HMME Reviewer

BIOETHICS would be based on factors such as personal benefit, group

-Circa 1977-present – some of the greatest advances were benefit, and intentions (as to whether they are benevolent or
made malevolent).
TRADITIONAL ETHICAL THEORIES
3 APPROACHES
DEONTOLOGY - duty based ethics - Immanuel FOUR PRINCIPLE -doing medical ethics is a 1. Autonomy-free-will
- derives the rightness or Kant – “PRINCIPLISM” matter or balancing 4 or agency
wrongness of one's conduct from “CATEGORICA principle of autonomy, 2. Beneficence-to do
the character of the behaviour L IMPERATIVE beneficence, non- good
itself rather than the outcomes -John Rawl – maleficence, justice. 3. Nonmaleficence-not
of the conduct “ORIGINAL to harm
- judges the morality of an action POSITION” 4. Justice-social
based on the action's adherence distribution of benefits
to a rule or rules and burdens.
- GOAL: fulfillment of one’s CAUSISTRY -case based reasoning
duties or the carrying out of -applying role specific
obligations without regard to morality to the
one’s desire circumstance of a
- CONS: suspicious of desire or particular cases
happiness as a guide to moral -more emphasis on how
action important that a
-seeks basis for duties – PRIORI particular circumstances
PRINCIPLE (need to appeal to are for the proper
one’s experience) resolution of problematic
CONSEQUENTIALI - actions are good and bad based - cases.
SM upon their consequences UTILITARIANI -“circumstances make
- a morally right act (or omission) SM (we need to the case” (people
is one that will produce a good take the actions experience will have the
outcome, or consequence that generally proper principle or
-CONS: we only come to know lead to resolution suggested by
the normal effects of actions happiness or the case it self
through experience pleasure) -“paradigm” cases
-“Choose the action that is likely -JOHN -method in applied ethics
to produce the greatest good for STUART MILL and jurisprudence
the greatest number.” & JEREMY -rule-based reasoning
BENTHAM COMMUNITARIAN -offshoot of a larger -EZEKIEL
VIRTUE ETHICS - describes the character of a -ARISTOTLE BIOETHICS political and social EMMANUEL
moral agent as a driving force for -THOMAS movement pioneered by
ethical behavior, rather than AQUINAS Alasdair Macintyre,
rules Micheal Sandel, and
(deontology), consequentialism( Charles Taylor
which derives rightness or -US is a pluralistic society
wrongness from the outcome of in which few values are
the act itself rather than shared.
character), or social context
(pragmatic ethics)
-particular actions are so variable
that they require a good deal of
judgement, not inflexible rules
NOTE: The difference between these four approaches to
morality tends to lie more in the way moral dilemmas are
approached than in the moral conclusions reached. For
example, a consequentialist may argue that lying is wrong
because of the negative consequences produced by lying —
though a consequentialist may allow that certain foreseeable
consequences might make lying acceptable. A deontologist
might argue that lying is always wrong, regardless of any
potential "good" that might come from lying. A virtue CONSCIENCE
ethicist, however, would focus less on lying in any particular - Judges the complete act as good or bad
instance and instead consider what a decision to tell a lie or - Moral faculty which tells people subjectively what is
not tell a lie said about one's character and moral behavior. good or evil and which manifest their moral
As such, lying would be made in a case-by-case basis that obligation to them

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STAGE 2: Naively -right action is satisfying

