UNIT 1 Flashcards
1
Q
are moral principles that are concerned with the good of individuals and the good of society.
A
Ethics
2
Q
govern our rights and responsibilities and guide moral decision-making. The term is derived from the Greek word ethos which can mean custom, habit, character or disposition.
A
Ethics
3
Q
derived from the Greek word ethos which can mean
A
custom, habit, character or disposition.
4
Q
Ethics covers the following dilemmas:
A
- how to live a good life
- our rights and responsibilities
- the language of right and wrong
- moral decisions - what is good and bad?
5
Q
-takes the emotion out of decision-making
-helps nurses navigate those gray areas to provide safe and competent care to their patients.
A
code of ethics
6
Q
provide part of the decision-making foundation for decision making when ethics are in play because these theories represent the viewpoints from which individuals seek guidance as they make decisions
A
Ethical theories
7
Q
Broad categories of ethical theory include
A
deontology, teleology and utilitarianism.
8
Q
states that people should adhere to their obligations and duties when engaged in decision making when ethics are in play. This means that a person will follow his or her obligations to another individual or society because upholding one’s duty is what is considered ethically correct.
A
deontological class of ethical theories
9
Q
contains many positive attributes, but it also contains flaws. One flaw is that there is no rationale or logical basis for deciding an individual’s duties.
A
Deontology
10
Q
A person who adheres to ____ will produce very consistent decisions since they will be based on the individual’s set duties.
A
deontological theory
11
Q
will always keep his promises to a friend and will follow the law.
A
deontologist
12
Q
is concerned with the consequences of actions which means the basic standards for our actions being morally right or wrong depends on the good or evil generated.
A
teleology
13
Q
is a reason or explanation for something as a function of its end, purpose, or goal.
- It is derived from two Greek words: telos (end, goal, purpose) and logos (reason, explanation).
A
Teleology or finality
14
Q
It is derived from two Greek words: telos (_____) and logos (___).
A
end, goal, purpose ; reason, explanation
15
Q
is a common practice in ethics. Like the definition implies, using teleology in ethics means you consider and explain actions based on the end result.
-For instance, stealing is bad, but a teleological thinker may say, “but in the end, I’m stealing to feed my family, which is good, so the action is good.” In other words, an action’s “goodness” is based on the outcome.
A
Teleology
16
Q
Types of Teleological Ethical Theories
A
Ethical egoism, Utilitarianism, Eudaimonism
17
Q
is a teleological theory that posits, an action is good if it produces or is likely to produce results that maximize the person’s self-interest as defined by him, even at the expense of others.
A
ethical egoism
18
Q
theory holds that an action is good if it results in maximum satisfaction for a large number of people who are likely to get affected by the action
A
Utilitarianism
19
Q
is a teleological theory which posits, that an action is good if it results in the fulfillment of goals along with the welfare of the human beings. In other words, the actions are said to be fruitful if it promotes or tends to promote the fulfillment of goals constitutive of human nature and its happiness.
A
Eudaimonism
20
Q
are based on one’s ability to predict the consequences of an action. To a utilitarian, the choice that yields the greatest benefit to the most people is the one that is ethically correct
A
Utilitarian ethical theories
21
Q
Two types of utilitarianism
A
- Act utilitarianism
- Rule utilitarianism
22
Q
takes into account the law and is concerned with fairness. A rule utilitarian seeks to benefit the most people but through the fairest and most just means available. Therefore, added benefits of rule utilitarianism are that it values justice and includes beneficence at the same time.
A
- Rule utilitarianism
23
Q
subscribes precisely to the definition of utilitarianism—a person performs the acts that benefit the most people, regardless of personal feelings or the societal constraints such as laws.
A
- Act utilitarianism
24
Q
can lead to unexpected results making the utilitarian decision maker appear unethical as time passes, as the choice made did not benefit the most people as predicted.
A
Uncertainty
25
An is concerned with achieving the maximum good. Thus, one individual’s rights may be infringed upon in order to benefit a greater number of people.
act utilitarian decision maker
26
ethics looks at virtue or moral character, rather than at ethical duties and rules, or the consequences of actions - indeed some philosophers of this school deny that there can be such things as universal ethical rules.
Virtue ethics
27
is particularly concerned with the way individuals live their lives, and less concerned in assessing particular actions.
Virtue ethics
28
teaches that an action is right if and only if it is an action that a virtuous person would do in the same circumstances, and that a virtuous person is someone who has a particularly good character.
virtue ethics
29
is concerned with the character of individual nurses and seeks ways to enable nurses to develop character traits appropriate for actions that enhance wellbeing.
virtue ethics in nursing
30
can be defined as an approach that emphasizes the character and disposition of a person, in contrast to an approach that emphasizes duties, rules or principles (deontology), or one that emphasizes the consequences of actions (consequentialism).
Virtue ethics
31
an approach that emphasizes duties, rules or principles
deontology
32
one that emphasizes the consequences of actions
(consequentialism).
33
emphasizes being rather than doing. Our being, in other words, who we truly are, influences our behavior.
virtue ethics
34
can be viewed as an approach of ethical deliberation about the moral character and dispositions of nurses as moral agents that enables them, as virtuous human beings, to fulfil their purpose and function as professional people.
virtue ethics in nursing
35
refers to the structure of one’s personality with special attention to its ethical components.
Character
36
is a source as well as the product of his/ her value commitments and actions
person’s character
37
enable the nurse to discover the relevant moral aspects of a moral dilemma and to interpret, judge and evaluate them, and to apply rules, principles and moral theories wisely to a situation in order to resolve the dilemma.
