MORALS VS.

ETHICS
The meanings of morals and ethics do overlap. Broadly speaking, morals are individual
principles of right and wrong, and a system of ethics deals with sets of those principles.
Both terms entered the language in the Middle English period, with moral being the
older form by about 100 years (c. 1300).
Morals and morality are about personal behavior, ethics more grandly philosophical.
However, linguistic use constrains the philosophical use and helps to blur the distinction:
one can have a single ethic, as in "a strong work ethic" or "an ethic of selfishness," but if
we talk about a single moral, we've shifted a bit in meaning to the realm of Aesop and
Uncle Remus, as in "the moral of the story." In the singular, a moral is a lesson to be
learned about a single principle of right and wrong, and an ethic is a single guiding
principle that affects your criteria for determining what is right and wrong.
The distinction is best illustrated by the contexts in which these terms are used. When
we disparage someone's behavior, we say that person has "low morals"; we would
never say that a drug dealer has "bad ethics." Ethics as a branch of philosophy is
studied in universities and theological seminaries. We have an Office of Government
Ethics and write articles about political and judicial ethics. Think of it as a hierarchy of
detail: when we talk about personal ethics, we are using the primary meaning of 'a set of
moral principles'. We say that children are taught good moral principles, or morals, if
they don't lie, cheat, or steal, and if they respect other people. Moral principles such as
"Respect others" are further broken down into rules such as "Don't stick out your tongue
at your sister." Why we don't simply call an individual moral principle a moral is that the
'object lesson' meaning is earliest and is still in use: the use of morals to mean 'moral
conduct' arose around 1600.
-------------------------------In common usage we speak and write about a professional code of ethics and a person
of high moral character.
From http://atheism.about.com/library/FAQs/phil/blfaq_phileth_what.htm:
There is a distinction between them in philosophy.
Strictly speaking, morality is used to refer to what we would call moral standards and
moral conduct while ethics is used to refer to the formal study of those standards and
conduct. For this reason, the study of ethics is also often called "moral philosophy."
Here are some examples of statements which express moral judgments:
1. Dumping chemicals in the rivers is wrong and ought be banned.
2. It's wrong that our company is trying to avoid the regulations and it should
stop.

3. He's a bad person - he never treats people well and doesn't seem to respect
anyone.
As seen in the above examples, moral judgments tend to be characterized by words like
ought, should, good and bad. However, the mere appearance of such words does not
mean that we automatically have a statement about morals. For example:
4.
Most
Americans
believe
that
racism
5.
Picasso
was
a
bad
6. If you want to get home quickly, you should take the bus.

is

wrong.
painter.

None of the above are moral judgments, although example #4 does describe the moral
judgments made by others. Example #5 is an aesthetic judgment while #6 is simply a
prudential statement explaining how to achieve some goal.
Another important feature of morality is that it serves as a guide for people's actions.
Because of this, it is necessary to point out that moral judgments are made about those
actions which involve choice. It is only when people have possible alternatives to their
actions that we conclude those actions are either morally good or morally bad.
When discussing morality it is important to distinguish between morals and mores. Both
are aspects of human conduct and human interaction, but they are very different types
of conduct. Mores are usually treated as "harmless customs," where "harmless" means
that failure to follow the custom may result in a negative reaction, but not a very serious
one. Such mores would include the time of day when meals are eaten and the proper
form of greeting particular individuals.
Morals, on the other hand, involve much more serious aspects of how we behave and
how we treat others. What this means is that failure to follow the dominant morals will
result in a much harsher reaction from others - examples of this would include
discrimination, physical abuse and theft.
Another important distinction in morality is that between standards, conduct and
character. When we form a moral judgment, we are employing moral standards principles against which we compare what we see in order to form a conclusion. Such
judgments might be about particular conduct, which includes a person's actions, or it
might be about a person's character, which includes their attitudes and beliefs.
Ethics, on the other hand, involves the study of those standards and judgments which
people create. Ethics assumes that the standards exist and seeks to describe them,
evaluate them, or evaluate the premises upon which those standards exist. This is
where the field of ethics is broken down into Descriptive Ethics, Normative Ethics and
Analytic Ethics (also called Metaethics).

The basic questions asked in Ethics include:

What does it mean to be good?
How can I differentiate good from evil?
Are morals objective or subjective?

-----------------------From http://atheism.about.com/library/FAQs/phil/blfaq_phileth_values.htm:
MORALS reflect Values
One of the most important characteristics of moral judgments is that they express our
values. Not all expressions of values are also moral judgments, but all moral judgments
do express something about what we value. Thus, understanding morality requires
investigating what people value and why.
There are three principle types of values which humans can have: preferential values,
instrumental values and intrinsic values. Each plays an important role in our lives, but
they don't all play equal roles in the formation of moral standards and moral norms.
Preference Value
The expression of preference is the expression of some value we hold. When we say
that we prefer to play sports, we are saying that we value that activity. When we say that
we prefer relaxing at home over being at work, we are saying that we hold our leisure
time more highly than our work time.
Most ethical theories do not place much emphasis on this type of value when
constructing arguments for particular actions being moral or immoral. The one exception
would be hedonistic ethical theories which explicitly place such preferences at the
center of moral consideration. Such systems argue that those situations or activities
which make us happiest are, in fact, the ones we should morally choose.
Instrumental Value
When something is valued instrumentally, that means we only value it as a means to
achieve some other end which is, in turn, more important. Thus, if my car is of
instrumental value, that means that I only value it insofar as it allows me to accomplish
other tasks, such as getting to work or the store.
Instrumental values play an important role in teleological moral systems - theories of
morality which argue that the moral choices are those which lead to the best possible
consequences (such as human happiness). Thus, the choice to feed a homeless person

