NURSING JURISPRUDENCE c.

better career prospect

d. dignified existence of nurses
 department of law which comprise all legal rules and BOARD OF NURSING:
principles affecting the practice of nursery.  supervision and regulation of nursing practice
 1 chairperson and 6 members
LAW  nursing education, nursing service and community
 a rule of civil conduct prescribed by the supreme power service
in a state commanding what is right and prohibiting what Powers and Duties:
is wrong. 1. Quasi-judicial
 Sum total of rules and regulations by which society is 2. Quasi-legislative
governed 3. Police Power
Removal or suspension:
SOURCES OF LAW 1. Neglect of duty
1. Divine Law – from the Creator 2. Irregularities in NLE
2. Human Law – made by a legislative body or any law making 3. Unprofessional, immoral conduct
body Registered Nurse:
a) General/Public Law  GWA of 75% with no grade < 60%
a) Constitutional  Registration by reciprocity
b) Criminal  Special/temporary permit
c) Administrative Revocation:
d) International 1. Criminal offense
e) Religious 2. Immoral/dishonorable conduct
b) Individual/Private Law 3. Mentally incompetent
a) Civil 4. Unprofessional and unethical practice
PHILIPPINE 5. Gross incompetence
NURSING LAW 6. Malpractice and negligence
7. Violation of Code
HISTORY:
March 1, 1919 - RA 2808 TYPES OF LAW
- First True Nursing Law  PRIVATE OR CIVIL LAW
- creation of Board of Examiners body of law that deals with relationship among private
 Chair: Dr. Juan Cabarus individuals
 Members: Anastacia Giron-Tupas  PUBLIC LAW
Belen Del Rosario body of law for the welfare of the general public; relationship
Function of BOE: between individuals and the government and government agencies
1. Issuance of certificate of registration
2. Revoke certificate of registration CLASSIFICATION OF LAWS
3. Administer exam Sources of law
4. Examine practice of nursing 1. Constitution
March 8, 1922 2. Legislation
 RA 3025 3. Executive Order, Administrative Order, Regulations and Rulings
 Registration of Red Cross Aids and Welfare 4. Precedents or Judicial decisions and Jurisprudence
Workers 5. Customs
December 5, 1932 6. Other sources
 RA 4007
 BOE put under custody of Bureau of Civil Service
1950
 RA 465 – Standardization of exam and fees LEGAL RIGHT
 RA 546 – BOE direct supervision of Pres. of Phil  a claim which can be enforced by legal means against a
person whose duty is to respect it.
1953
 Birth of Filipino Nurse Association COURT
Legislative Committee Chair:  An agency in the government wherein the administration of
Mrs. Obdulia Kabigting justice is delegated.
Members: Ms. Jovita Sotejo  COURT MECHANISM
Ms. Anne Sand LAWSUIT- proceeding in court for a purpose.
Ms. Conchita Ruiz Purpose:
June 19, 1953 Enforce a right
 Philippines Nursing Law by Sen. Geronima T. Redress a wrong
Pecson
November 21, 1991 PARTIES TO A CASE
 RA 7164 – Philippine Nursing Law of 1991  Complainant VS Defendant: Civil case - is a lawsuit that
 Sen. Edgardo Angara & Sen. Heherson Alvarez usually deals with contracts and/or torts. Torts, generally
speaking, are wrongful (negligent) acts that result in
Philippine Nursing Act of 2002 damage or injury

October 21, 2002  Plaintiff VS Accused: Criminal case - Crimes are

 RA 9173 – Philippine Nursing Act of 2002
 Sen. Juan Flavier
 more responsive nursing profession
 protection and improvement of the nursing profession by:
a. relevant nursing education
b. humane working conditions
considered offenses against the state, or society as a
whole
 Witness- an individual held upon to give necessary
details either for the accused or against the accused
Examples of Civil Cases
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  R.A. 7305- Magna Carta for Public Health Workers -Has
Civil cases deals with dispute between individuas. Civil law is designed provisions on benefits, rights and responsibilities of public
to monetarily compensate individuals for harm caused to them. health workers
 Malpractice Actions  R.A. 8344 “No Deposit Policy” - Prohibits hospitals
 Personal injury lawsuit and clinics from demanding advance payments/cash deposits
 Workers compensation before patients are admitted or treated
 Employment dispute
 LEGAL CONCEPTS AND ISSUES IN nursery
Examples of Criminal cases
 Negligence – failure to do something which a reasonable &
Criminal actions are brought by the state against a defendant accused prudent person should have done.
of breaking a law. 2 types:
 Negligent Homicide 1. Commission – wrong doing
 man-slaughter 2. Omission – total neglect of care – didn’t do anything
 Theft of narcotics
 Insurance fraud  ELEMENTS/TEST OF NEGLIGENCE
 Falsifying medical records  4D’S
Duty for nurse
When a nurses’s professional negligence rises to the level of “ reckless Dereliction (breach of duty)
disregard for human life”. Damages as result
Two well known cases involving the initiation of of criminal charges Direct result (injury, harm or
against nurses for clinical actions were: death)
1. Nurse who administered a lethal dose of Penicillin  OR…
2. Nurse who administered an epidural anesthetic agent to an An injury incurred within the
obstetric patient instead of IV antibiotics. Breadth of duty of the nurse where
Cause of injury is the failure to perform the
Witness- an individual held upon to give necessary details either for the Duty!
accused or against the accused
 SPECIFIC EXAMPLES
STATUTE OF LIMITATIONS  Burns resulting from hot water bags, heat lamps, vaporizers,
 Refers to the length of time following the event during which sitz bath
the plaintiff may file a suit.  Objects left inside the patient’s body; sponges suction tips
 Example:  Falls of the elderly, confused, unconscious, sedated patients
negligence- filed within 2-3 years from occurrence.  Falls of children whose bed rails were not pulled up and
Murder – 24 years locked
 Mistaken identity- drug given to the wrong patient
DUE PROCESS  Wrong medicine, wrong concentration, wrong route, wrong
 A fair and orderly process which aims to protect and enforce dose
a person’s right.  Defects in the equipment

