NCM108

HEALTH CARE ETHICS

1st semester 2020-2021
Professor: Dr. Ma.Virginia Bautista Camarinta

MODULE 2.
Bio Ethics and its Application in Various Health Care Situations
A. Sexuality and Human Reproduction
B. Dignity in Death and Dying

BIOETHICS AND ITS APPLICATION IN VARIOUS HEALTHCARE SITUATIONS

Objectives for this topic:

1. learn about bioethics in relation to various health situations;

2. develop a sense of deep understanding of values and morals in the encounter of contemporary issues
underlying the health care situations; and
3. apply the values and morals of a nurse in decision-making encountering various healthcare situations.

A. SEXUALITY AND HUMAN REPRODUCTION

The sacredness of Sexuality is portrayed as a fundamental component of personality, one of its modes
of being, of manifestations, of communicating to others, of feelings, of expressing, of living human love.
Femininity and masculinity are complementary gifts through which human sexuality becomes an integral
part of concrete capacity for love, which God has inscribed in man and woman.

Sexuality defines a man and a woman not only on the physical but also on the psychological and spiritual
levels, making its mark on each expressions. Such diversity, which is linked to the complementarity of
the two sexes, allows thorough response to the design of God according to the vocation to which each
one is called.

A theological reflection of the scriptural passages reveals three crucial truths about the bonding of a man
and a woman in marriage.

These are:
That a man and a woman are equally persons;
That God is the author of marriage and the one who gives its defining characteristics;
That men and women are persons with body and soul, not merely spirit persons.

Revelation clarifies that man’s vocation to love is authentically fulfilled- in its integrity- only in marriage
and in virginity; in Virginity by means of a direct giving of oneself to God; in marriage by means of a

1
unique form of self-giving between a man and a man which is truly human, one quite different from the
other kinds of love. Thus, virginity and marriage are love enabling realities, and person-affirming reality.

Conjugal love is the faithful and exclusive love that unites the spouses according to their truth as images
of God. It is characterized by unity and indissoluble fidelity of the spouses.

Conjugal love is an act of the total person, and not an instinctive impulse, it embraces the totality of the
body and soul in the human person. The family is the necessary place where the children- fruit of the
spouses’ mutual love- are born and formed.

Marriage is established by the consent and love is the object of that consent. The consent generates a
special bond which is the essence of marriage in facto esse (already done). Thus, love results in the
matrimonial institution. It becomes conjugal love.

Essential Properties of Matrimony:

1. Unity – an exclusive union of a man and one woman is clearly expressed in the words of Genesis: Man
shall cleave to his wife and the two of them shall be only one flesh. These words transcend the carnal
union and shed light on the profound union of feelings, interests, lives, and destinies.
The most important consequence or moral dimension of unity is fidelity, which consists in mutual loyalty,
in actions and intentions, in the fulfillment of the marriage contract.
2. Indissolubility – that matrimony is a state bond by its very reason of being is something that requires
no demonstration.

On the other hand, contemporary belief is that, sexuality and reproduction, conceived by the rigid
naturalistic morality, regarded a woman who broke her agreement with the divine nature of things as
transgressor, captive of libidinous passions and incapable of sticking to the health sexuality of marriage,
as the “Be fruitful and multiply” commandment was the only one accepted.

HUMAN REPRODUCTION

How Life Begins – Human Reproduction Notes

DETERMINATION OF SEX

A. CHROMOSOMES

The characteristics of organisms are determined by the genetic materials inside their cells.
Genetic information is carried by DNA which is present in the nucleus of a cell. DNA is a molecule consists
of 2 chains twisted around each other forming a double helix. DNA coils many times around some proteins
to form a chromosome. The sex of human is determined by a pair of sex chromosomes. Sex
chromosomes are the X chromosome and Y chromosome which differ greatly in size and shape.
The other chromosomes that are not sex chromosomes are known as autosomes. Autosomes exist as
homologous pairs (similar in size and length).

2
Human has 23 pairs of chromosomes (46 chromosomes): For female, the pair of sex chromosomes is
XX. For male, the pair of sex chromosomes is XY. In a female, during meiosis the pair of X chromosomes
separates and get into the eggs. All the eggs from the female contain X chromosome. In a male,
the XY chromosomes separate during meiosis. Sperms have ½ the chance to carry a X
chromosome and ½ the chance to carry a Y chromosome. If a sperm carrying a Y chromosome fertilizes
an egg, a boy will be resulted. If a sperm carrying a X chromosome fertilizes an egg, a girl will be resulted.

