B. ETHICAL PRINCIPLES 1. . Autonomy represents an agreement to respect the clients right to determine a course of action.

Clients are in charge of their own destiny in matters of health and illness. The purpose of the preoperative consent, for example, is the assurance in writing that the healthcare team respects clients independence by obtaining permission to proceed. The consent process implies that the client may refuse treatment, and in most cases, the healthcare team must agree to abide by the clients refusal.

Three basic elements of autonomy: The ability to decide for without adequate information, and intellectual competence, autonomy is shallow. The power to act upon decisions for example, it is obvious that those in death camps of World War II could have made all the decisions they might have wished but lacked power to implement such decisions. Respect for the individual autonomy of others this means the provision of a general respect for personal autonomy for both practitioner and patient that ennobles and professionalizes the process. The term self-determination is often used synonymously with autonomy. Autonomy as related to other themes Informed consent generally contains the elements of disclosure, understanding, voluntariness, competence, and permission-giving. Legal exceptions to the rules of informed consent under therapeutic privilege have been made in cases of emergency, incompetence, waiver, and when there is implied consent. A problematic area of therapeutic privilege is that of benevolent deception, where the practitioner is allowed to intentionally withhold information based on his/her sound medical judgement, that to divulge the information might potentially harm the depressed and unstable patient. Paternalism is the intentional limitation of the autonomy of one person by another, where the person who limits autonomy appeals exclusively to grounds of benefits to that literally means acting in a fatherly manner. The traditional view of paternal actions includes such role behaviors as leadership, benevolent decision-making, protection, and discipline. As commonly used in nursing the term paternalism carries negative connotations, particularly related to implied dominant male versus submissive female roles. Healthcare professionals have a special fiduciary relationship with patient based on the confidence placed in them and the inequality of their positions in regard to information.

THE PATIENTS BILL OF RIGHTS The catalogue of rights can guarantee fo the patient the kind of treatment he/she has a right to expect. A hospital has many functions to perform, including the prevention and treatment of disease, the education of both health professionals and patients, and the conduct of clinical research. All these activities must be conducted with an over-concern for the patient and anove all, the recognition of

his/her dignity as a human being. Success in achieving this recognition assures success in the defense of the rights of the patient. The PATIENT has the right to considerate and respectful care The Patient has the right to obtain from his physician complete, current information concerning his diagnosis, treatment, and prognosis in terms that when the patient can be reasonably expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his/her behalf. He/she has the right to know the name of the physician responsible coordinating his care. The PATIENT has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and treatment and what to expect in emergencies. Such information for informed consent should include but not necessarily be limited to the specific procedures and treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient also has the right to know the name of the person responsible for the procedure and treatment. The PATIENT has the right to Refuse treatment to the extent permitted by law and to be informed of the medical consequences of his action. The PATIENT has the right to Every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination, and his own medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. The PATIENT has the right to Expect that all communications and records pertaining to his care could be treated as confidential. The PATIENT has the right to Expect that within its capacity a hospital must make reasonable response to the request of a patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of the case. When medically permissible a patient may be transferred to another facility only after he has received complete information and explanation concerning the needs for and alternatives to such a transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The PATIENT has the right to Obtain information as to any relationship to his hospital to other healthcare and education institutions in so far as his care is concerned. The patient has the right to obtain information to the existence of any professional relationships among any individuals, by names, which are treating him. The PATIENT has the right to Be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse to participate in such research projects. The PATIENT has the right to Expect reasonable continuity of care. He has the right to know in advance what appointment times and physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby he is

informed by his physician or delegate of the physician of the patients continuing health care requirements following discharge. The PATIENT has the right to Examine and receive an explanation of his bill regardless of source of payment. The PATIENT has the right to Know what hospital rules and regulations apply to his conduct as a patient.