FUNDAMENTAL REQUIREMENTS OF DUE PROCESS:  DOCTRINES OF NEGLIGENCE

1. Right to be informed 1. RES IPSA LOQUITOR
2. Right to remain silent - “the things speak for itself”
3. Right to competent counsel - the injury is enough proof of negligence
4. No use of violence, threat, torture 2. RESPONDEAT SUPERIOR
5. Right to know the witness face to face - Let the master answer for the acts of the
subordinate
PHASES OF DUE PROCESS - The liability is expanded to include the master as
 PRE-TRIAL- eliminate matters not in dispute, agree on issues well as the employee
or settle procedural matters. 3. FORCE MAJEURE
 TRIAL- facts are presented and determined; law applied at - Irresistible force; unforeseen or inevitable event
the end. - No person shall be responsible for those events
which cannot be foreseen
WRITTEN ORDERS OF COURT - Ex. Flood, fire, earthquake
 WRIT- legal notes from court
 SUBPOENA- an order in court INCOMPETENCE: lack of ability, legal qualifications or fitness to
 Duces tecum (papers) bring documents, objects, discharge the required duty
materials, chart to court
 Ad testificandum (person) testify as witness at a
specified time and place ELEMENTS OF MALPRACTICE
 SUMMON- a writ commanding an authorized person to notify  Duty of the nurse
a party to appear in court to answer a complaint made against  Dereliction or breach of duty
him.  Direct result (injury or harm)
 Damages
LAWS THAT PROMOTE THE WELFARE AND WELL-BElNG OF  Exceeds the limits of the standards of care
NURSE’S  Foreseability of harm
 P.D. 442- Labor Code - Defines among other things, hours of
work, contract and nurse staffing in industrial clinics MEDICATIONS & PRESCRIPTIONS
 P.D. 807- Civil Service Law 1. Only registered medical, dental and veterinary practitioners
Provide for the recruitment and selection of employees in are authorized to prescribe drugs.
government service; qualification standards; personnel 2. Prescription information (based on R.A. 5921 of the
evaluation system; and personnel discipline Pharmacy Act)- all prescriptions must contain the following
information:

2
  Name of MD, PTR, PRC#, location of clinic/ hospital Ethics
 Name of patient, age, sex
 Information about drug – frequency duration 4. DEFAMATION
 Generic & brand name in prescription  Character assassination
 There must be a third person who hears or read the
R.A. 6675- Generics Act of 1988 comment before it can be considered defamation
 All prescribed drug must be written in generic and TYPES:
brand names or generic name but never the brand  Slander-oral defamation
name alone  Libel-written words
 Purpose: for the pt. to choose what brand they want
3. Know rights in giving meds RESTRAINTS
4. Proper identification of pt’s name  Restraints are protective devices used to limit the physical
5. In cases of doubts and errors in medication, refer to the activity of a client or to immobilize a client or an extremity.
physician. TYPES:
6. Special training is required before a nurse can administer IV  Physical restraints: restrict client’s movement through the
injection. application of a device
BON Resolution No. 8 states that who administers IV injection e.g. restraint jacket, straps,
without training shall be held liable whether causing or not an injury or  Chemical restraints: Medications given to inhibit a specific
death to the patient) behavior or movement.
7. Verbal or telephone order e.g. sedation, psychotrophic drug

General rule: as possible avoid T.O. RESTRAINTS SHOULD NOT BE USED PRN!!!
“whatever is not written is not an order”  R-equires physician’s order; consent
Exception: During extreme emergency only!  E-mergency, get MD’s order ASAP
 S-hortest duration, least restrictive type
What to do?  T-o protect pt. and others
1. nurse should read back such order to the physician to make  R-enew order every 24 hours
certain the order has been correctly written.  A-ssess every 15 to 30 minutes and document
2. Such order should be signed by the physician within 24  I-ndividualized supervision
hours.  N-ever used as a punishment
3. The nurse should sign the physician’s name per her own and  T-otal documentation
note the time and order was received.  S-eclusion as last step

INTENTIONAL WRONGS ALTERNATIVES TO RESTRAINTS

 TORTS: A legal wrong, committed against a person or  Before restraints offer explanations, ask someone to stay with
property the client, use clocks, calendars, TV & radio (to decrease
TYPES: disorientation) or any relaxation techniques.
1. Unintentional- do not require intent but do require the element of  Use LESS restrictive methods first. RESTRAINTS should
harm. always be the last.
A. Ex. Negligence and malpractice  Assign confuse and disoriented clients to rooms near the
2. Intentional- the act was done on purpose or with intent; no harm, nurse’s station.
injury or damage is needed to be liable.  Maintain toileting routines & institute exercise and ambulation
schedules as the client condition allows.
CRIMES & OTHER ACTS
1. ASSAULT AND BATTERY  CRIME: An act committed or omitted in violation of the law
Two elements:
 ASSAULT- an attempt or threat to touch another person  Criminal act
unjustifiably; mental or physical threat  Evil/criminal intent
 Ex.- forcing a pt. to take his medication or treatment  Criminal Actions
 BATTERY- physical harm through willful touching of person  Acts or offenses against public welfare
or clothing without consent.  Misdemeanor- offenses or acts less than a felony
Ex. – giving of injection without pt’s consent  Felony- a public offense committed with deceit and
2. FALSE IMPRISONMENT fault
 Unjustifiable detention of a person without a legal warrant  Criminal negligence
 occurs when the person is not allowed to leave a health care  Reckless imprudence- person does an act from
facility when there is no legal justification to detain the client. which damage results immediately
 occurs when restraining devices are used without an  Simple imprudence- did not use precaution and the
appropriate clinical need. damage was not immediate
3. INVASION OF PRIVACY
 Right to privacy is the right to be left alone CLASSIFICATION
 Right to be free from unwarranted publicity 1. Manner of commission:
 Exposure to public view  Deceit (dolo) with criminal intent
 Divulge information from patient’s chart to improper  Fault (culpa) without; negligence
sources or unauthorized person 2. Stages of Execution
3. Degree of penalty and fine
 PRIVILEGED COMMUNICATION: Statements uttered in good 4. Degree of participation
faith; not permitted to be divulged in court of justice
Circumstances affecting criminal liability
Exceptions: Confidential information can be revealed!  REMEMBER : J-E-M-A-A
Pt. consent, if there is
Inform HCT for precautionary measures JUSTIFYING
Crimes, child abuse, BWS 1. SELF-DEFENSE
Communicable disease- R.A. 3573 (Law on Notifiable Diseases) a. Unlawful aggression

