FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
PRINCLE OF DOUBLE EFFECT
Thomas Aquinas (1225 – 1274)
 An intellectual and religious
revolutionary.
 He was a member of the
Dominican Friars.
 Taught by one of the greatest
intellects of the age, Albert the
Great (1208- 1280)
 His most famous work is Summa
Theologica.
 Runs to some three and half
thousand pages and contains
many fascinating and profound
insights, such as proofs for God’s
existence.
MOTIVATING NATURAL LAW THEORY : THE
EUTHYPHRO DILEMMA AND DIVINE
COMMAND THEORY
Divine Command Theory
 Drawing link between what is right
and wrong and what God
commands and forbids
Euthyphro Dilemma
 The dilemma runs as follows : Either
God commands something is right
because it is, or it is right because
God commands it.
NATURAL LAW THEORY
Aquinas’s Natural Law Theory contains four
different types of law
A. Eternal Law - means God’s rational
purpose and plan for all thing
B. Natural Law - act according to
reason
C. Human Law - discovered through
rational reflection and created by
people
D. Divine Law - discovered through
revelation
EXAMPLE OF PRIMARY PERCEPTS
 Protect and preserve human life
 Reproduce and educate one’s
offspring
 Know and worship God
 Live in a society
 These precepts are primary
because they are true for all people
in all instances and are consistent
with Natural Law.
DOCTRINE/PRINCIPLE OF DOUBLE EFFECT
 Aquinas introduces one of his most
famous ideas: the “ Doctrine of
Double Effect”
Let’s see how this works.
 Imagine a child brought up in a
physically, sexually and emotionally
abusive family. He is frequently
scared for his life and is locked in the
house for days at a time. One day
when his father is drunk and ready
to abuse him again, he quickly
grabs a kitchen knife and slashes his
father’s artery. His father bleeds out
and dies in a matter of minutes. Do
you think the son did anything
wrong?
DEFINITION OF THE PRINCIPLE OF DOUBLE
EFFECT
 A principle that purports to answer
the following question is it right to
perform an action from which two
or more effects result. Some of
which are good and may rightly be
intended and some of which are
bad and may not rightly be
intended?
 One act can embrace two effects-
an intended good effect and an
unintended bad effect
G.T 1
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
THE FOUR CONDITIONS OF THE PRINCIPLE
OF DOUBLE EFFECT
1. The act-in-itself must not be morally
wrong.
2. The bad effect must not cause the good
effect.
3. The agent must not intend the bad effect
( as an end to be sought)
4. The bad effect must not outweigh the
good effect
LET’S GO BACK TO OUR EXAMPLE
Imagine a child brought up in a physically,
sexually and emotionally abusive family. He
is frequently scared for his life and is locked
in the house for days at a time. One day
when his father is drunk and ready to abuse
him again, he quickly grabs a kitchen knife
and slashes his father’s artery. His father
bleeds out and dies in a matter of minutes.
Do you think the son did anything wrong?
PRINCIPLE OF DOUBLE EFFECT
1. The act of the son was performed to save
his own life so that is good.
2. The act to save his life came about first.
3. The son did not first act to kill his father in
order to save his own life. That would be
doing evil to bring about good and that is
never morally acceptable. The intention of
the son was to preserve and protect his life,
so the intention was good.
4. The reasons were serious as it was his life
or his father’s life.
CLASSIC EXAMPLE
• The terminally ill pulmonary patient who is
experiencing both great pain and a low
respiratory rate. The treatment of choice,
injecting morphine sulfate, will quell the
pain but might also “ quell” the respiratory
rate. The nurse has a moral duty to prevent
and remove evil (pain) that appears to
conflict with the duty to benefit patients (
protect and preserve life), a dilemma
indeed. The answer to the question of
whether the nurse may administer
morphine is clearly YES.
APPLYING THE CRITERIA OF DOUBLE EFFECT
ILLUSTRATES WHY THIS IS SO:
1. The action of giving an injection of
morphine is itself morally different or good.
2. The intended effect is to relieve the pain,
not to depress the respirations
3. Respiratory depression is not the means
by which the pain relief is obtained.
4. The relief of pain and the related
reduction of suffering combine to provide
a sufficiently important reason, or
proportionately greater good than the
harm that is incurred-respiratory depression
and likely death.
APPLICATION OF THE PRINCIPLE OF DOUBLE
EFFECT
 Abortion
 Ectopic pregnancy
 Euthanasia
 Mutilation
 Sterility issues
 Mental Reservation
 Cooperation in an Evil Act
 Breaching Confidentiality
 Palliative Care
 Separation of conjoined twins
LEGAL RECOGNITION OF DOCTRINE OF
DOUBLE EFFECT
 R v Bodkin Adams (1957)
 GP acquitted of murder by
administration of increasing doses
of opiates to elderly patients.
 Devlin, J (judge) introduced double
effect doctrine:
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 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE

if the first purpose of

medicine, the restoration of health,
could no longer be achieved, there
was still much for the doctor to do,
and he was entitled to do all that
was proper and necessary to
relieve pain and suffering even if
the measures he took might
incidentally shorten life”
 Airedale NHS v Bland ( 1993)
 It is the established rule that a
doctor may, when caring for a
patient, who is, for example, dying
of cancer, lawfully administer
painkilling drugs despite the fact
that he knows than an incidental
effect of that application will be to
abbreviate the patient’s life…
 Such decisions may properly be
made as part of the care of the
living patient, in his best interest,
and on this basis, the treatment will
be lawful.
LEGAL RECOGNITION OF DOCTRINE OF
DOUBLE EFFECT- PROBLEMS
 Contrary to traditional notions of
criminal law intention and
causation
 Airedale NHS Trust v. Bland ( 1993)
 concern expressed about dubious
demarcation between primary
(direct) and secondary (oblique)
intention.
  Double effect – is it hypocrisy?
- isn’t the actor who
foresees the consequences
of an action acting
intentionally and therefore
culpable or responsible for
the act and its outcome?
PRINCPLE OF LEGITIMATE
COOPERATION
THE PRINCIPLE OF COOPERATION
- Portrays the Principle of the Double
effect in a scenario in which more
than one person participates in the
actions being evaluated.
- COOPERATION is working with
another in the performance of an
action.
- The degree of cooperation may
vary according to the gravity or
essentiality of the shared act in the
performance of an evil action.
FORMAL COOPERATION
- Occurs when one assents to the evil
intention of the person mainly
responsible for performing the evil
action.
- Consists of an explicit intention and
willingness for the evil act. The one
formally cooperating categorically
wills and intends the evil action.
- May occur if one advises,
encourages, or counsels the person
principally responsible for the evil
action, even though one does not
take part physically in the action.
MATERIAL COOPERATION
- Consists of an act other than the
evil act itself but facilitates and
contributes to its achievement
- The one materially cooperating
may provide means apart from the
evil act itself which is used to carry
out the performance of an evil act.

TYPES:

- Immediate material cooperation

- Mediate material cooperation

G.T 3
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
PRINCIPLE OF COMMON GOOD AND
IMMEDIATE MATERIAL COOPERATION
- If one's action contributes to the
active performance of the evil
action so much so that the evil
action could not be performed
without the help of the cooperator.
- This method of cooperation
involves the cooperator acting in
conjunction with the person
primarily responsible for the evil
action
- If the act in question is intrinsically
evil, then immediate material
cooperation is always prohibited.
MEDIATED MATERIAL COOPERATION
- If one's cooperation is not
needed to perform the evil
action, but only assists in the
performance of the action.
- This type of material
cooperation may be justified if
there is a serious reason for it
because the action on the part
of the cooperator is
fundamentally good.
MORAL RULES GOVERNING COOPERATION
- No one should formally and directly
cooperate in the performance of
an evil action.
- If a reason sufficiently grave exists,
material cooperation in the
performance of an evil action may
be morally excused.
- If the material cooperation is
proximate, a reason sufficiently
graver should exist to be morally
excused without which evil is
incurred.
SUBSIDIARITY
PRINCIPLE OF COMMON GOOD
- The principle of the common good,
to which every aspect of social life
must be related if it is to attain its
fullest meaning, stems from the
dignity, unity and equality of all
people.
- The common good does not consist
in the simple sum of the goods of
each subject of a social entity.
- Belonging to everyone and to each
person, it is and remains “
common”, because it is indivisible
and because only together is it
possible to attain it, increase it and
safeguard its effectiveness, with
regard also to the future.
- A society that wishes and intends to
remain at the service of the human
being at every level is a society that
has the common good – the good
of all people and of the whole
person- as its primary goal.
- The human person cannot find
fulfillment in himself, that is, apart
from the fact that he exists “ with”
others and “for” others.
RESPONSIBILITY OF EVERYONE FOR THE
COMMON GOOD
- The common good therefore
involves all members of society, no
one is exempt from cooperating,
according to each one’s
possibilities, in attaining it and
developing it.
- Everyone also has the right to enjoy
the conditions of social life that are
brought about by the quest for the
common good.
G.T 4
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
TASK OF THE POLITICAL COMMUNITY
- The responsibility for attaining the
common good, besides falling to
individual persons, belongs also to
the State, since the common good
is the reason that the political
authority exists.
- To ensure the common good, the
government of each country has
the specific duty to harmonize the
different sectoral interests with the
requirements of justice.
- The common good of society is not
an end in itself, it has value only in
reference to attaining the ultimate
ends of the person and the
universal common good of the
whole of creation.
PRINCIPLE OF SUBSIDIARITY
- A social principle that calls on
people to collaborate with each
other in various kinds of social
groupings to accomplish differing
common goods, from direct and
immediate to broad and complex
one, and directed to a higher
common good.
- A kind of sociological discipline
adhered to and advocated by the
church. Its moral implication is
embedded in its meaning.
- Means that what an individual,
lower or smaller group can achieve
within his/her or its capacity should
not be take away and transmitted
to the custody and performance of
a higher or bigger group.
PRINCIPLES OF BIOETHICS
PRINCIPLE OF STEWARDSHIP AND ROLE OF
NURSES AS STEWARDS
 STEWARDSHIP refers to the
expression of one’s responsibility to
take care of, nurture and cultivate
what has been entrusted to him.
 In health care practice,
STEWARDSHIP refers to the
execution of responsibility of the
health care practitioners to look
after, provide necessary health
care services, and promote the
health and life of those entrusted to
their care.
ROLES OF NURSES AS STEWARDS
 Practice of bearing witness or being
present to clients.
 Preserve and promote what is
intrinsically valuable within their
environments.
 Recognize openness to clients by
respecting their capacity to be
authentic.
 Assist clients to express their feelings.
 Encourage clients to gain insight
into their needs and their potential
satisfaction.
 Participate in setting visions for
health-care organizations that
promote the greater good.
PRINCIPLE OF TOTALITY AND ITS INTEGRITY
 These principles dictates that the
well-being of the whole person must
be considered in deciding about
any therapeutic intervention or use
of technology.
 A part exists for the good of the
whole and may be sacrificed when
necessary to serve a proportionate
good for the whole.
 INTEGRITY refers to everyone's duty
to “preserve a view of the whole
human person in which the values
of the intellect, will, conscience and
fraternity are preeminent”
 TOTALITY refers to the duty to
preserve intact the physical
component of the integrated
bodily and spiritual nature of
human life, whereby every part of
the human body “exists for the sake
G.T 5
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
of the whole as the imperfect for
the sake of the perfect”
INTEGRITY TYPES
 Anatomical Integrity
 Functional Integrity
ANATOMICAL VS FUNCTIONAL INTEGRITY
Anatomical integrity – Refers to the
material or physical integrity of the human
body.
Functional Integrity – Refers to the
systematic efficiency of the human body.
ORGAN TRANSPLANT
Transplanting organs from one living person
to another is ethically acceptable
provided that the following criteria are met:
1. There is a serious need on the part
of the recipient that cannot be
fulfilled in any other way.
2. The functional integrity of the donor
as a human person will not be
impaired, even though anatomical
integrity may suffer.
3. The risk taken by the donor as an
act of charity is proportionate to the
good resulting for the recipient.
4. The donor’s and the recipient’s
consents are free and informed.
PRINCIPLES OF ORDINARY AND
EXTRAORDINARY MEANS
Ordinary Means - ‘usual’ or ‘customary’ for
physicians to use them for certain diseases,
such as pneumonia, or certain problems,
such as malnutrition.
Extraordinary Means - ‘unusual’ or
‘uncustomary’ for physicians to use them
for certain diseases or problems.
PRINCIPLE OF PERSONALIZED SEXUALITY
 Based on an understanding of
sexuality as one of the basic traits of
a person and must be developed in
ways consistent with enhancing
human dignity.
 Takes note of a humanized
sexuality, one that represents the
fulfillment of physical and sensual
need but also evidenced with love
and sacramental mystery.
The principle of personalized sexuality may
be stated as follows:
 The gift of human sexuality must be
used in marriage in keeping with its
intrinsic, indivisible, specifically
human teleology. It should be loving,
bodily, pleasurable expression of the
complimentary, permanent self-
giving of a man and woman to each
other, which is open to fruition in
perpetuation and expansion of this
personal communion through the
family they beget and educate
BIOETHICS AND ITS APPLICATION IN
VARIOUS HEALTH CARE SITUATIONS:
SEXUALITY AND HUMAN
REPRODUCTION
SEXUALLY AND HUMAN REPRODUCTION
- Human Sexuality and its Moral
Evaluation
- Marriage
- Issues on Artificial Reproduction, its
Morality and Ethico-moral
Responsibility of Nurse
- Morality of Abortion, Rape and
other Problems related to
Destruction of Life
The Science of Human Sexuality?
Sex - Refers to anatomic sex, male or
female
Sexual - Refers to anatomic structures,
called sex organs or sexual organs, that
play a role in reproduction or sexual
pleasure.
G.T 6
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE

Having sex - Refers to physical activities  Orientation

involving our sex organs for purposes of  Self-esteem & confidence level
reproduction, or pleasure  Relationships with family & friends
 Roles as child & adult
Gender - Refers to social or cultural  Perception of self as male/female
categories.
REPRODUCTION - values, attitudes &
Human Sexuality - Refers to the ways in behaviors relating to reproduction
which we experience and express
 Contraception & fertility issues
ourselves as sexual beings.
 Lifestyles
MAKE-UP OF AN INDIVIDUAL’S UNIQUE  STIs (including AIDS)
SEXUAL BEING  Anatomy & physiology
 Morality issues
 Physical
SEXUALIZATION - use of sexuality to
 Psychological
influence, control or manipulate
 Social
 Cultural  Style of dress
 Spiritual  Appearance & body language
FIVE FEATURES OF SEXUALITY  Advertising
 Movies, talk shows & media
 Sensuality  Harassment & sexual assault
 Intimacy  Paraphilias (voyeurism,
 Sexual Identity exhibitionism)
 Reproduction
Values
 Sexualization

SENSUALITY - awareness and acceptance VALUES: the qualities in life which are
of our own body deemed important or unimportant, right, or
wrong, desirable, or undesirable
 knowledge of anatomy &
physiology MORAL VALUES: relate to our conduct with
 understanding sexual response and treatment of other people, more than
 body image just right or wrong, looks at the whole
 satisfaction of skin hunger picture
 attraction template
 fantasy SEXUAL MORAL VALUES: relate to the
rightness and wrongness of sexual conduct
INTIMACY - experiencing emotional and when and how sexuality should be
closeness to another expressed

 Caring SOURCES OF SEXUAL VALUES: we acquire

 Sharing our sexual values from our social
 Risk taking
environment
 Vulnerability
 Self- disclosure VALUE SYSTEM FOR MAKING SEXUAL
SEXUAL IDENTITY - process of discovering DECISIONS
who we are in terms of sexuality
- Legalism
 Gender roles - Situational ethics
- Ethical relativism