The Dying Patient's Bill of Rights

I have the right to be treated as a living human being until I die. I have the right to maintain a sense of hopefulness however changing its focus may be. I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this might be. I have the right to express my feelings and emotions about my approaching death in my own way. I have the right to participate in decisions concerning my care. I have the right to expect continuing medical and nursing attention even though "cure" goals must be changed to "comfort" goals. I have the right not to die alone. I have the right to be free from pain. I have the right to have my questions answered honestly. I have the right not to be deceived. I have the right to have help from and for my family in accepting my death. I have the right to die in peace and dignity. I have the right to retain my individuality and not be judged for my decisions which may be contrary to beliefs of others. I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others. I have the right to expect that the sanctity of the human body will be respected after death. I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face death.

2. Justice refers to the principle of fairness. However, what constitutes a fair distribution of resources may not always be clear. For example, approximately three times more candidates are on a waiting list for liver transplant than are liver available for transplant in the United States. 3. Fidelity means faithfulness and agreement to keep promises. Fidelity is the ethical foundation of nurse-client relationships. A commitment to fidelity explains the reluctance to abandon clients even when disagreement arises about decisions a client may make.

The standard of fidelity also includes an obligation to follow through with care offered to clients/ clients have the right to expect nurses to act in their best interests. A nurse functions as client advocate and upholds the principle of fidelity. Within the nurse-client relationship, nurses are to be loyal to their responsibilities, maintain privacy, keep promises, and meet the clients reasonable expectations. Nurses also have a duty to be faithful to themselves. Nurses may question who is owed fidelity when conflict between commitments occurs. Remaining to be client-centered may help clarify the question, but it may not resolve the conflict. For example, if a mother of a frightened teenage girl tried to pressure the nurses into revealing the results of the daughters pregnancy test after the daughter had already requested that her mother not be told, and even if nurses believe that the mother has the girls best interest at heart, the nurse must protect the clients right to privacy. 4. Beneficence means taking positive actions to help others. It refers to the duty to promote good and prevent harm, and is often viewed as the core of nursing practice. The practice of beneficence encourages the urge to do good for others. A commitment to beneficence helps in making difficult decisions wherein the benefits of a treatment may be challenged by risks to a clients well-being or dignity. For example, a childs immunization may cause discomfort during administration, but the benefits off protection from disease outweigh the temporary discomforts. Beneficence requires that the best interest of the client remain more important than self-interest. 5. Non-maleficence means to do no harm. Maleficence refers to harm or hurt, thus nonmaleficence is the avoidance of harm or hut. Nonmaleficence involves balancing the risks and benefits of the plan of care while striving to do the least harm possible. The commitment to provie least harmful interventions illustrates the term nonmaleficence. The standard of nonmaleficence provides a continuing effort to promote health. Thus, it is necessary to answer this question: will the treatment modality cause more harm or more good to the client? Consider the following: A reasonable expectation of benefit Lack of excessive pain, expense or other inconvenience Below are examples Preventing medication errors Being aware of potential risks

 Removing hazards For instance, a new bone marrow transplant procedure may promise a chance to cure, tut the long-term prognosis may be uncertain, or the procedure may require long periods of pain o suffering. The Principle of double effect states that secondary effects may be foreseen, but can never be the intended outcomes. For example, the practitioner could, when necessary, ethically prescribe or administer morphine for pain, while understanding that the analgesic suppresses respiration so long as the intended effect is the former and never the latter, and the good intentions equal o outweigh harmful effects. The elements contained with the principle of double effect are as follows. The course chosen must be good or at least morally neutral. The good must not follow as a consequence of the secondary harmful effects. The harm must never be intended but merely tolerated as causally connected with the good intended. The good must outweigh the harm. 6. Veracity means accuracy or conformity to truth. It guides the practice of truthfulness. Veracity binds both the health practitioner and the patient in association of truth. The patient must tell the truth in order to be provided appropriate care. The practice of truthfulness may be challenged during the delivery of health care. For example, a spouse may make a request that his wife not be given news of her poor prognosis. In this case, the principles that are generally in effect and that may take precedence over the spouses wishes include resect of the clients autonomy and principle of veracity. In some instances it may be tempting to tell a child that a medicine tastes good when it does not, or that a procedure will not hut when it probably will, to achieve level of compliance. Professional code of ethics guides nurses to tell the truth, however, and it is a rare circumstance where other principles would support another behaviour. Telling the truth may not be had but deciding how much truth to tell may be very hard. Exceptions to truth-telling are sometimes upheld by the principle of nonmaleficence, particular when the truth does greater harm than good. 7. Confidentiality is an important aspect of the trust that patients place in healthcare professionals. The patients bill of rights states that: the patient has the right to every consideration of his/her privacy concerning his/her own medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly: those not directly involved in his/her care must have the permission of the patient to be present.

