NCM108 - Healthcare Ethics: Bioethics honest all of the time or lying whenever it

is easier to do so.
- It is a learning process that continues
ETHICS
throughout your life.
● MORAL PHILOSOPHY
- DEONTOLOGICAL THEORY
● Derived from the Greek word ETHOS, which means
- This type of theory claims that there are
CUSTOM or CHARACTER
features within the actions themselves
● Philosophical science that deals with morality of
which determine whether or not they are
human conduct
right.
● Systematically establishes the standards or norms of
- These features define the extent to which
human acts
the actions conform with recognized
● Determines human acts as good or bad and right or
moral duties.
wrong
- Deontological theories do not consider
● Provides the principles on the morality of human acts.
consequences to be important when
● 4 MAJOR AREAS OF STUDY:
determining whether or not an action is
1. DESCRIPTIVE ETHICS
ethical.
- this is the division of philosophical or general
- It doesn’t matter if the drunk driver
ethics that involves the observation of the moral
made it home safely.
decision-making process with the goal of
- Immanuel Kant's ethical theory is
describing the phenomenon.
deontological.
- Describes the nature, essence or substance of
- He claims that actions are only morally
reality.
right when they are done out of duty.
- reports what people believe, how they reason,
- He sees moral duties as unchanging
and how they act.
laws for human conduct.
2. NORMATIVE PHILOSOPHY
- Always act out of duty, in accordance
- concerned with criteria of what is morally right
with a good will
and wrong.
- I.e. One does the right thing
- It includes the formulation of moral rules that
because one recognizes that it is
have direct implications for what human actions,
the right thing to do, not because it
institutions, and ways of life should be like.
pleases you to do it or will promote
- 3 TYPES OF NORMATIVE THEORIES:
good consequences.).
- VIRTUE-BASED THEORY
- TELEOLOGICAL THEORY
- Virtue based theories focus on the
- This describes an ethical theory which
character of the person.
judges the rightness of an action in terms
- According to virtue based theories,
of an external goal or purpose.
ethics is about what sort of person one
- According to a teleological theory,
should strive to become.
consequences always play some part,
- The qualities that one should develop in
be it small or large, in the determination
oneself are called virtues (ex. honesty,
of what one should or should not do.
fairness, kindness, faithfulness, generosity,
- Theory of morality that derives duty or
prudence, integrity, bravery, etc.).
moral obligation from what is good or
- For example:
desirable as an end to be achieved.
Aristotle claimed that in order to
3. PRACTICAL PHILOSOPHY
become an honest person, one should
- A division in philosophy which reflects on truth
tell the truth. (Aristotle) Eventually it
with due recourse of action.
becomes a habit.
- the attempt to work out the implicationsof
- One learns how to tell the truth
general theories for specific forms of conduct
appropriately, without being brutally
 and moral judgment; formerly called applied - It chooses.
ethics. - It implements what it has chosen.
4. CRITICAL PHILOSOPHY (EPISTEMOLOGY) - Enables him/her to choose which is good.
- is the study of the nature and scope of
Concrete Basis of Morality
knowledge and justified belief.
● Morality becomes vivid when one encounters a
- It analyzes the nature of knowledge and how it
moral experience.
relates to similar notions such as truth, belief and
● This moral experience leads him/her to a moral
justification.
problem.
- asks questions like: "What is knowledge?", "How is
● The human person is duty-bound to face his/her
knowledge acquired?", "What do people
obligation.
know?", "What are the necessary and sufficient
● Ex.
conditions of knowledge?"
- Should a person who has no money, steal?
MORALITY - Should a person who has no answer in an exam,

● Derived from the Latin word MOS or MORIS cheat?

