NCM 108: HEALTH CARE ETHICS

2 nd Semester, S.Y. 2020-2021

HANDOUT No.1.

ETHICS
• Comes for the Greek word “Ethicos.”
• The etymology of ethics suggests its basic concerns:
o Individual character, including what it means to be a good person.
o The social rules that govern and limit our behavior, especially the ultimate rules concerning good and
evil, which we called morality.
• In everyday parlance, however, we interchange ethical and moral to describe people we consider good
and actions we consider right.
• We interchange unethical and immoral to describe bad people and wrong action.
• Amoral means having no moral sense or being indifferent to right and wrong.
• Nonmoral means out of the realm of morality altogether.
• This is a philosophical science dealing with the morality of human acts.

PURPOSE
1. Ethics is the science of human acts with reference to right and wrong.
2. Ethics is the study of the rectitude of human conduct.
3. Ethics is the scientific inquiry into the principles of morality.
4. Ethics is the practical science of the morality of human actions.

IMPORTANCE OF ETHICS
1) To understand the principles, rules and procedures to have an orderly social life.
2) To help us to determine what is right and what is wrong.
3) To appraise and criticize past and present moral conduct and ethical system.
4) To be able to know the true values in life.
5) To make clear to us why one act is better than another.

MORALITY
• Being in accordance with moral principles and virtues.
• It refers to the rightness and wrongness of an action.

MORALITY AND ETIQUETTE

o Etiquette refers to any special code of behavior or courtesy.

o The so-called rules of etiquette that we learned at home and school are prescriptions for socially
acceptable
behavior. If we want to fit in, get along with others, and be thought well of by them, we should observe
common rules of etiquette. If you violate the rules, then you are rightly considered ill-mannered or
uncivilized,
but not necessarily immoral.

DIVISION OF ETHICS
1) Professional Ethics- the division of ethics that relates to professional behavior.• The branch of moral
science that pertains to the obligations which a member of a profession owes to the public, to his
profession, to his brothers in the profession and to his clients.

2) Medical Ethics- a system of principles governing the conduct of doctors and other health professionals.
One
of the subdivisions of medical ethics is nursing ethics.

Nursing Ethics> deals with the relationship of a nurse to the patient, family, her association, fellow
nurses, her
organization, and the community at large.

3)Health Ethics- the division of ethics that relates to human health.

4) Bioethics- the division of ethics that relates to human life.

BASIS OF CHRISTIAN ETHICS

The Science of ethics is based upon the acceptance of the following truths:
1) Human reason is capable of discovering some truths.
2) God Exists.
3) God is just.
4) A good life shall merit God’s reward.
5) An evil life shall merit God’s punishment.
 6) Man has a soul.
7) Man’s soul is immortal.
8) Man’s soul has the faculties of intellect and will.
9) The object of the intellect is truth.
10) The object of the will is goodness.
11) Man’s will be free and is, therefore, capable of moral good or moral evil.
12) Good must be done; evil must be avoided.
13) An act is good when it is in conformity with right reason.
14) An act is evil when it is not in conformity with right reasons.

HEALTH CARE ETHICS

 It consists of certain ethical precepts and principles, which serve as moral guidelines for the conduct
of
 healthcare professionals in the treatment of patients, particularly in taking care of their health.
 Like any other forms of human relationship, the doctor-patient or nurse-patient relationship brings with
it not
 only certain duties to be performed, but also certain rights to be respected.
 Health care ethics embodies the noble and exemplary mission of the medical profession that “Health
is a
 fundamental human right and it is the obligation of the society to make it possible for the individual to
attain a
 level of health consistent with the resources of the community in which he/she lives.
 Generally, healthcare ethics is interested on the processes that involve the maintenance of health of
people. In this light, healthcare ethics posits questions like:
 How can healthcare be rendered to the greatest number of individuals who factually need it?
 Who must have the heavier weight in drawing decisions that pertain to termination of life of terminally
ill patients?
 Who really deserves healthcare?
 Is healthcare part of the fundamental rights of all individuals?
 Who must really determine the expenses of treatment, hospitalization, and medication?
 Should the hospitalization expense be left only to respective hospital administrators or the
government must intervene and pass laws that will regulate these expenses for the latter to come
to
terms with social policy?

HUMAN: THE SOLE OF MORAL AGENTS

 Of all animals, only humans are qualified as moral agents. This is evidenced by the fact that only
humans are
rational animals.
 This rationality, being inherent, is not just a capability or a potency.
 Because humans are intrinsically rational, it is therefore their destiny to be the only moral agents.
 Being rational, the human person’s knowledge does not stop in the senses since his/her perceptions
(sensual
knowledge) is further “processed” by his/her intellect in the form of abstraction.
 The human person, therefore, does not just perceive things but also analyzes, assesses, criticizes, or
in a word, intellectualizes things (Babor, Ethics, 2006: 14).

MORAL PRINCIPLES
When a nurse is confronted with situations where moral judgment is necessary, the nurse may be guided
by
the following principles or rules:
1) The Golden Rule.
o “Do unto others what you would like others do unto you.”
2) The Two-fold Effect.
o When a nurse is faced with a situation which may have both good and bad effects, how should she
choose which one to follow? The basis of action may be the following:
➢ That the action must be morally good;
➢ That the good effect must be willed and the bad effect merely allowed;
➢ That the good effect must not come from an evil action but from the initial action itself directly;
and
➢ That the good effect must be greater than the bad effect.
3) The Principle of Totality.
o The whole is greater than any of its parts.
4) Epikia
o “Exception to the general rule.”
o It is a reasonable presumption that the authority making the law will not wish to bind a person in
some particular case, even though the case is covered by the letter of the law.
5) One who acts through an agent is himself if responsible.
 6) No one is obliged to betray himself/herself.
o In testifying before a court, no one can force any person to answer a question if such will incriminate
him/her.
7) The end does not justify the means.
8) Defects of nature may be corrected.
9) If one is willing to cooperate in the act, no injustice is done to him or her.
10) A little more or less does not change the substance of an act.
11) The greatest good for the greatest number.
12) No one is held to the impossible.
13) The morality of the cooperation.
14) Principle relating to the origin and destruction of life.
o “Thou shall of kill.”

CODE OF ETHICS FOR STUDENTS

1) The first obligation of the students is to study well and prepare well to his lessons and homework, term
papers,
etc. assigned by the instructors. These obligations correspond to the primary purpose of education
which aims
at the attainment of the necessary knowledge to make a living or to become a useful member of the
society.

