COURSE UNIT 5:

PRINCIPLES USED IN BIOETHICS

Prepared by: MC Belisario RN MAN LPT
UNIT EXPECTED OUTCOME
• At the end of this unit, the students are expected to:
• Cognitive:
• 1. Understand the principle of stewardship
• 2. Determine the role of nurses as stewards
• 3. Understand the principle of totality and integrity
• 4. Explain the principle of ordinary and extra ordinary
measures
• 5. Discuss the principle of personalized sexuality
 UNIT EXPECTED OUTCOME
• Affective:
• 6. Value the importance of principles of bioethics as nurses
guide in decision making process.

• Psychomotor:
• 7. Apply ethico-moral principles of bioethics in nursing care.
• 8. Participate during class discussion
PRINCIPLES USED IN BIOETHICS
•Content outline:
• A. Principle of stewardship.
• B. Principle of Totality and Integrity.
• C. Supporting Patients Rights and Choices
• D. Ethical Dilemmas
• E. Principle of Ordinary and Extraordinary Means.
• F. Principle of Personalized Sexuality.
• .
 PRINCIPLES USED IN BIOETHICS
• A. Principle of Stewardship
• Stewardship-The job of supervising or
taking care of something, such as an
organization or property.
• God has the absolute domain over
creation.
• Man is made in God’s image and
likeness, we have given the limited
dominion over creation and WE are
responsible for it’s care.
 STEWARDSHIP in Healthcare Practice
• refers to the expression of one’s
responsibility to take care , nurture
and cultivate what has been
entrusted to him.
• In healthcare practice,
STEWARDSHIP refers to the execution
of responsibility of the health care
practitioners to look after, provide
necessary health care services, and
promote the health and life of those
entrusted to their care.
Principle of Stewardship
• 2 great gifts that a wise and loving
God has given to us;
• 1. the earth, with all the natural
resource
• 2. human nature, with its biological,
psychological, social and spiritual
capacities.
 Principle of Stewardship
• Human creativity should be used to
cultivate nature, recognizing our
limitation and the risk of destroying
these gifts.
• Gifts of human life and environment
MUST be used with profound respect.
 Roles of nurses as Stewards
•A. Personal
• 1. The nurse steward ought to
structure educational opportunities
that encourage nurses to shift their
epistemology of practice to
integrating a virtue-based
practical reasoning.
 Roles of nurses as Stewards
•B. Social
• 1. Nurses advocate for the health promotion to
educate patients and public on the
prevention of illness and injury, provide care
and assist in cure, participate in rehabilitation
and provide support.
• 2. Nurses help families become healthy by
helping them understand the range of
emotional, physical, mental and cultural
experiences they encounter during health and
illness.
Roles of nurses as Stewards
• 3. Nurses help people
and their families to
cope with their illness
and deal with it and if
necessary live with it, so
that their normal life can
continue.
 Roles of nurses as Stewards
• C. Ecological
• 1. Nurses can help with waste management.
Health care sectors generates tons of waste
from the hospitals and since nurses are the
frontlines of care, they can be helpful in coming
up with policies about hospital waste
segregation and recycling. Nurses can lead a
way for communities to have a more
sustainable way of living.
 Roles of nurses as Stewards
• D. Biomedical
• 1. A nurse should be familiar and well versed
with new equipment and tools that are being
used in the hospital and other clinical setting.
• According to the theory of Locsin, entitled
Technological competency as caring in nursing,
a nurse can be a steward of patients if they
know how to use technology to their advantage.
B. Principle of Totality and Its Integrity
• The principle of totality states that
all decisions in medical ethics must
prioritize the good of the entire
person, including physical,
psychological and spiritual factors.
 C. SUPPORTING PATIENT RIGHTS AND CHOICES
• 1. Respect the dignity and worth of
individual patients.
• 2. Preserves and protects patient autonomy
and human rights.
• 3. Be knowledgeable about the moral and
legal rights of their patients and to protect
and support those rights.
• 4. Individual rights to self‐ determination in
health care should be overridden
temporarily to preserve the life of the
community.
Self‐ Determination VS. PUBLIC SAFETY
• For example, during a bioterrorism attack, victims
infected with transmissible organisms (eg, small pox,
covid 19) require infection control measures to prevent
transmission to others.
• These infection control measures may require isolation,
resulting in restricting a patient's right to freedom of
movement to protect others.
SUPPORTING PATIENT RIGHTS AND CHOICES

