HEALTH CARE ETHICS

BIOETHICS committed to my keeping and all family affairs coming

to my knowledge in the practice of my calling to the
ETHICS welfare of those committed to my care
 (grk) ethicos – custom or character
 Philosophical good(normative and theoretical) science CONCERNS
that deals with the morality of human conduct  Human life
 Systematically establishes the standards or norms of  Health
human acts  Research
 Determines human acts as good or bad, right, or wrong  Science
 Technology
MORALITY  Disciplines like Philosophy, theology, law, and medicine
 (latin) – mos or moris
 Goodness or badness/rightness or wrongness BIOETHICAL ISSUES
 Ends and purposes of life sciences, healthcare meaning
HENCE and implications of distributive justice, meaning of life,
 Ethics provides the theories ad principles of right or death, pain, sufferings, rights, duties and responsibilities
wrong and good or bad actions of the sick person, relatives, society, and the state
 Morality actualizes these theories and principles
REPRODUCTION
POSTULATES IN ETHICS  In vitro fertilization
 Existence of God  Sperm bank
 The existence of intellect and free will  Gene manipulation
 Spirituality and the immorality of the human soul  Genetic engineering
 Cloning
MORAL ASSUMPTIONS  Somatic cell manipulation
 Man knows that there are actions that are right or wrong  Sex reassignment
and good or bad  Surgical virginity, vaginal/hymen repair
 There are actions he/she is not obliged to do  Harvesting and transplanting of vital organs
 He/she is responsible for own action  Programs designed to prolong life

WRONG ACTIONS FETAL CARE

 Punishable  Surrogate motherhood
 Genetic fetal selection
RIGHT ACTIONS  Genetic fetal sexual testing
 Rewardable  Genetic alterations of babies
 In this place where we live, humans are the only
qualified moral agents ADVANCED BIOMEDICAL TECHNOLOGY
 Not all human experiences are moral ENDEAVORS
 Selective abortion
BIOLOGY  Gene therapy
 Natural science that deals with the issue of life  Stem cell manipulation
 Intrinsic role is to protect and safeguard the welfare of all
living species HEALTHCARE ETHICS
 Domain in the practice of the healthcare profession that
BIOETHICS sets the standards or guidelines relative to studies,
 Was first introduced by Daniel Callahan (1969) inquires and decisions on the part of the healthcare
 Popularized by Van Rensselaer Potter (1970) professionals in relation to the delivery of healthcare
 Blanket discipline in the ambit of human life and human
existence PROFESSIONAL ETHICS
 Deals with life sciences: medicine, healthcare, genetics,  Normative moral system that injuncts a kind of behavior
biology, research that is expected of a professional
 Bio – means life  Nurses, physicians, engineers, lawyers, teachers
 Ethos – morality of human conduct

ORIGINAL NIGHTINGALE PLEDGE

 Composed by Lystra Gretter (1883)
 Made in honor of Florence Nightingale

NIGHTINGALE PLEDGE
 I solemnly pledge myself before God and in the presence
of this assembly, to pass my life in purity and to practice
my profession faithfully. I will abstain from whatever is
deleterious and mischievous and will not take or
knowingly administer any harmful drug. I will do all in
my power
 To maintain and elevate the standards of my profession,
and will hold in confidence all personal matters
HUMAN ACT

DEFINITION OF HUMAN ACT

 A human act is an act which precedes from the deliberate
will of man
 Quite different from a human act is the act of man is one
that is not dependent upon intellect and freewill. In plain
language, an act of man is essentially an animal act

CLASSIFICATION OF HUMAN ACTS

The Adequate Cause of Human Acts
A. Elicited Acts – out of deliberate will
 Wish – the first tendency of the will towards a
thing, whether this thin be realizable or not
 Intention – the purposive tendency of the will
towards a thing regarded as realizable, whether
the thing is actually done or not
 Consent – the acceptance by the will of the
means necessary to carry out intention
 Election – the selection by the will of the
precise means to be employed (consented to) in
carrying out intention
 Use – the employment by the will of powers
(of body, mind, or both) to carry out its
intention by the means elected
 Fruition – the enjoyment of the thin willed and
done; the will’s act of satisfaction in intention
fulfilled

B. Commanded Acts
 Internal act – acts done by internal mental
power
 External – acts effected by bodily powers
under command of the will
 Mixed – acts that involve the employment of
bodily powers and mental powers

THE RELATION TO DICTATES OF REASON

 Human acts are either in agreement or disagreement with
the dictates of reason, and this relation (agreement or
disagreement) with reason constitutes their morality

