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MODULE II
BIOETHICS and its Application in

 Various Health Care Situations

BIOETHICS – The study of the ethical and moral implications of

new biological discoveries and biomedical advances, as
in the fields of genetic engineering and drug research.

LESSON 1: Sexuality and Human Reproduction

1. SEXUALITY AND ITS MORAL EVALUATION

Human reproduction is any form of sexual reproduction resulting in

human fertilization. It typically involves sexual intercourse, the
interaction between the male and the female reproductive systems results
in fertilization of the woman’s ovum by the man’s sperm.

Human sexuality is how people express themselves as sexual

beings.

Human sexuality has biological, physical, and emotional aspects.

Biologically, it refers to the reproductive mechanism as well as the

basic biological drive that exists in all species and can encompass sexual
intercourse and contacts in all forms.

Emotional aspects deal with the intense emotions relating to sexual

acts and associated social bonds.

Physical issues around sexuality range from purely medical

considerations to concerns about the physiological and sociological aspects o
human behavior.

(For more information: https://www.youtube.com/watch?v=mtYuUL3OdUY)

This lesson will discuss the following issues in sexuality: premarital sex,
homosexuality, adultery, masturbation pornography and prostitution.

1. Premarital Sex

➢ Refers to sexual intercourse between a couple

before they are married. It usually means that the
couple do intend to get married at some future date.
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Arguments Against Premarital Sex includes but not limited to:

1.1a It undermines traditional morality. The conservative position

toward liberalizing sexuality states that one of the greatest problems
created by encouraging or even allowing premarital sex is that it tends
to undermine traditional Western morality. According to this view,
sexuality should be something that is reserved for a heterosexual,
monogamous marriage and that should be used mainly but not necessary
exclusively for the procreation of children.

1.1b Traditions as obsolete. According to the liberal viewpoint, the old

traditions have already been undermined because they are simply no
longer applicable in an advanced, technological and rapidly changing
world.

1.2a It encourages promiscuity. Another argument that supports the

conservative point of view is that premarital sex fosters promiscuity and
encourages transitory rather than lasting human relationships.

1.2b Does not condone promiscuity. Many of this life style arrangement/
affairs are long-lasting sometimes as long- lasting as marriage - and such
relationships may even develop into marriages.

1.3a It can cause social diseases and AIDS. One of the most powerful
arguments against premarital sex is the possibility of spreading social
diseases especially AIDS (Autoimmune Deficiency Syndrome). People who
argue against premarital sex state that abstinence is the best way to avoid
contracting these diseases.

1.3b Take the necessary precautions. The proponents argue that

abstinence is unnatural and an elimination of one of humanity’s
greatest pleasures. All one need’s to do is take the proper precautions
such as using condom.

1.4a It fosters guilt and ostracism. Most of the people around them
especially their parents, other relatives and some of their friends are
generally opposed to their actions and because of this they may
experience guilt and be ostracized from accepted society.

1.4 b The fallacy of guilt and ostracism. Sociology teaches us that

people’s views of premarital sex have changed a great deal, and few
people who engage in premarital nowadays as ostracized from society.

2. Homosexuality

➢ Are those individuals who more or less

chronically feel an urgent sexual desire
towards and a sexual responsiveness to,
members of their own sex and who seek
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and seek gratification of this desire predominantly with members of

their own sex.

Arguments Against Homosexuality includes but not limited to:

2.1a It is unnatural and perverse. That is,it is against the laws of God
and the moral laws of nature. There are sections in both the Old and New
Testament that call homosexuality : an abomination” and prohibit it as an
acceptable sexual activity.

2.1b No conclusive evidence. First of all,there is no conclusive evidence

that because most people are heterosexual in our society homosexuality is
therefore immoral or unnatural.

2.2a Sets a bad example and attempts to proselytize. It is argued

that homosexuality sets a bad example for children and that it attempts
to proselytize (that is, gain followers or adherents for its cause)
thereby undermining our traditional cultural values.

2.2b Right of consenting adults. The main issue involved in homosexuality

is the right of freely consenting adults to engage in private sexuality in
any way they see fit as long as it does not directly harm others.

3. Adultery

➢ Means the voluntary engaging in sexual

intercourse with someone that other than
one’s marriage partner.