2) Student should not only learn the “know-how” concerning their chosen profession but also the
religious,
moral, and cultural values which give meaning to human life and substance to society.

3) Students should develop their reasoning faculties by inquiring into the fundamental truths about things,
life
and society. Discussions for the sake of finding the truth and sharpening the mind should be
encouraged by
instructors. Concentration of the mind and discipline of the will are vital conditions of education.

4) Educational institutions have adopted the regulations concerning absences and tardiness. Intentional
tardiness demoralizes classmates. Likewise, misbehavior in class is an offense against the dignity of
education and the rights of students.

5) Working students should not accept jobs which are conflict with the schedule of their studies or jobs
which
make great demands upon their mental and physical energies. At any rate, they should not undertake
a full
schedule in school.

6) Cleanliness, neat physical appearance and development of a pleasing personality should be part of
education.

7) Students should be encouraged to cooperate in extra-curricular activities, to join school organizations

and to
support educational projects, so as to develop discipline and charity.

8) Students should take care of school property like laboratory equipment, blackboards, charts, library
books,
etc. Destruction of school properties is a sign of ingratitude and lack of good manners. To scribble on
the
walls, chairs and blackboards betrays a paltry character.

9) In college sports, tournaments and other competitions, students should try to win and lose gracefully.
Sportsmanship is a lovely virtue.

IMMORALITY OF CHEATING
Cheating during examinations has developed into a crafty art with the employment of various
ingenious
devices ranging from copying the seatmate’s answer to doing a remote control to the operations. Cheats,
when caught will excuse themselves: “I cheat because almost everybody is cheating. If I don’t cheat, you
won’t pass the exams.
Cheating is just a little thing.”

MORAL AND CARDINAL VIRTUES

• Moral virtues are virtues in the proper sense, for they deal directly with the moral good or not with the
intellectual good.
 • Aristotle identified moral virtue with the “golden mean,” that is, with the moderation in everything.
Moderation
means neither too much nor too little, but just enough.
• The most important moral virtues are four and they are called the Cardinal Virtues (Temple of human
perfection).

THE 4 CARDINAL VIRTUES

1. PRUDENCE
• The first and most important of all the virtues, for man’s good actions are ultimately derived from the
rectitude of his mind.
• St. Thomas defines prudence s wisdom about human affairs; in particular about the most important
thing in life, which is the acquisition of the last end.
• Prudence is the habit of practical reason which enables us to judge promptly on particular cases or
contingent actions which is to be done or omitted.
• A prudent man has a distinct knowledge of the facts of life, of their causes and effects; he remembers
the past, is aware of the present and can foresee the future.

Auxillary or Assistant Virtues of Prudence

• Practical memory, or the ability to profit from past experiences.
• Practical understanding, or the ability to grasp the moral significance or concrete situations.
• Docility, or the actual to take good moral advice from others.
• Ingenuity, or the ability to make a quick and good judgment.
• Foresight, or the ability to direct our actions in advance.
• Circumspection, or the ability to consider the circumstances attending the action.
• Caution, or the ability to avoid think or act carefully to difficulties and obstacles.

2. FORTITUDE or COURAGE
• Man should confront life’s troubles with courage and resist the temptation to surrender or to despair.

3. TEMPERANCE
• Known as moderation.
• It is a moral virtue regulating the desire for sensible pleasures within the limits of right reason and
approved modes of social behavior.

4. JUSTICE
• Implies is equality, for as water seeks its won level, so justice demands equality in our relations and
dealings with other. It regulates human relations and defines human rights and duties.
• Right is the proper object of the virtue of justice and it means to do others what is just, to give what
is due to them.

CODE OF ETHICS FOR FILIPINO NURSES

Code of Ethics
➢ Are systematic guides for developing ethical behavior.
Code of Good Governance
➢ The Code of Good Governance promulgated by the Professional Regulation Commission (PRC) on July
23,
2003 states that the hallmark of all professionals is their willingness to accept a set of professional and
ethical
principles which they will follow in the conduct of their daily lives.
➢ This code is adopted by the PRC and 42 Professional Regulatory Boards to cover an environment of
good
governance in which all Filipino professionals shall perform their duties.

GENERAL PRINCIPLES
The general principles of the Code of Good Governance include the following:
1) Service to Others.
2) Integrity and Objectivity.
3) Professional Competence.
4) Solidarity and Teamwork.
5) Social and Civic Responsibility.
6) Global Competitiveness.
7) Equality of all professions.

PREVALENCE OF BIOETHICAL ISSUES

NEUROLOGICAL THEORY
➢ Under the neurological theory, the human life begins from four to six months after gestation. This means
that,
to the proponent of neurological theory, the substance inside the womb is not yet a human person but just
a
mere mass of flesh. And this theory is one of those that is vehemently rejected by the Catholic Church.

BIOLOGICAL INDEPENDENCE THEORY

➢ Based on the above theory, not until the fetus has acquired matured lungs that can strongly allow it to
be
viable, or exist outside the uterus, only then can it be said to have started to live, or have enjoyed the
status
of human life. This is another theory which the Catholic Church rejects as it stands as a blatant assault
to the
dignity of human life that must have begun, as the Catholic Church maintains, right at the moment of
conception.
METABOLIC THEORY
➢ This theory advocates the idea that, strictly speaking, there is no such thing as fertilization, or the
moment of
fusion of the ovum and the sperm cell that leads to the formation of the so-called new reality or being
termed
as zygote.
➢ This theory is also very hard to accept from among the folds of the Catholics since it just brushes aside
the
very important period that must have manifested the very beginning of human life which the Catholics
call
conception or fertilization.

EMBRYOLOGICAL THEORY
➢ This theory maintains that the beginning of human life happens at gastrulation, not at fertilization.
➢ The crusaders of this theory maintain that the embryo is credited of being a human being; however, it is
not
yet a person since it is bereft of individuality-arguing from the classic understanding of person as
introduced
by Boethius and popularized by St. Thomas Aquinas which goes: “A person is an individual substance of a
rational order.” (Aquinas, “Summa Theologica, 1945: 29).

SELF-CONSCIOUSNESS THEORY
➢ According to this theory, human life begins when the child earns consciousness of his/her very self.
➢ Also, the theory allows infanticide to be done since normally, infants do not have self-consciousness, or
consciousness yet.

