BIOETHICS

Health Care Ethics
(Bioethics)
Module #1 Student Activity Sheet
Name: _________________________________________________________________ Class number: _______
Section: ____________ Schedule: ________________________________________ Date: ________________
Lesson Title: Obligations of a Professional Materials:
Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Enumerate the four essential characteristics of a profession
and identify and define what is Health Ethics; References:
2. Differentiate the sanctions associated with inappropriate
legal, ethical and professional etiquette conduct; and, Ethics of Health Care: A Guide for Clinical
3. Identify and describe the principles and misunderstandings Practice Fourth Edition, Raymond S. Edge, J.
regarding the nature of law; and list and explain the steps of Randall Groves
a lawsuit.
A. LESSON PREVIEW/REVIEW
Your classroom instructor for this subject, Health Care Ethics is ________________________. Listed below are the
additional information vital in orientation:
B. MAIN LESSON
Allied Health
THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1

Health Care Ethics
(Bioethics)
 Twentieth century: over 200 specialties added to health care team

 Provides over 80% of direct patient care
 Combines science and technology with patient care
Essential Characteristics of a Profession

 Competence in specialized body of knowledge and skill
 Provision of particular service to society
 Standards of education and practice
 Self-regulation
Legal Practice Act

 Outlines activities providers perform in delivery of patient care
 Develops code of ethics to assist in self-regulation
 Outlines profession’s mission and objectives
Specialty Practice Acts

 Scope of professional practice
 Requirements and qualifications for licensure or certification
 Exemptions to basic requirements.
 Grounds for administrative actions
 Penalties and sanctions for unauthorized practice
Sanctions for Lapse in Ethical, Legal, and Professional Etiquette

Ethical conduct – right or wrong?
Sanction: loss of professional reputation, loss of professional affiliations
Legal requirements – legal or illegal?

Sanction: punishment as prescribed by law
Professional etiquette – proper or improper?

Sanction: loss of professional respect and fellowship
Professional Etiquette
• Avoid talking badly about another practitioner (especially in front of patients)
• Maintain appropriate relationships at the worksite
• Stay within role boundaries of your specialty
• Rules of etiquette help maintain order and civility
Health Care Ethics
- Ethical questions: values, morals, individual culture, intense personal beliefs, and faith
- Ethics: how we make judgments in regard to right and wrong
The Foundation of Law
Law
 Body of rules of action or conduct prescribed by controlling authority; having bound legal force
 Minimum standard of expected performance between individuals in a society

Health Care Ethics
(Bioethics)
Common Law
Emanates from judicial decisions
Statutory Law
Arises from legislative bodies
Administrative Law
Flows from rules and regulations and decisions of administrative agencies
Fundamental Principles of Law

- Concern for justice and fairness
- Plasticity and change
- Acts judged on universal standard of reasonable person
- Doctrine of Individual Rights and Responsibilities
Misunderstandings about Nature of Law

- Law is incomplete and always growing
- There are areas of law where there are no previous legal rulings; growth and change occurs
- Wise to view the law as guide to proper behavior; mistake to confuse legal and ethical behavior
The Lawsuit
Plaintiff
- Person who brings an action in a court of law
Defendant
- Person against whom an action is brought
Prima facie
- legally sufficient to establish a case
Steps in a civil lawsuit:

 Complaint
 Answer
 Discovery
 Trial and Judgment
 Appeal
1. Complaint
 Plaintiff files complaint or petition with court that addresses elements of prima facie case
 Plaintiff has the burden of proof
 Defendant has period of time in which complaint must be answered
2. Answer
 Defendant three choices: (1) admit, (2) deny, or (3) plead ignorance to each allegation in complaint
 Filing an answer moves case into pre-trial phase
3. Discovery: fact-finding phase

 Interrogatories
 Document requests
 Depositions

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Health Care Ethics
(Bioethics)
4. Trial and Judgment

 Case tried before a judge only or before a judge and jury
 During the trial, each side presents witnesses and evidence collected is placed in record
 Jury’s decisions not put into effect until judge makes a judgment
5. Appeal
 Losing party may appeal a trial court decision to a higher court
Philippine judicial system consists of the following courts: Lower

Courts
1. Municipal Trial Courts and Municipal Circuit Trial Courts

2. Metropolitan Trial Courts and Municipal Trial Courts in Cities
3. Regional Trial Courts
4. Shari'a Courts
5. Court of Tax Appeals
6. Sandiganbayan
7. Court of Appeals
The Highest Court - Supreme Court

The Supreme Court is the highest Court in the Philippines
Appellate court is a trier of law

Arbitration: neutral third party of whom both sides have agreed will have power to decide outcome and render a binding
decision.
CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
1. Which of the following is NOT considered one of the four essential characteristics of a profession?
A. Competence in a specialized body of knowledge and skill
B. The provision of a particular service to society
C. Grounds for administrative actions
D. Standards of education and practice
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Specialty practice acts will vary in emphasis, but the majority will address which of the following?
A. Requirements and qualifications for licensure or certification
B. Penalties and sanctions for unauthorized practice
C. Scope of professional practice
D. All of these apply
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. In regard to clients and patients, practitioners have a(n) relationship which requires them to act primarily in the best

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Health Care Ethics
(Bioethics)
interest of those they serve.

A. Fiduciary
B. Proper
C. Formal
D. Formulaic
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. It is often the longest part of a lawsuit and, in many instances, ends the case when information is detrimental to one of
the sides.
A. Complaint
B. Answer
C. Discovery
D. Appeal
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. All but one is the fundamental principles of law?

A. Plasticity and change
B. Concern for justice and fairness
C. Acts are judge on the universal standard of the reasonable person
D. Patient’s Bill of Rights
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. It is one of the sources of modern law that emanates from judicial decisions.
A. Common Law
B. Administrative Law
C. Statutory law
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. This a person who brings an action in a court law.

A. Plaintiff
B. Defendant
C. Complaint
D. Answer
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
8. Which of the following is NOT a major element of discovery?

A. Investigation
B. Interrogatory
C. Document request
D. Deposition
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. This is the opportunity for each side to question witnesses and parties to a suit to elicit information about the case?
A. Arbitration
B. Appeal
C. Trial
D. Deposition
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. In the foundation of law, the use of the principle of stare decisis provides the system with needed stability, and yet it
has allowed for the creation of new principles as changing patterns of facts have emerged. Stare decisis means?
A. Legally sufficient to establish a case
B. Let the decision stand
C. Let the law prevail
D. Legal case
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
AL Activity: CAT: 3-2-1
Instructions:
1. As an exit ticket at the end of the class period
2. Record three things you learned from the lesson.
3. Next, two things that you found interesting and that you’d like to learn more about.
4. Then, record one question you still have about the lesson.
Three things you learned:

1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________
Two things that you’d like to learn more about:

Health Care Ethics
(Bioethics)
1. __________________________________________________________________________________
2. __________________________________________________________________________________
One question you still have:

1.___________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Human Value Development and the System of Materials:

Public Law
Pen, paper, index card, book, and class List
Learning Targets:
1. Understand the interaction of needs and behavior with References:
Abraham Maslow’s Hierarchy of needs;
2. List the three value development stages and value Ethics of Health Care: A Guide for Clinical
orientations of Kohlberg model; Practice Fourth Edition, Raymond S. Edge, J.
3. Outline the theoretical position of carol Gilligan and Randall Groves
Kohlberg found in her research; and,
4. Identify the 5 current generational value cohorts in term of
their major value shaping events.
Brain Teaser: Answer the questions below.
1. What are the steps in civil lawsuit?

 ___________________
 ___________________
 ___________________
 ___________________
 ___________________
2. What are the 3 basic sources for modern law and where did it originate or arises?
 _______________________________________________________________
 _______________________________________________________________
 _______________________________________________________________
B. MAIN LESSON
Value Development
 As humans we are born with a series of undifferentiated potentials. As an example, we have the capacity to learn a
language, but the language is not prescribed by our genetic heritage. In the same sense, humans have an innate
ability to acquire ethical beliefs. But the value system we develop is dependent on the cultural framework in which
we live in.
World view or value system

 An inner subjective set of feelings, attitudes, beliefs, and opinions
Maslow’s Hierarchy of Needs

1. Survival or Physiological (foods, shelter, water)
2. Safety (security like purchasing a weapon)
3. Belonging and Love (love, affection, intimacy, family, joining a club)
4. Prestige and Esteem (becoming president of the club)
5. Self-actualization (fulfillment of personal potential)

Health Care Ethics
(Bioethics)
According to Maslow’s Hierarchy of needs, feelings of isolation result in needs satisfying activities like joining a bowling
team. Under most situations, our actions are explainable using this model as we seem to satisfy a given set of needs. As
each need level is satisfied the needs of the next level become the dominant motivators of our actions. If hierarchy of
needs is correct, an observer who could determine what level of need you were operating on could predict the nature of
your next actions.
Hume’s Law
 Unbridgeable gap between fact and value; between “is” and “ought”
o Facts of physical universe can tell us what is
o Our values guide us to understanding what ought to be as it relates to our behavior
 Individuals’ experiences will shape the way these values will be considered in personal decision making.
 Difference between needs and values: Our needs tell us what “is” in a particular situation, for example we are broke
and find a wallet. Our needs may tell us to take the money in the wallet, whereas our values provide guidance
regarding what “ought” to be done as it relates to human behavior.
Value Development Models
Lawrence Kohlberg created a value development model with three stages and associated value orientation.
Development was intimately tied to the individual’s cognitive and psychomotor development. For Kohlberg, the highest
personal value for humans was equality, where the individual issues based on an internal set of personal principles or
rules.
Kohlberg’s Stage of Moral Reasoning
Preconventional (Age 3-7)

 Punishment/Obedience
 Egotism (satisfy one’s desires)-self-importance, self-centered, thinking that you are superior to others
Conventional (Age 7-12)

 Please others
 Respect rules
Postconventional (12 and above)

 Social contract- they believe that some laws are unjust and need to be change
 Personal conscience
Kohlberg concluded in his original research model that females were often found not to progress to the final
autonomous stage of value development (Post conventional level) but seemed arrested in the conventional level.
Females seem to reach plateau in value orientation based on pleasing others rather than being true to their own moral
compass.
Carol Gilligan argued that Kohlberg’s research methods flawed, and gender biased that’s why she made a separate
value development pathway for females results in different highest values for each sex. Personality responsibility for
female and legalistic equality for males.
And this was confirmed by profile developed by Isabel Myers and Katherine Briggs. According to Myers Briggs
instrument men and women score equally on the major dimensions. Except on decision making where men are
predominantly on “thinking” category more comfortable following rules, laws and “feeling” category for women decisions
are based on personal relationship and outcomes.

Health Care Ethics
(Bioethics)
Value Development Models

GENERATIONAL THEORY
 This theory popularized in the 1970s and 1980s by sociologist Morris Massey
 Historical time in which individual is born shapes development of their world view
 Value systems formed in first decade by families, friends, communities, significant events
 “Who You Are Is Where You Were When" this phrase used to explain value differences between the cohorts
Generational Cohorts and Core Values
Silent Generation (born 1929-1945)

 Great Depression and World War II
 Conformity, stability, security etc.
Baby Boomers (born 1946-1960s)

 Civil rights, moon landings, freedom riders, calls for change
 Thought as the “ME Generation”
 Personal and social expression, idealism, health, and wellness
Generation X (born 1968-1989)

 Programmed in an era of social change
 Free agency, independence, cynicism, strive for balance in their lives
Millennials (born mid 1980s-2000)

 Defined by events immediately following Cold War
 Collaboration, social activism, tolerance for diversity, globally aware
Generation Z (late 1990s-2025)

 Foreign wars, September 11th and other terrorist attacks, both overseas and on homeland
 Unsettled time; personal and fiscal insecurity
 Masters at multitasking, techno-savvy, personally tolerant regarding social and ethnic diversity, thrive on instant
gratification, fiscally pragmatic
 Unbridgeable gap between fact and value; between “is” and “ought”
o Facts of physical universe can tell us what is
o Our values guide us to understanding what ought to be as it relates to our behavior
 Individuals’ experiences will shape the way these values will be considered in personal decision making.
 Difference between needs and values: Our needs tell us what “is” in a particular situation, for example we are broke
and find a wallet. Our needs may tell us to take the money in the wallet, whereas our values provide guidance

Health Care Ethics
(Bioethics)
regarding what “ought” to be done as it relates to human behavior.

1. According to Kohlberg’s stage theory of moral reasoning, a child between the ages of 3 and characteristic of satisfying
his or her desires is operating at the stage?
A. Pre conventional
B. Conventional
C. Post conventional
D. Nonconventional
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Carol Gilligan believes that for females, the highest value consideration is based on _.
A. Pleasing others
B. Personal responsibility C.
D. Respect for rules
E. Legalistic equality
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. He is a humanist psychologist who is known for his work regarding the interaction of needs and behavior which the
Hierarchy of needs?
A. Aristotle
B. Abraham Maslow
C. Abraham Lincoln
D. Isabel Myers
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Who is the foremost theorist of value development?

A. Katherine Briggs and Isabel Myers
B. Maslow and Barrie
C. Kohlberg and Piaget
D. Aristotle and Maslow
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. In Kohlberg’s theory what stage does these following characteristics; social contract and personal conscience fall
under?
A. Nonconventional
B. Preconventional

Health Care Ethics
(Bioethics)
C. Conventional
D. Postconventional
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. What do you call a term between each generational group?

A. Space
B. Generational gap
C. Cusp
D. Overlap
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. These are constructs from generational theory, which holds that generation occupy a 20-year span of time?
A. Value cohorts
B. Need
C. Behavior
D. Attitude
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. The Generation Z is best described by which of the following characteristics?

