Bioethics & Ethical Principles in Nursing - Cheat Sheet
Your last-minute revision companion for bioethics and ethical nursing practice. This sheet distills the core principles, frameworks, and real-world applications tested on the NLE. Focus on the core four principles, informed consent process, and common ethical dilemmas in the Philippine context.
The Four Core Ethical Principles (Beauchamp & Childress Framework)
Important facts
- Autonomy applies ONLY to competent individuals; minors, unconscious, and incapacitated require surrogate decision-makers.
- Beneficence and non-maleficence often work together but can conflict (e.g., chemotherapy: benefit vs. side effects).
- Double Effect Principle: harmful side effect is ethically permissible if intent is good, harm is not the means, and benefit outweighs harm.
- Justice ALWAYS includes non-discrimination; resource-limited settings require transparent, clinical-criteria-based allocation.
- These four principles form the foundation of ALL ethical nursing decisions in the NLE context.
Key definitions
Autonomy
Example
Patient refuses blood transfusion on religious grounds; nurse documents refusal and ensures it is informed.
Patient's right to self-determination; nurse respects informed decisions and refusals of competent adults.
Beneficence
Example
Turning patient every 2 hours to prevent pressure injuries; providing health teaching.
Duty to do good and promote patient welfare, prevent harm, remove harmful conditions.
Non-maleficence
Example
Right drug, dose, route, time, patient; checking allergies; refusing erroneous orders.
Duty to do no harm (primum non nocere); avoid negligent, careless, or intentional injury.
Justice
Example
Triage in disasters; fair allocation of ICU beds; equal standards of care for all patients.
Fairness in distribution of benefits, risks, and resources; no discrimination based on wealth, status, religion, ethnicity.
Diagrams to know
- Beauchamp & Childress Four-Principle Model (pyramid or intersecting circles showing relationships)
- Principle Application Flowchart (how to identify which principle applies to a clinical scenario)
Additional Professional Duties: Veracity & Fidelity
Important facts
- Veracity creates tension: patient's right to know vs. family request to conceal diagnosis — nurse's obligation is to COMPETENT PATIENT first.
- Fidelity grounded in therapeutic relationship and professional accountability.
- Confidentiality reinforced by RA 10173 (Data Privacy Act of 2012) — governs personal and sensitive health information.
- Mandatory reporting exceptions to confidentiality: communicable diseases, abuse, harm to self/others (legal requirement overrides privacy).
- Breach of confidentiality can result in administrative, civil, and criminal liability under RA 10173 and Revised Penal Code.
Key definitions
Veracity
Example
Nurse accurately explains a procedure; does not falsify medical records; discloses relevant patient information.
Duty to tell the truth and not deceive; underpins informed consent and professional trust.
Fidelity
Example
Returning with promised pain medication on time; advocating for patient at team meetings.
Faithfulness; keeping promises, honoring commitments, maintaining loyalty to patient and profession.
Confidentiality
Example
Not discussing patient condition with visitors; secured electronic health records; mandatory reporting of communicable diseases per Department of Health.
Duty to protect patient information disclosed in care; share only on need-to-know basis, with consent, or when law requires.
Diagrams to know
- Confidentiality Decision Tree (when to share information vs. when to protect)
- Veracity vs. Beneficence Conflict Scenario (truth-telling vs. protecting hope)
Informed Consent: Process & Legal Requirements
Important facts
- Informed consent is a PROCESS, NOT just a signature — assess comprehension, not just completion of form.
- PHYSICIAN obtains consent for medical/surgical procedures; NURSE witnesses signature and confirms understanding.
- Four elements required for VALID consent: (1) Disclosure, (2) Comprehension, (3) Capacity/Competence, (4) Voluntariness.
- Capacity requires patient can UNDERSTAND, REASON, and COMMUNICATE a choice — assess for confusion, cognitive impairment, intoxication.
- Minors and legally incapacitated adults: consent from authorized parent/guardian; exception: mature minor doctrine in some contexts (teen contraception, STI testing).
- Nurse responsibility: notify physician if patient confused, has unanswered questions, or appears coerced; document refusal clearly.
- Competent adult may REFUSE treatment — respect autonomy; ensure refusal is informed and documented; do NOT override.