ON THE SCORE OF THEIR MORALITY, OR
RELATION TO REASON, HUMAN ACTS ARE:
a. Good – when they are in harmony of directions to right
reason
b. Evil – when they are in opposition to these dictates
c. Indifferent – when they stand in no positive relation to
the dictates of reason
COMPONENTS/CONSTITUENTS OF THE HUMAN
ACTS
In order for an act to be human, it must possess 3 essential
qualities:
1. Knowledge of what is it about and what it means
- It means merely advertence, or knowledge in
intellect of what one is about and what this means
2. Freedom to do or leave it undone without coercion or
constraint
- Implies voluntariness which is to rationally choose
by deliberate will the object
- It is an act under the control of the will, an act that
the will can do or leave undone
3. Voluntariness – is the formal essential quality of human
act, and for it to be present, there must ordinarily be both
knowledge and freedom in the agent
KINDS OF DEGREES OF VOLUNTARINESS
1. Perfect and imperfect
 Perfect Voluntariness – present in the Human
Act when the agent fully knows and fully
intends the act
Example: Deliberate Lie
 Imperfect Voluntariness – is present when
there is some defect in the agent’s knowledge,
intention or in both
2. Simple and Conditional
 Simple voluntariness – is present in the human
act performed, whether the agent likes or
dislikes doing it
 Conditional Voluntariness – is present in
agent’s wish to do something other than that
which he is actually is doing, but doing with
dislike
3. Direct and Indirect
 Direct Voluntariness – is present in human act
willed in itself
a. Voluntary in se (in itself) – an act that is
directly willed
b. Voluntary in cause (its cause)
 Indirect Voluntariness – is present in the
human act which is an effect, foreseen or
foreseeable, of another act directly willed
VOLUNTARINESS OF HUMAN ACTS
Kinds of Degrees of Voluntariness
Positive and Negative
 Positive voluntariness is present in human acts
of doing, performing
 Negative voluntariness is present in human act
of omitting, refraining from doing
Actual, Virtual, Habitual, Interpretative
a. Actual voluntariness – present in the human act willed
here and now
b. Virtual Voluntariness – is present in the human act done
as a result of a formerly existed actual intention, even
that intention be here or now forgotten
c. Habitual Voluntariness – is present in human act done in
harmony with, but not as a result of, a formerly elicited
and unrevoked actual intention
d. Interpretative Voluntariness – that, in the judgment of
prudence and common sense, would be actually present
if opportunity or ability for it were given
PRINCIPLES INVOLVED IN FOLLOWING MODIFIERS
OF HUMAN ACTS
Ignorance – absence of intellectual knowledge in man
- Negation of knowledge it is a negative thing
THERE ARE 3 WAYS TO STUDY IGNORANCE,
NAMELY:
1. Ignorance in its object – the thing of which a person may
be ignorant is a matter of the law, fact, or penalty
a. Ignorance of the law – ignorance in the existence of
duty, rule, or regulation
b. Ignorance of the fact – ignorance of the nature or
circumstances of an act which is forbidden
c. Ignorance of Penalty – lack of knowledge of the
precise sanction affixed to the law
2. Ignorance in its subject – the person whom the ignorance
exists, ignorance (of law, fact or penalty) is ether vincible
or invincible
a. Vincible/Conquerable Ignorance – ignorance that
can be dispelled by the use of ordinary diligence. In
consequence, this is culpable ignorance
PRINCIPLES INVOLVED IN FOLLOWING MODIFIERS
OF HUAMN ACTS
There are degrees of vincible ignorance:
 Crass/Supine Ignorance – if it be the result of total, or
nearly total, lack of effort to dispel it
 Simply vincible – if some effort worthy the name, but not
preserving and wholehearted effort, be unsuccessfully
employed to dispel it
Invincible Ignorance – ignorance that ordinary and proper diligence
cannot dispel. It is known as the inculpable ignorance
There are two degrees of invincible ignorance:
 Physically Invincible – if no human effort can dispel it
 Morally Invincible – if such effort is good and prudent
men would expend to dispel it taking into the account the
character and importance of the matter about which
ignorance exists is found to be ineffective
3. Ignorance in its Result – ignorance with reference to acts
performed while ignorance exists
a. Antecedent Ignorance – is that which precedes all
consent of the will. It does not differ from invincible
ignorance
b. Concomitant Ignorance – ignorance which
accompanies an act that would have been performed
even if the ignorance did not exist
c. Consequent Ignorance – is that which follows upon
an act of the will. It does not differ from vincible
ignorance
PRINCIPLES INVOLVED IN FOLLOWING MODIFIERS
OF HUMAN ACTS
Ethical Principles which serve a modifier of Human Acts:
1. Invincible Ignorance destroys the voluntariness of an act
2. Vincible ignorance does not destroy the voluntariness of
an act
3. Vincible ignorance lessens the voluntariness of an act
4. Affected ignorance in one way lessens and, in another
way, increases voluntariness
Concupiscence –bodily appetite or little of such
tendencies called passion reprimands.
 love, hatred joy,  That is regarded
grief ,desire , by most people
aversion or as serious (E.g.,
horror , hope, Fear of death or
despair , courage loss of leg)
or daring , fear
and anger • 2. Slight Fear
Concupiscence  is that which is aroused by:
 Passions are in 1. Danger that is not serious (e.g., fear of losing one’s
revolt against our glove)
nobler self, and 2. Grave danger that is not very probable (e.g., fear of death
that revolt is when flying a plane on a slightly misty day.)
called  
CONCUPISCEN • Fear
CE.  Actions that are performed because of fear, however
 Passions are great the fear may be, are VOLUNTARY (at least
considered BAD conditionally) and so are imputable
when used by the  One acts because of fear if it is the fear that induces him
rational will to so to act (E.g.1. A little boy is raiding the pantry for cake.
accomplish Hearing his mother coming, he runs off for fear of being
MORALLY discovered. 2. Thomas is held up by a robber. Fear of
EVIL actions. getting killed if he refuses causes Thomas to surrender
his wallet.).
• There are 2 types of CONCUPISCENCE:
1. Antecedent Concupiscence – is that which arises spontaneously • Fear
before the previous judgment of reason and before the will controls  One acts with if fear merely accompanies one’s act but
the psycho logic situation. It precedes the act of the will and is not does not cause it. (E.g., A burglar, while robbing a house,
willfully stimulated by the will. experiences the fear of being caught. Actions that are
 (Sudden feelings of joy, anger, pity, grief, etc as reaction performed with fear are simply voluntary because the
to news are examples of these.) agent here chooses to do the act with or without fear)
 It may completely destroy freedom and consequently,
moral responsibility, when they suddenly arise and Habit – a lasting readiness and facility, born of frequently
compel us to act before any control of the will is repeated acts , for acting in certain manner
possible: Principle
EXAMPLE: A woman loves a man so much that in a moment of Habit does not destroy voluntariness; and act from habit are always
savage rage, the woman kills the man because of jealousy. voluntary, at least in a cause, as long as the habit is allowed to
 Antecedent passion lessens the freedom and hence the endure
responsibility of the agent because it tend to blind the
judgment of an intellect and block the freedom of the • Habit
will.  Are inclination to perform some particular action,
acquired by repetition, and characterized by decreased
• 2. Consequent Concupiscence power of resistance and an increased facility of
 is that which is deliberately aroused by the will in order performance.
to ensure a more prompt and willing operation.  If a habit disposes to EVIL, it is a VICE; if to GOOD it is
(For instance, continuously imagining and brooding over an a VIRTUE.
insult received from an enemy, a person may build himself up to
such a state of frenzy that he finally attacks and kills his enemy.) • Habit
• 2. Consequent Concupiscence  Two general principles may be stated concerning the
 Consequent passions do not lessen the voluntariness of effects of habits on the imputability of evil actions
an act but it may increase because these passions are 1. Evil habits do not lessen the imputability of evil actions
deliberately excited and they are voluntary in performed by force of habit if the habit has been
themselves. recognized as evil and is freely permitted to continue.
2. Evil habits lessen the imputability of evil actions
• Fear performed by forces of habit if one is sincerely trying to
 Is the mental agitation or disturbance brought about by correct the habit.
the apprehension of some present or imminent danger.
Types of Fear: • Violence
1. Grave Fear – is that which is aroused by the presence of a an external force applied by someone
danger or another in order to compel him to
perform an action against his will.
• 1. Grave Fear There are TWO types of VIOLENCE:
 That is judged to 1. Perfect Violence
be serious by the 2. Imperfect Violence
one concerned
(E.g., a young • Violence
girl dreads the  Perfect Violence – is that in which complete resistance is
thought of given.
receiving a  Under perfect violence we have physically perfect
scolding in violence where every possible means of resisting is
public, although utilized as in the case of a woman being raped by three
other girls make men.
  Morally Perfect Violence is that in which all powers of
resistance that should be used are employed.

