NLE Nursing Ethics, Jurisprudence & Professional Adjustment — Bioethics & Ethical Principles in NursingRevision Notes

Exam Tips

• NLE scenarios will NOT label the ethical theory — you must identify it from the situation described.
• If a question asks 'which principle applies,' look for the key word: patient decision = Autonomy; nurse doing good = Beneficence; nurse preventing harm = Non-maleficence; fair distribution = Justice; truth-telling = Veracity; keeping promises = Fidelity.
• Deontology supports actions like always telling the truth even if the outcome is uncomfortable — recognize this pattern in answer choices.

Key Points

• Bioethics is the branch of applied ethics that examines moral issues in health care, life sciences, and biomedical technology.
• Nursing ethics is the subset of bioethics focused on the moral obligations of nurses to patients, families, colleagues, the profession, and society.
• Two major ethical theories underpin nursing practice: Deontology (duty-based — actions are right or wrong regardless of outcome) and Teleology/Utilitarianism (consequence-based — the greatest good for the greatest number).
• Philippine nursing education primarily uses PRINCIPLISM — the four-principle framework of Beauchamp and Childress: Autonomy, Beneficence, Non-maleficence, and Justice, plus Veracity and Fidelity as professional duties.
• Ethical reasoning is required because clinical knowledge alone cannot answer 'should I' questions when values conflict.
• RA 9173 obligates every Registered Nurse to uphold ethical standards; violations may lead to disciplinary action by the PRC Board of Nursing.

Definitions

Section Title

Foundations of Bioethics: What It Is and Why It Matters

Common Mistakes

• Confusing deontology with teleology: Remember, deontology = DUTY (the act itself matters), teleology = OUTCOME (the result matters).
• Thinking bioethics is only for complex cases like euthanasia — in reality, every nursing action has an ethical dimension.
• Forgetting that RA 9173 has ethical practice built into its provisions — failure to act ethically is a legal issue, not just a moral one.

Exam Tips

• MEMORIZE the MNEMONIC: AB-NJ-VF — Autonomy, Beneficence, Non-maleficence, Justice, Veracity, Fidelity. The first four (ABNJ) are the Beauchamp-Childress core principles.
• In NLE scenarios involving patient refusal, the correct answer almost always involves RESPECTING the refusal (Autonomy) and DOCUMENTING it — not coercing or ignoring the patient.
• When a question involves resource allocation or triage, think JUSTICE — needs-based, clinically justified, non-discriminatory.
• Double Effect scenarios: look for terminal illness, palliative care, or pain management contexts. The nurse's intent must be COMFORT, not hastening death.
• Data Privacy Act (RA 10173): health data is 'sensitive personal information' — requires stricter protection. Know this for NLE jurisprudence questions.

Key Points

• AUTONOMY: The patient's right to self-determination — to make informed decisions about their own body and care without coercion. This is the most frequently tested principle on the NLE.
• BENEFICENCE: The duty to DO GOOD — act in the patient's best interest, promote welfare, and actively contribute to health. It goes beyond avoiding harm; it means taking positive action.
• NON-MALEFICENCE: The duty to DO NO HARM (primum non nocere). Requires nurses to avoid negligent or injurious acts and to weigh risks against benefits of all interventions.
• JUSTICE: Fairness in the distribution of benefits, risks, and resources — care is based on NEED and CLINICAL CRITERIA, not wealth, status, religion, or connections.
• VERACITY: The duty to tell the truth and not deceive. Underpins informed consent and the therapeutic trust relationship.
• FIDELITY: Faithfulness — keeping promises, honoring commitments, and maintaining loyalty to the patient and the professional relationship.
• The PRINCIPLE OF DOUBLE EFFECT applies when an action has both a good and a harmful effect (e.g., opioid analgesia in terminal illness): permissible if intent is good, harm is not the means to the good, and benefit outweighs harm.
• Autonomy is LIMITED: applies to competent individuals only. For minors, unconscious patients, and those lacking capacity, surrogate decision-makers exercise autonomy on their behalf.
• Confidentiality (linked to Autonomy and Fidelity) is reinforced by RA 10173 (Data Privacy Act of 2012) — share health information only on a need-to-know basis, with consent, or when legally required.

Definitions

Section Title

The Six Core Ethical Principles

Common Mistakes

• Confusing Beneficence and Non-maleficence: Beneficence = DO good (active, positive); Non-maleficence = do NO harm (avoid, prevent). They are complementary but distinct.
• Thinking a nurse can override a competent adult's refusal of treatment 'for their own good' — this violates Autonomy even when motivated by Beneficence.
• Applying Autonomy to all patients regardless of capacity: minors, unconscious patients, and those lacking decision-making capacity require surrogate consent.
• Assuming Justice only applies to scarce resources: it also requires equal quality of care and non-discrimination in everyday nursing practice.
• Forgetting that Veracity can conflict with family wishes to hide a diagnosis — in this conflict, the competent patient's right to know takes priority.

