Ethical and Bioethical Issues in

Nursing and Health Care

Presented by:
Matthew Chrysler L. Dionela, RN
Anabel V. Franada, RN, MN
Louthgarda V. Pantua, RN

Relativism, Healthcare and

Moral-cultural issues

LEARNING OBJECTIVES:
To know about Ethical Relativism and its importance

in the Nursing Practice.

To Learn the Different Healthcare issues
To Review different Moral-cultural issues
To know how Religion affects in the practice of
Nursing.
To emphasize Conscience as an intuition or guide in
the Nursing Practice
To know the Different Bioethical issues concerning the
Nursing Practice

OUTLINE
Relativism
Healthcare
Moral cultural Issues

Religion
Conscience
Bioethical issues

RELATIVISM
Ethical Relativism- This theory holds that
morality is relative to the norms of one's culture.
The theory states that before decisions are made,
the context of the decision must be examined

The doctrine states that there are no absolute

truths in ethics and that what is morally right or
wrong varies from person to person or from society
to society.

RELATIVISM
The theory believes that variances in culture and

society influence whether an act is moral.

Unlike deontology, this theory believes that what is
right for one group may not be right for another; this
theory believes there is no universal truth.
Those opposed to this theory feel that there are some
things (e.g. incest or torture) that are not open to
debate

RELATIVISM
Example: An example, often used, is female genital

circumcision. One side calls it female genital

mutilation. Another group may consider this an
appropriate cultural rite of passage. The ethical issue
discussedis this a cultural issue or human rights
issue? Since it is performed on girls as young as seven
years old, the issue of assent, consent, and culture are
prominent in ethical discussions.

Ethical issues in health care

We usually think of the big issues

e.g. definition of life, what is a person, quality of life, prolonging

life, ending life, human rights.
But day to day ethical issues can involve:

Respecting people
Treating people with dignity
Treating people fairly
Supporting patients choices

These principles are encompassed in the NMC code

The code is a useful source of ethical principles in health care

RELIGION, CONSCIENCE AND

BIOETHICAL ISSUES

Moral

latin word mores, which something to do

with a society's sense of what is good and bad.
raditionally called custom. Refers to the
quality of the habits and character of an
individual in the society.

Culture

is the total lifeways of a group of

interacting individuals, consisting of
learned patterns of values, beliefs,
behavior and customs shared by the
group.

Different Moral-Cultural Issues:

1.

Female Infanticide

is an act of killing a new born girl within 24 to48 hours of birth.

Cruel method by the middle late 19th century
sign of sacrifice to the god in some parts of Benga
if the couple had no children for a long time they took vow to the
goddess Ganga
if they will have a first child they were offer the first born to her, and
if the eldest is 3-4 years it will be given a holy bath in the river and
the child will encourage to go further into the water until it was
carried away by the stream.
With several causes of this due to poor economic status of the family,
Dowry system to avoid financial cost of marrying daughters,
or due to illiteracy of the parents, negative influence of their
neighbor and society. This is usually happen in the Orissa, India.

2. Female Genital Mutilation (FGM)

is a surgical procedure performed on the genitals of the girls and

women .
Served as female circumcision and introcision.
done after birth of a woman's first child.
a high valued ritual, whose purpose is to mark the transition from
childhood to womanhood.
It represent part of rites of passage of initiation ceremonies intended
to impart skills & information a woman need to fulfill her duties as a
wife & mother.
function of practice whether mild or severe is ultimately to reduce a
woman sexual desire and to ensure her virginity until marriage.
This procedure involves also in stitching of the vagina in order to
increase the husband's enjoyment of the sexual act.
Muslim or no Muslim residing in Sub Saharan Africa, Egypt, Sudan,
Somalia, Ethiopia Kenya & Chad. Minor form of procedure is also
performed at Middle East & South Asia.
The complication usually occurs are chronic urinary tract and other
infections, infertility, psychological trauma, sexual dysfunction,
menstrual problem.

