COURSE SYLLABUS

COURSE TITLE: Bioethics

COURSE CREDIT: 3 units
TIME ALLOTMENT: 2 hours per week
COURSE DESCRIPTION:
The course deals with the study of the important concepts and principles of
Bioethics as applied to the medical profession. It is designed to assist doctors and
other health care givers to familiarize themselves with the process of ethical reasoning
and decision making especially those referring to medical situations.

GENERAL COURSE OBJECTIVES:

The course aims to instill knowledge of the important concepts and principles of
ethics and to develop among the students, attitudes which are ethically sound, useful
and applicable in the practice of their profession.
At the end of the course the student should be able to:
1. Examine/affirm his personal beliefs, professional/moral values as a basis for
understanding ethical principles in health care;
2. Understand concepts and principles needed in the practice of the profession;
3. Act responsibly when faced with ethical issues, especially in patient care or in
any other situation.
4. Cope with moral ambiguity;
5. Understand the rights of the patients;
6. Acknowledge that each person is a moral agent;
7. Be sensitive to future ethical problems;
8. Grow in the process of ethical reflection; and
9. Affirm medicine as an ethically responsible profession.

SPECIFIC COURSE OBJECTIVES:

At the end of every topic/lesson, the student should be able to:
1. Discuss/explain the fundamental questions relating to the topic which concern
the practice of the medical profession;
2. Determine the ethical principle/s to be applied to specific situations;
3. Apply within the realms of morality these ethical principles; and
4. Identify her/his role and ethical responsibilities as a member of the health team.
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METHODOLOGY:
The methods of instruction include:
1. Lectures 3. Individual/group report 5. Brainstorming
2. Role-play 4. Debates 6. Grand Presentation

EVALUATION:
Students shall be evaluated based on the attainment of the objectives.This includes:
1. Written examinations - Quizzes, Prelim, Midterm, Finals
2. Class Standing - Individual/group work, Recitation, Debates, Role
Plays, Reflection Papers, Attitude, Attendance
3. Case studies/reports
4. Grand Presentation – to take the place of Final Examination

REINFORCEMENT ACTIVITIES:
1. Additional readings 3. Observations or real-life situations
2. In-depths discussion 4. Inter-action with stake holders

COURSE OUTLINE
The course includes BIOETHICS I, BIOETHICS II, and BIOETHICS III.
BIOETHICS I
1. Introduction To Bioethics
2. Human Person & Human Act
3. Conscience
4. History of Bioethics & the Hippocratic Oath
5. Philosophical Foundations of Bioethics & Decision Making
6. Bio-Ethical Principles
BIOETHICS II:
1. Review of Bioethical Principles
2. Patients’ rights
3. Informed Consent
4. The Medical Profession
5. Relationship Between:
a. Doctor-Doctor
b. Doctor and Other Health Care Professionals
c.. Doctor and Society page 2
 6. Ethics in Research
7. Health economics
BIOETHICS III:
1. Decision Making
2. Natural Law Ethics
3. Human Sexuality and Responsible Parenthood
4. Contraception
5. New Reproductive Technology
6. The Infertile Couple
7. Other New Technologies
8. Organ Transplant and Donation
9. Comparative/Alternative Medicine
10. End of Life
BIOETHICS I
INTRODUCTION TO BIOETHICS
1. The Purpose and Implications of Bioethical Knowledge
2. The Importance and Significance of Bioethics
3. The Need for Bioethics in Medical Schools and Other Health Services
4. The Rationale in the Study of Bioethics
5. The Fundamental Concepts in Bioethics
6. Some Fundamental questions About Health

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 INTRODUCTION TO BIOETHICS
There are many instances when healthcare matters require an ethical approach.
We cannot follow the principle: “Everything than can be done ought to be done.
Medical practice is subject to certain ethical limitations.
Modern Society is mobilizing all ways and means to alter world view by radically
destroying values to betray the sanctity and dignity of human life. Values have
changed radically.

Modern world wants to “kill” God by destroying men and their moral values as civilized
beings.

Today - complex and challenging issues confront the medical profession.

* Personal - values of person – abortion, euthanasia
* interpersonal - intrigues, sex transfers, organ transplants
* professional - rivalries
* institutional - different hospital policies
* social issues - population issue, control of AIDS

Medical practitioners have also to make everyday decisions:

* should you tell your patients about their disease;
* what treatments patient should consent to (or refuse)
* what patients should be prioritized in case of scarce resources
* how much of the society’s fund be spent on health care, etc.