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 b. Reasonable necessity 5. ABORTION- termination of product of conception before the age of
c. Lack of sufficient provocation viability.
2. Fulfillment of Duty 6. INFANTICIDE
3. Obedience to an order from superior - the killing of an infant less than three days or 72 hours.
a. Order must be lawful 7. ROBBERY
b. Superior acting within the scope of practice - Anyone who gets the personal property of
another with the use of force,violence or
EXEMPTING intimidation.
1. Insane/imbecile 8. THEFT- -anyone who gets the personal property of another
2. Performance of a lawful act causes injury by mere without the latter’s permission.
accident
3. Under 9 y/o 9. SIMULATION OF BIRTH
4. Under compulsion of uncontrollable force a) Pretend that a woman gave birth
5. Under impulse of uncontrollable fear b) Substitution or exchanging of babies in the nursery
6. Failure to perform an act required by law when prevented c) Intentionally putting wrong information in the birth registration
by some lawful cause form
P.D. 651 – Birth Registration Act - requires any person (RN,OB, nurse)
MITIGATING who shall assist in giving birth to report within 30 days without penalty
1. Under 18y/o or over 70 y/o any live birth at Local Civil Registrar’s Office.
2. No intention to commit so grave a wrong 10. DISPENSING OF PROHIBITED DRUGS
3. Sufficient provocation/threat preceding the act R.A. 6425 (1965) – Dangerous Drugs Act
4. Immediate vindication of a grave offense 1. Prohibited – chemicals or substances that are totally and
5. Voluntary surrender absolutely can’t be consumed by human being.
6. Deaf & dumb/ with physical defect  Ex. Shabu, cocaine, cannabis
7. Suffer from such illness that diminishes willpower 2. Regulated – can use this drug - with appropriate prescription - MD
with appropriated license
AGGRAVATING Ex.- Valium, dormicum
1. Treachery/taking advantage of superior strength or  PENALTY FOR VIOLATING THE ACT
position
2. Price, reward, promise For licensed health care providers
3. Use of fire, poison, explosion  Fines
4. Calamities  Imprisonment
5. Craft, fraud or disguise employed  Automatic revocation of license
6. Evident Premeditation GUIDELINES TO PREVENT CRIMINAL LIABILITY:
7. Cruelty 1. Be very familiar with the Philippine nursery law
2. Be familiar with the laws affecting nursery practice
3. Know agency rules, regulations, policies
ALTERNATIVE 4. Upgrade skills and competence
 May increase/ decrease criminal liability depending on 5. Develop good IPR with co-workers
the nature and effects of the crime 6. Consult superior as needed
1. Relationship 7. Verify vague/ erroneous orders
2. Intoxication 8. Always keep doctor updated regarding patient
3. Degree of instruction/ education 9. Ensure accurate recording and reporting
10. Get informed consent
DRILLS 11. Do not delegate responsibilities to others
1. Under compulsion of uncontrollable force
2. There is sufficient provocation TIPS FOR AVOIDING LEGAL PITFALLS:
3. Act is committed with abuse of confidence 1. Patient Falls
4. Fulfillment of a duty  do proper assessment
5. Offender is over 70 years old  appropriate assistance
6. Voluntary surrender  use protective measures
7. Disguise in being employed  document all nursery interventions
8. Defense of a stranger 2. Medication errors
9. Acts under the impulse of an uncontrollable fear  observe the rights of drug administration
10. Offender is insane  Check dr’s order
 Understand the medication you will administer
CRIMES CONCERNING THE NURSE  Consult drug handbook/ pharmacy
 Not exempt from liability for following wrong dr’s order
1. MORAL TURPITUDE 3. Equipment injuries
Are acts contrary to the accepted and customary rule of right  refuse to use a device you do not know how to operate
 report adverse events to superiors
 ANTI- RAPE LAW (RA 8353)  monitor patient regularly
2. MURDER- killing of another with intent  bring questionable orders to the attention
3. HOMICIDE- unintentional killing of another person of the doctor or superior
4. PARRICIDE
 Killing of a person to whom you have a relationship DRILLS: What type of crime?
1. father 1. A student nurse is overheard talking in the cafeteria about a client
2. mother and his suicidal tendencies.
3. brothers/sisters 2. A nurse asks a client why he chose Dr. Smith for her physician
4. ascendants when this doctor is always rude to the staff.
5. descendants 3. A client is told he must pay the remainder of his medical bill before
6. spouse he can leave the facility.

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4. A nurse told the client that she will inject her with sedatives if he  Emergency cases
does not cooperate.  Minors seeking birth control or pre-natal treatment
5. A nurse forcibly opened the mouth of a pedia patient and gave his  Over specific age (12 years old & above may give consent for
medication. STD, HIV testing, AIDS treatment, drugs & alcohol treatment
6. A nurse takes the wallet of the patient while the latter is sleeping. without parents consent.
7. A nurse takes the wallet of the patient with the use of violence and  Sexually abused minors & adolescents
intimidation.
8. A nurse gives a potent injection of morphine to a patient causing LEGAL CONSIDERATIONS IN CHARTING
his death.
9. A nurse poisons his client to end his life. PURPOSE OF THE PT’S. CHART
10. A patient died because of wrong medication given. Communication and continuity
Assurance of quality care
NURSES AND CONTRACTS Research
Legal document
CONTRACT Statistics of the disease
 Meeting of minds between two persons whereby one binds *The chart is owned by the hospital
himself, with respect to other, to give something or to render  DO’S & DONT’S IN CHARTING
some service  DO’S
 A promise which the law recognizes as a duty and when that Full, factual and objectively accurate
duty is not performed the law provides a remedy (Breach) Legible
Immediate
KINDS OF CONTRACT Personal
 Formal- refers to an agreement between parties and is  DON’T’S
required to be in writing. Language or unacceptable words
o E.g. marriage contract .. Improper corrections
 Informal- one in which the law does not require the same to Spaces & skips
be in writing. Abbreviation, not standard
 Express- the conditions and terms of contract are given orally  Don’t tamper the medical record by:
or in writing by the parties concerned. Adding
o E.g. PDN under the doctrine of "facio ut des" means Rewriting
I do that you may give. Destroying original record
 Implied- one that is concluded as a result of acts of conduct  Observe agency’s standards on documentation
of the parties into a contract. Complete & Concise
 Void- one that is inexistent from the very beginning and Specific & Standard abbreviations
therefore may not be enforced.
 Illegal- one that is expressly prohibited by law Writing an Incident Report
o Those that are made In protection of the law  A tool used as a means of identifying and improving client
o Consent obtained by fraud; duress; undue influence care. They are usually made immediately after its occurrence
and material misrepresentation and validated immediately by co-workers.
 Purpose: to provide accurate documentation of occurrences
CONSENT affecting the client as to have basis for its intervention.
 a free and rational act that presupposes knowledge of the
thing to which consent is being given by a person who is The following are common situations that require an incident report:
legally capable to give consent  MOST OF THEM ARE NEGLIGENT ACTS
Informed Consent- a written consent should be signed to show that  Falls , burns & medication error
the procedure is the one consented to and that the person understands  Break in the aseptic technique
the nature of the procedure  Incorrect sponge count during surgery
 Failure to report the clients condition
 nurse’s responsibility regarding informed consent
(1) witness the exchange between the client and the physician Rules in Incident Report
(2) witnessing the client affix his signature  Don’t use the word error or include lawful judgment or
(3) establishing that the client really understood. inflammatory words