- In genuine emergencies, IMPLIED CONSENT permits life-saving care without waiting for family (but only if truly life-threatening and delay = death/serious harm).
Key definitions
Informed Consent
Example
Before surgery, patient signs consent after physician explains procedure, risks of infection/anesthesia, and non-surgical alternatives.
Voluntary decision by competent patient after disclosure, comprehension, and understanding of procedure, risks, benefits, alternatives.
Express Consent
Example
Patient verbally agrees to or signs form for blood draw, medication, or surgery.
Explicit, written or spoken agreement to a specific treatment or procedure.
Implied Consent
Example
Patient extends arm for BP measurement; opens mouth for oral assessment (no explicit verbal agreement needed).
Patient's actions indicate agreement (e.g., extending arm for blood pressure check); routine, minimal-risk procedures.
Emergency/Doctrine of Emergency Consent
Example
Unconscious trauma victim brought to ER — surgery performed without waiting for family consent.
Life-saving treatment permitted without consent when patient cannot consent and no surrogate available; presumed patient would consent.
Diagrams to know
- Informed Consent Validity Checklist (four elements, assessment points)
- Decision Tree: Who May Consent? (competent adult vs. minor vs. incapacitated patient)
Ethical Dilemmas vs. Moral Distress
Important facts
- Ethical dilemma = TWO RIGHT principles in conflict; moral distress = knowing right action but unable to perform it.
- Moral distress leads to burnout, moral injury, and turnover if unaddressed — seek institutional ethics committee, supervisor, or peer support.
- Whistleblowing is a professional and legal duty under RA 9173 (Nursing Law) to protect public and uphold professional standards.
- Whistleblower protection: RA 8049 (Whistleblower Protection Act) protects nurse from retaliation if reporting in good faith.
- Recognize: Dilemma requires ethical reasoning; distress requires institutional or systemic change.
- Ethics committee involvement: especially for end-of-life decisions, DNR orders, withdrawal of treatment, fertility/reproductive issues.
Key definitions
Ethical Dilemma
Example
Patient autonomy (refusing transfusion) vs. beneficence (nurse's duty to save life) — no perfect answer.
Conflict between two or more moral principles; any available choice requires sacrificing one principle.
Moral Distress
Example
Nurse knows patient needs palliative care but hospital policy mandates aggressive resuscitation; nurse feels trapped.
Nurse KNOWS the right action but is constrained by institutional, hierarchical, or resource barriers from doing it.
Whistleblowing
Example
Nurse reports impaired colleague, falsified records, or unsafe staffing ratios to nursing supervisor, hospital administrator, or Philippine Nurses Association.
Reporting incompetent, unethical, or illegal practice to protect patients and profession; may be internal (supervisor) or external (regulatory body).
Diagrams to know
- Ethical Dilemma vs. Moral Distress Comparison Matrix
- Structured Ethical Decision-Making Process (six steps)
Structured Approach to Ethical Decision-Making (Six-Step Framework)
Important facts
- This six-step process is STANDARD in Philippine nursing ethics education and is expected on NLE.
- Assess → Identify → Explore → Apply → Act → Evaluate (remember as A-I-E-A-A-E).
- Always involve ETHICS COMMITTEE for complex cases; committee includes physicians, nurses, ethics consultant, chaplain, family representative.
- Documentation is CRUCIAL: record the ethical issue, decision process, outcome, and rationale in the medical record.
- Evaluation and reflection improve future ethical reasoning; use cases for team learning.
Key definitions
Assess
Example
Patient with advanced cancer refusing chemo; understand cancer stage, prognosis, patient's goals, family dynamics, DNR status.
Gather medical facts, patient values/wishes, legal context, family/team perspectives; identify stakeholders.
Identify
Example
Conflict: patient autonomy vs. family wishes vs. beneficence (prolonging life); is this a dilemma or moral distress?
Define the ethical problem clearly; name the principles in conflict; distinguish dilemma from distress.
Explore
Example
Option 1: honor patient's refusal → respects autonomy but family distress; Option 2: persuade patient → potential coercion but family support.
List all feasible options and their consequences for patient, family, team, institution; consider risks and benefits.