3. Suttee or Sati

refers to an age-old funeral custom of burning alive a newly widowed

woman,
be she old or young, after her husband death.
The term is derived from the original name of goddess who
immolated herself, unable to bear the humiliation of her living
husband.
Sati is sometimes interpreted as :Chaste woman this is a voluntary
act which mean atone for the couples sin and be ensure their reunion
in the afterlife.
Hindus usually practiced although there is apparently nothing
written in Hindu scripture.
Suttee has been practiced in India for two thousand years , sources
suggest that it originated in European countries such as Greece and
Germany.
Suttee was outlawed by the British in India in 1829.About 40cases
had been reported since the Indian independence in 1947.
one of the example here was and 18-year old Roop Kanwar who
belonged to a middle class of family and just married for eight
months then the husband died , she do was to climbed her husband
funeral pyre, cradled the head of her husband on her lap, then
commanded to fire be lit. That time the cops arrived she and her
husband had been reduced to ashes.

4. China's Foot binding

is a custom which they practiced to be maimed and crippled in

the name of beauty and obedience.
began in the Sung Dynasty (9960-976 BC) were reportedly to
imitate an imperial concubine who was required to dance with
her foot bound.
On the 12th century the practice was widespread and more severe
girl's feet were bound so tightly and early in life that they were
unable to dance and with difficulty in walking.
the girls turned three years old , ,all her toes but first were
broken, her feet were bound tightly with cloth strips to keep her
feet from growing larger than 10cm or about 3.9 inches.
The practice can cause severe life-long disability for millions of
elderly women until today in China.

5. Chastity Belt

is a locking item of clothing designed to prevent sexual

intercourse and masturbation.
The purpose of this is to protect the wearer from rape and
temptation.
These devices is created for both males and females. Historically
this chastity belt were first used by crusading knights on their
wives.
The Victorian era, masturbation came to be regarded as harmful
in Western medicine.
This used to prevent masturbation in children and adolescent.
In India some ascetic practitioners of the Hindu faith ,known as
Vaishnavan sadhus a tradition wearing arbandh or metal balls or
cups enclosing the penis for decades at a time as way of
demonstrating their strict celibacy and dedication to austerity.

CUTURAL RELATIVELY IN HEALTH

CARE ( DOS AND DON'T THAT
HEALTH CARE PROVIDER OUGHT
TO KNOW).

Don't assume that all ethnic minorities do not speak English.

Don;'t ask non-Christians for a Christian name.
Do remember that many Eastern religions fast on certain days; pray
at certain times; wear religious objects and symbols.
Do check to see if any medical intervention will compromise any
religious belief.
Don't give Jews or Muslims pork or pork products.
Do approach all patients sensitively, ensure privacy and maintain the
individual's right to respect.
Don't give Muslims, Jews and vegetarians iron injections derived
from pigs.
Do allow the family to participate in the care of the patient.
Do remember that limiting visiting to two people may cause distress
in extended family cultures.
Do remember that every individual has a different level of pain
tolerance , regardless of race,culture, and country of origin or creed.

 Inherent in nursing is respect for life, dignity and

rights of man. It is unrestricted by considerations of
nationality, race, creed, colour, age, sex, politics or
social status.

The nurse, in providing care, promotes an

environment in which the values, customs and
spiritual beliefs of the individual are respected.

Contd
Each registered nurse is accountable for his or
her practice, and, in the exercise of professional
accountability shall take account of the customs,
values and spiritual beliefs of patients/ clients.

Individualized programs of nursing care are

designed to accommodate the psychological,
social, cultural and spiritual needs of clients, as
well as their biological needs.

Contd
Providing culturally appropriate nursing care can be
very challenging, requiring much thought and caring
concern, and a willingness to learn from those we
nurse.

