Privacy & Confidentiality, Equality, Justice and Equity

Dr. Ma. Lorena Lorenzo

ARTICLE 7 : Privacy and Confidentiality DUTY OF HEALTH CARE PROVIDERS TO

MAINTAIN CONFIDENTIALITY
PRIVACY CONFIDENTIALITY The duty of maintaining confidentiality (also known as
o Privacy is the right of an o Confidentiality is an ‘professional secrecy’) has been part of Western medical ethics
individual or a group to attribute of personal since Hippocrates (5th century B.C.E.).The Hippocratic Oath
be free from intrusion information requiring states, ‘Whatever I see or hear, professionally or privately,
from others, and that it not be disclosed which ought not to be divulged, I will keep secret and tell no
includes the right to to others without one’. Ethics courses in non-Western countries should discuss
determine which sufficient reason. the source of medical confidentiality in their cultures.
information about them o Confidentiality is about
should be disclosed to information. CONFIDENTIALITY EXTENDS TO ALL
others o Protects the information PERSONAL HEALTH INFORMATION,
o Privacy talks about a from the range of INCLUDING GENETIC DATA.
person. unauthorized persons. UNESCO International Declaration on Human Genetic Data: ‘….all
o Restricts the public medical data including genetic data and proteomic data,
from accessing the regardless of their apparent information content, should be
personal details about a treated with the same high standards of confidentiality’.
person.
JUSTIFIED BREACHES OF CONFIDENTIALITY:
REASONS FOR RESPECTING PRIVACY AND Sharing o Sharing information for patient care
CONFIDENTIALITY o In the hospital setting, many individuals
o Individuals ‘own’ their information: it is essential to need access to the patient's chart in order
their personal integrity, to provide care; however, each of these
o For many people privacy is an essential aspect of individuals is bound to maintain
their dignity; invading their privacy against their will confidentiality to the greatest extent
is a violation of their dignity. possible; outside the hospital setting,
o Respect for others requires protecting their privacy family members may need patient
and the confidentiality of information about them. information in order to provide care
o Patients are less likely to trust health care providers and/or to protect themselves.
and confide in them if they think that the health care * Taking a picture of a patient’s chart is a violation
providers will not keep the information confidential. of privacy.
This can have serious consequences for the patients’ Using o Using interpreters
health and well-being and sometimes for the health o Where the health care provider does not
of others (e.g family members) speak the patient's language, an
interpreter will be needed who will then
DUTY OF HEALTH CARE PROVIDERS TO have access to information about the
PROTECT THE PRIVACY OF PATIENTS patient; interpreters should be bound to
o Health care providers have an ethical obligation to observe confidentiality.
protect patient privacy to the greatest extent possible Teaching o Observation and discussion of patients is
in the circumstances. medical a necessary part of medical education;
o For example, they should interview patients where students students should be informed of their
they cannot be overheard; they should ask the obligation to maintain confidentiality.
patient’s permission to examine him or her Mandatory o Health care providers should be familiar
unclothed; and they should ensure that an unclothed reporting with the laws about mandatory reporting
patient cannot be viewed by passers-by. of infectious diseases, suspected child
abuse and other conditions in the
country where they practice; normally
patients should be informed that their
information has to be reported to the
appropriate authorities.

Dr.
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 Serious For example, in exceptional circumstances
danger to and generally as a last resort, health care
others providers may need to inform other
persons that the patient has threatened to
harm them; whether by violence or by
sexual contact when the patient has a
transmissible disease such as HIV.
Genetic There is controversy regarding whether
Information other individuals with the same genetic
makeup (usually close family members)
have a right to a patients genetic
information. Physicians should consult their
national regulations or guidelines when
faced with this situation.
With This should generally be obtained for all
patient or breaches of confidentiality and renders the
guardian breach acceptable ethically.
consent
*Patient’s chart/data should be kept on a cabinet to avoid exposure from
other people.
*Patients are to be called as Patient A, B or C / initials
Special circumstances of Research
o Disclosure of personal health information obtained
in the course of a research study requires the prior
consent of the research subject.
o There is a great controversy regarding whether
anonymized patient information requires consent for
disclosure; researchers should consult their national
regulations or guidelines if such exist.
o Otherwise international guidelines such as the
declaration of Helsinki.
o In research, communities as well as individuals have a
right to privacy, and information about them should
be kept confidential especially when its disclosure
may be harmful to the community
o Scientific publication should respect confidentiality
to the greatest extent possible. Consent is always
required when an individual research subject can be
identified in a publication.
ARTICLE 10 : Equality, Justice & Equity
Different types of Justice
Distributive Ensuring that each person receives a fair
share of public resources); this is the most
important type for health care
Ex: ayuda due to pandemic or health care
service – whether you are rich or poor
Procedural Ensuring a fair process for making
decisions and settling disputes
Retributive Ensures punishment of wrongdoers
Social Combination of the previous types as
applied to a society in which individuals
and groups receive fair treatment and an
equitable share of the benefits of society .
Dr.
Different concepts of Distributive Justice
Authoritarian what the highest authority decrees is just
Libertarian what an individual decides to do with his
or her own property is just
Utilitarian what most contributes to the greatest
good of the greatest number is just
Egalitarian justice is achieved when everybody has
equal access to the societal resources that
they need
Restorative or justice requires favoring previously
transformative disadvantaged individuals or groups
Different concepts of Justice reflected in different
healthcare systems around the world
o The Libertarian one is strong in the U.S.A.
o The Egalitarian one is predominant in many
European countries where the value of social
solidarity is recognized.
o South Africa is attempting to implement a restorative
approach.
o Most economists lean towards the Utilitarian
approach. Which predominates in your country?
Approaches to Justice
A. Utilitarian
o What is due is determined by utility consequences:
the greatest good (happiness, satisfaction) for the
greatest number regardless of the value for the
particular person involved.
o “…an action is right if it tends to promote happiness
and wrong if it tends to produce the reverse of
happiness - not just the happiness of the performer
of the action but also that of everyone affected by it.”
(Britannica encyclopedia)
Ex: A tram is running down a track and is out control. If it
continues on its course unchecked and undiverted, it will run
over five people who have been tied to the tracks. You have
the chance to divert it onto another track simply by pulling a
lever. If you do this, though, the tram will kill a man who
happens to be standing on this other track. What should you
do? (thoughco.com)
Answer: Utilitarian duty is to promote the greatest happiness
of the greatest number. Five lives saved is better than one life
saved. Therefore, the right thing to do is to pull the lever.
Ex: Making yourself happy is utilitarian - Choosing an ice
cream flavor that makes you happy.
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 B. Egalitarian Ex: Celebrating the achievements of all organizational
o What is due is what is fair members, rather than just senior people or top achievers.
o Equal distribution of benefits and burdens, equal Offering employees progressive benefits (partner benefits,
opportunity. paid leave for men and women, etc.) rather than just the
o An egalitarian favors equality of some sort; People bare minimum because you can. Choosing to keep all
should get the same, or be treated the same, or be employees on the payroll during hard times or a crisis.
treated as equals, in some respect (Stanford
Encyclopedia of Philosophy, 2013). E. Equity
Equity Equality
Ex: Ayuda / Goods being distributed in the whole community o What is due depends on o Together with justice and
during pandemic regardless of social status or financial what has been equity, it has become a
income. given/received. fundamental principle. As
o It is " paying back." human beings, we are not
C. Libertarian o Equity is very limited: if physically, mentally,
o For as long as there is no restraints on individual nothing is given first then psychologically or genetically
liberty, justice is served. nothing will be given return. equal, nor are we equal in our
o “...a collection of political philosophies and o Has been considered a values or principles.
movements that uphold liberty as a core principle. concept even more o But, it is generally accepted
Libertarians seek to maximize political freedom and important than justice. and fully desirable that we be
autonomy, emphasizing freedom of choice, voluntary o Aristotle described it as considered equals in terms of
association, individual judgment, and self- follows: dignity, justice, rights,
ownership.” § What is just, then, and opportunities, freedom,
o Is the view that each person has the right to live what is equitable are benefits, and obligations.
his life in any way he chooses so long as he generally the same, and o Justice and Equity are only
respects the equal rights of others. both are good, though possible if all human beings
o Libertarians defend each person's right to life, liberty, what is equitable is better. are treated equally in their
and property—rights that people possess naturally, § According to Rawls, dignity and rights. (Article 10,
before governments are created. In the libertarian equity is a fundamental Universal Declaration on
view, all human relationships should be voluntary; requirement in terms of Bioethics and Human Rights)
the only actions that should be forbidden by law justice. Equity is justice. o Treated the same way
are those that involve the initiation of force § It exists when all regardless of socioeconomic
against those who have themselves used force— participants freely define status
actions like murder, rape, robbery, kidnapping, and and accept the rules,
fraud. David Boaz, Executive Vice President, Cato Institute ( The Advocates, benefits and charges.
2017)
o Refers to fairness, justice o Refers to equal sharing and
and impartiality division, keeping everyone at
Ex: You have a choice whether you want to be vaccinated with o Give more to those who the same level
the COVID-19 vaccine or not. It is not mandatory. BUT, if it need it the most, and less to
is mandated (e.g. needed for clerkship), it is not Libertarian. those who have resources
anyway
D. Communitarian o Equity = Fairness and o Equality = sameness
o What is valued by the community determines what is justice
just. It emphasizes social meaning, community
membership, shared values, individual responsibility o Equity is need based o Equality is not affected by
and solidarity. approach the need of the people or
o “…a philosophy that emphasizes the connection society
between the individual and the community. Its
overriding philosophy is based upon the belief that a o It justifies things on the o It justifies things on the basis
person’s social identity and personality are basis of quality of quantity
largely molded by community relationships, with
a smaller degree of development being placed on o Ex: 1 peso to those who o Ex: 1 peso to all of those
individualism.” need it the most here in the who are here in the
classroom classroom

o It focuses on need and o It gives the same thing to all

requirement of an the people, irrespective of
individual. Thus, known as their need
need based approach.

Dr.
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Makes sure what is needed and Does not look at what is Roles of health care professionals in establishing health
in which quantity to an needed for an individual. care priorities and allocating scarce health resources
individual Health care professionals play several roles in establishing
Equity is the means/process Equality is the outcome/end health care priorities and allocating scarce health care
result of the process resources
Equity is subjective. It differs Equality is measurable. It o As government policy makers and officials
from situation and from person does not vary and neither o As hospital authorities
to person matter whoever looks at it o As direct health
Equity is positive Equality might give rise to o As researchers care providers
discrimination negative discrimination What concept of distributive justice is most appropriate for
People are treated fairly but People are treated equally but each of these roles? How should health care professionals deal
differently may be unfairly with conflicts between roles (e.g., between providing
Here, people can get what they Here, people will only get what expensive curative measures for individual patients in need
need everyone else gets and vaccination programs for the population)?
Equity cannot be achieved Equality can be achieved
through equality through equity Ex:
o Scarcity of PPE – priority are the frontliners
o Vaccine – priority are the frontliners and vulnerable
population
o Double blinding in research is justice – experimental
and control group are blinded
o 5 patients, 1 cartridge – choose who will benefit the
most
o Only one respirator is available at ‘X’ Hospital.
Respirator is in use by a patient who is dying. A new
patient comes in and has a better chance of living
with the use of a respirator. – Don’t play God,
explain to the family the situation and refer to the
nearest hospital where there are better amenities.
Given that the one person is Same size boxes were given for o Giving ayuda is justice
small, he was provided with 2 everyone to watch the game o Vaccination is justice if given to frontliners.
boxes to watch the game through the fence = justice was Vaccination is not justice if he was vaccinated but he
through the fence. Given that served, each one of them is not in the prioritization list.
the other person can already received a box
watch through the fence, no Note: Scenarios – Doc Lorenzo J
box was given = justice was
served, all of them were able to 1. lecture
Gmeet
watch through the fence PPT
Right to Health Care
The Constitution of the World Health Organization states that
the ‘enjoyment of the highest attainable standard of health is
one of the fundamental rights of every human being...’
International statements on human rights, such as the
International Covenant on Economic, Social and Cultural
Rights and the Convention on the Rights of the Child, support
the right to health and require signatory nations to secure its
observance.

Disparities in Health Status

Health care professionals are faced with many disparities in
health status, generally associated with disparities in wealth/
income or with discrimination against women, minorities or
other disadvantaged groups
o Local disparities
o National disparities
o Global disparities

Dr.
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Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
Lourdes Carpena-Medalla MD| 14 September 2019

I. ARTICLE 9: PRIVACY AND CONFIDENTIALITY

Premise:
of their personal information should be respected. To the greatest
extent possible, such information should not be used or disclosed for
purposes other than those for which it was collected or consented to,
consistent with international law, in particular international human
A. PRIVACY
The right of an individual or a group to be free from
intrusion or meddling from others, and includes the right to
determine which information about them should be
disclosed to others.
1. Confidentiality
An attribute of person information requiring that it not be disclosed
to others without sufficient reason
The basic principles and values of Article 9 emerge from
Universal Declaration of Human Rights of 1948.
The concept of CONFIDENTIALITY is already stated in the
Hippocratic Oath.
The DIGNITY and AUTONOMY of the person, being an
integral part of rights and fundamental freedoms of human
beings, has to be recognized and respected in an effective
and universal manner.
CULTURAL & PSYCHO-SOCIAL FACTORS of persons and
social groups have to be considered.
ARTICLE 9 is related to AUTONOMY & CONSENT. Here is the
content of the article according to UNESCO, 2005.:
1. A right to privacy guarantees control over personal
information in various ways. Privacy extends beyond data
protection, as certain private spheres of the individual that
are not manifested in data processing can also be protected
by the right to privacy.
2. Confidentiality refers to a special and often fiduciary
relationship between researchers, doctors and patients
provided that the shared information shall remain secret
and shall not be disclosed readily to a third person.
3. The importance of privacy has been recognized in
numerous legal instruments.
1.2 Duty of Health Care Provider To provider the privacy of patients
Health care providers have an ethical obligation to protect
circumstances. For example, they should interview patients
where they cannot be overheard, especially when the
patients declare that they did not bring any companions
during consultation. However, take ethics into
consideration like bringing in a witness of the same sex as
the patient during consultation. They should ask the patient
permission to examine him or her unclothed. You have to
tell or ask the patient everything and anything that you
need to do during the examination. They should ensure that
an unclothed patient cannot be viewed by passersby. If the
patient does not want a procedure to be done on him or
her, the physician cannot do the procedure. Understand
that some patients do not want to be heard or seen.
1.3 Duty of Health Care Provider To Maintain Confidentiality
The duty of maintaining confidentiality, a.k.a. professional
secrecy, has been part of western medical ethics since
see or hear, professionally or privately, which ought not to
courses in non-western countries should discuss the source
of medical confidentiality in their culture.
Confidentiality extends to all personal health information,
including genetic data
UNESCO international declaration on Human Genetic
proteomic data, regardless of their apparent information
content, should be treated with the same high standards of
B. JUSTICE
2. Justified Breaches of Confidentiality
2.1 Sharing Information for Patient Care
In the hospital setting, many people (doctors, nurses) need

1.1 Reason for respecting the privacy and confidentiality However, each of these persons is bound to maintain
confidentiality to the greatest extent possible. Outside the
1. Individual owns the information
hospital setting, family members may need patient
2. For many people, privacy is an essential aspect of
information in order to provide care and/or to protect
their dignity. Invading their privacy against their
themselves
will is a violation of their dignity.
3. Respect for other people requires protecting their
2.2 Using Interpreters
privacy and their confidentiality of information
about them. When the health care provider does not speak the patien
4. Patients are less likely to trust health care language, an interpreter will be needed who will then have
providers and confide in them because they think access to information about the patient. The interpreter
that the health care providers will not keep the should be bound to observe confidentiality.
information confidential. This can have serious
-
being; sometimes for the health of others,
especially family members.
2.3 Teaching Medical Students

S 1 T 1 |Guinea Pigs Batch 2021: OBE is Life 1 of 3

 Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
Observation and discussion of patients is a necessary part
of medical education. Students should be informed of their
obligation to maintain confidentiality.
2.4 Mandatory Reporting
Health care providers should be familiar with laws about
mandatory reporting of infectious diseases, suspected child
abuse, and other conditions in the country when they
practice. Normally, patients should be informed that their
information has to be reported to the appropriate
authorities.
2.5 Serious Danger to Others
For example, in exceptional circumstances and generally as
a last resort, health care provider may need to inform other
persons that the patient has threatened to harm them
whether by violence or by sexual contact when the patient
has a transmissible disease such as HIV or any STDs.
2.6 Genetic Information
There is controversy regarding whether other individuals
with the same genetic makeup (usually close family
Physicians should consult their national regulations or
guidelines when faced with this situation
2.7 With Patient or Guardian Consent
This should generally be obtained for all breaches of
confidentiality and ender the breaches acceptable ethically
2.8 Special Circumstances of Research
Disclosure of personal health information obtained in the
course of a research study requires the prior consent of the
research subject
There is a great controversy regarding whether
disclosure, researchers should consult their national
regulations or guidelines if such exist, otherwise
international guidelines such as the Declaration of Helsinki.
In research, communities as well as individuals have a right
to privacy, and information about them should be kept
confidential, especially when its discharge may be harmful
to the community.
Scientific publication should respect confidentiality to the
greatest extent possible. Consent is always required when
an individual research subject can be identified in a
publication.
II. ARTICLE 10: EQUALITY, JUSTICE AND EQUITY
Premise:
dignity and rights is to be respected so that they are treated
Different types of Justice
Distributive
Ensuring that each person receives a fair share of public
resources
S1T6
This is the most important type for health care under
conditions of scarcity
according to
his or her needs; Each must receive according to his or her
effort; or according to his/her contributio
Procedural
Ensuring a fair process for making decisions and settling
disputes
Retributive
Ensures punishment of wrongdoers
Social
Combination of the previous types as applied to a society in
which individuals and groups receive fair treatment and an
equitable share of the benefits of society
Different Concept of Distributive Justice
Authoritarian
What the highest authority decrees is just
Libertarian
What an individual decides to do with his or her own
property is just
Utilitarian
What most contributes to the treated good of the greatest
number is just
Egalitarian
Justice is achieved when everybody had equal access to the
societal resources to that they need
Restorative or transformative
Justice requires favoritism previously disadvantaged
individual or groups
Different Concept of Distributive Justice Reflected in Different
Healthcare System
The libertarian one is strong in the USA. The egalitarian one
is predominant in many European countries where the
value of social solidarity is recognized. South Africa is
attempting to implement restorative approach. Most
economists lean toward Utilitarian approach
Approach to Justice
Utilitarian
· What issue is determined by utility consequences:
· the greatest good (happiness, satisfaction) for the
greatest number regardless of the values for the particular
person involved.
wrong if it tends to produce the reverse of happiness---- not
just the happiness of the performer of an action but also
Egalitarian
· What is due is what is fair
Equal distribution of benefits and burden, equal
opportunity
2 of 3
 Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
· An egalitarian favors equality of some sort; People
should get the same, or be treated the same, or be treated
as equals, in some respect
Libertarian
· For as long as there is no restraints on individual liberty,
justice is served
· A collection of political philosophies and movement that
uphold liberty as a core principle. Libertarians seek to
maximize political freedom and autonomy, emphasizing
freedom of choice, voluntary association, individual
judgement, and self-ownershi
·
· Is the view that each person has the right to live his life
in any way he chooses so long as he respects the equal
rights of others
·
and property---rights that people possess naturally, before
governments are created. In the libertarian view, all human
relationships should be voluntary; the only actions that
should be forbidden by law are those that involve the
initiation of force against those who have themselves used
force--actions like murder, rape, robbery, kidnapping, and
Communitarian
· What is valued by the community determines what is
just. It emphasizes social meaning, community
membership, shared values, individual responsibility and
solidarity
· A philosophy that emphasizes the connection between
the individual and the community. Its overriding philosophy
personality are largely molded by community relationships,
with a minimal degree of development being placed on
C. EQUITY
Fundamental requirement in terms of justice
Equity exists when all participants freely define and accept
the rules, benefits and even the charges. Hence, any
differences in charges or benefits must represent a benefit
to ALL members of the society.
What us due depends on what has been given/received
Equity is very limited: if nothing is given first then nothing
will be given return
Has been considered a concept even more important that
justice
Aristotle described it as follows:
What is just, then and what is equitable are generally the
same, and both are good, though what is equitable is better.
According to Rawls, equity is a fundamental requirement in
terms of justice.equity is justice.
It exists when all participants freely define and accept the
rules, benefits and charges
S1T6
D. EQUALITY
- Together with justice and equity, it has become a
fundamental principle. As human beings, we are not
physically, mentally, psychologically, or genetically equal.
We are not equal in our values or principles.
· But, it is generally accepted and fully desirable that we
be considered equals in terms of dignity, justice, rights,
opportunities, freedom, benefits and obligations.
· Justice and equity are only possible if all human beings
are treated equally in their dignity and rights (Article 10,
Universal Declaration on Bioethics and Human Rights)
Right to health care
· oyment of
the highest attainable standard of health is one of the
International statements on human rights, such as the
International Covenant on Economic, Social and Cultural
Rights and the Convention on the Rights of the Child,
support the right to health and require signatory nations to
secure its observance.
Disparities in health status
· Health care professionals are faced with many
disparities in health status, generally associated with
disparities in wealth/income or with discrimination against
women, minorities or other disadvantaged groups
o Local disparities
o National disparities
o Global disparities
Roles of health care professionals in establishing health care priorities
and allocating scarce health resources
Health care professionals play several roles in establishing health care
priorities and allocating scarce health care resources
· As government policy makers and officials
· As hospital authorities
· As direct health care providers
· As researchers
What concept of distributive justice is most appropriate for each of
these roles? How should health care professionals deal with conflicts
between roles (e.g between providing expensive curative measures
for individual patients in need and vaccination programs for the
population)?
3 of 3
 Non-discrimination & Non-stigmatization
Dr. Joseph A. Jao
Insight from the Hippocratic Oath
“l will prevent whenever I can, for prevention is
preferable to cure”, I remember that I remain a member of
society, with special obligations to all my fellow human beings,
those sound of mind and body as well as the infirm
Stigma
o A deeply derogatory characteristic or attribute which
occurs when a difference or deviation provokes
negative reactions towards the individual who is
different (Goffman 1980).
o Stigma belittles the individual making them less than
others, undermining their human dignity and
decreasing their chances in life.
o Human dignity is an intrinsic human characteristic. It
is indispensable, inalienable and cannot be taken
away.
o Reduced individuality resulting from stigmatization
can even dehumanize the stigmatized, their identity
becomes defined by the stigma itself, or confused
with it when, for example, comes to be known by the
attribute
o Individuality discovering who you are meant to be so
you can make a difference
Phenomena Associated with Stigma
1. Refusal to seek medical attention (ex. TB patients)
Stigma can make people hide COVID-19 and refuse
to seek medical attention
2. Poor adherence to treatment
o When an individual is labelled with negative
characteristics, there is a rational construct which
disqualifies, rejects or excludes
ex: 1. hiring a woman is not good because she has
many excuses like dysmenorrhea, pregnancy etc .
2. hiring a disabled person is not productive
3. “Elderly persons are prone to diseases and can
make us cost more money”
o Stigma means that the stigmatized individual
experiences situations of being socially
disadvantaged
o Stigma creates structural discrimination which
negatively affects the environment them
Dr.
o Although stigma is conceptualized as a personal
mark or attribute, it is essential to recognize that it
is the fruit of structural social product, conditions
and power relationships established in societies. (Link
and Phelan, 2001; Parker and Aggleton, 2001; Parker, 2001)
o Leads to loss of status and to discrimination
o Discrimination is an inherent part of stigma
o There would be no stigma without discrimination
Stereotype ⇢ Division us vs them ⇢ Low social status ⇢
discrimination ⇢ Labelling ⇢ Stereotype
Possible Negative Consequences of Stigma
o Tense and uncomfortable social interactions
o Limited social interactions
o Compromised quality of life
o Low self esteem
o Symptoms of depression
o Unemployment
o Loss of income
STIGMATIZATION
Introduced in bioethics by UNESCO as a distinguished kind
of discrimination that may have a serious impact on the right
to health and benefit of scientific research
DISCRIMINATION
o Latin word: “Discriminare” which means to
distinguish between
o To discriminate socially is to make a distinction
between people on the basis of class or category
without regard to individual merit
§ Infringement of the ethical theory of
egalitarianism based on social equality
o Not considered as social discrimination:
§ Distinction based on individual merit such
as personal achievement, skill or
development
o Social discrimination:
§ Distinction based on race, social class or
caste, nationality, religion, sex, sexual
orientation, disability, ethnicity, height, age
or any other ground in violation of human
dignity, human rights and fundamental
freedoms
1
 o The principle of non-discrimination is based on the
understanding that discrimination is socially
constructed rather than “natural”
PRINCIPLE OF NON-DISCRIMINATION
Seeks “to guarantee that human rights are
exercised without discrimination of any kind based on race,
color, sex, language, religion, political or other opinion,
national or social origin, property, birth or other status such as
disability, age, marital and family status, sexual orientation and
gender identity, health status, place of residence, economic and
social situation”.
POSITIVE OR REVERSE DISCRIMATION
o Negative Discrimination – discrimination of
majority group to the minority group
o Positive / Reverse Discrimination– discrimination
against the majority (corrective measure)
o Discriminatory policies or acts that benefit a
historically and and socio-politically
nondominant group (typically women and
minorities but sometimes majorities), at the expense
of a historically and socio-politically dominant group
(typically men and majority races) are called ‘positive
or reverse discrimination’ or ‘affirmative action
policies’.
o However, whether a given example of discrimination
is positive or negative is often a subjective
judgement. Positive or negative, there is still
discrimination.
o In the field of health care and bioethics, some groups
need more protection such as infants and elderly
people, AIDS patients, psychiatric patients and
depressed patients. These belong to the vulnerable
group, there should be equitable resources to this
group.
o Whether it is a conscious act of positive valuing the
other constitute significant causes of discrimination
and social exclusion.
o Whatever the source of the stigma, the consequences
are the same:
§ violating human dignity,
§ isolation and exclusion,
§ less access to health care services,
§ compromised chances in life,
§ deterioration in quality of life and
§ increased risk of death.
GROUNDS FOR DISCRIMINATION AND
STIGMATIZATION
o Advances in medical technology have the
potential to create disproportionate disadvantages for
some social groups, either by being applied in ways
that harm members of these groups directly or by
encouraging the adoption of social policies that
discriminate unfairly against them with significant
individual, social and legal consequences.
Dr.
o Reproductive medicine has developed techniques
that enable parents to choose the sex of their child
which raises the concern of discrimination against
girls and women in societies where male children
are valued more highly than female children.
o Similar concerns have been raised about the
increasing use of abortion as a method of birth
control in overpopulated countries where there is
considerable social and legal pressure to limit family
size and where the vast majority of the parents who
use it choose to have a boy rather than a girl.
o In the field of genetics, the use of relatively simple
tests for determining a patient's susceptibility to
certain genetically transmitted diseases has led to
concerns that the results of such tests, if not
properly safeguarded, could be used against the
individual’s own interests, to discriminate them in
the interests of employers, health insurance
companies, and government agencies.
o In addition, through genetic counselling,
prospective parents can be informed about the
chances that their offspring will inherit a certain
genetic disease or disorder; this will enable them to
make more informed decisions about
reproduction.
❌ therapeutic abortion
o This is viewed by some bioethicists and some NGOs
as contributing to a social atmosphere
considerably less tolerant of disability than it
ought to be. The same criticism has been levelled
against the practice of diagnosing, and in some cases
treating, congenital defects in unborn children.
o Research on the genetic bases of behavior,
though still in its infancy, is controversial, because of
its potential to encourage the adoption of crude
models of genetic determinism in the development of
social policies, especially in the areas of education
and crime prevention. Such policies, it is claimed,
could result in unfair discrimination against large
numbers of people judged to be genetically disposed
to ‘undesirable’ forms of behavior, such as aggression
or violence.
2
 o References to human dignity and to non- When wealth is passed off as merit, bad luck is seen as bad character.
stigmatization and non-discrimination are hallmarks This is how ideologues justify punishing the sick and the poor. But poverty
of decisions on better health care policies and is neither a crime nor a character flaw. Stigmatize those who let people
practices, contributing to making difficult decisions die, not those who struggle to live.' Sarah Kendzior, author
involving questions such as: @sarahkendzior
1. Use of surgery in gender reassignment Gmeet lecture
2. The right of homosexual individuals to PPT
maternity/paternity
3. The right of individuals living with HIV/AIDS to
exercise their sexuality and have children
4. Critical situations involving cultures very distant from
western culture

Bioethical Principles associated with Non-Stigmatization

and Non-Discrimination:
o Autonomy
o Confidentiality
o Privacy
o Equity
o Justice

LIMITATIONS OF THE PRINCIPLE

o Article 26 of the Declaration states that the principles
should be understood as complementary and
interrelated; the Declaration is to be understood as a
whole. This implies that if a bioethical issue or
problem emerges, it is usually the case that several
principles are relevant to the issue or problem and
need to be balanced in order to reach a justified
conclusion about what to do.
o Article 27 specifies the limitations on the application
of the principles. It mentions several conditions in
which applications may be limited:
§ By law
• laws in the interests of public safety
• Laws for the investigation, detection,
and prosecution of criminal offences
• Laws for the protection of public health
• Laws for the protection of the rights and
freedoms of others
§ Such law needed to be consistent with
international human rights law.

SUMMARY
o Has been recognized as universal principles of
bioethics in Article 11 of the Universal Declaration
on Bioethics and Human Rights (UNESCO, 2005).
o It recognizes the need and paves the way for
concerted action against inequality and the
institutional mechanism which perpetuate it.
o It also aims to fight against any discrediting process,
which stigmatizes an individual or a group on any
kind of ground.
o Thus, the principle of non-discrimination and non-
stigmatization is to be understood, implemented,
protected, and promoted, at national and
international level, in accordance with the whole set
of principles proclaimed in the UNESCO Universal
Declaration on Bioethics and Human Rights.
Dr.
3
 Clinical Bioethics
Lecturer: Dr. Gloria Clarion
UNESCO universal declaration on bioethics & human rights
i. Human dignity & human rights
ii. Benefit & harm
iii. Autonomy & individual responsibility
iv. Consent
v. Persons without capacity to consent
vi. Respect for human vulnerability & personal integrity
vii. Privacy & confidentiality
viii. Equality, justice & equity
ix. Non-discrimination & non-stigmatization
x. Respect for cultural diversity & pluralism
xi. Solidarity & cooperation
xii. Social responsibility & health
xiii. Sharing of benefits
xiv. Protecting future generations
xv. Protection of the environment, the biosphere & biodiversity
Insight from the Hippocratic oath
I will prevent disease whenever I can, for prevention is preferable to
cure; I will remember that I remain a member of society, with special
obligations to all my fellow human beings, those sound of mind &
body as well as the infirm (1)
Stigma
A deeply derogatory characteristic or attribute, which occurs
when a difference or deviation provokes negative reactions
towards the individual who is different
Stigma belittles the individual, making them less than others,
undermining their human dignity & decreasing their chances in
life
Reduced individuality resulting from stigmatization can even
dehumanize the stigmatized, their identity becomes define by
the stigma itself, or confused with it, when for example, the
person comes to be known by the attribute
Phenomena associated with stigma:
1. Refusal to seek medical attention
2. Poor adherence to treatment
When an individual is labeled with negative characteristics, there
is a rational construct which disqualifies, rejects & excludes
Stigma means that he stigmatized individual experiences
situation of being socially disadvantaged
Stigma creates structural discrimination which negatively affects
the environment around them
Although stigma is conceptualized as a personal mark or
attribute, it is essential to recognize that it is a social product.
The fruit of structural conditions and power relationships
established in societies
Stigma is a social product which reproduces social inequalities
Stigma may be reproducing hierarchical & dominating systems
when related to social class, gender, race, ethnicity & sexual
orientation, serving to create, maintain & reinforce social
inequalities
Pink Italic= Recording
Stigma leads to loss of status & to discrimination
Discrimination is an inherent part of stigma
There would be no stigma without discrimination
Possible negative consequences of stigma
1. Tense and uncomfortable social interactions
2. Limited social networks
3. Compromised quality of life
4. Low self esteem
5. Symptoms of depression
6. Unemployment
7. Loss of income
Stigmatization
Introduced in bioethics by UNESCO as a distinguished kind of
discrimination that may have a serious impact on the right to
health & benefit of scientific research
Discrimination
discrimination discriminare
which means to distinguish 0between. Thus, to discriminate
socially is to make a distinction between people on the basis of
class or category without regard to individual merit. Which is an
infringement of the ethical theory of egalitarianism based on
social equality (see unit 10)
Distinction between people which are based just on individual
merit (such as personal achievement, skill or ability) are
generally not considered socially discriminatory, contrary to
distinctions based on race, social class or caste, nationality,
religion, sex, sexual orientation, disability, ethnicity, height age
or any other ground in violation of human dignity, human rights
& fundamental freedoms
Principle of non-discrimination
The principle of non-discrimination is based on the
understanding that discrimination is based on the understanding
that discrimination is socially constructed rather than natural
human rights are exercised without
discrimination of any kind based on race, color, sex, language,
religion, political or other opinion, national or social origin,
property, birth or other status such as disability, age, marital &
family status, sexual orientation & gender identity, health status,
place of residence
Positive or reverse discrimination
Discriminatory policies or acts that benefit a historically & socio-
politically non-dominant group (typically women & minorities
but sometimes majorities), at the expense of a historically &
socio-politically dominant group (typically men and major races)
However, whether a given example of discrimination is a positive
or negative is often a subjective judgement
In the field of health care and bioethics, some groups need more
protection such as infants and elderly people, AIDS patients,
psychiatric patients & depressed patients
Page 1 of 2
Blue= PPT
 Clinical Bioethics

Grounds of discrimination & stigmatization
Advances in medical technology have the potential to create
disproportionate disadvantages for some social groups, either by
being applied in ways that harm members of these groups
directly or by encouraging the adoption of social policies that
discriminate unfairly against them with significantly individual,
social & legal consequences
For instance, reproductive medicine has developed techniques
that enable parents to choose the sex of their child which raises
the concern of discrimination against girls and women in
societies where male children, are valued more highly than
female children
Similar concerns have been raised about the increasing use of
abortion as a method of birth control in overpopulated countries
where there is considerable social & legal pressure to limit family
size & where the vast majority of the parents who use it choose
to have boy rather than girl
In the field of genetics, the use of relatively simple test for
susceptibility to certain genetically
transmitted diseases has led to concerns that the results of such
tests, if not properly safeguarded, could be used against the
to discriminate them in the interests
of employers, health insurance, companies & government
agencies
In addition, through genetic counselling, prospective parents can
be informed about the chances that their offspring will inherit a
certain genetic disease or disorder; this will enable them to
make more informed decisions about reproduction
contributing to a social atmosphere considerably less tolerant of
disability than it ought to be. The same criticism has been
levelled against the practice of diagnosing, and in some cases
treating, congenital defects in unborn children
Research on the genetic bases of behavior, though still in its
to encourage
the adoption of crude models of genetic determinism in the
development of social policies, especially in the areas of
education and crime prevention. Such policies, it is claimed
could result in unfair discrimination against large numbers of
people judged to be genetically disposed to undesirable forms of
behavior, such as aggression or violence
References to human dignity and to non-stigmatization and non-
discrimination are hallmarks of decisions on better health care
polices, contributing in making difficult decisions involving
questions such as:
1. Use of surgery in gender reassignment
2. The right of homosexual individuals to maternity/ paternity
3. The right of individuals living with HIV/AIDS to exercise their
sexuality & have children
4. Critical situations involving cultures very distant from
western culture
balanced in order to reach a justified conclusion about what to
do.
Article 27 specifies the limitations on the application of the
principles. It mentions several conditions in which application
may be limited:
1. Laws in the interests of public safety
2. Laws for the investigation, detection & prosecution of
criminal offenses
3. Laws for the protection of public health
4. Laws for the protection of the rights and freedom of
others
Such law needed to be consistent with international human
rights law
When therefore public health is at risk, exceptions or restrictions
to the non-discrimination principle can be necessary either by
affirmative actions in favor of some key persons or groups, or by
negative actions that may infringe upon individual rights. These
exceptions must be publicly discussed and applied with
transparency and according to the national law. They also must
be subject to revision according to developments of the situation
and scientific knowledge
Summary Non-discrimination & non-stigmatization
Has been recognized as universal principles of bioethics in article
11 of the universal declaration on bioethics & human rights
It recognizes the need and paves the way for concerted action
against inequality and the institutional mechanism which
perpetuate it
It also aims to fight against any discrediting process, which
stigmatizes an individual or a group on any kind of ground
Thus, the principle of non-discrimination & stigmatization is to
be understood, implemented, protected & promoted at national
& international level in accordance with the whole set of
principles proclaimed in the UNESCO universal declaration on
Bioethics & Human rights

Limitations of the principle

Article 26 of the declaration states that the principles should be

understood as complementary and interrelated; the declaration
is to be understood as a whole. This implies that if a bioethical
issue or problem emerges, it is usually the case that several
principles are relevant to the issue or problem and needs to be

Page 2 of 2
Pink Italic= Recording Blue= PPT
Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
Angel Erich R Sison, MD stepping in for Zorayda E Leopando, MD | 2019
PAGBABALANGKAS NG ARALIN
I. Notion of Vulnerability
II. Aspects of Vulnerability
A. Biological/Corporeal Vulnerability
B. Social Vulnerability
C. Cultural Vulnerability
III. The Powers of Medicine: Fighting Vulnerability
IV. Problems vs Fight Against Vulnerability
V. Dilemmas of Vulnerability
VI. Notion of Personal Integrity
VII. Care Ethics
VIII. Ethical Perspectives
IX.
I. NOTION OF VULNERABILITY
vulnus :
Susceptibility of being wounded
Ethical principles and guidelines for the protection of
human subjects of research (1978 Belmont Report)
o refers to individuals and populations
o need for protection
Target groups:
o Racial minorities
o Economically disadvantaged
o Very sick
o Institutionalized
May continually be sought as research subjects, owing to
their ready availability in settings where research is
conducted.
Given their dependent status and their frequently
compromised capacity for free consent, they are easy to
manipulate as a result of their illness or socioeconomic
condition
involved in research solely for administrative c
(National Commission for the Protection of Human Subjects
of Biomedical and Behavioural Research, 1979)
Throughout the first half of the 20th century, these
vulnerable members of the population have been used in
unethical research studies:
o Institutionalized groups of persons like orphans
o Prisoners, the elderly and, later, Jews
o Other ethnic groups, considered as inferior and
even subhuman by the Nazis
o Persons such as the Chinese, who were exploited
by the Japanese in order to pursue their scientific
and military objectives.
o Ethnic minorities
o Socially underprivileged groups and women
reinforcing the principle of autonomy and of the
consequent demand, increasingly more inclusive and
stricter, for informed consent. (Beauchamp and Childress,
2001: 63).
S1T3| Guinea Pig Batch 2021: OBE is Life
Vulnerability expresses two basic ideas (Barcelona
Declaration, 1998):
o It expresses the finitude and fragility of life which,
in those capable of autonomy, grounds the
possibility and necessity for all morality.
o Vulnerability is the object of a moral principle
requiring care for the vulnerable. The vulnerable
are those whose autonomy or dignity or integrity
is capable of being threatened
In applying and advancing scientific knowledge, medical
practice and associated technologies, human vulnerability
should be taken into account.
Individuals and groups of special vulnerability should be
protected and the personal integrity of such individuals
respected.
The notion of vulnerability is not just a neutral description
of the human condition but instead a normative
prescription to take care of the vulnerable that is
characteristic for human beings.
Ethics is more than respecting individual choices and
decisions; it aims at care for the other.
o For example, the human face can show the
vulnerability of the human person and at the
same time appeal for help and assistance.
II. ASPECTS OF VULNERABILITY
BIOLOGICAL/CORPOREAL VULNERABILITY
Concerns the fragility of the human organism originating
from:
o Natural threats are coming from our biology:
ageing, susceptibility to illness and disease, and
death
o Environmental and other natural and man-made
threats: famine, earthquake, hurricanes,
pollution and environmental disasters
SOCIAL VULNERABILITY
Fragility of the human capacity for creating coherence in
o Social threats stemming from war and crime,
prejudice and discrimination, cruelty and
indifference
o Persons also become vulnerable due to
hospitalization and institutionalization
o Social circumstances and conditions
CULTURAL VULNERABILITY
Concerns the fragility of particular traditions and
conceptions of values that are typical for a community or
local cultures
III. THE POWERS OF MEDICINE: FIGHTING VULNERABILITY
A common idea is that the vulnerability of the human
condition should be eliminated or reduced.
o Science and technological innovations should be
used to overcome the natural threats.
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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
o Medical research should be focused on
eliminating the biological threats to the human
body
The basic assumption behind this fight is that many
vulnerabilities of the human condition are contingent, not
inherent.
This fight has been successful but at the same time has
failures.
o Life expectancy and health have improved,
poverty and starvation reduced, but at the same
time
o Many people die from common diseases, life
expectancy is decreasing in many countries, and
poverty is still widespread.
An unrestrained fight against human vulnerability
generates its own problems. Not the struggle against
human vulnerability is a mistake but the struggle to rid the
human condition of all vulnerability.
For a sustainable medicine it is necessary to accept some
vulnerability as a permanent part of the human condition.
IV. PROBLEMS VS FIGHT AGAINST VULNERABILITY
Religion, alternative medicine and traditional knowledge
present different ways of knowing and valuing
o Because they are open to different perspectives,
they can give meaning to vulnerability, but their
views are generally not accepted by mainstream
science or bioethics
Economic problems
o The success of science and technology has
created financial difficulties in almost all countries
in achieving decent levels of health care for the
population.
o Because of its continuous fight against
vulnerability, medicine often
Medical progress itself has created new forms of
vulnerability, i.e. chronic illness.
o This presents continuing vulnerability for a
growing population aging population
V. DILEMMA OF VULNERABILITY
Requires a balance between eliminating and accepting
human vulnerability
Disability
o Viewed as abnormal and the disabled therefore
are, by definition, vulnerable
o At the same time the disabled should not be
stigmatized by being treated as abnormal.
Death
o In medicine, the place of death in human life is
ambivalent
o In palliative care, death is understood as being
part of life; in some other sectors of medicine
death is still treated as the enemy.
S1T3
Depression
o Prozac (fluoxetine) is widely used as an anti-
depressant drug, when there are clear clinical
symptoms of depression;
o At the same time, it is regarded as medication for
unhappiness and sadness
Human suffering and misery express human vulnerability.
They also pose a challenge.
o We must at the same time struggle to keep
suffering to a minimum and also accept it as part
of life.
VI. CARE ETHICS
The challenge of human vulnerability is that it can never be
entirely eliminated from human life.
o Instead, it should inspire new approaches in
bioethics
The human condition requires solidarity; human beings all
share common vulnerabilities
Human vulnerability also leads to an ethics of care.
o Because it is a shared characteristic, it is also a
source of concern for others as well as awareness
that we rely on others.
o It is the basis for the duty to care for those
threatened by biological, social and cultural
threats as well as by the power of medicine itself.
VII. NOTION OF PERSONAL INTEGRITY
Latin origin verb tangere
o This is the root both of the adjective integer,
noun integritas
integrity all the
parts are maintained and the quality of that which is
unaltered.
Confirmed in 1996, in the Declaration of Helsinki, in which
as an attribute of the recognized inviolability of the subject
of experimentation, which
physically or psychologically:
o The right of the research subject to safeguard his
or her integrity must always be respected.
o Every precaution should be taken to respect the
privacy of the subject and to minimize the impact
of the study on the subject's physical and mental
integrity and on the personality of the subject
(World Medical Association, 1996: I.6)
The principle of respect for human vulnerability is related to
the notion of personal integrity; this is mentioned in the last
part of Article 8.
o Integrity concerns the wholeness of an individual.
In ethical discourse, integrity is often considered as a virtue,
related to the
example.
But respect for personal integrity in this Article does not
refer to moral character or his/her good
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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
behaviour. It refers to fundamental aspects of a human life BASIC PRINCIPLES OF ENVIRONMENTAL ETHICS
that should be respected. Respect for Nature
Personal integrity refers here to respect for the The prosperity of human beings depends on the prosperity
understanding of his or her own life and illness, but also for of nature.
his/her interests and free will. Human beings are part of nature. They have therefore the
In the field of health policies, the principle of vulnerability duty to conserve and protect the integrity of the ecosystem
demands, both at the social and international level: and its biodiversity
o Benefit of some should not be attained by
exploiting the weakness of others Environmental Justice
o Those of bio-industries must not aggravate Environmental benefits and burdens should be equally
human vulnerability but rather seek to eliminate distributed
it as far as possible and to respect what is beyond Opportunities to participate in decision-making concerning
their reach. environmental issues should be equally provided
At the level of experimentation, it demands protection
which goes beyond that which can be expressed in Intergenerational Justice
informed consent of the body or part of the body and Every generation should leave the following generation an
demands respect for personal identity in the relationship equal opportunity to live a happy life, and should therefore
between the subject of experimentation and the researcher bequeath a healthy earth
between patient and doctor, at the level of clinical
assistance.
Respect for integrity demands new forms of
communication
o Allow the doctor to focus more on the patient
than the illness facilitates the involvement of
the patient in his own therapeutic process as a
partner in the health team the development of
therapies which are perceived as less invasive and
more respectful of the individual (e.g. at the
cultural or religious level)
In the field of health policies, the principle can play an
important role in:
o Prohibition of commercializing human body parts
o Regulation of genetic manipulation, particularly
in safeguarding the human genome
o Consideration of patentable human matter

VIII. ETHICAL PERSPECTIVES

ANTHROPOCENTRIC/HUMAN-CENTERED ENVT. ETHICS
Human beings have moral duties only towards one another
Human interests prevail over the interests of other species

NON-ANTHROPOCENTRIC ENVT. ETHICS

Biocentric
Other living organisms have intrinsic value
All life forms are are
entitled to moral consideration
It is therefore an ethical imperative to respect all life forms
All organisms have intrinsic value
More related to non-western cultural traditions

Ecocentric
Ecosystems have intrinsic value as well
Nature as a whole
All organisms and entities in the ecosphere, as parts of the
interrelated whole, are equal in intrinsic value
Holistic methodology

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Clinical Bioethics
Article 3: Human Dignity & Human Rights
Angel Erich R. Sison, MD | 31 August 2019
PAGBABALANGKAS NG ARALIN
I. Concepts of Dignity
A. Classical Antiquity
B. World Religions
C. Modern Philosophy
D. Contemporary International Law
II. The Notion of Human Dignity
III. Dignity and Healthcare Provider Relations
I. CONCEPTS OF DIGNITY
A. CLASSICAL ANTIQUITY
Common understanding of dignity as deserving of honour
and esteem according to personal merit, inherited or
achieved.
In ancient Greek philosophy, particularly of Aristotle and
the Stoics, dignity was associated with human abilities of
deliberation, self-awareness, and free decision-making.
B. WORLD RELIGIONS
Human dignity is considered to be predetermined by the
creation of human beings in the image of God; those who
are weak in body and soul have dignity equal to those who
are robust and sturdy.
C. MODERN PHILOSOPHY
Proposed secular understanding of human dignity and
progressively associated this concept with the idea of
human rights.
In different teachings human dignity was presented as an
o Aspect of personal freedom (Giovanni Pico della
Mirandola)
o E
Hobbes)
o Universal virtue, unconditional and incomparable
origin, wealth, or social status (Immanuel Kant)
to treat any other person always at
the same time as an end, never merely
as a means (categorical imperative)
has been accepted by moral and
political philosophy as the actual basis
for the conception of human rights and
in this sense it is a foundational
concept.
D. CONTEMPORARY INTERNATIONAL LAW
Contemporary international law, national constitutions,
and other normative documents, human dignity is strongly
connected with human rights.
According to Art. 1 of the Universal Declaration of Human
dignity The Declaration establishes human
rights (like freedom from repression, freedom of expression
and association) on the inherent dignity of every human
being.
S1T5| Guinea Pig Batch 2021: OBE is Life
The European Convention on Human Rights and
dignity and
identity of all human beings and guarantees everyone,
without discrimination, respect for their integrity and other
rights and fundamental freedoms with regard to the
II. THE NOTION OF HUMAN DIGNITY
The notion of human dignity expresses the intrinsic value
of the person capable of reflection, sensitivity, verbal
communication, free choice, self-determination in
conduct, and creativity.
Unlike material values or financial prices, human dignity
has no external equivalent; it is an end in itself.
Unlike merit as an embodiment of publicly recognized
personal achievements, a person is dignified as a human
being as such.
All human beings are equal in dignity irrespective of
gender, age, social status or ethnicity.
respect for her human rights, self-esteem and self-
determination, as well as care for her privacy, protecting
her from illegitimate intrusions and preserving her valid
public space.
A society or a community should respect each of its
members as a person or a moral agent on the basis of the
notion of human dignity.
This notion also requires that the interests and welfare of
the individual are considered as prior to the sole interest of
society, community, or any particular kind of publicly
It implies that because of his/her human dignity, the
individual should never be sacrificed for the sake of
science (as has happened in medical experiments during
the Second World War) or for the sake of society (as has
happened in totalitarian regimes).
circumstances in which the interest of others or the
community as a whole are so important that infringing
upon the interests of individuals is unavoidable in order to
save others or the community. An example is the threat of
a deadly pandemic.
Human dignity is a foundational concept and it is
theoretically and normatively inappropriate to reduce it to
decision-making or to taking into account her autonomy.
Respect for dignity means
worth as a human being.
In a comparative view, human dignity has diverse forms in
different cultural and ethical traditions (for example,
Confucian, Judeo-Christian, Muslim) and is respected in
various ways in different types of societies (traditional,
modern, totalitarian, democratic). It is less respected in
totalitarian societies and more respected in modern and
democratic societies.
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Clinical Bioethics
Article 3: Human Dignity & Human Rights
Regardless of cultural, confessional, and political varieties Inequality in the status of the health care provider and the
human dignity is universal - patient may be aggravated in special cases when patients
awareness and appropriate respectful treatment towards are children, handicapped individuals, and elderly persons.
her. Particularly risky are cases of patients who are mentally
As it is emphasized in Declaration, the regard to cultural handicapped.
Special attention in regard to human dignity and human
e rights is required in palliative treatment of terminal
Article 12). patients vegetative state
Though there is no consensus either in public or in the
III. DIGNITY AND HEALTHCARE PROVIDER RELATIONS expert community concerning the ethical and legal status of
embryos and foetuses, the latter should be treated with
Healthcare Provider-Patient relations are just one kind of
respect and care.
human relations, presupposing all ethical requirements.

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Clinical Bioethics
Protecting Future Generations (Article 16)
Dra. Maria Teresita S. Chua, MD | October 26, 2019
WHY CARE ABOUT THE FUTURE?
Economic growth has consequences such as increasing
inequity or environmental degradation
Economic growth is often based on natural resources. If
present trends continue, the world will be more crowded,
more polluted, less stable ecologically and more vulnerable
to disruption
needs of the present without compromising the ability of
future gene
The ethical context of the principle is articulated in the
Declaration on the Responsibilities of the Present
Generations towards Future generations, adopted by
UNESCO in 1997. Article 4 of this Declaration states that
ent generations have been the responsibility to
bequeath to future generations an Earth that will not end
one day be irreversibly damaged by human activity .
THREE FACTORS RESPONSIBLE FOR CONTEMPORARY SENSIBILITY
TOWARDS FUTURE GENERATIONS
Technology has altered the nature of human activity
Present-day reality is interdependent and interrelated
o There are a lot of wildfires on going - Amazon,
California, and it has destroyed acres of forest. Its
effect isn t only affecting the area around it but
other places as well.
The increasing awareness of the finitude and fragility of our
TECHNOLOGICAL AND SCIENTIFIC PROGRESS THAT HAVE SERIOUS
o There is a limit to our existence and what the
Earth can offer.
One example is the use of medication without rationale;
THE CONCEPT OF MORAL RESPONSIBILITIES TOWARDS FUTURE
GENERATIONS IS ALSO RELATED TO THE CONCEPT OF INTER
GENERATIONAL JUSTICE
Activities of present generations are limited by the
obligation to take into account and safeguard the
development and needs of future generations
Traditionally, justice has been defined iving to everyone
his or her due
AGUING THAT WE HAVE RESPONSIBILITIES TO POSTERITY OR
OBLIGATIONS OF JUSTICE TOWARDS FUTURE GENERATIONS,
HOWEVER, PROBLEMATIC
Does it make sense to claim that we have responsibilities
towards persons who do not exist yet?
Our children or grandchildren who have just been
born, human being who are not yet born, and
who cannot even consider as individual persons,
S 1 | #TheUglyHiker
or all distant generations, human and non human,
who will inherit the earth from us?
Two positions are usually defended:
We only have a moral relationship with
generations of the immediate future
All future generations can claim that we take
them into account
that
which belongs to all humanity cannot
be considered simply as unexplored and
belong to all generations
HOW DO WE REPRESENT THE FUTURE IN PRESENT DECISION
MAKING?
Even if we agree that moral concern for future generations
is necessary, what kind of obligations do we have to people
who do not yet exist or who might even not ever exist?
Future generations can, by definition, not have any claims
upon us because they are not present to make them
A solution to this last problem is to have others who act on
their behalf. It is a matter of justice to give voice to the
voiceless. Institutional mechanisms should therefore be
created to make our responsibilities towards future
generations a reality
An example is the Commission for Future Generations,
created in one Member State of UNESCO
IN HEALTH CARE, THERE ARE SEVERAL EXAMPLES OF
IMPACTS ON FUTURE GENERATIONS
antibiotics are widely used in agriculture as well as the bio
industry
antibiotics
(a) xenotransplantation, (procedure from one species to
another)
(b) genetically modified food and (food derived from
organisms whose DNA is modified by inserting material
from another organism, unnatural)
(c ) germ - line genetic interventions (Reproductive cells are
used. They make insertions into the genes of reproductive
cells such as the change is inheritable. Commonly used in
treatment of genetically linked diseases. Issue: Genetic
modification - custom made child)
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Introduction to Clinical Bioethics
ONE PRINCIPLE THAT IS OFTEN USED IN THIS CONTEXT IS THE
PRECAUTIONARY PRINCIPLE
Where a threat to health or the environment is serious and
imminent, we cannot afford to wait for a high degree of
proof before acting to prevent damage

REFERENCES
Dra. Maria Teresita S. Chua, MD

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Clinical Bioethics
Protection of the Environment, Biosphere, and Biodiversity
(Article 17)
Dra. Maria Teresita S. Chua, MD | October 26, 2019
o All organisms and entities in the ecosphere, as
ETHICS AND THE ENVIRONMENT VIEWS OF NATURE part of the interrelated whole, are equal in
Ethical concerns with the environment intrinsic value
CHARACTERISTICS o Holistic methodology
BASIC PRINCIPLES OF ENVIRONMENTAL ETHICS
community and nation to include also animals and the Respect for nature
whole of nature o The prosperity of human beings depends on the
Interdisciplinary prosperity of nature. Human beings are part of
Plural nature. They have therefore the duty to conserve
Global and protect the integrity of the ecosystem and its
Revolutionary biodiversity
BACKGROUND Environmental justice
Ecological crisis o Environmental benefits and burdens should be
Report of the Club of Rome (Limits to Growth) in 1972 equally distributed
First United Nations environmental conference in o Opportunities to participate in decision - making
Stockholm in 1972 concerning environmental issues should be
equally provided
1992 Rio Earth Summit Conference (Protect the Intergenerational justice
environment Every generation should leave the following
generation an equal opportunity to live a happy
2000 UN Millennium Declaration: the core of our
life, and should therefore bequeath a healthy
earth
on a irredeemably spoilt by human activities, and

NOTION OF SUSTAINABILITY
Clearly indicates the object of environmental concern:
current unsustainable patterns of production and 2002 Johannesburg Declaration on Sustainable Development:
consumption A new ethic of conservation and stewardship should be
adopted, focusing on:
ETHICAL PERSPECTIVES Measures to curb global climate change
Conservation and management of all types of
ANTHROPOCENTRIC ENVIRONMENTAL ETHICS: HUMAN CENTERED
forests; better use of water resources
ETHICS
Human beings have moral duties only towards one another Intensified cooperation to reduce the number
and effects of natural and man-made disasters
Utilitarianism is an ethical theory that determines right
from wrong by focusing on outcomes Fundamental change in the lives of the affluent
equitable access to resources
Deontology is an approach to Ethics that focuses on the
rightness or wrongness of actions themselves, as opposed
WHAT IS SUSTAINABLE DEVELOPMENT?
to the rightness or wrongness of the consequences of those
actions ORIGINAL DEFINITION
Given in report of World Commission on Environment and
More related to Western culture (in which nature has an
Development (1987):
economic value)
Sustainable development is development that meets the
NON ANTHROPOCENTRIC ENVIRONMENTAL ETHICS
Biocentric: needs of present generations without compromising the
o ability of future generations to meet their needs
that are entitled to moral consideration TWO IMPORTANT QUALIFICATIONS:
The needs of the poor are central in sustainable
o It is therefore an ethical imperative to respect all
development
life forms
The World Commission on Environment and
o All organisms have intrinsic value more related to
Development considers poverty as the main
non-western cultural traditions
cause and effect of environmental degradation
Ecocentric:
The only constraint of sustainable development is the state
o Ecosystems have intrinsic values as well
of technology and social organization in society
o

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 Clinical Bioethics
Introduction to Clinical Bioethics
Social institutions need to be remodelled. Human
attitudes need to be changed radically.
Technologies need to be developed for
conservation of environmental resources.
DIFFERRENT VIEWS OF SUSTAINABLE DEVT
Weak notion sustainability
Classic view:
Integration of economic, sociopolitical and
ecological spheres: problem is that they are often
viewed as separate spheres with their own logic
and values; often also trade-offs between
human and social development and ecological
concerns; this notion is also strongly
anthropocentric; everything in nature has
instrumental value.
Strong notion of sustainability
In order to prevent a continuing decline of natural
resources over time, a drastic change in patterns
of production and consumption is a necessary. It
is necessary to emphasize the intrinsic value of
nature; nature has a value in and of itself

REFERENCES
Dra. Maria Teresita S. Chua, MD

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Clinical Bioethics
Ethics and the Pharmaceutical Industry
Jena Angela T. Perano, MD | AY 2020-2021
PAGBABALANGKAS NG ARALIN
I. Physicians and the Pharmaceutical Sector
II. The Mexico City Principles for Voluntary Codes of Business
Ethics in the Biopharmaceutical Sector
A. The Six Principles
B. Interactions with Healthcare Professionals
C. Promotional Information and Activities
D. Public Sector Relationships and Procurement
E. Clinical Trials
I. PHYSICIANS AND THE PHARMACEUTICAL SECTOR
A conflict of interest exists in medicine when the following
conditions have all been met:
o The physician has a duty to advocate for the
interests of the patient (or public).
o The physician is also subject to other interests
her own, or those of a third party.
o The physician becomes a party to certain social
arrangements.
o Those arrangements, as viewed by a reasonable
onlooker, would tempt a person of normal human
interests in favor of the
II. THE MEXICO CITY PRINCIPLES
B includes companies,
regardless of ownership status, that develop, manufacture,
market, or distribute pharmaceutical and/or biologic
products.
o Such products are also referred to in these
Principles as "medicines."
Ethical interactions help ensure that medical decisions are
made in the best interests of patients
For relationships with healthcare professionals and other
stakeholders to meet this standard, companies in the
biopharmaceutical sector
by these six principles:
A. THE SIX PRINCIPLES
Healthcare and Patient Focus
o Everything we do is intended to benefit patients
Integrity
o Dealing ethically, honestly, and respectfully in
everything we do.
Independence
o Respect the need of autonomous decision-
making of all parties, free from improper
influence.
Legitimate Intent
o Everything we do is for the right reasons, is lawful,
and aligns with the spirit and the values of these
Principles.
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Transparency
o A general willingness to be open about our
actions while respecting legitimate commercial
sensitivities and intellectual property rights.
Accountability
o A willingness to be responsible for our actions and
interactions.
B. INTERACTIONS WITH HEALTHCARE PROFESSIONALS
Interactions between companies and healthcare
professionals provide valuable scientific, clinical, product,
and policy information about medicines that may lead to
improved patient care.
Appropriate marketing is critical to achieving these goals
because they enable companies to:
o Inform healthcare professionals about the
benefits and risks of medicines to help advance
appropriate patient use
o Provide scientific and educational information
o Support medical research and education
o Obtain feedback and advice about our products
through consultation with medical experts.
All interactions with healthcare professionals are to be
conducted in a professional and ethical manner.
o Healthcare professionals must not be improperly
influenced by companies.
o Nothing should be offered or provided by a
Company in a manner that inappropriately
influences a healthcare professional's
prescribing practices.
o Education and promotional activities should
encourage the appropriate use of medicines by
presenting them objectively and without
exaggerating their properties
o Relationships between Company personnel and
healthcare professionals should encourage the
development of a medical practice committed to
and be based on truthful,
accurate, and updated scientific evidence.
C. PROMOTIONAL INFORMATION AND ACTIVITIES
No medicines shall be promoted for use in a specific
economy until the requisite approval for marketing for such
use has been given in that economy.
Promotion should be consistent with locally approved
product information.
Promotional information should be clear, legible, accurate,
balanced, fair, objective, and sufficiently complete to
enable healthcare professionals to form his or her own
opinion of the therapeutic value of the medicines
concerned.
Safety of Medicines
Medicines provided by Companies will conform to high
standards of quality, safety and efficacy as determined by
regulatory authorities in each economy in which they
operate.
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Ethics and the Pharmaceutical Industry
Companies will report adverse events or adverse drug
reactions to regulatory authorities, subject to applicable
laws and regulations.
Symposia and Congresses
The purpose and focus of all symposia, congresses or (an
organized or
sponsored by a Company should be to inform healthcare
professionals about products and/or to provide scientific or
educational information.
Company relationships with healthcare professionals are
regulated by multiple entities and intended to benefit
patients and to enhance the practice of medicine.
Any sponsorship provided to individual healthcare
professionals must not be conditional upon an obligation
to prescribe, recommend, or promote any medicine.
All Events should be held in an appropriate venue that is
conducive to the scientific or educational objectives and the
purpose of the Event or meeting. Companies should avoid
using extravagant venues or resorts.
Hospitality should be limited to refreshments and/or meals
incidental to the main purpose of the Event and should only
be provided:
o To participants of the Event and not their guests
o Is moderate and reasonable as judged by local
standards.
Companies should not pay any costs associated with
individuals accompanying invited healthcare professionals.
Informational Presentations by Company Representatives
In order to provide important scientific information and to
schedules and provide patient care, Company
representatives may take the opportunity to present
information during healthcare ,
including mealtimes, in accordance with applicable laws
and regulations.
Entertainment
Companies should not provide any form of entertainment
or recreational items, such as tickets to the theater or
sporting events, sporting equipment, or leisure or vacation
trips, to any healthcare professional.
Such entertainment or recreational benefits should not be
offered, regardless of
o The value of the items
o Whether the Company engages the healthcare
professional as a speaker or consultant
o Whether the entertainment or recreation is
secondary to an educational purpose.
No standalone entertainment or other leisure or social
activities should be provided or paid for by Companies. At
events, entertainment of modest nature, which is
secondary to refreshments or meals, is allowed.
S T
Educational Items and Gifts
Payments in cash or cash equivalents (such as gift
certificates) or gifts for the personal benefit of healthcare
professionals should not be provided or offered to
healthcare professionals.
It is appropriate for Companies, where permitted by law or
local codes of ethics, to offer items designed primarily for
the education of patients or healthcare professionals if the
items are of modest value and do not have value to
healthcare professionals outside of his or her professional
responsibilities.
These items should not subsidize normal routine operations
of a medical practice.
Support for Continuing Medical Education
Helps physicians and other medical professionals to obtain
information and insights that can contribute to the
improvement of patient care and the medical practice.
CME grant decisions to ensure that programs funded are
bona fide and quality educational programs that financial
support is not an inducement to prescribe or recommend a
particular medicine or course of treatment
Samples
When used appropriately, samples can be an important tool
for healthcare professionals and provide benefit to patient
health outcomes.
Companies should have adequate systems of control and
accountability for samples provided to healthcare
professionals including how to look after such samples
while they are in possession of medical representatives.
Samples should not be used as payment for services, return
for favorable treatment, or other inappropriate
inducements.
Consultant and Speaker Arrangements
The following factors support the existence of a bona fide
consulting or speaking arrangement (not all factors may be
relevant to any particular arrangement):
o A written contract specifies the nature of the
services to be provided and the basis for payment
of those services
o A legitimate need for the services has been clearly
identified in advance of requesting the services
and entering into arrangements with the
prospective consultants
o The criteria for selecting consultants and speakers
are directly related to the identified purpose, and
the persons responsible for selecting the
consultants and speakers have the expertise
necessary to evaluate whether the particular
healthcare professionals meet those criteria
o The number of healthcare professionals retained
is not greater than the number reasonably
necessary to achieve the identified purpose
o The retaining Company maintains records
concerning, and makes appropriate use of, the
services provided
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Ethics and the Pharmaceutical Industry
o The venue and circumstances of any meeting with
consultants or speakers are conducive with the
primary focus of the meeting; specifically, resorts
are not appropriate venues.
Clinical trials should not be used as inappropriate
inducements for past or future sales.
Clinical trials should be undertaken in an ethical manner,
without undue influence by competitors.

