WEEK 1: HEALTH CARE ETHICS

ETHICS
 Greek word ethicos which means “custom” or “character”
 Defined as the philosophical science (normative and theoretical) that deals with the morality of human conduct
 It is how we make judgements in regard to right and wrong.

Difference between Ethics and Morality

Ethics (Greek) ethos
Morality (Latin) mos/moris
Both means custom
The former provides the theories & principles of right or wrong/ good or bad actions while the later, actualizes
these theories & principles.

Health Care Ethics

 Concerned with the type of conduct or character that is approved or disapproved of in terms of right or wrong or
good or bad related to health-care service.
 Designed to promote orders and maintain civility.

Ethical Theories
 Provides a schema, structure or framework in order that the rightness or wrongness, and goodness or badness of
human conduct will be determined – Mappes & DeGrazia
 A guiding principle in resolving moral judgements, problems and issues.

ETHICAL THEORIES
Deontology
 Came from the Greek word DEON, which means duty, implying obligations.
 A system of ethics which judges the rightness or wrongness of action based on whether they adhere to a rule or
set of rules
 Duty or principle based theory
 An act is right if it conforms to an overriding moral duty

Teleology
 Refers to moral system that determines the moral value of actions by their outcomes or results.
 Came from the Greek word TELOS meaning END. An action is morally right if its favorable consequences are
greater than its adverse outcomes.

Utilitarianism
 Derived from the Latin term utilis which means “useful”.
 Is the most influential consequentialist theory.
 States that what is useful is good, and that the moral value of action are determined by the utility of its
consequences.
 Utilitarianism explains that those actions that bring about favorable effects are moral while those that produce
damaging results are immoral.

Virtue Ethics
 Its primary focus is the heart of the moral agent making the decision rather than the reasoning to a right action.
 It is primarily about personal character and moral habit development rather than a particular action
 Not “what shall I do?” but rather “how should I carry out my lie if I am to live well?”.

What is virtue ethics in nursing?

 An approach to moral dilemmas in nursing. On the contrary, decision-making about moral issues in healthcare
demands that nurses exercise rational control over emotions. This clearly focuses the attention on the nurse as
moral agent and in particular their character.
Core Values of a Professional Nurse (by PNA)
 Love of God and Country
 Caring
 Quality and Excellence
 Integrity
 Collaboration
WEEK 2 & 3: ETHICAL PRINCIPLES

Autonomy
 Comes from the Greek word autos (self) and nomos (governance).
 In healthcare, it has come to mean a personal liberty, where the individual is free to choose and implement his or
her own decision, free from deceit, duress, constraint or coercion.
Nurses must respect the right of patients to make decisions on their own behalf. Nurses must \respect a patient's
right to accept or reject any or all courses of treatment.

Patient’s Rights
1. Right to Appropriate Medical Care and Humane Treatment.
2. Right to Informed Consent
3. Right to Privacy and Confidentiality
4. Right to Information.
5. The Right to Choose Health Care Provider and Facility
6. Right to Self-Determination.
7. Right to Religious Belief.
8. Right to Medical Records.
9. Right to Leave
10. Right to Refuse Participation In Medical Research.
11. Right to Correspondence and to Receive Visitors
12. Right to Express Grievances.
13. Right to be Informed of His Rights and Obligations as a Patient.

Patient’s Bill of Rights

1. The patient has the right to considerate and respectful care irrespective of socio-economic status.
2. The patient has the right to obtain from his physician complete current information concerning his diagnosis,
treatment and prognosis in terms the patient can reasonably be expected to understand. When it is not medically
advisable to give such information to the patient, the information should be made available to an appropriate
person in his behalf. He has the right to know by name or in person, the medical team responsible in coordinating
his care.
3. The patient has the right to receive from his physician information necessary to give informed consent prior to the
start of any procedure and/or treatment. Except in emergencies, such information for informed consent should
include but not necessarily limited to the specific procedure and or treatment, the medically significant risks
involved, and the probable duration of incapacitation. When medically significant alternatives for care or treatment
exist, or when the patient requests information concerning medical alternatives, the patient has the right to such
information. The patient has also the right to know the name of the person responsible for the procedure and/or
treatment.
4. The patient has the right to refuse treatment/life – giving measures, to the extent permitted by law, and to be
informed of the medical consequences of his action.
5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case
discussion, consultation, examination and treatment are confidential and should be conducted discreetly. Those
not directly involved in his care must have the permission of the patient to be present.
6. The patient has the right to expect that all communications and records pertaining to his care should be treated as
confidential.
7. The patient has the right that within its capacity, a hospital must make reasonable response to the request of
patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of
care. When medically permissible a patient may be transferred to another facility only after he has received
complete information concerning the needs and alternatives to such transfer. The institution to which the patient is
to be transferred must first have accepted the patient for transfer.
8. The patient has the right to obtain information as to any relationship of the hospital to other health care and
educational institutions in so far as his care is concerned. The patient has the right to obtain as to the existence of
any professional relationship among individuals, by name who are treating him.
9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation
affecting his care or treatment. The patient has the right to refuse or participate in such research project.
10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what
appointment times the physicians are available and where. The patient has the right to expect that the hospital will
provide a mechanism whereby he is informed by his physician or a delegate of the physician of the patient’s
continuing health care requirements following discharge.
11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.
12. The patient has the right to know what hospital rules and regulation apply to his conduct as a patient.
Informed Consent
 The process by which a patient learns about and understands the purpose, benefits, and potential risks of a
medical or surgical intervention, including clinical trials, and then agrees to receive the treatment or participate in
the trial. Informed consent generally requires the patient or responsible party to sign a statement confirming that
they understand the risks and benefits of the procedure or treatment.
Proxy Consent
 This is done when the patient is not capable of giving informed consent and is legitimately represented by a
competent surrogate who acts on his behalf. The patient may either be unconscious, insane or a minor/child who
is out of reason or not the age of reason.
Privacy
 Privacy refers to the right of an individual to keep his or her health information private.
Privacy rule
 A national standard to protect individuals’ medical records and other personal health information and applies to
health plans, healthcare clearinghouses, and those health care providers that conduct certain health care
transactions electronically.
Confidentiality
 The principle that binds the practitioner to hold in strict confidence those things learned about a patient in the
course of medical practice
Veracity
 Truth telling. The practice of health care is best served in a relationship of trust in which practitioner and patient
are bound to the truth.
Fidelity
 Derived from the Latin word fidelitas meaning faithfulness. Faithfulness to one’s obligations, duties, and
responsibilities. Fidelity in nursing means that nurses must be faithful to the promises they made as professionals
to provide competent, quality care to their patients.
Justice
 The basic principle that deals with fairness, just deserts, and entitlements in the distribution of goods and
services. When nurses care for a group of patients, care must be given equitably, fairly and justly to each
individual.
Beneficence
 The principle that imposes on the practitioner a duty to seek the good for patients under all circumstances
 Do unto others what you want others do unto you
Non-Maleficence
 The principle that imposes the duty to avoid or refrain from harming the patient.