is considered a moral choice and is valued not simply for its own sake but, rather,
because it leads to some other good - the well-being of another person.
Intrinsic Value
Something which has intrinsic value is valued purely for itself - it isn't used simply as a
means to some other end and it isn't simply "preferred" above other possible options.
This sort of value is the source of a great deal of debate in moral philosophy because
not all agree that such intrinsic values actually exist.
If intrinsic values do exist, how is it that they occur? Are they like color or mass, a
characteristic which we can detect so long as we use the right tools? We can explain
what produces the characteristics like mass and color, but what would produce the
characteristic of value? If people are unable to reach any sort of agreement about the
value of some object or event, does that mean that its value, whatever it is, can't be
intrinsic?
Instrumental vs. Intrinsic Values
One problem in ethics is, assuming that intrinsic values really do exist, how do we
differentiate them from instrumental values? That may seem simple at first, but it isn't.
Take, for example, the question of good health - that is something which just about
everyone values, but is it an intrinsic value?
Some might be inclined to answer "yes," but in fact people tend to value good health
because it allows them to engage in activities they like. So, that would make good
health an instrumental value. But are those pleasurable activities intrinsically valuable?
People often perform them for a variety of reasons - social bonding, learning, to test
their abilities, etc.
So, perhaps those activities are also instrumental rather than intrinsic values - but what
about the reasons for those activities? We could keep going on like this for quite a long
time. It seems that everything we value is something which leads to some other value,
suggesting that all of our values are, at least in part, instrumental values. Perhaps there
is no "final" value or set of values and we are caught in a constant feed-back loop where
things we value continually lead to other things we value.
Values: Subjective or Objective?
Another debate in the field of ethics is the role humans play when it comes to creating
or assessing value. Some argue that value is a purely human construction - or at least,
the construction of any being with sufficiently advanced cognitive functions. Should all
such beings disappear from the universe, then some things like mass would not
change, but other things like value would also disappear.
Others argue, however, that at least some forms of value (intrinsic values) exist
objectively and independently of any observer. Thus, our only role is in recognizing the
intrinsic value which certain objects of goods hold. We might deny that they have value,
but in such a situation we are either deceiving ourselves or we are simply mistaken.

Indeed, some ethical theorists have argued that many moral problems could be
resolved if we could simply learn to better recognize those things which have true value
and dispense with artificially created values which distract us.
---------------------------------Someone else makes this distinction:
Morals / Morality: The Social Contract itself; what we all agree we should do, e.g. our
public out-loud consensus.
Ethics: The integrity of our private decisions, e.g. what we choose to do when no one is
looking and we are reasonably certain our actions will not be discovered.

Morals vs. Ethics by Larry John

I am not a moral person however, I am an ethical person. The reason I have chosen
not to rule my life based on morals is that I think there is an extreme difference
between morals and ethics. In my mind I clearly see a big difference between making
your decision based on morals and making your decisions of life based on your
personal ethics. The dictionary has this to offer
Ethics: choosing principles of conduct as a guiding philosophy.
Morals: conforming to a standard of right behavior.
Here is where I see the difference. Morals are rules and standards that we are told we
must conform to when deciding what is right behavior. Morals are dictated to us by
either society or religion. We are not free to think and choose. You either accept or you
dont! We are taught by society and religion that you shall not lie or you should give to
the poor or you must love others as you would have others love you or you must do
something because it is your moral obligation. The key issue with morals is that you
are expected to conform to a standard of right behavior and not question that
conforming or you are not a moral person. But again, where do these morals come
from to which we are expected to conform? Yep, from society and/or religion, but not
from YOU, and thats what bothers me.
Ethics, on the other hand, are principles of conduct that YOU CHOOSE to govern your
life as a guiding philosophy that YOU have chosen for your life. Again, call it semantics
if you want, but I see a big difference between conforming and choosing. With
MORALS the thinking has been done; with ETHICS theres a freedom to think and
choose your personal philosophy for guiding the conduct of your life.

MORALS. I like to watch movies about the mafia or TV shows like the Sopranos. The
people on these shows are extremely devoted people to their families and religions, but
they have somehow morally justified their actions of killing, stealing, and lying. How is
it that these extremely devoted family men and supposedly devoted members of the
Catholic religion think that what they are doing is moral is a mystery to me. Yet they
wear their crosses, cross themselves, love their kids, and dedicate themselves to the
family while killing people who get in the way. Now thats an interesting morality. But
morals dont stop there. Think of all the hundreds of cultures who have totally different
ideas of morality. Some cultures think it is perfectly fine to have as many wives as they
want; some think only one wife is moral in the eyes of God. Some cultures think that it is
fine to steal if you need food; other cultures think that stealing is stealing and is never
morally justified. Some cultures think that an eye for an eye and a tooth for a tooth
judgment is fine; other cultures think that this type of moral thinking is barbaric. When
you leave MORAL THINKING to society and religion, there is no such thing as absolute
morality. So, is there anything as a 100% MORAL PERSON? I think not, at least based
on the criteria, culture, society, and religion telling us what our morals should be.
ETHICS is totally another matter. With ethics, you are free to choose your personal
philosophy of conduct to guide your life. You are not dependent on the judgment of
society or religion based in fear when making your ethical decisions. For example, I
believe in telling the truth not because God may curse me, but because it is the right
and best thing to do based on my personal ethics. I believe in being 100% faithful to my
wife, not because adultery is a sin, but because being true to your wife is the smart and
right thing to do. It is a better and happier way to live, again not because God will send
me to hell if I commit adultery, but because it is the right and best way to live my life
based on my ethical way of seeing things. I believe in keeping the laws of the land,
however, I am not living my life based on the rules of society and religion, but solely
based on a pragmatic and ethical way of living. I dont steal because Im afraid I might
go to jail. I dont steal because I have decided not to steal based on my ethics. I dont
have to be commanded to give to the poor. I concern myself with giving to and helping
the poor based on my ethics. I have the freedom to choose and if I am smart, I will
choose personal ethics that will enrich my life and the lives of others.
As with all other freedoms, there is always the risk that I will make ethical decisions that
could cause me to drift over to the dark side. Thats the problem with the freedom to
choose or free agency. Anytime we allow people the freedom to choose, we also give
them the freedom to make bad choices. If you want to make bad ethical decisions that
will make you, and perhaps others, unhappy, then you can. However, if you want to
make good ethical decision that will make you and others happier, you have the
freedom to make those ethical decisions too. I choose personal ethics to govern my life
that make me happier, while I strive to enrich the lives of others. Its the ethical thing to
do based on my personal ethics. You dont have to tell me not to lie, not to steal, not to
kill, not to commit adultery, etc. I have already made my ethical decisions to NOT do
those things. You dont have to tell me to give to the poor, love my neighbor and my
enemies, use my free agency for good, etc. I have already made these personal ethical
decisions. I choose my principles of personal conduct because I have thought about

