Healthcare Ethics — NUR81012
learns and internalizes - usually during early
ETHICS
● came from the Greek word “​ETHOS​” – character,
focuses on the behavior/custom of an individual
or certain group
● DECLARATION OF R/W
○ process oriented - ​entails a lot of factors
to arrive at a certain decision​, ​ needs
contemplation,​ involves critical analysis of
action
■ example: attend or not attend Sir
Cuadra’s lessons despite having
recorded online sessions
○ reflects the “​SHOULD​” of human
behavior, ​how should we conform - to
expectations or to the right thing to do
● Study of moral conduct or principles of underlying
desirable types of human conduct - ​is this the
ideal / appropriate decision? or is this what the
society dictates? is it simply because what you
were accustomed to / grown to?
● SCIENCE OF IDEALS
○ guides our judgment concerning morality
of human acts.
■ example: Do we understand our
grumpy patients or not?
ETHICS
● A theoretical task that involves careful reflection
on the nature of a human person
○ example: Every suggestion or our point of
view is negated by the patient. We still
should not judge the patient; we should
understand the personality. Maybe there
are trust issues or maybe there are
significant others that the patient depends
on.
Based on this reflection, one derives the normative
principles which govern one’s relationship with the others,
the environment, and God.
example: Should classes still be held when it is
“bed weather”? Should wrappers be directly thrown
anywhere or should wrappers be kept first and then later
on thrown?
MORALS
● came from the Greek word “​MOS​” –
custom/conduct
● Refers to human conduct (​specific decisions)
itself-application of ethics.
○ example: Should we fight with people
who disagree/against with us?
● Fundamental standards of r/w that an individual
stages of childhood development
○ We gain conscience during toddler stage
(3 - 5 y/o); where there are thinking
abilities; where initiation starts; where the
child asks “what is that?”
○ During 1 - 2 years old, we simply follow.
Terrible 2s: the child says no, but it is
because thinking abilities are still weak.
● reflects what is done in a situation
○ example: Pre-school stage: child tells
another classmate to not eat when it is
not yet time.
○ example: Elementary stage: child tells
another classmate not to cuss because
God may give punishment.
Morality
○ measure of relation between the human act
performed & its norm according to the dictates of
right reason, human nature & ultimately, God’s
Eternal Law
○ refers to final decision before action is performed
“To cultivate morality, you must cultivate your mind on all
occasions, train your mind in all situations, and elevate
your mind in all places.”
● Be concerned with everyone around you.
Example: Attendance is being checked because
there is concern about the welfare of each student
within the class.
● Example: Lorraine Pingol’s attempt to assist in the
delivery of a baby despite her last experience of
delivering a baby during college years.
WHY STUDY ETHICS?
Ethics determine:
1. Why one act is ​ better than the other. - needs
careful reflection; advantages/disadvantages;
consequences
2. To have an ​ orderly social life. - ​ You did
something because it benefits the person or does
no harm to the patient; you know that your
decision will also be carried out by another person
3. Seek to point out to men the ​ true values ​of life -
sometimes redirection is needed; misconceptions
of another person should be assisted / changed
ETHICAL CONCERNS in Healthcare
● Confidentiality​ of Records
○ Example: Discussing the patient’s records
to someone who is not involved in patient
care - the person may only be doing
“chismis.” / The condition of the person
should only be limited to the person and
his/her family.
E. Fineza, J. Borlaza, J. Dimasacat
 ● Right to ​Privacy
The patient has the right to see her chart: ​the
people who are not involved in the healthcare
➖
should not snoop around the chart works.
Gathered information should be kept to
oneself, share if and only if, those are
➖
involved to the patient’s care
No pictures & videos, unless for case
presentation (except name)
○ example: During BSE, the patient’s
breasts are the only body parts that
should be exposed.
● Right to ​Information
Also right to CORRECT information
● Competent ​Consent​ to Treatment
The patient UNDERSTANDS the procedure &
underlying risks
○ Explain the patient below 18 y/o about the
procedure then ask for patient/guardian’s
signature
○ At 19 y/o, you are still under the
pediatrics when admitted, but you can still
sign.
● Right to ​Refuse​ Treatment
● Termination​ of Treatment
● Quality of Service provided for disabled or
terminal patients
○ Even though the patient is terminally ill/
has poor prognosis, the patient should
not be abandoned.
BIOETHICS
● application of ethical theories and principles to
problems in healthcare concerned with what
should be done
○ Overall welfare of the clients should be
the concern
● Christian bioethics
○ study of the concepts and principles of
christianity
WHY STUDY BIOETHICS?
The following changes gave rise to the need of bioethics:
● Scientific Advances
○ “What is technologically possible is not
always ethically justifiable”
what SHOULD vs CAN be done
■ Cloning should not always be
done.
● Inequalities in socio-economic, educational and
political positions
○ There is discrimination among the
vulnerable groups and/or poor people.
● Finitude of resources
○ Example: There are 5 patients that need
insulin but the resources only cover 3
patients. Who would come first?
● Changes in the doctor- patient relationships
○ “Doctor w/o ethics is only a technician,
but with ethics, he is properly called a
physician”
patient-oriented
■ Paying the right amount to the
doctor / Placing the right
●
expenses on the patient’s tab
Rampant unethical behavior
Be professional! No pictures or laughing
● example: Getting angry at a mother
having her 10th child without assurance
that the child may grow well.
ETHICS COMMITTEE
Functions:
● Provide ethics ​education programs​for staff
○ staff nurses, medical staff, etc. and
expectations from them when they are
prompted by different scenarios
● Advisory Function / Council
○ formulate policies, guidelines; should be
adhered to
● Consultative Function
○ in the event that there are malpractices or
unethical decisions, they will be ​
consulted
to but;
○ should ​ not exercise decision – making
power
○ only recommendatory
some ethical standards are not
included in the legal standards
● Other functions:
○ In the absence of Institutional Review
Board (IRB) it can ​ review research
protocols​on its ethical aspects
○ It can also serve as ​advocates for
legislative development on health and
contributes its share to public debate on
health care issues.
COMMITTEE COMPOSITION
● Must have a well-balanced representation from
medical, nursing & administrative staff
○ should not be dominated by only 1
discipline or administration
e.g. not all can be doctors
● Representatives from pastoral care, social work &
other areas involved in patient care
● A lawyer can be an effective committee member
as long as he is careful not to put legal concern
above ethical concerns.
● A liaison from the administration should be an
active member of the committee
● A committee that does not have the full
support of the administration is doomed to fail
E. Fineza, J. Borlaza, J. Dimasacat