Virtues
38
are necessary for the realization of various types of moral obligations in nursing, including dealing with moral dilemmas.
intellectual virtues (practical wisdom) and the moral virtues (virtues of character)
39
Besides the cardinal virtues expounded by ancient Greek philosophers, such as the
virtues of courage, temperance, prudence and justice.
40
The _________ as virtues for the nurse as a moral agent.
reflection, empathy, fairness, honesty, dedication, responsibility and respect for people
41
In addition, the following five virtues as applicable to health professionals:
trustworthiness, integrity, discernment, compassion and conscientiousness.
42
demands that the health practitioner or the nurse exercise rational control over emotions.
Decision-making about moral issues in health care
43
are necessary for rational control, because it takes a so-called mean position between the vices or excess and deficiency.
virtues
44
is possible if the nurse possesses virtues. In this manner, a nurse who demonstrates these virtues in a balanced form can be seen as a virtuous nurse.
Self-control in situations of moral difficulty
45
Where virtues reflect the characteristic in itself, ____ refers to the quality of that virtue, especially when demonstrated in character.
virtuousness
46
are ethical nurses, because they have a deep desire to behave well, irrespective of the circumstances.
Virtuous nurses
47
encompasses empathy for and connection with people.
-is best demonstrated by a nurse's ability to embody the core values of professional nursing.
Caring
48
Within the context of the Philippine society, nursing education with caring as its foundation, subscribes to the following core values which are vital components in the development of a professional nurse:
1.1 Love of God
1.2 Caring as the core of nursing
a. Compassion
b. Competence
c. Confidence
d. Conscience
e. Commitment (commitment to a culture of excellence, discipline, integrity and professionalism)
1.3 Love of People
a. Respect for the dignity of each person regardless of creed, color, gender and political affiliation.
1.4 Love of Country
a. Patriotism (Civic duty, social responsibility and good governance)
b. Preservation and enrichment of the environment and culture heritage
49
Nurses are held to seven ethical principles:
autonomy, accountability, veracity, fidelity, justice, beneficence and non-maleficence.
50
- Self-determination that is free from both controlling interferences by others and personal limitations preventing meaningful choice (such as inadequate understanding or faulty reasoning).
- the decision making process must be free of coercion or coaxing. In order for a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success.
1. AUTONOMY
51
requires the patient to have autonomy of thought, intention and action when making decisions regarding health care procedures.
Autonomy
52
Patient’s Rights
1. Right to medical treatment
2. Right to information
3. Right to choices
4. Right to privacy
5. Right to complaint
6. Right to health education
7. Right to a healthy and safe environment
53
* The patient has the right to receive medical and/ or surgical advice and treatment which fully meet the currently accepted standards of quality care.
* The currently accepted standards are those adopted by the Department of Health, Philippine Pediatric Society and other Specialty Societies as applicable in our hospital setting, and in the light of accepted contemporary medical practice.
* The patient shall be treated with utmost care, consideration, respect and dignity without discrimination of any kind.
1. Right to medical treatment
54
* The right to know the identity and professional status of the individuals involved in the care, diagnosis and/or treatment of the patient.
* The right to information about what kind/ type of medical/ surgical services are available, and what are the charges/costs are involved.
* The right to be given a clear description of the patient’s medical condition, with probable/definitive diagnosis, prognosis (i.e., an opinion as to the likely future course of any illness), and of the treatment options considered, the risks and complications that may be encountered.
* The description given to the patient is within scope and level of understanding.
* The right to know the names of any medication or procedures to be prescribed, its actions, and potential side-effects given the patient’s condition.
* The right to access medical information which relates to the patient’s condition and treatment.
2. Right to information
55
* The right to accept or refuse any procedure/medication, investigation or treatment, and to be informed of the likely consequences of doing so.
* The right to second medical and/ or surgical opinion.
* The right to refuse to take part in medical research programs.
* The right to choose doctor and or health care personnel in accordance to medical/surgical needs (applicable to private patients).
3. Right to choices
56
* The right to have privacy, dignity, religious and cultural beliefs respected.
* The right to have information relating to medical condition be kept confidential.
* The right of a pediatric patient to the company of a parent or guardian.
4. Right to privacy
57
* The right to make a complaint through proper channels provided for by the hospital authority, and to have complaint dealt with promptly and fairly.
5. Right to complaint
58
* Patient’s shall have the right to seek and obtain health education or advice with regards to promotive, preventive and curative medical, surgical and rehabilitative to maintain or regain good health and healthy life.
6. Right to health education
59
* The patient has the right to healthy and safe environment that is conductive to good health supportive of the rest and recuperation. Reasonable safety measures should be assured within the hospital facility.
7. Right to a healthy and safe environment
60
Filipino Patients’ Bill of Rights
1. The patient has the right to considerate & respectful care, irrespective of socio-economic status.
2. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected to understand.
3. The patient has the right to receive from his physician information necessary to give informed consent prior to start of any procedure and or treatment.
4. The patient has the right to refuse treatment / life-giving measures, to the extent permitted by law and to be informed of the medical consequence of his action.
5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly.
6. The patient has the right to expect that all communication and records pertaining to his care should be treated as confidential.
7. The patient has the right that within its capacity, a hospital must make reasonable response to the request of patient for services.
8. The patient has the right to obtain information as to any relationship of the hospital to other health care and to other health care and educational institutions in so far as his care is concerned.
9. The patient has the right to be advised if the hospital proposes to engage on or perform human experimentation affecting his care or treatment.
10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where
11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.
12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.
61
Doctors will give you information about a particular treatment or test in order for you to decide whether or not you wish to undergo a treatment or test. This process of understanding the risks and benefits of treatment is known as informed consent.
Informed Consent
62
is based on the moral and legal premise of patient autonomy: You as the patient have the right to make decisions about your own health and medical conditions.