G.T 7
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
- Hedonism
- Asceticism
- Utilitarianism
- Rationalism
LEGALISM
- The legalistic approach formulates
ethical behavior based on a code
of moral laws derived from an
external source, such as a religion.
- The Hebrew and Christian Bibles
contain many examples of the
moral code of the Jewish and
Christian religions.
Book of Leviticus (20:10 – 17)
- 10: And the man that committed
adultery with another man’s wife,
even he that committed adultery
with his neighbor’s wife, the
adulterer and the adulteress shall
surely be put to death.
- 11: And the man that lieth with his
father’s wife hath uncovered his
father’s nakedness: both shall surely
be put to death; their blood shall be
upon them.
- 12: And if a man lies with his
daughter in law, both shall surely be
put to death: they have wrought
confusion; their blood shall be upon
them.
- 13: If a man also lies with mankind, as
he lieth with a woman, both have
committed an abomination: they
shall surely be put to death; their
blood shall be upon them.
- 14: And if a man takes a wife and her
mother, it is wickedness: they shall be
burnt with fire, both he and they;
that there be no wickedness among
you.
- 15: And if a man lie with a beast, he
shall surely be put to death: and ye
shall slay the beast
- 16: And if a woman approach unto
any beast, and lie down thereto,
thou shalt kill the woman, and the
beast: they shall surely be put to
death; their blood shall be upon
them.
- 17: And if a man shall take his sister,
his father’s daughter, or his mother’s
daughter, and see her nakedness,
and she see his nakedness; it is a
wicked thing; and they shall be cut
off in the sight of their people: he
hath uncovered his sister’s
nakedness; he shall bear his iniquity.
- 18: And if a man shall lie with a
woman having her sickness and shall
uncover her nakedness; he hath
discovered her fountain, and she
hath uncovered the fountain of her
blood: and both shall be cut off from
among their people.
SITUATIONAL ETHICS
- Episcopal theologian Joseph
Fletcher (1966) argued that ethical
decision making should be guided
by love for others rather than by rigid
moral rules, and that sexual decision
making should be based on the
context of the situation that the
person faces.
- “The situationist is prepared in any
concrete case to suspend, ignore, or
violate any principle if by doing so
he can effect better than by
following it” (1966, p. 34)
SITUATION ETHICS
- Joseph Fletcher in ‘situation ethics
captured the mood of 1960’s when
approaches to sex and relationships
became freer – because of
contraceptive pill
- Situation ethics seeks equal
treatment of everyone and acts out
of love. Sex is a genuine expression
of love.
- Situation ethics has one Primary
principle – agape for Unconditional
love; not love as an emotion but the
love That put what is best for the
other person first.
G.T 8
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
- N.B. This is not easy when applied in
practice when strong feelings and
physical drives take over
- Situation ethics rejects free love like
natural law and Kantian ethics.
Rejecting one nightstand, orgies etc.
ETHICAL RELATIVISM
- Assumes that diverse values are
basic to human existence.
- Ethical relativists reject the idea that
there is a single correct moral view
about subjects as diverse as wearing
revealing clothing, masturbation,
premarital sex, oral sex, anal sex,
contraception, and abortion.
CULTURAL RELATIVISM
- One form of ethical relativism.
- From this perspective, what is right or
wrong must be understood in terms
of the cultural beliefs that affect
sexual decision making.
HEDONISM
- Guided by the pursuit of pleasure,
not by whether a particular behavior
is morally or situationally justified.
- “If it feels good, do it” expresses the
hedonistic ethic.
ASCETICISM
- Religious celibates, such as Roman
Catholic priests and Buddhist monks,
choose asceticism (self-denial of
material and sexual desires) to
devote themselves to spiritual
pursuits.
UTILITARIANISM
- The English philosopher John Stuart
Mill (1806– 1873) proposed an
ethical system based on
utilitarianism —the view that moral
conduct is based on that which will
bring about “the greatest good for
the greatest number” (Mill, 1863)
UTILITARIANISM
Utilitarian reasons for having sex:
1. The value of pleasure
2. The contribution which shared
pleasure makes to the value of a
relationship
3. That consensual sex creates much
good, and, if harm to another
person is avoided, provides the
greatest happiness for the greatest
number.
- Utilitarian view to sex is called
libertarian. More than a
contractarian approach which
emphasizes the importance of
mutual voluntary informed consent.
- Bentham - if there is mutual consent
for pleasure sex is not wrong if both
partners are willing. He also asked
whether such a relationship harmed
society/caused unhappiness, either
physical or moral (Undermining
marriage, fidelity etc.)
- Sex is immoral if one or both of those
involved lack a knowledgeable
consent. i.e., a man having sex with
15-year-old illegal immigrant
desperate for money. This is immoral
many prostitutes have been forced
into it.
UTILITARIANISM & SEX
- John Stuart Millsstresses the value of
liberty, sex should be a matter of
individual choice, without state
interference. However, we should try
to seek higher pleasures and the
goal of ethics is to seek the
happiness of all by taking their needs
into account
- Masturbation, homosexuality, and
bisexuality is tolerated. However, if
everyone was a homosexual it
would harm society.
- Harm principle – (an act or
consequence is morally permissible if
G.T 9
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
no harm is done) is important to
utilitarianism especially in extra-
marital affairs – short-term pleasure
will produce long term pain. Etc.
RATIONALISM
- Rationalism is the use of reason to
determine a course of action.
- The rationalist believes that decisions
should be based on intellect and
reason rather than emotions or faith.
Aquinas – Natural Law
- Aquinas concluded that the
purpose of sexual organs and sexual
activity was procreation, and any
other use of sex was intrinsically
wrong. Sex is only in marriage.
- View of Catholic Church.
- He attempted to unite Aristotle with
Christian theological – looking at
end purpose –telos.
1) Sex is wrong if it does not coincide
with the act of procreation –
Masturbation, bestiality,
homosexuality, and foreplay are all
immoral.
2) Sexual acts can be morally wrong
even if it is natural – i.e., incest, rape,
or adultery
Kant – categorical imperative
- A husband who commits adultery
cannot want extra-marital sex to be
universal law unless he wants his
wife, children, parents and so on to
engage in extra-marital activities.
- Neither can homosexuality be
universalized since every
homosexual is conceived through a
heterosexual relationship – although
artificial insemination could change
this.
- Kant does not see sex within
marriage as wrong, the purpose of
marriage is NOT PROCREATION, but
a union of two people of different
sexes. Sex is morally acceptable in a
monogamous relationship
- You should not use humans to an
end i.e., prostitution.
- Sexual pleasure is only allowed when
service more valuable goals such as
marriage
VIRTUE ETHICS
- Rosalind Hursthouse – A Virtuous
person is one who exercises the
virtues in circumstances
- Michael Slote – Emphasis ethics of
care in relationships, requires a sort
of 3-way balance as far as sex and
relationships: 1) care for those who
are near to us (intimate care) 2) care
for other people in general
(humanitarian care) 3) care for our
own well-being (self-care)
- Virtue ethics looks from the
standpoint of the individual and his
or her personal qualities, virtue, and
ideas.
- Virtue Ethics Points to the values of –
love commitment, honesty, loyalty,
friendship, pleasure. Vices –
exploitation and selfishness.
- Virtue Ethics would consider what
kind of sexual practices will tend to
make a person more virtuous – those
that involve taking pleasure in giving
oneself to another and developing
intimacy and commitment, less
virtuous- those that use others for
one’s own pleasure.
G.T 10
 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
ISSUES TODAY IN CHRISTIAN ETHICS
- Today the unitive role of love is a
comparatively modern element,
and the role of sex in marriage as an
expression of that love is also now
recognized. Even sexual pleasure is
seen as a gift from God in
heterosexual marriage. (See song of
Solomon)
- Richard Holloway points out, that the
Bible is being used for the possible
split of the Church over ordination of
gay bishops. Holloway states that
the impetus for social reform comes
from society and not the Church.
- Jack Dominion states that sex is not
dangerous and should only be used
for procreation. Sex is so powerful
and meaningful that justice can only
be done to it in a continuous and
enduring relationship.
- He accepts cohabitation,
premarital sex and even accepts
homosexual sex if it is in a loving
relationship. He sees the church as
having to rethink ideals.
- There is a big divide today with
homosexuality. The rejects
homosexuality stating it is an
abomination. However, the Bible
also says you shouldn’t mix milk with
meat. Of which most Christians
ignore
PERSPECTIVES ON HUMAN SEXUALITY
 Historical
 Biological
 Evolutionary
 Cross-species
 Cross-cultural
 Psychological
 Sociocultural
HISTORICAL PERSPECTIVE
- Prehistoric Sexuality: From Female
Idols to Phallic Worship
- Art produced in the Stone Age
suggests the worship of women’s
ability to bear children and
perpetuate the species (Fichner-
Rathus, 2013).
- As people grew aware of the male
role in reproduction, phallic worship
(worship of the penis) sprang into
being.
- The penis became glorified in art as
a plough, ax, or sword. Phallic
symbols played roles in religious
ceremonies in ancient Egypt.
- The incest taboo may have been
the first human taboo.
THE ANCIENT HEBREWS
- The ancient Hebrews viewed sex, at
least in marriage, as a satisfying
experience intended to fulfill the
divine command to “be fruitful and
multiply.”
- The ancient Hebrews believed that
sex helped strengthen marital bonds
and solidify the family.
- According to the Book of Proverbs, a
good wife rises before dawn to tend
to her family’s needs, brings home
food, instructs the servants, tends the
vineyards, makes the clothes, keeps
the ledger, helps the needy, and
works well into the night.
THE ANCIENT GREEKS
- Greeks valued family life, but Greek
men also admired the well-
developed male body and enjoyed
nude wrestling in the arena.
- Erotic encounters and off-color jokes
characterized the plays of
Aristophanes and other playwrights.
- The Greeks held that the healthy
mind must dwell in a healthy body.
They cultivated muscle and
movement along with mind.
- Three aspects of Greek sexuality are
of particular interest to our study of
sexual practices in the ancient
world: male–male sexual behavior,
pederasty, and prostitution.
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- The Greeks viewed people as - Christians, like Jews before them,

