BIOETHICS PRELIM
PRELIM 1. The Scope, Profession, and Ethics of Nursing
Presenter: A. Professional Adjustment / Nursing Foundations
1. Nursing Ethics: Rights, Responsibilities, and Research
Key Focus: The reciprocal relationship between nurses, patients, and the healthcare system.
2. MEDICAL ETHICS
1. Defining the Profession: Profession vs. Professional Nursing
What is a Profession?
An occupation that requires specialized knowledge and intensive academic preparation.
Key Attributes:
Specialized Education: Mastery of a specific body of knowledge.
Service Orientation: Altruism; placing the client's needs above personal gain.
Autonomy: Self-regulation and independence in decision-making.
Code of Ethics: A binding guide for conduct.
2. What is Professional Nursing?
Definition:
The performance for a fee, salary, or other reward or compensation of professional nursing services.
Diagnosis and treatment of human responses to actual or potential health problems (ANA definition).
In the Philippines, it is regulated by the Professional Regulation Commission (PRC) and the Board of Nursing (BON).
Speaker Note:
Emphasize that nursing is not just a "job"; it is a vocation regulated by law and governed by strict ethical standards.
3. The Legal Scope of Practice
Title: Scope of the Nursing Profession (Philippines)
Legal Basis: Republic Act 9173 (Philippine Nursing Act of 2002), Section 28
Duties and Responsibilities:
Promote Health & Prevent Illness: Independent nursing actions, health education.
Curative & Rehabilitative Care: Administration of written prescriptions for treatment, therapies, and medication.
Collaborative Care: Working with the healthcare team.
Delivery of Child: In the absence of a doctor, nurses may perform internal exams and delivery during labor (with specific training requirements).
Suturing: Repair of perineal lacerations (with specific training).
Key Restriction: Nurses cannot practice medicine (e.g., prescribing drugs, performing major surgery).
Speaker Note:
Highlight that the "Scope of Practice" is legally binding; violating this leads to malpractice suits. RA 9173 is the "Bible" of Filipino nurses regarding their professional boundaries.
4. Introduction to Ethics
Title: Code of Professional Conduct & Ethics - HEALTH CARE ETHICS (BIOETHICS)
What is the Code of Ethics?
Definition: A formal statement of a group's ideals and values; a standard for professional actions.
Legal Basis in the Philippines:
Board of Nursing Resolution No. 220, Series of 2004: "Code of Ethics for Registered Nurses" promulgated by the PRC and the Board of Nursing after consultation with the Philippine Nurses Association (PNA).
Core Principles:
Respect for the dignity of the individual.
Integrity and accountability.
Excellence in practice.
5. Ethical Relationship 1: Registered Nurses and People
Core Value: Respect for Human Dignity
Customs and Beliefs: Nurses must respect the values, customs, and spiritual beliefs of the individual.
Example: Respecting dietary restrictions due to religion.
Informed Consent: Nurses verify that patients understand treatment plans and have given consent voluntarily.
Confidentiality (Data Privacy): Protecting patient information (privileged communication) unless required by law to disclose.
Right to Self-Determination: Supporting the patient’s right to choose or refuse treatment.
Speaker Note:
Discuss "Privileged Communication." Nurses cannot reveal secrets entrusted to them unless public safety is at risk (e.g., reportable communicable disease or crime).
6. Ethical Relationship 2: Registered Nurse and Practice
Core Value: Competence and Accountability
Accountability: The nurse is personally answerable for their own actions and omissions.
Continuous Learning: Ongoing Continuing Professional Development (CPD). Nurses must stay updated with current trends.
Standard of Care: Practicing within the bounds of safety and evidence-based medicine.
Personal Health: Nurses must maintain their own physical and mental health to provide safe care.
Speaker Note:
Emphasize the concept of "Prudent Nurse." Would a careful, reasonable nurse perform the same action? If not, it is negligence.
7. Ethical Relationship 3: Registered Nurse and Co-workers
Core Value: Collaboration and Teamwork
Solidarity: Maintaining a harmonious relationship with fellow nurses and other health professionals (doctors, pharmacists, medical technologists).
Constructive Criticism: Correcting colleagues privately and professionally, avoiding public humiliation.
Patient Safety First: If a co-worker’s action endangers a patient, the nurse must intervene and report through proper channels.
Equitable Treatment: Treating all members of the health team with respect regardless of rank or position.
Speaker Note:
Discuss the "Chain of Command." Resolve disputes at the lowest level first before escalation unless patient safety is immediately threatened.
8. Ethical Relationship 4: Registered Nurse, Society, and Environment
Core Value: Social Justice and Advocacy
Health Needs: Nurses advocate for the health needs of the community, especially marginalized groups.
