Kohlberg's Moral Development, Values Confrontation & Confidentiality / Data Privacy (Nursing Notes)

Kohlberg's Stages of Moral Development

Preconventional Level (first level of moral thinking; generally found at the elementary school level).
- Stage 1 (2-3 years): Punishment-Obedience — Child does right to avoid punishment.
- Stage 2 (4-7 years): Instrumental Orientation — Carries out actions to satisfy own needs rather than society's.
Conventional Level (second level of moral thinking; generally found in society).
- Stage 3 (7-10 years): Nice Girl - Nice Boy — Children follow rules to be a good/nice person in own eyes and others.
- Stage 4 (10-12 years): Law & Order — Follows self-care measures only if someone is there to enforce them.
Post-conventional Level (third level of moral thinking; Kohlberg believed this is not reached by the majority of adults).
- Stage 5 (older than 12): Social Contract — Follows standards of society for the good of all people.
- Stage 6: Universal Ethical Principle Orientation — Following internalized standards of conduct.
Key notes and implications:
- Levels reflect progression from concrete, concrete-rule-based reasoning to abstract, principled reasoning about justice and rights.
- Emphasis on moral reasoning processes rather than mere actions.
- Age ranges are approximate as given in the material; progression is not strictly tied to age for all individuals.

Values Confrontation & Universal Ethical Principles

Week 7 learning outcomes:
- Understand the concept of value confrontations.
- Analyze the difference between Teleological and Deontological theories.
- Execute the ethical reasoning process to address ethical distress and moral dilemmas.
Universal ethical principles in health care:
- 1. Respect for Individuals
- 2. Autonomy
- 3. Nonmaleficence
- 4. Beneficence
- 5. Justice
- 6. Confidentiality
- 7. Fidelity
- 8. Veracity

Respect for Individuals

The essential prerequisite of beneficence, nonmaleficence, and justice is the recognition of the autonomy of individuals and treating them as autonomous agents.
Example: The patient has the right to choose the type of care she would have.

Autonomy

Autonomy is the ability to make an independent, self-governed decision.
Characteristics of autonomy:
- 1. Autonomy as free action — intentional and conscious choice of the actor.
- 2. Authenticity — consistent with the individual's attitudes, values, dispositions, and life plans.
- 3. Effective deliberation — giving clear thought, considering alternatives and their consequences; the patient must be informed of all information necessary to decide.
- 4. Moral reflection — deeper self-analysis and awareness of personal values.
Applications of autonomy:
1) Informed Consent — Because the client is autonomous, do not provide coercive advice; inform patient of available options, including costs, procedures, benefits, and risks.
2) Paternalism/Parentalism — Physicians can make decisions for patients only when the patient lacks decision-making capacity (e.g., diminished capacity, mental incompetence, delirium, unconsciousness, or intoxication). Significant others should be present if possible.
3) Standard of Best Interest — When patients cannot decide, health care providers decide the best course of action in the patient’s best interest.

Beneficence

The goal of health care providers should be the benefit of the client.
Action: Take positive steps to prevent and remove harm from the patient.

Justice

Health care providers should treat clients as persons with equal rights and ensure equal access to appropriate care.

Confidentiality & Data Privacy

Respecting confidentiality is foundational to trust between patients and health care providers.
Confidentiality duty is supported by data privacy laws and professional ethics.
Basis for data privacy protection (as listed in the material):
- 1) The 1987 Philippine Constitution Bill of Rights
- 2) Republic Act 10175 (Cybercrime Prevention Act of 2012)
- 3) Republic Act 10173 (Data Privacy Act of 2012)
- 4) Philippine Medical Association’s Code of Ethics
- 5) Magna Carta of Patients' Rights and Obligations
Sensitive Personal Information includes (examples):
- Race/ethnic origin, age, marital status, religious/political affiliations, health/education, genetic/sexual life,
- criminal/civil/administrative proceedings, decisions rendered, government-issued identifiers.
Privileged information:
- Includes data privileged under rules of court, other laws, husband-wife communications, client-attorney, and clergy-penitent communications.
Health care information categories:
- Interview, research data, physical exam, laboratory results, surveys, etc.
General rule: Consent is required prior to collection and processing of personal data.
Major concepts in confidentiality:
- Do No Harm — protect patient information during gathering, recording, and sharing; honest relationship ensures data is disclosed with minimal risk.
- Use information proactively — data used to inform diagnosis, treatment, and care.
- Threat of self-destruction — confidentiality may be overridden if concealment poses serious danger to the patient.
- Irreversibility — once shared, information cannot be unshared or deleted.
Exceptions to the duty of confidentiality:
- 1) Consent — patient or legally authorized surrogate can authorize disclosure.
- 2) Court Order — disclosure upon court order.
- 3) Continued Treatment — information necessary for ongoing treatment.
- 4) Compliance with the Law — mandatory reporting (e.g., child abuse), law enforcement, administrative investigations, etc.
- 5) Communicate a Threat — duty to protect others from violence by a patient.
Breach of the Data Privacy Act:
- Breach is a criminal offense.
Obligation of Confidentiality (overview):
- Prohibits disclosure to unauthorized parties; encourages precautions to ensure authorized access only.
Data privacy and confidentiality in practice:
- Data handling includes interviews, research data, physical exams, laboratory results, and surveys; consent governs collection and processing.
Exceptions in more detail:
- Consent, Court Order, Continued Treatment, Compliance with Law, and Threat Communication are recognized exceptions with specific criteria.

