JAN MIKHAIL M.

ROSALES
INTRODUCTION TO BIOETHICS

A. DEFINE THE FOLLOWING TERMS

1. Ethics
-At its simplest, ethics is a system of moral principles. They affect how people make decisions and lead
their lives. Ethics is concerned with what is good for individuals and society and is also described as a moral
philosophy.The term is derived from the Greek word ethos which can mean custom, habit, character or
disposition.

2. Biology
-The word biology is derived from the Greek words bios meaning “life” and logos meaning “study” and is defined
as the science of life and living organisms. It is a natural science with a broad scope but has several unifying
themes that tie it together as a single, coherent field.

3. Bioethics
-Branch of applied ethics that studies the philosophical, social, and legal issues arising in medicine and the life
sciences. It is chiefly concerned with human life and well-being, though it sometimes also treats ethical questions
relating to the nonhuman biological environment.
There are four key principles in bioethics:
1. Autonomy: which is respecting a person's right to make their own decisions.
2. Beneficence: To treat people with dignity.
3. Non-maleficence: Do not to inflict harm on people.
4. Justice: To treat people fairly.

The four ethical rules covers following:

1. Veracity – telling truth, respecting autonomy and informed consent.
2. Privacy – it's the right of person to remain private and not to disclose information.
3. Confidentiality – this is sharing private information on a 'need to know basis' only.
4. Fidelity – is maintaining the duty to care for all no matter who they are or what they may have done.

4. Health ethics
-Health ethics is the branch of ethics that deals with ethical issues in health, health care, medicine and science.
It involves discussions about treatment choices and care options that individuals, families, and health care
providers must face. Health ethics looks at moral issues involved in our understanding of life. In health ethics we
ask questions such as when does life begin, how should it continue, and when does it end. Often we think of
health ethics and its relationship with healthcare, medicine and human values

5. Professional ethics
-Professional ethics is concerned with the standards and moral conduct that govern the profession and its
members. More specifically, professional ethics examines issues, problems, and the social responsibility of the
profession itself and individual practitioners in the light of philosophical and, in some contexts, religious principles
among which are duty and obligation.

B. WHAT IS THE IMPORTANCE OF BIOETHICS

Bioethics involves medical ethics and studying about balance between benefits, harm and duties.
It does have an influence both on patients and health professionals and relevance of bioethics varies from
birth to end of life. Bioethics not only provides a guideline to medical professionals about clinical decision-
making, advancements in medical technologies, but also playing vital role in policy changes and legislation in
recent years.
 Its importance is reflected in different parts of our society such as healthcare, research and our
society in general. Bioethics in healthcare brought about awareness to health workers of the medical practice
as well as enriching the ability of health workers to further understand the patient as a person. Highlighting the
ethical side of bioethics, health workers were now able to follow an ethical code when working with patients
which was once a problem. Ethical problems had a clear connection to problems in health care, so by the
emergence of bioethics, the healthcare of our country has been significantly improved. In other words, these
ethical guidelines help the professionals specially us nurses to work through difficult situations and provide
them with a moral compass to do their jobs fairly and also Bioethics contributes to the rights and
responsibilities of patients as persons. At the same time, these guidelines promote high levels of care and
attention.

C. RESEARCH ABOUT THE DIFFERENT PREVALENCE OF BIOETHICAL ISSUES:

1. Abortion
What has been said about contraception becomes an even greater issue when related to
abortion. In medical terms, abortion is the termination of pregnancy before the viability of the fetus—that
is, any time before the end of the 6th month of gestation. An abortion may occur spontaneously as a
result of natural causes (spontaneous abortion). A pregnancy may be interrupted deliberately for medical
reasons (therapeutic abortion), or for personal reasons (elective abortion). It is the last two classifications
(especially the latter) that induce bioethical debate. Ethically, the entire debate revolves around the
definition of human life and when the fetus should be considered a human being. There are two major
schools of thought about the nature of the fetus: one supports the belief that new life occurs at the
moment of conception; the other contends that human life does not exist until the fetus is sufficiently
developed biologically to sustain itself outside the uterus.
Those who support abortion without restriction usually do so because they believe that women
should have control over their own bodies, which is tied to issues of privacy. They further argue that the
quality of life of an “unwanted” child, or a child born with a deformity or genetic defect, may be minimal.
Interesting and challenging cases have emerged with respect to this concept. These are generally
known as wrongful birth cases, and are based on the principle that it is wrong to give birth to children
(such as those with birth defects or limitations that can be diagnosed or anticipated before birth) who will
not have the same quality of life as other children. As a student nurse, these issues present some
difficult questions you will need to answer. To what extent do you believe you can personally participate
in the abortion procedure? Would the stage of pregnancy and type of procedure make a difference? As a
nurse, you have the right to refuse, based on your own ethical beliefs, to be involved in abortion
procedures or the care of patients seeking abortion. Employment in certain areas (e.g, labor and delivery
rooms), however, may rest on the nurse’s willingness and ability to assist with abortions and to give
conscientious care to the patient who has had an abortion. Some religiously affiliated hospitals have
elected to close their labor and delivery services rather than perform abortions.