A. Law and order
B. Techno savvy multitaskers
C. Social Activist
D. Street smart
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. He is a sociologist who popularized the phrase “Who You Are Is Where You Were When”?
A. Morris Johnson
B. Morris Massey
C. Carol Gilligan
D. Lawrence Kohlberg
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Which generation received its value programming by the events surrounding the Great Depression and World War 2?
A. Silent Generation
B. Baby Boomer Generation
C. Millennial Generation

Health Care Ethics
(Bioethics)
D. Generation X
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
AL Activity: Minute Paper
1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Human Value Development and the System of Materials:

Public Law Part 2
Learning Targets:
1. Understand world view, moral nihilism, ethical relativism and References:
hedonistic value system;
2. Explain why standpoint theory is important consideration Ethics of Health Care: A Guide for Clinical
in making value decision; Practice Fourth Edition, Raymond S. Edge, J.
3. Differentiate the private and public law Randall Groves
Brain Teaser: Identify what generational cohorts is being describe.
1. Born 1946-1960s
2. Masters at multitasking
3. Collaboration, social activism, tolerance for diversity, globally aware
4. Born in late 1990s-2025
5. Programmed in an era of social change
B. MAIN LESSON
World View and Public Law
World view-system of thoughts, feelings, opinions, and beliefs with which we screen events occurring around us Moral
nihilism
 There are no moral truths, moral rules, moral knowledge or responsibilities
 Heinous acts would not necessarily be wrong Ethical relativism
 All morality is relative to society in which one is brought up
 is the theory hold morality is relative to the norms of one’s culture? Whether action is right or wrong depends on
moral norms of the society
Acts considered ethically wrong regardless of cultural orientation:

 Rape-forcing someone on sexual activity
 Slavery- exhausting a person in labor
 Genocide- Deliberate killing of a large group of people those of a particular ethnic group
 Torture- inflicting severe pain on someone as punishment
 Sexism- is a prejudice or discrimination based on a person’s sex or gender but it primarily affects women and girls. It
is linked to gender roles and may include the belief that in sex or gender is intrinsically superior to another.
Hedonistic value systems
Is and ought the same; individual devoid of other-regarding impulses. For such an individual, the major guideposts for
decisions are desire and aversion and nothing can be right or wrong apart from them. Value associated with this world
view would include:

Health Care Ethics
(Bioethics)
 Power
 Self-preservation
 Self-aggrandizement
 Maneuverability
 Pleasure
 Security
Standpoint Theory
– Try to adopt or listen to standpoint of most marginalized and vulnerable persons involved
– One of the useful concepts that helps avoid the problems of self interest in deciding ethical issues.
The System of Public Law
Private Law
– Deals with relationships between citizen and citizen, or with definition, regulation, and enforcement of rights in
cases where both parties involved are private citizens
Public Law
– Deals with relationships between private parties and the government; concerned with the state in its political or
sovereign capacity:
 Constitutional
 Administrative
 Criminal
Public Law consists in the following forms:

 Constitution supreme law of the land; highest level of American law
 If any conflicts exist between federal and state laws, federal laws must govern
 Constitutional Law: national and state law that deals with organization, invested powers, and framework of
government
Statutory Law: Created by legislative bodies
– Health care providers practice and licensure acts

– Informed consent
– Peer review
– Good Samaritan Act
– Living will statute
– Competency determination
– Emergency medical services
Administrative Laws: rules, regulations, orders, and decisions created by administrative agencies to implement their
powers and duties
– Rulemaking, adjudication, or enforcement of specific regulatory agenda
Criminal Law: prohibits conduct injurious to public order and provides for punishment of those found to have engaged in
prohibited practices
– Felony: serious breach of law; punishable by death or imprisonment in state or federal penitentiary
– Misdemeanor: crime punishable by less than a year incarceration in jail or house of correction

Health Care Ethics
(Bioethics)
International Law
– Regulates relations of nations to each other
– Customs and usages, treatise, and decisions of tribunals such as International Court of Justice and International
Court of Human Rights

1. Those in society who believe that there are no moral truths, no moral rules, no moral knowledge and responsibilities
subscribe to a philosophy of moral.
A. Felony
B. Misdemeanor
C. Nihilism
D. Immunity
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The law that deals with the relationships between citizen to citizen is called?
A. Public Law
B. Private Law
C. Administrative Law
D. International Law
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Which of the following is NOT included in Unethical Acts according to most culture?
A. Procrastinating
B. Rape
C. Sexism
D. Genocide
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. This theory holds that one should always try to adopt or listen to the standpoint of the marginalized and vulnerable
person involved.
A. Generational theory
B. Moral reasoning theory
C. Standpoint theory
D. Kohlberg’s theory
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
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5. Crimes are divided by their seriousness and levels of punishment. A crime punishable by less than a year of
incarceration in a jail or house of correction is known as?
A. Felony
B. Misdemeanor
C. Kidnapping
D. Rape
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. These deals with relationships between private parties and the government; concerned with the state in its political or
sovereign capacity?
A. Private Law
B. Public Law
C. Tort
D. Contract Law
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. This term is unequal and harmful treatment based on gender?

A. Rape
B. Slavery
C. Sexism
D. Genocide
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. Human bondage is also known as?

A. Genocide
B. Slavery
C. Sexism
D. Torture
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. This theory believes that all morality is relative to society in which one is brought up?
A. Standpoint Theory
B. Ethical Relativism
C. Virtue ethics theory
D. Moral reasoning
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
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10. A system of thoughts, feelings, opinions, and beliefs with which we screen events occurring around us?
A. World view
B. Ethics
C. Values
D. Morals
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
AL Activity: Muddiest Point
In today’s session, what was least clear to you?

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
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Lesson Title: Decision Making in Value Issues and Private Law Materials:
1. List the theorist who are considered the fathers of
contemporary duty-oriented, consequence oriented, and References:
virtue ethics;
2. Outline the theoretical positions known as duty-oriented, Ethics of Health Care: A Guide for Clinical
consequence oriented, divine mandate and virtue ethics Practice Fourth Edition, Raymond S. Edge, J.
reasoning; Randall Groves
3. Differentiate between act and rule utilitarianism; and,
4. List the major criticisms of duty-oriented, consequence
oriented, divine mandate and virtue ethics systems.
Brain Teaser: You will be asked by your instructor some questions about the previous
topic.
B. MAIN LESSON
Value Confrontation
Values
– Tell us what is right and wrong, good, and evil
– Imply a preference to correct human behavior
– Attempt to be constructive, not destructive, over issues involving personal values
Essential Mental Attributes for Ethical Reasoning

1. Ethical humility- awareness of the limits of one’s own ethical insights
2. Ethical courage- willingness to assess fairly ideas, beliefs, and viewpoints differing from your own
3. Ethical empathy- willingness to attempt to understand the opinions of others and try to see the issue from their
position.
4. Ethical fair-mindedness- to hold one’s own beliefs and opinions to the same standard of proof and evidence that we
require for the opinions of others.
As professionals, it is necessary, even in our opposition, to attempt to be constructive, not destructive, in the methods we
use when we come to disagreements over issues involving personal values. When trying to come to mutual
understanding regarding value disagreements it is wise to follow J.M Barrie’s admonition “Never ascribe to an opponent
motive meaner than your own.”
Teleological (Consequence-oriented) Theories

– Judge rightness or wrongness of decisions based on outcomes or predicted outcomes
– The right thing to do is the good thing to do
Utilitarianism
– Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873) – Fathers of utilitarianism

Health Care Ethics
(Bioethics)
– The good resides in promotion of happiness or greatest net increase of pleasure over pain
– Happiness as higher-order pleasures: intellectual, aesthetic, and social enjoyments as defined by Stuart Mill
There are criticisms that this kind of reasoning might lead to situations in which group derives pleasure from the pain of
others:
– To overcome this objective or this criticism some consequentialist have required the principles of equal
consideration of interest
– Utilitarian theory uses when they seek to divide scarce resources such as health care.
Act Utilitarianism
– Decision based on possible alternatives for action
– Weighing each to amount of pleasure or utility it provides
– Selecting course of action that maximizes pleasure
Equal Consideration of Interest

– Individual not allowed to increase his share of happiness at expense of another
– One ought to act to produce greatest balance of happiness over unhappiness, everyone considered
Consequence-Oriented Reasoning
Criticisms of Utilitarianism
– Calculation of all possible consequences of our actions, or inactions, appears impossible
– May be used to sanction unfairness and violation of rights
– Not sensitive to agent-relativity of duty
– Does not seem to give enough respect to persons
– Justifiable to prevent others from doing what we believe to be harmful acts to themselves
– Does not provide basis for our own moral attitudes and presuppositions
Rule Utilitarianism
– Action deemed to be right if it conforms to a rule validated by the principle of utility
– Principle of utility: rule brings about positive results when generalized to variety of situations
Deontological (Duty-Oriented) Theories
Duty-oriented Theories
– Basic rightness or wrongness of act depends on its intrinsic nature rather than on situation or consequences
– Act right or wrong; it could not be both
Immanuel Kant (1724–1804)

– Morality derived from rationality, not from experience

Health Care Ethics
(Bioethics)
– Based his moral philosophy on the crucial fact that we are rational beings, and a central feature of this rationality
was that principles derived from reason are universal.
– Obligation grounded in pure reason
Categorical imperative: do not admit exceptions
Imperative
– Command derived from a principle
– Maxim understood as universal law
3 elements
– Universal application (i.e., binding on every individual)
– Unconditionality
– Demanding an action
Categorical imperative - an action is known to be right when it was in accordance with rule that satisfied a principle.
Duty-Oriented Reasoning
Criticisms of Kant
– Too rigid for real life
– Morality cannot be derived from pure reason
– Disregard of consequences of our actions can lead to disastrous results
– Even though nonhuman animals feel pain and pleasure, they do not have independent moral standing since
they are not rational beings
– Possible to be faced with a conflict between two duties equally supported by an imperative
Contract Theory of John Rawls

– Individual in social situation requiring value choice without knowing role he was playing in situation
– Individual would choose alternative that best supported or favored most disadvantaged person
– Secure basic liberties for all

Health Care Ethics
(Bioethics)
1. The most common form of consequence-oriented reasoning is known as?

A. Divine command theory
B. Deontological theory
C. Utilitarianism
D. Virtue ethics
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Held that morality Is derived from rationality, not from experience, and obligation is grounded in pure reason.
A. Jeremy Bentham
B. Immanuel Kant
C. John Stuart Mill
D. Aristotle
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Utilitarianism is a form of what type of reasoning?

A. Consequence-oriented
B. Duty oriented
C. Virtue ethics
D. Divine mandate
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. For the ethicist, the basic wrongness of an act depends on the intrinsic nature of the act itself?
A. Consequence-oriented
B. Duty oriented
C. Virtue ethics
D. Divine mandate
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Is a form of utilitarianism that holds that an action can be deemed to be right if it conforms to a rule that has been
validated by the principle of utility.
A. Act of utilitarianism
B. Rule of utilitarianism
C. Kantian ethics
D. Ethics of care
Answer: ________

Health Care Ethics
(Bioethics)
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. The “categorical imperative is part of __ ethics.

A. Duty oriented
B. Virtue
B. Kantian
C. Consequence oriented
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. “Groundwork of the Metaphysic of Morals “is the classic work of?

A. Immanuel Kant
B. John Rawls
C. Lawrence Kohlberg
D. Aristotle
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. In the principle of categorical imperative, the imperatives seem to have three elements, which of the following is NOT
part of the elements?
A. Demanding action
B. Unconditionality
C. Golden Rule
D. Universal application
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. A Scottish author that quoted “Never ascribe to an opponent motive meaner than your own.”
A. Immanuel Kant
B. J.M Barrie
C. John Rawls
D. Morris Massey
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Who are considered the Fathers of Utilitarianism?

A. Jeremy Bentham and John Stuart Mill
B. J.M Barrie and John Rawls
C. Morris Massey and J.M Barrie
D. Mahatma Gandhi and Aristotle
Answer: ________

Health Care Ethics
(Bioethics)
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
AL Activity: Formative Assessment
This strategy focuses on the assessment of your learnings after a lesson. You must answer the following questions, as
honest as possible, based on your own understanding.
1. What specific part of the Main Lesson for this session do you find the most confusing?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________
2. What makes your answer in #1 confusing? What is the question in your mind?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________
3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Decision Making in Value Issues and Private Law Materials:
Part 2
Learning Targets:
1. List three of the virtues that are used in problem solving References:
using the Ethics of Care;
2. Identify the two basic types of Private Law; Ethics of Health Care: A Guide for Clinical
3. Differentiate assault to battery and libel to slander; and, Practice Fourth Edition, Raymond S. Edge, J.
4. Define res ipsa loquitor and respondent superior. Randall Groves
Brain Teaser: Assume that you made a medication error and want to decide whether you need to tell someone about
the error. Create a series of steps you would use in making the decision, using the following forms of ethical reasoning:
utilitarianism and Kantian.
Utilitarianism:
a. _________________________________________________________
b. _________________________________________________________
c. _________________________________________________________
d. _________________________________________________________
Kantian:
a. _________________________________________________________
b. _________________________________________________________
c. _________________________________________________________
d. _________________________________________________________
B. MAIN LESSON
Value Ethics
 Focus on characteristics, traits, or virtues a good person should have
 Personal character and moral habit development rather than a particular action
Aristotle’s Traits of a Virtuous Character

 Virtuous acts must be chosen for their own sakes
 Choice must proceed from firm and unchangeable character
 Virtue is a disposition to choose the mean
Virtue- oriented Reasoning

Health Care Ethics
(Bioethics)
Divine being set down finite series of rules that adherents claim can provide guidance to most, if not all, moral decisions
 Judeo-Christian Ten Commandments
 Buddhism’s Four Noble Truths and Eight-Fold Pat
Private Law
 Recognition and enforcement of rights and duties of private citizens and organizations
 Two basic types are tort and contract law
Tort action
 Existence of legal duty from defendant to plaintiff
 Breach of that duty
 Damages which are a proximate result
Tort Categories
 Negligent torts
 Intentional torts
 Liability assessed irrespective of fault
Negligence
 Unintentional commission or omission of act a person would or would not do under same or similar circumstances
Common forms of negligence

1. Malfeasance: execution of unlawful or improper act
2. Misfeasance: improper performance of act that leads to injury
3. Nonfeasance: failure to perform an act, when there is a duty to act
4. Criminal negligence: reckless disregard for safety of another
Intentional Torts in Health Care Practice:

1. Assault- no physical contact, verbally cursing or threatening someone
2. Battery- offensive touching and bodily injury
Defamation of Character
1. Libel- written defamation, harmed reputation of others
2. Slander- spoken or oral defamation
3. False imprisonment- illegal confinement against individual against his or her violates confined individual right to
be free from constraint.
4. Invasion of privacy- in health care we only need to know the information centered on patient care.if its not for
health care reason for examining patient’s record

1. The question, “How should I carry out my life if I am to live well,” is representative of which of the following theoretical
positions?
A. Duty-oriented
B. Consequence- oriented

Health Care Ethics
(Bioethics)
C. Virtue ethics reasoning

D. Utilitarianism
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. All of the following are elements of a torte, EXCEPT:

A. The existence of a legal duty owing from plaintiff to defendant
B. A breach of duty owing from defendant to plaintiff
C. The existence of a legal duty owing from defendant to plaintiff
D. Damages as a result of a breach of duty
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. To sustain a claim of negligence, all of the following must be in place EXCEPT:

A. Duty
B. Dereliction of duty
C. Direct cause
D. Due process
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. A written violation of a patient’s right to privacy that may result in a charge of defamation of character being filed against
a health care provider is termed .
A. Libel
B. Slander
C. Assault
D. Nonfeasance
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. This means “let the master answer”.

A. Res ipsa loquitor
B. Respondeat superior
C. Parens patriae
D. Stare decisis
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Which of the following is a form of intentional torts that have an implication to heath care setting?
A. Libel
B. Slander

Health Care Ethics
(Bioethics)
C. Invasion of privacy
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. This is the unintentional commission or omission of an act that a reasonably prudent person would or would not do
under the same or similar circumstances.
A. Battery
B. Libel
C. Negligence
D. Slander
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. It is the execution of an unlawful or improper act?

A. Malfeasance
B. Misfeasance
C. Nonfeasance
D. Slander
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. The fourth type of theory is usually used in ethical debate. This theory believes that a divine being who has set down a
finite series rules that adherents claim can provide guidance to most?
A. Duty oriented
B. Consequence oriented
C. Divine theory
D. Virtue ethics
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Aristotle’s traits of virtuous character include which of the following?

