week 2

autonomy, beneficence, non maleficence, justice

4 core principles

a. Respecting patient right to make their own decisions

b. Acting in the best interest of the patient

c. Do no harm

d. Fair distribution of healthcare resources

contraception, abortion, artifical reprod

3 issues under sexuality and human reprod

autonomy and non-maleficence

EUTHANASIA & ASSISTIVE SUICIDE Balancing

Genetic testing ➔ CRISPR and gene editing ➔ Reproductive tech

Nurses and healthcare providers must be knowledgeable about: 3

risks and benefits

Important: Engage in informed discussion with patient and family about

ai, m health app, telemed, wearable iot

DIGITAL HEALTH & TECHNOLOGY 4 issues

Maternal/fetal conflict ➔ Insurance coverage decisions ➔ Patient privacy vs Public Health needs ➔ Cost effectiveness vs optimal care

HEALTHCARE MANAGEMENT ISSUES: RESOURCE ALLOCATION & PUBLIC HEALTH 4

sexuality, end of life care, biological, digital, resource allocation, informed consent, res ethics

KEY AREAS WHERE BIOETHICS IS APPLIED 7

compassionate care, advocate

ROLE OF HEALTHCARE PROFESSIONALS 2

legal contract, social institution, interpersonal commitment

marriage as 3

civil, religious, customary

Types of Marriage 3

Emotional support ➔ Sexual intimacy ➔ Procreation/childbearing ➔ Economic partnership ➔ Social recognition

Functions of Marriage 5

Mutual respect ➔ Communication ➔ Consent ➔ Commitment ➔ Conflict resolution ➔ Shared responsibility

CORE ELEMENTS IN HEALTHY MARRIAGES 6

pro choice, religious,public health ethics

3 ETHICAL PERSPECTIVES

dignity

being worthy and noble

dying with dignity

dying comfortably, respectfully, and according to one’s wishes

INVIOLABILITY OF HUMAN LIFE

Human life is sacred and should not be unlawfully ended; it must be treated with respect.

PROLONGATION OF LIFE

Treatment that extend life

DYSTHANASIA

Prolonging the dying process against the patient’s best interest through using “heroic” or artificial means

Euthanasia

Act of ending a life that is believed to be suffering

ACTIVE EUTHANASIA

Deliberate action to cause death (ex: lethal injection) Usually voluntary

PASSIVE EUTHANASIA

Withholding / withdrawing life-sustaining treatment Can be voluntary or non-voluntary

voluntary euthanasia

Patient explicitly requests it

NON VOLUNTARY

Patient cannot consent (ex: unconscious)

INVOLUNTARY

Against patient’s will no - ethically unacceptable

assisted suicide

px performs the final act

a. hc provider

b. doctor

c. highly controversial, illegal

euthanasia

a. who administer

b. control

c. ethical debate

a. px

b. px

d. legal in some death w dignity laws

assisted suicide

a. who administer

b. control

c. ethical debate

orthonasia

normal or natural manner of death and dying. It: ● Denotes deliberately stopping artificial or heroic means of maintaining life ● Is equivalent to passive euthanasia in some contexts

neither prolonging death (dysthanasia) nor hastening it (euthanasia)

orthonasia golden mean

palliative care

practice of relieving distress in terminally ill person during the last hours/days of life, usually via:

Advanced Directives

are legal documents allowing you to specify end-of-life care decisions ahead of time. They: ● Give you a way to tell family, friends and healthcare professionals your wishes ● Avoid confusion during crises ● Include living wills, durable power of attorney for healthcare, and DNR orders

DNR Order

medical order instructing healthcare providers not to perform CPR if the patient’s heart stops or breathing ceases

expected to die within 12 months ;

When does End-Of-Life Care Begin

Living Will

legal document stating future healthcare decisions only when a person becomes unable to make decisions on their own

maintain humanity, opt to restore control, pain relief, adv directives, treated w compassion

A dying person has the right to 5

RES IPSA LOQUITUR

"The thing speaks for itself"

1. That the accident was of a kind which does not ordinarily occur unless someone is negligent.

2. That the instrumentality or agency which caused the injury was under the exclusive control of the person charged with negligence. 3. That the injury suffered must not have been due to any voluntary action or contribution from the injured person.

RES IPSA LOQUITUR application 3

FORCE MAJEURE

Provides that no person shall be responsible for a fortuitous event (i.e., events that could not be foreseen, were inevitable). ★ This may refer to natural occurrences such as floods or typhoons, or "an act of man," such as riots, strikes, or wars

RESPONDEATE SUPERIOR

Embodies the general rule that an employer is responsible for the negligent acts or omissions of its employees.

CAPTAIN OF THE SHIP

surgeon is likened to the captain of the ship, and it is his or her duty to control everything that is going on in the operating room. ★ Liability is imposed by virtue of the surgeon's status,

DAMNUM ABSQUE INJURIA

This doctrine states that, although there was physical damage, there was no legal injury. ★ The victim is not entitled to recover damages or compensation for the loss or injury.

