SAINT LOUIS UNIVERSITY

SCHOOL OF MEDICINE
DEPARTMENT OF OBSTETRICS & GYNECOLOGY

GROUP 1: BIOETHICAL ISSUE #1

✔ GUIDE QUESTION:
o DEFINE BIOETHICS.
o DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE
APPLY TO THE CASE

ALESTE, JANUS RAY

⮚ DEFINE BIOETHICS.
o “Bioethics” is a term with two parts, and each needs some explanation.
Here, “ethics” refers to the identification, study, and resolution or mitigation
of conflicts among competing values or goals. The ethical question is, “What
should we do, all things considered?” The “bio” puts the ethical question
into a particular context.
o Bioethics is the study of ethical, social, and legal issues that arise in
biomedicine and biomedical research. Bioethics includes medical ethics,
which focuses on issues in healthcare; research ethics, which focuses
issues in the conduct of research; environmental ethics, which focuses on
issues pertaining to the relationship between human activities and the
environment, and public health ethics, which addresses ethical issues in
public health.
⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO
THE CASE
Beneficence, nonmaleficence, autonomy, and justice constitute the 4
principles of ethics. The first 2 can be traced back to the time of Hippocrates “to
help and do no harm,” while the latter 2 evolved later.

o Beneficence: The principle of beneficence is the obligation of a physician

to act for the benefit of the patient and supports a number of moral rules to
protect and defend the right of others, prevent harm, remove conditions that
will cause harm, help persons with disabilities, and rescue persons in
danger. It is worth emphasizing that, in distinction to nonmaleficence, the
language here is one of positive requirements. The principle calls for not
just avoiding harm, but also to benefit patients and to promote their welfare.
While physicians’ beneficence conforms to moral rules, and is altruistic, it is
 also true that in many instances it can be considered a payback for the debt
to society for education (often subsidized by governments), ranks and
privileges, and to the patients themselves (learning and research).

o Nonmaleficence: Nonmaleficence is the obligation of a physician not to

harm the patient. This simply stated principle supports several moral rules
– do not kill, do not cause pain or suffering, do not incapacitate, do not cause
offense, and do not deprive others of the goods of life. The practical
application of nonmaleficence is for the physician to weigh the benefits
against burdens of all interventions and treatments, to eschew those that
are inappropriately burdensome, and to choose the best course of action
for the patient. This is particularly important and pertinent in difficult end-of-
life care decisions on withholding and withdrawing life-sustaining treatment,
medically administered nutrition and hydration, and in pain and other
symptom control. A physician’s obligation and intention to relieve the
suffering (e.g.refractory pain or dyspnea) by the use of appropriate drugs
including opioids override the foreseen but unintended harmful effects or
outcome (doctrine of double effect).

o Autonomy: The philosophical underpinning for autonomy, as interpreted

by philosophers Immanuel Kant (1724–1804) and John Stuart Mill (1806–
1873), and accepted as an ethical principle, is that all persons have intrinsic
and unconditional worth, and therefore, should have the power to make
rational decisions and moral choices, and each should be allowed to
exercise his or her capacity for self-determination [9]. This ethical principle
was affirmed in a court decision by Justice Cardozo in 1914 with the
epigrammatic dictum, “Every human being of adult years and sound mind
has a right to determine what shall be done with his own body.”

o Informed Consent: The requirements of an informed consent for a medical

or surgical procedure, or for research, are that the patient or subject (i) must
be competent to understand and decide, (ii) receives a full disclosure, (iii)
comprehends the disclosure, (iv) acts voluntarily, and (v) consents to the
proposed action.

o Truth-Telling: Truth-telling is a vital component in a physician-patient

relationship; without this component, the physician loses the trust of the
patient. An autonomous patient has not only the right to know (disclosure)
of his/her diagnosis and prognosis, but also has the option to forgo this
 disclosure. However, the physician must know which of these 2 options the
patient prefers.

o Confidentiality: Physicians are obligated not to disclose confidential

information given by a patient to another party without the patient’s
authorization. An obvious exception (with implied patient authorization) is
the sharing of medical information necessary for the care of the patient from
the primary physician to consultants and other health-care teams. In the
present-day modern hospitals with multiple points of tests and consultants,
and the use of electronic medical records, there has been an erosion of
confidentiality. However, individual physicians must exercise discipline in
not discussing patient specifics with their family members or in social
gatherings and social media. There are some noteworthy exceptions to
patient confidentiality. These include, among others, legally required
reporting of gunshot wounds and sexually transmitted diseases and
exceptional situations that may cause major harm to another (e.g.,
epidemics of infectious diseases, partner notification in HIV disease,
relative notification of certain genetic risks, etc.).