Considerations to be observed:
1. The healthcare professional (physicians, nurses, etc.) cannot limit himself to
the fulfillment of a technically perfect job, achieving what we can call neutral
or aseptic. Faith, if it is genuine, is projected on to one’s life, including one’s
professional work. The Christian professional cannot be a spiritual
schizophrenic who forgets the religious dimension of his existence, ignoring
the duties subsequent to his Faith.

2. Those who work in health professions, whether Christians or not, will meet
people who have faith, whose illness will make them feel more strongly the (4)
 religious dimension of their life. These patients hope for and seek the
necessary help in this matter.

Nevertheless, whether it is question of living one’s faith or helping a patient

who has faith, one needs to master the ethical criteria on certain important
questions that arise in our work.

The “Great Medical Profession” calls each one, according to his specialty, to
unite in a continuous dedication to the care of the patient, trying to cure or alleviate,
safeguard his life and health, while improving whatever can be improved.

What to do:
* Educate or train our conscience or sense of judgment.
* We must be educated in virtue so that we can act with ease, competence and
confidence.
* Equipped with scientific knowledge and skills. .
* Know human needs and human values.
* study HUMAN Acts. - Ethics is concerned and interested in human behaviors,
subject to the determination of
RIGHT (VIRTUE) – reward
WRONG (VICE) – punishment
* Modern biological technology

The medical professional - sensitive:

Appropriate responses to the different dilemmas are not clear and depend on so
many Variables:
* contextual factors (circumstances)
* professional status
* gender
* social, economic, institutional & political climate
* patient and family values
* relationships
* religious beliefs
* cultural orientation
* legal constraints page 5
 Dilemmas:
* right for a woman to have an abortion
* children with serious birth defects be put to death?
* People have a right to die?
* Right to medical care?
* Physicians lie to their patients
* People suffering from genetic disease be allowed to have children?
* Parents agree to allow their children to be used as experimental subjects?
* Reporting of reportable diseases to proper authority?
* Organic transplants
* Sex change
* Life-support apparatus
* Contraceptive technologies
* Love-making without baby-making
* Test tube babies

As medical practitioners - we have to know the basic principles in the practice of our
profession, because as members of the health team, all have to unite in a continuous
dedication to:
* the care of the patient
* alleviate pain and cure the disease
* safeguard the patient’s life and health

As members of the health team, there is a need for cooperation of all the members for
effective health care, hence, we have to know
1. What are the different roles and ethical responsibilities of each member?
2. What are the responsibilities of society for the health care of its citizens?

To offer solutions to these different dilemmas, we need to apply the different

ethical principles, hence, the need for us to understand the ethical principles

THE PURPOSE AND IMPLICATIONS OF BIOETHICAL KNOWLEDGE

* The path to moral knowledge is narrow, arduous and demanding.

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* Any human behavior performed under or with KNOWLEDGE, FREEDOM
and VOLUNTARINESS is within the ambit of moral or ethical judgment

* Controversies and problems in any professional discipline will always

involve ETHICS - The reason why ETHICS IS IMPORTANT

* Ethics is concerned and interested in human behaviors, subject to the

determination of : RIGHT (VIRTUE) – reward
WRONG (VICE) – punishment

* Many instances when health care matters require ethical approach, we

cannot follow the principle:
“Everything than can be done ought to be done”.

* Health practice is subject to certain ethical limitations. Ethical problems

increasingly command the attention of medical practitioners, health
professional, and lay persons alike. Given the following situations:
* right for a woman to have an abortion
* children with serious birth defects be put to death?
* People have a right to die?
* Right to medical care?
* Physicians lie to their patients
* People suffering from genetic disease be allowed to have children?
* Parents agree to allow their children to be used as experimental
subjects?
* Reporting of reportable diseases to proper authority?
* Organic transplants
* Sex change
* Life-support apparatus
* Contraceptive technologies
* Love-making without baby-making Test tube babies

What to do:
* Educate or train our conscience or sense of judgment. Page 7
* We must be educated in virtue so that we can act with ease, competence and
confidence.
* Equipped with scientific knowledge and skills. .
* Know human needs and human values.
* study HUMAN Acts. –
* Modern biological technology have particularly affected human values and
have given rise to major dilemmas concerning life, health and death.