A. Choice must proceed from a firm character
B. Virtue is a disposition to choose the mean
C. Virtuous acts must be chosen for their own sakes.
D. All of these
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP

Health Care Ethics
(Bioethics)
Instructions:

1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________

1. __________________________________________________________________________________
2. __________________________________________________________________________________

1.___________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Basic Principles of Health Care and the Nature of Materials:
Rights in Ethical Discourse
Learning Targets:
1. Identify the applications of the basic principles of health care References:
ethics in our ethical codes;
2. Define the basic principle found in health care ethics; Ethics of Health Care: A Guide for Clinical
3. Understand the historical background of rights; Practice Fourth Edition, Raymond S. Edge, J.
4. Explain how rights and their attendant correlative obligations Randall Groves
are grounded in the same overarching principles and rules.
Brain Teaser: Answer the questions below:
1. A competent elderly tells you,” I want to go home.” You respond with, “We won’t let you go home; you’re not capable
of taking care of yourself.” You may have just created the elements for what tort?
ANSWER: :_______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_
2. The patient tells you, “I don’t want the treatment.” You respond with, “Your doctor ordered the treatment and told me
to make sure you take it, even If I have to hold you down.” You may have just created the elements of what tort?
ANSWER: :_______________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_
B. MAIN LESSON
Basic Ethical Principles
Determine right and wrong regarding:

 Autonomy
 Veracity
 Confidentiality
 Beneficence
 Nonmaleficence
 Justice
 Role fidelity
Hierarchy of thinking regarding biomedical ethics: proceed from general worldview to universal principles, to rules and
codes, to decisions

Health Care Ethics
(Bioethics)
UNIVERSAL PRINCIPLES
 Autonomy
 Form of personal liberty
 Ability to decide
 Power to act on your decisions
Respect for the individual autonomy of other

--- Self-determination often used synonymously with autonomy
 Informed consent- derived from basic principles of autonomy

o Legal exceptions: under therapeutic privilege and implied consent
 Paternalism: intentional limitation of autonomy of one person by another
 Health care professionals fiduciary relationship with patients
1. Veracity
- Binds both health practitioner and patient in an association of truth
- Harm to patient autonomy and potential loss of practitioner credibility makes lying to patients a practice to be
avoided
2. Beneficence
- Acts of mercy and charity
- Any action that benefits another
Hippocratic Oath: physician will “apply measures for the benefit of the sick”
3. Non-malefiecnce
- One ought not to inflict evil or harm
Beneficence
- One ought to prevent evil or harm
- One ought to remove evil or harm
- One ought to do or promote good
Nonmaleficence
- Principle of double effect: secondary effects may be foreseen but can never be intended outcomes.
E.g., administering morphine for pain, ethically prescribe but the analgesics suppresses respiration
- Under what circumstances can one act morally when some of the foreseeable effects of that action are harmful?
Principles of Double Effect (Guiding Elements)

 Course chosen must be good or at least morally neutral
 Good must not follow because of secondary harmful effects
 Harm must never be intended but merely tolerated as casually connected with good intended
 Good must outweigh harm
4. Confidentiality
- American Hospital Association’s The Patient Care Partnership: Understanding Expectations, Rights
and Responsibilities
- Outline of current state of practice with regard to individual’s right to privacy in health care

Health Care Ethics
(Bioethics)
5. Justice
- Procedural justice or due process: disputes between individuals
- Distributive justice: distribution of scarce resources
- Compensatory justice: individuals seek compensation for a wrong that has been done
6. Role Fidelity
- Modern health care is the practice of a team
- Allied health over 100 individual professions
- Ethics of health care require practitioner practice faithfully within constraints of role
- Prescribed by scope of practice of state legislation
Rights
- Entitlements, interests, powers, claims, needs
- If one possesses a right, one need not feel gratitude to others for its possession
- In moral philosophy and political theory thought of as justified claims
- A right creates obligation in others to behave in a certain way
- Symbolic language of covenants, charters, manifestos, and conventions
- Expressions of hope for future of humanity
- Not meant to outline a reality grounded in law or claims that can be enforced
Right to Health Care?

- Many claim health care as a human right. Is it?
- And if it is, where would such a right come from, and who has obligation to provide it?
- Health care as a right difficult to define
- Is it a positive or recipient, right?
Historical Background of Rights Reasoning

 Natural Rights
– Equated to the law of God such as Golden Rule
 Natural Liberties
– Universal moral rights exist prior to and independent of guarantees of social contract or
institutionalized government
– Negative rights: obligate others from interference
 Human Rights
– All humans equally separated from beasts of the field and are unique unto themselves
– Positive rights: basic needs we all share, recognize, and respect as a person’s just due
– Basic truths understood and known by human reason alone not dependent on outside dictates
 Traditions of Natural Law

– Humans possess rational nature as a gift from God
– Natural laws are not dependent on social contract
– Natural laws are unchangeable and universal
– Inability to effect natural rights does not distinguish them
– Natural laws discovered even without knowledge of God

Health Care Ethics
(Bioethics)
Contractarian and Consequentialist Rights Theory

 John Stuart Mill
– Duties of perfect obligation: inherent within them assigned correlative rights
– Duties of imperfect obligation: do not give birth to any right
– Moral rights: backed up by force of law or public opinion
 Contractarian Theory
– Force or mechanism for selection of correct principles is agreement or bargain reached by initial agents
– Moral agents come to initial situation and bargain to a choice
 Hobbesian Model
– Those living in the state of nature do not come to the table as equals
– Only law of self-preservation existed
– World where strong and ruthless armed with force and fraud are only ones allowed to come to
bargaining table
 John Rawls
– Original position: all individuals are free and equal
– Veil of ignorance denies each agents’ knowledge of who is to receive rights to goods and services
– Seen in the fair opportunity rule
Fair Opportunity Rule

 Contractarians
– Individual rights grounded in principle of justice and collective choice
– Collective choice forms basis of morality
 Original Position
- Posited concept of moral right to equal concern and respect
- Rights existed prior to collective choice procedure

1.The principle that deals with the need to tell the truth.
A. Beneficence
B. Veracity
C. Confidentiality
D. Role fidelity
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The legal principle of a right to privacy is matched to the ethical principle of .

A. Confidentiality
B. Justice
C. Veracity
D. Nonmaleficence

Health Care Ethics
(Bioethics)
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. The use of placebos is most problematic when you are considering the principle of .
A. Veracity
B. Beneficence
C. Role fidelity
D. Maleficence
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The famous admonition “If you can’t do the patient good, at least avoid harm,” speaks of the two important principles of
beneficence and .
A. Confidentiality
B. Justice
C. Veracity
D. Non maleficence
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. “Nurses should practice nursing and allied health specialist should only practice within their specialty areas” is an
application of the basic principle of .
A. Veracity
B. Beneficence
C. Role fidelity
D. Maleficence
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. When one person has a right, others have obligations to either refrain from hindrance or provide the required goods
and services associated with the right. What type of obligation is this?
A. Imperfect obligation
B. Perfect obligation
C. Correlative obligation
D. Personal obligation
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Perhaps the most famous moralized contractarian theory of rights that includes the concept of an original position
comes from the work of .
A. John Locke

Health Care Ethics
(Bioethics)
B. John Stuart Mill

C. John Rawls
D. Thomas Aquinas
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. What rights are generally equated to the law of God?

A. Artificial Rights
B. Natural Rights
C. Legal Rights
D. Moral Rights
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. We have different Golden rules across religions, what religion has its golden rule which says “Hurt not others which you
would find hurtful?”
A. Buddhism
B. Brahmanism
C. Islam
D. Taoism
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. He is an English philosopher where in his model he assumes that the state of nature was a state of social chaos, and
that the origins of law, which are simultaneous with those of morality, are in social contract.
A. John Rawls
B. John Locke
C. Thomas Aquinas
D. Thomas Hobbes
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Basic Principles of Health Care and the Nature of Materials:
Rights in Ethical Discourse Part 2
Learning Targets:
1. Define what Legal right is; References:
2. Differentiate moral rights and legal rights; and,
3. Identify problems regarding Rights. Ethics of Health Care: A Guide for Clinical
Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves
Brain Teaser: You will be asked to answer the following questions.
1. What do you understand about the fair opportunity fair?

2. Who is Thomas Hobbes?
3. What do you mean by natural rights?
B. MAIN LESSON
Legal Rights
 Not only asserted as moral prerogatives but afforded governmental guarantees
 Created through constitutional guarantees, legislative statutes, judicial review, governmental agencies
 Easier to put into place laws that protect negative rights
Characteristics of a Legal Person

 Persons can be injured
 Persons can be thought to have interests
 Persons can be benefited
 Legal rights often used to reaffirm moral rights, do not necessarily coincide
Moral and Legal Rights

 Universal
 Moral rights provide equality among humans
 Moral rights not product of human creativity, but are inherent to our species
The Problem of Rights

 Multiplication of claims to personal rights
 Human imagination and creativity can create more claims to rights than we could possibly honor

1. “Right to bear arms” are example under what kind of legal right?
A. Human rights
B. Personal right
C. Negative rights

Health Care Ethics
(Bioethics)
D. Positive rights
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Which of the following characteristics are commonly attributed to a legal person?

A. Person can be benefitted
B. Person can be injured
C. Person can be thought to have interest
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. This be thought of as recipient or welfare rights as they require goods or service provided.
A. Positive rights
B. Negative rights
C. Human rights
D. Natural rights
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. A power, privilege, or immunity guaranteed under a constitution, statutes, or decisional law.

A. Legal Rights
B. Justice
C. Confidentiality
D. Natural rights
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Right to a public education is under what type of legal rights?

A. Natural Rights
B. Positive Rights
C. Negative Rights
D. Human Rights
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP

_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Confidentiality and the Management of Health Materials:

Care Information
Learning Targets:
1. Understand further what confidentiality all is about especially References:
in Health care;
2. Give five instances in which the practitioner would have a Ethics of Health Care: A Guide for Clinical
legal requirement to report confidential matters that relate Practice Fourth Edition, Raymond S. Edge, J.
to health care Randall Groves
3. Understand what human subjects are; and,
4. Identify the purpose of Institutional Review Board to human
subject.
1. What was our topic last meeting?

2. What are the characteristics of a legal person?
3. What are the common problems of rights?
B. MAIN LESSON
Confidentiality: A Principle with Qualifications

 Any breach of confidentiality is invasion of privacy
 Expectation of patient-provider relationship
 Arrived at and defended using the four systematic approaches to ethical decision making
Utilitarian
 Health care conducted under agreement of confidentiality
 Practitioners who breach trust in violation of agreed-on expectation
Duty-oriented
 Privacy viewed as person’s right
 Confidentiality is professional’s duty
Virtue ethics
 Patient confidentiality mainstay of health care practice
 Forms virtue from the “good practitioner”
 Emphasizes virtue of character and sense of honesty
 Protective privilege of confidentiality is limited where health and safety of others involved
 Harm principle: requires health care providers refrain from acts or omissions that would foreseeably result in harm
to others, especially in cases in which individuals vulnerable to the risk
Invasion of Privacy Tort Actions

 Misappropriation: deals with unpermitted use of a person’s name or likeness for another’s benefit or advantage
 Intrusion: involves intrusion upon another’s solitude or seclusion

Health Care Ethics
(Bioethics)
 Public disclosure of private facts involves publicity of objectionable nature of private information
 Presenting someone in a false light to the public involves publication of information that leads to the public
regarding the plaintiff falsely.
Common Legal Reporting Requirements

 Child abuse
 Drug abuse
 Communicable disease
 Births and deaths
 Injuries with guns or knives
 Blood transfusion reactions
 Poison and industrial accidents
 Misadministration of radioactive materials
Modern Health Care and Confidentiality

 Patients record accessible to physicians and technical and administrative staff who generate and handle patient
data
 Access to patient information exacerbated by use of computerized information systems
 Prior to enactment of HIPAA and the Privacy Rule there was no unifying federal privacy act for medical records
Health Insurance Portability and Accountability Act

 Encourage use of electronic transmission of health information
 Provide safeguards to protect security and confidentiality of the information
 Encourage use of electronic transmission of health information
 Provide safeguards to protect security and confidentiality of the information
 Protect and enhance rights of consumers by providing them access to their health information and controlling
inappropriate use of information
 Improve quality of healthcare in U.S. by restoring trust in health care system
 Improve efficiency and effectiveness of health care delivery by creating a national framework for health privacy
protection
 HIPAA rules affect virtually all health care records
DATA PRIVACY ACT- In 2012 the Philippines passed the Data Privacy Act 2012, comprehensive and strict privacy
legislation “to protect the fundamental human right of privacy, of communication while ensuring free flow of information to
promote innovation and growth.”
Medical Record
 Property of hospital or clinic
 Patient has legal interest and right to information
 Record is confidential
Medical Record Maintenance

 Access limited to patient, authorized representatives, attending physician, hospital staff members who have
legitimate interest
 If correction is significant, someone designated in facility’s policy should review correction to determine it meets
policy requirements
 Health care practitioners should only make changes within scope of practice for their specialty
 Draw single line to cross out incorrect entry, enter correction, error initialed and dated.
 Mistakes should not be erased or unreadable

Health Care Ethics
(Bioethics)
 If legal suit threatened, no changes in medical record without consulting risk management.
Human Subject Research

 Protocol that sets forth explicit objectives
 Formal procedures designed to reach objectives
Researchers may conduct both invasive and noninvasive procedures
Basic ethical principles in planning research protocol involving human subjects:

 Autonomy
 Beneficence
 Nonmaleficence
 Confidentiality
 Justice
Human subject research generally requires:

 Risks to subjects minimized by using procedures consistent with sound research design that do not unnecessarily
expose subjects to risk
 Risks to subjects reasonable in relation to anticipated benefits
 Selection of subjects is equitable Informed consent sought and appropriately documented from subject or
subject’s legal representative
 Provision for monitoring data collected to ensure safety of subjects
 Provision for protection of privacy and maintenance of confidentiality of collected data.
Institutional Review Boards

 Ensure satisfactory compliance with appropriate research standards
 Review research protocols prior to implementation
 To protect rights and welfare of human subjects
Research: systematic investigation designed to develop or contribute to generalizable knowledge

Human subjects: living individuals whom investigator conducting research obtains:
 Data through intervention or interaction with individual

1. Which of the following privacy issues usually deals with the unpermitted use of a person's name or likeness for
another’s benefit or advantage?
A. Slander
B. Libel
C. Misappropriation
D. Fraud
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The allowance of unessential or lay personnel to be present during a surgical procedure examination in a clinical is an
example of?
A. Slander

Health Care Ethics
(Bioethics)
B. Libel
C. Intrusion
D. Misappropriation
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. This usually involves the publication of information that leads to the public regarding the plaintiff falsely.
A. Public disclosure of facts
B. Intrusion
C. Misappropriation
D. Presenting someone in a false light to the public
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Invasion of privacy is a breach of what health care principle.

A. Beneficence
B. Maleficence
C. Confidentiality
D. Veracity
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. A review of the appropriateness of care and the various types of patient care provided within an institution.
A. Institutional Review Board
B. Utilization review
C. Privacy review
D. Third party payers
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. All but one is TRUE about a medical record?