Apply
Example
Apply autonomy, beneficence, non-maleficence, justice; check PNA Code of Ethics; involve hospital ethics committee.
Apply ethical principles, Code of Ethics for Nurses in the Philippines, and relevant laws; consult ethics committee if available.
Act
Example
Decision made to honor patient's refusal; document in medical record; communicate with family compassionately.
Make decision based on reasoning; implement action; communicate to patient, family, team; document.
Evaluate
Example
Did decision respect patient's wishes? Was family supported? What would we do differently next time?
Reflect on outcome, process, and learning; use case for future practice improvement.
Diagrams to know
- Six-Step Ethical Decision Framework (flowchart or sequential diagram)
- Ethics Committee Decision Pathway
Common Bioethical Issues in Philippine Nursing Practice
Important facts
- ACTIVE EUTHANASIA IS NOT LEGAL IN THE PHILIPPINES — assisting death is illegal; DNR and withholding futile treatment are ethically and legally distinct.
- Withholding treatment (never starting) and withdrawing treatment (stopping) are ethically equivalent if the treatment is futile or burdensome.
- Palliative sedation: ethically permissible to relieve suffering in dying patient; intent is comfort, not hastening death (double effect).
- Reproductive issues: nurse provides accurate information, respects patient choice, and practices within Philippine laws and professional standards; RA 10354 (Reproductive Health Law) mandates family planning access.
- Mandatory reporting: communicable diseases (TB, COVID-19, etc.), child/elder abuse, domestic violence, threats of harm — legal duty overrides confidentiality.
- Triage protocols must be transparent, clinical, non-discriminatory, and documented; prioritize those most likely to survive and benefit.
- Family-centered decision-making is culturally normative in Philippines; balance respect for family with protection of patient's autonomous wishes.
- Philippines has NO legal right-to-die or physician-assisted suicide laws; comfort and dignity in natural dying are the ethical standard.
Key definitions
End-of-Life Care
Example
Patient with terminal cancer requests DNR; family struggles with hospice vs. ICU; nurse advocates for palliative care aligned with patient wishes.
Care for dying patients: DNR orders, withholding/withdrawing treatment, palliative sedation; distinct from active euthanasia.
Do-Not-Resuscitate (DNR) Order
Example
Competent elderly patient with metastatic cancer signs DNR; must be documented, reviewed, and honored.
Physician order (on patient or surrogate request) to forgo cardiopulmonary resuscitation if cardiac/respiratory arrest occurs.
Reproductive/Beginning-of-Life Issues
Example
Nurse respects patient's choice on contraception within legal/religious context; provides accurate information without imposing values.
Ethical questions about contraception, fertility, pregnancy, abortion, adoption; heavily influenced by Filipino culture and religion.
Confidentiality vs. Duty to Warn
Example
Patient with active TB refuses isolation; nurse has duty to warn close contacts; mandatory disease reporting to Department of Health.
Balancing patient privacy vs. preventing serious harm to identifiable third parties (e.g., contagious disease, threats).
Truth-Telling & Cultural Mediation
Example
Family asks nurse not to tell patient about cancer diagnosis; nurse clarifies patient's right to know, then works with family on compassionate communication.
Honoring veracity while navigating family requests to conceal diagnosis; respect autonomy without imposing Western individualism.
Resource Allocation & Triage
Example
COVID-19 pandemic: allocation of ventilators using triage protocols; based on likelihood of survival, organ function, age-neutral criteria.
Fair distribution of limited resources (beds, medications, ventilators) in disasters, pandemics, or resource-limited settings based on clinical criteria.
Diagrams to know
- End-of-Life Decision Pathway (DNR, withholding, withdrawing, palliative care)
- Duty to Warn vs. Confidentiality Decision Tree (mandatory reporting scenarios)
Nursing Advocacy & Professional Responsibility
Important facts
- Advocacy operationalizes beneficence, autonomy, and fidelity SIMULTANEOUSLY — the nurse is best positioned closest to patient.
- RA 9173 (Nursing Law) defines nurse's accountability and scope; practicing outside scope is illegal and unethical.
- Refusing unsafe orders: nurse has duty to refuse obviously erroneous or harmful orders (e.g., impossible dose, wrong route); report to physician and supervisor.