WEEK 4 & 5: RELEVANT ETHICAL PRINCIPLES

1. Principle of Double Effect (from St. Thomas Aquinas)
 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.
 The principle contemplates on two effects or outcomes arising from the performance of an action. The
first or primary effect results from the agent’s intent, desire wish or will, while the secondary effect is only
allowed, tolerated or permitted or unintended effect.
Doctrine of double effect
 performing a good action may be permissible even if it has bad effects, but performing a bad action for
the purpose of achieving good effects is never permissible.
 the principle contemplates on two effects or outcomes arising from the performance of an action. The 1st
or primary effect results from the agent’s intent, desire wish or
There are 4 conditions or criteria
1. The act must be good in itself, or at least, 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
3. There must be sufficient reason for the performance of an act in its attainment of the good effect
4. The motive of the agent must be holy and honest
Double effect
 usually regarded as the combined effect of beneficence and non-maleficence.
Morphine
 beneficial effect - easing the pain and suffering of the patient,
 maleficent effect - hastening the death of the patient through suppression of the
 2. Principle of Cooperation
 Cooperation comes from the Latin word cum meaning “with” and operari which means “to work”. Cooperation
is working with another in the performance of an action.
Various Degrees of Cooperation
 Formal cooperation consists of an explicit intention and willingness for the evil act. The one formally
cooperating categorically wills and intends the evil action.
o Ex. Medical doctor agrees to perform hysterectomy (remove uterus) when the patient demand. – not
really necessary or valid reason but doctor still accepted it
 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.
o Ex. Scrub Nurse assisting in the surgery – accomplice in formal cooperation.
 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 Ex. The patient that demanded hysterectomy.
 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.
o Ex. Janitor – may saw the illegal procedure done.
 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.

3. Principle of Common Good and Subsidiarity

 Common Good is the sum total of those conditions of social living whereby citizens are enabled more fully
and more readily to achieve their own perfection.
 Subsidiarity implies that the first responsibility to meet human needs rest with the free and incompetent
individual, then with the local group.
It 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. (Ex.
Brgy. Captain implemented something without consulting others.)
PRINCIPLES OF BIOETHICS
1. Principle of Stewardship and Role of Nurses as Stewards
 Steward/stewardess is a person appointed in the place of another. He/she takes charge of representing and
protecting another’s interest, and sees to it that the service is carried out faithfully. This management and
supervision for others is stewardship.
 refers to expression of one’s responsibility to take care of, nurture and cultivate what has been entrusted to
him
 In health care ethics, 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
o Personal – taking care of self
o Social – Zumba
o Ecological – proper waste disposal
o Biomedical – researches for betterment
2. Principle of Totality
 Totality connotes wholeness, completeness or entirety. The principle of totality applies to any entity that is
made up of parts that together constitute as a whole
 The human body is an integral part of the human person and is therefore worthy of human dignity. It must be
kept whole. No body part should be removed, mangled or debilitated unless doing so is necessary for the
health of a more essential body part or the body of a whole. An unessential or redundant body part may be
removed for the good of another person.
o Surgeries that needlessly remove body parts or organs are immoral
o Self-mutilation is self-hatred expressed through spite of the body
o That chemical contraception effectively shuts down a healthy bodily system is part of what makes it
immoral.
o Even if the pro-choice argument that an embryo is part of the woman’s body rather than an independent
human person is true, it should not be removed except when its presence endangers the woman’s life.
The person should be considered as a single entity, that is, whenever medical procedures, therapies and medications are
being decided, the patient ought to be taken into consideration. This implies that whenever therapeutic procedures have
the tendency to cause harm to the patient or cause disagreeable side-effects, it is imperative that the benefits justify
proportionally the advantages of the medical treatment.
Principle in organ donation
 A person can dispose his body parts and to destine it, that are still useful, morally, irreproachable, noble and
among them the desire to aid the sick and suffering.
 It should not change the personality of the person.
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 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. Donor consent is free and informed
5. The recipients for the scarce organs are selected justly.
3. Principle of Ordinary Means and Extraordinary means
 The one hand life-prolonging measures the application of which is morally obligatory (ordinary measures) -
as they are likely to help the patient. On the other hand those measures which can be applied optionally
(extraordinary measures) as the benefit to the patient is not immediately obvious or subject to considerable
debate.
 Ordinary means are all medicines, treatments and operations that offer a reasonable hope of benefit and
that can be obtained without excessive expense, pain or other inconvenience
 Extraordinary means are all medicines, treatments and operations that cannot be obtained or used without
excessive expense, pain or other inconvenience or that, if used, would not offer a reasonable hope or benefit.
4. Principle of Personalized Sexuality
 Takes note of a humanized sexuality, one that represents the fulfilment of physical and sensual need but also
evidenced with love and sacramental mystery