GENETIC THEORY
➢ According to this theory, fertilization or conception occurs the moment the sperm cell fuses with the egg
cell.
This glorious event marks the beginning of humanness and personhood.
➢ Strong and convincing the rhetoric and the arguments of the opponents of genetic theory, the Catholic
Church
does not stop to hail and glorify it as the most fitting theory to embrace in consonance with the recognition
of
the sanctity of humanness and personhood that occurs during fertilization.

III. KEY POINTS FOR REVIEW

• Difference of Healthcare ethics and professional ethics and their importance.
• What is morality and its significance to nursing practice.
• Discussion of the division of ethics.
• Different concepts of moral principles.
• Identification of different bioethical issues in healthcare and church.
HANDOUT No. 2: HOMINIZATION

HOMINIZATION
➢ Term used for the beginning of human person.
➢ Latin “homo” means human being.
➢ Life begins in its entirety at conception or some other stage in a pregnancy, then our obligation to
protect the protect the unborn starting from that time.
➢ Instantaneous hominization> opinion maintains that hominization occurs at the time of conception.
➢ Delayed hominization> opinion states that hominization happens some later in the pregnancy.

ABORTION
➢ There are a range of moral and ethical issues which may arise about unplanned pregnancy and
abortion.
At the Pregnancy Advisory Centre, we support a woman’s right to make her own decision about her
pregnancy, based on her unique circumstances, in relation to her own personal values. This
information is not intended to tell women what they should think about abortion, it aims to explore
some of ideas and dilemmas that some women face when making a decision about an unplanned
pregnancy.

➢ Abortion is a serious issue and ethical dilemma, there is a debate going on whether abortion should be
legalized or not.

Is the Embryo/ Fetus a Person?

➢ The pregnancy is a form of life, however there is debate around when a pregnancy becomes a person.
There is not just one answer to this question and the answer varies depending on your personal
views.
Some common thoughts in the community include:

➢ When conception takes place, however it is unclear when this actually occurs. Is it when the sperm
enters into the egg, or six days later when the fertilized ovum beds into the lining of the uterus or is it at
some other stage?

➢ At quickening, which is when the first fetal movement can be felt (approximately 18 – 20 weeks).
➢ When the pregnancy becomes viable and can survive outside the woman’s body (this too is quite
complex).

➢ When the head or the greater portion of the fetus has been born.
➢ Once the woman makes a decision to continue the pregnancy.
➢ When God infuses or breathes soul into the embryo, fetus or baby.
➢ When the pregnancy develops thoughts/feelings/consciousness.

Does the fetus feel pain?

➢ There are some myths and misinformation on this question, which can cause confusion. However,
reputable studies ii demonstrate that the fetus cannot experience pain in any sense prior to 24 weeks
gestation.

➢ This is because developing connections from the body to the cortex in the brain are necessary for pain
perception and these are not intact before 24 weeks gestation.

➢ After 24 weeks there is continuing development of these intracortical networks.

➢ Additionally, to experience pain consciousness is also required.
➢ There is good evidence that the fetus is ‘sedated’ by the physical environment of the womb/ uterus and
generally does not awaken before birth (Royal College of Obstetricians and Gynaecologists 2010).

Is Abortion Murder?
➢ Murder is a legal concept that describes the unlawful killing of a living person.
➢ The laws regarding abortion do not refer to it as murder. The pregnancy can either be viewed as part of
the woman’s body or a separate individual with rights.
➢ People who oppose abortion under any circumstance often use the term ‘murder’ to describe abortion.
➢ The use of this term is not legally or medically correct.
➢ When people describe abortion as murder it often says more about how they feel about abortion than
 what it is.

Religious Perspectives:
➢ Religious and spiritual beliefs might play a role in how you understand pregnancy, fertility and birth
control. This might be a significant contributing factor to your decision.
➢ Religious perspectives vary in their interpretation of when life begins, and whether the pregnancy is
given similar or higher value than the woman.
➢ There are some religions that adopt a pro-choice stance, and there are some that are primarily anti
choice.
➢ Even some religions which are primarily anti-choice may have a diversity of opinion, with some
components being pro-choice.

Couple Counseling Services

➢ As a heath care professional, we should respect patient values and shouldn’t impose religious beliefs on
client. ANA code for nurses’ states, “The registered professional nurse has professional obligations
that must be maintained while provide care to woman who choose to have abortion.”
➢ In addition, abortion is not based on single partner decision so we should emphasize couple counseling.
➢ It is our responsibility to teach such clients regarding antenatal care in order to prevent mother and fetus
from harm.

CONTRACEPTION AND STERILIZATION

➢ Contraception is the deliberate prevention of conception using drugs techniques or devices of birth
control.One of these techniques is sterilization, which consist of procedures that lead to infertility. Form of
sterilization include vasectomy and tubal ligation.

➢ Not requiring consultation with physician:

o Mechanical method (Condom)
o Chemical method (Jellies, creams, foams, foaming tablets, douche, and suppositories).
o Behavioral methods (Post-coital douche, withdrawal method/ coitus interruptus, abstinence).

➢ Methods of Sterilization (Tubal ligation and Vasectomy).

EUTHANASIA
➢ The act or practice of medically assisting someone to die, or allowing one to die painlessly is called
euthanasia.
➢ Known as “Mercy Killing.”
➢ Voluntary and Involuntary euthanasia.
➢ Orthonasia
➢ Dysthanasia
➢ Since euthanasia is a form of suicide, nurses should not participate in any act that would constitute this
practice.

SUICIDE
➢ Suicide is the intentional taking of one’s own life.
➢ It is committed by some people for various reasons, such as hopelessness, financial difficulties,
depression, and the like.
➢ Nurses, having been tasked with preserving life, should not have anything to do with this act, nor
support or help anyone who plans to do it.

➢ Assisted Suicide.
o Advocates of assisted suicide state that suicide allows that terminally ill patient to control the time
and situation of her or his death. They believe that an autonomous competent person should be
able to declare when her or his life has become burdensome and she or he no longer desires to
live.o In fact, 87% of the patients requesting assisted suicide report that the loss of autonomy is a
factor
in their request.