Compliance Procedures and Responsibilities

It is the responsibility of Companies to ensure that internal
compliance procedures exist that facilitate compliance with
these Principles and the spirit they embody.
These procedures should be documented and provided to
employees to further enhance compliance.

Conduct and Training of Company Representatives

Companies should ensure that all representatives who are
employed by or acting on behalf of the companies, and who
visit healthcare professionals, receive training about the
applicable laws, regulations and industry codes of ethics

healthcare professionals.
In addition, companies should train their representatives to
ensure that they have sufficient knowledge of general
science and product-specific information to provide
accurate, up-to-date information, consistent with
applicable laws and regulations.
Companies should provide updated or additional training in
all of the areas needed for their representatives who visit
healthcare professionals.
Companies should also assess their representatives
periodically to ensure that they comply with relevant
Company policies and standards of conduct.
Companies should take appropriate action when
representatives fail to comply with relevant Company
policies that are consistent with these Principles and
national and local industry codes of ethics.

D. PUBLIC SECTOR RELATIONSHIPS AND PROCUREMENT

The decision-making process by Companies and
Governments during and including the government
procurement process, through bidding or any other
procedure of government procurement, must be
professional and ethical. There should be no attempt to
exert inappropriate influence.
Companies must provide accurate and balanced
information to the Government.
Companies and government officials should ensure that
their relationships and fee-for-service arrangements
comply with government ethics rules or procedures.

E. CLINICAL TRIALS
All clinical trials (phases I to IV) and scientific research
involving patients sponsored or supported by companies
will be conducted with the intent to develop bona fide
scientific knowledge that will benefit patients and advance
science and medicine.
o Companies must ensure transparency and
accountability in the presentation of research
and publication of study results.

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 CLINICAL BIOETHICS
HUMAN DIGNITY & HUMAN RIGHTS
Dr. Angel Erich Sison
ARTICLE 3: HUMAN DIGNITY AND HUMAN RIGHTS
1. Human dignity, human rights and
fundamental freedoms are to be fully
respected.
2. The interest and welfare of the individual
should have priority over the sole interest
of science or society.
HUMAN RIGHTS
Moral principles or norms that describe
certain standards of human behavior
and are regularly protected in
municipal and international law.
Commonly understood as inalienable.
*Inalienable: unable to taken away by
possession.
Fundamental rights
inherently entitled simply because she
and which are
, from each other
regardless of their age, ethnic origin,
location, language, religion, ethnicity, or
other status.
*Group of rights that have been recognized by
the Supreme Court as a requiring of high
degree of protection from government
encroachment.
OTHER VALUES THAT CAN BE DERIVED FROM THE
2 FUNDAMENTAL VALUES OF HUMAN RIGHTS
(HUMAN DIGNITY AND EQUALITY)
Freedom: Human will is an important
part of human dignity
Respect for others: Lack of respect for
someone fails to appreciate their
individuality and essential dignity.
Non-discrimination: Equality in human
dignity mean we should not judge
rtunities on the
basis of their characteristics.
Tolerance: Intolerance indicates a lack
of respect for difference, and equality
does not signify uniformity.
Justice: People equal in their humanity
deserve fair treatment.
Responsibility: Respecting the rights of
actions and exerting effort for the
realization of the rights of one and all.
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CHARACTERISTICS OF HUMAN RIGHTS
Human rights are inalienable
o You cannot lose them because
they are linked to the very fact of
human existence.
o Inherent to all human beings
o May be suspended or restricted
Found guilty of a crime:
liberty can be taken away
In times of national
emergency: imposing
curfew restricting freedom
of movement.
Human Rights are indivisible,
interdependent and interrelated
o Different human rights are
intrinsically connected
o Cannot be viewed in isolation
o They enjoyment of one right
depends on the enjoyment of
many other rights.
o No one right is more important
than the rest.
Human Rights are universal
o Apply equally to all people
everywhere in the world with no
time limit.
o Every individual is entitled to
enjoy his or her human rights
without distinction
ethnic background, color, sex,
sexual orientation, disability,
language, religion, political or
other opinion, national or social
origin, birth or other status
o Universality is not unanimous with
uniformity.
HUMAN RIGHTS (UDHR)
The states have obligations and duties
under international laws to respect,
protect and fulfil human rights.
Meanwhile as individuals, while we are
entitled to our human rights, we should
also respect and stand for the human
rights of others.
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 CLINICAL BIOETHICS
HUMAN DIGNITY & HUMAN RIGHTS
Dr. Angel Erich Sison
The obligation to respect:
The states must refrain from interfering
with or curtailing the enjoyment of
human rights
The obligation to protect:
Requires the states to protect individuals
and groups against human rights
abuses.
The obligation to fulfil:
The state must take positive action to
facilitate the enjoyment of basic human
rights.
HUMAN DIGNITY
Dignity is the right of a person to be
valued and respected for their own
sake, to be treated ethically.
o It is of significance in morality,
ethics, law and politics as
extension of the Enlightenment
era concepts of inherent,
inalienable rights
o The term may also be used t
describe personal conduct, as in
CONCEPTS OF HUMAN DIGNITY
Classical Antiquity
Dignity as deserving of honor and
esteem according to personal merit,
inherited or achieved.
In ancient Greek philosophy, particularly
of Aristotle and the Stoics, dignity was
associated with human abilities of
deliberation, self-awareness, and free
decision-making.
World Religions
In many world religions, human dignity is
considered to be predetermined by the
creation of human beings in the image
of God.
Those who are weak in body and soul
have dignity equal to those who are
robust and sturdy.
A few of the verses in religious texts that
speak to the Principle of Respect for
Human Dignity:
o Islam:
honoured the descendants of
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o Christianity:
that you are the Temple of God?
(Corinthians 3:16)
o Judaism:
image of God, God created
o Buddhism:
without exception have the
Buddha-
o Hinduism:
Modern Philosophy
Modern philosophy proposed secular
understanding of human dignity and
progressively associated this concept
with the idea of human rights.
In different teachings, human dignity
was presented as:
o An aspect of personal freedom
(Giovanni Pico Della Mirandola)
o public
worth (Thomas Hobbes)
o As universal virtue, unconditional
and incomparable worth
autonomy
rather than origin, wealth, or
social status. (Immanuel Kant)
-
to treat any other person always at the
same time as an end, never merely as a
means
o Categorical imperative- has
been accepted by moral and
political philosophy as the actual
basis for the conception of
human rights and in the sense its
is a foundational concept.
Contemporary International Law
In contemporary international law,
national constitutions, and other
normative documents, human dignity is
strongly connected with human rights.
According to Art. 1 of the Universal
Declaration of Human Rights (1948):
human beings are born free and
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 CLINICAL BIOETHICS
HUMAN DIGNITY & HUMAN RIGHTS
Dr. Angel Erich Sison
The Declaration establishes human rights
(like freedom from repression, freedom
of expression and association) on the
inherent dignity of every human beings
THE EUROPEAN CONVENTION ON HUMAN
RIGHTS AND BIOMEDICINE IN ART.1
Declares protection of the dignity and
identity of all human beings and
guarantees everyone, without
discrimination, respect for their integrity
and other rights and fundamental
freedoms with regard to application of
biology and medicine as its main
purpose.
THE NOTION OF HUMAN DIGNITY
The notion of human dignity expresses
the intrinsic value of the person capable
of:
o Reflection- part of learning
o Sensitivity-
might be easily offended or hurt
o Verbal communication- use of
words to convey a message, to
share information to other people
o Free choice-
opportunity and autonomy to
perform an action selected from
at least two available options.
Ability or discretion to choose.
o Self determination in conduct
and creativity- skills, knowledge
and beliefs
Unlike material values or financial prices,
human dignity has no external
equivalent; it is an end in itself
All human beings are equal in dignity
irrespective of:
o Gender
o Age
o Social status
o Ethnicity
presupposes active respect for his/her
human rights, self esteem and self
determination, as well as for his/her
privacy, protecting him/her from
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illegitimate intrusions and preserving
his/her valid public space.
A society or a community should
respect each of its members as a
person or a moral agent on the basis of
the notion of human dignity.
This notion also requires that the interests
and welfare of the individual are
considered as prior to the sole interest of
society, community, or any particular
kind of publicly wholesome activity.
The emphasis on
is important.
It implies that because of his/her human
dignity, the individual should never be
sacrificed for the sake of science (as
has happened in totalitarian regimes)
There might be exceptional
circumstances in which the interest of
other or the community as a whole are
so important that infringing upon the
interests of individuals is unavoidable in
order to save others or the community.
An example is the dread of deadly
pandemic.
Human dignity is a foundational
concept and it is theoretically and
normatively inappropriate to reduce it
to functional characteristics of a
making or taking into account of the
autonomy.
Respect for dignity means recognition of
In a comparative view, human dignity
has diverse forms in different cultural
and ethical traditions (for example,
Confucian, Judeo-Christian, Muslim)
and is respected in various ways in
different types of societies (traditional,
modern, totalitarian democratic).
It is less respected in totalitarian
societies and more respected in modern
and democratic societies.
Regardless of cultural, confessional, and
political varieties human dignity is
-
awareness and appropriate respectful
treatment towards her
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 CLINICAL BIOETHICS
HUMAN DIGNITY & HUMAN RIGHTS
Dr. Angel Erich Sison

As it is emphasized in the Declaration,

be invoked to infringe upon human

dignity, human rights and fundamental
(See article 12).

DIGNITY AND HEALTH CARE PROVIDER

RELATIONS
Health Care Provider- Patient relations
are just one kind of human relations,
presupposing all ethical requirements.
Inequality in status of the health care
provider and the patient may be
aggravated in special cases when
patients are:
o Children
o Handicapped individuals
o Elderly persons
Particularly risky are cases of patients
who are mentally handicapped.
Special attention in regard to human
dignity and human right is required in
palliative treatment of terminal patients

Though there is no consensus either in

public or in the expert community
concerning the ethical and legal status
of the embryos and fetuses, the latter
should be treated with respect and
care.

REFERENCES:
-
DISCLAIMER: The content of this transcription is from the references
mentioned above. If you have any correction / objection, feel free to do

USE AT YOUR OWN RISK!

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 CLINICAL BIOETHICS
RESPECT FOR HUMAN VULNERABILITY AND HUMAN INTEGRITY
Dr. Angel Erich Sison
NOTION OF VULNERABILITY
- (Beauchamp and Childress, 2001:63)
Susceptibility of being wounded
1978 Belmont Report: Ethical Principles
and Guidelines for the Protection of
Human Subjects of Research
o Refers to individuals and
populations
o - need for
protection
Target Groups:
1. Racial minorities
2. Economically disadvantaged
3. Very sick
4. Institutionalized
May continually be sought as research
subjects, owing to their ready availability
in setting where research is conducted.
Given their dependent status and their
frequently compromised capacity for
free consent.
They are easy to manipulate as a result
of their illness or socioeconomic
condition.
Target Groups:
danger of being involved in research
Throughout the first half of the 20th century,
these vulnerable members of the population
have been used in unethical research studies:
Institutionalized groups of persons like
orphans
Prisoners, the elderly and, later Jews
Other ethnic groups, considered as
inferior and even subhuman by the
Nazis
Persons such as Chinese, who were
exploited by the Japanese in order to
pursue their scientific and military
objectives
Ethnic minorities
Socially underprivileged groups and
women
by reinforcing the principle of autonomy and
of the consequent demand, increasingly more
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inclusive and stricter, for informed consent
Vulnerability expresses two basic ideas:
(Barcelona Declaration, 1998)
a) It expresses the finitude and fragility of
life which, in those capable of
autonomy, grounds the possibility and
necessity for all mortality
b) Vulnerability is the object of a moral
principle requiring care for the
vulnerable. The vulnerable are those
whose autonomy or dignity or integrity is
capable of being threatened.
In applying and advancing scientific
knowledge, medical practice and
associated technologies, human
vulnerabilities should be taken into
account.
Individuals and groups of special
vulnerability should be protected and
the personal integrity of such individuals
respected.
The notion of vulnerability is not just a
neutral description of the human
condition but instead a normative
prescription to take care of the
vulnerable that is characteristics of
human beings
Ethics is more than respecting individual
choices and decisions; it aims at care
for the other.
ASPECTS OF VULNERABILITY
1. Biological or corporeal vulnerability
This concerns the fragility of the human
organism originating from:
Natural threats that are coming from
our biology; aging, susceptibility to
illness and disease, and death
Environmental and other natural and
man-made threats: famine,
earthquake, hurricanes, pollution
and environmental disasters
2. Social Vulnerability
The fragility of the human capacity for
sharing goods and services
Social threats stemming from war
and crime, prejudice and
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 CLINICAL BIOETHICS
RESPECT FOR HUMAN VULNERABILITY AND HUMAN INTEGRITY
Dr. Angel Erich Sison
discrimination, cruelty and
indifference
Persons also become vulnerable due
to hospitalization and
institutionalization
Social circumstances and conditions
3. Cultural Vulnerability
Concerns the fragility of particular
traditions and conceptions of values
that are typical for a community or
local cultures.
THE POWERS OF MEDICINE: FIGHTING VULNERABILITY
A common idea is that the vulnerability of the
human condition should be eliminated or
reduced.
1. Science and technological
innovations should be used to
overcome the natural threats
2. Medical research should be focused
on eliminating the biological threats
to the human body.
The basic assumption behind this
fight is that many vulnerabilities of
the human conditions are
contingent, not inherent
This fight has been successful but at
the same time is failures
Life expectancy and health have
improved, poverty and starvation
reduced.
But at the same time, many people
still die from common diseases, life
expectancy is decreasing in many
countries, poverty is still widespread.
An unrestrained fight against human
vulnerability generates its own
problems.
o Not the struggle against
human vulnerability but the
struggle to rid the human
condition of all vulnerability
For a sustainable medicine it is
necessary to accept some
vulnerability as a permanent part of
the human condition.
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PROBLEMS VS FIGHT AGAINST VULNERABILITY
Religion, alternative medicine and
traditional knowledge present different
ways of knowing and valuing.
o Because they are open to
different perspectives.
They can give meaning to
vulnerability
But their views are
generally not accepted
by mainstream science or
bioethics.
Economic problems, the success of
science and technology has related
financial difficulties in almost all
countries in achieving decent levels of
health care for the population.
o Because of its continuous fight
against vulnerability, medicine
often is
Medical progress itself has created new
forms of vulnerability, i.e. chronic illness.
o This presents continuing
vulnerability for a growing
population-aging population
DILLEMA OF VULNERABILITY
Requires a balance between
eliminating and accepting human
vulnerability.
Disability
It is viewed as abnormal and the
disabled therefore are by definition
vulnerable; at the same time the
disabled should not be stigmatized by
being treated as abnormal.
Death
In medicine the place of death in
human life is ambivalent; in palliative
care, death is understood as being part
of life; in some other sectors of medicine
death is still treated as the enemy.
Depression
Prozac is widely used an an anti-
depressant drug, when there are clear
clinical symptoms of depression
At the same time it is regarded as
medication for unhappiness and
sadness
2|Page
 CLINICAL BIOETHICS
RESPECT FOR HUMAN VULNERABILITY AND HUMAN INTEGRITY
Dr. Angel Erich Sison
Human suffering and misery
Express human vulnerability
They also pose a challenge
We must at the same time struggle to
keep suffering to a minimum and also
accept it as part of life.
CARE ETHICS
The challenge of human vulnerability is
that it can never be entirely eliminated
from human life. Instead, it should inspire
new approaches in bioethics.
The human condition requires solidarity;
human beings all share common
vulnerabilities
Human vulnerability also leads to an
ethics of care.
Because it is a shared characteristics, it s
also a source of concern for others as
well as awareness that we rely on
others.
It is the basis for the duty to care for
those threatened by biological, social
and cultural threats as well as by the
power of medicine itself.
NOTION OF PERSONAL INTEGRITY
Integrity
Latin origin verb tangere which means
Ths is the root both of the
adjective integer, which means
integiritas which means
state in which all the parts are
maintained and the quality of which all
the parts are maintained and the quality
of that which is unaltered.
This was confirmed in 1996, in the
Declaration of Helsinki, in which the
noun
an attribute of the
recognized inviolability of the subject of
experimentation, which should not be
psychologically.
Circle of Willis
1. The right of the research subject to
safeguard his or her integrity must
always be respected.
2. Every precaution should be taken to
respect the privacy of the subject
and to minimize the impact of the
study physical and
mental integrity and on the
personality of the subject.
The principle of respect for human
vulnerability is related to the notion od
personal integrity; this is mentioned in
the last part of Article 8.
Integrity concerns the wholeness of an
individual
In ethical discourse, integrity is often
considered as a virtue, related to the
example.
But respect for personal integrity in this
article does n
moral character or his/her good
behaviour. It refers to fundamental
aspects of a human life that should be
respected.
Personal integrity refers here to respect
her own life and illness, but also for
his/her interests and free will.
In the field of health policies, the principle of
vulnerability demands, both at the social and
international level:
1. Benefit of some should not be attained
by exploiting the weakness of others
2. Those of bio-industries must not
aggravate human vulnerability but
rather seek to eliminate it as far as
possible and to respect what is beyond
their reach.
At the level of experimentation:
1. It demands protection which goes
beyond that which can be expressed in
informed consent of the body r part of
the body and demands respect for
personal identity in the relationship
between the subject of experimentation
and the researcher.
2. Between patient and doctor, at the
level of clinical assistance:
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 CLINICAL BIOETHICS
RESPECT FOR HUMAN VULNERABILITY AND HUMAN INTEGRITY
Dr. Angel Erich Sison

Respect for integrity demands new o Holistic methodology

forms of communication.
Allows the doctor to focus more on Basic Principles of Environmental Ethics
the patient than the illness Respect for Nature
o Facilitates the involvement of o The prosperity of human beings
the patient in his own depends on the prosperity of
therapeutic process as a nature. Human beings are part of
partner in the health team. nature. They have therefore the
o Development of therapies duty to conserve and protect the
which are perceived less integrity of the ecosystem and its
invasive and more respectful bioadversity.
of the individual, for example
at a cultural or religious level. Non-anthropocentric Environmental Ethics
In the field of Health Policies, the principle can Intergenerational Justice
play an important role in the: o Every generation should have the
Prohibition of commercializing human following generation an equal
body parts opportunity to live a happy life,
Regulation of genetic manipulation, and should therefore bequeath a
particularly in safeguarding the human healthy earth.
genome. REFERENCE:
Consideration of patentable human -
matter
DISCLAIMER: The content of this transcription is from the references
ETHICAL PERSPECTIVES mentioned above. If you have any correction / objection, feel free to do
Anthropocentric Environmental Ethics:
Human-centered Ethics USE AT YOUR OWN RISK!
o Human beings have moral duties #MD2023
only towards one another
o Human interests prevail over the
interests of other species.
Non-anthropocentric Environmental Ethics
Biocentric: Other living organisms have
intrinsic value
o
i.e subjects that are entitled to
moral consideration
o It is therefore an ethical
imperative to respect all life
forms.
o All organisms have intrinsic value
o More related to non-western
cultural traditions.
Eccocentric: ecosystems have intrinsic
value as well
o

o All organisms and entities in the

ecosphere, as parts of the
interrelated whole, are equal in
intrinsic value
Circle of Willis 4|Page
Clinical Bioethics
Ethics and the Pharmaceutical Industry
Jena Angela T. Perano, MD | AY 2020-2021
PAGBABALANGKAS NG ARALIN
I. Physicians and the Pharmaceutical Sector
II. The Mexico City Principles for Voluntary Codes of Business
Ethics in the Biopharmaceutical Sector
A. The Six Principles
B. Interactions with Healthcare Professionals
C. Promotional Information and Activities
D. Public Sector Relationships and Procurement
E. Clinical Trials
I. PHYSICIANS AND THE PHARMACEUTICAL SECTOR
A conflict of interest exists in medicine when the following
conditions have all been met:
o The physician has a duty to advocate for the
interests of the patient (or public).
o The physician is also subject to other interests
her own, or those of a third party.
o The physician becomes a party to certain social
arrangements.
o Those arrangements, as viewed by a reasonable
onlooker, would tempt a person of normal human
interests in favor of the
II. THE MEXICO CITY PRINCIPLES
B includes companies,
regardless of ownership status, that develop, manufacture,
market, or distribute pharmaceutical and/or biologic
products.
o Such products are also referred to in these
Principles as "medicines."
Ethical interactions help ensure that medical decisions are
made in the best interests of patients
For relationships with healthcare professionals and other
stakeholders to meet this standard, companies in the
biopharmaceutical sector
by these six principles:
A. THE SIX PRINCIPLES
Healthcare and Patient Focus
o Everything we do is intended to benefit patients
Integrity
o Dealing ethically, honestly, and respectfully in
everything we do.
Independence
o Respect the need of autonomous decision-
making of all parties, free from improper
influence.
Legitimate Intent
o Everything we do is for the right reasons, is lawful,
and aligns with the spirit and the values of these
Principles.
S T | Batch 2022: The Google Doks
Transparency
o A general willingness to be open about our
actions while respecting legitimate commercial
sensitivities and intellectual property rights.
Accountability
o A willingness to be responsible for our actions and
interactions.
B. INTERACTIONS WITH HEALTHCARE PROFESSIONALS
Interactions between companies and healthcare
professionals provide valuable scientific, clinical, product,
and policy information about medicines that may lead to
improved patient care.
Appropriate marketing is critical to achieving these goals
because they enable companies to:
o Inform healthcare professionals about the
benefits and risks of medicines to help advance
appropriate patient use
o Provide scientific and educational information
o Support medical research and education
o Obtain feedback and advice about our products
through consultation with medical experts.
All interactions with healthcare professionals are to be
conducted in a professional and ethical manner.
o Healthcare professionals must not be improperly
influenced by companies.
o Nothing should be offered or provided by a
Company in a manner that inappropriately
influences a healthcare professional's
prescribing practices.
o Education and promotional activities should
encourage the appropriate use of medicines by
presenting them objectively and without
exaggerating their properties
o Relationships between Company personnel and
healthcare professionals should encourage the
development of a medical practice committed to
and be based on truthful,
accurate, and updated scientific evidence.
C. PROMOTIONAL INFORMATION AND ACTIVITIES
No medicines shall be promoted for use in a specific
economy until the requisite approval for marketing for such
use has been given in that economy.
Promotion should be consistent with locally approved
product information.
Promotional information should be clear, legible, accurate,
balanced, fair, objective, and sufficiently complete to
enable healthcare professionals to form his or her own
opinion of the therapeutic value of the medicines
concerned.
Safety of Medicines
Medicines provided by Companies will conform to high
standards of quality, safety and efficacy as determined by
regulatory authorities in each economy in which they
operate.
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Clinical Bioethics
Ethics and the Pharmaceutical Industry
Companies will report adverse events or adverse drug
reactions to regulatory authorities, subject to applicable
laws and regulations.
Symposia and Congresses
The purpose and focus of all symposia, congresses or (an
organized or
sponsored by a Company should be to inform healthcare
professionals about products and/or to provide scientific or
educational information.
Company relationships with healthcare professionals are
regulated by multiple entities and intended to benefit
patients and to enhance the practice of medicine.
Any sponsorship provided to individual healthcare
professionals must not be conditional upon an obligation
to prescribe, recommend, or promote any medicine.
All Events should be held in an appropriate venue that is
conducive to the scientific or educational objectives and the
purpose of the Event or meeting. Companies should avoid
using extravagant venues or resorts.
Hospitality should be limited to refreshments and/or meals
incidental to the main purpose of the Event and should only
be provided:
o To participants of the Event and not their guests
o Is moderate and reasonable as judged by local
standards.
Companies should not pay any costs associated with
individuals accompanying invited healthcare professionals.
Informational Presentations by Company Representatives
In order to provide important scientific information and to
schedules and provide patient care, Company
representatives may take the opportunity to present
information during healthcare ,
including mealtimes, in accordance with applicable laws
and regulations.
Entertainment
Companies should not provide any form of entertainment
or recreational items, such as tickets to the theater or
sporting events, sporting equipment, or leisure or vacation
trips, to any healthcare professional.
Such entertainment or recreational benefits should not be
offered, regardless of
o The value of the items
o Whether the Company engages the healthcare
professional as a speaker or consultant
o Whether the entertainment or recreation is
secondary to an educational purpose.
No standalone entertainment or other leisure or social
activities should be provided or paid for by Companies. At
events, entertainment of modest nature, which is
secondary to refreshments or meals, is allowed.
S T
Educational Items and Gifts
Payments in cash or cash equivalents (such as gift
certificates) or gifts for the personal benefit of healthcare
professionals should not be provided or offered to
healthcare professionals.
It is appropriate for Companies, where permitted by law or
local codes of ethics, to offer items designed primarily for
the education of patients or healthcare professionals if the
items are of modest value and do not have value to
healthcare professionals outside of his or her professional
responsibilities.
These items should not subsidize normal routine operations
of a medical practice.
Support for Continuing Medical Education
Helps physicians and other medical professionals to obtain
information and insights that can contribute to the
improvement of patient care and the medical practice.
CME grant decisions to ensure that programs funded are
bona fide and quality educational programs that financial
support is not an inducement to prescribe or recommend a
particular medicine or course of treatment
Samples
When used appropriately, samples can be an important tool
for healthcare professionals and provide benefit to patient
health outcomes.
Companies should have adequate systems of control and
accountability for samples provided to healthcare
professionals including how to look after such samples
while they are in possession of medical representatives.
Samples should not be used as payment for services, return
for favorable treatment, or other inappropriate
inducements.
Consultant and Speaker Arrangements
The following factors support the existence of a bona fide
consulting or speaking arrangement (not all factors may be
relevant to any particular arrangement):
o A written contract specifies the nature of the
services to be provided and the basis for payment
of those services
o A legitimate need for the services has been clearly
identified in advance of requesting the services
and entering into arrangements with the
prospective consultants
o The criteria for selecting consultants and speakers
are directly related to the identified purpose, and
the persons responsible for selecting the
consultants and speakers have the expertise
necessary to evaluate whether the particular
healthcare professionals meet those criteria
o The number of healthcare professionals retained
is not greater than the number reasonably
necessary to achieve the identified purpose
o The retaining Company maintains records
concerning, and makes appropriate use of, the
services provided
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Clinical Bioethics
Ethics and the Pharmaceutical Industry
o The venue and circumstances of any meeting with
consultants or speakers are conducive with the
primary focus of the meeting; specifically, resorts
are not appropriate venues.
Clinical trials should not be used as inappropriate
inducements for past or future sales.
Clinical trials should be undertaken in an ethical manner,
without undue influence by competitors.

Compliance Procedures and Responsibilities

It is the responsibility of Companies to ensure that internal
compliance procedures exist that facilitate compliance with
these Principles and the spirit they embody.
These procedures should be documented and provided to
employees to further enhance compliance.

Conduct and Training of Company Representatives

Companies should ensure that all representatives who are
employed by or acting on behalf of the companies, and who
visit healthcare professionals, receive training about the
applicable laws, regulations and industry codes of ethics

healthcare professionals.
In addition, companies should train their representatives to
ensure that they have sufficient knowledge of general
science and product-specific information to provide
accurate, up-to-date information, consistent with
applicable laws and regulations.
Companies should provide updated or additional training in
all of the areas needed for their representatives who visit
healthcare professionals.
Companies should also assess their representatives
periodically to ensure that they comply with relevant
Company policies and standards of conduct.
Companies should take appropriate action when
representatives fail to comply with relevant Company
policies that are consistent with these Principles and
national and local industry codes of ethics.

D. PUBLIC SECTOR RELATIONSHIPS AND PROCUREMENT

The decision-making process by Companies and
Governments during and including the government
procurement process, through bidding or any other
procedure of government procurement, must be
professional and ethical. There should be no attempt to
exert inappropriate influence.
Companies must provide accurate and balanced
information to the Government.
Companies and government officials should ensure that
their relationships and fee-for-service arrangements
comply with government ethics rules or procedures.

E. CLINICAL TRIALS
All clinical trials (phases I to IV) and scientific research
involving patients sponsored or supported by companies
will be conducted with the intent to develop bona fide
scientific knowledge that will benefit patients and advance
science and medicine.
o Companies must ensure transparency and
accountability in the presentation of research
and publication of study results.

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Clinical Bioethics
Article 13: Solidarity and Cooperation
Arnel V. Herrera, MD, FPAFP |26 October 2019
I. Notion of Solidarity
II. Level of Solidarity
III. Threats to Solidarity
IV. Solidarity and Cooperation
V. Solidarity and Interdependence
VI. Cooperation
VII. Morality of Cooperation
VIII. Relationship of Solidarity, Autonomy, and Justice
IX. Good Samaritan Law
I. NOTION OF SOLIDARITY
What do you associate with this notion?
Mutual respect
Support of the weak and vulnerable (ex: very young
and the very old, pregnant patients)
Commitment to a common cause or the common
good belonging together (ex.: no to drugs, no to
smoking)
Mutual understanding shared responsibility
Solidarity is applicable in the context of health care systems.
Solidarity is showing personal and social concern for vulnerable
groups like the chronically ill, the handicapped, political
refugees, immigrants and the homeless.
(Everyone is obliged to make a fair financial contribution to a
collective, organized insurance system and that is an example of
solidarity.)
Example is universal health care. All of us are titled for free
services, either you are the ones who are paying or non-paying.
Even though you are non-paying you are enrolled to Philhealth.
This is an example of solidarity. We are all enrolled under
Philhealth, either we are contributing or not.)
From an ethical perspective, solidarity is a moral value focused
on providing support to those who need it. However,
distinction should be made between two forms of solidarity:
A. SOLIDARITY AS AN INSTRUMENTAL VALUE
Solidarity as self interest, reciprocal solidarity. The
enlightened self interest of rationally calculating
individuals motivates them to cooperate.
(ex.: Others contribute voluntarily to their Philhealth, SSS,
Pag-
investment.)
B. SOLIDARITY AS A MORAL VALUE
Group oriented responsibility to care for the weaker and
more vulnerable members of the community. Known as
it is the expression of an ethics
of commitment, a sense of responsibility towards the most
vulnerable in the society. Not self interest but the
interest of others motivates cooperation.
others.)
S1T1 |TPerez, Quiban, Quitalig, Enjelrivers
Solidarity has to be directed at the promotion of health and
o Quality of health care
o Sufficient water and nutrition:
(30%of pre-school children are still stunted.)
o Favourable life and environmental circumstances
(Climate change, illegal mining, etc.)
o Elimination of marginalization and exclusion
(Nagkaroon ng party list because they want
the marginalized people to be represented but
s not working because those who loose in
the previous elections used party list as a
platform for them to become congressman.)
o Diminishing poverty and illiteracy
(According to WHO, 96.5% of the Filipinos are
literate HOWEVER we are still a poor country;
22million Filipinos are below the poverty line, )
II. LEVEL OF SOLIDARITY
LEVEL 1: INTERPERSONAL LEVEL
Refers to manifestations of willingness to carry costs to
assist others.
upbringing; probably you saw it from your parents. They
modelled their willingness to help why
)
LEVEL 2: GROUP PRACTICES
Refers to manifestations of collective commitment to
carry costs to assist others.
(ex.: organize a medical mission)
LEVEL 3: CONTRACTUAL LEVEL
Refers to legal provisions and contractual norms.
(There is a legally and forced agreement between two or
more parties. Best example is insurance system there are
obligations and agreement.) Ex. Phil health is considered
as an example of contractual level.
III. THREATS TO SOLIDARITY
Increasing demands for expensive treatments for instance due
to the aging of populations; the range of options for individuals
has enlarged.
(Aging population is a threat because for example in Philhealth,
there is continuous giving of pensions. Those who are in working
class will take the burden. Their contribution will increase.)
Changing and more demanding attitudes of clients, related to
increasing individualization of societies with increasing stress
on the moral significance of individual autonomy.
(All of us are free to choose the lifestyle we prefer. However,
your paying healthcare system is socialized. You chose the right
lifestyle compared to the other person that is very carefree in
choosing lifestyle and yet you are paying for his health
insuran
socialized.)
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Clinical Bioethics
Article 13: Solidarity and Cooperation
Shift towards more private financial responsibility and B. RELATIONSHIP OF SOLIDARITY, AUTONOMY AND JUSICE
increasing pressure of market ideology. Solidarity goes beyond justice.
Erosion of local communities and extended family networks Justice is a matter of obligation from one free individual to
changing personal and social relationships. another; it is based on the shared interest of preserving the
(The threat here is increasing individual autonomy.) requisite amount of freedom for all citizens
Solidarity indicates that vulnerability and need have to be Solidarity is not necessarily a legal obligation.
addressed, by means of active cooperation. Solidarity does not necessarily restrict autonomy
The concept of cooperation indicates a realization of
interdependence which implies the knowledge that the DO OFF DUTY DOCTORS HAVE TO HELP IN AN EMERGENCY
individual, group or community is sometimes powerless in the SITUATION?
presence of greater national and global problems. No, an off-duty doctor has no affirmative duty to provide
(ex.: poverty, obesity risk factor for diabetes and hypertension) medical assistance to injured persons.
Tackling the problems together has a better chance of making
an impact and bringing about change. (Should be involved the REASONS DOCTORS ARE OFTEN RELUCTANT TO ATTEND TO
stockholders.) EMERGENCIES:
Harbouring apprehensions about having to visit police stations
IV. SOLIDARITY AND INTERDEPENDENCE Being called to court repeatedly as witness, sometimes facing
long and unnecessary cross examination.
Losing earning hours
Demands equal and equitable development for all; problems
Good Samaritan Law- works under the following
identified:
conditions
1. The increasing gap between developing and developed
o Act in good faith
countries indicates the absence and continuing
o Not receive compensation
disregard for solidarity.
o Avoid grossly negligent conduct
2. The current global economic and political structure that
(Here in the Philippines, there is no Good Samaritan Law.
allows the developed countries to progress
We only have Good Samaritan Act, implied only.)
exponentially while impoverishes the developing/under-
developed countries clearly indicate the unequal and
unfair treatment to all. Notes:
3. As long as there are sectors of society who feel 1. Black Power point
exploited and oppressed clearly indicate that such 2. Blue recordings
society violates the principle of solidarity and 3. Red additional notes (nabanggit niya na may Penal
interdependence. (Sectors of society who are exploited Code ditto sa Philippines about sa punishment in
women, sexual exploitation) abortion pero di nya matandaan yung exact number
ng article
V. COOPERATION
REFERENCES
Cooperation does not only refer to charity, altruism (unselfish
1.
act of kindness) and philanthropy but also refers to
2.
symmetrical relations and capacity.
3. https://en.wikipedia.org/wiki/Abortion_in_the_Philippines
(Philanthropist you give to human causes on large scale,
4. https://reproductiverights.org/world-abortion-
more than giving to a charity. You want to improve human
laws/philippines-abortion-provisions
welfare. For example, Bill Gates donated to eradicate Malaria
in Africa and also donated to eliminate Polio)
Solidarity is not -
during which the givers and receivers of solidarity work
together as equals, and equipment and tools are given to
people in need to enable them to escape the vulnerable
situation in a sustainable way.

A. MORALITY OF COOPERATION
Formal cooperation in evil act is never allowed. (Ex:
cheating) Immoral operations such as abortion shall not be
participated upon by a nurse even if the doctor commands.
(Articles 256, 258 and 259 of the Revised Penal Code of
the Philippines mandate imprisonment for women who
undergo abortion, as well as for any person who assists in
the procedure.)

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Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
Lourdes Carpena-Medalla MD| 14 September 2019

I. ARTICLE 9: PRIVACY AND CONFIDENTIALITY

Premise:
of their personal information should be respected. To the greatest
extent possible, such information should not be used or disclosed for
purposes other than those for which it was collected or consented to,
consistent with international law, in particular international human
A. PRIVACY
The right of an individual or a group to be free from
intrusion or meddling from others, and includes the right to
determine which information about them should be
disclosed to others.
1. Confidentiality
An attribute of person information requiring that it not be disclosed
to others without sufficient reason
The basic principles and values of Article 9 emerge from
Universal Declaration of Human Rights of 1948.
The concept of CONFIDENTIALITY is already stated in the
Hippocratic Oath.
The DIGNITY and AUTONOMY of the person, being an
integral part of rights and fundamental freedoms of human
beings, has to be recognized and respected in an effective
and universal manner.
CULTURAL & PSYCHO-SOCIAL FACTORS of persons and
social groups have to be considered.
ARTICLE 9 is related to AUTONOMY & CONSENT. Here is the
content of the article according to UNESCO, 2005.:
1. A right to privacy guarantees control over personal
information in various ways. Privacy extends beyond data
protection, as certain private spheres of the individual that
are not manifested in data processing can also be protected
by the right to privacy.
2. Confidentiality refers to a special and often fiduciary
relationship between researchers, doctors and patients
provided that the shared information shall remain secret
and shall not be disclosed readily to a third person.
3. The importance of privacy has been recognized in
numerous legal instruments.
1.2 Duty of Health Care Provider To provider the privacy of patients
Health care providers have an ethical obligation to protect
circumstances. For example, they should interview patients
where they cannot be overheard, especially when the
patients declare that they did not bring any companions
during consultation. However, take ethics into
consideration like bringing in a witness of the same sex as
the patient during consultation. They should ask the patient
permission to examine him or her unclothed. You have to
tell or ask the patient everything and anything that you
need to do during the examination. They should ensure that
an unclothed patient cannot be viewed by passersby. If the
patient does not want a procedure to be done on him or
her, the physician cannot do the procedure. Understand
that some patients do not want to be heard or seen.
1.3 Duty of Health Care Provider To Maintain Confidentiality
The duty of maintaining confidentiality, a.k.a. professional
secrecy, has been part of western medical ethics since
see or hear, professionally or privately, which ought not to
courses in non-western countries should discuss the source
of medical confidentiality in their culture.
Confidentiality extends to all personal health information,
including genetic data
UNESCO international declaration on Human Genetic
proteomic data, regardless of their apparent information
content, should be treated with the same high standards of
B. JUSTICE
2. Justified Breaches of Confidentiality
2.1 Sharing Information for Patient Care
In the hospital setting, many people (doctors, nurses) need

1.1 Reason for respecting the privacy and confidentiality However, each of these persons is bound to maintain
confidentiality to the greatest extent possible. Outside the
1. Individual owns the information
hospital setting, family members may need patient
2. For many people, privacy is an essential aspect of
information in order to provide care and/or to protect
their dignity. Invading their privacy against their
themselves
will is a violation of their dignity.
3. Respect for other people requires protecting their
2.2 Using Interpreters
privacy and their confidentiality of information
about them. When the health care provider does not speak the patien
4. Patients are less likely to trust health care language, an interpreter will be needed who will then have
providers and confide in them because they think access to information about the patient. The interpreter
that the health care providers will not keep the should be bound to observe confidentiality.
information confidential. This can have serious
-
being; sometimes for the health of others,
especially family members.
2.3 Teaching Medical Students

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 Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
Observation and discussion of patients is a necessary part
of medical education. Students should be informed of their
obligation to maintain confidentiality.
2.4 Mandatory Reporting
Health care providers should be familiar with laws about
mandatory reporting of infectious diseases, suspected child
abuse, and other conditions in the country when they
practice. Normally, patients should be informed that their
information has to be reported to the appropriate
authorities.
2.5 Serious Danger to Others
For example, in exceptional circumstances and generally as
a last resort, health care provider may need to inform other
persons that the patient has threatened to harm them
whether by violence or by sexual contact when the patient
has a transmissible disease such as HIV or any STDs.
2.6 Genetic Information
There is controversy regarding whether other individuals
with the same genetic makeup (usually close family
Physicians should consult their national regulations or
guidelines when faced with this situation
2.7 With Patient or Guardian Consent
This should generally be obtained for all breaches of
confidentiality and ender the breaches acceptable ethically
2.8 Special Circumstances of Research
Disclosure of personal health information obtained in the
course of a research study requires the prior consent of the
research subject
There is a great controversy regarding whether
disclosure, researchers should consult their national
regulations or guidelines if such exist, otherwise
international guidelines such as the Declaration of Helsinki.
In research, communities as well as individuals have a right
to privacy, and information about them should be kept
confidential, especially when its discharge may be harmful
to the community.
Scientific publication should respect confidentiality to the
greatest extent possible. Consent is always required when
an individual research subject can be identified in a
publication.
II. ARTICLE 10: EQUALITY, JUSTICE AND EQUITY
Premise:
dignity and rights is to be respected so that they are treated
Different types of Justice
Distributive
Ensuring that each person receives a fair share of public
resources
S1T6
This is the most important type for health care under
conditions of scarcity
according to
his or her needs; Each must receive according to his or her
effort; or according to his/her contributio
Procedural
Ensuring a fair process for making decisions and settling
disputes
Retributive
Ensures punishment of wrongdoers
Social
Combination of the previous types as applied to a society in
which individuals and groups receive fair treatment and an
equitable share of the benefits of society
Different Concept of Distributive Justice
Authoritarian
What the highest authority decrees is just
Libertarian
What an individual decides to do with his or her own
property is just
Utilitarian
What most contributes to the treated good of the greatest
number is just
Egalitarian
Justice is achieved when everybody had equal access to the
societal resources to that they need
Restorative or transformative
Justice requires favoritism previously disadvantaged
individual or groups
Different Concept of Distributive Justice Reflected in Different
Healthcare System
The libertarian one is strong in the USA. The egalitarian one
is predominant in many European countries where the
value of social solidarity is recognized. South Africa is
attempting to implement restorative approach. Most
economists lean toward Utilitarian approach
Approach to Justice
Utilitarian
· What issue is determined by utility consequences:
· the greatest good (happiness, satisfaction) for the
greatest number regardless of the values for the particular
person involved.
wrong if it tends to produce the reverse of happiness---- not
just the happiness of the performer of an action but also
Egalitarian
· What is due is what is fair
Equal distribution of benefits and burden, equal
opportunity
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 Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
· An egalitarian favors equality of some sort; People
should get the same, or be treated the same, or be treated
as equals, in some respect
Libertarian
· For as long as there is no restraints on individual liberty,
justice is served
· A collection of political philosophies and movement that
uphold liberty as a core principle. Libertarians seek to
maximize political freedom and autonomy, emphasizing
freedom of choice, voluntary association, individual
judgement, and self-ownershi
·
· Is the view that each person has the right to live his life
in any way he chooses so long as he respects the equal
rights of others
·
and property---rights that people possess naturally, before
governments are created. In the libertarian view, all human
relationships should be voluntary; the only actions that
should be forbidden by law are those that involve the
initiation of force against those who have themselves used
force--actions like murder, rape, robbery, kidnapping, and
Communitarian
· What is valued by the community determines what is
just. It emphasizes social meaning, community
membership, shared values, individual responsibility and
solidarity
· A philosophy that emphasizes the connection between
the individual and the community. Its overriding philosophy
personality are largely molded by community relationships,
with a minimal degree of development being placed on
C. EQUITY
Fundamental requirement in terms of justice
Equity exists when all participants freely define and accept
the rules, benefits and even the charges. Hence, any
differences in charges or benefits must represent a benefit
to ALL members of the society.
What us due depends on what has been given/received
Equity is very limited: if nothing is given first then nothing
will be given return
Has been considered a concept even more important that
justice
Aristotle described it as follows:
What is just, then and what is equitable are generally the
same, and both are good, though what is equitable is better.
According to Rawls, equity is a fundamental requirement in
terms of justice.equity is justice.
It exists when all participants freely define and accept the
rules, benefits and charges
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D. EQUALITY
- Together with justice and equity, it has become a
fundamental principle. As human beings, we are not
physically, mentally, psychologically, or genetically equal.
We are not equal in our values or principles.
· But, it is generally accepted and fully desirable that we
be considered equals in terms of dignity, justice, rights,
opportunities, freedom, benefits and obligations.
· Justice and equity are only possible if all human beings
are treated equally in their dignity and rights (Article 10,
Universal Declaration on Bioethics and Human Rights)
Right to health care
· oyment of
the highest attainable standard of health is one of the
International statements on human rights, such as the
International Covenant on Economic, Social and Cultural
Rights and the Convention on the Rights of the Child,
support the right to health and require signatory nations to
secure its observance.
Disparities in health status
· Health care professionals are faced with many
disparities in health status, generally associated with
disparities in wealth/income or with discrimination against
women, minorities or other disadvantaged groups
o Local disparities
o National disparities
o Global disparities
Roles of health care professionals in establishing health care priorities
and allocating scarce health resources
Health care professionals play several roles in establishing health care
priorities and allocating scarce health care resources
· As government policy makers and officials
· As hospital authorities
· As direct health care providers
· As researchers
What concept of distributive justice is most appropriate for each of
these roles? How should health care professionals deal with conflicts
between roles (e.g between providing expensive curative measures
for individual patients in need and vaccination programs for the
population)?
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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
Angel Erich R Sison, MD stepping in for Zorayda E Leopando, MD | 2019
PAGBABALANGKAS NG ARALIN
I. Notion of Vulnerability
II. Aspects of Vulnerability
A. Biological/Corporeal Vulnerability
B. Social Vulnerability
C. Cultural Vulnerability
III. The Powers of Medicine: Fighting Vulnerability
IV. Problems vs Fight Against Vulnerability
V. Dilemmas of Vulnerability
VI. Notion of Personal Integrity
VII. Care Ethics
VIII. Ethical Perspectives
IX.
I. NOTION OF VULNERABILITY
vulnus :
Susceptibility of being wounded
Ethical principles and guidelines for the protection of
human subjects of research (1978 Belmont Report)
o refers to individuals and populations
o need for protection
Target groups:
o Racial minorities
o Economically disadvantaged
o Very sick
o Institutionalized
May continually be sought as research subjects, owing to
their ready availability in settings where research is
conducted.
Given their dependent status and their frequently
compromised capacity for free consent, they are easy to
manipulate as a result of their illness or socioeconomic
condition
involved in research solely for administrative c
(National Commission for the Protection of Human Subjects
of Biomedical and Behavioural Research, 1979)
Throughout the first half of the 20th century, these
vulnerable members of the population have been used in
unethical research studies:
o Institutionalized groups of persons like orphans
o Prisoners, the elderly and, later, Jews
o Other ethnic groups, considered as inferior and
even subhuman by the Nazis
o Persons such as the Chinese, who were exploited
by the Japanese in order to pursue their scientific
and military objectives.
o Ethnic minorities
o Socially underprivileged groups and women
reinforcing the principle of autonomy and of the
consequent demand, increasingly more inclusive and
stricter, for informed consent. (Beauchamp and Childress,
2001: 63).
S1T3| Guinea Pig Batch 2021: OBE is Life
Vulnerability expresses two basic ideas (Barcelona
Declaration, 1998):
o It expresses the finitude and fragility of life which,
in those capable of autonomy, grounds the
possibility and necessity for all morality.
o Vulnerability is the object of a moral principle
requiring care for the vulnerable. The vulnerable
are those whose autonomy or dignity or integrity
is capable of being threatened
In applying and advancing scientific knowledge, medical
practice and associated technologies, human vulnerability
should be taken into account.
Individuals and groups of special vulnerability should be
protected and the personal integrity of such individuals
respected.
The notion of vulnerability is not just a neutral description
of the human condition but instead a normative
prescription to take care of the vulnerable that is
characteristic for human beings.
Ethics is more than respecting individual choices and
decisions; it aims at care for the other.
o For example, the human face can show the
vulnerability of the human person and at the
same time appeal for help and assistance.
II. ASPECTS OF VULNERABILITY
BIOLOGICAL/CORPOREAL VULNERABILITY
Concerns the fragility of the human organism originating
from:
o Natural threats are coming from our biology:
ageing, susceptibility to illness and disease, and
death
o Environmental and other natural and man-made
threats: famine, earthquake, hurricanes,
pollution and environmental disasters
SOCIAL VULNERABILITY
Fragility of the human capacity for creating coherence in
o Social threats stemming from war and crime,
prejudice and discrimination, cruelty and
indifference
o Persons also become vulnerable due to
hospitalization and institutionalization
o Social circumstances and conditions
CULTURAL VULNERABILITY
Concerns the fragility of particular traditions and
conceptions of values that are typical for a community or
local cultures
III. THE POWERS OF MEDICINE: FIGHTING VULNERABILITY
A common idea is that the vulnerability of the human
condition should be eliminated or reduced.
o Science and technological innovations should be
used to overcome the natural threats.
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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
o Medical research should be focused on
eliminating the biological threats to the human
body
The basic assumption behind this fight is that many
vulnerabilities of the human condition are contingent, not
inherent.
This fight has been successful but at the same time has
failures.
o Life expectancy and health have improved,
poverty and starvation reduced, but at the same
time
o Many people die from common diseases, life
expectancy is decreasing in many countries, and
poverty is still widespread.
An unrestrained fight against human vulnerability
generates its own problems. Not the struggle against
human vulnerability is a mistake but the struggle to rid the
human condition of all vulnerability.
For a sustainable medicine it is necessary to accept some
vulnerability as a permanent part of the human condition.
IV. PROBLEMS VS FIGHT AGAINST VULNERABILITY
Religion, alternative medicine and traditional knowledge
present different ways of knowing and valuing
o Because they are open to different perspectives,
they can give meaning to vulnerability, but their
views are generally not accepted by mainstream
science or bioethics
Economic problems
o The success of science and technology has
created financial difficulties in almost all countries
in achieving decent levels of health care for the
population.
o Because of its continuous fight against
vulnerability, medicine often
Medical progress itself has created new forms of
vulnerability, i.e. chronic illness.
o This presents continuing vulnerability for a
growing population aging population
V. DILEMMA OF VULNERABILITY
Requires a balance between eliminating and accepting
human vulnerability
Disability
o Viewed as abnormal and the disabled therefore
are, by definition, vulnerable
o At the same time the disabled should not be
stigmatized by being treated as abnormal.
Death
o In medicine, the place of death in human life is
ambivalent
o In palliative care, death is understood as being
part of life; in some other sectors of medicine
death is still treated as the enemy.
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Depression
o Prozac (fluoxetine) is widely used as an anti-
depressant drug, when there are clear clinical
symptoms of depression;
o At the same time, it is regarded as medication for
unhappiness and sadness
Human suffering and misery express human vulnerability.
They also pose a challenge.
o We must at the same time struggle to keep
suffering to a minimum and also accept it as part
of life.
VI. CARE ETHICS
The challenge of human vulnerability is that it can never be
entirely eliminated from human life.
o Instead, it should inspire new approaches in
bioethics
The human condition requires solidarity; human beings all
share common vulnerabilities
Human vulnerability also leads to an ethics of care.
o Because it is a shared characteristic, it is also a
source of concern for others as well as awareness
that we rely on others.
o It is the basis for the duty to care for those
threatened by biological, social and cultural
threats as well as by the power of medicine itself.
VII. NOTION OF PERSONAL INTEGRITY
Latin origin verb tangere
o This is the root both of the adjective integer,
noun integritas
integrity all the
parts are maintained and the quality of that which is
unaltered.
Confirmed in 1996, in the Declaration of Helsinki, in which
as an attribute of the recognized inviolability of the subject
of experimentation, which
physically or psychologically:
o The right of the research subject to safeguard his
or her integrity must always be respected.
o Every precaution should be taken to respect the
privacy of the subject and to minimize the impact
of the study on the subject's physical and mental
integrity and on the personality of the subject
(World Medical Association, 1996: I.6)
The principle of respect for human vulnerability is related to
the notion of personal integrity; this is mentioned in the last
part of Article 8.
o Integrity concerns the wholeness of an individual.
In ethical discourse, integrity is often considered as a virtue,
related to the
example.
But respect for personal integrity in this Article does not
refer to moral character or his/her good
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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
behaviour. It refers to fundamental aspects of a human life BASIC PRINCIPLES OF ENVIRONMENTAL ETHICS
that should be respected. Respect for Nature
Personal integrity refers here to respect for the The prosperity of human beings depends on the prosperity
understanding of his or her own life and illness, but also for of nature.
his/her interests and free will. Human beings are part of nature. They have therefore the
In the field of health policies, the principle of vulnerability duty to conserve and protect the integrity of the ecosystem
demands, both at the social and international level: and its biodiversity
o Benefit of some should not be attained by
exploiting the weakness of others Environmental Justice
o Those of bio-industries must not aggravate Environmental benefits and burdens should be equally
human vulnerability but rather seek to eliminate distributed
it as far as possible and to respect what is beyond Opportunities to participate in decision-making concerning
their reach. environmental issues should be equally provided
At the level of experimentation, it demands protection
which goes beyond that which can be expressed in Intergenerational Justice
informed consent of the body or part of the body and Every generation should leave the following generation an
demands respect for personal identity in the relationship equal opportunity to live a happy life, and should therefore
between the subject of experimentation and the researcher bequeath a healthy earth
between patient and doctor, at the level of clinical
assistance.
Respect for integrity demands new forms of
communication
o Allow the doctor to focus more on the patient
than the illness facilitates the involvement of
the patient in his own therapeutic process as a
partner in the health team the development of
therapies which are perceived as less invasive and
more respectful of the individual (e.g. at the
cultural or religious level)
In the field of health policies, the principle can play an
important role in:
o Prohibition of commercializing human body parts
o Regulation of genetic manipulation, particularly
in safeguarding the human genome
o Consideration of patentable human matter

VIII. ETHICAL PERSPECTIVES

ANTHROPOCENTRIC/HUMAN-CENTERED ENVT. ETHICS
Human beings have moral duties only towards one another
Human interests prevail over the interests of other species

NON-ANTHROPOCENTRIC ENVT. ETHICS

Biocentric
Other living organisms have intrinsic value
All life forms are are
entitled to moral consideration
It is therefore an ethical imperative to respect all life forms
All organisms have intrinsic value
More related to non-western cultural traditions

Ecocentric
Ecosystems have intrinsic value as well
Nature as a whole
All organisms and entities in the ecosphere, as parts of the
interrelated whole, are equal in intrinsic value
Holistic methodology

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Clinical Bioethics
Article 3: Human Dignity & Human Rights
Angel Erich R. Sison, MD | 31 August 2019
PAGBABALANGKAS NG ARALIN
I. Concepts of Dignity
A. Classical Antiquity
B. World Religions
C. Modern Philosophy
D. Contemporary International Law
II. The Notion of Human Dignity
III. Dignity and Healthcare Provider Relations
I. CONCEPTS OF DIGNITY
A. CLASSICAL ANTIQUITY
Common understanding of dignity as deserving of honour
and esteem according to personal merit, inherited or
achieved.
In ancient Greek philosophy, particularly of Aristotle and
the Stoics, dignity was associated with human abilities of
deliberation, self-awareness, and free decision-making.
B. WORLD RELIGIONS
Human dignity is considered to be predetermined by the
creation of human beings in the image of God; those who
are weak in body and soul have dignity equal to those who
are robust and sturdy.
C. MODERN PHILOSOPHY
Proposed secular understanding of human dignity and
progressively associated this concept with the idea of
human rights.
In different teachings human dignity was presented as an
o Aspect of personal freedom (Giovanni Pico della
Mirandola)
o E
Hobbes)
o Universal virtue, unconditional and incomparable
origin, wealth, or social status (Immanuel Kant)
to treat any other person always at
the same time as an end, never merely
as a means (categorical imperative)
has been accepted by moral and
political philosophy as the actual basis
for the conception of human rights and
in this sense it is a foundational
concept.
D. CONTEMPORARY INTERNATIONAL LAW
Contemporary international law, national constitutions,
and other normative documents, human dignity is strongly
connected with human rights.
According to Art. 1 of the Universal Declaration of Human
dignity The Declaration establishes human
rights (like freedom from repression, freedom of expression
and association) on the inherent dignity of every human
being.
S1T5| Guinea Pig Batch 2021: OBE is Life
The European Convention on Human Rights and
dignity and
identity of all human beings and guarantees everyone,
without discrimination, respect for their integrity and other
rights and fundamental freedoms with regard to the
II. THE NOTION OF HUMAN DIGNITY
The notion of human dignity expresses the intrinsic value
of the person capable of reflection, sensitivity, verbal
communication, free choice, self-determination in
conduct, and creativity.
Unlike material values or financial prices, human dignity
has no external equivalent; it is an end in itself.
Unlike merit as an embodiment of publicly recognized
personal achievements, a person is dignified as a human
being as such.
All human beings are equal in dignity irrespective of
gender, age, social status or ethnicity.
respect for her human rights, self-esteem and self-
determination, as well as care for her privacy, protecting
her from illegitimate intrusions and preserving her valid
public space.
A society or a community should respect each of its
members as a person or a moral agent on the basis of the
notion of human dignity.
This notion also requires that the interests and welfare of
the individual are considered as prior to the sole interest of
society, community, or any particular kind of publicly
It implies that because of his/her human dignity, the
individual should never be sacrificed for the sake of
science (as has happened in medical experiments during
the Second World War) or for the sake of society (as has
happened in totalitarian regimes).
circumstances in which the interest of others or the
community as a whole are so important that infringing
upon the interests of individuals is unavoidable in order to
save others or the community. An example is the threat of
a deadly pandemic.
Human dignity is a foundational concept and it is
theoretically and normatively inappropriate to reduce it to
decision-making or to taking into account her autonomy.
Respect for dignity means
worth as a human being.
In a comparative view, human dignity has diverse forms in
different cultural and ethical traditions (for example,
Confucian, Judeo-Christian, Muslim) and is respected in
various ways in different types of societies (traditional,
modern, totalitarian, democratic). It is less respected in
totalitarian societies and more respected in modern and
democratic societies.
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Clinical Bioethics
Article 3: Human Dignity & Human Rights
Regardless of cultural, confessional, and political varieties Inequality in the status of the health care provider and the
human dignity is universal - patient may be aggravated in special cases when patients
awareness and appropriate respectful treatment towards are children, handicapped individuals, and elderly persons.
her. Particularly risky are cases of patients who are mentally
As it is emphasized in Declaration, the regard to cultural handicapped.
Special attention in regard to human dignity and human
e rights is required in palliative treatment of terminal
Article 12). patients vegetative state
Though there is no consensus either in public or in the
III. DIGNITY AND HEALTHCARE PROVIDER RELATIONS expert community concerning the ethical and legal status of
embryos and foetuses, the latter should be treated with
Healthcare Provider-Patient relations are just one kind of
respect and care.
human relations, presupposing all ethical requirements.