LEVELS OF CONSCIENCE Egoistic the self’s need
LEVEL 1 -a characteristic -Basic sense of responsibility that Orientation -conform to obtain
characterizes the human person rewards
-General sense of value -positive reinforcement
-awareness of personal responsibility; - example: Children who
To be accountable performed well in school
-First principle of moral order: “DO would get a star (the more
GOOD AVOID EVIL” the merrier)
-all humans shares a sense of LEVEL 2: STAGE 3: Good -orientation to approval
goodness and badness of their deeds CONVENTIONAL boy orientation and pleasing others
-infallible STAGE -conform to avoid
LEVEL 2 -A process - Exercise of moral reasoning disapproval, dislikes by
-formation of conscience other
-deals with specific perception values, -CONS: Violates law to
concrete individual values. please other people
-it needs to be educated, formed, -often seen in adolescent
guided, directed, illuminated and -example: cheating in
assisted examination
-kneels before truth STAGE 4: -orientation to “doing
-“truth is supreme”; truth is the Authority and duty”
object which is sought Social order -showing respect to
-Church has the greatest role as a authority
teacher of moral values -conform to avoid censure
-Led us to analyze and understand our by legitimate authorities
situation in a particular way -Law abiding citizen
-fallible/absolute LEVEL 3: STAGE 5: -analyze the law and
-Steps: POST- Contractual discern it
1. Gather information CONVENTIONAL Legalistic -duty defined in terms or
2. Form morally certain judgment STAGE orientation contract
3. Act accordingly -general avoidance of
4. Accept responsibility for action violation of will or rights
Level 3 -An event -Judgment by which we evaluate a of others and majority will
particular action and welfare
-defined as an ultimate practical -community welfare
judgment on the morality of a STAGE 6: -fight for your principle
concrete action Conscience of -orientation to principles
-commanding to do good and avoid principle of choice involving appeal
evil orientation to logical universality and
-infallible (not absolute) consistency
-constitute the final norm by which a -conform to avoid self-
person’s action must be guided. condemnation
-Example: Civil
disobedience
STAGES IN DEVELOPMENT OF CONSCIENCE
 AUTHORITARIAN CONSCIENCE –conscience in
DIVISION OF CONSCIENCE
childhood; “must-conscience”
I. ANTECEDENT OR CONSEQUENT
 MATURE (ADULT) CONSCIENCE – “ought
ANTEDECENT – Before the action; judgment on the
conscience”; no longer sustained by fear of
morality of an action and the obligation to
punishment and mental limitation; originate from
perform or omit is passed before the action is
the conviction of the inner value of the moral
translated to reality; commands, forbids, permits,
obligation from the inner law of man’s nature and
exhorts
divine calling as spelled out in the center of the
human person which is true self; personal
CONSEQUENT – After the action; evaluates deed
responsibility
done; approves, excuses, reproves, accuses
SIX STAGES OF MORAL DEVELOPMENT (KOHLBERG):
II. CERTAIN OR DOUBTFUL
LEVEL 1: STAGE 1: -egocentric deference to
PRECONVENTIONAL Obedience and superior power CERTAIN CONSCIENCE - Judgment without fear or
STAGE Punishment -obey rule avoid error; all reasonably fear be excluded; must
Orientation punishment always be obeyed when it commands or forbids;
-often seen in children
wide moral certainty is sufficient (accompanied by
slight yet negligible fear of error because the