Arguments Against Adultery includes but not limited to:

3.1a A direct violation of the marriage contract. When people get married,
they usually contract to live together as husband and wife and to be
faithful to one another - this usually means sexually faithful.
Committing adultery involves lying, cheating, and infidelity on the
part of one marriage partner or another ans these actions are morally
reprehensible in most ethical systems.

3.1b It Individual freedom. Some people who condone adultery would say
that the basic ethical assumption here is that “ what they don’t know
won’t hurt them”, bad results only occur when adultery is discovered.
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3.2a It destroys marital relationship. It can lead to separation or divorce

and to the injuring of innocent children.

3.2b Not a cause of broken families. Some arguethat families should not
be broken up under any circumstances because of the children involved
and for economic and social reasons.

4. Masturbation
➢ It is a sexual act that people usually perform with and by themselves.

Arguments Against Masturbation includes but not limited to:

4.1a There are basically two arguments against it today. First, there is the
religious argument that it is an abuse of one’s sexuality, which is a gift given
by God. The second argument is that it causes people to become preoccupied
with sex and it can lead them to other sexual “violations” of morality
(fornication, pornography, adultery and so on).

4.2b All the information reveled by modern science indicates that

masturbation is a perfectly normal act, both biologically and psychologically
and that it causes no ill effects whatsoever.

5. Pornography
➢ Is a very difficult term to define. It usually refers to obscene
literature, art, film, or live display. The word obscene usually means
morally offensive according to the general and prevailing standards of
morality in any particular culture, society or group.

Arguments Against Pornography includes but not limited to:

5.1a It is degrading to humans. A preoccupation with pornography, they

maintain, will lower the viewer’, listeners, or reader’s humanity to the
animal levels and as such preoccupation becomes more widespread, it will
destroy the moral fabric of our civilization.

5.2b No proof that it is degrading. In fact, there is evidence that it helps to

eliminate depression, relieve sexual tensions and actually lower sex crime
rates rather that raising them.

Enactment of Laws. Although it is true that pornography can involve

actual sexual crimes, our laws against murder, child abuse and molestation
can be enforced to stop this type of criminality.

6. Prostitution
➢ Sometimes referred to as the “oldest profession” is like pornography,
a confused issue in morality. What prostitution essentially means is
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that people will pay others (prostitutes - male or female) to have sex
with them.

Arguments Against Prostitution includes but not limited to:

6.1a Extramarital and commercialized sex id immoral. It may be the oldest

profession, but it is also the world’s most immoral one. Prostitution fosters a
lack of respect for the prostitute (usually a woman) and for human sexual
activity itself, which is supposed to enhance the intimacy of relationship
between partners and also contributes to the creation of children.

6.1b A safe sexual release. Prostitution is the world’s oldest profession

because human beings have sexual needs that are not always satisfied by
dating and marriage, partially because of all our taboos against sex as
pleasure giving and sex outside of marriage.

6.2a It causes crime. Prostitution is a big business and is usually managed and
run by criminal elements.

6.2b A victimless crime. Proponents of prostitution as moral argue that it

should not be considered either immoral or illegal because there are no
victims.

THINK!

1. In your opinion, is homosexuality a result of defective

parenting (environment) or a master of genetics (hereditary).

To ensure a clear and logical presentation of you ideas/

views, write down first the highlights of your stand/ arguments
regarding this issue.

2. What are your personal views on the moral issue of adultery?

Consider the arguments presented for and against adultery in
answering this question.
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2. MARRIAGE

The legally or formally union of

two people as partners in a personal
relationship historically and in some
jurisdictions specifically a union
between a woman and a man.

There are many factors that

contribute to a satisfying marriage/

relationship such as love, commitment,trust, time, attention, good

communication, including listening partnership, tolerance, patience,
openness, honesty, respect, sharing, consideration and so many others.

❖ Fundamental Objectives of Marriage:

Essentially, all denomination hold marriage to be ordained
by God for the union between a man and a woman. They see the
primary purposes of this union as intimate companionship,
rearing children and support for both husband and wife to fulfill
their life’s calling.