2.2 MALE REPRODUCTIVE SYSTEM

A. STRUCTURES OF THE MALE REPRODUCTIVE SYSTEM

1. Testis (pl. testes) Each male has a pair of testes in the scrotum. The testis consists of numerous
seminiferous tubules which are the sites of sperm production. Functions of testis: j production of sperms
(male gametes) from seminiferous tubules k production of male hormone (testosterone) from interstitial
cells;

2. Epididymis It is a elongated saclike structure joining to the testis for the storage of sperms.

3. Sperm duct / Vas deferens (pl. vasa deferentia) It transfers sperms from epididymis to urethra.

4. Accessory glands: seminal vesicle, prostate gland and Bulbourethral gland (Cowper’s gland)
• 1 pair of seminal vesicles connected to sperm ducts
• 1 pair of bulbourethral glands connected to urethra
• 1 prostate gland below the urinary bladder and surrounding part of the urethra.
These glands secrete seminal fluid which provides a nutritive medium for sperms
and a fluid medium for sperms to move. Prostate gland can also provide propulsive force
during ejaculation of semen. Seminal vesicles are not used for the storage of sperms. Semen =
sperms + seminal fluid About 100 million sperms are present in 1 mL of semen. The volume of semen
in each ejaculation is about 2 – 4 ml.

5. Penis It is a tubular structure for transferring sperms into the female’s vagina. It consists of
spongy/erectile tissue. Vasodilation of arterioles of the penis causes the spongy tissue-filled with
blood causing the erection of penis.

B. PROCESSES OF SPERM

PRODUCTION (SPERMATOGENESIS) AND SPERM MATURATION (SPERMIOGENESIS)

Sperms are produced at the rate of abut 120 million per day.
1. Spermatogenesis – production of spermatids. Spermatogonia are diploid cells (i.e. 2n or 46
chromosomes) on the seminiferous tubule.

3
At puberty (adolescence), the spermatogonia undergo mitosis to increase their number. Then
the matured spermatogonia carry mitosis to produce primary spermatocytes (2n). The primary
spermatocytes undergo the 1st division of meiosis to give rise to secondary spermatocytes.
The secondary spermatocytes then undergo the 2 nd division of meiosis to give rise to spermatids.
Spermatids are haploid cells (n) with 23 chromosomes.

2. Spermiogenesis differentiation and maturation of spermatids into sperms (spermatozoa). The

Golgi body of spermatid becomes a flattened sac called acrosome containing hydrolytic enzymes for
entering the ovum during fertilization. The centrioles of spermatid elongate and forming a flagellum which
will become the tail of the sperm. Numerous mitochondria are aggregated around the flagellum.
The spermatid becomes a tadpole-shaped cell, it is known as sperm / spermatozoon. The heads of
spermatozoa are then embedded in Sertoli cells (nutritive cells) which provides nutrients for
the maturation of the spermatozoa. Maturation of sperms requires a temperature at about 32 centrigrade,
the testes are therefore located outside the abdominal cavity but in the scrotum. Normal body
temperature (37 C) can kill sperms or cause the sperms abnormal.

FEMALE REPRODUCTIVE SYSTEM

A. STRUCTURES OF THE FEMALE REPRODUCTIVE SYSTEM

1. Ovary There are 2 ovaries in the abdominal cavity of a female. Ovary produces ova and
female hormones.
2. Oviduct / Fallopian tube Oviducts are the site of fertilization. The released ovum or fertilized egg is
transferred through oviduct down to the uterus.
3. Uterus It is divided into 2 layers, namely endometrium and myometrium.
a) Endometrium ~ the inner layer of the uterus ~ with numerous mucus gland and blood vessels
~ thickness changes during menstrual cycle ~ for implantation of embryo
b) Myometrium is the outer layer of the uterus. It is made up of muscle. It contracts during menstruation
to shed the thicken endometrium and during giving birth to push the baby out
4. Cervix It is the entrance to the uterus from vagina.
5. Vagina is a tubular structure for reception of penis and the place where sperms are deposited.

B. PRODUCTION OF FEMALE GAMETES

1. Before birth / Fetal stage Oogonia in the ovaries undergo mitosis to increase their number.
The oogonia develop into primary oocytes. The primary oocytes are surrounded by follicular cells to form
primary follicles.
2. After birth About 200,000 primary oocytes are found in each ovary at birth. The primary follicles
remain dormant after birth until puberty.
3. From Puberty to Menopause

Between puberty and menopause, several primary follicles develop each month under the influence of
the hormone. (Menopause: menstruation stops). The primary oocytes have entered the first
meiotic division. But the division of cytoplasm in the 1st meiotic division is unequal. A secondary

4
oocyte and a first polar body (a very small daughter cell from the meiosis I which will not
undergo division anymore) are formed. The secondary oocyte will continue the meiosis only
after fertilization. After ovulation, if there is sperm to fertilize the secondary oocyte, it will enter the 2nd
meiotic division. The division of cytoplasm in the 2nd meiotic division is also unequal. An ovum and a 2nd
polar body are formed.