A. Property of hospital or clinic
B. Patient has legal interest and right to information
C. Record is confidential
D. None of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. With regards to medical record maintenance, which of the following is NOT true?
A. Draw single line to cross out incorrect entry, enter correction, error initialed and dated
B. Mistakes should be erased or unreadable

Health Care Ethics
(Bioethics)
C. If legal suit threatened, no changes in medical record without consulting risk management
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
.
8. HIPAA has three self-declared major purposes which includes?

A. To protect and enhance the rights of consumers by providing them access to their health information and controlling
the inappropriate use of information.
B. Safeguards to protect the patient’s privacy will be part of the research protocol
C. Only those involved in the study will have access to the raw data
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. Basic ethical principles in planning research protocol involving human subjects include?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. All the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Which of the following is NOT considered a minimum standard set by institutional review boards?
A. Research results should be presented in such a fashion as to protect the anonymity of the patients.
B. Safeguards to protect the patient’s privacy will be part of the research protocol.
C. Any member of the public will have access to the raw data collected from the study.
D. The same level of obligation to maintain patient confidentiality in the practice of health care is expected in the conduct
of medical research.
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
_________________________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Justice and the Allocation of Scarce Resources. Materials:
1. Understand the difference between formal and material
justice; References:
2. Differentiate between micro- allocation and macro-
allocation as they relate to health care. Ethics of Health Care: A Guide for Clinical
3. Differentiate between the theoretical positions of Practice Fourth Edition, Raymond S. Edge, J.
utilitarianism, egalitarianism, and libertarianism as they Randall Groves
relate to distributive justice.
4. Identify the four general system in health care.
5. Compare the rationing systems: Prudent Person, Fair
Innings, and Natural Life Span.
Do patients with DNR orders belong in intensive care if there is a bed shortage? How would you make the decision as to
who stays and who goes? Would you use medical utility, social utility or egalitarian first come, first served?
Answer:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________
B. MAIN LESSON
Principle of Justice
 Equated to obligation to be fair in distribution of benefits and risks
 Maintenance of this principle simple in abstract and complex in application
 Reform of health care delivery, regarding equity and access to health care services, major issues
Formal Justice
 In distribution, equals must be treated equally, and unequal’s must be treated unequally
Material Justice
 Principles that specify relevant characteristics or morally relevant criteria regarding treatment are material
principles
Common methods for distribution of goods and resources:

 To each person an equal share
 To each person according to need
 To each person according to merit
 To each person according to contribution
 To each person according to effort
 To each person according to social worth

Health Care Ethics
(Bioethics)
Fair Opportunity Rule

 No persons granted social benefits on basis of undeserved advantage
 No persons denied social benefits on basis of undeserved disadvantages
Micro- and Macro-Allocation of Health Care
Macro-allocation
 Province of Congress, state legislatures, insurance companies, private foundations, and health
organizations
Micro-allocation
 More personal determination of who will receive scarce resources
Two-Tier System
 Everyone guaranteed coverage for basic care and catastrophic health needs
 Cultural and social barriers bar the way for many citizens to receive health care
Lifeboat Ethics
 Who shall be saved from drowning, and what will be the criteria for our selection?
Triage
 Allocating scarce resources practiced and justified in crises of war or disaster Micro-Allocation
Medical Utility
 Which patient has best prognosis?
 Often difficult to assess
Social Utility
Which patient has greatest social worth?
Invites problems of racism, ageism, sexism, bias against retarded and mentally ill
First Come, First Served

 Random selection treats all patients as equal
Theories of Justice
1. Egalitarian
2. Utilitarian
3. Libertarian
Egalitarian Theories
 Emphasize equal access to goods and services
 Advocates of a right to health care
 Socialistic universal access health care systems
Daniel’s Veiled Prudence

 Prudent planner does not know her age
 Prudent planner ignorant of her conception of the good
 Prudent planner guided by a time neutral concern for her well-being over the lifespan
 Prudent planner has to plan for each stage of her life under assumption she will live through it
Fair Innings Argument

Health Care Ethics
(Bioethics)
 Finite span of years considered reasonable lifetime

 Everyone equal chance to have a full set of fair innings, to reach appropriate life expectancy
 Injustice when one who has not had full opportunity to reach full allotment of innings
Utilitarian Theories
 Criteria so public utility is maximized
 Public utility: greatest good for greatest number
 Political planning and intervention methods of redistributing goods and wealth
 QALY: quality adjusted life years
– Measures cost-benefit of applying a medical procedure
Callahan Natural Life Span Argument
– After a person has lived normal life span, medical care no longer oriented to resisting death
– Medical care following natural life span limited to relief of suffering
– Technologies capable of extending life beyond normal life span create no technological imperative for its use
Libertarian Theories
– Emphasize personal rights to social and economic liberty
– Choice of allocation system freely chosen
– Free-market system operates on material principle of ability to pay
Health Care Crisis

 Society spends 17.4 percent of gross domestic product on health care
 $2.9 trillion or $9,255 per person
 Per capita medical costs increased 1,000 percent
 Aging population places great burden on stressed system
 Use of high technology in medicine
World Health Care Models

 Beverage Model
 Bismarck Model
 National Health Insurance
 Out of Pocket
Beverage Model
 Model originated in Great Britain
 Health care financed by government and taxed based rather than insurance based
 No medical bills; health care treatment public service
 Strong emphasis on primary care
 Costs controlled by rationing
 Long wait times for non-acute secondary and tertiary care
 Newest technologies not easily available
 Low costs per capita
 Government, as sole payer, controls what doctors can do and what they will charge
Bismarck Model
 Germany, France, Japan, Belgium, Switzerland
 Care providers and payer’s private entities
 Private not-for-profit health insurance (“sickness funds”) financed jointly by employees and employers through
payroll deductions
o Basically, charities and cover everybody

Health Care Ethics
(Bioethics)
National Health Insurance

 Canada, Australia, Taiwan, South Korea
 Health care provider’s private
 Payer is government-run insurance program all citizens pay into
 Insured residents entitled to same level of care
 No profit motive, no need to advertise, no expensive underwriting
 National system great leverage and market power to negotiate lower prices
Patient Protection and Affordable Care Act

 Law requires Americans to purchase health insurance
 Expands Medicaid rolls
 Establishes health-insurance exchanges to provide more competitive rates
 Provides subsidies to the poor and middle-class to assist them in purchasing a private plan
 Imposes billions in new taxes, mainly on the rich and health care industry
 Still most complicated, expensive, and inequitable health care system in developed nations
 Imposes billions in new taxes, mainly on the rich and health care industry
 Still most complicated, expensive, and inequitable health care system in developed nations
 National shortage of primary care physicians
 Disparity in reimbursement levels between Medicare and Medicaid
 Geography creates access maldistribution
The Quality Improvement Movement and Standard of Care

 Medical errors: top 10 causes of deaths
 Health care quality assessment top priority for health care providers
 Health care providers conform to specific standard of care to protect others.

1. The process of allocating scarce resources has been commonly practiced and justified in the crises of war or disaster?
A. Utilitarianism
B. Libertarianism
C. Triage
D. Social utility
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The allocation of scarce resources to those with the best prognosis.

A. Distributive justice
B. Libertarianism
C. Medical utility
D. Social utility
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
3. When it comes to allocation of resources the most common neutral system is?
A. First come, first served
B. Social utility
C. Medical utility
D. Lifeboat
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Which of the following is not included in common methods for distribution of goods and resources?
A. To each person an equal share
B. To each person according to need
C. To each person according to merit
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. This theory of justice emphasizes equal access to goods and services.

A. Libertarianism
B. Utilitarianism
C. Egalitarianism
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. This is a national health care program that primarily serves indigent populations.
A. Medicare
B. Medicaid
C. Micro-allocation
D. Macro-allocation
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. It is one of the general system models where generally health care providers are private but the payer is a government
run insurance program that all citizens pay into?
A. Bismarck Model
B. Beveridge Model
C. Out of pocket model
D. National Health Insurance Model
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
8. This major theory of justice using the free-market system operates on the material principle of ability to pay?
A. Libertarian
B. Utilitarian
C. Egalitarian
D. Distributive
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. In Egalitarian theories, Daniel’s uses a concept of veiled prudence. Veiled prudence consists of ignorance of four key
elements, which are?
A. The prudent planner does not know her age.
B. The prudent planner is guided by a time neutral concern for her well-being over the lifespan.
C. The prudent planner has to plan for each stage of her life under the assumption that she will live through.
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. In QALYs which is also known as Quality Adjusted Life Years, what score is associated if you are already dead?
A. 0
B. 1
C. 2
D. 3
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
Instructions:

1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________

Health Care Ethics
(Bioethics)

1. __________________________________________________________________________________
2. __________________________________________________________________________________

1.___________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Role Fidelity Materials:
1. List rationale for a profession’s creating a code of ethics;
2. Define disparagement, and state why it is a problem that is References:
to be avoided in health care practice; and,
3. State an ethically based rationale for discouraging conflict of Ethics of Health Care: A Guide for Clinical
interest in our practice; Practice Fourth Edition, Raymond S. Edge, J.
4. Explain an ethically based rationale for forbidding sexual Randall Groves
relations between patients and health care providers.
Brain Teaser: Students will be asked to answer the following questions.
Options:
A. Beverage Model
B. Bismarck Model
C. National Health Insurance
1. This health care model is of nonprofit motive, no need to advertise, no expensive underwriting.
Answer: _________________
2. Payer is government-run insurance program all citizens pay into.

Answer: _________________
3. Private not-for-profit health insurance (“sickness funds”) financed jointly by employees and employers through
payroll deductions
Answer: _________________
4. Health care financed by government and taxed based rather than insurance based
Answer: _________________
5. This health care model is used in Taiwan, Canada and Australia.

Answer: _________________
B. MAIN LESSON
Conflicts of Interest
Joint venturing
 Group of individuals join performing a business venture
 Any commercial relationship between practitioner and a company, in which practitioner has material interest that
could form basis for a conflict of interest, spelled out in a disclosure statement
Self-referral
 To self-refer to an establishment in which you do not provide service but have an economic interest is at least
suspect and perhaps unethical

Health Care Ethics
(Bioethics)
Sexual Misconduct in Health Care Practice

Sexual Relations
 Between practitioners and patients unethical
 Relationship between practitioner and patient always unequal
 Create emotional factors that interfere with therapeutic relationship and objective judgment
When practitioner feels potential for misunderstanding or mutual feelings of romantic interest, it is time to end
professional relationship
Scope of Practice
Role Fidelity
 Requires we remain within scope of clear legitimate practice
 One does not cross line without willful intention
Nurse-patient Relationship Models

 Bureaucratic model: emphasis on maintenance of social order at expense of individual patient’s welfare
 Physician advocate model: goal is to enhance authority of physician
Impaired Colleagues
 Impaired colleagues place clients at risk
 Behavioral difficulties: absenteeism, illogical decision making, excessive errors
 Question is not whether practitioner has a duty to intervene, but the manner of the intervention
 Health care provider must be confronted
 Made to seek effective assistance
 Treat impaired colleague humanely
Codes of Ethics and Professional Conduct
Codes of conduct and ethics include:

 Appropriate scope of practice
 Conflicts of interests
 Serving best interest of patients
 Obligations to promote patient autonomy and privacy
 Obligations beyond patients to others in society
 Ethics of research
 Informing on unethical or illegal behavior
Common Problems with Professional Codes

 Vagueness as to duties and prohibitions and self-regulation and peer enforcement
 Incompleteness as to duties
 Excessive concern with promotion and prestige of profession and financial and business interests
Gatekeeping
 One looks out for the interests of the profession or of others in a similar practice
 Result of professional obligations and training
 Strong sense of collegiality with others in practice
 Disparaging: talking ill of

Health Care Ethics
(Bioethics)
Gaming the System

 Practitioner attempting to get around the system
 Willing to lie in the process
 Often done on behalf of patient or at patient’s request
 Health care practitioners’ responsibility to be truthful, keep promises, be fair
 Lying undermines a person’s credibility
 If individual clinician found to be lying, can have harmful effect on entire health care profession
 Gaming can harm other patients

1. The physician assistant who certifies that an elderly patient with bunions needs a handicapped parking sticker, when in
fact the severity of the problem does not meet the standard for authorizing the sticker. What moral problem is involved in
this situation?
A. Disparagement
B. Gaming the system
C. Gatekeeping
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The common problems associated with professional codes are as follows EXCEPT?
A. Incompleteness as to duties
B. Vagueness as to duties and prohibitions
C. Excessive concern with prestige of profession
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. One looks out for the interest of the profession or of others in a similar practice is known as?
A. Disparagement
B. Gaming the system
C. Gatekeeping
D. Code of conduct
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Code of conducts and ethics include the following EXCEPT?

A. Serving best interest of patients
B. Ethics of research
C. Incompleteness to duties
D. Appropriate scope of practice

Health Care Ethics
(Bioethics)
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. What are the ways of a healthcare professional to avoid disparagement?

A. Offer professional courtesy to others
B. Avoid sexual and conflict of interest
C. Look after the welfare of the profession
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Which of the following statements about sexual misconduct is INCORRECT?