Informed consent
63
The legal term for failing to obtain informed consent before performing a test or procedure on a patient is called
battery (a form of assault).
64
Under certain circumstances, there are exceptions to the informed consent rule. The most common exceptions are these:
* An emergency in which medical care is needed immediately to prevent serious or irreversible harm
* Incompetence in which someone is unable to give permission (or to refuse permission) for testing or treatment
65
Components of Informed Consent
1. You must have the capacity (or ability) to make the decision.
2. The medical provider must disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood (or probability) that the benefits and risks will occur.
3. You must comprehend the relevant information.
4. You must voluntarily grant consent, without coercion or duress.
66
Essential Elements of Informed Consent
1. Confidentiality
2. New information
3. Voluntary participation
4. Person/s to contact for study information
5. Rights of subject, if study related injury
6. Reasons for termination
7. Duration of study
8. Number of subjects
67
is the process by which people with the legal right to consent to medical treatment for themselves or for a minor or a ward delegate that right to another person.
Proxy consent
68
There are three fundamental constraints on this delegation:
a. The person making the delegation must have the right to consent.
b. The person must be legally and medically competent to delegate the right to consent.
c. The right to consent must be delegated to a legally and medically competent adult.
(an aged person in a coma, a two-month old child).
69
For the ethical and legal use of proxy consent, two conditions must be present:
a. The patient or research subject cannot offer informed consent
b. The person offering the consent ought to determine what the incompetent person would have decided where he or she able to make the ethical decision. This second condition is difficult to ascertain and may be subject to dispute.
70
Two Types of Proxy Consent for Adults
a. The power of attorney to consent to medical care, is usually used by patients who want medical care but are concerned about who will consent if they are rendered temporarily incompetent by the medical care. A power of attorney to consent to medical care delegates the right to consent to a specific person.
b. The living will
71
should be made in view of the good of the individual patient, not for the higher good of society, nor for a class good, because this would amount to manipulation of the person.
Decisions of proxy consent
72
means taking responsibility for one's actions. Nurses must accept the professional and personal consequences associated with the decisions they make regarding patient care.
Accountability
73
is the principle of truth telling, and it is grounded in respect for persons and the concept of autonomy. In order for a person to make fully rational choices, he or she must have the information relevant to his or her decision. Moreover, this information must be as clear and understandable as possible.
Veracity
74
Truth telling is violated in at least two ways.
a. By the act of lying, or the deliberate exchange of erroneous information. However, the principle of veracity is also violated by omission, the deliberate withholding of all or portions of the truth.
b. By the deliberate cloaking of information in jargon or language that fails to convey information in a way that can be understood by the recipient or that intentionally misleads the recipient.
75
In the health care context, there are two broad applications of veracity.
a. The first relates to patient care and such issues as informed consent. Patients and families rely upon physicians and other caregivers for the information they need to make informed choices about their care. They also expect to be told the truth about their care, including any errors or untoward events. Alternatively, some patients or patients’ families do not want to be told the truth, placing the physician, nurse or other health care professional in a situation in which his or her duty to obtain informed consent is compromised by the wishes of the patient or family.
b. The second application relates more generally to professional ethics and the basic expectation that we are honest in our professional interactions. This particular application of veracity is apparent in a broad range of issues including professional relationships, documentation standards, billing practices, risk management, peer review, community relations, and regulatory reporting, and compliance.
76
in nursing means that nurses must be faithful to the promises they made as professionals to provide competent, quality care to their patients.
Fidelity
77
The idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Requires that procedures uphold the spirit of existing laws and are fair to all players involved. Reproductive technologies create ethical dilemmas because treatment is not equally available to all people.
JUSTICE
78
The health care provider must consider four main areas when evaluating justice:
a. fair distribution of scarce resources
b. competing needs
c. rights and obligations
d. potential conflicts with established legislation
79
requires that the procedure be provided with the intent of doing good for the patient involved. Demands that health care providers develop and maintain skills and knowledge, continually update training, consider individual circumstances of all patients, and strive for net benefit.
Beneficence
80
requires that a procedure does not harm the patient involved or others in society. Infertility specialists operate under the assumption that they are doing no harm or at least minimizing harm by pursuing the greater good. However, because assistive reproductive technologies have limited success rates uncertain overall outcomes, the emotional state of the patient may be impacted negatively. In some cases, it is difficult for doctors to successfully apply the do no harm principle.
Non-maleficence
81
is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end.
principle of double effect
82
sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end.
principle of double effect
83
is credited with introducing the principle of double effect in his discussion of the permissibility of self-defense in the Summa Theologica. Killing one’s assailant is justified, he argues, provided one does not intend to kill him.
Thomas Aquinas
84
observes that “Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Accordingly, the act of self-defense may have two effects: one, the saving of one’s life; the other, the slaying of the aggressor.”
Aquinas
85
Four Conditions for the Application of the Principle of Double Effect
1. The act itself must be morally good or at least indifferent.
2. The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary.
3. The good effect must flow from the action at least as immediately (in the order of causality, though not necessarily in the order of time) as the bad effect. In other words, the good effect must be produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad means to a good end, which is never allowed.
4. The good effect must be sufficiently desirable to compensate for the allowing of the bad effect.
86
The Principle of Double Effect Will Be Invoked of the Following Reasons
1. When the act by its nature is evil.
2. When the good effect directly proceeds from the evil effect and not from the act itself.
3. When there is no sufficient reason for the performance of an act with two effects, one-good, the other-evil.
4. When the motive of the agent is not honest.
87
Example of double effect
Example of a situation, to kill a person whom you know to be plotting to kill you would be impermissible because it would be a case of intentional killing; however, to strike in self-defense against an aggressor is permissible, even if one foresees that the blow by which one defends oneself will be fatal.
