bioethics TOQUILAR

Health care ethics

• Ethics
Þ Declaration of Right and Wrong – process Even when there are optimum conditions for arriving at
oriented, involves critical analysis of a decision regarding an ethics-laden situation, the
action – reflects the “should” of human possibility that not everyone will be completely satisfied
behavior is always there.
Þ Weigh the pros and cons
Þ I needs to have a rational behind it,
hindi basta-basta lang Why Study Ethics?
Þ Leave your biases aside Þ Scientific Advances
Þ The Ethics of before, is the ethics of Þ Inequalities in socio-economic, education
today and political positions
Þ Study of moral conduct or principles of Þ Finitude of resources
underlying desirable types of human Þ Changes in the doctor-patient
conduct relationships
§ Science of Ideals – guides our judgement Þ Rampant unethical behavior of a lot of
concerning morality of human acts health care professionals

Based on this reflection, one derives the normative Ra. 9173 – Taking pictures and phones during duty is not
principles which govern one’s relationship with others, allowed
the environment and God.
“What are the unchanging principles that guide me in Different Kinds of Ethics
the determining good from bad, right from wrong?” 1. General Ethics – presents truths about human
Being a moral person is not the same as ethical person acts – general principles of morality
2. Special Ethics
• Moral Þ Applied ethics – applies principle of gen
Þ Refers of human conduct itself – ethics
application of ethics Þ Individual – god self fellowmen
Þ Fundamental standard of Right and Þ Social – fam state world
Wrong that an individual learns and 3. Virtue ethics
internalizes – usually during early stages of 4. Professional ethics
childhood
Þ Reflection is done in a situation Virtue Ethics
- Aristotle – believed in “ergon” (tendency
Kholberg’s theory towards fulfillment)
……. - To achieve “eudamonia” (happiness)
• Virtue – a trait of a character that allowed people
• Morality to achieve the fulfillment of this tendency
Þ Refers to the practical application of
ethical principles in determining good Virtue according to Aristotle
moral behavior “Both fear and confidence and appetite and anger and
pity ang general pleasure and pain may both be felt
“What should I do in this situation? Do I have the right to both too much and too little and in both cases not well;
do this? Am I willing to be accountable for the but to feel them at the right times, with reference to the
consequences of my action?” right objects, towards he right people, with the right
motive and in the right way, is what both intermediate
There are many complex ethical questions/ dilemmas and best and this is characteristic virtue”
often do not have definitive answers
Aristotle’s Golden Menu
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Deficiency ß Golden Mean à Excess 5. Acting rightly does not require we maximize the
good- good is not enough- “excellence” is
In deficient and Excess it’s a vice, if in the Golden Mean needed
it’s a balance and virtue. Golden mean means if you
didn’t do anything you’re a coward. It is a deficiency of PROFESSIONAL CODE OF ETHICS
the character. If you cannot control it, call for help. The normative principles which govern a professional’s
Being virtue is not about being deficient nor excess, its standards of behavior both as individual and as he/she
about balance. relates with society, the environment and God

- Acting virtuously involves judgement (practical “What are the unchanging principles that determine my
wisdom) behavior and functions as a professional?”
- Includes thinking caring and sensitive
perception 1989 – PNA promulgated a new code of ethics and was
§ Prudent person – consistently makes approved by the BON through its BON Resolution
judgements about the rightness/ #1955 s. 1989
appropriateness of what is to be done and be
motivated by these judgements to act RA 9173
accordance with them; you do it all the time
“how am I to live well?” BON Resolution 220 series of 2004 – promulgation of
§ Habit – an action being done consistently the code of ethics for registered nurse
- Upbringing is very important in moral
development BIOETHICS COMMITTEE- offers recommendations only
- Role Model` 1) Issues of patient care that presents as ethical
- Providing students with appropriate role dilemmas
models/ developing habits appropriate to a 2) Recommendatory, they are not the final
virtuous person by observation of virtue in decision maker
actions 3) The institution’s ability to protect the rights and
- If we can just focus on being good people, right interest of clients in general
actions will follow 4) The development of institutional policies and
- 2 important points on virtue ethics educational programs on ethical issues
1) Choice to do the right thing - The right
thing to do cannot always be laid down RESPECT FOR PERSON- most fundamental human
in a rule. Reception of the particular right; foundation of all ethical principles, respects the
case or situation is needed
worth and value of a person
2) Appropriate emotion - It matters what
one feels
Who and What is a Person?
- From the time of conception to NATURAL DEATH
Claims of virtue ethics:
• Conception – starts at fertilization
1. An action is right if and only if it is what the agent
• Personhood - depends on the values, attitudes,
with a virtuous character would do in the
beliefs and needs
circumstances
2. Goodness is prior to rightness- person matters
All Human beings have needs and anything that fulfills a
before the action
need is a VALUE
3. The virtues are irreducibly plural intrinsic goods-
- Values give direction and meaning to life and guide
virtues cannot be reduced to just one value but
a person’s behavior. They are freely chosen,
various virtues are necessary for good actions
cherished and consistently incorporated into one’s
4. Some intrinsic goods are agent relative- every
behavior.
action depends on the person
- Values are shaped by culture, ethnicity, family,
environment and education
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- Everybody is different and what makes one person
happy may leave another person feeling anxious or • Human rights - needs and values as it relates to
disengaged. Defining your personal values and other human beings
then living by them can help you to feel more ¬ it is universal
fulfilled and to make choices that make you happy, ¬ equal among everybody
even if they don’t make sense to other people. ¬ not a product of human creativity but
- Value awareness inherent to us