them. My ethics are my ethics, and yet interestingly enough, they almost always agree
with society and religion. The only difference is I made these decisions. My personal
thinking determines my ethics. I made these ethical choices. Not because I was told by
society or religion to think a certain way but because I thought it was the best way to live
a complete and fulfilled life of happiness.
Sanctity of life
In religion and ethics, inviolability or sanctity of life is a principle of implied protection
regarding aspects of sentient life which are said to be holy, sacred, or otherwise of such
value that they are not to be violated.
The concept of inviolability is an important tie between the ethics of religion and the
ethics of law, as each seeks justification for its principles as based on both purity and
natural concept, as well as in universality of application.
The phrase sanctity of life refers to the idea that human life is sacred and holy and
precious, argued mainly by the pro-life side in political and moral debates over such
controversial issues as abortion, contraception, euthanasia, embryonic stem-cell
research, and the "right to die" in the United States, Canada, United Kingdom and other
English-speaking countries. (Comparable phrases are used in other languages.)
Although the phrase was used primarily in the 19th century in Protestant discourse,
after World War II the phrase has been appropriated for Roman Catholic moral theology
and, following Roe v. Wade, evangelical moral rhetoric.
In Western thought, sanctity of life is usually applied solely to the human species
(anthropocentrism, sometimes called dominionism), in marked contrast to many schools
of Eastern philosophy, which often hold that all animal life is sacredin some cases to
such a degree that, for example, practitioners of Jainism carry brushes with which to
sweep insects from their path, lest they inadvertently tread upon them.
General Principles:
Beneficence is the duty to do or promote good. You can think of this principle as being
on a continuum with nonmaleficence. At one end of the continuum is the duty to do no
harm; beneficence, at the other end, is the duty to bring about positive good. The
following examples illustrate the duties in priority order.
- Do no harm. (Dont push the man into the river.)
-Prevent harm when you can. (If the man is getting dangerously close to the rivers
edge, warn him that he is about to fall into the river.)

-Remove harm when it is being inflicted. (If you see a struggle and someone is trying to
push the man into the river, interfere and try to stop it.)
-Bring about positive good. (If the man has fallen in the river, jump in and try to save
him.)
When weighing the risks and benefits of an action, you are actually balancing
nonmaleficence with beneficence. It is well to remember that patients, family members,
and other professionals may identify benefits and harms differently. A benefit to one may
represent a burden to another. For example, you may see a blood transfusion as a
benefit to the client, but to the parents it may represent harm.

Non-maleficence is the twofold duty to do no harm and to prevent harm.

Nonmaleficence refers to both actual harm and risk of harm, as well as to intentional
and unintentional harm. In nursing it is rare to find intentional harm, but unintentional
harm due to lack of careful planning and consideration does occur.
When using the principle of nonmaleficence to guide treatment regimens, ask the
question, Does this treatment cause more harm or more good to the patient?
Nonmaleficence requires that you think critically about patient care and research
situations, weighing the potential risks against the potential benefits. Risk of harm is not
always clear. Suppose you are about to get a patient out of bed for the first time after
surgery. The benefit clearly is that this will prevent postoperative complications such as
pneumonia and thrombophlebitis, but the risks and benefits is a value laden exercise.
Who is to say what amount of pain is excessive you or the patient? To honor the
principle of nonmaleficence in this situation, you would need to be sure to premedicate
the patient and carefully assess his status as you are helping him to ambulate.
Nonmaleficence is a fundamental duty of health care professionals. Both the
physicians Hippocratic Oath and the nurses Nightingale Pledge state that care
providers are to cause no harm to patients. When you are careful to prevent
medication errors, or provide a walker, or use an ambulation belt for ambulating
patients, you are honoring the nonmaleficence principle.
2. Totality

These principles dictate that the well-being of the whole person must be taken into
account in deciding about any therapeutic intervention or use of technology. In this
context , "integrity" refers to each individuals duty to "preserve a view of the whole
human person in which the values of the intellect, will, conscience, and fraternity are
pre-eminent. Totality" refers to the duty to preserve intact the physical component of
the integrated bodily and spiritual nature of human life, whereby every part of the
human body "exists for the sake of the whole as the imperfect for the sake of the
perfect".
Autonomy refers to a persons right to choose and his ability to act on that choice. The
principle of autonomy rests on the belief that every competent person has the right to
determine his own course of action. Maintaining autonomy is one way to show respect
for each persons humanity. You demonstrate respect for autonomy when you treat
people with consideration, believe patients stories about the course and symptoms of
their illnesses, and protect patients who are unable to decide for themselves.
The Principle of autonomy underlies informed consent - clients right to decide
for themselves whether or not they will agree to a proposed procedure or treatment. You
also honor autonomy when you respect patients or surrogates right to decide; even
when you believe those choices are not in the patients best interest.

Justice is the obligation to be fair. It implies equal treatment of all clients. This
principle is reflected in the first provision in the ANA Code of Ethics for Nurses
(ANA, 2001). Questions of justice will become a part of your everyday experience
in patient care, from deciding how to allocate your time among patient to larger
decisions, scuah as how to allocate limited health care resources.