● Applied Ethics BIOLOGY

● Actualizes/ applies the theories and principles ● Natural science that deals with the issue of life

provided by ethics ● Important in bioethics because it deals with the

multifarious (DIVERSE) dimensions and domains of all
Postulates in Ethics life forms.
(Presumed to be true)
1. The existence of God. BIOETHICS

2. The existence of intellect and free will. ● This term was introduced by DANIEL CALLAHAN in

3. The spirituality and immortality of the human soul. 1969, together with WILLARD GAYLIN when they
founded the HASTINGS CENTER
Moral Assumptions ● Popularized by VAN RENSSELAER POTTER in 1970
1. As a rational and free grade of animal, man knows ● A discipline that deals with the ethical implications of
that there are actions that are right or wrong, and biological research.
good or bad. ● The study of ethical issues that emanate from the
2. Man knows that there are actions that he is not changes and developments in the life science
obliged to do. technologies.
3. Man knows that he is responsible for his actions. ● A branch of ethics that deals with the life sciences
4. Man knows that those actions are considered wrong and their impact in society.
are punishable and that those actions that are right ● A branch of ethics that analyzes moral values in the
are rewardable. context of biomedical sciences.
● A branch of the ethics of biological science and
Humans: The Sole Moral Agents
medicine.
● It is their being rational that makes humans humans.
● A systematic study of the human conduct in the
● The human person’s perceptual knowledge helps
areas of the life sciences and healthcare.
him/her draw judgements as he/she compares ideas.
● It belongs to the auspices of medical ethics and is
● The human person, therefore, does not just perceive
loosely anchored in the avenues of life sciences.
things but also analyzes, assesses, criticizes, or
● The study of the moral problems in medicine and
intellectualizing things.
biological technology.

Intellect Compared with Will

HEALTHCARE ETHICS
● What does intellect do?
● A domain in the practice of the healthcare
- It knows.
profession that sets the standards or guidelines
- Acts as the thinking faculty of the human person.
relative to studies, inquiries, and decisions on the part
- Enables him/her to search for truth
● What about the will?
 of healthcare professionals in relation to the delivery
of healthcare.
● Deals with ethical issues such as: life-support system,
testing of diseases, access to healthcare services,
brain death, clinical death, suicide, euthanasia, vices
and virtues, conscience and law.

PROFESSIONAL ETHICS
● The normative moral system that injuncts a kind of
behavior that is expected of a professional.
○ NOT ONLY OF AN INDIVIDUAL BUT ALSO AS A
GROUP.

NIGHTINGALE’S PLEDGE
● was composed in 1893 by Lystra E. Gretter and a
Committee for the Farrand Training School for Nurses,
Detroit. It was called the Florence Nightingale Pledge
as a token of esteem for the founder of modern
nursing.
● It was first administered to the 1893 graduating class
of the Farrand Training School, Harper Hospital,
Detroit, Michigan. It is as follows:

I solemnly pledge myself before God

and in the presence of this assembly, to pass
my life in purity and to practice my profession
faithfully. I will abstain from whatever is
deleterious and mischievous, and will not take
or knowingly administer any harmful drug.

I will do all in my power to maintain and

elevate the standard of my profession, and will
hold in confidence all personal matters
committed to my keeping and all family affairs
coming to my knowledge in the practice of my
calling.

With loyalty will I endeavor to aid the

physician in his work, and devote myself to the
welfare of those committed to my care.
SUICIDE ➔ Utilitarian Principle
● Derived from the Latin word SUICIDIUM which means - Whenever one has become a burden and
“to kill oneself”. liability to the greatest number of people, its
● The direct killing of oneself on one’s own authority. justifiable to commit suicide
● The intentional killing of one’s own life. ➔ Kant’s Ethics
● The agent of death is the person himself. - Categorical Imperative
- Treat individuals not as means only but
ASSISTED SUICIDE also as ends
● the act of deliberately assisting or encouraging - Principle of autonomy/self-determination
another person to kill themselves. - Has the right to decide whether to
commit suicide or not

MEDICAL EUTHANASIA ASSISTED SUICIDE

Is SUICIDE immoral? YES
Physician directly commits The physician provides the ● It is nothing else but tantamount to cowardice.
the act by medical medical means ● It is a total reversion and aversion of sanctity of the
means God-given life.
● It is a blatant negation to accept the facts of life in
The physician is necessary The physician is necessary,
and sufficient for the act but not sufficient for the the name of courage, obligation, respect, love &
to be completed act to be completed gratitude to God and members of human society.