❖ Rights and Obligations of Husband and Wife

(The Family Code of the Philippines)

1. The husband and wife are obliged to live together, observe

mutual love, respect and fidelity, and render mutual help and
support. (Art. 68)

2. The husband and wife shall fix the family domicile. In case of
disagreement, the court shall decide. (Art 69)

The court may exempt one spouse from living with the other if
the latter should live abroad or there are other valid and
compelling reasons for the exemption. However, such
exemption shall not apply if the same is not compatible with the
solidarity of the family.
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3. The spouses are jointly responsible for the support of the

family. The expenses for such support and other conjugal
obligations shall be paid from the community property and, in
the absence thereof, from the income or fruits of their separate
properties. In case of insufficiency or absence of said income or
fruits, such obligations shall be satisfied from the separate
properties. (Art. 70)

4. The management of the household shall be the right and the

duty of both spouses. (Art. 71)

5. When one of the spouses neglects his or her duties to the

conjugal union or commits acts which tend to bring danger,
dishonor or injury to the other or to the family, the aggrieved
party may apply to the court for relief. (Art. 72)

6. Either spouse may exercise any legitimate profession,

occupation, business or activity without the consent of the
other. The latter may object only on valid, serious, and moral
grounds. (Art. 73)

In case of disagreement, the court shall decide whether or not:

1. The objection is proper; and

2. Benefit has occurred to the family prior to the objection or
thereafter. If the benefit accrued prior to the objection, the
resulting obligation shall be enforced against the separate
property of the spouse who has not obtained consent.

❖ Legal separation
Legal separation is a legal process by which a
married couple may formalize a de facto separation while
remaining legally married. A legal separation is granted in
the form of a court order. In cases where children are
involved, a court order of legal separation often makes
child custody arrangements, specifying sole custody or
shared parenting, as well as child support. Some couples
obtain a legal separation as an alternative to a divorce,
based on moral or religious objections to divorce.

The family code provides for legal separation on the following grounds:

1. Repeated physical violence or grossly abusive conduct directed against

the petitioner, a common child, or a child of the petitioner;

2. Physical violence or moral pressure to compel the petitioner to change

religious or political affiliation;
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3. Attempt of respondent to corrupt or induce the petitioner, a common

child, or a child of the petitioner, to engage prostitution or connivance
in such corruption of inducement.

4. Final judgment sentencing the respondent to imprisonment of more

than six years, even if pardoned;

5. Drug addiction or habitual alcoholism of the respondent;

6. Lesbianism or homosexuality of the respondent;

7. Contracting by the respondent of a subsequent bigamous marriage,

whether in the Philippines or abroad;

8. Sexual infidelity or perversion;

9. Attempt by the respondent against the life of the petitioner, or

10. Abandonment of petitioner by respondent without justifiable cause for

more than one year.

While legal separation is provided by law, no decision on such matter

shall be decreed “ unless the Court has taken steps towards the reconciliation
of the spouses and if fully satisfied, despite such efforts, that reconciliation
is highly improbable.

THINK!

How can couples avoid ending up with legal separation?

Cite at least two examples.

Contraception: Its Morality.

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Contraception - voluntary prevention of conception

➢ Uses artificial means that prevents the union of sperm and egg
➢ Synonymous with; family planning, responsible parenthood. planned
parenthood, birth control

Ethical Issues surrounding Sterilization: Responsibility of Nurses

3. ISSUES ON ARTIFICIAL REPRODUCTION, ITS MORALITY AND ETHICO-MORAL

RESPONSIBILTY OF NURSES

❖ Artificial Insemination

➢ is the deliberate introduction of sperm into a

female’s cervix or uterine cavity for the
purpose of achieving a pregnancy through in
vitro fertilization by means other than sexual
intercourse.

(To explain further: https://www.youtube.com/watch?v=Psv0FKA2bKg)

❖ In-vitro Fertilization

➢ is a process of fertilization where an egg

is combined with sperm outside the body
( in-vitro ). The process involves
monitoring and stimulating a woman’s
ovulatory process, removing an ovum or
ova, from the woman’s ovaries and letting
sperm fertilize them in a liquid in a
laboratory. In Vitro fertilization is an
assisted reproductive technology (ART)
commonly referred to as IVF.

(To explain further: https://www.youtube.com/watch?v=P27waC05Hdk)

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❖ Surrogate Motherhood

➢ practice in which a woman ( the

surrogate mother) bears a child for a
couple unable to produce children in the
usual way. Usually because the wife is
infertile or otherwise unable to undergo
pregnancy.