A. Between practitioners and patients unethical
B. Relationship between practitioner and patient always equal
C. When practitioner feels potential for misunderstanding or mutual feelings of romantic interest, it is time to end
professional relationship
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Sheryl is a respiratory therapy technician in a small town in Michigan. The town has a small hospital and a small
durable medical supply company. She is known locally as an entrepreneur ball of fire and has managed to become both
the head of the hospital respiratory care department and the owner of the small durable medical supply company. What
code of ethics and professional conduct best describe the scenario?
A. Role fidelity
B. Conflict of interest
C. Moral duty
D. Duty to treat
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. What universal principle requires remaining within the scope of legitimate practice. Scope of practice is clear, and one
does not cross the line without willful intention?
A. Justice
B. Autonomy
C. Role Fidelity
D. Veracity
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. The nature substance abuse is such that even fine practitioners begin to experience behavioral difficulties such as

Health Care Ethics
(Bioethics)
EXCEPT.
A. Behaves naturally
B. Absenteeism
C. Illogical decision making
D. Excessive error
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. An example of conflict of interest where a group of individuals join together to perform a business venture.
A. Self-referral
B. Business partners
C. Joint venturing
D. Stark law
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Role Fidelity Part 2 Materials:
1. Explain the difference between a moral duty and a moral
option regarding a duty to treat; References:
2. List three basic principles that underpin our need to be
sensitive to cultural difference between ourselves and our Ethics of Health Care: A Guide for Clinical
patients.; and, Practice Fourth Edition, Raymond S. Edge, J.
3. Identify common functions of ethics committees Randall Groves
1. A process in which a patient or the patient’s family is introduced to additional health resources in the community in
which the referring practitioner has a financial interest.
Answer: _________________
2. This principle stands for many things including dedication, loyalty, truthfulness, advocacy and fairness to patients.
Nurses are encouraged to keep their commitments, based on their virtue of caring. They should always be in line with
their practice.
Answer: _________________
3. What code of conduct is represented when a healthcare practitioner joins together performing business venture?
Answer: _________________
4. TRUE OR FALSE: It is none of our business if we saw a colleague who always comes to work drunk especially in his or
her night shift duty because that is of personal matter. Why?
Answer: _________________
B. MAIN LESSON
Health Care Provision in a Multicultural Society

 We are a nation of immigrants, a multicultural society, a universal nation, a pluralistic society
 We have competing ideas regarding basic issues such as the meaning of health and illness
 Most health care practitioners in the United States adhere to Western system of health care delivery
 Health care providers often not only ethnocentric but also xenophobic
 Culture shock: communication barrier raised; problem patient or uncommunicative one
ANA Committee on Ethics

Fundamental criteria for moral duty decisions:
 Patient at significant risk of harm, loss, or damage if practitioner does not assist
 Practitioner’s intervention or care directly relevant to preventing harm
 Practitioner’s care will probably prevent harm, loss, or damage to patient
 Benefit the patient will gain outweighs any harm practitioner might incur and does not present more than a minimal
risk to health care provider
 If practitioner answers yes to all four criteria, it is a moral duty to treat under principle of beneficence

Health Care Ethics
(Bioethics)
 If all criteria could not be answered with yes, the decision to treat would become a moral option rather than a duty
for the practitioner
Institutional Ethics Committee

 Interdisciplinary body of health care providers, community representatives, and nonmedical professionals
 Address ethical questions within health care institution, especially on care of patients
 Committees play advisory role
 Often multidisciplinary group
 Physicians, nurses, social workers, philosophers, laypersons, lawyers, administrators, religious leaders
 Ethical training increasing in health care programs

1. An interdisciplinary body of health care providers, community representatives, and non-medical professionals who
address ethical questions within the health care institution.
A. American Nurses Association
B. Institutional Ethics Committee
C. Joint Commission
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. An act or course of action that is required by one on the basis of moral position is termed.?
A. Role fidelity
B. Moral duty
C. Moral option
D. Morality
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. A high-stress situation in which one finds oneself in another culture in which former behavior patterns are ineffective
and one fails to understand the basic cues of social intercourse is termed .
A. Culture shock
B. Ethnocentrism
C. Culture bias
D. Racism
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The patient with a heart condition who is restricted to be. Although he is told to remain in bed and appears to
understand, he is found several times a day standing and gazing out his window. The patient, a devout Muslim who by
faith is required to pray several times a day facing in a particular direction, feels that the religious priority overcomes the
requirement of bedrest. What should you do if you are assigned to this patient?

Health Care Ethics
(Bioethics)
A. Report the patient for being uncooperative

B. Restraint the patient
C. Respect the patient’s cultural activity
ANSWER: C
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. It is the most devastating Ebola outbreak dates back in?

A. December 2013
B. March 2014
C. August 2015
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Reproductive Issues Materials:
1. Outline the distinction between “human” and “person,” and
the dispute regarding personhood criteria; References:
2. Describe the distinction between the quality of life and life
itself; Ethics of Health Care: A Guide for Clinical
3. List the basic facts of fetal development; and, Practice Fourth Edition, Raymond S. Edge, J.
4. Understand the religious arguments against abortion Randall Groves
What is culture shock and what is the effect of this in providing health care? Explain your answer.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
B. MAIN LESSON
The Abortion Issue

 Abortion statistics
– More than half of American women receiving abortions are in their 20s
– 17 percent of all U.S. abortions are teenagers
– 60 percent of women already have a child
– 37 percent have two or more children
– No racial or ethnic group makes up a majority of women having abortions
– 70 percent of women reported religious affiliation
– 40 percent of women with family incomes below federal poverty level
– 10 percent occur in second trimester
– 90 percent in first twelve weeks of pregnancy
– 60 percent occur in first eight weeks
 Abortion is a very common experience for women
 2012: 1.31 million abortions in United States
 Reasons diverse and complex
 Experience of abortion real, immediate, personal
 Americans evenly divided between pro-choice/pro-life positions
 Pro-choice advocates favor intact dilation and evacuation

 Pro-life advocates use term partial birth abortion
 Fewer than a thousand third-trimester abortions performed each year
The Legal Debate

1973: In Roe v. Wade, Supreme Court, legalized a woman’s right to have an abortion

Health Care Ethics
(Bioethics)
 Right not considered to be unrestricted

 Balanced the interests of the woman and the state
 Term person used only postnatally
 28th week: allowed state to shift to protection of fetus
1976: Danforth v. Planned Parenthood of Central Missouri

 Statutory provision required a woman to receive her husband’s, or if a minor, her parent’s or guardian’s, permission
prior to having abortion
 Court held requirements were unconstitutional
1976: Hyde amendment restricted availability of Medicare funding for abortions

 Modified to allow funding in which mother’s life threatened by carrying fetus full term or in cases of incest or rape
 It does primarily affect poor women
Webster v. Reproductive Health Services

Court held that a state could ban public employees and public health facilities from performing or assisting in performing
nontherapeutic abortions
 State legislatures in Northeast and West Coast have consistently supported abortion rights
 Legislatures in a number of states have passed restrictive laws designed to stop or slow process
 Main framework of Roe v. Wade still in place and is the law of the land
The Moral Issues

 Personhood
 Sanctity of life
 Quality of life
 Autonomy
 Mercy
 Freedom
 Social stability
The Two Positions

 Pro-life: anti-abortion, believes abortion is murder and should be stopped
 Pro-choice: believes decision to abort is one of personal liberty and should be legal
Sanctity of Life Argument

 Fetus is a live human
 Killing him or her is wrong
 Allow for a few exceptions
 Human life sacred on basis of divine mandate, unalienable natural or human rights, or common collective decision
 Genetic code argument
The Facts of Fetal Development

 Conceptus: union of sperm and egg
 Zygote: full genetic code will determine sex, hair color, skin color, and other attributes
 Embryo: zygote settles into uterine wall
 8 weeks: entity is a fetus
 Second trimester: fetus will have begun to move (quickening)

Health Care Ethics
(Bioethics)
 5th month: neurologically, fetus can feel pain

 6th month: fetus period of potential viability
 Third trimester: fetus develops minimal consciousness
 Birth occurs after nine months
 Infant completely dependent on mother
Killing and Self-Defense

 If someone is about to kill you, and the only way to save yourself is to kill the other person first, then killing is
permissible
 Doctrine of double effect: distinguish intended effect of an action from other, unintended effects
“Human” or “Person”?
Traits Central to Personhood
 Member of the moral community
 Consciousness of objects and events
 Ability to feel pain
 Reasoning
 Self-motivated activity
 Capacity to communicate
 Concept of the self
The Viability Argument

 Viability: characteristic of biological independence
 Some argue a fetus has standing only when it becomes viable outside the mother
 Some philosophers believe there is more to the abortion question than the issue of personhood
Method of Analogical Thought Experiments

 The Violinist Analogy
 The Rapidly Growing Child Analogy
 The Carpet-Seed Children Analogy
Women’s Liberty and the Priority of Life Plan

 Pro-choice: crucial a woman have control over her life plan in the way a man has control
 Pro-life: root of abortion problem is modern attitude toward sex
 Differing ideas concerning sexuality, one’s religious beliefs, or deeply held moral beliefs
 Pro-choice: crucial a woman have control over her life plan in the way a man has control
 Pro-life: root of abortion problem is modern attitude toward sex
 Differing ideas concerning sexuality, one’s religious beliefs, or deeply held moral beliefs
 Pro-life theorist:
 Will see the social problem as another manifestation of rampant immorality of modern age
 Considers element of autonomy in reproduction a matter of “convenience” than a life plan
Traditionalism vs. Modernism

Pro-life Activists
 Tend to be more traditional and religious
 Sex should be reserved for marriage
Pro-choice Activists
 Tend to be less traditional and religious

Health Care Ethics
(Bioethics)
 More career oriented with higher incomes

 Sex is a natural expression of oneself
Abortion and the Freedom of Religion

Pro-life Theorists
 Reject the idea their views on abortion are the result of their religious views
 They are result of basic moral reasoning
 Freedom of religion is not absolute
Pro-choice Theorists
 Reflect one’s most deeply held beliefs
 Even if views are not religious in the partisan sense, they are equally profound
 Best solution: tolerance

1. The position that abortion is murder and must be stopped is known as the position.
A. Sanctity of life
B. Viability
C. Pro-life
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. This is a widely accepted exception to the “thou shalt not kill” proscription.
A. Self defense
B. Abortion
C. Mercy Killing
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. This term is when the fetus begins to move, and the mother will be able to sense the movement at a point?
A. Conception
B. Quickening
C. `Viability
D. Conceptus
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Which of the following is NOT included in the list of traits central to personhood?
A. Reasoning
B. The ability to manage stress

Health Care Ethics
(Bioethics)
C. The ability to feel pain

D. A concept of the self
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Judith Thomson uses the method of analogical thought of experiment because she believes there is more to the
abortion question than issue of personhood. One of her analogy talks about faulty contraception which is?
A. Viability argument
B. The Violinist Analogy
C. The Rapidly Growing Analogy
D. The Carpet-Seed Analogy
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. They are known as the conservative traditionalist?

A. Pro-life activist
B. Pro-life theorist
C. Pro-choice activist
D. Pro-choice theorist
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. In the 1973 case, the Supreme Court of the United States, relying on the constitutional right of privacy, legalized a
woman’s right to have an abortion 1983
A. Doe v. Bolton
B. Planned Parenthood. Detroit
C. Roe v. Wade
D. Harris v. McRae
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. In this case of about abortion, Supreme Court examined a statutory provision that a woman required to receive her
husband’s permission prior having an abortion.
A. 1976 Danforth v.Planned Parenthood of Central Missouri case
B. Planned Parenthood. Detroit
C. Roe v. Wade
D. Harris v. McRae
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. This is the union of sperm and the ovum in the stage of human embryo development?

Health Care Ethics
(Bioethics)
A. Intercourse
B. Implantation
C. Embryo
D. Conception
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. The position that the decision to abort is one of personal liberty and thus should be legal is known as the position.
A. Pro-choice
B. Pro-life
C. Viability
D. Sanctity of life
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: Reproductive Issues Part 2 Materials:
1. Explain the process of In vitro fertilization and list the ethical
issues involved; References:
2. Understand the Family Planning Perspective; and,
3. Identify pro and con arguments for the issue of surrogacy. Ethics of Health Care: A Guide for Clinical
Randall Groves
Brain Teaser: Describe traditionalism in three words or sentences and modernism as well for you to be able to
differentiate them.
Traditionalism
Answers:
 ___________________________________________
 ___________________________________________
 ___________________________________________
Modernism
Answers:
 ___________________________________________
 ___________________________________________
 ___________________________________________
B. MAIN LESSON
The Environmental Perspective

• See humans as members of a biotic community
• Duty to maintain a balance of numbers with other members of that community
• Maintain and perhaps encourage use of abortion as a tool to control world population
• Aggressive attitude toward family planning
The Family Planning Perspective

• Asks why we should favor accidental babies over planned babies
• People should have the right to choose at what point they will have their children
• Pro-life perspective: family planning example of decadent culture of permissiveness
In Vitro Fertilization
• Eggs removed from a woman and fertilized in a laboratory dish (by husband or another man)
• Embryos implanted in a woman (donor or other woman), where egg brought to term
• Extra, or spare, embryos
• Implantation process may fail and be repeated
• Freezing of embryos
• Rating them for quality
• Discarding those that hold genetic defects

Health Care Ethics
(Bioethics)
• Thawing them and disposing of them

– What happens to excess embryos can be a moral dilemma and controversial
• Women could postpone pregnancy without risking infertility or diseases of pregnancy
• Identifying genetic abnormalities
• Embryonic tissue in medical research
– Embryo: mitochondria, cytoplasm, DNA of mother and father
• In Vitro Fertilization or IVF is a complex series of procedures used to treat fertility or genetic problems and assist
with the conception of a child.
• IVF is a type of assisted reproductive technology used for infertility treatment and gestational surrogacy, in which
a fertilized egg is implanted into a surrogate’s uterus, and the resulting child is genetically unrelated to the
surrogate. Some countries banned or otherwise regulate the availability of IVF treatment, giving rise to fertility
tourism. Restrictions on availability of IVF include costs and age to carry a healthy pregnancy to term. IVF is
mostly attempted if less invasive or expensive options have failed or are unlikely to work. IVF is a choice for
couples who are not able to conceive without assistance.
Surrogacy
• When a woman agrees to carry a baby to term and give it up to another set of parents to raise
• Sometimes done for money, sometimes as a favor
– Pregnancy a deeply personal experience that should never be undergone for the sake of others
– Very reason surrogacy supreme gift to another
• Kantians: surrogacy problematic since birth mother is being used as incubator and not regarded as a rational
actor
• Utilitarian: faced with very complicated utility calculations
• Well-accepted practice despite misgivings of some people

Health Care Ethics
(Bioethics)

1. The analogy titled “The Carpet-Seed Children Analogy” which attempts to deal with the issue of failed contraception is a
defense of abortion by?
A. Mary Anne Warren
B. Michael Tooley
C. Judith Thomson
D. Lydia Saad
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. When a woman agrees to carry a baby to term and give up to another parent is known as?
A. Surrogacy
B. Adoption
C. In vivo fertilization
D. Artificial Insemination
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. The most common ethical problems associated with the process of in vitro fertilization comes from what is to be done
with the unneeded.
A. Conceptus
B. Embryos
C. Egg
D. Sperm
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. In 1979, China introduced the to reduce the rate of their population growth.
A. Only boy child policy
B. Contraceptives policy
C. One child policy
D. No child policy
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. This is a procedure in which eggs are removed from a woman and fertilized in a laboratory dish?
A. Surrogacy
B. In vivo fertilization
C. Artificial Insemination

Health Care Ethics
(Bioethics)
D. In vitro fertilization
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Laws that single out the medical practices of doctors who provide abortions and impose on them requirements that are
different and more burdensome than those imposed on other medical practices are called laws.
A. Trap
B. Stark
C. Pro-life
D. Pro-choice
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Her birth received enormous press attention as the world was alerted to her birth. She was called the first “test tube
baby.”
A. Leslie Brown
B. Louise Brown
C. Karen Quinlan
D. Nancy Cruzan
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. It is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus.
A. Expulsion
B. Abortion
C. In vitro fertilization
D. Surrogacy
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9. He is the communist revolution that encouraged the population to multiply in China to increase available manpower.
A. Lao Tzu
B. Wo Bin
C. Mao Zedong
D. Kim Jong Ill
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. What year did Congress enact the Hyde amendment?

