HEALTH CARE ETHICS

INTRO: BASIC CONCEPTS AND HISTORY

Health Care Ethics Team
 Learning Objective:
• Define significant terms on health care ethics.
• Describe basic concepts of ethics. Answer
questions related to it.
• Reflect on how nursing ethics has evolved.
• Explain the pivot to Bioethics.
• Identify remote and recent sources of
Bioethics
• Deliberate on Bioethics as a new type of
wisdom.
 What is Ethics?
Ethics according to Aristotle
1. Comes from the Greek word “ethos” or “ethous” meaning use,
custom, way of behaving, character
2. Corresponds to the Latin term “mos” or “moris”.
3. These behaviors are basic human behaviors that are specific &
inherent to human beings.
4. They are natural to humans which confers and develops goodness
in them.
In essence, Ethics is that branch of Philosophy that deals with
the principles of morality and the well-defined standards of right and
wrong that prescribe the human character and conduct, in terms of
obligations, rights, rules, benefit to society, fairness etc.
 Ethics

• It refers to
(a) a method of inquiry that helps people to understand the morality of
human behavior (i.e., it is the study of morality),
(b) the practices or beliefs of a certain group (e.g., medical ethics, nursing
ethics), and
(c) the expected standards of moral behavior of a particular group as
described in the group’s formal code of professional ethics.

• Nurses have been viewed as the most honest and ethical professionals in
U.S. Gallup polls every year since 1999 except when firefighters ranked
first shortly after the September 11, 2001, terrorist attacks (Brenan, 2018)
 BIOETHICS


It is concerned with questions about:


Basic human values such as the rights to life and health.

Rightness or wrongness of certain developments in
healthcare institutions, life technology, medicine, and the
health professions.

Society's responsibility for the life and health of its
members.
 Bioethics

• Bioethics is ethics as applied to human life or health (e.g., to

decisions about abortion or euthanasia).
• Nursing ethics refers to ethical issues that occur in nursing
practice.
• The American Nurses Association’s (ANA) Nursing: Scope and
Standards of Practice (2015a) holds nurses accountable for
their ethical conduct.
• Professional Performance Standard 7 relates to ethics. The
current edition of this standard was significantly expanded to
include greater emphasis on nurse advocacy and professional
responsibility.
 HEALTH ETHICS


At the core of health care ethics are our sense of
right and wrong and our beliefs about rights we
possess and duties we owe others.
 PROFESSIONAL ETHICS


Each practitioner, upon entering a profession, is invested with
the responsibility to adhere to the standards of ethical
practice and conduct set by the profession.
 Types of Ethics

General Ethics
• It teaches that man must do good and avoid evil.
• It explains the norms with which the moral significance of
human act is determined.

Applied/Special Ethics
• It demonstrates what is good or evil, and therefore, what is to
be done or avoided.
• It is the application of the principles of General Ethics into the
problems and issues confronting a person on account of his
circumstances in life.
Importance of Bioethics to Health Care Professionals


PROTECTION OF LIFE OF PATIENTS

ENSURE QUALITY OF SERVICE DELIVERY

PROTECTION FROM LEGAL SANCTIONS
 Purposes of the Study of Bioethics


GUIDES THE PROFESSIONALS IN THE CONDUCT OF THEIR
RESPECTIVE DUTIES


PRESCRIBE STANDARD OF CARE TO ENSURE CLIENT
PROTECTION AND SATISFACTION
 Definition of Terms
Intellect - the faculty of reasoning and understanding objectively, especially
with regard to abstract or academic matters.

Will- the process or power of wishing, choosing, desiring, or intending

Freedom - the power or right to act, speak, or think as one wants without
hindrance or restraint.

Conscience - an inner feeling or voice viewed as acting as a guide to the

rightness or wrongness of one's behavior.

Morality - standards of right and wrong of the action.

Beliefs - are interpretations or conclusions that people accept as true

Values - are enduring beliefs or attitudes about the worth

of an individual, object, idea, or action.
 Definition of Terms

Law - the system of rules which a particular country or community

recognizes as regulating the actions of its members and which it may
enforce by the imposition of penalties.
Natural Law - system of right or justice held to be common to all
humans and derived from nature rather than from the rules of society
Human Acts - acts that are freely chosen in consequence of a judgment
of conscience, can be morally evaluated. They are either good or evil.
Acts of Man - Acts of man are instinctive, such as physiological in
nature. These are actions done under the circumstances of ignorance,
passion, fear, violence, and habits. Acts that are performed by men
without being master of them through his intellect and will, therefore
acts of man are involuntary actions.
https://www.merriam-webster.com/dictionary/will
https://languages.oup.com/google-dictionary-en/
https://www.britannica.com/topic/natural-law
https://www.vatican.va/content/catechism/en/part_three/section_one/chapter_one/article_4/the_morality_of_human_acts.html
https://prezi.com/1bylomwnecre/the-human-acts-and-acts-of-man
Kozier, Fundametals of Nursing
 Natural Law