HUMAN SEXUALITY
 The expression of sexual sensation and related intimacy between human beings.
 Human sexuality involve sexual attraction to another person, which for the most part is to the opposite sex
(heterosexuality), some to the same sex (homosexuality), or some having both (bisexuality) or not being attracted
to anyone in a sexual manner (asexuality).
 The quality of being male or female.
 The way in which we experience and express ourselves as sexual beings

HUMAN REPRODUCTION
 Human reproduction is any form of sexual reproduction resulting in human fertilization

MARRIAGE
 Special contract of permanent union between a man and a woman entered into in accordance with law for the
establishment of conjugal and family - Family Code of the Philippines
 Marriage is a lifetime institution conceived of, comprised of, and created together by two people who wish to
derive individual and joint benefits that are only possible from the properly functioning marriage they themselves
create.

LEGAL REQUIREMENTS OF MARRIAGE

1. Legal capacity of the contracting parties, who must be male and female; and
2. Consent of the parties freely given in the presence of the solemnizing officer
The parties must be of different sexes and must be of legal age. There must be no fraud, force, intimidation, undue
influence or deceit

PURPOSES OF MARRIAGE
There are two purposes of marriage according to the law and the Bible:
1. For procreation – bringing children into world and rearing them
2. For companionship and mutual help – when the parties past the age of procreation they still enter into marriage

ESSENCE OF MARRIAGE AND MORALITY

 Since marriage is intended for procreation, same sex marriage is not recognized by Philippine law and also
considered immoral for the reason that it defeats the very essence and purpose of marriage.
 Marriage in the absence of love, done and entered into the purpose of acquisition of new citizenship to another
state, w/c many Filipinos usually do, violates its sacredness, hence it is considered immoral
ISSUES ON SEX OUTSIDE MARRIAGE
Real Reasons for Sex Before Marriage
The practical reasons for premarital sex trump religion and morality.
1. Contraception
 With the wider use of effective contraceptives, young women do not fear unwanted pregnancy so much as
earlier generations did. The key event here was the widespread adoption of the contraceptive pill in the early
1970s. Because this was highly effective and female-controlled, it took away most of the anxiety about
unwanted pregnancy.
2. Reduced Parental Supervision
 Teens are less supervised after school if both parents work full-time and may take advantage of this
opportunity for sexual activity. Increased enrolment in higher education means that a lot of young women live
apart from their families in an environment that encourages sexual expression. This is in marked contrast to
sexually restrictive societies, where young, single women are heavily chaperoned by relatives.
3. Earlier Sexual Maturation of Women and Later Age of Marriage
 In the 1860s, women did not mature reproductively until the age of 16 years, compared to 11-12 years today.
First marriages are later today also, with European women postponing matrimony until the age of about 29.
So there is a very long interval of about 10-20 years between puberty and marriage during which complete
sexual abstinence is unlikely.
4. More Women in the Workforce
 As more women enter paid employment and careers, they spend more time preparing for the workforce
through third-level education. So the number of single, never-married young women is on the rise. Most of
these women are sexually active.
5. More Gender Equality in Jobs
 Women used to be far more economically dependent on fathers and husbands.
 With greater economic independence and more female-headed households, women are freer to control their
sex lives. This means more premarital sex and increased single parenthood.
6. Women Are More Competitive and Sensation-Seeking
 Contemporary women are more competitive in a number of arenas, from sports to education, politics, and
careers. Competitiveness is associated with a hormone profile of high sex drive in both sexes. Women's risk
profile is converging with that of men, as illustrated by rises in problem drinking and dangerous driving. They
are also less risk-averse in sexual matters, increasing premarital sexuality.
7. Declining Marriage
 About a fifth of American women never marry. Of those who do marry, the chances of remaining married to
the same person for life are low. The time spent in marriages is decreased by divorce, even if most divorcees
remarry. In the U.S., close to half of first marriages end in divorce, and the typical duration of a first marriage
is only seven years. Between non-marriage, late marriage, and frequent divorces, larger numbers of women
live as singles than ever before, boosting premarital sex.
8. The Mate Market
 A large number of sexually active, single women means that men do not need to marry to enjoy an active sex
life. If a man may sleep with various attractive women without any long-term commitment, he is less likely to
propose marriage to any of them. So romantic relationships are negotiated on the basis of what typical men
want, which is sex early in a relationship with little in the way of a permanent commitment such as marriage.
(Note the irony that with “sexual liberation,” women actually lost power in relationships at the same time that
they gained power in the economy.)