 NURSING BIOETHICS COMMITTEE
o We have RB (Review Boards) - there are
questions pertaining to nursing discipline
● Help nurses increase their knowledge about
applied ethics
● assist nurses in making ethical judgments and
decisions
● serve as nursing representatives in the hospital’s
multidisciplinary ethics committee
CODE OF ETHICS
● The “Code of Ethics for Nurses” BON Resolution 220
series 2004- provides guidance for carrying out
nursing responsibilities consistent with the ethical
obligations of the profession
FUNDAMENTAL CONCEPT:
Health is the fundamental right of every individual.
NURSES PRIMARY RESPONSIBILITY:
Preserve Health At All Cost!
● Promotion Of Health
● Prevention Of Illness
● Alleviation Of Suffering
● Restoration Of Health
Who and What is a Person?
● From the time of conception till death
○ even once fertilization occurs (womb to
tomb)
● Personhood
○ depends on the values, attitudes, beliefs
and needs
● All Human beings have needs
● Anything that fulfills a need is a ​VALUE
para kanino ka bumabangon?
○ give direction and meaning to life and
guide a person’s behavior
○ shaped by culture, ethnicity, family,
environment and education
○ freely chosen, cherished and consistently
incorporated into one’s behavior
● Attitude
○ one’s disposition toward an object or a
situation
○ emotional or mental mindset
○ positive or negative
● Beliefs
○ ideas that one accepts as true
○ one that changes the least
○ opinions, decisions
● Behaviors
○ observable actions or reactions in relation
to the environment
find someone who can support you
What is a patient?
● The most important person in the hospital
● The patient is ​not an interruption​of our work
○ he is the purpose of it
○ He gives meaning and nobility to our
profession
● The patient is not an outsider of our day to day
operations. He is our concern
● The patient is a person, not a statistic
● He has feelings, emotion, wants, aspirations and
dreams
● It is our business to satisfy him
● Above all, he is an instrument of our ultimate
salvation
KEY CONCEPTS
● All human interactions are value based
● Nurses must ​ clarify and ​
respect the values of
others and examine their own values
● Values are enhanced and refined by experiences
that cultivate values development such as
interactions with people of differing values and
viewpoints and experiences that challenge one’s
way of thinking
● Maslow’s Hierarchy of Needs (Biological,
psychological, social and spiritual and creative
needs)
● St Thomas Aquinas
○ need to preserve life; need to procreate;
need to know the truth and the need to
live in society
● Ethical problems exist when we have to make
decisions so that all these needs will be satisfied
in an integrated and consistent manner
Values and Value Clarification
● Ethical problems results from changes in society,
advances in technology and the nurse’s
conflicting loyalties and obligations
● Nurse’s ethical decisions will be influenced by
their moral theories and principles, levels of
cognitive development and personal and
professional values
● The goal of ethical reasoning is ​ to reach a
mutual, peaceful agreement that is in the best
interests of the patient.
RESPECT FOR PERSON
made in the image and likeness of God
● Most fundamental human right
● Foundation of all ethical principles
● Respecting the worth and value of a person =
HUMAN DIGNITY
E. Fineza, J. Borlaza, J. Dimasacat
“Human Dignity is used to indicate that persons
should always be ​treated as ends in themselves and
never merely as a means”
- Thomas Aquinas & Emmanuel Kant
BASIS of Human Dignity
dignity is not made but inherent
● Salvation History
1. Creation of man
2. Fall of Man
3. Promise of a Savior
4. Preparation for the Coming
5. Fulfillment of the Promise
6. Establishment of the Church
7. Heavenly Kingdom
● Image and Likeness of God
● Christ redeemed us
● Ultimate destiny to fulfill
● Rational​beings
SIGNIFICANCE of Being a Person
● Has an inherent dignity which must be respected
● Has an ultimate destiny- to live with God
● Lives with other persons in the community
PRINCIPLE of Human Dignity
All ethical decisions (by patients & healthcare givers)
must aim basically & ultimately at human dignity.
● They must protect, defend, enhance and enable
the person’s worth.
● They must aim for the maximum and integrated
satisfaction of every person’s needs, as an
individual and members of his community.
HUMAN DIGNITY
● Every human being has an inner worth and
inherent dignity. These he possesses not
because of what he has or what he does but
because of what he is: a human person
● As a human person, he must be respected
regardless of the nature of his health problem,
social status, competence, past actions
Treat a patient as a patient (with respect), save
lives!
● Decisions about health must aim at the maximum
integrated satisfaction of his needs: biological,
psychological, social and spiritual
● Certain actions may never be done because
performing them would constitute a violation
against the person’s dignity
➖
HUMAN RIGHTS
needs and values as it relates to other human beings
● it is universal
● equal among everybody
● not a product of human creativity but inherent to
us
Universal Declaration of Human Rights​ (1948)
● respects the dignity of the human person
CASE SCENARIO
Teen Mom Beats Her 26-day-Old Son to Death
Because She Considered Him a Burden
17yo Daniela Villareal beat her 26-day-old son to
death. Paramedics arrived on the scene and rushed her
son to the nearest medical center where he was
pronounced dead.
An investigation has determined that the baby died as
a result of physical assault.
On her FB page, the teen mom appeared excited
about having a baby in the months leading up to his birth
however, in September, she updated her FB status
complaining that she cannot work or take classes
because of her unborn son. She said “can’t wait til this
little Boy comes and I’m able to do what I want” I want to
be successful in life.”
➖ Tragically, accdg to the NIH, in the US 8 in every
100,000 newborns die from infanticide and usually the
perpetrator is the victim’s parent or step parent. Although
most people agree that this horrific, new findings from
pro-life groups show that some college students support
post-birth abortion and suggest that children up to 4 or
5-years-old can also be killed, because they are not yet
➖
“self aware.”
Mark Harrington, director of Created Equal, expounded
on our society’s growing acceptance of ​ infanticide​. He
said,“We encounter people who think it is morally
acceptable to kill babies after birth on a regular basis at
almost every campus we visit. While this viewpoint is still
seen as shocking by most people, it is becoming
increasingly popular.” He concluded,“This is the whole
problem with devaluing human life at any stage—it will
naturally grow to include other groups of humans; in this
case, born humans as well as preborn humans,”
Harrington said.“I talked with one young man at the
University of Minnesota who thought it was alright to kill
children if they were under the age of 5 years old, as he
did not consider them persons until that age.”
➔ Is Daniela more important than his son?​ NO
➔ How would you (as the paramedics) treat
Daniela? Treat with respect even if it won’t be
easy.
➔ Will she be punished? It will go through a
process since it covers ethical, moral, and legal
concerns. She may be screened for mental
status.
E. Fineza, J. Borlaza, J. Dimasacat