bisexual. Male–male sex was demanded virginity of brides
deemed normal and tolerated so (MacCulloch, 2011).
long as it did not threaten the - Prostitution was condemned.
institution of the family. - The goal of procreation should
- Pederasty means love of boys. govern sexual behavior—the spirit
- Prostitution flourished at every level should rule the flesh.
of society. Prostitutes ranged from - Saint Augustine (353–430 CE)
refined courtesans to concubines, associated sexual lust with the
who were usually slaves. original sin of Adam and Eve in the
Garden of Eden. Lust and shame
THE WORLD OF ANCIENT ROME
were passed down through the
generations.
- Julius Caesar is reputed to have
been bisexual— “a man to every
woman and a woman to every
man.” ISLAM
- Other emperors, such as Caligula,
sponsored orgies at which guests - The Islamic tradition treasures
engaged in sexual practices marriage and sexual fulfillment in
including bestiality and sadism. marriage.
- Romans disapproved of male–male - Premarital sex and adultery invite
sexual behavior as a threat to the shame and social condemnation
integrity of the Roman family. - Islamic tradition permits a sexual
- Western society traces the roots of double standard
many of its sexual terms to Roman
INDIA
culture, as indicated by their Latin
roots. - Hindu sexual practices were
- Fellatio, for example, derives from codified in a sex manual, the Kama
the Latin fellare, meaning “to suck.” Sutra, which illustrates sexual
- Cunnilingus derives from cunnus, positions, some of which would
meaning “vulva,” and lingere, “to challenge a contortionist.
lick.”
- Fornication derives from fornix, an THE FAR EAST
arch or vault.
- To the Taoist masters of China, who
THE EARLY CHRISTIANS influenced Chinese culture for
millennia, sex was a sacred duty—a
- Early Christian views on sexuality form of worship that led toward
were largely shaped by Saint Paul harmony with nature and
and the church fathers in the first immortality.
century and by Saint Augustine in - The Chinese culture was the first to
the latter part of the fourth century. produce a detailed sex manual,
- Adultery and fornication were which came into use about 200
rampant among the upper classes years before the birth of Jesus.
of Rome at the time, and early - Taoists believed that it was wasteful
Christian leaders began to associate for a man to “spill his seed.”
sexuality with sin (MacCulloch, Masturbation, acceptable for
2011). women, was ruled out for men.
Sexual practices such as anal
intercourse and oral–genital