• Attitudes - one’s disposition toward an object Universal Declaration of Human Rights (1948) –
or a situation; emotional or mental mindset; respects the dignity of the human person (after World
positive or negative War II)
• Beliefs - ideas that one accepts as true- one that - A lot of experimentation was done during
changes the least- opinions, decisions the time of Hitler.
• Behaviors - observable actions - Sulfonamides from Sulfur on wounds on
Jews (prisoners of war) but not Germans
Have you ever been in any of these situations? - They cannot do something against you
- Someone said or did something that you strongly because you are a person and you have your
disagreed with, but you didn’t speak up about it and own rights
felt ashamed afterwards
- You’re so busy pleasing other people that you’re not Basis of Human Dignity
even sure what you own true values are. A. Salvation History
1. Creation of man
Key Concepts: 2. Fall of Man
- All human interactions are value based 3. Promise of a Savior
- Nurses must clarify and respect the values of 4. Preparation for the Coming
others and examine their own values 5. Fulfillment of the Promise
- Values are enhanced and refined by 6. Establishment of the Church
experiences that cultivate values 7. Heavenly Kingdom
development such as interactions with » Image and likeness of God
people of differing values and viewpoints » Christ Redeemed us
and experiences that challenge one’s way of » Rational beings
thinking
SIGNIFICANCE OF BEING A PERSON
“Good values are easier caught than thought” - Has an inherent dignity which must be
respected
Values and Needs - A person should not be destroyed;
- Maslow’s Hierarchy of Needs (Biological, uniqueness must not be altered; genes can’t
psychological, social and spiritual and be manipulated; organs removed without
creative needs) any reason; one can’t be cloned
- St Thomas Aquinas - Actions should be done to satisfy one’s
Þ need to preserve life needs not another’s interest. One cannot be
Þ need to procreate examined, treated experimented, studied
Þ need to know the truth and the need on for another person’s gain.
to live in society - A person should and can decide what is
- If you know the truth, then you can make BEST for one (autonomy and informed
good judgement consent) without constraint from another.
- Ethical problems exist when we have to One’s intelligence and free will fosters
make decisions so that all these needs will rational choices which one is responsible for
be satisfied in an integrated and consistent (well-formed conscience)
manner
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1) Has an ultimate destiny- to live with God ¬ divine revelation manifested through
- To fulfill this, one has needs that must be reason
met, resources must help one meet these ¬ a system of rights held to be common to all
needs; but he is only a steward humans and derived from nature rather
2) Lives with other persons in the community than from the rules of the society
- Interacts with people; helps them in times of ¬ it dictates that now we makes decision we
need base it to what comes naturally to us or what
is our nature as man
1st principle of Morality: Principle of ¬ innate in us
Human Dignity 3. Positive law
All ethical decisions (made by patients and healthcare ¬ dictated by the authority of the church or
givers) must aim basically and ultimately at human state
dignity
- They must protect, defend, enhance and CONTENTS OF NATURAL LAW
enable the person’s worth. Properties of Natural Law
- They must aim for the maximum and 1. Universal – applies to all
integrated satisfaction of every person’s 2. Obligatory – all of us are bound to it
needs, as an individual and members of his 3. Recognizable – no need to be explained
community. thoroughly
4. Unchangeable – Law of before is the law of
HUMAN DIGNITY today
- Every human being has an inner worth and
inherent dignity. These he possesses not CONSCIENCE
because of what he has or what he does but
“to follow one’s conscience” is not……
because of what he is: a human person
§ to follow feelings or emotions
- As a human person, he must be respected
§ to follow law or custom
regardless of the nature of his health
§ Blind obedience to the inspiration of God
problem, social status, competence, past
§ Follow personal freedom and autonomy
actions
(leads to conflict)
- Decisions about health must aim at the
maximum integrated satisfaction of his
“The capacity to make practical judgments in matters
needs: biological, psychological, social and
involving ethical issues”
spiritual
- Certain actions may never be done because
o It involves reasoning about moral principles
performing them would constitute a
o Must be rooted in reality and truth and not on
violation against the person’s dignity
- Newborn, healthy adult, senile elderly mere will or desire or blind choice
- Comatose patient, crazy individual o Sound, true and certain conscience- own
- Illiterate slum dweller, university president, perception, sound education, understanding of
uneducated housemaid, convicted killer natural law, traditional wisdom, teachings of
family and Church, experience
3 Basic Laws o Conscience can be in error as when one
1. Eternal law misunderstands principles, misjudges facts or
¬ will of God is led by misguided affections
¬ divine revelations o Time is important in making a good decision
2. Natural law o In making a major decision, STOP FIRST
¬ human reason and experience used to o If you make a wrong decision, accept the
determine what actions best serve true consequences
human welfare- nature of man
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o One is culpable (accountable) of an erroneous theories of Ethics
decision of conscience only within one’s Utilitarianism
capability and freedom to prevent the error. - Utility means use
- telos- “end”; teleology
QUALITIES OF CONSCIENCE - right action is that which has the greatest utility
A. PERSONAL FREEDOM and no action is in itself either good or bad
- if the end is good, then the action is good
1) Free