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possibility of error is of little probability; example:
assumption that physician will act responsibly)
DOUBTFUL CONSCIENCE – Uncertain concerning
the morality of an action; suspends judgment;
passes judgment with reasonable fear for erring.
III. RIGHT OR ERRONEOUS
ERRONEOUS CONSCIENCE
A. INVINCIBLY ERRONEOUS CONSCIENCE –
inculpable (guiltless); person has no awareness
of the possibility error; “honest mistake”
B. VINCIBLY ERRONEOUS CONSCIENCE –
Culpable; with some good will its errors could
be corrected; full accountability; cannot be
followed as a legitimate rule of action
C. LAX CONSCIENCE – judges something sinful to
be lawful; does not face up the gravity of the
moral situation; needs to reform their state of
mind; a wrongful act becomes normal
D. PERPLEXED CONSCIENCE –confronted with 2
alternative precepts; fear sin in whatever choice
it makes; choose the lesser evil
E. SCRUPULOUS CONSCIENCE – constant dread
of sin where there is none; very strong super
ego; OCD
MORALITY OF HUMAN ACTS
HUMAN ACT – outward expression of a person’s choice
- proceed from insight into the nature and
purpose of one’s doing and from consent free will
- Needs 2 constituent: knowledge
(intellectual constituent) & free-will (freedom from external
or internal compulsion)
ACT OF MAN - performed without intervention of
intellect and free will
DIVISION OF THE VOLUNTARY ACT AND EFFECT
I. VOLUNTARY ACT
A. PERFECTLY VOLUNTARY – performed with full
attention (knowledge) and full consent (free will)
B. IMPERFECTLY VOLUNTARY – attention or
consent of will is both imperfect
II. VOLUNTARY EFFECT
A. DIRECTLY VOLUNTARY – It is intended in itself
as an end; example: murder for the sake of revenge
B. INDIRECTLY VOLUNTARY – results are not
intended; inevitable result of an object direct
willed; example: medications side effect
C. POSITIVELY VOLUNTARY – Exercising active
influence on the causation of an object; caused
intentionally
D. NEGATIVELY VOLUNTARY – voluntary omission
of an act which could have averted an evil from
another person; permitted
OBSTACLES OF HUMAN ACT
A. IMPAIRMENT OF REQUIRED KNOWLEDGE
1. IGNORANCE
a. INVINCIBLE IGNORANCE – cannot be corrected
by reasonable diligence; prevents the act from
being voluntary in regard to that which is not
known.
b. VINCIBLE – could be corrected by reasonable
diligence; possibility of solving the doubt by means
of inquiry
2. ERROR –deficient education, influence of bad
company, reading misleading papers; overcome by
sound reason
3. INATTENTION –actual and momentary privation of
knowledge
B. IMPAIRMENT OF FREE CONSENT
1. PASSION/CONSCUPISCENCE –hinders reflection;
weakens attention; feelings
2. FEAR & SOCIAL PRESSURE – moral force against
will; lessens guilt as well as its merit
3. VIOLENCE – compulsive force by intrinsic agent
4. DISPOSITION AND HABIT – incline man to certain
ways of reaction conduct; habits weakens the
intellect and will in concrete situation
CASE 1: A first year med student who always receives
excellent grades gets a GWA of 77% and she commits
suicide.
- Human act; imperfectly voluntary; impairment of free
will; passion(overwhelming emotion: depression)
CASE 2: A resident assists in fallopian tube ligation on a
single prostitute because he may lose his job if he refuses to
assist (Under natural law ethics it is immoral; supposing that
the physician believes in the natural law ethics)
- Human act; imperfectly voluntary; impairment of
freewill; pressure (pressure of losing his job)
CASE 3: Maria salivates and feels like eating whenever she
sees a beautifully decorated cake
- Act of man; spontaneous biological
SOURCES DEFINING MORALITY OF HUMAN ACT
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OBJECT -action
-primary source for judgment on the morality
of an act
-can be morally good, evil or indifferent
-morally evil: presupposes the existence of
moral absolutes (prohibition of action w/c on
account on their object are considered
absolutely and intrinsically evil)
INTENTION -Goal
-the end or the reason for w/c the agent
undertaken an act
CIRCUMSTANCES -situation
-particulars of the concrete human act which
are not necessarily connected with its object
-who? What? When? Why? How? What
means?
FOUR PRINCIPLES
I. BENEFICENCE
 Obligation to do good
 Latin word: “Bene” – good
 Always goes along with non maleficence
II. NONMALIFICENCE
 We ought not to inflict evil or harm; do no harm
PRINCIPLE OF DOUBLE EFFECT
 Provides that a person may perform an act which
has risks or evil effect. Four conditions:
1. The action itself is good or indifferent A= g/I
2. The good effect and not the evil effect is the one I= g
directly intended by the agent
3. The good effect is not produced by means of evil gE=gA
effect. Good effect must follow the action at least
as immediately as the harmful effect
4. There’s a proportionate reason for permitting the C=PR
foreseen evil to occur
CASE 1: Giving sedative or analgesic to alleviate pain to a
dying patient even if it may shorten the patients’ life
- Action: Giving sedative/analgesic = Good
- Intention: To alleviate pain = Good
- Circumstances: dying patient = Proportionate
- Possible Effect: May shorten the life of the patient
- Non Violation of Principle Double effect
CASE 2: Giving morphine overdose to kill the suffering of
terminally ill patient upon his request.
- Action: Giving of morphine overdose = Bad
- Intention: to kill = Bad
- Circumstances: Suffering terminally ill patient = not
proportionate
- Circumstances: upon patient’s request
- Violation of Principle double effect
CASE 3: Performing an abortion to unmarried rape victim to
prevent psychological trauma
- Action: Performing an abortion = Bad
- Intention: Prevent psychological trauma = Good
- Circumstances: Unmarried rape victim = Not Proportionate
- Violation of Principle of double effect
CASE 4: Removal of a pregnant cancerous uterus when the
treat is the best recommended treatment to avoid spread of
cancer.
- Action: Removal of (a pregnant cancerous) uterus = Good
- Intention: to avoid spread of cancer = good
- Circumstances: pregnant cancerous uterus =Proportionate
- Circumstances: Best recommended treatment
- Non violation of Principle of Double Effect
PRINCIPLE OF LEGITIMATE COOPERATION
- Act is performed by more than one person
1. FORMAL COOPERATION –person is mainly responsible
for performing the evil action; advises, encourage, or
counsels the person principally responsible for the evil
action
2. MATERIAL COOPERATION – One becomes involved in
an action without the same intention of the evil doer
a. IMMEDIATE –one’s action contributes to the active
performance of the evil action so that the evil action
could not be done without his help; example: Nurse
who assisted the doctor perform abortion
b. MEDIATE – One’s cooperation is not needed in the
performance of the evil action but may assist in the
performance of an action; example: the pt who
undergone abortion was transferred to ward, and the
nurse is attending to her needs, making sure that she
is comfortable(but she has no intention in
participating in the abortion procedure)
III. AUTONOMY
 Latin: “auto” – self
 Obligation to respect the decision making
capacity of autonomous person
 Why? To dignify human
 Concept of independence
 Gave birth to : INFORMED CONSENT
 Autonomy vs. Nonmaleficence =
NONMALEFICENCE
 Your right is limited by the right of other people
IV. JUSTICE
 Giving what is due
 Obligation of fairness in distribution of benefits
and risk
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MIDTERM TOPICS: is Allowed:

