) physical or (2) informational inaccessibility
 In hospital settings, “respect for patient’s privacy” oftentimes
alludes to territorial inaccessibility and non-exposure to others as in
screening the patient’s territorial area when giving health care.
 Likewise, discussing the patient’s case publicly, as in nursing
students’ round w/o asking the patient’s permission that his or her
case will be discussed for the betterment of his or her health care
management, is trespassing the patient’s privacy.
CONFIDENTIALITY

Keeping in confidence all that one has learned in

the course of caring for the patient & the family.
 Infringement of Privacy (IP) vs. Infringement of Confidentiality
(IC)
 IC occurs only if the person to whom the information is disclosed in
confidence fails to protect the information or deliberately discloses it
without consent, WHEREAS; IP occurs when a person, without
authorization, obtain information/data about other persons
 IC is limited only on informational matters, WHEREAS; IP includes both
informational, physical or territorial matters
FIDELITY

 It is the obligation to
1. act in good faith;
2. keep vows and promises,
3. fulfil agreements,
4. maintain relationships and fiduciary responsibilities.

 ABANDONMENT is a breach of fidelity, and infidelity amounting to

disloyalty (Council on Ethical and Judicial Affairs on Health Care [1992])
STEWARDSHIP & ACCOUNTABILITY

Stewardship is caretaking or administering

goods or services according to the will of the
owner of the goods or services
Only creator has the absolute dominion over creation
STEWARDSHIP & ACCOUNTABILITY

 It is a principle which says that human body and soul is owned by

God, hence the former should take care of it as
manager/caretaker/steward.
 Human as such, is accountable to his Creator
 E.g.: Suicide and other self-directed harms are violations of this
principle; A person who did not give in to donation of an organ
because he believed that he has to take care also of himself in the
name of God.
RESPECT FOR LIFE / OTHER

 Respect is the regard and esteem one has for a person of dignity
 Accordingly, this is the highest principle and incorporates all other
principles
 Respect for life is integrated in all stages of life from conception to
death because bioethics is the living study of how human being
conduct his life.
 General Ethical Principle
REFERENCES:

 Venzon, Lydia M. 2010. Nursing Practice in the Philippines.

 Evangelista, Maria Loreto J. 2008. Midwifery Law and Ethics 2nd Edition