C. MENSTRUATION / MENSTRUAL CYCLE

Menstruation is the periodic changes in the lining of the uterus with shedding of the uterine epithelium.
The changes in the uterine lining and ovaries are under the influences of hormones. The length of
the cycle in women is about 28 days. Follicles under the influence of hormone from the pituitary
gland develop. During the cycle, only one follicle can mature and burst to release the ovum (secondary
oocyte). Ovulation is the process of releasing an ovum from the ovary. It happens around the middle of
the cycle. The ovum will then be collected by the oviduct and transferred to the uterus. The lining of
the uterus getting thicker and thicker to prepare for the implantation of embryo. If there is no fertilization,
the lining will shed off at the end of the cycle and causes bleeding (menstrual flow).

FERTILIZATION AND DEVELOPMENT OF EMBRYO

FERTILIZATION

After ejaculated into the vagina of the female, sperms remain alive for few days.
The ovum only remains alive for about 24 hours after ovulation.

For a regular 28 day menstrual cycle, sexual intercourse on days 12 to 16 will have the greatest chance
having fertilization.

Sperms swim up to the oviduct and meet the ovum there.

The released ovum is surrounded by corona radiata (several layers of follicular cells) and a layer of
zona pellucida (a layer of glycoprotein).

The acrosome in the head of the sperm releases its hydrolytic enzymes when the sperm touches the cells
of the corona radiata.

The enzymes break down the cells of corona radiata and make a hole on the zona pellucida.

The cell membrane of ovum is then broken and the sperm head penetrates into the ovum with the tail
left outside.

Then the zona pellucida becomes thickened and with the formation of the fertilization membrane which
prevents the entry of another sperm. (Polyspermy: fertililzation of an egg by more than one sperm.)
The nucleus of the ovum enters the 2nd meiotic division. The nuclei of the ovum and the sperm
fuse together to give the diploid zygote.

5
Prevention of Polyspermy:
• Fast block: The egg plasma membrane becomes depolarized (change in the potential of the cell
membrane), therefore no other sperms can fuse with it.
• Slow block: the formation of the fertilization membrane.

DEVELOPMENT OF EMBRYO

The duration of pregnancy on average is 266 days (38 weeks) from the day of fertilization and 280 days
(40 weeks) from the 1st day of last menstrual period.

The zygote undergoes cleavage as it passes down the oviduct.

(Cleavage: a series of rapid mitotic divisions with no period of growth of the cells, the cell
number increases but the embryo does not increase in size). The cells formed are called blastomeres.
Morula: 32cell stage, a solid ball of blastomeres.
Blastocyst: 64 cells to hundreds of blastomeres, a hollow ball with a fluidfilled cavity (blastoceol).
Gastrula: the blastula becomes a three-layered embryo

Zygote → early cleavage stages → morula → blastula (blastocyst) → gastrula.

When the blastocyst reaches the uterus, it embeds among the cells of the endometrium of the uterus.
This process is called implantation. A placenta will be developed for the exchange of gases, nutrients
and wastes between the fetus and the mother. The fetus is linked to the placenta via the umbilical cord.
The fetus is surrounded by chorion and amnion. The amnion secretes amniotic fluid which supports
the fetus and protects it from mechanical shock, desiccation. Functions of placenta: j site of exchange of
metabolites such as gases, nutrients and wastes between the mother and the fetus k secretes hormones
to inhibit contraction of myometrium for maintaining pregnancy.

PARTURITION / GIVING BIRTH

Myometrium of the uterus contracts rigorously (labor) to expel the fetus from the uterus. The amnion
and chorion are ruptured and amniotic fluid is released to the vagina as lubricant for the passage of
the fetus. The cervix dilates. The fetus is then expelled out and the umbilical cord is tied up and cut.
The placenta will later also be expelled out forming the afterbirth.

CHANGES DURING PUBERTY (secondary sexual characteristics)

Boys - the penis and testes become larger. Growth of pubic, axillary and facial hair. The body becomes
more muscular and shoulders broaden. Voice deepens.
Girls. Development of breasts. Growth of pubic and axillary hair. The hips broaden. More fat is
deposited under the skin. Starts to have periods (menstruation).

Reproductive Ethics

6
Concerned with the ethics surrounding human reproduction and beginning of life issues such as
contraception, assisted reproductive technologies (e.g., in vitro fertilization, zygote intra-fallopian transfer
(ZIFT), intracytoplasmic sperm injection (ISCI), etc.), surrogacy, and pre-implantation genetic diagnosis.
Ethical issues specific to this field include among other concerns the introduction of technology into the
reproductive process, distinctions between reproduction and procreation, the potential for abortifacient
effects through the use of certain contraceptives, embryo & oocyte cryopreservation, embryo adoption &
donation, uterus transplants, mitochondrial replacement/donation interventions; synthetic gametes, the
exploitation and commodification of women for reproductive services (i.e., egg donation and surrogacy),
and sex selection of embryos or fetuses.

