REVIEWER (ETHICS)  Voluntariness

Disclosure/Information
AUTONOMY
-The extent of information given to the patient by the
Derived from the Greek words ‘auto’ meaning ‘self’
physician/nurse relating to the medical procedure.
and ‘nomos’ meaning ‘rule’.Thus, autonomy means
self-law or law to oneself.The original usage then of -The expenses to be incurred, likewise is decisive
autonomy is to mean ‘self-rule’ or ‘self-governance’ of whether or not consent is to be given by the patient for
independent city-states. medical procedure.

Capacities for Self-Governance: Competence/comprehension

-To Understand (moral reflection) the issue and what -The patient’s level of education greatly affect one’s
the situation is all about and to reason out and give own decision and the level of emotion to the extent
one’s opinion/ relevantly possible.

-To Deliberate (effective deliberation) by weighing the
pros and cons of the issue.
-To Make an Independent choice (free choice) basic to
making an independent choice is one’s capacity to
make decisions.
-The health care provider can appropriately assess the
accessibility of the language that will understood by
patient. Patient can finally render an intelligent
decision
Voluntariness

Practical Implication of respect for Autonomy in This element of informed consent is customarily
medical practice. understood as free and willfully given by the patient.
The issue at hand is that the patient must be given
 Right of the patient, that is, right to self-
sufficient time and ample space
determination which is guaranteed by the
patient’s bill of rights. The Two function of informed consent
 Informed consent
 Actual directive 1. Projective (to safeguard against the tension of
 Advance directive/Living will integrity)
 Refusal of treatment
2. Participative (to be involved in the health care
Informed Consent decision making)