Exam Tips

• NLE PATTERN: If a patient asks the nurse to explain the surgery before signing, the CORRECT action is to notify the physician — the nurse does not explain the surgical procedure.
• If a patient appears confused or uncertain after signing, the nurse MUST notify the physician before proceeding — this protects both the patient and the nurse.
• For emergency scenarios with an unconscious patient and no family: proceed with life-saving care under implied/emergency consent.
• Remember the 4 elements of valid consent: Disclosure, Comprehension, Capacity, Voluntariness. A question about what the nurse should assess before witnessing consent is asking about CAPACITY and COMPREHENSION.
• Voluntariness is often tested through scenarios where family pressure is applied — a patient changing a decision because a family member 'insisted' may lack voluntariness.

Key Points

• Informed consent is the practical expression of Autonomy and Veracity — it is a PROCESS, not merely a signature on a form.
• FOUR ELEMENTS of valid informed consent: (1) Disclosure, (2) Comprehension, (3) Capacity/Competence, (4) Voluntariness.
• DISCLOSURE includes: nature of the procedure, purpose, expected benefits, material risks, and reasonable alternatives including no treatment.
• COMPREHENSION requires information in language the patient understands; interpreters must be used when there is a language barrier.
• CAPACITY: The patient must be able to understand, reason about, and communicate a choice. A patient may have capacity for some decisions but not others.
• VOLUNTARINESS: The decision must be free from coercion, manipulation, or undue influence by healthcare providers or family.
• PHYSICIAN'S RESPONSIBILITY: Obtaining consent for a medical or surgical procedure is the physician's responsibility — NOT the nurse's.
• NURSE'S ROLE in consent: (1) Witness the signature, (2) Confirm patient understanding, (3) Ensure proper documentation, (4) Notify the physician if the patient appears confused or has unanswered questions.
• EXPRESS consent = written or spoken agreement. IMPLIED consent = inferred from action (e.g., patient extends arm for blood pressure check).
• EMERGENCY / DOCTRINE OF EMERGENCY: When a patient cannot consent and no surrogate is available, life-saving treatment may proceed under implied emergency consent.
• MINORS and INCAPACITATED adults require consent from a legally authorized representative (parent, legal guardian).
• A competent adult MAY REFUSE treatment — this is a valid, protected exercise of Autonomy. The nurse must ensure the refusal is informed, documented, and respected.

Definitions

Section Title

Informed Consent: Process, Components, and the Nurse's Role

Common Mistakes

• Thinking the NURSE obtains informed consent for surgical/medical procedures — this is the PHYSICIAN's responsibility. The nurse witnesses and confirms understanding.
• Equating consent with a signature alone: a signed form without true understanding, capacity, or voluntariness is NOT valid informed consent.
• Forgetting that a competent patient's REFUSAL is as valid and legally protected as consent — overriding a competent refusal is a violation of Autonomy and may constitute battery.
• Confusing implied consent (routine, everyday actions like arm extension) with emergency doctrine consent — they are different contexts.
• Assuming all minors require parental consent: in some Philippine contexts, emancipated minors or mature minors may have limited decision-making rights.

Exam Tips

• The NLE 6-step decision process: ASSESS the facts → IDENTIFY the conflict → EXPLORE options → APPLY principles/Code of Ethics → ACT → EVALUATE. This sequence may be tested directly.
• When a scenario involves a family asking the nurse to withhold a diagnosis, the nurse's FIRST action is to explore the patient's competency and then ensure the patient has the right to know — prioritize the COMPETENT PATIENT's autonomy.
• DNR order scenarios: the nurse follows the order during arrest, but continues all other nursing care. Not having a DNR does NOT mean the patient wants aggressive life support — assess and clarify.
• Whistleblowing questions: the nurse reports unsafe or unethical practice first to the IMMEDIATE SUPERVISOR, then up the chain of command if unresolved. In the Philippines, ultimate reporting authority is the PRC Board of Nursing.
• Philippine cultural context questions: pakikisama and family decision-making are REAL influences — the correct answer acknowledges them while still protecting the patient's individual rights.