ISSUES ON SEX OUTSIDE MARRIAGE

Sex plays a vital part in God’s plan for human beings. The first command recorded in the Bible that God
gave to Adam and Eve was to have sexual relations, in Genesis 1:28. He essentially repeated the
command in Genesis 2:24-25. It is also seen on 1 Corinthians 6:16, becoming one flesh, a bonding occurs
between them.

Sexual revolution in the 1960s become drastic relaxing the sexual mores. This is aided by contraceptives
and birth control pills. The idea of sex with no repercussions led to slogans “if it feels good, do it”. Free-
wheeling sex had practically no consequences for them.

The shocking numbers – the level of pre-marital sexual activity in western nation is extra ordinary, so
casual. The telling consequences of premarital sexual involvement are damaging on many levels. On an
emotional level, they often include a profound sense of guilt, shame, and regret. In addition, the following
noted consequences that are irreversible.

Loss of virginity
Getting pregnant
Abuse of self
Worry for sexually transmitted diseases (STDs) as promiscuity can be associated to sex with no relations.

Sex counselors push contraceptive devices as a means of assuring safe sex but no device can protect a
person’s heart. When the heart is assaulted, defensive patterns develop that will affect any future
relationship.

Moral responsibility of a Nurse in this issue is to provide sound advice about the repercussions of sex
outside marriage and/or pre-marital sex.

7
ISSUES ON CONTRACEPTION, ITS MORALITY AND ETHICO-MORAL RESPONSIBILITY OF
NURSES

Contraception is defined as voluntary prevention of contraception by the positive use of artificial means
which hinders the generative cells from uniting, during the sexual act. When we speak of contraception,
we refer to the prevention of conception rather than prevention of birth;

Methods of Contraception

1. Folk Methods

1.a. Douche (pre coital/ post coital)

Vinegar and brine which are highly spermicidal substances are prescribed as pre coital douche but some
people experiences a burning sensation in the sensitive membranes of the genitals so they then prefer
post-coital douching which is believed to flush out and immobilize the sperms in the vagina. Douching
maybe too late and often does not eliminate all the semen.

1.b. Prolonged Lactation

it is believed that prolongation of milk secretion or production in the mother’s mammary glands could
delay ovulation as a result of the hormonal imbalance occurring inside the mother’s body.

1.c. Withdrawal (Coitus interruptus)

This is withdrawal the penis from the vagina immediately, before ejaculation. Hence, coitus is interrupted
just prior to orgasm, and he makes ejaculation outside the female organ.
Some couples find this method very disrupting, and it may lead to sexual dissatisfaction and irritability in
sexual relations especially when the male insists on withdrawal over the female, vice-versa. This kind of
method is commonly known to all couples as “interrupted melody”.

1.d. Coitus Reservatus

The male withholds ejaculation just before orgasm and allows the erection to subside gradually, hence,
coitus is reserved or kept in reservation.

2. Mechanical Methods
This refers to blocking the sperm from entering the uterine cavity to prevent conception.

2.a. Condom – a sheath of latex rubber (or animal skin) which is inserted into the penis before coitus to
prevent the sperm from spilling out into the uterine cavity.

2.b. Diaphragm – a dome shaped latex rubber membrane placed in the vagina to close the opening of
the cervix to prevent entrance of the sperm. It is also called cervical cap or intra cervical pessary.

2.c. Sponge – another variation of the diaphragm. Rectangular in shape with a ring attached for easy
removal.

8
3. Chemical Methods

Use spermicides that prevent conception by killing the sperm cells before they enter the uterine cavity or
reach the fallopian tubes.

3.a. Vaginal Suppositories and Tablets

1. Vaginal Suppository – small bullet-shaped substance. Similar to paraffin or a piece of candle, that
contains chemical, capable of killing sperms.
2. Vaginal Tablets – the tablets when moistened with water is then inserted to the vagina 10-15 minutes
before coitus. It melts at body temperature and forms a coat of foam to prevent sperm from entering the
uterine cavity.
3.b. Vaginal jellies, creams, and foams
- inserted into the vagina shortly before copulation, immobilizing and killing sperms. This is effective for
one hour.

4. Hormonal Methods
4.a. Contraceptive pills – a pill combined synthetic hormones, usually estrogen and progesterone. It
helps maintain a constantly high hormonal level which prevents the ovary from releasing an egg, thus,
conception will not take place, no matter how often the couple will engage themselves in sexual relations.
4.b. Injections and Implants – a biodegradable pill implant, which is one cm. long and be injected
through a large-bone needle right to the woman’s skin. This is a combination of hormones and cholesterol
which works up to three years and does not require surgery for insertion. Later, if the woman would like
to conceive, the implant can be removed through minor surgery.

5. Abortifacients
5.a. Intrauterine Device (IUD) it is a small object made of plastic or stainless steel and comes in various
shapes and sizes. This IUD is placed or inserted inside the uterine cavity. Pregnancy therefore is
discontinued as it irritates and inflames the lining of the uterus in such a way that the developing fetus
that descends from the fallopian tube, after it has been fertilized, cannot implant itself in the uterus and
eventually die. The disintegrated remnants which is also being mistaken as menstruation comes out as
the woman’s monthly period.