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 THE PRINCIPLE OF RESPECT FOR
HUMAN
VULNERABILITY
AND PERSONAL
INTEGRITY
Report of the International
Bioethics Committee of
UNESCO (IBC)

3
THE PRINCIPLE OF RESPECT FOR
HUMAN
VULNERABILITY
AND PERSONAL
INTEGRITY
Report of the International
Bioethics Committee of
UNESCO (IBC)
Published in 2013 by the United Nations Educational, Scientific and Cultural Organization
7, place de Fontenoy, 75352 Paris 07 SP, France

© UNESCO 2013
All rights reserved

ISBN 978-92-3-001111-6

The designations employed and the presentation of material throughout this publication do not imply the expression of any opinion
whatsoever on the part of UNESCO concerning the legal status of any country, territory, city or area or of its authorities, or con-
cerning the delimitation of its frontiers or boundaries.

The ideas and opinions expressed in this publication are those of the authors; they are not necessarily those of UNESCO and do
not commit the Organization.

Graphic design: S.C.I.P.P.

Typeset: Jeddi Editorial Design Ltd, London, UK

 CONTENTS

INTRODUCTORY REMARKS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

REPORT OF THE INTERNATIONAL BIOETHICS COMMITTEE

OF UNESCO ON THE PRINCIPLE OF RESPECT FOR HUMAN
VULNERABILITY AND PERSONAL INTEGRITY

I. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

II. THE DETERMINANTS OF “SPECIAL VULNERABILITY” . . . . . . . . . . . . . . . . . . . . . . . 11

III. VULNERABILITY IN THE HEALTHCARE SETTING . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

III.1. Access to healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
III.1.1. Poor people in developing countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
III.1.2. Disadvantaged people in developed countries . . . . . . . . . . . . . . . . . . . . . . . . 19
III.1.3. Migrants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
III.2. Provision of appropriate healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
III.2.1. Paediatric HIV infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
III.2.2. Unfair allocation of resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
III.3. Inequality of power in healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
III.3.1. Disrespect for the patient’s will . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
III.3.2. Professional self-interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

IV. VULNERABILITY IN HUMAN PARTICIPANT RESEARCH . . . . . . . . . . . . . . . . . . . . . . 23

IV.1. ‘Double Standard’ research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
IV.2. Equivocal donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
IV.3. Inappropriate research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
IV.4. Social vulnerability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
IV.5. Vulnerability as a result of lack of research . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

3
V. VULNERABILITY IN THE DEVELOPMENT AND APPLICATION OF EMERGING
TECHNOLOGIES IN THE BIOMEDICAL SCIENCES . . . . . . . . . . . . . . . . . . . . . . . . . . 29
V.1. Stigmatization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
V.2. Unfair pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
V.3. Premature applications of technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
V.4. Genetic information and patient privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
V.5. Unexpected risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
V.6. Unconsented collection of genetic data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

VI. CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

ANNEXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
I. UNESCO Universal Declaration on Bioethics and Human Rights (2005) . . . . . . . 41
II. Composition of the International Bioethics Committee (IBC) in 2010–2011 . . . . . 49

4
 I N T R O D U C TO RY R E M A R KS
Article 8 of the Universal Declaration on Bioethics and Human Rights (2005) enshrines the principle
of respect for human vulnerability and personal integrity as a bioethical value of universal concern
to the Member States of UNESCO. The specific purpose of Article 8 is to address special
vulnerabilities that occur, whether as a consequence of personal disability, environmental burdens or
social injustice, in the contexts of healthcare, research and the application of emerging technologies
in the biomedical sciences. This Report is the result of three years of reflection by the International
Bioethics Committee of UNESCO (IBC).

We are definitely all equally entitled to meet our basic needs related to our health and well-being,
but we are certainly not all equally and permanently able to meet all those basic needs of ours.

Over the course of its reflections, the Committee has investigated the multiple ethical implications of
this very basic inequality among human beings which is particularly highlighted and exacerbated in
the context of advances in the fields of biomedical sciences. As a matter of fact, these advances have
opened the way for many new and powerful capacities for the safeguarding of human welfare, but
they have also created mechanisms of exploitation and degradation which can take advantage of
natural and context-related vulnerabilities.

Vulnerability, in its first and more general sense, is an essential feature of human nature and may
therefore boost awareness of a common destiny and responsibility. This Report seeks to elaborate the
scope and content of Article 8 of the Declaration of 2005, focusing on special vulnerabilities and
taking into account conditions that, more or less directly, impinge upon the capacity to live as free
and autonomous individuals; and on the right to live in a world where significant inequalities in the
capacity to meet everyone’s basic needs are adequately addressed.

In writing this report, which is neither exhaustive, nor prescriptive, the ethicists, geneticists, biologists,
lawyers, philosophers, psychiatrists, neurologists and immunologists composing the IBC aimed at
paving the way for a broader reflexion and indicating possible lines of action not only for States, but
also for individuals, groups, communities, institutions and corporations, public as well as private.

They specifically call on all concerned stakeholders to exercise great vigilance in protecting those
who are especially vulnerable. Nearly every country of the world is the home of one or the other
type of vulnerable groups: countries in which proper antiretroviral therapies are for various reasons
not being provided to a majority of HIV/AIDS infected people; countries in which poor patients are
refused healthcare because they lack insurance coverage; countries in which people are involved in
clinical trials without respecting the principle of free and informed consent, just for the sake of profit.
Unfortunately, the list is easy to extend.

Special Vulnerabilities of Women and Girls

Gender-related vulnerabilities and in particular the special vulnerabilities of women and girls have
always been in the forefront of the Committee’s reflections throughout its work on this publication.
Females, both children and women, are given special attention in the Report. Seven of the eighteen
cases proposed for discussion specifically refer to the treatment of women in healthcare delivery,

5
research and the applications of new biotechnologies. Female cases are prominent as they are
particularly exposed to the whole range of the social, cultural, economic, educational and political
determinants of vulnerability. This is also highlighted in one of the concluding paragraphs of the
Report:

“A further important example of special vulnerabilities can be provided using the example of the
position of women. In some cultures, female children are uniquely vulnerable to the risk of being
unwanted, uncared for, abused and rejected. Female children may also find their interest in bodily
integrity gravely threatened, including especially their right to be free from sexual assault and
exploitation. Adult women may find themselves transferred from the patronage of their father to the
patronage of their husband, thereby denying them the personal authority to make important life and
healthcare decisions on their own behalf. As women live longer in many parts of the world, elderly
women might find themselves abandoned by their families, subject to inadequate healthcare, and
disregarded by society. Migrant women and women affected by war are especially vulnerable to
abuse and are often disenfranchised from engaging in conflict resolution and reconciliation.”

Special Vulnerabilities in Africa

Human vulnerabilities that are present in developed countries are often exacerbated in developing
countries, due to a wide range of factors, including extreme poverty. This is especially visible in the
case of developing countries of sub-Saharan Africa. The Committee has consistently maintained this
concern within its reflection on Article 8. This is particularly evident with the mention of three specific
cases from Africa, even though the general practice is to remove specific regional or national
references. Other cases highlight vulnerabilities of immediate relevance to the African context, while
the remaining cases are applicable to fast emerging situations on the continent. In essence, all the
possible remedies elaborated within the Report, from providing vulnerable populations with
adequate health education and access to available therapies, to striving against poverty and strictly
limiting the use of potentially discriminating incentives in medical research, have universal application
across both developed and developing countries, but are especially pertinent to the African context.

Ultimately, the goal of our efforts in this regard is to inspire and stimulate all stakeholders, not only
States, to take the necessary steps to protect the interests of vulnerable populations in the context of
healthcare, research and the application of emerging technologies in the biomedical sciences; and
to ensure the realization and enjoyment of human rights across all strata of society.

Stefano Semplici
Chairperson
UNESCO’s International Bioethics Committee

6
THE PRINCIPLE OF RESPECT FOR
HUMAN
VULNERABILITY
AND PERSONAL
INTEGRITY
Report of
the International Bioethics
Committee of UNESCO (IBC)
This Report is the result of a long reflection within the
International Bioethics Committee (IBC) which began
at its fifteenth session (Paris, October 2008), was
pursued at its sixteenth session (Mexico, October
2009), and was further developed within the
framework of its work programme for 2010-2011.

It does not pretend to be exhaustive nor prescriptive

and does not necessarily represent the views of the
Member States of UNESCO.
 I. INTRODUCTION

1. Article 1 of the UNESCO Universal Declaration on Bioethics and Human Rights (2005)
(hereafter “the Declaration”) states that it seeks to address the “ethical issues related to medicine, life
sciences and associated technologies as applied to human beings, taking into account their social,
legal and environmental dimensions” (the full text of the Declaration is given in Annex I). Article 8
reinforces this commitment by linking it to respect for personal integrity and the need to protect
vulnerable individuals and groups:

In applying and advancing scientific knowledge, medical practice and associated technologies,
human vulnerability should be taken into account. Individuals and groups of special vulnerability
should be protected and the personal integrity of such individuals respected.

2. This notion is not new. The concept of vulnerability appears in important national documents,
starting with the US Belmont Report of 1978, and in international documents, such as the third and
most complete version of the International Ethical Guidelines for Biomedical Research Involving
Human Subjects of the Council for International Organizations of Medical Sciences (CIOMS)
(2002) and in the latest (2008) version of the Declaration of Helsinki, which makes specific
reference to vulnerability in articles 9 and 17.

3. Article 8 of the Declaration entails both a ‘negative’ duty to refrain from doing something and a
‘positive’ duty to promote solidarity and to share the benefits of scientific progress. There is an integral
relationship between respect for the integrity and dignity of persons on the one hand and the
vulnerability of persons on the other. Indeed, UNESCO itself had previously acknowledged the
importance of the principle according to which States “should respect and promote the practice of
solidarity towards individuals, families and population groups who are particularly vulnerable” with
regard to disease or disability of a genetic character (Universal Declaration on the Human Genome
and Human Rights, 1997).

4. The UNESCO International Bioethics Committee (IBC) has focused its two more recent Reports on
the principles of consent (Art. 6 of the Declaration) and of social responsibility and health (Art. 14).
This Report on article 8 of the Declaration will investigate the scope and content of the principle of
respect for human vulnerability and personal integrity, focusing on special vulnerabilities and taking
into account conditions that, more or less directly, impinge upon the capacity to live as a free,
autonomous individual and the right to live in a world where significant inequalities in the capacity
to meet everyone’s basic needs are adequately addressed.

5. Article 1.2 of the Declaration makes it clear that it is addressed to States. However, States and
governments are not the only addressees of Article 8. As in the case of the principle of social
responsibility, it is rather necessary to boost awareness of the responsibility that all sectors of society
share and to promote, at the international as well as the domestic level, those strategies and means
of cooperation that are most likely to effectively address the determinants of “special” vulnerability
to which Article 8 refers. Of course, both an in-depth reflection on the concept of vulnerability as a
general feature of the human condition and denunciation of political, economic or cultural

9
discrimination among human beings are important. Nonetheless, they constitute the background
more than the focal point of the challenge faced in Article 8. The specific task of this Article is to
address special vulnerabilities that occur, whether as a consequence of personal disability,
environmental burdens or social injustice, in the contexts of health care, research and the application
of emerging technologies in the biomedical sciences. Article 8 enjoins everyone to exercise vigilance
in protecting the well-being of individuals and groups in these contexts. As the Declaration (taken as
a whole) confirms, every human being has a claim to our care that must be respected.

10
THE DETERMINANTS
OF “SPECIAL
VULNERABILITY”
 II. THE DETERMINANTS OF
“SPECIAL VULNERABILIT Y”

6. The human condition implies vulnerability. Every human being is exposed to the permanent risk of
suffering “wounds” to their physical and mental integrity. Vulnerability is an inescapable dimension
of the life of individuals and the shaping of human relationships. To take into account human
vulnerability acknowledges that we all may lack at some point the ability or the means to protect
ourselves, our health and our well-being. We are all confronted with the possibility of disease,
disability and environmental risks. At the same time, we live with the possibility that harm, even death,
can be caused by other human beings.

7. Of course, article 8 does not require us to protect vulnerability as such, but rather vulnerable
individuals, families and groups in the contexts in which they live. While some groups of people can
always be considered vulnerable because of their status (e.g. children), others may be vulnerable in
one situation but not in another. Therefore, vulnerability cannot be considered as a one-off concept.
The principle of respect underpinned in Article 8 entails a commitment to identify threats to well-being
and appropriate means to foster the principles stated in Article 3 to be the primary ones “to be
respected”: human dignity, human rights and fundamental freedoms. Thus, attempts to define
vulnerability in general risk drawing the concept too widely or too narrowly, thereby triggering
disputes rather than resolving them. In most cases, however, it is relatively easy to recognise
vulnerability when it arises: something fundamental is indeed at stake.

8. That is also why human vulnerability and personal integrity, the other essential concept evoked in
Article 8, relate to each other. When a part of our body is inappropriately ‘touched’ (this is the
meaning of the ancient Latin verb from which the noun ‘integrity’ stems), our life itself, or at least our
health, may be threatened. When our freedom is hampered, either by adverse circumstances or by
the actions of others, we experience a “wound” to our identity, to its value and dignity. Preservation
of integrity implies protection against these kinds of intrusions, the capacity to “say no” to any sort of
impingement upon our freedom or to any sort of exploitation of our body and our environment. We
are nonetheless committed at least to seek to ameliorate the effects of harms and disadvantages
imposed by circumstances. This is a prerequisite of human flourishing and self-fulfilment.

9. The Declaration, taken as a whole, enjoins governments, but also public and private institutions
and individuals, to exercise greater vigilance in protecting the well-being of every human being in the
face of advances in the fields of medicine, life sciences and associated technologies. By doing so, it
underscores the importance of a wide array of principles familiar to the language of both moral and
juridical sciences: autonomy, beneficence, justice, dignity, equality and the like. The principle of
respect for vulnerability and personal integrity not only emphasises these aims, but also clarifies that
the final goal of the progress of science in the bioethical domain cannot solely be profit. Vulnerability
as a human condition calls on every human being, especially those who have the responsibility to
advance knowledge and to decide how to use it, to fulfil the fundamental obligations we have one
to another. It has been said that acknowledging the reality of vulnerability might provide a bridge
between the moral ‘strangers’ of a pluralistic society, thereby enhancing the value of solidarity rather
than mere individual interests.
13
10. At the same time, Article 8 clarifies that we cannot be satisfied with the simple exercise of restraint
and forbearance in pursuing our own objectives when this might threaten the autonomy and dignity
of others. We are compelled to act in a positive way to help other people cope with the natural or
social determinants of vulnerability. Article 24 underscores the duty to “respect and promote
solidarity between and among States” and points out some circumstances that may render
individuals, families and groups vulnerable: disease; disability; other personal, societal or
environmental conditions or limited resources. There is no doubt that the empowerment of people to
protect them from special vulnerabilities in health care entails making more resources available,
providing safe living conditions and access to quality health care as a precondition to every human
being’s “enjoyment of the highest attainable standard of health” (Art. 14 of the Declaration). In this
sense, commitment to respect for human vulnerability and personal integrity is a necessary constituent
of unavoidable political responsibilities.

11. Humankind as such is vulnerable, but there are individuals, groups and situations to which a
greater attention must be paid. This is the essential point to underline. Article 8 explicitly addresses
the “special vulnerability” of individuals and groups, inasmuch as they are potential recipients of
therapies, involved in scientific research or potential recipients of the products or technologies
deriving from the advancement and applications of scientific knowledge. Of course, this is not the
only context in which vulnerability occurs. Human dignity, human rights and fundamental freedoms
are equally at stake in many other fields of human activity. They are, however, relevant to the scope
of the Declaration only insofar as they overlap with the specific tasks of bioethics and medical ethics.

12. Two fundamental categories are highlighted that are relevant to these special responsibilities and
obligations:
a) special (temporary or permanent) disabilities, disease and limitations imposed by the stages
of human life;
b) social, political and environmental determinants: for example culture, economy, relations of
power, natural disasters.

13. In a) for example, children are assumed to be vulnerable regardless of their social conditions.
Elderly people may be more vulnerable because of their reduced physical and sometimes mental
capacities. Persons with disabilities need help to access and sustain the exercise of their self-
determination. Persons with mental disorders may not be able to defend themselves or claim their
rights. These can all be considered as “natural” determinants of special individual vulnerabilities. Of
course, a crucial distinction is to be made between these and special vulnerabilities which result from
a deliberate restriction of autonomy.

14. The issue of social, political and environmental determinants is more complex and involves the
fundamental matter of justice in the relations between individuals, groups and States. Many
individuals, groups and populations nowadays become especially vulnerable because of factors
created and implemented by other human beings, in many cases in blatant violation of
fundamental human rights. Social vulnerability is a phenomenon determined by the structure of
people’s and communities’ daily lives. Situations of social vulnerability usually interfere with the
self-determination of individuals and lead to significantly increased exposure to risks caused by
social exclusion. Social vulnerability plays a role not only in biomedical research but also in the
healthcare setting and in the development, implementation and application of emerging
technologies in biomedical sciences and is a fact of life for a considerable portion of world’s
14
population. Vulnerability is caused or exacerbated by a lack of means and of the capacity to
protect oneself, as in the following examples:
• poverty, inequalities in income, social conditions, education and access to information
(e.g. unemployed persons, homeless persons, illiterate persons, individuals involved in
research activities that follow a ‘double standard’ procedure in which the same research
is not subjected to the same ethical scrutiny in different locations);
• gender discrimination (e.g. lack of equitable access to healthcare);
• situations of substantial limitation or deprivation of personal liberty (e.g. prisoners);
• hierarchical relations (e.g. students involved in research projects carried out by their
teachers, employees in situations where safe working conditions are not guaranteed,
members of the armed forces or the police);
• marginalization on various grounds (e.g. immigrants, nomads, ethnic and racial minorities);
• trade-offs between the right of every human being to quality health care and other rights,
such as intellectual property rights, whose inappropriate protection can directly or indirectly
impinge negatively upon the sharing of the benefits of scientific progress;
• exploitation of resources in developing countries (e.g. the consequences of deforestation
which can compromise duties towards future generations);
• wars (e.g. asylum seekers and displaced persons);
• negative effects of human activity, for example climate change or different kinds of pollution;
• impact of natural disasters like earthquakes, hurricanes or tsunamis leading to death, injury
and displacement.

15. All of these examples help contextualize the issue of vulnerability and respect for personal
integrity within the three specific domains pointed out in Article 8. They serve to highlight the issues
in the healthcare setting, in the researcher-participant relationship in human participant research, and
in the development and application of emerging technologies in the biomedical sciences. In each of
these settings people are vulnerable in ways over and above that which the human condition
necessarily involves.

16. As to vulnerability in the healthcare setting, it is well understood that even those patients whose
physical and cognitive capacities meet or exceed those of the average human population are
uniquely vulnerable when submitting to medical care, given the greater expertise and social authority
of the treating physician (and other professionals). A patient’s vulnerability may be further
aggravated by his or her illness – pain, discomfort and the desire for healing can frustrate reasoning
and sound judgment. This is a fortiori true of those patients whose physical or cognitive abilities are
severely diminished such that their capacity for self-determination is limited or even non-existent. In all
healthcare settings, the patient, to a greater or lesser degree, depends on the skills, expertise,
judgment and good will of the treating professional. Individually and collectively, patients are thereby
uniquely vulnerable. Article 8 calls our attention to this fact and enjoins decision makers to respond
in a fitting way. One possible option would be for States to develop a patients’ rights charter which
would be instrumental in protecting those who are especially vulnerable in the healthcare setting.

17. The same is true of human participants in biomedical research. However, in this context, the
additional safeguard of the physician’s (or researcher’s) primary focus being on restoring the patient
to health is absent. The interests of researchers and subjects are not always aligned as they are in the
relationship between healthcare professionals and patients, thus amplifying concerns regarding
vulnerability in this domain. Moreover, in some instances, the researcher’s (or society’s)

15
understandably strong desire to pursue useful generalisable knowledge gives rise to the temptation
to under-protect or ignore the participants’ wellbeing. The Declaration’s emphasis on special
vulnerability rightly invites careful attention to this and related concerns in the human research
context. It is clear, however, that the engagement of people as participants in clinical research is key
in providing solutions to, and understanding of, medical problems afflicting humankind. Biomedical
research, including clinical research, has evolved over the years to the extent that international and
national standards and guidelines have been developed. The practices uncovered at the Nuremberg
trials showed the range and extent of the abuse of human beings in research and resulted in a flurry
(1)
of activity on this subject. The resulting Nuremberg Code the template for a number of successive
declarations on human participant research, culminating in the World Medical Association’s
Declaration of Helsinki, which states that:
Medical research is subject to ethical standards that promote respect for all human subjects and
protect their health and rights. Some research populations are particularly vulnerable and need
special protection. These include those who cannot give or refuse consent for themselves and
those who may be vulnerable to coercion or undue influence.(2)

18. Equally, some individuals or communities may be denied access to, or the benefits of, research.
They too are especially vulnerable.

19. It is especially important in all forms of research that close attention is paid to the kinds of pressures
that might encourage people to act in a manner that potentially competes with their own interests; in
particular, the avoidance of coercion or of the appearance of coercion is vital. Coercion may arise
from a number of sources, including the simple omission of relevant information about possible risk. As
research is often conducted by investigators from the developed world in countries of the developing
world, a number of concerns arise acutely. First, the personal, economic or socio-political situation of
potential research participants may render them vulnerable to exploitation. Second, again because of
the so-called ‘therapeutic misconception’, people may agree to participate in research in the mistaken
belief that there may be some benefit for them; this is particularly likely where healthcare services are
inadequate or unavailable. CIOMS’ most recent guidelines note that, special justification is required
for inviting vulnerable individuals to serve as research participants and, if they are selected, the means
of protecting their rights and welfare must be strictly applied.(3)

20. Advances in biomedical science and biotechnology have opened the way for many new and
powerful capacities for the protection of human welfare. At the same time, they have created novel
and potent mechanisms of exploitation and degradation. Such advances potentially give rise to a
special vulnerability for individuals and groups to which Article 8 rightly draws our attention.

21. Each of these contexts presents instances where individuals and groups may be vulnerable in a
unique and amplified form. A number of examples follow which illuminate some situations within
healthcare, human participant research and the development of biotechnology which give rise to
“special vulnerability”. It is, of course, not intended that these examples are exhaustive of situations
where vulnerability can be identified; rather, they are illustrative.

(1) Available at http://ohsr.od.nih.gov/guidelines/nuremberg.html (accessed 03/08/2010).

(2) Declaration of Helsinki, article 9. Most recently revised at the 59th WMA General Assembly, Seoul, October 2008.
(3) For discussion, see Macrae, D.J., ‘The Council for International Organizations and Medical Sciences (CIOMS) Guidelines on Ethics of Clinical Trials’, Proc. Am. Thorac. Soc. Vol. 4,
176–179, 2007.

16
VULNERABILITY IN
THE HEALTHCARE
SETTING
 I I I . V U L N E R A B I L I T Y I N T H E H E A LT H C A R E S E T T I N G

III.1. Access to healthcare

III.1.1. Poor people in developing countries

22. According to the Joint United Nations Program on HIV/AIDS (UNAIDS) in its 2008 report(4), by
the end of 2007, 33.2 million people were living with HIV, of whom 2.1 million were children, and
2.1 million died from AIDS. Some 6,800 people are newly infected with HIV every day because of
poor access to affordable, proven interventions to prevent HIV transmission. Only 2700 people
receive antiretroviral therapy per day. Only 31% of people in need were receiving antiretroviral
therapy in 2007, and only one third of infected pregnant women receive antiretroviral drugs to
prevent transmission; even fewer receive medications for their own health.
The nature of the vulnerability
A shortened life of poor quality and the risk of imminent death.
The cause or context of the vulnerability
The inability or failure of States to purchase adequate supplies of existing and effective drugs,
coupled with the inadequate promulgation of preventive strategies.
Remedies
States to intervene directly by providing adequate health education and access to available
therapies. International solidarity to be encouraged to facilitate such provision.

III.1.2. Disadvantaged people in developed countries

23. A 24 year old female with a history of headaches consulted a physician for treatment. Following
the initial diagnosis, it became clear that advanced diagnostic tests were required, but these tests
were expensive and not covered by her insurance. Under these circumstances, the tests were not
offered. A few months later, further examination revealed an advanced cerebral tumor, which had a
poor prognosis.
The nature of the vulnerability
Lack of access to diagnostic tests which fatally delayed possible life-saving treatment.
The cause or context of the vulnerability
Advanced diagnostic tests could have permitted an early diagnosis, which might have given the
patient a better prognosis. However, tests or therapies that patients are unable to pay for, either
directly or by insurance, are not made available by the healthcare system. Patients are, therefore, not
always informed about alternative techniques and therapies.
Remedies
The availability of appropriate healthcare resources to meet the needs of the patient population
irrespective of ability to pay, and the requirement that full information is available to patients about
alternative diagnostic or therapeutic opportunities.

(4) Available at www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008 (accessed on 02/08/2010).

19
 II.1.3. Migrants
24. P. was a young pregnant woman who was an immigrant in a country which provides free access
to quality health care for all its citizens. During her pregnancy, she did not seek ante-natal care and
was never visited by a doctor. At the moment of delivery, her husband took her to the hospital, but
the newborn immediately needed intensive care and ventilation. The child was premature and its birth
weight was extremely low compared with children of the same gestational age. P. suffered serious
kidney and liver problems that required lengthy treatment. A survey carried out in the hospital showed
that this sort of complication and the rate of in-hospital mortality were significantly higher in the case
of babies born to immigrant women. These rates appeared to be related to risk factors which could
be easily prevented by routine testing during pregnancy.
The nature of the vulnerability
Migrants may not be aware whether or not they have a right to treatment. They may also be unaware
of the range of tests and therapies available, and may be impaired in their ability to seek access to care.
The cause or context of the vulnerability
Migrants in general, whether within or between States, may find themselves marginalized, because
of a lack of knowledge of local language and social and legal entitlements.
Remedies
Thorough social integration of migrant individuals and communities into the mainstream, better and
more targeted education about healthcare risks and ease of access to healthcare professionals.

III.2. Provision of appropriate healthcare

III.2.1. Paediatric HIV infection

25. Antiretroviral therapy (ART) coverage of all age groups in sub-Saharan Africa was 44% in 2008,
compared to 33% in 2007. However, only 5–7% of those receiving treatment were children. Out of
22 antiretroviral drugs approved and available for use in adults, 6 have no paediatric indication and
7 have no paediatric formulation.
The nature of the vulnerability
The high risk of infection leading to an early death, as well as the inappropriate use of drugs not tested
upon children or not suitable for them. The health and wellbeing of children are threatened by being
potential recipients of therapies that are not formulated for them and where the data on toxicities is limited.
The cause or context of the vulnerability
The lack of paediatric formulation for the treatment of HIV/AIDS means that children are administered
crushed drugs or those in powder form which need to be reconstituted with clean drinking water. In
resource poor settings clean water may not be available, leading to additional problems such as
infections, diarrhoea and vomiting. In addition, children are not mini-adults, and it is important that
ethically sound research into the development of paediatric therapies is conducted. A lack of
appropriate care and education during pregnancy and childbirth, as well as the absence of alternatives
to breast feeding for many HIV positive women, conspire to spread HIV to future generations.
Remedies
The provision of targeted educational programmes for women, coupled with the availability of
appropriate medication suitable for paediatric use.

20
 III.2.2. Unfair allocation of resources
26. A 73 year old diabetic patient was admitted to hospital with obstructive vascular disease and
necrosis of his right foot. The amputation of his right leg was indicated. The surgery was scheduled
on a number of occasions but was postponed due to a shortage of resources and because of his
age. He remained hospitalized for 5 months, and his leg was never amputated. Finally, he
succumbed to sepsis and died, despite the fact that the amputation could have saved his life.
The nature of the vulnerability
The patient was more vulnerable to death because of the policy to discriminate against older patients
when allocating scarce resources.
The cause or context of the vulnerability
The increase in healthcare costs reduces the opportunities for many patients to receive appropriate
treatment. While more and more technologies are available, they are used on fewer patients
because of associated costs. The uneven availability of medical treatment occurs even in developed
countries, but has even more dramatic dimensions in developing countries.
Remedies
States should have in place a robustly resourced healthcare system that fairly and without
discrimination provides adequate care to all citizens.

III.3. Inequality of power in healthcare

III.3.1. Disrespect for the patient’s will

27. A 78 year old man with terminal lung cancer was admitted at the emergency room because of
respiratory failure. The medical exam and x-rays showed evidence of respiratory infection. The
patient was transferred to the Intensive Care Unit (ICU). He asked for a no intubation order. When
the doctor talked to the patient’s family, to explain to them that the patient would probably need
intubation, the patient’s daughters challenged their father’s wishes because of their religious beliefs.
A few hours later, the patient had severe respiratory failure, but he refused to be intubated. Minutes
later he fell into a coma, was intubated and connected to mechanical ventilation. The next day he
underwent dialysis. During the next 20 days, he continued to be intubated, underwent dialysis,
received antibiotics, mechanical ventilation and hemodynamic support, until he finally died.
The nature of the vulnerability
The clear wishes of the patient were disregarded and his autonomy was thus disrespected. There is
no suggestion in the case that his autonomy was impaired at the time he made his wishes clear.
The cause or context of the vulnerability
The principle of informed consent is at risk whenever someone claims to know what is the right thing
to do, and insists that his or her decision should prevail over the self-determination of the patient,
whether that person is the physician or a family member. In this case, the precarious condition of the
patient alone cannot justify overriding his wishes but the dire consequences of not intubating and the
pressure from the family serve to undermine respect for patient autonomy.
Remedies
Reinforcement of the need to protect an individual patient’s integrity, including specifically the
importance of respecting the right to refuse treatment. Appropriate clarification of the legal relevance

21
of the views of relatives of incompetent patients should be provided to healthcare professionals as
part of their professional education.

III.3.2. Professional self-interest

28. A doctor devises a treatment which he/she believes is likely to be beneficial, and advertises and
offers it to many patients, without disclosing that he/she stands to benefit financially and that the
procedure has not been satisfactorily tested.
The nature of the vulnerability
The vulnerability is to financial exploitation and potential physical harms.
The cause or context of the vulnerability
The inequalities in the doctor-patient relationship, the relationship between the expert helper and
the needy patient, made the patients vulnerable to exploitation and harm as a result of the powerful
combination of the attractiveness of the promised outcomes and the perceived authority of the
caring doctor.
Remedies
The creation and enforcement of safety controls for medicines and medical devices and insistence on
independent ethical review of innovative treatments, including the use of medical devices.

22
VULNERABILITY IN
HUMAN PARTICIPANT
RESEARCH
V U L N E R A B I L I T Y I N H U M A N PA R T I C I PA N T R E S E A RC H

IV.1. ‘Double Standard’ research

29. The proposal was made that a new vaccine be tested on citizens of a developing country where
the targeted disease had reached epidemic proportions. The proposal failed to pass the scrutiny of
ethical review committees in the country of origin on the grounds of safety. The justification for moving
the application to the needy country was said to be that the extra risks for participants could be
justified by the pressing needs of their country’s population. In addition, the research institutions in the
targeted communities were offered significant financial incentives to participate.
The nature of the vulnerability
The vulnerability was to the loss of individual dignity, the risk of exploitation and threats to wellbeing.
In addition, it is unlikely that the residents of this poor country would be able to afford access to the
vaccine should it prove efficacious.
The cause or context of the vulnerability
The needs of the target population could be argued to be almost overwhelming. However, they also
created a powerful temptation to overlook the needs of a small number of individuals who might
potentially become infected as participants in the study, given that these vaccines have the potential
to cause infection with the target disease and that safety was the issue which caused the body
reviewing the ethics of the research protocol not to approve the clinical trial. This increase in
vulnerability to the harm caused by the disease in the name of the public good was a threat to their
dignity and autonomy as individuals. Moreover, there was reason to doubt that the research could
be ethically justified. Additionally, the handsome rewards offered to the research institutions which
were in desperate need of funds encouraged researchers to sacrifice the interests of individual
participants to the interests of society, in direct opposition to a fundamental rule of medical research.
Remedies
Insistence that research protocols be approved both by independent ethics committees in the country of
origin of the research and in the country where the research is to be executed. In the absence of ethical
review networks in the country of the research, companies should actively support the creation of such
facilities before making proposals to carry out research in the area in question. Moreover, there should
be a guarantee that the benefits derived from such research will be shared with the research population.

IV.2. Equivocal donations

30. A gift of much needed antibiotics was made to a country torn by civil war, as part of an
international aid package in the form of a drug which has not been fully tested or licensed. The gift
was dependent on an agreement by the doctors administering the drug to monitor the use and
outcomes of the drug and report results back to the donor.
The nature of the vulnerability
The nature of the vulnerability is to exploitation and possible harm to health.

25
The cause or context of the vulnerability
The desperate shortage of antibiotics and the extreme needs of the population made the improper
offer attractive to the potential recipients. The potential harm results from the lack of transparency of
the donation and pressure on potential recipients – even if they were informed of the condition of the
gift – to take risks that they would likely, in normal circumstances, be unwilling to take. The subterfuge
in fact avoided the disclosure of risks and the necessity of obtaining consent to participate in research
rather than medical treatment.
Remedies
The creation and enforcement of strict international controls over the export of medicines from donor
countries, with special vigilance in emergency situations.

IV.3. Inappropriate research

31. Drug company A, a large multinational company, initiated a human participant ‘trial’ whose
purported aim was to evaluate the relative efficacy of its own product in relation to similar drugs produced
by companies B and C. The trial – which was conducted by eminent doctors in highly regarded academic
institutions and who received significant financial benefit – purportedly established that the drug was
indeed more efficacious than those of the other companies. However, analysis of the published results
subsequently showed that the trial design was flawed in such a way that it was not unbiased.
The nature of the vulnerability
Participants were exposed to unnecessary risks and were not provided with honest and accurate
information about the purpose of the ‘trial’. Their autonomy and wellbeing were at risk. The fact that
eminent doctors and institutions were involved resulted in patients ‘volunteering’ for something in
which they might otherwise have declined to participate.
The context and cause of the vulnerability
The ‘trial’ was inherently flawed and arguably entirely unnecessary, and it was, in fact, little more
than a marketing exercise.
Remedies
Enhanced regulatory control of clinical trials of medicinal products and improved scientific and
ethical review of such proposals.

IV.4. Social vulnerability

32. A woman of African origin, 45 years old and resident in a poor neighbourhood in a big city of
a developing country, had recently been abandoned by her husband. She was the mother of six
children, living in poverty. Her 4 year old son was unwell, with a possible diagnosis of acute
glomerulonephritis. Overcrowding at the hospital meant that her son had yet to be seen by a doctor
after one full day of waiting; she was eventually informed that her son would be entitled to receive
the necessary interventions if she would participate in a clinical trial being developed at the hospital.
She would be required to take two tablets of a new anti-inflammatory drug, daily, for 15 days. She
agreed to participate in return for the treatment her son needed.

26
The nature of the vulnerability
The woman’s autonomy was at risk as her ability to provide a valid consent was in doubt, given her
concerns for her son’s health. She was also vulnerable to any risks involved in the trial.
The cause or context of the vulnerability
Situations of social vulnerability often interfere with the power of self-determination of individuals and
lead to significantly increased exposure to a variety of risks. Some of the contextual factors that
generate social vulnerability in biomedical research are: poverty and low educational level among
the population; difficulty in accessing healthcare; being female; marginalised racial and ethnic
background; low capacity for research in a country.
Remedies
The alleviation of poverty and strict limitations on the use of potentially coercive incentives to
participate in research.

IV.5. Vulnerability as a result of lack of research

33. A group of diseases, known as Neglected Tropical Diseases (NTDs), are parasitic and bacterial
tropical diseases that primarily affect the most impoverished and vulnerable populations in the world.
Pharmaceutical companies show little interest in their treatment and eradication as research and
development costs are likely to exceed or reduce profit.
The nature of the vulnerability
The vulnerability is to potential physical harm and discrimination as to the right of every human being
to the highest attainable standard of health.
The cause or context of the vulnerability
People suffering from NTDs are usually poor and lack access to quality health care and essential
medicines. Pharmaceutical industries have failed to invest in the necessary research and development
to produce treatment for these conditions.
Remedies
Recognition of the right of all peoples to benefit from scientific advances and its applications is
fundamental. Global corporations should be encouraged by the international community and
national governments to engage in ‘public good’ research. If research were conducted and resulted
in appropriate treatment for these conditions, the treatment must be affordable for the populations of
the countries where these conditions are endemic.
Moreover, particular attention should be paid to the special vulnerability of the groups who would
be the subjects of this research. This would require a robust infrastructure to protect people from
exploitation or harm. Governments should take responsibility for their citizens by developing policies
that give priority to vulnerable communities with the aim of improving their quality of life.

27
VULNERABILITY IN
THE DEVELOPMENT
AND APPLICATION
OF EMERGING
TECHNOLOGIES IN
THE BIOMEDICAL
SCIENCES
 V U L N E R A B I L I T Y I N T H E D E V E LO P M E N T A N D A P P L I -
C AT I O N O F E M E R G I N G T E C H N O LO G I E S I N T H E
BIOMEDICAL SCIENCES

V.1. Stigmatisation

34. A research study using DNA genetic technologies was conducted on a specific ethnic
community, whose members were informed that the research was part of a study of cigarette use. A
mutation was discovered which had been suggested in the literature possibly to indicate a tendency
to criminality and violence. The researcher intuitively linked the finding to the higher representation
of members of this group in the country’s prisons. This was not the purpose of the research to which
the community concerned had consented, but the press took up the ‘finding’ with enthusiasm. The
result was an unsubstantiated claim against this group which was socially damaging and offensive.
The nature of the vulnerability
The vulnerability was to the stigmatisation, victimisation and social discrimination of all members of
the group.
The context and cause of the vulnerability
The research ‘findings’ were foreign to the objectives of the research in which the participants had
agreed to participate. No permissions had been sought to amend the research protocol. In addition,
the conclusions drawn showed a misunderstanding of the nature of genetic susceptibilities, and drew
conclusions that were not substantiated by the research itself.
Remedies
Regulations should be established that require proper consultation with social groups of participants
rather than simply with individual participants in the preparation of protocols for studies where
knowledge about the group as a whole is sought. The objectives of such studies should be clearly
agreed in the consent procedure. Any amendments to the protocol should be reconsidered by the
group or its representatives and specific consent sought.

V.2. Unfair pressure

35. Because of a shortage of volunteers prepared to provide oocytes to a clinic’s authorized assisted
reproduction programme, a scheme was devised to recruit ‘volunteers’ by offering free access to IVF
cycles on condition that the woman agreed that her surplus oocytes would be donated for the
treatment of other infertile women. This free service is offered in return for undergoing one procedure
of ovarian hyperstimulation, and the harvesting of resultant oocytes for use in the treatment of infertile
women who are clients of the clinic.
Nature of the vulnerability
The vulnerability is the threat to the autonomy and wellbeing of the ‘volunteers’.
The cause and context of the vulnerability

31
The offer of a reward in kind to these needy patients put them under considerable pressure to do what
most women who have no such needs would not contemplate doing (vide the shortage of donors).
They were singled out as a group who were likely to have a weakened resistance to the proposal
because of their infertility. In addition, in some cases the incentive to participate was exacerbated by
the women’s inability to pay for IVF treatment which would otherwise be unavailable to them.
Remedies
Regulations to provide for ethical review of all clinical interventions offered with no promise or
expectation of clinical benefit to the patient, including stricter licensing, oversight, monitoring and
evaluation of clinics offering these services.

V.3. Premature applications of technology

36. A new sunscreen advertised its superior effectiveness in protecting against UV rays by describing
the product as microfine. The description referred to the nanoparticles of Zinc Oxide in the cream.
Nanoparticles have been demonstrated to have heightened and powerful properties compared with
the normal inorganic particles of materials. However they have also been shown to be capable of
penetrating cells, crossing the blood brain barrier and producing serious lipid and protein damage. Yet
the cream was marketed on the basis that it provided greater protection of health than other creams.
Nature of the vulnerability
The lack of information in the beguiling advertisement of the product and the lack of adequate risk
assessment of the effect of rubbing millions of particles on to the skin fail to facilitate an autonomous
decision to apply the cream and threatens the health of the user while promising to do just the opposite.
The cause and context of the vulnerability
The commercial pressure to recoup research and development costs of a technology and to gain an
advantage over rival products corrupts the endeavour to provide better healthcare. Undue haste in
marketing products by short circuiting proper risk assessment results in hazards to the health of consumers.
Remedies
Cosmetics should be as strictly assessed for safety as pharmaceutical products. Licensing bodies
should be aware that the safe use of materials in their normal inorganic state does not provide an
adequate guide to their use in nanoparticulate form.

V.4. Genetic information and patient privacy

37. A woman gave birth to a child with serious genetic abnormalities. The clinical team recognised
that she carried a mutation responsible for the condition of the neonate. It was a mutation that was
likely to be carried by any sister of hers. On enquiry the team discovered that she had a sister in her
early twenties. They sought the patient’s permission to contact her and offer a genetic test. The patient
refused on the basis that she hated her sister and hoped that she had a similar experience and,
further, that she did not want the sister to know about the reason for the child’s misfortune.
The nature of the vulnerability
The technology gave rise to two special vulnerabilities in this case. The first was the vulnerability of the

32
patient to an invasion of her privacy if her genetic health information was revealed to another. The
second was the vulnerability of her sister to experience what was now an avoidable health hazard.
The cause and context of the vulnerability
Genetic information is not simply information about the presenting patient but might well be
information about biological relatives too. Insofar as this is so, there will be inevitable tensions
involved in decisions to share or deny such information to those relatives for whom it might be
important for health reasons. This might be described as a tension between the right to know, on the
one hand, and the right to privacy on the other.
Remedies
Policies should be developed to aid clinicians in such decision making. This is a difficult task, but one
possible criterion for divulging confidential information of this kind without the consent of the patient
would be the seriousness of the possible health consequences of leaving the relatives involved in
ignorance of the matter. Quite different considerations would apply to the many other threats to
privacy engendered by the possession of genetic information. These would include access to the
genetic data of patients by researchers, insurance companies, employers and governments. Such
disclosures would engender major vulnerabilities to restrictions of civil liberties.

V.5. Unexpected risks

38. X-linked severe combined ımmune deficiency (X-SCID) is a rare genetic disease where gene
therapy (which entails modifying or replacing disease causing genes using genetic engineering
techniques) was used in clinical trials. Unfortunately, in some of the children treated, leukaemia
developed after 3-6 years. This result was attributed to the retroviral vector used to carry the gene to
the cells. Cancer developed in patient groups from different centres that were using the experimental
treatment. Protocols had to be redefined after the trials have been suspended.
The nature of the vulnerability
Other effective treatments are not yet available and, while those who enter this kind of trial may
otherwise die untreated, the full risks of participation cannot be envisioned.
The cause and context of the vulnerability
In life sciences gene therapy is a new form of therapy with high hopes for genetic diseases. However,
patients often enter clinical trials without foreseeable knowledge of the increased risk due to the
experimental protocol.
Remedies
A full explanation to those contemplating entering such trials concerning what is, and is not, known
about the potential risks of their participation.

V.6. Unconsented collection of genetic data

39. A medical organisation proposed that a programme of community genetic screening be

introduced by means of which a complete genetic map of neonates could be produced at birth which
would constitute part of their permanent medical record. Such a programme would provide valuable

33
information for the development of future health policies and health research. It would also make it
possible for the owners of the map to benefit rapidly from scientific developments in
pharmacogenomics and disease prevention as they came to light.
The nature of the vulnerability
The persons from whom data were collected were unable to consent to the collection and storage of
this data when there was no imminent need for that information, thereby undermining their potential
future autonomy. While parents are generally permitted to offer consent on behalf of their incapable
children, this is usually constrained by the need to consider the best interests of the children in question.
The cause and context of the vulnerability
Knowledge of one’s genetic profile can provide diagnostic information about late onset conditions
and a growing number of susceptibilities to diseases such as breast cancer. While it might be thought
that to be warned of the possibility of developing a serious condition in the future would be an
advantage, there are some consequences that need addressing. For example, the potential threat to
privacy that arises from the mere holding of this information raises the possibility of discrimination
based on genetic profile. In addition, while individuals may wish to know such information, routine
neonatal genetic screening makes the right not to know one’s genetic status unavailable.
Remedies
Careful consideration of the benefits and drawbacks of collection of such information and the
consequences of encouraging parental consent in the absence of the full knowledge of the
potential harms. These harms may result either from the fact that the information is recorded, or
from the possibility of causing distress to children once they are mature enough to gain access to
this information.

34
CONCLUSIONS
 V I . C O N C LU S I O N S

40. In this report, IBC has provided both a theoretical account of the principle of respect for personal
integrity and the need to protect those who are especially vulnerable, as well as a series of practical
examples. These examples are not exhaustive of the issues that could be raised; they are rather
intended as a useful template for further discussion and development.

41. Vulnerability as a risk of a human being to be harmed in his or her physical and mental integrity
is an element of human condition. Special vulnerability in the scope of Article 8 of the Universal
Declaration on Bioethics and Human Rights means that there are individuals and groups that are
especially prone to violation of personal integrity or disrespect for autonomy due to exploitation,
deception, coercion and disregard through the application and advancing of scientific knowledge,
medical practice and associated technologies. People can be especially vulnerable for many
reasons: because of their age like children, their kind of disease like rare or neglected diseases,
because of lacking access to health care due to the health care system of their country, their own
education or the education of physicians and researchers.

42. A further important example of special vulnerabilities can be provided using the example of the
position of women. In some cultures, female children are uniquely vulnerable to the risk of being
unwanted, uncared for, abused and rejected. Female children may also find their interest in bodily
integrity gravely threatened, including especially their right to be free from sexual assault and
exploitation. Adult women may find themselves transferred from the patronage of their father to the
patronage of their husband, thereby denying them the personal authority to make important life and
healthcare decisions on their own behalf. As women live longer in many parts of the world, elderly
women might find themselves abandoned by their families, subject to inadequate healthcare, and
disregarded by society. Migrant women and women affected by war are especially vulnerable to
abuse and are often disenfranchised from engaging in conflict resolution and reconciliation.

43. It must be accepted that situations of vulnerability seldom exist in isolation. Lack of access to
education, lack of social authority, limited access to healthcare and freedom from coercion can
combine negatively to affect the integrity of people throughout the world. In addition, there are often
complex, social, cultural and political barriers that negatively impact on respect for personal integrity,
and create seemingly intractable, situations of special vulnerability for both individuals and groups.
In particular, lower levels of education always predict higher levels of vulnerability.

44. In its Article 1, the Universal Declaration on Bioethics and Human Rights makes it clear that it is
addressed to States, but also to individuals, groups, communities, institutions and corporations, public
or private. We all share responsibilities in this area. While we cannot eradicate vulnerability entirely,
given that it is a feature of the human condition, we can and should provide every human being with
the best available means to ensure that they do not find themselves in a position of special
vulnerability, regardless of age, gender, educational level, financial situation, health status and life
experiences. Securing the protection of groups and individuals with special vulnerability, by
addressing the context and causes that give rise to it, is the foremost test of our capacity and
willingness to foster the idea of equal rights and the dignity of every human being.

37
ANNEXES
 ANNEX I

U N I V E R S A L D E C L A R AT I O N
O N B I O E T H I C S A N D H U M A N R I G H T S (1)

The General Conference,

Conscious of the unique capacity of human beings to reflect upon their own existence and on their
environment, to perceive injustice, to avoid danger, to assume responsibility, to seek cooperation and
to exhibit the moral sense that gives expression to ethical principles,
Reflecting on the rapid developments in science and technology, which increasingly affect our
understanding of life and life itself, resulting in a strong demand for a global response to the ethical
implications of such developments,
Recognizing that ethical issues raised by the rapid advances in science and their technological
applications should be examined with due respect to the dignity of the human person and universal
respect for, and observance of, human rights and fundamental freedoms,
Resolving that it is necessary and timely for the international community to state universal principles
that will provide a foundation for humanity’s response to the ever-increasing dilemmas and
controversies that science and technology present for humankind and for the environment,
Recalling the Universal Declaration of Human Rights of 10 December 1948, the Universal
Declaration on the Human Genome and Human Rights adopted by the General Conference of
UNESCO on 11 November 1997 and the International Declaration on Human Genetic Data
adopted by the General Conference of UNESCO on 16 October 2003,
Noting the United Nations International Covenant on Economic, Social and Cultural Rights and
the International Covenant on Civil and Political Rights of 16 December 1966, the United Nations
International Convention on the Elimination of All Forms of Racial Discrimination of 21 December
1965, the United Nations Convention on the Elimination of All Forms of Discrimination against
Women of 18 December 1979, the United Nations Convention on the Rights of the Child of
20 November 1989, the United Nations Convention on Biological Diversity of 5 June 1992,
the Standard Rules on the Equalization of Opportunities for Persons with Disabilities adopted by
the General Assembly of the United Nations in 1993, the UNESCO Recommendation on the Status
of Scientific Researchers of 20 November 1974, the UNESCO Declaration on Race and Racial
Prejudice of 27 November 1978, the UNESCO Declaration on the Responsibilities of the Present
Generations Towards Future Generations of 12 November 1997, the UNESCO Universal
Declaration on Cultural Diversity of 2 November 2001, the ILO Convention 169 concerning
Indigenous and Tribal Peoples in Independent Countries of 27 June 1989, the International Treaty
on Plant Genetic Resources for Food and Agriculture which was adopted by the FAO Conference on
3 November 2001 and entered into force on 29 June 2004, the Agreement on Trade-Related
Aspects of Intellectual Property Rights (TRIPS) annexed to the Marrakech Agreement establishing
the World Trade Organization, which entered into force on 1 January 1995, the Doha Declaration
on the TRIPS Agreement and Public Health of 14 November 2001 and other relevant international
instruments adopted by the United Nations and the specialized agencies of the United Nations
system, in particular the Food and Agriculture Organization of the United Nations (FAO) and
the World Health Organization (WHO),
(1) Adopted by acclamation on 19 October 2005 by the 33rd session of the General Conference of UNESCO.

41
Also noting international and regional instruments in the field of bioethics, including the Convention
for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of
Biology and Medicine: Convention on Human Rights and Biomedicine of the Council of Europe,
which was adopted in 1997 and entered into force in 1999, together with its Additional Protocols,
as well as national legislation and regulations in the field of bioethics and the international and
regional codes of conduct and guidelines and other texts in the field of bioethics, such as
the Declaration of Helsinki of the World Medical Association on Ethical Principles for Medical
Research Involving Human Subjects, adopted in 1964 and amended in 1975, 1983, 1989, 1996
and 2000 and the International Ethical Guidelines for Biomedical Research Involving Human
Subjects of the Council for International Organizations of Medical Sciences, adopted in 1982 and
amended in 1993 and 2002,
Recognizing that this Declaration is to be understood in a manner consistent with domestic and
international law in conformity with human rights law,
Recalling the Constitution of UNESCO adopted on 16 November 1945,
Considering UNESCO’s role in identifying universal principles based on shared ethical values to
guide scientific and technological development and social transformation in order to identify
emerging challenges in science and technology taking into account the responsibility of the present
generations towards future generations, and that questions of bioethics, which necessarily have an
international dimension, should be treated as a whole, drawing on the principles already stated in
the Universal Declaration on the Human Genome and Human Rights and the International
Declaration on Human Genetic Data and taking account not only of the current scientific context
but also of future developments,
Aware that human beings are an integral part of the biosphere, with an important role in protecting
one another and other forms of life, in particular animals,
Recognizing that, based on the freedom of science and research, scientific and technological
developments have been, and can be, of great benefit to humankind in increasing, inter alia,
life expectancy and improving the quality of life, and emphasizing that such developments should
always seek to promote the welfare of individuals, families, groups or communities and humankind
as a whole in the recognition of the dignity of the human person and universal respect for, and
observance of, human rights and fundamental freedoms,
Recognizing that health does not depend solely on scientific and technological research
developments but also on psychosocial and cultural factors,
Also recognizing that decisions regarding ethical issues in medicine, life sciences and associated
technologies may have an impact on individuals, families, groups or communities and humankind
as a whole,
Bearing in mind that cultural diversity, as a source of exchange, innovation and creativity,
is necessary to humankind and, in this sense, is the common heritage of humanity, but emphasizing
that it may not be invoked at the expense of human rights and fundamental freedoms,
Also bearing in mind that a person’s identity includes biological, psychological, social, cultural and
spiritual dimensions,
Recognizing that unethical scientific and technological conduct has had a particular impact on
indigenous and local communities,
Convinced that moral sensitivity and ethical reflection should be an integral part of the process of
scientific and technological developments and that bioethics should play a predominant role in
the choices that need to be made concerning issues arising from such developments,

42
Considering the desirability of developing new approaches to social responsibility to ensure
that progress in science and technology contributes to justice, equity and to the interest of humanity,
Recognizing that an important way to evaluate social realities and achieve equity is to pay attention
to the position of women,
Stressing the need to reinforce international cooperation in the field of bioethics, taking into account,
in particular, the special needs of developing countries, indigenous communities and vulnerable
populations,
Considering that all human beings, without distinction, should benefit from the same high ethical
standards in medicine and life science research,
Proclaims the principles that follow and adopts the present Declaration.

GENERAL PROVISIONS
Article 1 – Scope
1. This Declaration addresses ethical issues related to medicine, life sciences and associated
technologies as applied to human beings, taking into account their social, legal and environmental
dimensions.
2. This Declaration is addressed to States. As appropriate and relevant, it also provides guidance
to decisions or practices of individuals, groups, communities, institutions and corporations, public and
private.

Article 2 – Aims
The aims of this Declaration are:
(a) to provide a universal framework of principles and procedures to guide States in the formulation
of their legislation, policies or other instruments in the field of bioethics;
(b) to guide the actions of individuals, groups, communities, institutions and corporations, public
and private;
(c) to promote respect for human dignity and protect human rights, by ensuring respect for
the life of human beings, and fundamental freedoms, consistent with international human
rights law;
(d) to recognize the importance of freedom of scientific research and the benefits derived from
scientific and technological developments, while stressing the need for such research and
developments to occur within the framework of ethical principles set out in this Declaration
and to respect human dignity, human rights and fundamental freedoms;
(e) to foster multidisciplinary and pluralistic dialogue about bioethical issues between all
stakeholders and within society as a whole;
(f) to promote equitable access to medical, scientific and technological developments as well as
the greatest possible flow and the rapid sharing of knowledge concerning those developments
and the sharing of benefits, with particular attention to the needs of developing countries;
(g) to safeguard and promote the interests of the present and future generations;
(h) to underline the importance of biodiversity and its conservation as a common concern of
humankind.