- Teamwork and collaboration: nurse advocates within interprofessional team; does not undermine physician authority but ensures patient safety.
- Continuing professional development: ethical duty to maintain competence, attend in-service trainings, and practice evidence-based care.
- Professional organizations (PNA, specialty nurses) provide ethical guidance, continuing education, and support for ethical practice.
Key definitions
Patient Advocacy
Example
Nurse explains patient's right to refuse treatment; ensures informed consent; reports medication error immediately; opposes unsafe staffing.
Nurse's role to inform patients of rights, support decisions, protect from incompetent/unethical practice, speak up when care is unsafe.
Professional Accountability
Example
Nurse maintains competence through continuing education; reports unsafe practice; practices within scope of authority; maintains confidentiality.
Nurse's responsibility to the profession, patients, colleagues, and public; includes adherence to RA 9173 (Nursing Law) and Code of Ethics.
Scope of Nursing Practice (RA 9173)
Example
Nurse independently assesses and diagnoses; collaboratively implements physician orders; independently provides health teaching within scope.
Legally defined functions nurses may perform: assessment, planning, implementation, evaluation; independent, dependent, collaborative roles.
Diagrams to know
- Nurse Advocacy Framework (operationalizing principles through practice)
- Scope of Practice: Independent vs. Dependent vs. Collaborative Nursing Actions
Ethics in Filipino Cultural Context
Important facts
- Ethical nursing in the Philippines requires CULTURAL HUMILITY: respect family-centered decision-making while protecting individual patient autonomy.
- Family input is normative and EXPECTED in Filipino health decisions; exclude family entirely can be seen as disrespectful.
- BALANCE: honor cultural values (pakikisama, utang na loob) while ensuring competent adult's own wishes are protected and informed.
- Avoid PATERNALISM: do not assume family decision is patient's true preference; explore with patient privately if possible.
- Communication style: use respectful language, involve respected family elders, allow time for family discussion, and explain clearly in Tagalog/local language if needed.
- Religion heavily influences reproductive, end-of-life, and blood transfusion decisions; respect Catholic, Muslim, and other beliefs while providing evidence-based care options.
Key definitions
Pakikisama
Example
Family member makes medical decisions for adult patient to avoid family conflict; nurse validates but clarifies patient's own preferences.
Filipino value of smooth interpersonal relations; patients/families may prioritize group harmony over individual autonomy.
Utang na Loob
Example
Patient agrees to procedure because 'doctor knows best' and to repay doctor's kindness, not from informed understanding; nurse assesses for true autonomy.
Debt of gratitude; patient may feel obligated to follow healthcare provider's recommendation out of gratitude rather than true consent.
Hiya (Shame)
Example
Patient with STI may not report symptoms due to shame; nurse creates non-judgmental environment to encourage disclosure.
Filipino sensitivity to shame; patient may not disclose relevant health information or ask questions to avoid embarrassment.
Respect for Authority (Malasakit)
Example
Patient reluctant to refuse treatment or ask questions; nurse actively solicits patient's concerns and validates right to participate in decisions.
Deference to physicians and healthcare providers; patients often do not question authority, limiting true informed consent.
Diagrams to know
- Cultural Values Impact on Healthcare Decisions (pakikisama, utang na loob, hiya)
- Balancing Autonomy and Family-Centered Care in Filipino Context
Legal Framework: RA 9173 & Related Laws
Important facts
- RA 9173 is the PRIMARY legal framework for nursing practice in Philippines; violation = administrative penalties, loss of license, criminal charges.
- Professional Regulation Commission (PRC) Board of Nursing enforces RA 9173; NLE tests competence in ethical and legal nursing practice.
- Data Privacy Act (RA 10173) applies to ALL patient information; breaches carry fines up to P100,000+ and imprisonment; applies even after patient discharge.
- Whistleblower protection (RA 8049) is a LEGAL RIGHT; reporting unsafe practice is not insubordination but a professional duty.
- Reproductive Health Law (RA 10354) ensures access to family planning; nurse cannot refuse to provide information based on personal beliefs (though can refer).
- Additional relevant laws: Revised Penal Code (crimes against patients), Code of Medical Ethics, local barangay health ordinances.