- consequentialism- action is judged as good or
2) Unfree - impeded by some obstacles such as
bad in relation to the consequence, outcome or
fear and anger
end that is derived from it
- “the end justifies the means”- sometimes it is
B. OBJECTIVE FREEDOM
possible to do wrong to achieve “right”
1) Correct - subjective conforms to the objective
- Utilitarianism- the only right action are those
moral values
that produce the greatest happiness to all
2) Objective - norms of morality
concerned
3) Erroneous - lack of conformity to the objective
- “Primary responsibility is to support the interest
norms of morality
of the group”
4) Culpable - one is in error and therefore
o Example: One child policy of China
responsible
Advantages:
5) Inculpable - has erred in good faith
- easy to use
- can justify many decisions based on the
C. MORAL ATTITUDE
happiness principle
1) Lax - careless in its effort to seek the truth
Disadvantages:
2) Strict - follow to the letter
- average happiness of all or total happiness for
3) Scrupulous - tends to judge sin to be present
few
when there is none
- harm can be done to the minority
4) Pharisaical - judgmental towards other; you are
- what constitutes happiness? Who determines
right and everything is wrong
what is good? end justifies the means
5) Clear – conscience that critically thinks about the
situation
Deontology
6) Callous- worst type; no sensitivity to sin - Deon- “duty”- “duty oriented”
- Nature of the action
D. DEGREE OF CERTITUDE - Kantinism – “one treats others always as ends
1) Perplexed - wrong if you don’t do; wrong if you and never as means – respect for person –
did making a person’s end your own treating others
2) Doubtful - lack of sufficient evidence the same way you treat yourself”
3) Probable - made a decision already but still - rationalist view that the rightness or wrongness
admitting the possibility that the opposite is true of an act depends upon the nature of the act
4) Certain - rather than the consequences that occur as a
result of it
- human beings have the freedom,
CONSCIENCE FORMATION thoughtfulness and sensibility to act in a moral
§ Faced with a specific ethical dilemma, one manner- knows what he/she ought to do
should use his conscience. - Respect a person worth/dignity
§ Making moral decisions demand mature - A person’s action is right if it follow moral rules-
responsibility fair, honest, doing good
§ A fully mature and responsible conscience - A person’s action is wrong, without exception, if
should be free, correct, clear and certain it violates these rules
§ We must follow our decision only after we have - Consent is difference from assent
done our best to search for the truth regarding
the issues facing us
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- Parents give consent, but if it is a child, you ethical question, people are morally obliged to do the
assent to procedure (7-17 years old) following:
- Philippine Pediatric Society: You can get assent 1. Informed themselves as fully as practically
at the age of 7 possible about the facts and the ethical norms
- Consequences (-), action still ethically right if the 2. Form a morally certain judgment of conscience
original motive is consistent with moral precepts on the basis of this information
- Nurses code of ethics- importance of fulfilling 3. Act according to this well-formed conscience
duties that are inherently owed to patients 4. Accept responsibility for their actions
o Example:
o If the client asks the nurse to promise to 3rd principle: The Principle of Stewardship
tell the truth regarding her diagnosis and Creativity
and prognosis, the - It guides people in their ethical management of
o nurse is duty bound to keep this their life with others and of the limited resources of
promise. this world
Advantages - It calls for personal, social and ecological
- provides clear guidelines for judging the responsibility
rightness and wrongness of an act
- recognizes the dignity and autonomy of “the office, duties and obligations of a steward”
individuals and allows all people equal “the conducting supervising or managing of something
consideration especially: the careful and responsible management
Disadvantages of something entrusted to one’s care”
- problem with disregard for consequences
- all ethical precepts are viewed as equally The gifts of multidimensional nature and its natural
important environment should be used with profound respect for
- exceptionless and rigid their intrinsic teleology (purpose they serve) and
especially the gift of human creativity should be used to
Religion Answers: Secular Answers: cultivate nature and environment with care set by the
» Revelation » Reason limits of actual knowledge and the risk of destroying
» Scriptures » Experience and these gifts
» Church tradition observation
» Experience » Institution And especially the gift of human creativity should be
» Social used to cultivate nature and environment with care set
agreement by limit of actual knowledge and the risk of destroying
these gifts
CONSCIENCE FORMATION
- Diligently learning the laws of moral life The principle of Stewardship
- Seeking expert advice on difficult cases - It guides people in their management of their life
- Asking God for light through prayer with others and of the limited resources of this
- Removing the obstacles to right judgment world
- Personal examination of conscience - It calls for personal, social and ecological
responsibility
“My conscience is my guide” - It advocates an end to the huge inequalities there
“What I don’t know won’t hurt me” are between the few rich and the many poor
“It is God’s will”
“The evils of modern technology are not the result of
2nd Principle: Principle of Well-Formed creative use of knowledge but of rash exploitation of a
Conscience nature little understood”
To attain the true goals of human life by “Research and experimentation, with all the risks
responsible actions, in every free decision involving an involved, are necessary but we must proceed with
reverence for the persons and the environment at risk”