PRINCIPLES
Within the scope of this Declaration, in decisions or practices taken or carried out by
those to whom it is addressed, the following principles are to be respected.

43
 Article 3 – Human dignity and human rights
1. Human dignity, human rights and fundamental freedoms are to be fully respected.
2. The interests and welfare of the individual should have priority over the sole interest of science
or society.

Article 4 – Benefit and harm

In applying and advancing scientific knowledge, medical practice and associated technologies,
direct and indirect benefits to patients, research participants and other affected individuals should be
maximized and any possible harm to such individuals should be minimized.

Article 5 – Autonomy and individual responsibility

The autonomy of persons to make decisions, while taking responsibility for those decisions and
respecting the autonomy of others, is to be respected. For persons who are not capable of exercising
autonomy, special measures are to be taken to protect their rights and interests.

Article 6 – Consent
1. Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with
the prior, free and informed consent of the person concerned, based on adequate information.
The consent should, where appropriate, be express and may be withdrawn by the person concerned
at any time and for any reason without disadvantage or prejudice.
2. Scientific research should only be carried out with the prior, free, express and informed consent of
the person concerned. The information should be adequate, provided in a comprehensible form and
should include modalities for withdrawal of consent. Consent may be withdrawn by the person
concerned at any time and for any reason without any disadvantage or prejudice. Exceptions to this
principle should be made only in accordance with ethical and legal standards adopted by States,
consistent with the principles and provisions set out in this Declaration, in particular in Article 27,
and international human rights law.
3. In appropriate cases of research carried out on a group of persons or a community, additional
agreement of the legal representatives of the group or community concerned may be sought.
In no case should a collective community agreement or the consent of a community leader or other
authority substitute for an individual’s informed consent.

Article 7 – Persons without the capacity to consent

In accordance with domestic law, special protection is to be given to persons who do not have
the capacity to consent:
(a) authorization for research and medical practice should be obtained in accordance with
the best interest of the person concerned and in accordance with domestic law. However,
the person concerned should be involved to the greatest extent possible in the decision-
making process of consent, as well as that of withdrawing consent;
(b) research should only be carried out for his or her direct health benefit, subject to the authorization
and the protective conditions prescribed by law, and if there is no research alternative of
comparable effectiveness with research participants able to consent. Research which does not
have potential direct health benefit should only be undertaken by way of exception, with the
utmost restraint, exposing the person only to a minimal risk and minimal burden and if
the research is expected to contribute to the health benefit of other persons in the same

44
 category, subject to the conditions prescribed by law and compatible with the protection of the
individual’s human rights. Refusal of such persons to take part in research should be respected.

Article 8 – Respect for human vulnerability and personal integrity

In applying and advancing scientific knowledge, medical practice and associated technologies,
human vulnerability should be taken into account. Individuals and groups of special vulnerability
should be protected and the personal integrity of such individuals respected.

Article 9 – Privacy and confidentiality

The privacy of the persons concerned and the confidentiality of their personal information should be
respected. To the greatest extent possible, such information should not be used or disclosed for
purposes other than those for which it was collected or consented to, consistent with international
law, in particular international human rights law.

Article 10 – Equality, justice and equity

The fundamental equality of all human beings in dignity and rights is to be respected so that they are
treated justly and equitably.

Article 11 – Non-discrimination and non-stigmatization

No individual or group should be discriminated against or stigmatized on any grounds, in violation
of human dignity, human rights and fundamental freedoms.

Article 12 – Respect for cultural diversity and pluralism

The importance of cultural diversity and pluralism should be given due regard. However, such
considerations are not to be invoked to infringe upon human dignity, human rights and fundamental
freedoms, nor upon the principles set out in this Declaration, nor to limit their scope.

Article 13 – Solidarity and cooperation

Solidarity among human beings and international cooperation towards that end are to be encouraged.

Article 14 – Social responsibility and health

1. The promotion of health and social development for their people is a central purpose of
governments that all sectors of society share.
2. Taking into account that the enjoyment of the highest attainable standard of health is one of
the fundamental rights of every human being without distinction of race, religion, political belief,
economic or social condition, progress in science and technology should advance:
(a) access to quality health care and essential medicines, especially for the health of women and
children, because health is essential to life itself and must be considered to be a social and
human good;
(b) access to adequate nutrition and water;
(c) improvement of living conditions and the environment;
(d) elimination of the marginalization and the exclusion of persons on the basis of any grounds;
(e) reduction of poverty and illiteracy.

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 Article 15 – Sharing of benefits
1. Benefits resulting from any scientific research and its applications should be shared with society as
a whole and within the international community, in particular with developing countries. In giving
effect to this principle, benefits may take any of the following forms:
(a) special and sustainable assistance to, and acknowledgement of, the persons and groups that
have taken part in the research;
(b) access to quality health care;
(c) provision of new diagnostic and therapeutic modalities or products stemming from research;
(d) support for health services;
(e) access to scientific and technological knowledge;
(f) capacity-building facilities for research purposes;
(g)vother forms of benefit consistent with the principles set out in this Declaration.
2. Benefits should not constitute improper inducements to participate in research.

Article 16 – Protecting future generations

The impact of life sciences on future generations, including on their genetic constitution, should be
given due regard.

Article 17 – Protection of the environment, the biosphere and biodiversity

Due regard is to be given to the interconnection between human beings and other forms of life,
to the importance of appropriate access and utilization of biological and genetic resources, to respect
for traditional knowledge and to the role of human beings in the protection of the environment,
the biosphere and biodiversity.

APPLICATION OF THE PRINCIPLES

Article 18 – Decision-making and addressing bioethical issues
1. Professionalism, honesty, integrity and transparency in decision-making should be promoted,
in particular declarations of all conflicts of interest and appropriate sharing of knowledge. Every
endeavour should be made to use the best available scientific knowledge and methodology in
addressing and periodically reviewing bioethical issues.
2. Persons and professionals concerned and society as a whole should be engaged in dialogue on
a regular basis.
3. Opportunities for informed pluralistic public debate, seeking the expression of all relevant opinions,
should be promoted.

Article 19 – Ethics committees

Independent, multidisciplinary and pluralist ethics committees should be established, promoted and
supported at the appropriate level in order to:
(a) assess the relevant ethical, legal, scientific and social issues related to research projects
involving human beings;
(b) provide advice on ethical problems in clinical settings;
(c) assess scientific and technological developments, formulate recommendations and contribute
to the preparation of guidelines on issues within the scope of this Declaration;
(d) foster debate, education and public awareness of, and engagement in, bioethics.

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 Article 20 – Risk assessment and management
Appropriate assessment and adequate management of risk related to medicine, life sciences and
associated technologies should be promoted.

Article 21 – Transnational practices

1. States, public and private institutions, and professionals associated with transnational activities
should endeavour to ensure that any activity within the scope of this Declaration, undertaken, funded
or otherwise pursued in whole or in part in different States, is consistent with the principles set out
in this Declaration.
2. When research is undertaken or otherwise pursued in one or more States (the host State(s)) and
funded by a source in another State, such research should be the object of an appropriate level of
ethical review in the host State(s) and the State in which the funder is located. This review should be
based on ethical and legal standards that are consistent with the principles set out in this Declaration.
3. Transnational health research should be responsive to the needs of host countries, and the importance
of research contributing to the alleviation of urgent global health problems should be recognized.
4. When negotiating a research agreement, terms for collaboration and agreement on the benefits
of research should be established with equal participation by those party to the negotiation.
5. States should take appropriate measures, both at the national and international levels, to combat
bioterrorism and illicit traffic in organs, tissues, samples, genetic resources and genetic-related materials.

PROMOTION OF THE DECLARATION

Article 22 – Role of States
1. States should take all appropriate measures, whether of a legislative, administrative or other
character, to give effect to the principles set out in this Declaration in accordance with international
human rights law. Such measures should be supported by action in the spheres of education, training
and public information.
2. States should encourage the establishment of independent, multidisciplinary and pluralist ethics
committees, as set out in Article 19.

Article 23 – Bioethics education, training and information

1. In order to promote the principles set out in this Declaration and to achieve a better understanding
of the ethical implications of scientific and technological developments, in particular for young
people, States should endeavour to foster bioethics education and training at all levels as well as to
encourage information and knowledge dissemination programmes about bioethics.
2. States should encourage the participation of international and regional intergovernmental
organizations and international, regional and national non governmental organizations in this endeavour.

Article 24 – International cooperation

1. States should foster international dissemination of scientific information and encourage the free
flow and sharing of scientific and technological knowledge.
2. Within the framework of international cooperation, States should promote cultural and scientific
cooperation and enter into bilateral and multilateral agreements enabling developing countries to
build up their capacity to participate in generating and sharing scientific knowledge, the related
know-how and the benefits thereof.

47
3. States should respect and promote solidarity between and among States, as well as
individuals, families, groups and communities, with special regard for those rendered vulnerable
by disease or disability or other personal, societal or environmental conditions and those with
the most limited resources.

Article 25 – Follow-up action by UNESCO

1. UNESCO shall promote and disseminate the principles set out in this Declaration. In doing so,
UNESCO should seek the help and assistance of the Intergovernmental Bioethics Committee (IGBC)
and the International Bioethics Committee (IBC).
2. UNESCO shall reaffirm its commitment to dealing with bioethics and to promoting collaboration
between IGBC and IBC.

FINAL PROVISIONS
Article 26 – Interrelation and complementarity of the principles
This Declaration is to be understood as a whole and the principles are to be understood as
complementary and interrelated. Each principle is to be considered in the context of the other
principles, as appropriate and relevant in the circumstances.

Article 27 – Limitations on the application of the principles

If the application of the principles of this Declaration is to be limited, it should be by law, including
laws in the interests of public safety, for the investigation, detection and prosecution of criminal
offences, for the protection of public health or for the protection of the rights and freedoms of others.
Any such law needs to be consistent with international human rights law.

Article 28 – Denial of acts contrary to human rights, fundamental freedoms and human dignity
Nothing in this Declaration may be interpreted as implying for any State, group or person any claim
to engage in any activity or to perform any act contrary to human rights, fundamental freedoms and
human dignity.

48
 ANNEX II

C O M P O S I T I O N O F T H E I N T E R N AT I O N A L
BIOETHICS COMMITTEE (IBC)
( 2 010 – 2 011 )

NAME TERM OF OFFICE

BAGHERI Prof. (Mr) Alireza (Islamic Republic of Iran) 2010–2013

Assistant Professor of Medical Ethics, School of Medicine, Teheran University
Deputy Director (Education) of the Center for Study and Research on Medical Ethics and History of
Medicine, Teheran University of Medical Sciences
Vice-President of the Asian Bioethics Association

BARTNIK Prof. (Mrs) Ewa (Poland) 2010–2013

Professor of Molecular Biology and Human Genetics, University of Warsaw
Former Vice-Chairperson, Intergovernmental Bioethics Committee of UNESCO (IGBC)

BOIRO Prof. (Mr) Ibrahima (Republic of Guinea) 2010–2013

Professor of Biology
Director of the Research and Studies Centre on Environment, Conakry University
Vice-Rector for Scientific Research, Conakry University
Chairperson of the National Bioethics Committee

BOUSTANY Prof. (Mr) Fouad (Lebanon) 2008–2011

Professor at the Medical School of Beirut
Secretary-General, Lebanese Ethics Advisory Committee for Health and Life Sciences
Member of the National Council for Scientific Research
Former President of the Lebanese Order of Physicians

BROWN (Ms) Cheryl (Jamaica) 2010–2013

Attorney-at-Law
Manager of the Office of Sponsored Research, Mona Campus, University of the West Indies
Member of the National Bioethics Committee
Former Vice-Chairperson, Intergovernmental Bioethics Committee of UNESCO (IGBC)

49
CHANDRA Prof. (Mr) Sharat H. (India) 2008–2011
Emeritus Professor, Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore
Honorary Professor, Jawaharlal Nehru Centre for Advanced Scientific Research, Bangalore
Director of the Centre for Human Genetics, Bangalore
Member of the National Bioethics Committee

DAAR Prof. (Mr) Abdallah (Oman) 2008–2011

Professor of Public Health Sciences and Professor of Surgery, University of Toronto, Canada
Co-Director, Programme in Life Sciences, Ethics and Policy, McLaughlin-Rotman Centre for Global
Health, University Health Network and University of Toronto
Senior Scientist and Director of Ethics and Policy, McLaughlin Centre for Molecular Medicine,
University of Toronto
Fellow of the Third World Academy of Science (TWAS)
UNESCO Avicenna Prize for Ethics in science, 2005

DRUML Dr (Mrs) Christiane (Austria) 2008–2011

Doctor of Law
Managing Director of the Ethics Committee, Medical University of Vienna and the Vienna General
Hospital
Chair of the Commission for Bioethics, Federal Austrian Chancellery

D’EMPAIRE Prof. (Mr) Gabriel (Venezuela) 2004–2011

Professor of Bioethics, Central University of Venezuela
Director of Coronary and Intensive Care Unit, Clínicas Caracas Hospital
President of the Bioethics Clinical Association of Venezuela
Guest Member of the National Academy of Medicine of Venezuela

EVANS Prof. (Mr) Donald (New Zealand) 2004–2011

Professor of Philosophy
Director of the Bioethics Centre, University of Otago
Former member of the National Ethics Advisory Committee of New Zealand

GARRAFA Prof. (Mr) Volnei (Brazil) 2010–2013

Director, UNESCO Chair in Bioethics, University of Brasilia
Professor at the Post-Graduate Program in Bioethics of the University of Brasilia
Chairperson of the UNESCO-REDBIOETICA
Editor-in-Chief, Brazilian Journal of Bioethics

50
GRACIA Prof. (Mr) Diego (Spain) 2008–2011
Professor of History of Medicine and Bioethics, Medical Faculty, Complutense University of Madrid
Director, Institute of Bioethics of the Foundation for the Health Sciences, Madrid
Honorary Professor at the University of Chile, University of Lima, Peru, and University of Cordoba, Argentina
Member of the Royal National Academy of Medicine of Spain

HU Prof. (Mr) Ching-li (China) 2006–2009

Emeritus Professor of Medicine and Senior Advisor, Shanghai Jiaotong University School of Medicine
Deputy Director, Biomedical Ethics Research Centre, Shanghai Jiaotong University School of Medicine
Former Deputy Director-General (1988–1997) and former Assistant Director-General (1995–1997)
of the World Health Organization (WHO)

HURIET Prof. (MR) Claude (France) 2004–2011

Emeritus Professor of Medicine, Faculty of Medicine, Nancy
President of the Institut Curie
Honorary Senator
Former Member of the National Consultative Ethics Committee for Health and Life Science

KASHMEERY Prof. (Mr) Amin (Saudi Arabia) 2010–2013

Emeritus Professor of Physiology
Founding Head of the Bioethics Department, King Abdullaziz University for Health Sciences (Riyadh)
Editor-in-Chief, Oxford Research Forum Journal, United Kingdom

KUBAR Prof. (Mrs) Olga (Russian Federation) 2008–2011

Head of the Clinical Department, Saint-Petersburg Pasteur Institute
Former Chair, Forum for Ethics Committees in the Commonwealth of Independent States

LA ROSA RODRIGUEZ Dr (Mr) Emilio (Peru) 2006–2013

Surgeon
Doctor in Anthropology and Human Ecology
Member of the Peruvian Society of Bioethics
Former Director of the Health and Society Study and Research Centre (CRESS), France
Former Vice-Chairperson of the Intergovernmental Bioethics Committee of UNESCO (IGBC)

LOLAS STEPKE Prof. (Mr) Fernando (Chile) 2008–2011

Psychiatrist
Professor at the Faculty of Medicine and Director of the Interdisciplinary Centre on Bioethical Studies,
University of Chile
Director of the Bioethics Programme, Pan American Health Organization (PAHO)
Member of the Royal Spanish Academy
Former Director of the Psychiatric Clinic and Former Vice-Rector of the University of Chile
51
MAIMETS Prof. (Mr) Toivo (Estonia) 2004–2011
Professor at the Institute of Molecular and Cell Biology, University of Tartu
Director of the National Centre of Excellence for Gene and Environmental Technologies
Former Minister of Education and Research
Former Vice-Rector of the University of Tartu

MARTIN Dr (Mr) Jean (Switzerland) 2006–2013

Physician
Member of the National Commission of Ethics for Human Medicine
Former Chief Medical Officer for the Canton of Vaud
Former Consultant of the World Health Organization (WHO) and the United Nations Population
Funds (UNFPA)

MASSOUGBODJI Prof. (M.) Achille (Benin) 2008–2011

Senior Physician, Laboratory of Microbiology, National Hospital and University Centre of Cotonou
(CNHU)
Founding member of the Ethics Committee, Faculty of Health Sciences, Cotonou
Founding member of the Pan African Bioethics Initiative (PABIN)
President of the Beninese Association of Fight against AIDS

MATSIEGUI Prof. (Mr) Pierre-Blaise (Gabon) 2010–2013

Clinician and Research Associate, Medical Research Unit, Schweitzer Hospital, Lambaréné
Director of the Research Medical Centre of Ngounié, Fougamou
Chairperson of the National Research Ethics Committee

MC LEAN Prof. (Mrs) Sheila (United Kingdom) 2006–2013

International Bar Association Professor of Law and Ethics of Medicine
Director of the Institute of Law and Ethics in Medicine, University of Glasgow
Member of the Wellcome Trust Biomedical Ethics Panel

MORISAKI Prof. (Mr) Takayuki (Japan) 2004–2011

Professor of Molecular Pathophysiology, Osaka University
Director of the Department of Bioscience, National Cardiovascular Centre Research Institute
Member of the Bioethics and Biosafety Commission, Council of Science and Technology of Japan

ÖZGÜC Prof. (Mrs) Meral (Turkey) 2004–2011

Professor and Director of the Department of Medical Biology, Hacettepe University
Director, Scientific and Technical Research Council of Turkey (TUBITAK) DNA/Cell Bank
Chairperson of the Bioethics Committee of the Turkish National Commission for UNESCO
Member of the European Society for Human Genetics

52
PERALTA-CORNEILLE Prof. (Mr) Andrés (Dominican Republic) 2006–2013
Medical Doctor
Professor of Bioethics, Santiago Technological University
Member of the Executive Board of the UNESCO-REDBIOETICA for Latin America and the Caribbean
Member of the International Bioethics Association
Founding member and former Chairperson of the National Bioethics Committee

SALEH Prof. (M.) Fawaz (Syrian Arab Republic) 2004–2011

Professor of Law, University of Damascus
Professor and Secretary-General of the Higher Institute of Business Administration
Head of Legal Affairs, University of Damascus
Member and Secretary-General of the Syrian Bioethics Committee

SASTROWIJOTO Prof. (Mr) Soenarto (Indonesia) 2008–2011

Doctor of Medicine
Emeritus Professor, Department of Ear-nose-Throat and Head & Neck Surgery, School of Medicine,
Gadjah Mada University, Yogyakarta
Director of the Center for Bioethics and Medical Humanities School of Medicine Gadjah Mada
University, Yogyakarta
Member of National Bioethics Committee
Member of National Committee on Research Ethics in Health Sciences
Former Vice-Chairperson of the Intergovernmental Bioethics Committee of UNESCO (IGBC)

SEMPLICI Prof. (Mr) Stefano (Italy) 2008–2011

Professor of Social Ethics, Faculty of Philosophy, University of Rome Tor Vergata
Editor of the international journal Archives of Philosophy
Scientific Director, Lamaro Pozzani College, Rome
Member of the Scientific Board, Institute for General and Applied Ethics, Borromeo College, Pavia

SNEAD Prof. (Mr) Carter IV (United States of America) 2008–2011

Associate Professor, Notre Dame Law School, Indiana
US Permanent Observer on the Council of Europe Steering Committee on Bioethics
Former General Counsel of the President’s Council on Bioethics

STIENNON Prof. (Mrs) Jeanine-Anne (Belgium) 2006–2013

Emeritus Professor at the Faculty of Medicine, University of Mons-Hainaut
Vice-President and former President of the National Bioethics Committee
Honorary Dean of the Faculty of Medicine, University of Mons-Hainaut
Member of the Belgian Royal Academy of Medicine

53
TOURE Dr (Mrs) Aïssatou (Senegal) 2006–2013
Immunologist and Researcher, Pasteur Institute, Dakar
Member of the National Health Research Council

TRONTELJ Prof. (Mr) Jože (Slovenia) 2010–2013

Professor of Neurology
President of the Slovenian Academy of Sciences and Arts
Chairperson of the National Medical Ethics Committee
Member of the Steering Committee on Bioethics of the Council of Europe
VUORIO Prof. (Mr) Eero (Finland) 2010–2013
Professor of Molecular Biology
Director of the Biocenter Finland, University of Helsinki
Chair of the National Board of Research Ethics
Former Vice-Rector of the University of Turku

WASUNNA Dr (Mrs) Monique K. Ajilong (Kenya) 2008–2011

Consultant Physician and Specialist in Tropical Medicine and Infectious Disease
Acting Director of the Kenya Medical Research Institute (KEMRI)
Chief Research Officer in Tropical Medicine and Infectious Disease (KEMRI)
Scientific Advisory Committee member for the World Health Organization on Accessible Quality-
Assured Diagnostics
Member of the University of Nairobi and Kenyatta Hospital Scientific and Ethics Committee
Board member of the University of Nairobi, Institute of Tropical Medicine and Infectious Diseases

WOOPEN Prof. (Mrs) Christiane (Germany) 2010–2013

Professor of Ethics and Theory of Medicine, University of Cologne
Vice-Chairperson of the German National Ethics Council

54
 3

CONTACT
Secretariat of the International Bioethics Committee
Division of Ethics and Global Change, Bioethics Programme
978-92-3-001111-6
Social and Human Sciences Sector
UNESCO
1, rue Miollis – 75732 Paris Cedex 15 – France
E-mail: ibc@unesco.org
9 789230 011116
Website: www.unesco.org/shs/bioethics
 CLINICAL BIOETHICS
HUMAN DIGNITY AND HUMAN RIGHTS
Dr. Joseph A. Jao October 22, 2021
LEARNING OBJECTIVES
At the end of the unit, the students should be able
to:
o Define human rights and human dignity
o Apply the concepts of human dignity and
human rights
o Understand the relevance of these
concepts in the context of bioethics
ARTICLE 3: HUMAN DIGNITY AND
HUMAN RIGHTS
Human dignity, human rights and fundamental
freedoms are to be fully respected
The interest and welfare of the individual
should have priority over the sole interest of
science or society
HUMAN RIGHTS
Right is an inherent, irrevocable entitlement by all
individual or member of the society from the
moment of birth so that it cannot be taken or given
away.
Privilege is a temporary entitlement given by
someone in authority to a certain group of
individuals, it is up to the authority to whom the
entitlement will be given.
Human rights are moral principles or norms
that describe certain standards of human
behavior and are regularly protected in municipal
and international law -
in born
Commonly understood as inalienable
o It cannot be taken away nor given away
by human law.
Fundamental rights
inherently entitled simple because she or he is
and which are
regardless of their age, ethnic
origin, location, language, religion, ethnicity or
other status. deemed by supreme court
OTHER VALUES THAT CAN BE DERIVED
FROM 2 FUNDAMENTAL VALUES OF
HUMAN RIGHTS
(HUMAN DIGNITY AND EQUALITY)
Human rights is connected to human dignity
o Human dignity is the heart of human
rights
Freedom: Human will is an important part of
human dignity
USE AT YOUR OWN RISK
o They have the capacity to decide on what
will be beneficial to them
Respect for others: Lack of respect for someone
fails to appreciate their individuality and essential
dignity
o We cannot demand right by impinging on
the right of others, it cancels out our right.
Non-discrimination: Equality in human dignity
opportunities on the basis of their characteristics.
o Disability, age, disease, homeless,
unemployment
Tolerance: Intolerance indicates a lack of respect
for difference, and equality does not signify
uniformity.
o Respect the views, belief of practices of
others
Justice: People equal in their humanity deserve
fair treatment
o Give right due.
Responsibility: Respecting the rights of others
entails respon
exerting effort for the realization of the rights of
one and all
o For every right comes responsibility, duty
and obligation
CHARACTERISTICS OF HUMAN RIGHTS (3)
① Human rights are inalienable
o You cannot lose them because they are
linked to the very fact of human existence
o Inherent to all human beings
In some instance they can be
violated, especially in vulnerable
people
We have to make policies and
guidelines to ensure that their
o May be suspended or restricted
Found guilt of a crime: Liberty
can be taken away
In times of national emergency:
Imposing curfew restricting
freedom of movement
④ Human rights are indivisible, interdependent
and interrelated
o Different human rights are intrinsically
connected
o Cannot be viewed in isolation from each
other
page 1 of 4
 HUMAN DIGNITY AND HUMAN RIGHTS
o The enjoyment of one right depends on
the enjoyment of many other rights
o No one right is more important than
the rest
③ Human rights are universal
o Apply equally to all people
everywhere in the world with no time
limit
o Every individual is entitled to enjoy his
☒ even
those or her human rights without distinction of
61 DA
sexual orientation, disability, language,
religion, political or other opinion,
national or social origin, birth or other
status
o Universality is not unanimous with
uniformity
HUMAN RIGHTS (UDHR*)
The states have obligations and duties under
international laws to respect, protect and fulfill
human rights
Meanwhile as individuals, while we are entitled to
our human rights we should also respect and
stand for the human rights of others
The obligation to respect
o The states must retrain from interfering
with or curtailing the enjoyment of human
rights
The obligation to protect
o Requires the states to protect individuals
and groups against human rights abuses
by others
The obligation to fulfill
o The states must take positive action to
facilitate the enjoyment of basic human
rights
- Should adapt appropriate
measures that would ensure the
full realization of this right
HUMAN DIGNITY
Dignity is the right of a person to be valued and
respected for their own sake to be treated
ethically
o It is the heart of human right
o It is of significance in morality, ethics, law
and politics as extension of the
Enlightenment era concepts
inherent, inalienable rights
USE AT YOUR OWN RISK
o The term may also be used to describe
personal conduct, as in
CONCEPTS OF HUMAN DIGNITY
According to:
o Classical antiquity
o World religions
o Modern philosophy
o Contemporary international law
CLASSICAL ANTIQUITY
Dignity as deserving of honor and esteem
according to personal merit, inherited or
achieved Magelang mataths , animas ng ping avalon
-
o Slaves / undesirables before have no
dignity, they were stigmatized
In ancient Greek philosophy, particularly of
Aristotle and the Stoics, dignity was associated
with human abilities of deliberation, self-
awareness and free decision-making
o You have to make sure na hindi ka
makakagawa ng hindi maganda because
dignity can be taken from you and you
may be treated like animal in old times.
Dignity does not consist in possessing honors,
but in the consciousness that we deserve them
- Aristotle
WORLD RELIGIONS
In many world religions, human dignity is
considered to be predetermined by the creation
of human beings in the image of God.
Those who are weak in body and soul have
dignity equal to those who are robust and sturdy.
o Regardless of status, we have dignity
A few of the verses in religious texts that speak to
the Principle of Respect for Human Dignity:
o Islam: honored the
descendants of Adam (i.e. human
o Christianity
3:16)
o Judaism:
o Buddhism: All sentinel beings without
of exception have the buddha-
(Nirvana Sutra)
o Hinduism:
page 2 of 4
 HUMAN DIGNITY AND HUMAN RIGHTS
MODERN PHILOSOPHY
Modern philosophy proposed secular
understanding of human dignity and
progressively associated this concept with the
idea of human rights
In different teachings human dignity was
presented as:
o An aspect of personal freedom
(Giovanni Pico Della Mirandola)
If we have free will then we can
be considered as having dignity
o public worth
(Thomas Hobbes) or
o As universal virtue, unconditional and
autonomy rather than origin, wealth, or
social status (Immanuel Kant)
- to treat
any other person always at the same time as
an end, never merely as a means* (categorical
imperative)- has been accepted by moral and
political philosophy as the actual basis for the
conception of human rights and in the sense, it is
a foundational concept
CONTEMPORARY INTERNATIONAL LAW
In contemporary international law, national
constitutions, and other normative documents,
human dignity is strongly connected with
human rights
According to Art 1 of the Universal Declaration of
Human Rights (1948):
o All human beings are born free and
equa
The declaration establishes human rights (like
freedom from repression, freedom of expression
and association) on the inherent dignity of
every human being.
THE EUROPEAN CONVENTION ON HUMAN
RIGHTS AND BIOMEDICINE IN ART. 1
Declaration protection of the dignity and
identity of all human beings and guarantees
everyone, without discrimination, respect for
their integrity and other rights and
fundamental freedoms with regard to
application of biology and medicine as its main
purpose
o There should be policies in place
USE AT YOUR OWN RISK
THE NOTICE OF HUMAN DIGNITY
The notion of human dignity expresses the
intrinsic value of the person capable of:
o Reflection
o Sensitivity
o Verbal communication
o Free choice
o Self-determination in conduct and
creativity
Decide what they want to them
with their own self and own life
Unlike material values or financial prices, human
dignity has no external equivalent; it is an end
in itself
All human beings are equal in dignity
irrespective of:
o Gender
o Age
o Social status
o Ethnicity
active respect for his/her human rights, self-
esteem and self-determination, as well as for
his/her privacy, protecting him/her from
illegitimate intrusion and preserving his/her
valid public space
A society or a community should respect each of
its member as a person or a moral agent on
the basis of the notion of human dignity
This notion also requires that the interests and
welfare of the individual are considered as
prior to the sole interest of society, community
or any particular kind of publicly wholesome
It implies that because of his/her human dignity,
the individual should never be sacrificed for
the sake of science (as has happened in
medical experiments during the Second World
War) or for the sake of society (as has
happened in totalitarian regimes)
There might be exceptional circumstances in
which the interest of others or the community
as a whole are so important that infringing
upon the interests of individuals is
unavoidable in order to save others or the
community. An example is the dread of a deadly
pandemic.
Human dignity is a foundational concept and it
is theoretically and normatively inappropriate to
reduce it to functional characteristics of a
per
taking into account her autonomy
page 3 of 4
 HUMAN DIGNITY AND HUMAN RIGHTS

Respect for dignity means recognition of

In comparative view, human dignity has diverse

forms in different cultural and ethical traditions
(for example, Confucian, Judeo-Christian,
Muslim) and is respected in various ways in
different types of societies (traditional, modern,
totalitarian democratic)
It is less respected in totalitarian societies and
more respected in modern and democratic
societies
Regardless of cultural, confessional and
political varieties human dignity is universally
based on the -awareness and
appropriate respectful treatment towards her.
As it is emphasized in the Declaration, the regard

upon human dignity, human rights and

DIGNITY AND HEALTH CARE

PROVIDER RELATIONS
Health Care Provider-Patient relations are just
one kind of human relations, presupposing all
ethical requirements.
Inequality in status of the health care provider and
the patient may be aggravated in special cases
when patients are children, handicapped
individuals and elderly persons. Particularly
risky are cases of patients who are mentally
handicapped.
o Vulnerable patients
Special attention in regard to human dignity and
human rights is required in palliative treatment
of terminal

Though there is no consensus either in public or

in the expert community concerning the ethical
and legal status of the embryos and fetuses,
the latter should be treated with respect and care.
o They already have the right to live

man is an ideal worth fighting for and worth dying

- Robert C. Maynard

USE AT YOUR OWN RISK page 4 of 4

Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
Lourdes Carpena-Medalla MD| 14 September 2019

I. ARTICLE 9: PRIVACY AND CONFIDENTIALITY

Premise:
of their personal information should be respected. To the greatest
extent possible, such information should not be used or disclosed for
purposes other than those for which it was collected or consented to,
consistent with international law, in particular international human
A. PRIVACY
The right of an individual or a group to be free from
intrusion or meddling from others, and includes the right to
determine which information about them should be
disclosed to others.
1. Confidentiality
An attribute of person information requiring that it not be disclosed
to others without sufficient reason
The basic principles and values of Article 9 emerge from
Universal Declaration of Human Rights of 1948.
The concept of CONFIDENTIALITY is already stated in the
Hippocratic Oath.
The DIGNITY and AUTONOMY of the person, being an
integral part of rights and fundamental freedoms of human
beings, has to be recognized and respected in an effective
and universal manner.
CULTURAL & PSYCHO-SOCIAL FACTORS of persons and
social groups have to be considered.
ARTICLE 9 is related to AUTONOMY & CONSENT. Here is the
content of the article according to UNESCO, 2005.:
1. A right to privacy guarantees control over personal
information in various ways. Privacy extends beyond data
protection, as certain private spheres of the individual that
are not manifested in data processing can also be protected
by the right to privacy.
2. Confidentiality refers to a special and often fiduciary
relationship between researchers, doctors and patients
provided that the shared information shall remain secret
and shall not be disclosed readily to a third person.
3. The importance of privacy has been recognized in
numerous legal instruments.
1.2 Duty of Health Care Provider To provider the privacy of patients
Health care providers have an ethical obligation to protect
circumstances. For example, they should interview patients
where they cannot be overheard, especially when the
patients declare that they did not bring any companions
during consultation. However, take ethics into
consideration like bringing in a witness of the same sex as
the patient during consultation. They should ask the patient
permission to examine him or her unclothed. You have to
tell or ask the patient everything and anything that you
need to do during the examination. They should ensure that
an unclothed patient cannot be viewed by passersby. If the
patient does not want a procedure to be done on him or
her, the physician cannot do the procedure. Understand
that some patients do not want to be heard or seen.
1.3 Duty of Health Care Provider To Maintain Confidentiality
The duty of maintaining confidentiality, a.k.a. professional
secrecy, has been part of western medical ethics since
see or hear, professionally or privately, which ought not to
courses in non-western countries should discuss the source
of medical confidentiality in their culture.
Confidentiality extends to all personal health information,
including genetic data
UNESCO international declaration on Human Genetic
proteomic data, regardless of their apparent information
content, should be treated with the same high standards of
B. JUSTICE
2. Justified Breaches of Confidentiality
2.1 Sharing Information for Patient Care
In the hospital setting, many people (doctors, nurses) need

1.1 Reason for respecting the privacy and confidentiality However, each of these persons is bound to maintain
confidentiality to the greatest extent possible. Outside the
1. Individual owns the information
hospital setting, family members may need patient
2. For many people, privacy is an essential aspect of
information in order to provide care and/or to protect
their dignity. Invading their privacy against their
themselves
will is a violation of their dignity.
3. Respect for other people requires protecting their
2.2 Using Interpreters
privacy and their confidentiality of information
about them. When the health care provider does not speak the patien
4. Patients are less likely to trust health care language, an interpreter will be needed who will then have
providers and confide in them because they think access to information about the patient. The interpreter
that the health care providers will not keep the should be bound to observe confidentiality.
information confidential. This can have serious
-
being; sometimes for the health of others,
especially family members.
2.3 Teaching Medical Students

S 1 T 1 |Guinea Pigs Batch 2021: OBE is Life 1 of 3

 Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
Observation and discussion of patients is a necessary part
of medical education. Students should be informed of their
obligation to maintain confidentiality.
2.4 Mandatory Reporting
Health care providers should be familiar with laws about
mandatory reporting of infectious diseases, suspected child
abuse, and other conditions in the country when they
practice. Normally, patients should be informed that their
information has to be reported to the appropriate
authorities.
2.5 Serious Danger to Others
For example, in exceptional circumstances and generally as
a last resort, health care provider may need to inform other
persons that the patient has threatened to harm them
whether by violence or by sexual contact when the patient
has a transmissible disease such as HIV or any STDs.
2.6 Genetic Information
There is controversy regarding whether other individuals
with the same genetic makeup (usually close family
Physicians should consult their national regulations or
guidelines when faced with this situation
2.7 With Patient or Guardian Consent
This should generally be obtained for all breaches of
confidentiality and ender the breaches acceptable ethically
2.8 Special Circumstances of Research
Disclosure of personal health information obtained in the
course of a research study requires the prior consent of the
research subject
There is a great controversy regarding whether
disclosure, researchers should consult their national
regulations or guidelines if such exist, otherwise
international guidelines such as the Declaration of Helsinki.
In research, communities as well as individuals have a right
to privacy, and information about them should be kept
confidential, especially when its discharge may be harmful
to the community.
Scientific publication should respect confidentiality to the
greatest extent possible. Consent is always required when
an individual research subject can be identified in a
publication.
II. ARTICLE 10: EQUALITY, JUSTICE AND EQUITY
Premise:
dignity and rights is to be respected so that they are treated
Different types of Justice
Distributive
Ensuring that each person receives a fair share of public
resources
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This is the most important type for health care under
conditions of scarcity
according to
his or her needs; Each must receive according to his or her
effort; or according to his/her contributio
Procedural
Ensuring a fair process for making decisions and settling
disputes
Retributive
Ensures punishment of wrongdoers
Social
Combination of the previous types as applied to a society in
which individuals and groups receive fair treatment and an
equitable share of the benefits of society
Different Concept of Distributive Justice
Authoritarian
What the highest authority decrees is just
Libertarian
What an individual decides to do with his or her own
property is just
Utilitarian
What most contributes to the treated good of the greatest
number is just
Egalitarian
Justice is achieved when everybody had equal access to the
societal resources to that they need
Restorative or transformative
Justice requires favoritism previously disadvantaged
individual or groups
Different Concept of Distributive Justice Reflected in Different
Healthcare System
The libertarian one is strong in the USA. The egalitarian one
is predominant in many European countries where the
value of social solidarity is recognized. South Africa is
attempting to implement restorative approach. Most
economists lean toward Utilitarian approach
Approach to Justice
Utilitarian
· What issue is determined by utility consequences:
· the greatest good (happiness, satisfaction) for the
greatest number regardless of the values for the particular
person involved.
wrong if it tends to produce the reverse of happiness---- not
just the happiness of the performer of an action but also
Egalitarian
· What is due is what is fair
Equal distribution of benefits and burden, equal
opportunity
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 Clinical Bioethics
Art. 9: Privacy & Confidentiality
Art. 10: Equality, Justice and Equity
· An egalitarian favors equality of some sort; People
should get the same, or be treated the same, or be treated
as equals, in some respect
Libertarian
· For as long as there is no restraints on individual liberty,
justice is served
· A collection of political philosophies and movement that
uphold liberty as a core principle. Libertarians seek to
maximize political freedom and autonomy, emphasizing
freedom of choice, voluntary association, individual
judgement, and self-ownershi
·
· Is the view that each person has the right to live his life
in any way he chooses so long as he respects the equal
rights of others
·
and property---rights that people possess naturally, before
governments are created. In the libertarian view, all human
relationships should be voluntary; the only actions that
should be forbidden by law are those that involve the
initiation of force against those who have themselves used
force--actions like murder, rape, robbery, kidnapping, and
Communitarian
· What is valued by the community determines what is
just. It emphasizes social meaning, community
membership, shared values, individual responsibility and
solidarity
· A philosophy that emphasizes the connection between
the individual and the community. Its overriding philosophy
personality are largely molded by community relationships,
with a minimal degree of development being placed on
C. EQUITY
Fundamental requirement in terms of justice
Equity exists when all participants freely define and accept
the rules, benefits and even the charges. Hence, any
differences in charges or benefits must represent a benefit
to ALL members of the society.
What us due depends on what has been given/received
Equity is very limited: if nothing is given first then nothing
will be given return
Has been considered a concept even more important that
justice
Aristotle described it as follows:
What is just, then and what is equitable are generally the
same, and both are good, though what is equitable is better.
According to Rawls, equity is a fundamental requirement in
terms of justice.equity is justice.
It exists when all participants freely define and accept the
rules, benefits and charges
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D. EQUALITY
- Together with justice and equity, it has become a
fundamental principle. As human beings, we are not
physically, mentally, psychologically, or genetically equal.
We are not equal in our values or principles.
· But, it is generally accepted and fully desirable that we
be considered equals in terms of dignity, justice, rights,
opportunities, freedom, benefits and obligations.
· Justice and equity are only possible if all human beings
are treated equally in their dignity and rights (Article 10,
Universal Declaration on Bioethics and Human Rights)
Right to health care
· oyment of
the highest attainable standard of health is one of the
International statements on human rights, such as the
International Covenant on Economic, Social and Cultural
Rights and the Convention on the Rights of the Child,
support the right to health and require signatory nations to
secure its observance.
Disparities in health status
· Health care professionals are faced with many
disparities in health status, generally associated with
disparities in wealth/income or with discrimination against
women, minorities or other disadvantaged groups
o Local disparities
o National disparities
o Global disparities
Roles of health care professionals in establishing health care priorities
and allocating scarce health resources
Health care professionals play several roles in establishing health care
priorities and allocating scarce health care resources
· As government policy makers and officials
· As hospital authorities
· As direct health care providers
· As researchers
What concept of distributive justice is most appropriate for each of
these roles? How should health care professionals deal with conflicts
between roles (e.g between providing expensive curative measures
for individual patients in need and vaccination programs for the
population)?
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Clinical Bioethics
Article 3: Human Dignity & Human Rights
Angel Erich R. Sison, MD | 31 August 2019
PAGBABALANGKAS NG ARALIN
I. Concepts of Dignity
A. Classical Antiquity
B. World Religions
C. Modern Philosophy
D. Contemporary International Law
II. The Notion of Human Dignity
III. Dignity and Healthcare Provider Relations
I. CONCEPTS OF DIGNITY
A. CLASSICAL ANTIQUITY
Common understanding of dignity as deserving of honour
and esteem according to personal merit, inherited or
achieved.
In ancient Greek philosophy, particularly of Aristotle and
the Stoics, dignity was associated with human abilities of
deliberation, self-awareness, and free decision-making.
B. WORLD RELIGIONS
Human dignity is considered to be predetermined by the
creation of human beings in the image of God; those who
are weak in body and soul have dignity equal to those who
are robust and sturdy.
C. MODERN PHILOSOPHY
Proposed secular understanding of human dignity and
progressively associated this concept with the idea of
human rights.
In different teachings human dignity was presented as an
o Aspect of personal freedom (Giovanni Pico della
Mirandola)
o E
Hobbes)
o Universal virtue, unconditional and incomparable
origin, wealth, or social status (Immanuel Kant)
to treat any other person always at
the same time as an end, never merely
as a means (categorical imperative)
has been accepted by moral and
political philosophy as the actual basis
for the conception of human rights and
in this sense it is a foundational
concept.
D. CONTEMPORARY INTERNATIONAL LAW
Contemporary international law, national constitutions,
and other normative documents, human dignity is strongly
connected with human rights.
According to Art. 1 of the Universal Declaration of Human
dignity The Declaration establishes human
rights (like freedom from repression, freedom of expression
and association) on the inherent dignity of every human
being.
S1T5| Guinea Pig Batch 2021: OBE is Life
The European Convention on Human Rights and
dignity and
identity of all human beings and guarantees everyone,
without discrimination, respect for their integrity and other
rights and fundamental freedoms with regard to the
II. THE NOTION OF HUMAN DIGNITY
The notion of human dignity expresses the intrinsic value
of the person capable of reflection, sensitivity, verbal
communication, free choice, self-determination in
conduct, and creativity.
Unlike material values or financial prices, human dignity
has no external equivalent; it is an end in itself.
Unlike merit as an embodiment of publicly recognized
personal achievements, a person is dignified as a human
being as such.
All human beings are equal in dignity irrespective of
gender, age, social status or ethnicity.
respect for her human rights, self-esteem and self-
determination, as well as care for her privacy, protecting
her from illegitimate intrusions and preserving her valid
public space.
A society or a community should respect each of its
members as a person or a moral agent on the basis of the
notion of human dignity.
This notion also requires that the interests and welfare of
the individual are considered as prior to the sole interest of
society, community, or any particular kind of publicly
It implies that because of his/her human dignity, the
individual should never be sacrificed for the sake of
science (as has happened in medical experiments during
the Second World War) or for the sake of society (as has
happened in totalitarian regimes).
circumstances in which the interest of others or the
community as a whole are so important that infringing
upon the interests of individuals is unavoidable in order to
save others or the community. An example is the threat of
a deadly pandemic.
Human dignity is a foundational concept and it is
theoretically and normatively inappropriate to reduce it to
decision-making or to taking into account her autonomy.
Respect for dignity means
worth as a human being.
In a comparative view, human dignity has diverse forms in
different cultural and ethical traditions (for example,
Confucian, Judeo-Christian, Muslim) and is respected in
various ways in different types of societies (traditional,
modern, totalitarian, democratic). It is less respected in
totalitarian societies and more respected in modern and
democratic societies.
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Clinical Bioethics
Article 3: Human Dignity & Human Rights
Regardless of cultural, confessional, and political varieties Inequality in the status of the health care provider and the
human dignity is universal - patient may be aggravated in special cases when patients
awareness and appropriate respectful treatment towards are children, handicapped individuals, and elderly persons.
her. Particularly risky are cases of patients who are mentally
As it is emphasized in Declaration, the regard to cultural handicapped.
Special attention in regard to human dignity and human
e rights is required in palliative treatment of terminal
Article 12). patients vegetative state
Though there is no consensus either in public or in the
III. DIGNITY AND HEALTHCARE PROVIDER RELATIONS expert community concerning the ethical and legal status of
embryos and foetuses, the latter should be treated with
Healthcare Provider-Patient relations are just one kind of
respect and care.
human relations, presupposing all ethical requirements.

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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
Angel Erich R Sison, MD stepping in for Zorayda E Leopando, MD | 2019
PAGBABALANGKAS NG ARALIN
I. Notion of Vulnerability
II. Aspects of Vulnerability
A. Biological/Corporeal Vulnerability
B. Social Vulnerability
C. Cultural Vulnerability
III. The Powers of Medicine: Fighting Vulnerability
IV. Problems vs Fight Against Vulnerability
V. Dilemmas of Vulnerability
VI. Notion of Personal Integrity
VII. Care Ethics
VIII. Ethical Perspectives
IX.
I. NOTION OF VULNERABILITY
vulnus :
Susceptibility of being wounded
Ethical principles and guidelines for the protection of
human subjects of research (1978 Belmont Report)
o refers to individuals and populations
o need for protection
Target groups:
o Racial minorities
o Economically disadvantaged
o Very sick
o Institutionalized
May continually be sought as research subjects, owing to
their ready availability in settings where research is
conducted.
Given their dependent status and their frequently
compromised capacity for free consent, they are easy to
manipulate as a result of their illness or socioeconomic
condition
involved in research solely for administrative c
(National Commission for the Protection of Human Subjects
of Biomedical and Behavioural Research, 1979)
Throughout the first half of the 20th century, these
vulnerable members of the population have been used in
unethical research studies:
o Institutionalized groups of persons like orphans
o Prisoners, the elderly and, later, Jews
o Other ethnic groups, considered as inferior and
even subhuman by the Nazis
o Persons such as the Chinese, who were exploited
by the Japanese in order to pursue their scientific
and military objectives.
o Ethnic minorities
o Socially underprivileged groups and women
reinforcing the principle of autonomy and of the
consequent demand, increasingly more inclusive and
stricter, for informed consent. (Beauchamp and Childress,
2001: 63).
S1T3| Guinea Pig Batch 2021: OBE is Life
Vulnerability expresses two basic ideas (Barcelona
Declaration, 1998):
o It expresses the finitude and fragility of life which,
in those capable of autonomy, grounds the
possibility and necessity for all morality.
o Vulnerability is the object of a moral principle
requiring care for the vulnerable. The vulnerable
are those whose autonomy or dignity or integrity
is capable of being threatened
In applying and advancing scientific knowledge, medical
practice and associated technologies, human vulnerability
should be taken into account.
Individuals and groups of special vulnerability should be
protected and the personal integrity of such individuals
respected.
The notion of vulnerability is not just a neutral description
of the human condition but instead a normative
prescription to take care of the vulnerable that is
characteristic for human beings.
Ethics is more than respecting individual choices and
decisions; it aims at care for the other.
o For example, the human face can show the
vulnerability of the human person and at the
same time appeal for help and assistance.
II. ASPECTS OF VULNERABILITY
BIOLOGICAL/CORPOREAL VULNERABILITY
Concerns the fragility of the human organism originating
from:
o Natural threats are coming from our biology:
ageing, susceptibility to illness and disease, and
death
o Environmental and other natural and man-made
threats: famine, earthquake, hurricanes,
pollution and environmental disasters
SOCIAL VULNERABILITY
Fragility of the human capacity for creating coherence in
o Social threats stemming from war and crime,
prejudice and discrimination, cruelty and
indifference
o Persons also become vulnerable due to
hospitalization and institutionalization
o Social circumstances and conditions
CULTURAL VULNERABILITY
Concerns the fragility of particular traditions and
conceptions of values that are typical for a community or
local cultures
III. THE POWERS OF MEDICINE: FIGHTING VULNERABILITY
A common idea is that the vulnerability of the human
condition should be eliminated or reduced.
o Science and technological innovations should be
used to overcome the natural threats.
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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
o Medical research should be focused on
eliminating the biological threats to the human
body
The basic assumption behind this fight is that many
vulnerabilities of the human condition are contingent, not
inherent.
This fight has been successful but at the same time has
failures.
o Life expectancy and health have improved,
poverty and starvation reduced, but at the same
time
o Many people die from common diseases, life
expectancy is decreasing in many countries, and
poverty is still widespread.
An unrestrained fight against human vulnerability
generates its own problems. Not the struggle against
human vulnerability is a mistake but the struggle to rid the
human condition of all vulnerability.
For a sustainable medicine it is necessary to accept some
vulnerability as a permanent part of the human condition.
IV. PROBLEMS VS FIGHT AGAINST VULNERABILITY
Religion, alternative medicine and traditional knowledge
present different ways of knowing and valuing
o Because they are open to different perspectives,
they can give meaning to vulnerability, but their
views are generally not accepted by mainstream
science or bioethics
Economic problems
o The success of science and technology has
created financial difficulties in almost all countries
in achieving decent levels of health care for the
population.
o Because of its continuous fight against
vulnerability, medicine often
Medical progress itself has created new forms of
vulnerability, i.e. chronic illness.
o This presents continuing vulnerability for a
growing population aging population
V. DILEMMA OF VULNERABILITY
Requires a balance between eliminating and accepting
human vulnerability
Disability
o Viewed as abnormal and the disabled therefore
are, by definition, vulnerable
o At the same time the disabled should not be
stigmatized by being treated as abnormal.
Death
o In medicine, the place of death in human life is
ambivalent
o In palliative care, death is understood as being
part of life; in some other sectors of medicine
death is still treated as the enemy.
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Depression
o Prozac (fluoxetine) is widely used as an anti-
depressant drug, when there are clear clinical
symptoms of depression;
o At the same time, it is regarded as medication for
unhappiness and sadness
Human suffering and misery express human vulnerability.
They also pose a challenge.
o We must at the same time struggle to keep
suffering to a minimum and also accept it as part
of life.
VI. CARE ETHICS
The challenge of human vulnerability is that it can never be
entirely eliminated from human life.
o Instead, it should inspire new approaches in
bioethics
The human condition requires solidarity; human beings all
share common vulnerabilities
Human vulnerability also leads to an ethics of care.
o Because it is a shared characteristic, it is also a
source of concern for others as well as awareness
that we rely on others.
o It is the basis for the duty to care for those
threatened by biological, social and cultural
threats as well as by the power of medicine itself.
VII. NOTION OF PERSONAL INTEGRITY
Latin origin verb tangere
o This is the root both of the adjective integer,
noun integritas
integrity all the
parts are maintained and the quality of that which is
unaltered.
Confirmed in 1996, in the Declaration of Helsinki, in which
as an attribute of the recognized inviolability of the subject
of experimentation, which
physically or psychologically:
o The right of the research subject to safeguard his
or her integrity must always be respected.
o Every precaution should be taken to respect the
privacy of the subject and to minimize the impact
of the study on the subject's physical and mental
integrity and on the personality of the subject
(World Medical Association, 1996: I.6)
The principle of respect for human vulnerability is related to
the notion of personal integrity; this is mentioned in the last
part of Article 8.
o Integrity concerns the wholeness of an individual.
In ethical discourse, integrity is often considered as a virtue,
related to the
example.
But respect for personal integrity in this Article does not
refer to moral character or his/her good
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Clinical Bioethics
Art. 8: Respect for Human Vulnerability & Personal Integrity
behaviour. It refers to fundamental aspects of a human life BASIC PRINCIPLES OF ENVIRONMENTAL ETHICS
that should be respected. Respect for Nature
Personal integrity refers here to respect for the The prosperity of human beings depends on the prosperity
understanding of his or her own life and illness, but also for of nature.
his/her interests and free will. Human beings are part of nature. They have therefore the
In the field of health policies, the principle of vulnerability duty to conserve and protect the integrity of the ecosystem
demands, both at the social and international level: and its biodiversity
o Benefit of some should not be attained by
exploiting the weakness of others Environmental Justice
o Those of bio-industries must not aggravate Environmental benefits and burdens should be equally
human vulnerability but rather seek to eliminate distributed
it as far as possible and to respect what is beyond Opportunities to participate in decision-making concerning
their reach. environmental issues should be equally provided
At the level of experimentation, it demands protection
which goes beyond that which can be expressed in Intergenerational Justice
informed consent of the body or part of the body and Every generation should leave the following generation an
demands respect for personal identity in the relationship equal opportunity to live a happy life, and should therefore
between the subject of experimentation and the researcher bequeath a healthy earth
between patient and doctor, at the level of clinical
assistance.
Respect for integrity demands new forms of
communication
o Allow the doctor to focus more on the patient
than the illness facilitates the involvement of
the patient in his own therapeutic process as a
partner in the health team the development of
therapies which are perceived as less invasive and
more respectful of the individual (e.g. at the
cultural or religious level)
In the field of health policies, the principle can play an
important role in:
o Prohibition of commercializing human body parts
o Regulation of genetic manipulation, particularly
in safeguarding the human genome
o Consideration of patentable human matter

VIII. ETHICAL PERSPECTIVES

ANTHROPOCENTRIC/HUMAN-CENTERED ENVT. ETHICS
Human beings have moral duties only towards one another
Human interests prevail over the interests of other species

NON-ANTHROPOCENTRIC ENVT. ETHICS

Biocentric
Other living organisms have intrinsic value
All life forms are are
entitled to moral consideration
It is therefore an ethical imperative to respect all life forms
All organisms have intrinsic value
More related to non-western cultural traditions

Ecocentric
Ecosystems have intrinsic value as well
Nature as a whole
All organisms and entities in the ecosphere, as parts of the
interrelated whole, are equal in intrinsic value
Holistic methodology

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Clinical Bioethics
Article 13: Solidarity and Cooperation
Arnel V. Herrera, MD, FPAFP |26 October 2019
I. Notion of Solidarity
II. Level of Solidarity
III. Threats to Solidarity
IV. Solidarity and Cooperation
V. Solidarity and Interdependence
VI. Cooperation
VII. Morality of Cooperation
VIII. Relationship of Solidarity, Autonomy, and Justice
IX. Good Samaritan Law
I. NOTION OF SOLIDARITY
What do you associate with this notion?
Mutual respect
Support of the weak and vulnerable (ex: very young
and the very old, pregnant patients)
Commitment to a common cause or the common
good belonging together (ex.: no to drugs, no to
smoking)
Mutual understanding shared responsibility
Solidarity is applicable in the context of health care systems.
Solidarity is showing personal and social concern for vulnerable
groups like the chronically ill, the handicapped, political
refugees, immigrants and the homeless.
(Everyone is obliged to make a fair financial contribution to a
collective, organized insurance system and that is an example of
solidarity.)
Example is universal health care. All of us are titled for free
services, either you are the ones who are paying or non-paying.
Even though you are non-paying you are enrolled to Philhealth.
This is an example of solidarity. We are all enrolled under
Philhealth, either we are contributing or not.)
From an ethical perspective, solidarity is a moral value focused
on providing support to those who need it. However,
distinction should be made between two forms of solidarity:
A. SOLIDARITY AS AN INSTRUMENTAL VALUE
Solidarity as self interest, reciprocal solidarity. The
enlightened self interest of rationally calculating
individuals motivates them to cooperate.
(ex.: Others contribute voluntarily to their Philhealth, SSS,
Pag-
investment.)
B. SOLIDARITY AS A MORAL VALUE
Group oriented responsibility to care for the weaker and
more vulnerable members of the community. Known as
it is the expression of an ethics
of commitment, a sense of responsibility towards the most
vulnerable in the society. Not self interest but the
interest of others motivates cooperation.
others.)
S1T1 |TPerez, Quiban, Quitalig, Enjelrivers
Solidarity has to be directed at the promotion of health and
o Quality of health care
o Sufficient water and nutrition:
(30%of pre-school children are still stunted.)
o Favourable life and environmental circumstances
(Climate change, illegal mining, etc.)
o Elimination of marginalization and exclusion
(Nagkaroon ng party list because they want
the marginalized people to be represented but
s not working because those who loose in
the previous elections used party list as a
platform for them to become congressman.)
o Diminishing poverty and illiteracy
(According to WHO, 96.5% of the Filipinos are
literate HOWEVER we are still a poor country;
22million Filipinos are below the poverty line, )
II. LEVEL OF SOLIDARITY
LEVEL 1: INTERPERSONAL LEVEL
Refers to manifestations of willingness to carry costs to
assist others.
upbringing; probably you saw it from your parents. They
modelled their willingness to help why
)
LEVEL 2: GROUP PRACTICES
Refers to manifestations of collective commitment to
carry costs to assist others.
(ex.: organize a medical mission)
LEVEL 3: CONTRACTUAL LEVEL
Refers to legal provisions and contractual norms.
(There is a legally and forced agreement between two or
more parties. Best example is insurance system there are
obligations and agreement.) Ex. Phil health is considered
as an example of contractual level.
III. THREATS TO SOLIDARITY
Increasing demands for expensive treatments for instance due
to the aging of populations; the range of options for individuals
has enlarged.
(Aging population is a threat because for example in Philhealth,
there is continuous giving of pensions. Those who are in working
class will take the burden. Their contribution will increase.)
Changing and more demanding attitudes of clients, related to
increasing individualization of societies with increasing stress
on the moral significance of individual autonomy.
(All of us are free to choose the lifestyle we prefer. However,
your paying healthcare system is socialized. You chose the right
lifestyle compared to the other person that is very carefree in
choosing lifestyle and yet you are paying for his health
insuran
socialized.)
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Clinical Bioethics
Article 13: Solidarity and Cooperation
Shift towards more private financial responsibility and B. RELATIONSHIP OF SOLIDARITY, AUTONOMY AND JUSICE
increasing pressure of market ideology. Solidarity goes beyond justice.
Erosion of local communities and extended family networks Justice is a matter of obligation from one free individual to
changing personal and social relationships. another; it is based on the shared interest of preserving the
(The threat here is increasing individual autonomy.) requisite amount of freedom for all citizens
Solidarity indicates that vulnerability and need have to be Solidarity is not necessarily a legal obligation.
addressed, by means of active cooperation. Solidarity does not necessarily restrict autonomy
The concept of cooperation indicates a realization of
interdependence which implies the knowledge that the DO OFF DUTY DOCTORS HAVE TO HELP IN AN EMERGENCY
individual, group or community is sometimes powerless in the SITUATION?
presence of greater national and global problems. No, an off-duty doctor has no affirmative duty to provide
(ex.: poverty, obesity risk factor for diabetes and hypertension) medical assistance to injured persons.
Tackling the problems together has a better chance of making
an impact and bringing about change. (Should be involved the REASONS DOCTORS ARE OFTEN RELUCTANT TO ATTEND TO
stockholders.) EMERGENCIES:
Harbouring apprehensions about having to visit police stations
IV. SOLIDARITY AND INTERDEPENDENCE Being called to court repeatedly as witness, sometimes facing
long and unnecessary cross examination.
Losing earning hours
Demands equal and equitable development for all; problems
Good Samaritan Law- works under the following
identified:
conditions
1. The increasing gap between developing and developed
o Act in good faith
countries indicates the absence and continuing
o Not receive compensation
disregard for solidarity.
o Avoid grossly negligent conduct
2. The current global economic and political structure that
(Here in the Philippines, there is no Good Samaritan Law.
allows the developed countries to progress
We only have Good Samaritan Act, implied only.)
exponentially while impoverishes the developing/under-
developed countries clearly indicate the unequal and
unfair treatment to all. Notes:
3. As long as there are sectors of society who feel 1. Black Power point
exploited and oppressed clearly indicate that such 2. Blue recordings
society violates the principle of solidarity and 3. Red additional notes (nabanggit niya na may Penal
interdependence. (Sectors of society who are exploited Code ditto sa Philippines about sa punishment in
women, sexual exploitation) abortion pero di nya matandaan yung exact number
ng article
V. COOPERATION
REFERENCES
Cooperation does not only refer to charity, altruism (unselfish
1.
act of kindness) and philanthropy but also refers to
2.
symmetrical relations and capacity.
3. https://en.wikipedia.org/wiki/Abortion_in_the_Philippines
(Philanthropist you give to human causes on large scale,
4. https://reproductiverights.org/world-abortion-
more than giving to a charity. You want to improve human
laws/philippines-abortion-provisions
welfare. For example, Bill Gates donated to eradicate Malaria
in Africa and also donated to eliminate Polio)
Solidarity is not -
during which the givers and receivers of solidarity work
together as equals, and equipment and tools are given to
people in need to enable them to escape the vulnerable
situation in a sustainable way.