The patient's condition The patient needs to do SUICIDE

provides the context the final act
➢ It is therefore the paramount duty of the healthcare
providers to keep track of the emotional status and
COMMON METHODS: mental directions of their patients, especially those
● Asphyxiation - Deprivation of O2 by hanging oneself who are suffering from malignant diseases, to hold
● Toxification - Poisoning on to their life, no matter what.
● Blunt force trauma - Jumping from a building, etc. ➢ Healthcare providers must always be ready to assist
● Self-defenestrating - Making oneself killed by a train, their patients in their spiritual, physical, emotional,
truck, etc. psychological, and mental turmoils.
● Exsanguination/Bloodletting - Slitting one’s wrist,
abdomen, etc. DANGERS OF LEGAL EUTHANASIA AND ASSISTED SUICIDE
● Drowning • Safeguards don’t prevent abuse of euthanasia laws
● Electrocution • Doctors killing people becomes normalized
● Self-immolation - A deliberate and willing sacrifice of • It compromises palliative and hospice care
oneself often by fire. • People will die because of mistaken diagnosis or
● Starvation prognosis
• Euthanasia and assisted suicide don't guarantee a
CAUSES OF SUICIDE: dignified death
● Physical pain, illness • Euthanasia and assisted suicide are the ultimate
● Anxiety, emotional pressure tools for elder abuse
● Financial difficulties
● Shame, guilt, depression, desperation CHARACTERISTICS OF DEATH:
● Psychological disturbance, mental disturbance ❖ It is ineffable.
- Incapable of being expressed in words; complex
APPLIED ETHICAL THEORIES in nature; mysterious
➔ Natural Law of Ethics ❖ It is inescapable.
- Principle of stewardship - Everybody dies
- Suicide is a sin ❖ It is beyond experience.
 - One can never have a chance to have a 5. Legally dead
taste of death and later share her encounter
with it. CLINICAL DEATH
❖ It is personal. A medical condition that precedes death rather than
- There is no such thing as “untimely death”. being actually dead.
❖ It is ontological. Cardiac arrest
- Intrinsically embedded in us at the very
moment when we earned the breath of life. STEM CELL TECHNOLOGY
- “As soon as man comes to life, he is at once STEM CELL
old enough to die”. ● A cell that has the ability to divide or self replicate
❖ It is the grand equalizer. for indefinite periods---often throughout the life of
- It is never choosy of who it seeks to take. an organism.
- Death takes anybody in a designated ● Stem cells have the potential to develop into
moment as it strikes. mature cells that have the characteristic shapes
and specialized functions.
DEFINITION OF DEATH
● MEDICAL DEFINITION 2 PRINCIPAL CHARACTERISTICS OF STEM CELLS
- Death is the permanent cessation of all 1. They are unspecialized cells that renew
bodily functions. themselves for long periods through cell
● LEGAL DEFINITION division;
- Death is the cessation of life as indicated by 2. They can be induced to become cells of the
the absence of blood circulation, respiration, heart muscle, or the insulin-producing cells in the
pulse and other vital functions. pancreas.
- The dead person is fit to be buried.
● LEGAL AND MEDICAL PURPOSES DEFINITION Stem cells are primitive cells.
- Death is the irreversible cessation of all the ● They can develop into:
following: - Blood
(1) EEG assessed flat-lined total cerebral function - Bones
(2) Spontaneous function of the respiratory system - Nerve cells
(3) Spontaneous function of the circulatory system - Liver cells
● UNIFORM DETERMINATION OF DEATH ACT (UDDA) - Heart tissues
DEFINITION - Brain cells
- An individual who has sustained either (1)
irreversible cessation of circulatory and ● There are several kinds of stem cells in the human
respiratory functions; or (2) irreversible body.
cessation of all functions of the entire brain, - Example:
including the brain, is dead. A determination a. Hematopoietic stem cells found in the
of death must be made in accordance with bone marrow
accepted medical standards. b. Neural stem cells found in the nervous
system.
BRAIN DEATH ● Their supply in the human body is so limited as
1. Patient shows total unreceptivity or unawareness compared to the stem cells found in the embryos.
to all external stimuli and is unresponsive to
painful stimuli. EMBRYONIC STEM CELL
2. All spontaneous muscular movement and ● The most undifferentiated stem cell is the zygote,
respirations are gone. embryo, or the fertilized egg.
3. The pupils lose reflexes and are dilated and fixed. ● Removal of cell from the human embryo was
4. Still breathe with the help of a ventilator. initiated in August 09, 2001.
 ● 3 Kinds of Stem Cells:
- Totipotent
- Multipotent
- Pluripotent

