DAVAO CENTRAL COLLEGE, INC.

Juan dela Cruz Street, Toril, Davao City

Landline No. (082) 291 1882

Accredited by ACSCU-ACI
GE ETH1
Week 14: Bioethics

Learning Outcomes:
1. Discuss the different cases of bioethics;
2. Justify their ethical principles on certain bioethical cases
anchored on moral theories as discussed in this learning
material.

Concept Digest

Introduction

The previous chapters constitute what we call “General Ethics”, wherein basic principles and
theories of morality are presented and studied. This chapter ventures beyond the theoretical
and into the practical, like examining cases and practices in specific fields- in this case
Bioethics- and see the application of such principles and theories.

Overview of Bioethics

In the world characterized by great scientific and technological progress, the view on human
self is also scientific. The human being has gradually lost his/her value as a unique creature.
Today, most human problems can be addressed by science. What is the left with the human
beings that cannot be dealt with science? Shall we say noting?

It seems that many people submit to the objectivity of science and forget its limitations in
knowing the truth. Hence, this discipline is designed to enable teachers to teach the students
the limitations of scientific objectivity.

More than that, this discipline also reminds the students that ethical principles cannot be
taken away from every scientific discovery. The different cases provided in this part will help
the student evaluate the risk and beneficial impact associated by every scientific and
technological advance. The more informed students are, the more they can decide
responsibly. Though it may be a hasty generalization, the incorporation of bioethics in the
academic curriculum makes the Filipino citizens gradually aware of the various issues brought
by scientific progress. This awareness is the onset of a more responsible citizen. Responsibility
in this context is determined by the citizens wise choice of leaders who will present every
Filipino in the arena of policy-making.
Moreover, the various issues presented in this chapter may also develop the student’s skills to
weigh things in many perspectives. It is expected that every student has each own point of
view in every presented issue. Engaging in the debate with a diver’s opinion trains the
students to argue and participate in public discussion. This is an early training for a
responsible democratic society. Exploring this discipline gives students the chance to develop
their ethical reasoning skills so that they can critically analyze problems in a more careful and
reflective way.

History of Bioethics

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Bioethics is a young discipline. It was introduced by Van Potter in the early 70’s According to
him, the cope of bioethics biological knowledge (the science of living systems) and the
knowledge of human value system. The purpose of this young discipline is to “bridge”
between scientific fact and ethical value in the world that is characterized by development
accompanied with destruction and annihilation.

a. Ancient

The subject matter of bioethics can be traced back to the ancient times. The father of
medicine, Hippocrates, contributed a lot in this area. Accordingly, in Giuramento, Hippocrate
outlined the principles that would be guide the medical practitioners in the practice of their
profession. These principles are the following: 1) abortion could not be permitted; 2)
euthanasia was to be avoided; 3) professional secrets have to be maintained; 4) decorum and
honesty dictated life; and 5) the patient could not be harmed, rather the patient’s wellbeing a
goal to be looked for. These principles are promised by some medical practitioners in present
time. I made mention of some medical practitioners in order to emphasize that in our time,
some countries are legalizing abortion and euthanasia, thus jeopardize some of the
Hippocratic ought.

b. Medieval

The Middles ages was metaphysical by nature due to its Theo-centric orientation. However,
there were traces of bioethical discussions in the works of St. Thomas which showed the
occurrence of the discipline’s subject matter in this period. In Summa Theological, St. Thomas
dealt with issues relating to homicide, suicide, the pain of death and mutilation. As the
proponent and expert of the Natural Law theory, all the issues mentioned above were
discussed with the emphasis of the Natural Law.

c. Modern

In 17th century, there was an emergence of the two strands of bioethics, the Medical
deontology and the Teleological Interpretation. The former is supported by Kant’s
Philosophical view which emphasizes the elaboration of the duties of the doctor towards the
patient. The later which is grounded on Bentham’s utilitarian perspective emphasizes the
absolute autonomy of the patient on choosing and deciding the medical treatment for
himself/herself. The advantage of the many is the good which determines the social
acceptance. These two trends are present and influential in contemporary bioethics.

d. Post-Modern

This era is characterized by highly progressive period in the realm of bioethics. Nevertheless,
together with the conspicuous development is the question on the capability of man to
handle such progress. In addition, discussion on justice, freedom and societal order paved the
way for the rising knowledge of human rights which is rooted man’s dignity. To understand

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 DAVAO CENTRAL COLLEGE, INC.
Juan dela Cruz Street, Toril, Davao City
Landline No. (082) 291 1882

Accredited by ACSCU-ACI
more of the contemporary period, the four factors influenced the rise of bioethics in the 2 nd
half, of the 20th century must be understood thoroughly.