HUMAN DIGNITY
● Newborn, healthy adult, senile elderly
● Comatose patient, crazy individual
● Illiterate slum dweller, university president,
uneducated housemaid, convicted killer
Are they all persons? ​- Yes
Do they have equal human dignity?
- Yes because it is inherent
How is respect for this dignity manifest?
- when we treat patients equally with 3C’s
CASE SCENARIO
In many medical laboratories in England, close to 2
thousand fertilized ova have been frozen in a depository
similar to a sperm bank.The process has been made with
a view to using these ova in future experiments for the
prevention and better understanding of human diseases
and human reproduction. Meanwhile, these ova have
been frozen for more than 7 years and can be utilized any
time by whoever wants or needs them.
➔ What are the ethical issues involved here?
Human conception thru artificial means; They are
only made for experimental purpose (as means)
and not to reproduce;
➔ How do you determine its ethical dimension?
This is unethical and immoral.
3 Basic Laws
— set of rules to regulate the behavior of the society
1. Eternal law
● “the divine will or command that directs all actions
& movements in the universe. It commands that
the natural order of things be preserved & forbids
that it be disturbed”. — Law of God
2. Natural law
● commands that nature must be ​respected in its
integrity & it prohibits the destruction of such
nature – nature of human being
● integrity of human being or human person must
be respected
● Focus
3. Positive law
● dictated by the authority of the church or state
● Church you believe in or belong to.
NATURAL LAW
— According to St. Thomas
Properties of Natural Law
1. Universal​ - applicable to all regardless
2. Obligatory​ - cannot go against it
3. Recognizable​ - you don't need explanation
4. Unchangeable - stays the same even if time
changes
Main emphasis:
1. ​
Fundamental Principles of Action
● “Good is to be done and evil to be avoided”
● Basically, you want to do what is good, and avoid
doing what is bad
● “Never do to others what you would not want
them done unto you”
2. ​
General Moral Principles of Relationship
● “Adore God, Honor your father and mother”;
Preserve life
● Relationship to God, relationship to parents
3. ​
Application of General Principles of Morality to
specific situations in Life and Society
THEORIES OF ETHICS
— Law ​common misunderstanding especially law that is
created by human beings.
— Differentiate it from legal and ethical. Some things that
are legal may not be ethical. — Some of the things you do
are not legal to do to them, but it will benefit the person.
1. ​
TELEOLOGICAL
● telos- “end” ; “goal”
more concerned on the end product
— end product or result is good, result is
good action is good, then bad result means
bad action
● The means by which the result achieved doesn’t
matter, what matters is the good product.
● consequentialism ​— ​action is judged as good or
bad in relation to the consequence, outcome or
end that is derived from it
● “​
the end justifies the means”​- sometimes it is
possible to do wrong to achieve “right”
● the only right action are those that produce the
greatest happiness to majority concerned
● right action is that which has the greatest utility
and no action is in itself either good or bad
1.A ​
Utilitarianism
● Concerned with the consequences or end product
of our actions. An action is right if it brings
increased happiness or benefit for those
concerned; an action is wrong if it decreases
people’s happiness or benefit
● “Primary responsibility is to support the interest of
the group”
● “​ the greatest good for the greatest number of
people”
● “​ the greatest happiness principle​”
are more people happy? Increased happiness
to the majority.
○ Problem: not everyone will be happy, the
minority will be affected.
● Mass immunization of children - prevent children
from getting sick.
E. Fineza, J. Borlaza, J. Dimasacat
 — voluntary or involuntary
— Random drug testing for hospital workers
(Dengvaxia vaccine bad repercussions later
on, theory applies to this).
What is the goal? What is the result? Find if
workers are using illicit drugs.
— Policy of university where students in UST
signed a consent regarding random drug
testing. It’s not forced, there’s a consent.
● Advantages​ :
○ easy to use
○ because you can justify it by end result
and happiness principle
As long as the action will pursue
happiness and the result is good
where action is good as well.
○ can justify many decisions based on the
happiness principle
● Disadvantages​:
○ average happiness of all or total
happiness for few
○ harm can be done to the minority
what if they don't want an action to be
performed
— autonomy is affected
○ What constitutes happiness? Who
determines what is good?
In case of students, there are different
meanings for each student
○ end justifies the means
CASE SCENARIO
Mary, a junior nursing student, was assigned to observe
the L&D of a small provincial hospital. As frequently in
small towns, the nurses and doctors were acquainted with
many of the women- they knew their backgrounds and
home situations. During her 2nd day, Mary attended the
delivery of a set of premature twins. Unhappy that she
was pregnant again, the 35-year old mother had 9 living
children and 2 previous miscarriages.After delivering the
tiny babies, the doctor walked to a nearby room and
placed them on a metal table. He turned and said to those
in attendance,“​Nobody is to touch them. She doesn’t
need any more babies​”
The statement of the doctor allows babies to die, you
