bioethics
Health care ethics
• Ethics
Þ Declaration of Right and Wrong – process
oriented, involves critical analysis of
action – reflects the “should” of human
behavior
Þ Weigh the pros and cons
Þ I needs to have a rational behind it,
hindi basta-basta lang
Þ Leave your biases aside
Þ The Ethics of before, is the ethics of
today
Þ Study of moral conduct or principles of
underlying desirable types of human
conduct
§ Science of Ideals – guides our judgement
concerning morality of human acts
Based on this reflection, one derives the normative
principles which govern one’s relationship with others,
the environment and God.
“What are the unchanging principles that guide me in
the determining good from bad, right from wrong?”
Being a moral person is not the same as ethical person
• Moral
Þ Refers of human conduct itself –
application of ethics
Þ Fundamental standard of Right and
Wrong that an individual learns and
internalizes – usually during early stages of
childhood
Þ Reflection is done in a situation
Kholberg’s theory
…….
• Morality
Þ Refers to the practical application of
ethical principles in determining good
moral behavior
“What should I do in this situation? Do I have the right to
do this? Am I willing to be accountable for the
consequences of my action?”
There are many complex ethical questions/ dilemmas
often do not have definitive answers
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Even when there are optimum conditions for arriving at
a decision regarding an ethics-laden situation, the
possibility that not everyone will be completely satisfied
is always there.
Why Study Ethics?
Þ Scientific Advances
Þ Inequalities in socio-economic, education
and political positions
Þ Finitude of resources
Þ Changes in the doctor-patient
relationships
Þ Rampant unethical behavior of a lot of
health care professionals
Ra. 9173 – Taking pictures and phones during duty is not
allowed
Different Kinds of Ethics
1. General Ethics – presents truths about human
acts – general principles of morality
2. Special Ethics
Þ Applied ethics – applies principle of gen
ethics
Þ Individual – god self fellowmen
Þ Social – fam state world
3. Virtue ethics
4. Professional ethics
Virtue Ethics
- Aristotle – believed in “ergon” (tendency
towards fulfillment)
- To achieve “eudamonia” (happiness)
• Virtue – a trait of a character that allowed people
to achieve the fulfillment of this tendency
Virtue according to Aristotle
“Both fear and confidence and appetite and anger and
pity ang general pleasure and pain may both be felt
both too much and too little and in both cases not well;
but to feel them at the right times, with reference to the
right objects, towards he right people, with the right
motive and in the right way, is what both intermediate
and best and this is characteristic virtue”
Aristotle’s Golden Menu

Deficiency ß Golden Mean à Excess
In deficient and Excess it’s a vice, if in the Golden Mean
it’s a balance and virtue. Golden mean means if you
didn’t do anything you’re a coward. It is a deficiency of
the character. If you cannot control it, call for help.
Being virtue is not about being deficient nor excess, its
about balance.
- Acting virtuously involves judgement (practical
wisdom)
- Includes thinking caring and sensitive
perception
§ Prudent person – consistently makes
judgements about the rightness/
appropriateness of what is to be done and be
motivated by these judgements to act
accordance with them; you do it all the time
“how am I to live well?”
§ Habit – an action being done consistently
- Upbringing is very important in moral
development
- Role Model`
- Providing students with appropriate role
models/ developing habits appropriate to a
virtuous person by observation of virtue in
actions
- If we can just focus on being good people, right
actions will follow
- 2 important points on virtue ethics
1) Choice to do the right thing - The right
thing to do cannot always be laid down
in a rule. Reception of the particular
case or situation is needed
2) Appropriate emotion - It matters what
one feels
Claims of virtue ethics:
1. An action is right if and only if it is what the agent
with a virtuous character would do in the
circumstances
2. Goodness is prior to rightness- person matters
before the action
3. The virtues are irreducibly plural intrinsic goods-
virtues cannot be reduced to just one value but
various virtues are necessary for good actions
4. Some intrinsic goods are agent relative- every
action depends on the person
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5. Acting rightly does not require we maximize the
good- good is not enough- “excellence” is
needed
PROFESSIONAL CODE OF ETHICS
The normative principles which govern a professional’s
standards of behavior both as individual and as he/she
relates with society, the environment and God
“What are the unchanging principles that determine my
behavior and functions as a professional?”