88
portrays the principle of the double effect in a scenario in which more than one person participates in the actions being evaluated.
principle of legitimate cooperation
89
comes from the Latin word cum which means “with” and operari which means “to work”. Cooperation is working with another in the performance of an action.
Cooperation
90
cum ; __
operari ; ___
cum ; with
operari ; to work
91
Criteria to Judge Principle of Legitimate Cooperation
* The moral object of your action is good and you are operating out of good intentions.
* The evil is only tolerated as a side effect of your action
* Your cooperation is only material cooperation, not formal
* Your cooperation is remote rather than proximate so it causes minimal evil effects
* Your action does not cause scandal
92
The degrees of cooperation may vary according to the gravity or essentiality of the shared act in the performance of an evil action.
1. Formal and Material Cooperation
2. Direct and Indirect Cooperation
3. Proximate and Remote
93
consists of an explicit intention and willingness for the evil act. The one formally cooperating categorically wills and intends the evil action.
Formal Cooperation
94
consists of an act other than the evil act itself but facilitates and contributes to its achievement. The one materially cooperating may provide means apart from the evil act itself which is used to carry out the performance of an evil act.
Material Cooperation-
95
consists of direct participation in the performance of an evil act. The one directly cooperating gets involved by openly and straightforwardly taking part in the practice of an evil action.
Direct Cooperation-
96
consists of an act that is not intimately connected with the performance of an evil act as in formal and direct cooperation but whose effect may have an indirect bearing upon it.
Indirect Cooperation-
97
consists of an act that is intimately linked with the performance of an evil action due to its close bearing.
Proximate Cooperation-
98
consists of an act with a distant bearing upon or connection with the execution of an evil act.
Remote Cooperation-
99
Moral Rules Governing Cooperation
a. No one should formally and directly cooperate in the performance of an evil action.
b. If a reason sufficiently grave exists, material cooperation in the performance of an evil action may be morally excused.
c. If the material cooperation is proximate, a reason sufficiently graver should exist so as to be morally excused without which evil is incurred.
100
as “the sum total of social conditions which allows people, either as groups or as individuals, to reach their fulfilment more fully and more easily.” It is about the progress of persons.
principle of common good
101
consists not only of the material or external good of all human beings; it also includes the comprehensive good of the human being, including even the spiritual good.
common good
102
is not an end in itself. It is only part of a bigger picture, the ultimate end of which is God.
common good of society
103
, as a mere materialistic socio-economic ideal, would count for little without any transcendental goal.
common good
104
is intended to ensure that decisions are taken as closely as possible to the citizen and that constant checks are made as to whether action at Community level is justified in the light of the possibilities available at national, regional or local level.
subsidiarity principle
105
often considered a result of the principle of the common good, subsidiarity requires those in positions of authority to recognize that individuals have a right to participate in decisions that directly affect them, in accord with their dignity and with their responsibility to the common good.
Principle of subsidiarity
106
should be made at the most appropriate level in a society or organization, that is, one should not withdraw those decisions or choices that rightly belong to the individuals or smaller groups and assign them to a higher authority
Decisions
107
is defined as governance, which refers to the wide range of functions carried out by the steward as they seek to achieve national health policy objectives.
-help to improve overall levels of population health. The objectives are likely to be framed in terms of equity, coverage, access, quality, and patients' rights.
Stewardship
108
The traditional definition of stewardship in the Book of Genesis
God appoints humanity as the steward of all creation.
109
State-orientated definitions of stewardship
is that the function of government is responsible for the welfare and interests of the population, especially the trust and legitimacy by the general public.
110
the Institute of Medicine proposed six aims to improve the health care system for the 21st century. The recommendations were that health care should be:
1. safe
2. effective
3. patient-centered
4. timely
5. efficient
6. equitable
111
To achieve the six aims, nurse leaders will have to engage in
developing, assessing and refining innovative and fresh modes of health care delivery.
112
This lead to leadership opportunities for nursing that initiate dialogue with colleagues to use knowledge base ideas. This allows nursing leaders for transformational structures, programs and systems to meet the six recommendations of the Institute of Medicine (2001).
These recommendations have been assumed by the health care community. / PRINCIPLE OF STEWARDSHIP AND ROLE OF NURSES AS STEWARDS
113
To meet the domains of stewardship in health care and the nursing profession, it is crucial that nurse leaders engage with the development of self. Succession planning to develop and nurture a new generation of transformational nurse leaders may be the only way to achieve this. To meet the concept of lifelong learning, nurse leaders or stewards will need to use of mentors and personal coaches to assist them in refining skills and improving competencies. Healthy nurse leader stewards will thus become visible and sound role models within their institutions to maintain the balance between self and professional fulfilment.
Personal Stewardship
114
Another prospect of stewardship is to revive a sense of social purpose among public sectors of management, together with assisting to restore a sense of trust and legitimacy to the role of the state.
Social Stewardship
115
may be a realistic (and achievable) possibility to channel fresh and emerging systems of integrated care in more socially responsible ways.
This ‘attractiveness’ of a stewardship
116
We are social beings, committed to build a just, free and fraternal world; we have rights and duties; the world has been created by God for all and, therefore,
all humans have the right to a share in the goods of the earth.
117
Through our work, we have to improve the world, but not destroy it, nor exploit it. Protect against pollution, deforestation, chemical dumping and the exploitation of the environment, we have to respect biodiversity.
Ecological Stewardship
118
is the cause of ecological garbage”
Moral garbage
119
has an implication in energy conservation, food sourcing and integrated waste program.
Green operation
120
Health care providers are obliged to respect and improve human life and nature; they must not play God; they must accept death not as a medical failure but as part of human life. Above all, they must respect the right to life, which is the basic human right.