cannot touch them.
➔ If the physician were thinking in terms of
utilitarianism, what could have been the
arguments to support his actions?
— Premature babies burden to mother
— happiness principle - the mother is unhappy
— the mother has already 9 babies at age of 35
➔ Name some arguments in opposition to the
physician’s decision?
— If you can do it to one, you can do it to all; the
doctor has no right to the baby
— the baby is already aliven; basically murder by
omission of action to save the baby
— baby has own human dignity
➔ What thoughts would have gone through your
mind if you were in the situation?
self-explanatory
➔ If you were the nurse in the situation, what
would you do? seek to authorities or any help
(e.g. clinical instructor) to avoid malpractice;
— Responsibility of nurses to be patient’s
advocate
— As a nurse, do no harm. Protect the human
dignity of the patient as well as his\her human
rights.
Simple ends cannot justify the means, the means
by acquiring the good here is allowing babies to
die which is inherently evil.
— end goal of the doctor is to decrease burden of
the family
D​EONTOLOGY
2. ​
d​uty” or “duty oriented” want to know what is
● “​
right or wrong, what are you supposed to do as a
nurse or as a person.
Basis right or wrong is duty
● rationalist view that the rightness or wrongness of
an act depends upon the ​ nature of the act rather
than the consequences that occur as a result of it
Gauging if good or bad
● human beings have the freedom, thoughtfulness
and sensibility to act in a moral manner- knows
what he/she ought to do
Intelligence will tell us
● Respect for person worth/dignity
Serve, respect, defend the patient
● Person’s action right if it follow moral rules-fair,
honest, doing good
● A person’s action is wrong, without exception, if it
violates these rules
● does not look into consequences, as long as
action is considered to be good don’t look at the
end result.
● Consequences (-), action still ethically right if the
original motive is consistent with moral precepts
○ Nurses code of ethics - importance of
fulfilling duties that are inherently owed to
patients
○ Example: If the client asks the nurse to
promise to tell the truth regarding her
diagnosis and prognosis, the nurse is
duty bound to keep this promise.
● Advantages
- provides clear guidelines (Code of Ethics) for
judging the rightness and
- wrongness of an act
- recognizes the dignity and autonomy of
individuals and allows all people equal
consideration
E. Fineza, J. Borlaza, J. Dimasacat
● Disadvantages
- problem with disregard for consequences
VIRTUE ETHICS
- all ethical precepts are viewed as equally
important ● An approach that deemphasizes rules,
- exceptionless and rigid (black or white) consequences and particular acts and places the
- cannot applies this principle with patient who focus on the kind of person who is acting.
has an alzheimer’s disease We look at the person and the character
● VIRTUES – admirable character traits, perfection
The nurse is duty bound to act under moral rules that of character
establish the right or wrong : ● VICES​ – opposite
A. duty to honor a ​patient’s autonomy
What if the patient cannot decide? state will Theological virtues​: faith, hope & charity
make a decision for the goodness of the Cardinal virtues​
: prudence, justice, temperance & fortitude
patient Moral acquired virtues​ : fidelity, honesty, humility,
B. duty to ​promote good and well-being compassion, justice, courage & prayerfulness
C. duty to be ​just and fair
D. duty to ​do no harm — A virtuous person may have a correct action,
E. duty to ​tell the truth consistently attempting to do what is good.
F. duty to ​keep promises and confidentiality ● Fidelity
○ Faithfulness to trust & promise
A person has free will and self-determination and can fulfilling promises
refuse any medical or nursing treatment or procedure ● Honesty
- If a patient has the capacity to think for himself, ○ Truthfulness & integrity
he can decide for himself. walk the talk
A right action is only right if it is done out of sense of duty ● Humility
- The patient doesn’t want the drug or medication, ○ Recognizing one’s capabilities &
as long as the patient can think rationally, the limitations
nurse can reconsider what the patient wants. e.g. don’t give the medication YET -
- Refer to the physician and make interventions for know the rationale first
the patient. recognize limits and do something
about it
● Compassion
CASE SCENARIO
○ Feeling for the loss/suffering of another
A 13 year old girl tells the nurse caring for her in a family with an attempt to help or avoid that
practice clinic that she suspects that she has contracted a loss/suffering
STD. She says that she is afraid to tell her mother that empathize with the patient
she is sexually active.After the interview, the girl’s mother ● Justice
takes the nurse aside and inquires about the nature of her ○ Constant will to give another his due
daughter’s concern. ● ​ Courage
○ Doing what is right without undue fear
➔ Consider patient then execute the duty, huwag e.g. frontliners
pangunahan yung patient because it may cause ● Prayerfulness
discomfort ○ Inclines one to seek God’s help in
➔ Since she is a ​minor​, duty-bound to the parents everything one does.
but explain it first to the patient
➔ Responsibility or duty of a nurse to care for the
CONSCIENCE
patient and at the same time there’s a need to tell
the parents since the patient is a minor. ● CON​ – with; S
​ CIENCE​ – knowledge
logical thinking
● An act of judgment
● Determines whether an act is good or bad