ARTIFICIAL INSEMINATION
➢ This produces by which impregnation is made possible by placing a sperm into female’s uterus using
artificial means.
➢ Like contraception, this process is also unnatural, although nurses may also help in providing
information
about the process to inquiring couples.
In vitro fertilization (IVF) is a method of assisted reproduction in which a man's sperm and a woman's eggs
are combined outside of the body in a laboratory dish. One or more fertilized eggs (embryos) may be
transferred to the woman's uterus, where they may implant in the uterine lining and develop.
III. KEY POINTS FOR REVIEW
• Concept of hominization
• Points to consider in abortion.
• Types of Euthanasia
• Morality in suicide and assisted suicide.
• Ethical issues in contraception, artificial insemination and in-vitro fertilization.

HANDOUT No. 3: PERSONHOOD OF A NURSE

HUMAN PERSON, DIGNITY AND PERSONHOOD

• Christian philosophers, including prominent theologians, lament that there should be no distinction
between the notions of human being and human person. To them, human being is synonymous with
human person.

• As God’s own image, humans are considered by Christians as God’s highest achievement.
• Personhood, is inherent in every human being. As od’s own image, humans reap the worth, the
dignity, and the intrinsic value as human persons.

• Person hood of the man is the foundation of morality, philosophy, art, science, law and the like.
• Sullivan, a phyisican by profession, according to him, the issue of personhood is the “Ground Zero”
of bioethical reflections.

• Plato and Aristotle, among others, are philosophers who maintain that soul is the principle of life.
This means that as long as there is life, there is soul.

• Aristotle asserts that there are 3 kinds of soul, namely: Vegetative (plant soul), sensitive (soul among
animals), and rational (soul that is exclusive to humans which is capable of performing functions of
both the vegetative and the sensitive souls, like feeding, growing, reproducing, and feeling,
specifically of pleasure or pain).

HUMAN ACTS
• Human acts are actions that proceed from the deliberate free will of man (Andres, 1998: 14).
• This also refers to any activity performed by man. It could be either physical, spiritual internal, or
external.

• The essential nature of human acts can further be verified through the Latin maxim Agere sequitur
esse” which means “a thing acts according to its nature” or “the action of something follows being.”

• Humans by nature is a rational animal. It is their being rational that makes them perform actions that
are proper only to nature which is basically good.

• Acts of man, however, do not only refer to actions that occur inside the body of a human person, but
also for those that occur outside the body that are done without a man’s consciousness, knowledge,
and free will.

THREE-FOLD ELEMENT

1. Knowledge
• Doing an act with knowledge makes the act deliberate. This means that the agent has
intellectual knowledge of the act.

2. Freedom
• A human act is an act done with freedom. This means that the agent does an act under the
control of his/her will.
• This suggests that when the agent performs an act with freedom, his/her will is not affected
or influenced by any constraint either within or outside himself/herself.

3. Voluntariness
• Of the three constituents of human act, it is voluntariness that requires the presence of the
two other constituents.
• This means that the voluntary act is synonymous with human act.

VOLUNTARINESS OF HUMAN ACTS

 • A voluntary act is defined as the act which proceeds from an intrinsic principle with knowledge of the
end. In other words, the voluntary act proceeds from the will and depends upon the will for its
performance (Agapay 1991: 15).

CONSCIENCE
• Derived from the Latin phrase cum alia scientia which means the individual man’s application of
knowledge or “acting with knowledge.”
• It is the conviction of moral philosophers that conscience is the connecting link between law and
individual acts. This is the reason why conscience is properly called the means by which law is
applied to the acts of the individual persons.
• Conscience is applicable both to the act per se and the consequence of the act.
• If conscience is a practical judgment of reason, the question is: Is conscience really the rational
(intellectual) or is it intuitive? Does the judgment of conscience undergo an intellectual reasonable
explanation? Or does its judgment employ a direct intuitive reasoning process?

TYPE OF CONSCIENCE
1. Antecedent Conscience
• Is the one that draws a judgment before an action is executed. Its main functions are to
command, to advice, to forbid, and to permit.
• This kind of conscience “advises” the moral agent of the morbidity of an evil act and the
graciousness of a good.

2. Consequent Conscience
• Is the direct opposite of antecedent as it judge only after an act is executed.
• The result of this kind of conscience is either inner peace or remorse.

3. True Conscience
• Is a conscience which judges things truly as they are. Knowledge and the sense of
responsibility for one’s action are great aids in forming a correct conscience (Wood, 1962).

4. Erroneous Conscience
• Known as False Conscience.
• It is a kind of conscience that judges things in a distorted or slanted manner since it considers
bad acts as good and good acts as bad. This distorted judgment in erroneous conscience is
brought about by false interpretation of the moral principles.

• Types:
➢ Invincible/ Unculpable (Unconquerable)
➢ Means that the doer of the act is without fault since he/she does not know that the acts he/she
does is bad.
➢ Vincible/ Culpable (Conquerable)
➢ Means that the moral agent has full knowledge that the acts he/she does is
wrong or bad; hence, the moral agent is liable.

5. Certain Conscience
• Refers to the subjective certainty on the legality of particular actions to be executed or not.

6. Doubtful Conscience
• Occurs when a moral agent is not sure about a moral judgment. To the moralists, this kind
of conscience should not be followed unless the person has resolved the doubt.

7. Scrupulous conscience
• Is a kind of conscience that sees wrong where there is actually none.

8. Lax Conscience
• It is one that fails to see wrong even when there is actually wrong. This conscience
categorically needs a right education.

ETHICAL THOUGHTS

ETHICAL THEORIES
➢ Ethical theories are those that provide a schema, structure or framework in order that the rightness
or wrongness, and goodness or badness of human conduct will be determined (Mappes & DeGrazia,
1996) .

DEONTOLOGICAL ETHICS
 ➢ The term deontology was coined by Charlie Dunbar Broad (1857-1971).
➢ It is derived from Greek word Deon which means “obligation” or “duty” and the Greek word Logos
which means “inquiry” or “study” (Ashley & O’Rourke, 1986).
➢ This is an approach to ethics that puts focus on the rightness or wrongness of actions as such; it is,
therefore, not interested of the consequences of those actions.

IMMANUEL KANT (1724-1804)

➢ He posits that morality is a pure philosophy.
➢ This German philosopher emphasized that philosophy is divisible either on the context of empeiria
or experience or on the basis of an a priori demonstration or pure philosophy.
➢ To him, metaphysics is cclassified either as metaphysics of nature or metaphysics of morals. Ethics
is not a pure philosophy since it requires experience which he calls practical anthropology, and a
rational part which he calls morals proper.
➢ He writes: “Duty is the obligation to act from reverence, respect for, and obedience to the moral law.”