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1. Personal Dimension of Stewardship prevent and remedy the defects to which we are
The Human Person liable
- Individual of rational nature - False principle: “If it can be done, it should be
- Created in God’s image and likeness done”
Human Life - “Should it be done?”- YES- develop and use the
- A great value technology to do it
- A gift of God - Stewards of the environment- we can cultivate and
- Human life is inviolable and sacred improve the earth with modern technology but not
- Human life must be defended from moment of do it carelessly- it should be creative
conception to natural death
Medical Experimentation
The stewardship or right use of our faculties and powers 1. Preceded by research with animals
as rational creatures “in accord to their God-given and 2. Respect for subjects as human persons
natural purpose”; the care of our own bodies 3. Respect for social justice
4. Respect for the principle of informed consent
• Health - a dynamic harmony within the body 5. Approval of Ethics Committee
• Sickness - part of life; at times caused by an
unhealthy lifestyle Research Codes:
We are responsible for our own health and therefore our 1. Nuremberg Code (1949)- foundation of all
health has an ethical dimension research ethics codes
10 principles
2. Social Dimension - Voluntary consent, results need to be of good to
- The human person as a social being the society, animal experiments 1st, avoid
- Poverty in Spirit; a simple lifestyle; solidarity with unnecessary physical and mental suffering/ injury,
the poor should not be done if it will cause death/disability;
- Catholic healthcare ought to be distinguished risk vs benefits, proper preparations and adequate
by service and even advocacy for the – most facilities , only on qualified patients, free to end
vulnerable participation, researcher must be prepared to
- Principle of Justice/ Beneficence/ Non- terminate experiment at any time
Maleficence 2. Declaration of Helskinski (1964, 1975, 1983,
1989, 1996, 2000, 2008)
3. Ecological and Biomedical Dimension - Developed by WMA- guidance to research not
- Ecological crisis present in Nuremberg Code; for doctors doing
- Co-creators with God and Under God research on their patients
- Creation has its own goodness and perfection 3. Belmont Report (1976) (Medical and Behavioral
but it did not come out of the hands of the Research)
Creator as completed- fully completed. It was - Practice vs Research
created “on the way” towards perfection still to
be reached and to which it is destined by God HUMAN RECONSTRUCTION
(CCC, no 302) - God made human beings free and intelligent- we
have the right and obligation to improve
Ecological and Biomedical Dimension (Principle of ourselves- good stewardship
Creativity) - But we must use it with profound respect for God’s
- God gave us 2 gifts: human nature (intelligent creation especially if it will undermine the very
freedom; creative intelligence) with biological, freedom and intelligence given to us by God
psychological, ethical and spiritual capacities and - We should not as faithful stewards, harm but rather
the environment improve and care for them. We have to treat them
- We have the need and the right to improve our with utmost respect, use originality and creativity
bodies and to develop medical technology that to cultivate them, know and respect their limits.
We cannot contradict human nature.
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- A person can dispose of individual parts,
4thPrinciple: Principle Of The Totality Of destroying them, if and to the extent that is
The Human Person necessary for the good of his being as a whole, to
ensure its existence or to avoid and to repair grave
To promote human dignity in community, every person and lasting damage which could not be avoided in
must develop, use, care for, and preserve all of his or her any other way
natural physical and psychic functions in such a way that:
Why is it permissible to sacrifice one of the basic human
A. Lower functions are never sacrificed except capacities to preserve life?
for the better functioning of the whole person - Not to sacrifice one basic capacity from the other
and even then with an effort to compensate for - Not for the better functioning of all other human
this sacrifice. capacities
B. The basic capacities that define human - But sacrificing one function so as to continue
personhood are never sacrificed unless this is functioning at all
necessary to preserve life
MUTILATION
- To be a complete human being is not merely - Destruction of member, organ or part of the body
having the higher level of functions but to have all (organic) or the suppression of a physical function
the basic human functions in harmonious order (functional) in such a way that the organism
- Human body functions contribute to higher becomes no longer basically whole
functions not merely by supplying what is needed Types
for physiological functioning; they also supply part 1. Direct- willed in itself, as end or as means,
of the human experience that is essential to human intended and caused
intelligence and freedom 2. Indirect ( therapeutic)- caused by the exigencies
of the health or survival of the patient; at times
Conditions for principle of totality willed as means, at others tolerated as an
1. That the organ, by its deterioration in function, unavoidable side effect
may cause damage to the whole organism or at
least pose a serious threat to it Direct mutilation- intrinsically wrong- offends human
2. That there is no other way than taking the dignity- individual does not have the right to mutilate
indicated action against it of obtaining the himself, much less does society
desired good result Therapeutic mutilation- licit as an act of good
3. That the damage being avoided to the whole is stewardship of the body – necessary for the survival of
proportional to that which is caused by the the patient or to free him of proportional sufferings or
mutilation or incapacitation of the part infirmities