1989 – PNA promulgated a new code of ethics and was
approved by the BON through its BON Resolution
#1955 s. 1989
RA 9173
BON Resolution 220 series of 2004 – promulgation of
the code of ethics for registered nurse
BIOETHICS COMMITTEE- offers recommendations only
1) Issues of patient care that presents as ethical
dilemmas
2) Recommendatory, they are not the final
decision maker
3) The institution’s ability to protect the rights and
interest of clients in general
4) The development of institutional policies and
educational programs on ethical issues
RESPECT FOR PERSON- most fundamental human
right; foundation of all ethical principles, respects the
worth and value of a person
Who and What is a Person?
- From the time of conception to NATURAL DEATH
• Conception – starts at fertilization
• Personhood - depends on the values, attitudes,
beliefs and needs
All Human beings have needs and anything that fulfills a
need is a VALUE
- Values give direction and meaning to life and guide
a person’s behavior. They are freely chosen,
cherished and consistently incorporated into one’s
behavior.
- Values are shaped by culture, ethnicity, family,
environment and education

- Everybody is different and what makes one person
happy may leave another person feeling anxious or
disengaged. Defining your personal values and
then living by them can help you to feel more
fulfilled and to make choices that make you happy,
even if they don’t make sense to other people.
- Value awareness
• Attitudes - one’s disposition toward an object
or a situation; emotional or mental mindset;
positive or negative
• Beliefs - ideas that one accepts as true- one that
changes the least- opinions, decisions
• Behaviors - observable actions
Have you ever been in any of these situations?
- Someone said or did something that you strongly
disagreed with, but you didn’t speak up about it and
felt ashamed afterwards
- You’re so busy pleasing other people that you’re not
even sure what you own true values are.
Key Concepts:
- All human interactions are value based
- Nurses must clarify and respect the values of
others and examine their own values
- Values are enhanced and refined by
experiences that cultivate values
development such as interactions with
people of differing values and viewpoints
and experiences that challenge one’s way of
thinking
“Good values are easier caught than thought”
Values and Needs
- Maslow’s Hierarchy of Needs (Biological,
psychological, social and spiritual and
creative needs)
- St Thomas Aquinas
Þ need to preserve life
Þ need to procreate
Þ need to know the truth and the need
to live in society
- If you know the truth, then you can make
good judgement
- Ethical problems exist when we have to
make decisions so that all these needs will
be satisfied in an integrated and consistent
manner
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• Human rights - needs and values as it relates to
other human beings
¬ it is universal
¬ equal among everybody
¬ not a product of human creativity but
inherent to us
Universal Declaration of Human Rights (1948) –
respects the dignity of the human person (after World
War II)
- A lot of experimentation was done during
the time of Hitler.
- Sulfonamides from Sulfur on wounds on
Jews (prisoners of war) but not Germans
- They cannot do something against you
because you are a person and you have your
own rights
Basis of Human Dignity
A. Salvation History
1. Creation of man
2. Fall of Man
3. Promise of a Savior
4. Preparation for the Coming
5. Fulfillment of the Promise
6. Establishment of the Church
7. Heavenly Kingdom
» Image and likeness of God
» Christ Redeemed us
» Rational beings
SIGNIFICANCE OF BEING A PERSON
- Has an inherent dignity which must be
respected
- A person should not be destroyed;
uniqueness must not be altered; genes can’t
be manipulated; organs removed without
any reason; one can’t be cloned
- Actions should be done to satisfy one’s
needs not another’s interest. One cannot be
examined, treated experimented, studied
on for another person’s gain.
- A person should and can decide what is
BEST for one (autonomy and informed
consent) without constraint from another.
One’s intelligence and free will fosters
rational choices which one is responsible for
(well-formed conscience)

1) Has an ultimate destiny- to live with God
- To fulfill this, one has needs that must be
met, resources must help one meet these
needs; but he is only a steward
2) Lives with other persons in the community
- Interacts with people; helps them in times of
need
1st principle of Morality: Principle of
Human Dignity
All ethical decisions (made by patients and healthcare
givers) must aim basically and ultimately at human
dignity
- They must protect, defend, enhance and
enable the person’s worth.
- They must aim for the maximum and
integrated satisfaction of every person’s
needs, as an individual and members of his
community.