 Characteristics of a Valid Consent NURSES AND WILLS, GIFTS, ADVANCE DIRECTIVES

 Voluntariness; free from coercion  WILLS- legal declaration of a person’s intentions upon death.
 Opportunities to ask questions expalined  Called a testamentary document because it takes
 Treatment explained effect after the death of its maker
 Understood by the patient  An act whereby a person is permitted with the
 Maturity of parties (physically and mentally) formalities prescribed by law, to control a certain
degree the deposition of his estate, to take effect
 CRITERIA OF GOOD CONSENT after death.
 Eighteen years old and above  Decedent – a person whose property is transmitted through
 Mentally capacitated succession whether or not he left a will
 Proxy consent- <18 and mentally  Testator – a person who left a will.
incapacitated  Testatrix – a woman who is making a will
o Parent  Heir – a person called to succession either by the provision of
o Guardian (in order) a will or by operation of law
o Physician  Testate – a person who dies leaving a will
o Guardian ad litem  Intestate – a person who died without leaving a will
 Probate – validation of a will in court
Exceptions to an Informed Consent  Administrator – one who administers the provision of the will
 Married & mature minors  Estate – the interest a person has in lands or in any other
 Emancipated minors subject to property

5
  Attestation Clause- means the clause wherein the witness Do not Resuscitate (DNR)
certifies that the instrument has been executed before them,  Factors in giving order of resuscitation:
and the manner of the same. 1. Client’s will and advance directives
2. Disease prognosis such as cancer or HIV
TYPES OF WILLS 3. Client’s ability to cope
 Holographic will – a will is written, dated and signed by the 4. Whether CPR will be given or not
testator  Reasons for refusing to perform resuscitation
 Nuncupative will or Nuncupation- an oral will  Epidemic or widespread disease or debilitating condition
& that CPR is not beneficial
WHO CAN MAKE A WILL?  CPR will aggravate or prolong the agony of the client
Sound mind against cultural & religious suffering
Eighteen years old & above
Not prohibited by law
Advance directives & Will
WHO CAN WITNESS?
Sound mind REQUIREMENTS:
Eighteen years old & above  Any person 18 years of age or older may become an organ
Able to read and write donor by written consent.
Not blind, deaf or dumb  Informed choice to donate an organ can take place with the
use of a written document signed by the client prior to death,
The nurse’s obligation in the Execution of a will a will, or a donor card or an advance directive.
 Note the soundness of the Pt’s mind  In the absence of appropriate documentation, a family
 Ensure there was freedom from fraud or under influence member or legal guardian may authorize donation on the
 The Pt should be above 18 years of age descendant’s organs.
 Note the will was signed by the testator and that the  In case of newborns, they must be full term already (more
witnesses signed the will in the presence of the testator than 200 grams)
 For protection, the nurse must make a notation on the Pt’s
chart TYPES:
1. Autotransplantation- donor and recipient are one and the same
Gifts Ex: skin and bones
 Another way of disposing property 2. Heterologous- donor and recipient are two different individuals.
a. animal to human
Four legal requirements for a gift: b. human to human
 gift must consist of personal property c. cadaver donor
 Intention to make the gift d. living donor
 Indication of transfer of control over such property
 acceptance by the recipient Types of organs used :
1. Those that regenerate - bone marrow, skin
Gifts Causa Mortis or Donation Causa Mortis – Gifts made by a 2. Those that come in pair - kidneys, eyes
person because of anticipation of death or beliefs in approaching death.  Religions that have different views regarding organ donations
 Russian Orthodox: permits all donations EXCEPT THE
ADVANCE CARE DIRECTIVE HEART.
 a document written or completed by the client and used by a  Jehovah’s Witness: DOES NOT ALLOW organ donation and
facility or hospital to provide care at a time when client cannot all organ to be transplanted must be drained of blood first.
make his own decision  Judaism: They permit organ donation as long as with
SUBJ ECTS: RABBINICAL CONSULTATION.
1. Show risk for early dementia  Islam: will NOT USE ORGAN STORED IN ORGAN BANKS.
2. Show risk for stroke .
3. Activities- severe head injuries
4. Severe and recurring psychiatric illness ETHICS
5. Terminally ill  Came from the Greek word ETHOS ‘moral duty’
 Studies how people make judgment in regard to right or
Characteristics of Advance Directives wrong
A. Allows clients to participate in choosing health care providers MORALITY
B. Allows also in choosing the type of medical treatment the  It is the right or wrong; good or evil; proper or improper, cruel
client desires. or benevolent acts
C. Allows clients to consent or refuse treatments
Health Care ethics
TYPES:  Division of ethics that relates to human health
1. INSTRUCTIVE DIRECTIVE- specifies life- sustaining treatment to be
withheld or withdrawn. Bioethics
 Focuses on moral issues in the field of health care
LIVING WILL-legal document stating person does not wish to have
extra-ordinary life saving measures when not able to make decisions NURSING ETHICS
about his own care.  The examination of all ethical and bio-ethical issues from the
 applicable for life saving treatment only. prospective of nursery theory and practice
 Example: DNR  BIOETHICS VIS-À-VIS THE HEALTH CARE PROFESSION
 Health care professionals are oftentimes members of medical
2. PROXY OR DURABLE POWER OF ATTORNEY teams.
 legal document giving designated person authority to make  Hence, they are inevitably exposed to and confronted with
health care decisions on the client’s behalf when the client is bioethical problems, issues, and dilemmas.
unable to do so.  And, they must not be morally/ethically indifferent or amoral.
 They must make a clear and specific moral/ethical stand.