 Informed consent is also known as Two basic of obtaining consent

enlightened consent, to mean, any prior
1. Written consent (it is often use upon admission of
substantial or therapeutic and research
patient into the hospital, another used it maybe dream
participation, patient must have a full
necessary for other procedure likely surgery)
information of what procedure is all about,
objective, need and advantage. 2. Verbal consent (it usually comes the comes in the
 It is also a form of invitation to a patient to form of an implied consent like when a patient seeks
participate in his health care decisions. consultation with is physician)
Informed consent maybe be expressed into two Significance and justification of informed consent
settings:
1. Patient of an opportunity to be an informed
 Therapeutic setting participant in health decision.
 Research setting
2. It is also a legal document and as a form of an
Elements of informed consent: assurance of safety for the and for healthcare
Threshold elements professionals (ex: invasive procedure such as: surgery,
anesthesia and others)
 Disclosure/Information
 Competence/comprehension
3. A form of protocol of the research process because
most researches involve patient’s lives.
4. It emphasizes honesty trait of the professional to
carry in their very selves an honest character when
asking patient to sign informed or enlightened consent.
5. It reduces risks and avoids unfair treatment and
exploitation by the professional and it is also
regulatory and institutional control.
6. It also protects the autonomous choice, by which the
claim of patient’s right to autonomy was promoted.
Barriers to informed consent vis-à-vis nursing
intervention
1. Language: the nurse can use intermediary such as a
translator to translate information to language that can
be understood by the patient.
2. Cultural differences: the nurse can use intermediary
or let patient meet other persons who underwent the
same medical procedure or treatment of the same
culture background as the patient.
3. Physical impairment/illiteracy: the nurse can show
pictures, videos, literature and other related teaching
aid.
4. Incompetence: the nurse help to ensure that decision
made by the person responsible for the patient is for
letters benefit and well-being.
General it is ethical as well as legal responsibility of
the nurse to overcome these barriers and everything in
her capacity to ensure that the patient sufficiently gets
all the needed information to make an informed
decision.
Actual directive and advance directive
 The right to self-determination originated from
the principle of autonomy which entails every
individual to informed consent including the
right of person of legal age and sound mind to
voluntarily refuse a diagnosis.
 Actual directive is an instruction that was
given on the very moment that is being done
by any person with a normal condition.
 Advance directive, on the other hand, is an
issue given in anticipation of what a person
might think would happen relative to his/her
health condition.
A. Biological parents of the patient
B. the oldest child of the patient if of legal age
C. legally adapting parents of the patient
D. nearest kin
E. municipal health officer of the place where the
hospital is located/medical director
Two forms advance directive
1. Living Will (instructional directive) A will by which
any competent adult give direction and instruction for
future care in the event that the patient involve can no
longer make due to terminal or severe illness or an
impending death
2. Medical Power of Attorney (Health care proxy). A
probable patient can name a person trusted so as to act
in their behalf as an agent/proxy in making health care
decisions in an event of incapacity.
Practical Implication/issues of limiting Autonomy
Paternalism (Parentalism)
 Paternalism ( Parentalism ) comes from the
Latin word ‘pater’ to mean father. The conflict
between respect for autonomy and the desire
to help the patient ( beneficience ) brings the
problem into forefront of paternalism.
 Paternalism describe as ‘the principle and
practice of paternal administration;
government as by a father; the claim or
attempt to supply needs or to regulate the life
of a nation or community in the same way a
father does to the children.
 Two important features of Paternalism: That
the father acts beneficently, namely, in
accordance with the conception of the interest
of his children and he makes all or at least
some of the decisions relating to his children’s
welfare, rather then letting them make those
decision.
 In medicine, Paternalism is applied when
health care givers such as doctor, nurses and
the like, assumed the authority to make
decision for and in behalf of the patient
without their consent or knowledge.
PLACEBO
-(Latin for "I shall please") is a pharmacologically
inert substance (such as saline solution or a starch
tablet) that seems to produce an effect similar to what
would be expected of a pharmacologically active
substance (such as an antibiotic)
THE PLACEBO EFFECT
-The placebo effect consists of several different effects
woven together, and the methods of placebo
administration may be as important as the
administration itself
-a simulated or otherwise medically ineffectual
treatment for a disease or other medical condition
intended to deceive the recipient. Sometimes patients
given a placebo treatment will have a perceived or
actual improvement in a medical condition, a
phenomenon commonly called the placebo
effect or placebo response.
Resuscitation
 A form of medical intervention done in a
series of steps directed to sustain adequate
circulation of oxygenated blood to vital organs
while an effective heartbeat was restored.
 Do not Attempt Resuscitate (DNAR) or
commonly known as Do not Resuscitate
(DNR) a request to forego resuscitation
maneuvers.
Indications for DNR orders
1. When the patient condition is terminal and
death is immanent so that life support only
prolongs the dying process.