Not only nurses must be a ware of the clients cultural

point of view his relation to the life , to realize his
vision of his world, but be willing to look at health
needs and problems in new ways, planning nursing
interventions that are culturally acceptable and
meaningful to the client

Health Disparities
Life expectancy for whites is 75.2 years; for
African-Americans, 69.6 years
Causes of death for minority groups
Cancer
Cardiovascular disease and stroke
Chemical dependency
Diabetes
Homicides and accidents
Infant mortality

Cultural Competence
in Nursing Education
Beliefs and practices of various cultural groups
Disease prevalence and mortality rates
Cultural factors related to situations such as birth
and death
Specific culture-bound syndromes
Roles and responsibilities of family members

Definitions
1) Spirituality
Spirituality refers to a belief in a higher power, an

awareness of life and its meaning, the centering of a person

with purpose in life. It involves relationships with a higher
being, with self, and with the world around the individual..
Spirituality implies living with moral standards.
The spirit of a human is his essence, that part of him or
her that is not visible. The part that does not die but is
immortal. Webster defines spirit as a life giving force
and as the active presence of God in human life.

(National Center of Continuing Education, Inc. Death and Dying, pg. 23)

2) Religion
Religion is an organized and public belief system of

worship and practices that generally has a focus on a god or

supernatural power. It generally offers an arrangement of
symbols and rituals that are meaningful and understood by
its followers.
Religion is primarily a set of beliefs, a collection of prayers,
or rituals. Religion is first and foremost a way of seeing. It
cant change the facts about the world we live in, but it can
change the ways we see those facts, and that in itself can
often make a difference. (Harold Kushner)

Major World Religions

Christianity

Catholic, Lutheran, Presbyterian, Methodist,Nazarene,

Episcopal
Baptist (largest protestant denomination in US)
Non-denominational
Other Western faiths
Judaism
Reform, Conservative, and Orthodox

Hinduism

Buddhism
Islam (Muslims)
George Ann Daniels MS, RN

Spirituality
Spirituality fulfills specific needs
Meaning to life, illness, crises, and death
Sense of security for present and future
Guides daily habits
Elicits acceptance or rejection of other people
Provides psychosocial support in a group of likeminded people
Strength when facing lifes crises
Healing strength and support

George Ann Daniels MS, RN

Spiritual Care

Practice of compassionate presence

Listening to patients fears, hopes, pain, dreams
Obtaining a spiritual history
Attentiveness to all dimensions of the patient and
patients family: body, mind and spirit
Incorporation of spiritual practices as appropriate
Involve chaplains as members of the
interdisciplinary healthcare team
George Ann Daniels MS, RN

A More Compassionate Model of

Care
Focus on The Whole Person
Physical
Emotional
Social
Spiritual

Christina Puchalski MD

Sharing the patients faith

If the patient expresses a need for assist with their spiritual

situation, a chaplain should be made available. In the effort

to assist the patient to understand their faith, the chaplain
might ask these questions: "Who is God?," "Who are We?,"
"Who is Jesus?," "What Did Jesus Do?," "What Can We Not
Do?," "What Do We Have to Do?," and "What Does God
Promise to Those Who Believe?.

Don't discount the beliefs or experiences of others. Show

respect for them. Simply ask people to evaluate how their

current belief system is working in their lives. Dont
proselytize. When appropriate, sharing your own
testimony can be powerful.

The nurses role in spirituality

Define your own philosophy of life and death.

What do you believe? What does human life mean

to you? What does death mean? Is there life
beyond? Is there a God? Is there a Heaven and a
Hell?
You must be comfortable and confident in what
you believe in order to help others. Or you will be
threatened and fearful when confronting death
and dying in your patients.
Identify your emotional and physical limitations.
National Center of Continuing Education, Inc. Death and Dying, pg. 29

9 dimensions
of
patient
assessment
1. Illness / treatment
6. Social
summary
2. Physical
3. Psychological
4. Decision making
5. Communication