• 5. Supporting patient's participation

in decision making, confirming
informed consent, and implementing
advance directive policies.
• 6. Provide patients with honest and
accurate answers to their questions.
 SUPPORTING PATIENT RIGHTS AND CHOICES
• 7. Perioperative nurses should explain the
procedures and OR environment before
initiating actions.
• 8. Respect patients' wishes in regard to
advance directives and end‐ of‐life
choices.
• 9. Patients have the right to self‐
determination (ie, the ability to decide for
oneself what course of action will be
taken in various circumstances).
 SUPPORTING PATIENT RIGHTS AND CHOICES

• 10. Nurses can empower patients by

providing opportunities for them to make
autonomous decisions about their health
care.
• 11. When dealing with informed consent,
the nurse's role is to validate that the
patient has been given the information
and understands as much as possible
about the surgical intervention.
 SUPPORTING PATIENT RIGHTS AND CHOICES
• 12. The principle of autonomy provides
for patients to make decisions freely,
even if those decisions are against
medical advice.
• 13. Even if the surgeon and nurse
believe that surgery is in the best
interest of the patient, the patient has
the right to refuse the procedure at
any time, regardless of whether he or
she signed the surgical consent form.
 SUPPORTING PATIENT RIGHTS AND CHOICES
• 14. Nurses ethically should support
patients in their choices, regardless of
whether they agree with the patient's
decision.
• 15. Nursing assessment and care also
applies to situations in which patients
identify advance directive choices or
decisions related to do‐not‐resuscitate
orders. It is the nurse's role to ensure that
surgical team members are aware of a
patient's wishes in these matters.
SUPPORTING PATIENT RIGHTS AND CHOICES

• 16. It is important that all team

members and the patient discuss
and identify a plan of care before
beginning the surgical procedure.
 D. ETHICAL DILEMMAS
• An ethical dilemma (ethical paradox or moral
dilemma) is a problem in the decision-making
process between two possible options, neither
of which is absolutely acceptable from an
ethical perspective
• .Ethical dilemma when a patient is anxious
because he or she does not understand fully
what is going to happen in surgery and the
nurse is being pressured for a fast turnover time.
•.
 ETHICAL DILEMMAS
• 3. Nurse is told to get the patient's signature on a
consent form. Nurses must realize that they are
not being asked to provide informed consent for
the patient.
• 4. The nurse is merely acting as a witness to the
identity of the patient and to the patient's
signature on the consent form.
• - Once again assess the patient's level of
understanding and see if he or she wishes to
further discuss the proposed intervention with the
physician.
Sterilization
• Sterilization refers to any process
that eliminates, removes, kills, or
deactivates all forms of life and
other biological agents.
Mutilation
• Female genital mutilation (FGM)
comprises all procedures that
involve partial or total removal of
the external female genitalia, or
other injury to the female genital
organs for non-medical reasons.
 Preservation of bodily functional integrity
• Principle of integrity refers to every
individual’s duty to preserve the view of
the human person in which the
order/function of the body and its
systems are respected and not duly
compromised by medical interventions.
• Anatomical- material or physical
integrity of the body
• Functional- systemic efficiency or
functionality of the body
 Preservation of bodily functional integrity

• These principle dictates that the well-

being of the whole person must be
taken into account in deciding about
any therapeutic intervention or use of
technology.
• Therapeutic procedures that are likely
to cause harm or undesirable side
effects can be justified only by a
proportionate benefit of the patient.
 Preservation of bodily functional integrity