Distributive justice, which is one type of justice that is particularly relevant to health
care, requires fair distribution of both benefits and burdens, as in the following issues.
1.Allocating resources. Distributive justice questions come up when more than one
person or group competes for the same resources. One example arises in determining

how to spend federal and state tax dollars: should money be spent to fund AIDS
research or to find better treatments for Alzheimers disease? Other examples surround
organ transplantation. Human organs are scarce resources. How do we decide which
patient should receive an available organ for transplantation? Is an 18-year-old more
deserving of a kidney that a 75-year-old? Is a person with liver disease due to
alcoholism less deserving of a liver than someone with liver disease not cause by
alcoholism? The decision of who should live and who may die is never an easy
decision. In the United Sates, we use a national committee to set criteria for how organs
will be distributed so the standard of justice can be considered.
2. Fair access to care. Access to care is a specific kind of healthcare resource. The
principle of distributive justice hold that we should provide equal access to health care
for all. As the baby boomer generation ages, the Medicare budget will be strained. At
the same time, baby boomer nurses will be retiring in record number. There will be
fewer nurses to care for more patients at a time when national healthcare dollars are
stretched very thin. How will the nation decide where to spend the limited dollars? How
will nurse managers decide how to provide adequate care when they do not have
enough nurses on their staff? The ability to develop sound criteria on which to base the
allocation of resources is the challenge of distributive justice.
Compesatory Justice focuses on compensation for wrongs that have been done to
individuals or groups. This is the type of justice considered when there are malpractice
suits, for example, when a patient climbs out of bed and falls and breaks a hop. Groups
of citizens may also be harmed, for instance, by a companys unintentional pollution of
water in a community. If this pollution were proven to cause cancer in the members of
the community, a monetary settlement might be made.
Procedural Justice is relevant in processes that require ranking or ordering. Often as a
basis for delivery of services. In many situations, this is considered fair. Institutional
policies are written

to ensure that the same procedures apply to all clients or

employees in the same way (e.g., visiting hours, working on holidays, sick leave).

Veracity is the duty to tell the truth. This seems very straightforward, and you
may wonder why it even needs discussion. However; there are times when
veracity may present a challenge. For example, should you tell the truth when
you know that it might cause harm to the client? Would it be appropriate to tell a
lie in order to relieve extreme patient anxiety? Most nurses would agree that it
isnt hard to determine how much of the truth to tell. For example, healthcare
professionals feel uncomfortable giving families bad news. So instead of
saying, Your father has a fatal illness and is unlikely to live for more than a
month, they may say, Your father is very ill, but we will do everything we
possibly can for him. In this as in most situations, the risk of losing patient trust
outweighs any benefit of withholding the truth.
Although you always presume the value of telling the truth, there may be times

when you are justified to withhold information. In some cultures, for example, families go
to great lengths to protect a dying patient form the harsh truth of his prognosis, and the
patient himself may not wish to know.

Stewardship
This principle is grounded in the presupposition that God has absolute Dominion
over creation, and that, insofar as human beings are made in Gods image and
likeness, we have been given a limited dominion over creation and are
responsible for its care. The principle requires that the gifts of human life and its
natural environment be used with profound respect for their intrinsic ends.
Accordingly, simply because something can be done does not necessarily mean
that it should be done (the fallacy of the technological imperative). As applied to
Catholic-sponsored health care, the principle of stewardship includes but is not
reducible to concern for scarce resources; rather, it also implies a responsibility
to see that the mission of Catholic health care is carried out as a ministry with its
particular commitment to human dignity and the common good.

PRINCIPLES OF COMMUNICATION
Communication is a two-way process of giving and receiving information through any
number of channels. Whether one is speaking informally to a colleague, addressing a
conference or meeting, writing a newsletter article or formal report, the following basic
principles apply:

Know your audience.

Know your purpose.

Know your topic.

Anticipate objections.

Present a rounded picture.

Achieve credibility with your audience.

Follow through on what you say.

Communicate a little at a time.

Present information in several ways.

Develop a practical, useful way to get feedback.

Use multiple communication techniques.

Communication is complex. When listening to or reading someone else's message, we

often filter what's being said through a screen of our own opinions. One of the major
barriers to communication is our own ideas and opinions.
There's an old communications game, telegraph, that's played in a circle. A message is
whispered around from person to person. What the exercise usually proves is how
profoundly the message changes as it passes through the distortion of each person's
inner "filter."

Professional Communication
1. Truth-telling
give accurate complete information justification: it is right for respect and trust
to prevent harm for diagnosis & management.

Truth-telling
duty:
tell: appropriate time and manner
violation: withheld truth, lies
considerations: emergency therapeutic privilege.
2. Confidentiality
keep professional data private
justification: for respect and trust to prevent harm for diagnosis and management
duty: keep secret
violation: telling others
Confidentiality considerations: required by legitimate authority with consent to avoid a
greater harm.

Legitimate Cooperation
Participation in a wrong-doing
Classification
intention: formal or material involvement: immediate or mediate action: proximate or
remote
Duty: not to cooperate in a wrong doing
Violation: cooperation in a wrong doing
Consideration: may be allowed if material, mediate and as remote as possible
significant proportionate reason scandal avoided no alternative lesser evil action.

Informed Consent: An Ethical Obligation or Legal Compulsion?

Informed consent is a vital document while performing all surgical and aesthetic
procedures, particularly in the current day practice. Proper documentation and
counseling of patients is important in any informed consent.

INTRODUCTION
Medical practice today is not simple because of various factors impinging on the doctorpatient relationship. Mutual trust forms the foundation for good relationship between
doctor and patient. Today, patients tend to be well- or ill-informed about the disease and
health. With the hype created in the print and visual media regarding beauty, shape,
size and appearance of body parts, quality and quantity of hair, etc., patients tend to
come to dermatologists with unreasonable demands and unrealistic expectations.
Therefore, providing adequate information and educating the patient about realities and
obtaining informed consent before subjecting a patient to any test/procedure/surgery is
very essential.
ETHICAL ANGLE
The concept of consent arises from the ethical principle of patient autonomy and basic
human rights.Patient's has all the freedom to decide what should or should not happen
to his/her body and to gather information before undergoing a test/procedure/surgery.
No one else has the right to coerce the patient to act in a particular way. Even a doctor
can only act as a facilitator in patient's decision making.

LEGAL ANGLE
There is also a legal angle to this concept. No one has the right to even touch, let alone
treat another person. Any such act, done without permission, is classified as battery physical assault and is punishable. Hence, obtaining consent is a must for anything
other than a routine physical examination.

CONSENT
In simple terms, it can be defined as an instrument of mutual communication between
doctor and patient with an expression of authorization/permission/choice by the latter for
the doctor to act in a particular way.