the patient has the right to expect that all communications and records pertaining to his/her care should be treated as confidential.

C. ETHICAL THEORIES. BASES FOR PRACTICE Ethical theories states that the value of a situation is determined by its consequencesconsequentialism. It originated from the Greek word telos meaning end, or the study of ends or final causes. Its guiding principle is that of the greatest good for the greatest number of people. An act must result in the greatest positive benefit and deliver positive results for it t be considered ethical. The rightness or wrongness of decisions is judged based upon outcomes or predicted outcomes. The good resides in the promotion of happiness (a set of higher-order pleasures such as intellectual aesthetic, and social enjoyments, rather than mere sensual pleasure) or the greatest net increase of pleasure over pain. Prevention, elimination, and control of disease, relief from unnecessary pain and suffering, amelioration of disabling condition, and the prolongation of life are intrinsic good in health. Types of consequence-Oriented Theories Act-utilitarianism states that people choose an action that will, in any given circumstance, increase the overall good. For example it is the best to tell the truth when the overall consequence will be better for everyone concerned even if the rights of some individuals are violated. Role-utilitarianism states that people should act according to rules that tend to maximize happiness and diminish unhappiness. It requires that people tell the truth in all circumstance Situation Ethics (Agape) seeks general goodwill or love for humanity. In the final analysis, human needs to determine what is ethica or not. There are six guidelines for making an ethical choice o Compassion for people as human beings o Consideration of consequences o Proportionate good o Priority of actual needs, the ideal or potential needs o A desire to enlarge choice and reduce chance o A courageous acceptance of the need to make decisions and the equally courageous acceptance of the consequence of our decisions. 2. Deontological (Duty-Oriented) Theories/Formalism/Kantianism (Immanuel Kant) Deontology comes from the Greek word deon, which means duty. It is based upon the rationalist vview that the ighttness or wrongness of an act depends upon the nature of the act,

rather than its consequence. This ethical theory considers the intrinsic significance of an act itself as the criterion for determination of good. It considers the motives of the individual performing the act, not the consequences of the act. For example, healthcare researchers might risk the well-being of a person participating in an experimental procedure for the sake of finding a drug that will save many people from suffering. Most professional codes of ethics are based upon Kantian principles. 3. Virtue Ethics/Character Ethics represents the idea that the individuals actions are based upon a certain degree of innate moral virtue as stated in the writings of Homer, Plato, Aristotle, and the early Christians. Virtue should not be thought of as a moral requirement, because this confuses it with a principle or rule; rather, we could say that virtue is a character trait that is socially valued. 4. Divine Command Ethics states that there is a divine being who has set down a finite series of rules that adherents claim can provide guidance to most, if not all, moral decisions, e.g. The Ten Commandments. A variant of this theory is a command theory based on non-divine, but morally exemplary individuals such as the Buddha with his Four Noble Truths and the related Eight-Fold Path. The sets of rules for nuns and monks follow the same logic as divine command theory; the only difference being that the teaching s originated from a non-divine person.