o Justice: Justice is generally interpreted as fair, equitable, and appropriate

treatment of persons. Of the several categories of justice, the one that is
most pertinent to clinical ethics is distributive justice. Distributive justice
refers to the fair, equitable, and appropriate distribution of health-care
resources determined by justified norms that structure the terms of social
cooperation. How can this be accomplished? There are different valid
principles of distributive justice. These are distribution to each person (i) an
equal share, (ii) according to need, (iii) according to effort, (iv) according to
contribution, (v) according to merit, and (vi) according to free-market
exchanges. Each principle is not exclusive, and can be, and are often
combined in application. It is easy to see the difficulty in choosing,
balancing, and refining these principles.

APPLICABLE BIOETHICAL PRINCIPLE

1. Beneficence: The notion demands for not merely avoiding injury, but also
to benefit patients and to enhance their welfare, even though the surgery
need not be started. By doing this, the patient's risk of acquiring breast
cancer is reduced.
2. Autonomy: As a doctor, we must respect or acknowledge the patient's
decision in this case because the patient is aware of her risk of developing
the condition at this point. In this case, this may be applied to the statement
 that "Every human being of adult years and sound mind has a right to
determine what shall be done with his own body."

CAMANGA, JECK
⮚ DEFINE BIOETHICS.
● Bioethics is the interdisciplinary study of ethical issues arising in the life
sciences, health care, and health and science policy.
⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO
THE CASE

Bioethical Principle Definition

Autonomy Any notion of moral decision-making assumes that rational

agents are involved in making informed and voluntary
decisions. In health care decisions, our respect for the
autonomy of the patient would, in common parlance, imply
that the patient has the capacity to act intentionally, with
understanding, and without controlling influences that
would mitigate against a free and voluntary act. This
principle is the basis for the practice of "informed consent"
in the physician/patient transaction regarding health care.

As defined by the above definition, she has total control of

what she does to her body. However, the practice of this
principle in her case contradicts the principle of totality.

Nonmaleficence The principle of nonmaleficence requires us that we not

intentionally create harm or injury to the patient, either
through acts of commission or omission. In common
language, we consider it negligent if one imposes a
careless or unreasonable risk of harm upon another.

Beneficence The ordinary meaning of this principle is that health care

providers have a duty to be of benefit to the patient, as well
as to take positive steps to prevent and to remove harm
from the patient. These duties are viewed as rational and
self-evident and are widely accepted as the proper goals
of medicine. Â This principle is at the very heart of health
care implying that a suffering supplicant (the patient) can
enter into a relationship with one whom society has
licensed as competent to provide medical care, trusting
that the physician’s chief objective is to help. The goal of
providing benefit can be applied both to individual patients,
 and to the good of society as a whole. For example, the
good health of a particular patient is an appropriate goal of
medicine, and the prevention of disease through research
and the employment of vaccines is the same goal
expanded to the population at large.

Justice Justice in health care is usually defined as a form of

fairness, or as Aristotle once said, "giving to each that
which is his due." This implies the fair distribution of goods
in society and requires that we look at the role of
entitlement. The question of distributive justice also seems
to hinge on the fact that some goods and services are in
short supply, there is not enough to go around, thus some
fair means of allocating scarce resources must be
determined

Totality "The parts of the physical entity, as parts, are ordained to

the good of the physical whole." From the medical
perspective, the principle of totality would mean that "all the
parts of the human body, as parts, are meant to exist and
function for the good of the whole body, and are thus
naturally subordinated to the good of the whole body."The
term "totality" points to the duty to preserve intact the
physical component of that integrated whole. In the
following sections we will discuss the philosophical and
theological foundations, different views, and the scope of
the principle of totality.

This principle is applicable in the case of our patient who

opts for mastectomy and oophorectomy. When she
undergoes oophorectomy, how would her basic function of
procreation be possible?