• Eternal law refers to the plan of divine Wisdom leading all creation
towards its goal. (St. Thomas Aquinas, Summa Theologiae, I-II, q. 93, a.1,
c; Second Vatican Council, Dignitatis humanae, 3., retrieved
https://opusdei.org/en/article/topic-26-freedom-law-and-conscience/)

• The natural moral law is the participation in the eternal law by the rational
creature. (t. Thomas Aquinas, Summa Theologiae, I-II, q.91, a.2.)

• The natural law “is itself the eternal law, implanted in beings endowed
with reason, and inclining them towards their right action and end.” (John
Paul II, Enc Veritatis splendor, 44.) It is, therefore, a divine law (divine-
natural).
 Human Acts
• Human acts being the object of the study of ethics, are voluntary acts that
proceed from free will. Human acts depend on human judgment and
choice and hence entail a moral responsibility.
• Human acts form the human personality and structure. Human acts that
humans perform, build up their lives. The doing or the absence of doing
builds the kind of life the person lives. (Ocampo, 2018) The kind of life that
is good, well and happy. For patients, the kind of life that is healthy.
• An act is done knowingly, when the doer is conscious (all senses are
active, sensory-perception is functional) and aware of the reason and the
consequences on his actions.
• Human acts are actions done intentionally, free, and deliberate of a
person.
• These are actions that a man properly master for he does them with full
knowledge and of his own will.
•
https://prezi.com/1bylomwnecre/the-human-acts-and-acts-of-man
 Acts of Man

• Acts of man are instinctive, such as physiological in nature.

• These are actions done under the circumstances of ignorance,
passion, fear, violence, and habits.
• Acts that are performed by men without being master of
them through his intellect and will

https://prezi.com/1bylomwnecre/the-human-acts-and-acts-of-man
 What is the difference between human acts and
natural acts of man?
Human acts Natural Acts of Man
• Actions done Consciously and • Actions beyond one’s consciousness;
freely by the agent/or by man not dependent on the intellect & the
• ESSENTIAL QUALITIES/ will.
Constituent Elements of • ESSENTIAL QUALITIES of Acts of Man
Human Acts o Done without knowledge
1. Knowledge of the act o Without consent
2. Freedom o Involuntary
3. Voluntariness • Ex: unconscious, involuntary, semi-
• Man takes into responsibility deliberate, spontaneous actions
of these actions • Acts of man can become human acts
when he employs his intellect & will
in performing the act.
Laws, Norms and Codes as reference points for Human
Acts

• Through intentional examination of human acts and what is

good, man is able to discern the right thing to do.

• On doing and acting, man uses certain reference points or

criteria for examining the elements of human behavior which
are necessary to be able to further ethically act on the issues
and concerns of the moral order.

• These reference points are the laws, norms, and codes

identified by the society to govern human acts.
 Civil Laws
• Civil laws are designed to protect the freedom of the people. The freedom
to lead a good life away from harm and evil.
• Civil laws are designed out of reason and the natural law is the rule of
reason, it is then logical to say that all civil laws are anchored on the
Natural Law. The reason why the preamble of the constitution is stated in
this manner.
• “We, the sovereign Filipino people, are imploring the aid of Almighty God,
in order to build a just and humane society, and establish a Government
that shall embody our ideals and aspirations, promote the common good,
conserve and develop our patrimony, and secure to ourselves and our
posterity, the blessings of independence and democracy under the rule of
law and a regime of truth, justice, freedom, love, equality, and peace, do
ordain and promulgate this Constitution.”
• -(https://www.officialgazette.gov.ph/constitutions/the-1987-constitution-of-the-republic-of-the-philippines/the-1987-constitution-of-the-republic-of-
the-philippines-preamble/)
 What is an Ethical Dilemma / Moral Distress

• Jameton, a nursing philosopher first introduced moral

distress, in 1984, which means ethical distress.

• Moral distress is a negative experience that occur when

that person knows the right way of action, but
organizational limits would make the execution impossible
for him.

• Wilkinson defined moral distress as the experienced mental

imbalance and negative emotion when the individual makes
an ethical decision but is not able to act in line with their
decision.
 The Pivot to Bioethics

• In the 1960s and forward, with nursing education being moved into
colleges and universities from hospitals, nursing's heritage ethics was left
behind and forgotten in a convergence of events according to Fowler.