Biomedical Stewardship
121
The leadership potential of stewardship in nursing requires new models of delivery of care, and we need to address the ever-changing nature of the work of a nurse. With evolving new roles in the nursing profession, collaboration with nursing research colleagues will be required to develop mechanisms of evaluation and assessment which further refine evidence that supports the essential and exclusive contributions of the professional nurse in outcomes of care and prevention.
Stewardship of Nursing
122
call for nursing stewards who will embark on such issues to design new financial models in order to constantly build the business side of nursing care delivery models. Such leadership will become synergistic with the work in the area of stewardship of the health care system.
Development and enhancement of the evidence in research
123
The intended outcome is to make practice environments more positive, healthy and engaging. Areas for dialogue may be within:
1. patient-population centeredness
2. safety for patients and health care personnel
3. the needs of an ageing workforce
4. increased autonomy for advanced nurse practitioners
5. increased respect for the contributions made by professional nurses
6. clarification of the caring work of the nurse, and
7. enhancement of the collaborative practice of the multidisciplinary health care team.
124
an opportunity for nursing stewardship lies in the
regulatory and accreditation aspects of the profession.
125
are finding themselves collaborating with regulatory boards to improve on standards of practice, certification and accreditation, thus ensuring that standards and regulations support the nurse of the future and new models of care delivery, and remain true to a patient/population-centered health care system.
Nurse leaders or stewards
126
This principle states that all decisions in medical ethics must prioritize the good of the entire person, including physical, psychological and spiritual factors.
PRINCIPLE OF TOTALITY AND ITS INTEGRITY
127
According him, all of the organs and other parts of the body exist for the sake of the whole person. Because the purpose of the part is to serve the whole, any action that damages a part of the body or prevents it from fulfilling its purpose violates the natural order and is morally wrong.
to the philosopher Thomas Aquinas
128
- is an integral part of the human person and is therefore worthy of human dignity.
-must be kept whole. No body part should be removed, mangled or debilitated unless doing so is necessary for the health of a more essential body part or the body of a whole.
human body
129
single part may be sacrificed if the loss is necessary for the good of the whole person. Also, an unessential or redundant body part may be removed for the good of another person.
PRINCIPLE OF TOTALITY AND ITS INTEGRITY
130
Applications PRINCIPLE OF TOTALITY AND ITS INTEGRITY
* The amputation of a gangrenous limb, because the person could die if the gangrene spread.
* Surgeries that needlessly remove body parts or organs are immoral
* Torture is a moral evil because it seeks to disintegrate the body and the spirit
131
is a vital part of the surgical team. The registered nurse in the operating room may perform tasks in the preoperative, intraoperative or postoperative phase of surgery.
surgical nurse, more correctly called a perioperative nurse
132
has ethical and moral responsibility to represent the patient's interests, show humility, respect and protect patient autonomy and preserve patient dignity. They have responsibility to themselves, their profession, and their patients to maintain the highest ethical principles. It is important to advocate for patient care, patient rights, and ethical consideration of practice.
Registered Nurse
133
Ethico-Moral Aspects in Nursing
* Autonomy - the right/freedom to decide, the patient has the right to refuse despite the explanation of the nurse. Example: surgery, or any procedure.
* Non-maleficence - the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social).
134
Duties in the Operating Room
1. Perioperative nurses assess patients prior to surgery and complete documentation that is used by other members of the team.
2. They perform patient education and provide emotional support to the patient and family.
3. During and after the operation, the perioperative nurse may perform tasks such as taking the patient’s pulse and blood pressure, emptying suction equipment or removing dirty linens.
4. Perioperative nurses must know how to operate all equipment in the operating rooms and where all supplies and equipment are stored.
5. Helping to transport a patient to surgery or to the post-anesthesia recovery area.
6. The perioperative nurse may administer medications to help sedate the patient prior to a procedure, order supplies or instruments and assure that equipment is properly cleaned and stored.
7. The perioperative nurse may also be responsible for sterilization of instruments in some organizations.
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The Scrub Nurse
* Perioperative nurses may work as either scrub or circulating nurses.
* While the physicians perform the surgery and manage the anesthesia, the scrub nurse selects and passes instruments, tools and supplies used during the operation.
* Since infection is one of the biggest risks of any surgery, she watches carefully for possible contamination to assure sterile technique is maintained at all times.
* The scrub nurse will assure that all items on the surgical trays are counted before and after the operation so the patient doesn't wind up with something extra inside him.
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The Circulating Nurse
* The circulating nurse is the extra pair of hands for each of the other health-care professionals in the room.
* She will assist the surgeon, assistant and scrub nurse in donning their sterile clothing or protective equipment.
* She may bring more dressings or pick up an instrument that has been dropped.
* If the anesthesiologist needs his cart restocked or an additional vial of medication, the circulating nurse will perform those tasks.
* The circulating nurse is also the room monitor.
* She keeps an eye on all activity to keep the patient and the surgical team safe.
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In Bioethics is a surgical technique leaving a male or female unable to reproduce. It is a method of birth control.
sterilization
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is when the vas deferens (the tubes which connect the testicles to the prostate) are cut and closed. This prevents sperm produced in the testicles to enter the ejaculated semen (which is mostly produced in the seminal vesicles and prostate).
* Vasectomy
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(also known as orchiectomy) is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad.
* Castration
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which is known popularly as "having one's tubes tied". The Fallopian tubes, which allow the sperm to fertilize the ovum and would carry the fertilized ovum to the uterus, are closed. This generally involves a general anesthetic and a laparotomy or laparoscopic approach to cut, clip or cauterize the fallopian tubes.