HOMOSEXUALITY
 Came from the Greek word homos meaning same and Latin word sexualis meaning sexual behavior. A sexual
or romantic attraction among members of the same gender. The common term used for Male homosexuals is
“gays” while “lesbians” is for female homosexuals.

ISSUES ON HOMOSEXUALITY
1. Equal treatment – workplace (particular); society (general)
Employment discrimination (hiring, promotion, job assignment, termination and compensation)
2. Membership in military service
3. Promiscuity – having lots of different sexual partners or sexual relationships, or sexual habits involving a lot of
different partners which can lead to spread of HIV and STI.
Pedophilia
4. Illegal drugs (greater among homosexuals than in general population)
CONTRACEPTION
 The use of any of various methods intended to prevent a woman from becoming pregnant by interfering with the
normal process of ovulation, fertilization, and implantation.
 It refers to a direct and positive method of preventing conception before, during or after the act of sexual
intercourse.

DIFFERENT METHODS OF CONTRACEPTION

1. Oral contraceptive pill “Thew Pill”
 It is made up of hormones that are similar to those which are found in a woman’s body. Its function is to
prevent the ovary from releasing an egg.
a. The combined pill -estrogen and progesterone
b. The mini-pill – POP (progesterone only pill)
2. Intra-Uterine System “Mirena”
 A small, T-shaped plastic device that's put into the womb (uterus) by a doctor or nurse. It releases the
hormone progestogen to prevent getting pregnant. This guarantee a straight long five years of contraception.
3. Intra-Uterine Device (IUD)
 This is usually made up of copper which is inserted into the uterus. It changes the chemistry of the uterus
and eventually destroys the sperms that enters therein.
4. Contraceptive patch
 A small sticky patch that releases hormones into your body through your skin to prevent pregnancy.
5. Contraceptive Injections “Depo-Provera” (medroxy-progesterone acetate)
 It contains progesterone which readily interferes with the natural menstrual cycle of woman. The shot must
be taken four times in a year to prevent pregnancy.
6. Male and female condoms
 Latex or polyurethane sheath which block the ejaculated semen from entering in the reproductive tract of
women.
7. Contraceptive Sponge
 A soft, disk-shaped device made of polyurethane foam that contains spermicide which is inserted in the
vagina before sex to prevent pregnancy by preventing sperm from entering the uterus.
8. Diaphragm
 A reusable dome-shaped cup. It fits over the opening of the cervix. It is common to use a diaphragm with
spermicide (gel, cream, or foam that kills sperm).
9. Cervical cap
 The cervical cap is similar to the diaphragm, but smaller. It is also worn over the cervix and use with
spermicide.
10. Vaginal Contraceptive Ring
 A contraceptive ring which sits inside the vagina. It contains two hormones, estrogen and progestogen and
stops ovaries from releasing an egg each month. It is inserted for 3 out of 4 weeks each month or it can be
used continuously.
11. Emergency Contraception / “Morning after Pill”
 It used to prevent pregnancy for women who've had unprotected sex or whose birth control method has
failed. The morning-after pill is intended for backup contraception only, not as a primary method of birth
control. Morning-after pills do not end a pregnancy that has implanted. They work primarily by delaying or
preventing ovulation.
12. Progestin subdermal implant (PSI)
 It consist of hormone-filled capsules or single, matchstick-sized rods” inserted under the skin of a woman’s
upper arm which contains the hormone progestin, commonly used in hormonal birth control. PSIs can
provide protection for up to 3 years.
13. Tubal ligation (female sterilization)
 In this method, the fallopian tubes are disconnected so that the egg can no longer be transported from the
ovaries to the uterus for it to meet the sperm at the ampulla.
14. Vasectomy (male sterilization)
 A form of male birth control that cuts the supply of sperm to your semen. It's done by cutting and sealing the
tubes that carry sperm.
15. Withdrawal / Coitus Interruptus
 Literally called “interrupted sex” since a man has to withdraw or pull his penis from the vagina before
ejaculation.
16. Outercourse / Non-Vaginal Sex
 It allows the sex partners to attain orgasm or sexual gratification without penile penetration inside the vagina.
NATURAL FAMILY PLANNING METHOD
1. Rhythm method
 One of the oldest ways of natural family planning, this is based simply on the calendar. A woman's normal
menstrual cycle lasts between 28 and 32 days.
 Ovulation usually happens around day 14. So you would avoid unprotected sex on days 8 through 19, since
that’s when you’re most fertile.
2. Cervical mucus or ovulation method.
 Here, you track the mucus your cervix makes. When you're ovulating, your mucus is clear, stretchy, and wet,
like raw egg whites. You write down what your mucus is like each day so you know when you're ovulating.
 Billings Method
3. Basal body temperature (BBT) method.
 Your temperature can rise between 0.5 and 1 degree when you ovulate and stay there until your next period.
With this method, you take your temperature before you get out of bed each morning, before you have
anything to eat or drink. BBT by itself isn't a good way to prevent pregnancy because charting your
temperature tells you when ovulation has already happened.
 BBT = body temp in resting state on waking
 Slight drop immediately before ovulation
 After ovulation, release of progesterone slight increase in temperature
4. Symptothermal method
 With this, you combine several methods, usually BBT and cervical mucus. Using more than one method can
give you a better idea what's going on in your body
 If two or more signs (cervical mucus, cervical position and temperature