• The prevailing error was that nursing already had nursing ethics, but it had
simply been forgotten. This positive project of nursing ethics is what needs
to be reclaimed.

• As the profession of nursing moved away from nursing ethics and into
bioethics, there was, however, one persistent, nagging, vestige that should
have signaled the existence of a prior, nursing-focused ethics: The ANA
Code of Ethics for Nurses with Interpretive Statements (Code) (ANA, 2015).
 Bioethics

• Bioethics is derived from the two words bio (life) and ethics
(behavior). To study the behavior of human life comes under the
umbrella of bioethics.

• Until the 1970s the term bioethics was not taken until the scientist
Van Renssealaer Potter used the term bioethics for the first time in
1971. He is a medical oncologist who defines bioethics as a
combination of biological knowledge and human values.

• Bioethics was born as a response to scientific and social progress.

Such progress resulted in threatening conditions and critical
concerns that also raised doubts about human’s ability to survive.
 The Conditions that Prompted the Birth of Bioethics?

1. 1930 -1970 - TUSKEGEE, ALABAMA, US GOV’T HAD SYPHILIS EXPERIMENT

AMONG 400 BLACK AMERICANS (1947) WHO WERE NOT TREATED DESPITE
THE DISCOVERY OF PENICILLIN.

2. 1947 - Nuremberg Code. Condemned all experimentation on human

subjects without their consent in response to Nazi’s experiments.
As a result of the trial, the Nuremberg Code was established in 1948, stating that "The
voluntary consent of the human subject is absolutely essential," making it clear that
subjects should give consent and that the benefits of research must outweigh the
risks.

3. 1963 - tumor cells were injected without consent to elderlies at the Jewish
Chronic Disease Hospital in Brooklyn New York
 Conditions that prompted the birth of Bioethics

4. 1965-1971 - Studies on viral hepatitis immunization at Willowbrook State

Hospital in New York where handicapped children were inoculated with the
virus.

5. Discoveries in genetic engineering which brought the potential for

manufacturing biological weapons and altering the very constitution of life
forms, species, and individuals.
 What are the critical concerns in Medical ethics?

1. Human experimentation
2. The discovery of genetics
3. Organ Transplants
4. The beginning of life and human procreation
5. End of life issues
 Development of Bioethics

• Individual scholars began to legitimize bioethical issues as questions

deserving rigorous academic study. But bioethics solidified itself as
a field only when it became housed in institutions dedicated to the
study of these questions.
• 1969 -HASTING’s CENTER – founded by the Philosopher Daniel
Callahan and the Psychiatrist Willard Gaylin.
• 1970 -1971 – Van Rensseler Potter introduced the term bioethics in
two publications:
– Bioethics : The science of survival (1970)
– Bioethics : Bridge to the Future (1971)
 Recent Sources of Bioethics

• Nuremberg Code (1947) condemned all experimentation on human

subjects without their consent.

• Alarm caused by several experiments in the USA – Tuskegee Experiment

for Syphilis, The Jewish Chronic Disease Hospital in Brooklyn experiment
on tumor cells injected to elderly patients, the Willowbrook State Hospital
experiment in New York on injecting hepatitis virus injected on
handicapped children with consent coerced from parents.

• World Medical Association – HELSINKI Declaration on clinical

experimentation
 Bioethics
• Potter (1970) considered bioethics as a new type of wisdom that
would have to know how to use scientific knowledge in order to
safeguard the social good.

• According to Potter, The only possible way of preventing catastrophe

was to bridge the two cultures, one scientific and the other humanistic
and moral, otherwise indiscriminate scientific and technological
processes will endanger humanity and the very survival of life on
earth.
 Historical Perspective in Nursing Ethics

• Dr. Marcia D. Fowler, in her extensive writing about ethical heritage in

nursing, asserted that literature on nursing ethics was already developed
from the 1880’s until 1960’s before the rise of the field of medical
ethics/biomedical ethics/bioethics in the mid 1960’s. (M. Fowler, 2020)

• Fowler (2016) describes early nursing ethics as nurse-centric, relationally

based, addressed nurse’s ethical comportment in all roles, advanced the
social ethics of nursing especially in response to disparities in health and
set forth ethical expectations for the profession as a whole. Her writings
published in the online journal of issues in Nursing is worth the read to
appreciate historical accounts on early nursing ethics literature and
practice.(M. D. Fowler, 2017)
THANK YOU!
My Dear Students 