• For example:
• If one organ is missing from the
person’s body = lack of
anatomical integrity
• But if one kidney is healthy,
present and functioning well
=functional integrity is preserved
 Issues on Organ Donation
• Organ donation is when a person allows
an organ of their own to be removed
and transplanted to another person,
legally, either by consent while the donor
is alive or dead with the consent of the
next of kin
• Donation may be for research or, more
commonly, healthy transplantable
organs and tissues may be donated to
be transplanted into another person.
Issues on Organ Donation
• Some organs and tissues can be
donated by living donors, such as a
kidney or part of the liver, part of the
pancreas, part of the lungs or part of
the intestines, but most donations
occur after the donor has died.
• Common transplantations include
kidneys, heart, liver, pancreas,
intestines, lungs, bones, bone marrow,
skin, and corneas.
E. Principle of Ordinary and Extraordinary
Measures
• Ordinary measures are those that are based on medication
or treatment which is directly available and can be applied
without incurring severe pain, costs or other inconveniences
• Ordinary means must be taken to preserve life
• ordinary means are those “means of treatment available
are objectively proportionate to the prospects for
improvement.”
• For example, a feeding tube is an ordinary means of
preserving life
 Principle of Ordinary and Extraordinary
Measures
• Extraordinary means are “medical
procedures which no longer correspond
to the real situation of the patient, either
because they are by now
disproportionate to any expected results
or because they impose an excessive
burden on the patient and his family.
• Ordinary means must be taken to
preserve life, and extraordinary means
can be morally refused
 F. Principle of Personalized Sexuality
• Sex is a social necessity for the
procreation of children and their
education in the family so as to
expand the human community
and guarantee its future beyond
the death of individual members.
Teaches that God created persons
as male and female and blessed
their sexuality as a great and good
gift
Reference:
• Textbook:
• Bioethics and moral decision making 4th edition, Florentino
Timbreza
• Websites:
• Principle of bioethics
• https://pdfcoffee.com/principles-of-bioethics-pdf-free.html
• Nurse Leaders as stewards
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737121/
 COURSE UNIT 6:
BIOETHICS AND ITS APPLICATION
IN VARIOUS HEALTH CARE
SITUATIONS
Prepared by: Ma Concepcion S Day, LPT, RN, MAN
 LEARNING OBJECTIVES
At the end of this unit, the students are expected to:
Cognitive:
1. Understand the human sexuality and its moral EVALUATION .
2. Discuss the fundamentals of marriage, issues and legalities of marriage.
3. Comprehend issues in contraception.
Affective:
4. Practice effective listening during class discussion.
5. Inquire on topics that are not completely understood .
6. Share opinions on the subject matter that can enhance class discussion.
Psychomotor:
7. Follow class rules and netiquettes.
8. Participate during class discussion .
 Bioethics and its Application in Various Health Care
Situations: CONTENT OUTLINE:
1. Human Sexuality and its Moral Evaluation
• Sexual orientation
2. Marriage
• Fundamentals of Marriage
• Issues on Sex Outside Marriage
• Homosexuality
• Issues on contraception, ethical-moral; nurses
responsibilities
 1. Human Sexuality and its Moral Evaluation
• Human sexuality refers to people’s sexual interest
in and attraction to others, as well as their
capacity to have erotic experiences and
responses.
• People’s sexual orientation is their emotional and
sexual attraction to particular sexes or genders,
which often shapes their sexuality.
• Sexuality may be experienced and expressed in a
variety of ways, including thoughts, fantasies,
desires, beliefs, attitudes, values, behaviors,
practices, roles, and relationships.
Moral Evaluation
➢ Christian ethics has centered its consideration of human sexuality in
committed monogamous lifelong heterosexual Christian marriage
➢Marriage, is seen biblically and theologically, to signify Christ's union with
the Church.
➢In Christian marriage sexuality is only good insofar as it is open to
PROCREATION.

➢Sexuality is both a good in itself and a means of achieving other goods

and purposes, including for example such things as commitment, fidelity,
mutual joy, and comfort.
Moral Evaluation
➢The basic criteria for evaluating any relationship have to do with
the extent to which key relational components are present and
expressed in ways appropriate to the particular relationship.
➢ Mutual regard, respect, and truthfulness are minimums for any
relationship.
➢Relationships that are more than fleeting ought also to involve
responsibility, loyalty, accountability, attentiveness, and
availability.
➢ Long-enduring relationships require commitment, fidelity,
reciprocity, forgiveness, and generativity.
 2. Marriage
• Marriage is defined differently, and by
different entities, based on cultural,
religious, and personal factors.
• A commonly accepted and
encompassing definition of marriage is
the following:
• a formal union and social and legal
contract between two individuals that
unites their lives legally, economically,
and emotionally.
 2. Marriage
• The contractual marriage agreement
usually implies that the couple has
legal obligations to each other
throughout their lives or until they
decide to divorce.
• Being married also gives legitimacy to
sexual relations within the marriage.
• Traditionally, marriage is often viewed
as having a key role in the preservation
of morals and civilization.
Marriage as a Moral Act
➢Marriage is sacred and was ordained of God from before the
foundation of the world thus, it affirmed the divine origins of
marriage
• Commitment . Respect
• Fidelity . Understanding
• Loyalty
• Sacrifice
➢The sacred nature of marriage was closely linked to the power of
procreation.
➢marriage is a vital institution for rearing children and teaching
them to become responsible adults.
 2. Marriage
❖Under the Family Code of the Philippines (FC),
marriage is defined as a special contract of
permanent union between a man and a woman
entered into in accordance with law for the
establishment of conjugal and family life.
Fundamentals of marriage
• Husband- A married man considered in relation to his
spouse.
• Wife- A married woman considered in relation to her
spouse
• Marriage License- A license that a couple must obtain
before getting married
2. Marriage