A. MORALITY OF COOPERATION
Formal cooperation in evil act is never allowed. (Ex:
cheating) Immoral operations such as abortion shall not be
participated upon by a nurse even if the doctor commands.
(Articles 256, 258 and 259 of the Revised Penal Code of
the Philippines mandate imprisonment for women who
undergo abortion, as well as for any person who assists in
the procedure.)

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Clinical Bioethics
Ethics and the Pharmaceutical Industry
Jena Angela T. Perano, MD | AY 2020-2021
PAGBABALANGKAS NG ARALIN
I. Physicians and the Pharmaceutical Sector
II. The Mexico City Principles for Voluntary Codes of Business
Ethics in the Biopharmaceutical Sector
A. The Six Principles
B. Interactions with Healthcare Professionals
C. Promotional Information and Activities
D. Public Sector Relationships and Procurement
E. Clinical Trials
I. PHYSICIANS AND THE PHARMACEUTICAL SECTOR
A conflict of interest exists in medicine when the following
conditions have all been met:
o The physician has a duty to advocate for the
interests of the patient (or public).
o The physician is also subject to other interests
her own, or those of a third party.
o The physician becomes a party to certain social
arrangements.
o Those arrangements, as viewed by a reasonable
onlooker, would tempt a person of normal human
interests in favor of the
II. THE MEXICO CITY PRINCIPLES
B includes companies,
regardless of ownership status, that develop, manufacture,
market, or distribute pharmaceutical and/or biologic
products.
o Such products are also referred to in these
Principles as "medicines."
Ethical interactions help ensure that medical decisions are
made in the best interests of patients
For relationships with healthcare professionals and other
stakeholders to meet this standard, companies in the
biopharmaceutical sector
by these six principles:
A. THE SIX PRINCIPLES
Healthcare and Patient Focus
o Everything we do is intended to benefit patients
Integrity
o Dealing ethically, honestly, and respectfully in
everything we do.
Independence
o Respect the need of autonomous decision-
making of all parties, free from improper
influence.
Legitimate Intent
o Everything we do is for the right reasons, is lawful,
and aligns with the spirit and the values of these
Principles.
S T | Batch 2022: The Google Doks
Transparency
o A general willingness to be open about our
actions while respecting legitimate commercial
sensitivities and intellectual property rights.
Accountability
o A willingness to be responsible for our actions and
interactions.
B. INTERACTIONS WITH HEALTHCARE PROFESSIONALS
Interactions between companies and healthcare
professionals provide valuable scientific, clinical, product,
and policy information about medicines that may lead to
improved patient care.
Appropriate marketing is critical to achieving these goals
because they enable companies to:
o Inform healthcare professionals about the
benefits and risks of medicines to help advance
appropriate patient use
o Provide scientific and educational information
o Support medical research and education
o Obtain feedback and advice about our products
through consultation with medical experts.
All interactions with healthcare professionals are to be
conducted in a professional and ethical manner.
o Healthcare professionals must not be improperly
influenced by companies.
o Nothing should be offered or provided by a
Company in a manner that inappropriately
influences a healthcare professional's
prescribing practices.
o Education and promotional activities should
encourage the appropriate use of medicines by
presenting them objectively and without
exaggerating their properties
o Relationships between Company personnel and
healthcare professionals should encourage the
development of a medical practice committed to
and be based on truthful,
accurate, and updated scientific evidence.
C. PROMOTIONAL INFORMATION AND ACTIVITIES
No medicines shall be promoted for use in a specific
economy until the requisite approval for marketing for such
use has been given in that economy.
Promotion should be consistent with locally approved
product information.
Promotional information should be clear, legible, accurate,
balanced, fair, objective, and sufficiently complete to
enable healthcare professionals to form his or her own
opinion of the therapeutic value of the medicines
concerned.
Safety of Medicines
Medicines provided by Companies will conform to high
standards of quality, safety and efficacy as determined by
regulatory authorities in each economy in which they
operate.
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Clinical Bioethics
Ethics and the Pharmaceutical Industry
Companies will report adverse events or adverse drug
reactions to regulatory authorities, subject to applicable
laws and regulations.
Symposia and Congresses
The purpose and focus of all symposia, congresses or (an
organized or
sponsored by a Company should be to inform healthcare
professionals about products and/or to provide scientific or
educational information.
Company relationships with healthcare professionals are
regulated by multiple entities and intended to benefit
patients and to enhance the practice of medicine.
Any sponsorship provided to individual healthcare
professionals must not be conditional upon an obligation
to prescribe, recommend, or promote any medicine.
All Events should be held in an appropriate venue that is
conducive to the scientific or educational objectives and the
purpose of the Event or meeting. Companies should avoid
using extravagant venues or resorts.
Hospitality should be limited to refreshments and/or meals
incidental to the main purpose of the Event and should only
be provided:
o To participants of the Event and not their guests
o Is moderate and reasonable as judged by local
standards.
Companies should not pay any costs associated with
individuals accompanying invited healthcare professionals.
Informational Presentations by Company Representatives
In order to provide important scientific information and to
schedules and provide patient care, Company
representatives may take the opportunity to present
information during healthcare ,
including mealtimes, in accordance with applicable laws
and regulations.
Entertainment
Companies should not provide any form of entertainment
or recreational items, such as tickets to the theater or
sporting events, sporting equipment, or leisure or vacation
trips, to any healthcare professional.
Such entertainment or recreational benefits should not be
offered, regardless of
o The value of the items
o Whether the Company engages the healthcare
professional as a speaker or consultant
o Whether the entertainment or recreation is
secondary to an educational purpose.
No standalone entertainment or other leisure or social
activities should be provided or paid for by Companies. At
events, entertainment of modest nature, which is
secondary to refreshments or meals, is allowed.
S T
Educational Items and Gifts
Payments in cash or cash equivalents (such as gift
certificates) or gifts for the personal benefit of healthcare
professionals should not be provided or offered to
healthcare professionals.
It is appropriate for Companies, where permitted by law or
local codes of ethics, to offer items designed primarily for
the education of patients or healthcare professionals if the
items are of modest value and do not have value to
healthcare professionals outside of his or her professional
responsibilities.
These items should not subsidize normal routine operations
of a medical practice.
Support for Continuing Medical Education
Helps physicians and other medical professionals to obtain
information and insights that can contribute to the
improvement of patient care and the medical practice.
CME grant decisions to ensure that programs funded are
bona fide and quality educational programs that financial
support is not an inducement to prescribe or recommend a
particular medicine or course of treatment
Samples
When used appropriately, samples can be an important tool
for healthcare professionals and provide benefit to patient
health outcomes.
Companies should have adequate systems of control and
accountability for samples provided to healthcare
professionals including how to look after such samples
while they are in possession of medical representatives.
Samples should not be used as payment for services, return
for favorable treatment, or other inappropriate
inducements.
Consultant and Speaker Arrangements
The following factors support the existence of a bona fide
consulting or speaking arrangement (not all factors may be
relevant to any particular arrangement):
o A written contract specifies the nature of the
services to be provided and the basis for payment
of those services
o A legitimate need for the services has been clearly
identified in advance of requesting the services
and entering into arrangements with the
prospective consultants
o The criteria for selecting consultants and speakers
are directly related to the identified purpose, and
the persons responsible for selecting the
consultants and speakers have the expertise
necessary to evaluate whether the particular
healthcare professionals meet those criteria
o The number of healthcare professionals retained
is not greater than the number reasonably
necessary to achieve the identified purpose
o The retaining Company maintains records
concerning, and makes appropriate use of, the
services provided
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Clinical Bioethics
Ethics and the Pharmaceutical Industry
o The venue and circumstances of any meeting with
consultants or speakers are conducive with the
primary focus of the meeting; specifically, resorts
are not appropriate venues.
Clinical trials should not be used as inappropriate
inducements for past or future sales.
Clinical trials should be undertaken in an ethical manner,
without undue influence by competitors.

Compliance Procedures and Responsibilities

It is the responsibility of Companies to ensure that internal
compliance procedures exist that facilitate compliance with
these Principles and the spirit they embody.
These procedures should be documented and provided to
employees to further enhance compliance.

Conduct and Training of Company Representatives

Companies should ensure that all representatives who are
employed by or acting on behalf of the companies, and who
visit healthcare professionals, receive training about the
applicable laws, regulations and industry codes of ethics

healthcare professionals.
In addition, companies should train their representatives to
ensure that they have sufficient knowledge of general
science and product-specific information to provide
accurate, up-to-date information, consistent with
applicable laws and regulations.
Companies should provide updated or additional training in
all of the areas needed for their representatives who visit
healthcare professionals.
Companies should also assess their representatives
periodically to ensure that they comply with relevant
Company policies and standards of conduct.
Companies should take appropriate action when
representatives fail to comply with relevant Company
policies that are consistent with these Principles and
national and local industry codes of ethics.

D. PUBLIC SECTOR RELATIONSHIPS AND PROCUREMENT

The decision-making process by Companies and
Governments during and including the government
procurement process, through bidding or any other
procedure of government procurement, must be
professional and ethical. There should be no attempt to
exert inappropriate influence.
Companies must provide accurate and balanced
information to the Government.
Companies and government officials should ensure that
their relationships and fee-for-service arrangements
comply with government ethics rules or procedures.

E. CLINICAL TRIALS
All clinical trials (phases I to IV) and scientific research
involving patients sponsored or supported by companies
will be conducted with the intent to develop bona fide
scientific knowledge that will benefit patients and advance
science and medicine.
o Companies must ensure transparency and
accountability in the presentation of research
and publication of study results.

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Non-discrimination and non-stigmatization
UNESCO universal declaration on bioethics and human
rights
I. Human dignity and human rights
II. Benefit and harm
III. Autonomy and individual responsibility
IV. Consent
V. Persons without capacity to consent
VI. Respect for human vulnerability and personal
integrity
VII. Privacy and confidentiality
VIII. Equality, justice and equity
IX. Nondiscrimination and non-stigmatization
X. Respect for cultural diversity and pluralism
XI. Solidarity and cooperation
XII. Social responsibility and health
XIII. Sharing of benefits
XIV. Protecting future generations
XV. Protection of the environment biosphere and
biodiversity
Insight from the Hippocratic oath
I will prevent disease whenever I can, for prevention is
preferable to cure; I will remember that I remain a
member of society, with special obligations to all my
fellow human beings, those sound of mind and body as
well as the infirm (1)
Stigma
- Deeply derogatory characteristic or attribute,
which occurs when a difference or deviation
provokes negative reaction towards the
individual who is different
- Stigma belittles the individual, making them less
than others, undermining their human dignity and
decreasing their chances in life
- Reduced individuality resulting from
stigmatization can even dehumanize the
stigmatized, their identity becomes define by
stigma itself, or confused with it, whe for example,
the person comes to be known by the attribute.
Phenomena associated with stigma
1. Refusal to seek medical attention
2. Poor adherence to treatment
- When an individual is labeled with negative
characteristics, there is a rational construct which
disqualifies, rejects and excludes
- Stigma means that he stigmatized individual
experiences situation of being social
disadvantaged
- Stigma creates structural discrimination which
negatively affects the environment around them.
- Although stigma is conceptualized as a personal
mark or attribute, it is essential to recognize that it
is a social product. The fruit of structural
conditions and power relationships established in
societies
- Stigma may be reproducing hierarchical and
domination systems when related to social class,
gender, race, ethnicity and sexual orientation,
serving to create, maintain and reinforce social
inequalities
- Stigma leads to loss of status and to
discrimination
- Discrimination is an inherent part of stigma
- There would be no stigma without discrimination
Possible negative consequences of stigma
1. Tense and uncomfortable social interactions
2. Limited social networks
3. Compromised quality of life
4. Low self esteem
5. Symptoms of depression
6. Unemployment
7. Loss of income
Stigmatization
- Introduced in bioethics by UNESCO as a
distinguished kind of discrimination that may
have a serious impact on the right to health and
benefit to scientific research
Discrimination
- The word discrimination come from the Latin,
discriminare which means distinguished between.
Thus to discriminate is to make a distinction
between people on the basis of class or
category without regard to individual merit.
Which is an infringement of the ethical theory of
egalitarianism based on social equality.
- Distinction between people which are based just
on individual merit (such as personal
achievement, skill or ability) are generally not
considered socially discriminatory, contrary to
distinctions based on race, social class or caste,
nationality, religion, sex, sexual orientation,
disability, ethnicity, height age or any other
ground in violation of human dignity, human
rights & fundamental freedoms
Principle of non-discrimination
- The principle of non-discrimination is based on
the understanding that discrimination is based on
the understanding that discrimination is socially
constructed rather than natural
- Seeks "to guarantee that human rights are
exercised without discrimination of any kind
based on race, color, sex, language, religion,
political or other opinion, national or social origin,
property, birth or other status such as disability,
age, marital & family status, sexual orientation &
gender identity, health status, place of
residence"
Positive or reverse discrimination
- Discriminatory policies or acts that benefit a
historically & socio-politically non-dominant
group (typically women & minorities but
sometimes majorities), at the expense of a
historically & socio-politically dominant group
(typically men and major races) are called
'positive or reverse discrimination' or 'affirmative
action policies'
- However, whether a given example of
discrimination is a positive or negative is often a
subjective judgement
 - In the field of health care and bioethics, some
groups need more protection such as infants and
elderly people, AIDS patients, psychiatric patients
& depressed patients
Grounds of discrimination & stigmatization
- Advances in medical technology have the
potential to create disproportionate
disadvantages for some social groups, either by
being applied in ways that harm members of
these groups directly or by encouraging the
adoption of social policies that discriminate
unfairly against them with significantly individual,
social & legal consequences
- For instance, reproductive medicine has
developed techniques that enable parents to
choose the sex of their child which raises the
concern of discrimination against girls and
women in societies where male children, are
valued more highly than female children
- Similar concerns have been raised about the
increasing use of abortion as a method of birth
control in overpopulated countries where there is
considerable social & legal pressure to limit family
size & where the vast majority of the parents who
use it choose to have boy rather than girl
- In the field of genetics, the use of relatively simple
test for determining a patient's susceptibility to
certain genetically transmitted diseases has led
to concerns that the results of such tests, if not
properly safeguarded, could be used against the
individual's own interests to discriminate them in
the interests of employers, health insurance,
companies & government agencies
- In addition, through genetic counselling,
prospective parents can be informed about the
chances that their offspring will inherit a certain
genetic disease or disorder; this will enable them
to make more informed decisions about
reproduction
- This is viewed by some bioethicists and some
NGO's as contributing to a social atmosphere
considerably less tolerant of disability than it
ought to be. The same criticism has been levelled
against the practice of diagnosing, and in some
cases treating, congenital defects in unborn
children
- Research on the genetic bases of behavior,
though still in its infancy, it's controversial because
of its potential to encourage the adoption of
crude models of genetic determinism in the
development of social policies, especially in the
areas of education and crime prevention. Such
policies, it is claimed could result in unfair
discrimination against large numbers of people
judged to be genetically disposed to undesirable
forms of behavior, such as aggression or violence
- References to human dignity and to non-
stigmatization and non- discrimination are
hallmarks of decisions on better health care
polices, contributing in making difficult decisions
involving questions such as:
1. Use of surgery in gender reassignment
2. The right of homosexual individuals to maternity/
paternity
3. The right of individuals living with HIV/AIDS to exercise
their
sexuality & have children
4. Critical situations involving cultures very distant from
western culture
Limitations of the principle
Article 26 of the declaration states that the principles
should be understood as complementary and
interrelated; the declaration is to be understood as a
whole. This implies that if a bioethical issue or problem
emerges, it is usually the case that several principles are
relevant to the issue or problem and needs to be
balanced in order to reach a justified conclusion about
what to do.
- Article 27 specifies the limitations on the
application of the principles, It mentions several
conditions in which application may be limited; a
By laW.
1. Laws in the interests of public safety
2. Laws for the investigation, detection & prosecution of
criminal offenses
3. Laws for the protection of public health
4. Laws for the protection of the rights and freedom of
Others
- Such law needed to be consistent with
international human rights law
- When therefore public health is at risk, exceptions
or restrictions to the non-discrimination principle
can be necessary either by affirmative actions in
favor of some key persons or groups, or by
negative actions that may infringe upon
individual rights. These exceptions must be
publicly discussed and applied with transparency
and according to the national law. They also
must be subject to revision according to
developments of the situation and scientific
knowledge
Summary
Non-discrimination & non-stigmatization
- Has been recognized as universal principles of
bioethics in article 11 of the universal declaration
on bioethics & human rights
- It recognizes the need and paves the way for
concerted action against inequality and the
institutional mechanism which perpetuate it
- It also aims to fight against any discrediting
process, which stigmatizes an individual or a
group on any kind of ground
- Thus, the principle of non-discrimination &
stigmatization is to be understood, implemented,
protected & promoted at national &
international level in accordance with the whole
set of principles proclaimed in the UNESCO
universal declaration on Bioethics & Human rights
 CLINICAL BIOETHICS
Protecting Future Generations
Dr. Fraulein Tormon January 7, 2022

Why Care About the Future? GERM-LINE GENETIC INTERVENTIONS

We have economic growth that has consequences such o Process by which the genome of individual is
edited in such a way that the change is
as increasing inequity or environmental degradation.
heritable
It is often based on natural resources, if it is present the
o Achieved through genetic alterations within
world will be more crowded, polluted, less stable and more
the germ or reproductive cells such as egg
vulnerable to disruption
and sperm
Sustainable development is development that meets the
o Germ-line gene therapy- DNA transferred
needs of the present without compromising the ability of
into the cells that produce reproductive cells
future generations to meet their own needs
in the body. This allows the correction of
Three factors responsible for contemporary sensibility
diseases-causing variants certain to be
towards future generations:
passed down from generation to generation
o Technology has altered the nature of human
Why
activity
o Present-day reality is interdependent and
PROTECTION OF THE ENVIRONMENT,
interrelated
BIOSPHERE AND BIODIVERSITY
Environmental disasters in one region
BIOSPHERE
will affect other regions and other
o Ecosphere or the worldwide sum of all
generations
ecosystem,
o The increasing awareness of the finitude and
o Can also be termed the zone of life on Earth
fragility of our existence and our one and only
or closed system and self-regulating
Earth
o It is the area of the planet where organisms
live
2 POSITIONS USUALLY DEFENDED
BIODIVERSITY
We only have a moral relationship with generations of the
o Variety of life in the world or particular habitat
immediate future
or ecosystem
All future generations can claim that we take them into
ENVIRONMENT
account
o Everything that surrounds us
o Living (biotic), nonliving (abiotic)
HOW DO WE REPRESENT THE FUTURE IN
o Includes physical, chemical and other natural
PRESENT DECISION-MAKING?
forces
In health care, there are several examples of
technological and scientific progress that have serious
ETHICS AND THE ENVIRONMENT:
impact on future generations
VIEWS OF NATURE
o Ex. Use of medication without rationale.
Ethically it is hard, but sometimes antibiotics
ETHICAL PERSPECTIVES
are widely used in agriculture and bioindustry
Anthropocentric environmental ethics: Human-
so that production of meat for human
centered ethics
consumption would be profitable
o Human beings have moral duties only toward
o Human viral infections like flu are
one another
increasingly treated with antibiotics
o Human interests prevail over the interests of
other species
APPLICATION OF PRINCIPLE
o Ethical methodologies: Utilitarianism
XENOTRANSPLANTATION
(consequentialism, greatest good) and
o Procedure that involves the transplantation,
Deontology (focus on rightness or wrongness)
implantation or infusion to a human recipient
o More related to Western culture (in which nature
of either live cells, tissue or organs from non-
often has an economic value)
human animal source or human body fluid
Non-anthropocentric environmental ethics
that have contact with life
o Biocentric
o Development of these is in part driven with a
fact that demand for human organs for
subjects that are entitled to moral
clinical transplantation exceeds the supply
consideration
GENETICALLY MODIFIED FOOD
It is therefore an ethical imperative to
o Foods derived from organisms whose
respect all life forms
genetic material or DNA has been modified
All organisms have intrinsic value
in a way that does not occur naturally,
More related to non-western cultural
through introduction of gene from a different
traditions
organism.
o Ecocentric
o Ex. Plants (crops, resistant to plant diseases
Ecosystems have intrinsic value as
or increase tolerance of herbicides)
well

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 PROTECTING FUTURE GENERATIONS
All organisms and entities in the
ecosphere as parts of the interrelated
whole, are equal in intrinsic value
Holistic methodology
Ecosystem is defined as a large
community of living organism, living
and physical components are linked
together through nutrient cycles and
energy flows
Basic principles of environmental ethics
o Respect for nature
The prosperity of human beings
depends on the prosperity of nature.
Human beings are part of nature. They
have therefore the duty to conserve
and protect the integrity of the
ecosystem and its biodiversity.
o Environmental justice
Fair treatment and meaningful
involvement of all people regardless of
race, color, national origin or income
with respect to the development,
implementation or enforcement of
environmental laws, regulation and
policies
Ex. Inadequate access to healthy food,
transportation, air and water, pollution
and unsafe homes
Environmental benefits and burdens
should be equally distributed
Opportunities to participate in
decision-making concerning
environmental issues should be
equally provided
o Intergenerational justice
Intergenerational equity in economics,
psychological, sociological context is
the concept or idea of fairness or
justice between generations
Concept can be applied to fairness and
dynamics between children, youth,
adults or each and everyone in terms
of treatment and interactions
Every generation should leave the
following generation an equal
opportunity to live a happy life and
should therefore bequeath a healthy
earth
Fundamental change in the lives of
the affluent equitable access to
resources
WHAT IS SUSTAINABLE DEVELOPMENT?
Original definition given in report of World Commission
on Environment and Development (1987):
o Sustainable development is development that
meets the needs of present generations without
compromising the ability of future generations
to meet their needs
TWO IMPORTANT QUALIFICATIONS:
The needs of the poor are central in sustainable
development
The only constraint on sustainable development is the
state of technology and social organization in society
DIFFERENT VIEWS OF SUSTAINABLE DEVELOPMENT
WEAK NOTION OF SUSTAINABILITY
o CLASSIC VIEW
Economic, socio-political and
ecological spheres are often viewed
as separate spheres with their own
logic and values; often also trade-
offs between human and social
development and ecological concerns
This notion is also strongly
anthropocentric; everything in nature
has instrumental value
STRONG NOTION OF SUSTAINABILITY
o In order to prevent a continuing decline of
natural resources over time, a drastic change in
patterns of production and consumption is
necessary
o It is necessary to emphasize the intrinsic value
of nature; nature has a value in and of itself

NOTION OF SUSTAINABILITY
2002 Johannesburg Declaration on Sustainable
Development
o A new ethic of conservation and stewardship
should be adopted, focusing on:
Measures to curb global climate
change
Conservation and management of all
types of forests
Better use of water resources
Intensified cooperation to reduce the
number and effects of natural and
man-made disasters

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 CLINICAL BIOETHICS
PRIVACY & CONFIDENTIALITY
EQUALITY, JUSTICE & EQUITY
DR. GLORIA PERET-CLARION NOV. 5, 2021
PRIVACY & CONFIDENTIALITY
OUTLINE ARTICLE 7
I. UNESCO Declaration on Bioethics and Human
Rights PRIVACY
II. Privacy & Confidentiality Privacy is the right of an individual or a group to
A. Privacy be free from intrusion from others, and includes
B. Confidentiality the right to determine which information about
C. Reasons on Respecting them should be disclosed to others
D. Duty of HCP on Privacy Privacy talks about a person
E. How to Maintain Restricts the public from accessing the personal
F. Duty of HCP on Confidentiality details
G. Confidentiality in Genetic Data
H. When can you share? CONFIDENTIALITY
I. Justified Breaches Confidentiality is an attribute of personal
J. Privacy Breaches information requiring that it not be disclosed to
K. Special Circumstances of Research others without sufficient reason
III. Equality, Justice & Equity Confidentiality is about information
A. Objectives Protects the information from the range of
B. Justice unauthorized persons
C. Equity An important aspect of trust that patients place in
D. Equality health care practitioners, especially physicians
E. Right to Health Care Thus, patients have the right to every
F. Disparities to Health Status consideration of their privacy concerning
G. Role of HCP their medical problem and the
corresponding programs planned to
References: address them
LECTURE Case discussion, consultations,
examinations and treatment are
UNESCO UNIVERSAL DECLARATION ON confidential and should be conducted
BIOETHICS AND HUMAN RIGHTS discreetly
Human dignity & human rights
Benefit & harm IMPORTANCE OF CONFIDENTIALITY-
Autonomy & individual responsibility 4 PILLARS
Consent Autonomy
Persons without capacity to consent Right of the patient
Respect for human vulnerability & personal Implied Promise
integrity Patients assume doctors will maintain
Privacy & confidentiality their confidentiality
Equality, justice & equity Virtue Ethics
Non-discrimination & non-stigmatization Patient assumes doctors will not breach
Respect for cultural diversity & pluralism confidentiality
Solidarity & cooperation Consequentialist
Social responsibility & Health Breach of confidentiality will result of loss
Sharing of Benefits of patient trust
Protecting future generations
Protection of the environment, the biosphere &
biodiversity

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 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
REASONS FOR RESPECTING PRIVACY &
CONFIDENTIALITY
to their personal integrity
For many people, privacy is an essential aspect
of their dignity. Invading their privacy against their
will is a violation of their dignity
Respect for others requires protecting their
privacy and the confidentiality of information
about them
Patients are less likely to trust healthcare
providers and confide in them if they think that the
healthcare provider will not keep the information
confidential. This can have serious
cons
being and sometimes for the health of others
(e.g., family members)
DUTY OF HEALTH CARE PROVIDERS TO
PROTECT THE PRIVACY OF PATIENTS
Health care providers have an ethical obligation
cy to the greatest
extent possible in the circumstances.
For example, they should interview patients
where they cannot be overheard. They should
unclothed and they should ensure that an
unclothed patient cannot be viewed by passers-
by.
HOW TO MAINTAIN CONFIDENTIALITY & PRIVACY
Avoid discussions of personal health information
in public areas (cafeteria, hallway other patient
rooms)
Never leave charts, computers or other devices
containing Patient health information unattended
or in clear view of others. File information or put
charts away in their proper place. Transport
charts or other Patient health information face
down or in envelope
Do not share passwords. Always log off the
computer. You are responsible for activity under
your password
Do not engage in conversations with family,
friends, neighbors, etc. in the hospital unless they
People have the right to keep their reason for
being on hospital property private.
USE AT YOUR OWN RISK
DUTY OF HEALTH CARE PROVIDERS TO
MAINTAIN CONFIDENTIALITY
The duty of maintaining confidentiality (Also
known as ) has been part
of western medical ethics since Hippocrates (5th
century B.C.E.)
The Hippocratic Oath states
Whatever I see or hear, professionally or
privately, which ought not to be divulged,
I will keep secret and tell no one
Ethics courses in non-western countries should
discuss the source of medical confidentiality in
their cultures
- CONFIDENTIALITY EXTENDS TO ALL PERSONAL
HEALTH INFORMATION INCLUDING GENETIC
DATA
UNESCO International Declaration on Human
Genetic Data
and proteomic data, regardless of their
apparent information content, should be
treated with the same high standards of
WHEN CAN YOU SHARE CONFIDENTIAL
INFORMATION?
When accessing and sharing Patient health
Only access or share what is relevant for patient
care. This helps maintain privacy
Circle of care includes the healthcare providers
that are directly involved in the provision of
services to a patient
Confidential information should only be shared
with individuals within the circle of care
JUSTIFIED BREACHES OF CONFIDENTIALITY
Sharing information for patient care
In the hospital setting, many individuals
order to provide care.
However, each of these individuals is
bound to maintain confidentiality to the
greatest extent possible
Outside the hospital setting, family
members may need patient information
in order to provide care and/or to protect
themselves
Using interpreters
Where the healthcare provider does not
interpreter will be needed who will then
have access to information about the
patient
Page 2 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
Interpreters should be bound to observe
confidentiality
Teaching medical students
Observation and discussion of patients is
a necessary part of medical education
Students should be informed of their
obligation to maintain confidentiality
Mandatory Reporting
Healthcare providers should be familiar
with the laws about mandatory reporting
of infectious diseases, suspected child
abuse and other conditions in the country
where they practice
Normally, patients should be informed
that their information has to be reported
to the appropriate authorities
Serious danger to others
For example, exceptional circumstances
and generally as a last resort, health care
providers may need to inform other
persons that the patient has threatened
to harm them, whether by violence or by
sexual contact when the patient has a
transmissible disease such as HIV
Genetic information
There is controversy regarding whether
other individuals with the same genetic
makeup (usually close family members)
information. Physicians should consult
their national regulations or guidelines
when faced with the situation
With the patient or guardian consent
This should generally be obtained for all
breaches of confidentiality and renders
the breach acceptable ethically
EXAMPLES OF PRIVACY BREACHES
Misdirected faxes
Improper destruction of patient health information
Cell phones used to take pictures in the hospital
Staff member/clerk discussing the patient outside
of patient care
Sharing personal health information on social
networks (e.g., Facebook)
Unauthorized access - you must NOT look at a
SPECIAL CIRCUMSTANCES OF RESEARCH
Disclosure of personal health information
obtained in the course of a research study
requires the prior consent of the research
subject
There is great controversy regarding whether
anonymized patient information requires consent
USE AT YOUR OWN RISK
for disclosure. Researchers should consult their
national regulations or guidelines if such exist,
otherwise international guidelines such as the
Declaration of Helsinki
In research, communities as well as individuals
have a right to privacy and information about
them should be kept confidential especially when
its disclosure may be harmful to the community
Scientific publication should respect
confidentiality to the greatest extent possible.
Consent is always required when an individual
research subject can be identified in a publication
EQUALITY, JUSTICE & EQUITY
ARTICLE 8
OBJECTIVES
Describe/ask the students to identify several
issues in allocating health care resources and
accessing health care in your area
Discuss definitions of:
Equality - sameness in some respect
such as human dignity
Justice - different types, but generally
fairness
Equity - application of fairness, which
may require unequal treatment
Example of Equality in Health care:
No matter the social status, all will receive
same service of care
In health centers, they provide free health
services to the community regardless of social
condition, preferences, religious beliefs ,etc.
In regards to COVID vaccine, whatever
your social status, whichever vaccine is
available, you have to receive it. There is no
preferential treatment
Example of Justice in Health care:
Children who participated as research
subjects are compensated especially if harm
or death resulted - Legal justice
Other countries are already giving booster
doses for COVID vaccine while other
countries still have not even reached 10%.
This is not fair justice.
Example of Equity in Health care:
Bigger allocation for poorer countries
since they have lesser resources
Give patients what they need
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 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
JUSTICE
Also termed fairness
Both a principle and a virtue relating to the
rightness of people's interactions and
relationships
As a principle, one should give another
As a virtue, it is the constant will to render
Related to:
Truthfulness
Autonomy
Stewardship
Solidarity
Nonmaleficence
In health, it is expressed in the individual and
obligation to deliver competent,
affordable and accessible healthcare
Issues on justice occur in public policy, health
insurance, health management organization,
research and relationships with drug
representatives
It is also equated with equity.
What is due to one depends on what
he/she has given
Based on the natural law of the golden rule that
states,
Do unto others what you would want
others to do unto you
DIFFERENT TYPES OF JUSTICE
Distributive
Ensuring that each person receives a fair
share of public resources
This is the most important type for health
care
Key factor in resource allocation
Ex: In the hype of the pandemic, OPD
was closed and inaccessible and for a
patient to be admitted or treated, they
need to undergo swab tests, even if they
don't have COVID. This is not fair justice.
Although in reality, not all patients can
have the best care.
Procedural
Ensuring a fair process for making
decisions and settling disputes
Retributive
Ensures punishment of wrongdoers
Social
Combinations of the previous types as
applied to a society in which individuals
and groups receive fair treatment and an
equitable share of the benefits of society
USE AT YOUR OWN RISK
CRITERIA FOR (DISTRIBUTIVE) JUSTICE
To each person an equal share
To each person according to need
To each person according to effort
To each person according to contribution
To each person according to merit
To each person according to free-market
exchanges
DIFFERENT CONCEPTS OF (DISTRIBUTIVE)
JUSTICE
Authoritarian
What the highest authority decrees is just
Libertarian
What an individual decides to do with his
or her own property is just
Utilitarian
What most contributes to the greatest
good of the greatest number is just
Egalitarian
Justice is achieved when everybody has
equal access to the societal resources
that they need
Restorative or Transformative
Justice requires favoring previously
disadvantaged individuals or groups
The Libertarian one is strong in the USA.
The Egalitarian one is predominant in many
European countries where the value of social
solidarity is recognized
South Africa is attempting to implement a
Restorative approach
Most economists lean towards the Utilitarian
approach
Which is predominant in our country? Libertarian
UTILITARIAN
What is due is determined by utility
consequences: the Greatest Good (Happiness,
satisfaction)
For the greatest number regardless of the value
for the particular person involved
An action is right if it tends to promote happiness
and wrong if it tends to produce the reverse of
happiness - not just the happiness of the
performer of the action but also that of everyone
accepted by it
EGALITARIAN
What is due what is fair
Equal distribution of benefits and burdens, equal
opportunity
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 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
An egalitarian favors equality of some sort;
People should get the same, or be treated the
same, or be treated as equals, in some respect
LIBERTARIAN
For as long as there is no restraints on individual
liberty, justice is served
movements that uphold liberty as a core principle.
libertarians seek to maximize political freedom
and autonomy, emphasizing freedom of choice,
voluntary association, individual judgment and
self-
Libertarianism
Is the view that each person has the
right to live his life in any way he
chooses so long as he respects the
equal rights of others
Libertarians defend each perso
liberty and property - rights that people possess
naturally, before governments are created
In the libertarian view, all human relationships
should be voluntary
The only actions that should be forbidden
by law are those that involve the initiation
of force against those who have
themselves used force (murder, rape,
robbery, kidnapping, and fraud)
COMMUNITARIAN
What is valued by the community determines
what is just
It emphasizes social meaning, community
membership, share values, individual
responsibility and solidarity
between the individual and the community. Its
overriding philosophy is based upon the belief
that a p
are largely molded by community
relationships, with a smaller degree of
EQUITY
What is due depends on what has been given
or received
Is very limited
If nothing is given first, then nothing will
be given in return
USE AT YOUR OWN RISK
JUSTICE IN HEALTH CARE
Fairness in all medical decisions
Many patients do not receive fair service
just because of their social status,
ethnicity, sexual orientation, etc.
Competency on emergency decisions to deliver
best care for all patients
and procedures. Discuss their condition,
alternatives, treatments and all information.
Justice for healthcare providers are given through
having a professional and a good environment for
service
EQUITY
Has been considered a concept even more
important than justice
Aristotle described it as follows:
What is just, then and what is equitable
are generally the same, and both are
good, though what is equitable is better.
According to Rawls
Equity is a fundamental requirement in
terms of justice. Equity is justice
It exists when all participants freely define and
accept the rules, benefits and charges
HEALTH EQUITY
Health equity means giving patients the care
they need when they need it
Or as the Institute of Medicine report put it, health
equity means providing care that does not vary in
quality because of personal characteristics such
as gender, ethnicity, geographic location and
socioeconomic status
HOW TO PROMOTE HEALTH EQUITY
Identify health disparities in community and how
it affects specific groups
Recognize that each person has their own racial
and ethnic biases
Learn how to recognize when a policy or an
environment may exclude a person or a group
Show respect to all people of all groups then
make efforts to involve all groups in enacting
change
Frequently evaluate how well the policies aimed
at equity are working
Make changes if necessary to ensure these
policies are most effective
Page 5 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
Health equity is something that takes time and
individual need
effort to address. But are the contributions of
individuals who are willing to help others have Makes sure what is Does not look at what is
access to safe and non-judgmental healthcare needed and in which needed for an individual
that can genuinely make a difference quantity to an individual
By modeling and promoting health equity,
Means/Process Outcome/End result
individuals and organizations can improve
healthcare for those living with health disparities Subjective, differs from Measurable, does not vary
situation and from person and neither matter
HEALTH INEQUITY to person whoever looks at it
Health equity means ensuring that every person
Positive discrimination Negative discrimination
has the opportunity to achieve their best health
Unfortunately, many social and environmental People are treated fairly People are treated equally
factors can but differently but may be unfairly
continued use of good health practices and
healthcare. These are health inequalities People can get what they People can only get what
Examples of these obstacles include: need everyone gets
Racial and ethnic discrimination Cannot be achieved Can be achieved through
Lack of access to quality education through equality equity
Income and wealth gaps
Inadequate housing or lack of housing
Unsafe environments WHAT DOES EQUALITY MEAN?
Equality means giving everyone equal positions
EQUALITY or treatment by the society.
Together with justice and equity, it has become a Hence, caste, gender, religion, and nationality
fundamental principle does not count to treat everyone equal.
As human beings, we are not physically, Therefore, equality is when ethics are accepted
mentally, psychologically or genetically equal, nor as same or equal in any aspect
are we equal in our values or principles In other words, equality refers to the quality of
But it is generally accepted and fully desirable being the same in quantity or value or status
that we be considered equals in terms of As a result, no person will be maltreated or
dignity, justice, rights, opportunities, marginalized due to the certain differences they
freedom, benefits and obligations might have within a social system.
Justice and Equity are only possible if all human Thus, in a society, equality is more of a
beings are treated equally in their dignity and principle which emphasizes equal or same
rights acceptance to everyone

DIFFERENCE OF EQUITY AND EQUALITY RIGHT TO HEALTH CARE

The Constitution of WHO states that the
Enjoyment of the highest attainable
EQUITY EQUALITY standard of health is one the fundamental

Refers to fairness, justice Refers to equal sharing

and impartiality
Equity=Fairness + Justice
Need based approach
and division, keeping
everyone at the same level
Equality = Sameness
Not affected by the need of
the people or society
International statements in human rights, such as
the International Covenant on Economic,
Social and Cultural Rights and the Convention
on the Rights of the Child, support the right to
health and require signatory nations to secure its
observance

Justifies things on the Justifies things on the DISPARITIES IN HEALTH STATUS

basis of quality
Focuses on need and
requirements of an
USE AT YOUR OWN RISK
basis of quantity
Gives the same things to
all people, irrespective of
Healthcare professionals are faced with many
disparities in health status, generally associated
with disparities in wealth/income or with
discrimination against women, minorities or other
disadvantaged groups
Page 6 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
Local Disparities
National Disparities
Global Disparities

ROLE OF HEALTH CARE PROFESSIONALS IN

ESTABLISHING HEALTH CARE PRIORITIES AND
ALLOCATING SCARCE HEALTH RESOURCES
Health care professionals play several roles:
As government policy makers and
officials
As hospital authorities
As direct health care providers
As researchers
What concept of distributive justice is most
appropriate for each of these roles?
How should healthcare professionals deal with
conflicts between roles (e.g., between providing
expensive curative measures for individual
patients in need and vaccination programs for the
population)?

USE AT YOUR OWN RISK Page 7 of 7

 CLINICAL BIOETHICS
HUMAN DIGNITY AND HUMAN RIGHTS
Dr. Joseph A. Jao October 22, 2021
LEARNING OBJECTIVES
At the end of the unit, the students should be able
to:
o Define human rights and human dignity
o Apply the concepts of human dignity and
human rights
o Understand the relevance of these
concepts in the context of bioethics
ARTICLE 3: HUMAN DIGNITY AND
HUMAN RIGHTS
Human dignity, human rights and fundamental
freedoms are to be fully respected
The interest and welfare of the individual
should have priority over the sole interest of
science or society
HUMAN RIGHTS
Right is an inherent, irrevocable entitlement by all
individual or member of the society from the
moment of birth so that it cannot be taken or given
away.
Privilege is a temporary entitlement given by
someone in authority to a certain group of
individuals, it is up to the authority to whom the
entitlement will be given.
Human rights are moral principles or norms
that describe certain standards of human
behavior and are regularly protected in municipal
and international law
Commonly understood as inalienable
o It cannot be taken away nor given away
by human law.
Fundamental rights
inherently entitled simple because she or he is
and which are
regardless of their age, ethnic
origin, location, language, religion, ethnicity or
other status.
OTHER VALUES THAT CAN BE DERIVED
FROM 2 FUNDAMENTAL VALUES OF
HUMAN RIGHTS
(HUMAN DIGNITY AND EQUALITY)
Human rights is connected to human dignity
o Human dignity is the heart of human
rights
Freedom: Human will is an important part of
human dignity
USE AT YOUR OWN RISK
o They have the capacity to decide on what
will be beneficial to them
Respect for others: Lack of respect for someone
fails to appreciate their individuality and essential
dignity
o We cannot demand right by impinging on
the right of others, it cancels out our right.
Non-discrimination: Equality in human dignity
opportunities on the basis of their characteristics.
o Disability, age, disease, homeless,
unemployment
Tolerance: Intolerance indicates a lack of respect
for difference, and equality does not signify
uniformity.
o Respect the views, belief of practices of
others
Justice: People equal in their humanity deserve
fair treatment
o Give right due.
Responsibility: Respecting the rights of others
entails respon
exerting effort for the realization of the rights of
one and all
o For every right comes responsibility, duty
and obligation
CHARACTERISTICS OF HUMAN RIGHTS
Human rights are inalienable
o You cannot lose them because they are
linked to the very fact of human existence
o Inherent to all human beings
In some instance they can be
violated, especially in vulnerable
people
We have to make policies and
guidelines to ensure that their
o May be suspended or restricted
Found guilt of a crime: Liberty
can be taken away
In times of national emergency:
Imposing curfew restricting
freedom of movement
Human rights are indivisible, interdependent
and interrelated
o Different human rights are intrinsically
connected
o Cannot be viewed in isolation from each
other
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 HUMAN DIGNITY AND HUMAN RIGHTS
o The enjoyment of one right depends on
the enjoyment of many other rights
o No one right is more important than
the rest
Human rights are universal
o Apply equally to all people
everywhere in the world with no time
limit
o Every individual is entitled to enjoy his
or her human rights without distinction of
sexual orientation, disability, language,
religion, political or other opinion,
national or social origin, birth or other
status
o Universality is not unanimous with
uniformity
HUMAN RIGHTS (UDHR*)
The states have obligations and duties under
international laws to respect, protect and fulfill
human rights
Meanwhile as individuals, while we are entitled to
our human rights we should also respect and
stand for the human rights of others
The obligation to respect
o The states must retrain from interfering
with or curtailing the enjoyment of human
rights
The obligation to protect
o Requires the states to protect individuals
and groups against human rights abuses
by others
The obligation to fulfill
o The states must take positive action to
facilitate the enjoyment of basic human
rights
- Should adapt appropriate
measures that would ensure the
full realization of this right
HUMAN DIGNITY
Dignity is the right of a person to be valued and
respected for their own sake to be treated
ethically
o It is the heart of human right
o It is of significance in morality, ethics, law
and politics as extension of the
Enlightenment era concepts
inherent, inalienable rights
USE AT YOUR OWN RISK
o The term may also be used to describe
personal conduct, as in
CONCEPTS OF HUMAN DIGNITY
According to:
o Classical antiquity
o World religions
o Modern philosophy
o Contemporary international law
CLASSICAL ANTIQUITY
Dignity as deserving of honor and esteem
according to personal merit, inherited or
achieved
o Slaves / undesirables before have no
dignity, they were stigmatized
In ancient Greek philosophy, particularly of
Aristotle and the Stoics, dignity was associated
with human abilities of deliberation, self-
awareness and free decision-making
o You have to make sure na hindi ka
makakagawa ng hindi maganda because
dignity can be taken from you and you
may be treated like animal in old times.
Dignity does not consist in possessing honors,
but in the consciousness that we deserve them
- Aristotle
WORLD RELIGIONS
In many world religions, human dignity is
considered to be predetermined by the creation
of human beings in the image of God.
Those who are weak in body and soul have
dignity equal to those who are robust and sturdy.
o Regardless of status, we have dignity
A few of the verses in religious texts that speak to
the Principle of Respect for Human Dignity:
o Islam: honored the
descendants of Adam (i.e. human
o Christianity
3:16)
o Judaism:
o Buddhism: All sentinel beings without
of exception have the buddha-
(Nirvana Sutra)
o Hinduism:
page 2 of 4
 HUMAN DIGNITY AND HUMAN RIGHTS
MODERN PHILOSOPHY
Modern philosophy proposed secular
understanding of human dignity and
progressively associated this concept with the
idea of human rights
In different teachings human dignity was
presented as:
o An aspect of personal freedom
(Giovanni Pico Della Mirandola)
If we have free will then we can
be considered as having dignity
o public worth
(Thomas Hobbes) or
o As universal virtue, unconditional and
autonomy rather than origin, wealth, or
social status (Immanuel Kant)
- to treat
any other person always at the same time as
an end, never merely as a means* (categorical
imperative)- has been accepted by moral and
political philosophy as the actual basis for the
conception of human rights and in the sense, it is
a foundational concept
CONTEMPORARY INTERNATIONAL LAW
In contemporary international law, national
constitutions, and other normative documents,
human dignity is strongly connected with
human rights
According to Art 1 of the Universal Declaration of
Human Rights (1948):
o All human beings are born free and
equa
The declaration establishes human rights (like
freedom from repression, freedom of expression
and association) on the inherent dignity of
every human being.
THE EUROPEAN CONVENTION ON HUMAN
RIGHTS AND BIOMEDICINE IN ART. 1
Declaration protection of the dignity and
identity of all human beings and guarantees
everyone, without discrimination, respect for
their integrity and other rights and
fundamental freedoms with regard to
application of biology and medicine as its main
purpose
o There should be policies in place
USE AT YOUR OWN RISK
THE NOTICE OF HUMAN DIGNITY
The notion of human dignity expresses the
intrinsic value of the person capable of:
o Reflection
o Sensitivity
o Verbal communication
o Free choice
o Self-determination in conduct and
creativity
Decide what they want to them
with their own self and own life
Unlike material values or financial prices, human
dignity has no external equivalent; it is an end
in itself
All human beings are equal in dignity
irrespective of:
o Gender
o Age
o Social status
o Ethnicity
active respect for his/her human rights, self-
esteem and self-determination, as well as for
his/her privacy, protecting him/her from
illegitimate intrusion and preserving his/her
valid public space
A society or a community should respect each of
its member as a person or a moral agent on
the basis of the notion of human dignity
This notion also requires that the interests and
welfare of the individual are considered as
prior to the sole interest of society, community
or any particular kind of publicly wholesome
It implies that because of his/her human dignity,
the individual should never be sacrificed for
the sake of science (as has happened in
medical experiments during the Second World
War) or for the sake of society (as has
happened in totalitarian regimes)
There might be exceptional circumstances in
which the interest of others or the community
as a whole are so important that infringing
upon the interests of individuals is
unavoidable in order to save others or the
community. An example is the dread of a deadly
pandemic.
Human dignity is a foundational concept and it
is theoretically and normatively inappropriate to
reduce it to functional characteristics of a
per
taking into account her autonomy
page 3 of 4
 HUMAN DIGNITY AND HUMAN RIGHTS

Respect for dignity means recognition of

In comparative view, human dignity has diverse

forms in different cultural and ethical traditions
(for example, Confucian, Judeo-Christian,
Muslim) and is respected in various ways in
different types of societies (traditional, modern,
totalitarian democratic)
It is less respected in totalitarian societies and
more respected in modern and democratic
societies
Regardless of cultural, confessional and
political varieties human dignity is universally
based on the -awareness and
appropriate respectful treatment towards her.
As it is emphasized in the Declaration, the regard

upon human dignity, human rights and

DIGNITY AND HEALTH CARE

PROVIDER RELATIONS
Health Care Provider-Patient relations are just
one kind of human relations, presupposing all
ethical requirements.
Inequality in status of the health care provider and
the patient may be aggravated in special cases
when patients are children, handicapped
individuals and elderly persons. Particularly
risky are cases of patients who are mentally
handicapped.
o Vulnerable patients
Special attention in regard to human dignity and
human rights is required in palliative treatment
of terminal

Though there is no consensus either in public or

in the expert community concerning the ethical
and legal status of the embryos and fetuses,
the latter should be treated with respect and care.
o They already have the right to live

man is an ideal worth fighting for and worth dying

- Robert C. Maynard

USE AT YOUR OWN RISK page 4 of 4

 CLINICAL BIOETHICS
Ethics and the Pharmaceutical Industry
Dr. Jena Angela Perano November 26, 2021
PHYSICIANS AND THE
INTERACTIONS WITH HEALTHCARE PROFESSIONALS
PHARMACEUTICAL SECTOR
A conflict of interest exists in medicine when the
following conditions have all been met:
o The physician has a duty to advocate for the
interests of the patient (or public).
o The physician is also subject to other
interests her own, or those of a third
party.
o The physician becomes a party to certain
social arrangements.
o Those arrangements, as viewed by a
reasonable onlooker, would tempt a person
of normal human psychology to neglect the
interests in favor of the
THE MEXICO CITY PRINCIPLES
includes companies,
regardless of ownership status, that develop,
manufacture, market, or distribute pharmaceutical
and/or biologic products.
o Such products are also referred to in these
Principles as "medicines."
Ethical interactions help ensure that medical
decisions are made in the best interests of patients
For relationships with healthcare professionals and
other stakeholders to meet this standard, companies
in the biopharmaceutical sector
should be guided by these six principles:
THE SIX PRINCIPLES
Healthcare and Patient Focus
o Everything we do is intended to benefit
patients
Integrity
o Dealing ethically, honestly, and respectfully
in everything we do.
Independence
o Respect the need of autonomous decision
making of all parties, free from improper
influence.
Legitimate Intent
o Everything we do is for the right reasons, is
lawful, and aligns with the spirit and the
values of these Principles.
Transparency
o A general willingness to be open about our
actions while respecting legitimate
commercial sensitivities and intellectual
property rights.
Accountability
o A willingness to be responsible for our
actions and interactions.
USE AT YOUR OWN RISK
Interactions between companies and healthcare
professionals provide valuable scientific, clinical,
product, and policy information about medicines that
may lead to improved patient care.
Appropriate marketing is critical to achieving these
goals because they enable companies to:
o Inform healthcare professionals about the
benefits and risks of medicines to help
advance appropriate patient use
o Provide scientific and educational information
o Support medical research and education
Experimental covid vaccine
o Obtain feedback and advice about our
products through consultation with medical
experts.
All interactions with healthcare professionals are to
be conducted in a professional and ethical manner.
o Healthcare professionals must not be
improperly influenced by companies.
o Nothing should be offered or provided by a
Company in a manner that inappropriately
influences a healthcare professional's
prescribing practices.
o Education and promotional activities should
encourage the appropriate use of
medicines by presenting them objectively
and without exaggerating their properties
o Relationships between Company personnel
and healthcare professionals should
encourage the development of a medical
practice committed to
and be based on truthful, accurate, and
updated scientific evidence.
PROMOTIONAL INFORMATION AND ACTIVITIES
No medicines shall be promoted for use in a specific
economy until the requisite approval for marketing for
such use has been given in that economy.
Promotion should be consistent with locally approved
product information.
o Anything under this should be approved by
the FDA
Promotional information should be clear, legible,
accurate, balanced, fair, objective, and sufficiently
complete to enable healthcare professionals to form
his or her own opinion of the therapeutic value of the
medicines concerned.
SAFETY OF MEDICINES
Medicines provided by Companies will conform to high
standards of quality, safety and efficacy as determined
by regulatory authorities in each economy in which they
operate.
Companies will report adverse events or adverse drug
reactions to regulatory authorities, subject to applicable
laws and regulations.
page 1 of 3
 ETHICS AND PHARMACEUTICAL INDUSTRY
SYMPOSIA AND CONGRESSES
The purpose and focus of all symposia, congresses or
sponsored by a Company should be to inform
healthcare professionals about products and/or to
provide scientific or educational information.
Company relationships with healthcare professionals
are regulated by multiple entities and intended to
benefit patients and to enhance the practice of
medicine.
Any sponsorship provided to individual healthcare
professionals must not be conditional upon an
obligation to prescribe, recommend, or promote any
medicine.
All Events should be held in an appropriate venue that
is conducive to the scientific or educational objectives
and the purpose of the Event or meeting. Companies
should avoid using extravagant venues or resorts.
Hospitality should be limited to refreshments and/or
meals incidental to the main purpose of the Event and
should only be provided:
o To participants of the Event and not their
guests
o Is moderate and reasonable as judged by
local standards.
Companies should not pay any costs associated with
individuals accompanying invited healthcare
professionals.
INFORMATIONAL PRESENTATIONS BY
COMPANY REPRESENTATIVES
In order to provide important scientific information and
nage
their schedules and provide patient care,
Company representatives may take the opportunity to
present information during healthcare
, including mealtimes,
in accordance with applicable laws and regulations.
ENTERTAINMENT
Companies should not provide any form of
entertainment or recreational items, such as tickets to
the theater or sporting events, sporting equipment, or
leisure or vacation trips, to any healthcare professional.
Such entertainment or recreational benefits should
not be offered, regardless of:
o The value of the items
o Whether the Company engages the
healthcare professional as a speaker or
consultant
o Whether the entertainment or recreation is
secondary to an educational purpose.
No standalone entertainment or other leisure or social
activities should be provided or paid for by Companies.
At events, entertainment of modest nature, which is
secondary to refreshments or meals, is allowed.
EDUCATIONAL ITEMS AND GIFTS
Payments in cash or cash equivalents (such as gift
certificates) or gifts for the personal benefit of
healthcare professionals should not be provided or
offered to healthcare professionals.
It is appropriate for Companies, where permitted by law
or local codes of ethics, to offer items designed
primarily for the education of patients or healthcare
USE AT YOUR OWN RISK
professionals if the items are of modest value and do
not have value to healthcare professionals outside of
his or her professional responsibilities.
These items should not subsidize normal routine
operations of a medical practice.
SUPPORT FOR CONTINUING MEDICAL EDUCATION
Helps physicians and other medical professionals to
obtain information and insights that can contribute to
the improvement of patient care and the medical
practice.
CME grant decisions to ensure that programs funded
are bona fide and quality educational programs that
financial support is not an inducement to prescribe or
recommend a particular medicine or course of
treatment
SAMPLES
When used appropriately, samples can be an important
tool for healthcare professionals and provide benefit to
patient health outcomes.
o Starter doses
Companies should have adequate systems of control
and accountability for samples provided to healthcare
professionals including how to look after such samples
while they are in possession of medical
representatives.
Samples should not be used as payment for services,
return for favorable treatment, or other inappropriate
inducements.
CONSULTANT AND SPEAKER ARRANGEMENTS
The following factors support the existence of a bona
fide consulting or speaking arrangement (not all factors
may be relevant to any particular arrangement):
o A written contract specifies the nature of the
services to be provided and the basis for
payment of those services
o A legitimate need for the services has been
clearly identified in advance of requesting the
services and entering into arrangements with
the prospective consultants
o The criteria for selecting consultants and
speakers are directly related to the identified
purpose, and the persons responsible for
selecting the consultants and speakers have
the expertise necessary to evaluate whether
the particular healthcare professionals meet
those criteria
o The number of healthcare professionals
retained is not greater than the number
reasonably necessary to achieve the
identified purpose
o The retaining Company maintains records
concerning, and makes appropriate use of,
the services provided
o The venue and circumstances of any meeting
with consultants or speakers are conducive
with the primary focus of the meeting;
specifically, resorts are not appropriate
venues.
page 2 of 3
 ETHICS AND PHARMACEUTICAL INDUSTRY
COMPLIANCE PROCEDURES AND RESPONSIBILITIES
It is the responsibility of Companies to ensure that
internal compliance procedures exist that facilitate
compliance with these Principles and the spirit they
embody.
These procedures should be documented and
provided to employees to further enhance compliance.

CONDUCT AND TRAINING OF COMPANY

REPRESENTATIVES
Companies should ensure that all representatives who
are employed by or acting on behalf of the companies,
and who visit healthcare professionals, receive training
about the applicable laws, regulations and industry

interactions with healthcare professionals.

In addition, companies should train their
representatives to ensure that they have sufficient
knowledge of general science and product-specific
information to provide accurate, up-to-date information,
consistent with applicable laws and regulations.
Companies should provide updated or additional
training in all of the areas needed for their
representatives who visit healthcare professionals.
Companies should also assess their representatives
periodically to ensure that they comply with relevant
Company policies and standards of conduct.
Companies should take appropriate action when
representatives fail to comply with relevant Company
policies that are consistent with these Principles and
national and local industry codes of ethics.

PUBLIC SECTOR RELATIONSHIPS

AND PROCUREMENT
The decision-making process by Companies and
Governments during and including the government
procurement process, through bidding or any other
procedure of government procurement, must be
professional and ethical. There should be no attempt
to exert inappropriate influence.
Companies must provide accurate and balanced
information to the Government.
Companies and government officials should ensure
that their relationships and fee-for-service
arrangements comply with government ethics rules
or procedures.

CLINICAL TRIALS

All clinical trials (phases I to IV) and scientific research

involving patients sponsored or supported by
companies will be conducted with the intent to develop
bona fide scientific knowledge that will benefit patients
and advance science and medicine.
o Companies must ensure transparency and
accountability in the presentation of
research and publication of study results.
Clinical trials should not be used as inappropriate
inducements for past or future sales.
Clinical trials should be undertaken in an ethical
manner, without undue influence by competitors.