IMPLIED VS. EXPRESSED CONSENT

The very act of a patient entering a doctor's chamber and expressing his problem is
taken as an implied (or implicit) consent for general physical examination and routine
investigations. But, intimate examination, especially in a female, invasive tests and risky

procedures require specific expressed consent. Expressed (explicit) consent can be oral
or written. Written consents are preferable in situations involving long-term follow-up,
high-risk interventions and cosmetic procedures and surgeries. It is also needed for skin
biopsy, psoralen with ultraviolet A (PUVA) therapy, intralesional injection,
immunosuppressive therapy, electrocautery etc.
Consent is necessary for photographing a patient for scientific/educational/research
purpose or for follow up. Specific consent must be taken if the identity of the patient is
likely to be revealed while publishing.
Consent is a must for participation in clinical trials and research projects.

INFORMED CONSENT
Informed consent must be preceded by disclosure of sufficient information. Consent can
be challenged on the ground that adequate information has not been revealed to enable
the patient to take a proper and knowledgeable decision. Therefore, accurate, adequate
and relevant information must be provided truthfully in a form (using non-scientific
terms) and language that the patient can understand. It cannot be a patient's signature
on a dotted line obtained routinely by a staff member.

DISCLOSURE OF INFORMATION
The information disclosed should include:

The condition/disorder/disease that the patient is having/suffering from

Necessity for further testing

Natural course of the condition and possible complications

Consequences of non-treatment

Treatment options available

Potential risks and benefits of treatment options

Duration and approximate cost of treatment

Expected outcome

Follow-up required

Patient should be given opportunity to ask questions and clarify all doubts. There must
not be any kind of coercion. Consent must be voluntary and patient should have the
freedom to revoke the consent. Consent given under fear of injury/intimidation,
misconception or misrepresentation of facts can be held invalid.

PRE-REQUISITES
Patient should be competent[ to give consent; must be an adult and of sound mind. In
case of children, consent must be obtained from a parent. In case of incapacitated
persons, close family members or legal guardians can give consent. Adequate
information should be provided to a prudent patient during informed consent.
Prudent patient means a reasonable or average patient. To decide whether adequate
information has been given, courts rely on this Prudent Patient Test. It is not easy to
answer the question, How much information is adequate? A netizen may expect and
demand detailed information. On the other hand, an illiterate may say that I do not
understand anything, doctor, you decide what is best for me! If a patient knowingly
prefers not to get full information that attitude also needs to be respected as a part of
patient's right to autonomy.
Patients' perception of risk of a medical intervention is also highly individualistic,
variable and unpredictable. The information provided to a patient should include all
material risks. But, the list of risks and side effects cannot be exhaustive to the level of
absurdity and impracticality. For example, hardly any patient can go through the product
information leaflet included in any drug pack and if some body does, it is unlikely that
the drug is consumed. So, what is expected is that the doctor should provide
information that a prudent or reasonable patient would expect to make a knowledgeable
decision about the course of action to be taken in the presence of alternatives.

EXCEPTIONS TO DISCLOSURE
Therapeutic privilege
If a doctor is of the opinion that certain information can seriously harm a patient's health
- physical, mental or emotional - he has the privilege to withhold such information. But, it
should be shared with close relatives. This situation usually does not occur in cutaneous
aesthetic surgical procedures.
Placebo

Use of placebos in certain self-limiting conditions or in patients with high psychological

overlay or in those who insist for some form of medication is justified as there are high
chances of benefit to the patient with negligible risk. Revealing the truth to the patient
takes away the very purpose of administration of placebo.

BLANKET CONSENT
An all-encompassing consent to the effect I authorize so and so to carry out any
test/procedure/surgery in the course of my treatment is not valid. It should be specific
for a particular event. If, consent is taken for microdermabrasion, it cannot be valid for
any other procedure like acid peel. Additional consent will have to be obtained before
proceeding with the latter.
If a consent form says that patient has consented to undergo laser resurfacing by Dr. X,
the procedure cannot be done by Dr. Y, even if Dr. Y is Dr. X's assistant, unless it is
specifically mentioned in the consent that the procedure may be carried out by Dr. X or
Dr. Y (or his authorized assistants).

DOCUMENTATION
It is important to document the process of consent taking. It should be prepared in
duplicate and a copy handed over to the patient. It should be dated and signed by the
patient or guardian, the doctor and an independent witness. Assisting nurse preferably
should not be a witness. Like all other medical records, it should be preserved for at
least 3 years.
INFORMED REFUSAL
Patient has got the right of self-determination. If, a doctor diagnoses varicella in a child,
the parent may choose to avail no treatment because of religious belief. Doctor's duty is
to explain the possible consequences of non-treatment and benefits of treatment and
leave the decision to the parent. Such informed refusals must be documented clearly.
But, a patient's freedom cannot impinge on the rights of others or cause harm to a third
party or community. Therefore, the said parent's freedom of choice cannot extend to
sending the child to school, as the infection can spread to other children.
Discharge against medical advice also falls into this category and needs to be properly
recorded in the case sheet with signature of the patient/guardian.

In an emergency situation, for example intestinal perforation, a doctor may have to

operate even in the absence of consent, to save the life of the patient. It is possible that
even with such an intervention, the patient may not survive. Assuming that the doctor is
competent and has exercised due care and diligence, doctor cannot be held responsible
for patient's death, as he has acted in good faith and in the best interest of the patient.
This protection is given under Section 88 of Indian Penal Code.
CONCLUSION
Obtaining consent is not only an ethical obligation, but also a legal compulsion. The
level of disclosure has to be case-specific. There cannot be anything called a standard
consent form. No doctor can sit in comfort with the belief that the consent can certainly
avoid legal liability. This is highlighted by the note of The California Supreme Court:
One cannot know with certainty whether a consent is valid until a lawsuit has been filed
and resolved.
One can only take adequate precaution and act with care and diligence. Maintaining
good relationship with patient often works better than the best informed consent!

Patient's Bill of Rights

(1)Right to Appropriate Medical Care and Humane Treatment.
- Every person has a right to health and medical care corresponding to his state of
health,without any discrimination and within the limits of the resources, manpower
andcompetence available for health and medical care at the relevant time.The patient
has the right to appropriate health and medical care of good quality.In the course of
such care, his human dignity, convictions, integrity, individualneeds and culture shall be
respected.

(2)Right to Informed Consent.