CONTRACEPTION AND MORALITY

 It really should established that the Church and the State are not against family planning. The bone of intention is
the mode of family planning or birth control. The Church endorses the natural method while the state favors the
artificial method.
 The use of rhythm method and abstinence is moral while the artificial methods of birth control are considered
immoral on the side of the Roman Catholic

POINTERS FOR THE HEALTH CARE PRACTITIONER

1. With the knowledge and morality of contraception, be honest enough to tell your clients who are asking for it
about its adverse effects and the moral questions it foments while respecting their freedom of conscience.
2. While couple are allowed not to intend to procreate in each marital act, they are not allowed to frustrate by an
action before, during, or after the marital act, the procreative aspect of the marital act.
3. Actively take part in the education of your clients along natural family planning with its different methods. There is
no moral objection as long as they are motivated with valid reasons to give proper upbringing and education to
their children.
4. When married couples fruitfully exercise their procreative power, they come to enjoy a certain special participation
in God’s own creative work. This is a dignifying task that needs to be inculcated in one’s mind and heart through
family planning seminars.

ARTIFICIAL INSEMINATION
- Refers to an assisted method of reproduction in which the sperm is injected into the woman’s reproductive tract
through a catheter. The purpose of this relatively simple procedure is to achieve fertilization and pregnancy. It can
either be:
A. Homologous or artificial insemination from the husband (AIH) - using sperm from a woman's
husband.
B. Heterologous or Artificial insemination from a donor (AID) - using sperm from a man she is not
married to or known as “donor”.

Types of Artificial Insemination

 Intracervical Insemination – this procedure is typically one of the easiest and least costly of the types of artificial
insemination in humans because it most closely mimics intercourse. It is the process of transferring semen or
ejaculate directly into the female reproductive tract, right at or near the cervical opening
 Intrauterine Insemination – is one of the most efficient types of artificial insemination in humans and has some
of the highest success rates. It is a procedure that involves inserting sperm past the cervix and directly into the
uterus.
 Intrauterine Tuboperitoneal Insemination – this option is great fit for couples with mild male infertility or mild
endometriosis because it bypasses the organs that are affected. Injection of washed sperm into both the uterus
and fallopian tubes.
 Intratubal Insemination – sperm are injected into catheter and pushed into either of the fallopian tubes
Advantages of AI
- 80% Success rate
- Low Cost
- Safe; minimal side effects
- Sperm bypasses organs
- Advantageous to men with low sperm count
- Beneficial to those with unreceptive cervical mucus
- Usually prescribed when diagnosis for infertility is unclear.
- Simple process
- Painless, minimal discomfort

Disadvantages of AI
- Success rates get lower with old age.
- Ineffective for women with severe endometriosis
- Damaged fallopian tube
- Not 100% success rate
- Several attempts before working
- Risk of infection
- Risk of multiple births
- Risk of birth defects is 2x higher
- 4.24 percent of A.R.T. infants are born with defects

Morality
Some Catholic theologians argue that AIH is acceptable despite the fact that the child is conceived out of the context of
conjugal act and the sperm was made available through masturbation. To these theologians, the act is justifiable since the
sperm that allows the wife to conceive comes from her husband. However, in the case of AID, the same theologians have
assumed a different stand. For them, it is equivalent to “permitted” adultery, contrary to morals ads public policy (Ashley &
O’Rourke, 1986: 132-133). Therefore, the healthcare provider must not support and accept couple’s resort to AID.

IN VITRO FERTILIZATION
- It refers to the conception of a new human life in vitro (glass) that is outside the female reproductive system. The
union between the sperm and egg cells takes place in a test-tube so that the baby conceived this way is called
test-tube baby.

Steps of the Procedure

1. Hormones are injected to enable the woman to produce multiple eggs.
2. The woman is tested to determine whether she is ready for egg retrieval.
3. Instructions are given the night before and the day of the procedure.
4. Then, a healthy egg from the woman is obtained (procedure proper).
5. Immediately, after the retrieval, eggs are mixed with some sperm in the laboratory.
6. If the eggs are fertilized, they are kept in the clinic under observation to ensure optimal growth.
7. Once they are ready, one or more embryos will be transferred into the uterus of a woman for gestational
development.

The First Test-tube

On July 25, 1978, Louie Brown, the first baby conceived in a Petri dish, was born. Dr. R.G. Edwards and Dr. Patrick
Steptoe of Britain were the medical scientists who produced Louise through IVF.