CARLOS, FELIX DANIEL

⮚ DEFINE BIOETHICS.
o Bioethics deals with the genuine problems in the medical field, and non-
medical field. It answers questions with the guidance of philosophy,
sociology, law, and religion. The aim of bioethics is to guide professionals
in dealing with everyday choices, and decisions. In the medical field the
important principles include beneficence, which means doing what is right
for the patient. Non-maleficence, doing no harm to the patient. Autonomy,
or the right of the patient to decide for themself, and etc.
⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO
THE CASE
o The principles of ethics include:
▪ Autonomy: control that you exercise when making individual
decisions, especially regarding your well-being. In health care,
autonomy is the right or freedom of the patient to maintain control of
their body before and after treatment.
▪ Beneficence: is the act of showing kindness or mercy. The actions
of any health care provider should always bring positivity.
▪ Non-maleficence: means that you as a health care professional
must do no harm. According to the ANA code of ethics, all health
care workers should carefully evaluate each situation before making
decisions.
▪ Justice: states that there should be fairness in all medical decisions.
For instance, patients deserve advanced health care delivery
regardless of their situation. There have been numerous cases
where patients fail to get the necessary treatment due to economic
status, ethnicity, sexual orientation.
o The principles of Autonomy can be applied because we need to honor the
decision of the patient while also providing her the risks, benefits, and
repercussions of doing the procedure. Non-maleficence can also be
considered because the procedure is prophylactic and not yet indicated,
doing the procedure will remove the patient the ability of child bearing and
it can be considered mutilation.

DELA CRUZ, JOHN ROBERT

○ DEFINE BIOETHICS.
■ Bioethics is commonly understood to pertain to the ethical implications and
applications of health-related life sciences. Basically, it deals with ethical
evaluation that includes the morality of all actions that might help, benefit
and or harm human beings, even any organism capable of fear.

○ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO

THE CASE
● The Four Principles of Ethics constitute beneficence, non-maleficence,
autonomy and justice. These principles have been extremely influential in the field
of medical ethics and are fundamental for understanding the current and timely
approach to ethical assessment in health care.
 ■ Principle of Autonomy - ‘Self rule’ or ‘Self Determination’; pertains to an
individual’s exercise of the capacity to form, revise and or pursue personal
plans for life. In this case, the patient has the power to make rational
decisions and moral choices, and she is allowed to exercise her own
capacity for self-determination and or decision.
■ Principle of Beneficence - ‘To do good’ or ‘To provide benefit’. It simply
means choosing actions that would bring the most benefit and the least
burden. The principle calls for not just avoiding harm to benefit the patient
in this case, but to also promote her welfare.
■ Principle of Nonmaleficence - means ‘Do no Harm’, This simply stated
principle supports several moral rules- do not kill, do not cause pain or
suffering, do not incapacitate and do not cause offense. In this case,
nonmaleficence is the obligation of the physician not to harm the patient,
the practical application of the principle is to weigh the benefits against
burdens of all interventions and treatments and to suggest the best course
of action for the patient.
■ Principle of Justice - simply means giving everyone his due. Distributive
justice refers to fair, equitable and appropriate distribution of health care
resources and their rightful claim to health care and services. In this case,
the patient is entitled to a fair and justified treatment, as well as her claim to
such service or health care procedure, considering it has been prudently
decided.
■ Principle of Totality - it declares that parts are integral, and destined to be
part of a whole being; each part exists for the whole and consequently, the
good of part remains subordinate to the good of the whole life. Its
application, the patient may not dispose of her organs or destroy their
capacity to function except to the extent this is essential and extremely
necessary for the general well-being of the whole body.

FABREAG, JEREMIAH
⮚ DEFINE BIOETHICS.

The field of bioethics deals with moral questions that come up in the context of
healthcare, such as those concerning life and death, healing, and comfort. Bioethics
seeks to understand and understand how decisions regarding health care are made by
applying the ethical principles into the practice of medicine. It is necessary to ensure that
medical procedures and practices are beneficial to the society as a whole.

⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO

THE CASE
 o Autonomy: refers to every individual’s right of self-determination,
independence and freedom to make his or her own choices.
o Beneficence: “to do good”, Protecting them from harm and to secure their
well-being. Demands that health care providers develop and maintain skills
and knowledge, continually update training, consider individual
circumstances of all patients, and strive for net benefit.
o Non-maleficence: non-maleficence is the principle of refraining from
causing intentional harm toward another human being.
o Justice: the idea that the burdens and benefits of new or experimental
treatments must be distributed equally among all groups in society. The
health care provider must consider four main areas when evaluating justice:
fair distribution of scarce resources, competing needs, rights and
obligations, and potential conflicts with established legislation.