❖PERSONAL OBLIGATIONS OF THE

SPOUSES TO EACH OTHER
• Live together;
• To observe mutual love, respect,
and fidelity; and
• To render mutual help and
support.
Issues on sex outside marriage
Premarital sex- Premarital sex is a sexual activity
that is practiced by people before they are
married.
• > Historically, premarital sex has been
considered a moral issue that is taboo in many
cultures and it is also considered a sin by a
number of religions, but since the sexual
revolution of the 1960s, it has become
accepted by certain liberal movements,
especially in Western countries.
Issues on sex outside marriage
Extra Marital Sex- occurs when a married person engages in sexual activity with
someone other than their spouse.
• Where extramarital sexual relations do breach a sexual norm, it may be referred
to as adultery or non-monogamy (sexual acts between a married person and a
person other than the spouse), fornication (sexual acts between unmarried
people), philandery, or infidelity.
• These terms imply moral or religious consequences, whether in civil law or
religious law Extra-Marital
 Issues on sex outside marriage
Adultery and Concubinage
• Philippines' law criminalizes adultery and concubinage.
Both are deemed “crimes against chastity”
• under the Revised Penal Code of the Philippines and are
treated as sexual infidelity in the Family Code.
• The law discriminates against wives. The crime of adultery
can be committed only by a wife and her paramour.
• The husband need only prove that his wife had sexual
intercourse with a man other than him.
Contraception
•Methods of Contraception
1. Folk methods Precoital/Poscoital Douche Prolonged Lactation Withdrawal-
coitus interruptos, coitus reservatus
2. Mechanical methods condom Diaphragm Sponge
3. Chemical methods Vaginal suppositories and tablets Vaginal jellies, creams,
and foams
4. Hormonal methods Contraceptive pills Injections and implants
5. Abortifacients Intrauterine Device DES( diethylstilbestrol Prostaglandin Anti
pregnancy vaccine Low-dose of contraceptive pills
6. Surgical methods Tubal ligation Vasectomy Hysterectomy
7. Natural or behavioral methods Rhythm or calendar method Temperature
method Ovulation
(Mucus) Method Sympto-thermal method Sex relations during menstruation
Morals of Contraception
➢Many believe that personhood begins at fertilization, when the genes
from two parent cells combine to create a unique genome (Gilbert,
Tyler, & Zackin, 2005).
➢The moral issue of contraception is concerned with the rightness or
wrongness of the use of various methods by which contraception can
be prevented in the conjugal union of the sperm and egg thus
prevented the born of a fetus.
• If personhood begins with God’s thought of a person, using
contraception therefore would seem to go against God’s will. (Gerber
2013)
• On this view, it interferes with God’s plan for that potential human
being.
Contraception leads to "immoral
behaviour"
➢Contraception makes it easier for people to have sex outside
marriage
➢Contraception leads to widespread sexual immorality
➢Contraception allows people (even married people) to have sex
purely for enjoyment

https://www.bbc.co.uk/ethics/contraception/against_1.shtml
Ethico-Moral Responsibility of Nurses in
Contraception
• Primary Concern
• Welfare of the patient and respecting the autonomy of
the patient
• Secondary Concern
• Make sure the patient gets all the information and
advice that they need to be able to choose wisely.
Ethico-Moral Responsibility of Nurses
in Contraception
• Patient needs to know: reliability of the method, ease of use of the
method, potential side effects, and health risks.
• Help the patient weigh the advantages and disadvantages. Usually
the doctor does this but if the patient will ask you, you also have to
know
• Health care practitioners should respect also the confidentiality of a
patient.
• The problem here is when teenagers ask for contraceptive help and
make it clear that they do not want their parents to know about it.
What to do? Encourage the minors to inform their parents and explore
the reasons the patient does not want to do so
 References:
• Textbook:
• Bioethics and Moral Decision 4th edition Florentino Timbreza
• Websites:
• Premarital sex
• https://en.wikipedia.org/wiki/Premarital_sex

• What Is the Definition of Marriage?

• by Sheri Stritof
• Updated 08/05/21
• https://www.brides.com/definition-of-marriage-2303011
• What Are Good Marriage Values? Happiness Is Not One of ...https://relatefoundation.com › blog › what-are-good-
m.
• PHILIPPINES’ LAWS ON ADULTERY, CONCUBINAGE AND MARRIAGE NULLITY
• Posted by Jeremy Morley | Nov 30, 2016
• https://www.international-divorce.com/2016/11/philippines-laws-on-adultery.html
• Gerber, Joella R., "Morality of Contraceptives Based on When Personhood Begins" (2013). CedarEthics Online. 53.
• http://digitalcommons.cedarville.edu/cedar_ethics_online/5
Thank you!

End of Week 7