5.b. DES (Diethystilbestrol) – also known as morning after pill. It is a very strong kind of hormone that
forces the endometrium, it could still be destroyed.
5.c. Prostaglandins – a powerful drug, if taken orally, or by injection or by suppository, causes a violent
contraction of the uterus, that can expel out the product of conception, the fetus then could be expelled
out either dead or alive. If alive, the fetus will eventually die due to prematurity.
5.d. Anti-pregnancy vaccine – this vaccine produces anti-bodies on the woman that neutralizes HCG
(Human Gonadotropin Hormone). If the HCG level drops, then the woman menstruates and a miscarriage
occurs. Hence, this induces early abortion.
5.e. Low-dose type of contraceptive pills – This makes the endometrium not sufficiently prepared for
implantation. This is related to the damaged endometrium; hence, miscarriage occurs and the
descending fetus flows with the vaginal discharges.

9
The morality of contraception. Any conjugal act must be open to the transmission of life. Contraception
is thus always illicit, even when it is used as a means for some good purpose, though it is true that
sometimes it is lawful to tolerate a lesser moral evil in order to avoid a greater one or in order to promote
a greater good, it is never lawful, even for the greatest reasons, to do evil so that good may come from
it.

The nurse role is to advise clients on the morality of contraception and the right choice of contraception.

ISSUES ON ARTIFICIAL REPRODUCTION

ARTIFICIAL INSEMINATION (AI) consists of depositing a man’s semen in the vagina (intra-vagina),
cervical canal (intra-cervical), or uterus (intra-uterine), through the use of instruments to bring about
conception unattained or unattainable by sexual intercourse. The semen may be frozen, fresh, and still
use a mixture of both.

Types of Artificial Insemination

1. Homologous (AIH)- semen is obtained from the husband himself; Justifications for AIH: Husband’s
impotence i.e. penile erection dysfunction, anatomical defects in the urethra, deficient sperm count,
defect in the quality of the sperm, and certain physical/psychological problems that hinder normal
intercourse. For the woman, physical obstruction in the genitals, malposition of the cervix, and/or too
small opening in virtue the sperm cannot reach the ovum in the oviduct.

2. Heterologous (AID) – semen is acquired from a donor other than the husband; Justifications for AID:
Husband is sterile, husband is a carrier of a disease, wife’s oocytes are defective or carrier of a defective
genes or disorder, or wife’s fallopian tubes are severely damaged by Gonorrhea.

Morality of Artificial Insemination. Christian ethics considers AI as immoral, in so far as the AI child is
not a fruit of the conjugal act as an expression of personal love. AI, it is argued, splits the sexual unity of
the husband and wife in marriage as it transfers procreation into a biological laboratory where unitive
meaning of conjugal love is completely lost. On the hand, for the moral pragmatist, AI is the most practical,
beneficial, useful technique to be undertaken by spouses who are beset with problems of impotence,
hereditary disorders, defective genes, and anatomical defects. The decision, however, must be optional,
volitional, and mutual. What is practical and workable to one individual or couple may not be to another.
Its practicality must be gauged on a case-to-case basis.

IN VITRO FERTILIZATION (IVF)

Fertilization in IVF means fertilization “within a glass” as opposed to fertilization in the utero. Also known
as “laboratory fertilization” in so far as the fusion of generative cells is done in the laboratory; it is also
called “test-tube fertilization” insofar as performed in a petri dish or test tube. Hence, the usual phrase
“test-tube baby”.

10
The technique involves conception outside the womb by artificial means. which is sometimes referred to
as procreation without sex” or baby making without love.

Other significant goals of IVF

1. Observe and evaluate the process of in vitro, which is not possible in utero;
2. Test the effectiveness of anti-fertility agents and to evaluate the fertilization of the ova of the patients
with infertility problems;
3. Assess the structural and biochemical normality of the conceptus in patients who have repeated
spontaneous abortions;
4. Better understand the mechanisms needed for genetic studies;
5. Advance the study of abnormal and normal cell growth differentiation; and
6. Increase knowledge that is used in contraceptive technology and in the alleviation of genetic disorders
and other deformities.

Morality of IVF

Christian ethics demands the preservation of biological process of human reproduction. In a utilitarian
moralist, IVF would be beneficial, useful, advantageous, and profitable to the understanding of human
reproduction, which would pave the way for the discovery of medical drugs for fetal disorders and
children’s diseases. In a situational ethicist, IVF is the answer to childlessness. It is the technological way
by which couples can subdue nature, in order to carry out God’s mandate. i.e. to increase and multiply
and replenish the earth. This is a situation whereby a non-biological means (i.e. procreation without sex)
is justified to attain a good end (i.e. begetting a child). The good end justifies the means.

