BIOETHICS

Applied Clinical Ethics

Dr. Irwina M. Lazo November 22,
APPLIED CLINICAL ETHICS 2018
Cloning Procedure
I. Care at the beginning of life Table 1
1. In-vitro fertilization (IVF) Donor supplies
Tissue Cell Donor
2. Artificial insemination unfertilized eggs
3. Surrogacy Cells from Animals
to be cloned in the
4. Genetic engineering Egg Cell
lab so they do not
5. Human cloning grow or divide
6. Abortion Nucleus is
Nucleus is Removed
7. Contraception & birth control removed
Nucleus fuses with empty egg after electric current is
II. Other moral issues applied.
1. Stem cell research & therapy The reconstructed embryo grows for 7 days
Embryo’s implanted into surrogate mother
2. Organic transplant
Cloned animal is born with exact DNA as the tissue cell
Human Cloning of the Donor.
*See last page for Image version of Table 1 (the one with a sheep)
 Greek word “clone” – twig Cloning
 Cutting a plant stuck in the soil in which the cut *See last page for Image of Human Cloning. (Human)
twig is able to grow into a “new plant” with the
same genetic composition as the original Have humans been cloned?
Despite several highly publicized claims, human
 Non-sexual reproduction
cloning still appears to be fiction. There currently is no
 produce a copy of exact Genome of an original
solid scientific evidence that anyone has cloned human
specie embryos.
 In animals: Remove the nucleus of somatic cell;
you will have a donor and get the egg cell; try to Ethical Considerations – Cloning
remove both nucleus & use the somatic cell to A. Justifications – human cloning
the empty egg after an electric current & it will a. Way to perpetuate genius
be implanted to a surrogate to produce a clone b. Improvement of human race
individual c. Prevention of genetic disease in selected
 There is animal cloning of sheep and pigs fosterity
 Animal cloning is not available in the d. Provide “immortality” to donors
Philippines B. Christian Ethics:
o Chromosomal manipulation or intervention
Reproductive cloning: ex. 10 clones of myself is contrary to the dignity, integrity &
identity of the human being
Therapeutic cloning: form an embryonic stem cell
C. Inviolability of life:
o Embryos are destroyed

D. Stewardship:
o Process is artificial being a laboratory
procedure
E. Nonmaleficence:
o Concept of family is distorted

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 BIOETHICS
Applied Clinical Ethics
Dr. Irwina M. Lazo November 22,
o Psychological & physical risk to the 2018 *Principle of Double Effect applies
child
F. Justice:
o Only the rich can afford the procedure C. Eugenic Abortion
 Selective abortion
G. Respect for persons:
 Abortion of fetal indication – get rid of abnormal
o Denatured & destroyed by
babies to avoid “contaminating” the human race
stockbreeding with no uniqueness &
individuality  Depends on the gravity of the fetal abnormalities
o Embryo becomes tools for  Ex. Fetus has a genetic chromosomal disorder
experimentation  Terminate as early as possible
H. Personalized Sexuality  Depends on the gravity of fetal abnormality

D. Indirect abortion
Abortion  Removal of the fetus as a secondary effect of a
 Expulsion of the living fetus from the mother’s legitimate or licit action, which is the direct and
womb primary object of the intention.
 Termination of pregnancy, spontaneous or by  “Principle of double effect” applies
inducement, prior to age of viability
 20th week- age of gestation
Total Effect/Double Effect
Viability:  When an act has both good and bad effects, it is
permissible if:
 Child capacity to live independently of its a. Action directly intended must be good in
mother after it has left the womb. itself
b. Good effect must follow from the action
Types of Abortion: immediately as the evil effect
A. Natural
c. Foreseen effect must not be intended or
B. Therapeutic
approved but merely permitted to occur
C. Eugenic or selective
d. There must be a proportionate & sufficient
D. Indirect
reason for allowing the evil effect to happen