* Tubal ligation
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* is when the uterus is surgically removed, permanently preventing pregnancy and some diseases, such as uterine cancer.
Hysterectomy
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Type of Sterilization
1. Direct or Indirect
2. Temporary or Permanent
3. Medical or Surgical
4. Punitive or Eugenic
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refers to a type of sterilization that is directly willed either as an end or a means. (Ex. Vasectomy or ligation).
a. Direct Sterilization
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refers to a type of sterilization that is not wilfully employed either as an end or a means. (Ex. Surgical removal of the ovaries or testicles sick with cancer).
b. Indirect Sterilization
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refers to a type of sterilization that brings about provisionary and reversible sterility (Ex. Oral and hormonal contraceptives)
a. Temporary Sterilization
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refers to a type of sterilization that creates irreversible and lasting sterility. (Ex. Hysterectomy, oophorectomy, salpingectomy)
b. Permanent Sterilization
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refers to a type of sterilization that produces medically-sterilizing effect. (as temporarily like: Pills for women who doesn’t want to get pregnant).
Medical sterilization
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refers to a surgical procedure that sterilizes or renders one unable to reproduce.
Surgical sterilization
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refers to a type of sterilization which is a form of penalty or punishment usually ascribed to sex-related crimes. It may be permanent, surgical form of sterilization
Punitive Sterilization
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refers to a type of sterilization that is intended for one whose genetic or eugenic make up is seen to produce defective offspring.
. Eugenic Sterilization-
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Moral Issues on Sterilization
The Catholic church has strongly condemned all artificial methods of Contraception (a position also held by most Protestant churches up to 1930, when the Anglican church voted for change). This includes the contraceptive pill, condoms and also medical procedures such as vasectomy and ligation. In fact, the church regards contraception as mortally sinful. The official position is stated in the papal encyclical Humanae Vitae, issued by Pope Paul VI in 1968.
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is an act or physical injury that degrades the appearance or function of the (human) body, usually without causing death.
Mutilation
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Refers to the procedure that destroys the functional integrity of the human body so that it becomes incapacitated of its natural function. It may usually be done by means of surgical procedures. Ex. Radical Mastectomy, Appendectomy, Herniorrhaphy, Caesarean Section, Craniotomy.
1. Major Mutilation
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Refers to the procedure that diminishes but does not destroy the functional integrity of the human body. Ex. Biopsies (mole, warts), excision of ingrown
Minor Mutilation
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Moral Issues on Mutilation
The principle of totality assumes that parts exist for the whole. The good of the part is subordinated to the good of the whole; the whole is the determining factor for the part and can dispose of its own interest.
Aristotle puts it briefly as totum quam parte, prius esse necesse est. The main notions on which the principle grounds itself are “the whole, the part, and their mutual relationships.”
Regarding the part, Aristotle explains it in the following manner: A part denotes any portion of a major into which it can “be divided, for that which is taken from a quantum qua quantum” remains always a part of it.
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Even though the scholastics unanimously accepted the justification of mutilation by Thomas Aquinas, there are differences in the application of these principles to particular issues.
* A diseased part is harmful to the whole body.
* Another question pertains to “the predicament of a person who was ordered by a tyrant to cut off his own hand.”
* Another case is “the necessity to amputate an extremity.”
* Concerning the morality of mutilation, traditional moral theologians base their arguments that man/woman has only a limited right over his/her body.
* More precisely, mutilation on the ground of the principle of totality is justified only by the physical good of the person.
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can be a sufficient reason for the performance of mutilation.
Restoration of health or preservation of life
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is the process when a person allows an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive or dead with the assent of the next of kin.
Organ donation
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Common transplantations include
* kidneys
* Heart
* Liver
* Pancreas
* Intestines
* Lungs
* Bones
* bone marrow
* Skin
* Corneas
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An act authorizing the legacy or donation of all or part of a human body after death for specified purposes
REPUBLIC ACT NO. 7170 / Organ Donation Act of 1991.”
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a facility licensed, accredited or approved under the law for storage of human bodies or parts thereof.
“Organ Bank Storage Facility”
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a deceased individual, and includes a still-born infant or fetus.
Decedent”
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” – an individual who makes a legacy of all or part of his body.
“Testator
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” – an individual authorized under this Act to donate all or part of the body of a decedent.
Donor
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– a hospital licensed, accredited or approved under the law, and includes a hospital operated by the Government.
Hospital”
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– includes transplantable organs, tissues, eyes, bones, arteries, blood, other fluids and other portions of the human body.
Part”
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– an individual, corporation, estate, trust, partnership, association, the Government or any of its subdivisions, agencies or instrumentalities, including government-owned or -controlled corporations; or any other legal entity.
Person”
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– a physician or surgeon licensed or authorized to practice medicine under the laws of the Republic of the Philippines.
“Physician” or “Surgeon”
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of the decedent – the persons enumerated in Section 4(a) of this Act.
“Immediate Family”
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the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem
“Death” –
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. A person shall be medically and legally dead if either:
1) In the opinion of the attending physician, based on the acceptable standards of medical practice, there is an absence of natural respiratory and cardiac functions and, attempts at resuscitation would not be successful in restoring those functions. In this case, death shall be deemed to have occurred at the time these functions ceased; or
2) In the opinion of the consulting physician, concurred in by the attending physician, that on the basis of acceptable standards of medical practice, there is an irreversible cessation of all brain functions; and considering the absence of such functions, further attempts at resuscitation or continued supportive maintenance would not be successful in restoring such natural functions. In this case, death shall be deemed to have occurred at the time when these conditions first appeared.
The death of the person shall be determined in accordance with the acceptable standards of medical practice and shall be diagnosed separately by the attending physician and another consulting physician, both of whom must be appropriately qualified and suitably experienced in the care of such patients. The death shall be recorded in the patient’s medical record.