6

CHRISTIAN PRINCIPLES OF BIOETHICS
1. Inviolability of life
- all human life from the moment of conception and through all
subsequent stages, is sacred.
- life is a gift of God and the fruit of love.
- all have the duty to affirm, respect, love, and defend it.
2. Principle of Stewardship
- The principle of stewardship maintains / claims that:
- Human life and nature, our bodies and the earth, with all its
natural resources that sustain life, belong to God. Therefore,
NO individual owns his body or life, nor is he/she the master
of his/her own body.
- God, the owner, assigned us to be stewards or caretakers of
our own bodies, life, health, the earth and everything in it.
- As faithful stewards, we, therefore, have the responsibility to
A. OURSELVES SUCH AS:
1. Respect, use our originality and creativity to cultivate our
bodies and everything on earth
2. Take good care or ourselves, to maintain a sound in
mind and body and safeguard our dignity
3. to improve our bodies, know and respect our limits as we
improve ourselves
4. to develop medical technologies that prevent and
remedy the defects but we must do so with the greatest
respect for what we already are as human beings
5. to use our greatest natural gift of intelligence and
freedom in a COCREATIVE manner, not a reckless
wasting of the gift
6. not to contradict human nature
 As faithful stewards, we, therefore, have the
responsibility to:
Ways by which we care for our own health (Good Habits):
B. to take care of the health of our neighbors and the environment
by:
 help conserve our ecological system – not
polluting the air, land and water
 recycling / reusing nature’s raw materials and
energy supplies
C. To help liberate others from poverty, disease, oppression and
exploitation
• Hence, all human beings must take care and cultivate
(improve) creatures within the creatures’ innate nature
and teleology, and within their (human beings)
knowledge and understanding.
• There is an intrinsic value in human life. It is a gift from
God.
 PRINCIPLE OF STEWARDSHIP
• states that “our bodies, our life, our human nature and
everything in this earth are gifts we have dominion over”.
• This means that we are responsible for them.
• Ergo, we should not, as faithful stewards, harm but rather
improve and care for them. We have to treat them with utmost
respect…
3. PRINCIPLE OF TOTALITY
• This states that “totality refers to the whole. Every person
must develop, use, care for and preserve all his parts and
functions for themselves as well as for the good of the whole.
• If a part or lower function harms the whole, this part or lower
functions may be sacrificed for the good or better of function
of the whole”.
Refers to the whole or wholeness of an individual, which includes the
physical, mental / psychological, spiritual, social and emotional aspects.
It also includes wholeness of a community (SPECE).
 The principle of Totality maintains that:
A. Human health is not merely a matter of organs but of capacity
to function humanely and on the basis of wholeness.
B. Every person must develop, use, care for and preserve all
his/her parts and functions for the own sake of each part and
function as well as for the good of the whole.
C. Every person must preserve life and the integrity of our
bodies.
D. The basic capacities, which define personhood (organs,
functions, all other aspects), however, are sacrificed ONLY
when there is a need to preserve life.
E. If a body part or lower function harms the whole, this part of
lower function maybe sacrificed for the good or better function
of the whole.
 Any particular human functional capacity can be
diminished when necessary for the good of the
whole person as in the case of over production of
thyroid hormones. Medications are given to
decrease or diminish the function of the thyroid
gland.
 A secondary function can be sacrificed for a more
basic one as in the case of
F. NOT ALLOWED UNDER THE PRINCIPLE OF TOTALITY is
the donation of a healthy organ if it weakens the health of
the donor.
3.PRINCIPLE OF DOUBLE EFFECT. This principle states or claims
that:
 Double effect means that an act is foreseen to have
both good and bad effects.
 There are certain conditions in which some evil or
bad effects, voluntary in cause, maybe permitted to
occur.
Four conditions that must be met so that such an act with bad effects
may be permitted:
A. The direct-freely-chosen effect of the act must be morally
good while the other indirect-not freely-chosen effect maybe
physically harmful.
B. The action itself must be good or at least morally neutral (not
extrinsically nor intrinsically evil act).
C. The foreseen beneficial effect must be equal to or greater
than the foreseen harmful effect.
D. The beneficial effect must follow from the action at least as
immediately as the harmful effect. The good effect must not
be produced by the bad effect.
Principle of Double Effect: Requisites
P - proportionate reason for doing the act.
A – act must be good in itself.
G – good effect must precede the evil effect, or they must occur
simultaneously.
E – evil effect must not be intended in itself, or there must be an honest
intention for doing the act.
4. PRINCIPLE OF LEGITIMATE COOPERATION
• This refers to formal cooperation, i.e. when we identify
ourselves formally with an immoral act.
• To achieve a well-formed conscience, one should always
judge it unethical to cooperate formally with an immoral act
(i.e. directly to intend the evil act per se.)
• “COOPERATION is the participation of one agent to produce
a particular effect or joint effect.
• Cooperation becomes a problem when the action of the
primary agent is morally wrong.”
 Types of cooperation
 In order to carry out our responsibilities, we need to
cooperate with others. In cooperating with others, we
frequently foresee that this may involve us in conducts that
are maybe objectively wrong but perceived by the main doer
as not evil. When should we cooperate or refuse to
cooperate?
The principle of cooperation states that:
1. We may participate in a material mediate cooperation. This
means that cooperation is merely material or that the
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 cooperation is with the good that is being done and only
indirectly with evil, which we would prevent if possible.
 Reason why material mediates cooperation. This means that
cooperation is permitted: To prevent a greater harm from
occurring.
2. Cooperation is even obligatory permissible if:
A. the refusal to cooperate would result in a greater
evil than if we cooperate
B. “the cooperation is not immediate and is more
remote the greater the evil involved”
C. a scandal is caused or a bad example is given to
others when cooperation is done
3. We must refuse to cooperate when:
A. the action of the primary agent is morally wrong.
B. we would involve ourselves in formal cooperation, that is,
agreeing with, advising, counseling, promoting or condoning
the objectively evil action of another, because formal
cooperation demands that we directly intend the evil action
itself, which is morally equivalent to doing it ourselves.
4. When the secondary agent does not willingly participate but
his action is indirectly bound to the performance of the evil
action (material immediate cooperation).
5. PRINCIPLE OF PROFESSIONAL COMMUNICATION
• This refers to privileged communication that exists between
the doctor/care giver and the patient.
• To fulfill this obligation to the patients, medical/allied health
professionals have the responsibility to do the following:
1. To strive to establish and preserve trust at both the emotional