Key definitions
RA 9173 (Philippine Nursing Law)
Example
Nurse cannot prescribe medications, perform surgery, or diagnose independently; must report to physician and follow lawful orders.
Defines nursing profession, scope of practice, licensure, ethical standards, and disciplinary procedures; all nurses must practice within its scope.
RA 10173 (Data Privacy Act of 2012)
Example
Nurse cannot post patient photos on social media, share medical records without consent, or discuss patient publicly; breach = fines and imprisonment.
Governs collection, storage, use, and sharing of personal and sensitive personal information (including health data); breach has civil and criminal liability.
RA 8049 (Whistleblower Protection Act)
Example
Nurse reports impaired colleague to supervisor or hospital administrator without fear of firing, demotion, or harassment.
Protects persons reporting illegal, unethical, or unsafe practice from retaliation; nurse protected when reporting in good faith.
RA 10354 (Reproductive Health Law)
Example
Nurse provides information on contraceptive options; respects patient choice; documents counseling provided.
Mandates family planning services, contraceptive access, maternal health, and sex education; nurse provides information within legal framework.
Diagrams to know
- Legal Framework for Nursing Practice (RA 9173, RA 10173, RA 8049, RA 10354)
- Disciplinary Process Under RA 9173 (complaint → investigation → hearing → decision)
Must remember
- The Four Core Principles (Autonomy, Beneficence, Non-maleficence, Justice) form the foundation of ALL ethical nursing decisions. Every clinical choice involves at least one.
- Informed Consent is a PROCESS (disclosure → comprehension → capacity → voluntariness), NOT just a signature. Physician obtains; nurse witnesses and confirms understanding.
- A Competent Adult May Refuse Treatment—Respect autonomy. Ensure refusal is informed and documented. Do NOT override.
- Ethical Dilemma = conflict between principles with no perfect answer (use 6-step framework). Moral Distress = knowing right action but blocked by barriers (escalate to ethics committee/supervisor).
- Active Euthanasia is ILLEGAL in Philippines. Withholding/withdrawing futile treatment and palliative sedation are ethically and legally distinct and permissible (double effect principle).
- Confidentiality (RA 10173): Share on need-to-know basis, with consent, or when legally required. Mandatory reporting (communicable disease, abuse, threats) overrides privacy.
- Double Effect Justifies Foreseen Harm: if intent is good, harm is not the means, benefit outweighs harm, and all else equal (e.g., morphine side effects in terminal patient).
- The Nurse is the Patient's Advocate—operationalizing beneficence, autonomy, and fidelity. Speak up when care is unsafe; refuse erroneous orders; report unsafe practice (RA 8049 protection).
- Emergency Doctrine Permits Life-Saving Care WITHOUT Consent when patient cannot consent and no surrogate available—only in true emergencies (imminent death/serious harm); not for routine procedures.
- Balance Autonomy and Family-Centered Care in Filipino Context: honor pakikisama and utang na loob while protecting competent patient's informed wishes. Avoid paternalism; ask patient privately if possible.
Last minute tips
- On the NLE, look for the phrase COMPETENT ADULT — this almost always triggers autonomy principle and respect for informed refusal. If the patient is incompetent, surrogate decision-maker applies.
- When you see INFORMED CONSENT, check for four elements: disclosure, comprehension (assess understanding, not just form completion), capacity, and voluntariness. Missing any = invalid consent. This is tested heavily.
- Distinguish DILEMMA from DISTRESS quickly: dilemma = conflicting principles (use ethics framework); distress = know right action but blocked (escalate to authority). Exam often asks you to identify which is happening.
- MANDATORY REPORTING overrides confidentiality—if you see communicable disease, abuse, or threats, the nurse MUST report despite privacy concerns. This is law (RA 10173, DOH regulations), not optional.
- For END-OF-LIFE scenarios, remember: DNR is legal and ethical (patient/surrogate choice); withholding/withdrawing futile treatment is legal and ethical (NOT euthanasia); active euthanasia is ILLEGAL. Do not confuse these—exam will trick you.