“To follow one’s conscience”

● To follow feelings
● To follow law or custom
● To Blind obedience to the inspiration of God
● To Follow personal freedom and autonomy
based on our free willingness to

E. Fineza, J. Borlaza, J. Dimasacat

 ● “The capacity to make practical judgments in
matters involving ethical issues”
Appropriate for patient
TYPES OF CONSCIENCE
CORRECT
● judgment of an act as good when it is truly good
and an act as evil when it is truly evil.
ERRONEOUS
● Judgment of an act as good when it is evil and an
act as evil when it is good.
○ Inculpable – one who has an erroneous
conscience through no fault of his own &
w/o any knowledge about being in error
Not responsible for the action
○ Culpable – one who has an erroneous
conscience through his own fault and
neglect.
negligence; if you are responsible for
the actions of others
CERTAIN
● An assured & firm judgment of an act w/o any fear
of being in error
doing the best of your ability to study before
taking an action
DOUBTFUL​ or ​DUBIOUS
● No sure judgment of whether an act is good or
bad.
LAX
● Perceives even morally grave evils as allowable;
makes excuses of evil acts though seriously evil
by rationalizing & justifying them.
justifying wrong actions
e.g. ​A nurse who carries out an order to
administer medication without checking the
patient's vital signs feels she it is not so important,
others do it too.
Recognized the action but it's okay because
everyone is doing it.
SCRUPULOUS
● Perceives evil in an act when there is none
Always guilty
CALLOUS
● Worst type ; no sensitivity to sin
● Done repeatedly
e.g. kills people for money
e.g. ​Mr. G, an ex-convict, was hired for a fee by
Mr. D. ro assassinate Mr. R. Mr. G rationalizes
that he will not be at fault and will be doing society
a favor because he gets rid of unjust men like Mr.
R. ​Not recognizing his wrongdoing = callous.
e.g. ​Your classmate habitually signs in at 7am
even if he arrives to duty at 7:15am. He doesn't
think anything his wrong with it as long he doesn't
get caught by your CI. He has what type of
conscience?
FORMATION OF CONSCIENCE
● GOAL: An integrated life of mature virtue, so that
one’s deepest sense of self is able to judge and
put into practice what is objectively good and right
You will make a decision that will affect all
WHERE or to whom do we look to form our conscience:
● WISDOM OF KEY OTHERS
(Persons we respect, Persons with expertise in given
area)
WISDOM OF KEY OTHERS
(Persons we respect, Persons with expertise in given
area)
WISDOM OF GOD
(Revelation/God’s Word)
PROCESS OF FORMING OUR CONSCENCE
— HEART​: ​ prayer, openness to conversion​, desire to
be a disciple of Jesus, willingness to say “yes” to God’s
will for us, a deep “gut -level” sense of what is right/wrong
— HEAD​: ​ Study, learn, ask questions, know ​facts, seek
advice, pray, be willing to change one’s minds, prudently
deciding the best course of action
— HANDS: consistently put the right choice ​into
practice, taking responsibility for consequences,
integrating our lives around patterns of virtue, pray,
connect to communities/ groups that support good moral
values
A formed & informed conscience is that which knows how
to make a proper judgment on an act as truly good to be
done or truly evil to be avoided in its three moral
determinants: ​
act itself​, ​
motive​ of the agent &
circumstances​ surrounding the act
A fully mature and responsible conscience should be
based on the following: the truth, Education and
experience & Understanding of the Law. EXCEPT
Personal will and desire.
How do we know what is ethical?
Religious Answers: Secular Answers:
- Revelation - Reason
- Scriptures - Experience And Observation
- Church Tradition - Intuition
- Experience - Social agreement or contract
E. Fineza, J. Borlaza, J. Dimasacat
Principle of Well-Formed Conscience the extent for both. ​They are both culpable but
- To attain the true goals of human life by responsible to different extent. Jerry is callous and caused
actions, in every free decision involving an ethical another to sin while Tom is influenced. However,
question, people are morally obliged to do the following: Tom decided on his own regardless of the
insistence of others.
A. Informed themselves as fully as practically
possible about the facts and the ethical norms
B. Form a morally certain judgment of conscience on
the basis of this information
C. Act according to this well formed conscience
D. Accept responsibility for their actions

Principle of Moral Discernment

- To make a conscientious ethical decision, one must do
the following:
1. Proceed on the basis of a fundamental
commitment to God and to human persons
(including oneself) according to their God-given
and graced human nature
2. Among possible actions that might seem to be
means of fulfilling that commitment, ​exclude any
that are contradictory to it (intrinsically evil)
3. Also consider how one’s own motives and other
circumstances may contribute to or nullify the
effectiveness of these other possible actions as
means to fulfill one’s fundamental commitment
4. Among the possible means not excluded or
nullified, select one by which one is ​most likely to
fulfill that commitment and act on it

CASE SCENARIO
A newly graduate nurse working in a non-Catholic hospital
was asked to assist in an abortion case.The nurse refused
to participate in the case but was threatened by the doctor
that she will be reported to the administration if she did
not comply with the order of the doctor.
➔ Do health professionals have the duty to
participate in abortions even if they find them
morally repugnant?
➔ If you were the nurse, how would you achieve
a well-formed conscience regarding this
issue? ​We should not be forced to do
something that is against our beliefs or
principles