➢ 2 divisions of duties:
o Perfect Duty
▪ One which must always be observed regardless of any given circumstance, like
place and time.
▪ Kind of duty that is considered as “compulsory to do” or one that must be abstained.
▪ Duty not to kill; duty not to lie; and duty to keep promises.

o Imperfect Duty
▪ Refers to those duties wherein one promotes or pursues certain actions, like the
welfare of others, or showing respect, love, compassion, and understanding to
others.

WILLIAM DAVID ROSS (1877-1971)

➢ A Scottish philosopher who authored The Right and The Good in 1930.
➢ Ross fashions his in the seem-to-be-legal term prima facie duties.
➢ Prima facie means “At first sight” or “on the face of it.”
➢ Prima facie, according to Ross, is considered a “conditional duty” that arise in the context of relation.

PRIMA FACIE DUTY

➢ Is one that directs or commands what one ought to perform when other relevant factors are not taken
into account.
TYPES:
1. Duty of Fidelity
➢ We should be faithful to our duties, obligations, vows or pledges; this likewise refers to one’s
loyalty to a worthy cause, telling the truth as the situation demands it, keeping the actual and
implicit promises, and do not representing fictions as truth.

2. Duty of Reparation
➢ We should make amends for injury we have inflicted to others. Asking for the other person’s
forgiveness is insufficient. We have to do that person good to atone for our wrongdoing.

3. Duty of Gratitude
➢ We have a duty to appreciate and recognize the services others have done for us, which
may be either a favor, kindness, good fortune, a great help, or saving one’s life.

4. Duty of Justice
➢ Ross stresses the proper distribution of social benefits and burdens. Not only should we
enjoy social benefits with others, but we should also equally share with them the burdens of
social living. The duty of justice demands fairness for everyone.

5. Duty of Beneficence
➢ This type of duty enjoins us not only to bring about what is good for others but also to help
them better conditions with respect to virtue, intelligence, or comfort. This duty requires the
provision of benefits and balancing of benefits and for all people concerned in the given
circumstance.

6. Duty of Self-Improvement
➢ Has we had duty to help others better themselves, so we can also have a duty to improve
and develop ourselves with respect to virtue, intelligence and happiness.

7. Duty of Nonmaleficence
➢ We ought to avoid inflicting evil, injury or harm upon others as we should avoid doing so to
ourselves. We ought to prevent evil or harm, which encompasses pain, suffering, disability,
 and death.

TELEOLOGICAL ETHICS
➢ Derived for Greek word Telos which means, “end” or “purpose” and logos which means “science.”
➢ Teleological ethics derives moral obligation from what is considered good or desirable as an end or
purpose to be achieved.
➢ The focus is on the consequences of the act that is executed by the agent premised on the purpose
or reason why the agent performs the act.
➢ Inasmuch as teleological ethics put emphasis on the consequence of the act, be it happiness
(eudaimonia in Greek) or pleasure (hedone in Greek), it then includes consequentialist or utilitarian
ethics.

ST. THOMAS AQUINAS (1224-1274)

➢ Theoretically, Thomistic ethics is better understood if one has a good background reading of
Aristotelian ethics. This means, according to Aquinas, Aristotelian Ethics is not complete in that it
needs his theological virtues as complements.

➢ Aquinas maintains that human actions are always directed towards ends. It is the ambit of ends that
makes actions voluntary as they are willed by the agent. So that actions can be clearly construed as
voluntary or willful, they must have the following conditions:
o If the act is in itself overt (externally manifested).
o If the agent acts because of a motive that prompts him/her to act.
o If the agent is responsible for the consequences of his/her actions.

➢ Likewise, for him, the eternal law of God governs all things in their order and purpose, and man, in
his intrinsic nature, cannot be exempted from the governance of the eternal law.

CONSEQUENTIALISM
➢ Was introduced by Gertrude Elizabeth Margaret Anscombe (1919-2001).
➢ This refers to those theories which hold that the consequences of a particular act form the basis for
any valid moral judgment about the action.
➢ Consequentialist moralist puts much weight on the consequences of the act as the gauge to
determine if the act is right or wrong.

UTILITARIAN ETHICS
• It is an ethical theory that espouses the concept that if one is happy or pleased with one’s act, the
one is a good human person.
• It upholds the notion that human beings should act for them to produce the greatest happiness, or
the highest quantity of pleasure directed towards the greatest number of recipients or beneficiaries.

CONTRACTARIAN ETHICS
• Is theoretically anchored on a political philosophy usually called social contract.
• Social contract is forged both by the government and its subjects or citizens. In social contract, the
authority of the government is premised in an agreement between the ruler (the government) and
the ruled (the subject or citizen) in which the ruler agrees to provide order in return for obedience of
the ruled.

JOHN RAWLS (1921-2002)

• An American philosopher of note who used to be a professor of philosophy in Harvard university and
is bent on teaching his theories on social justice which he successfully outlined in his book the Theory
of Justice in 1971.
• He explains that moral contract must be taken in a hypothetical or imaginary plane based on the
following reasons:
o Justice, in the context of equality, is so elusive to have. He succinctly argues that we can
never be equal since there are lot of variations among ourselves in terms of “natural lottery.”
o These variations can be readily seen in terms of religion, race, gender, physical appearance,
culture, educational opportunities, financial standing, and the like.
o We are theoretically and practically thrown helplessly into this natural lottery thing which
denies us of a free choice of what sort of more beneficial and far-off advantageous contents
of this natural lottery matter.
o This natural lottery is called by him as contingent attributes.
o Since we have varied contingent attributes, we become bias and prejudiced toward each
other.

VIRTUE ETHICS
• In this theory, it put much weight on the moral character of the moral agent, rather than of what
he/she has done.
 • It insists that it is the character rather than the consequence of actions that should be the focal point.
• To Beauchamp and Walters, “A morally good person with right desires or motives is more likely to
understand what should be done, more likely to perform required acts, and more likely to form an act
on moral ideals than a morally bad person.”

• To Tod Chambers:
1) One who can discern the right course of action in the situation without relying
on principles and rules.
2) One who desires to do what is right and avoid what is wrong.