HUMAN DIGNITY
- Every human being has an inner worth and
inherent dignity. These he possesses not
because of what he has or what he does but
because of what he is: a human person
- As a human person, he must be respected
regardless of the nature of his health
problem, social status, competence, past
actions
- Decisions about health must aim at the
maximum integrated satisfaction of his
needs: biological, psychological, social and
spiritual
- Certain actions may never be done because
performing them would constitute a
violation against the person’s dignity
- Newborn, healthy adult, senile elderly
- Comatose patient, crazy individual
- Illiterate slum dweller, university president,
uneducated housemaid, convicted killer
3 Basic Laws
1. Eternal law
¬ will of God
¬ divine revelations
2. Natural law
¬ human reason and experience used to
determine what actions best serve true
human welfare- nature of man
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¬ divine revelation manifested through
reason
¬ a system of rights held to be common to all
humans and derived from nature rather
than from the rules of the society
¬ it dictates that now we makes decision we
base it to what comes naturally to us or what
is our nature as man
¬ innate in us
3. Positive law
¬ dictated by the authority of the church or
state
CONTENTS OF NATURAL LAW
Properties of Natural Law
1. Universal – applies to all
2. Obligatory – all of us are bound to it
3. Recognizable – no need to be explained
thoroughly
4. Unchangeable – Law of before is the law of
today
CONSCIENCE
“to follow one’s conscience” is not……
§ to follow feelings or emotions
§ to follow law or custom
§ Blind obedience to the inspiration of God
§ Follow personal freedom and autonomy
(leads to conflict)
“The capacity to make practical judgments in matters
involving ethical issues”
o It involves reasoning about moral principles
o Must be rooted in reality and truth and not on
mere will or desire or blind choice
o Sound, true and certain conscience- own
perception, sound education, understanding of
natural law, traditional wisdom, teachings of
family and Church, experience
o Conscience can be in error as when one
misunderstands principles, misjudges facts or
is led by misguided affections
o Time is important in making a good decision
o In making a major decision, STOP FIRST
o If you make a wrong decision, accept the
consequences

o One is culpable (accountable) of an erroneous
decision of conscience only within one’s
capability and freedom to prevent the error.
QUALITIES OF CONSCIENCE
A. PERSONAL FREEDOM
1) Free
2) Unfree - impeded by some obstacles such as
fear and anger
B. OBJECTIVE FREEDOM
1) Correct - subjective conforms to the objective
moral values
2) Objective - norms of morality
3) Erroneous - lack of conformity to the objective
norms of morality
4) Culpable - one is in error and therefore
responsible
5) Inculpable - has erred in good faith
C. MORAL ATTITUDE
1) Lax - careless in its effort to seek the truth
2) Strict - follow to the letter
3) Scrupulous - tends to judge sin to be present
when there is none
4) Pharisaical - judgmental towards other; you are
right and everything is wrong
5) Clear – conscience that critically thinks about the
situation
6) Callous- worst type; no sensitivity to sin
D. DEGREE OF CERTITUDE
1) Perplexed - wrong if you don’t do; wrong if you
did
2) Doubtful - lack of sufficient evidence
3) Probable - made a decision already but still
admitting the possibility that the opposite is true
4) Certain -
CONSCIENCE FORMATION
§ Faced with a specific ethical dilemma, one
should use his conscience.
§ Making moral decisions demand mature
responsibility
§ A fully mature and responsible conscience
should be free, correct, clear and certain
§ We must follow our decision only after we have
done our best to search for the truth regarding
the issues facing us
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theories of Ethics
Utilitarianism
- Utility means use
- telos- “end”; teleology
- right action is that which has the greatest utility
and no action is in itself either good or bad
- if the end is good, then the action is good
- consequentialism- action is judged as good or
bad in relation to the consequence, outcome or
end that is derived from it
- “the end justifies the means”- sometimes it is
possible to do wrong to achieve “right”
- Utilitarianism- the only right action are those
that produce the greatest happiness to all
concerned
- “Primary responsibility is to support the interest
of the group”
o Example: One child policy of China
Advantages:
- easy to use
- can justify many decisions based on the
happiness principle
Disadvantages:
- average happiness of all or total happiness for
few
- harm can be done to the minority
- what constitutes happiness? Who determines
what is good? end justifies the means
Deontology
- Deon- “duty”- “duty oriented”
- Nature of the action
- Kantinism – “one treats others always as ends
and never as means – respect for person –
making a person’s end your own treating others
the same way you treat yourself”
- rationalist view that the rightness or wrongness
of an act depends upon the nature of the act
rather than the consequences that occur as a
result of it
- human beings have the freedom,
thoughtfulness and sensibility to act in a moral
manner- knows what he/she ought to do
- Respect a person worth/dignity
- A person’s action is right if it follow moral rules-
fair, honest, doing good
- A person’s action is wrong, without exception, if
it violates these rules
- Consent is difference from assent

- Parents give consent, but if it is a child, you
assent to procedure (7-17 years old)
- Philippine Pediatric Society: You can get assent
at the age of 7
- Consequences (-), action still ethically right if the
original motive is consistent with moral precepts
- Nurses code of ethics- importance of fulfilling
duties that are inherently owed to patients
o Example:
o If the client asks the nurse to promise to
tell the truth regarding her diagnosis
and prognosis, the
o nurse is duty bound to keep this
promise.