Environmental Safety: Participation in sustaining a healthy environment (e.g., proper waste disposal, infection control).
Policy Making: Involvement in national and local health policy formulation.
Citizenship: Nurses are citizens first; upholding the laws of the country.
Speaker Note:
This covers Community Health Nursing (CHN). A nurse’s duty extends beyond hospital walls into community ecosystems.
9. Ethical Relationship 5: Registered Nurses and the Profession
Core Value: Professionalism and Integrity
Image of the Profession: Nurses must refrain from activities that degrade the profession (e.g., false advertising, scandalous behavior).
Professional Organizations: Active membership in accredited professional organizations (PNA - Philippine Nurses Association).
Research & Standards: Contribution to the development of the nursing body of knowledge via research.
Fair Conditions: Advocacy for equitable social and economic working conditions for nurses.
10. Summary of Nursing Ethics
1. Nursing is a Profession: Governed by specialized education, autonomy, and ethics.
2. RA 9173: Defines what nurses can do (Scope of Practice).
3. BON Res. 220: Defines how nurses should behave (Code of Ethics).
Respect rights and dignity of people.
Be competent and accountable in practice.
Collaborate respectfully with co-workers.
Advocate for public health in society.
Uphold the image and standards of the profession.
11. Nursing Ethics: Rights, Responsibilities, and Research
The Nurses’ Bill of Rights
Title: Protecting the Caregiver
Context: Patients have rights, and nurses also require protections to provide safe care.
Key Tenets as per the American Nurses Association (ANA):
Right to Practice: Fulfill obligations to patients within the legal & ethical scope of practice.
Safe Environment: Work in an environment that minimizes physical and emotional risk (e.g., safe staffing, zero tolerance for violence).
Advocacy: The right to advocate for themselves and their patients freely without fear of retribution.
Fair Compensation: Right to fair wages and ability to negotiate employment conditions.
Professional Judgment: The right to exercise professional judgment regarding patient care and safety.
Speaker Note:
Emphasize that these rights aren’t just perks; they are prerequisites for safe patient care.
Patients’ Responsibilities
Title: The Patient's Role in Care
Context: Healthcare is a partnership requiring patient participation for successful outcomes.
Key Responsibilities of Patients:
Honesty & Disclosure: Provide accurate and complete medical history and information.
Compliance: Follow the treatment plan set by healthcare providers or accept the consequences of refusal.
Respect: Treat hospital staff and other patients with courtesy and respect.
Financial Obligation: Fulfill financial commitments to healthcare institutions promptly.
Reporting: Report any unexpected changes in their condition to healthcare professionals.
Speaker Note:
Discuss "Non-compliance." Patients have the right to refuse care but take responsibility for the repercussions.
12. Nurses’ Responsibility to the Patient
Title: The Primary Commitment
Core Ethical Principle: Beneficence & Non-Maleficence
1. Primacy of Patient: The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
2. Safety & Advocacy: Promoting and protecting the health, safety, and rights of the patient.
3. Non-Discrimination: Providing care irrespective of race, religion, lifestyle, or ability to pay.
4. Professional Boundaries: Maintain appropriate professional distance, avoiding romantic or exploitative relationships.
13. Nurses’ Responsibility to the Physician
Title: Collaborative Practice
Core Ethical Principle: Collaboration
1. Implementation of Orders: Carry out legal and safe medical orders diligently.
2. Clarification: Clarify any orders that seem erroneous or unclear before execution.
3. Communication: Inform the physician about changes in the patient’s status (e.g., abnormal vital signs, adverse reactions).
4. Professional Respect: Avoid criticizing the physician in front of the patient; handle disagreements privately.
Speaker Note:
Explain "Intelligent Obedience." Nurses must not blindly follow orders; they are responsible for ensuring patient safety in all cases.
14. Nurses’ Responsibility to Colleagues
Title: Solidarity in the Workplace
Core Ethical Principle: Fidelity (Faithfulness)
1. Mentorship: Support new nurses and students; provide knowledge and skill sharing.
2. Intervention: Take action when a colleague's practice is impaired (e.g., substance abuse) or incompetent.
Protocol: Ensure patient safety first, then report to a supervisor.
3. Civil Environment: Refrain from workplace bullying, harassment, or lateral violence (e.g., "eating their young").
4. Chain of Command: Value organizational hierarchy in conflict resolution.
15. Nurses’ Responsibility to Themselves
Title: The Duty to Self
Core Ethical Principle: Self-Respect & Integrity
1. Self-Care: Maintain physical and mental health to ensure the capacity to provide quality care. "You cannot pour from an empty cup."