Key Points

• An ETHICAL DILEMMA exists when two or more moral principles are in genuine conflict and ANY choice requires sacrificing at least one principle — there is no perfect answer.
• MORAL DISTRESS is DIFFERENT from an ethical dilemma: the nurse KNOWS the right action but is prevented from taking it by institutional, hierarchical, or resource barriers.
• Classic dilemma example: Autonomy (patient refusing treatment) vs. Beneficence (nurse wants to save life) — both principles have valid claims.
• STRUCTURED ETHICAL DECISION-MAKING PROCESS (6 steps): Assess → Identify → Explore → Apply → Act → Evaluate.
• ETHICS COMMITTEES: Interdisciplinary bodies that deliberate complex ethical cases (DNR orders, withdrawal of life support, end-of-life decisions). The nurse's role is to provide accurate clinical and psychosocial information and represent the patient's expressed wishes.
• WHISTLEBLOWING: The nurse has a professional and ethical obligation to report incompetent, unethical, or illegal practice to protect patients — this is an act of advocacy and justice.
• END-OF-LIFE ISSUES: DNR (Do-Not-Resuscitate) orders and withdrawal of futile treatment are ethically and legally distinct from active euthanasia. Active euthanasia is NOT legal in the Philippines.
• CULTURAL CONTEXT in the Philippines: Decisions are often made within the family unit (not by the individual alone). Concepts like pakikisama, utang na loob, and deference to elders/physicians influence decision-making. The nurse must balance cultural sensitivity with protecting the competent patient's individual autonomy.

Definitions

Section Title

Ethical Dilemmas, Moral Distress, and the Decision-Making Process

Common Mistakes

• Confusing ethical dilemma with moral distress — an ethical dilemma involves uncertainty about what is right; moral distress involves knowing what is right but being blocked.
• Thinking that DNR = no care: a DNR order only limits resuscitation; the patient still receives all other nursing care, comfort measures, and pain management.
• Equating active euthanasia with withdrawal of futile treatment — allowing a natural death is NOT the same as causing death.
• Ignoring the family context in Philippine nursing: failing to involve family in a culturally appropriate way can damage the therapeutic relationship, but the nurse must still protect the competent patient's individual rights.
• Not documenting ethical decisions and actions — documentation protects the patient, the nurse, and the institution.

Exam Tips

• RA 10173 and RA 11332 are commonly tested in NLE Jurisprudence items. Know the key provisions: RA 10173 = Data Privacy (health data = sensitive personal information); RA 11332 = Mandatory reporting of notifiable diseases.
• Confidentiality exception scenarios: court order, patient consent, need-to-know care team, mandatory disease reporting, duty to warn — these are the ONLY valid exceptions.
• Advocacy scenarios: the nurse who speaks up about a wrong medication order, who informs a patient of their right to refuse treatment, or who escalates an unsafe situation is ALWAYS exhibiting correct ethical practice.
• When family and patient interests conflict: the COMPETENT PATIENT's wishes ALWAYS take priority over family preferences.
• Triage and resource allocation questions: fair, transparent, needs-based, non-discriminatory criteria = JUSTICE principle. Discrimination based on wealth or status = violation of Justice.

Key Points

• The nurse is the PATIENT'S ADVOCATE — the professional closest to the patient and best positioned to voice the patient's interests.
• Advocacy actions include: informing patients of rights, supporting decisions, protecting from incompetent/unethical practice, and speaking up about unsafe care.
• CONFIDENTIALITY is a professional duty and a legal requirement under RA 10173 (Data Privacy Act of 2012). Health data is classified as 'sensitive personal information' requiring stricter protection.
• The nurse shares patient information ONLY: (1) on a need-to-know basis for care, (2) with patient consent, or (3) when law requires (e.g., mandatory reporting of communicable diseases under RA 11332).
• TRUTH-TELLING CONFLICT: When a family requests that a diagnosis be hidden, the nurse's obligation runs FIRST to the competent patient's right to know — not to the family's wishes.
• CONFIDENTIALITY vs. DUTY TO WARN: When a patient discloses intent to seriously harm an identifiable third party, the duty to protect the third party may override confidentiality.
• RESOURCE ALLOCATION and TRIAGE: Justice principles guide fair, transparent allocation in resource-limited settings. Criteria should be clinical and needs-based, not discriminatory.
• BEGINNING-OF-LIFE and REPRODUCTIVE ISSUES: Heavily shaped by Filipino cultural and religious values. The nurse respects the patient's choices while practicing within the law.
• ORDINARY ACTS as ethical practice: double-checking a high-alert medication = non-maleficence; explaining a procedure calmly = autonomy and veracity; distributing attention fairly = justice; keeping a bedside promise = fidelity.

Definitions

Section Title

Advocacy, Confidentiality, and Common Bioethical Issues in Philippine Practice

Common Mistakes

• Sharing patient information with family without the patient's consent 'out of kindness' — this violates confidentiality and RA 10173 unless the patient has authorized family disclosure.
• Thinking confidentiality is absolute: it has legally recognized exceptions (mandatory reporting, duty to warn, court orders).
• Failing to distinguish between the nurse's role as advocate vs. the nurse acting paternalistically — advocacy supports the PATIENT's choices, not the nurse's preferences for the patient.
• Forgetting that mandatory reporting of notifiable diseases (RA 11332) is a LEGAL DUTY that supersedes confidentiality in specific circumstances.
• Not linking ordinary nursing actions to ethical principles: students who think ethics only applies to dramatic dilemmas miss the daily ethical dimension of nursing.