APPARENT AUTHORITY OR ESTOPPEL

This doctrine is a species of the doctrine of estoppel

Article 1431 of the Civil Code

“Through estoppel, an admission or representation is rendered conclusive upon the person making it, and cannot be denied or disproved as against the person relying thereon.”

GOOD SAMARITAN

Offers legal protection to people who give reasonable assistance to those who are, or whom they believe to be, injured, ill, in peril, or otherwise incapacitated.

CONTRIBUTORY NEGLIGENCE

This is a common defense in medical malpractice cases. ★ When the doctor or another medical professional provides substandard care that directly results in serious injury to a patient, but the patient, through his/her own acts, also contributed to his/her own injury, the liability of the health provider may be reduced.

Contributory negligence

is negligent conduct on the part of the patient that contributed to harm him- or herself and that was below the required standard necessary for patients to protect their own safety

IN PARI DELICTO / DELICTUM

This is the descriptive phrase that indicates that parties involved in an action are equally culpable for a wrongful act.

ASSUMPTION OF RISK OR WAIVER

In medical malpractice suits, the defense might try to prove that the doctor is not liable for any injury or damage sustained by the patient because the patient consented to the procedure and understood the risks involved

epikeia

It simply means that there is an exception to the general rule. ★ This doctrine provides excuses for errors committed if it serves the best interest of the patient.

TOTALITY

that all decisions in medical ethics must prioritize the good of the entire person, including physical, psychological, and spiritual factors.

DUE PROCESS

Is a requirement that legal matters shall be resolved according to established rules and principles, and that individuals shall be treated fairly.

golden rule

This is the principle of treating others as you want to be treated. ★ It is a maxim that is found in many religions and cultures.

felony

Act or omission punishable by law (delitos) ➔ Committed not only by means of deceit (dolo) but also by means of fault (culpa)

deceit, fault

There is — when the act is performed with deliberate intent, and there is — when the wrongful act results from imprudence, negligence, lack of foresight, or lack of skill

offense

Crimes punishable under special laws (dangerous drugs act, law on anti-violence on women and children)

MISDEAMEANOR

Crimes punishable under special laws (dangerous drugs act, law on anti-violence on women and children)

tort

Act or omission that gives rise to injury or harm to another, and amounts to a civil wrong for which courts impose liability

dolo, culpa

2 class of felonies

DOLO OR DECEIT

There is deceit when the act is performed with deliberate intent.

CULPA OR FAULT

There is fault when the wrongful act results from imprudence, negligence, lack of foresight, or lack of skill.

consummated, frustrated, attempted

felony ACCORDING TO THE STAGES OF EXECUTION: 3

consummated

when all the elements necessary for its execution and accomplishment are present.

frustrated

offender performs all the acts of execution which would produce the felony as a consequence, but which nevertheless do not produce it by reason of causes independent of the will of the perpetrator

attempted

offender commences the commission of a felony directly by overt acts and does not perform all the acts of execution which should produce the felony by reason of some cause or accident other than his own spontaneous desistance.

Grave Felony

Those to which the law attaches the capital punishment or penalties which in any of their periods are afflictive, in accordance with Article 25 of the Revised Penal Code.

Less Grave Felony

Those which the law punishes with penalties which in their maximum period are correctional, in accordance with the above-mentioned article

Light Felony

Those infractions of law for the commission of which the penalty of arresto menor or a fine not exceeding 200 pesos, or both, is provided.

principal, accomplice, accessory

According to the Degree of Participation 3

principal

Those who take a direct part in the execution of the act. ● Those who directly force or induce others to commit it. ● Those who cooperate in the commission of the offense by another act without which it would not have been accomplished.

accomplice

one who directly participates or cooperates, but such participation or cooperation is not vital nor invisible to consummating the criminal act. The crime is committed either before or simultaneous with the principal act.

accessory

having knowledge of the commission of the crime, and without having participated therein either as principals or accomplices, take part subsequent to its commission

● Justifying Circumstances

● Exempting Circumstances

● Mitigating Circumstances

● Aggravating Circumstances

● Alternative Circumstances

CIRCUMSTANCES AFFECTING CRIMINAL LIABILITIES 5

Art. 147 – Illegal Associations

● Art. 172 – Falsification by Private Individual and Use of Falsified Documents

● Art. 174 – False Medical Certificates, False Certificates of Merit or Service

● Art. 175 – Using False Certificates

● Art. 180 – False Testimony Against a Defendant

● Art. 181 – False Testimony Favorable to the Defendants

● Art. 182 – False Testimony in Civil Cases

● Art. 183 – False Testimony in Other Cases and Perjury in Solemn Affirmation

● Art. 184 – Offering False Testimony in Evidence

● Art. 210 – Direct Bribery

APPLICABLE CRIMES UNDER THE REVISED PENAL CODE Articles 147–210

147

172

174

175

180

181

182

183

184

210

● Art. 211 – Corruption of Public Officials

● Art. 217 – Malversation of Public Funds or Property; Presumption of Malversation