Advantages
- provides clear guidelines for judging the
rightness and wrongness of an act
- recognizes the dignity and autonomy of
individuals and allows all people equal
consideration
Disadvantages
- problem with disregard for consequences
- all ethical precepts are viewed as equally
important
- exceptionless and rigid
Religion Answers: Secular Answers:
» Revelation » Reason
» Scriptures » Experience and
» Church tradition observation
» Experience » Institution
» Social
agreement
CONSCIENCE FORMATION
- Diligently learning the laws of moral life
- Seeking expert advice on difficult cases
- Asking God for light through prayer
- Removing the obstacles to right judgment
- Personal examination of conscience
“My conscience is my guide”
“What I don’t know won’t hurt me”
“It is God’s will”
2nd Principle: Principle of Well-Formed
Conscience
To attain the true goals of human life by
responsible actions, in every free decision involving an
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ethical question, people are morally obliged to do the
following:
1. Informed themselves as fully as practically
possible about the facts and the ethical norms
2. Form a morally certain judgment of conscience
on the basis of this information
3. Act according to this well-formed conscience
4. Accept responsibility for their actions
3rd principle: The Principle of Stewardship
and Creativity
- It guides people in their ethical management of
their life with others and of the limited resources of
this world
- It calls for personal, social and ecological
responsibility
“the office, duties and obligations of a steward”
“the conducting supervising or managing of something
especially: the careful and responsible management
of something entrusted to one’s care”
The gifts of multidimensional nature and its natural
environment should be used with profound respect for
their intrinsic teleology (purpose they serve) and
especially the gift of human creativity should be used to
cultivate nature and environment with care set by the
limits of actual knowledge and the risk of destroying
these gifts
And especially the gift of human creativity should be
used to cultivate nature and environment with care set
by limit of actual knowledge and the risk of destroying
these gifts
The principle of Stewardship
- It guides people in their management of their life
with others and of the limited resources of this
world
- It calls for personal, social and ecological
responsibility
- It advocates an end to the huge inequalities there
are between the few rich and the many poor
“The evils of modern technology are not the result of
creative use of knowledge but of rash exploitation of a
nature little understood”
“Research and experimentation, with all the risks
involved, are necessary but we must proceed with
reverence for the persons and the environment at risk”

1. Personal Dimension of Stewardship
The Human Person
- Individual of rational nature
- Created in God’s image and likeness
Human Life
- A great value
- A gift of God
- Human life is inviolable and sacred
- Human life must be defended from moment of
conception to natural death
The stewardship or right use of our faculties and powers
as rational creatures “in accord to their God-given and
natural purpose”; the care of our own bodies
• Health - a dynamic harmony within the body
• Sickness - part of life; at times caused by an
unhealthy lifestyle
We are responsible for our own health and therefore our
health has an ethical dimension
2. Social Dimension
- The human person as a social being
- Poverty in Spirit; a simple lifestyle; solidarity with
the poor
- Catholic healthcare ought to be distinguished
by service and even advocacy for the – most
vulnerable
- Principle of Justice/ Beneficence/ Non-
Maleficence
3. Ecological and Biomedical Dimension
- Ecological crisis
- Co-creators with God and Under God
- Creation has its own goodness and perfection
but it did not come out of the hands of the
Creator as completed- fully completed. It was
created “on the way” towards perfection still to
be reached and to which it is destined by God
(CCC, no 302)
Ecological and Biomedical Dimension (Principle of
Creativity)
- God gave us 2 gifts: human nature (intelligent
freedom; creative intelligence) with biological,
psychological, ethical and spiritual capacities and
the environment
- We have the need and the right to improve our
bodies and to develop medical technology that
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prevent and remedy the defects to which we are
liable
- False principle: “If it can be done, it should be
done”
- “Should it be done?”- YES- develop and use the
technology to do it
- Stewards of the environment- we can cultivate and
improve the earth with modern technology but not
do it carelessly- it should be creative
Medical Experimentation
1. Preceded by research with animals
2. Respect for subjects as human persons
3. Respect for social justice
4. Respect for the principle of informed consent