The medical professional - sensitive to the different Dilemmas, like:

* right for a woman to have an abortion
* children with serious birth defects be put to death?
* People have a right to die?
* Right to medical care?
* Physicians lie to their patients
* People suffering from genetic disease be allowed to have children?
* Parents agree to allow their children to be used as experimental subjects?
* Reporting of reportable diseases to proper authority?
* Organic transplants
* Sex change
* Life-support apparatus
* Contraceptive technologies
* Love-making without baby-making
* Test tube babies

* To offer solutions to these different dilemmas, we need to apply the different

ethical principles, hence, the need for us to understand the ethical principles.

* Modern individuals, including health professionals now live in a technological

age in an artificial environment, and we view the world through scientific eyes.

* Equipped with scientific knowledge and skills many have practically assumed
a God-like attitude, believing that they cannot only modify and improve
nature, but also to redesign and change it for their own perceived good.
However, though modern health professionals may be so equipped with the
advanced technological skills to make technical decisions, every health care
 decision always involves human needs and human values, since we are
dealing with humans, and therefore, also involves ethical decision. .
* By the time a person under the age of reason wakes up in the morning until he
goes to bed at night, all over again, all his actions, be they big or small, are
subjected to the determination of good or evil, right or wrong.
* Nothing is certainly absolute and definite under any human judgment because
humans that we are, we are essentially flawed and can commit errors or
mistakes. The reason why we should educate or train our conscience or sense
of judgment.
* We must be educated in virtue so that we can act with ease, competence and
confidence. It is imperative that in any endeavor or undertaking, we must be
aware of any human weakness and limitation that can hamper even our most
candid and purest acts and intentions. For there are apparent “good” that are
actually evil. To choose that “good” will therefore be a tragedy and disaster.

* Hence, the need to know human needs and human values.

* Ethics is concerned and interested in human behaviors, subject to the

determination of RIGHT (VIRTUE) – reward & WRONG (VICE) – punishment.

* Any human behavior performed under or with KNOWLEDGE, FREEDOM,

VOLUNTARINESS is within the ambit of Moral or Ethical judgment. Hence, we
have to study HUMAN Acts.

* To attain the true goals of human life by responsible actions, in every free
decision involving an ethical question, one is morally obliged to do the
following:
1. Inform himself 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 his actions.
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 Just as in human acts, some norms or standards of acting are followed, the
same can be said with regard to the moral behavior of people. Norms of moral actions
are highly necessary if people have to live in peace, order and harmony.

Two norms or standards of moral or ethical actions recognized and understood

in Bioethics: (Standards of Morality)
1. Natural Law
2. Conscience
The moral precepts (Natural Law) as objective norms of morality can be
compared to signposts and markers on the road, which indicate the direction the
traveler, must take in order to reach his goal.

To know the directions, you need knowledge of the goal to be reached. You also
need sense to perceive the signs, to select from among them the relevant ones. This
sense is the person’s conscience. (Subjective norm)
* Nothing is certainly absolute and definite under any human judgment
because humans that we are, we are essentially flawed and can commit errors
or mistakes.
* The reason why we should educate or train our conscience or sense of
judgment.
* We must be educated in virtue so that we can act with ease, competence and
confidence. It is imperative that in any endeavor or undertaking, we must be
aware of any human weakness and limitation that can hamper even our most
candid and purest acts and intentions. For there are apparent “good” that are
actually evil. To choose that “good” will therefore be a tragedy and disaster. (10)
Man has the right to act in conscience and in freedom so as personally to
make moral decisions. He must not be forced to act contrary to his conscience,
nor must be prevented from acting according to his conscience.

* When it comes to concrete ethical decisions, each normal individual has

the capacity and the responsibility to judge and to act on his or her own
judgment. This responsibility cannot be delegated to anyone else or to
any institution.
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* A person who acts ethically is said to be acting in conscience. Conscience
judges a concrete act as good or evil in accord with a norm of morality
given to it. This norm is NATURAL LAW.

Morality always involves a choice in arriving at a moral decision:

1. There are many alternative means to a goal, some of which are clearly in-
appropriate, but often many are appropriate, each with its advantages and
disadvantages;
2. It is possible for people to reconsider their goals and to redefine or even alter
them in view of some higher goal.