1. Physician’s therapeutic privilege
TRUTH TELLING & CONFIDENTIALITY
Research
Patient’s right to the Truth o Randomized clinical trials
o Research in psychosis
Patient-physician relationship – basis for medical practice
o Placebo
b. Comprehension – if it is understood
c. Voluntariness
INFORMED CONSENT
d. Competence – capacity to make a decision
Rights – moral & inviolable power vested in the patient as a Limits of Patient’s Rights:
person in do, hold or demand something as his own 1. Do not include the right to die
2. Moribund condition
Duty – moral obligation to do or omit something in favour of
3. Not absolute
another according to the demands of strict justice
Methods of Obtaining Informed Consent
TYPES OF PATIENTS’ RIGHTS 1. Written
2. Verbal
Right of Self Determination (Principle of Autonomy) – moral
Emergency Situations: Consent not Required
right to determine what is good for himself
1. Comatose/obtunded patients
1. Right to informed consent – receive all necessary 2. Blind/illiterate patients
info 3. Underage/unable to understand the
Informed Consent – willing and uncoerced circumstance
acceptance of a medical intervention by a patient 4. Language-barrier patients
after adequate disclosure by the health professional; Implied/presumed Consent
knowledge of information about the consent to a Surrogate Consent
particular form of medical treatment before it is
administered
2. Right to informed decision
Informed Decision – necessary info and decision of a
medical treatment before it is administered
ALLOCATION OF SCARCE RESOURCES
3. Right to informed choice
Informed Choice – necessary info a patient should <manual>
know about a medical treatment or experiment so
HUMAN SEXUALITY
that moral choice can be made
4. Right to refusal of treatment ABORTION
ELEMENTS OF INFORMED CONSENT Abortion – expulsion of a non-violable fetus before the 28th
week of gestation
a. Disclosure – content of what a patient is told or
informed about during the consent negotiation Forms:
General Standards of Adequate Disclosure:
(Medical Standpoint)
1. Professional Practice Standard – necessary info
to disclose 1. Spontaneous, accidental or involuntary abortion
2. Reasonable Person Standard – patient-centered - No moral problem
3. Subjective Standard – what the patient needs to 2. Induced abortion
know 3. Therapeutic Abortion – aims to eliminate a real or
Necessary Items to Disclose: presumed risk for the mother precipitated by pregnancy
1. Current medical status, treatment
(Legal Standpoint)
2. Procedure, medication
3. Alternative treatment 1. Criminal Abortion
4. Risks and benefits
(Moral Standpoint)
5. Opportunity to ask questions
6. Right to withdraw (research) 1. Direct
7. Professional opinion - Principal end
Situation When Telling Part of the Truth or Delaying - Includes all types of abortion

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- Sought as an end or as a means to an end

2. Indirect
- Not wanted nor sought directly
- Consequence of an operation intended to cure a
gynaecological lesion, independent of pregnancy
Techniques of Induced Abortion
1. By dilatation & curettage – abortive techniques of long
standing; utilizing a carved blade introduced though the
vagina into a previously dilated cervix until it reaches the
endometrial wall; endometrium is scraped carefully until
all fetal remain and placental tissues are remived
2. By caesarean section or by abdominal hysterectomy
3. By suction technique
4. Via intra-amniotic infiltration – carries a risk of uterine
perforation
5. Via intravenous infusion of prostaglandin

GENETICS
DEATH & DYING
AIDS
PSYCHIATRY

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