2. When the patient is irreversibly comatose or in
persistent vegetative state and there is no hope
of improvement.
3. When the burden of treatment far outweigh the
benefit (adapted from the Southeast Asia
Center of Bioethics).
4. The following are reasons for DNR orders,
these were taken from different sources
gathered: no medical benefit, poor quality of
life before CPR,poor prognosis, severe brain
damage, extreme suffering or disability in a
chronically or terminally ill patient, request by
the a patient or family member, enormous cost
and personnel commitment as opposed to the
low probability of patient recovery, by not
administering any cardiopulmonary in the
event of cardiac arrest, we are actually letting
the person go in peace and dignity.
BENEFICENCE
 Etymologically, comes from the two Latin
words:
› “bonus” where bene was taken to mean “good”
› “fic” where fiche was taken to mean “to act or
do”.
 It refers to “action done for the good of the
others”.
 In the language of medicine, this principles
highlights the duty of health provider to do
good and take positive steps, such as
prevention and removal of harm to the patient.
 Beauchamp, Childress & Psyche believed that
it could be seen through associated acts of
kindness, charity, humanity, altruism & love.
 Beneficence was often thought to broadly
include all form of actions. (Benevolence &
Provenance, intended to benefit other persons.
 So, beneficence refers to an action done
benefit others.
› Benevolence – refers to the character, trait or
virtue of being disposes to act for the benefit of others.
› Provenance – is the attentiveness dictated by
kindness to anticipate what one needs since each one
of us, has that inner goodness that pushes us to
alleviate the pain and discomfort to others.
 Therefore, Beneficence goes hand in hand
with benevolence and provenance.
Beneficence: Obligatory and Ideal Beneficence
 Some ethnical theories like Utilitarianism are
based on the principle of beneficence. This
means, that goodness and kind-deed form the
substratum of the Utilitarian Theory.
 J. Bentham and W.D. Ross differ in the
meaning of beneficence yet they employed the
term beneficence as a positive obligation, to
others, though some critics denied this kind of
beneficence for he holds that the beneficence
is a virtuous ideal/acts of charity, thus any
person therefore is not morally deficient if
he/she failed to act beneficently.
 Beneficence then is sometimes an admirable
ideal of action that exceeds obligation.
  Nobody denies that the Beneficient acts is
morally meritorious and therefore, morally
praiseworthy away from a personal obligation.
› Example: Donating one’s kidney to a stranger.
 We are not morally required as morality
dictates to perform all posible acts of
generosity or charity that will benefit others.
By this,
› Ideal Beneficence means going out of one’s way in
order to do good to others, while Beneficence, is
merely goodness to others without going out of one’s
way.
› To sum up, Ideal Beneficence is benevolent act that
involves going out of one’s way to do good as that of
Good Samaritan.
› Obligatory Beneficence is a mandatory act to do
good and to give aid to those who are in need.
Practical Applications of the Principle of
Beneficence
 Protect and defend the right of others
 Prevent harm from occuring to others
 Remove conditions that will cause harm to
others
 Help persons with disabilities
 Rescue persons in danger
* The principle of beneficence is already practice by
Filipinos by showing one’s goodness such as, delicate
and generous hospitality and this is shown in different
situations like; Sharing of goods & Lending of money,
materials, equipment and even human resources like
bayanihan.
NON-MALEFICENCE
One’s own obligation to do good in the practice of
medicine is also limited by one’s own obligation to
avoid evil/harm. One’s avoidance of harm on others is
embedded into what we call, the principle of
nonmaleficence. In medical ethics it has been closely
associated with the maxim, primum non nocere, which
means, above all (or first) do no harm (Beauchamp and
Childress, 2001). This maxim expresses an obligation
of nonmaleficence in the Hippocratic tradition, ‘I will
use treatment to help the sick according to my ability
and judgment, but I will never use it to injure or wrong
them’. This principle helps in decision-making about
issues that may alter one’s own life, such as on killing
and letting go, withholding and withdrawing treatment,
use of extraordinary and ordinary means/procedures
and other issues.
The meaning of nonmaleficence
 Nonmaleficence comes from a Latin words:
‘non’ to mean ‘not’; ‘malos’ from which
‘male’ is taken to mean ‘bad/evil’ and ‘faceo’
from which ‘fic’ comes which means
‘do/make’. Thus the term nonmaleficence
means not to make or to do bad or to make evil
things intentionally.
 In medicine, nonmaleficence means not to
inflict harm which is not different from ‘not
doing evil or bad things’. This principle
requires a health care provider to prevent or
refrain from any sort of actions that eventually
causes harm to patient and more importantly
when the action is never been justified.
Distinction between nonmaleficence and
beneficence
Generally an obligation of nonmaleficence is more
stringent than obligations of beneficence and in some
cases, nonmaleficence perhaps may override
beneficence. Beauchamp and Childress suggested the
following schema to distinguish the principle of
nonmaleficence and beneficence. But the said authors
do not propose a hierarchical order.
INSTRUCTIVE PRINCIPLE BIOETHICAL PRINCIPLE
One ought not to inflict evil or
harm
Nonmaleficence
One ought to prevent evil or
Beneficence
harm
One ought to remove evil or
Beneficence
harm
One ought to do or promote
Beneficence
good
EXAMPLES OF NONMALEFICENCE:
1. Do not kill
2. Do not cause pain or suffering to others
3. Do not cause offense to others
4. Do not incapacitate others
5. Do not deprive others of the goods of life
