INTRODUCTION: BASIC ETHICAL CONCEPTS

Geraldine S. Canete, MAN, RN

Ethics according to Aristotle comes from the Greek word “ethos” or “ethous” meaning use, custom, way
of behaving, character and corresponds to the Latin term “mos” or “moris”. These behaviours are basic
human behaviors that are specific & inherent to human beings. They are natural to human which confers
and develops goodness in them.

Ethics as you have learned, is that branch of Philosophy that deals with the principles of morality and the
well-defined standards of right and wrong that prescribe the human character and conduct, in terms of
obligations, rights, rules, benefit to society, fairness etc. In simple terms, Ethics is that field of philosophy
that specifically studies human acts in the light of morality. The issue of man’s action in every stage of life
will always be a source of enduring philosophical wonder.

WHAT ARE HUMAN ACTS?

Human acts being the object of study of Ethics are voluntary acts which proceeds from the free will. Human
acts depend on human’s judgment and choice hence entail a moral responsibility. Human acts form the
human personality and structure. Human acts that humans perform, build up their lives. The doing or the
absence of doing build the kind of life the person lives. (Ocampo, 2018) The kind of life that is good, well
and happy. For patients, the kind of life that is healthy.

St. Thomas Aquinas asserted that, in the study of moral philosophy or ethics, human acts are said to be
proceeding from man’s will according to the dictate of reason. Acts performed by the individual which are
not subject to his will and reason are not called strictly human acts but rather are natural acts. (Ortigas,
2006, p. 66)

Below is the bullet point summary about the difference between human acts and natural acts of man.

Keypoints:

• All Human act are subjected to morality.

• Human acts are different from animal act because man by nature acts towards an end. His life
has a purpose.
• Human acts are those that are freely chosen in consequence of a judgment of conscience.
• They are either good or evil.
• Their morality depends on: the object chosen, the intention and the circumstances.
• Human Acts are not merely physical events that come & go, like the falling of rain or the turning
of the leaves, nor do they as Karol Wojtyla emphasized in THE ACTING PERSON, “happen” to a
person.
• They are, rather, the outward expression if a person’s choices for at the core of a human act is
free, self determining choice, an act of the will, which as such is something spiritual that abides
within the person, giving him his identity as a moral being.

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 • Although many human acts have physical, observable components, they are morally significant
because they embody and carry out free human choices.
• We are free to choose what we are to do and, by so choosing, to make ourselves the kind of
person we are.
• But we are not free to make what we choose to do to be good or evil, right or wrong.
• We know this from our own sad experience, for at time we have freely chosen to do things that
we knew, at the very moment we choose to do them, were morally wrong. We can, in short,
choose badly or well.

Human acts
Actions done Consciously and freely by the agent/or by man
ESSENTIAL QUALITIES/ Constituent Elements of Human Acts
1. Knowledge of the act
2. Freedom
3. Voluntariness
Man takes into responsibility of these actions

Natural Acts of Man

Actions beyond one’s consciousness; not dependent on the intellect & the will.
• ESSENTIAL QUALITIES of Acts of Man
– Done without knowledge
– Without consent
– Involuntary
• Ex: unconscious, involuntary, semi-deliberate, spontaneous actions
• Acts of man can become human acts when he employs his intellect & will in performing the act.

ACTS not morally accountable

• Acts of persons asleep or under hypnosis.
• Reflex actions where the will has no time to intervene.
• Acts of performed under serious physical violence
• e.g. a hostage obliged to do an evil action.
• Since the will is constrained, then it is not a moral act which could be evaluated.
Discussion activity:
Identify which of the following is a human act (HA) or a natural act of man (NAM).

1. Looking
2. Seeing
3. Dreaming
4. Day dreaming
5. Hearing
6. Listening
7. Walking
8. Sleepwalking

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Why do we need to study human acts?

I have my answer from Socrates famous and inspiring thesis which says “the unexamined life is not worth
living”. And this Socratic Method is realized in conversation- in dialogue.

Imagine Socrates in the olden days, receiving inquiries from pre-socratic philosophers and there in the
marketplace, the Agora, started discussions with different people from different walks of life earnestly
exchanging ideas with one another. The fundamental attitude of the Greeks towards knowledge is truly
inspiring and worth emulating. For them true knowledge has been forged with criticism and judicious
reflections, tested and tried.

