Other relevant Ethical Principle:

1. Principle of Double Effect

- When an act is foreseen to have both good and bad effects is applied. The direct freely
chosen effect of the act must be morally good while the other indirect not freely chosen
effect may be physically harmful.
- An action that is good in itself that has two effects- an intended and otherwise not
reasonably attainable good effect, and an unintended yet foreseen evil effect– is licit,
provided there is a due proportion between the intended good and the permitted evil.
- A good act may have several good effects and is worthy of being performed thereby
increasing its goodness or even adding new goodness. An evil act may also have several
evil effects and is unworthy of being chosen.
- The four conditions:
1. The act must be good in itself, or at least, morally indifferent.
 Being the primary moral determinant, the act by it very nature must be
good. Its goodness proceeds from within itself. If it not possible to be good,
the act must not be evil in itself. At least, it is morally indifferent.
2. The good effect must directly proceed from the act itself and not from the evil
effect. At the very least, both effects must occur simultaneously.
 It indicates the fact that the good effect is the one that is being directly
willed and not the evil effect in the performance of an act. The good effect
is the very purpose for which the act is done, and as such, it is produced not
by the evil effect but by the act itself. In fact, it comes ahead of the evil act.
3. There must be sufficient reason for the performance of an act in its attainment
of the good effect.
 As determined by the nature of the act and its circumstances, sufficiency
of reason exists when there is no other means by which the desired good
effect is as equally important as to permit the occurrence of the evil effect.
4. The motive of the agent must be holy and honest.
 How can the agent be honest in his intention? By directly willing to
obtain the good effect and not the evil effect of the act. This can be proven
when the evil effect just follows after the good effect is achieved.
- When can the principle of double effect not be invoked?
1. When the act by its nature is evil.
2. When the good effect directly proceeds from the evil effect and not from the
act itself.
3. When there is no sufficient reason for the performance of an act with two
effects, one-good, and the other-evil.
4. When the motive of the agent is not honest.
2. Principle of Legitimate Cooperation
- Is the participation of one agent with another agent to produce a particular effect or
joint effect. Cooperation becomes a problem when the action of the primary agent is
morally wrong.
- Cooperation comes from the Latin word cum which means “with” and operari which
means “to work”.  COOPERATION is working with another in the performance of
an action.
- Various degrees of cooperation:
 The degrees of cooperation may vary according to the gravity or essentiality of
the shared act in the performance of an evil action.
- 1. Formal and material
o FORMAL COOPERATION- consists of an explicit intention and willingness
for the evil act. The one formally cooperating categorically wills and intends
the evil action.  Ex: a medical director who wills and intends the evil act of
contraception by means of hysterectomy at the request of an interested party,
by arranging with the members of the O.R. team as to the operation and its
schedule.
o MATERIAL COOPERATION- consists of an act other than the evil act itself
but facilitates and contributes to its achievement. The one materially
cooperating may provide means apart from the evil act itself which is used to
carry out the performance of an evil act.
- 2. Direct and indirect
o DIRECT COOPERATION- consists of direct participation in the performance
of an evil act. The one directly cooperating gets involved by openly and
straightforwardly taking part in the practice of an evil action.
o INDIRECT COOPERATION- 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.
- 3. Proximate and remote
o PROXIMATE COOPERATION- consists of an act that is intimately linked
with the performance of an evil action due to its close bearing.  REMOTE
COOPERATION- consists of an act with a distant bearing upon or connection
with the execution of an evil act.
- Moral rules governing cooperation
a. No one should formally and directly cooperate in the performance of an evil
action. b. If a reason sufficiently grave exists, material cooperation in the
performance of an evil action may be morally excused.
c. If the material cooperation is proximate, a reason sufficiently graver should exist
so as to be morally excused without which evil is incurred.

3. Principle of Common Good and Subsidiary

- Often considered a corollary of the principle of the common good, subsidiarity requires
those in positions of authority to recognize that individuals have a right to participate
 in decisions that directly affect them, in accord with their dignity and with their
responsibility to the common good.
- Decisions should be made at the most appropriate level in a society or organization,
that is, one should not withdraw those decisions or choices that rightly belong to the
individuals or smaller groups and assign them to a higher authority.
- The principle of subsidiarity is a kind of sociological discipline adhered to and
advocated by the church. Its moral implication is embedded in its meaning.
- It means that what an individual, lower or smaller group can achieve within his/her or
its capacity should not be taken away and transmitted to the custody and performance
of a higher or bigger group.
- Ex: in an effort to control the apparent rapid population growth in the country, the State
formulates program on responsible parenthood which rebounds to the enactment of a
law mandating every family to just limit the number of its offspring only to one or two
under pain of penalty. And so, the State through the Department of Health conducts
contraceptive programs and distributes various forms of contraceptive methods to
ensure the State-directed number of children every family ought to raise.
4. Principle of Stewardship
- Stewardship requires us to appreciate the two great gifts that a wise and loving God has
given: the earth, with all its natural resources and our own human nature, with its
biological, psychological, social, and spiritual capacities. This principle is grounded in
the presupposition that God has absolute Dominion over creation, and that, in so far as
human beings are made in God’s image and likeness (Imago Dei), we have been given
a limited Dominion over creation and are responsible for its care.
- The principle of stewardship includes but is not reducible to concern for scarce
resources, rather, it also implies a responsibility to see that the mission of Catholic
health care is carried out as ministry with its particular commitment to human dignity
and the common good.
- Refers to the expression of one’s responsibility to take care of, nurture and cultivate
what has been entrusted to him.
- In health care practice, STEWARDSHIP refers to the execution of responsibility of the
health care practitioners to look after, provide necessary health care services, and
promote the health and life of those entrusted to their care.

Role of a Nurse as a:
 Steward
- A steward is a person who provides leadership that preserves and promotes the intrinsic
value of nursing (Haase-Herrick, 2005 ). This may occur when the leader develops a values
based culture whereby staff share mutual values and incorporate these in their practice,
such as acknowledging and respecting the consumer—their rights, dignity, and self-
determination—as well as considering issues of equity and fairness (Murphy & Roberts,
2008). Murphy and Roberts (2008) purport that the actions and decisions of these nurse
leaders are underpinned by their values and beliefs, and they preserve and promote these
values at the point of service and to those who influence decision-making .
-The Bodies, our life, our human nature are everything in this earth are gifts we have
dominion over.
- Being stewards, harm but rather improve and care for our mother nature and apply it to
health care practice.
- Ex. “As a good steward I must take care of my health, neighbor/ environment. Work
against poverty, disease and oppression.”