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HEALTH CARE ETHICS
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contact (fellatio and cunnilingus)
was permissible.
- Same-sex activity was not prohibited
by Taoist holy writings, but some
Taoists frowned on exclusive
homosexuality.
CHRISTIANITY IN THE MIDDLE AGES
- The attitudes of the Roman Catholic
Church toward sexuality, largely
unchanged since the time of
Augustine, dominated medieval
thought (Crawford et al., 2011)
- There were two conflicting concepts
of woman: One was the woman as
Eve, the temptress; the other was the
woman as Mary, virtuous and pure.
THE PROTESTANT REFORMATION
- Martin Luther disputed many Roman
Catholic doctrines on sexuality.
- He believed that priests should be
FOUNDATIONS OF THE SCIENTIFIC STUDY OF
allowed to marry and rear children.
- To Luther, marriage was as much a
part of human nature as eating or
drinking.
- John Calvin rejected the Roman
church’s position that sex in
marriage was permissible only for
procreation. He believed that sexual
expression in marriage also
strengthened the marriage bond
and helped relieve the stresses of
everyday life.
COMING TO AMERICA
- Early settlers brought to North
America the religious teachings that
had dominated Western thought
and culture for centuries.
- A woman’s place, by and large, was
in the home and in the fields.
- Not until 1833, when Oberlin College
opened its doors to women, were
women permitted to attend college
in the United States.
THE VICTORIAN PERIOD
- Victorian society in Europe and the
United States, on the surface at
least, was prim and proper.
- Sex was not discussed in polite
society.
- Many women viewed sex as a
marital duty to be performed for
procreation or to satisfy their
husbands’ cravings.
- It was widely believed among
medical authorities in England and
the United States that sex drains the
man of his vitality
- Prostitution flourished during the
Victorian era.
- Same-sex sexual behavior was
considered indecent in Victorian
society.
SEXUALITY
- The English physician Havelock Ellis
(1859–1939) published a veritable
encyclopedia of sexuality between
1897 and 1910, Studies in the
Psychology of Sex.
- The influential German psychiatrist
Richard von Krafft-Ebing (1840–1902)
described case histories of people
with sexual deviations in his book,
Psychopathia Sexualis (1886)
- Sigmund Freud (1856–1939), was
developing a theory of personality
that has had an enormous influence
on modern culture and science.
- Alfred Kinsey (1894–1956), an
Indiana University zoologist,
conducted the first large-scale
studies of sexual behavior in the
1930s and 1940s.
THE SEXUAL REVOLUTION
- The period of the mid-1960s to the
mid-1970s is often referred to as the
sexual revolution.
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- The sexual revolution gained
momentum from a timely interplay
of scientific, social, political, and
economic forces. The war (in
Vietnam), the bomb (fear of the
nuclear bomb), the pill (the
introduction of the birth control pill),
and the mass media (especially
television) were four such forces.
GAY ACTIVISM
- Gay activism mushroomed during
the sexual revolution.
- Not only did gays become more
voluble in demanding equal rights,
but they also began gay parades in
major cities, such as the annual
parades in San Francisco and New
York’s Greenwich Village.
- In the early 1980s, gay people also
built social institutions to tackle the
problem of HIV/AIDS, which afflicted
gay males disproportionately.
SEX RESEARCH
- Shere Hite published controversial
books based on magazine surveys,
but her popularity fell when it
became clear that 3,000 magazine
readers did not represent the
country, or even all readers of the
magazine.
- Morton Hunt conducted a Schmitt, 2011).
telephone survey financed by
Playboy in the 1970s, and he
claimed to find a populace more
sexually liberal than in Kinsey’s day.
- In the 1960s, Masters and Johnson
were condemned by many as
destroying the moral fabric of the
nation—a complaint like those
leveled earlier against Kinsey.
- Today, research on sexual behavior
continues, with more valid methods
of sampling the population and a
largely jaded citizenry.
RECENT TRENDS
- More teenagers are sexually active
today, and at younger ages, than
they were a couple of generations
ago (Russell et al., 2012).
- In addition to premarital sex, two
other features of the sexual
revolution have become
permanent parts of our social fabric:
the liberation of female sexuality
and a greater willingness to discuss
sex openly.
- All societies have some form of an
incest taboo.
- Most societies place a value on
procreative sex within the context of
an enduring relationship, usually in
the form of marriage.
THE BIOLOGICAL PERSPECTIVE
- Focuses on the roles of genes,
hormones, the nervous system, and
other biological factors in human
sexuality.
- Study of the biology of sex informs us
about the mechanisms of
reproduction as well as of the
mechanisms of sexual arousal and
response.
THE EVOLUTIONARY PERSPECTIVE
- Scientists look to evolution to help
explain such variability (Buss &
- The English naturalist Charles Darwin
(1809–1882) showed that current
species of animals and plants
evolved from other life-forms
through natural selection, or
“survival of the fittest.”
- New variations in species can also
be introduced through random
genetic changes called mutations.
- Traits are transmitted by units of
heredity called genes.
- Some scientists suggest that there is
also a genetic basis to social
behavior, including sexual behavior,
among humans and other animals
(Buss & Schmitt, 2011).
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HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
THE EVOLUTIONARY PERSPECTIVE AND
EROTIC PLASTICITY
- Consider the concept of “erotic
plasticity” (Baumeister, 2000), which
addresses the fact that in response
to various social and cultural forces,
people show different levels of sex
drive and express their sexual desires
in a variety of ways.
- There is evidence that women show
greater erotic plasticity than men do
(Baumeister, 2000; Yost & Thomas,
2011).
ALTRUISM
- In evolutionary terms, his “altruism”—
his personal sacrifice—is adaptive if
it increases the chances that the
offspring will survive and carry his
genes.
- In other species, it may be adaptive
for fathers to “love them and leave
them”—that is, to mate with as many
females as possible and abruptly
abandon them to “plant their seed”
elsewhere.
GENDER DIFFERENCES IN PREFERRED
NUMBER OF SEX PARTNERS
- Some evolutionary psychologists
argue that men are naturally more
promiscuous than women because
they are the genetic heirs of
ancestors whose reproductive
success was related to the number
of women they could impregnate
(Buss & Schmitt, 2011).
THE CROSS – SPECIES PERSPECTIVE
- The study of other animal species
places human behavior in broader
context.
- Cross-species research reveals an
interesting pattern. Sexual behavior
among “higher” mammals, such as
primates, is less directly controlled by
instinct than it is among the “lower”
species, such as birds, fish, or lower
mammals.
- Experience and learning play more
important roles in sexuality as we
travel up the evolutionary ladder.
SOCIOLOGICAL PERSPECTIVES
- In Sex and Temperament in Three
Primitive Societies (1935), Mead laid
the groundwork for recent
psychological and sociological
research challenging gender role
stereotypes.
- In such cultures, men are perceived
as strong, active, independent, and
logical. Women are viewed as
passive, dependent, nurturing, and
emotional.
- In 1951, Clellan Ford, an
anthropologist, and Frank Beach, a
psychologist, reviewed sexual
behavior in almost 200 preliterate
societies around the world. They
found great variety in sexual
customs and beliefs.
- Kissing was quite common although
not universal.
- The frequency of sexual intercourse
also varies from culture to culture,
but intercourse is relatively more
frequent among young people
everywhere.
- Societies differ in their attitudes
toward childhood masturbation.
- Societies differ widely in their sexual
attitudes, customs, and practices.
PSYCHOLOGICAL PERSPECTIVES
- Sigmund Freud and Psychoanalytic
Theory
- Sigmund Freud, a Viennese
physician, formulated a grand
theory of personality termed
psychoanalysis.
- Freud believed that we are all born
with biologically based sex drives
that must be channeled through
socially approved outlets if family
and social life are to carry on without
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HEALTH CARE ETHICS
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undue conflict.
ACCORDING TO FREUD
- Each person’s approach to sex and
relationships is based on their
upbringing and their relationship
with their parents.
- He suggests that sexual personality
may be found at the core of moral
personality – how we behave
towards sexual partners both
influences and mirrors how we
perceive and interact with people in
general. – failure to learn to control
the pursuit of sexual pleasure
undermines the achievement of
virtuous character.
- We have a Super-ego – an inner
voice reminding us of social norms
which comes from parents and
authority figures in society. – we
need this voice to live ethically in
society.
- As a result of the superego rules
about sex and relationships change
dependent upon cultures.
- Oedipus and castration complex –
The wants to sleep with his mother
but doesn’t because she has no
penis, therefore his father
(according to the child’s mind) has
chopped his mother’s penis off. He
will then submit to his father. His urges
will only be later directed to his wife.
LEARNING THEORIES
- Behaviorists such as John B. Watson
(1878–1958) and B. F. Skinner (1904–
1990) emphasized the importance
of rewards and punishments in the
learning process.
- Behaviorists Learning theorists who
argue that a scientific approach to
understanding behavior must refer
only to observable and measurable
behaviors.
COGNITIVE VIEWS
- Cognitive psychologists emphasize
the importance of cognitive activity.
- Observational learning refers to
acquiring knowledge and skills
through observing others
- According to social–cognitive
theory, children acquire the gender
roles deemed appropriate in a
society through reinforcement of
gender-appropriate behavior and
through observing the genderrole
behavior of their parents, their peers,
and other models on television, in
films, in books, and so on
FEMINIST THEORY
- The Greek philosopher Aristotle is
said to have described a female as
a deformed male.
- Feminism and feminist theory are
born against ideas such as those of
Aristotle’s—ideas that remain with us
today in many if not most parts of the
world (Petersen & Hyde, 2010).
FEMINIST THEORY CHALLENGES
 Traditional views of men as
breadwinners and women as
homemakers
 Traditional views of men as
political policymakers, especially
since those policies affect
women and children
 Traditional views of men as
sexual “aggressors” and women
as sexual “gatekeepers”
 Traditional gender roles that
view men as objective and
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BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
rational, and women as
emotional and irrational
QUEER THEORY
- Queer theory challenges several
commonly held assumptions about
gender and sexuality, such as the
assumptions that heterosexuality is
normal and superior to
homosexuality (Semp, 2011).
- Queer theory also challenges the
assumption that people are
naturally divided into heterosexuals
and homosexuals (Downing &
Gillett, 2011).
- According to queer theory, the
concepts of heterosexuality and
homosexuality are social constructs
that ignore commonly experienced
mismatches among people’s
anatomic sex, society’s gender
roles, and individuals’ sexual desires
(Downing & Gillett, 2011).
SEXUAL MORALITY AND MARRIAGE
KANT’S DEFINITION OF MARRIAGE
- [Marriage] is an agreement
between two persons by which they
grant each other equal reciprocal
rights, each of them undertaking to
surrender the whole of their person
to the other with a complete right of
disposal over it.
Sex within marriage is about the whole
person and not simply the genitals, sexual
desire, and pleasure. How does this work?
- This is how Soble starts to approach
this question:
- But because the acquisition [of
another through sex] in marriage is
reciprocal, each person regains his
or her personhood (and hence does
not lose it, after all). When I
“surrender” myself to you, and you
thereby acquire me, but you also
“surrender” yourself to me, and I
thereby acquire you, which “you”
includes the “me” that you have
acquired, we each surrender but
then reacquire ourselves.
VATICAN DECLARATION ON SOME
QUESTIONS IN SEXUAL ETHICS
One of the Vatican’s arguments against
premarital sex:
1. Nonmarital sex cannot
“guarantee” the sincerity and
fidelity of the relationship, nor
protect it against changes in desire.
2. Marriage can guarantee these
things
3. Sex is permissible only if it takes
place in a context where
commitment is guaranteed.
4. Sex outside of marriage (including
premarital sex) is not permissible
(that is, morally wrong).
SEX OUTSIDE OF MERIAGE
What are the underlying issues?
- Are sexual relations a matter of a
contract OR
- A matter of historical existentially
grounded human beings?
The central issue for me is the vulnerability
that occurs during intimacy.
Reminding: This is a PHILOSOPHICAL