EPEC- AMA

7. Spiritual
8. Practical
9. Anticipatory planning
for death

Approach to
spiritual assessment
Suspect spiritual pain

Establish a conducive atmosphere

Express interest, ask specific

questions
Listen for broader meanings
Be aware of your own beliefs and
biases

EPEC- AMA

Spiritual needs neglected

Why? Many people have not recognized their own

spiritual needs, and thus are uncomfortable in

assessing them in others.
Religion is often considered a private matter and
one not to be discussed.
It is important in medicine to assess a persons
physical situation related to his bowel movements
or his or her sex life. Arent these private matters
as well?
Should a nurse be interested in spiritual needs in
their patients? Yes.
National Center of Continuing Education, Inc. Death and Dying, pg. 26

 Nurses must be compassionate and empathic in caring

for patients In all of their interactions with patients

they must seek to understand the meaning of the
patients stories in the context of the patients beliefs
and family and cultural values. They must continue
to care for dying patients even when disease-specific
therapy is no longer available or desired.

MSOP Report I,
Association of American Medical colleges, 1998

CONSCIENCE
Society is filled with shady 'professionals' who

have no problems engaging in lying, theft,

deception, fraud, and cover-ups at the expense of
the people whom they're supposed to help.
Nurses should take pride in continuing to act
upon their active consciences to do right by their
patients. Without an active conscience, nothing
much is stopping a person from doing really
horrible things to humankind.

Nursing Ethics
System of principles concerning the action of the

nurse in relationships with patients, families, other

health care providers, policy makers, and society

Code of Ethics
Implicit values and standards for the profession
American Nurses Association (ANA)
ANA Code of Ethics
International Council of Nurses (ICN)
ICN Code for Nurses

Bioethics
Interdisciplinary field within health care that has

evolved with modern medicine to address

questions created as science and technology
produce new ways of knowing
Physicians, nurses, social workers, psychiatrists,
clergy, philosophers, and theologians are joining to
address ethical questions in health care

Dilemmas for Health

Professionals
Life and death
Quality of life
Right to decide
Informed consent
Alternative treatment issues

Dilemmas Created by Technology

Illnesses once leading to mortality are now

classified as chronic illnesses

Cost is a consequence of prolonging life with
technology

Health Care Decisions

Patient
Family
Nurse

Transdisciplinary team

Values Formation and Moral

Development
Value: Personal belief about worth that acts as a

guide to behavior
Value system: Entire framework on which actions
are based
Values clarification: Process by which people
examine personal values and how the values
function as part of the whole

Values Formation and Moral

Developmentcontd
Moral development: Forming a world view and

value system in an evolving, continuous, dynamic

process that moves along a continuum of
development

Examining Values Systems

Nurses must examine their own values
Nurses must commit to a virtuous values system

World View
Provides a cohesive model for life
Encourages personal responsibility for living life
Prepares one for making ethical choices

Learning Right and Wrong

Infants
No concept of right or wrong
If basic need for trust is met, will develop foundation
for secure moral thought
School-age children
Have learned that good behavior is rewarded and
bad behavior is punished
Begin to make choices based on an understanding of
good and bad

Learning Right and Wrong

contd
Adolescents
Question moral values and relevance to society
Become aware of contradictions in adults values
systems
Adults
Strive to make sense of contradictions
Develop own morals and values
Begin to make choices based on internalized set of
principles

Moral Development Theory

Kohlbergs theory
Most widely accepted
Cognitive developmental process; sequential in
nature
Rules imposed by authority
Conformity to expected social and religious mores
Autonomous thinker strives for a moral code beyond
the issues of authority and reverence

Ethical Theories
Utilitarianism
Greatest good for the most people
Assumes that an action is right if it leads to the
greatest balance of good consequences or to the
fewest possible bad consequences
Deontology
Decision is right if it conforms to an overriding
moral duty and wrong if it violates that moral duty

Purpose of Ethical Principles

Establish common ground between nurse, patient,

family, other health care professionals, and society

to discuss ethical questions and make ethical
decisions
Permit people to take a consistent position on
specific or related issues
Provide an analytical framework by which moral
problems can be evaluated

Bioethical Dilemmas
Life

Reproduction
Death
Dilemmas in between
Injustice and the right to health care
Organ transplantation and allocation of scarce
resources