• Plato:
1) Wisdom;
2) 2) Courage;
3) 3) Temperance;
4) 4) Justice. Wisdom arises in the rational soul,
courage is the spiritual soul, and temperance in the appetitive soul. Temperance means moderation.
Justice means “the observance of duty and righteousness; it is what is due to or from a person.

• Aristotle:
1) Intellectual and
2) moral virtues. Intellectual virtue arises from teaching, and through the
reflection of theoretical moral truths and the discovery of rational principles that ought to control
our
actions. Moral virtue arises as a consequence of habit or of one’s habitual choice of action in
consonance with rational principles.

• To Augustine: 1) Prudence, justice, temperance, fortitude, and charity/love, all of which are
indispensable to attain salvation.

• Aquinas added Theological Virtues to Aristotle namely

1) faith,
2) hope, and
3) love.

SITUATION ETHICS
• Posited by Joseph Fletcher (1905-1991), an American Scholar and an Episcopal Priest.
• In situation ethics, right and wrong depend upon the situation (“Ethics of Love”). There are no
universal moral rules or rights - each case is unique and deserves a unique solution.• Situation ethics
rejects 'prefabricated decisions and prescriptive rules'. It teaches that ethical
decisions should follow flexible guidelines rather than absolute rules, and be taken on a case-by
case basis.

• So, a person who practices situation ethics approaches ethical problems with some general moral
principles rather than a rigorous set of ethical laws and is prepared to give-up even those principles
if doing so will lead to a greater good.

III. KEY POINTS FOR REVIEW

• The difference between human dignity and personhood.
• The proponents of different ethical thoughts.
• The application of ethical principles to nursing.
• The attributes proposed by different philosophers and scholars as to their views and principles
with their own proposed ethical theories.
HANDOUT 4
WHAT IS A PROFESSION?
• The older medieval professions were divinity (theology), physic (medicine), and law. Industrial
society has greatly fostered the professions, but it has also depersonalized them.
• Professions themselves have been depersonalized by a loss of a clear identity. This loss which
notoriously true for the ministry is now evident in law, teaching, and medicine.
• What is even more confusing is that many ministers, lawyers, and physicians counsel clients in
ways not easily distinguishable from those with psychotherapists.

PERSONALISTIC CONCEPT OF A PROFESSION

• Today, the term profession is used for almost any prestigious occupation because it has the
aura of an ideal.
• It is a symbol rather than a reality.
• Robert Merton explains the social value of profession very succinctly:
o First, the value placed upon systematic knowledge and intellect (Knowing).
o Second, the value placed upon technical skill and trained capacity (Doing).
o Third, the value placed upon putting this conjoint knowledge and skill to work in the service
of others (Helping).

• To call the technologies and the arts (engineering, business, fine arts) professions is confusing
and dangerous because this disguises the fact that they produce things and do not directly help
persons.

• A true profession is rooted in theory but aimed at practice-practice that does not produce things
external to persons, but a service done directly to persons themselves.

• Person professionals would not act on clients nor dominate them, but enable them to become
fully, autonomously themselves. It communicates power rather than enforces dependency.

• Professional help in the full sense is concerned precisely with those problems which are deeply
personal, or are matters of life and death. Such help engages both professionals and client in a
profound responsibility both to each other and to the larger community.

THE HEALTH CARE PROFESSION

• Is one that belongs to the ambiance of professional ethics.

• “A code of morals is more universal and fundamental than a code of professional ethics.

• The norms of that healthcare professionals are required to obey and respect are those that
regulate their actuations, decisions, and responsibilities in the context of health.

• Healthcare profession is well represented by physician, nurses, medical technologists, dietitians,

medical laboratory technicians, as well as sociologists, historians, politicians, scientists,
philosophers, lawyers, economists, theologians, psychologists, and anthropologists.

• Healthcare profession carefully and sympathetically calls to respect both the issues of life and
death.

• As person becomes ill or suffers from a certain disease, healthcare professionals, especially the
nurse, are called to abide by a lot of norms, principles, theories, and values that should be upheld
and respected with the aid of certain acceptable guides to help them come to terms with the
better,
if not best, decision relative to healthcare giving.

THE CLIENT
• The client (whether in the hospital or community) is the summit of the meaning of the healthcare
profession.
• Every human being who becomes ill is somebody whom any healthcare provider is morally
obligated to care for.
• The healthcare provider does not have the legal, moral, or even intrinsic right to choose the kind
of client he/she will take care of.
THE HEALTH CARE PROVIDER
• The healthcare provider, especially the nurse, is no ordinary professional whose duties and
obligations can just be accomplished by mere compliance of those that he/she s expected or
required to do, like a mechanic, a carpenter, an engineer, a lawyer, among others.

VIRTUES
• Romans take the word vir for the English term man. Consequently, the term virtue finds
meaning in the circles of thinkers, especially moralists and ethicists.
• Are required habits or dispositions to do what is morally right.

VICES
• In contradiction to habit, vice is considered an immoral, depraved, or degrading act to all the
members in a given society.
• In a euphemistic consideration, vice can be taken to mean a defect, infirmity, fault, iniquity,
offence, wickedness, or corruption.
• Vice is derived from the Latin word vitium which means failing or defect.
• If virtue is a habitual execution of a good deed, vice is considered the product of a repeated
sinful
act.

HABITS
• Habits is defined as a constant, easy way of doing things acquired by the repetition of the same
act (Ibid).
• Modern language clarifies the meaning of the term via a distinction between entitative habits
and
operative habits.

o Entitative habits are habits of being. They refer to our connatural qualities, like health,
strength, or beauty, which we hardly call habits today.
o Operative habits mean habits of acting. They refer to the tendencies we have developed in
ourselves from repeated acts.

VIRTUES OF THE HEALTHCARE PROVIDER

Fidelity
o Helen Keller made a modest attempt to define fidelity in the context of the healthcare
profession:
“many persons have the wrong idea about what constitutes true happiness. It is not attained
through self-gratification but through fidelity to a worthy purpose.”

o Keller is exhorting all healthcare professionals to stick to fidelity as they serve the needs of their
patients as such is the very purpose why they become healthcare providers.

o Fidelity is derived from the Latin word fidelitas which means faithfully.

Honesty
o Lies, sometimes, are sweeter and much more tempting to pursue than the truth. This explains
why a lot of people are hooked to live a life gravely pestered by lies.

o Honesty is derived from the Latin word honestus which means honor. Literally, it refers to
people
who are holding honorable or respectable positions.

o He/She is supposed to be sincere, truthful, straightforward, decent, comely, tidy, open, upright,
virtuous, trustworthy, fair, honorable, creditable, and of good moral character. He/she should not
cheat on his/her patients nor steal anything from them.