It is my hope that as we study human acts in different bioethical issues, we will also earnestly share ideas
even though we are not seeing each other in the classroom with everyone willing to go deeper, wider and
higher in terms of studying human acts to develop sound ethical judgment in every ethical issue we
encounter as nurses.

ON ETHICAL DILEMMA

To be able to assist patients/clients ethically -be it individuals, families, population groups and/or
community- nurses are to develop sound ethical judgment along with scientific knowledge and
interpersonal skills.

Nurses are guided by the broad base of knowledge sifted through the critical and creative skills to
determine what is good and bad for the patients. However, there are times when we face a dilemma
whenever we encounter two opposing yet equally beneficial for the patients.

Example of Ethical Dilemma Nurses encounter

1. A young woman asking for abortion because she is not ready for a baby and has no job. – you
believe in the inviolability of life yet you also understand the young woman’s predicament on
raising the child and respects her autonomy.
2. A woman with congestive heart disease pregnant, being asked to terminate pregnancy but wants
to deliver the baby to full term despite the risk on her part. – you respect the patient’s autonomy
and also believes in the inviolability of life yet you also recognize the risk and harm the patient is
facing due to her pregnancy,
3. A cancer patient in pain asking for more morphine despite being given already the prescribed
dosage. – you understand the suffering of the patient but you also recognize that harm that
morphine can do and can’t do on terminal pain.
4. An old couple wanting for a designer baby – you believe in the natural law yet you also recognize
the longing of the old couple to have a child of their own liking.
5. A middle age couple, childless, wanting for surrogate mother to carry their child. – you believe in
the natural law yet you also understand the longings of the middle age couple to have a child.
6. A young man selling his kidney so he can support his ailing child. – you believe in the principle of
totality yet you also understand the young man’s needs to support his family.

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 7. A young man choosing sex reassignment surgery because he doesn’t want to live any longer as a
man. – you believe in the natural law yet you also believe in respecting the autonomy/freedom of
choice of the young man.
8. You want to pass the summative exam to maintain your scholarship, but you did not study, then
here comes your classmate offering help by sharing her answers. – you believe in the principle of
veracity that supports truth regarding your capacity yet you also do not want to fail the summative
exam and lose the scholarship.

The list can go on as the person progresses in his or her personal and professional life. Oftentimes though,
a person is left wondering with a dilemma: How to decide in the face of what appears to be two equally
good and beneficial options.

Questions worth asking ourselves are, how do we know if it is good? how do we know if it is bad? In the
face of what seems to be two equally good, how do we choose which is the better good. Where does
goodness come from?

To determine the good requires careful study and reflection. Humans are equipped to search for what is
good in the world and what is good in human action. It is the main focus of Aristotle in his writings on
Ethics as what you have learned in your Philosophy subject. The Ethics of Aristotle investigates the
goodness of human acts that build a good life.

Human acts take on the ethical feature when it is examined based on its value as good or bad. Hence, it
is important that we know how to determine the goodness and badness of human actions.

ON WHAT IS GOOD
In the previous years that I was teaching Bioethics first, for Dentistry students and now Student Nurses, a
few students wrote in their reflective paper about their musings on what is good. Oftentimes I wished I
have offered a more in-depth discussion. I initially did not include this topic in the early years, since I
believed this can be covered on other subjects like Philosophy and Anthropology. However, I decided to
insert a brief discussion because I do not want to regret not discussing whenever I read the reflective
papers of my students.

On the question “what is good”, Dr. Ma. Liza Ocampo, the author of Ethics Primer, wrote an exhaustive
chapter on the Moral Good. She wrote that Aristotle critiqued Plato’s form of Good. According to her If
Plato believed that there is a single form of good and virtue, Aristotle argued that there exists, multiple
virtues of varying degrees. These virtues can be acquired through the practice of habit. (Ocampo, 2018,
p. 56) Furthermore, Aristotle asserted in his Nicomachean Ethics (after the name of his son Nicomachus),
that goodness in the moral world for him, allows for degrees, levels and difference.

Keypoints on Moral Good

The following is a point by point summary I wrote based from Dr. Ocampo’s discussion of Aristotle’s writing
on Moral Good:

1. The sense of good or the good of man can be understood not only on how the said good affects
himself but also with those around him since man is a political animal.