In this case, the patient with a sound mind has the right to undergo bilateral
mastectomy and bilateral oophorectomy given that she has a strong personal and family
history of breast cancer. Principle of beneficence can also be applied to this case since
prophylactic mastectomy and oophorectomy will lower the chances of breast cancer and
is beneficial to the patient.

ABDUL KARIM, SORAYA MHAE

⮚ DEFINE BIOETHICS.
o It is a normative study on ethical and moral issues based on the standards
of the society which will guide one's behavior.
⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO
THE CASE
o The basic principles of ethics:
▪ Beneficence: beneficence means to do good. In explaining how
physiotherapists respond to human maladies (e.g. suffering,
disease, injury, and disability), caring can be defined as a principle
of beneficence i.e a moral requirement to promote well-being, which
in term implies, and is limited by, respect for autonomy and
professional standards of due care for patients.
▪ Non-maleficence: non-maleficence means to do no harm, or to
inflict the least harm possible in order to reach a beneficial outcome.
The principle of non-maleficence requires that we not intentionally
create harm or injury to the patient, either through acts of commission
or omission.
▪ Respect for patient autonomy: respect for autonomy concerns a
belief that patients who are competent, should be able to make
 informed choices about their lives and bodies. Respect for autonomy
can be manifested in several ways, but the two sections below
highlight some common ones.
▪ Informed consent: a successful relationship between patient and
health care practitioner is based on trust, which is developed partly
by respecting the autonomy of the patient i.e. their right to make their
own decisions about their bodies. Informed consent is the exercise
of informed choice by a patient who has the capacity to give consent
and is therefore a component of developing a trusting relationship
between patient and therapist. Patients need complete and honest
information about various aspects of their health care.
▪ Refusing therapy: in general competent adults or their legal or
designated surrogates have the autonomy to refuse any form of
therapy that is undesirable, for whatever reason they deem
appropriate. There are many reasons for why patients may refuse
treatment, including:
● Discomfort: this factor indicates the pain and fatigue
associated with exercise.
● Barriers: the second factor indicates the barriers and
problems; the patients perceive in exercising. Specifically,
time constraints, time management (clashing of scheduled
appointments and exercising).
● Helplessness: The third factor is indicative of a low sense of
self confidence within their exercise regimen. In conclusion
patients were extremely de-motivated.
● Dependence: The patients’ dependence on the therapist is
expressed in the final factor, specifically regarding recovery
and others believed their aches and pains would disappear
without exercise, hence they were not compliant.
● Traditional barriers of adherence to therapy include the
complexity of the regimen and failure on the patient’s part to
understand the importance of adherence, which may in turn
stem from poor communication by the health care provider.
▪ Justice: the principle of justice is typically expressed as a need to
treat patients fairly, not violating what they are entitled to, and
supporting fair procedures and background institutions in health care
(Gabard & Martin, 2011)

Based on the case, the principles that we can apply here are the non-maleficence,
informed consent and autonomy. The action itself is not intrinsically wrong because the
patient intends only the good effect for her which is to avoid having breast cancer.
However, she must know all the risks, prognosis, treatment options, likely treatment
outcomes, common or serious side effects, and the timescale of the treatment in order
for her to give her informed consent.