How to Process an Ethical Dilemma Step 1: Is this an ethical dilemma? If a review of scientific data does not resolve the question, if the question is perplexing, and if the answer will have relevance for areas of human concern, an ethical dilemma probably exists. Step 2: Gather information relevant to the case. Patient, family, institutional, and social perspectives are important sources of relevant information. Step 3: Clarify values. Distinguish among fact, opinion, and values. Step 4: Verbalize the problem. A clear, simple statement of the dilemma is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion. Step 5: Identify possible courses of action. Step 6: Negotiate a plan. Negotiation requires a confidence in one's own point of view and a deep respect for the opinions of others. Step 7: Evaluate the plan over time. D. CODE OF ETHICS is a set of ethical principles that are generally accepted by all members of a profession, the code states the groups expectations and standards of behaviour and serves as guidelines to assist nurses and other professional groups when conflict or disagreement

arises about correct practice or behaviour. It also sets forth ideals of nursing conduct and provides a common foundation for nurses training. Underlying Principles 1. Responsibility Refers to the execution of duties associated with the nurses particular role. A nurse who acts in a responsible manner gains the trust of clients & other professionals. A responsible nurse remains competent in knowledge & skills & demonstrates a willingness to perform within the ethical guidelines of the profession. For example: When administering medications, the nurse is responsible for assessing clients need for the drugs, giving them safely & correctly, and evaluating the responses. By agreeing to his/her responsibility. The nurse gains trust from clients, colleagues, and society. 2. Accountability refers to the ability to answer for ones actions. it is said that you are accountable too yourself most of all A nurse must also balance accountability to the client, the profession the employing institution, and society (Potter and Perry, 2008) For example, a nurse may know that a client who will be discharged soon remains confused about how to self-administer insulin. The action that he/she takes in response to this situation will be guided by the professional commitment to accountability. The nurse might request more hospitalization or arrange home care to continue teaching at home. The goal is the prevention of injury to then client. The principle of accountability guides the nurses action. 3. Competence refers to specific skills necessary to perform a task For example, one has to make sure that he/she knows all necessary information about a drug before it is administered. The must understand a clients expected response to the medication. Because the nurse is competent, the client can trust that the medication he/she offers are safe. 4. Judgement refers to the ability to form an opinion or draw sound conclusions. Good judgement is leaned in the nursing school. Judgement skills are continuously improved in the practice of the profession. 5. Advocacy involves giving clients the information they need to make decisions and then supporting those decisions. It also implies that care providers should strive to understand then articulate a clients point of view.

The nurses ability to document, articulate, and contribute forms a key aspect of client advocacy. E. THE INTERNATIONAL COUNCIL OF NURSES (ICN) CODE OF ETHICS 1. Preamble a. Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. 2. THE CODE The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct. 1. NURSES AND PEOPLE The nurse's primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment. The nurse holds in confidence personal information and uses judgement in sharing this information. The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction. 2. NURSES AND PRACTICE The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgement regarding individual competence when accepting and delegating responsibility.

The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence. The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people. 3. NURSES AND THE PROFESSION The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge. The nurse, acting through the professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in nursing. 4. NURSES AND CO-WORKERS The nurse sustains a co-operative relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. F. PHILIPPINE CODE OF ETHICS

Republic of the Philippines Professional Regulation Commission Manila

BOARD OF NURSING Board Resolution No. 220 Series of 2004 PROMULGATION OF THE CODE OF ETHICS FOR REGISTERED NURSES WHEREAS, the

Board of Nursing has the power to promulgate a Code of Ethics for Registered Nurses in coordination and consultation with the accredited professional organization (Sec. 9,(g), Art. III of R.A. No.9173, known as the Philippine Nursing Act of 2002); WHEREAS, in the formulation of the code of Ethics for Registered Nurses, the Code of Good Governance for the Professions in the Philippines was utilized as the principal basis therefore: All the principles under the said Code were adopted and integrated into the Code of Ethics as they apply to the Nursing Profession; WHEREAS, the promulgation of the said Code as a set of guidelines, regulations at measures shall be subject to approval by the Commission (Sec. 9 Art. II of R.A. No. 9173); and