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2. Aside from existing in degrees, levels and differences, the senses of good can be understood in
an empirical manner. The good (of human experience) has to be seen, heard, touched, tasted and
felt.
3. All forms of good actions seek happiness.
4. To understand moral goodness, study the soul of man. (From chapter 13 of Nicomachean Ethics)
– one does not grow in the true understanding if the soul is unknown. Aristotle wrote: “But by
human goodness is meant goodness not of the body but of the soul and happiness we define as
an activity of the soul. This being so, it is understood that a doctor who intends to treat the eye
must have a knowledge of the body as a whole, and a statesman too must study with the view of
politics”
5. The content of moral goodness passes through reason and will and the mark of moral goodness
passes through the teat of rationality through different people, places and cultures.
6. Moral goodness has to be contextualized in different times and places hence there is a need to
study different cultures, histories and cases to understand the core of the moral goodness at that
particular time and space.
7. Moral goodness is described in terms of: honorable good, useful good and pleasurable good.
The language and classification of these goods is based on the natural movements of man’s
dynamic appetite. (this can be studied further on human anthropology)

Honorable good – is a good which is desired in itself because of its intrinsic goodness, which
means that man naturally tends towards these goods. Example: any virtue, health, science and
wellness.

Pleasurable good – is the same honorable good in as much as its possession silences desire and
produces joy. Examples are any sense-perceptible good in so far as it produces pleasure or delight
and the satisfaction produced by a virtue of by scientific knowledge.

Useful good – is a good which is not desired for its own goodness but for the sake of attaining
some other good. It is a good which is desired as a means. It is not desired for its own sake but
for the sake of honorable or pleasurable good. Any useful good is directed towards an ultimate
good. Example: bitter medicine to obtain health or a painful surgery to help a person recover from
a diseased organ and be healthy.
8. The honorable, pleasurable and useful goods are analogous and relate to each other in varying
situations. The character of being good primarily befits the honorable good, secondarily the
pleasurable good and remotely, the useful good.
9. The honorable and the pleasurable good are linked together since the source of joy is the good
and the root of pain is evil. The good is delightful and causes greater satisfaction while privation
of good/evil or bad results to sadness and pain.
10. Sometimes the honorable good is dissociated from the pleasurable good. Badness or evil ca be
pleasing because of some good that accompanies it but not necessarily honorable. The delight
produced by this is transitory and deceptive and oftentimes in the end is transformed into pain.
Example, a prohibited drugs that can give some pleasure. Similarly, an honorable good may be
painful. Example, healing process often involves painful cures like surgery or breaking away from
a disordered relationship or breaking off from an unhealthy habit (too much eating, no exercise,
drinking, etc.).

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 11. Goodness is objective and is not a matter of man’s subjective take on the goodness of the things
in the world. The default mode of the rational appetite of man is to go after the good. Example,
how does a baby learn that breastmilk is its food? No one taught the baby to consume milk. Yes
the mother offered her breast but the baby consumed the breastmilk.
12. Moral good especially the higher moral good, the honorable good are acquired through the
exercise of virtue and reason.
13. Any existent thing or living being is not good because it is desirable. It is desirable because it is
good.

NORMS OF HUMAN ACTS

• These are directives or guides in making decisions on what we ought to do or to be.

a. Law – an ordinance of reason, promulgated for the common good by one who has legitimate
authority. It is an authoritative order that should be just, honest, possible of fulfilment, useful, to
a certain degree of permanency and promulgated or made known to the subject.
b. Conscience – the practical judgment of reason upon an individual act as good and to be
performed or as evil and to be avoided.

IMPORTANT CLASSES OF LAWS

a. Eternal Law – It is God’s eternal plan and providence for the universe. It is the diverse reason or
will commanding the preservation of the natural order of things and forbidding its disturbance.
According to St. Thomas, it is the plan flowing from God’s wisdom directing all acts and
movements.

b. Natural Law – it is the eternal law as known to human through reason. It is nothing than the
rational creatures’ participation in the eternal law of God and Human comes to the knowledge of
this law by natural light of his/her reason. e.g. do good and avoid evil. (St. Thomas)

• The reason why it is called Natural is because it is neither communicated in a supernatural way,
nor a result of a command of a legislative or authority. The precept of natural law is found and
derived for the very nature of human beings.