discussion [religious precepts may base a
prohibition of pre-marital sex on the bible,
or other religious teachings.]
BELLIOTI: SEXUAL INTERCOURSE BETWEEN
CONSENTING ADULTS IS ALWAYS
PERMISSIBLE
- He argues that Sexual Relations are
contractual nature
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HEALTH CARE ETHICS
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- This means the act is morally wrong
only if it involves:
 Deception
 Promise-breaking
 Exploitation
BELLIOTI ARGUES FROM A KANTIAN
POSITION
1. It is never right to treat another human
being as a “mere means.”
 To treat a person as a “mere
means” is t o make them
into an object.
 People are to be “equal
subjects of experience.”
2. Sexual relations are CONTRACTUAL in
nature.
 This involves the notion of
reciprocity = that none of us
is self-sufficient
 “Voluntary agreement of
both parties to satisfy the
expectations of the other.”
3. Voluntary contracts incur a moral
obligation to provide/fulfill that which
they have agreed to.
4. And that promise-breaking and
deception are immoral actions.
 One argument against the
contractual view is that the
feelings of intimacy involved
make the contract a bad
model.
 Belliotti replies that all this shows
is that it “may well be” the most
important contract that people
make
5. He says we need to be careful in
assuming what the other has offered.
6. His conclusion:
 Sex is immoral if and only if it
involves deception, promise-
breaking and/or treating the
other party as a “mere means”
to one’s own ends.
Examples
- Rape is intrinsically immoral because
the participation of one party is
involuntary
- He argues that rape is possible within
marriage. Because of lack of
consent.
- Bestiality raises the question of
whether an animal is an object, or
whether it has interests that are not
advanced by the act.
- Necrophilia is immoral because of
involuntary participation
 Some argue a dead person is
an object
 But we do honor requests
beyond the grave – and this
“object” once was a person- so
“it” is not a “mere object”.
BELLIOTI: FINAL COMMENTS
- The role of religion: Belliotti is not
providing a religious argument, but
he notes that religious convictions
have become part of society’s
moral code.
 Note: Remember that Kant
has shifted the “command”
of the moral law from God to
human reason.
- On Belliotti’s analysis “teasing”
without the intention to fulfill is
immoral on his contractual view of
sexual relations.
PUNZO: SEXUAL INTERCOURSE SHOULD
ALWAYS BE CONFINED TO MARRIAGE
- Punzo argues that sex is different
from other human activities
because it involves EXISTENTIAL
INTEGRITY:
 What dies he mean by
“existential integrity”?
- He asks whether having sexual
relations is no different from any
other event-choice that we make –
like choosing a dinner from a menu
or which movie to attend?
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PUNZO ARGUES THAT
1. There is a distinctive nature to sexual
relations that makes them different
from other activities or relationships
we engage in. It is a matter of
CONTEXT
 In sexual relations you give
your bodies over – it is not a
contractual relation
2. The reason we can say all human
activities are alike is the acquisitive
character of our society.
 The contract model “works”,
if this is the way we view
human sexual relations – as a
form of acquisition.
PUNZO CONTINUED..
- He believes that we need to face
the nature of sexual relations
“squarely” and directly.
 The human self is historical as
well as physical – the role of
the past and the future.
 This is an existential
understanding of the human
self
IF WE AGREE THAT THE HUMAN SELF IS
HISTORICAL THEN
- It is not possible to amputate our
bodily existence from the most
intimate expression of our selfhood.
 To do this is a form of
“depersonalization.”
 Sexual relations are not
simply a PHYSICAL merging,
but a merging of the non-
physical dimensions of the
partners.
- Without a commitment to marriage
there is an amputation of their
physical being from their historical
being.
 The union is
“depersonalized”
 Sexual union is not simply a
matter of being honest [the
contract model]
MARRIAGE AS A TOTAL HUMAN
COMMITMENT
Punzo makes a distinction between “pre-
ceremonial” intercourse and “pre-marital”
intercourse.
 People can be “morally married”
without a ceremony BUT
 The ceremony is part of the
“historicity” of the relationship – this
acknowledges that they do not
exist in a vacuum.
 The marriage ceremony “roots”
them in the world in which they live.
[Hence the gay/lesbian desire for
marriage.]
VATICAN DECLARATION ON SOME
QUESTIONS IN SEXUAL ETHICS
- The Vatican also argues against
the morality of masturbation, in
much the same way it argues
against homosexual activity.
- Notice the reliance on the idea
that the sexual organs have a
proper function, and thus,
sexual activity does as well.
- Do they have such a function?
If they do, does the Vatican
correctly identify that function?
JOHN CORVINO, “WHY SHOULDN'T
TOMMY AND JIM HAVE SEX?”
- In this article, Corvino attempts to
refute two kinds of arguments
against homosexuality: those that
appeal to its being unnatural, and
those that appeal to its being
harmful.
- To do this, he reformulates the
unnaturalness argument in five
ways and objects to each
reformulation.
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THE FIVE DISCUSSED MEANINGS OF
“UNNATURAL”:
1. Unnatural = unusual or abnormal
2. Unnatural = not practiced by other
animals
3. Unnatural = does not proceed in
accordance with innate desires
4. Unnatural = violates an organ's
principal purpose
5. Unnatural = disgusting or offensive
JOHN CORVINO, “WHY SHOULDN'T TOMMY
AND JIM HAVE SEX?”
- Corvino also responds to harm-
based arguments against
homosexuality.
- One version of this argument claims
that homosexual activity harms the
person who performs that activity.
- Another version claims that
homosexual activity harms other,
nonconsenting parties
- The final version Corvino mentions
claims that homosexuality harms
society
THOMAS A. MAPPES, “SEXUAL MORALITY
AND THE CONCEPT OF USING ANOTHER
PERSON”
- Mappes' article is an application of
Kant's Humanity Formulation of the
Categorical Imperative to the
question of when it is wrong to
sexually interact with another
person.
- The Humanity Formulation of the
Categorical Imperative:
 “It is morally wrong for A to
use B merely as a means to
achieve A's ends.”
THOMAS A. MAPPES, “SEXUAL MORALITY
AND THE CONCEPT OF USING ANOTHER
PERSON”
- Mappes' main principle of sexual
morality:
- “A sexually uses B if and only if A
intentionally acts in a way that
violates the requirement that B's
sexual involvement with A be based
on B's voluntary informed consent.”
- Deception (either through lying or
withholding information) violates
the “informed” aspect of this
requirement.
- Coercion (either through physical
force or threats) violates the
“voluntary” aspect of this
requirement.
THOMAS A. MAPPES, “SEXUAL MORALITY
AND THE CONCEPT OF USING ANOTHER
PERSON”
- A third way to violate the
requirement: exploitation.
- Offers are proposals to reward an
individual for compliance; they do
not propose punishment for
noncompliance. When the reward
is something the individual
desperately needs, then the offer is
coercive. Exploitation is taking
advantage of an individual's
desperate situation.
- Offers differ from threats, since
threats do propose punishment for
noncompliance, and they do not
propose any reward for
compliance.
RAJA HALWANI, “VIRTUE ETHICS AND
ADULTERY”
- Halwani applies a version of virtue
ethics to reach his conclusion that
adultery is often—but not always—
wrong.
- Halwani's main argument, then,
appeals to the following principle of
virtue ethics:
- An action is wrong if and only if (and
because) it is what a virtuous agent
would not do.
- After providing some reasons to
accept this argument, Halwani
then tries to explain adultery is,
generally speaking, not something
a virtuous agent would do.
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 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
ONE WAY TO UNDERSTAND HALWANI'S
CENTRAL ARGUMENT:
1. Love and exclusive commitment
are constituents of a marriage.
2. Given the connection between
love, commitment, and sex, sexual
fidelity is an ideal in marriage.
3. If fidelity is an ideal in marriage, a
virtuous person would strive to
realize it and would avoid
engaging in activities that are
contrary to this ideal.
4. An action is wrong if and only if (and
because) it is what a virtuous agent
would not do. Thus,
5. Adultery is wrong.
RAJA HALWANI, “VIRTUE ETHICS AND
ADULTERY”
- A few details about Halwani's view:
- Halwani accepts that there are
possible cases where adultery is not
wrong. This makes Halwani's
conclusion non-absolutist.
- This is because while fidelity is an
ideal, according to Halwani, there
could be cases where the virtuous
agent would decide that there is
sufficient reason to not seek this
ideal.
- Halwani also claims that his
argument applies not just to
marriages, but to committed
romantic relationships generally.
MAGGIE GALLAGHER, “NORMAL”
MARRIAGE: TWO VIEWS
The two views of what normal marriage is,
according to Gallagher:
1. The relationship view: Marriage is an
essentially private relationship
whose fundamental aim is to
enhance the personal well-being of
the married partners.
2. The public view: Marriage is a public
bond and sexual institution
between members of the opposite
sex; it is fundamentally about
reproduction and the continuation
of society.
MAGGIE GALLAGHER, “NORMAL
MARRIAGE: TWO VIEWS
Gallagher provides several considerations
against the relationship view:
1. It erodes the idea that there is a
special connection between a
child and his/her biological parents
that explains the parents'
obligations to their child.
2. It cannot make sense of the state's
traditional regulation of marriage.
3. Legalizing same-sex marriage on
the basis of the relationship view
would have bad consequences for
society.
MAGGIE GALLAGHER, “NORMAL
MARRIAGE: TWO VIEWS
Gallagher provides several considerations
for the public view:
1. Adopting this view is necessary for
the survival of society.
2. Adopting this view would have
good consequences for children,
who need to be raised by married
opposite-sex couples to thrive.
3. Even if the law reflects this view
(and it should) by not allowing
same-sex marriage, same-sex
couples could still enjoy many of
the legal benefits that married
couples do.
EVAN WOLFSON, “ENOUGH MARRIAGE TO
SHARE”
- Wolfson replies directly to
Gallagher.
- He quotes several legal and
scientific sources to express his view
that:
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 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
1. There is no reason to believe that
same-sex couples are generally not
as capable of successfully raising
children as opposite-sex couples.
2. Denying same-sex marriage has no
benefits but many costs (especially
to same-sex couples and children
of these couples).
3. Marriage is not necessarily about
procreation.
4. There is little or no reason to think
that legalizing same- sex marriage
would have serious negative
consequences.
ISSUES ON ARTIFICIAL REPRODUCTION,
ITS MORALITY AND ETHICO-MORAL
RESPONSIBILITY OF NURSES
IN VITRO FERTILIZATION
- In 1978 in England, much attention
focused on the birth of the first child
who was conceived in a test tube,
a process referred to as in vitro
fertilization (IVF).
- When the number of implanted
embryos is too great, consideration
is given to aborting several of them
to improve the chances of full
development for the remaining
ones; this creates additional ethical
dilemmas for the family.
- Other offshoots of in vitro fertilization
allow people who are carrying a
severe genetic disease to be
assured that their children will not
be affected by the condition or
carry the defective gene. Fertilized
ova are examined for possible
disease before being implanted in
the uterus; those that are diseased
would not be implanted
- As wonderful as this may seem,
concerns exist regarding what
some would call the misuse of IVF.
- In Italy, a 62-year-old woman
became pregnant using donated
eggs and IVF before implantation in
her uterus. She gave birth by
cesarean section in 1994.
- A 59-year-old woman in England
delivered twins by this method.
- A record was set for what is thought
to be the oldest woman to give
birth to a healthy infant, when it was
announced in April 1997 that a 63-
year-old woman had given birth via
cesarean section on November 7,
1996.
- The woman, married and previously
childless, is said to have told doctors
she was 50 and had medical
records attesting to that age. (The
medical center where the IVF
occurred sets an age limit of 55 on
accepting patients.) A donor egg
and the husband’s sperm were
used for the IVF (Roan, 1997).
- In January 1994, the French Senate
opted to prohibit the use of
reproductive options in certain
cases (Capron, 1994).
- One can readily identify some of
the difficulties in starting the
mothering process at age 62 or 63,
not the least of which would be
living long enough to see the child
reach adulthood.
- Quality-of-life issues also may be
involved. If the mother is 62 when
the child is born, she will be 67 or 68
when the child starts school and 75
when the child becomes a
teenager.
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BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE

- Other concerns focus on the fear through artificial insemination and

that PGD will be used to make to relinquish the baby at birth to
“perfect babies” or for sex others for rearing.
selection, even when there is not a - The term biologic is no longer
medical reason (such as adequate for making some critical
hemophilia, Tay-Sachs, or sickle-cell conceptual distinctions. Macklin
anemia) for such action. (1991, p. 6) states, “The techniques
of egg retrieval, in vitro fertilization
ARTIFICIAL INSEMINATION
(IVF), and gamete intrafallopian
transfer (GIFT), now make it possible
- The planting of sperm in the
for two different women to make a
woman’s body to facilitate
biological contribution to the
conception
creation of a new life.”
- There are two different kinds of
- Macklin further believes that the
artificial insemination:
woman who contributes her womb
 Homologous (Artificial
during gestation is also a biologic
Insemination Homologous—
mother. We find terms such as
AIH), in which the husband’s
genetic mother used to refer to the
sperm is used, and
individual contributing the ovum,
 heterologous (Artificial
and gestational mother used to
Insemination Donor—AID),
refer to the individual who provides
in which a donor’s sperm is
the uterus in which the child
used.
develops. In some instances, the
- Using the husband’s sperm is by far
surrogate mother is both.
the most common and creates the
- Ethically, carrying a child for a
fewest problems legally, ethically,
family member out of love and
and morally. In some instances, the
concern and planning to remain in
sperm from the husband and the
that child’s life as part of the family
sperm from a donor with similar
reflect a commitment to a child
physical characteristics are mixed.
and respect for the personhood of
- Although some religious groups
the child.
may have objections, few concerns
- Most serious conflicts have
arise when the husband’s sperm is
occurred in situations in which a
used. That is not true with donor
woman has been paid to serve as a
sperm.
surrogate mother. A formal,
- If the woman is artificially
contractual relationship is usually
inseminated with donor sperm
established.
without the knowledge and
- The couple who wish to have the
consent of her partner, the
child agree to pay all expenses
problems are multiplied. If
associated with the pregnancy,
conception occurs and the child is
and to pay the surrogate mother an
not biologically that of the
agreed sum for her time and
husband, can one say that adultery
involvement. The contract must be
has occurred? Others suggest that
carefully drawn up because it is
the husband should legally adopt
illegal in all states to sell a child.
the child
SPERM BANKS
SURROGATE MOTHERS
- Sperm banks have been
- A surrogate mother is one who
established in different parts of the
agrees to bear a child conceived
United States for various reasons