(To explain further: https://www.youtube.com/watch?v=t3Sgq7UmGQE)

(For other example of contraceptives:

https://www.youtube.com/watch?v=KyU880oHSxM)

Pregnancy is achieved through in-vitro fertilization (IVF). A

traditional surrogate both donates her own egg and carries a pregnancy.
Donor sperm may also be used.

4. MORALITY OF ABORTION, RAPE AND OTHER PROBLEMS REALTED TO

DESTRUCTION OF LIFE

In religion and Ethics, the inviolability or sanctity of life is a

principle of implied protection regarding aspects of life as holy, sacred,
or otherwise of such value that they are not to be violated.
Nurses have the ethical and moral obligation to protect and promote
life. Nursing dilemma lies in the right and responsibilities of nurses towards
abortion.

The rights of patients choosing to abort

- The role of and the responsibility of the nurse as well as the
rights of patients are supported within law, and within the
ethical framework of the Philippine code of Ethics.

❖ What is an abortion?

Abortion is the termination of a pregnancy by removal

or expulsion of an embryo or fetus. An abortion that occurs
without intervention is known as a miscarriage or
"spontaneous abortion" and occurs in approximately 30% to
40% of pregnancies. When deliberate steps are taken to end
a pregnancy, it is called an induced abortion, or less
frequently "induced miscarriage". The unmodified word
abortion generally refers to an induced abortion.
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There are two common techniques that are referred to as
abortions.

One is uterine or vacuum aspiration, in which the cervix is widened

by instruments, a tube is inserted into the uterus, and its contents are
suctioned out.

The other method is called dilation and curettage. The method is

the same except that, instead of using suction, the contents of the
uterus are scraped out with the use of a surgical instrument.

Late abortions, which are less common, are brought about through
the use of of a saline injection, which induces miscarriage. Although
rarely used, cesarean sections are sometimes used to abort a fetus.

❖ Moral Issues on Abortion

The abortion issue involves many of the same concepts that

underlie the issues of euthanasia and impaired infants. In each of these
issues, there are disputes concerning parenthood. Sanctity of life, quality
of life, autonomy, and mercy-as well as larger concepts such as freedom
and social stability.

The health care professional is often placed in situations that involve

adjudicating among these concepts, and more often is placed in situations
in which others make decisions using these concepts. The fact that others
make these decisions does not mean the health care professional can ignore
them, for he or she is often put in the position of carrying out decisions. So
even if one has no role in the decision-making process, one may come to
terms with actions that may morally controversial and heartrending.

❖ What is a rape?

➢ the crime, typically committed by a man, of forcing

another person to have sexual intercourse with the
offender against their will.

➢ Rape is a type of sexual assault usually involving sexual

intercourse or other forms of sexual penetration carried out against
a person without that person's consent. The act may be carried out
by physical force, coercion, abuse of authority, or against a person
who is incapable of giving valid consent, such as one who is unconscious,
incapacitated, has an intellectual disability, or is below the legal age
of consent. The term rape is sometimes used interchangeably with
the term sexual assault.
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THINK!

Is rape a moral justification for abortion?

❖ PREVALENCE OF BIOETHICAL ISSUES

1. Abortion-is the termination of pregnancy by the removal or

expulsion of an embryo or fetus from the uterus,resulting in
spontaneously due to complications during term or can be induced.
Abortion as a term is most commonly referred to the induced
abortion of a human pregnancy, while spontaneous abortions are
usually termed miscarriages.

2. Euthanasia-(Greek term “Thenatos”)

- the act of practice of permitting the death of hopelessly sick or
injured individuals in a relatively painless way for reasons of mercy.
It is commonly called merciful killing to relieve suffering.

3. Suicide- intentional self-inflicted death. A uniquely human acts,

suicide occurs in all cultures. People who attempt or complete
suicide usually suffer from extreme emotional pain and distress
and feels unable to cope with their problems. They are likely to
suffer from mental illness particularly, severe depression and feels
hopelessness about the future.