CASE SCENARIO
You are the Team Leader of the RLE group for the week.
You noticed that 2 of your classmates \were late for your
6am duty, but signed in at 6am anyway. One of them,
Jerry, habitually does it, the other, Tom, was persuaded to
do the same because of Jerry's insistence.
➔ As the TL, what should you do? As the TL, talk
to them privately first. If repeated, report to the CI.
➔ Are both Tom and Jerry culpable with regards
to their conscience? WHY OR WHY NOT? If
they don't have the same culpability, explain
E. Fineza, J. Borlaza, J. Dimasacat

PRINCIPLE OF THE TOTALITY OF THE HUMAN
PERSON
— Totality & integrity
— used to justify certain medical procedures
— To promote human dignity in community, every person
must develop, use, care for, and preserve all of his or
her natural physical and psychic functions in such a
way that:
A. Lower functions are never sacrificed except for
the better functioning of the whole person and
even then with an effort to compensate for this
sacrifice.
B. The basic capacities that define human
personhood are never sacrificed unless this is
necessary ​to preserve life
— To be a complete human being is not merely having
the higher level of functions but to have all the basic
human functions in harmonious order
— Human body functions contribute to higher functions
not merely by supplying what is needed for physiological
functioning; they also supply part of the human
experience that is essential to human intelligence and
freedom
CONDITIONS for principle of totality
1. That the organ, by its deterioration in function,
may cause damage to the whole organism or at
least pose a serious threat to it
2. That there is no other way than taking the
indicated action against it of obtaining the desired
good result
no other way to save life but remove the
organ; to PRESERVE life
3. That the damage being avoided to the whole is
proportional to that which is caused by the
mutilation or incapacitation of the part
removing or suppressing the
— This principle ​does not apply to moral organisms
(family, society & humanity)- a person is still independent-
he is not a subordinate to any group- “He is the subject,
principle and end of all the social institutions
— Authority ​cannot directly dispose the physical and
personal being of a person- removal of the undesirable or
weak parts of the society
— It applies to the management of health and integrity of
the body
— It throws light to the licitness or illicitness of all kinds of
medical interventions, surgical procedures and transplants
Justifiable because there is a higher purpose for it.
Selfless; heroic action
— A person can dispose of individual parts, destroying
them, if and to the extent that is necessary for the good of
his being as a whole, to ensure its existence or to avoid
and to repair grave and lasting damage which could not
be avoided in any other way
WHY IS IT PERMISSIBLE TO SACRIFICE?
● Not to sacrifice one basic capacity from the other
● Not for the better functioning of all other human
capacities
● But sacrificing one function so as to continue
functioning at all
MUTILATION
● Destruction of member, organ or part of the body
(organic) or the suppression of a physical function
(functional) in such a way that the organism
becomes no longer basically whole
● TYPES:
○ direct - willed in itself, as end or as
means, ​intended​and caused
○ indirect (therapeutic) - caused by the
exigencies of the health or survival of the
patient; at times willed as means, at
others tolerated as an ​unavoidable side
effect
e.g. there is a mass, upon surgery it
metastasized = removing the
reproductive system
● Direct mutilation - intrinsically wrong-
offends human dignity- individual does
not have the right to mutilate himself,
much less does society
● Therapeutic mutilation - licit as an act of
good stewardship of the body –
necessary for the survival of the patient or
to free him of proportional sufferings or
infirmities
STERILIZATION
● A medical or surgical intervention which causes a
patient, incapacity of generation
● Therapeutic - inevitably required for the survival
and health of a person- sexual organs- integrating
parts which must yield to the good of the whole;
licit if:
○ sickness is grave, certainly diagnosed
and definitive that it offsets the evils of
sterilization
○ it is necessary because it is the only
possible effective remedy
○ exclusively curative - intention is
important
DIRECT STERILIZATION
— the immediate effect is to render procreation
impossible
E. Fineza, J. Borlaza, J. Dimasacat
— TYPES:
1. Eugenics - seeking to avoid the transmission of
hereditary defects
2. Hedonistic - evade the complications &
responsibilities of procreation without giving up
the sexual pleasure
3. Demographic​ - to control the birth rate
e.g. one child policy
4. Preventive - render pregnancy impossible which
might aggravate sickness that already exist
3. The risk taken by the donor as an act of charity is
proportionate to the good resulting for the
recipient.
Recipient will extend his life through
transplants.
Not proportional if the recipient will not
preserve the organ (e.g. not drinking meds)
4. The donor’s consent is free and informed.
5. The recipients for the scarce organs are selected
justly.

LIVE DONOR
CASE SCENARIO
● Informed consent
Hemophilia is a dangerous genetic disease transmitted ○ benefits & risks
through the mother. It is life-threatening, often very ○ Unforeseen adverse events
painful, and requires expensive transfusion therapy. Dr. ● He must understand that he will have some
G. government Pediatrician, proposes to gradually lifestyle changes
eliminate it from the population by passing a law requiring ● He is going to rely on technology
all hemophiliac women to have their Fallopian tubes
ligated. He argues that this is for the common good and CADAVER DONORS
that the government has the responsibility to correct ● brain death
problems that are not corrected at a lower level. Since the ○ EEG will show that there is no brain
parents of girls carrying this defective gene do not have activity
their daughters sterilized, the government must order it ○ By 2 doctors (attending & neurologist)
done. Furthermore, it is for the good of the girls ● Proper care at death
themselves to sacrifice their fertility to avoid the burden of
caring for a hemophiliac son. RECIPIENT
mother ➡ son (father’s genes to daughters) ● continued drug therapy
➔ Do you agree with this? No because it removes ○ dependence on technology
the patient’s right to choose. There is only a 25% ○ Shortened life span
to transmit the disease. The only rationalization of
removing or suppressing it, if it is diseased, but WHO RECEIVES ORGANS?
the woman is not. ● those who will benefit
● Those who will comply w/ treatment
ORGAN DONATION ● Allocation must be just

A person may will to dispose of his body and to destine it

to ends that are useful, morally irreproachable and even
noble, among them the desire to aid the sick and
suffering. One may make a decision of this nature with
respect to his own body with full realization of the
reverence which is due it … This decision should not be
condemned but positively justified.
- Pope Pius XII, “Allocation to Eye Specialist,” May
14, 1957; The Human Body (Boston: St. Paul
Press, 1960), p. 637.