CRITERIA ON DETERMINING NEGLIGENCE:
1. The professional must have the duty to the affected
party
2. The professional must breach that duty
3. The affected party must experience harm.
4. The harm must be caused by the breach of duty.
PRINCIPLE OF NONMALEFICENCE
 affirms the need for medical competence
 a part of Filipino character through avoidance
of confrontational dialogue that will eventually
cause harm to others
Practical application/implication of the principle of
Non-maleficence
Withholding Treatment and Withdrawing Treatment
are bioethical issues which can be acted upon or
justified by the following conditions:
1. When the case is irreversible any form of
treatment will not benefit the patient
2. When death is immanent or when patient is
already dead
Ordinary and Extra-ordinary Treatments
Ordinary treatment comprises of the provision of
necessities of life that usually pertain to food, normal
respiration and elimination process. Hence like
intravenous fluids, nasogastric tube feedings,
indwelling catheters, are some among the many
considered ordinary and necessary measure of
treatment and may be sustained even if the case is
irreversible.
Extra ordinary treatment comprises of the use of
aggressive modalities vis-à-vis the capacities of the
family or maybe some family who can very well afford
it, continue to give extra ordinary measure. But this
means do not necessarily offer any benefit to the
patient.
Killing and Letting Die
 In ordinary language ‘killing’ is a causal
action that deliberately brings about another’s
death
 ‘Letting die’ is ‘prima facie’ acceptable in
medicine under two conditions:
1) A medical technology is useless (medically futile)
and
2) Patients (or valid surrogate/proxy) have validly
refused a medical technology
JUSTICE
 Justice comes from the Latin word "jus" means
"right".
 Justice is a concept of moral rightness based
ethics, rationality, law, natural law, religion,
equity and fairness, as well as the
administration of the law, taking into account
the inalienable and inborn rights of all human
beings and citizens, the right of all people and
individuals to equal protection before the law
of their civil rights, without discrimination on
the basis of race, gender, sexual orientation,
gender identity, national origin, color,
ethnicity, religion, disability, age, wealth, or
other characteristics, and is further regarded as
being inclusive of social justice.
FORMAL PRINCIPLE OF JUSTICE
Aristotle in Nichomachean Ethics
 Equals must be treated equally
 Unequal must be treated unequally
MATERIAL PRINCIPLE OF JUSTICE
Principle that specify the relevant characteristics for
equal treatment are called "Material" because they
identify the substantive properties of distribution.
Engelhadrt, Keusch, Wildes and others have
suggested the following material principle of
Justice.
 To each person an equal share
 To each person according to need
 To each person according to contribution
 To each person according to free- market
exchange
Wildes and others have suggested the following
material principle of Justice.
 To each person according to merit
 To each person according to effort
SOME ETHICAL ISSUES
CARE AT THE BEGINNING OF LIFE
The way life is brought into existence (reproductive
technology) and the way in which the nature of future
human lives are intervened with (like, embryonic stem
cell research, human cell line and commodification)
reflect this age of consumer mentality and market
ethics. Babies have to come at the appropriate time,
number and space. For a service fee, then, sex were
selected, genes were improved. Children therefore
were made to satisfy the desire market (like baby
making parent, supplier or baby breaking
experimenters). Though this may sound economically
good yet its not done for the common good.
Commercialization had led to the continued use and
abuse of human life and human person. Issue at the
beginning of life is peculiar because it involves:
mother/woman, father/man and fetus that cannot give
consent, has no wishes and cannot defend itself.
Nurses in this regard must be able to inculcate in the
minds of those proxies to act in and for the best
interest.
Natural reproduction
The female ovaries expel the mature egg towards the
Fallopian tubes every 28 days. The male’s testes
produce the sperms which are expelled at ejaculation.
With the conjugal act the perms are deposited in the
vaginal canal. The sperm travel up the uterus into the
uterus into the Fallopian tubes and there fertilize the
egg. The fertilize egg (mean the embryo) travels down
to the uterus where it is implanted, develops, grow
(embryo, fetus) after 9 months the baby is born.
Principles
The principles involved and promoted in the
reproductive issue are:
1. Inviolability of Life. All human from the moment of
conception (fertilization) and through all subsequent
stages is sacred. Thus, all have the duty to affirm,
respect, love and defend it. Violation of this principle
occurs like in: abortion, in vitro-fertilization and stem
cell research.
2. Stewardship. Man msut take care, cultivate,
creatures within the creature’s innate nature and
teleology and within man’s knowledge and
understanding. Violations arises in: surgical sterility,
substitution of reproduction, use of hormones, intra-
uterine devices (IUD) donation of sperm or egg genetic
manipulation.
3. Double Effect. A foreseen evil effect may be
allowed if the foreseen intended good effect is greater
than and does not result from the evil effect. This is
applied into maternal-fetal conflict, removal of
diseased organ like in ectopic pregnancy, anencephalic
ifants.
4. Nonmaleficence. Do no and risk no harm. This
is applied into: sterilization, hormones psychological
harm psychological and financial effect of new
technologies.
5. Beneficence: do good and provide a benefit.
This applies when removing diseased organs,
facilitating pregnancy, educating on responsible
parenthood.
6. Respect for Person. 1) Not to be
denatured/destroyed. Issues/ and violation arises in:
artificial methods of reproduction (like: IVF and AID
or AIH), cloning. 2) to be an end and not a means to an
end. This happens in contraceptions, commodifications
of sperm/egg, uterus dysfunction, and embryonic
manipulation.
Assisted reproduction
The right to procreate is limited by man’s
nature. Artificial methods that help the conjugal act
and ultimately reproduction are praiseworthy. Like, the
use of folic acid, sex education, fertility awareness and
planning, fertility drugs or hormones, viagra (for
sexual dysfunction) microsurgery to correct
reproductive organ defects, delivery with forceps,
these assisted reproduction abide with the bioethical
principles.
Artificial insemination by AIH/AID including
zygote implantation into fallopian tube (ZIFT),
intracytoplamic sperm injection (ICSI) replace the
conjugal act and are illicit.
1. In-vitro fertilization and embryonic transfer (IVF-
ET). In IVF-ET the gametes are separately harvested,
in number of eggs are fertilized in ‘Patri Dish’ some
zygotes are implanted into the mother, and unwanted
embryo may be removed. This is not in conformity
with the following principles:
a) Inviolability of Life (some unwanted zygote are
allowed to die)
b) Stewardship (the procedure is artificial and it
substitutes the conjugal act)
c) Nonmaleficence (the baby may develop the
‘genealogical bewilderment syndrome’, also, if sperm
is from a donor, the unknown biological lineage may
lead to incest or inherited diseases. Mothers are
psychologically harm by series of unsuccessful
attempt)
d) Justice (if private funds are used the prohibitive cost
limits availability to the rich. If public funds are used,
more essential needs are abandoned)
e) Respect for Person (the human body, the uterus,
sperm egg becomes commodities trafficked,
transferred or sold; the baby is not a gift but a product
of other’s will to be disposed of as desired (the unused
embryo; ‘take home’ baby in term of wasted babies are
often not shared with parents)
2. Cloning it is the reproduction of a genetic copy of
another human being either through ‘splitting’ of the
embryo’s cell or through somatic cell nuclear transfer.
The latter, involved the removal of the nucleus from
the unfertilized female egg and its replacement by the
nucleus of a cell taken from donor.
Embryos are cloned either to provide human
embryonic stem cells (ES cells) as precursors for
differentiated cells to treat diseased (mean therapeutic
cloning) or to produce a new individual by implanting
it in a woman’s uterus (mean reproductive cloning).
Now, harvesting of human ES cells requires
destruction of the embryo. Cloning violates:
a) Inviolability of Life (embryo are destroyed in the
therapeutic cloning)
b) Stewardship (the process is artificial)
c) Nonmaleficence(the psychological and physical
risks to mother and child. In accdition the concept of
the ‘family’ is perhaps destroyed)
d) Respect for Person (denatured and destroyed by
stockbreeding with no uniqueness ans individuality;
parents were reduced to a mere providers of human
‘materials’, like, sperm, egg and uterus)
3. Human Embryonic stem cells (Human ES cells) it is
the production of human embryos/the use of surplus
embryos from IVF or aborted embryos or frozen
embryos. The isolation of the inner cell mass (ICM)
which is cultured and subcultured to form colonies
then cell lines must be done early in the embryonic life
and destroyed the embryo (nonmaleficence). This
intentional killing is morally illicit. Thought the end
may be praiseworthy as in a regenerative medicine, it
cannot justify the means (double effect). To use
commercially available or supplied ES cells obtained
from them is proximate material cooperation with
scandal in the act of embryo destruction (respect for
person and nonmaleficence).
Prevention of reproduction
There are two ways by which reproduction may be
prevented it is through contraceptive and abortive.
There are some obvious reasons why other people
choose this methods, one is space pregnancy, health,
economics, unreadiness, no desire to be obligated to
try to have children and others.
1. Contraception is any action which in anticipation of
the conjugal act (castration, tube ligation, vasectomy,
oral or parental hormones to prevent ovulation) or in
its accomplishment (like, spermatocides in creams,
jellies, foams or suppositories, coitus interuptus,
condoms, diaphragm, hormones which thicken cervical
muscus) or in the development of its natural
consequences (like IUD, abortion, fetal reduction)
whether as an end or means, prevents the creation of
new life (anti-life). contraceptives treat fertility as a
negative value that should be suppressed. It vilates or it
is nonconformity to:
a) inviolability of life (drugs and devices that inhibit
fertilized ovum transport to and implantation in the
uterus or its development are abortificient. They kill
the fetus.
b) Stewardship (it promotes hedonistic mentality with
refusal to accept the reproductive responsibility of
sexual or to recognize a new human being. (perhaps as
god is the final Creator)
c) Nonmaleficence (castration removes a healthy
organ, tubal occlusion or ligation and vasectomy
prevents a healthy function. IUD promotes infection as
well. Contraception as well promotes a premarital sex,
extramarital sex, or homosexuality.
d) Respect for person. (to have one spouse use the
other spouse as a means for one’s satisfaction or
pleasure is a sign of disrespect)
2. Abortion is the process of deliberately terminating
pregnancy with the resulting death of an entity or it is a
process of deliberately terminating pregnancy at any
stage of its development. Types of abortion:
a) direct abortion or induced: it a kind of abortion with
the intentional of immediate purpose of ending or
destroying the fetus at any stage of after its conception.
b) Indirect abortion is a process of terminating
pregnancy directly in which the moral object of the
action is the therapy of the mother and the death of the