4. Determination of death- an individual who has sustained either:

A. Irreversible cessation of circulatory and respiratory

functions
B. Irreversible cessation of all functions of the entire
brain, including, the brain stem, is dead. A
determination of death must be made in accordance
with accepted medical standards.

◆ Clinical death is the popular term for cessation of blood

circulation. It occurs when the heart stops beating in a regular
rhythm, a condition called cardiac arrest. The term is also
sometimes used in resuscitation research.

Stopped blood circulation has historically been difficult to

reverse. The absence of blood circulation and vital functions
related to blood circulation was considered to be the definition
of death.
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At the onset of clinical death, consciousness is lost within
several seconds.

Measurable brain activity stops within 20-40 seconds. Irregular

gasping may occur during this early time period ,and is sometimes
mistaken by rescuers as a sign that CPR is not necessary. During
clinical death, all tissues and organs in the body steadily
accumulate a type of injury called ischemic injury.

5. Clinical Death and the Determination of Death.

Death was historically believed to be an event that coincided

with the onset of clinical death. It is now understood that death is
a process, not an event. Where in this process a dividing line is
drawn between life and death depends on factors beyond the
presence or absence of vital signs. In general, clinical death is
neither necessary nor sufficient for a determination of legal death.

If clinical death occurs unexpectedly ,it will be treated as a

medical emergency. CPR will be initiated. In a hospital, Code Blue
will be declared and Advanced Cardiac Life Support procedures used
to attempt to restart a normal heartbeat. This effort will
continue until either the heart is restarted, or a physician
determines that theheart is too damaged to be restarted. If this
determination is made, the physician will pronounce legal
death and resuscitation efforts will stop.

If clinical death is expected due to terminal illness or

withdrawal of supportive care, typically a Do Not Resuscitate
(DNR) order will be in place. This means that no resuscitation
efforts will be made, and la physician or nurse may pronounce legal
death at the onset f the clinical death.

A patient with working heart and lungs who is determined to

be brain dead, can be pronounced legally dead without clinical
death occurring.

6. Biological and Clinical death

The Philosophical investigation of human death has focused

on two overreaching questions (1). What is human death? And (
2.)How we determine that it has occurred? The first question is
ontological or conceptual. An answer to this question will consist
of a definition (or conceptualization).

Examples include death as the irreversible cessation of

organismic functioning and human death as the irreversible loss
of personhood.
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The second question is epidemiological. A complete answer to

this question will furnish both a general standard ( or criterion ) for
determining that death has occurred and specific clinical tests to
show whether the standard has been are met in a given case.
Examples of standards for human death are the traditional
cardiopulmonary standard and the whole-brain standard. Insofar as
clinical tests are primarily a medical concern,the present entry will
not address them.

7. In Vitro-fertilization

In vitro-fertilization-(IVF) is a process by which egg cells are

fertilized by sperm outside the womb ,in vitro. IVF is a major
treatment in infertility when other methods of assisted reproductive
technology have failed. The process involves hormonally controlling
the ovulatory process ,removing the ova (eggs) from the woman’s
ovaries and letting egg (zygote) is then transferred to the patient’s
uterus with the sperm fertilize them in a fluid medium. The
fertilized be intended to establish a successful pregnancy.
The first “test tube baby”, Loiuse Brown, was born in 1978.

8. STEM CELL TECHNOLOGY

The stem cell effort consists of technology development in

the U.S. aimed at the production, expansion, and differentiation of
multipotent stem cells. Revivicor’s program involves the de-
differentiation of skinfibroblast cells, thus bypassing the need for
creating and then destroying human embryos or fetal tissues. It
should be noted that this proprietary method does not provide the
ability to create an embryo,and thus is not “therapeutic cloning.”

❖ CLONING
Cloning Human Embryonic Stem Cells

Cloning is now possible by inserting a skin cell from a baby into an

unfertilized human egg that has had its own DNA removed. This
produces a blastocyte (an undifferentiated embryonic cell), which
includes stem cells identical to the baby’s. With this technique it is
possible to make genetically identical embryonic stem cells from any
cell in the human body. This would remove the need to harvest these
cells from existing embryos.

Theoretically these stems cells could be grown into a variety of

cell lines and organ tissues. The current research is aimed at
creating genetically matched tissues, as replacement body parts;
however, it is not a stretch to see the technique could also be used
to make genetically identical human beings-clones. Because of this
potential some medical ethicists say that the new technique points
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to the need for a legal ban on cloning human beings. Cardinal Sean O’
Malley of the US Council of Bishops called the research immoral.