5. Approval of Ethics Committee
Research Codes:
1. Nuremberg Code (1949)- foundation of all
research ethics codes
10 principles
- Voluntary consent, results need to be of good to
the society, animal experiments 1st, avoid
unnecessary physical and mental suffering/ injury,
should not be done if it will cause death/disability;
risk vs benefits, proper preparations and adequate
facilities , only on qualified patients, free to end
participation, researcher must be prepared to
terminate experiment at any time
2. Declaration of Helskinski (1964, 1975, 1983,
1989, 1996, 2000, 2008)
- Developed by WMA- guidance to research not
present in Nuremberg Code; for doctors doing
research on their patients
3. Belmont Report (1976) (Medical and Behavioral
Research)
- Practice vs Research
HUMAN RECONSTRUCTION
- God made human beings free and intelligent- we
have the right and obligation to improve
ourselves- good stewardship
- But we must use it with profound respect for God’s
creation especially if it will undermine the very
freedom and intelligence given to us by God
- We should not as faithful stewards, harm but rather
improve and care for them. We have to treat them
with utmost respect, use originality and creativity
to cultivate them, know and respect their limits.
We cannot contradict human nature.

4thPrinciple: Principle Of The Totality Of
The Human Person
To promote human dignity in community, every person
must develop, use, care for, and preserve all of his or her
natural physical and psychic functions in such a way that:
A. Lower functions are never sacrificed except
for the better functioning of the whole person
and even then with an effort to compensate for
this sacrifice.
B. The basic capacities that define human
personhood are never sacrificed unless this is
necessary to preserve life
- To be a complete human being is not merely
having the higher level of functions but to have all
the basic human functions in harmonious order
- Human body functions contribute to higher
functions not merely by supplying what is needed
for physiological functioning; they also supply part
of the human experience that is essential to human
intelligence and freedom
Conditions for principle of totality
1. That the organ, by its deterioration in function,
may cause damage to the whole organism or at
least pose a serious threat to it
2. That there is no other way than taking the
indicated action against it of obtaining the
desired good result
3. That the damage being avoided to the whole is
proportional to that which is caused by the
mutilation or incapacitation of the part
- This principle does not apply to moral organisms
(family, society & humanity)- a person is still
independent- he is not a subordinate to any
group- “He is the subject, principle and end of all
the social institutions
- Authority cannot directly dispose the physical and
personal being of a person- removal of the
undesirable or weak parts of the society
- It applies to the management of health and
integrity of the body
- It throws light to the licitness or illicitness of all
kinds of medical interventions, surgical
procedures and transplants
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- A person can dispose of individual parts,
destroying them, if and to the extent that is
necessary for the good of his being as a whole, to
ensure its existence or to avoid and to repair grave
and lasting damage which could not be avoided in
any other way
Why is it permissible to sacrifice one of the basic human
capacities to preserve life?
- Not to sacrifice one basic capacity from the other
- Not for the better functioning of all other human
capacities
- But sacrificing one function so as to continue
functioning at all
MUTILATION
- Destruction of member, organ or part of the body
(organic) or the suppression of a physical function
(functional) in such a way that the organism
becomes no longer basically whole
Types
1. Direct- willed in itself, as end or as means,
intended and caused
2. Indirect ( therapeutic)- caused by the exigencies
of the health or survival of the patient; at times
willed as means, at others tolerated as an
unavoidable side effect
Direct mutilation- intrinsically wrong- offends human
dignity- individual does not have the right to mutilate
himself, much less does society
Therapeutic mutilation- licit as an act of good
stewardship of the body – necessary for the survival of
the patient or to free him of proportional sufferings or
infirmities
STERILIZATION
- A medical or surgical intervention which causes a
patient, incapacity of generation
- Therapeutic- inevitably required for the survival
and health of a person- sexual organs- integrating
parts which must yield to the good of the whole;
licit if:
- sickness is grave, certainly diagnosed and
definitive that it offsets the evils of sterilization
- it is necessary because it is the only possible
effective remedy
- exclusively curative- intention is important
 TOQUILAR
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