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. – Any individual, at least eighteen (18) years of age and of sound mind, may give by way of legacy, to take effect after his death, all or part of his body for any purpose specified in Section 6 hereof.
sec 3Person Who May Execute A Legacye
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a) Any of the following persons, in the order of priority stated hereunder, in the absence of actual notice of contrary intentions by the decedent or actual notice of opposition by a member of the immediate family of the decedent, may donate all or any part of the decedent’s body for any purpose specified in Section 6 hereof:
1) Spouse;
2) Son or daughter of legal age;
3) Either parent;
4) Brother or sister of legal age; or
5) Guardian over the person of the decedent at the time of his death.
SEC. 4. Person Who May Execute a Donation. –
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A legacy or donation of all or part of a human body authorizes any examination necessary to assure medical acceptability of the legacy or donation for the purpose(s) intended.
For purposes of this Act, an autopsy shall be conducted on the cadaver of accident, trauma, or other medico-legal cases immediately after the pronouncement of death, to determine qualified and healthy human organs for transplantation and/or in furtherance of medical science.
SEC. 5. Examination of Human Body or Part Thereof. –
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– The following persons may become legatees or donees of human bodies or parts thereof for any of the purposes stated hereunder:
a) Any hospital, physician or surgeon – For medical or dental education, research, advancement of medical or dental science, therapy or transplantation;
b) Any accredited medical or dental school, college or university – For education, research, advancement of medical or dental science, or therapy;
c) Any organ bank storage facility – For medical or dental education, research, therapy, or transplantation; and
d) Any specified individual – For therapy or transplantation needed by him.
SEC. 6. Persons Who May Become Legatees or Donees.
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– A hospital authorized to receive organ donations or to conduct transplantation shall train qualified personnel and their staff to handle the task of introducing the organ donation program in a humane and delicate manner to the relatives of the donor-decedent enumerated in Section 4 hereof. The hospital shall accomplish the necessary form or document as proof of compliance with the above requirement.
SEC. 7. Duty of Hospitals.
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a) Legacy of all or part of the human body under Section 3 hereof may be made by will. The legacy becomes effective upon the death of the testator without waiting for probate of the will. If the will is not probated, or if it is declared invalid for testamentary purposes, the legacy, to the extent that it was executed in good faith, is nevertheless valid and effective.
b) A legacy of all or part of the human body under Section 3 hereof may also be made in any document other than a will. The legacy becomes effective upon death of the testator and shall be respected by and binding upon his executor or administrator, heirs, assigns, successors-in-interest and all members of the family. The document, which may be a card or any paper designed to be carried on a person, must be signed by the testator in the presence of two witnesses who must sign the document in his presence. If the testator cannot sign, the document may be signed for him at his discretion and in his presence, in the presence of two witnesses who must, likewise, sign the document in the presence of the testator. Delivery of the document of legacy during the testator’s lifetime is not necessary to make the legacy valid.
c) The legacy may be made to a specified legatee or without specifying a legatee. If the legacy is made to a specified legatee who is not available at the time and place of the testator’s death, the attending physician or surgeon, in the absence of any expressed indication that the testator desired otherwise, may accept the legacy as legatee. If the legacy does not specify a legatee, the legacy may be accepted by the attending physician or surgeon as legatee upon or following the testator’s death. The physician who becomes a legatee under this subsection shall not participate in the procedures for removing or transplanting a part or parts of the body of the decedent.
d) The testator may designate in his will, card or other document, the surgeon or physician who will carry out the appropriate procedures. In the absence of a designation, or if the designee is not available, the legatee or other persons authorized to accept the legacy may authorize any surgeon or physician for the purpose.
SEC. 8. Manner of Executing a Legacy. –
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Any donation by a person authorized under subsection (a) of Section 4 hereof shall be sufficient if it complies with the formalities of a donation of a movable property.
In the absence of any of the persons specified under Section 4 hereof and in the absence of any document of organ donation, the physician in charge of the patient, the head of the hospital or a designated officer of the hospital who has custody of the body of the deceased classified as accident, trauma, or other medico-legal cases, may authorize in a public document the removal from such body for the purpose of transplantation of the organ to the body of a living person: Provided, That the physician, head of hospital or officer designated by the hospital for this purpose has exerted reasonable efforts, within forty-eight (48) hours, to locate the nearest relative listed in Section 4 hereof or guardian of the decedent at the time of death.
SEC. 9. Manner of Executing a Donation. –
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In all donations, the death of a person from whose body an organ will be removed after his death for the purpose of transplantation to a living person, shall be diagnosed separately and certified by two (2) qualified physicians neither of whom should be:
a) A member of the team of medical practitioners who will effect the removal of the organ from the body; nor
b) The physician attending to the recipient of the organ to be removed; nor
c) The head of hospital or the designated officer authorizing the removal of the organ.
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Only authorized medical practitioners in a hospital shall remove and/or transplant any organ which is authorized to be removed and/or transplanted pursuant to Section 5 hereof.
SEC. 10. Person(s) Authorized to Remove Transplantable Organs. –
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– If the legacy or donation is made to a specified legatee or donee, the will, card or other document, or an executed copy thereof, may be delivered by the testator or donor, or his authorized representative, to the legatee or donee to expedite the appropriate procedures immediately after death. The will, card or other document, or an executed copy thereof, may be deposited in any hospital or organ bank storage facility that accepts it for safekeeping or for facilitation or procedures after death. On the request of any interested party upon or after the testator’s death, the person in possession shall produce the document of legacy or donation for verification.
SEC. 11. Delivery of Document of Legacy or Donation.