The patient has a right to a clear, truthful andsubstantial explanation, in a manner and
language understandable to the patient, of all proposed procedures, whether
diagnostic, preventive, curative, rehabilitativeor therapeutic, wherein the person who will
perform the said procedure shall provide his name and credentials to the patient,
possibilities of any risk of mortality or serious side effects, problems related to
recuperation, and probability of success and reasonable risks involved.

(3)Right To Privacy and Confidentiality.

-

The privacy of the patients must beassured at all stages of his treatment.

(4)Right to Information.
-

In the course of his/her treatment and hospital care,the patient or his/her legal
guardian has a right to be informed of the result of the evaluation of the nature
and extent of his/her disease, any other additional or further contemplated
medical treatment on surgical procedure or procedures,including any other
additional medicines to be administered and their genericcounterpart including
the possible complications and other pertinent facts,statistics or studies,
regarding his/her illness, any change in the plan of care before the change is
made, the persons participation in the plan of care andnecessary changes
before its implementation, the extent to which payment maybeexpected from
Philhealth or any payor and any charges for which the patientmaybe liable, the
disciplines of health care practitioners who will furnish the careand the frequency
of services that are proposed to be furnished.]

5)The Right To Choose Health Care Provider and Facility.

-

The patient is free to choose the health care provider to serve him as well as the
facility except when he is under the care of a service facility or when public health
and safetyso demands or when the patient expressly or impliedly waives this right.

(6) Right to Self-Determination.

- The patient has the right to availhimself/herself of any recommended diagnostic
and treatment procedures.
(7) Right to Religious Belief.
- The patient has the right to refuse medical treatment or procedures which may be
contrary to his religious beliefs, subject tothe limitations described in the preceding
subsection: Provided, That such a rightshall not be imposed by parents upon their
children who have not reached the legalage in a life threatening situation as
determined by the attending physician or themedical director of the facility.

(8)Right to Medical Records.

-

The patient is entitled to a summary of hismedical history and condition, He has the
right to view the contents of his medicalrecords, except psychiatric notes and other
incriminatory information obtainedabout third parties, with the attending physician
explaining contents thereof. At hisexpense and upon discharge of the patient, he
may obtain from the health careinstitution a reproduction of the same record
whether or not he has fully settled hisfinancial obligation with the physician or
institution concerned

9 Right to Leave
.
- The patient has the right to leave a hospital or any other health care
institution regardless of his physical condition.
(10) Right To Refuse Participation in Medical Research.
- The patient has theright to be advised if the health care provider plans To
involve him in medicalresearch, including but not limited to human experimentation
which may be performed only with the written informed consent of the patient.
(11) Right to Correspondence and to Receive Visitors
- The patient has the rightto communicate with relatives and other persons and to
receive visitors subject toreasonable limits prescribed by the rules And regulations of
the health careinstitution.
(12) Right to Express Grievances.
- The patient has the right to expresscomplaints and grievances about the care and
services received without fear of discrimination or reprisal and to know about the
disposition of such complaints.
(13) Right to be Informed of His Rights and Obligations as a Patient.
-

Every person has the right to be informed of his rights and obligations as
a patient. The Department of Health, in coordination with health care
providers, professional and civic groups, the media, health insurance
corporations, peoplesorganizations, local government organizations, shall launch
and sustain anationwide information and education campaign to make known to
people their rights as patients, as declared in this Act. Such rights &d

obligations of patients shall be posted in a bulletin board onspicuously placed in

a health care institution.

Triage Principles

Mettag: RED Priority I Immediate attention. Identifier is a Mettag torn to the

red stripe or Roman numeral I placed on the forehead or back of left hand. First
priority casualties are those that have life-threatening injuries that are readily
correctable. For purposes of priority for dispatch to the hospital, however, a
second sorting or review may be necessary so only those transportable cases
are taken early. Some will require extensive stabilization at the scene before
transport may be safely undertaken. A red tag may be used as an additional
means of identification.

Mettag: YELLOW Priority II Delayed attention. Identifier is the Mettag torn to

the yellow stripe or Roman numeral II placed on the forehead or back of left
hand. Delayed category casualties are all those whose therapy may be delayed
without significant threat of life or limb and those for whom extensive or highly
sophisticated procedures are necessary to sustain life.

Mettag: GREEN Minor injuries. Casualties with minor injuries will receive
minimum first aid treatment. They will not be transported to hospitals until all
Priority I and II patients have received care. They will be sent from the triage area
to a designated area away from the disaster scene in order to reduce confusion.
If they are capable, they may also be used as litter bearers or first aid providers.

Mettag: BLACK Dead. Identifier is the Mettag torn up to the black stripe or an X
on the forehead and covered with a sheet, blanket or other opaque material as
soon as possible. Unless absolutely necessary, they should be left in place until
released by the coroner. The temporary morgue should be an area away from
the scene of the triage area.

Persons who are psychologically disturbed, who interfere with casualty handling,
should be isolated from the incident scene as quickly as possible. Campus Police
will be requested to escort individuals to a designated area away from the
disaster scene.

Major Ethical Dilemmas in Nursing

Nurses face ethical dilemmas on a daily basis regardless of where they practice. No
matter where nurses function in their varied roles, they are faced with ethical decisions
that can impact them and their patients. There is no right solution to an ethical
dilemma

What is an ethical dilemma?

It is a problem without a satisfactory resolution. The significance of ethical decisionmaking lays in the fact that very different ethical choices regarding the same ethical
dilemma can be made resulting in neither choice being a right or wrong decision.
Ethics involve doing good and causing no harm. But how one defines what is ethical
can vary differently from nurse to nurse. Classes on the principles of nursing ethics give
the nurse the tools to base ethical decisions upon. However, this knowledge is then
shaped by the values, beliefs and experiences of the nurse. Consequently, very different
choices may be made involving the same dilemma.
There are many ethical issues nurses can encounter in the workplace. Quantity may
address how long a person lives or perhaps how many people will be affected by the
decision. Quality pertains to how good a life a person may have and this varies
depending on how a person defines good.
How does the nurse support a patient deciding between a therapy that will prolong life
but the quality of life will be compromised? The person may live longer, but will likely
experience significant side effects from the therapy. What should the nurses position
be?
1. Pro-choice versus pro-life. This issue affects nurses personally. Many of the
positions nurses assume in this dilemma are influenced by their own beliefs and
values. How does a nurse care for a patient who has had an abortion, when the
nurse considers abortion murder? Can that nurse with very opposing values
support
that
patients
right
to
choose
her
autonomy?
2. Freedom versus control. Does a patient have the right to make choices for ones
self that may result in harm, or should the nurse prevent this choice? For
example, a patient wants to stop eating, but the nurse knows the consequences
will harm the patient. Does the nurse have the right to force the patient to eat?
3. Truth telling versus deception. This is another issue that nurses may have to deal
with, especially when families want to deny telling the patient the truth about the
medical condition. What should a nurse do when a family insists telling the