SURROGATE MOTHERHOOD (UTERUS FOR RENT)

From the Latin word “surrogatus” meaning “in place of another”. Surrogate means substitute. Surrogacy
of surrogate motherhood is a biomedical technique whereby a fertilized ovum is implanted into the uterus
of another woman who will carry the baby to term either as a favor or for a fee. It is precisely because of
the financial arrangement involved that this procedure is often referred to as the “womb for hire” or “uterus
for rent” business.

In such cases, a woman who can produce normal ova, but whose health would be endangered by
pregnancy, can have her own ovum fertilized by her husband’s semen either in vitro or in vivo and after
three to five days of growth the embryo could be transferred to the uterus of a healthy woman, who, either
out of friendship or for payment, would give the baby to the couple who are the genetic parents of the
child.

In a medical context, some women are born without uterus but they have an ovary. For obvious reason
they cannot carry a child but they can produce eggs as a result of ovulation. In case one is similarly
situated, she can ask another woman with a uterus to carry her child for and in her behalf. Eggs removed
from her ovary are fertilized in vitro and implanted into the uterus of the surrogate woman.

11
A married woman who has undergo a hysterectomy in which her uterus was removed but not her ovaries,
can still produce eggs. Since she can no longer bear a child, is for her to undergo surrogacy. In this way,
surrogacy offers a medico-technological solution to infertility and/or childlessness.

Morality of Surrogate Motherhood

In a pragmatist approach, surrogacy is deemed to be the most practical, beneficial, and workable
procedure for a woman to undergo (is she wishes to have a child), whenever the natural process is
biologically impossible.

In a utilitarian ethicist, this counts the greatest benefits and happiness that surrogacy will bring forth for
childless and infertile individuals who wish to have a child.

In a Christian perspective, who considers surrogacy as a high-tech form of baby farming, in which babies
are reproduced through a “uterus for rent” business or “womb for hire” procedure. By all indications, this
is not suitable and proper for human nature, even as it does not speak well of our rationality as human
beings. Surrogacy destroys a woman’s dignity and integrity as a human being.

MORALITY AND PROBLEMS RELATED TO DESTRUCTION OF LIFE

ABORTION

The expulsion of the living fetus from a mother’s womb before it is viable is known as abortion.
Abortion is defined as the termination of pregnancy, spontaneously or by inducement, prior to viability.
Thereafter, the termination of pregnancy is called delivery. Viability has to do with the child’s capacity to
live independently of its mother after it has left the womb.

Normally, a child is considered to be viable at about the 28th week (calculated from the first day of the
last menstrual period) or toward the end of the 7th month (at least 10% of survival). The availability of an
incubator to keep a prematurely born baby warm will heighten its chances of survival.

Types of Abortion
1. Natural (Spontaneous or accidental) - expulsion of the fetus through natural or accidental causes.
In lay man’s term, called miscarriage. Abortion of this type is unintentional and involuntary, and hence,
devoid of moral significance.

It assumes a moral bearing if and when it is voluntary in cause. A pregnant woman, for example, who
scrubs the floor with all her might or willfully steps in a banana peel, in order to slip, with the intention of
inducing abortion makes her act intentional and voluntary, and therefore, she is morally responsible for
it.

2. Therapeutic Abortion – deliberately induced expulsion of a living fetus in order to save the mother
from danger brought on by pregnancy. A pregnant woman who has a heart condition, for example, will

12
probably have a heart attack if she carries her pregnancy to term; hence, expulsion of the fetus is
recommended. Note that the health and the life of the mother are considered paramount in this case.

3. Eugenic or Selective Abortion – recommended in case where certain defects are discovered in the
developing fetus. It is argued that it is better for a child not to be born than for it to live a miserable life,
burdened with crippling genetic disorders. It is called Eugenic because it is meant to get rid of abnormal
babies, and thus, prevent from contaminating human species. It is also known as Selective abortion or
abortion on fetal indications in the sense that it is recommended on a case-by-case basis, depending
upon the gravity of fetal indications or abnormalities.

4. Indirect abortion – removal of the fetus as a secondary effect of a legitimate or licit action, which is
direct and primary object of intention.
Example 1. a case of a woman who has a cancerous uterus (tumor or myoma);
2. another with ectopic pregnancy, occurs when the fertilized ovum does not descend into the uterus but
becomes implanted in the fallopian tube and begins to develop there. The embryo cannot grow into
viability in the tube, in the course of its growth, it will cause rupture with subsequent bleeding, endangering
the life of the mother.

5. Habitual Abortion - occurs consecutively in three or more pregnancies.

Moral Issue of Abortion

Pro-life advocates maintain that the fetus has full ontological status (i.e. already a human being) and is
hence, an individual human person with moral status who possesses the same rights as those who are
born. Life, from the moment conceived, must be regarded with greatest care.