Ethical Distribution: Supply & Demand (Distributive Justice)

Ethical problems of supply and demand involve deciding how scarce resources should be allocated.
- Principles include:
- Equal share — distribute resources equally where possible.
- According to need — allocate based on need (e.g., aid to the needy, immunization programs).
- According to effort — allocation based on patient compliance or effort.
- According to contribution — allocation based on contribution (e.g., insurance/coverage).
Modes of allocation decisions:
- Free market exchange — services to those who can afford them (e.g., cosmetic procedures).
- Merit-based — allocation to meet established criteria (e.g., eligibility programs).
Cooperation concepts:
- Formal cooperation — participation in actions of a principal agent with freedom.
- Implicit formal cooperation — participant may not intend the object but contributes to action.
- Immediate material cooperation — participation essential to act (act could not occur without it).
- Mediate material cooperation — participation not essential; act could occur without cooperation.

Confidentiality, Data Privacy Act — Implications for Health Care (Week 9)

Learning outcomes:
- Understand the concept of confidentiality.
- Describe management of health care information.
- Determine ethics and standards in health care information.
- Identify nursing responsibilities regarding health care information.
Key components of data privacy protection (broad legal framework):
- The 1987 Constitution; RA 10175 (Cybercrime Prevention Act); RA 10173 (Data Privacy Act); PMA Code of Ethics; Magna Carta of Patients’ Rights and Obligations.
Sensitive Personal Information (examples listed above).
Privileged Information (examples listed above).
Health Care Information (types of data):
- Interview, research data, physical exams, laboratory results, surveys, etc.
General rule: Consent is required prior to collection and processing of personal data.
Major concepts concerning confidentiality:
- Do no harm — protect patient data; maintain honest patient-doctor relationship.
- Use information proactively — use data to improve diagnosis and treatment.
- Threat of self-destruction — confidentiality can be overridden to protect the patient or others.
- Irreversibility — once disclosed, information cannot be un-shared.
Exceptions to confidentiality (summary):
- Consent; Court Order; Continued treatment; Compliance with law; Communicate a threat.
Breach of data privacy act remains a criminal offense; breach consequences underline the seriousness of privacy.

Explicit Examples of Confidentiality Systems (Practical Details)

Confidentiality obligations include protecting patient information across interview, examination, lab results, and research data; patient expectations include a higher standard of confidentiality than might be typical in general practice.
Privileged communications may be protected under specific legal categories (e.g., physician-patient privilege, attorney-client privilege, priest-penitent, etc.).

Summary of Core Ethical Principles in Health Care

Respect for Individuals and Autonomy are foundational prerequisites for other ethical duties (beneficence, nonmaleficence, justice).
Beneficence and Nonmaleficence focus on promoting good and preventing harm.
Fidelity and Veracity underpin trust, honesty, and loyalty in professional relationships.
Confidentiality and Data Privacy regulate information handling and patient privacy.
Distributive Justice guides fair allocation of scarce resources.

Quick Reference: Key Acronyms and Acts

RA 10175 — Cybercrime Prevention Act of 2012
RA 10173 — Data Privacy Act of 2012
PMA Code of Ethics — Professional standards for physicians
Magna Carta of Patients' Rights and Obligations — patient rights framework