patient the prognosis will cause harm? How can a nurse know if this is true?
Does
the
patient
have
the
right
to
know?
4. Another dilemma involves the distribution of resources. Who should get the
limited resources? For example, nurses working with patients that are in a
vegetative state; should these patients be left on life support? Look at the cost of
maintaining these patients. These patients are consuming resources that could
be used for patients in whom such costly interventions, if available, could save
their lives. What is the role of the nurse when a family wants to continue life
support
for
a
medically
futile
family
member?
5. Empirical knowledge versus personal belief. In these dilemmas, research based
knowledge in nursing practice is contrasted to beliefs gained from such things as
religious beliefs. For example, what should a nurse do when a patient is admitted
to the hospital that desperately needs a transfusion to live but has the belief that
transfusions are unacceptable? The nurse knows this patient will die without the
transfusion. How does that nurse empathize with the patients family who
supports the family members choice and still be supportive of the patients and
familys right to this decision?
Ethical dilemmas in nursing come daily in which they must make a decision. The
decisions they will make will be affected by so many factors including principles learned
in school and their own personal beliefs, values and experiences.

ANA Code of Ethics

Provision 1
The nurse practices with compassion and respect for the inherent dignity, worth, and
unique attributes of every person.
Provision 2
The nurses primary commitment is to the patient, whether an individual, family, group,
community, or population.
Provision 3
The nurse promotes, advocates for, and protects the rights, health, and safety of the
patient.
Provision 4
The nurse has authority, accountability, and responsibility for nursing practice; makes

decisions; and takes action consistent with the obligation to promote health and to
provide optimal care.
Provision 5
The nurse owes the same duties to self as to others, including the responsibility to
promote health and safety, preserve wholeness of character and integrity, maintain
competence, and continue personal and professional growth.

Provision 6
The nurse, through individual and collective effort, establishes, maintains, and improves
the ethical environment of the work setting and conditions of employment that are
conducive to safe, quality health care.
Provision 7
The nurse, in all roles and settings, advances the profession through research and
scholarly inquiry, professional standards development, and the generation of both
nursing and health policy.
Provision 8
The nurse collaborates with other health professionals and the public to protect human
rights, promote health diplomacy, and reduce health disparities.
Provision 9
The profession of nursing, collectively through its professional organizations, must
articulate nursing values, maintain the integrity of the profession, and integrate principle
of social justice into nursing and health policy.

ETHICAL PRINCIPLES
Ethical principles provide a generalized framework within which particular ethical
dilemmas may be analyzed. As we will see later in this module, these principles can
provide guidance in resolving ethical issues that codes of ethics may not necessarily
provide. What follows are definitions of five ethical principles that have been applied
within a number of professions (Beauchamp & Childress, 1979):
1. Respecting autonomy
2. Doing no harm (nonmaleficence)
3. Benefiting others (beneficence)
4. Being just (justice)
5. Being faithful (fidelity)

The major principled theories: utilitarianism and Kantian ethics

The two most influential ethical theories, utilitarianism and Kantian deontology , claim
that one or a few basic principles provide the only proper perspective from which moral
decisions may be made. Each is a fundamentally influential view in the history of ethical
theory, claiming to support all the valid ingredients of moral experience. When
examining such theories, we should keep in mind the inherent limitation of principled
approaches: that principles are quite abstract and general and that their application to
real moral problems often involves a surreptitious introduction of moral evaluations that
are not part of the principle.

HUMAN ACTS
Introduction Human persons intelligent and free
-

capable of determining our own livesby our own free choices

HOW?
by freely choosing to shape our lives and actions in accord with thetruth
by making good moral choices

These choices performed as free persons are called

HUMANACTSDEFINITION OF HUMAN ACTS
Acts which man does as man = acts proper to man as man
Acts of which he is properly master = because he does them with fullknowledge and of
his own will
= actions performed by man knowingly andfreely = will

properly enlightened by knowledge

supplied by the intellect

Therefore, Human acts are those acts which proceed from a deliberate freewill HUMAN
ACTS THE CONCERN OF MORALIT
only human acts are moral acts = it is only with human acts that man isresponsible for
his actionsREASON AND FREEDOM makes man a moral subject
REASON- Human acts are either in agreement or in disagreement with the dictates of
reason

dictates of reason
- shared consciousness of prudent people about the manner ofaction or behavior- Norm
of morality which is the standard by which actions are judged as good or evil

= good --- in harmony with reason

= evil --- opposed to reason
= indifferent --- neutral

FREEDOM- makes man a moral subject- when man acts in deliberate manner --- he
is the father of his acts - man is thus responsible for those acts --- he can
acknowledge that he has donethem because he wanted to --- and he can explain
why he decided to do them =those acts can be morally classified they are either
good or evil

INTELLECT AND WILL IN HUMAN ACTSintellect and the will are not 2 successive acts but 2 elements of human acts
-

it is not that the intellect that knows and the will that decides but man
who both know and decides through simultaneous
use of the 2 faculties

- will directs the intellect to know

- intellect directs the will to want the object it proposes
WILL
- the only object which necessarily
attracts the will --ABSOLUTE GOOD
perfectly known as such- Partial goods or God imperfectly known
will not necessarily attract the will
WILL naturally inclined to the good but man may sometimes deliberately choose
something morally evil, how come?- In this case, the will chooses a partially good
that the will itself hascommanded the intellect to present as such = how did it
happen?