PROPERTIES OF NATURAL LAW

a. Universality – the natural moral law binds every person at all times and in all places or its basis is
the very nature of human. One cannot remain ignorant of the natural law, at least not of its basic
precepts. However, human beings do not possess the knowledge of this law, in a fully
developed form from the beginning. She or he must develop it just as the development of other
forms of knowledge. E.g. respect for life
b. Immutability – as soon as the human being has the capacity of using his/her reason, certain
fundamental norms will become self-evident to humans. These fundamental norms are imprinted

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 in human nature, so that they exist as long as human nature exists. The genuine commands and
prohibitions of natural law cannot be changed.
c. Indispensability – no one is dispended or excused in the observance of the natural law. Why?
Because, the origin of natural law is God. Natural law is identical to God’s will. Evidently, human
has no authority over a law of this status. This means that if there is dispensation of this law,
there is a violation in God’s Law.

TYPES OF NATURAL LAW AS PRESENTED OR FORBID AN ACT

1. Affirmative – laws which bind always, but not at very moment. It states that human is morally
obliged to adopt all ordinary means of preserving health and life. However, not morally
obliged to adopt extraordinary means of preserving life, except if the point is not spiritually
prepared for death. Humans may adopt extraordinary means to conserve health and life. If it
appears to be useful, desirable and prudent thing to do.
2. Negative – laws that are prohibitory. These are laws of the natural order, which bind always
and at every moment. It states that no act – (+) or (-). Maybe directly, deliberately willed as a
means of destroying health or life.

At this point, it is good that we identify the ordinary from extraordinary means of preserving life,
from the standpoints of physicians and moralists.

VIEWPOINTS ORDINARY MEANS EXTRAORDINARY MEANS

PHYSICIANS Standard, recognized,
established medicines or
procedure of the period at the
level of medical practice.
MORALISTS Include not only normal food,
drink and rest but also in terms
of hospital practice, all medicines
and treatment procedures which
offer reasonable hope or benefit
for the patient which can be
obtained and used of excessive
expense, pain or other
inconvenience.
A medicine or procedure that
might be fanciful, bizarre,
experimental, incompletely
establishes and not recognized.
All medicines, treatments and
operations which cannot be
obtained or used of excessive
expense, pain or other
inconvenience for the point or
for others, or which if used would
offer a reasonable hope for the
point.

3. HUMAN POSITIVE LAW

• Law enhanced by the church or state.

• An ordinance of reason derived from the natural law or making a concrete and determinate
application of the natural law, promulgated for the common good by a human institution in
charge of society.

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Note: Whenever we perform actions that are in conformity to the law, it is good. We are talking now of
laws that are also morally sound, this will guide us not only to become citizens who abide to certain rules
but also develop us to become moral individuals. The knowledge on the different aspects of laws will
enable us to become more careful in following the norms to fulfill our duty in the preservation of human
life.

In studying human activity in the strictest sense, one has to recognize that such activity stems from freedom
and is directed towards a final goal. (Alvira & Rodriguez, 1992 cited in Ocampo, 2018, p. 8). Hence, for
acts to be called human acts, they must be voluntary not coerced, done with full knowledge and based on
an intention towards achieving a certain end. And Good is the basic reality of the moral order and the end
of man because again, the default mode of the rational appetite is is to go after the good.

Ethics is then considered an important practical science since it studies how human acts are directed
towards man’s purpose or end. It does not stop at the contemplation of truths but applies that learning
into actions, providing the necessary knowledge so man can choose what is good and consequently live
in a morally upright way. (Ortigas, 2006)

REFERENCES:

Edge, R. & Groves, J. (2019) Ethics of Health Care: A Guide for Clinical Practice. 4th ed. Philippine Edition:
Cengage Learning Asia Pte. Ltd.,.

Monge, M. (2014) Ethics in Medical Practice: Summary, Explanation & Defense of Concrete Ethical
Problems. Revised Edition. Manila: Sinagtala Publishers

Ocampo, M. L. R. (2018) Ethics Primer A Young Person’s Guide to Moral Reasoning. Vibal Group, Inc.

Rice, C. (1996) 50 Questions on the Natural Law: What It Is & Why We Need It. Ignatius Press,

Scgreccia, E. (2012) Personalist Bioethics: Foundations and Applications (T. Di Camillo, J. & Miller, M.
Translation). The National Catholic Bioethics Center. 2007, 1998, 1994, 1988

Internet sources
1. https://opusdei.org/en/article/topic-26-freedom-law-and-conscience/
2. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_200812
08_dignitas-personae_en.html Dignitas Personae Document September 8, 2008

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