Comparison tables
Four Core Principles vs. Additional Professional Duties
| Concept | Definition | Focuses On | Common Conflict | NLE Application | |
|---|---|---|---|---|---|
| Autonomy | Self-determination | Patient's right to decide | Respect for choices | vs. Beneficence (forcing 'good' on patient) | Patient refuses treatment; ensure informed refusal |
| Beneficence | Do good, promote welfare | Nurse's duty to help | Health promotion | vs. Autonomy (patient refuses beneficial care) | Assess what benefits patient; offer alternatives |
| Non-maleficence | Do no harm | Avoiding injury/negligence | Safety, competence | vs. Beneficence (harm as side effect of good) | Double effect: foreseen harm acceptable if benefit outweighs |
| Justice | Fair distribution of resources | Equitable allocation | Non-discrimination | vs. Individual need (cannot give all to one patient) | Triage, fair staffing, equal care standards for all |
| Veracity | Tell the truth | Honesty, transparency | Informed consent | vs. Beneficence (kind lie to protect hope) | Patient's right to know; disclose relevant information |
| Fidelity | Faithfulness, loyalty | Keep promises, honor commitments | Therapeutic relationship | vs. Resource constraints (cannot always deliver) | Follow through on promises; advocate for patient |
Ethical Dilemma vs. Moral Distress vs. Moral Uncertainty
| Type | Definition | Cause | Nurse Knows Right Action? | Solution Pathway | NLE Scenario |
|---|---|---|---|---|---|
| Ethical Dilemma | Conflict between TWO moral principles | Competing duties/values in collision | NO — all options sacrifice something | Use structured ethical reasoning (6 steps) | Patient autonomy vs. beneficence: patient refuses life-saving transfusion |
| Moral Distress | Knowing right action but CANNOT do it | Institutional, hierarchical, resource barriers | YES — but blocked by barriers | Escalate to supervisor, ethics committee, whistleblow | Nurse knows DNR is patient's wish but hospital forces resuscitation |
| Moral Uncertainty | Unsure WHAT is the right action | Lack of knowledge, conflicting information | UNCERTAIN — need guidance | Gather facts, consult ethics committee, seek mentorship | Nurse unsure if withdrawing nutrition is abandonment or comfort care |
Consent Types & When Each Applies
| Consent Type | Definition | Requirements | Examples | Nurse Role | Common NLE Pitfall |
|---|---|---|---|---|---|
| Express Consent | Explicit verbal or written agreement | Four elements: disclosure, comprehension, capacity, voluntariness | Surgery, major procedures, research | Witness signature; confirm understanding; document | Assuming signature = understanding (NOT enough) |
| Implied Consent | Actions indicate agreement (no explicit agreement needed) | Routine, minimal-risk procedures; patient action shows assent | BP check, oral temperature, injection, routine exam | Assume consent; document what was agreed to | Using implied for invasive/high-risk procedures (WRONG) |
| Emergency/Doctrine of Emergency Consent | Life-saving treatment WITHOUT consent when patient cannot consent + no surrogate available | True emergency (imminent death/serious harm), patient incapacitated, no surrogate, treatment time-critical | Trauma surgery, resuscitation, airway management in unconscious patient | Provide life-saving care; document why consent not possible; notify family after | Using emergency doctrine for non-life-threatening procedures (WRONG) |
| Surrogate Consent | Legal representative consents for incapacitated patient | Parent/guardian for minor; healthcare proxy for incapacitated adult; follows advance directive | Surgery on child, unconscious adult, mentally disabled person | Confirm surrogate authority; ensure surrogate understands; document | Asking wrong person (asking patient when incapacitated; asking child when adult is capable) |
When NOT to Do Something vs. Doing Something Harmful (Withholding vs. Withdrawing)
| Action Type | Definition | Ethical Status | Legal Status (Philippines) | Example | Distinction from Euthanasia |
|---|---|---|---|---|---|
| Withholding Treatment | Never initiating a treatment (not starting) | Ethically permissible if futile, burdensome, unwanted | Legal if based on informed refusal or advance directive | Do NOT start antibiotics in terminal patient requesting comfort care | Allowing natural death; not hastening death |
| Withdrawing Treatment | Stopping a treatment already started (discontinuing) | Ethically equivalent to withholding if treatment futile/burdensome | Legal if patient/surrogate requests and documented | Discontinue ventilator per DNR order; patient expected to die from underlying disease | Intention is comfort/honoring wishes, not causing death |