Integrity
o This comes from the Latin word enteros which means a whole.
o An honest person is one who can distinctly discern the variance between right and wrong, or
one
whom is determined to act on a right decision.
 o Integritas means soundness, is another Latin word through which the term integrity can be
traced. The healthcare provider practices integrity when he/she does his/her duties and
obligations as a healthcare provider according to the beliefs, principles, and values he/she claims to
embrace or cherish.

Humility
o As the nurse lives with fidelity, honesty, and integrity, he/she is at the same time summoned to
practice humility. Humility does not mean that one has to think less of himself/herself; rather, it
invites one to think of himself/herself less.

o Only when one can readily restrain his/her proven talents, abilities, skills, and achievements,
only then can one openly welcome humility.

o It is recognizing one’s capabilities and limitations.

o It is doing one’s best and asking for help as needed.

Respect
o The healthcare provider must earn the respect of his/her patients for him/her to become strong
catalyst for the healing process of the patient.

o In many instances, respect is paired with fear, giving raise to questions like “are you afraid of
the
person that is why you respect him or do you have respect for the person that is why you are
afraid
of him?”

o Respect fit the profession of the healthcare provider who is tasked to care for the sick. In the
absence of respect, illness will never be conquered as the spirit of care will be tainted by
selfishness, arrogance, and malice.

o It is listening attentively to a patient’s or colleague’s opinion.

o It is very important for the healthcare provider to respect and acknowledge the feelings, beliefs,
convictions, status, and condition of the patient in relation to the latter’s disease and to his/her
stature as a human being.

COMPASSION
o Is loving kindness, a feeling for those who suffer. It is self-sacrifice voluntarily given for the
benefit of another or given with no hope of return gain, recognition, or payment but given because
the needs of other are more important.

o Random House Webster’s College Dictionary (2001) defines compassion as “a feeling of deep
sympathy and sorrow for someone struck by misfortune, accompanied by a desire to alleviate the
suffering.”

PRUDENCE
o One of the cardinal virtues according to St. Augustine.

o Defined as an exercise of good judgment, common sense, and caution in the conduct of
practical
matters.

o Scholars should consider discretion (wise self-restraint), foresight (ability to foresee the future or
what may happen as a result of one’s decision), forethought (advance rational calculation of
future
events), and circumspection (moral considerations as effect of one’s actions).

COURAGE
 o Is doing what one sees as right without undue fear, or standing up against what one sees as
wrong even it means standing up alone or taking some risk.

o Courage is one of the virtues taught by Aristotle. To him, courage is the mean (virtue) between
confidence (excess) and fear (deficiency).

o Defined as “the quality of mind or spirit that enables a person to face difficulty, danger, and pain
without fear.”

o It also means confidence, resolution, and conscious self-sacrifice for the sake of something
greater than one’s own self-interest.

VICES OF THE HEALTHCARE PROVIDER

While the above virtues should be developed by health care providers, they should be careful
with
following vices, which they may develop as they go through their work.

FRAUD
o In the case of The Philippine Manufacturing Company versus Go Jocco, 48 Phil 630, fraud is
defined as “a false representation of fact, made with a knowledge of its falsehood, or recklessly,
without belief in its truth, with the intention that it should be acted upon it” (Moreno, 2005).

o It is also understood as a “deliberate deceit; trickery; an intentional perversion of truth for the or
to surrender a legal right.”

o In another case, i.e., Cajucom versus the Philippine Commercial and Industrial Bank, 62316-R,
November 23, 1979, fraud is defined as that which “…connotes a serious willingness and
deliberate intent on the part of the erring party to do wrong or to cause damage to another
(Moreno 2007).”

o Applied in the healthcare profession, it becomes a grave offense on the part of the nurse to
deceive, trick, or eventually harm the dignity and health of his/her patient.

PRIDE
o Defined as a “feeling of gratification arising from association with something good and
laudable.”

o It is also understood as “….a high or inordinate opinion of one’s own dignity, importance, merit,
or superiority; conceit; arrogance” (Random House Webster’s College Dictionary, 2001).

o Proverbs 29:23 states that “a man’s pride will bring him low, but he who is lowly in spirit will
obtain honor.”

o “Pride is the root of all vice/sin and the strongest influence propelling us to sin.”

GREED
o Greed is an excessive desire for wealth or possessions (Random House Webster’s College
Dictionary, 2001).

o The Catholic Church of vice, St. Thomas Aquinas remarked, “…it sin against God, just as all
moral sins, inasmuch as man condemns things eternal for the sake of the temporal things.”

o Construed in the nomenclature of avarice, greed is understood as an utter display of distasteful

behaviors, such as betrayal, bribery, theft, violence, and manipulation of authority.

II. KEY POINTS FOR REVIEW

• Definition of profession.
• Identify the characteristics of the healthcare profession.
• Identify the professionals under the healthcare profession.
• Recall the virtues ad vices of the healthcare providers.
HANDOUT 5

STEWARDSHIP
• Man has dominion over God’s creations: himself (life and death), other creatures and the environment.
One should reasonably, responsibly and respectfully benefit from them for service not dominion.

TOTALITY
• This principle presumes background commitments to bodily integrity functions and a correlative
prohibition of mutilation. Parts are integral, destined to be part of and subordinate to a whole.

SOLIDARITY
• Solidarity is to be one with others; to have a unity of interest, responsibility or goal. It is based on the
common good, love of neighbor, preferentially for the most proximate and most needy.

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.

JUSTICE
• It is both a principle and a virtue relating to the rightness of people’s interactions and relationships. It
hinges on fair play, keeping promises, role commitments, and reciprocity.

• As the principle: one should give the person what is due for him. As the virtue: it is the constant will to
render what is right (one’s due).

• Just decision is based on client need and fair distribution resources. It would be unjust to make such
decision based on how much he or she likes each client.

NON-MALEFICENCE
• This requires nurses to act in such a way as to avoid causing harm on clients. The principle seeks to do
no
harming situations requiring nursing actions.

• The principle also addresses the need to avoid harm regardless of reasons for negative actions.

• Nurses should act with empathy without bad faith or ill-will, nor make false accusations.