In addition, transplanting organs from one living person to

another is also ethically acceptable provided that the
following ​CRITERIA​ are met:
with consideration to the donors, if not unethical
1. There is serious need on the part of the recipient
that cannot be fulfilled in any other way.
e.g. dialysis is burdensome
2. The functional integrity of the donor as a human
person will not be impaired, even though
anatomical integrity may suffer.
- we can survive with one kidney, one eye
- removing one can ​reduce functionality
E. Fineza, J. Borlaza, J. Dimasacat

STEWARDSHIP
● “ The office, duties and obligations of a steward”
● “ The conducting, supervising or managing of
something especially the careful and responsible
management of something entrusted to one’s
care”
- Merriam Webster’s Collegiate Dictionary
PRINCIPLE OF STEWARDSHIP
● It guides people in their ethical management of
their life with others and of the limited resources
of this world
● It calls for personal, social and ecological
responsibility
● It advocates an end to the huge inequalities there
are between the few rich and the many poor
● God is the Lord of life and death. Human persons
are creatures of and co-creatures with and under
God and therefore stewards of their own life and
of the whole creation.
Bible tells us that we are the temple of the
Holy Spirit, we are the vessel
Take care of ourselves physically, holistically
● “As a good steward, I must take care of my
health, I must take care of the health of my
neighbor/ the environment and I must work for
liberation from poverty, disease and oppression’
● 1 Corinthians 6 :19-20: “Or don’t you know that
your body is the temple of the Holy Spirit, who
lives in you and was given to you by God? You do
not belong to yourself for God bought you with a
high price. So you must honor God with your
body”
● The gifts of ​multidimensional nature and its
should be used with profound respect for their
intrinsic teleology and especially the gift of human
creativity should be used to cultivate a natural
environment with ​care set by the limits of actual
knowledge and the risk of destroying these
gifts.
improving oneself
PERSONAL DIMENSION ​OF STEWARDSHIP
— how we take care of ourselves since we are endowed
with intelligence and free will. Human life must be
defended from the moment of conception until the time of
natural death.
● The Human Person
○ Individual of rational nature
○ Created in God’s image and likeness
● Human Life
○ A great value
○ A gift of God
○ Human life is inviolable and sacred
○ Human life must be defended from
moment of conception to natural death
● The stewardship or right use of our faculties and
powers as rational creatures “in accord to their
God-given and natural purpose”; The care of our
own bodies
● Health - ​a dynamic harmony within the body
● Sickness - part of life; at times caused by an
unhealthy lifestyle
● We are responsible for our own health and
therefore our health has an ethical dimension
Take care of ourselves right
We are not only stewards of ourselves but
also of others.
● VIOLATIONS​: Smoking, Using prohibited drugs,
not eating right
SOCIAL DIMENSION ​OF STEWARDSHIP
● The human person as a social being
We do not need so much, live simply
live in solidarity with the poor
● Poverty in Spirit; a simple lifestyle; solidarity with
the poor
● Catholic healthcare ought to be distinguished by
service and even advocacy for the – most
vulnerable
● Principle of Justice/ Beneficence/
● Non-Maleficence
“No one can be poor in spirit while living like the rich man”
- M. Descalzo
“Always help others when you can; if you cannot, never
harm” - The Dalai Lama
Who is a Thief?
“When someone steals a man’s clothes, we call him a
thief. Should we not give the same name to one who
could clothe the naked and does not? The bread in your
cupboard belongs to the hungry man; the coat hanging
unused in your closet belongs to the man who needs it;
the shoes rotting in your closet belong to the man who
has no shoes; the money which you hoard up belongs to
the poor” (St. Basil)
— the rich become richer
ECOLOGICAL & BIOMEDICAL DIMENSION
OF STEWARDSHIP
● Ecological crisis
● Co-creators with God and Under God
Creation has their own goodness and perfection,
but it did not come out of the hands of the Creator
as completed - fully completed. It was created “on
the way” towards perfection still to be reached
and to which it is destined by God (CCC, no 302)
● Genesis 1: 26: “Then God said, let us make man
in our image to be like ourselves. They will be
E. Fineza, J. Borlaza, J. Dimasacat
 masters over all life- the fish in the sea the birds
in the sky and all the livestock wild and small
animals”
● Genesis 2:15: “The Lord God placed the man in
the Garden of Eden to tend and take care of it”
God gave us 2 gifts:
● human nature (intelligent freedom; creative
intelligence) with biological, psychological, ethical
and spiritual capacities and the ​environment​.
● We have the need and the right to improve our
bodies and to develop medical technology that
prevent and remedy the defects to which we are
liable.
False principle:
● “If it can be done, it should be done”
● “Should it be done?” - YES – develop and use the
technology to do it
● Stewards of the environment we can cultivate and
improve the earth with modern technology but not
do it carelessly- it should be creative
PRINCIPLE OF CREATIVITY
Are these creative uses of our Creativity?
● Ultrasound and other advanced technologies to
be used to kill deformed babies
● Cloning
● In-vitro fertilization
Harvesting multiple eggs from a woman
● Abortifacient Drugs
“The evils of modern technology are not the result of
creative use of knowledge but of rash exploitation of a
nature little understood”
“Research and experimentation, with all the risks involved,
are necessary but we must proceed with reverence for the
persons and the environmental risk”
MEDICAL EXPERIMENTATION
● Preceded by research with animals
● Respect for subjects as human persons
No coercions
● Respect for social justice
All who needs it must have access
