• Ethics — the systematic study of what is right and good in human conduct. Nursing ethics applies it to the nurse's relationships with clients, co-workers, society, and the profession.
• Morals — personal or cultural beliefs about right and wrong. Values — ideals a person or group considers important.
• Law vs ethics — law sets the minimum enforceable standard; ethics often asks more. An act can be legal but unethical (e.g., rude, dismissive care), and the law usually builds on ethical principles.
• Ethical dilemma — a situation in which two or more morally valid options conflict, and choosing one means not fully honoring the other.
• Moral distress — knowing the right action but being unable to carry it out because of internal or external constraints (policy, hierarchy, staffing).
• Code of ethics — a profession's formal statement of its values and duties. For Filipino nurses: the Code of Ethics for Registered Nurses, promulgated by the Board of Nursing through Board Resolution No. 220, series of 2004, under the Philippine Nursing Act of 2002 (RA 9173).

Hierarchy of ethical reasoning (from general to specific): theories → principles → rules → particular judgments. Principles are broad (e.g., respect autonomy); rules are more specific and practical guides derived from principles (e.g., obtain informed consent, keep confidences, tell the truth).

Major ethical theories

Core bioethical principles

Derived rules and related principles

• Veracity — tell the truth
• Fidelity — keep promises and commitments; faithfulness to duties
• Confidentiality — protect information shared in the care relationship
• Privacy — respect the client's control over access to self and information
• Accountability — answer for one's own actions
• Double effect — an act with a good intended effect and a foreseen but unintended bad effect may be permitted if the act itself is not wrong, the bad effect is not the means to the good effect, the good intended outweighs the bad, and the bad effect is not intended (e.g., opioid doses titrated to relieve pain in terminal illness despite a risk of respiratory depression)

Moral development theories

Kohlberg (justice-based):

Stages occur in a fixed order and are not skipped; many adults remain at the conventional level.

Gilligan (care-based) criticized Kohlberg's work as based on male subjects and focused on justice and rights, neglecting the ethics of care:

1. Orientation to individual survival (self-centered), then a transition from selfishness to responsibility
2. Goodness as self-sacrifice (others' needs placed above one's own), then a transition from goodness to truth
3. Morality of nonviolence — caring for both self and others; avoiding harm to anyone is the highest principle

Code of Ethics for Registered Nurses (Board Res. No. 220, s. 2004)

The Code was based on the Code of Good Governance for the Professions in the Philippines, and it replaced the earlier code promulgated under RA 877 and P.D. No. 223. The ICN Code of Ethics for Nurses is the international reference.

• Confidentiality — do not discuss clients outside the care team, in public areas, or on social media; share records only with those directly involved in care or when required by law.
• Informed decisions — give clients the information and time they need before consenting (autonomy).
• Fairness — when workload prevents equal attention to all clients, prioritize by need and report unsafe staffing (justice).
• Truthful documentation and communication — accurate records are the hallmark of accountability (veracity, fidelity).
• Alternative therapies — give objective information about risks and benefits and encourage discussion with the health team, respecting the client's choice while preventing harm.
• Team relationships — communicate respectfully with physicians, therapists, and social workers; raise concerns about a colleague's practice through proper channels instead of public criticism.

• Know and apply the Code of Ethics and the ICN Code
• Act as client advocate — safeguard rights, speak up when care is unsafe
• Refuse assignments beyond competence when client safety is at risk, explain the reason, and ask for help or training
• Maintain competence and continual learning
• Recognize and address moral distress; use ethics committees and supervisors
• Model professional conduct on and off duty, including online

• The Code is legally enforceable: violations can lead to suspension or revocation of registration (RA 9173 Sec. 23; Code Art. VII).
• Confidentiality is also a legal duty under the Data Privacy Act of 2012 (RA 10173), where health information is sensitive personal information.
• Ethical duties sometimes conflict with legal duties (e.g., confidentiality vs. mandatory reporting of notifiable diseases under RA 11332); lawful public-health reporting is a recognized exception to confidentiality.
• The Code allows withholding information "deemed harmful" to the client's well-being; in current practice this must be applied narrowly, and it does not allow families to override a competent client's right to know.

Case 1. A nurse tells a friend about a famous client's diagnosis.

Principle violated: confidentiality (Code Art. II: personal information held in strict confidence), also a Data Privacy Act violation. Correct action: never disclose; report breaches per policy.

Case 2. A nurse is asked to manage a ventilator she has never been trained to use, with no supervisor nearby.

Correct action: inform the charge nurse that she is not competent, ask for a trained nurse or supervision, and meanwhile keep the client safe. Why: practice must meet safe standards (Art. III); refusing unsafe work to protect the client is ethically justified.

Case 3. A nurse must decide how to allocate time between a stable client asking for a bath and a client with new chest pain.

Correct action: attend to the client with chest pain first. Why: justice in nursing means allocation according to need, not equal time; nonmaleficence requires preventing serious harm.

Case 4. A student asks which Kohlberg stage fits "Rules must be followed because they keep society in order."

Answer: Stage 4, law and order (conventional level).

• Confusing beneficence (doing good) with nonmaleficence (avoiding harm).
• Calling "efficiency" an ethical principle — it is a management value, not one of the four principles.
• Placing "good boy–good girl" at the postconventional level — it is conventional (stage 3).
• Mixing Gilligan's levels: self-sacrifice is the middle level; nonviolence (care for self and others) is the highest.
• Treating the Code as mere advice — it is enforced by the Board of Nursing.
• Assuming respect for culture always wins — when culture conflicts with care, the client's welfare and safety take precedence (Art. II).

• Utilitarianism = outcomes, greatest good; deontology = duty, rules; virtue = character; care ethics = relationships
• Four principles: autonomy, beneficence, nonmaleficence, justice; rules: veracity, fidelity, confidentiality, privacy
• Double effect: good intended, bad foreseen but not intended, bad not the means, proportionate
• Kohlberg: preconventional (1–2), conventional (3–4), postconventional (5–6)
• Gilligan: survival → self-sacrifice → nonviolence; ethics of care
• Code of Ethics for Registered Nurses: BON Resolution No. 220, s. 2004
• Four responsibilities of the nurse: promote health, prevent illness, alleviate suffering, restore health; assist toward a peaceful death when these are not possible
• "Accurate documentation is the hallmark of nursing accountability"
• "Human life is inviolable"; nurses are advocates
• Code violations → suspension or revocation (RA 9173 Sec. 23)