MEDICAL ETHICS
1D PRINCIPLE OF MEDICAL ETHICS
Dr. Borja | Septem ber 25 , 2017
ME-03
PRINCIPLE OF CONFIDENTIALITY
Case #1. In the case of Carlos, tell Carlos that the sister
needs to know if the sister will be taking care of Carlos.
Though the risk of HIV infection is very small, ethics say
that the sister and the family members must know. You
can delay and move slowly/gradually until the truth will
be known. Nowhere for the doctor to side with the
patient because truth will be known.
- Truth is ABSOLUTE.
When to breach confidentiality?
1. When there is imminent threat of serious and
irreversible harm
2. No alternative to averting that threat other
than the breach of confidentiality
3. The harm that thought to be averted should be
proportionate to harm associated with
breaching confidentiality
Importance of confidentiality:
- Respect, improve patient-physician relationship
(patient will be hesitant to tell the doctor if
there’s no confidentiality)
- Trust and privacy between the physician and
the patient
Patient refused information:
 Like example you (physician) telling the disease,
risks and treatment so that he will be able to
choose the treatment he wants, but he said no
doctor I don’t want that information anymore
Patient gives you full trust and
confidence
Patient lacks decision making capacity/ incompetent
patient:
 Emergency – doctor will decide
 If not emergency – surrogate decision maker
 Surrogate means two things in medical
ethics
1. Surrogate decision maker - Substitute
decision maker usually members of the
family or someone close to the patient
2. Wombs/Uterus for rent – childless
couple would want a child but the
woman can’t bear the child. Get sperm
of husband and fertilize the wife’s
ovum and put that fertilized ovum to
Case #2. Nelly Lim vs. Court of Appeal
Story: Juan filed a petition for annulment of his
marriage with Nelly on the ground that the latter has
been allegedly suffering from mental illness called
schizophrenia “before, during and after the marriage
and until the present.”
The trial court allowed Dr. Acampado to testify,
she was qualified as an expert witness and was asked
hypothetical questions related to her field of expertise.
She neither revealed the illness she examined and
treated Nelly for nor disclosed the results of her
examination and the medicines she had prescribed.
Expert witness – tells about opinion
Ordinary witness- tells what he/she percieves
*Annulment of marriage – erases the marriage
Legal Separation – live separately and no sexual
privileges; bond of marriage still exists
*The cause/ground of annulment must exist at the
beginning of the marriage
Exception : Psychological incapacity – wherein it may
not exist at the beginning of the marriage but it will
manifest itself during the marriage
Principle of Stewardship
 Protect and care for your body and patient
 Between beneficence and justice
 Responsible use of society’s medical resources
(Medical professionals are the proper stewards
of these resources)
Ex. Health care spending without sacrificing
quality
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 Utilize most efficient means to diagnose and
treat
Conflicts
Supposing only limited meds in the ICU and 10 of them
wanted to be admitted to the ICU.
 Criteria to choose – select on the chance of
survival rather to the one with serious illness
 Ex. AIDS - young or old? – with greater chance
of survival
 Rich or poor? – you don’t choose in the richness
but of survival
 Importance in the community? Ex. Mayor –
chance of being healed
Evidence Based Medicine a basis for physician’s
judgement:
 from journals, experiments as result of surveys
 Readings from different international studies
Personal dimension of stewardship
Religious/Christian teaching on stewardship:
 Person is created by God
 Created in the image and likeness of God
 You’re life is a gift from God
 Respect life from conception to natural death
Social dimension:
 Person is a social being
 Interaction with others since no man is an
island
 Everybody should be your friend – opportunity
to be a member of the same class
 Share what you have
 Protect your friends
 Beneficence do good, be just, do not harm
Ecological dimension
 Stewards of the environment
PRINCIPLE OF DOUBLE EFFECT
2
 Principle in medical ethics that you do an act
that will produce two effects: either good or
bad
Certain Conditions to meet to justify double
effect:
1. The intention of the act must be good
2. The benefit must be greater than the harm
or at least equal
3. The act itself must be good or indifferent
4. The good effect must be sufficiently
desirable or outweigh the bad effect
Ex. Cancer patients undergoing chemotherapy
Organ transplant – requirement for the donor – donor
should not be harmed or injured as result of organ
removal
Ex. Kidney Transplant – you can compromise the
anatomical integrity for functional physiological
integrity
PRINCIPLE OF TOTALITY
 The relation of the whole in relation to the parts
of the whole
 Prioritize the good of the whole by sacrificing
the parts that will make it difficult for the whole
to function well
Ex. A deceased part of the body – sacrifice
(amputation of a gangrenous limb)
In case of Organ Donor – sacrifice the donor for
the good of the beneficiary
PRINCIPLE OF COOPERATION
 In medical practice – Physicians
Ex. The other doctor that helps the main
physician is the one that apply principle of
cooperation
Formal Cooperation – support, one in mind,
cooperate, intend , desire, approved the act;
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consists of an explicit intention and willingness
for the evil act.

a. Explicit – Ex. “Yes, I’m happy to drive the

getaway car because I want to be an
accomplice.”
b. Implicit – you do not agree but you went
anyway; attributed when even though the
cooperator denies intending the
wrongdoer’s object, no other explanation
can distinguish the cooperator’s object
from the wrongdoer’s object

Material cooperation – involvement of supporting

actor; lesser in the mean than the formal
cooperation – thus not identify himself with the
intention of the main actor; Forced to do the act;
consists of an act other than the evil act itself but
facilitates and contributes to its achievement

a. Immediate – objects to cooperate with the

main actor; the one directly cooperating
gets involved by openly and
straightforwardly taking part in the practice
of an evil action.
Exception that makes it permissible if it is
demanded or have no choice.
Ex. nurse in the operating room or he only
knows when he was already in the
operating room
b. Mediate/Remote – consists of an act that is
not intimately connected with the
performance of an evil act as in formal and
direct cooperation but whose effect may
have an indirect bearing upon it.
Ex. the one that sterilizes the instruments
or the one that cares for her wounds