Medical practitioners have to make everyday decisions:

* should you tell your patients about their disease
* what treatments patient should consent to (or refuse)
* what patients should be prioritized in case of scarce resources
* how much of the society’s fund be spent on health care, etc.

Modern biological technology, have particularly affected human values and

have given rise to major dilemmas concerning life, health, and death.

THE NEED FOR BIOETHICS IN MEDICAL SCHOOLS AND OTHER HEALTH

SERVICES
To address all these problems, we need Bioethics to guide us in our decision
making:.
A.. To address legal problems in health care with ethical concerns. - medico-legal
cases.
* Why do we have legal problems in the practice of medicine?
Malpractice due to:
* Negligence?
* Ignorance?
* Arrogant doctors?
* Objective to get rich faster? Etc.

A LEGAL PROBLEM IN MEDICAL PRACTICE BEGINS WITH

AN ETHICAL OR MORAL PROBLEM. Page 11
 No medico-legal problem starts on a purely legal angle. It has always at its root
some ethical or moral basis. A legal problem always begin with an ethical problem.

A GOOD PHYSICIAN IS AN ETHICAL PHYSICIAN.

An ethical physician is likely to avoid a legal problem.

* A doctor without ethics is a mere technician.

* A doctor with ethics is properly called a physician. (expert about the nature
of life).
* An ethical physician is not created overnight.
* An unethical physician – becomes personified due to a long protracted
ignorance and contempt for ethical values.

Since medical practice is ethical practice, physicians cannot be ethical without

having assimilated knowledge of Bioethics. Bioethics must be an essential part
of medical education.

3. IMPORTANCE AND SIGNIFICANCE OF BIOETHICS

Knowledge gained in the study and applications of Bioethics will contribute

substantially to the holistic care of patients.
a. those who are found outstanding, effective and efficient in the care of patients
are those who are both technical and ethical in ethos and praxis.
b. Knowledge gained will affect their future or current professional practice as
important human resources in health care organizations;
1. they will have more edge and advantage over those without ethical
knowledge;
2. they will excel in the their workplace, be it locally or globally;
* those who will excel in the practice of medicine are those who
are equipped with those capacities, capabilities or qualities that
can offer assistance and fulfill the human needs of the person as
individuals and as members of the human society. Page 12
 * those who are found outstanding, effective and efficient in the care of
patients are those who are both technical and ethical in ethos and
praxis.
“Bonum est diffusivum sui” - “good is self-diffusive”

Since knowledge is good, nature has its distinct way of diffusing or

disposing it to where it is beneficially good and to which it is in
homeostasis. - It follows that, ethical knowledge that one possesses will
surely have implications on the profession or practice of medicine as well
as on the health environment.

3. Important, not only to put right order and direction in the practice of an
ethical profession, but also to recognize the society’s awareness of its
significance to those who seek holistic medical care.
a. The health care procedures done by health professionals and their
corresponding right conduct in the practice of health care which
covers:
* preventive
* curative
* rehabilitative
b. The possession of health or wholeness of the health seekers or
patients entrusted to health professionals. – Medical practice being
an integrally technical and ethical profession. The doctor is a
physician, not a technician.
c. The world of health profession and life, can only be possibly
practiced and lived by recognizing the ethical dimension in them
through which they can regulate human actions and relations. -
No profession can thrive unless the practice of moral virtues among
the practitioners are in order and geared towards the well-being of
the society.

THE RATIONALE IN THE STUDY OF BIOETHICS

1. To address the perennial ethical problems, issues and dilemmas confronting
health and pastoral workers; page 13
2. To address legal problems in health care with ethical concerns. - medico-legal
cases.
3. The study of Bioethics deserves careful recognition especially by those who
have not been well-versed in the complexities of the medical or health care
professions. - A health practice bereft of Ethics is highly questionable

THE FUNDAMENTAL CONCEPTS OF BIOETHICS

Since every ethical decision ought to be based on good reasons that are not merely
subjective and arbitrary but that can be rationally defended, then the general concern
for the search of meaning/ solutions to the different dilemmas and problems
concerning life, health and disease, there is a need to study Philosophy.