2. Euthanasia
Meaning “good death,” may be classified as either negative or positive. The word, as it is
generally applied, refers to the act or method of causing death painlessly so as to end suffering.
NEGATIVE EUTHANASIA
Negative, or passive, euthanasia refers to a situation in which no extraordinary or heroic
measures are undertaken to sustain life. The concept of negative euthanasia has resulted in what are
called “no codes” (also designated as DNR—do not resuscitate) in hospital environments. In these
situations, hospital personnel do not attempt to revive or bring back to life persons whose vital processes
have ceased to function on their own.
POSITIVE EUTHANASIA
Positive, or active, euthanasia occurs in a situation in which the physician prescribes, supplies, or
administers an agent that results in death. In the case in which parents choose to let a newborn with
 Down syndrome and an intestinal blockage die, positive euthanasia would have occurred if the doctors
had hastened the infant’s death with medication. There may well be more instances of positive
euthanasia than we know about publicly.

3. SUICIDE
Assisted death involves helping another end his or her life. The activities of a retired Michigan
pathologist, Jack Kevorkian, who is alleged to have assisted patients in their suicide, have received much
media attention in the past few years. Although eluding criminal charges for a number of years, in March
1999, Dr. Kevorkian was convicted of second-degree murder and the delivery of a controlled substance
after CBS televised a video showing him administering lethal drugs. The first case in which he was
charged but not convicted involved an Oregon woman with Alzheimer’s disease.
The ANA has developed a position statement on assisted suicide in which they state that the
nurse should not participate in assisted suicide. Such an act is viewed as a violation of the Code for
Nurses (see Chapter 9). It is the position of the ANA that the challenge for nurses should not be in
legalizing assisted suicide. Rather, the role of the nurse should be directed toward reversing the despair
and pain experienced in the last stages of life, and in fulfilling the obligation to provide competent,
comprehensive, and compassionate end-of-life care (ANA, 1994).
The right to refuse treatment is an issue closely aligned with the right to die. However, it carries
special implications that require separate consideration. Although we discussed some of the parameters
of this issue in the previous section on the right to die, other aspects can create even bigger problems for
the nurse. The moral, if not legal, precedent for refusing treatment occurred in 1971.

4. DO NOT RESUSCITATE
A do-not-resuscitate order, also known as no code or allow natural death, is a legal order, written
or oral depending on country, indicating that a person does not want to receive cardiopulmonary
resuscitation if that person's heart stops beating. Sometimes it also prevents other medical
interventions. Its purpose is to let medical professionals know you do not want to be resuscitated if you
suddenly go into cardiac arrest or stop breathing. This is a common concern of the chronically ill and the
elderly.

5. DETERMINATION OF DEATH
In the late twentieth century, as a response to certain advances in critical care medicine, a new
standard for determining death became accepted in both the medical and legal communities in the United
States and many other parts of the world. Until then, the prevailing standard was the traditional
cardiopulmonary standard: the irreversible loss of heart and lung functions signals the death of a human
being. The new standard, which took its place alongside the traditional one, is based on the irreversible
loss of all brain-dependent functions. In most human deaths, the loss of these neurological functions is
accompanied by the traditional, familiar markers of death: the patient stops breathing, his or her heart
stops beating, and the body starts to decay. In relatively rare cases, however, the irreversible loss of
brain-dependent functions occurs while the body, with technological assistance, continues to circulate
blood and to show other signs of life. In such cases, there is controversy and confusion about whether
death has actually occurred. It was a key advance in medical technology—the mechanical ventilator—that
originally gave rise to the confusions and controversies about when death occurs in a critical care setting

6. HUMAN EXPERIMENTATION
The conduct of biomedical research involving the participation of human beings implicates a
variety of ethical concerns pertaining to such values as dignity, bodily integrity, autonomy, and privacy.
These ethical concerns have been translated into a complex regulatory apparatus in the USA, containing
specific legal provisions concerning such matters as participant safety, informed consent, and
 confidentiality. A topic of particular interest for pathologists is the handling of human tissue specimens that
may be used for present, or stored for future, research purposes.
Unnecessary and questionable human experimentation is not limited to pharmaceutical
development. In experiments at the National Institutes of Health (NIH), a genetically engineered human
growth hormone (hGH) is injected into healthy short children. Consent is obtained from parents and
affirmed by the children themselves. The children receive 156 injections each year in the hope of
becoming taller. Growth hormone is clearly indicated for hormone-deficient children who would otherwise
remain extremely short. Until the early 1980s, they were the only ones eligible to receive it; because it was
harvested from human cadavers, supplies were limited. But genetic engineering changed that, and the
hormone can now be manufactured in mass quantities. This has led pharmaceutical houses to eye a huge
potential market: healthy children who are simply shorter than average.