1. Totipotent stem cells

- Have the total potential to develop into different
types of cell.
2. Multipotent stem cells
- Are those whose potentiality to develop into
other cell types are minimal or limited in numbers.
3. Pluripotent stem cells
- Can develop into any cell type except in the
potentiality to develop as a fetus.

● Only the Totipotent stem cells have the intrinsic

potency to become a zygote or an embryo.
● Scientists extract Pluripotent stem cells from
human embryos to come to terms with cure or
healing of various diseases.
- Embryos used for this purpose are those that
are considered extra or surplus which are
generated from experiments outside the
womb of the mother.
New Method:
- In 2006, scientists discovered the production of
induced pluripotent stem cells (iPS) by using skin
cells.
- This method allows doctors to create stem cells
with a specific patient’s genetic code,
eliminating the risk that the body would reject
transplanted tissues or organs.
 Issues on Artificial Reproduction its Morality - Children conceived as a result of artificial
insemination of the wife with the sperm of the
and EthicoMoral Responsibility of Nurses
husband or that of a donor or both are likewise
legitimate children of the husband and his wife,
ARTIFICIAL REPRODUCTION
provided, that both of them authorized or ratified
Artificial Insemination
such insemination in a written instrument executed
● Assisted Reproductive Technology
and signed by them before the birth of the child. The
● Methods used to achieve pregnancy through the
instrument shall be recorded in the civil registry
use of artificial or partially artificial means
together with the birth certificate of the child.
● Grossly used for infertility treatment
(Executive Order No. 209, s. 1987)
● Defines as the act through which sperm is placed into
a female’s uterus, or the intrauterine method, or into In-Vitro Fertilization
the cervix, or the intracervical method Louise Brown
WHAT IS IVF?
● TWO PROCESS THAT AI EMPLOYS:
- is a procedure in which eggs are removed from a
○ Homologous or Artificial Insemination from the
woman and fertilized in laboratory dish (either
Husband (AIH) – sperm of the Husband of the
husband or another man) embryos are then
Woman
implanted in a woman, where egg may be brought
○ Heterologous or Artificial Insemination from a Donor
to term. (Edge & Groves, 2019)
(AID) – sperm of a construed donor
❖ It must be clear that in AIH or AID, it is the wife REASON WHY IT’S DONE
who is incapable of reproduction and not the - Infertility
husband - desire to have a child without male partner (Staff,
2019)
RISKS of ARTIFICIAL INSEMINATION
● Multiple Delivery BEFORE IVF:
● Preterm Delivery -Fertility
● Birth – Weight Delivery -Semen Sample
Some Catholic Theolegians argue that the AIH is -Donor sperm
acceptable while AID is not for it is equivalent to
‘‘permitted’’ adultery. STEPS:
❖ AID carves out a lot of moral considerations like: 1. Ovarian Stimulation
- Does the true father have a right obligation to the 2. Egg Retrieval
conceive child? 3. Sperm Retrieval
- Would the stepfather(husband of the infertile 4. Fertilization
woman) offer or give authentic love to the child 5. Embryo transfer
conceived not from his sperm but from another
person? Ovulation Induction
- Can the other members of the couples damily show If you're using your own eggs during IVF, at the start of a
true acceptance to the child? cycle you'll begin treatment with synthetic hormones to
stimulate your ovaries to produce multiple eggs — rather
❖ Is it LEGAL here in our country? than the single egg that normally develops each month.
- According to EXECUTIVE ORDER NO. 209 or THE Multiple eggs are needed because some eggs won't
FAMILY CODE OF THE PHILIPPINES under PATERNITY fertilize or develop normally after fertilization.
AND FILIATION
- CHAPTER 1. LEGITIMATE CHILDREN To determine when the eggs are ready for collection,
- Art. 164. Children conceived or born during the your doctor will likely perform:
marriage of the parents are legitimate. Vaginal ultrasound, an imaging exam of your ovaries to
monitor the development of follicles where eggs mature
Blood tests, to measure your response to ovarian EMBRYO TRANSFER
stimulation medications — estrogen levels typically ● Embryo transfer is done at your doctor's office or a
increase as follicles develop, and progesterone levels clinic and usually takes place two to five days after
remain low until after ovulation egg retrieval.
● You might be given a mild sedative. The procedure is
Egg Retrieval usually painless, although you might experience mild
● During egg retrieval, you'll be sedated and given cramping.
pain medication. ● The doctor will insert a long, thin, flexible tube called
● Transvaginal ultrasound aspiration is the usual a catheter into your vagina, through your cervix and
retrieval method. An ultrasound probe is inserted into into your uterus.
your vagina to identify follicles. Then a thin needle is ● A syringe containing one or more embryos
inserted into an ultrasound guide to go through the suspended in a small amount of fluid is attached to
vagina and into the follicles to retrieve the eggs. the end of the catheter.
● If your ovaries aren't accessible through transvaginal ● Using the syringe, the doctor places the embryo or
ultrasound, an abdominal ultrasound may be used to embryos into your uterus.
guide the needle. ● If successful, an embryo will implant in the lining of
● The eggs are removed from the follicles through a your uterus about six to 10 days after egg retrieval.
needle connected to a suction device. Multiple eggs (Staff, 2019)
can be removed in about 20 minutes.
● After egg retrieval, you may experience cramping RISKS OF IVF
and feelings of fullness or pressure. ● Multiple births
● Mature eggs are placed in a nutritive liquid (culture ● Premature delivery and low birth weight
medium) and incubated. Eggs that appear healthy ● Ovarian hyper stimulation syndrome
and mature will be mixed with sperm to attempt to ● Miscarriage
create embryos. However, not all eggs may be ● Egg-retrieval procedure complications.
successfully fertilized. ● Ectopic pregnancy. (Staff, 2019)