Why is it done?
- Fallopian tube damage or blockage.
- Ovulation disorders
- Endometriosis
- Uterine fibroids
- Previous tubal sterilization or removal.
- Impaired sperm production or function
- Unexplained infertility
- Genetic disorder
- Fertility preservation for cancer or other health conditions
Advantages of IVF
1. IVF helps many patients who would be unable to conceive. It helps people who have:
 Blocked or damaged fallopian tubes
 Older patients/ patients with a low ovarian reserve
 Male infertility/Unexplained infertility
 Polycystic Ovary Syndrome (PCOS)
 Endometriosis
 Premature ovarian failure or menopause
2. It has been used for a long time and has a safe track record. The first ‘IVF baby’, Louise Brown, was born using
natural IVF in 1978. Since then, the technology has advanced, and techniques refined in order to create safer and
successful treatment.
3. IVF can be more successful than IUI and other forms of assisted reproductive technology.
4. It can help single women and same-sex couples who wish to have a child
5. Unused embryos can be donated to research or another couple. If you are lucky enough to have embryos to
spare, these can be used to help other people and even save lives. With parents, unused embryos can be
donated for research purposes, or to another couple to have a child.
6. Embryos can be used to screen for inherited diseases.
7. IVF with pre-implantation genetic diagnosis (PGD) is one of the most reliable ways to ensure that a child
conceived will not suffer from the disorder. Pre-implantation genetic screening (PGS) can improve the chances of
a successful outcome, as it screens embryos for chromosomal disorders

Disadvantages of IVF
1. An IVF cycle may be unsuccessful. The success of IVF is not guaranteed, and patients often have to undergo
more than one cycle of treatment before they are successful.
2. There may be associated side effects and risks. As a medical treatment, IVF comes with a small chance of
developing side effects, the most severe of these being severe ovarian hyper-stimulation syndrome (OHSS).
Other side effects include:
 Soreness
 Bruising from injections
 Nausea
 Bloating
 Hot Flashes
 Mood, Swings
 Fatigue
 Allergic Reactions
3. There is a slightly higher chance of ectopic pregnancy
4. There is evidence that high estrogen levels associated with high stimulation IVF can increase the risk of
prematurity and low birth weight in babies.
5. Expensive
6. Miscarriage
7. Multiple pregnancy

Morality
In IVF, the process of fertilization is done in an artificial method, meaning the fetal life and development does not occur in
a normal copulation but in a petri dish. Another pertains to the moral offense of discarding excess or unwanted embryos.
As has been presented, the Catholics and many other believers of God consider the embryo, much more the zygote, to be
already infused with humanness and personhood in potential. Hence, destroying them is tantamount to killing. In this
regard, Christian and /or Catholics healthcare providers must not endorse all types of and kinds of assisted reproductive
technology except for AIH.

SURROGATE MOTHERHOOD
- A practice in which a woman (the surrogate mother) bears a child for a couple unable to produce children in the
usual way. It is also called “mothering by proxy”.
- A "surrogate mother" is a woman who, for financial or other reasons, agrees to bear a child for another woman
who is incapable to conceive herself. In other words, she is a "substitute mother" that conceives, gestates and
delivers a baby on behalf of another woman who is subsequently to be seen as the "real" (social and legal)
mother of the child.
Types of Surrogacy
1. Traditional surrogate - It's a woman who gets artificially inseminated with the father's sperm. A traditional
surrogate is the baby’s biological mother.
2. Gestational surrogate - A technique called "in vitro fertilization" (IVF) now makes it possible to gather eggs from
the mother, fertilize them with sperm from the father, and place the embryo into the uterus of a gestational
surrogate. The surrogate then carries the baby until birth. A gestational surrogate is the birth mother.
The baby born by surrogacy may be the biological child of:
 Both parents. The egg is retrieved from the intended mother (IM) and joined with sperm from the intended
father (IF).
 Mother and sperm donor. The egg is retrieved from the IM and joined with the donor sperm.
 Surrogate mother and intended father. The surrogate mother goes through a process of artificial
insemination using the IF’s sperm.
 Neither parent. Often also referred to as embryo adoption. The surrogate mother may or may not be a
biological parent in this case.

Advantages and Disadvantages of Surrogacy

Advantages Disadvantages
Biologically/Genetically Related Cost
Builds Relationship Lengthy process
Better Option Life-Changing Experience
Health Pregnancy Stigma Stigma
Financial Compensation
Life-Changing Experience

Moral imperatives about surrogacy

 Procreation is God’s plan; children are blessings from God, medical technologies that aid fertility do not venture
from biblical principles that are acceptable in good conscience.
 The decision to use medical technology is a personal matter. There are acceptable reasons and forms of Christian
service that may limit or refrain procreation.
 Due to cost, Christian stewardship is a relative factor. As Christians apply these principles to their decision-making
they can be confident that the Holy Spirit will be there to assist them. Infertile couples should always keep the
door ajar, so if necessary, they can fall back on adoption as an alternative.

ABORTION
- Refers to the expulsion of human fetus before the period of viability (refers to the age of gestation when the
human fetus can survive outside the uterus).

Types of Abortion
 Complete abortion is when all of the contents of the uterus such as the pre-born child and the placenta have been
expelled from the uterus.
 Incomplete abortion maybe intentional or unintentional abortion in which parts of the pre-born child and/or
placenta remain within the uterus.
 Early abortion is an abortion within the first trimester of pregnancy. It necessarily includes the embryonic stage
from the moment of conception.
 Induced abortion is an intentional (willful and deliberate) abortion brought about by mechanical (surgical) or
chemical means.
 Criminal abortion is any abortion committed outside the parameters set by law.
 Habitual abortion is spontaneous abortion or the so-called miscarriage occurring in three or more consecutive
pregnancies.
 Infected abortion is a type of abortion associated with and possibly caused by an infection of the uterus or the
genital tract.
 Septic abortion is associated with and possibly caused by an infection of the uterus.
 Spontaneous abortion is caused by disease or accident. Unintentional expulsion of a fetus.
 Threatened abortion is a type of spontaneous abortion which usually includes vaginal bleeding.
 Inevitable abortion is brought about pathologic condition
 Therapeutic abortion is a direct and deliberate expulsion of the fetus to restore the mother’s health and/or save
her from death.
Methods of Surgical Abortion
 Suction abortion
 Dilation and Curettage (D&C) abortion
 Dilation and Evacuation (D&E) abortion
 Saline abortion
 Dilation and extraction (D&X) abortion
 Prostaglandin abortion
 Hysterectomy abortion
 Inter-cardiac injection abortion