A. 1976
B. 1967

Health Care Ethics
(Bioethics)
C. 1986
D. 1968
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
Instructions:

1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________

1. __________________________________________________________________________________
2. __________________________________________________________________________________

1.___________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: The Human Organism Materials:
1. Differentiate between “life” as defined in either a biological
or biographical sense; References:
2. Define the concept and criteria of brain death; and,
3. Define PVS and state the characteristics of the syndrome. Ethics of Health Care: A Guide for Clinical
Randall Groves
Brain Teaser: Differentiate in Vitro Fertilization to surrogacy.
Traditionalism
Answers:
 ___________________________________________
 ___________________________________________
 ___________________________________________
Modernism
Answers:
 ___________________________________________
 ___________________________________________
 ___________________________________________
B. MAIN LESSON
What does "brain death" mean?
Brain death is a legal definition of death. It is the complete stopping of all brain function and cannot be reversed. It means
that, because of extreme and serious trauma or injury to the brain, the body's blood supply to the brain is blocked, and the
brain dies. Brain death is death. It is permanent.
The diagnosis of brain death is defined as "death based on the absence of all neurologic function." Families who have had
a loved one declared brain dead may have questions about what the term really means.
With the modern technology of respiratory and cardiac support, in certain cases of severe trauma we can keep the
remainder of the body’s cells alive for days and months with no brain activity being present.
Harvard medical School Brain Death Test

 Unreceptivity and unresponsiveness
 No movements or breathing
 No reflexes
 Flat E.E.G of confirmatory value
Persistent Vegetative States (PVS)

Health Care Ethics
(Bioethics)
The vegetative state is a chronic condition that preserves the ability to maintain blood pressure (BP), respiration, and
cardiac function, but not cognitive function. Hypothalamic and medullary brain stem functions remain intact to support
cardiorespiratory and autonomic functions and are sufficient for survival if medical and nursing care is adequate. The
cortex is severely damaged (eliminating cognitive function), but the reticular activating system (RAS) remains functional
(making wakefulness possible). Midbrain or pontine reflexes may or may not be present. Patients have no awareness of
self and interact with the environment only via reflexes. Seizure activity may be present but not be clinically evident.
Traditionally, a vegetative state that lasts > 1 month is considered to be a persistent vegetative state. However, a
diagnosis of persistent vegetative state does not imply permanent disability because in very rare cases (eg, after
traumatic brain injury), patients can improve, reaching a minimally conscious state or a higher level of consciousness.
KEYPOINTS
 No recognizable cognitive function
 Characterized by permanent eyes-open state of unconsciousness
 Patient is not comatose
 Patient is awake but unaware
 Irreversible loss of all neocortical function
 Brain stem functions remain
 Patients can breathe on their own
 Elicitable reflexes, spontaneous respirations, and reactions to external stimuli
 Recovery rather remote

1. When we speak of life in the sense of relationships, dreams, and expectations for the future, we are speaking of?
A. Biographical life
B. Biological life
C. Ordinary life
D. Extraordinary life
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. In which of the following cases did the New Jersey Supreme court rule that the state has no right to order respiratory
support to be continued?
A. Nancy Beth Cruzan
B. Baby Doe
C. Karen Ann Quinlan
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Criteria for brain death given by Harvard Medical School are which of the following?
A. No movements or breathing
B. Unresponsiveness
C. Flat EEG of confirmatory value

Health Care Ethics
(Bioethics)
D. All of the above

Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. In certain cases of brain trauma, we can keep the remainder of the body’s cells alive for days and months with no brain
activity present. This case is considered as.
A. Persistent Vegetative State
B. Brain Death
C. Bedridden
D. Brain Activity
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. This is characterized by a permanent eyes state of consciousness with no recognizable cognitive function:
A. Persistent Vegetative State
B. Brain Death
C. Bedridden
D. Brain Activity
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
Lesson Title: The Human Organism Part 2 Materials:
1. Explain the difference between the “ordinary” and
“extraordinary” care; References:
2. Outline the arguments for personhood criteria and state how
they could be uses in withdrawing care determination; and, Ethics of Health Care: A Guide for Clinical
3. Understand the purpose of advance directives.. Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves
Brain Teaser: Find the 4 words that describe biological life and 4 words that describe biographical life.
E S E C N E I R E P X E E A E I C X Y
K H F C D O B E B E R P X E F S V N L
G H J K L W M R B C X S P T Q E H G D
F D S A E H E A R T B E A T I I L P P
Q D G H Y A D D F U I P R O L R T A E
F K N V T E U X D E X R G X F O B B R
M E M H A B C H U I P O I U A M Q D S
J E I S X O A D Z Q N W D R P E L I M
Y N M J J K T N X S A G E F L M D H S
G N B O J L I V I N T H K L Y A Q W X
E D U C R T O I O N Q Z X Y W O K G D
F L L I V I N G T H I N G S D G S L V
L E E W S F A V N M K Y Y G F I L O P
O I T E L I M I N A T I O N N M I L E
B. MAIN LESSON
Ordinary and Extraordinary Care

Every person with decisional capacity has the right to refuse any treatment, regardless of the nature of the treatment or
consequences of the refusal. The surrogate decision-making has the power to act on this right for the patient, as long as
there is reason to believe that the surrogate is making decisions based on the patient’s wishes, values, or interests.

Health Care Ethics
(Bioethics)
That said, some people and groups believe that some refusals of treatment are acceptable and not others. They argue
that it is morally worse to refuse “ordinary treatment” rather than “extraordinary treatment.” This was based on the idea
that people have a general obligation to act to sustain their own lives. A certain degree of pain and suffering is normal. To
refuse to do the basic minimum to sustain one’s life is morally wrong because it undermines life itself, much like suicide.
Lately, insurance providers have used the ordinary/extraordinary distinction to determine which treatments they need to
cover, and which do not constitute “basic care.”
The key to both arguments is the focus on categorizing types of treatment. The error (on their own terms) comes when it
is not acknowledged that what is ordinary for one patient may be extraordinary for another. Legally no distinction between
treatment in categories is recognized about the right to refuse treatment. However, some see a moral difference and
refusal of ordinary treatment may be a sign that a surrogate is not acting in good faith.
Ordinary and extraordinary treatments are generally categorized as follows:
Ordinary Treatment
1. Low risk of harm.
2. Simple, relatively low tech.
3. Routine.
4. Good chance for benefit to the patient.
5. Relatively inexpensive.
6. Available to most people who need it.
7. Causes little pain or distress.
Extraordinary Treatment
1. High Risk
2. Complex, relatively high tech.
3. Innovative, experimental, unusual.
4. Relatively small chance for benefit to the patient.
5. Relatively expensive.
6. Available to few (may involve distributive justice issues).
7. Usually, a source of pain or distress.
Any treatment is extraordinary if the burdens outweigh the benefits, or it offers no hope of benefit for the patient. (Purtilo,
R. Ethical Dimensions in the Health Professions (Saunders, 1999) p220.) But who defines benefit and burden? And what
meets the criteria of hope?
Personhood
 One who could be said to have interests
 One who has cognitive awareness
 One who is capable of relationships
 One who has a sense of futurity
Advanced Directives

Health Care Ethics
(Bioethics)
o 1990 Patient Self-Determination Act (PSDA)

 Federal law regarding advanced directives
 To make people aware of their rights
o Joint Commission
 Developed standards for the documentation of patients’ wishes regarding advanced directives
o No uniformity in laws on living wills and surrogate decision makers
o Many authorities recommend use of durable power of attorney over a living will.
Living will is a type of advance directive. It is a written, legal document. It describes the treatments you would want if you
were terminally ill or permanently unconscious. These could be medical treatments or treatments that will help you live
longer. A living won’t let you select someone to make decisions for you.
A durable power of attorney (DPA) for health care is another kind of advance directive. A DPA states that you have
chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical
decisions (and may be called Medical Power of Attorney, or MPOA). A DPA is generally more useful than a living will. But
a DPA may not be a good choice if you don’t have another person you trust to make these decisions for you.
Supreme Court
 Upheld concept that competent individuals could refuse life-sustaining treatment
 Made no legal distinction between tube feeding and other life-sustaining measures

1. In December 1989, this case became the first right-to-die cases to be heard by the Supreme Court in the United States.
A. Baby doe case
B. Nancy Cruzan case
C. Karen Anne Quinlan case
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Philosophers such as Joseph Fletcher and Joel Feinberg have attempted to define characteristics that a being must
possess in order to be considered the bearer of rights. Among the suggested criteria are as follows EXCEPT.
A. One who has cognitive awareness
B. One who could be said to have interests
C. One who has a sense of futurity
D. One who is incapable of relationships
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Procedure, medicine or treatment given to a patient offered no reasonable hope of benefit is an example of _____
care?
A. Extraordinary
B. Advanced
C. Ordinary

Health Care Ethics
(Bioethics)
D. Exceptional
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. This is a federal law regarding advance directives that tell patients upon admission their rights under the state of law?
A. Living will statement
B. Patient Self-Determination Act (PSDA)
C. Durable power of attorney
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. A 50-year-old woman is dying of cancer. She has only a few days to live. She has severe anemia due to the cancer.
Even though blood transfusion is the usual treatment for severe anemia, the decision is made not to give. What care does
this case involve?
A. Advanced care
B. Ordinary care
C. Extraordinary care
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
1. Differentiate between “best interest” and “substituted”
“judgment” standards as they relate to proxy decision; and, References:
2. Understand what DNR means and its guidelines.
Ethics of Health Care: A Guide for Clinical
Randall Groves
Brain Teaser: Write 3 important things they have learned from the last session.
1.
2.
3.
B. MAIN LESSON
Proxy Decision-making Standards

 Courts have not made their decisions on basis of personhood criteria
 Courts created standards for allowance of decisions by proxy
Best-interest Standard
 Considers tangible factors as harms and benefits, physical and fiscal risks
Substituted-judgment Standard
 Decision about treatment or nontreatment must remain that of the patient
 Based on principle of autonomy
Informed Non-consent
 Patients who understand the nature of their conditions and the consequences of refusing care
Court Ruling
 Acuity of patient is irrelevant to the allowance of treatment refusal
 Patient’s own perceived view of her quality of life and treatment requirements necessary to preserve it are of

Health Care Ethics
(Bioethics)
paramount importance
 There is no meaningful legal distinction between mechanical life support and nasogastric feeding; both are
invasive
 Distinctions between withholding and withdrawing care are legally irrelevant
Do Not Resuscitate (DNR)
A do-not-resuscitate (DNR) order placed in a person’s medical record by a doctor informs the medical staff that
cardiopulmonary resuscitation (CPR) should not be attempted. Because CPR is not attempted, other resuscitative
measures that follow it (such as electric shocks to the heart and artificial respirations by insertion of a breathing tube)
will also be avoided. This order has been useful in preventing unnecessary and unwanted invasive treatment at the
end of life. The success rate of CPR near the end of life is extremely low.
Doctors should discuss with seriously ill patients the possibility of cardiopulmonary arrest (when the heart stops and
breathing ceases) in light of their immediate medical condition, describe CPR procedures and likely outcomes, and ask
patients about treatment preferences. If a person is incapable of making a decision about CPR, an authorized
surrogate may make the decision.
A DNR order does not mean "do not treat." Rather, it means only that CPR will not be attempted. Other treatments (for
example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided.
Depending on the person's condition, these other treatments are usually more likely to be successful than
CPR. Treatment that keeps the person free of pain and comfortable (called palliative care) should always be
given.
Languages of DNR
- Code
- No code
- Slow code
- Chemical code
Do Not Resuscitate (DNR) Guidelines

1. DNR order should be documented in the written medical record.
2. DNR orders should specify the exact nature of the treatments to be withheld.
3. Patients, when they are able, should participate in DNR decision. Their involvement and wishes should
be documented in the medical record.
4. Decisions to withhold CPR should be discussed with the health care team.
5. DNR status should be reviewed on a regular basis.

1. Amira, a 40-year-old patient in coma has a DNR order placed in his medical chart to avoid the use of CPR. DNR
means?
A. Do Not Regurgitate
B. Do Not Revive
C. Do Not Resuscitate
D. Do Not Retaliate
Answer: ________

Health Care Ethics
(Bioethics)
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Which of the following are included in the DNR Guidelines?

A. DNR status should be reviewed on a regular basis.
B. DNR orders should be documented in the written medical record.
C. Decisions to withhold CPR should be discussed with the health care team
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Standard maintains that the decision about treatment or nontreatment must remain that of the patient, based on the
principle of autonomy.
A. Parens patriae
B. Substituted judgement
C. Best-interest
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The case of ___________ become the landmark decision regarding the right to informed non-consent
A. Karen Ann Quinlan case
B. Nancy Cruzan case
C. Elizabeth Bouvia case
D. Baby Doe case
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. This refers to the practice in a hospital or other medical center to purposely respond slowly or incompletely to a patient
in cardiac arrest, particularly in situations for which CPR is of no medical benefit.
A. No code
B. Chemical code
C. Code
D. Slow code
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP

Health Care Ethics
(Bioethics)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________________

Health Care Ethics
(Bioethics)
1. Identify the various lines of reasoning and arguments
needed to decide for the case of Baby Doe regarding References:
withdrawing or withholding care.
2. Understand the ethical issues about Organ transplant; and, Ethics of Health Care: A Guide for Clinical
3. Explain the difference between active and passive Practice Fourth Edition, Raymond S. Edge, J.
euthanasia. Randall Groves
Brain Teaser: Enumerate the languages of DNR.
1. ___________
2. ___________
3. ___________
4. ___________
B. MAIN LESSON
Baby Doe
 Baby Doe Regulations
 Consider withholding of medical care for handicapped infants, reglect
 Exceptions
 When infant chronically and irreversibly comatose
 When treatment would only prolong dying
 When treatment would be futile, or inhumane
 Translated into the language of personhood:
 Infant who has no present or future potential for self-awareness or relationships can be said to have no
interests at all
 Incomprehensible to provide life-extending care
Organ Donation
 Advances in technique and immunosuppressive drugs have made it possible to transplant:
 Hearts
 Lungs
 Kidneys
 Livers
 Bone marrow
 Skin
 Corneas
 Pancreases
 Survival and success rate progressively improving
 Shortage of supply

Health Care Ethics
(Bioethics)
 Uniform Anatomical Gift Act

 Purely voluntary decision
 Organs may be donated by those close to individual
 Need to obtain family consent in time of grief and stress major barrier to organ procurement
 Volunteerism and public education have not provided adequate supplies of donated organs
Euthanasia
Euthanasia refers to deliberately ending someone’s life, usually to relieve suffering. Doctors sometimes perform
euthanasia when it’s requested by people who have a terminal illness and are in a lot of pain.
It’s a complex process and involves weighing many factors. Local laws, someone’s physical and mental health, and their
personal beliefs and wishes all play a role.
Are there different types?