WHEREAS, the

board , after consultation on October 23, 2003 at IloIlo city with the accredited professional organization of the registered nurses, in the Philippine Nurses Association, Inc (PNA), and other affiliate organizations of Registered Nurses, Decided to adopt a new Code of Ethics under the afore-mentioned new Law; NOW, THEREFORE, the board hereby resolved, as it now resolves, to promulgate the hereunder Code of Ethics for registered Nurses: ARTICLE I PREAMBLE SECTION 1. Health is fundamental right of every individual. The Filipino registered Nurse, believing in the worth and dignity of each human being, recognizes the primary responsibility to preserve health at all cost. This responsibility encompasses promotion of health, prevention of illness, alleviation of suffering, and restoration of health. However, when the foregoing are not possible, assistance towards a peaceful death shall be his/her obligation. SECTION 2 To assume this responsibility, registered nurses have to gain knowledge and understanding of mans cultural, social, spiritual, physiological, psychological, and ecological aspects of illness, utilizing the therapeutic process. Cultural diversity and political and socio-economic status are inherit factors to effective nursing care. SECTION 3 The desire for the respect and confidence of clientele, colleagues, co-workers, and the members of the community provides the incentive to attain and maintain the highest possible degree of ethical conduct. ARTICLE II REGISTERED NURSES AND PEOPLE SECTION 4. Ethical Principles 1. Values customs, and spiritual beliefs held by individuals shall be respected. 2. Individual freedom to make rational and unconstrained decisions shall be respected. 3. Personal information acquired in the process of giving nursing care shall be held in strict confidence. SECTION 5. Guidelines to be observed: REGISTERED Nurses must a. consider the individuality and totality of patients when they administer care. b. Respect the spiritual beliefs and practices of patients regarding diet and treatment. c. Uphold the rights of individuals. d. Take into consideration the culture and values of patients in providing nursing care. However, in the event of conflicts, their welfare and safety must take precedence.

ARTIICLE III REGISTERED NURSES AND PRACTICE SECTION 6. Ethnical Principles 1. Human life is inviolable. 2. Quality and excellence in the care of the patients are the goals of nursing practice. 3. Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability. SECTION 7. Guidelines to be observed: REGISTERED Nurse must a. know the definition and scope of nursing practice which are in the provisions of R.A. No. 9173, known as the Philippine Nursing Act of 2002 and board Res. No. 425, Series of 2003, the Rules and Regulations Implementing the Philippine Nursing Act. Of 2002, (the IRR). b. Be aware of their duties and responsibilities in the practice of their profession as defined in the Philippine nursing Act of 2002 and the IRR. c. Acquire and develop the necessary competence in knowledge, skills, and attitudes to effectively render appropriate nursing services though varied learning situations. d. They are administrators, be responsible in providing favorable environment for the growth and developments of registered nurses in their charge. e. Be cognizant that professional programs for specialty certification by the BON are accredited through the Nursing Specialty Certification Council (NSCC). f. See to it that quality nursing care and practice meet the optimum standard of safe nursing practice. g. Insure that modification of practice shall consider the principles of safe nursing practice. h. If in position of authority in a work environment, be normally and legally responsible for devising a system of minimizing occurrences of ineffective and unlawful nursing practice. i. Ensure that patients records shall be available only if they are to be issued to those who are professionally and directly involved in their care and when they are required by law. SECTION 8. Ethical Principle 4. Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and privileges. Guidelines to be observed: REGISTERED Nurses must a. Respect the patients Bill of Rights in the delivery of nursing care. b. Provide the patients or their families with all pertinent information except those which may be deemed harmful to their well-being. c. Uphold the patients rights when conflict arises regarding management of their age.