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 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
- Men who want to have a
vasectomy may contribute to a
sperm bank “just in case” they
change their minds in the future.
- Men who will be exposed to high
levels of radiation in their work, or
during treatment of disease, may
wish to have sperm stored because
radiation may cause mutation of
the genes or result in sterility. This
allows them to father children later
without concern about the effect
on the sperm.
- In most cases, the medical
community establishes sperm banks
so that sperm is available for
artificial inseminations.
- In California, a sperm bank was
started that contains only sperm of
outstanding and brilliant men. The
idea was to create children with this
sperm who will be genetically
endowed with greater intelligence
and creativity.
- Many find this unacceptable
because it brings up the issue of
creating a super race. Concerns
also have been raised regarding
the possible number of offspring in a
single community who might be
genetically related without
knowing it.
ETHICO-MORAL RESPONSIBILITY OF NURSES
- The nurse, in all professional
relationships, practices with
compassion and respect for the
inherent dignity, worth, and
uniqueness of every individual,
unrestricted by considerations of
social or economic status, personal
attributes, or the nature of health
problems. There are biomedical
ethical principles, which are widely
accepted in health care:
1. Respect for autonomy of patient
decision-making
2. Beneficence states that positive
steps must be taken to help others
3. Non-malfeasance principle refers
to do no harm
4. Justice, also referred to as fairness,
describes equity in the distribution
of medical resources (Beauchamp
and Childress, 2001; Beal and
Cappiello, 2008)
In addition, the Code of Ethics for Nurses
serves the following purposes:
 It is a succinct statement of the
ethical obligations and duties of
every individual who enters the
nursing profession.
 It is the profession’s nonnegotiable
ethical standard.
 It is an expression of nursing’s own
understanding of its commitment to
society.
1.1 RESPECT FOR HUMAN DIGNITY
- A fundamental principle that
underlies all nursing practice is
respect for the inherent worth,
dignity, and human rights of every
individual. Nurses take int account
the needs and values of all persons
in all professional relationships.
1.2 RELATIONSHIPS TO PATIENTS
- The need for health care is
universal, transcending all
individual differences. The nurse
establishes relationships and
delivers nursing services with
respect for human needs and
values, and without prejudice. An
individual’s lifestyle, value system
and religious beliefs should be
considered in planning health care
with and for each patient. Such
consideration does not suggest that
the nurse necessarily agrees with or
condones certain individual
choices, but that the nurse respects
the patient as a person.
1.3 THE NATURE OF HEALTH PROBLEMS
- The nurse respects the worth,
dignity and rights of all human
beings irrespective of the nature of
the health problem. The worth of
the person is not affected by
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BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
disease, disability, functional status,
or proximity to death. This respect
extends to all who require the
services of the nurse for the
promotion of health, the prevention
of illness, the restoration of health,
the alleviation of suffering, and the
provision of supportive care to
those who are dying.
1.4 THE RIGHT TO SELF-DETERMINATION
- Respect for human dignity requires
the recognition of specific patient
rights, particularly, the right of self-
determination. Self-determination,
also known as autonomy, is the
philosophical basis for informed
consent in health care. Patients
have the moral and legal right to
determine what will be done with
their own person; to be given
accurate, complete, and
understandable information in a
manner that facilitates an informed
judgment; to be assisted with
weighing the benefits, burdens, and
available options in their treatment,
including the choice of no
treatment; to accept, refuse, or
terminate treatment without
deceit, undue influence, duress,
coercion, or penalty; and to be
given necessary support
throughout the decision-making
and treatment process. Such
support would include the
opportunity to make decisions with
family and significant others and
the provision of advice and support
from knowledgeable nurses and
other health professionals. Patients
should be involved in planning their
own health care to the extent they
are able and choose to participate.
2.2 CONFLICT OF INTEREST FOR NURSES
- Nurses are frequently put in
situations of conflict arising from
expectations from patients,
families, physicians, colleagues,
and in many cases, health care
organizations and health plans.
Nurses must examine the conflicts
arising between their own personal
and professional values, the values
and interests of others who are also
responsible for patient care and
health care decisions, as well as
those of patients. Nurses strive to
resolve such conflicts in ways that
ensure patient safety, guard the
patient’s best interests and preserve
the professional integrity of the
nurse.
4.1 Acceptance of accountability and
responsibility
- Individual registered nurses bear
primary responsibility for the nursing
care that their patients receive and
are individually accountable for
their own practice. Nursing practice
includes direct care activities, acts
of delegation, and other
responsibilities such as teaching,
research, and administration. In
each instance, the nurse retains
accountability and responsibility for
the quality of practice and for
conformity with standards of care.
Nurses are faced with decisions in
the context of the increased
complexity and changing patterns
in the delivery of health care. As the
scope of nursing practice changes,
the nurse must exercise judgment in
accepting responsibilities, seeking
consultation, and assigning
activities to others who carry out
nursing care. For example, some
advanced practice nurses have
the authority to issue prescription
and treatment orders to be carried
out by other nurses. These acts are
not acts of delegation. Both the
advanced practice nurse issuing
the order and the nurse accepting
the order are responsible for the
judgments made and accountable
for the actions taken.
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BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
4.2 ACCOUNTABILITY FOR NURSING
JUDGEMENT AND ACTION
- Accountability means to be
answerable to oneself and others
for one’s own actions. To be
accountable, nurses act under a
code of ethical conduct that is
grounded in the moral principles of
fidelity and respect for the dignity,
worth, and self-determination of
patients. Nurses are accountable
for judgments made and actions
taken while nursing practice,
irrespective of health care
organizations’ policies or providers’
directives. The Standards apply to
registered nurses who provide
preconception, antepartum,
intrapartum, postpartum, and
newborn care and to women’s
health. Registered nurses who
provide care across the woman’s
life span or targeted to specific
ages and stages of development.
ETHICAL ISSUES OF ABORTION
HISTORICAL OVERVIEW
- The Bible is silent on the specific
issue of abortion
- Christianity has always opposed
abortion, but the definition of
abortion has changed over time
- In the 5th century the Christian
church said celibacy was the
ideal...but that posed a problem for
the survival of the church
- So, St. Augustine revised the
Catholic position to allow sex in
marriage but only for the purpose of
procreation...this abortion was
wrong because it defeated the
purpose of sex
- By the 12th century Christian
doctrine differentiated between
the “formed” and “unformed”
embryo
- Thomas Aquinas taught that God
ensouled male embryos at 40 days
and female embryos at 90 days
- Thus, it was sinful to abort, but less
sinful to abort a female embryo at
40 days than a male embryo at 40
days
- In 1896 Pope Pius IX put a blanket
ban on all forms of abortion
- However, the Catholic doctrine of
double effect allowed abortion in
the case of ectopic pregnancy and
uterine cancer
- From the 17th - 19th centuries
abortion was considered a religious
offense, but few legal systems
bothered to prosecute it.
- In the US this changed after the Civil
War when birthing became
MARGARET SANGER (1879 – 1966)
- She was an American birth control
activist, sex educator, and nurse
who popularized the term birth
control.
- In 1921, Sanger founded the
American Birth Control League,
which later became the Planned
Parenthood Federation of America.
SHERRI FINKBINE (1962)
- After taking thalidomide
tranquilizers and learning that they
caused severe birth defects Sherri
Finkbine wanted a safe abortion
- An abortion was scheduled, but the
local D.A. threatened to prosecute
- The Finkbines traveled to Sweden
where the severely deformed fetus
was aborted legally
- Abortion had been legal in Sweden
since 1940
ROE V. WADE, 1973
- Jane Roe, a.k.a. Norma McCorvey
was a woman living in Dallas, Texas,
where abortion was illegal
- She wanted a safe abortion
performed by a physician in a
clinical setting, so she challenged
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 FATHER SATURNINO URIOS UNIVERSITY
BACHELOR OF SCIENCE IN NURSING – 3RD YEAR LEVEL
HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE
Texas state law, suing for the
constitutional right to an abortion
- The Supreme Court, in a 7 to 2
decision, said that Texas abortion
laws were unconstitutional because
it violated the 14th Amendment’s
Right to Privacy and Due Process
However, the court recognized
circumstances in which states could pass
abortion laws:
 If the fetus was viable, meaning
potentially able to exist outside the
mother’s womb, albeit with artificial
aid
 Viability at that time was assessed
at about 7 months (28 weeks) but
could be pushed as far forward as
24 weeks.
FORMS OF ABORTION
- Abdominal trauma
- Methotrexate Injection
- Suction Aspiration
- Dilation and Evacuation
- Prostaglandins Injection
- Saline Amniocentesis (Salt
Poisoning)
- Hysterectomy
- “Partial Birth” Abortion
Partial Birth Abortion
- Method of abortion used during the
second or third trimester where the
fetus partially exits the birth canal,
and the physician collapses the
fetus’ skull then uses delivers a dead
baby
- In the 1990s many states banned
Partial Birth Abortion
- In 2000 in the case of Stenberg v.
Carhart, the Supreme Court said
that Nebraska’s ban was
unconstitutional
- In 2003 Congress responded to the
Supreme Court’s decision by
passing the Federal Partial Birth
Abortion Ban Act which maintains
that “PBA” is never necessary to
maintain the health of the mother.
PERSONHOOD VS. VIABILITY
- When does personhood begin?
- Is viability too nebulous a term given
the fact that neonatal technology
is constantly advancing?
- Does it matter...if a woman does
not want a baby is that the end of
the issue?
FOREIGN ANTI-ABORTION LAWS
There are only six countries where abortion
is not allowed or performed under any
circumstances
 Chile
 El Salvador
 Malta
 Nicaragua
 The Philippines
 Vatican City
FOREIGN PRO-ABORTION LAWS
- China has practiced forced
abortions as a means of population
control since the 1970s
- Couples are allowed one child, but
in rare cases a couple is allowed a
second child if they pay a large fine
to the government
- In the case of rape and unmarried
pregnant women forced abortions
are often practiced
ATTEMPTED ABORTIONS RESULTING IN LIVE
BIRTH
- Late-term abortions can sometimes
result in live births
- Most physicians today will rarely
perform an abortion after 23-week
gestation
FETAL RESEARCH
- In 1979, Congress banned all
federally funded research involving
fetuses or embryos
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HEALTH CARE ETHICS
FIRST SEM | MIDTERM | OLIVA ASENDENTE

- This includes late term fetuses, and “conscience clause," which gives
all embryos older than three days pharmacists the right to refuse to
- In 1993 President Clinton lifted the perform certain services based on a
ban on fetal tissue violation of personal beliefs or
research...allowing the tissue from values.
aborted fetuses to be used in - 46 states permit refusal to provide
research if the woman agrees to it abortions, 17 states permit refusal to
after the abortion perform sterilization, and 13 states
permit refusal to provide
THE MORNING AFTER PILL
contraceptives.
- Emergency contraceptive pills
(ECPs)—sometimes simply referred
to as emergency contraceptives
(ECs) or the "morning-after pill"—
are drugs intended to disrupt or
delay ovulation or fertilization,
which are necessary for pregnancy
(contraceptives)

MYFEGYNE (MIFEPRISTONE)

- Ends a pregnancy that is less than 7

weeks along (49 days or less since
the start of your last menstrual
period).
- Originally known as RU-486, it was
approved for abortion in the United
States by the FDA, in September
2000. It is legal and available in all
50 states, Washington, D.C., Guam,
and Puerto Rico. It is a prescription
drug, but it is not available to the
public through pharmacies; its
distribution is restricted to specially
qualified licensed physicians, sold
by Danco Laboratories under the
tradename Mifeprex.

THE CONSCIENCE CLAUSE

- Health provider “refusal clauses”

(also known as "conscience
clauses") were first enacted in
response to the United States
Supreme Court's decision in the Roe
v. Wade case, 410 U.S. 113 (1973)
- Now, the issue is expanding as
pharmacists are refusing to fill
emergency contraception and
contraception prescriptions. This
movement resulted in the term

G.T 28