❖ GENETIC ENGINEERING

The recombinant DNA process is the most dramatic

technological tool to date in the growing biotechnological arsenal.
The biologist is learning to manipulate, recombine and reorganize
living tissue into new forms and shapes, just as his craftsmen
ancestors did by firing inanimate matter. The speed of the
discoveries is truly phenomenal. It is estimated that biological
knowledge is currently doubling very fast , and in the field of
genetics.

We are virtually hurling ourselves into the age of

biotechnology.

Research into Recombinant DNA is indeed a marvel of modern

science, but it also brings forth some of the greatest fears of all.
Scientists are now genetically altering organisms for various purposes.
We have heard about genetically altering fruits and vegetables, but
the range of experiments is extremely varied.

The fear is that experimenters will develop organisms that

will endanger humans or other living beings. The possibilities
are the stuff of science fiction,and such fears have led to calls
for restricting this research or even banning it altogether. Such
calls have increased I recent years, and many argue for a
complete ban on genetically altered foods.

The ethical issues that arise involve whether these purposes

can be useful and there are awesome responsibilities scientist do
have to consider.

❖ GENE TESTING

Generally performed for the following reasons:

a. Conformational diagnosis for a symptomatic individual

b. Presymptomatic testing for estimating risk of developing disease
c. Presymptomatic testing for predicting disease
d. Prenatal diagnosis screening
e. Newborn screening
f. Preimplantation genetic diagnosis
g. Carrier screening
h. Forensic screening
i. Paternal testing

For example. We can test couples for sickle cell, a disease that
deforms red blood cells into thin, elongated sickle-shaped forms and
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causes anemia, cough, and muscle cramps. Sickle cell appears only
when both parents are genetic carriers of the recessive gene. If both
parents are carriers, there are 25 percent chance that the child will
have the disease.
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LESSON II: DIGNITY IN DEATH AND DYING

❖ EUTHANASIA

➢ it also called “mercy killing”. Act or practice of painlessly putting to

death persons suffering from painful and incurable disease or
incapacitating physical disorder or allowing them to die by withholding
treatment or withdrawing artificial life support measures.

➢ sometimes after injury or a long illness the main organs of the body no
longer properly without support. Medical care to prolong life can keep
you alive when these organs stopped working well. The treatments
extend your life, but do not cure you.

❖ DYSTHANASIA

➢ “bad death” and is considered a common fault of modern medicine.

Dysthanasia occurs when a person who is dying has their biological life
extended through technological means without regard to the person’s
quality of life.

❖ ORTHOTHANASIA

➢ a normal or natural manner of death and dying. Sometimes used to

denoted the deliberate stopping of artificial or heroic means of
maintaining life.

❖ SUICIDE

➢ is the act of intentionally causing one’s own death.

Mental disorders have been influenced by broad existential themes

such as religion, honor, and the meaning of life.

❖ ORTHOTHANASIA

➢ "Death with dignity"

➢ The orthothanasia term refers to taking necessary measures for a
patient state terminal has more dignified death possible. This
situation involves a technique to substantially reduce any type of pain a
person may have, whether physical or psychological.

( To explain further: https://englopedia.com/what-is-orthothanasia)

❖ DYSTHANASIA

➢ Dysthanasia from Greek, means to make death difficult, and it is

currently an ethical problem with significant consequences. Considering
that death itself has two moments, the process of death and the
moment of death, dysthanasia is the undue prolongation of the process
of death with the help of technological devices that allows the life
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sustaining procedures.

(To explain further: https://file.scirp.org/Html/91650719_71731.htm)

❖ ADMINISTRATION OF DRUGS TO THE DYING:

In medicine, specifically in end of life care, palliative sedation is

the practice of relieving distress in a terminally ill person in the last hours
or days of a dying patient’s life, usually by means of a continuous
intravenous or subcutaneous infusion of a sedative drug or by means of a
specialized catheter designed to provide comfortable and discreet
administration of on going medications via the rectal rout.

• Palliative sedation is an option of last resort for patients whose

symptoms cannot be controlled by any other means.