BARBA, JHERONIQUE FEI

⮚ DEFINE BIOETHICS.
o Bioethics is a field that explores ethical issues and analyzes advances in
healthcare-related sciences. It promotes a set of principles to serve as
guidance for the interactions between human issues and other disciplines.
⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO
THE CASE
o The four commonly accepted principles of bioethics are:
▪ Principle for respect of autonomy
● Any notion of moral decision-making assumes that rational
agents are involved in making informed and voluntary
decisions. In healthcare decisions, respect for autonomy of
the patient would imply that the patient has the capacity to act
intentionally, with understanding and without controlling
influences that would mitigate against a free and voluntary
act.
▪ Principle nonmaleficence
● Requires no creation of intentional harm or injury to the patient
either through acts of commission or omission. Negligence is
considered if one imposes a careless or unreasonable risk of
harm upon another.
▪ Principle of beneficence
● To have a duty to be of benefit to the patient as well as to take
positive steps to prevent and to remove harm from the patient.
These duties are viewed as rational and self-evident and are
widely accepted as the proper goals of medicine.
▪ Principle of justice
● Justice in health care is usually defined as a form of fairness,
or as Aristotle once said, "giving to each that which is his due."
This implies the fair distribution of goods in society and
requires that we look at the role of entitlement.
In analyzing the above case, a physician has a prima facie duty to respect the
autonomous choice of the patient, as well as a prima facie duty to avoid harm and to
provide a medical benefit. For the principle of double effect in which a single action may
have two effects, one that is considered a good effect, the other a bad effect. How does
our duty to the principle of nonmaleficence direct us in such cases? There are four
conditions that usually apply to the principle of double effect:
1. The nature of the act. The action itself must not be intrinsically wrong; it must be a
good or at least morally neutral act.
2. The agent’s intention. The agent intends only the good effect, not the bad effect,
even though it is foreseen.
3. The distinction between means and effects. The bad effect must not be the means
of the good effect,
4. Proportionality between the good effect and the bad effect. The good effect must
outweigh the evil that is permitted, in other words, the bad effect.
These criteria can be applied in the above case and that the principle of double effect
applies and the four conditions are not violated by the prescribed treatment plan

CANAMA, IRENE
⮚ DEFINE BIOETHICS.
● Bioethics is derived from the Greek word bios meaning life and ethike
meaning ethics which is a traditional word for the systematic study of right
conduct. This is a branch of applied ethics that focuses on ethical, social,
and legal issues that arise in biomedicine and biomedical research. It is
mainly concerned with human life and well-being, as well as the nonhuman
biological environment.

⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO

THE CASE
The four basic principles of bioethics
● Principle of Autonomy
➢ Emphasizes the right of the patient to make voluntary healthcare decisions
without coercion or controlling influences. It implies that each person has
an intrinsic and unconditional worth which gives them the power to make
rational decisions and moral choices.
● Principle of Beneficence
➢ Refers to the obligation of a physician to act with the intent of doing good
for the patient. It demands continuous enhancement of skills and knowledge
to be able to provide the best health care for the patient.
 ➢ This principle calls for not just avoiding harm, but also to benefit patients
and to promote their welfare.
● Principle of Non-maleficence
➢ Refers to the obligation of a physician not to harm the patient. It supports
moral rules such as do not kill, do not cause pain or suffering, do not
incapacitate, do not cause offense, and do not deprive others of the goods
of life
➢ In practice, the physician must be able to weigh the benefits against
burdens of all interventions and treatments, to avoid those that will not
benefit the patient, and to choose the best course of action for the patient
● Principle of Justice
➢ Refers to fair, equitable, and appropriate treatment
➢ Distributive justice is the most pertinent of all categories of justice. It refers
to the fair, equitable, and appropriate distribution of health care resources
determined by justified norms that structure the terms of social cooperation

Another important principle in bioethics is the principle of double effect

● Principle of Double effect
➢ An act is foreseen to have good and bad effects
➢ Explains the permissibility of an action that causes a serious harm as a side
effect of promoting some good end

The principle of autonomy is applicable in this case. As mentioned above, this

principle focuses on the right of the patient to make healthcare decisions without any
coercion. The primary role of the physician in this case is to inform the patient of the
possible risks and benefits associated with these procedures. After a thorough
explanation, the final decision should still come from the patient. If she decides to undergo
these procedures, then we should honor and respect this.
If we consider the factor that the patient is still in her reproductive age, we can also
apply the principle of double effect. The good result is that both bilateral mastectomy
and bilateral oophorectomy will significantly decrease the cancer risk of the patient,
however bilateral oophorectomy will remove the chance of the patient for child bearing
and this can be considered as an unfavorable outcome of the procedure. Applying the
principle of double effect, the action is permissive as the good result outweighs the risk
or bad result.
 CANDOG, RHEA JANE
⮚ DEFINE BIOETHICS.
o Bioethics is a multidisciplinary field of learning that studies and responds to
different moral and ethical questions involving the study and professional
practice of medicine and biological sciences by drawing learnings from
many established academic disciplines, such as philosophy, jurisprudence,
sociology, and others.

Moral and ethical questions in bioethics also involve issues from various
fields such as life sciences, biotechnology, public health, medicine, public
policy, law, philosophy and theology. They often arise in clinical, research,
and political fields as a result of advances in biology, health care, and
technology, particularly biotechnology.

⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO

THE CASE

MAJOR PRINCIPLES
The major four principles that are generally accepted in bioethics are the
principles of respect for autonomy, non-maleficence, beneficence and justice.
Respect for autonomy refers to the notion that a moral decision is made
through the informed and voluntary decision of the rational agents. Patients should
be able to make educated healthcare decisions, without excessive outside
influence or compulsion. This is the rationale for the practice of “informed consent”
in every physician-patient contract in health care.
Nonmaleficence refers to the principle of intentionally not creating or doing
any harm/ injury to a patient, either through acts of commission or omission.
Therefore, medical procedures should never unnecessarily harm patients, and
there should always be a benefit to offset any harm done.
The common understanding of the principle of beneficence is that medical
interventions should always be in the patients' benefit and best interest. This
principle is at the very core of healthcare, and this obligation is universally
acknowledged as the major objectives of medicine and are seen as self-evident
and logical.
Justice in health care is typically defined as a form of fairness. It states that
patients should not be subjected to unethical discrimination and should have
equitable access to medical care.

OTHER PRINCIPLES
 Principle of totality is a doctrine partially developed by St. Thomas
Aquinas, who combined Catholic theology with Aristotelian philosophy. He
advocated the idea that a person's every part exists for the benefit of that person
as a whole.
Principle of double effect states that it is morally acceptable to take a
course of action that will have both positive and negative effects to a patient, as
long as all of the following criteria are satisfied:
1. The action itself is good or at least neutral;
2. The good effect, not the bad effect, is what is intended;
3. The good effect is not produced by the bad effect;
4. There is a proportionately grave reason for permitting the bad effect.

APPLICABLE BIOETHICAL PRINCIPLES

The bioethical principles that are applicable for this page includes the
following:
1. Respect for autonomy - in this case, since the patient already knows the
risks of developing cancer in the future, she is willingly offering her
informed consent for the procedures.
2. Nonmaleficence - although the 2 operations being requested by the
patient may bring unnecessary harm at this point, they also have a good
benefit for the patient by removing her risks of developing breast and
ovarian cancers.
3. Beneficence - although the operations requested by the patient may be
deemed “unnecessary” at this point, on the other hand, it will also greatly
benefit the patient by removing her risks of developing breast and
ovarian cancers in the future.
4. Double effect - the procedures requested by the patient bring both good
and bad effects on the patient. Although the procedures may result to
sexual sterility, removing her breast and ovaries can help by remove her
risks of developing breast and ovarian cancers in the future. In this case,
we can say that the benefit outweighs the harms of the procedures.

DACIO, SALVACION PAULA

⮚ DEFINE BIOETHICS.
o Bioethics is the ethical implications and applications of the health-related
life sciences. It is the study of ethical, social, and legal issues that arise in
biomedicine and biomedical research. It provides a guideline to medical
professionals about clinical decision-making, advancements in medical
technologies, and also important in policy changes and legislation.
 ⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO
THE CASE
o The four basic principles of health care ethics that should be considered in
practice are the following:
▪ Principle of Autonomy
● Autonomy of thought, intention, and action when making
decisions regarding health care procedures
● Decision-making process must be free of coercion or coaxing
● For the patient to have a fully informed decision, she/he must
understand all risks and benefits of the procedure and the
likelihood of success.
▪ Principle of Justice
● Requires that procedures uphold the spirit of existing laws and
are fair to all players involved.
● The health care provider must consider four main areas when
evaluating justice:
o fair distribution of scarce resources
o competing needs
o rights and obligations
o potential conflicts with established legislation
▪ Principle of Beneficence
● Intent of doing good for the patient involved.
● Health care providers develop and maintain skills and
knowledge, continually update training, consider individual
circumstances of all patients, and strive for net benefit.
▪ Principle of Non-maleficence
● Does not harm the patient involved or others in society.
● An obligation not to inflict harm on others.
● Closely associated with the maxim primum non nocere (first
do no harm).

Based from these four principles, the principles of autonomy and beneficence is
applicable for the case. In addition, other bioethical principles such as the principle of
totality and principle of double effect can be applied.