= the will has a fixed inclination to the good the will can only choose something
badwhen it is presented under its good aspects
= it is due to the disordered disposition ofthe will with respect to its last end, and
themeans leading to it
= there lies theculpability of the choice

Abortion
The matter of abortion, the quintessential bioethics topic, raises intensely personal
issues for many people. It is a polarising and divisive issue that raises discussions
about morals, science, medicine, sexuality, autonomy, religion, and politics. A central
matter is deciding what we can say about unborn children, initially known as embryos
and later, foetuses. What is their moral status how much do they matter, and what are
our obligations towards them? The matter of 'personhood' arises, as a philosophical
and legal discussion about what rights to grant them.

'Personhood' aside, what is our relationship to them, all of us as members of the human
family? Should their lives be protected, or should their mothers be allowed to make
decisions about killing or protecting them? If killing is allowed, under what
circumstances may it take place? If their lives are not protected, what kind of crime is it
to perform an abortion on a woman without her consent, or to cause her to suffer a
miscarriage?
The ethical aspect of abortion is related but distinct from the legal. Whether or not it is
moral, should abortion be legal? Generally prohibited but with some exceptions? Should
it be regulated? Publicly funded? Should doctors and nurses be able to object
according to their conscience?
A less prominent but still important debate focuses on the reasons why women might
seek abortion. Is it at all times a free choice, or are women responding to coercion in
any way? Is it a free choice to seek abortion in desperation because of poverty,
violence, or lack of support? What should be the community and policy response to
women who feel unable to give birth to their children? And what is the role of the father
in decisions about abortion?
Contraception
The use of contraceptives the deliberate interference with the natural process of
fertility in order to prevent conception - is widespread across the global community.
Hormonal contraceptives are considered convenient and effective methods of spacing
children or even not having children at all. Meanwhile, barrier methods of
contraception are hailed as the answer to international problems such as AIDS and
other Sexually Transmitted Infections (STIs). Together, both methods allow individuals
to exert full control over their reproductive lives. However, the effects of widespread
contraceptive usage are perhaps not as clear as they first seem. Hormonal
contraceptives come with their own health risks some of which will remain unknown.
They also raise a host of medical questions concerning their mechanism of action (how
the contraceptive actually works) and whether or not contraceptives have an
abortifacient effect (a drug which allows conception to occur yet renders the womans
womb hostile to implantation effectively, working as an early abortion). This is
particularly problematic for Judeo-Christian or Islamic tradition where life begins at
conception. Yet, the ethical questions arising from contraception are by no means
confined to questions of health. The increased usage of contraception has contributed
to a new understanding of the role of sexual intercourse, the family and the notion of
responsible parenthood all of which bear intimately on the functioning of society as a
whole.

Euthanasia
Euthanasia is the intentional and painless taking of the life of another person, by act or
omission, for compassionate motives. The word euthanasia is derived from the Ancient
Greek language and can be literally interpreted as good death. Despite its etymology,

the question whether or not euthanasia is in fact a good death is highly controversial.
Correct terminology in debates about euthanasia is crucial. Euthanasia may be
performed by act or omission - either by administering a legal drug or by withdrawing
basic health care which normally sustains life (such as food, water or antibiotics). The
term euthanasia mostly refers to the taking of human life on request of that person the
euthanasia is voluntary. However, euthanasia may also occur without the request of
person who subsequently euthanasia is non-voluntary. Involuntary euthanasia refers
to the taking of a persons life against that persons expressed wish/direction.
Central to discussion on euthanasia is the notion of intention. While death may be
caused by an action or omission of medical staff during treatment in hospital,
euthanasia only occurs if death was intended. For example, if a doctor provides a dying
patient extra morphine with the intention of relieving pain but knowing that his actions
may hasten death, he has not performed euthanasia unless his intention was to cause
death (Principle of Double Effect). Euthanasia may be distinguished from a practice
called physician-assisted suicide, which occurs when death is brought about by the
persons own hand (by means provided to him or her by another person). All practices of
euthanasia and physician-assisted suicide are illegal in Australia.
Suicide: An Ethical Typology
Three distinct forms of suicide may be identified based on the role that a clinician plays
in the process:
1. Unassisted Suicide
2. Facilitated Suicide
3. Assisted Suicide
Unassisted Suicide
This may take two forms. The first applies where the victim completes suicide while not
currently or recently in the care of a clinician. The second applies where the victim was
currently under care but not for a condition associated with suicidality. The clinician had
no basis to assume or suspect risk. The victim did not confide any ideation, plan, or
threat or did not acknowledge such behavior if queried by the clinician.
Facilitated Suicide
This applies where the victim completes suicide while currently or recently in the care of
a clinician and where these factors were present:

A clinical or custodial relationship existed

The clinician or provider had knowledge of the risk

Means of prevention or intervention were available

A suicide in this context suggests a breach of duty. This could include ignoring the
danger, and/or not effectively using resources that may have ameliorated the risk.
In such cases, the suicide has, in effect, been facilitated. This is not to say that the
clinician caused the suicide. The ethical failing was doing nothing or acting passively or
conservatively despite the client's mortal danger.
Assisted Suicide
This applies where a clinician with knowledge of the individual's wishes and consent
enables completion by providing the lethal means and guidance as to use. This mode
assumes capacity and rationality. However, most victims of assisted suicide appear
driven by extreme stress and/or chronic intractable pain which impair capacity and
rationality. Enabling the suicide of such individuals, statutes to the contrary, is unethical.
Volition and Suicide
Assisted suicide is justified, by its advocates, as a personal right. Unassisted suicide is
customarily characterized as a personal decision. Where does that leave facilitated
suicide? Consider the following:

Assisted Suicide = Voluntary Action

Facilitated Suicide = Involuntary Action

Unassisted Suicide = Nonvoluntary Action

Professional Ethics and Suicide

The conduct of clinicians is guided by ethics codes that provide nominal protection to
suicidal clients. The codes draw on these principles:

Autonomy - Respect for the individual self-determination

Beneficence - Doing the greatest good possible

Non-maleficence - Minimizing or preventing harm

Justice - Fairness and equal access to care.

Bioethics has developed responsibilities based on autonomy:

Respect for person - The basis of client rights

Telling the truth and giving all the facts - Disclosure

Confidentiality - Maintaining client privacy

Fidelity - Doing the job" and "being there" for the client.