7. BIRTH CONTROL
Much of the controversy over birth control is related to the theologic teachings of some religious
groups, who believe interference with procreative powers is wrong. The Roman Catholic Church has
strongly advocated that the natural purpose of sexual activity is to create new life and nothing should try to
interfere with that potential. During your career as a nurse, you will care for patients who represent many
differing viewpoints. When caring for individuals whose personal beliefs prohibit the use of artificial birth
control, you must be knowledgeable about natural methods of family spacing, such as fertility awareness
methods, that will meet the patient’s needs. If your personal views regarding contraception differ, your
values must be set aside as you focus on assisting the patient in selecting a method that is compatible
with the patient’s personal values and beliefs.
Central to all discussions of contraception is the issue of freedom of a woman to control her own
body. This immediately raises a second question: who has that right? Is it the woman’s right because it is
her body? What if the partners disagree about family planning practices? Does one have more say than
the other? What if one partner wants to have a family and the other does not?

8. IN VITRO FERTILIZATION
Unlike in vivo fertilization, IVF requires the intervention of a medical team. This intervention
begins by taking a history of the couple. This is followed by physical and laboratory examinations that
include a test for the sperm count of the male partner and a pelvic examination, cervical culturing, and
staining of cervical secretions for the presence of Chlamydia for the female partner.
THE ETHICAL ISSUES:
 ISSUE 1: THE POSSIBLE WRONG DONE TO THE PRE-EMBRYO
 ISSUE 2: THE POSSIBLE WRONG DONE TO THE INFERTILE COUPLE OR THE EXPECTED
OFFSPRING BY THE PHYSICIAN IN USING IVF
 ISSUE 3: THE POSSIBLE WRONG DONE TO THE OFFSPRING BY THE INFERTILE
COUPLE WHO USES IVF
 ISSUE 4: THE POSSIBLE WRONG DONE TO THE COMMUNITY BY THE USE OF IVF ON
THE PARTS OF THE PHYSICIAN AND THE INFERTILE COUPLE

There are numerous problems concerning the implementation of IVF, including whether there is a
right to this technology, whether such access should be funded by health insurance, and whether access
should be limited to women of a specified age group. However, these problems take on meaning and
importance only if IVF is perceived to be sanctioned ethically.

9. STEM CELL TECHNOLOGY

Stem cell research offers great promise for understanding basic mechanisms of human
development and differentiation, as well as the hope for new treatments for diseases such as diabetes,
spinal cord injury, Parkinson’s disease, and myocardial infarction. However, human stem cell (hSC)
research also raises sharp ethical and political controversies. The derivation of pluripotent stem cell lines
 from oocytes and embryos is fraught with disputes about the onset of human personhood. The
reprogramming of somatic cells to produce induced pluripotent stem cells avoids the ethical problems
specific to embryonic stem cell research. In any hSC research, however, difficult dilemmas arise regarding
sensitive downstream research, consent to donate materials for hSC research, early clinical trials of hSC
therapies, and oversight of hSC research. The main ethical and policy issues with stem cells concern the
derivation and use of embryonic stem cells for research. A vocal minority of Americans objects to the
destruction of embryos that occurs when stem cells are derived. Embryonic stem cell research is
especially controversial for those who believe that five-day-old preimplantation human embryos should not
be destroyed no matter how valuable the research may be for society.

10. HOMOSEXUALITY
Some of the problem seems to center around the fact that people define “acceptable behavior” in
different and sometimes conflicting ways. When is behavior deviant? When is the client mentally ill? An
excellent example is that of homosexuality, which the American Psychiatric Association at one time listed
as a mental illness. Although many people may not approve of homosexuality, they would not classify all
homosexuals as being mentally ill. Increasingly, society looks on sexual orientation as a personal matter
Implicit metaphysical assumptions concerning the nature of sexual orientation are reflected in the
language used to frame ethical debates concerning “reorientation” therapies. An alternative metaphysical
construal is presented concerning sexual orientation and sexual identity development and synthesis. This
alternative construal allows for humility concerning what we know and do not know about sexual
orientation, underscores the client’s self-determination and autonomy, and demonstrates regard for
personal and religious valuative frameworks. Rather than focusing on therapies aimed specifically at
sexual reorientation, clinicians would do well to provide clients with informed consent and to facilitate
identity development and synthesis in keeping with their clients’ requests for professional services.