- This principle does not apply to moral organisms STERILIZATION

(family, society & humanity)- a person is still - A medical or surgical intervention which causes a
independent- he is not a subordinate to any patient, incapacity of generation
group- “He is the subject, principle and end of all - Therapeutic- inevitably required for the survival
the social institutions and health of a person- sexual organs- integrating
- Authority cannot directly dispose the physical and parts which must yield to the good of the whole;
personal being of a person- removal of the licit if:
undesirable or weak parts of the society - sickness is grave, certainly diagnosed and
- It applies to the management of health and definitive that it offsets the evils of sterilization
integrity of the body - it is necessary because it is the only possible
- It throws light to the licitness or illicitness of all effective remedy
kinds of medical interventions, surgical - exclusively curative- intention is important
procedures and transplants
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Direct sterilization- the immediate effect is to render
procreation impossible
Types:
§ Eugenics - seeking to avoid the transmission of
hereditary defects
§ Hedonistic - evade the complications &
responsibilities of procreation without giving up
the sexual pleasure
§ Demographic - to control the birthrate
§ Preventive - render pregnancy impossible
which might aggravate sickness that already
exist

Organ transplantation
Transplanting organs from one living person to
another is also ethically acceptable provided that the
following criteria are met:

1. There is serious need on the part of the recipient that

cannot be fulfilled in any other way.
2. The functional integrity of the donor as a human
person will not be impaired, even though anatomical
integrity may suffer.
3. The risk taken by the donor as an act of charity is
proportionate to the good resulting for the recipient.
4. The donor’s consent is free and informed.
5. The recipients for the scarce organs are selected
justly.

ORGAN DONATION
A. Live donor
- Informed consent, benefits & risks, unforeseen
adverse events
B. Cadaver donors- brain death, proper care at death
C. Recipient - continued drug therapy, dependence on
technology, shortened life span

Who receives organs?

- those who will benefit
- those who will comply w/ treatment
- Allocation must be just