• 1. Imperfect Violence
 occurs when some resistance is shown but not as much as
should be.
 Three principles may be applied in determining the effect
of violence on the voluntariness of the act and the
imputability of the agent:

• Three principles …
1. If one resists the violence as much as possible, such as in the
case of perfect violence, the evil act to which one is forced is in no
way culpable.
• (E.g., a young girl is forced by a man to do the marital
act. The girl fights back. Nevertheless, since the man is
stronger than the girl, he succeeds in his evil intention. In
this case the young girl is not responsible for the act.).

2. If one does not resist the violence as fully as possible, such as in

the case of imperfect violence, the culpability of the evil act is
lessened but not taken away.
(E.g., another girl is carried off bodily by two young male
acquaintances. The girl resists somewhat but not enough. She could
have been released by screaming or shouting for help. By not
offering stronger resistance which she knows would be effective,
she is judged to consent to evil into which he is taken. Her guilt,
however, is not as great as it would be if no violence were present.

3. If one sees that any resistance would be wholly

ineffective, there is no obligation to resist. The reason is
that no one is obliged to so what is useless. However,
though a show of resistance would in some case be
fruitless with regard to affecting a release from violence,
it might serve a very useful purpose: (1) such resistance
might disclose one’s lack of consent to the act which one
is being forced or, 2) such resistance might aid one in
preventing internal consent to the external act. (E.g., a
bank cashier and his two bodyguards are held up by ten
heavily armed men. The bank cashier and his bodyguards
know that no amount of resistance would be effective to
stop the hold-up men. Here, there is no obligation to
resist although resistance may be useful to show the
cashier’s lack of consent to the act of the holdup men.