bioethics - mam chua

8/3/2019 Bioethics - Mam Chua

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UST COLLEGE OF NURSING

Michael John M. Vallarit

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BIOETHICS – MAM CHUA

Ethics

- Practical science of the morality of human conduct

- Practical because it:

o Applies a direction

o Represents the reason which show these data to be trueo Moral because it is related to the dictates of reason (how it should be)

o Human conduct because it deals with human activity and how one should act

Morals

- Refers to human conduct itself

- Internalization of what you have learned since childhood

- Based on norms of conduct about right or wrong

- Society’s moral codes guide what people ought to do

- Professional codes such as code of ethics for nurses, communicate the goals and ideals of the

profession

o ICN – International Code for Nurseso BON Res 220

Code of Ethics

- The Code of Ethics for Nurses

- Bon Resolution 220 Series 2004

- Provides guidance for carrying out nursing responsibilities consistent with the ethical obligations of the

profession

Professional Code of Ethics

- Nurses have a contract with society to behave in accordance with rules dictated by society and the

nursing profession

- Nurse Practice Acts VS Code of Ethics

ETHICAL PRINCIPLES

Autonomy

Beneficence

Non maleficence

Veracity

Confidentiality

Justice

Fidelity

Respect for Person

- Most fundamental human right

- Foundation of all ethical principles

- Respecting the worth and value of a person

- Imago Dei – created in the image of God

- The human person ought to be respected always

- Every human being has an inner worth and inherent dignity.

- Certain action may never be done because performing them would constitute a violation against the

person’s dignity





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o It is a patient’s right to exercise freedom to make decisions for his/her health. Appropriate and

necessary information are required so that medical protocols and management may be done for

his interest.

o To protect the basic need of every human person for health care and the person’s primary

responsibility for his or her own health,

No physical or psychological therapy may be administered without the free and informed

consent of the patient, or If the patient is incompetent, the person’s legitimate guardian acting for the patient’s

benefit and, as far as possible, in accordance with the patient’s known and reasonable

wishes

Proportionality – Risks VS. Benefits

o Elements of informed consent

Disclosure

What operation, how is it done, complications, prognosis, alternatives, cost

Understanding

Avoid medical terms/ jargons

Voluntariness – autonomy; no force or coercion Competence

Consent

Only for 24 hours

If deferred, secure another one. File the previous consent

o Who are incompetent?

Comatose

Below 18 yrs old

Mentally incoherent

- Nuremberg Code 1947

o Foundation of all research ethic codeso 10 principles

o Voluntary consent, results need to be of good to the society, animal experiments first, avoid

unnecessary physical and mental suffering/ injury, should not be done if it will cause death or

disability

- Declaration of Helskinski

o Developed by WMA – guidance to research no t present in Nuremberg Code;

o For MD doing research on their patients

- Belmont Report – 1976

o Medical and behavioural research

o Washington DC- Basic ethical Principles of all codes

o Respect for persons

Respect for autonomy and protection of persons with diminished autonomy

o Beneficence and non-maleficence

Maximize benefits and minimize harm

o Justice

Equitable distribution of both burdens and benefits of research

CONFIDENTIALITY





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- Requires the non disclosure of private or secret info with which one is entrusted

- ICN (2000) the nurse holds in confidence personal information and uses judgment in sharing this info

- An important component of autonomy- maintains dignity and respect for the person

- Only with directly involved in the care of the client

- The ff are subjects of confidentiality and should not be revealed to anyone except for graver cause:

o Private secrets

o Contractual secretso Professional secrets

- Graver cause:

o Personal decision

o Reportable cause – communicable diseases – SARS, AH1N1, HIV; child abuse and neglect

Abused children

Bruises in different stages of healing

Remove the clothes to assess

If it is only a suspicion, REPORT!

o If MD does not support, report to supervisor. She will report it to socia

services.o Legal cause

- Breaches of confidentiality

o Computerization of medical records

o Access to hospital patient charts

o Patients discussed by colleagues

- Mandatory disclosure

o Communicable diseases

o Child abuse and neglect

o Vulnerable adults

PRINCIPLE OF BENEFICENCE AND NON MALEFICENCE

- Beneficence

o Duty to actively do good for patient

o Positive form

o Primary goal of health care is to do good for patients under their care

o Consider:

Deciding what interventions should be provided for patients when some of those

interventions may cause pain

Burn clients receiving mafenide acetate

Before giving, provide pain relief measures; analgesics 15 minutes prior to administration of drug

o May create a duty when the law does not – doing something out of duty at times

Often conflicts with principle of autonomy

I’m doing you good, but you don’t want it.

Beneficent Act: A nurse prevents a patient from acting on suicidal impulses

Good Samaritan Act: what a prudent nurse could do in a certain situation

o - Non maleficence

o Negative form





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o Preventing, avoiding

o Duty to prevent or avoiding harm whether intentional or unintentional

o Does not mean avoidance of harm altogether... avoidance of harm unless the action promises a

greater good

o Consider this:

Is it harmful to accept an assignment to float to an unfamiliar area that requires

administration of unfamiliar medications? Float but you take care patients of you knowyou can take care of – prioritization.

Death and Advance Refusals of Treatment

- Apparent Death – the cessation of life as indicated by the absence of all vital functions

- Clinical Death – death of all organs wherein vital signs are absent

o Declared dead by MD

- Biological Death – with signs of death

o Rigor mortis – after 1 hour

- Brain Death – absence of all electrical activity of the brain including cerebral perfusion

o Only criteria for harvesting organs for organ donation

- Orthothanasia – acceptable; allowing patient to die in normal causes

- Euthanasia – mercy killing

o Active / Commission

o Passive / Omission

- Dysthanasia – Prolonging suffering

JUSTICE

- The duty to treat all patients fairly

- Equal treatment of equal cases and equal distribution of benefits- no discrimination on the basis of sex,race, religion, age and socioeconomic status

- Involves allocation of scarce and expensive health care resources

VERACITY

- Duty to tell the truth

- Fundamental to the development and continuance of trust among human beings- truth telling, integrity

and honesty

- Consider this:

o Is lying to a patient ever justified? If a patient finds out that you have lied to them, will they

have a reason to trust you?

FIDELITY

- Obligation of an individual to be faithful to commitments to him/herself and also to others

- Main support for the concept of accountability

- Keeping information confidential and maintaining privacy and trust

- Consider this:

o To whom do we owe fidelity? Who has the right to access patient medical record? When should

we blow the whistle on unsafe staffing patterns?

Tell to supervisor > Go to higher persons/ Chief Nurse > Medical Director > Outside –

media / DOH

bioethics - mam chua

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