fetus is a side effect that is inevitably unavoidable
effect. Ex., removal of pathological tube containing a
fertilized ovum in an ectopic pregnancy, removal of
the cancerus gravid uterus. This act is justified by the
principle of double effect. Obviously direct abortion
violates the principles of natural reproduction.
Abortion is done through:
1) injection with concentration saline (salt) (it is an
injection of a concentrated saline solution into the their
mothers womb. It burns their skin off them while were
still alive the babies breathe it in and swallow it, frying
their insides. Some of babies were born alive despite
this torture and are then ‘disposed of’)
2) dilation and Evacuation Dilation (this is
characterized by using a suction tube to remove the
fetus and placenta)
3) Hysterotomy (abortion by caesarian surgery)
4) Vacuum aspiration (is a method by suctioning of the
lining of the uterus through the use of a thin and
flexible tube inserted through the opening of the
cervix)
CARE AT THE PROMOTION OF LIFE: ORGAN
TRANSPLANTATION AND DONATION
Advance in surgery and introduction of new
drugs have led to the steady growth of organ
transplantation and donation. The removal of the organ
from one being and its implantation into another has
saved lives or made lives better. Unfortunately organs
are scarce resource. Thus, many who need new organs
die while on the waiting lists. This lack of organs has
led to abuses such as robbing, maiming, or even killing
of donors, commercialization of organs by health care
givers, middle men or institutions and coercion
exploitation of disadvantaged donors or needy
recipients. It is in the abuse that violation occurs.
Terms to consider:
Organ donation means the giving of tissue/organ/body
by a person to another person or to an institution
Donor the given who may be a cadaver (with an
assumptive document by the donor when still alive or
by proxy) or a living person (either by relatives, non-
relative)
Vendor is a person who exchange their organ for
money
Recipient the receiver of the organ given by the donor
or institution; a recipient who pay the organ is a buyer
Organ transplantation means the transfer or the
planting across of organ from donor/vendor to
recipient/buyer
Xenotransplantation is the planting of an organ from
animal organ to human beings.
Allotransplantation it is the transplantation of the
organ from one body to another body of the same
species.
Organ donor
Our main concern is to care life that is the life of the
donor. The principle stewardship and nonmaleficence
state that man must take care of his body and do no
harm to it. If the donor is the cadaver, harvesting an
organ will do no harm. If the donor is living, taking
away a healthy organ is not taking care one’s body: no
life is saved, no health is restored. Removal o organ
may even be mutilation. However, a very
proportionate reason and a meritorious act my override
the rule of stewardship and nonmaleficence. The rule
of unselfish love, solidarity love of neighbor,
beneficence, and charity these may supercede the rules
of stewardship and nonmaleficence.
In such a case it is praiseworthy, for it takes
what it means to belong to a human society that we are
fulfilling our duty to one another (deontological duty)
and to contribute to the goal of medicine (healing). By
this it makes the giver a better person. Still in spite of
its meritorious promise there are some requirement
before an organ may be considered moral/bioethically
acceptable:
1) the harm and risk must be minimal and
proportionate to the benefits to be derived. Things
need to be considered:
a. accurate definition of death must be followed and
observed
b. the dying cannot be killed
c. the organ to be removed must not be a necessary
condition for life or for personal procreation, like,
brain and gonads
d. an part of the body that can easily be regenerated
can be given such as blood, hair, bone marrow
e. a second kidney or a portion of the liver these are
nor necessary for the personal or procreational identity
2) the donor must be care for before, during and after
the donation. This includes the following
consideration:
a. proper screening
b. standard of health care
c. reimbursement of medical expenses
d. disability and livelihood lost (burial expenses of the
cadaver)
e. prevention of discrimination in job
f. prevention in community acceptance
3) the intrinsic worth and dignity of the donor must be
respected. The following must observed:
a. free and informed consent must be given
b. information given should include process of
matching, the chance of success of the transplant and
permission to refuse
c. financial need and ignorance make te marginalized
vulnerable to exploitation
4) in case of cadaver, consideration must be observed:
a. consent for the donation must be given or obtained
specially person that met an accident
Organ Recipient
Stewardship dictates that in case of serious
illness man has the right and the obligation to take
necessary measures to promote life and health. A new
organ may preserve life of the person. To the extent
that if it is available one has a right to and obligation
to get it. Some bioethical consideration are required for
it to be morally and bioethally accepted:
1) respect for autonomy must be allow the recipient to
choose how to get an organ. It requires:
a. to give free and informed consent
2) there must be justice in allocation. Justice as equal
benefits for everyone in need would dictate giving
nothing to anyone and letting everyone die. It is
pointless and harms all.. the following must be
consider:
a. the criterion for judging equality is based on the
chance of success
b. the ability to pay the costs of the transplant and the
expensive anti-rejection medication determines success
and access
c. given the case that both are capable to spend has
success and access, the first come first serve must be
serve.
What the nurse can do, they must contribute on the
communal dialogue and public education must be