Potential physical effects of abortion

 Pelvic Inflammatory disease (PID) - this pathologic condition is life-threatening and can lead to subsequent
infertility and an increased risk of ectopic pregnancy.
 Uterine perforation - perforation can lead to infection, heavy bleeding or both, depending on the severity of the
cut. Surgery may be required to repair the uterine tissue, and in serious cases, a hysterectomy (surgical removal
of the uterus) may be required.
 Cervical lacerations - suturing of lacerated cervix occurs in about 1% of all 1st trimester abortions. Less severe
undiagnosed cervical damage may result in subsequent cervical incompetence, premature delivery and labor
complications.
 Placenta previa - this involves a placenta (in an abnormal position) being superimposed upon the os and causes
severe hemorrhage during labor. Abortion increases the risk of this condition as often as it may be performed.
 Ectopic pregnancies – abnormal location of the baby during subsequent pregnancies can be ascribed to
previous abortion which can threaten the mother’s fertility and even her life.
 Endometritis - abortion increases the risk of inflammation of the endometrium (the mucous membrane lining the
uterus) especially among teenagers.
 Cervical, ovarian and liver cancer – women who have had one abortion more than double their risks of cervical,
ovarian, and liver cancer, and women with more than one abortion quadruple their risks.
 Death – many women form United States die from legal abortion every year excluding death cases stemming
from illegal and unreported abortions. The vast majority of these deaths are not reported as caused by abortion
but attributed to other causes such as blood poisoning”, anesthetic misadventure”” or spontaneous gangrene”” of
the ovaries.

Psychological effects of abortion

 Depression – After abortion, the woman may feel guilt upon her actions which in worst scenarios may lead to
depression
 Eating disorders – they may have troubles accepting and coping up with abortion and may develop eating
disorders.
 Hysterical outbreaks
 Loss of self-confidence and self-esteem
 Illegal drugs
 Loss of pleasure during intercourse
 Anniversary syndrome – It is defined as a unique set of unsettling feelings, thoughts or memories that occur on
the anniversary of a significant experience.
 Relationship problems – After having abortion, the mother may trouble in trusting and opening up in a
relationship.
 Suicidal attempts – The mother may have recurrent thoughts of suicide due to the feelings of guilt and distraught

Is abortion moral?
As long as it is performed deliberately and willfully, it is immoral. It is a blatant transgression of natural law that is ascribed
both in the hearts of men and in the Ten Commandments. It is against the order of right reason which dictates, regardless
of religious beliefs and social orientation that innocent life must not be taken directly, deliberately and willfully for whatever
reasons. These reasons, however serious and tragic, can never justify the deliberate killing of an innocent human being.
RAPE
Unlawful sexual activity and usually sexual intercourse carried out forcibly or under threat of injury against a person's will
or with a person who is beneath a certain age or incapable of valid consent.

Types of Rape
 Date Rape - is a specific kind of acquaintance rape referring to assault(s) experienced by the victim from the
person they are on date with.
 Serial Rape - The term serial rape is used to describe a series of rapes committed on different occasions by the
same perpetrator and can happen repeatedly. Serial rapists have multiple victims.
 Incest - defined as sexual abuse by the relative, sexual contact/abuse between family members.
 Home Invasion Sexual Assault - perpetrator breaks into survivor’s home to commit the assault.
 Contact Sexual Assault - the perpetrator works to gain trust and confidence before assaulting.
 Substance facilitated Rape - occurs when alcohol and drugs are used to compromise an individual’s ability to
consent for sexual activity.
 Acquaintance Rape - this type of rape happens between two people that know each other acquaintance rape is
known as "date rape" two people involved may be in a social relationship at the time.
 Aggravated rape is a type of rape defined in the law. Aggravated statutory rape involves: Forced sex acts by the
threat of death or serious bodily injury. Forced sex acts involving an unconscious or drugged victim Sex acts with
children under the age from below 12 to below 16 (Philippines).
 Diminished Capacity Rape - the type of rape known as diminished capacity rape is committed when one person
forces sexual penetration on another person who cannot consent to the sex act. example would be a person with
an intellectual disability.
 Partner Rape also known as spousal rape or marital rape, is a type of rape involving a person's partner or
previous partner (no matter whether the partners are married) Types of partner rape
o Battering rape – battering rape occurs when physical and sexual violence occur together. Victims may
experience the physical and sexual violence at the same time or one may occur after another. The rape
may occur after physical violence as an attempt to "make up."
o Force-only rape – this type of rape happens when physical violence is not present. As with all rape, this
type of spousal rape is spurred by a desire to exert power and control over another person. This desire
manifests in acting as if sex is an entitlement to one party from another.
o Obsessive/Sadistic rape – obsessive or sadistic rape is rape that involves torture or perverse sexual
acts. This type of marital rape tends to be very violent and result in physical injuries.

