PNLE 2023 Professional Adjustment
RDGRacho
1
BIOETHICAL PRINCIPLES
• Autonomy – Paternalism
• Veracity – Benevolent Deception
• Beneficence
• Non-maleficence
• Confidentiality – anonymity and privacy
AUTONOMY
• Right of person to self-determination, to
decide for his own welfare; decision making
• “Auto” – means self
• “Nomy” – governance
• Ex. patient refuses medication, nurse must
accept the pt’s decision
• Priority: immediately document the refusal
• Usually happens when the patient has been
taking the medication quite some time and
feels like it is not effective
• Nurses are not allowed to make the patient
sign a waiver of refusal because it is ONLY the
responsibility of the Doctor
• After refusal, the nurse must NOT try to explain
the purpose of medication trying to change the
pt’s mind
• Code of Ethics – BON Resolution 220 Series
2004
• If the medication is new and the pt refused the
medication, the nurse must accept it and still
do not explain the purpose of the drug
• Paternalism – when the physician decides for
the patient
• Informed consent is given by patient, the MD
explains the procedure and consent, and the
nurse serves as the witness 5 things:
o There should be an actual
conversation between the patient and
the doctor
o There should be full or sufficient
explanation coming from the doctor
(benefits, risks, S/E, prognosis, etc)
o Patient should have fully understood
(questions are answered)
o Patient should have voluntarily
consented (no coercion, no
intimidation, patient is
conscious/coherent), patient is of
sound mind
o Patient should have voluntarily signed
the consent
• Requirement in signing the consent:
1. Age – legal age 18 y/o and above, a person
can already enter an agreement/contract
and it is valid and binding
2. If there is an inability to read and write
(illiterate), patient can still give consent as
long as the patient is able to give a
thumbmark (thumbmark is a signature)
provided there is a person who will explain
the purpose
3. Ability to read and write is not a
requirement
4. If the patient is a minor, it cannot sign the
consent, but the next of kin can give
consent on behalf of the minor
5. The minor mother cannot give consent on
behalf of her child because there is no
emancipated law in the Philippines, ONLY
the legal father of the child, if not, the next
of kin can give consent in the maternal side
(grandparents)
6. During an emergency, informed consent is
NOT waived, except if time is of the
essence, the patient’s life is in danger (ex.
gunshot wound)
VERACITY
• Honesty and truthfulness
• Benevolent deception – withholding the truth
from the patient for the benefit of the patient
because the patient’s condition is unstable
o Vehicular accident, the whole family is
involved, and everyone died except
the father who is in coma, the nurse
must not tell the truth to the patient
but the doctor.
BENEFICENCE
• To do good
• Giving paracetamol for a patient with a fever
• giving paracetamol PRN
NON-MALEFICENCE
• To do no harm
• To prevent or protect from harm
• 4-month-old baby ordered to be given 500mg
paracetamol and the nurse withheld it
• Picking up banana peel on the floor and
throwing it away to prevent accidents
• Post-op patient and the nurse raised the side
rails preventing falls
Beneficence
Non-maleficence
principle of double effect