Sperm Retrieval Ethical Issues

If you're using your partner's sperm, he'll provide a semen ● The process results in extra or “spare” embryos

sample at your doctor's office or a clinic through that may then be disposed of, frozen, or

masturbation the morning of egg retrieval. experimented on, none of which is without its

● Other methods, such as testicular aspiration — the detractors.

use of a needle or surgical procedure to extract ● For those who believe human life is sacred from

sperm directly from the testicle — are sometimes the moment of conception then the process of

required. IVF and what happens to excess embryo

● Donor sperm also can be used. becomes a moral dilemma.

● Sperm are separated from the semen fluid in the ● Although 90% success rate with thawed

lab. embryos may be acceptable to laboratory

animals, probably not acceptable with humans
FERTILIZATION particularly if failure or partial failure is not
Fertilization can be attempted using two common detectable in later life
methods: ● Once frozen, embryos may outlive the donor
1. Conventional insemination healthy sperm and thus increase possibility of postmortem
mature eggs are mixed and incubated conception and birth.
overnight. ● Use of embryonic tissue in medical research with
2. Intracytoplasmic sperm injection (ICSI) In ICSI, a the aim to treat diseases like Parkinson also for
single healthy sperm is injected directly into each transplantation (Edge & Groves, 2019)
mature egg.
❖ Is it LEGAL here in our country?
❖ According to the Fourteenth Congress of the be construed to require a participant or beneficiary
Philippines S.B. 1342, the Constitution, Article II, to undergo infertility therapy
Section 15 provides: the State shall protect and
Surrogate Motherhood
promote the right to health of the people and instil
What is Surrogate Motherhood?
health consciousness among them. A fundamental
● It occurs when a woman agrees to carry a baby to
part of human experience is fulfilling the desire to
term and give it up to another set of parents to raise.
reproduce.
● The contracting couple may be unable to contribute
❖ Unfortunately, millions of Filipino women and men are
genetic material for some reason or the female is
suffering from infertility. While recent improvements in
unable to carry baby to term
therapy make pregnancy possible for more couples
● sometimes done for money or favor
now than in past years, the majority of group health
plans do not provide coverage for infertility therapy;
Kinds of Surrogate Motherhood
thus making it impossible for low and middle income
Altruistic surrogacy
families to avail of the technology. This bill seeks to
- When a woman offers herself to carry the child of
require coverage for the treatment of infertility in any
an infertile couple — or of others — for
group health plan or individual health insurance
philanthropic reason, not for money.
❖ This act is an act requiring coverage for the
treatment of infertility in any group health plan or
Commercial surrogacy
health insurance. This Act shall be known as the
- When it is carried out for financial gain, and is
“Family Build Act of 2007” which also has standards
often called womb for rent or womb for hire: “a
relating to benefits for treatment of infertility. A group
woman offers herself to carry a pregnancy in
health plan and a health insurance issuer, offering
exchange for money.”
health insurance coverage for treatment of infertility