SECTION 9. Ethical Principle 5. Registered Nurses are aware that their actions have professional, ethical, moral, and legal dimensions. They strive to perform their work in the best interest of all concerned. SECTION 10. Guidelines to be observed: REGISTERED Nurses must: a. perform their professional duties in conformity with existing laws, rules regulations, measures, and generally principles of moral conduct and proper decorum. b. not allow themselves to be used in advertisement that should demean the image of the profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.). c. decline any gift, favor or hospitality which might be interpreted as capitalizing on patients. d. not demand and receive any commission, fee or emolument for recommending or referring a patient to a physician, a co-nurse or another health care worker; not to pay any commission, fee or other compensations to the one referring or recommending a patient to them for nursing care. e. avoid any abuse of the privilege relationship which exists with patients and of the privilege access allowed to their property, residence or workplace. ARTICLE IV REGISTERD NURSES AND CO-WORKERS SECTION 11. Ethical Principles 1. The Registered Nurse is in solidarity with other members of the healthcare team in working for the patients best interest. 2. The Registered Nurse maintains collegial and collaborative working relationship with colleagues and other health care providers. SECTION 12. Guidelines to be observed: REGISTERED Nurses must a. maintain their professional role/identity while working with other members of the health team. b. conform with group activities as those of a health team should be based on acceptable ethico-legal standards. c. Contribute to the professional growth and development of other members of the health team. d. Actively participate in professional organizations. e. Not act in any manner prejudicial to other professions. f. Honor ad safeguard the reputation and dignity of the members of nursing and other professions; refrain from making unfair and unwarranted comments or criticisms on their competence, conduct, and procedures; or not do anything that will bring discredit to a colleague and to any member of other professions. g. respect the rights of their co-workers.

ARTICLE V REGISTERED NURSES, SOCIETY, AND ENVIRONMENT SECTION 13 . Ethical Principles 1. The preservation of life, respect for human rights, and promotion of healthy environment shall be a commitment of a Registered Nurse. 2. The establishment of linkages with the public in promoting local, national, and international efforts to meet health and social needs of the people as a contributing member of society is a noble concern of a Registered Nurse. SECTION 14. Guidelines to be observed: REGISTERED Nurses must a. be conscious of their obligations as citizens and, as such, be involved in community concerns. b. be equipped with knowledge of health resources within the community, and take active roles in primary health care. c. actively participate in programs, projects, and activities that respond to the problems of society. d. lead their lives in conformity with the principles of right conduct and proper decorum. e. project an image that will uplift the nursing profession at all times. ARTICLE VI REGISTERD NURSES AND THE PROFESSION SECTION 15. Ethical Principles: 1. Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal. 2. Compliance with the by-laws of the accredited professional organization (PNA), and other professional organizations of which the Registered Nurse is a member is a lofty duty. 3. Commitment to continual learning and active participation in the development and growth of the profession are commendable obligations. 4. Contribution to the improvement of the socio-economic conditions and general welfare of nurses through appropriate legislation is a practice and a visionary mission. SECTION 16. Guidelines to be observed: Registered Nurse must a. be members of the Accredited Professional Organizations ( PNA ). b. Strictly adhere to the nursing standards. c. Participate actively in the growth and development of the nursing profession. d. Strive to secure equitable socio-economic and work conditions in nursing through appropriate legislation and other means. e. Assert for the implementation of labor and work standards.

\ ARTICLE VII ADMINISTRATION PENALTIES, REPEALING CLAUSE, AND EFFECTIVITY SECTION 17. The Certificate of Registration of Registered Nurse shall either be revoked or suspended for violation of any provisions of this Code pursuant to Sec.2.3 (f), Art. IV of R.A. No. 9173 and Sec. 23 (f), Rule III of Board Res. No. 425, Series of 2003, the IRR. SECTION 18. The Amended Code of Ethics promulgated pursuant to R.A. No. 877 and P.D. No.223 is accordingly repealed or superseded by the herein Code. SECTION 19. This Code of Ethics for Nurses shall take effect after fifteen (15) days from its full and complete publication in the Official Gazette or in any newspapers of general circulation. Done in the City of Manila, this 14th day of July, 2004.