USE AT YOUR OWN RISK page 3 of 3

 CLINICAL BIOETHICS OLFU BATCH 2023
ETHICS AND PHARMACEUTICAL INDUSTRY I DR. MEDALLA November 26, 2021

PHYSICIANS AND PHARMACEUTICAL SECTOR PROMOTIONAL INFORMATION AND ACTIVITIES

• A conflict of interest exists in medicine when the following conditions
have all been met:
1. The physician has a duty to advocate for the interests of the
patient (or public).
2. The physician is also subject to other interests— her own, or those
of a third party.
3. The physician becomes a party to certain social arrangements.
4. Those arrangements, as viewed by a reasonable onlooker, would
tempt a person of normal human psychology to neglect the
patient’s/public’s interests in favor of the physician’s (or third
party’s).
THE MEXICO CITY PRINCIPLES
For Voluntary Codes of Business Ethics in the Biopharmaceutical Sector
• “Biopharmaceutical sector” includes companies, regardless of
ownership status, that develop, manufacture, market, or distribute
pharmaceutical and/or biologic products. Such products are also
• No medicines shall be promoted for use in a specific economy until
the requisite approval for marketing for such use has been given in
that economy.
• Promotion should be consistent with locally approved product
information.
• Promotional information should be clear, legible, accurate,
balanced, fair, objective, and sufficiently complete to enable
healthcare professionals to form his or her own opinion of the
therapeutic value of the medicines concerned.
SAFETY OF MEDICINES
• Medicines provided by Companies will conform to high standards of
quality, safety and efficacy as determined by regulatory authorities
in each economy in which they operate.
• Companies will report adverse events or adverse drug reactions to
regulatory authorities, subject to applicable laws and regulations.
•

referred to in these Principles as "medicines."

SYMPOSIA AND CONGRESSES
• The purpose and focus of all symposia, congresses or (an “Event”) for
• Ethical interactions help ensure that medical decisions are made in
healthcare professionals organized or sponsored by a Company
the best interests of patients
should be to inform healthcare professionals about products and/or
• For relationships with healthcare professionals and other stakeholders
to provide scientific or educational information.
to meet this standard, companies in the biopharmaceutical sector
• Company relationships with healthcare professionals are regulated
(“Companies”) should be guided by these six principles:
by multiple entities and intended to benefit patients and to enhance
THE SIX PRINCIPLES the practice of medicine.
• Any sponsorship provided to individual healthcare professionals must
• Healthcare and Patient Focus
not be conditional upon an obligation to prescribe, recommend, or
o Everything we do is intended to benefit patients
promote any medicine.
• Integrity
• All Events should be held in an appropriate venue that is conducive
o Dealing ethically, honestly, and respectfully in
to the scientific or educational objectives and the purpose of the
everything we do.
Event or meeting. Companies should avoid using extravagant
• Independence
venues or resorts.
o Respect the need of autonomous decision-making
• Hospitality should be limited to refreshments and/or meals incidental
of all parties, free from improper influence.
to the main purpose of the Event and should only be provided:
• Legitimate Intent
o To participants of the Event and not their guests
o Everything we do is for the right reasons, is lawful,
o Is moderate and reasonable as judged by local
and aligns with the spirit and the values of these
standards.
Principles.
• Companies should not pay any costs associated with individuals
• Transparency
accompanying invited healthcare professionals.
o A general willingness to be open about our actions
while respecting legitimate commercial sensitivities
INFORMATIONAL PRESENTATIONS BY COMPANY REPRESENTATIVE
and intellectual property rights.
• In order to provide important scientific information and to respect
• Accountability
healthcare professionals’ abilities to manage their schedules and
o A willingness to be responsible for our actions and
provide patient care, Company representatives may take the
interactions.
opportunity to present information during healthcare professionals’
INTERACTIONS WITH HEALTHCARE PROFESSIONALS working day, including mealtimes, in accordance with applicable
laws and regulations.
•

What are the premise of the interactions with HCP

• Interactions between companies and healthcare professionals
ENTERTAINMENT
provide valuable scientific, clinical, product, and policy information
• Companies should not provide any form of entertainment or
about medicines that may lead to improved patient care.
recreational items, such as tickets to the theater or sporting events,
• Appropriate marketing is critical to achieving these goals because
sporting equipment, or leisure or vacation trips, to any healthcare
they enable companies to:
professional.
o Inform healthcare professionals about the benefits and risks of
• Such entertainment or recreational benefits should not be offered,
medicines to help advance appropriate patient use
regardless of
o Provide scientific and educational information
o The value of the items
o Support medical research and education
o Whether the Company engages the healthcare
o Obtain feedback and advice about our products through
professional as a speaker or consultant
consultation with medical experts.
o Whether the entertainment or recreation is secondary to
• All interactions with healthcare professionals are to be conducted in
an educational purpose.
a professional and ethical manner.
• No standalone entertainment or other leisure or social activities
o Healthcare professionals must not be improperly influenced by
should be provided or paid for by Companies. At events,
companies.
entertainment of modest nature, which is secondary to refreshments
o Nothing should be offered or provided by a Company in a
or meals, is allowed.
manner that inappropriately influences a healthcare
professional's prescribing practices.
EDUCATIONAL ITEMS AND GIFTS
o Education and promotional activities should encourage the
• Payments in cash or cash equivalents (such as gift certificates) or
appropriate use of medicines by presenting them objectively
gifts for the personal benefit of healthcare professionals should not
and without exaggerating their properties
be provided or offered to healthcare professionals.
o Relationships between Company personnel and healthcare
• It is appropriate for Companies, where permitted by law or local
professionals should encourage the development of a medical
codes of ethics, to offer items designed primarily for the education of
practice committed to patients’ wellbeing and be based on
patients or healthcare professionals if the items are of modest value
truthful, accurate, and updated scientific evidence.

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 CLINICAL BIOETHICS OLFU BATCH 2023
ETHICS AND PHARMACEUTICAL INDUSTRY I DR. MEDALLA November 26, 2021
and do not have value to healthcare professionals outside of his or
her professional responsibilities. PUBLIC SECTOR RELATIONSHIPS AND PROCUREMENT
• These items should not subsidize normal routine operations of a • The decision-making process by Companies and Governments
medical practice. during and including the government procurement process, through
bidding or any other procedure of government procurement, must
SUPPORT FOR CONTINUING MEDICAL EDUCATION be professional and ethical. There should be no attempt to exert
• Helps physicians and other medical professionals to obtain inappropriate influence.
information and insights that can contribute to the improvement of • Companies must provide accurate and balanced information to the
patient care and the medical practice. Government
• CME grant decisions to ensure that programs funded are bona fide • Companies and government officials should ensure that their
and quality educational programs that financial support is not an relationships and fee-for-service arrangements comply with
inducement to prescribe or recommend a particular medicine or government ethics rules or procedures.
course of treatment
CLINICAL TRIALS
SAMPLES
• All clinical trials (phases I to IV) and scientific research involving
• When used appropriately, samples can be an important tool for
patients sponsored or supported by companies will be conducted
healthcare professionals and provide benefit to patient health
with the intent to develop bona fide scientific knowledge that will
outcomes.
benefit patients and advance science and medicine.
o Companies should have adequate systems of control and
o Companies must ensure transparency and accountability
accountability for samples provided to healthcare
in the presentation of research and publication of study
professionals including how to look after such samples
results.
while they are in possession of medical representatives.
• Clinical trials should not be used as inappropriate inducements for
o Samples should not be used as payment for services,
past or future sales.
return for favorable treatment, or other inappropriate
• Clinical trials should be undertaken in an ethical manner, without
inducements
undue influence by competitors.
CONSULTANT AND SPEAKER ARRANGEMENTS
• The following factors support the existence of a bona fide consulting REFERENCES
• Lecture and PPT
or speaking arrangement (not all factors may be relevant to any • Old Trans
particular arrangement):
o A written contract specifies the nature of the services to be
provided and the basis for payment of those services
o A legitimate need for the services has been clearly identified
in advance of requesting the services and entering into
arrangements with the prospective consultants
o The criteria for selecting consultants and speakers are directly
related to the identified purpose, and the persons responsible
for selecting the consultants and speakers have the expertise
necessary to evaluate whether the particular healthcare
professionals meet those criteria
o The number of healthcare professionals retained is not greater
than the number reasonably necessary to achieve the
identified purpose
o The retaining Company maintains records concerning, and
makes appropriate use of, the services provided
o The venue and circumstances of any meeting with consultants
or speakers are conducive with the primary focus of the
meeting; specifically, resorts are not appropriate venues.

COMPLIANCE PREOCEDURES AND RESPONSIBILITIES

• It is the responsibility of Companies to ensure that internal
compliance procedures exist that facilitate compliance with these
Principles and the spirit they embody.
• These procedures should be documented and provided to
employees to further enhance compliance.

CONDUCT AND TRAINING OF COMPANY REPRESENTATIVES

• Companies should ensure that all representatives who are employed
by or acting on behalf of the companies, and who visit healthcare
professionals, receive training about the applicable laws, regulations
and industry codes of ethics that govern the representatives’
interactions with healthcare professionals.
• In addition, companies should train their representatives to ensure
that they have sufficient knowledge of general science and
product-specific information to provide accurate, up-to-date
information, consistent with applicable laws and regulations.
• Companies should provide updated or additional training in all of
the areas needed for their representatives who visit healthcare
professionals.
• Companies should also assess their representatives periodically to
ensure that they comply with relevant Company policies and
standards of conduct.
• Companies should take appropriate action when representatives fail
to comply with relevant Company policies that are consistent with
these Principles and national and local industry codes of ethics.

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 CLINICAL BIOETHICS
RESPECT FOR HUMAN VULNNERABILITY AND INTEGRITY DR. JAO
NOTION OF VULNERABILITY
• Latin Origin: “vulnus” à “ wound”
• Susceptibility of being wounded
• 1978 Belmont Report: Ethical Principles and Guidelines for the
Protection of Human Subjects of Research
o Refers to individuals and populations
o “Informed consent”: à need for protection
• TARGET GROUPS
o Racial minorities
o Economically disadvantaged
o Very sick
o Institutionalized
• May continually be sought as research subjects, owing to their ready
availability in settings where research is conducted
• Given their dependent status and their frequently compromised
capacity for free consent
• They are easy to manipulate as a
result of their illness or socioeconomic
condition
• Target groups: “They should be
protected against the danger of
being involved in research solely for
administrative convenience
(National Commission for the protection
of human subjects of biomedical and behavioral research (1979)
• Throughout the first half of the 20th century, these vulnerable
members of the population have been used in unethical research
studies:
o Institutionalized groups of persons like orphans
o Prisoners, the elderly and, later Jews
o Other ethnic groups, considered as inferior and even
subhuman by the Nazis
o Persons such as Chinese, who were exploited by the
Japanese in order to pursue their Scientific and Military
Objectives
o Ethnic minorities
o Socially underprivileged groups and women
“Bioethics has attempted to justify this, mainly by reinforcing the principle
of autonomy and of the consequent demand, increasingly more inclusive
and stricter, for informed consent” (Beauchamp and Childress,
2001:63)
• Vulnerability expresses two basic ideas: (Barcelona Declaration,
1998)
o It expresses the finitude and fragility of life which, in those
capable of autonomy, grounds the possibility and
necessity of all morality
o Vulnerability is the object of a moral principle requiring
care for the vulnerable. The vulnerable are those whose
autonomy or dignity or integrity is capable of being
threatened
• In applying and advancing scientific knowledge, medical practice
and associated technologies, human vulnerabilities should be taken
into account
• Individuals and groups of special vulnerability should be protected
and the personal integrity of such individuals respected
• The notion of vulnerability is not just a neutral description of the
human condition but instead a normative prescription to take care
of the vulnerable that is characteristics of human beings
• Ethics is more than respecting individual choices and decisions; it
aims at care for the other
ASPECTS OF VULNERABILITY
BIOLOGICAL OR CORPOREAL VULNERABILITY
• This concerns the fragility of the human organism originating from
o Natural threats that are coming from our biology: ageing
susceptibility to illness and disease, and death
o Environmental and other natural and man-made threats:
famine, earthquake, hurricanes, pollution and
environmental disasters
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SOCIAL VULNERABILITY
• The fragility of the human capacity for creating coherence in one’s
life and for sharing goods and services
o Social threats stemming from war and crime, prejudice and
discrimination, cruelty and indifference
o Persons also become vulnerable due to hospitalization and
institutionalization
o Social circumstances and conditions
CULTURAL VULNERABILITY
• Concerns the fragility of particular traditions and conceptions of
values that are typical for a community or local cultures
THE POWERS OF MEDICINE : FIGHTING VULNERABILITY
• A common idea is that the vulnerability of the human condition
should be eliminated or reduced
o Science and technological innovations should be used to
overcome the natural threats
o Medical research should be focused on eliminating the
biological threats to the human body
• The basic assumption behind this fight is that many vulnerabilities of
the human conditions are contingent, not inherent
• This fight has not been successful but at the same time has failures
• Life expectancy and health have improved, poverty and starvation
reduced
• But at the same time, many people still die from common diseases,
life expectancy is decreasing in many countries, poverty is still
widespread
• An unrestrained fight against human vulnerability fight against
human vulnerability generates its own problems
o Not the struggle against human vulnerability but the struggle
to rid the human condition of all vulnerability
• For a sustainable medicine it is necessary to accept some
vulnerability as a permanent part of the human condition
PROBLEMS VS FIGHT AGAINST VULNERABILITY
• Religions, alternative medicine and traditional knowledge present
different ways of knowing and valuing
o Because they are open to different perspectives
§ They can give meaning to vulnerability
§ But their views are generally not accepted by
mainstream science or bioethics
§ An unrestrained fight against human vulnerability
fight against human vulnerability generates its own
problems
o Not the struggle against human vulnerability but the
struggle to rid the human condition of all vulnerability
• Economic problems, the success of science and technology has
created financial difficulties in almost all countries in achieving
decent levels of health care for the population
o Because of its continuous fight against vulnerability,
medicine often is not “sustainable”
• Medical progress itself has created new forms of vulnerability, i.e.,
chronic illness
o This presents continuing vulnerability for a growing
population à aging population
DILEMMA OF VULNERABILITY
• Requires a balance between eliminating and accepting human
vulnerability
DISABILITY
• Disability is viewed as abnormal and the disabled therefore are by
definition vulnerable; at the same time the disabled should not be
stigmatized by being treated as abnormal
DEATH
• In medicine the place of death in human life is ambivalent; in
palliative care, death is understood as being part of life; in some
other sectors of medicine death is still treated as the enemy
DEPRESSION
• Prozac is widely used as an anti-depressant drug, when there are
clear clinical symptoms of depression
• At the same time it is regarded as medication for unhappiness and
sadness
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RESPECT FOR HUMAN VULNNERABILITY AND INTEGRITY DR. JAO October 22, 2021

HUMAN SUFFERING AND MISERY • In the field of health policies, the principle can play an important role
• Express human vulnerability in the:
• They also pose a challenge o Prohibition of commercializing human body parts
• We must at the same time struggle to keep suffering to a minimum o Regulation of genetic manipulation, particularly in
and also accept it as part of life safeguarding the human genome
o Consideration of patentable human matter
CARE ETHICS
• The challenge of human vulnerability is that it can never be entirely ETHICAL PERSPECTIVES
eliminated from human life. Instead, it should inspire new
approaches in bioethics ANTHROPOMETRIC ENVIRONMENTAL ETHICS: HUMAN CENTERED
• The human condition requires solidarity; human beings all share • Human beings have moral duties only towards one another
common vulnerability • Human interests prevail over the interests of other species
• Human vulnerability also leads to an ethics of care
• Because it is a shared characteristics, it is also a source of concern NON- ANTHROPOMETRIC ENVIRONMENTAL ETHICS
for others as well as awareness that we rely on others • BIOCENTRIC: Other living organisms have intrinsic value
• It is the basis for the duty to care for those threatened by biological, o All life forms are “moral patients”, i.e. subjects that
social and cultural threats as well as by the power of medicine itself are entitled to moral consideration
o It is therefore an ethical imperative to respect all life
forms
NOTION OF PERSONAL INTEGRITY o All organisms have intrinsic value
o More related to non-western cultural traditions
INTEGRITY • ECOCENTRIC: Ecosystems have intrinsic value as well
• Latin origin verb tangere which means “to touch”. This Is the root o Nature as whole is a “moral patient”
both of the adjective integer, which means “untouched”, “integral” o All organisms and entities in the ecosphere, as parts
of the interrelated whole, are equal in intrinsic value
and the noun integritas which means “totality”, “integrity”
o Holistic methodology
• The noun “integrity” evokes both the state in which all parts are
maintained and the quality of that which Is unaltered
BASIC PRINCIPLES OF ENVIRONMENTAL ETHICS
• This was confirmed in 1996, in which the declaration of Helsinski, in
• RESPECT FOR NATURE
which the noun “integrity” is used in the “Basic principles” section as
o The prosperity of human beings depends on the
an attribute of the recognized inviolability of the subject of prosperity of nature.
experimentation, which should not be “touched” physically or o Human beings are part of nature. They have
psychologically therefore the duty to conserve and protect the
1. The right of the research subject to safeguard his or her integrity integrity of the ecosystem and its biodiversity
must always be respected • ENVIRONMENTAL JUSTICE
2. Every precaution should be taken to respect the privacy of the o Environmental benefits and burdens should be
equally distributed
subject and to minimize the impact of the study on the
o Opportunities to participate in decision making
subject’s physical and mental integrity and on the personality concerning environmental issues should be equally
of the subject (World Medical Association, 1996: 1.6) provided
• Principle of respect for human vulnerability is related to the notion of • INTERGENERATIONAL JUSTICE
personal integrity; this is mentioned in the last part of Article 8 o Every generation should leave the following
• Integrity concerns the wholeness of an individual generation an equal opportunity to live a happy life,
and should therefore bequeath a healthy life
• In ethical discourse, integrity is often considered as a virtue, related
to the honesty of somebody’s character for example REFERENCES
• But respect for personal integrity in this article does not refer to • Lecture and PPT
somebody’s moral character or his/her good behavior. It refers to
fundamental aspects of a human life that should be respected
• Personal integrity refers here to respect for the patient’s
understanding of his/her own life and illness, but also for his/her
interests and free will.
• In the field of health policies, the principle of vulnerability demands,
both at the social and international level:
o Benefit of some should not be attained by exploiting the
weakness of others
o Those of bio-industries must not aggravate human
vulnerability but rather seek to eliminate it as far as
possible and to respect what is beyond their reach
• At the level of experimentation
1. It demands protection which goes beyond that which can be
expressed in informed consent of the body or part of the body
and demands respect for personal identity in the relationship
between the subject of experimentation and the researcher
2. Between patient and doctor, at the level of clinical assistance:
§ Respect for integrity demands new forms of
communication
§ Allows the doctor to focus more on the patient than the
illness
• Facilitate the involvement of the patient in his
own therapeutic process as a partner in the
health team
• Development of therapies which are
perceived less invasive and more respectful of
the individual, for example at a cultural or
religious level.

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 CLINICAL BIOETHICS
HUMAN DIGNITY AND HUMAN RIGHTSI DR. JAO
ARTICLE 3
HUMAN DIGNITY AND HUMAN RIGHTS
1. Human dignity, human rights and fundamental freedoms are to be
fully respected.
2. The interests and welfare of the individual should have priority over
the sole interest of science or society.
HUMAN RIGHTS
• Are moral principles or norms that describe certain standards of
human behavior and are regularly protected in municipal and
international law
• Commonly understood as inalienable
• Fundamental rights “to which a person is inherently entitled simply
because she or he is a human being”, regardless of their age, ethnic
origin, location, language, religion, ethnicity, or other status
OTHER VALUES THAT CAN BE DERIVED FROM THE 2 FUNDAMENTAL VALUES
OF HUMAN RIGHTS (Human Dignity and Equality)
o FREEDOM: Human will is an important part of human dignity
o RESPECT FOR OTHERS: Lack of respect for someone fails to appreciate
their individuality and essential dignity
o NON DISCRIMINATION: Equality in human dignity means we should not
judge people’s rights and opportunities on the basis of their
characteristics
o TOLERANCE: Intolerance indicates a lack of respect for difference, and
equality does not signify uniformity
o JUSTICE: People equal in their humanity deserve fair treatment
o RESPONSIBILITY: Respecting the rights of others entails responsibility for
one’s actions and exerting effort for the realization of the rights of one
and all
CHARACTERISTICS OF HUMAN RIGHTS
HUMAN RIGHTS ARE INALIENABLE
• You cannot lose them because they are linked to the very fact of
human existence
• Inherent to all human beings
• May be suspended or restricted
o Found guilty of a crime: Liberty can be taken away
o In times of national emergency: Imposing curfew
restricting freedom of movement
HUMAN RIGHTS ARE INDIVISIBLE, INTERDEPENDENT AND
INTERRELATED
• Different human rights are intrinsically connected
• Cannot be viewed in isolation from each other
• The enjoyment of one right depends on the enjoyment of many
other rights
• No one’s right is more important than the rest
HUMAN RIGHTS ARE UNIVERSAL
• Apply equally to all people everywhere in the world with no time
limit
• Every individual is entitled to enjoy his or her human rights without
distinction of “race” or ethnic background, color, sex, sexual
orientation, disability, language, religion, political or other opinion,
national or social origin, birth or other status
• Universality is not unanimous with uniformity
THE STATE’S OBLIGATION & DUTIES ON HUMAN RIGHTS
(Universal Declaration of Human Rights)
• The states have obligations and duties under international laws to
respect, protect and fulfill human rights
• Meanwhile as individuals, while we are entitled to our human rights,
we should also respect and stand for the human rights of others
•
THE OBLIGATION TO RESPECT
• The states must refrain from interfering with or curtailing the
enjoyment of human rights
THE OBLIGATION TO PROTECT
• Requires the states to protect individuals and groups against human
rights abuses by others
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THE OBLIGATION TO FULFILL
• The states must take positive action to facilitate the enjoyment of
basic human rights
HUMAN DIGNITY
• DIGNITY is the right of a person to be valued and respected for their
own sake, to be treated ethically.
o It is of significance of morality, ethics, law and politics as
extension of the enlightenment era concepts of inherent,
inalienable rights
o The term may also be used to describe personal conduct,
as in “behaving with dignity”
CONCEPTS OF HUMAN DIGNITY
ACCORDING TO:
• Classical Antiquity
• World Religions
• Modern Philosophy
• Contemporary International Law
CLASSICAL ANTIQUITY
• Dignity as deserving of honor and esteem according to personal
merit, inherited or achieved
• In ancient Greek Philosophy, particularly of Aristotle and the Stoics,
dignity was associated with human abilities of deliberation, self-
awareness, and free decision-making
WORLD RELIGIONS
• In many world religions, human dignity is considered to be
predetermined by the creation of human beings in the image of God
• Those who are weak in the body and soul have dignity equal to
those who are robust and sturdy
• A few of the verses in religious texts that speak to the Principle of
Respect for Human Dignity:
o Islam: “ We have indeed honored the descendants of
Adam (i.e., human beings)” (Qur’an 17:70)
o Christianity: “ Do you not know that you are the temple of
God? (1 Corinthians 3:16)
o Judaism: “So God created humanity in God’s image, in
the image of God, God created them” (Genesis 1:27)
o Buddhism: “All sentient beings without exception have the
Buddha-nature” (Nirvana Sutra)
o Hinduism: “The human body is the temple of God” (Rig
Veda)
MODERN PHILOSOPHY
• Modern philosophy proposed secular understanding of human
dignity and progressively associated this concepts with the idea of
human rights
• In different teachings human dignity was presented as:
o An aspect of personal freedom (Giovanni Pico Della
Mirandola)
o An embodiment of one’s public worth (Thomas Hobbes)
o As universal, virtue, unconditional, and incomparable
worth determined by one’s autonomy rather than origin,
wealth, or social status (Immanuel Kant)
• One of Kant’s basic principles of ethics – to treat any other person
always at the same time as an end, never merely as a means (*All
human beings have dignity rather than mere piece)
• Categorical imperative has been accepted by moral and political
philosophy as the actual basis for the conception of human rights
and in the sense it is a foundational concept
CONTEMPORARY INTERNATIONAL LAW
• In contemporary international law, national constitutions, and other
normative documents, human dignity is strongly connected with
human rights
• According to Article 1 of the Universal Declaration of Human Rights
(1948): “All human beings are born free and equal in dignity”
• The declaration establishes human rights (like freedom from
repression, freedom of expression and association) on the inherent
dignity of every human being
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HUMAN DIGNITY AND HUMAN RIGHTSI DR. JAO October 22, 2021

The European Convention on human Rights and Biomedicine in Art. 1 REFERENCES

• Lecture and PPT
- Declares protection of the dignity and identity of all human
beings and guarantees everyone, without discrimination,
respect for their integrity and other rights and fundamental
freedoms with regard to application of biology and medicine
as its main purpose
THE OBL
THE NOTION OF HUMAN DIGNITY
• The notion of human dignity expresses the intrinsic value of the
person capable of
o Reflection
o Sensitivity
o Verbal communication
o Free choice
o Self determination in conduct and creativity
• Unlike material values of financial prices, human dignity has no
external equivalent; it is an end in itself
• All human beings are equal in dignity irrespective of
o Gender
o Age
o Social Status
o Ethnicity
• Recognition of a person’s dignity presupposes active respect for
his/her human rights, self esteem and self determination, as well as
for his/her privacy, protecting him/her from legitimate intrusions and
preserving his/her valid public space
• A society or a community should respect each of its members as a
person or a moral agent on the basis of the notion of human dignity
• This notion also requires that the interests and welfare of the
individual are considered as prior to the sole interest of society,
community, or any particular kind of publicly wholesome activity.
• The emphasis on “the sole interest of science or society” is important
• It implies that because of his/her human dignity, the individual
should never be sacrificed for the sake of science (as has happened
in medical experiments during the Second World War) or for the sake
of society (as has happened in totalitarian regimes).
• But ‘sole’ also implies that there might be exceptional circumstances
in which the interest of others or the community as a whole are so
important that infringing upon the interests of individuals is
unavoidable in order to save others or the community. An example is
the threat of a deadly pandemic.
• Human dignity is a foundational concept and it is theoretically and
normatively inappropriate to reduce it to functional characteristics
of person’s activity, ability to decision-making or to taking into
account her autonomy.
• Respect for dignity means recognition of other’s intrinsic worth as a
human being.
• In a comparative view, human dignity has diverse forms in different
cultural and ethical traditions (for example, Confucian, Judeo-
Christian, Muslim) and is respected in various ways in different types
of societies (traditional, modern, totalitarian, democratic).
• It is less respected in totalitarian societies and more respected in
modern and democratic societies.
• Regardless of cultural, confessional, and political varieties human
dignity is universally based on the person’s self- awareness and
appropriate respectful treatment towards her.
• As it is emphasized in Declaration, the regard to cultural diversity is
‘not to be invoked to infringe upon human dignity, human rights and
fundamental freedoms’ (See Article 12).
•

DIGNITY AND HEALTH CARE PROVIDER RELATIONS

• Healthcare Provider-Patient relations are just one kind of human
relations, presupposing all ethical requirements.
• Inequality in the status of the health care provider and the patient
may be aggravated in special cases when patients are children,
handicapped individuals, and elderly persons. Particularly risky are
cases of patients who are mentally handicapped.
• Special attention in regard to human dignity and human rights is
required in palliative treatment of terminal patients and patients in
‘vegetative state’.
• Though there is no consensus either in public or in the expert
community concerning the ethical and legal status of embryos and
fetuses, the latter should be treated with respect and care.

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 CLINICAL BIOETHICS
PRIVACY AND CONFIDENTIALITY I DR. CLARION
PRIVACY VS CONFIDENTIALITY
ARTICLE 9 : The privacy of the persons concerned and the confidentiality
of their personal information should be respected. To the greatest extent
possible, such information should not be used or disclosed for purposes
other than those for which it was collected or consented to, consistent
with international law, in particular international human rights law.
PRIVACY
• Privacy is the right of an individual or a group to be free from
intrusion from others, and includes the right to determine which
information about them should be disclosed to others
• Privacy talks about a person
• Restricts the public from accessing the personal details about a
problem
•
CONFIDENTIALITY
• Confidentiality is an attribute of personal information requiring that it
not be disclosed to others without sufficient reason
• Confidentiality is about information
• Protects the information from the range of unauthorized persons
CONFIDENTIALITY
• An important aspect of trust that patients place in health care
practitioners, especially physicians
o Thus, patients have the right to every consideration of their
privacy concerning their medical problem and the
corresponding programs planned to address them.
o Case discussions, consultations, examinations, and treatment
are confidential and should be conducted discreetly
From Old Trans
o The basic principles and values of Article 9 emerge from Universal
Declaration of Human Rights of 1948.
o The concept of CONFIDENTIALITY is already stated in the Hippocratic
Oath.
o The DIGNITY and AUTONOMY of the person, being an integral part of
rights and fundamental freedoms of human beings, has to be recognized
and respected in an effective and universal manner.
o CULTURAL & PSYCHO-SOCIAL FACTORS of persons and social groups have
to be considered.
o ARTICLE 9 is related to AUTONOMY & CONSENT.
o Here is the content of the article according to UNESCO, 2005.:
1. A right to privacy guarantees control over personal information in
various ways. Privacy extends beyond data protection, as certain
private spheres of the individual that are not manifested in data
processing can also be protected by the right to privacy.
2. Confidentiality refers to a special and often fiduciary relationship
between researchers, doctors and patients provided that the
shared information shall remain secret and shall not be disclosed
readily to a third person.
3. The importance of privacy has been recognized in numerous legal
instruments.
IMPORTANCE OF CONFIDENTIALITY
• FOUR PILLARS
o Autonomy
o Implied Promise
o Virtue Ethics
o Consequentialist
REASONS FOR RESPECTING PRIVACY AND CONFIDENTIALITY
• Individuals ‘own’ their information. It is essential to their personal
integrity
• For many people, privacy is an essential aspect of their dignity.
Invading their privacy against their will is a violation of their dignity.
• Respect for other people requires protecting their privacy and their
confidentiality of information about them.
• Patients are less likely to trust health care providers and confide in
them because they think that the health care providers will not keep
the information confidential. This can have serious consequences for
the patient’s health and well- being; sometimes for the health of
others (e.g., family members)
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DUTY OF HEALTH CARE PROVIDERS TO PROTECT
THE PRIVACY OF PATIENTS
• Health care providers have an ethical obligation to protect patient’s
privacy to the greatest extent possible in any circumstances. For
example, they should interview patients where they cannot be
overheard, especially when the patients declare that they did not
bring any companions during consultation. However, take ethics into
consideration like bringing in a witness of the same sex as the patient
during consultation. They should ask the patient permission to
examine him or her unclothed. You have to tell or ask the patient
everything and anything that you need to do during the
examination. They should ensure that an unclothed patient cannot
be viewed by passersby.
From Old Trans
• If the patient does not want a procedure to be done on him or her, the
physician cannot do the procedure. Understand that some patients do
not want to be heard or seen.
HOW TO MAINTAIN CONFIDENTIALITY/PRIVACY
o Avoid discussions of personal health information in public areas e.g.
cafeteria, hallway, other patient rooms
o Never leave charts, computers, or other devices containing personal
health information unattended or in clear view of others. File information
or put charts away in their proper place. Transport charts or other
personal health information face down or in envelopes
o Do not share password. Always log off the computer. You are responsible
for activity under your password
o Do not engage in conversations with family, friends, neighbors, etc. in the
hospital, unless they approach you first. Don’t ask “ Why are you here?”
People have the right to keep their reason for being on hospital property
private
DUTY OF HEALTH CARE PROVIDERS TO
MAINTAIN CONFIDENTIALITY
• The duty of maintaining confidentiality, also known as. professional
secrecy, has been part of western medical ethics since Hippocrates
(5th Century B.C.E)
• The Hippocratic oath states that “whatever I see or hear,
professionally or privately, which ought not to be divulged, I will keep
secret and tell no one”.
• Ethics courses in non-western countries should discuss the source of
medical confidentiality in their culture.
Confidentiality extends to all personal health information, including
genetic data
• UNESCO international declaration on Human Genetic Data...
“all medical data, including genetic data and proteomic data,
regardless of their apparent information content, should be
treated with the same high standards of confidentiality.”
JUSTIFIED BREACHES OF CONFIDENTIALITY
SHARING INFORMATION FOR PATIENT CARE
• In the hospital setting, many people (doctors, nurses) need access to
the patient’s chart in order to provide care. However, each of these
persons is bound to maintain confidentiality to the greatest extent
possible. Outside the hospital setting, family members may need
patient information in order to provide care and/or to protect
themselves
SHARING INFORMATION FOR PATIENT CARE
• When the health care provider does not speak the patient’s
language, an interpreter will be needed who will then have access
to information about the patient. The interpreter should be bound to
observe confidentiality.
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 CLINICAL BIOETHICS OLFU BATCH 2023
PRIVACY AND CONFIDENTIALITY I DR. CLARION November 5, 2021

TEACHING MEDICAL STUDENTS

• Observation and discussion of patients is a necessary part of
medical education. Students should be informed of their obligation
to maintain confidentiality.

MANDATORY REPORTING
• Health care providers should be familiar with laws about mandatory
reporting of infectious diseases, suspected child abuse, and other
conditions in the country when they practice. Normally, patients
should be informed that their information has to be reported to the
appropriate authorities.

SERIOUS DANGERS TO OTHER

• For example, in exceptional circumstances and generally as a last
resort, health care provider may need to inform other persons that
the patient has threatened to harm them whether by violence or by
sexual contact when the patient has a transmissible disease such as
HIV or any STDs.

GENETIC INFORMATION
• There is controversy regarding whether other individuals with the
same genetic makeup (usually close family members) have a right
to a patient’s genetic information
• Physicians should consult their national regulations or guidelines
when faced with this situation.

WITH PATIENT OR GUARDIAN CONSENT

• This should generally be obtained for all breaches of confidentiality
and ender the breaches acceptable ethically
•

SPECIAL CIRCUMSTANCES OF RESEARCH

• Disclosure of personal health information obtained in the course of a
research study requires the prior consent of the research subject
• There is a great controversy regarding whether anonymized
patient’s information requires consent for disclosure, researchers
should consult their national regulations or guidelines if such exist,
otherwise international guidelines such as the Declaration of Helsinki.
• In research, communities as well as individuals have a right to
privacy, and information about them should be kept confidential,
especially when its discharge may be harmful to the community.
• Scientific publication should respect confidentiality to the greatest
extent possible. Consent is always required when an individual
research subject can be identified in a publication.

EXAMPLES OF PRIVACY BREACHES

o Misdirected faxes
o Improper destructions of PHI
o Cellphones used to take pictures in the hospital
o Staff member/clerk discussing the patient, outside of patient care
o Sharing personal health information on social networks
o Unauthorized access – you MUST NOT look at patient’s records if you are
NOT providing care

REFERENCES
• Lecture and PPT
• Old trans

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 CLINICAL BIOETHICS
EQUALITY, JUSTICE, AND EQUITY I DR. CLARION
EQUALITY, JUSTICE, AND EQUITY
• ARTICLE 10: The fundamental equality of all human beings in dignity
and rights is to be respected so that they are treated justly and
equitably.
JUSTICE
• Also termed as fairness
• Both a principle and a virtue relating to the rightness on people’s
interactions and relationships
o As a principle, one should give another what is one’s due
o As a virtue, it is the constant will to render what is right
(one’s due)
• Related to truthfulness, autonomy, stewardship, solidarity, and non-
maleficence
• In health, it is expressed in the individual and society’s obligation to
deliver competent, affordable and accessible healthcare
• Issues on justice occur in public policy, health insurance, health
management organization, research, and relationships with drug
representatives
• It is also equated with equity. What is due to one depends on what
he/she has given.
• Based on natural law of the golden rule that states “do unto others
what you would want others to do unto you.”
DIFFERENT TYPES OF JUSTICE
• DISTRIBUTIVE
o Ensuring that each person receives a fair share of public
resources
o This is the most important type for health care under
conditions of scarcity
o Material Principle: “Each person must receive according
to his or her needs; Each must receive according to his or
her effort; or according to his/her contributions.”
• PROCEDURAL
o Ensuring a fair process for making decisions and settling
disputes
• RETRIBUTIVE
o Ensures punishment of wrongdoers
• SOCIAL
o Combination of the previous types as applied to a society
in which individuals and groups receive fair treatment and
an equitable share of the benefits of society
•
DIFFERENT TYPES OF JUSTICE
• To each person an equal share
• To each person according to need
• To each person according to effort
• To each person according to contribution
• To each person according to merit
• To each person according to free-market exchanges
DIFFERENT CONCEPTS OF DISTRIBUTIVE JUSTICE
• AUTHORITARIAN
o What the highest authority decrees is just
• LIBERTARIAN
o What an individual decides to do with his or her own
property is just
• UTILITARIAN
o What most contributes to the treated good of the
greatest number is just
• EGALITARIAN
o Justice is achieved when everybody had equal access to
the societal resources to that they need
• RESTORATIVE OR TRANSFORMATIVE
o Justice requires favoritism previously disadvantaged
individual or groups
DIFFERENT CONCEPTS OF JUSTICE REFLECTED IN DIFFERENT
HEALTHCARE SYSTEMS AROUND THE WORLD
• The libertarian one is strong in the USA. The egalitarian one is
predominant in many European countries where the value of social
solidarity is recognized. South Africa is attempting to implement
restorative approach. Most economists lean toward Utilitarian
approach
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APPROACHES TO JUSTICE
• UTILITARIAN
o What issue is determined by utility consequences:
the greatest good (happiness, satisfaction) for the
greatest number regardless of the values for the particular
person involved
o “An action is right if it tends to promote happiness and
wrong if it tends to produce the reverse of happiness----
not just the happiness of the performer of an action but
also that of everyone affected by it.”
o Encyclopedia Britannica
• EGALITARIAN
o What is due is what is fair
o Equal distribution of benefits and burden, equal
opportunity
o An egalitarian favors equality of some sort; People should
get the same, or be treated the same, or be treated as
equals, in some respect
• LIBERTARIAN
o For as long as there is no restraints on individual liberty,
justice is served
o A collection of political philosophies and movement that
uphold liberty as a core principle. Libertarians seek to
maximize political freedom and autonomy, emphasizing
freedom of choice, voluntary association, individual
judgement, and self-ownership.”
o Is the view that each person has the right to live his life in
any way he chooses so long as he respects the equal
rights of others
o Libertarians defend each person’s right to life, liberty and
property---rights that people possess naturally, before
governments are created. In the libertarian view, all
human relationships should be voluntary; the only actions
that should be forbidden by law are those that involve the
initiation of force against those who have themselves
used force--actions like murder, rape, robbery,
kidnapping, and fraud.”
• COMMUNITARIAN
o What is valued by the community determines what is just.
It emphasizes social meaning, community membership,
shared values, individual responsibility and solidarity
o A philosophy that emphasizes the connection between
the individual and the community. Its overriding
philosophy is based upon the belief that a person’s social
identity and personality are largely molded by community
relationships, with a minimal degree of development
being placed on individualism.”
EQUITY
• What is due depends on what has been given/received
• It is “paying back”
• Equity is very limited if nothing is given first then nothing will be given
in return
• Fundamental requirement in terms of justice
• Equity exists when all participants freely define and accept the rules,
benefits and even the charges.
• Hence, any differences in charges or benefits must represent a
benefit to ALL members of the society.
• Has been considered a concept even more important than
justice
• Aristotle described it as follows:
o What is just, then and what is equitable are generally the
same, and both are good, though what is equitable is
better.
• According to Rawls, equity is a fundamental requirement in terms of
justice. Equity is justice.
• It exists when all participants freely define and accept the rules,
benefits and charges
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 CLINICAL BIOETHICS OLFU BATCH 2023
EQUALITY, JUSTICE, AND EQUITY I DR. CLARION November 5, 2021

HEALTH EQUITY RIGHT TO HEALTH CARE

• Health equity means giving patients the care they need when they
need it. Or as the institute of Medicine (IOM) report put it, health
equity means “providing care that does not vary in quality because
of personal characteristics such as gender, ethnicity, geographic
location, and socioeconomic status.” Dec. 5, 2016
• Health equity means ensuring that every person has the opportunity
to achieve their best health
• Unfortunately, many social and environmental factors can limit a
person’s access to and continued use of good health practices and
healthcare. These are health inequities
• Examples of these obstacles include:
o Racial and ethnic discrimination
o Lack of access to quality education
o Income and wealth gaps
o Inadequate housing or lack of housing
o Unsafe environments
Summary
• Health equity is something that takes time and effort to address. But it is
the contributions of individuals who are willing to help others have
access to safe and non-judgmental healthcare that can genuinely
make a difference
• By modeling and promoting health equity, individuals and organizations
can improve healthcare for those living with health disparities
EQUALITY
• Together with justice and equity, it has become a fundamental
principle. As human beings, we are not physically, mentally,
psychologically, or genetically equal. We are not equal in our values
or principles.
• But, it is generally accepted and fully desirable that we be
considered equals in terms of dignity, justice, rights, opportunities,
freedom, benefits and obligations.
• Justice and equity are only possible if all human beings are treated
equally in their dignity and rights (Article 10, Universal Declaration on
Bioethics and Human Rights)
• The constitution of WHO states that the “enjoyment of the highest
attainable standard of health is one of the fundamental rights of
every human being...”
• International statements on human rights, such as the International
Covenant on Economic, Social and Cultural Rights and the
Convention on the Rights of the Child, support the right to health
and require signatory nations to secure its observance.
DISPARITIES IN HEALTH STATUS
• Health care professionals are faced with many disparities in health
status, generally associated with disparities in wealth/income or with
discrimination against women, minorities or other disadvantaged
groups
o Local disparities
o National disparities
o Global disparities
ROLE OF HEALTHCARE PROFESSIONALS IN ESTABLISHING HEALTH
CARE PRIORITIES & ALLOCATING SCARCE HEALTH RESOURCES
• Health care professionals play several roles in establishing health
care priorities and allocating scarce health care resources
o As government policy makers and officials
o As hospital authorities
o As direct health care providers
o As researchers
• What concept of distributive justice is most appropriate for each of
these roles? How should health care professionals deal with conflicts
between roles (e.g., between providing expensive curative
measures for individual patients in need and vaccination programs
for the population)?
REFERENCES
• Lecture and PPT
• Old Trans

DIFFERENCE BETWEEN EQUITY AND EQUALITY

EQUITY
• Refers to fairness, justice and
impartiality
• Equity = fairness and justice
• Equity is need based approach
• It justifies things on the basis of
quality
• It focuses on need and requirement
of an individual. Thus, known as
need based approach
• Makes sure what is needed and in
which quantity to an individual
• Equity is the means/ process
• Equity is subjective. It differs from
situation and from person to person
• Equity is positive discrimination
• People are treated fairly but
differently
• Here, people can get what they
need
• Equity cannot be achieved through
equality
EQUALITY
• Refers to equal sharing and division,
keeping everyone at the same level
• Equality = Sameness
• Equality is not affected by the need of
the people or society
• It justifies things on the basis of quantity
• It gives the same thing to all the
people, irrespective of their need
• Does not look at what is needed for an
individual
• Equality is the outcome/ end result of
the process
• Equality is measurable. It does not vary
and neither matter whoever looks at it
• Equality might give rise to negative
discrimination
• People are treated equally but may be
unfairly
• Here, people will only get what
everyone else gets
• Equality can be achieved through
equity

WHAT DOES EQUALITY MEAN:

• Equality means giving everyone equal position or treatment by
the society. Hence, caste, gender, religion, and nationality
doesn’t count to treat everyone equal. Therefore, equality is
when things are accepted as same or equal in any aspect
• In other words, equality refers to the quality of being the same
in quantity or value or status. As a result, no person will be
maltreated or marginalized due to the certain differences they
might have within a social system. Thus, in a society, equality is
more of a principle which emphasizes equal or same
acceptance to everyone

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 CLINICAL BIOETHICS OLFU BATCH 2023
NON- DISCRINATION AND NON STIGMATIZATION I DR. PERANO November12, 2021

INSIGHT FROM THE HIPPOCRATIC OATH PRINCIPLE OF NON-DISCRIMINATION

• “ I will prevent whenever I can, for prevention is preferable to cure '', • The principle of non-discrimination is based on the understanding
I will remember that I remain a member of society, with special that discrimination is socially constructed rather than “natural”
obligations to all my fellow human beings, those sound of mind and • Seeks “to guarantee that human rights are exercised without
body as well as the infirm. discrimination of any kind based on race, color, sex, language,
religion, political, or other opinion, national or social origin, property,
STIGMA
birth or other status such as disability, age, marital and family status
• A deeply derogatory characteristic or attribute which occurs when a such as disability, age, marital, and family status, sexual orientation
difference or deviation provokes negative reactions towards the and gender identity, health status, place of residence, economic
individual who is different (Goffman 1980) and social situation
• “Mark of shame”
• Stigma belittles the individual making them less than others, POSITIVE OR REVERSE DISCRIMINATION
undermining their human dignity and increasing their chances in life. • Discriminatory policies or acts that benefit a historically and socio-
• Reduced individuality resulting from stigmatization can even politically non-dominant group (typically women and minorities but
dehumanize the stigmatized, their identity becomes defined by the sometimes majorities), at the expense of a historical and socio-
sigma itself, or confused with it when, for example, comes to be politically dominant group (typically men and majority races) are
known by the attribute called positive or reverse discrimination’ or ‘affirmative action
• Phenomenon associated with stigma policies’.
o Refusal to seek medical attention • However, whether a given example of discrimination is positive or
o Poor adherence to treatment. negative is often a subjective judgment
• When an individual is labelled with negative characteristics, there is • In the field of health care and bioethics, some groups need more
a rational construct which protection such as infants and elderly people, AIDS patients,
disqualifies, rejects or psychiatric patients and depressed patients.
excludes • Whether it is a conscious act of positive valuing the other- constitute
• Stigma means that the significant causes of discrimination and social exclusion
stigmatized individual • Whatever source of stigma, the consequences are the same:
experiences a situation of o Violating human dignity
being socially o Isolation and exclusion
disadvantaged. o Less access to healthcare services
• Stigma creates structural o Compromised chances in life
discrimination which o Deterioration in quality of life, and
negatively affects the o Increased risk of death.
environment around them
• Although stigma is conceptualized as a personal mark or attribute, it GROUNDS FOR DISCRIMINATION AND STIGMATIZATION
is essential to recognize that it is a social product, the fruit of • Advances in medical technology
structural conditions and power have the potential to create
relationships, established in societies. disproportionate disadvantages for
(Link and Phelan, 2001)
some social groups, either by being
• Leads to loss of status and to
applied in ways that harm
discrimination
members of these groups directly
• Discrimination is an inherent part of stigma
or by encouraging the adoption of
• There would be no stigma without
social policies that discriminate
discrimination
unfairly against them with
significant individual, social, and
POSSIBLE NEGATIVE CONSEQUENCES OF STIGMA
legal consequences.
• Tense and uncomfortable social interactions
• Limited social interactions
• For instance, reproductive medicine has developed techniques that
• Compromised quality of life
enable parents to choose the sex of their child which raises the
• Low self-esteem
concern of discrimination against girls and women in societies where
• Symptoms of depression
male children are valued more highly than female children.
• Unemployment
• Similar concerns have been raised about the increasing use of
• Loss of income.
(Arboleda-Florez, 2008)
abortion as a method of birth control in overpopulated countries
where there is considerable social and legal pressure to limit family
STIGMATIZATION size and where the vast majority of the parents who use it choose to
• Introduced in bioethics by UNESCO as a distinguished kind of have a boy rather than a girl.
discrimination that may have a serious impact on the right to health • In the field of genetics, the use of relatively simple tests for
and benefit of scientific research. determining a patient’s susceptibility to certain genetically
DISCRIMINATION transmitted diseases has led to concerns that the results of such
• Latin word: “Discriminare” which means to distinguish between tests, if not properly safeguarded, could be used against the
• To discriminate social is to make distinction between people on the individual’s own interests, to discriminate them in the interests of
basis of class or category without regard to individual merit employees, health insurance companies, and government
o Infringement of the ethical theory of egalitarianism based agencies.
on social equality. • In addition, through genetic counselling, prospective parents can
• Not considered as a social discrimination be informed about the chances that their offspring will inherit a
o Distinction based on individual merit such as personal certain generic disease or disorder; this will enable them to make
achievement, skill or development more informed decisions about reproduction
• Social discrimination • This is viewed by some bioethicists and some NGOs as contributing
o distinction based on race, social class or caste, to a social atmosphere considerably less tolerant of disability than it
nationality, religion, sex, sexual orientation, disability, ought to be. The same criticism has been levelled against the
ethnicity, height, age, or any other ground in violation of practice of diagnosing, and in some cases treating, congenital
human dignity, human rights and fundamental freedoms. defects in unborn children.

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 CLINICAL BIOETHICS OLFU BATCH 2023
NON- DISCRINATION AND NON STIGMATIZATION I DR. PERANO November12, 2021

• Research on the genetic basis of behavior, though still in its infancy, is

controversial because of its potential to encourage the adoption of
crude models of genetic determinism in the development of social
policies, especially in the areas of education and crime prevention.
Such policies, it is claimed, could result in unfair discrimination
against large numbers of people judged to be genetically disposed
to ‘undesirable’ forms of behaviors, such as aggression or violence.
• References to human dignity and to non-stigmatization and non-
discrimination are hallmarks of decisions on better health care
policies and practices, contributing to making difficult decisions
involving questions such as:
o Use of surgery in gender reassignment
o The right of homosexual individuals to maternity/ paternity
o The right of individuals living with HIV/AIDS to exercise their
sexuality and have children
o Critical situations involving cultures very distant from
western culture.

LIMITATIONS OF THE PRINCIPLE

• Article 26 of the Declaration states that the principles should be
understood as complementary and interrelated; the Declaration is
to be understood as a whole. This Implies that if a bioethical issue or
problem emerges, it is usually the case that several principles are
relevant to the tissue or problem and need to be balanced in order
to reach a justified conclusion about what to do.
• When therefore public health is at risk, exception or restrictions to
the non-discrimination principle can be necessary either by
affirmative actions in favor of some key persons or groups, or by
‘negative’ actions that may infringe upon individual rights
• These exceptions must be publicly discussed and applied with
transparency and according to the national law. They also must be
subject to revision according to development of the situation and
scientific knowledge.

NON-DISCRIMINATION AND NON-STIGMATIZATION

SUMMARY
• Has been recognized as universal principles of bioethics in Article 11
of the Universal declaration on Bioethics & human Rights (UNESCO, 2005)
• Recognizes the need and paves the way for concerted action
against inequality and institutional mechanism which perpetuate it
• It also aims to fight against any discrediting process, which
stigmatizes an individual or a group on any kind of ground.
• Thus, the principle of non-discrimination and stigmatization is to be
understood, implemented, protected, and promoted at national
and international level, in accordance with the whole set of
principles proclaimed in the UNESCO Universal Declaration on
Bioethics and Human Rights.