and rational levels.
2. To share such information which is legitimately needed, to
others, in order for them to have informed conscience.
3. To refrain from lying or giving misinformation.
4. To keep secret information which is not legitimately needed
by others, for this might harm the patient or others or destroy
trust.
6. PRINCIPLE OF CONFIDENTIALITY
• In close connection with the principle of professional
communication is the principle of confidentiality.
• This means that patient/s have the right to know the truth
about their health because they have the responsibility for
their health.
• They also have the right to privacy about those aspects of life
that do not directly affect others.
• Human community is based on free communication, which is
impossible if confidence cannot be shared.
• Hence, health care professionals have a serious obligation to
maintain such confidence that protect the patient’s right to
confidentiality.
7. PRINCIPLE OF AUTONOMY
• This essentially refers to the personal choice/determination of
the health care users with regard to management or
treatment of their illness / disability.
• An essential component of autonomy is knowledge.
• Failure to obtain informed consent from patients or their
guardians (when patients are incapable to choose) is to
undermine the patient’s autonomy.
AUTONOMY / SELF-DETERMINATION
 Definitions:
 From the Greek word autos (self) and nomos
governance → self governance. A term
synonymously used with autonomy is self-
determination.
 In health care it has come to mean “a form of
personal liberty, where the individual is free to
choose and implement one’s own decisions, free
from deceit (lie) or duress (constraints, threat,
pressure, force or coercion)”. (Edge & Jones,
1999,p41).
 The Principle of Autonomy upholds that:
 Every individual has the right to exercise autonomy which
should not be constrained by others such that:
 Person X has the right to determine what will be
done to him.
 Person Y has a duty NOT to constrain X’s
autonomous choices and actions.
 Because human beings have inner worth, dignity with the
greatest gift of intellect, they should then be accepted as
responsible for their own actions and allowed to make
decisions for themselves.
For autonomy to be possible / occur, three basic elements must be
present:
1. Ability to decide – requires adequate information and
intellectual competence as basis for choosing and decision
making.
2. The power to act upon one’s decisions – the capability and
influence to enforce what one has decided upon.
3. Provision for a general respect for the individual autonomy of
others – this is the one that affirms or specifically identifies
the concept of autonomy.
 Importance/significance of autonomy in the health care
setting:
1. It enhances a person’s worth, especially the patient.
2. It protects a person, the patient, from being used or exploited
by others.
3. It helps develop a mature therapeutic alliance (partnership)
between the health professional and the patient.
4. It forms the basis for the steps and rules of informed consent.
 Actions considered as violations to the principle of autonomy:
1. Actions performed that constrain a person’s capacity to make
a decision.
2. Actions performed that constrain a person’s capacity to act
according to his decision.
 Responsibility of the health professional: The health
professional should help the patient make an autonomous
choice and act on it by:
1. Providing the patient with the information necessary to weigh
risks and benefits.
2. Stating his or her own convictions and clearly explaining the
reason for his opinion.
3. Not exercising coercion, manipulation, undue influence, or
irrational persuasion.
8. PRINCIPLE OF SOLIDARITY
• Solidarity means to be one with others.
• In the provision of health care, it is most important for the
provider to be in solidarity with the patient when seeking,
always, the latter best interest.
PRINCIPLE OF SOLIDARITY (COMMON GOOD, SUBSIDIARITY AND
FUNCTIONALISM) – principle that conceives social authority or
leadership in the community as service rather than domination.
 SOLIDARITY – means to be one with others
 The principle of solidarity states or claims that human
communities exist only to promote and share the common
good among all its members “from each according to
ability, to each according to need” in such a way hat:
A. Decision making rests vertically first with the
person, then with the lower social levels and
horizontally with functional social units.
B. The higher social units intervene only to supply the
lower units what they cannot achieve by
themselves, while at the same time, working to
make it easier in the future for lower units and
individuals to satisfy these needs by their own
efforts.
Explanation of this principle:
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  This principle enhances the principle and spells out the
importance of human dignity which requires that various
levels of responsibility be established within the community –
meaning, various levels have their own respective roles to
play, like the individual, sub-group in the community and the
bigger community itself.
 If this division of labor happens, the dignity of every
community member will be fully recognized and actively
promoted.
 Because of the presence of various levels that share the
task, it is therefore important to keep decision making as
close as possible to those persons concerned and affected in
the community ( subsidiarity – those affected in the vertical
organization; functionalism – those affected horizontally)
While those in authority must protect and promote the
common good.
 Implications or importance of this principle of solidarity:
1. In health care provision, it is most important for health care
providers to be in solidarity with the patient when seeking
always the latter’s best interest.
2. In the Philippines, this is most important when dealing with
the poor, the uneducated, the disadvantaged and the
marginalized, because they are the ones least provided, but
most in nee, with adequate health care.
3. The strong will help the poor.
4. As role models, the health care providers must be in solidarity
with each other in order to develop professional cooperation.
9. PRINCIPLE OF SUBSIDIARITY
• Every creature should be entrusted with the functions he is
capable of performing.
• It relates to human dignity and recognizes persons as free
and responsible agents able to care and make decisions for
them.
• Healthcare should not be transferred to a higher body unless
and until the person is unable to provide for himself.
• Even then, care should be cooperative and supportive and
aim towards patient’s self-confidence, independence, and
self-reliance.
• There should always be free and informed consent.
10. PRINCIPLE OF UTILITY
 This states that moral rightness of an action is determined by
its utility, defined as its contribution to the greatest good of the
greatest number.
11. PRINCIPLE OF PERSONALIZED SEXUALITY
Sexuality must be used in keeping with its human teleology.
The conjugal act has inseparable and integrated:
• UNITIVE (signifies, expresses, and incarnates the mutual
love between husband and wife)
• PROCREATIVE (inherent orientation to the transmission of
life) dimensions.
 MAJOR BIOETHICAL PRINCIPLES
1. RESPECT FOR PERSON
 Is the recognition of the equality possessed by all human
beings as unique, worthy, rational, self-determining
creatures, having the capacity and right to decide what is
best for them.
 Is the responsibility of all to treat persons as an end and