| Active Euthanasia | Actively CAUSING death by giving lethal medication/injection | MORALLY impermissible in Philippine context | ILLEGAL in Philippines; criminal homicide/murder | Giving potassium chloride IV to stop heart | Intent is to CAUSE death; actively hastens death |
| Palliative Sedation | Sedating dying patient to relieve severe suffering | Ethically permissible (double effect); intent is comfort, not death | Legal if patient/surrogate consents; should be last resort | Morphine infusion to relieve severe pain/dyspnea in actively dying patient | Foreseen side effect (respiratory depression, hastened death) acceptable if intent is comfort |
Confidentiality: MUST Share vs. MUST NOT Share vs. CAN Share
| Scenario | Rule | Legal Basis | Action | NLE Application | |
|---|---|---|---|---|---|
| Mandatory Reporting (MUST Share) | Communicable disease (TB, COVID-19, measles, etc.); child/elder abuse; threats of harm | Legal duty overrides confidentiality | DOH regulations, RA 10173, Revised Penal Code | Report to DOH, police, barangay health, supervisor immediately | Patient with active TB refusing isolation; nurse MUST report to DOH despite confidentiality |
| Patient Consent (CAN Share) | Patient authorizes sharing with family, employer, insurance, other provider | Autonomy principle; patient controls their information | RA 10173; informed consent for disclosure | Get written authorization; document consent; share only what authorized | Family asks for patient medical info; get patient permission first |
| Need-to-Know (CAN Share) | Team members involved in care (physician, other nurses, pharmacist, lab) | Only essential information for direct care; minimum necessary | Professional practice standard, RA 10173 | Discuss with team for patient care; do NOT discuss in hallways or with non-caring personnel | RN hands over to incoming shift; shares relevant clinical info (vital signs, medications, plan) |
| Breach (MUST NOT Share) | Posting on social media, discussing with friends, sharing without consent, accessing chart out of curiosity | Violates confidentiality; RA 10173 violation | RA 10173; criminal and civil liability; professional discipline | Do NOT share; risk: fines, imprisonment, license revocation | Nurse posts patient selfie with IV on Facebook; BREACH; disciplinary action + civil suit |
Diagrams
Bioethics & Ethical Principles in Nursing — Concept Map
This mind map organizes all major topics in bioethics and ethical nursing practice around the core four principles (autonomy, beneficence, non-maleficence, justice), professional duties, consent types, the six-step ethical decision-making framework, common bioethical issues, and the Philippine legal framework. Use this as a quick visual overview of how concepts relate.
Six-Step Ethical Decision-Making Framework
This flowchart walks through the six-step ethical decision-making framework (Assess → Identify → Explore → Apply → Act → Evaluate). Follow this sequence when faced with an ethical dilemma on the NLE. The framework ensures systematic, principled reasoning and is standard in Philippine nursing ethics practice.
Informed Consent Validity Checklist
Decision tree for assessing whether informed consent is valid. Check all four elements: (1) competence, (2) disclosure, (3) comprehension, (4) voluntariness. This is a heavily tested NLE concept. If any element is missing, consent is invalid unless emergency doctrine applies.
When to Share Patient Information (Confidentiality Rules)
Quick decision tree for determining when confidentiality can be breached. Mandatory reporting (communicable disease, abuse, threats) ALWAYS overrides privacy. Patient consent or care need-to-know allows sharing. Otherwise, protect privacy per RA 10173 (Data Privacy Act).
Ethical Dilemma vs. Moral Distress — How to Recognize & Respond
Flowchart to differentiate ethical dilemma (conflict between principles), moral distress (knowing right action but blocked), and moral uncertainty (unsure what is right). Each requires a different response strategy. This distinction is frequently tested on the NLE.
End-of-Life Care Pathway (DNR, Withholding, Withdrawing, Palliative)
State diagram showing the progression of end-of-life decision-making. Key points: DNR is about resuscitation choice only, not total withdrawal of care. Withholding and withdrawing are ethically equivalent. Palliative sedation uses double effect principle (intent is comfort, not death). This pathway is heavily tested in NLE scenarios.