Principle of autonomy can be applied in this case since patients have the right to
decide regarding the health care procedures to be done to them. However, the patient
must be able to understand all the risks and benefits of the procedure and the likelihood
of success. A healthcare worker has a vital role in providing this information to the patient
in order for the patient to have fully informed decision before the procedure is done to
them. While in the principle of beneficence, it is ethical to respect the decisions of the
patient, however, one must make sure that the decision of the patient will be beneficial
for them.

Principle of totality states that all decisions in medical ethics must prioritize the
good of the entire person, including physical, psychological and spiritual factors. This is
applicable in the case since the procedures that the patient requested can change her life
and may affect her reproductive life. We must inform the patient on the possible outcomes
of the procedure and how it can change her life.

Principle of double effect states that sometimes it is permissible to cause a harm

as a side effect of bringing about a good result even though it would not be permissible
to cause such a harm as a means to bringing about the same good end. This is applicable
in the case since there is harm that can be done to the patient. However, if the procedures
will benefit the patient more than harm the patient, the procedures should be done to save
the patient or for the patient to have a better quality of life.

FERMIN, JUDY ANN

⮚ DEFINE BIOETHICS.
o Bioethics came from the 2 greek word “bios” which means Life and
“ethike” which means ethics. Basically, bioethics is a division of ethics
that relates to human life. It can be defined roughly as the study of ethical
issues and values of medicine, Biology and biological sciences and it is an
interdisciplinary study and response of problems created by biological and
medical progress.

⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO

THE CASE
o 4 fundamental principles of ethics
▪ Principle of inviolability of life: life is sacred and to be affirmed,
respected, and defended not to be violated or destroyed. However,
this principle recognizes that death is inevitable
▪ Principle of beneficence and non-maleficence
● Beneficence means to do good and provide benefit.
Beneficent act are acts choosing to bring most benefit and
least burden
● Non-maleficence means to do no harm whether by physical,
mental psychological, social, financial or spiritual.
▪ Principle of Justice
 ● Equitable distribution of benefits and burdens to individuals in
social institutions, and how the rights of various individuals are
realized. Since health is a right, justice can be served by
respecting that rightful claim to health care
▪ Principle of Autonomy
● This principle provides the intrinsic value of self-determination
or worth where decision making is free from external influence

Other bioethical principle from a religious perspective:

o Principle of Totality- which states that all decisions in medical ethics must
prioritize the good of the entire person, including physical, psychological and
spiritual factors.
o Principle of double effect- applies when an act is foreseen to have good and bad
effect

The principles of Autonomy, totality and double effect will apply to this case. For the
principle of autonomy, the patient exercised her right to decide for herself to ask for
bilateral mastectomy and bilateral oophorectomy because of her strong personal and
family history of breast cancer. While the principle of totality applies to this in order to fulfill
the need to preserve life, the patient decided to let her breast and both ovaries be
removed in order to spare her from getting the cancer that she is at risk for. For the
principle of double effect, the consequences of the decision of the patient have foreseen
good and bad effects. The good effect is that she can preserve her body to acquire the
disease but the bad effect will be she can no longer reproduce since both reproductive
organs (ovaries) which are capable of producing eggs will no longer be present.

JAMERO, ALYSSA JEWEL

⮚ DEFINE BIOETHICS.
o Bioethics is a division of ethics that relates to human life. This is the ethics
of life sciences and healthcare, both delivery and research. Bioethics can
be defined roughly as the study of ethical issues and values in Medicine,
Biology and the biological sciences. It can be defined also as the
interdisciplinary study of the problems created by biological and medical
progress.

⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO

THE CASE
Principles of Ethics
 1) Principle of respect for autonomy
➢ Requires that while making decisions about receiving medical
treatment, the patient have autonomy of thought, intention, and
action. Therefore, there cannot be any coercion or persuasion during
the decision-making process.
➢ A patient must be properly informed about the procedure's risks,
advantages, and chances of success in order to make an informed
choice. It is challenging to assume that patients are making decisions
with full knowledge of the risks and benefits because ARTs are very
technical and may involve strong emotions.
2) Principle of nonmaleficence
➢ Demands that a technique not be harmful to the patient or to other
members of society.
➢ Specialists under the premise that by pursuing the greater good, they
are causing no harm or at the very least minimizing harm.
➢ However, the patient's emotional condition could suffer as a result
of assistive technologies' low success rates and unknown overall
results. It might be challenging for doctors to successfully implement
the do no harm rule in particular circumstances.
3) Principle of beneficence
➢ Demands that the procedure be performed with the intention of
benefiting the patient. requires that healthcare professionals acquire
new skills and information, keep their training current, take into
account the unique circumstances of each patient, and work toward
greater benefit.
4) Principle of justice
➢ The notion that new or experimental treatments must fairly divide
the costs and benefits to all groups in society.
➢ Procedures must be fair to all parties concerned and adhere to the
letter of the law.
➢ When assessing justice, the healthcare practitioner must take four
primary factors into account: the equitable distribution of limited
resources, competing needs, rights and obligations, and any
inconsistencies with existing law. Because not everyone has equal
access to treatment, reproductive technologies raise ethical
concerns.