There are several types of euthanasia. What’s chosen depends on a variety of factors, including someone’s outlook and
level of consciousness.
Assisted suicide vs. euthanasia

Assisted suicide is sometimes called physician-assisted suicide (PAS). PAS means a doctor knowingly helps someone
end their life. This person is likely experiencing persistent and unending suffering. They may have also received a
terminally ill diagnosis. Their doctor will determine the most effective, painless method.
In many Trusted Source cases, doctors will provide people with a drug they can take to end their life. A lethal dose of
opioids, for example, may be prescribed for this. In the end, it’s up to the person to decide whether they take the drug.
With euthanasia, a doctor is allowed to end the person’s life by painless means. For example, an injection of a lethal
drug may be used.
Active vs. passive

When most people think of euthanasia, they think of a doctor directly ending someone’s life. This is known as active
euthanasia. Purposely giving someone a lethal dose of a sedative is considered active euthanasia.
Passive euthanasia is sometimes described as withholding or limiting life-sustaining treatments so that a person passes
more quickly. A doctor may also prescribe increasingly high doses of pain-killing medication. Overtime, the doses may
become toxic.
This makes the distinction between passive euthanasia and palliative care blurry. Palliative care focuses on keeping
people as comfortable as possible at the end of their life.
For example, a palliative care doctor might allow someone approaching death to stop taking a medication that causes
unpleasant side effects. In other cases, they might allow someone to take a much higher dose of a pain medication to
treat severe pain. This is often a standard part of good palliative care. Many don’t consider it euthanasia.
Voluntary vs. nonvoluntary

If someone makes a conscious decision to seek help with ending their life, it’s considered voluntary euthanasia. The
person must give their full consent and demonstrate that they fully understand what will happen.
Nonvoluntary euthanasia involves someone else making the decision to end someone’s life. A close family member
usually makes the decision. This is generally done when someone is completely unconscious or permanently
incapacitated. It usually involves passive euthanasia, such as withdrawing life support from someone who’s showing no
signs of brain activity.
https://www.healthline.com/health/what-is-euthanasia#types (visit this page to understand facts about euthanasia)
Legal and Social Standing of Euthanasia

Health Care Ethics
(Bioethics)
 2016: Oregon and four other states allow physician-aid-in dying (PAD)
 No clear consensus for legalizing euthanasia
Key points
 Passive Euthanasia
 Doing nothing to preserve life
 Active Euthanasia
 Requires actions that speed process of dying
 Involuntary Euthanasia
 Ignores individual’s autonomous rights
 Could bring about death of unwilling victim
 A person has committed suicide when:
 That person brings about his or her own death
 Others do not coerce him or her to do the action
 Death caused by conditions arranged by person for purpose of bringing about his or her death
World Status of Euthanasia

 Netherlands: first modern industrialized nation to fully sanction physician assisted suicide
 German-speaking nations: law allows assisted suicide as long as drug is taken without any help
 Switzerland: allows physician assisted suicide as long as there are no “self-seeking motives”
 Belgium: second Western nation to legalize physician-assisted suicide; policies less stringent Netherlands
 United States: doctors allowed to prescribe lethal doses of drugs to terminally ill patients to “aid in dying” in five
states; active euthanasia is illegal

1. The Baby doe regulations consider the withholding of medical care for these handicapped infants to be neglect. The
regulations provided three exceptions which are?
A. When the infant is chronically and irreversibly comatose
B. When the treatment would futile; or inhumane.
C. When treatment would only prolong dying.
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. This Act was passed in the US in 1968 and has since revise in 1987 and in 2006. The act sets a regulatory framework
for the donation of organs, tissues, and other human body parts in the US?
A. Uniform Anatomical Gift Act of 2006
B. Patient Self-determination Act
C. Consumers Act
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
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3. With regards to Options for Increasing the Supply of Salvageable Organ, this option would require all competent adults
to decide and record whether they wish to become organ donors at their death.
A. Presumed consent
B. Mandated choice
C. Xenografting
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. Failing to revive a patient who has signed a DNR order is an example of what type of euthanasia?
A. Active euthanasia
B. Involuntary euthanasia
C. Passive euthanasia
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. It is the first modern industrialized nation to fully sanction physician-assisted suicide.

A. Belgium
B. Germany
C. Netherlands
D. United States
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
Instructions:

1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________

Health Care Ethics
(Bioethics)
1. __________________________________________________________________________________
2. __________________________________________________________________________________

1.___________________________________________________________________________________

Health Care Ethics
(Bioethics)
1. Understand arguments for and against euthanasia; and,
2. Discuss the nature of Hospice movement in the United References:
States and how this impact the debate regarding
euthanasia. Ethics of Health Care: A Guide for Clinical
Randall Groves
Brain Teaser: Differentiate voluntary and non-voluntary euthanasia.
Answer:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
B. MAIN LESSON
Mercy Killing
• Health care practitioner deliberately hastens death of a patient
• Practice prohibited under homicide laws
• “Consent and humanitarian motive” is never a defense under the law for murder
Arguments for and Against Euthanasia

• Arguments for:
 Concern and compassion for those painfully and/or terminally ill
 Duty-oriented: extension of personal autonomy—to live our life according to our own vision, unrestricted
by views of others
• Arguments Against:
 Religious grounds: our lives are not ours but gifts from God; to take our life is to destroy what belongs to
God
 How does one decide euthanasia is appropriate for another?
Controversy around euthanasia

• There are many arguments both for and against euthanasia and PAS. Most of these arguments fall into four main
categories:
Morality and religion

Some people believe euthanasia is murder and find it unacceptable for moral reasons. Many also argue that the ability to
decide your own death weakens the sanctity of life. In addition, many churches, religious groups, and faith organizations
argue against euthanasia for similar reasons.
Physician judgement
PAS is only legal if someone is mentally capable of making the choice. However, determining someone’s mental

Health Care Ethics
(Bioethics)
capabilities isn’t very straightforward. One study Trusted Source found that doctors aren’t always capable of recognizing
when someone is fit to make the decision.
Ethics
• Some doctors and opponents of PAS are concerned about the ethical complications doctors could face. For more
than 2,500 years, doctors have taken the Hippocratic oath. This oath encourages doctors to care for and never harm
those under their care.
• Some argue that the Hippocratic oath supports PAS since it ends suffering and brings no more harm. On the other
hand, some debate it results in harm to the person and their loved ones, who must watch their loved one suffer.
Personal choice
“Death with dignity” is a movement that encourages legislatures to allow people to decide how they want to die. Some
people simply don’t want to go through a long dying process, often out of concern of the burden it puts on their loved
ones.
The Hospice Alternative

• Hospice Programs
 Provide palliative care, abatement of pain, and an environment that encourages dignity
 Do not cure or treat intensively
 Ceased to be a place and have become a concept
 Philosophy: dying is a natural part of life

1. This care is given for people living with a serious illness to relieve pain and alleviate their suffering, example is patient
with terminal cancer?
A. Rehabilitative care
B. Primary care
C. Secondary care
D. Palliative care
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. These programs are set up to provide palliative care, abatement of pain and an environment that encourages dignity,
but they do not cure or treat intensively.
A. Palliative programs
B. Hospice programs
C. Rehabilitation programs
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. The best-known hospice in Great Britain, founded by Dr. Cicely Saunders in 1967?
A. St. Luke’s
B. St. Christopher’s

Health Care Ethics
(Bioethics)
C. St. Agustin’s
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. He is a noted ethicist and a theologian, In the situation of euthanasia he quoted that “It is harder morally to justify letting
someone die a slow and ugly death, dehumanized, than it is to justify helping him to escape from such misery.”
A. Dr. Cicely Saunders
B. Joel Feinberg
C. Christopher White
D. Joseph Fletcher
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Euthanasia is synonymously known as which means putting a person to death painlessly or allowing them to die, as
withholding extreme medical measures a person is suffering from an incurable disease or condition?
A. Mercy killing
B. Suicide
C. Homicide
D. Killing me softly
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
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Health Care Ethics
(Bioethics)
Lesson Title: Health Care and the Near Future Materials:
1. Explain the promise of the human genome project; and,
2. Understand genetic as social policy. References:
Ethics of Health Care: A Guide for Clinical

Randall Groves
Brain Teaser: Write 3 important things they have learned from the last session.
1.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3.
_________________________________________________________________________________________________
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B. MAIN LESSON
Genomics and Medical Progress Human Genome Project
Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the U.S. Department of
Energy (DOE) and the National Institutes of Health. During the early years of the HGP, the Wellcome Trust (U.K.) became
a major partner; additional contributions came from Japan, France, Germany, China, and others. Project goals were to
• identify all the approximately 20,500 genes in human DNA,
• determine the sequences of the 3 billion chemical base pairs that make up human DNA,
• store this information in databases,
• improve tools for data analysis,
• transfer related technologies to the private sector, and
• address the ethical, legal, and social issues (ELSI) that may arise from the project
Human Genome Project

– List of chemical letters that compose map of human genome
– May change nature of health care itself
– Missing is overarching vision that provides the way forward beyond initial steps

Health Care Ethics
(Bioethics)
Huntington’s Disease
• Affects men and women equally across all ethnic and racial lines
• 30,000 people in United States
• Devastating disease, without a cure
• Affects patient’s ability to think, talk, and move
• Develops between a person’s 30s and 50s
• Huntington gene has been found
• 20 percent of birth defects caused by genetic or hereditary factors
• Should we just let genetic disease continue if we have power to stop it or at least lessen its impact?
Human Genome Project

• While human genome project was pure research, we moved forward into application
 What are we to do with this knowledge?
 Is humankind in danger of overreaching its proper boundaries?
 Can mankind be trusted to use (or not use) the knowledge in question?
• Genetic information is exceptional compared to other medical information about a patient as genetic conditions
are family problems
 Allows physician to diagnose a future ailment
 Individualize therapy at level never possible
Genetics as Social Policy

• Eugenics
– Manipulating the genes of offspring through breeding or genetic alteration
– the selection of desired heritable characteristics in order to improve future generations, typically in reference to
humans.
The term eugenics was coined in 1883 by British explorer and natural scientist Francis Galton, who, influenced by Charles
Darwin’s theory of natural selection, advocated a system that would allow “the more suitable races or strains of blood a
better chance of prevailing speedily over the less suitable.” https://www.britannica.com/science/eugenics-genetics
• Negative Eugenics
 Ability to screen and prenatally test for genetic disease to eliminate genetic diseases
 defined as prohibiting marriage and breeding between “defective stock”
• Positive Eugenics
 Not only breeding but genetic intervention
 Attempts to improve gene pool by increasing the numbers of those with positive attributes
 defined as promoting the proliferation of “good stock”
• Best Course of Action

 Use genetic testing to help individuals rather than to alter genetic makeup of humanity


1. Which of the following provides a complete list of chemical letters that compose the map of a human genome?
A. Eugenics project
B. Stem cell research
C. Regenerative medicine

Health Care Ethics
(Bioethics)
D. Human genome project

Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Which of the following is an example of a genetic disease?

A. Huntington’s Disease
B. Cystic fibrosis
C. Down syndrome
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Whose psychologist quoted that “For almost every behavioral trait so far investigated, from reaction time to religiosity,
an important fraction of the variation among people turns out to be associated with genetic variation.”
A. Thomas Bouchard
B. Dan Abnett
C. Dr. Fautus
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. The study of methods for controlling the characteristics of future human populations through selective breeding?
A. Human enhancement
B. Cryogenics
C. Eugenics
D. Genetic therapy
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. As discussed in this chapter, The Republic, refers to the practice of infanticide for diseased or disabled newborns.
A. Faustus’
B. Plato’s
C. Socrates’s
D. Bauchard’s
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP


Health Care Ethics
(Bioethics)
_________________________________________________________________________________________________
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Health Care Ethics
(Bioethics)
Lesson Title: Health Care and the Near Future Part 2 Materials:
1. Understand the scientific advances possible with
recombinant DNA as well as the dangers that unregulated References:
research can create;
2. Identify reasons why genetic testing is performed; and, Ethics of Health Care: A Guide for Clinical
3. Explain how ethical problems with genetics make Practice Fourth Edition, Raymond S. Edge, J.
necessary a new virtue of family planning with guidelines Randall Groves
that help us utilize genetic counseling in an ethical manner.
Brain Teaser: You will be randomly asked to answer some questions.
B. MAIN LESSON
Genetic Engineering
What is genetic engineering?

 Genetic engineering, sometimes called genetic modification, is the process of altering the DNA? in an organism’s
genome?
 This may mean changing one base pair. (A-T or C-G), deleting a whole region of DNA, or introducing an
additional copy of a gene?
 It may also mean extracting DNA from another organism’s genome and combining it with the DNA of that
individual.
 Genetic engineering is used by scientists to enhance or modify the characteristics of an individual organism.
 Genetic engineering can be applied to any organism, from a virus? to a sheep.
 For example, genetic engineering can be used to produce plants that have a higher nutritional value or can
tolerate exposure to herbicides.
How does genetic engineering work?

To help explain the process of genetic engineering we have taken the example of insulin, a protein? that helps regulate
the sugar levels in our blood.
 Normally insulin? is produced in the pancreas? but in people with type 1 diabetes? there is a problem with insulin
production.
 People with diabetes therefore have to inject insulin to control their blood sugar levels.
 Genetic engineering has been used to produce a type of insulin, very similar to our own, from yeast and
bacteria? like E. coli?
 This genetically modified insulin, ‘Humulin’ was licensed for human use in 1982.
The genetic engineering processes

1. A small piece of circular DNA called a plasmid? is extracted from the bacteria or yeast cell.
2. A small section is then cut out of the circular plasmid by restriction enzymes, ‘molecular scissors.
3. The gene for human insulin is inserted into the gap in the plasmid. This plasmid is now genetically modified.
4. The genetically modified plasmid is introduced into a new bacteria or yeast cell.
5. This cell then divides rapidly and starts making insulin.

Health Care Ethics
(Bioethics)
6. To create large amounts of the cells, the genetically modified bacteria or yeast are grown in large
fermentation vessels that contain all the nutrients they need. The more the cells divide, the more insulin is
produced.
7. When fermentation is complete, the mixture is filtered to
Scientists are genetically altering organisms for various purposes

– Can we rely on scientists to take the necessary precautions to keep the organisms they create
harmless to human beings?
Genetic Testing
Genetic testing is a type of medical test that identifies changes in chromosomes, genes, or proteins. The results of a
genetic test can confirm or rule out a suspected genetic condition or help determine a person’s chance of developing
or passing on a genetic disorder. More than 1,000 genetic tests are currently in use, and more are being developed.
Several methods can be used for genetic testing:
 Molecular genetic tests (or gene tests) study single genes or short lengths of DNA to identify
variations or mutations that lead to a genetic disorder.
 Chromosomal genetic tests analyze whole chromosomes or long lengths of DNA to see if there are large
genetic changes, such as an extra copy of a chromosome, that cause a genetic condition.
 Biochemical genetic tests study the amount or activity level of proteins; abnormalities in either can
indicate changes to the DNA that result in a genetic disorder.
Genetic testing is voluntary. Because testing has benefits as well as limitations and risks, the decision about whether
to be tested is a personal and complex one. A geneticist or genetic counselor can help by providing information
about the pros and cons of the test and discussing the social and emotional aspects of testing.
 Gene testing for the following reasons:
– Conformational diagnosis for symptomatic individual
– Presymptomatic testing for estimating risk of developing disease

Health Care Ethics
(Bioethics)
– Presymptomatic testing for predicting disease

– Prenatal diagnosis screening
 Gene testing for the following reasons:
 Newborn screening
– Preimplantation genetic diagnosis
– Carrier screening
– Forensic screening
– Paternal testing
• Assumption
– Existence is a good thing
– For some it may not be
– Testing would be preventing injury
– Can existence be an injury?
– Should policy aim at the majority, and exceptions to the rule be regarded as exceptional?
• 2008: Genetic Information Nondiscrimination Act (GINA)
– Protects individuals from genetic discrimination by health insurers and employers
The Role of Parents

 Virtue ethics: to make many decisions for their children, including decision of life and death (or nonexistence) prior
to conception and birth (assuming one is pro-abortion)

1. The practice of altering DNA by splicing parts of one into another?

A. Recessive gene
B. Recombinant DNA
C. Genetic carriers
D. Genetic predisposition
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Genetic testing is generally performed for the following reason, EXCEPT?