● Respect for the principle of informed consent
● Approval of Ethics Committee
● Nuremberg Code​ (1949)
- foundation of all research ethics codes
10 PRINCIPLES
Voluntary ​consent​, results need to be of good to the
society, animal experiments 1st, avoid unnecessary,
physical and mental suffering/ injury, should not be done if
it will cause death/disability risk vs benefits, proper
preparations and adequate facilities , only on qualified
patients, free to end participation, researcher must be
prepared to terminate experimental anytime
MEDICAL RESEARCH
● Declaration of Helsinki (1964, 1975, 1983, 1989,
1996, 2000, 2008)
○ Developed by WMA- guidance to
research not present in Nuremberg Code;
for doctors doing research on their
patients
● Belmont Report (1976)
(Medical and Behavioral Research)
HUMAN RECONSTRUCTION
● God made human beings free and intelligent we
have the right and obligation to improve
ourselves- good stewardship
Our creativity must be used with profound
respect of God’s creation
● But we must use it with profound respect for
God’s creation especially if it will undermine the
very freedom and intelligence given to us by God
RESPONSIBLE STEWARDSHIP OF AVAILABLE
RESOURCES
★ Managing resources with prudence and
moderation
★ Wasting or squandering of scarce resources is a
sin
As simple as conserving
★ Not to fall into the trap of the technological
imperative
STEWARDSHIP
● Man has dominion over God’s creation: himself
(life and health), other creatures and the
environment
● Man must take care and cultivate (improve)
creatures within the creature’s innate nature and
teleology and within man’s knowledge and
understanding
ECOLOGICAL & BIOMEDICAL DIMENSION
● Our bodies, our life, our human nature and
everything in this earth are gifts we have
dominion over. This means we are responsible for
them.
● We should not as faithful stewards, harm but
rather improve and care for them. We have to
treat them with utmost respect, use originality and
creativity to cultivate them, know and respect their
limits. We cannot contradict human nature.
E. Fineza, J. Borlaza, J. Dimasacat
 CASE SCENARIO
Medical and Technological advances today in imaging
procedures have made it interestingly easier to determine
prenatal gender, genetic makeup and health prospects.
There are times when physical and psychological defects
are known before the baby is born. Unborn baby
“Roxanne” is in her 18th week AOG. Through an
advanced ultrasound imaging, she has been diagnosed to
have Down’s syndrome. Her mother Lily, 35, a laundry
woman has already had 7 children who seldom get even
the needed nutrition. Another baby, according to her,
would be a serious additional burden to an already poor
condition, more so that the new baby will require a lot of
care. Lily is thinking of terminating the pregnancy unless
someone adopts the child.
➔ What are the ethical issues in the case?
➔ Does the disease and absence of adopting
parents warrant the termination of pregnancy on
ethical grounds?
CASE SCENARIO
Janna, is an 18 year old girl who had been diagnosed to
have a bone marrow deficiency. In three years, her
chances of survival may be slim, if not treated. The only
therapy that may be feasible and available is through
bone marrow transplantation. Janna is the only child of
her parents and no one in her relatives matches her bone
marrow constitution. The last chance that she has is to
have a sibling. Her parents, being still of a productive age,
decided to have another child with the view to harvesting
from the latter the needed bone marrow for
transplantation. Within a year a child was born to them.
When the baby was a year old, a bone marrow was
extracted from her and transplanted to Janna. According
to doctors, Janna is now healthy and has become a happy
young adult
Principle of Double Effect
To form a good conscience when an act is foreseen to
have both ethically beneficial and physically harmful
effects, the following conditions should be met:
1. The directly intended object of the act must not be
intrinsically contradictory to one’s fundamental
commitment to God and neighbor (including
oneself)
- the act must not be evil in itself
- e.g. something evil like killing someone
for the good of the society
2. The intention of the agent must be to achieve the
beneficial effects and as far as possible to avoid
the harmful effect (that is, must only indirectly
intend the harm).
- the intention is the good effect and the
evil is not directly intended ​
but it may be
permitted
3. The beneficial effects must follow from the action
at least as immediately as do the harmful effects.
- Both effects must proceed equally directly
from the act or the immediate effect of the
act must be good while the evil effects is
remote
- Alternate
4. The foreseen beneficial effects must be equal to
or greater than the foreseen harmful effects.
- A proportionately grave reason must be
present in order to justify the toleration of
the indirect evil effect
- good effect is more or equal
CASE SCENARIO
Mrs. J. Jimenez, 35 year old, has been diagnosed to have
a breast cancer. She is pregnant for 24 weeks. It is her
first baby and she was very ecstatic that after 10 years of
marriage, she finally got her wish. Her OB-Gyn prescribed
Chemotherapy to neutralize the cancerous cells. Her
OB-Gyn advised her that such a procedure could affect
the viability of her baby. She became depressed. She
advised further that it would be better to terminate her
pregnancy so that she can be better managed medically.
— Act is chemotherapy
— 2 effects: cancer will be eradicated (intended) but
the baby would be affected (not directly intended but
it is possible)
— if she or she doesn’t have chemotherapy, what will
happen to both of them?
➔ Is the termination of pregnancy ethical as
prescribed by the Doctor? Weigh out options.
We do not choose between 2 lives and we must
base on the 4 criterias. What is more beneficial to
the both of them?
➔ Should Mrs. Jimenez agree to the procedure?
The mother should decide.
E. Fineza, J. Borlaza, J. Dimasacat