On the other hand, pro-choice of abortion, claims that abortion is always permissible whatever the state
of fetal development may be. Its proponents uphold that the fetus has no ontological status; it is neither
an individual, human, nor a person; therefore, it possesses no rights and no moral status. It may be
expelled in cases of rape or incest.

Christian ethics considers abortion to be intrinsically wrong. The fetus is precisely human because it is
conceived by humans. Hence we must accord its human rights, most especially the right to life.

In a utilitarian ethicist, it would take into account that abortion has practical, beneficial, and workable
consequences of aborting a terribly malformed fetus, most particularly in cases caused by rape and
incest.

SELF KILLING (SUICIDE)

Self-murder or self-killing, suicide is the direct, willful destruction of one’s own life. It is direct, in so far,
primary object of the act itself is the killing of oneself. It is willful, insofar, as it is deliberate, voluntary, and
intentional. It is destructive, insofar, terminating one’s own life, more often than not, brutal, violent, or

13
harsh and bloody. Suicide presupposes one’s healthy physical condition, interrupts, and destructs the life
processes.

Causes of Suicide. There are cultural, religious, personal, financial, and socio-economic causes.
Personal reasons may include 1. Misfortune and frustration in love or marriage; 2. Parental differences;
3. In law problems; 4. Failure in an examination; 5. Loss of honor and integrity; 6. Inability to cope with
problems, inability to adjust to new situations.

Moral Issue of Suicide

Suicide violates the fifth commandment “thou shall not kill”. Suicide is against the natural law (inclination
to self-preservation and conservation. Suicide is usurpation of God’s function - life is God’s gift to man,
and hence, suicide involves an arrogant act which one is not at liberty to perform.

Christian ethics, with its principles of stewardship and inviolability of life considers suicide as self-murder.
An individual has no right to kill himself and has no right to murder someone. No individual has no
dominion over his own life, it is but a gift to him. A person is only a steward, a caretaker at most. Life is
inviolable.

B. DIGNITY IN DEATH AND DYING

1. EUTHANASIA

Death is more complicated as it used to be; it is the time of ethical conflict.

The moral issue of Euthanasia revolves around the preservation of human dignity in death even to the
individual’s last breath. This issue has a positive and negative side.

a. positive – states that euthanasia aims to preserve human dignity until death. Not only does one have
a duty to preserve life but one has also a duty to die with dignity. To die with dignity means that one
should be able to make the decision to die when dying would be better than to go on living with an
incurable distressing sickness.

b. negative – declares that euthanasia erodes human dignity. For it is cowardliness, in the face of pain
and suffering. People who have faced the realities of life with courage dies with dignity.

This is the crossroads of the moral issue: whereas the positive side insists that mercy killing preserves
human dignity, the negative side claims the opposite since this act hastens the death of an individual.

EUTHANASIA derives from the Greek word eu (good) and Thanatos (death). It etymologically signifies
good death, pleasant, gentle death, without awful suffering. Euthanasia may be defined in action or
omission, that by its very nature, or intention, causes death, for the purpose of eliminating pain.

14
The word was first used for the first time by F. Bacon in 1623. He affirmed “that the task of the physician
is to bring back health, to mitigate suffering, and pain not so much in that this mitigation can lead to a
cure, but it may also serve to procure a peaceful and easy death (euthanasia). The word is used today
to signify that procedure which facilitates death and liberates from all types of pain, provoking the death
of the hopeless patient and suppressing “useless” human lives.

Kinds of Euthanasia

1. Suicidal Euthanasia – when the subject himself to resort to lethal means to interrupt or suppress his
life. Therefore, it is done with the subject’s consent.

2. Homicidal Euthanasia – (two forms)

2.1 Euthanasia for Piety (Pious homicide) is performed to liberate a person from a terrible disease,
agonizing senility, etc. Most reasonable compared to other types of euthanasia. It is death without
suffering for hopeless patients, saving them for unnecessary suffering.
2.2. social or eugenic euthanasia seeks to eliminate “lives devoid of vital value” or to “purify the race”.

3. Ortothanasia – means normal death. The subject is to left to die by omitting any medical assistance.
But for some authors, this terminology has other meanings (just death, death in due time) which are
considered ethical.

4. Positive or Negative Euthanasia – positive euthanasia provokes death through adequate intervention
(equivalent to suicidal and homicidal euthanasia). On the other hand, negative euthanasia, is the result
of omitting necessary medical support, i.e. ortothanasia.

5. Active (Direct) Euthanasia –procure death to eliminate the pain; Negative (Indirect) Euthanasia – seeks
to alleviate a patient from his sufferings with the accompanying risk of shortening his life.

6. Painless Death - this is not euthanasia. Acceleration of death when it is due to drug therapy which
shortens life but is not intended for his end.