REFERENCES
• Lecture and PPT
• Old Trans

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 CLINICAL BIOETHICS
Protecting Future Generations
Dr. Fraulein Tormon January 7, 2022

Why Care About the Future? GERM-LINE GENETIC INTERVENTIONS

We have economic growth that has consequences such o Process by which the genome of individual is
edited in such a way that the change is
as increasing inequity or environmental degradation.
heritable
It is often based on natural resources, if it is present the
o Achieved through genetic alterations within
world will be more crowded, polluted, less stable and more
the germ or reproductive cells such as egg
vulnerable to disruption
and sperm
Sustainable development is development that meets the
o Germ-line gene therapy- DNA transferred
needs of the present without compromising the ability of
into the cells that produce reproductive cells
future generations to meet their own needs
in the body. This allows the correction of
Three factors responsible for contemporary sensibility
diseases-causing variants certain to be
towards future generations:
passed down from generation to generation
o Technology has altered the nature of human
Why
activity
o Present-day reality is interdependent and
PROTECTION OF THE ENVIRONMENT,
interrelated
BIOSPHERE AND BIODIVERSITY
Environmental disasters in one region
BIOSPHERE
will affect other regions and other
o Ecosphere or the worldwide sum of all
generations
ecosystem,
o The increasing awareness of the finitude and
o Can also be termed the zone of life on Earth
fragility of our existence and our one and only
or closed system and self-regulating
Earth
o It is the area of the planet where organisms
live
2 POSITIONS USUALLY DEFENDED
BIODIVERSITY
We only have a moral relationship with generations of the
o Variety of life in the world or particular habitat
immediate future
or ecosystem
All future generations can claim that we take them into
ENVIRONMENT
account
o Everything that surrounds us
o Living (biotic), nonliving (abiotic)
HOW DO WE REPRESENT THE FUTURE IN
o Includes physical, chemical and other natural
PRESENT DECISION-MAKING?
forces
In health care, there are several examples of
technological and scientific progress that have serious
ETHICS AND THE ENVIRONMENT:
impact on future generations
VIEWS OF NATURE
o Ex. Use of medication without rationale.
Ethically it is hard, but sometimes antibiotics
ETHICAL PERSPECTIVES
are widely used in agriculture and bioindustry
Anthropocentric environmental ethics: Human-
so that production of meat for human
centered ethics
consumption would be profitable
o Human beings have moral duties only toward
o Human viral infections like flu are
one another
increasingly treated with antibiotics
o Human interests prevail over the interests of
other species
APPLICATION OF PRINCIPLE
o Ethical methodologies: Utilitarianism
XENOTRANSPLANTATION
(consequentialism, greatest good) and
o Procedure that involves the transplantation,
Deontology (focus on rightness or wrongness)
implantation or infusion to a human recipient
o More related to Western culture (in which nature
of either live cells, tissue or organs from non-
often has an economic value)
human animal source or human body fluid
Non-anthropocentric environmental ethics
that have contact with life
o Biocentric
o Development of these is in part driven with a
fact that demand for human organs for
subjects that are entitled to moral
clinical transplantation exceeds the supply
consideration
GENETICALLY MODIFIED FOOD
It is therefore an ethical imperative to
o Foods derived from organisms whose
respect all life forms
genetic material or DNA has been modified
All organisms have intrinsic value
in a way that does not occur naturally,
More related to non-western cultural
through introduction of gene from a different
traditions
organism.
o Ecocentric
o Ex. Plants (crops, resistant to plant diseases
Ecosystems have intrinsic value as
or increase tolerance of herbicides)
well

USE AT YOUR OWN RISK page 1 of 2

 PROTECTING FUTURE GENERATIONS
All organisms and entities in the
ecosphere as parts of the interrelated
whole, are equal in intrinsic value
Holistic methodology
Ecosystem is defined as a large
community of living organism, living
and physical components are linked
together through nutrient cycles and
energy flows
Basic principles of environmental ethics
o Respect for nature
The prosperity of human beings
depends on the prosperity of nature.
Human beings are part of nature. They
have therefore the duty to conserve
and protect the integrity of the
ecosystem and its biodiversity.
o Environmental justice
Fair treatment and meaningful
involvement of all people regardless of
race, color, national origin or income
with respect to the development,
implementation or enforcement of
environmental laws, regulation and
policies
Ex. Inadequate access to healthy food,
transportation, air and water, pollution
and unsafe homes
Environmental benefits and burdens
should be equally distributed
Opportunities to participate in
decision-making concerning
environmental issues should be
equally provided
o Intergenerational justice
Intergenerational equity in economics,
psychological, sociological context is
the concept or idea of fairness or
justice between generations
Concept can be applied to fairness and
dynamics between children, youth,
adults or each and everyone in terms
of treatment and interactions
Every generation should leave the
following generation an equal
opportunity to live a happy life and
should therefore bequeath a healthy
earth
Fundamental change in the lives of
the affluent equitable access to
resources
WHAT IS SUSTAINABLE DEVELOPMENT?
Original definition given in report of World Commission
on Environment and Development (1987):
o Sustainable development is development that
meets the needs of present generations without
compromising the ability of future generations
to meet their needs
TWO IMPORTANT QUALIFICATIONS:
The needs of the poor are central in sustainable
development
The only constraint on sustainable development is the
state of technology and social organization in society
DIFFERENT VIEWS OF SUSTAINABLE DEVELOPMENT
WEAK NOTION OF SUSTAINABILITY
o CLASSIC VIEW
Economic, socio-political and
ecological spheres are often viewed
as separate spheres with their own
logic and values; often also trade-
offs between human and social
development and ecological concerns
This notion is also strongly
anthropocentric; everything in nature
has instrumental value
STRONG NOTION OF SUSTAINABILITY
o In order to prevent a continuing decline of
natural resources over time, a drastic change in
patterns of production and consumption is
necessary
o It is necessary to emphasize the intrinsic value
of nature; nature has a value in and of itself

NOTION OF SUSTAINABILITY
2002 Johannesburg Declaration on Sustainable
Development
o A new ethic of conservation and stewardship
should be adopted, focusing on:
Measures to curb global climate
change
Conservation and management of all
types of forests
Better use of water resources
Intensified cooperation to reduce the
number and effects of natural and
man-made disasters

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 CLINICAL BIOETHICS
HUMAN DIGNITY AND HUMAN RIGHTS
Dr. Joseph A. Jao October 22, 2021
LEARNING OBJECTIVES
At the end of the unit, the students should be able
to:
o Define human rights and human dignity
o Apply the concepts of human dignity and
human rights
o Understand the relevance of these
concepts in the context of bioethics
ARTICLE 3: HUMAN DIGNITY AND
HUMAN RIGHTS
Human dignity, human rights and fundamental
freedoms are to be fully respected
The interest and welfare of the individual
should have priority over the sole interest of
science or society
HUMAN RIGHTS
Right is an inherent, irrevocable entitlement by all
individual or member of the society from the
moment of birth so that it cannot be taken or given
away.
Privilege is a temporary entitlement given by
someone in authority to a certain group of
individuals, it is up to the authority to whom the
entitlement will be given.
Human rights are moral principles or norms
that describe certain standards of human
behavior and are regularly protected in municipal
and international law
Commonly understood as inalienable
o It cannot be taken away nor given away
by human law.
Fundamental rights
inherently entitled simple because she or he is
and which are
regardless of their age, ethnic
origin, location, language, religion, ethnicity or
other status.
OTHER VALUES THAT CAN BE DERIVED
FROM 2 FUNDAMENTAL VALUES OF
HUMAN RIGHTS
(HUMAN DIGNITY AND EQUALITY)
Human rights is connected to human dignity
o Human dignity is the heart of human
rights
Freedom: Human will is an important part of
human dignity
USE AT YOUR OWN RISK
o They have the capacity to decide on what
will be beneficial to them
Respect for others: Lack of respect for someone
fails to appreciate their individuality and essential
dignity
o We cannot demand right by impinging on
the right of others, it cancels out our right.
Non-discrimination: Equality in human dignity
opportunities on the basis of their characteristics.
o Disability, age, disease, homeless,
unemployment
Tolerance: Intolerance indicates a lack of respect
for difference, and equality does not signify
uniformity.
o Respect the views, belief of practices of
others
Justice: People equal in their humanity deserve
fair treatment
o Give right due.
Responsibility: Respecting the rights of others
entails respon
exerting effort for the realization of the rights of
one and all
o For every right comes responsibility, duty
and obligation
CHARACTERISTICS OF HUMAN RIGHTS
Human rights are inalienable
o You cannot lose them because they are
linked to the very fact of human existence
o Inherent to all human beings
In some instance they can be
violated, especially in vulnerable
people
We have to make policies and
guidelines to ensure that their
o May be suspended or restricted
Found guilt of a crime: Liberty
can be taken away
In times of national emergency:
Imposing curfew restricting
freedom of movement
Human rights are indivisible, interdependent
and interrelated
o Different human rights are intrinsically
connected
o Cannot be viewed in isolation from each
other
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 HUMAN DIGNITY AND HUMAN RIGHTS
o The enjoyment of one right depends on
the enjoyment of many other rights
o No one right is more important than
the rest
Human rights are universal
o Apply equally to all people
everywhere in the world with no time
limit
o Every individual is entitled to enjoy his
or her human rights without distinction of
sexual orientation, disability, language,
religion, political or other opinion,
national or social origin, birth or other
status
o Universality is not unanimous with
uniformity
HUMAN RIGHTS (UDHR*)
The states have obligations and duties under
international laws to respect, protect and fulfill
human rights
Meanwhile as individuals, while we are entitled to
our human rights we should also respect and
stand for the human rights of others
The obligation to respect
o The states must retrain from interfering
with or curtailing the enjoyment of human
rights
The obligation to protect
o Requires the states to protect individuals
and groups against human rights abuses
by others
The obligation to fulfill
o The states must take positive action to
facilitate the enjoyment of basic human
rights
- Should adapt appropriate
measures that would ensure the
full realization of this right
HUMAN DIGNITY
Dignity is the right of a person to be valued and
respected for their own sake to be treated
ethically
o It is the heart of human right
o It is of significance in morality, ethics, law
and politics as extension of the
Enlightenment era concepts
inherent, inalienable rights
USE AT YOUR OWN RISK
o The term may also be used to describe
personal conduct, as in
CONCEPTS OF HUMAN DIGNITY
According to:
o Classical antiquity
o World religions
o Modern philosophy
o Contemporary international law
CLASSICAL ANTIQUITY
Dignity as deserving of honor and esteem
according to personal merit, inherited or
achieved
o Slaves / undesirables before have no
dignity, they were stigmatized
In ancient Greek philosophy, particularly of
Aristotle and the Stoics, dignity was associated
with human abilities of deliberation, self-
awareness and free decision-making
o You have to make sure na hindi ka
makakagawa ng hindi maganda because
dignity can be taken from you and you
may be treated like animal in old times.
Dignity does not consist in possessing honors,
but in the consciousness that we deserve them
- Aristotle
WORLD RELIGIONS
In many world religions, human dignity is
considered to be predetermined by the creation
of human beings in the image of God.
Those who are weak in body and soul have
dignity equal to those who are robust and sturdy.
o Regardless of status, we have dignity
A few of the verses in religious texts that speak to
the Principle of Respect for Human Dignity:
o Islam: honored the
descendants of Adam (i.e. human
o Christianity
3:16)
o Judaism:
o Buddhism: All sentinel beings without
of exception have the buddha-
(Nirvana Sutra)
o Hinduism:
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 HUMAN DIGNITY AND HUMAN RIGHTS
MODERN PHILOSOPHY
Modern philosophy proposed secular
understanding of human dignity and
progressively associated this concept with the
idea of human rights
In different teachings human dignity was
presented as:
o An aspect of personal freedom
(Giovanni Pico Della Mirandola)
If we have free will then we can
be considered as having dignity
o public worth
(Thomas Hobbes) or
o As universal virtue, unconditional and
autonomy rather than origin, wealth, or
social status (Immanuel Kant)
- to treat
any other person always at the same time as
an end, never merely as a means* (categorical
imperative)- has been accepted by moral and
political philosophy as the actual basis for the
conception of human rights and in the sense, it is
a foundational concept
CONTEMPORARY INTERNATIONAL LAW
In contemporary international law, national
constitutions, and other normative documents,
human dignity is strongly connected with
human rights
According to Art 1 of the Universal Declaration of
Human Rights (1948):
o All human beings are born free and
equa
The declaration establishes human rights (like
freedom from repression, freedom of expression
and association) on the inherent dignity of
every human being.
THE EUROPEAN CONVENTION ON HUMAN
RIGHTS AND BIOMEDICINE IN ART. 1
Declaration protection of the dignity and
identity of all human beings and guarantees
everyone, without discrimination, respect for
their integrity and other rights and
fundamental freedoms with regard to
application of biology and medicine as its main
purpose
o There should be policies in place
USE AT YOUR OWN RISK
THE NOTICE OF HUMAN DIGNITY
The notion of human dignity expresses the
intrinsic value of the person capable of:
o Reflection
o Sensitivity
o Verbal communication
o Free choice
o Self-determination in conduct and
creativity
Decide what they want to them
with their own self and own life
Unlike material values or financial prices, human
dignity has no external equivalent; it is an end
in itself
All human beings are equal in dignity
irrespective of:
o Gender
o Age
o Social status
o Ethnicity
active respect for his/her human rights, self-
esteem and self-determination, as well as for
his/her privacy, protecting him/her from
illegitimate intrusion and preserving his/her
valid public space
A society or a community should respect each of
its member as a person or a moral agent on
the basis of the notion of human dignity
This notion also requires that the interests and
welfare of the individual are considered as
prior to the sole interest of society, community
or any particular kind of publicly wholesome
It implies that because of his/her human dignity,
the individual should never be sacrificed for
the sake of science (as has happened in
medical experiments during the Second World
War) or for the sake of society (as has
happened in totalitarian regimes)
There might be exceptional circumstances in
which the interest of others or the community
as a whole are so important that infringing
upon the interests of individuals is
unavoidable in order to save others or the
community. An example is the dread of a deadly
pandemic.
Human dignity is a foundational concept and it
is theoretically and normatively inappropriate to
reduce it to functional characteristics of a
per
taking into account her autonomy
page 3 of 4
 HUMAN DIGNITY AND HUMAN RIGHTS

Respect for dignity means recognition of

In comparative view, human dignity has diverse

forms in different cultural and ethical traditions
(for example, Confucian, Judeo-Christian,
Muslim) and is respected in various ways in
different types of societies (traditional, modern,
totalitarian democratic)
It is less respected in totalitarian societies and
more respected in modern and democratic
societies
Regardless of cultural, confessional and
political varieties human dignity is universally
based on the -awareness and
appropriate respectful treatment towards her.
As it is emphasized in the Declaration, the regard

upon human dignity, human rights and

DIGNITY AND HEALTH CARE

PROVIDER RELATIONS
Health Care Provider-Patient relations are just
one kind of human relations, presupposing all
ethical requirements.
Inequality in status of the health care provider and
the patient may be aggravated in special cases
when patients are children, handicapped
individuals and elderly persons. Particularly
risky are cases of patients who are mentally
handicapped.
o Vulnerable patients
Special attention in regard to human dignity and
human rights is required in palliative treatment
of terminal

Though there is no consensus either in public or

in the expert community concerning the ethical
and legal status of the embryos and fetuses,
the latter should be treated with respect and care.
o They already have the right to live

man is an ideal worth fighting for and worth dying

- Robert C. Maynard

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 CLINICAL BIOETHICS
Protecting Future Generations
Dr. Fraulein Tormon January 7, 2022

Why Care About the Future? GERM-LINE GENETIC INTERVENTIONS

We have economic growth that has consequences such o Process by which the genome of individual is
edited in such a way that the change is
as increasing inequity or environmental degradation.
heritable
It is often based on natural resources, if it is present the
o Achieved through genetic alterations within
world will be more crowded, polluted, less stable and more
the germ or reproductive cells such as egg
vulnerable to disruption
and sperm
Sustainable development is development that meets the
o Germ-line gene therapy- DNA transferred
needs of the present without compromising the ability of
into the cells that produce reproductive cells
future generations to meet their own needs
in the body. This allows the correction of
Three factors responsible for contemporary sensibility
diseases-causing variants certain to be
towards future generations:
passed down from generation to generation
o Technology has altered the nature of human
Why
activity
o Present-day reality is interdependent and
PROTECTION OF THE ENVIRONMENT,
interrelated
BIOSPHERE AND BIODIVERSITY
Environmental disasters in one region
BIOSPHERE
will affect other regions and other
o Ecosphere or the worldwide sum of all
generations
ecosystem,
o The increasing awareness of the finitude and
o Can also be termed the zone of life on Earth
fragility of our existence and our one and only
or closed system and self-regulating
Earth
o It is the area of the planet where organisms
live
2 POSITIONS USUALLY DEFENDED
BIODIVERSITY
We only have a moral relationship with generations of the
o Variety of life in the world or particular habitat
immediate future
or ecosystem
All future generations can claim that we take them into
ENVIRONMENT
account
o Everything that surrounds us
o Living (biotic), nonliving (abiotic)
HOW DO WE REPRESENT THE FUTURE IN
o Includes physical, chemical and other natural
PRESENT DECISION-MAKING?
forces
In health care, there are several examples of
technological and scientific progress that have serious
ETHICS AND THE ENVIRONMENT:
impact on future generations
VIEWS OF NATURE
o Ex. Use of medication without rationale.
Ethically it is hard, but sometimes antibiotics
ETHICAL PERSPECTIVES
are widely used in agriculture and bioindustry
Anthropocentric environmental ethics: Human-
so that production of meat for human
centered ethics
consumption would be profitable
o Human beings have moral duties only toward
o Human viral infections like flu are
one another
increasingly treated with antibiotics
o Human interests prevail over the interests of
other species
APPLICATION OF PRINCIPLE
o Ethical methodologies: Utilitarianism
XENOTRANSPLANTATION
(consequentialism, greatest good) and
o Procedure that involves the transplantation,
Deontology (focus on rightness or wrongness)
implantation or infusion to a human recipient
o More related to Western culture (in which nature
of either live cells, tissue or organs from non-
often has an economic value)
human animal source or human body fluid
Non-anthropocentric environmental ethics
that have contact with life
o Biocentric
o Development of these is in part driven with a
fact that demand for human organs for
subjects that are entitled to moral
clinical transplantation exceeds the supply
consideration
GENETICALLY MODIFIED FOOD
It is therefore an ethical imperative to
o Foods derived from organisms whose
respect all life forms
genetic material or DNA has been modified
All organisms have intrinsic value
in a way that does not occur naturally,
More related to non-western cultural
through introduction of gene from a different
traditions
organism.
o Ecocentric
o Ex. Plants (crops, resistant to plant diseases
Ecosystems have intrinsic value as
or increase tolerance of herbicides)
well

USE AT YOUR OWN RISK page 1 of 2

 PROTECTING FUTURE GENERATIONS
All organisms and entities in the
ecosphere as parts of the interrelated
whole, are equal in intrinsic value
Holistic methodology
Ecosystem is defined as a large
community of living organism, living
and physical components are linked
together through nutrient cycles and
energy flows
Basic principles of environmental ethics
o Respect for nature
The prosperity of human beings
depends on the prosperity of nature.
Human beings are part of nature. They
have therefore the duty to conserve
and protect the integrity of the
ecosystem and its biodiversity.
o Environmental justice
Fair treatment and meaningful
involvement of all people regardless of
race, color, national origin or income
with respect to the development,
implementation or enforcement of
environmental laws, regulation and
policies
Ex. Inadequate access to healthy food,
transportation, air and water, pollution
and unsafe homes
Environmental benefits and burdens
should be equally distributed
Opportunities to participate in
decision-making concerning
environmental issues should be
equally provided
o Intergenerational justice
Intergenerational equity in economics,
psychological, sociological context is
the concept or idea of fairness or
justice between generations
Concept can be applied to fairness and
dynamics between children, youth,
adults or each and everyone in terms
of treatment and interactions
Every generation should leave the
following generation an equal
opportunity to live a happy life and
should therefore bequeath a healthy
earth
Fundamental change in the lives of
the affluent equitable access to
resources
WHAT IS SUSTAINABLE DEVELOPMENT?
Original definition given in report of World Commission
on Environment and Development (1987):
o Sustainable development is development that
meets the needs of present generations without
compromising the ability of future generations
to meet their needs
TWO IMPORTANT QUALIFICATIONS:
The needs of the poor are central in sustainable
development
The only constraint on sustainable development is the
state of technology and social organization in society
DIFFERENT VIEWS OF SUSTAINABLE DEVELOPMENT
WEAK NOTION OF SUSTAINABILITY
o CLASSIC VIEW
Economic, socio-political and
ecological spheres are often viewed
as separate spheres with their own
logic and values; often also trade-
offs between human and social
development and ecological concerns
This notion is also strongly
anthropocentric; everything in nature
has instrumental value
STRONG NOTION OF SUSTAINABILITY
o In order to prevent a continuing decline of
natural resources over time, a drastic change in
patterns of production and consumption is
necessary
o It is necessary to emphasize the intrinsic value
of nature; nature has a value in and of itself

NOTION OF SUSTAINABILITY
2002 Johannesburg Declaration on Sustainable
Development
o A new ethic of conservation and stewardship
should be adopted, focusing on:
Measures to curb global climate
change
Conservation and management of all
types of forests
Better use of water resources
Intensified cooperation to reduce the
number and effects of natural and
man-made disasters

USE AT YOUR OWN RISK page 2 of 2

 CLINICAL BIOETHICS
PRIVACY & CONFIDENTIALITY
EQUALITY, JUSTICE & EQUITY
DR. GLORIA PERET-CLARION NOV. 5, 2021
PRIVACY & CONFIDENTIALITY
OUTLINE ARTICLE 7
I. UNESCO Declaration on Bioethics and Human
Rights PRIVACY
II. Privacy & Confidentiality Privacy is the right of an individual or a group to
A. Privacy be free from intrusion from others, and includes
B. Confidentiality the right to determine which information about
C. Reasons on Respecting them should be disclosed to others
D. Duty of HCP on Privacy Privacy talks about a person
E. How to Maintain Restricts the public from accessing the personal
F. Duty of HCP on Confidentiality details
G. Confidentiality in Genetic Data
H. When can you share? CONFIDENTIALITY
I. Justified Breaches Confidentiality is an attribute of personal
J. Privacy Breaches information requiring that it not be disclosed to
K. Special Circumstances of Research others without sufficient reason
III. Equality, Justice & Equity Confidentiality is about information
A. Objectives Protects the information from the range of
B. Justice unauthorized persons
C. Equity An important aspect of trust that patients place in
D. Equality health care practitioners, especially physicians
E. Right to Health Care Thus, patients have the right to every
F. Disparities to Health Status consideration of their privacy concerning
G. Role of HCP their medical problem and the
corresponding programs planned to
References: address them
LECTURE Case discussion, consultations,
examinations and treatment are
UNESCO UNIVERSAL DECLARATION ON confidential and should be conducted
BIOETHICS AND HUMAN RIGHTS discreetly
Human dignity & human rights
Benefit & harm IMPORTANCE OF CONFIDENTIALITY-
Autonomy & individual responsibility 4 PILLARS
Consent Autonomy
Persons without capacity to consent Right of the patient
Respect for human vulnerability & personal Implied Promise
integrity Patients assume doctors will maintain
Privacy & confidentiality their confidentiality
Equality, justice & equity Virtue Ethics
Non-discrimination & non-stigmatization Patient assumes doctors will not breach
Respect for cultural diversity & pluralism confidentiality
Solidarity & cooperation Consequentialist
Social responsibility & Health Breach of confidentiality will result of loss
Sharing of Benefits of patient trust
Protecting future generations
Protection of the environment, the biosphere &
biodiversity

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 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
REASONS FOR RESPECTING PRIVACY &
CONFIDENTIALITY
to their personal integrity
For many people, privacy is an essential aspect
of their dignity. Invading their privacy against their
will is a violation of their dignity
Respect for others requires protecting their
privacy and the confidentiality of information
about them
Patients are less likely to trust healthcare
providers and confide in them if they think that the
healthcare provider will not keep the information
confidential. This can have serious
cons
being and sometimes for the health of others
(e.g., family members)
DUTY OF HEALTH CARE PROVIDERS TO
PROTECT THE PRIVACY OF PATIENTS
Health care providers have an ethical obligation
cy to the greatest
extent possible in the circumstances.
For example, they should interview patients
where they cannot be overheard. They should
unclothed and they should ensure that an
unclothed patient cannot be viewed by passers-
by.
HOW TO MAINTAIN CONFIDENTIALITY & PRIVACY
Avoid discussions of personal health information
in public areas (cafeteria, hallway other patient
rooms)
Never leave charts, computers or other devices
containing Patient health information unattended
or in clear view of others. File information or put
charts away in their proper place. Transport
charts or other Patient health information face
down or in envelope
Do not share passwords. Always log off the
computer. You are responsible for activity under
your password
Do not engage in conversations with family,
friends, neighbors, etc. in the hospital unless they
People have the right to keep their reason for
being on hospital property private.
USE AT YOUR OWN RISK
DUTY OF HEALTH CARE PROVIDERS TO
MAINTAIN CONFIDENTIALITY
The duty of maintaining confidentiality (Also
known as ) has been part
of western medical ethics since Hippocrates (5th
century B.C.E.)
The Hippocratic Oath states
Whatever I see or hear, professionally or
privately, which ought not to be divulged,
I will keep secret and tell no one
Ethics courses in non-western countries should
discuss the source of medical confidentiality in
their cultures
- CONFIDENTIALITY EXTENDS TO ALL PERSONAL
HEALTH INFORMATION INCLUDING GENETIC
DATA
UNESCO International Declaration on Human
Genetic Data
and proteomic data, regardless of their
apparent information content, should be
treated with the same high standards of
WHEN CAN YOU SHARE CONFIDENTIAL
INFORMATION?
When accessing and sharing Patient health
Only access or share what is relevant for patient
care. This helps maintain privacy
Circle of care includes the healthcare providers
that are directly involved in the provision of
services to a patient
Confidential information should only be shared
with individuals within the circle of care
JUSTIFIED BREACHES OF CONFIDENTIALITY
Sharing information for patient care
In the hospital setting, many individuals
order to provide care.
However, each of these individuals is
bound to maintain confidentiality to the
greatest extent possible
Outside the hospital setting, family
members may need patient information
in order to provide care and/or to protect
themselves
Using interpreters
Where the healthcare provider does not
interpreter will be needed who will then
have access to information about the
patient
Page 2 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
Interpreters should be bound to observe
confidentiality
Teaching medical students
Observation and discussion of patients is
a necessary part of medical education
Students should be informed of their
obligation to maintain confidentiality
Mandatory Reporting
Healthcare providers should be familiar
with the laws about mandatory reporting
of infectious diseases, suspected child
abuse and other conditions in the country
where they practice
Normally, patients should be informed
that their information has to be reported
to the appropriate authorities
Serious danger to others
For example, exceptional circumstances
and generally as a last resort, health care
providers may need to inform other
persons that the patient has threatened
to harm them, whether by violence or by
sexual contact when the patient has a
transmissible disease such as HIV
Genetic information
There is controversy regarding whether
other individuals with the same genetic
makeup (usually close family members)
information. Physicians should consult
their national regulations or guidelines
when faced with the situation
With the patient or guardian consent
This should generally be obtained for all
breaches of confidentiality and renders
the breach acceptable ethically
EXAMPLES OF PRIVACY BREACHES
Misdirected faxes
Improper destruction of patient health information
Cell phones used to take pictures in the hospital
Staff member/clerk discussing the patient outside
of patient care
Sharing personal health information on social
networks (e.g., Facebook)
Unauthorized access - you must NOT look at a
SPECIAL CIRCUMSTANCES OF RESEARCH
Disclosure of personal health information
obtained in the course of a research study
requires the prior consent of the research
subject
There is great controversy regarding whether
anonymized patient information requires consent
USE AT YOUR OWN RISK
for disclosure. Researchers should consult their
national regulations or guidelines if such exist,
otherwise international guidelines such as the
Declaration of Helsinki
In research, communities as well as individuals
have a right to privacy and information about
them should be kept confidential especially when
its disclosure may be harmful to the community
Scientific publication should respect
confidentiality to the greatest extent possible.
Consent is always required when an individual
research subject can be identified in a publication
EQUALITY, JUSTICE & EQUITY
ARTICLE 8
OBJECTIVES
Describe/ask the students to identify several
issues in allocating health care resources and
accessing health care in your area
Discuss definitions of:
Equality - sameness in some respect
such as human dignity
Justice - different types, but generally
fairness
Equity - application of fairness, which
may require unequal treatment
Example of Equality in Health care:
No matter the social status, all will receive
same service of care
In health centers, they provide free health
services to the community regardless of social
condition, preferences, religious beliefs ,etc.
In regards to COVID vaccine, whatever
your social status, whichever vaccine is
available, you have to receive it. There is no
preferential treatment
Example of Justice in Health care:
Children who participated as research
subjects are compensated especially if harm
or death resulted - Legal justice
Other countries are already giving booster
doses for COVID vaccine while other
countries still have not even reached 10%.
This is not fair justice.
Example of Equity in Health care:
Bigger allocation for poorer countries
since they have lesser resources
Give patients what they need
Page 3 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
JUSTICE
Also termed fairness
Both a principle and a virtue relating to the
rightness of people's interactions and
relationships
As a principle, one should give another
As a virtue, it is the constant will to render
Related to:
Truthfulness
Autonomy
Stewardship
Solidarity
Nonmaleficence
In health, it is expressed in the individual and
obligation to deliver competent,
affordable and accessible healthcare
Issues on justice occur in public policy, health
insurance, health management organization,
research and relationships with drug
representatives
It is also equated with equity.
What is due to one depends on what
he/she has given
Based on the natural law of the golden rule that
states,
Do unto others what you would want
others to do unto you
DIFFERENT TYPES OF JUSTICE
Distributive
Ensuring that each person receives a fair
share of public resources
This is the most important type for health
care
Key factor in resource allocation
Ex: In the hype of the pandemic, OPD
was closed and inaccessible and for a
patient to be admitted or treated, they
need to undergo swab tests, even if they
don't have COVID. This is not fair justice.
Although in reality, not all patients can
have the best care.
Procedural
Ensuring a fair process for making
decisions and settling disputes
Retributive
Ensures punishment of wrongdoers
Social
Combinations of the previous types as
applied to a society in which individuals
and groups receive fair treatment and an
equitable share of the benefits of society
USE AT YOUR OWN RISK
CRITERIA FOR (DISTRIBUTIVE) JUSTICE
To each person an equal share
To each person according to need
To each person according to effort
To each person according to contribution
To each person according to merit
To each person according to free-market
exchanges
DIFFERENT CONCEPTS OF (DISTRIBUTIVE)
JUSTICE
Authoritarian
What the highest authority decrees is just
Libertarian
What an individual decides to do with his
or her own property is just
Utilitarian
What most contributes to the greatest
good of the greatest number is just
Egalitarian
Justice is achieved when everybody has
equal access to the societal resources
that they need
Restorative or Transformative
Justice requires favoring previously
disadvantaged individuals or groups
The Libertarian one is strong in the USA.
The Egalitarian one is predominant in many
European countries where the value of social
solidarity is recognized
South Africa is attempting to implement a
Restorative approach
Most economists lean towards the Utilitarian
approach
Which is predominant in our country? Libertarian
UTILITARIAN
What is due is determined by utility
consequences: the Greatest Good (Happiness,
satisfaction)
For the greatest number regardless of the value
for the particular person involved
An action is right if it tends to promote happiness
and wrong if it tends to produce the reverse of
happiness - not just the happiness of the
performer of the action but also that of everyone
accepted by it
EGALITARIAN
What is due what is fair
Equal distribution of benefits and burdens, equal
opportunity
Page 4 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
An egalitarian favors equality of some sort;
People should get the same, or be treated the
same, or be treated as equals, in some respect
LIBERTARIAN
For as long as there is no restraints on individual
liberty, justice is served
movements that uphold liberty as a core principle.
libertarians seek to maximize political freedom
and autonomy, emphasizing freedom of choice,
voluntary association, individual judgment and
self-
Libertarianism
Is the view that each person has the
right to live his life in any way he
chooses so long as he respects the
equal rights of others
Libertarians defend each perso
liberty and property - rights that people possess
naturally, before governments are created
In the libertarian view, all human relationships
should be voluntary
The only actions that should be forbidden
by law are those that involve the initiation
of force against those who have
themselves used force (murder, rape,
robbery, kidnapping, and fraud)
COMMUNITARIAN
What is valued by the community determines
what is just
It emphasizes social meaning, community
membership, share values, individual
responsibility and solidarity
between the individual and the community. Its
overriding philosophy is based upon the belief
that a p
are largely molded by community
relationships, with a smaller degree of
EQUITY
What is due depends on what has been given
or received
Is very limited
If nothing is given first, then nothing will
be given in return
USE AT YOUR OWN RISK
JUSTICE IN HEALTH CARE
Fairness in all medical decisions
Many patients do not receive fair service
just because of their social status,
ethnicity, sexual orientation, etc.
Competency on emergency decisions to deliver
best care for all patients
and procedures. Discuss their condition,
alternatives, treatments and all information.
Justice for healthcare providers are given through
having a professional and a good environment for
service
EQUITY
Has been considered a concept even more
important than justice
Aristotle described it as follows:
What is just, then and what is equitable
are generally the same, and both are
good, though what is equitable is better.
According to Rawls
Equity is a fundamental requirement in
terms of justice. Equity is justice
It exists when all participants freely define and
accept the rules, benefits and charges
HEALTH EQUITY
Health equity means giving patients the care
they need when they need it
Or as the Institute of Medicine report put it, health
equity means providing care that does not vary in
quality because of personal characteristics such
as gender, ethnicity, geographic location and
socioeconomic status
HOW TO PROMOTE HEALTH EQUITY
Identify health disparities in community and how
it affects specific groups
Recognize that each person has their own racial
and ethnic biases
Learn how to recognize when a policy or an
environment may exclude a person or a group
Show respect to all people of all groups then
make efforts to involve all groups in enacting
change
Frequently evaluate how well the policies aimed
at equity are working
Make changes if necessary to ensure these
policies are most effective
Page 5 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
Health equity is something that takes time and
individual need
effort to address. But are the contributions of
individuals who are willing to help others have Makes sure what is Does not look at what is
access to safe and non-judgmental healthcare needed and in which needed for an individual
that can genuinely make a difference quantity to an individual
By modeling and promoting health equity,
Means/Process Outcome/End result
individuals and organizations can improve
healthcare for those living with health disparities Subjective, differs from Measurable, does not vary
situation and from person and neither matter
HEALTH INEQUITY to person whoever looks at it
Health equity means ensuring that every person
Positive discrimination Negative discrimination
has the opportunity to achieve their best health
Unfortunately, many social and environmental People are treated fairly People are treated equally
factors can but differently but may be unfairly
continued use of good health practices and
healthcare. These are health inequalities People can get what they People can only get what
Examples of these obstacles include: need everyone gets
Racial and ethnic discrimination Cannot be achieved Can be achieved through
Lack of access to quality education through equality equity
Income and wealth gaps
Inadequate housing or lack of housing
Unsafe environments WHAT DOES EQUALITY MEAN?
Equality means giving everyone equal positions
EQUALITY or treatment by the society.
Together with justice and equity, it has become a Hence, caste, gender, religion, and nationality
fundamental principle does not count to treat everyone equal.
As human beings, we are not physically, Therefore, equality is when ethics are accepted
mentally, psychologically or genetically equal, nor as same or equal in any aspect
are we equal in our values or principles In other words, equality refers to the quality of
But it is generally accepted and fully desirable being the same in quantity or value or status
that we be considered equals in terms of As a result, no person will be maltreated or
dignity, justice, rights, opportunities, marginalized due to the certain differences they
freedom, benefits and obligations might have within a social system.
Justice and Equity are only possible if all human Thus, in a society, equality is more of a
beings are treated equally in their dignity and principle which emphasizes equal or same
rights acceptance to everyone

DIFFERENCE OF EQUITY AND EQUALITY RIGHT TO HEALTH CARE

The Constitution of WHO states that the
Enjoyment of the highest attainable
EQUITY EQUALITY standard of health is one the fundamental

Refers to fairness, justice Refers to equal sharing

and impartiality
Equity=Fairness + Justice
Need based approach
and division, keeping
everyone at the same level
Equality = Sameness
Not affected by the need of
the people or society
International statements in human rights, such as
the International Covenant on Economic,
Social and Cultural Rights and the Convention
on the Rights of the Child, support the right to
health and require signatory nations to secure its
observance

Justifies things on the Justifies things on the DISPARITIES IN HEALTH STATUS

basis of quality
Focuses on need and
requirements of an
USE AT YOUR OWN RISK
basis of quantity
Gives the same things to
all people, irrespective of
Healthcare professionals are faced with many
disparities in health status, generally associated
with disparities in wealth/income or with
discrimination against women, minorities or other
disadvantaged groups
Page 6 of 7
 PRIVACY & CONFIDENTIALITY; EQUALITY, JUSTICE & EQUITY
Local Disparities
National Disparities
Global Disparities

ROLE OF HEALTH CARE PROFESSIONALS IN

ESTABLISHING HEALTH CARE PRIORITIES AND
ALLOCATING SCARCE HEALTH RESOURCES
Health care professionals play several roles:
As government policy makers and
officials
As hospital authorities
As direct health care providers
As researchers
What concept of distributive justice is most
appropriate for each of these roles?
How should healthcare professionals deal with
conflicts between roles (e.g., between providing
expensive curative measures for individual
patients in need and vaccination programs for the
population)?

USE AT YOUR OWN RISK Page 7 of 7

 CLINICAL BIOETHICS
Ethics and the Pharmaceutical Industry
Dr. Jena Angela Perano November 26, 2021
PHYSICIANS AND THE
INTERACTIONS WITH HEALTHCARE PROFESSIONALS
PHARMACEUTICAL SECTOR
A conflict of interest exists in medicine when the
following conditions have all been met:
o The physician has a duty to advocate for the
interests of the patient (or public).
o The physician is also subject to other
interests her own, or those of a third
party.
o The physician becomes a party to certain
social arrangements.
o Those arrangements, as viewed by a
reasonable onlooker, would tempt a person
of normal human psychology to neglect the
interests in favor of the
THE MEXICO CITY PRINCIPLES
includes companies,
regardless of ownership status, that develop,
manufacture, market, or distribute pharmaceutical
and/or biologic products.
o Such products are also referred to in these
Principles as "medicines."
Ethical interactions help ensure that medical
decisions are made in the best interests of patients
For relationships with healthcare professionals and
other stakeholders to meet this standard, companies
in the biopharmaceutical sector
should be guided by these six principles:
THE SIX PRINCIPLES
Healthcare and Patient Focus
o Everything we do is intended to benefit
patients
Integrity
o Dealing ethically, honestly, and respectfully
in everything we do.
Independence
o Respect the need of autonomous decision
making of all parties, free from improper
influence.
Legitimate Intent
o Everything we do is for the right reasons, is
lawful, and aligns with the spirit and the
values of these Principles.
Transparency
o A general willingness to be open about our
actions while respecting legitimate
commercial sensitivities and intellectual
property rights.
Accountability
o A willingness to be responsible for our
actions and interactions.
USE AT YOUR OWN RISK
Interactions between companies and healthcare
professionals provide valuable scientific, clinical,
product, and policy information about medicines that
may lead to improved patient care.
Appropriate marketing is critical to achieving these
goals because they enable companies to:
o Inform healthcare professionals about the
benefits and risks of medicines to help
advance appropriate patient use
o Provide scientific and educational information
o Support medical research and education
Experimental covid vaccine
o Obtain feedback and advice about our
products through consultation with medical
experts.
All interactions with healthcare professionals are to
be conducted in a professional and ethical manner.
o Healthcare professionals must not be
improperly influenced by companies.
o Nothing should be offered or provided by a
Company in a manner that inappropriately
influences a healthcare professional's
prescribing practices.
o Education and promotional activities should
encourage the appropriate use of
medicines by presenting them objectively
and without exaggerating their properties
o Relationships between Company personnel
and healthcare professionals should
encourage the development of a medical
practice committed to
and be based on truthful, accurate, and
updated scientific evidence.
PROMOTIONAL INFORMATION AND ACTIVITIES
No medicines shall be promoted for use in a specific
economy until the requisite approval for marketing for
such use has been given in that economy.
Promotion should be consistent with locally approved
product information.
o Anything under this should be approved by
the FDA
Promotional information should be clear, legible,
accurate, balanced, fair, objective, and sufficiently
complete to enable healthcare professionals to form
his or her own opinion of the therapeutic value of the
medicines concerned.
SAFETY OF MEDICINES
Medicines provided by Companies will conform to high
standards of quality, safety and efficacy as determined
by regulatory authorities in each economy in which they
operate.
Companies will report adverse events or adverse drug
reactions to regulatory authorities, subject to applicable
laws and regulations.
page 1 of 3
 ETHICS AND PHARMACEUTICAL INDUSTRY
SYMPOSIA AND CONGRESSES
The purpose and focus of all symposia, congresses or
sponsored by a Company should be to inform
healthcare professionals about products and/or to
provide scientific or educational information.
Company relationships with healthcare professionals
are regulated by multiple entities and intended to
benefit patients and to enhance the practice of
medicine.
Any sponsorship provided to individual healthcare
professionals must not be conditional upon an
obligation to prescribe, recommend, or promote any
medicine.
All Events should be held in an appropriate venue that
is conducive to the scientific or educational objectives
and the purpose of the Event or meeting. Companies
should avoid using extravagant venues or resorts.
Hospitality should be limited to refreshments and/or
meals incidental to the main purpose of the Event and
should only be provided:
o To participants of the Event and not their
guests
o Is moderate and reasonable as judged by
local standards.
Companies should not pay any costs associated with
individuals accompanying invited healthcare
professionals.
INFORMATIONAL PRESENTATIONS BY
COMPANY REPRESENTATIVES
In order to provide important scientific information and
nage
their schedules and provide patient care,
Company representatives may take the opportunity to
present information during healthcare
, including mealtimes,
in accordance with applicable laws and regulations.
ENTERTAINMENT
Companies should not provide any form of
entertainment or recreational items, such as tickets to
the theater or sporting events, sporting equipment, or
leisure or vacation trips, to any healthcare professional.
Such entertainment or recreational benefits should
not be offered, regardless of:
o The value of the items
o Whether the Company engages the
healthcare professional as a speaker or
consultant
o Whether the entertainment or recreation is
secondary to an educational purpose.
No standalone entertainment or other leisure or social
activities should be provided or paid for by Companies.
At events, entertainment of modest nature, which is
secondary to refreshments or meals, is allowed.
EDUCATIONAL ITEMS AND GIFTS
Payments in cash or cash equivalents (such as gift
certificates) or gifts for the personal benefit of
healthcare professionals should not be provided or
offered to healthcare professionals.
It is appropriate for Companies, where permitted by law
or local codes of ethics, to offer items designed
primarily for the education of patients or healthcare
USE AT YOUR OWN RISK
professionals if the items are of modest value and do
not have value to healthcare professionals outside of
his or her professional responsibilities.
These items should not subsidize normal routine
operations of a medical practice.
SUPPORT FOR CONTINUING MEDICAL EDUCATION
Helps physicians and other medical professionals to
obtain information and insights that can contribute to
the improvement of patient care and the medical
practice.
CME grant decisions to ensure that programs funded
are bona fide and quality educational programs that
financial support is not an inducement to prescribe or
recommend a particular medicine or course of
treatment
SAMPLES
When used appropriately, samples can be an important
tool for healthcare professionals and provide benefit to
patient health outcomes.
o Starter doses
Companies should have adequate systems of control
and accountability for samples provided to healthcare
professionals including how to look after such samples
while they are in possession of medical
representatives.
Samples should not be used as payment for services,
return for favorable treatment, or other inappropriate
inducements.
CONSULTANT AND SPEAKER ARRANGEMENTS
The following factors support the existence of a bona
fide consulting or speaking arrangement (not all factors
may be relevant to any particular arrangement):
o A written contract specifies the nature of the
services to be provided and the basis for
payment of those services
o A legitimate need for the services has been
clearly identified in advance of requesting the
services and entering into arrangements with
the prospective consultants
o The criteria for selecting consultants and
speakers are directly related to the identified
purpose, and the persons responsible for
selecting the consultants and speakers have
the expertise necessary to evaluate whether
the particular healthcare professionals meet
those criteria
o The number of healthcare professionals
retained is not greater than the number
reasonably necessary to achieve the
identified purpose
o The retaining Company maintains records
concerning, and makes appropriate use of,
the services provided
o The venue and circumstances of any meeting
with consultants or speakers are conducive
with the primary focus of the meeting;
specifically, resorts are not appropriate
venues.
page 2 of 3
 ETHICS AND PHARMACEUTICAL INDUSTRY
COMPLIANCE PROCEDURES AND RESPONSIBILITIES
It is the responsibility of Companies to ensure that
internal compliance procedures exist that facilitate
compliance with these Principles and the spirit they
embody.
These procedures should be documented and
provided to employees to further enhance compliance.

CONDUCT AND TRAINING OF COMPANY

REPRESENTATIVES
Companies should ensure that all representatives who
are employed by or acting on behalf of the companies,
and who visit healthcare professionals, receive training
about the applicable laws, regulations and industry

interactions with healthcare professionals.

In addition, companies should train their
representatives to ensure that they have sufficient
knowledge of general science and product-specific
information to provide accurate, up-to-date information,
consistent with applicable laws and regulations.
Companies should provide updated or additional
training in all of the areas needed for their
representatives who visit healthcare professionals.
Companies should also assess their representatives
periodically to ensure that they comply with relevant
Company policies and standards of conduct.
Companies should take appropriate action when
representatives fail to comply with relevant Company
policies that are consistent with these Principles and
national and local industry codes of ethics.

PUBLIC SECTOR RELATIONSHIPS

AND PROCUREMENT
The decision-making process by Companies and
Governments during and including the government
procurement process, through bidding or any other
procedure of government procurement, must be
professional and ethical. There should be no attempt
to exert inappropriate influence.
Companies must provide accurate and balanced
information to the Government.
Companies and government officials should ensure
that their relationships and fee-for-service
arrangements comply with government ethics rules
or procedures.

CLINICAL TRIALS

All clinical trials (phases I to IV) and scientific research

involving patients sponsored or supported by
companies will be conducted with the intent to develop
bona fide scientific knowledge that will benefit patients
and advance science and medicine.
o Companies must ensure transparency and
accountability in the presentation of
research and publication of study results.
Clinical trials should not be used as inappropriate
inducements for past or future sales.
Clinical trials should be undertaken in an ethical
manner, without undue influence by competitors.

USE AT YOUR OWN RISK page 3 of 3

HRT has been proven to be effec.tive in relieving vasornotor symptoms in many we\\·
dcsfgned studies. It Is inap1>roprlate for the researchers to repeat an estab\ished therapy
v1hkh rn;•y potentially c.ause harm to them:

0 rcc.tronlc Detailing of Pharmaceuticals to Physicians

0 €thrcal tssllcs In Pharmaceutical Research

0 Ethkal tsslles In Disclosures b

Respect the Principles and develop and implement Codes of Ethics:

0 Companies and Industry Associations

0 APEC Economics

0 Health Care Organizations

0 Patient Organizations
: the BEST answer

Question 3 1 pts

Patients need more information about their medications and prefer to discuss drug-related
Issues with physicians as primary care providers. Knowledge about medications provide a
good chance for pharmacists to show their abilities and expertise.

0 Ethical tssues in Importation of Drugs

0 fthfcal fssucs in Pharmaceutical Research

0 Ethical Issues in Drug Safety

0 Etllfcs In Pharmaceutical Promotion & lnfJucncc on Drug Prescription

.b
Cno ose the BEST answer

Question 4 1 pts

P.'ltents in the pharmaceutical industry are somewhat different and possibly more important
than in other industries because of the laboratory research and clinical trials that must be

I
done beforehand:

0 Ethical Issues in Drug Pricillg

0 Issues in Data Disclosures

0 Ethical Issues in Cost Efrectivcness of Drug Treatment

O Ethical Issues in Patent Exclusivity

d \
'
- -- - -
 Question 5 1 pts
l

Overt promotion such as magazine advertisements. free product samples and vis;ts to
I t
physicia ns by medical sales representatives are tried and tested methods of pushing new
products:

0 Ethical rssues in Data Disclosures

0 Ethical Issues in Marketing ot Pharmaceutical Products

0 Ethical Issues in Drug Safety

0 Ethical Issues in Cost crtcctivcncss of Drug Treatment

'\
b
Next "'
 1. pts
Question 6

In Clinical Trials. all of the fol 1owmg

· arc done • ExccQt:

0 . ·r
All Clinical trials and saent• •c research sponsored bycompa ...es w ill be conducted with the intent
to develops< ientiftc knowledge

0 Should not be used as inaps>ropriatc for past <M future sales

0 Shoold be undertaken in an ethkal manner. without undue influence by competitors

0 Companies should ensure that 54Kh support is not Undertaken solely ro< P<oduct PTOmotion
Question 7 1 pts
I
Benefits should not be offered. regardless of the value of the items. or whether the
company engages the healthcare professional as a speaker or consultant:
I
I
I
 -Question 8 1 p t !>

In Patient
- -
Fir_st statement: eompanies shoufd respect the autonomy of patient organization and their
-
-
-

Second state men_!:- Support frorn companies must not be conditional on the prornotion of a
spcclftc rncdlctnc: _:_

- - -
_0 _Ttic farst statement 's incortect and second statement Is correct
first statement ancfsecond statements are both incorrect

; -=-a Ttte (Jtst and $eCond statements are both co((ect I

0 is coned and second is incorrect
t -=---- - - -
Question 9 1 pts

AH JntcrA(tfons with health care professionals are to be conducted in a professional and

ot.htcal ttU'tnnor. This rncans:

First stntcmont: t-icalth Care Professionals must not be Improperly Influenced by Companles
Second sttttomont: Materials sponsored by a company relating to medicines and their uses
houfd Indicate by whotn they have been sponsored

1st is incorrect; 2nd is

Q The (artt stntomcnt c\lid second sl.,tcmcnh both lncorted correct
O The state1ment Js corrt:tt and sGtond Is lmorrec t
Question 10 1 pts \

\
Companies must provide accurate and balanced information to the Government: \

0 Compliance Procedures and Responsibilities

0 Public Sector Relationships and Procurement

0 Support for Conti_

nuing Medical Education

0 Clinkaltrials

a
 1 pts
Question 11

Adv 'rSC drug events can be captured through pharmacy logs, chart review and direct

Ethic:tllssues ill Disclosure

) Ethicall$sucs in [)lUg

0 Ethicailssues irl Oru& Pricilll

0
" . I nnrt<ltiO" of ()rugs
EthiC ill Mt!CS 10 n1J""· B
Question 12 1 pts

Which among the following is Not a demonstration of company donations for charitab\c
purposes;

0 Ackllow1edgement of the recipient organlzalion should be restricted to appropriate recognition

0 should ensure that there arc no incentives to prescribe.• recommend a produd based on
fmancial support ·

0 fundins and donat;ons in klnd shou1d be documented based on the nature of donation

0 should respect the autonomy of patient organizations

b
 1 pt s

Question 13
APEC (Asia Pacific Ec()ll(lfllic Cooperation) Econo111ies should do the following, '

0 ()eVeiOI' and make known clear, accountable and comprehensive policies on pro<.oremcnt ""d
procedures
0 Contribute to and participate in capacitY build ins of small and mcdlum·slznd ontorprloo• (SM[•l

0 Encourage companies to adhere to nalfonaland local industry codes ol cthlu

0 Work together to ensure that the Mcxl<o Principle< remain r.-tova nt to addross no w b• •I
arrangclllCflts •' • 110 ••

c
 Question 14 1 pts

I
Safety of Medicines:.
!·

First statement: Medicines provided by Companies will conform to high standards of quality

Second statement: Companies will report adverse event or drug reactions to regulatory
authorities

0 The fnt statcnlent is correct and second statement is ln<:orrett

() The first staterncnt and se<ond statements are both incorrect

0 The f.rst and second statements are both correct

O The first statetnent is incOfrect and second statement is correc.t

Question 15 1 pts

Includes companies, regardless of ownership status that develop$. manuf(f(tU(C. mar1<ct <lnd
disttioote pharmxeutkal products:
Question 16 1 pt.s

Do not use or divulge any other personal data, unless 3J)plicablc raws or regulations require
the company to continue storing such data:

0 Ethkal ls$ues in Dfug Safetv

0 in Dfug Pricing

0 £thkal in lmpoflatiofl of ()rugs

0 Ethical Issues in Data Disc.losurc

 Question 17 1 p\s

After invest-ing in developing a new drug, a company has the c:ucclus'"c right to sen and
prol1t froan tho product:

0 £thlc.11 fs.sues of P•1tent Exclusivity

0 Ethfc<ll fssucs In Drug Prldng

0 Ethical Issues i1\ Drug Safety

0 Ethfcal rssucs In Data Disclosure

B
Nm
I
Pharmaceutical Samples:

First statement; Company interactions should be in

-
-
-
_ I
-I -
I
intended to facilitate exchange of medical information
- . : . -=- - -
--

Second statement: When used appropriately, can be an for;bc-al(h •

- -- -- -=- -- '":
care prorcssionals and provides bcncf•t to patient health outcomes - - -
_
-
I
I -= -
-_
0 The fll'st statement and second statements arc both incorrect

0 The fvst and second statements are both correct

0 The (l(st statemeot is correct and second st:dement is incorrect _--1

- _,.- --
0 The fll'st statNIK'nt is incorrect and scc:ood statement k correct -
1

I
 A conflict of interest exists in medicine when the touowmg c..ouulliUII-> .... .w ......... _ ••

First statement: The physician becomes a partv to certain social arrangements

Second statement: The physkian is subject to other Interests, her own or those of
' a third party

0 The flf'st and second statements ate both correct

0 The fvst statement is in<:oucct and second statement Is correct

0 The (ws( and second statements are both incorrect

0 The ftrst statement rs correct and second statement is rncotrcc.t

Question 20

Consul tant and Speaker Arrangements:

The following factors support the existence of a bona fide consulting or speaker
arrangement, Excellli

0 Companies should take appropriate action when representatives fail to comply with relevant
policies
·..; a lt numoer IS Just:

0 Ubertarian

0 or transfOt"rnativc

0 Ult atariall

0 Egafit.arian

(_)

c Next •
Question 22 1 pts

Equity Is subjective; It differs from situation and from person to person. Justice and Equity
are only possible If all human beings are treated equaUy In their dignity and rights.

0 s1,1tcmcnt Is wrong, second Is correc.t

0 First statement corrcc.t, second statement is wrong,

0 Both statements arc correct.

0 Both stc''ltcmcnts arc wrong.

c
Quest1on 23 1 pts

"Contented stave• syndrome may occur as a resutt of this principle:

0 Egalilarl"''
0 Utilitarian

0 Communitarian

B
Next •
0 libertarian
\•
•
0 Autl-.oritarian \-
0 Utilitarian
this concept of distributive justice is -
\
l

0 Egalildrian considered strong in the USA \

i
-* =--

.
•I
() RestOfative or lfarrslormative
-
,
i
0 is the

0 f'K.'Cd--basc4 3Pf)(oach. the ff statements are true regarding equity and

equality except:
0 Eqwtity JusUhc-s tldngs on the basis of quantity.

b
N ext •
--
Question 26

Q)mbrnanon of t-he_: differentl'YP_es of justice aS -ap-plied -to soeiety in Wh'kll _individuals

-tair" treatment and an equitable-share the of
- -:::-_ -;-- -- -- = - - _-- - - -= - - - - - =- :: = i -- -= - - - - -

8-
Question 27 1 pts

EgaUtat1an stflves to achfeve the createst aood for the greatest number while creating the
feast number of harm or preventfna the greatest amount of suffering. Egatitarlanlsm Is an
effort to provide an answer to the practical question "What ought a man to do?" Its
answer It that he oupt to act 50 as to produce the best consequences possible.

Flr•t k WffC,t, IJ wrong,

8oth ttre COffO,I.

Question 28 1 pts

Concept of Distributive Justice wheretn justice Is achieved when everybody has equa\
access to the societal resourc.es that they need:

0 Eg.1lilarlan

0 Utilitarian

0 libertarian

0 Restorative or transformativc

0 Authoritarian
a
 - :-- --- - .
_ ""f!:::;-..o- -_

Most economists ,-ean towards this concept of di-stributive justice:-

0 Authoritarian-
0 Restorative or transtorrnM:ivc

0 Egaltarian

0
0 Ubcrtanan

0 lJtiitarian-:
e
 Question 30

Concept of Distributive Justice wherein justice requlres favouring previous\y

I disadvantaged Individuals or groups:

0 Aulhorilarian

0 Egalitarian

0 Restorative or lransformative
0 UWitari,ln

c
0 Libertarian
Question 31
1. pts
\\
\
Equality Is the outcome/end result of the process. Equality Is measurab\e. \t does vary '\
and neither matter whoever loot<s at lt.

0 Both statements are wrong.

0 Both statements arc correct

0 First statement· .
IS wrong, second statement ·,s
corrcc:t
0 First statement. '
IS correct. second k
 1 p ts.

Question 32

Ensures punishment of wrongdoers:

0 Sod."ll Justice

0 Procedural Justice
0 Retributive Justice

0 Distributive Jllsticc
 Question 33 1 pts
\
This concept of distributive justice Is predominant in many European the

I value of social solidarity fs recognized:

I 0 Ur· Arian

I
i
'

- -
-

-
-
c
- - ""-- =
- - - =- -
Question 34 1 pts

It is an ethkal concept. grounded in the principle of distributive justke. It exists when all
define and ac:cept the rules. benefits and charges.

B
Question 35 1. pts

Obstacles to health equity Includes the following; except:

0 ln:tdequate housing

0 Ethnic discrimination

0 Quality cduca ti o
11
0 gaps
 - - -

- - - -
\,..{UI"- , , ,_, .. , ...,..--- -

1 Question 36
I
concept of DistributiVe Justice wherein whatever the highest authoriW decrees \s just:

I
0 Authoritarian

0 Utilitarian

B
I
Question 37 1 pts

Health equity means ensuring every person has the opportunity to achieve his or her best
health. Health Inequities are social and environmental factors that can limit a person's
access to and continued use of good health practfces and health care.

0 Both sttltements are wrong. 1st is Correct; 2nd is Wrong

0 Both stCltcmcnts arc cor(cd.

Question 38 1 pts

Concept of Distributive Justice wherein whatever an individual decides to do with his or

her OYJn property is just:

0 lJDettarim

c
.. .
Question 39 1 pts

A theoretical pef'Spective that seeks to lessen the focus on Individual rights and increase
the foals responsibilities:
"' .

.... stion 40 1 pts

· ·ca is attempting to implement this concept of distributive justice:

A
c.-.oose me &ST answer - - -

J Question 4t 1 pts 1

\\
r
of the following refers to the Islam verse that speak to the Prindple of Respect for
Humdtl Dignity?
\\
\

\I
0 ..So. God cre.1ted humanity in God"s in the image of God. God cre"ted them" \
I
0 ·0o you not know that you arc the Temple of God? I
\
I '? ' We have iOOoed Adam' '\
•

/_I
_-Q i!"c mamfcstations of the D1vJnc
- - -

r
:__ -- -

Next
 1 pts
-
Question 42

/\<Co d .ng to Giovanni Pico Della Mirandola. was presented: -

O an a-sped ol pefS003I f(eedom

0 A'S an embodiment of onc·s public. worth

-
n As associdtc-d 'i-1ith human abilities of delibe(ation, sclf-awareness and free decision rna\( n &
 1 p\S
Question 43

Adopt appropriate towards the ful\ rcaHzC\\ion of the ri&ht:

0 Tile oblig,, tion of the stO\te to prote<t hlhl'-'" ' r\gh\s

0 ()( the state to respect protect ri&hts

0 The obligation of the state to respect human r ighl4i

0 The oblig.ltion of the st<ltc tore P<'C.t. prole< t \\nd f\•lf\1\ hmmm rl&h\s

0 The obli&al ion of the stale to fulr,u hurn::m rights

O The olbligalion of the state to respect, protect and fulfill human rights
state must take positive action to
O The obligation ofthe statetofulhil human rights facilitate the enjoyment of basic
human rights
O The obligation of the state to respect and protect human rights
O The obligation of the state to protcct human rights

O The obligation of the state to respect humanriehts

 1 pts

1: 1-!utndo -nily
- -
15 the right of a person to be valued and respe<.ted for their

D
I Question 46
Inherent to everY without discrin'11nat\on:

0
0
0 Ur,ivcrsa\

0 Interdependent
B
. __ =o f and tree detls\oo

- -_ _-_- __ --- - -
_J\ _: :9 hOnorable that
, - , _,-' C. -
in many world religions, human dignity is considered to
 - -'- ; - -
- 0

Q Requires Obligation
intcrtcrc iri orderof
to the state to protect agaTr\St human
groups human right, ?Y ; =

\ others - "-
EXCEPT:
-
0 -. -.

_-

--· - - : -
- -- - - -
Ans: refrain from
interfering
ind!Vidoals arid groupS ag,.;,.;!.t human rights abuSes · -• with
:-_: the
'c ._
-- -A - enjoyment-
 Question 49 1 pts
'\
· r o treat any other person a\ways at the same tlmc as an end. me:re\v means·. \
This basic prindp\e of ethics is associated \

0 Giov<fnru Pi<.o Dela Mitandob

ANS: Immanuel Kant
\ 0 Hobbes
Question 50 ANS: human dignity was asso. with human abilities of 1 pts
deliberation, self awareness and free decision making
Human dignity according to ancient Greek Phi1osophy:

0 dignity is progressively with the ldea of human righh

0 AU human beings arc born free and equal in human rtghts

0 Those who arc in body and soul have dignity equal to those who arc robust and sturdy
Question 51

Staten>ent 1: Medicine Is often sustainable because ot Its continuous l1ght agalnst

vulnerability
Staten1ent 2: Medical progress has created new torms ol

0 1st statement is corrc<t and second statement is \ncorrc<t

0 Both are lrlcorrec.t

0 Both statement arc correct

0 1st statement is \nco<retl and second s\atcn\cnt Is correct

D
 1. p\S \
<' l h.·'nl: ! I l l ' ' " -' , • ...

question 52

Statement 1: The Ill'"''"' conditio" requires solidaritY as hurn•" beillSS all share co&nmon

Staten•ent 2: Human vulnerabilitY can lead to an ethiCS of care

0 tst staten1ent is incorre<tand second statement is wrrcd

0 Both are con·ect \

0 1st statement is corrcd and second statcOlCnt is incorrect
- -\- \

0 Both stJtcmcots are incorrect

b -
- -

¥
 Question 53 1 pts

S ateme r t 1: Understanding what could make a person more likely to experience

cep s.sioo is the first step in developing prevention and treatment strategies to reduce
·ndvidwl vulnerability

Statement 2: Prozac which is a widely used anti-depressant should be given to individuals

,..;t · depression as this is a medication for unhappiness and sadness and they cannot
fi.!nction wi thout this medication.

0 Both statements are correct

0 1st statement is incorrect and second statement Is correct

0 Jst is correct and sccood statement is incorrect

0 Both st(1tcmcnts arc incof'fcd

c
 Question 54 1pts

Contextual factors such as ideologies, social norms. values and traditions influence either
directly or indirectly the vulnerability of a community:

0 Corporeal vulnerability

0 vulnerability

0 Social vulnerability

0 Cu'tural vun-rabWty

c Nex •
 - - - - - -
1 pts
Question 55

Statement 1: Medical research should be used to overcome natural threats that can lead to
human vulnerability

Statement 2: Science and technological innovations should be focused on elimlnating

biological threats to the human body

/0 1st statement is correct and second statement is incorrect

I
I
I
0
0 Both st<1tements are cor(ect

Both statements arc incorrect

c
f 0 lsl statement is incorrect and second statement is correct
 J ..I _J r l: ,. I (; I' f J I ( •' ' -' • -

Question 56 1 pts

The fragility of a particular traditions and conceptions of values that are typical for a
community:

I 0
0
0 Co rporeal vulnera bility

Sod.>! vulnerability

I Cultur.11vulnerability

0 Biological vulnerability

I
-
-
-
= -
-
-
-=
---=- -=
c
1 " '" '' t' tl w Ill" I ·" 1 '-\'1/ t ' l

Q uestion 57 1 pts

Vulncr<lblc g roups should have access to:

0 Livclihootls. f ood security, c ducC\Uor), h c<ll th Clnd nutritron

0 Uvclihoocls, fooct security <lnd sustain<"blc health a nd nutrition

0 Livelihoods and food security

0 Q u.llity educatio n

0 Sust:tinab le h ealth a nd nut ri tio n

 Question 58 1

Statement 1: It is feasible to rid hun1an conditions of all vulnerability

Statement 2: It is necessary to accept that some vulnerability are permanent part of the
hllman condition

0 Both statements are correct

0 lst slJtement is CO((ect Clnd second statement is incorrect

0 1st statement is incorrect and second statement is correct

0 Both stJtcmcnts are incorrect

A
- Next •
 • __ , . . ... , .,. ,., ,u l O Wlllls t:md ad'lcrso Impact
from rnulli plc strcssors to which they nrc exposed:

Corp ore...'ll \/u1nerabUity

refers to the inability of people, organizations
0 Cle1tural vulnerilbllltv
and socities to withstand
0 vlllocrablllty

0 Bloloelcnl Vlllnc rnbllity

Question 60 1 pts

The fragility of the human capacity for creating coherence in one's life for sharing goods and
services:

0 CullurO'II vulner."'bilily

0 vulnerability

0 vulnerability

0 Social

D Next •
 Question 61 1pts

Solid,lrity as instrumental value is also called:

0 associative solicbrity

0 wNclarlty

/ 0 rr«haniulsor.darhy
0 rcc iproc-dl so/iddrily
I
D
Next_t
 1 pt s

Question 62

Solidarity Js a moral value is also called:

0 solid<lrity

0 humanitari<'n solidarity

0 solidarity

0 associative solidarity
 - .
Choose t he BEST answer

1 pts
Question 63

The "truth" regarding the principles of solidarity and cooperation:

0 they ,1re ce,}frally focused to tlte futlclamenl:JI hldividu,11 freedom

0 coopcrilt:ion is historically the domain of a human being as a social being

0 ilmong beings is the dom.1in of liber ty in the real w orld

0 thNc is a logic behind the subordination of freedom to solidarit y that is formal and cxplidt

I
c
Next •
CliNICAL BIOETHICS- MIDTERM EXAM- DEC 17, 20:

Quiz Instructions
Chr;ow the OfSTanswer

Question 64 1 pts

The following statement Is TRUE about solidarity as applied in the context of health:

0 not are entiUed for free services IJy Pllill feall h

0 only contributing mc11nbef's can CllJO'I

, the benefits of Philt ICcJith

0 C".J('(yonc Is obliecd t o make a contribution to PhifHcalth

0 everyone Is ,11 pay•n8

• member or Philt tcaiUl
c
 1 pts
Question 65

to sociological aO<llysis. in post-industrial. globalized societies:

0 modem h.Jnc.liQns between non-related arld hnpersorlal members of a society

0 b •ikfing new form s of solicbrity is an ongoing project

Q uestion 66 I PIS
1-

The lollowong statement 3bout sohcbntv ;as apphed l n the context o f he>llh

i! oblittC"d lo rrukr .:J c.on&t,bution lo

0 onlv COI\Uil>utJnr. mCfl'lbel'\ ...,_ <ntOV lh<- b<:""h" Dl f'loolli <• 111•
 Question 66 1 pts

In post-industrial, globalized societies. solidarity takes the form of:

I, 0 associative solidatity

I 0
0
contractual solidarity

reciprocal solidari_ty

0 org6nkcd soliddrity

d Next •
Q uestion 67 1 pts

f hc no ti on of solidarity is associated with:

0 co mmit ment to cau se ·orfC"nted organizations

0 commit ment to elimi nate poverty

0 !.c.-If· rcs pc<. t

O m u tual understanding sl\clrcd responsibili ty

In traditional societies, solidarity takes the form of:

0 solidarity

0 orgcmiscd solid<trity
0 r cdprocal solidarity

O contractual

d Next
0 \tr,"\ l u.:ll solid<lrity

0 r solidarity in the transition from traditional to modern

socities, solidarity tales the form of:
0 .:l sod.ltive solidarity

0 solidcui ty

Next

A
Not saved Sub n
·_ ;r J5 C 'ne BEST answer

Question 70 1 pts

/ Solidarity is showing personal and social concern for the following vulnerable groups: t

0 the chronically ill

0 victims of body shaming

I 0 people targeted for bashings

J 0 LGBT plus community

.
A
-
-
Next
"" -
l hoosc th e BEST ;m sw cr

Question 71 '1 pts

According to sociological analysis, during the from traditional to

n1odcrn societies:

0 solid.1rity rest s on the sociJI uniformity of beliefs, l)r;'lctkes and sentiments

() thf" forrn rontrntc; o f til's b etw een lnf'livid11-1l5 .'HI" t r;msforn"'Nl

Quest\on 72

. . \cadi\\ona\ homo&eneoU
s soc.\c\\es:
1\ttording to sotio\ogica\ ana\)'SlS. '"

0 sor res\s o n \he social ot be\iets. prac.\.kes and sen\.\rnet'\\S

0 the form and tontcnts ol ties between indi'lidua\s. are \c

0 bui)Qirtt IOI"m<; ot !.0\id<lrity is an oogo\ng p ro ic-c t

Choose the BEST <1 n sw c r

1 pt s
Question 73

Criminalization of same sex relationship. This is a:

0 Exemption s>Oses a threat to public health

0 Need more Info

0 Discriminati on

0 N0n·discrimination
 UL.. Ill-"'-' ... . _ -

( s
tIH' OF T clllSWCr

Question 74

Which contribute to stigma the most?