given, so that the main goal of organ transplantation
shift back to its true nature of:
a. commodities to self love
b. commercialization to charity
c. potential donors must be protected against harm,
thus become an advocate of the donors
d. educating donors that selling organ is not encourage
e. nurse should address the underlying poverty,
ignorance and vulnerability of people that sells their
organs; organs ‘should not be for sale’
CARE AT THE END OF LIFE: EUTHANASIA
AND PHYSICIAN ASSISTED SUICIDE
One’s values regarding life and death are
reflected in how one dealt with the dying. If one
cannot bear to see suffering, then one resorts to an
“advance” death, such in euthanasia, suicide, or
physician assisted suicide. If one sees life as the
highest value with death as a form of human defeat, or
if one is overly influenced by available new
technology and biological idolatry then one does
everything to prolong life beyond one’s one time and
this is known as dysthanasia. On the other hand, if one
sees death as the culmination of a good life, to be
valued only until its natural end, one looks for a good
death this is orthothanasia.
Before proceeding to the types of death, it is
important to determine first signs of the moment of
death, signs of death and when to pronounce that a
person is dead.
Moment of death
1. Inevitable and critical moment when organism
ceases to function as specified, unified, homeostatic
system and becomes disorganized into a mere
collection of heterogeneous chemical substance. To
know that body is disorganized we must at least
become sure of three things:
a. that the body does not now exhibit specific human
behavior
b. the body does not function humanly in the future
c. the body has no more radical capacity for human
functions due to its lost of basic structure required for
human unity
The third reason is necessary due to the fact that
medical experience had shown that persons who are in
coma nevertheless have sometimes recovered full
human consciousness. Such resuscitation is possible,
however, after true human death some cells or even
organs of the human body for a time by artificial
respirator, continue to exhibit some life functions but
these functions are not those of human organism but
simply a residual life at level of organization similar to
a plant or animal. Thus, the essential point of
determining human death is not to decide whether any
life is present, but whether human life in the most
radical sense of a unified human person is still present.
2. life force of cell is no longer united to the matter
with which it was at any times united.
3. religious orientation, the separation of the body and
the soul (medically, it is understood as, body’s lack of
sensation and self-movement.
4. the lose of touch irrevocably with a person who
previously was able to communicate and to share our
human community of thought, of love, of freedom and
or creativity.
Signs of death
1. human organism is irreversibly dysfunctional and
dead
2. less conclusive, absence of breathing and heartbeat
Now, the signs are not a guaranteed bases and signs of
death due to some technological advancement that is
perfected to aid the lungs and heart to functions
artificially as in resuscitation. Such mechanism of
resuscitation restored back and sends blood through
the body, even if after the unity of the body cease to
exist. Be that as it may, it does not lead to a conclusion
that an individual organ simulates unity, unity or
organism is no longer present because the organs
would cease to exist right away if the mechanism is
removed. Thus, an artificial sustained heart and lung
activity is not a proof that human life still remains.
That is why as long as this heart and lung is sustained
by mechanical device that runs it artificially the
traditional bases of death is impossible to verify. Thus,
we ask the question? What then is the basis or are there
other clinical signs that can be used not to constitute a
new definition of death rather as an alternative,
complementary ways the same essential fact, namely,
the irreversible cessation of spontaneous heart and
lung functions.
Aside from the new technology used, another reason is
the possible organ transplant of heart and kidney. It is
said to be that the success of transplanting of heart will
likely to be very successful if the organs to harvested
from a body through which blood is circulating.
Hence, surgeons, kept the body alive in the respirator.
So then, how is it possible to be sure that the donor is
in fact dead?
Signs of a dead person
1. cardiovascular clinical signs (this is used when the
person is not attach to respirator. Thus, reliance on
technology must be moderated rather than encourage)
2. the new clinical sign must be ascertained by the
well-trained professionals (basis must be properly
observed. That is for no less than 24 hours when it uses
the EEG or electroencephalogram as it is done in the
USA: Harvard Criteria for Brain Death of 1968, this is
used to person who is under a hypothermia and drug-
induced coma. But today, short intervals is now
allowed within 6 hours, and the EEG is being replaced
by an Angiogram it is an apparatus to test the blood
flow in the cerebellum of the patient)
Types of Death
1. Euthanasia means an action/omission which of itself
or by intention causes death, in order that suffering
may be eliminated. It procures/imposes death before
one’s time.
Euthanasia is popular for a variety of reasons:
a. Utility: the economic constraints from the escalating
health costs for the growing elderly population
especially chronically ill, disabled.
b. Hedonism: when quality of life is poor or life is a f. Philippine culture (to add in the Filipino hospital
burdensome and useless then the person can be killed. context) (reasons: the Filipino non-confrontational
Since patient who see themselves as a burden to others attitude makes all concern hesitate to hear ‘badnews’,
are guilty to be alive. instead the ‘status quo’ is the main focus)