The first principle applicable to this case would be the principle of

respect for autonomy. Here, we believe that the patient is knowledgeable of
her situation and the procedure she wants to undergo. This would also
 mean having the capacity to act intentionally, with understanding, and
without controlling influences that would mitigate against a free and
voluntary act which is the meaning of this principle.

The patient's risk of developing breast cancer and the mortality that
comes with it will both be significantly decreased by the procedures she
wants to have done. This is the principle of beneficence. The principle states
the health care providers have a duty to be of benefit to the patient, as well
as to take positive steps to prevent and to remove harm from the patient.
These are universally acknowledged as appropriate medical goals and are
seen as self-evident and logical. The surgery spares the patient from
developing breast cancer, suffering from pain, dealing with the physical and
mental impacts of having cancer, undergoing chemotherapy, and dealing
with other cancer-related treatments and their adverse effects. It has all the
benefits of undergoing such procedures.

In this situation, the nonmaleficence principle may also be

applicable. Both bilateral oophorectomy and bilateral mastectomy are not
inherently bad decisions. The advantages of these procedures outweigh the
risks and the favorable consequences outweigh the unfavorable ones. The
goal is also honorable. The rule calls for us to avoid purposefully injuring or
harming the patient, whether via deeds of commission or omission.

LESTINO, JAZELLE VIA

⮚ DEFINE BIOETHICS
o Bioethics is a multi-disciplinary study of, and response of the moral and
ethical questions. It includes medical ethics, which focuses on issues in
healthcare; research ethics, which focuses issues in the conduct of
research; environmental ethics, which focuses on issues pertaining to the
relationship between human activities and the environment, and public
health ethics, which addresses ethical issues in public health.

⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO

THE CASE

The 4 main ethical principles are beneficence, nonmaleficence, autonomy, and justice:
o Autonomy is any notion of moral decision-making assumes that rational agents
are involved in making informed and voluntary decisions.
 o Principle of nonmaleficence requires of us that we not intentionally create a
harm or injury to the patient, either through acts of commission or omission.
o Beneficence means that health care providers have a duty to be of a benefit to
the patient, as well as to take positive steps to prevent and to remove harm from
the patient. These duties are viewed as rational and self-evident and are widely
accepted as the proper goals of medicine.
o Justice in health care is usually defined as a form of fairness, or as Aristotle once
said, "giving to each that which is his due." This implies the fair distribution of
goods in society and requires that we look at the role of entitlement.

Other principles that may apply in this case:

o Principle of Double Effect aims to provide specific guidelines for determining
when it is morally permissible to perform an action in pursuit of a good end in full
knowledge that the action will also bring about bad results.

LIZADA, JOHN BERNADETTE

⮚ DEFINE BIOETHICS
o Bioethics is an interdisciplinary field of study that deals with practical ethical
issues that fall somewhere between morality, medicine, and the life
sciences.
⮚ DISCUSS THE PRINCIPLES OF ETHICS, AND WHICH OF THESE APPLY TO
THE CASE
o PRINCIPLE OF AUTONOMY
▪ This is the individual’s exercise of the capacity to form, revise, and
pursue personal plans for life.
▪ The patient is aware of her family history of breast cancer and
requests surgical procedures to minimize the risk of acquiring the
said malignancy.
o PRINCIPLE OF NON-MALEFICENCE
▪ The principle of nonmaleficence holds that there is an obligation not
to inflict harm on others. It is closely associated with the maxim
primum non nocere (first do no harm).
o PRINCIPLE OF TOTALITY
▪ 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.
▪ As much as the patient wants to be spared from breast cancer based
on her family history, it is unethical to perform bilateral mastectomy
and bilateral oophorectomy without an urgent need or a sufficient
medical basis to carry these procedures out.