deemed appropriate by a participant or beneficiary
Ethical Issues
and the treating physician. Such treatment shall
❖ Unethical for women to be used
include ovulation induction, artificial insemination, in
❖ Economic opportunity for women who have
vitro fertilization (IVF), gamete intrafallopian transfer
few economic option
(GIFT), zygote intrafallopian transfer (ZIFT),
❖ Legitimacy of selling humans
intracytoplasmic sperm injection (ICST), and may
❖ Pregnancy viewed as deeply personal
other treatment provided It has been deemed as
experience that should never be undergone for
‘non-experimental’ by the Secretary of Health
the sake of others
❖ In case of assisted reproductive technology (ART) ,
❖ What if birth mother changes her mind?
coverage shall be provided if the participant or
beneficiary has been unable to bring a pregnancy
❖ Kantians find practice of surrogacy problematic
into a live birth through less costly medically
since birth mother is clearly used as an incubator
appropriate infertility treatments.The patient has not
and not regarded as rational actor.
undergone four complete oocyte retrievals. The ART
❖ Kantians in favor as long as long as there is no
include in vitro fertilization, gamete intrafallopian,
overt coercion and if woman is paid and
ZGIT, embryo cryopreservation, egg or embryo
agrees to donate her body for selfless reasons
donation and surrogate birth. A group health plan
and is acting as rational; and autonomous
and a health insurance coverage, in connection with
individual
a group health plan.
❖ Kantians disagree with it are more likely to
❖ Any law, presidential decree or insurance, executive
compare the practice to a clinical form of
order, letter of instruction, administrative order, rule or
prostitution without the act of sex
regulations contrary to or inconsistent with, the
❖ Utilitarian argument against surrogacy could
provisions of this Act is hereby repealed modified or
grant simple equation which is the birth mother is
amended accordingly. Nothing in this Section shall
given money and the contracting parents get a
child they could not otherwise have but then
 argue that the long term consequences un one
or more ways.
❖ another argument argues that pain of separation
of birth mother outweighs the happiness gained
by the contracting parents. (Edge & Groves,
2019)

❖ Is it LEGAL here in our country?

❖ According to the Thirteenth Congress of the
Republic of the Philippines Senate Bill No. 2344
introduced by Senator Manny Villar, surrogate
parenting is a concept that is relatively new in
this country, although for a long time it has been
widely known in the U S . and in other well-
developed countries. Surrogate motherhood is
nothing but baby selling. It is similar to the generic
experiments that are done with animals who are
bred for certain purposes. A woman becomes a
surrogate mother when she agrees to conceive
a child in her womb only to give away the child
after birth to another person for a valuable
consideration. Babies are not products like
microwave ovens and automobiles.
❖ Pregnancy should never be reduced to a
commercial service. The enclosed bill proposes
to penalize not only surrogacy arrangement but
also the act of selling infants by their mothers. The
practice of surrogacy arrangement is morally
and religiously wrong. We see no difference
between surrogate motherhood and
black-market baby selling. Hence, both practices
are outlawed in this bill.