Views on Euthanasia

1. it is intentional killing and opposes the natural moral law or the natural inclination to preserve life.
2. Euthanasia may be performed for self-interest or other consequences.
3. Doctors and other health care professionals may be attempted not to do their best to save the patient;
they may resort to same euthanasia as an easy way out and simply disregard any other alternatives.
4. “the right to life is a fundamental right”
5. From a Christian point of view, it is a crime.

ADVANCE DIRECTIVES

What kind of medical care would you want if reach a point in time that you are too ill or hurt to express
you wishes?

15
 Advance Directives are legal documents that allow you to spell out your decisions about end-of-life care
ahead of time. This give you a way to tell your wishes to family, friends, and health care professionals
and avoid confusion late on.

A living will tell which treatments you want if you are dying or permanently unconscious. You can accept
or refuse medical care. You might want to include instructions on:
1. the use of dialysis and breathing machines.
2. if you want to be resuscitated if your breathing or heartbeat stops
3. tube feeding
4. organ or tissue donation

A durable power of attorney for health care is a document that names your health care proxy. Your proxy
is someone you trust to make health decisions for you if you are unable to do so.

DNR (Do-not-resuscitate order) or END LIFE CARE PLAN

A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care
providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's
heart stops beating.

What is a DNR?

Ideally, a DNR order is created, or set up, before an emergency occurs. A DNR order allows you to
choose whether or not you want CPR in an emergency. It is specific about CPR. It does not have
instructions for other treatments, such as pain medicine, other medicines, or nutrition.
The doctor writes the order only after talking about it with the patient (if possible), the proxy, or the
patient's family.

What is Resuscitation?

CPR is the treatment you receive when your blood flow or breathing stops. It may involves:
• Simple efforts such as mouth-to-mouth breathing and pressing on the chest
• Electric shock to restart the heart
• Breathing tubes to open the airway
• Medicines

Making the Decision

If you are near the end of your life or you have an illness that will not improve, you can choose whether
you want CPR to be done.
• If you do want to receive CPR, you do not have to do anything.
• If you do not want CPR, talk with your doctor about a DNR order.

16
 These can be hard choices for you and those who are close to you. There is no hard and fast rule
about what you may choose.
Think about the issue while you are still able to decide for yourself.
• Learn more about your medical condition and what to expect in the future.
• Talk to your doctor about the pros and cons of CPR.
A DNR order may be a part of a hospice care plan. The focus of this care is not to prolong life, but to
treat symptoms of pain or shortness of breath, and to maintain comfort.
If you have a DNR order, you always have the right to change your mind and request CPR.

How is a DNR Order Created?

If you decide you want a DNR order, tell your doctor and health care team what you want. Your doctor
must follow your wishes, or:
• Your doctor may transfer your care to a doctor who will carry out your wishes.
• If you are a patient in a hospital or nursing home, your doctor must agree to settle any disputes so that
your wishes are followed.
The doctor can fill out the form for the DNR order.
• The doctor writes the DNR order in your medical record if you are in the hospital.
• Your doctor can tell you how to get a wallet card, bracelet, or other DNR documents to have at home or
in non-hospital settings.
• Standard forms may be available from your state's Department of Health.
Make sure to:
• Include your wishes in an advance care directive (living will)
• Inform your health care agent (also called health care proxy) and family of your decision
If you do change your mind, talk with your doctor or health care team right away. Also tell your family
and caregivers about your decision. Destroy any documents you have that include the DNR order.

When you are Unable to Make the Decision

Due to illness or injury, you may not be able to state your wishes about CPR. In this case:
• If your doctor has already written a DNR order at your request, your family may not override it.
• You may have named someone to speak for you, such as a health care agent. If so, this person or a
legal guardian can agree to a DNR order for you.
If you have not named someone to speak for you, under some circumstances, a family member can
agree to a DNR order for you, but only when you are not able to make your own medical decisions.

Alternative Names
No code; End-of-life; Do not resuscitate; Do not resuscitate order; DNR; DNR order; Advance care
directive - DNR; Health care agent - DNR; Health care proxy - DNR; End-of-life - DNR; Living will –
DNR.

Asynchronous Mode of Learning: Case Studies to reflect will be uploaded in the assignment
part of teams.

17
----End of module 2---

References:

Ciabal, Laura Evelyn, 2001. Health Ethics. Educational Publishing House. Manila, Philippines.
Timbreza, Florentino, 2007. Health Care Ethics. National Bookstore, Mandaluyong City, Philippines.
https://www.redalyc.org/pdf/783/78348447005.pdf
https://www.edb.gov.hk/attachment/tc/curriculum-development/major-level-of-
edu/gifted/resources_and_support/ijso/HKIJSO_TrainingManual/Phase1/Biology/Lesson2_Reproductio
n/PhaseI_Bio_L2_Reproduction_StudentNotes.pdfo
https://www.ucg.org/the-good-news/sex-outside-of-marriage-whats-the-big-deal
https://medlineplus.gov/advancedirectives.html
https://medlineplus.gov/ency/patientinstructions/000473.htm

18