never as a means.
 This is manifested in autonomy or the right of non-
interference.
 Persons must be allowed to determine their own destiny,
to deliberate about their plans, choose according to their
own values, and to act accordingly.
 They should be allowed to be their own persons without
constraints from the actions of others or from physical or
psychological limitations.
 In health issues, this relates to reproductive technology,
care for the elderly, organ donation, exploitation of
patients, students, or research subjects.
 The principle of free and informed consent is an
exercise of respect for person. Every patient has a right
to and every healthcare provider has a duty to obtain
free and informed consent before a procedure is
performed on a person.
2. JUSTICE
 Also termed as fairnes; means to give to each one what
he/she deserves or what is his/her due.
 Connotes fair play, keeping promises, role commitments,
reciprocity.
 This is related to truthfulness, autonomy, stewardship,
solidarity and non-maleficence.
 Kinds of Justice:
1. Commutative
2. Distributive
3. Legal
4. Social
3. PRINCIPLE OF FREE AND INFORMED CONSENT
• Mere consent – consent is really out of ignorance.
• Informed consent – individual is informed of the purpose of
the study, the procedures to be employed, the risks and
benefits of the procedures, and the medical / psychological
services available if any injury occurs during experiment.
• The individual is encouraged to ask questions and to have
other people present to make decisions. If the subject is a
child, both the child and the parent/guardian are fully informed
in a language they can understand.
• The subject and the guardian (if appropriate) then sign a
consent form indicating their understanding of the experiment
and their willingness to take part.
Presumed Consent – for a competent person, consent must be clear
and explicit. It cannot be presumed. For an incompetent person, in
emergency situations and consent for therapeutic interventions, the
attending physician is presumed to be working for the best interest of
the patient. (Beneficence)
SUBSTITUTE DECISION-MAKER
In non-emergency situations, when a person is incompetent to make
decision (too immature or too sick), the decision is made by a
substitute decision-maker (as in proxy consent). The substitute
(guardian, family member, designated surrogate) decides primarily
according to what the patient would have chosen, secondarily
according to the patient’s best interest.
Educated Consent
The individual is given all of the information stated in the informed
consent definition. In addition, there is a real attempt to educate the
individual regarding the physiological, psychological, physical or
biomedical underpinnings of the study and the risks and benefits
without disclosing so much of the study that it biases the subject. The
individual is then asked to make a decision from this educated base.
PRINCIPLE OF INFORMED CONSENT – a principle whose rules have
been derived from the principle of autonomy.
 Definition: In health care, informed consent is defined as the
willing and non-coerced acceptance of a medical or health
care intervention by a patient after adequate disclosure by the
health care professional of the nature of the intervention, its
benefits and expected risks and alternatives available.
Steps or rules to be followed in informed consent:
1. Disclosure of information – this is the strong moral obligation of the
health care professional to provide a TRUTHFUL AND HONEST
information base on which to weight risks and benefits in the light
of his or her own values and goods, to deliberate and finally, to
make rational choices.
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  General standards as basis about what information should be
disclosed:
A. Professional practice standards based on the traditional
disclosure practices of the professional community – what the
practicing physicians would generally accept as necessary
information to disclosure.
B. Reasonable person standard that is based on what a
hypothetical reasonable person would judge as pertinent to
the decision making process – what a prudent person thinks
is necessary for him or her to make a rational decision.
C. Subjective standard which is based on what a particular
patient needs to know.
 In general, the necessary items to disclosure include the
following:
A. The patient’s current medical status including the likely
course if no treatment is provided.
B. Contemplated procedure or medication
C. Alternative available procedures or medication
D. Anticipated risks and benefits of both
E. A statement offering the patient an opportunity to ask further
questions
F. In case of research, his right to withdraw anytime
G. A professional opinion about the alternatives.
2. Comprehension of information – this is the responsibility of the
health care professional to help the patient understand the information,
instead of just giving the information.
 Ways by which the health care professional would help the
patient understand the information:
 a. Give clear and simple explanations, instead of giving too
technical or complicated terms.
 b. Evaluate or get feedback to assess the patient’s
understanding.
 c. Provide written or printed instructions that are adapted to
the ability of the patient to read and understand.
3. Voluntariness – by virtue of the true information provided by the
health care provider and consequent understanding by the patient,
voluntariness would mean that the patient can now exercise his/her free
choice to participate or agree to whatever the information asks, without
coercion and other forms of control or influence.
Factors that may hamper the voluntariness of the patient:
A. Forces exerted on the patient – presence of fraud, deceit or
overreaching by the health care professional
B. Threat to abandon a patient unless he follows orders
C. Patient’s personal resistance
4. Competence – this is plainly the capacity of the patient to decide
about a recommended procedure or about participation in a research at
the time and in the context of the circumstances and based on rational
reasons (risks or benefits) and in the light of the person’s values and
goals. Whether the person chooses to use or not to use the information
he/she has decided upon is not anymore a criterion of competence:
 Responsibility of the health care professional in relation to
competence: The health care professional must be cautious
against too rapidly judging a patient as incompetent in
decision making because of the effect of illness, anxiety, pain
and hospitalization.
5. Permission giving
 Situations which are considered as non-violations of the
principles of autonomy and informed consent and where
therapeutic privilege is followed / allowed:
1. Situations or cases where a patient signs a waiver to
delegate the authority to others, usually the physician.
 Physician’s delegated prerogative – authority of a
physician over his patient as an authority delegated
to him/her by the patient.
2. Competence to give consent in absent or reduced
(incompetence of the patient is present) and the
procedure is necessary to save the person’s life. By
reason of paternalism (those who know best will decide)
and using his professional judgment, the health
professional can decide that the amount of benefit
offered by the procedure to be done outweighs the loss
resulting from failure to respect autonomy.
3. Competition of the respect for patient’s autonomy with
other moral principles or autonomy vs. non-maleficence.