2. Integrity: Maintain character integrity and refuse to participate in unethical actions (Conscientious Objection).
3. Competence: Assume responsibility for personal professional growth and continuous education.
4. Personal Image: Model a healthy lifestyle (e.g., not smoking in uniform) to embody credibility as a health educator.
16. Research on Human Subjects
Title: Ethical Principles in Research
Historical Context: The Nuremberg Code and The Declaration of Helsinki emphasize that science must never override human rights.
The Three Pillars (Belmont Report):
Respect for Persons: Treat individuals as autonomous agents while protecting those with diminished autonomy (children, prisoners).
Beneficence: "Do no harm"; maximize benefits while minimizing risks.
Justice: Fair distribution; no group should carry the burden of research if others benefit from it.
Title: The Nurse's Role in Research Ethics
1. Informed Consent: Ensure patients voluntarily agree to participate after fully understanding risks and benefits.
2. Right to Withdraw: Remind patients they can withdraw from the study anytime without penalty.
3. Privacy & Anonymity: Protect subjects’ data to ensure they cannot be identified.
4. Institutional Review Board (IRB): No research can proceed without approval from an ethics committee.
Speaker Note:
Emphasize that even if a nurse is not the researcher, they are the "last line of defense" for protecting patients from unethical research practices.
17. Summary of Rights and Responsibilities
Rights: Nurses have the right to a safe workplace to practice effectively.
Responsibilities:
To Patients: Safety and advocacy remain paramount.
To Physicians: Engaging in collaborative, intelligent execution of orders.
To Colleagues: Offer mentorship and intervene when safety is compromised.
To Self: Maintain health, competence, and integrity in practice.
Research: Uphold human rights over scientific goals, ensuring informed consent is non-negotiable.
18. MEDICAL ETHICS
Definition of Ethics
Ethics is a conscious or subconscious system of values that constitute the basis for particular human behavior. It is the philosophical study of morality.
Key Concept: Morality serves as the general term for good judgment, standards, and rules of conduct, often determined by societal norms.
Biomedical Ethics
The application of evaluative norms in assessing practices in the medical profession.
Four Major Areas of Medical Ethics:
The value of the physician-patient relationship based on trust and confidence.
Individual & social justice in healthcare delivery, considering societal impacts of patients.
Sanctity of life, debating issues like the legality of abortion and the promotion of comfort in treatment.
The meaning of sexuality and family life, including population control debates.
Human Acts
Defined as acts executed from deliberate free will; an individual must know what they are doing and make a free choice.
Elements of Human Acts:
Knowledge: Awareness of one's actions.
Freedom: The ability to choose one's actions.
Conscience
A personal judgment of reason regarding a specific act's morality, involving an understanding of moral principles and circumstances leading to a decision.
Types of Conscience:
True and Certain: Aligned with teachings from family, church, community.
Erroneous: Incorrect judgments believing one is right when they are wrong; must be corrected.
Scrupulous: Doubt exists about the morality of any action.
Perplexed: A feeling that every action may be wrong, leading to inaction.
Basic Ethical Principles
Stewardship: Responsibility for caring for Earth’s resources, recognizing human accountability to a higher power.
Totality: Each person is a whole entity where each part contributes symbiotically; harmful parts may be sacrificed only to save the whole.
Double Effect: Actions with good and bad outcomes must meet certain conditions for ethical acceptance, especially in healthcare situations.
Cooperation: Involves participation between agents toward desired effects, addressing both active and passive roles.
Informed Consent includes elements like knowledge, comprehension, subject competence, and freedom from undue pressure.
19. MAJOR BIOETHICAL PRINCIPLES
Autonomy: Respect for the individual’s capacity to make personal decisions.
Beneficence: A commitment to do good, enhancing benefits while minimizing harm.
Non-maleficence: Obligation to do no harm in all healthcare actions.
Justice: Fairness in treatment, distribution of resources, and ensuring an equitable process in care delivery.
Nursing is a profession governed by specialized education, autonomy, and ethics, emphasizing the reciprocal relationship between nurses, patients, and the healthcare system. Key aspects include:
Medical Ethics: Defined by professional nursing, autonomy, service orientation, and adherence to a Code of Ethics as guided by RA 9173.
Legal Scope of Practice: Nurses promote health, provide curative care, and collaborate with healthcare teams within legal boundaries.
Core Ethical Principles: Respect for persons, beneficence, non-maleficence, and justice guide nursing responsibilities to patients, physicians, colleagues, and society.
Patients’ Rights and Responsibilities: Patients should provide accurate information and follow treatment plans while nurses advocate for safe environments and fair compensation.
Research Ethics: Nurses ensure informed consent and the protection of human subjects in research, reflecting the importance of patients' rights.
Overall, the nursing profession emphasizes ethical practice, advocacy, and ongoing professional development to ensure safe, effective care for patients in diverse settings.