A. Maternal testing
B. Newborn screening
C. Carrier screening
D. Prenatal diagnosis screening
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. In 2008, this act was passed to protect individuals from genetic discrimination by health insurers and employers.
A. HIPAA
B. EMTALA
C. GINA
D. BAIPA
Answer: ________

Health Care Ethics
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Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. A genetically determined susceptibility to certain health problems is called.

A. Recessive gene
B. Recombinant gene
C. Genetic carriers
D. Genetic predisposition
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. This is a disease that deforms red blood cells into thin, elongated sickle-shaped forms and causes anemia, cough, and
muscle cramps.
A. Sickle cell disease
B. Pernicious anemia
C. Down syndrome
D. Huntington disease
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
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_____________________________________________________________________
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Health Care Ethics
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1. Identify the uses of recombinant DNA and the possible
danger that it will result when use in a careless way; References:
2. Understand the politics of genetic screening; and,
3. Define Pharmacogenomics. Ethics of Health Care: A Guide for Clinical
Randall Groves
Brain Teaser: The instructor will give questions to the students for them to answer. The students will write short answer
of what they have understood from the previous topic.
1. What is genetic engineering?

Answer:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________
2. What is genetic testing?

Answer:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________
3. What GINA stands for? And what it is for?
Answer:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________
B. MAIN LESSON
The Politics of Screening Genetic Testing
Genetic screening is really a term that's used to help us identify a smaller group of people from a large population. And
this smaller group of people might have a higher risk of either having a disease, developing that disease, or potentially
having children who may have that disease as well. So I want to differentiate genetic screening from the term "genetic
testing". Genetic testing is focused on an individual; genetic screening is really focused on a whole population of people,
trying to identify those specifically who are [at] increased risk to develop it or to have children with a condition in question
or the condition being screened for.
Genetic screening requires:

- Wisdom
- Sensitivity
- Good science
- Confidentiality
Recombinant DNA

Health Care Ethics
(Bioethics)
- Scientists recombine genetic material from one organism to another for various reasons
- Not always the case people trained in the sciences are conscious of their ethical duties
- Benefits from genetic engineering too great to ignore
Genetic Pharmacy
• Pharmacogenomics
– Study of genetic variations that influence individual response to drugs
– Combines traditional pharmaceutical sciences with understanding of common DNA variations in
human genome
– One of the most productive and promising applications of genetic engineering
• Pharmacogenomics is the study of how genes affect a person’s response to drugs. This relatively new field
combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop
effective, safe medications and doses that will be tailored to a person’s genetic makeup.
• Many drugs that are currently available are “one size fits all,” but they don't work the same way for everyone. It
can be difficult to predict who will benefit from a medication, who will not respond at all, and who will experience
negative side effects (called adverse drug reactions). Adverse drug reactions are a significant cause of
hospitalizations and deaths in the United States. With the knowledge gained from the Human Genome Project,
researchers are learning how inherited differences in genes affect the body’s response to medications. These
genetic differences will be used to predict whether a medication will be effective for a particular person and to
help prevent adverse drug reactions. Conditions that affect a person’s response to certain drugs include
clopidogrel resistance, warfarin sensitivity, warfarin resistance, malignant hyperthermia, Stevens-Johnson
syndrome/toxic epidermal necrolysis, and thiopurine S-methyltransferase deficiency.
• The field of pharmacogenomics is still in its infancy. Its use is currently quite limited, but new approaches are
under study in clinical trials. In the future, pharmacogenomics will allow the development of tailored drugs to treat
a wide range of health problems, including cardiovascular disease, Alzheimer disease, cancer, HIV/AIDS, and
asthma.

1. This is the study of genetic variations that influence individual response to drugs?
A. Pharmacology
B. Pharmacist
C. Pharmacogenomics
D. Gene therapy
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. A variant form of a given gene, which may determine a trait such as having type O or type A Blood.
A. Eugenics
B. Heterozygous
C. Genetic testing
D. Allele
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
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3. This is one of the most productive and promising applications of genetic engineering.
A. Gene therapy
B. Genetic pharmacy
C. Genetic testing
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. In recombinant DNA technology, what is the commonly used bacterium??

A. E. coli
B. Salmonella
C. Lactobacilli
D. Streptococcus
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Genetic screening requires which of the following?

A. Sensitivity
B. Wisdom
C. Good science
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
Instructions:

1. __________________________________________________________________________________
2. __________________________________________________________________________________
3. __________________________________________________________________________________

Health Care Ethics
(Bioethics)
1. __________________________________________________________________________________
2. __________________________________________________________________________________

1.___________________________________________________________________________________

Health Care Ethics
(Bioethics)
1. Explain the promise and ethical pitfalls associated with
gene therapy; References:
2. Understand issues about our genes that causes our
behavior; and, Ethics of Health Care: A Guide for Clinical
3. Identify different ethical issues about cloning. Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves
Brain Teaser: MODIFIED TRUE OR FALSE, Write TRUE if the statement is correct and FALSE if the statement is
incorrect and write the correct word to make the statement correct.
1. Genetic screening is different from genetic testing.
2. Pharmacokinetics is the study of how genes affect a person’s response to drugs.
3. Genetic screening requires wisdom, sensitivity, good science, and autonomy.
4. Recombinant DNA is the practice of altering DNA by splicing parts of one into another.
B. MAIN LESSON
Gene Therapy
• Copies of normal gene injected into cell with defective or non-present genes
• DNA of cell induced to incorporate new gene so that cell may function properly
• When cell reproduces, it passes along the new gene rather than the original
The Genetic Causes of Behavior

• Genetic modification of behavior could pose risks
• Behavior polygenic and environmental
• Scientists investigating genetic basis of criminal behavior
• Some have suggested all behavior is mediated through genes
Cloning
• Clones are organisms that are exact genetic copies. Every single bit of their DNA is identical.
• Clones can happen naturally identical twins are just one of many examples. Or they can be made in the lab.
Below, find out how natural identical twins are like and different from clones made through modern cloning
technologies.
How is cloning done?

• Many people first heard of cloning when Dolly the Sheep showed up on the scene in 1997. Artificial cloning
technologies have been around for much longer than Dolly, though.
• There are two ways to make an exact genetic copy of an organism in a lab: artificial embryo twinning and somatic
cell nuclear transfer.
1. Artificial Embryo Twinning

• Artificial embryo twinning is a relatively low-tech way to make clones. As the name suggests, this technique
mimics the natural process that creates identical twins.
• In nature, twins form very early in development when the embryo splits in two. Twinning happens in the first days

Health Care Ethics
(Bioethics)
after egg and sperm join, while the embryo is made of just a small number of unspecialized cells. Each half of the
embryo continues dividing on its own, ultimately developing into separate, complete individuals. Since they
developed from the same fertilized egg, the resulting individuals are genetically identical.
• Artificial embryo twinning uses the same approach, but it is carried out in a Petri dish instead of inside the mother.
A very early embryo is separated into individual cells, which are allowed to divide and develop for a short time in
the Petri dish. The embryos are then placed into a surrogate mother, where they finish developing. Again, since
all the embryos came from the same fertilized egg, they are genetically identical.
2. Somatic Cell Nuclear Transfer

• Somatic cell nuclear transfer (SCNT), also called nuclear transfer, uses a different approach than artificial embryo
twinning, but it produces the same result: an exact genetic copy, or clone, of an individual. This was the method
used to create Dolly the Sheep.
• What does SCNT mean? Let's take it apart:
• Somatic cell: A somatic cell is any cell in the body other than sperm and egg, the two types of reproductive cells.
Reproductive cells are also called germ cells. In mammals, every somatic cell has two complete sets of
chromosomes, whereas the germ cells have only one complete set.
• Nuclear: The nucleus is a compartment that holds the cell's DNA. The DNA is divided into packages called
chromosomes, and it contains all the information needed to form an organism. It's small differences in our DNA
that make each of us unique.
• Transfer: Moving an object from one place to another. To make Dolly, researchers isolated a somatic cell from an
adult female sheep. Next, they removed the nucleus and all of its DNA from an egg cell. Then they transferred the
nucleus from the somatic cell to the egg cell. After a couple of chemical tweaks, the egg cell, with its new nucleus,
was behaving just like a freshly fertilized egg. It developed into an embryo, which was implanted into a surrogate
mother and carried to term. (The transfer step is most often done using an electrical current to fuse the
membranes of the egg and the somatic cell.)
• The lamb, Dolly, was an exact genetic replica of the adult female sheep that donated the somatic cell. She was
the first- ever mammal to be cloned from an adult somatic cell.
https://learn.genetics.utah.edu/content/cloning/whatiscloning/
Cloning of a Human Baby

– President’s Council on Bioethics
• Is in clear opposition
• Process would violate principles of the ethics of human research
• Dangerous and unsafe
• High percentage of failures
• Radically new form of human procreation
• Likely we will master genes to enable us to clone distinct body parts for transplantation Alteration of agricultural
products and animals for human benefit key part of our future

1. When a disease is the result of a combination of genes, it is called?

A. Allele
B. Heterozygous
C. Polygenic
D. Monogenic
Answer: ________

Health Care Ethics
(Bioethics)
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Who wrote the book in 2013 entitled to Creation: How science is reinventing life itself?
A. Peter Goodfellow
B. Francis Crick
C. Bryan Appleyard
D. Adam Rutherford
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. The taking of a somatic cell from an adult animal, inserting it into an egg, and growing an identical twin is an example
of?
A. Cloning
B. Stem cell
C. Xenografting
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. This is the treatment of genetic diseases by the administration of genes to correct an absent or defective gene?
A. Genetic therapy
B. Genetic engineering
C. Genetic pharmacy
D. Genetic testing
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. The President’s Council on Bioethics holds that cloning-to-produce-children would be a radically new form of human
procreation that leads to concern such as which of the following?
A. Troubled family relations
B. Prospect of a new eugenics
C. Concerns regarding manufacture
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP

Health Care Ethics
(Bioethics)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
1. Explain the current state of stem cell research and provide
a pro and con argument for its continuance; and, References:
Explain the post humanist position regarding genetic
science and the discussion of ethics. Ethics of Health Care: A Guide for Clinical
Randall Groves
Brain Teaser: Find the 11 words hidden in the puzzle, related to the topics They will encircle the words in the puzzle. This
will be done in 10 minutes and after answering, the instructor will call 3 volunteer students to share their answer and other
students will check their work if they got the same answers of what are mentioned.
E S E H E H E T E R O Z Y G O U S S Y
K I F E D O B E B E R P X E F S C E R
G N J T L W M R B C X S P T T T H G D
G E N E T I C E N G I N E E R I N G P
Q G G R Y A D D F U I P M O L R T E E
F U N O T G U X D E X C G X F O B N R
M E M H E B C H U I E O I U A L L E E
J E I N X O A D Z L N W D R P E L T L
Y N O J J K T N L S C U E F L M D H E
G M B O J L I V I N T L K L Y A Q E L
E D U C R T O I O N Q Z O Y W O K R L
R R E C O M B I N A N T D N A G S A A
L E S W S F A V N M K Y Y G I I L P P
M O B R R E C E S S I V E G E N E Y X
P O S T H F E R T Y H E T E R O G H B
S C I N E G U E T W L K N Y T C W X Z
O I T E L I M S I N A M U H T S O P E

Health Care Ethics
(Bioethics)
B. MAIN LESSON
Stem Cell Research

• Dilemma in regard to research the word embryo
• Stem cell line: family of constantly dividing cells, product of a single embryo
• Human embryonic stem cells: building blocks of life
• Human life begins with embryo, grows into fetus, then infant, then child, then adult
• Does use of human embryos as raw materials for biotechnology undermine value of all human life?
• Benefits such great magnitude that required destruction of human embryos in the process is permissible Human
Enhancement
• Is human enhancement, beyond that needed to restore health, acceptable therapy?
– Modifications to appearance
– Neurological enhancements
• Post humanists
– Believe evolution is far from over
– “Cyborg” existence is not to be resisted
– Do not question ethics of contemporary uses of technology
– Technopian vision of a pain-free, unlimited, eternal humanity
• Advancements currently underway will:
– Change the quality of our lives
– Extend our lives
– Make the lives of our children healthier and longer

1. These are immature cells that function as blank slate capable of becoming any cell in the body?
A. heterozygous
B. Recessive
C. Stem cells
D. All of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. ___________ medicine is focused on growing specialized tissues for spinal cord injuries, diabetes, cancer, multiple
sclerosis, Parkinson’s disease, and many other currently unthought-of applications
A. Specialized
B. Regenerative
C. Human enhancement
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Health Care Ethics
(Bioethics)
3. A speculative theory that seeks to re-conceive what is human.

A. Eugenics
B. Posthumanism
C. Human enhancement
D. Stem cell
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. An endocrinologist prescribed Human Growth Hormone to young boy who is 4 feet tall and he grew 5 ft. and 7 inches
by the age of 16. This situation is an example of?
A. Stem cell
B. Eugenics
C. Human engineering
D. Human enhancement
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. A _________ carrier is a person who carries a defective gene that, when combined in reproduction with a similar one
from another person, may yield a genetic defect.
A. Recessive
B. Heterozygous
C. Genetic
D. Diseased
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP

_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

BIOETHICS

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Health Care Ethics

Module #1 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson Title: Obligations of a Professional Materials:

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 1

Module #1 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

 Twentieth century: over 200 specialties added to health care team

Essential Characteristics of a Profession

Legal Practice Act

Specialty Practice Acts

Sanctions for Lapse in Ethical, Legal, and Professional Etiquette

Legal requirements – legal or illegal?

Professional etiquette – proper or improper?

Health Care Ethics

The Foundation of Law

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 2

Module #1 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Fundamental Principles of Law

Misunderstandings about Nature of Law

Steps in a civil lawsuit:

3. Discovery: fact-finding phase

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 3

Module #1 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

4. Trial and Judgment

Philippine judicial system consists of the following courts: Lower

1. Municipal Trial Courts and Municipal Circuit Trial Courts

The Highest Court - Supreme Court

Appellate court is a trier of law

CHECK FOR UNDERSTANDING

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 4

Module #1 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

interest of those they serve.

5. All but one is the fundamental principles of law?

7. This a person who brings an action in a court law.

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 5

Module #1 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

8. Which of the following is NOT a major element of discovery?

AL Activity: CAT: 3-2-1

Three things you learned:

Two things that you’d like to learn more about:

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 6

Module #1 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

One question you still have:

THIS DOCUMENT IS THE PROPERTY OF PHINMA EDUCATION 7

Module #2 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson Title: Human Value Development and the System of Materials:

Brain Teaser: Answer the questions below.

1. What are the steps in civil lawsuit?

World view or value system

Name: ___________________________________________________________ Class number: _

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