Statistics
 In 2014, rape rate for Philippines was 10 cases per 100,000 population. Rape rate of Philippines increased from
3.4 cases per 100,000 population in 2005 to 10 cases per 100,000 population in 2014 growing at an average
annual rate of 19.08%.
 In 2017- 7,037 cases of rape reported in the Philippines. Data obtained by the PSA from the PNP as of February
2020 indicated there were 2,162 rape cases reported to the police in 2019, 30.6 percent higher than the 1,656
cases reported in 2018.
 Raped during this pandemic. Data from the Philippine National Police (PNP) showed that 602 people across the
country were raped from March 17 to May 23 or an average of eight people daily.

Rape and morality

God and society condemn rape. Rape is morally wrong because it violates the victim’s rights; it traumatizes the victim,
and it undermines the fabric of society.
Inviolability of Life
- It means the extent to which human life is considered precious. Human life should be valued and
considered as sacred and God-given.

EUTHANASIA
Derived from the Greek word eu = good or well and thanatos = death; literally means good death. The practice of
ending life in a painless way

Forms of performing euthanasia

1. Voluntary – indicates the measure of causing the death of the patient at his willful consent or request.
2. Non-voluntary- indicates the measure of causing the death of the patient who is unable to express his will and
make his intentions, known as unconscious or comatose state. The decision is made by either the watcher,
health care team or the society.
3. Involuntary - indicates the measure of causing the death of the patient in defiance of his expressed will and/or
against his consent.

Ways of administration
1. Passive – can be done by avoiding treatments like antibiotics and chemotherapy based on patient’s
knowledge that the avoidance will lead to his/her death Non-active – life support systems shall be withdrawn
from the patient
2. Active- pertains to one where lethal substance/s shall be used to kill a person. One may decide to use
euthanasia machine to kill himself/herself. It requires lethal substance that administered by the patient
himself/herself to achieve death. It’s akin to assisted suicide.

Dysthanasia
From Greek, dysthanatos, turning death difficult. It is the undue prolongation of life and delay of the occurrence of
natural death which in effect lengthens the suffering of a person.

Orthothanasia
Refers to the mere allowing and acceptance of natural death in its inescapable occurrence in due time as the final
moment of one’s earthly life.

Euthanasia and morality

Catholics are against euthanasia due to the fact that the fifth commandment states that everyone must have the right to
life. They believe that euthanasia is an attack on life and that nobody has the right to request or perform euthanasia. It
should not be endorsed as it destroys the person’s dignity and that people should be supporting the terminally ill, so
that they suffer less before they die. The Catholic response to euthanasia is that the quality of life is important.

SUICIDE
Derived from the Latin word suicidium which means “to kill oneself” The direct killing
of oneself on one’s authority
Morbid means of taking one’s life as a result of resignation from the human race The intentional killing of one’s own life
Causes:
- Physical pain - Culture
- Depression - Financial difficulties
- Illness - Religion
- Desperation - Shame
- Anxiety - Psychological disturbances
- Mental disorder - Guilt
- Emotional pressure
Common methods of suicide:
- Asphyxiation
- Toxification
- Blunt force trauma
- Self defenestrating
- Exsanguination
- Self immolation
- Drowning
- Electrocution
- Starvation
Suicide and morality
Based on the Christian doctrine, suicide is deemed as a mortal sin. Meaning, if you commits suicide, he would spend
eternity in hell. There is no forgiveness in suicide. It is a direct violation of the Ten Commandments, specifically the
fourth commandment “Thou shall not kill”. In fact, it involves the rejection of love of self and the renunciation of the
obligation of justice and charity towards one’s neighbors, towards the communities to which one belongs, and towards
society as a whole. In its deepest reality, suicide represents rejection of God’s absolute sovereignty over life and death.

Administration of drugs to the dying

Generally speaking, people who are dying need care in four areas—physical comfort, mental and emotional
needs, spiritual issues, and practical tasks. Their families need support as well

Advance Directives
Advance directives are decisions that can be written down prior to medical treatment, so the family can carry out a
person's wishes for health care if this person is unable to communicate them Senate of the Philippines, Meriam D.
Santiago

An Advance Directive is a patient’s instructions to his or her doctors and other healthcare workers, as well as his or her
family and loved ones the type of care preferred should he or she become unable to make medical decisions.

A Living Will is a document that describes the type of medical treatment you want in certain situations. It comes into
effect if you are terminally ill or permanently unconscious and is unable to express / communicate your medical wishes.

Durable power of attorney for health care/Medical power of attorney

A durable power of attorney for health care, also known as a medical power of attorney, is a legal document in which you
name a person to be a proxy (agent) to make all your health care decisions if you become unable to do so.

DNR
A Do Not Resuscitate (DNR) order is one type of advance directive. This allows you to decide NOT to undergo
cardiopulmonary resuscitation (CPR) or other treatments which will try to revive you if your heart stops or if you stop
breathing.

Declaration to withdraw or withhold treatment

This is another form of Advance Directive by a patient, or relative of a patient, to withhold or withdraw life-sustaining
procedures that will prolong the dying process.

Who needs an advance directive?

Everyone is entitled to have an advance directive. It is important that your doctor and loved ones know about your
healthcare wishes. The best time to put your wishes in writing is when you are in good health. These documents will
help your doctor and family to know and honor your choice