PHILOSOPHY:
The intense and critical examination of beliefs and assumptions, which:
1. gives coherence to the whole realm of thought and experience;
2. offers principles for deciding what actions and qualities are most worthwhile;
3. may also show inconsistency in meaning and context.

TWO BRANCHES: (Raphael)

1. Philosophy of knowledge: - attentive to critical examination of assumptions about
matters of fact and argument.
2. Philosophy of practice: - focuses on the critical examination of assumptions
about norms or values:
* Ethics (moral philosophy)
* Social and political philosophy
* Philosophy of the law

DEFINITION OF ETHICS: POSTULATES

ETHICS - moral philosophy:
(Greek – ethika – having to do with character; Latin - moral)
* The study of social morality and philosophical reflection on its norms and
practices.
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* That branch of philosophy concerned with principles that allow us to make
decisions about what is right and wrong.

* The discipline dealing with what is good and bad or right and wrong or with
moral duty and obligation.

* The discipline dealing with the rights and wrongs, in theory and practice, of
human behavior.

ETHICS (moral philosophy) is a practical and normative science, based on

reason, which studies human acts and provides norms for their goodness
or badness.
As a practical science – deals with a systematized body of knowledge that
can be used, practiced, and applied to human action.
As a normative science – establishes norms or standards for the direction
and regulation of human actions.

MEDICAL ETHICS - Concerned with value choices in medical practice. Specially

concerned with moral principles and decisions in the context of medical
practice, policy and research.

How is it distinguished from MORALS, VALUES, or MORES?

MORES - the behaviors which a society determines to be acceptable behavior. They

are set in time and place. Ethics transcends the passage of time.
MORALS - often seen as being concerned with practical rather than theoretical
issues. The distinction is not clear-cut and often used interchangeably.
VALUES - ideals or principles, as of a given society.

Ethical studies are based on reason.

Ethics deals only with human acts insofar as they are performed with Intellectual
deliberation and volition.

The acts of irrational animals or amoral beings (cats, dogs, insane persons) are devoid
of moral significance. Page 15
 This leads us to the distinction between:
Human acts – with knowledge & full consent of the will
Acts of man – performed in the absence of both conditions.

BIOETHICS
* - a more recent discipline, an outgrowth of philosophy focusing on man as the
center of reality and of human life; it is a philosophy of life. It centers on the
happiness of man. It is very comprehensive and treats of human life and society.

* the systematic study of human conduct in the area of life science and health
care in the light of moral values and principles.
* The branch of applied ethics which investigates practices & developments
in the life science and/or biomedical fields. (Beauchamp & Childress)
Bioethics involves:
* obtaining relevant factual information
* assessing its reliability
* identifying moral problems
* mapping out alternative solutions to the
problems

Bioethics, cannot be discussed thoroughly without a knowledge of health care

and responsibility. In this course, therefore, we will try to explain some fundamental
questions which concern HEALTH.

6. SOME FUNDAMENTAL QUESTIONS ABOUT HEALTH

* To understand human health and to make ethical decisions about how to care
for human health in a way that protects human values, we must be aware of the true
worth and dignity of human persons.
Who & what is the human person whose health is to be cared for?

Whether it is a question of living one’s faith (if one is a Christian) or helping a

patient who has faith, one needs to master the ethical criteria on certain important
questions that arise in our work.
Page 16
 In this course, therefore, we will try to explain some fundamental questions
which concern HEALTH.
* What is Health and who is responsible for it?
* What are the ethical principles of health care?
* How would these principles be applied to ethical issues?

Since we are members of the health team, there is a need for cooperation of all the
members for effective health care, hence, we have to know (2nd yr)
1) What are the different roles and ethical responsibilities of each
member?
2) What are the responsibilities of society for the health care of its
citizens?

To offer solutions to these different dilemmas, we need to apply the different ethical
principles, hence, the need for us to understand the ethical principles.

As medical practitioners, therefore, there are basic principles we have to know in the
practice of our profession, because as members of the health team, all have to unite in
a continuous dedication to:
• the care of the patient
• alleviate pain and cure the disease
• safeguard the patient’s life and health

As members of the health team, there is a need for cooperation of all the members for
effective health care, hence, we have to know
1. What are the different roles and ethical responsibilities of each member?
2. What are the responsibilities of society for the health care of its citizens?

THANK YOU

PAGE 17