• It is to avoid causing deliberate harm, risk of harm and harm that occurs during the performance of
beneficial acts. E.g. Experimental research that have negative consequences on the client.

AUTONOMY
• Autonomy is having the freedom to make choices about the issues that affect’s one’s life.
• It is the right to choose what will happen to one’s own person.
• Nurses should promote client’s independence in decisions and take action themselves.

BENEFICENCE
• Beneficence is a principle that requires nurses to act in ways that benefit the clients.
• Components:
o One ought to do or promote good.
o One must prevent evil or harm in all instances and always advocate for what is in the client’s best
interest.
o The nurse must not only prevent, but also must remove evil or harm.

GOOD SAMARITAN LAW

• Provides protection to health care providers by ensuring immunity from civil liability when assistance is
provided at the scene of emergency and the care giver does not intentionally or deliberately inflict injury.
Nurses have the responsibility to help others by doing what is best for them.

CONFIDENTIALITY
• This principle states that it is the nurse’s responsibility to safeguard “the client’s right to privacy by
judiciously protecting information of a confidential nature.”
• Confidentiality in the health care context is the requirement of health professionals (HPs) to keep
information obtained in the course of their work private.
• Nurses hold in confidence any information obtained in a professional capacity, and use professional
judgment in sharing such information. Each nurse will treat as confidential personal information obtained in
a professional capacity.
PRIVACY
1. Bodily privacy

• An ethical concept of bodily privacy can be derived from respect for autonomy, where autonomy includes
the freedom to decide what happens to one’s body.
• Bodily privacy is recognized in law: actions in assault, battery and false imprisonment may be available
to the person who does not consent to health care.

2. Decisional privacy
• Decisional privacy is distinguished as control over the intimate decisions one makes (e.g., about
contraception, abortion, and perhaps health care at the end of one’s life).

3. Informational privacy
• This type of privacy underlies the notion of confidentiality

VERACITY
• This is simply the practice of telling the truth.
• It is a universally accepted virtue; in fact, most of us were taught as children to always tell the truth.
• Nurses should communicate truthfully and accurately.
• The right to self-determination becomes meaningless if the client does not receive accurate, unbiased,
and understandable information .

FIDELITY
• Fidelity means being faithful to one's commitments and promises.
• Nurses’ commitments to clients include providing safe care and maintaining competence in nursing
practice.
• In some instances, a promise is made to a client in an over way
• Nurse must use good judgment when making promises to client. Fidelity means not only keeping
commitment but also keeping or maintaining our obligation.

Professional Boundaries and Moral Obligations for Nurses

The following professional boundaries and moral obligations for nurses are specified by the ANA Code of
Ethics for Nurses with Interpretive Statements (2015).

Clinical practice boundaries:

• Respecting patients’ dignity
• Right to self-determination
• Delegating tasks appropriately
• Practicing good judgment
• Accepting accountability in practice
• Alleviating suffering
• Being attentive to patients’ interests
Working within the nurse practice acts and nursing standards of practice Professional practice
boundaries:

• Maintaining authenticity in all relationships with others, such as nurse–nurse relationships, nurse–
physician relationships, nurse– patient relationships, and multidisciplinary collaboration

• Addressing and evaluating issues of impaired practice; fraternizing inappropriately with patients or
others; accepting inappropriate gifts from patients and families; confidentiality and privacy violations;
and unhealthy, unsafe, illegal, or unethical environments Self-care and self-development boundaries
and obligations:

• Participating in self-care activities to maintain and promote moral self-respect, professional growth
and competence, wholeness of character in nurses’ actions and in relationships with others, and
preservation of integrity.

• Advancing knowledge and research through professionalism, practice, education, and administrative
contributions

• Collaborating with other healthcare professionals and the public to promote community and national
and international efforts

• Promoting healthy practices in the community through political activism or professional organizations
by addressing unsafe, unethical, or illegal health practices that have the potential to harm the
community
PATIENT ADVOCACY
• Patient advocacy, an essential element of ethical nursing practice, requires nurses to embrace the
promotion of well-being and uphold the rights and interests of their patients (Vaartio, Leino-Kilpi,
Salanterä, & Suominen, 2006).
• The ANA (2015) did not explicitly define the terms advocacy or patient advocacy in the Code of Ethics for
Nurses with Interpretive Statements, although advocating for the patient is an expectation, as evidenced
by
Provision 3 of the code: “The nurse promotes, advocates for, and protects the rights, health, and safety of
the patient” (ANA, 2015, p. 9).
• Hanks (2007) identified barriers to nursing advocacy based on findings from existing literature:

1. Conflicts of interest between the nurse’s moral obligation to the patient and the nurse’s sense of
duty to the institution
2. Institutional constraints
3. Lack of education and time
4. Threats of punishment
5. Gender-specific, historical, critical social barrier related to nurses’ expectations of a subservient
duty to medical doctors.

CULTURALLY SENSITIVE CARE

• Culture refers to “integrated patterns of human behavior that include the language, thoughts,
communications, actions, customs, beliefs, values, and/or institutions of racial, ethnic, religious, and/or
social groups” (Lipson & Dibble, 2005, p. xi).

• Giving culturally sensitive care is a core element in closing the gap on health disparities.

• Culturally sensitive care means nurses must first have a basic knowledge of culturally diverse customs
and then demonstrate constructive attitudes based on learned knowledge (Spector, 2012).

• A culturally competent nurse or healthcare provider develops an awareness of his or her existence,
sensations, thoughts, and environment without letting these factors have an undue effect on those for
whom care is provided.

• Cultural competence is the adaptation of care in a manner that is consistent with the culture of the client
and is therefore a conscious process and nonlinear. (Purnell, 2002, p. 193).

• The process of nurses getting to know themselves and their values, beliefs, and moral compass is
fundamental to providing culturally competent care (Purnell, 2011).

• Nurses’ genuine attention to cultural diversity and the diversity within each culture promotes ethically
competent care, which is essential in everyday nursing practice. In addition, nurses must increase their
knowledge when caring for culturally diverse patients. Provision 1 of the Code of Ethics for Nurses with
Interpretive Statements (ANA, 2015) compels nurses to care for persons regardless of social or economic
status, personal attributes, or nature of health problems.

II. KEY POINTS FOR REVIEW

• Identify the different basic ethics principles in nursing.
• Recall the main principle of moral obligations of nurses.
• Determine the main purpose of patient advocacy and principle of culturally-sensitive care.