Principle of double effect

A. Natural abortion
 Removal of the fetus as a secondary effect of a
 Expulsion of fetus through spontaneous or
legitimate or licit action, which is the direct and
accidental causes
primary object of the intention.
 “miscarriage” – layman’s term
 “Principle of double effect”
 Unintentional & involuntary
 Devoid of moral significance Christian Ethics
All types of abortion is intrinsically wrong depends on
B. Therapeutic abortion the situation
 Deliberately induced expulsion of a living fetus
to save the mother from the dangers of death
brought about by pregnancy
 Health of the mother vs. life of the fetus
 Ex. Choose between the health of mother or life
of fetus
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 BIOETHICS
Applied Clinical Ethics
Dr. Irwina M. Lazo
Death
- Imminent approach of death (Dying)
- Irreversible cessation of life (Death)
Somatic death:
 Precedes cessation of function of body system,
organs and cells
 Cessation of respiration, heartbeat, movement,
reflexes & brain activity.
Stages of Death:
a. Pallor mortis
b. Algor mortis
c. Rigor Mortis
d. Livor Mortis
Changes that occurs after somatic death
a. Pallor mortis: after-death paleness
b. Algor mortis: cooling of the body after death
influenced by temperature of the immediate
environment
Ex. Humid environment- delayed cooling
c. Rigor mortis: stiffening of skeletal muscles
d. Livor mortis: reddish-blue discoloration on the
dependent portion of the body
Organs die at different rate:
 Brain cells - <5 minutes after somatic death
 Heart – 15 minutes
 Kidney – 30 minutes
Views of Death
1. Physiological definition
- A person is dead when the heart stop beating &
pulsations stop
- Example: CPR for 30 minutes to 1 hour and still
flat line on ECG with no pulse that is
Physiological Death
2. Religious or philosophical definition
- Separation of the body from the soul
- No one knows when the religious death happens
3. Brain death definition
- Is based on “a condition in which the brain is
completely destroyed, and in which the cessation
of function of all other organs are imminent and
inevitable”
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November 22,
2018- Example: no response at all, no reflexes
4. Cellular definition
- Complete disintegration & breakdown of
metabolic processes of the body’s substances
- Disintegration of everything from the human
body
Ethical Theories
*** To treat a human being who has irreversibly lost all
brain functions as if he/she is still alive seems to be “an
insult to the dignity” of the person
*** maintenance of a dead person on life-support
systems for no reason at all is an irresponsible waste of
economic & social resources.
Christian ethics:
Death is a part of nature
Let nature takes its course
Utilitarian, situation pragmatist ethics endorses brain
death definition
If categorized as brain dead person is already dead; you
can withdraw all life supports
Terror of Death
1. Flesh is the means to our control of our world
- Comprehensive loss of possession and control of
our world
- Example: Earthly material things- you can’t
bring it with you when you die
2. Flesh is instrumental & site for disclosure of the
world
- Separation from property-less creation & the
world (for the beholding of ritual, arts, & daily
routine)
- Example:
o You can’t do your daily routine
o You can’t attend your social functions
3. Flesh is revelatory
- Loss of revelatory power;
It tears us away from the community
4. Threatens us with separation from God
- Fear of “hell”/eternal suffering
“Death is not the opposite of life, but a part of it”.
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 BIOETHICS
Applied Clinical Ethics
Dr. Irwina M. Lazo November 22,
Ultimate Purpose of Life: To be with God/ Creator 2018

Suicide  “Self-killing” or “self-murder”

Suicide accounted for 1.4% of all deaths worldwide,  Direct, willful destruction of one’s own life
making it the 17th leading cause of death in 2015.– WHO

In the Philippines, statistics are harder to come by
because society still treats the topic as taboo. Most
suicides are placed under the category of death by
“intentional self-harm.”
Direct: Primary object is killing oneself
Willful: deliberate, voluntary & intentional
Destructive: Means of terminating one’s life is brutal,
harsh, bloody, violent acts.