0 re(1ctions towards the individual

0 None

0 DcviJtion from society of ccrlaio pcrsonatity

0 Being different by a ccrlain individual

A
-- --- • - fl.I -
-p

-
 llv10g w i th HIV/ AIOS to exerdse their sexuality and have ch1_
\dren.
is
the right of individuals living with HIV/AIDS to exercise...

A
Question 77

Which of the following recommendations is correct?

0 Women living wHh HIV llave tile right to have a normal sexual and reproductive lite. lnduding
children when and if they want

0 A women living with IIIV should terminate her pregnancy because of her li IV status

0 Wo me n living with HIV should be advised not to have children

- i : ....

Quiz Instructions
c.r oose th e BEST answer
1 pts

Question 78

Health disporiiY among different cities in metro manila. 1his is a:

0 Exeo ptioo bec.ause poses a threat to public health

0 Need more Info

0 Non·discrimioation

0 Discrimination

D Next •
che BESI

1 pts
Question 79

Dr. Ron has heard of a new technology: Genetic Counseling. The concept that genetic
co'-mscling must be nondirective arises directly from respect for which of the following
principles of medical ethics?

0 Aulonomy

0 None

0 Justice

0 Ocnc(Kcncc

0 P.l!em:\lislll

b
 f
I

I Question 80
1 pts

Which of the following statement/sis/arc True?

0 Neither

l
0 Both
I
0 Discrimination has a public health implication and must be addressed aCCO(dingly

I 0 In Pandemic situation discrimination is least priority

c Next •
 1 pts
Question 81

Vlh:ch of the following is a consequence of a stigma, except?

0 UnemJ)Ioyment

0 Greater Social intcrclction

0 Compromised quality of life

0 l ow self esteem
. . _- -cJ:>c- { c T. mwcr

1 pts
Question 82

\'Vhich one of the following is not true about stigma?

0 . kes J.)€ople feel alienated or feel "less lh(ln"

It n'11

0 It not a big problem for people with mental health conditions

0 It people fear if they share their story

0 It prevents people from seeking h<'IJJ tor symptoms

B Next .,
C.. .J .J .... , .... . _ __

BEST

1 pts
Question 83

The following statements shows discrimination. Except:

0 All sex workers should undergo mandatory te$ling lor HIV and other sexually transmitted infections

0 The names of people living with tiiV should be not be made public

0 Migrants should l!ndcrgo mandatory HIV testing and be deported if they have an HIV·positive
re5ult
I
0 All
I
Question 84
1 pts

Can a health-care provider choose not to treat a patient based on his or her race. gender
identity, occupation or HIV Status?

0 Yes

0 No

0 It dcpc·nds on the health-care provider's belief

B
Question 85

Ban of the usc of surge(y in gender reassignment. This is a:

0 Non-discrimination
ANS: Discrimination
f l f)(P.mntion bc<aLISC poses a threat tO pubHc health
 l NICAL BIOETHICS - MIDTERM EXAM- DEC 17, 202

Quiz Instructions
C. r 6f1S<: thf: BEST answer

Question 86 1pb

Which of the following is a discrimination?

0 /4JI

0 RatA a man who has stopped drinking. Tilts caused Raul to believe that people woo do reot
drink do not how to fun

0 A female Pttblk health of(1(ial that wome-n arc wpc(aor ncgotl3tors bcuu'c ttl(.-y are bdt.cr
at flndJrtg Vlhcn a open for a negotiat()r . me onlv intervie-ws fe-male.
 s on 7 l pi

c
t :..>se BEST a ns wer

I-
Question 88 1 pts
\

Jennifer is 17 year old; Which of the following is discrimination against her?

Q Early M-uriage \
-
O Needing f<K an tffV test
-
0 fk·ng sdl<>oJing

O
t--

B Nexf •
--
Question 89 1 pts

In order to prevent stigma and discrimination; confidentiality is important. Confldcntiafly in

the physician-patient relationship shoufd be breached in which of the following clinical
scenarios? Except:
ANS: A young women has just tested
0 You see a in the psychi('ltry outpatient clinic who tells you he has recurring thoughts of
n'' orrfMi n " hi" he iS now devising tl reC'Iistic pfan tO do SO.
 1 pts

-
- ,:-'l'l
.- t.'d m a movie in a theater and eat in a restaurant after, but she was
ber-.ause of vxdnation status. This is a: \

0 £ poses a threat to public health

0 'eed mo c Info

Next
 1 pts
e·tion 91

.Vh { -.)f ti-c owi is d ·scrimina tion?

0 are empfoy.1ble

B
 --- - -
( i·oosc lhc BEST

Question 92 1 pts

This typo of Discrimination is based on the family history of pco1>le without symptoms of a
disease.

0 Genetic Dis<rimination

0 Social discrimination

0 Individual dis<rimination

0 Perception

A
 uestion 93 1 pts

I
of a sexual partner that his/her partner is a person with HIV. This is a:

QE , b:<.c!JSe poses a threat to public hea lt h

A Next •
Qu Uon 94 1 pts

I Iw of trce\ling person or " group badly because they arc different hom you

l)

Preconception

( Perccl)t ion

A
 Question 95 1 pts

Person with HN arc not allowed to get married. This is a:

0 Disuirrnnalion

0 Non-discrimination

0 fxc'fnption a threat to public heallh

0 more Info

Next •
_ ,-· :)se the BEST answer

Question 96 1 pts

Wh ich of the following statement is true?

0 Persons with HIV should not be allowed to children as it poses pub1ic health risk

0 Doctors should understand the social implication of certain disease and help address it

0 Doctor should interfere with social aspects of their patient's lives

0 None
8
- Next •
Question 97 1 pts

1\n ti -ST D p ill was tested among sex health worker. This is a:

0 Non-d iscrim ination

0
0 £ xe11lptioe1
a
poses a threat to public heal til

0 N eed more Info

Next •
 { e BEST c1nswer

Question 98 1 pts

Cancer vaccine was tested among high school students. This is a:

0 Nofl-drSUiminatioo

0 Discri ination

0 because poses a threat to public

0 Nrx-d mme nlo

A
, enlor Citiz 'n :\t the covid vacdntlt1on in cl rurc'll center. This Is a:

Not\·tli crimhH\tion

Oi

b..: c\lusc thrc:tt to public hcaltl\

0 Need more Info

 CliNICAL BIOETHICS - fVIIU I L., ... -· -·
,f u t 'd ( 1' t 17 .l( tl p lll

Quiz Instructions
<.11 o' c lht' lJl 51 .m wer

Question 100 1 pts

Joel is for a service crew in a f.1st food chain. He asked for Hepatitis 8 status
prior to employment. This is a:

0 more Info

0 Exemption b('causc a thr('at to pt•blic health

0 Non·discrimin.ation

0
B
Discrimination
 TOPICS
PROTECTING FUTURE GENERATIONS AND
PROTECTION OF THE ENVIRONMENT, THE BIOSPHERE
AND THE BIODIVERSITY
PUBLIC HEALTH ETHICS
ETHICAL ISSUES IN PHARMACEUTICAL INDUSTRY
SOLIDARITY AND COOPERATION
CROSS-CULTURAL HEALTH CARE
SOCIAL RESPONSIBILITY AND HEALTH
SHARING OF BENEFITS

QUESTIONS ANSWERS
IN EITHER PUBLIC HEALTH RESEARCH
OR PRACTICE, THE RELEVANT
AUTHORITIES HAVE NO NEED OF THE
BASIC VITAL STATISTICS (E.G. CRUDE FALSE
BIRTH RATE, MATERNAL MORTALITY
RATE) IN ASSESSING HEALTH STATUS OF
THE CONCERNED COMMUNITY
THIS PERTAINS TO THE COLLECTION
AND ANALYSIS OF IDENTIFIABLE
HEALTH DATA BY A PUBLIC HEALTH
AUTHORITY FOR THE PURPOSE OF PUBLIC HEALTH RESEARCH
GENERATING KNOWLEDGE THAT WILL
PRIMARILY BENEFIT THOSE BEYOND
THE PARTICIPATING COMMUNITY
IMPROVE HEALTH ONLY AS INDIVIDUALS
THE FOLLOWING ARE TRUE FOR THE BUT ALSO THROUGH INDIVIDUAL
DEFINITION OF PUBLIC HEALTH EXCEPT EFFORTS IN THE SOCIETIES OF WHICH
THEY ARE A PART
THIS PERTAINS TO THE COLLECTION
AND ANALYSIS OF IDENTIFIABLE
HEALTH DATA BY A PUBLIC HEALTH
PUBLIC HEALTH PRACTICE
AUTHORITY FOR THE PURPOSE OF
PROTECTING THE HEALTH OF A
PARTICULAR COMMUNITY
ETHICS IS ABOUT AVOIDING A WRONG
DOING, DOING THE RIGHT THING, DOING REFLECTIVELY ANALYZING AND
WHAT IS BEST, DOING WHAT WE SHOULD EVALUATING THE RIGHTNESS OF
DO. ETHICS IS ALSO ALL ABOUT THE ACTIONS ONLY
FOLLOWING EXCEPT
 QUESTIONS ANSWERS
PHYSICIANS PERFORM ACTS OF
CHARITY, KINDNESS & MERCY; COME TO
BENEFICIENCE
THE AID OF THE INJURED, THE SICK &
THE DYING; & RELIEVE SUFFERING
THE AMERICAN PUBLIC HEALTH
ASSOCIATION ADOPTED THE
PRINCIPLES OF THE ETHICAL PRACTICE
OF PUBLIC HEALTH THAT WAS DRAFTED
BY THE PUBLIC HEALTH LEADERSHIP
12
SOCIETY IN 2002. THIS DOCUMENT
CONTAINED _______ KEY ETHICAL
PRINCIPLES THAT WERE DEEMED
ESSENTIAL TO THE PROPER PRACTICE
OF PUBLIC HEALTH
IT IS A PRINCIPLE BASED ON
ALLOCATION ISSUES & SCARCITY OF JUSTICE
GOODS
PUBLIC HEALTH IN GENERAL ONLY
CONSIDERS THE OPINIONS OF
DECISION-MAKERS (E.G. MUNICIPAL
HEALTH OFFICER, PUBLIC HEALTH FALSE
NURSE) AND POLICY-MAKERS (I.E.
LOCAL GOVERNMENT UNIT), NOT THE
COMMUNITY AT LARGE
PRACTITIONERS MUST ALWAYS
REMEMBER THAT THEY SHOULD NOT
DO, RISK, NOR CREATE ANY HARM OR
NON MALEFICIENCE
INJURY THEIR PATIENTS EITHER
THROUGH ACTS OF COMMISSION OR
OMISSION
PUBLIC HEALTH, SCIENCE AND
DECISION MAKING PROCESS ARE OFTEN FALSE
OBSCURED WITH EACH OTHER
PRIORITIZING AND INTEGRATING
DIVERSE VALUES IN DECISION MAKING
ETHICS IS GOVERNED BY WHICH OF THE EVALUATING THE RIGHTNESS OR
FOLLOWING SOCIAL PRINCIPLE WRONGNESS OF ACTIONS
RULES OF CONDUCT RECOGNIZED IN
RESPECT TO A PARTICULAR CLASS
ASSURING HEALTHFUL ENVIRONMENT
TRUE REGARDING APPLICATION AND
BY. ENCOURAGING INDIVIDUALS WITH
PRACTICE OF PUBLIC HEALTH ETHICS
HEALTH PRACTICES
BREACHING OF MORAL RULES TO
VIOLATION OF SOCIAL NORMS AND ARE FALSE
CONSIDERED CRIME
 QUESTIONS ANSWERS
PROGRAMS IMPLEMENTED IN A MANNER
THAT ENHANCES THE PHYSICAL AND MANILA BAY CLEAN UP PROGRAM
SOCIAL ENVIRONMENT
INVOLVEMENT OF COMMUNITIES IN
PUBLIC JUSTIFICATION AND COMMUNITY
PROMOTION & MAINTENANCE OF THEIR
PARTICIPATION
OWN HEALTH
MAJORITY OF PUBLIC HEALTH
INTERVENTIONS ENTAILS INVOLVEMENT TRUE
OF HEALTHY SUBJECTS
BEARS THE RESPONSIBILITY OF
SECURING FUNDS AND FACILITATING
DESIRED INTERVENTIONS FOR THE POLITICAL ACCEPTANCE
APPLICATION OF PUBLIC HEALTH
ETHICS
SEEKS INFORMATION NEEDED TO
ENFORCES TOTAL SMOKING BAN IN ALL
IMPLEMENT EFFECTIVE PROGRAMS
PUBLIC AREAS
THAT PROTECT & PROMOTE HEALTH
PROVIDING THE COMMUNITIES IDEAS OF
WHAT AVAILABLE PUBLIC HEALTH
INSTITUTIONS THAT IS AVAILABLE TO
THEM
WITH PROPER ADMINISTRATION OF
GUIDE PUBLIC HEALTH INSTITUTIONS
CODE OF ETHICS IN PUBLIC HEALTH THE
STANDARDS TO WHICH THEY CAN BE
FOLLOWING COULD BE ACHIEVED
HELD ACCOUNTABLE
PROVIDE A LIST OF PRINCIPLES THAT
SHOULD BE CONSIDERED IN
ADDRESSING CERTAIN DISPUTE
PUBLIC HEALTH INSTITUTIONS SHOULD NATIONAL PRIVACY COMMISSION
PROTECT THE CONFIDENTIALITY OF PROTECTS PERSONAL DATA IN THE TIME
INFORMATION THAT CAN HARM OF COVID-19
INDIVIDUALS ARE NOT GRANTED THE
CHOICE OF PARTICIPATION, BUT ARE TRUE
REQUIRED TO PARTICIPATE
PUBLIC HEALTH INTERVENTIONS MUST
BE MADE ACCESSIBLE TO ALL PEOPLE
EQUITY AND JUSTICE
IRRESPECTIVE TO THEIR ETHNICITY,
GENDER AND AGE
ENSURE THAT THE BASIC HEALTH
UNIVERSAL HEALTH CARE
RESOURCES ARE ACCESSIBLE TO ALL
WHICH OF THE FOLLOWING PUBLIC
ALLOCATING SCARCE RESOURCES
HEALTH PRACTICE SHOULD BE
FAIRLY TOWARDS THE COMMUNITY
IMPLEMENTED AND CARRIED OUT
 QUESTIONS ANSWERS
PUBLIC HEALTH INSTITUTIONS SHOULD PROGRAMS THE AIMS ENHANCEMENT
ENSURE THE PROFESSIONAL ON SKILLS, KNOWLEDGE AND
COMPETENCE OF THEIR EMPLOYEES BEHAVIORS
MOST PUBLIC HEALTH INTERVENTIONS
IN OUR COUNTRY ARE NOT SUPPORTED TRUE
BY LEGISLATIVE CODE
PREVENTS THE COUNTRY FROM THE
UNRULINESS THAT COULD BE CREATED
POLITICAL ACCEPTANCE
IN THE COUNTRY BY INDIVIDUAL & SELF-
DETERMINED INTERVENTIONS
MAKING MEDICAL SERVICES AVAILABLE
THE FOLLOWING CONCEPTS DEFINE
TO PEOPLE ADDRESS HEALTH
PUBLIC HEALTH ETHICS
CHALLENGES
YOU WHERE INVITED TO A SCIENTIFIC
THE COMPANY THAT INVITED YOU
SYMPOSIUM, AND THE EVENT IS ONE
SHOULD BE ABLE TO PROVIDE
HOUR DRIVE AWAY FROM YOUR CLINIC.
TRANSPORTATION
WHAT SHOULD HAVE BEEN DONE
IN A CLINICAL TRIAL, DR. JULIO HAS
SEEN THAT HE IS TESTING IS NOT
SUPERIOR TO PLACEBO, HE REPORTED
INTEGRITY
IT AS SUCH. WHICH OF THE FOLLOWING
ETHICAL PRINCIPLE BEST DESCRIBE
THIS
A MEDICAL REPRESENTATIVE SENT A
SIMPLE GIFT FOR YOUR BIRTHDAY. RESPECTFULLY DECLINE IT
WHAT SHOULD BEST BE DONE
WHICH OF THE FOLLOWING IS TRUE
REGARDING THE INTERACTION WITH
ALL MEMBERS OF THE MEDICAL TEAM
HCP AND THE BIOPHARMACEUTICAL
COMPANY
THE ULTIMATE GOAL OF CLINICAL TRIAL
IS TO BENEFIT PATIENTS. WHICH OF THE
HEALTHCARE FOCUS
FOLLOWING ETHICAL PRINCIPLE BEST
DESCRIBE THIS
IN CONDUCTING A CLINICAL TRIAL A
PHARMACEUTICAL COMPANY MUST BE
ABLE DISCLOSE THE OBJECTIVE OF THE
TRANSPARENCY
RESEARCH. WHICH OF THE FOLLOWING
ETHICAL PRINCIPLE BEST DESCRIBE
THIS
 QUESTIONS ANSWERS
SAFETY SIGNALS WHERE NEGLECTED
BY THE RESEARCHER, HENCE HARM
WAS INFLICTED. THE STUDY TEAM
ACCOUNTABILITY
ADMITTED THEIR SHORT COMINGS.
WHICH OF THE FOLLOWING ETHICAL
PRINCIPLE BEST DESCRIBE THIS
DR. RAUL WAS TAPPED BY A COMPANY
TO CONDUCT A CLINICAL TRIAL. SINCE
DR. RAUL IS AN EXPERT, HE WOULD
KNOW BEST HOW TO CONDUCT A INDEPENDENCE
CLINICAL TRIAL, WHICH OF THE
FOLLOWING ETHICAL PRINCIPLE BEST
DESCRIBE THIS
A PATIENT DEVELOPED MULTIPLE
SCLEROSIS WHILE BEING PART OF THE
CLINICAL TRIAL. THIS WAS SHARED TO A
TRANSPARENCY
MEDICAL COMMUNITY. WHICH OF THE
FOLLOWING ETHICAL PRINCIPLE BEST
DESCRIBE THIS
A MEDICAL SYMPOSIUM WAS HELD IN A
A BUSINESS TYPE HOTEL WOULD BE
5 STAR HOTEL. WHICH OF THE
MORE APPROPRIATE
FOLLOWING IS TRUE
PRIMARY DUTY TO UPHOLD AND
PROTECT THE RIGHTS OF ITS CITIZENS
RESPONSIBLE TO PROVIDE THE
RESPONSIBILITY OF GOVERNMENT
ENVIRONMENT THAT COULD MAXIMIZE
THE PROMOTION OF FUNDAMENTAL
RIGHTS
THE DEGREE OF RESPONSIBILITY
INCREASES AS ONE’S AMOUNT OF
TRUE
CONTROL OVER A GIVEN SITUATION
ARISES
DEFINED BY STATE LAWS OR BY RULES
AND REGULATIONS GOVERNING INDIVIDUAL
MEMBERSHIP OF A PARTICULAR GROUP
DUTY, OBLIGATION AND RESPONSIBILITY
ARE ACQUIRED BY INDIVIDUALS,
GROUPS OR INSTITUTIONS. WHICH
GOVERNMENT
AMONG THE FOLLOWING, AS DEFINED
CONSTITUTIONALLY BY THE
ESTABLISHED STATE
HEALTH PUTS A BURDEN ON
INDIVIDUALS, GROUPS AND
ROLES
INSTITUTIONS TO PROVIDE ASSISTANCE
THAT IS WITHIN THEIR MEANS
 QUESTIONS ANSWERS
IT IS THE STAGE OF CULTURAL
COMPETENCE WHEREIN CHANGES ARE
CULTURAL PROFICIENCY
IMPLEMENTED TO IMPROVE SERVICES
BASED UPON CULTURAL NEEDS
THERE IS PRESENCE OF RACISM,
STEREOTYPING, WITH UNFAIR HIRING CULTURAL INCAPACITY
PRACTICES AS AN EXAMPLE
A PERSON IS CONSIDERED AS
“CULTURAL COMPETENT” WHEN HE
RECOGNIZED INDIVIDUAL AND
THE 1ST STATEMENT IS CORRECT AND
CULTURAL DIFFERENCES, AS WELL AS
2ND STATEMENT IS INCORRECT
SEEK ADVICE FROM DIVERSE GROUPS.
GIVES PRIORITY TO THE NEEDS OF
DOMINANT GROUPS
IT IS THE STAGE OF CULTURAL
COMPETENCE WHERE THERE ARE
FORCED ASSIMILATION, SUBJUGATION, CULTURAL DESTRUCTIVENESS
RIGHTS AND PRIVILEGES ARE FOR
DOMINANT GROUPS ONLY
TO ACQUIRE CULTURAL COMPETENCE,
ONE HAS TO ASK HIMSELF QUESTIONS
ABOUT HIS CO-WORKERS AND PATIENTS
ON THEIR FAMILIES, AND HOW THEY
BOTH STATEMENTS ARE INCORRECT
WORK. SUCH INFORMATION PROVIDES
KNOWLEDGE OF THE CULTURAL
VALUES, BELIEFS AND PRACTICES OF
YOUR CO-WORKERS AND PATIENTS.
IT IS THE STAGE OF CULTURAL
COMPETENCE WHEREIN A PERSON
IGNORES THE DIFFERENCE, “TREAT CULTURAL BLINDNESS
EVERYONE THE SAME”, AND ONLY MEET
THE NEEDS OF DOMINANT GROUPS
ONE OF THE STATEMENTS BELOW IS IT IS THE AFFIRMATION AND
NOT A DEFINITION OF CULTURE ACCEPTANCE OF DIVERSITY
THE FIELD OF BIOETHICS CONTINUES TO
STRUGGLE WITH THE PROBLEM OF
CULTURAL DIVERSITY. THE ISSUE IS
SOMETHING THAT HEALTH CARE
BOTH STATEMENTS ARE CORRECT
PROVIDERS AND DECISION MAKERS IN
BIOETHICAL CONTEXTS SHOULD TRY TO
UNDERSTAND AND, WHEN POSSIBLE,
RESPECT
 QUESTIONS
WHEN A PERSON CONSIDERS
EXPLORING CULTURAL ISSUES, WHEN
ETHICAL ISSUES ARE ENCOUNTERED,
MAKES ASSESSMENT OF THE NEEDS OF
ORGANIZATION AND INDIVIDUALS
A HEALTH CARE GIVER IS SAID TO BE
“CULTURALLY COMPETENT” TOWARDS
HIS PATIENT BASED ON THE FOLLOWING
PREMISE
DO NOT OVERFILL GAS TANKS
FULLY LOADED DISH WASHING AND
LAUNDRY
USE OF RECHARGEABLE BATTERIES
DONATE USED CLOTHING
INSTALL FAUCET AERATORS
DO NOT BURN THE GARBAGE
USE OF SPRINKLER
TUNE-UP CARS
APPLYING MULCH AROUND
LANDSCAPES
RECYCLING
PATENTS AND INTELLECTUAL
PROPERTY
THIS PRINCIPLE SHOULD TAKE CENTRAL
PLACE IN SCIENTIFIC ENDEAVORS
BIOPIRACY AND FAIR BENEFITS OF
RESEARCH RESOURCES
ACTUALIZED THROUGH LONG-TERM
COMMITMENT OF ALL STAKEHOLDERS,
APPROPRIATE REVIEW AND SHARING OF
SCIENTIFIC KNOWLEDGE
ADDRESSING LOCAL NEEDS AND
CONCERNS
ANSWERS
CULTURAL PRE-COMPETENCE
ABLE TO DELIVER CULTURALLY
APPROPRIATE AND SPECIFICALLY
TAILORED CARE TO PATIENTS WITH
DIVERSE VALUES, BELIEFS, AND
BEHAVIORS
PURIFIES AIR
CONSERVES WATER
CLEAN LAND
CLEAN LAND
CUTS WATER USAGE
CLEAN AIR
CONSERVES WATER
PROTECTS OZONE LAYER
CONSERVES WATER
CLEAN LAND
MODELS OF BENEFIT-SHARING
AGREEMENT
GLOBAL JUSTICE AS BASIS OF SCIENCE
AND SCIENTIFIC RESEARCH
MODELS OF BENEFIT-SHARING
AGREEMENT
GLOBAL JUSTICE AS BASIS OF SCIENCE
AND SCIENTIFIC RESEARCH
INTEGRATION OF CAPACITY-BUILDING
COMPONENTS TO EXTERNALLY FUNDED
RESEARCH
 QUESTIONS ANSWERS
UNESCO, IN ITS PRACTICAL AND THIS ETHICS OF FREEDOM HAS TO BE
THEORETICAL SEARCH FOR UNIVERSITY SATISFIED AND IS LIMITED TO
NORMS IN BIOETHICS, HAS DEVELOPED ACCOMPANY THIS INFINITE PROGRESS
A UNIVERSAL NORM THAT IS PERFECTLY OF FREEDOM; PROGRESS IN ITSELF IS
EXPRESSED IN ARTICLE 13 OF THE REGARDED AS BENEFICIAL AND
DECLARATION. WHICH OF THE LIBERATING, BUT ITS NEGATIVE
FOLLOWING STATEMENTS IS EFFECTS ARE IGNORED OR AT MOST
INCORRECT MANAGED IN A PRAGMATIC MANNER
IT HAS TO BE NOTED THAT AWARENESS
AND FORMULATION OF ARTICLE 13 OF
ETHICS IN GENERAL IS UNOPPOSED TO
THE DECLARATION IS THE APPROPRIATE
THE ETHICS OF FREEDOM THAT THE
EXPRESSION OF A GENERAL ETHICS OF
DOMINANT MODERNITY ALWAYS
FREEDOM — FREEDOM THAT IS
PORTRAYS AS AN ABSOLUTE POWER
PERSONIFIED, RELATED, OPEN BUT
ORIGINATING FROM ABOVE REALITY
RESPONSIBLE FOR ITSELF AND ITS LIFE
AND EVEN LIFE REALITIES, AND THAT IS
FORMS, OF THE REALITY OF NATURE
AT WORK IN THE SCIENCES AND
AND LIFE, OF ‘EVERYTHING’ IN WHICH IT
TECHNOLOGIES
PARTICIPATES. WHICH OF THE
FOLLOWING IS INCORRECT
SOLIDARITY IS OFTEN CONSIDERED TO
BE OPPOSED TO INDIVIDUALISTIC
BEHAVIOUR AND CONTRASTED WITH
SELF-CENTERED INDIVIDUALISM, AS A
PARTICULAR AND SOCIAL CONCERN
TRUE
FOR VULNERABLE GROUPS IN MODERN
SOCIETIES, IN PARTICULAR THE
CHRONICALLY ILL, THE HANDICAPPED,
POLITICAL REFUGEES, IMMIGRANTS AND
THE HOMELESS
SHIFT TOWARDS MORE NON-PRIVATE
THE FOLLOWING ARE THREATS TO FINANCIAL RESPONSIBILITY AND
SOLIDARITY. WHICH IS INCORRECT INCREASING PRESSURE OF MARKET
IDEOLOGY
THE FORMULATION OF THE PRINCIPLE
OF SOLIDARITY AND COOPERATION HAS
BEEN IMPORTANT FOR THE
THIS WILL CONTRIBUTE TO MAKING
DECLARATION BECAUSE IT IS A
STATES TRANSPARENT AND MORE
COMPONENT OF THE CONCEPTUAL
READY TO PROMOTE INTERNATIONAL
FRAMEWORK OF PRINCIPLES AND
COOPERATION IN REGARD TO
PROCEDURES INTENDED TO ‘GUIDE
QUESTIONS, DECISIONS, SOLUTIONS
STATES IN THE FORMULATION OF THEIR
AND PROBLEMS OF PRESENT-DAY
LEGISLATION, POLICIES OR OTHER
BIOETHICS
INSTRUMENTS IN THE FIELD OF
BIOETHICS’. WHICH OF THE FOLLOWING
STATEMENTS IS CORRECT
 QUESTIONS ANSWERS
JUSTICE IS A MATTER OF OBLIGATION
FROM ONE FREE INDIVIDUAL TO
RELATIONSHIP OF SOLIDARITY,
ANOTHER; IT IS BASED ON THE SHARED
AUTONOMY AND JUSTICE. WHICH OF
INTEREST OF PRESERVING THE
THE FOLLOWING IS INCORRECT
REQUISITE AMOUNT OF FREEDOM FOR
ALL CITIZENS
A PRIVATE DOCTOR WHO ALWAYS JOINS
WHICH OF THE FOLLOWING BEST A MEDICAL MISSION IN THE BARANGAY
PORTRAYS SOLIDARITY HE BELONGS, RAIN OR SHINE, WITH OR
WITHOUT PAY
IN THE SECOND OUTLINE OF A TEXT,
WHICH OF THE FOLLOWING IS CORRECT
THIS HAS NOT ESSENTIALLY CHANGED,
IN THE EVOLUTION OF THE ARTICLE 13:
ALTHOUGH THE NUMBER OF GENERAL
SOLIDARITY AND COOPERATION
PRINCIPLES HAS INCREASED TO FIVE
IN THE MOVIE INVICTUS, WHICH OF THE
WHEN THE WHOLE COUNTRY WATCHED
FOLLOWING SCENES BEST PORTRAYS
THE GAME
SOLIDARITY
PROTECTION OF VULNERABLE
POPULATIONS INCLUDE THE AFFLUENT MINORITY
FOLLOWING, EXCEPT
RESEARCH HOSTING PROTOCOLS
SHOULD FOLLOW STANDARD OF CARE
IN INTERNATIONAL HEALTH RESEARCH. SUPPORT AFFLUENT MINORITY
WHICH OF THE FOLLOWING IS FALSE IN
THE ETHICAL FRAMEWORK GUIDE
STATEMENT 1: SOCIAL
RESPONSIBILITIES IN THE PRIVATE
SECTOR AND INDUSTRY HAVE AN
ETHICAL RESPONSIBILITY TO PROMOTE
THE 1ST STATEMENT IS INCORRECT AND
THE INTERESTS OF THE SOCIETY
2ND STATEMENT IS CORRECT
STATEMENT 2: THE RESPONSIBILITY
OUGHT TO BE SHARED IN ACCORDANCE
WITH RELEVANT PRINCIPLES OF
JUSTICE AND FAIRNESS
DOHA DECLARATION ON THE TRIPS PATENTS AND INTELLECTUAL
AGREEMENT AND PUBLIC HEALTH PROPERTY
PEOPLE FROM DIFFERENT CULTURES
SHARE SOME MORAL RULES IN
COMMON BUT ARE NOT IMPLEMENTED
THE SAME WAY IN THEIR RESPECTIVE
PRINCIPLE OF NON-MALEFICENCE
CULTURES, THESE MORAL RULES ARE
THEMSELVES LIKENED TO THE
UNIVERSAL ETHICAL PRINCIPLES
TAUGHT IN BIOETHICS. “DO NOT KILL”
 QUESTIONS ANSWERS
PEOPLE FROM DIFFERENT CULTURES
SHARE SOME MORAL RULES IN
COMMON BUT ARE NOT IMPLEMENTED
THE SAME WAY IN THEIR RESPECTIVE
CULTURES, THESE MORAL RULES ARE PRINCIPLE OF BENEFICENCE
THEMSELVES LIKENED TO THE
UNIVERSAL ETHICAL PRINCIPLES
TAUGHT IN BIOETHICS. “RESCUE
PERSONS WHO ARE IN DANGER”
THE PRINCIPLE OF NON-MALEFICENCE
REQUIRES BOTH RESPECTFUL
TREATMENT IN DISCLOSING
INFORMATION AND ACTIONS THAT BOTH STATEMENTS ARE INCORRECT
FOSTER GOOD DECISION MAKING;
FURTHERMORE IT ENSURES
UNDERSTANDING AND VOLUNTARINESS
PEOPLE FROM DIFFERENT CULTURES
SHARE SOME MORAL RULES IN
COMMON BUT ARE NOT IMPLEMENTED
THE SAME WAY IN THEIR RESPECTIVE
CULTURES, THESE MORAL RULES ARE PRINCIPLE OF AUTONOMY
THEMSELVES LIKENED TO THE
UNIVERSAL ETHICAL PRINCIPLES
TAUGHT IN BIOETHICS. “TELL THE
TRUTH”
THE PRINCIPLE OF BENEFICENCE IS ALL
ABOUT RESPECTING THE DECISION-
THE 1ST STATEMENT IS INCORRECT AND
MAKING CAPACITIES OF PATIENTS; AND
2ND STATEMENT IS CORRECT
ENCOURAGES ONE TO DO AND
PROMOTE GOOD
PARTICIPANTS SHOULD BENEFIT FROM
PROHIBITION OF USING IMPROPER
THE RESEARCH AND SHOULD NOT
INDUCEMENTS TO PARTICIPATE IN
COMPROMISE THEM FROM THEIR
RESEARCH
INFORMED CONSENT AND AUTONOMY
WHEN MANAGING COMPLEX OR
PROBLEMATIC CASES IN BIOETHICS,
THESE FOUR ETHICAL PRINCIPLES CAN THE 1ST STATEMENT IS CORRECT AND
BE USED. IT HELPS TO BROADEN THE 2ND STATEMENT IS INCORRECT
SCOPE OF DEALING WITH THE PROBLEM
THUS MAKING THE SOLUTION DOABLE
THE UNIVERSAL DECLARATION ON THE
INTERNATIONAL INSTRUMENTS ON
HUMAN GENOME AND HUMAN RIGHTS IS
BENEFIT SHARING
AN EXAMPLE OF THE FOLLOWING
 QUESTIONS ANSWERS
THIS SECTION EXAMINES THE ETHICAL
ISSUES INVOLVED AND SOME OF THE
MEASURES THAT HAVE BEEN OFFERED ORGAN TRANSPLANTATION
TO CURB UNETHICAL AND ILLEGAL
PRACTICES
THE PHYSICIANS’ ACTS OF BALANCING
AND SPECIFYING ETHICAL PRINCIPLES
POLITICAL WILL
OFTEN INVOLVE THE FOLLOWING
EXCEPT
IMPROVING HEALTH SYSTEMS BY INTEGRATION OF CAPACITY-BUILDING
STRENGTHENING LOCAL HEALTH COMPONENTS TO EXTERNALLY FUNDED
RESEARCH CAPACITIES RESEARCH AND OTHER INITIATIVES
RESPONSIBILITY TO PROMOTE THE
INTERESTS OF THE SOCIETY
INDUSTRY
REGARDLESS OF THE NATURE OF THE
PRODUCTS THEY PRODUCE
SOCIAL RESPONSIBILITY:
STATEMENT 1: ACCESS TO HEALTH
CARE AND ESSENTIAL MEDICINES BOTH STATEMENTS ARE CORRECT
STATEMENT 2: REDUCTION OF POVERTY
AND ILLITERACY
THE HUMAN GENOME IS PART OF THE BIOPIRACY AND FAIR-SHARING OF
COMMON HERITAGE OF HUMANITY BENEFITS OF RESEARCH RESOURCES
THE PRINCIPLE OF JUSTICE IS ALL
ABOUT FAIRNESS IN THE DISTRIBUTION
THE 1ST STATEMENT IS CORRECT AND
OF BENEFITS AND RISKS; THIS CALLS
2ND STATEMENT IS INCORRECT
FOR A FAIR HEALTH CARE SYSTEM THAT
WILL BENEFIT THE RICH
THIS DISEASE REQUIRES THE
HIV/AIDS PANDEMIC
ELIMINATION OF POVERTY
THE WIDE DISPARITIES IN THE
PROVISION OF HEALTHCARE
EQUALITY AND JUSTICE
EXPERIENCED GLOBALLY GIVE RISE TO
QUESTIONS OF
IN THE PRINCIPLE OF AUTONOMY, A
NEGATIVE OBLIGATION MEANS NO
OPTIONS OFFERED COME DECISION
MAKING TIME; WHEREAS A POSITIVE BOTH STATEMENTS ARE CORRECT
ACTION, ENCOURAGES ACTIONS THAT
FOSTER AUTONOMOUS DECISION
MAKING
DUTIES OF MEDICAL PRACTITIONERS:
WHICH AMONG THE FOLLOWING IS THIS HEALTH SECTOR
RESPONSIBILITY
 QUESTIONS ANSWERS
MORE THAN HALF OF THE DEPRIVED
POPULATION OF THE POOREST ESSENTIAL DRUGS
REGIONS OF AFRICA AND ASIA HAS NO HEALTH SERVICES
ACCESS TO WHICH OF THE FOLLOWING
A FAMILY PHYSICIAN OPERATING ON A
WHICH OF THE FOLLOWING IS
PATIENT WITH APPENDECTOMY UNDER
ASSOCIATED WITH SOLIDARITY AND
THE SUPERVISION OF AN
COOPERATION
ANESTHESIOLOGIST
WHEN A NEIGHBOR GAVE YOU HIS
SPARE USED DOOR BUT IN RETURN
EXPECTS YOU TO GIVE HIM YOUR
RECIPROCAL SOLIDARITY
BICYCLE. WHICH OF THE FOLLOWING
TYPES OF SOLIDARITY BECAUSE
DESCRIBES THE SITUATION
WHEN UNIVERSAL BIOETHICAL
PRINCIPLES ARE NOT APPLICABLE IN
SOME CULTURES, MORALITY IS
CONSIDERED AS REFLECTIVE TO THE
ETHICAL RELATIVISM
COMMUNITY WITHIN WHICH AN
INDIVIDUAL LIVES AND THE MANNER IN
WHICH THE INDIVIDUAL WAS BROUGHT
UP
IT REPRESENTS “THE MANY
RESPONSIBILITIES, ASPIRATIONS,
IDEALISM, ATTITUDES, AND
SENSITIVITIES THAT COME FROM MORALITY
CULTURAL TRADITIONS, RELIGIOUS
TRADITIONS, PROFESSIONAL PRACTICE,
INSTITUTIONAL RULES AND THE LIKE”
THE LESS “RECOGNIZABLE”
MANIFESTATIONS OF
GENDER
MULTICULTURALISM ARE THE
FOLLOWING EXCEPT
THE AWARENESS THAT OTHER
CULTURES EXISTS WILL GENERATE
MORE INTEREST TO SEEK KNOWLEDGE; BOTH STATEMENTS ARE CORRECT
AND WILL FURTHER BE STRENGTHENED
THRU CROSS-CULTURAL ENCOUNTERS
BE MORE SENSITIVE TO LANGUAGE
TO FURTHER CULTIVATE
BARRIERS
“MULTICULTURALISM” IN OURSELVES AS
BE MORE SENSITIVE TO PERSONAL
HEALTHCARE GIVERS, ONE MUST SHOW
HEALTH BELIEFS AND PRACTICES
MORE SENSITIVITY TO THE FOLLOWING
BE MORE SENSITIVE TO DIETARY
FACTORS
CULTURE
 QUESTIONS ANSWERS
PEOPLE FROM DIFFERENT CULTURES
SHARE SOME MORAL RULES IN
COMMON BUT ARE NOT IMPLEMENTED
THE SAME WAY IN THEIR RESPECTIVE
PRINCIPLE OF JUSTICE
CULTURES, THESE MORAL RULES ARE
THEMSELVES LIKENED TO THE
UNIVERSAL ETHICAL PRINCIPLES
TAUGHT IN BIOETHICS. “DO NOT STEAL”
EXCEPT FOR ONE, THE FOLLOWING
PRINCIPLES ARE ADVISED FOR HEALTH WE HAVE TO UNDERSTAND THAT
PROVIDES TO AVOID CULTURAL CULTURE IS HOMOGENOUS
STEREOTYPING
PRINCIPLE OF SOLIDARITY IN EQUAL ACCESS TO HEALTHCARE,
UNIVERSAL HEALTH CARE YOUNG AND OLD, MEN AND WOMEN
THE EUROPEAN BIOETHICS SCHOLAR’S
CONTENTION THAT WESTERN
BIOETHICAL PRINCIPLES CANNOT BE
APPLIED TO THEM AS WELL AS WITH
DEVELOPING COUNTRIES CAME UP WITH
FOUR ETHICAL PRINCIPLES
SPECIFICALLY SUITED FOR MANAGING INVIOLABILITY
PROBLEMATIC CASES OF BIOMEDICINE
WITH THE PRINCIPLE OF AUTONOMY AS
THE ONLY COMMON DENOMINATOR. THE
FOLLOWING LISTED BELOW ARE THE
THREE REMAINING EUROPEAN
PRINCIPLES EXCEPT
THE MORE “RECOGNIZABLE”
MANIFESTATIONS OF
AGE
MULTICULTURALISM ARE THE
FOLLOWING EXCEPT
IT IS THE RECOGNITION AND
ACKNOWLEDGMENT THAT SOCIETY IS
PLURALISTIC. RELATIVE TO THE FIRST
STATEMENT, IT IS THE ACCEPTANCE
THAT ASIDE FROM THE DOMINANT MULTICULTURALISM
CULTURE, THERE EXISTS MANY OTHER
CULTURES BASED AROUND ETHNICITY,
SEXUAL ORIENTATION, GEOGRAPHY,
RELIGION, GENDER, AND CLASS
THE PRINCIPLES DO NOT PROMOTE
ONE OF THE FOLLOWING STATEMENTS
RESPECT AND JUSTICE IN MEDICINE
IS FALSE REGARDING THE STATEMENT
AND MEDICAL RESEARCH BUT CANNOT,
“BIOETHICAL CONCERNS ARE GLOBAL,
IN FACT, CAUSE REAL HARM TO
BUT BIOETHICS IS WESTERN”
PERSONS
 QUESTIONS ANSWERS
A RESIDENT DOCTOR JOINED ANOTHER
WHICH OF THE FOLLOWING SITUATIONS
TEAM BECAUSE OF LACK OF
EXHIBIT THE PRINCIPLE OF SOLIDARITY
MANPOWER DURING THEIR TOUR OF
AND COOPERATION
DUTY
RITUALS ARE ASPECT OF PRESCRIBED
AND REPETITIVE FORMAL BEHAVIOR,
THAT ARE MORE SYMBOLIC THAN
HAVING TECHNOLOGICAL
CONSEQUENCES. ONE EXAMPLE OF A
RITUAL OF SOCIAL TRANSITION
TYPE OF RITUAL THAT MAY BE
DIFFERENT FROM ONE CULTURE TO
ANOTHER IS MOVING FROM A PHASE OF
BEING AN UNATTACHED ADULT TO A
MARRIED LIFE
AS HEALTHCARE PROVIDERS, WHEN
DEALING WITH CROSS-CULTURAL
TO HAVE AN IN-DEPTH KNOWLEDGE OF
PATIENT CARE, WE HAVE THE
EVERY CULTURE
OBLIGATION TO DO THE FOLLOWING
EXCEPT
IT’S THE BIRTHDAY OF THE DOCTOR AND
CELEBRATION WILL BE HELD AT SAN
RAFAEL RESORT IN BULACAN. ON THE YOU HAVE NO LEGAL OBLIGATION TO
WAY, HE PASSED BY AN ACCIDENT THAT THE VICTIM
NEEDS HELP. WHICH OF THE
FOLLOWING IS CORRECT
THE SOCIAL ASPECTS OF REACTION TO
SENSITIVITY ON CULTURE AND PAIN
PAIN BEHAVIORAL ATTITUDES AS
MEANS
SHAPED BY SOCIETY
IT IS THE ABILITY TO BE OPEN TO
LEARNING ABOUT AND ACCEPTANCE OF
DIFFERENT CULTURAL GROUPS. IT IS CULTURAL SENSITIVITY
ALSO ABOUT BEING TOLERANT OF
ANOTHER ACTION
IN SOME CULTURES, PARTICULARLY IN
ORIENTAL OR EASTERN COUNTRIES,
THE FAMILY EXPECTS TO BE INFORMED
BOTH STATEMENTS ARE CORRECT
OF BAD NEWS FIRST; THEN THE FAMILY
DECIDES WHETHER TO INFORM THE
PATIENT OR NOT
BY THE NUMBER OF RESEARCH A
HOW SHOULD A BIOPHARMACEUTICAL
DOCTOR HAS ON THAT PARTICULAR
COMPANY CHOOSE ITS SPEAKER
TOPIC
WHICH OF THE FOLLOWING IS TRUE CANNOT BE USED AS INAPPROPRIATE
ABOUT SAMPLES INDUCEMENT
 QUESTIONS ANSWERS
WHICH OF THE FOLLOWING ARE EDUCATIONAL TOOL FOR PATIENT AND
ACCEPTABLE AS GIFT DOCTORS
YOU ARE WORKING FOR MEDICAL
AFFAIRS IN A PHARMACEUTICAL
COMPANY AND OS TRYING TO REGISTER
A VEY IMPORTANT VACCINE, BUT THE
PAPER WORK HAS NOT BEEN MOVING.
INFORM THE HEAD OF COMPLIANCE IN
THEN SUDDENLY YOU HAVE NOTED
YOUR COMPANY
PAYMENTS IN CASH WITHOUT RECEIPT
FROM THE GOVERNMENT AGENCY AND
EVENTUALLY THE VACCINE WAS
REGISTERED FAST. WHAT SHOULD YOU
DO
GROUP ORIENTED RESPONSIBILITY TO
CARE FOR THE WEAKER AND MORE
HUMANITARIAN SOLIDARITY
VULNERABLE MEMBERS OF THE
COMMUNITY
GLOBALIZATION, MORE ANONYMOUS
APPROACH, AND LESS
CONNECTEDNESS WITH OTHER HUMAN TRUE
BEINGS IS ONE OF THE THREATS TO
SOLIDARITY
A VERY EXTRAVAGANT TRIP WAS GIVEN
TO DR. JOYCE IN RETURN FOR HER
PRESCRIPTIONS OF THE MEDICINE
INTEGRITY
FROM A CERTAIN DRUG COMPANY.
WHICH OF THE FOLLOWING PRINCIPLE
WAS VIOLATED
PHARMACEUTICAL COMPANY IS ASKING
DR. SISON TO DELIVER A LECTURE FOR
THEIR COMPANY. DR. SISON ASK FOR
CONTRACT FOR THE SPEAKING DECLINE IF THERE IS NO CONTRACT
ENGAGEMENT, AND NONE WAS
PROVIDED. WHAT SHOULD DR. SISON
DO?
YOUR NURSE IN THE CLINIC ACCEPTED
A GIFT BASKET FULL OF FOOD FROM A RESPECTFULLY TELL YOUR NURSE TO
MEDICAL REPRESENTATIVE. WHICH OF DECLINE
THE FOLLOWING IS TRUE
 QUESTIONS ANSWERS
ARTICLE 13 FORMULATING THE
PRINCIPLE OF SOLIDARITY AND
COOPERATION IS PART OF THE 15
ARTICLES IN THE DECLARATION THAT
ARE LISTED ON THE SECTION OF FALSE
PRINCIPLES. THESE PRINCIPLES ARE
NOT HIERARCHICAL AND ARE NOT
COMPLEMENTARY AND
INTERDEPENDENT
WHICH OF THE FOLLOWING TYPES OF
SOLIDARITY WHEREIN TRADITIONAL
SOCIETIES (HOMOGENEOUS AND
WITHOUT MUCH DIFFERENTIATION IN MECHANICAL SOLIDARITY
SOCIAL FUNCTIONS) SOLIDARITY RESTS
ON THE SOCIAL UNIFORMITY OF
BELIEFS, PRACTICES AND SENTIMENTS
IN MANY CASES, COMMON INTERESTS,
INTERDEPENDENCIES AND PERSONAL
RELATIONS STILL EXIST. ‘SOLIDARITY OF
STRANGERS’ IS POSSIBLE. MODERN FALSE
SOLIDARITY FUNCTIONS BETWEEN NON-
RELATED AND IMPERSONAL MEMBERS
OF A SOCIETY
APPROPRIATE MARKETING HELPS TO
ENSURE THAT MEDICINES ARE USED
INITIATING OFF-LABEL DISCUSSIONS
CORRECTLY FOR MAXIMUM PATIENT
THAT WILL BENEFIT PATIENTS
BENEFIT. THE FOLLOWING IS
APPROPRIATE MARKETING, EXCEPT
A TRIPARTITE CONTRACT WAS ENTERED
TO LAUNCH A NEW VACCINE, EACH
ORGANIZATION HAS A ROLE TO PLAY. INDEPENDENCE
WHICH OF THE FOLLOWING ETHICAL
PRINCIPLE SHOULD BE FOLLOWED
A MEDICAL REP MISINTERPRETED/
EXAGGERATED THE BENEFIT OF THE
INTEGRITY
DRUG. WHICH OF THE FOLLOWING
PRINCIPLE WAS VIOLATED
A DOCTOR WAS INVITED TO A
SYMPOSIUM, AFTER WHICH A “RAFFLE”
WAS CONDUCTED AS A “THANK YOU”
FOR THE ATTENDANCE. YOU WON AN
IF IT HAS NO OBLIGATION TO
IPHONE 12 PRO. THIS WILL CERTAINLY
PRESCRIBE MEDICATION
COME IN VERY USEFUL FOR YOU AS A
DOCTOR, THE UNIT HAS BETTER APP
FUNCTION, TO GUIDE PATIENT CARE.
WILL YOU ACCEPT THE PRIZE
 QUESTIONS ANSWERS
SOLIDARITY IS OFTEN CONSIDERED TO
BE OPPOSED TO INDIVIDUALISTIC
BEHAVIOUR AND CONTRASTED WITH
SELF-CENTERED INDIVIDUALISM, AS A
PERSONAL AND SOCIAL CONCERN FOR
TRUE
VULNERABLE GROUPS IN MODERN
SOCIETIES, IN PARTICULAR THE
CHRONICALLY ILL, THE HANDICAPPED,
POLITICAL REFUGEES, IMMIGRANTS AND
THE HOMELESS
WHAT REFERENCE CAN YOU USE WHEN
FACED WITH A VALUES AND ETHICS
MEXICO PRINCIPLES
PROBLEM RELATED TO DEALINGS WITH
PHARMACEUTICAL INDUSTRY
JARED A SALES REP IS GIVING AWAY A
PROMOTIONAL MATERIAL FOR HIS IT MUST BE UP TO DATE AND WELL
MEDICATIONS. WHICH OF THE BALANCED
FOLLOWING IS TRUE REGARDING THIS
IT HAS TO BE NOTED THAT THIS
AWARENESS AND ITS FORMULATION IN
ARTICLE13 OF THE DECLARATION IS THE
APPROPRIATE EXPRESSION OF A
GENERAL ETHICS OF FREEDOM -
CLOSED
FREEDOM THAT IS _______ FOR ITSELF
AND ITS LIFE FORMS, OF THE REALITY
OF NATURE AND LIFE, OF ‘EVERYTHING’
IN WHICH IT PARTICIPATES. WHICH OF
THE FOLLOWING IS INCORRECT
ACCORDING TO THE MEXICO PRINCIPLE,
DO NOT COMPROMISE OR APPEAR TO
THE ACCEPTANCE OF GIFTS,
COMPROMISE IN ANY WAY THE
HOSPITALITY, AND OTHER BENEFITS IS
INTEGRITY OF PUBLIC SERVICE
PERMISSIBLE IF THEY
THE GENERAL FRAMEWORK OF ETHICS THE FIRST ONE IS FREEDOM OF ACTION
WITH TWO DIFFERENT LEVELS. WHICH WITHIN NATIONS, THE SECOND ONE IS
OF THE FOLLOWING IS CORRECT COOPERATION BETWEEN NATIONS
WHICH OF THE FOLLOWING TYPES OF
SOLIDARITY WHERE DIFFERENTIATION
AND DIVERSIFICATION OF FUNCTIONS
AND TASKS CREATE RELATIONS OF
ORGANIC SOLIDARITY
INTERDEPENDENCE BETWEEN
INDIVIDUALS. DIVISION OF LABOUR AND
STRUCTURAL INTERDEPENDENCE
REQUIRE NEW RULES OF COOPERATION
ADVERSE DRUG REACTION SHOULD BE
REPORTED BY COMPANIES TO WHAT FDA
AGENCY
 QUESTIONS ANSWERS
HUMAN BEINGS HAVE MORAL DUTIES
ANTHROPOCENTRIC
ONLY TOWARDS ONE ANOTHER
A CHANGE IN PATTERNS OF
WHICH AMONG THE FOLLOWING IS A
PRODUCTION AND CONSUMPTION IS
STRONG NOTION OF SUSTAINABILITY
NECESSARY
A MEDICAL REPRESENTATIVE WAS NOT
TRAINED WELL IN THE PRODUCT
INTEGRITY
MONOGRAM. WHICH OF THE FOLLOWING
ETHICAL PRINCIPLE WAS VIOLATED
WHICH AMONG THE FOLLOWING USE OF INJUDICIOUS USE OF ANTIBIOTICS
ANTIBIOTICS WILL HAVE A SERIOUS TREATING VIRAL INFECTIONS
IMPACT TO FUTURE GENERATIONS TAKING INCOMPLETE DOSES
NATURE AS A WHOLE IS A ‘MORAL
ECOCENTRIC
PATIENT’
THE PRESENT GENERATIONS HAVE THE
WHICH AMONG THE FOLLOWING IS RESPONSIBILITY TO BEQUEATH TO
STATED IN THE 1992 RIO DECLARATION FUTURE GENERATIONS AN EARTH THAT
ON ENVIRONMENT AND DEVELOPMENT WILL NOT ONE DAY BE IRREVERSIBLY
DAMAGED BY HUMAN ACTIVITY
NOTION OF SUSTAINABILITY IS SEEN IN
SOLAR FARM
WHICH OF THE FOLLOWING
WHAT PRINCIPLE IMPLIES THAT THE
ACTIVITIES OF PRESENT GENERATIONS
ARE LIMITED BY THE OBLIGATION TO
INTERGENERATIONAL JUSTICE
TAKE INTO ACCOUNT AND SAFEGUARD
THE DEVELOPMENT AND NEEDS OF
FUTURE GENERATIONS
WHAT DOES SUSTAINABLE TO MEET THE NEEDS OF THE PRESENT
DEVELOPMENT MEAN AND OF FUTURE GENERATIONS
WHICH AMONG THE FOLLOWING IS THE FARMLANDS CONVERTED TO
BASIS OF ECONOMIC GROWTH INDUSTRIAL LANDS
THE MAIN GOAL OF MEXICO PRINCIPLE
IS TO BENEFIT WHICH OF THE BIOPHARMACEUTICAL SECTOR
FOLLOWING
WHEN YOU THINK OF NATURAL
RESOURCES AS IT BELONG TO ALL
HUMANITY AND SHOULD BE AVAILABLE
FOR EVERYONE’S USE AND BENEFIT SUSTAINABLE DEVELOPMENT
WITH THE FUTURE GENERATION ALSO IN
MIND, YOU ARE CONCERNED ABOUT
THIS CONCEPT
 QUESTIONS ANSWERS
WHAT SHOULD A DOCTOR DO WHEN HE
WORKS FOR THE GOVERNMENT AND HE
HE IS AN EXPERT, HE IS BEST TO DECIDE
IS FACED WITH A DECISION, WHERE HE
HAS A CONFLICT OF INTEREST
ACCORDING TO PRECAUTIONARY
WE CANNOT AFFORD TO WAIT FOR A
PRINCIPLE, WHERE THERE’S A THREAT
HIGH DEGREE OF PROOF BEFORE
TO HEALTH OR THE ENVIRONMENT THAT
ACTING TO PREVENT DAMAGE
IS SERIOUS AND IMMINENT
THIS IS AN EXAMPLE OF KEEPING THE MAKE PLANT POTS OUT OF OLD
LAND CLEAN CLOTHES
THIS WILL RESOLVE THE ISSUE ON HOW
CREATION OF COMMISSION FOR FUTURE
THE FUTURE CAN BE REPRESENTED IN
GENERATION
PRESENT DECISION-MAKING
THIS PRINCIPLE CLAIMS THAT “WHERE A
THREAT TO HEALTH OR THE
ENVIRONMENT IS SERIOUS AND
PRECAUTIONARY PRINCIPLE
IMMINENT, WE CANNOT AFFORD TO WAIT
FOR A HIGH DEGREE OF PROOF BEFORE
ACTING TO PREVENT DAMAGE”
A SUBDIVISION CONTRACTOR PROVIDED
GREEN SPACES IN HIS DEVELOPMENT
SUSTAINABLE DEVELOPMENT
PLAN. THIS IS AN APPLICATION OF
WHICH CONCEPT
A MULTINATIONAL COMPANY WISHES TO
LAUNCH A MEDICINE IN THE
PHILIPPINES. IT FIRST APPLIES FOR
PRODUCT REGISTRATION UNDER FDA
LEGITIMATE INTENT
AND SUBMITS COMPLETE AND NEEDED
REQUIREMENTS. WHICH OF THE
FOLLOWING ETHICAL PRINCIPLE
DESCRIBE THIS
AWARENESS OF THE FINITUDE AND
FRAGILITY OF THE EARTH
WHAT ARE THE FACTORS RESPONSIBLE
TECHNOLOGY HAS AN IMPACT TO THE
FOR THE CONTEMPORARY SENSIBILITY
LIVES OF THE FUTURE GENERATIONS
TOWARDS FUTURE GENERATIONS
WHAT HAPPENS AT PRESENT WILL
IMPACT THE FUTURE GENERATIONS
ETHICAL METHODOLOGIES INCLUDE
ANTHROPOCENTRIC
UTILITARIANISM AND DEONTOLOGY
A PHARMACEUTICAL COMPANY WANTS
TO DO A CLINICAL TRIAL. THIS WAS
REPORTED TO NIH AND FDA. WHICH OF TRANSPARENCY
THE FOLLOWING ETHICAL PRINCIPLES
BEST DESCRIBE THIS
 JEREMIAH 29:11
“FOR I KNOW THE
PLANS I HAVE FOR
YOU”, DECLARES
THE LORD,
“PLANS TO
PROSPER AND
NOT TO HARM
YOU, PLANS TO
GIVE YOU HOPE
AND A FUTURE .”