This means that when there is danger that respecting a
person’s autonomy may harm or impose unfair burden
on another or that the principles of autonomy are
overruled by the principle of malecficence.
4. Implied or presumed consent/common procedures upon
admission/ surgery anesthesia
A. By merely entering the patient-physician
relationship, implied (tacit or presume) consent for
the customary diagnostic and therapeutic
procedures in common use is given; therefore,
there’s no need to ask permission from the patient.
B. When consent in some general line of action has
been given.
5. Surrogate consent – happens when someone other that
the patient decides in behalf of the patient. The
surrogate is considered to be morally responsible for the
patient.
 Pre-requisites to the surrogate consent:
A. Surrogate consent must promote the patient’s
welfare.
B. If the patient has expressed preferences in making the
decision (substituted judgment) to give consent.
C. If the patient’s preferences are unclear, the surrogate must
consider the “best interest” of the patient using some more
objective, socially acceptable values, such as relief of
suffering and preservation and restoration of function.
D. For minor patients, the surrogate consents are usually given
by parents or guardians.
4. NONMALEFICENCE
 This means that one should not do and not risk harm
(physical, mental, psychological, social, financial,
spiritual, symbolic, etc.) on others.
 Hippocrates emphasized that the healthcare giver should
do no harm (NON NOCERE).
 Examples of Nonmaleficence
 Providing incompetent care
 Disrespecting dignity
 Breaching privacy
 Causing hopelessness
 Destroying reputation
 Misleading a younger colleague
 Stigmatizing a social group
5. BENEFICENCE
- This means one should prevent or remove harm or risk of harm, do
good, or provide a benefit.
- In healthcare, this connotes BENEVOLENCE, COMPASSION, and
CHARITY.
- This is often extraordinary act.
Conditions that require one to perform a beneficent act are:
 1. the person aided is at significant risk.
 2. the action is needed and likely to succeed.
 3. there is no significant risk for the doer.
 4. the benefit for the recipient outweighs the harm to the
doer.
Beneficent acts are sometimes PATERNALISTIC and may conflict with
autonomy and other interests.
 Standards of Care
 Guidelines for determining whether nurses have performed
duties in an appropriate manner & guidelines in which the
nurse should practice
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PATIENT’S BILL OF RIGHTS  Formal cooperation is an evil act and never allowed
1. Right to considerate and respectful care  Principle relating to the origin and destruction of life
 nurse avoids discriminating acts that tends to bring the  Thou shall not kill
appearance of favoritism
 a “ tender loving care attitude”
PATIENT’S RESPONSIBILITIES
2. Right to information about diagnosis, treatment and prognosis  Providing information
 Complying with instructions
3. Right to informed consent  Informing the physician of refusal to treatment
 refers to the capacity of the patient to accept or refuse  Paying hospital charges
treatment options offered by the health care provider.  Following hospital rules and regulations
Elements:  Showing respect and consideration
 Voluntariness
 Informed NURSE’S’ BILL OF RIGHTS
 Competent parties  Registered nurses promote and restore health
 Knowledgeable info. provided  Prevent illness
 Signed prior to pre-op meds  Protect the people entrusted to their care
 Alleviate suffering
4. Right to an advance care directive  Provide services that maintain respect for human dignity
5. Right to Privacy
6. Right to confidentiality Four basic ethical principles:
 all records and communications held in confidence 1. Fundamental responsibility of the nurse is four-fold
 when to divulge information: 2. nurse renders service regardless of race, creed, nationality or
1. patient placed in serious danger political belief.
2. public welfare 3. nurse protects life and respects the dignity of man.
3. legal proceeding 4. nurse works in collaboration with members of the health team
7. Right to go over records
8. Right to services and to transfer REGISTERED NURSE’S AND PEOPLE
 Referral Ethical Principles:
9. Right to know relationship with other health care and Values, customs and spiritual beliefs shall be respected
educational institutions Individual freedom to make decisions
10. Right not to be subjects of research or experimentation Personal information acquired must be held in
11. Right to expect reasonable continuity of care confidence
 follow up consultations
12. Right to know what hospital rules and regulations apply to his Guidelines to be observed:
conduct as a patient a. individuality and totality of patients
b. respect
MORAL PRINCIPLES c. uphold the rights of individuals
 The golden rule d. take into consideration culture and values
 Do unto others what you would like others do unto you  in the event of conflict, welfare and safety take precedence
 The two fold effect
 May have bad and good effect REGISTERED NURSE’S AND PRACTICE
 Must be morally good
 Good effect must be willed and the bad effect merely Ethical Principles
allowed A. a.Human life is inviolable
 Good effect must not come from an evil action B. b.Quality and excellence in the care of patients
 Good effect must be greater than the bad effect C. c.Accurate documentation- nursery accountability
 The Principle of Totality
 The whole is greater than any of its parts Guidelines to be observed:
 Epikia A. know the definition and scope of nursery practice
 Exception to the general rule B. be aware of duties and responsibilities
 One who acts through an agent is himself responsible C. acquire and develop competence in knowledge, skills and attitude
 Ex. nurse recommends patient to another clinic for D. optimum standard of safe nursery practice
abortion but does not want to perform E. be morally and legally responsible
 No one is obliged to betray himself/herself F. patient’s records considered confidential
 No one can force any person to answer a question if  RN’S are aware that their actions have professional, ethical,
such will incriminate him/her moral and legal dimensions
 The end does not justify the means
 Giving sleeping tablets to someone who has chronic Guidelines to be observed:
illness 1. Duties in conformity with law
 Defects of nature may be corrected 2. Not allow to be used in advertisements that demean image of the
 Corrected by plastic surgery profession
 If one is willing to cooperate in the act, no injustice is done to 3. Decline any gift, favor or hospitality from patient
him/her 4. Not demand and receive any commission, fee for
 With patient’s consent recommendations made
 A little more or less does not change the substance of an act 5. Avoid any abuse of relationship
 Stealing
 The greatest good for the greatest number REGISTERED NURSE AND THE PROFESSION
 Have more good effects for more people than a smaller Ethical Principles:
group 1. Maintain loyalty
 No one is held to the impossible 2. Compliance with by laws of accredited professional organizations
 Do not promise impossible things 3. Commitment to continual learning
 The morality of cooperation

11
4. Contribute to the improvement of the socio-economic conditions
and welfare of nurses

Guidelines to be observed:
1. Be a member of accredited prof organization (PNA)
2. Strictly adhere to nursery standards
3. Strive to secure equitable working conditions through
appropriate legislation and other means
4. Assert for the implementation of labor and work standards

12