• It is not a form of euthanasia as the goal of palliative sedation is to

control symptoms rather than to shorten the patient’s life.

❖ ADVANCE DIRECTIVES

➢ It’s a document or a couple of documents where you make it clear

what you would like to happen with your medical care if you ever
become so sick you are not able to make those decisions for
yourself.

➢ An advance health care directive, also known as living will, personal

directive, advance directive, medical directive or advance decision.

➢ Power of attorney or health care proxy can be authorized by the

patient to make decisions on their behalf when they are
incapacitated.

➢ If end-of-life-care is given at home, a special non-hospital DNR,

signed by a doctor is needed. This ensures that if emergency medical
technicians or EMTs are called to the house, they will respect your
wishes.

➢ During end of life care, the nursing care planning revolves around
controlling pain, preventing or managing complications, maintaining
quality of life as possible and planning in place to meet patients and
family’s last wishes.
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❖ DO NOT RESUSCITATE (DNR) ORDERS

Cardiopulmonary resuscitation (CPR) and advanced cardiac life
support (ACLS) are interventions that could theoretically be offered to
all patients within the hospital. In the hospital setting, a code
would usually contain all the elements of of advanced cardiac life
support, which includes oxygenation, ventilation, cardiac massage,
electroshock as necessary, and emergency drugs. These are sometimes
announced as “code blue” or some other designation to signal the
emergency team of the need to respond.

DNR (Do not Resuscitate)

➢ A written order placed in the medical chart to avoid the use of
cardiopulmonary resuscitation efforts. In previous times, the charts
were labeled with devices such as “red tags” or “purple dots” to
designated DNR status.

1. DNR orders should be documented in the written medical

record.

2. DNR orders should specify the exact nature of the

treatments to be withheld.

3. Patients, when they are able, should participate in DNR

decisions. Their involvement and wishes should be
documented in the medical record.

4. Decisions to withhold CPR should be discussed with the

health care team.

5. DNR status should be reviewed on a regular basis.

Lesson 3: NURSING ROLES RESPONSIBLITIES

Nurses have different roles. Though the some roles are

dependent on the setting and responsibility, there are common
roles of nurses regardless. The traditional, common, and most
essential roles of nurses, with high regards to the moral and
ethical viewpoints, are:

1. Care provider: Provides direct care to patients in a

respecting, nurturing, comforting, caring, and knowledgeable
way.
2. Educator: Increases patient knowledge through information
dissemination, encouraging healthy lifestyles and practices
and compliance to care.
3. Counselor: Promotes the patient’s ability to make sound
medical decisions, assists in developing new attitudes,
feeling, and behaviors, and helps patients initiate action to
improve health care or to change decisions or activities which
 20
are against the interests or wishes of the patient (Park,
2009).
4. Change agent: Takes the necessary actions to educate and
initiate change for the well-being and the health of the
society.
5. Researcher: Takes the initiative to examine and explore on
things affecting the sensitive health care issues, thereby
promoting the health system and protecting the people’s
rights of better health.

Lesson 4: ETHICAL DECISION PROCESS

➢ Ethical decision-making refers to the process of

evaluation and choosing among alternatives in a manner
consistent with ethical.

➢ In making ethical decisions it is necessary to perceive and

eliminate un-ethical options and select the best ethical
alternative.

THINK!

Why do you think depression is a very common issue to

children and teens nowadays? What’s your opinion
regarding suicide?
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 MODULE SUMMARY

In Module II, you have learned about Sexuality and Human

Reproduction, Dignity in Death and Dying, Nursing Roles and
Responsibilities and Ethical Decision Making Process.

There are four lessons in module I. It discusses on sexuality and

its moral evaluation, marriage, issues on artificial reproduction and
morality on different problems related to destruction of life.

Lesson 2 deals with dignity in death and dying and it discusses

on administration of drugs to the dying, advance directives and DNR
(Do Not Resuscitate).

Lesson 3 and 4 deals with the nursing roles and responsibilities

and ethical decision process.

Congratulations! You have just studied Module II. now you are
ready to evaluate how much you have benefited from your reading by
answering the summative test. Good Luck!!!

 SUMMATIVE TEST

The summative examinations will be scheduled by your Instructor.

Good luck!!!