c. Autonomy: a request for an early death may be an
attempt of the patient to regain control: even if it be
only in deciding when to die, it is practicing the “right
to die”
Types of Euthanasia:
Living should not be a penalty to be prolonged at all
cost. To cause suffering unnecessarily in unworthy of
trust and respect the healthcare provider has. Priority
of using the last moment of life must be given to finish
one’s own responsibilities to others.

a. Voluntary and involuntary (patient’s initiative)

b. Active and passive (healthcare provider’s initiative)

Human life must be promoted because we are as

stewards of it. Filipinos have seen that disabled
newborn as “good luck” and caring a sick person is a
privilege. In solidarity, one can’t abandoned, replaced,
worst of all, kill another person. May it be in the name
of economy, practicality, compassion or autonomy.
procuring death is a perversion of a diseased society
made worse if done by a family or healthcare provider.
It is then a betrayal of the trust and respect that health
care providers are known as healers. It harms the
victim and at the same the survivors in the spirit of
oneness to the one that passway.

2. Dysthanasia is the delaying or postponing death

beyond its natural time by all means available.

Dysthanasia is popular for the following reasons:

a. doctor’s training (reasons: treating is more

comfortable than not treating, doctor’s felt guilty to
abstain, death of patient is seen as a failure of
management)

b. technologic imperative (reasons: advances and

success pushes the doctor to use everything, that is,
malignant over-diagnosis and over-treatment. It is also
biology rather then personhood is the object of medical
attention)

c. ignorance (reasons: proxy’s are unaware of the

distinction between killing and letting die; lack of
information with regard on prognosis pain high quality
of end of life care, the best place to die)

d. hospital culture (reasons: rights of patients are

considered as preference rather than directives)

e. fear (reasons: doctor’s worry about on the

accusation of legal liability and malpractice if
everything were not done)