Example: Riding a motorcycle at 200km/hr and

hit an object to kill himself

1 Sri Lanka 34.6

2 Guyana 30.6
3 Mongolia 28.1
4 Kazakhstan 27.5
5 Cote d’lvoire 27.2
6 Suriname 26.9
7 Equatorial Guinea 26.6
8 Lithuania 26.1 Suicide notes
9 Angola 25.9  Suicide is 100% preventable
10 South Korea 24.1 - Speak up. Reach OUT
11 Sierra Leone 22.1
12 Bolivia 20.5 Causes of Suicide
13 Central African Republic 19.6 A. Biological perspective
14 Belarus 19.1 - Genetic & biological factors
15 Poland 18.5 - Psychotic disorders – schizophrenia
16 Zimbabwe 18.0 - Alcoholism
17 Russia 17.9 - Temperament (impulsive & violent behavior)
18 Swaziland 17.9 B. Psychological Theories
19 Cameroon 17.5
a. Sigmund Freud (1900s)
20 Latvia 17.4
 Hostility turned against self
21 Ukraine 16.6
22 Burkina Faso 16.5 b. Karl Menninger (American psychiatrists)
23 Belgium 16.1  Suicide has interrelated & unconscious
24 India 16.0 dimensions
25 Hungary 15.7 1. Revenge/hate (a wish to kill)

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 BIOETHICS
Applied Clinical Ethics
Dr. Irwina M. Lazo November 22,
2. Depression/hopelessness (a wish to die) 2018
Euthanasia
3. Guilt (a wish to be killed) Greek words:
C. Sociological Theories a. Eu – “easy”
a. Emile Durkheim b. Thanatos – “death”
- Suicide is related to social integration
Easy death
- Lack of social bonds - Easy, painless death
- Disrupted relationships
- Sudden change in status (unemployment) Mercy-killing
- Released from incurable & prolonged suffering
*** lack of social strategies to cope with stress
I. Self-administered
Young adults are at high risk for suicide because of
1. Act of commission (active)
volatile temperament and coping mechanisms are not yet
- A terminally-ill patient will deliberately &
establish. They are trying to identify themselves with the
directly terminate his life by employing painless
others in the community. (No solid reasoning and
methods
thinking)

Seniors (old people/elderly) committ suicide because 2. Act of omission (passive)

they feel hopeless and self-pity. - Whenever one allows oneself to die without
taking any medicine or refusing medical
Suicide: It will depend how the person will react to the treatment
society, to other people and to cope up with stress. - Example: Stage 4 Carcinoma; refuse to have
chemotherapy
A means to end reality.
- Maintenance medication; stop taking the
medicines
Application of Ethical Theories on Suicide
II. Other-administered
Christian Ethics 1. Active & voluntary
- Violates inviolability of life & stewardship - Either a physician, spouse or a friend will
considers suicide as self-murder terminate the life (of the patient) upon the
patient’s request, by using positive methods
Utilitarian principle
- Justifiable if suffering/pain is too much if a
person is already a financial liability 2. Passive & voluntary
- A terminally-ill patient is simply allowed to die
Kant’s ethics by the physician, spouse or an immediate
- Principle of autonomy (right to self- relative upon the patient’s request employing no
determination) positive method

Pragmatist principle
3. Active & non-voluntary
- Most practical & realistic when life is too much
Example: patient will not decide for himself
of a burden
4. Passive & non-voluntary

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 BIOETHICS
Applied Clinical Ethics
Dr. Irwina M. Lazo November 22,
Application of Ethical Theories on Euthanasia 2018

Christian Ethics
- mercy-killing is intrinsically wrong even if the
motive is good, the end does not justify the mean
- against principles

Principle of Double effect

- peaceful death as legitimate
- to give medication for the relief of pain

“To the well organized mind, Death is but the next great
adventure” – J.K. Rowling

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