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a) If the will, card or other document, or an executed copy thereof, has been delivered to a specific legatee or donee, the testator or donor may amend or revoke the legacy or donation either by:
1) The execution and delivery to the legatee or donee of a signed statement to that effect; or
2) An oral statement to that effect made in the presence of two other persons and communicated to the legatee or donee; or
3) A statement to that effect during a terminal illness or injury addressed to an attending physician and communicated to the legatee or donee; or
4) A signed card or document to that effect found on the person or effects of the testator or donor.
b) Any will, card or other document, or an executed copy thereof, which has not been delivered to the legatee or donee may be revoked by the testator or donor in the manner provided in subsection (a) of this section or by destruction, cancellation or mutilation of the document and all executed copies thereof.
Any legacy made by a will may also be amended or revoked in the manner provided for amendment or revocation of wills, or as provided in subsection (a) of this section.
SEC. 12. Amendment or Revocation of Legacy or Donation. –
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a) The legatee or donee may accept or reject the legacy or donation as the case may be. If the legacy or donation is of a part of the body, the legatee or donee, upon the death of the testator and prior to embalming, shall effect the removal of the part, avoiding unnecessary mutilation. After removal of the part, custody of the remainder of the body vests in the surviving spouse, next of kin or other persons under obligation to dispose of the body of the decedent.
b) Any person who acts in good faith in accordance with the terms of this Act shall not be liable for damages in any civil action or subject to prosecution in any criminal proceeding of this Act.
SEC. 13. Rights and Duties After Death.
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SEC. 14. International Sharing of Human Organs or Tissues. – Sharing of human organs or tissues shall be made only through exchange programs duly approved by the Department of Health: Provided, That foreign organ or tissue bank storage facilities and similar establishments grant reciprocal rights to their Philippine counterparts to draw human organs or tissues at any time.
SEC. 14. International Sharing of Human Organs or Tissues.
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In order that the public will obtain the maximum benefits from this Act, the Department of Health, in cooperation with institutions, such as the National Kidney Institute, civic and non-government health organizations and other health related agencies, involved in the donation and transplantation of human organs, shall undertake a public information program.
The Secretary of Health shall endeavor to persuade all health professionals, both government and private, to make an appeal for human organ donation.
SEC. 15. Information Drive. –
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– The Secretary of Health, after consultation with all health professionals, both government and private, and non-government health organizations shall promulgate such rules and regulations as may be necessary or proper to implement this Act.
SEC. 16. Rules and Regulations.
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– All laws, decrees, ordinances, rules and regulations, executive or administrative orders, and other presidential issuances inconsistent with this Act, are hereby repealed, amended or modified accordingly.
SEC. 17. Repealing Clause.
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– The provisions of this Act are hereby deemed separable. If any provision hereof should be declared invalid or unconstitutional, the remaining provisions shall remain in full force and effect.
SEC. 18. Separability Clause.
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This Act shall take effect after fifteen (15) days following its publication in the Official Gazette or in at least two (2) newspapers of general circulation.
SEC. 19. Effectivity. –
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A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.
Ordinary Means of Conserving Life
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Cronin’s definition (1956), this means of conserving life are those means commonly used in given circumstances, which this individual in his present physical, psychological and economic condition can reasonably employ with definite hope of proportionate benefit.
ordinary
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A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.
Extraordinary Means of Conserving Life
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Cronin’s definition (1956), this means of conserving life are those means not commonly used in given circumstances, or those means in common use which this individual in his present physical, psychological and economic condition cannot reasonably employ, or if he can, will not give him definite hope of proportionate benefit.
extraordinary
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is a search for sensual pleasure and satisfaction, releasing physical and psychic tensions.
-is a search for the completion of the human person through an intimate personal union of love expressed by bodily union
-is a symbolic (sacramental) mystery.
Sex
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is a complex aspect for our personality and self.
-is defined by sexual thoughts, desires and longings, erotic fantasies, turns-on and experiences.
sexuality
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is based on the understanding of sexuality as one of the basic traits of the human person and must be developed in ways consistent with enhancing human dignity.
Personalized Sexuality
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This element of human character often leads to a loss of human dignity and an inability to pursue the truly fulfilling goals of human life.
PRINCIPLES OF PERSONALIZED SEXUALITY
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The Gift of Sexuality
* must be used in keeping with its intrinsic, invisible, specifically human teleology.
* must be a loving, bodily, pleasurable expression of the complementary, permanent self-giving of a man and a woman to each other.
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Values of Sexual Morality
1. Sex is a search for sensual pleasure and satisfaction, releasing physical and psychic tensions.
2. Sex is a search for the completion of the human person through an intimate personal union of love expresses by bodily union.
3. Sex is a social necessity for the procreation of children and their education in the family so as to expand the human community and guarantee is future beyond the death of individual members.
4. Sex is a symbolic (sacramental) mystery.
5. Sex is based on the understanding of sexuality as one of the basic traits of the human person and must be developed in ways consistent with enhancing human dignity.
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is a set of beliefs that emphasize the importance of reason and of people rather than religion
(secular humanism
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For Secular Humanist, Reasonable Uses of Sex
1. use sex purely for sake of pleasure apart from any relation to love or family.
2. use it to reproduce (making test tube babies) without any reference to pleasure or love.
3. expression of unselfish love, but without any relation to marriage or family.
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Norms of Sexual Morality
1. Laws or social attitudes that hinder human freedom to achieve these values in ways the individuals’ desires are unjust and oppressive.
2. Sexual behavior, at least among consenting adults, is entirely a private matter to be determined by personal choice, free from any moral guilt.
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Reasonable Uses of Sex
Sexual behavior, at least among consenting adults, is entirely a private matter to be determined by personal choice, free from any moral guilt.