● Art. 246 – Parricide

● Art. 248 – Murder

● Art. 249 – Homicide

● Art. 253 – Giving Assistance to Suicide

● Art. 255 – Infanticide

● Art. 256 – Intentional Abortion

● Art. 257 – Unintentional Abortion

● Art. 258 – Abortion Practiced by the Woman Herself or by Her Parents

● Art. 259 – Abortion Practiced by the Physician or Midwife and Dispensing of Abortives

● Art. 263 – Serious Physical Injuries

● Art. 264 – Administering Injurious Substances or Beverages

● Art. 265 – Less Serious Physical Injuries

● Art. 266 – Slight Physical Injuries and Maltreatment

● Art. 267 – Kidnapping and Serious Illegal Detention

● Art. 268 – Slight Illegal Detention

211

217

246

248

249

253

255

256

257

258

259

267

268

Art. 275 – Abandonment of Person in Danger of One’s Own Victim

Art. 276 – Abandoning a Minor

● Art. 277 – Abandonment of Minor by Person Entrusted with His Custody; Indifference of Parents

● Art. 278 – Exploitation of Minors

● Art. 285 – Light Threats

● Art. 286 – Unjust Vexation

● Art. 335 – Rape is committed by having carnal knowledge of a woman under any of the following circumstances:

● Art. 336 – Acts of Lasciviousness

● Art. 347 – Simulation of Births, Substitution of One Child for Another and Concealment or Abandonment of a Legitimate Child

● Art. 353 – Libel

● Art. 358 – Slander

● Art. 359 – Slander by Deed

● Art. 360 – Persons Responsible for Libel

● Art. 361 – Proof of the Truth

● Art. 365 – Imprudence and Negligence

275

276

277

278

285

286

335

336

347

353

358

359

360

361

365

Negligence

Latin: negligentia ● failure to exercise appropriate and/or ethical care expected to be exercised in specified circumstances.

1. Duty

2. Breach of Duty

3. Resulting Injury, Harm, or Death

4. Causal Relation between the breach of duty and the resulting harm

To determine negligence, there must be the concurrence of four elements: 4

Assault 2. Battery 3. Fraud

3 other rel crimes

delegation

is defined as the transfer of the nurse's responsibility for the performance of a task to another nursing staff member while retaining accountability for its outcome. Responsibility can be delegated, but not accountability

1. The "Right" Person

2. The "Right" Task

3. The "Right" Circumstances

4. The "Right" Directions and Communication

5. The "Right" Supervision and Evaluation

5 Rights of Delegation

Teaching ● Assessment ● Planning ● Evaluating ● Decision-making

Tasks that cannot be delegated by the nurse to subordinate nursing personnel 5

Ambulating ● Turning ● Bathing ● Intake and Output ● Mouth Care

Tasks that can be delegated to a Nursing Assistant

● Tasks for unstable patients ● Medication administration ● Invasive procedures

Does NOT Delegate 3

intra discip, interdiscip, interdepartmental, inter agency

COLLABORATION OF PATIENT'S CARE 4

Intra-Disciplinary / Intra-Professional Collaboration

Coordination of patient care between members of the same discipline. ● Example: Endorsement or change-of-shift report between nurses.

Interdisciplinary / Inter-Professional Collaboration

Coordination of patient care among members of various health care disciplines. ● Example: Securing a physician's drug order or requesting a specific diet from a nutritionist

Interdepartmental Collaboration

Coordination of patient care among various hospital departments within an institution. ● Example: Transfer of a post-operative surgical patient from the OR to the ward.

Inter-Agency Collaboration

Coordination of patient care among various health institutions. ● Example: Referral of a high-risk delivery from a lying-in clinic to a tertiary hospital

triaging

is the process of sorting patients into groups based on their need for or likely benefit from immediate medical treatment.

24 hours a day, 7 days a week.

Triaging of patients shall be implemented

a. emergent

b. urgent

c. non urgent

The order that patients will be seen shall be based on triage categories:

a. The order that patients will be seen shall be based on triage categories:

b. shall be seen in 30–60 minutes

c.shall be seen within 2–4 hours

Red Tags (Immediate), Massive hemorrhage ○ Tension pneumothorax ○ Cardiac tamponade

Used to label those who cannot survive without immediate treatment but who have the chance of survival. 3 ex

Yellow Tags (Observation), Pulmonary contusion ○ Minor amputations ○ Wounds

For those who require observation and possible later re-triage. ● Their condition is stable for the moment and they are not in immediate danger of death. 3 ex

Green Tags (Wait), ○ Minor lacerations ○ Abrasions ○ Sprain

Reserved for walking wounded patients who need medical care at some point after more critical injuries have been treated. 3 ex

White Tags (Dismiss)

Given to those with minor injuries for whom a doctor's care is not required.

Black Tags (Expectant)

Assigned to those whose injuries are so extensive that they will not survive even with available care.

1. Narrative Charting (Traditional)

2. Problem-Oriented Medical Record (POMR) / SOAPIE(R) Format 3. Focus Charting ● Involves the Data, Action, Response (DAR) category.

4. Electronic Medical Records (EMR)

4