Ambivalence of Bio-medical progress

The past two decades prior to the emergence of bioethics were marked by a tumultuous
progress in biomedical sciences. Human beings, desire for development and discovery have
led them to tremendous achievements in the area of economy, politics, science and
technology. However, this grandeur success brought human being into a catastrophic
situation because of their incapability handling the potential of their discoveries. Instead of
using his invention for the benefit of the people, in turned out differently.

The World War II manifested some of the horrors of scientific and technological discovery.
History tells us how the Nazi misused power and abused humanity with the aid of science
invention. After the war, there were discoveries in science. 1953, the finding of the double
strands of DNA (Deoxyribonucleic Acid) led to enormous interest in genetics. With this
finding, human beings can be seen from the biological point of view. Nevertheless, it also
opened the way for man to be an object of experimentation. In 1994, the new techniques of
reanimation changed the course of sickness. The life-threatening diseases which one affected
the whole human race were gradually figured out. The transition between life and death
became fleeting. In 1955, the work transplanting. Began the possibility of renewing essential
parts of mands body. 1960, there was an extensive experimentation on anti-conception
device. Man could now separate the sexual and reproductive parts of his body. The last two
discoveries paved the way for major physical and sexual changes (sex organ transplant).

The facts presented above clearly necessitate ethical concern. Technological progress must be
accompanied by knowledge of the values involved in order to avoid further malpractices.

Human Rights

Incorporating human dignity in the philosophical treatises highlighted the discussion on

human rights. The right includes right to health and to health care as an aspect of justice, but
this justice was often neglected when society faced crisis in governance. During WWII,
violation of this basic right was rampant everywhere. Abuses ere to committed advance the
interest of the Nazi party. One basic example was when Nazi soldiers classified the prisoners
(mostly jews) according to age and health. Instead of letting the aged live and curing the sick,
they were brought to gas chambers since they were not useful anymore. These dysfunctional
prisoners were sentenced to death without consideration of their dignity (See the movie:
Schindler’s list). The capability to of the person to contribute became the basis of his
existence. When the war ended, all these human right violations were brought to trial. Many
were imprisoned and sentenced to death. After the Nuremberg trials (1945-1949) which
exposed all the horrors and the atrocities of Nazi concentration camps and the violation of
the laws of the state, there was a need to re-affirm the dignity of man and express them a
universal manner.
Just a decade after the war, alarming news of experimentation on human subjects brought
about a need to uphold the autonomy and dignity of the person even in complexities of
science. This was also the time when Tuskegee experiment in Alabama were exposed to the

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public. This medical scandal alarmed the world and had shaken the entire medical practice
most especially in the U.S. after the exposure of this 40-year government funded experiment
which tried to look for a cure of syphilis, the Ministry of Health declared that society could not
permit the equilibrium between individuals rights and scientific progress to be decided by
science alone.
Crisis regarding the myth of ethical neutrality of science
A positivistic approach by science retains a mentality which says; there is no need of a
general ethics which will be disturb the perfect impartiality and objectivity of facts. But many
events question the seeming neutrality of science and unmask the ease of instrumental use.
This means that there are events which clearly show how science sets aside the role of ethics
and purely uses science instrumentally to advance some vicious interest. Some of these are
the following: the wrong use of psychiatry in the Soviet Union and studies in American
universities which led to the production of bombs and new types of the role of ethics in every
scientific project. It must be noted that pure and applied science have to relate to ethics
because every scientific truth is not necessarily a valid one.
Environmental crisis
From the 60’s, philosophers, scientists, entrepreneurs, politicians and public opinions
have had to consider the vast damage to the environment, water, air, the extinction of many
species and the breaking of the relationships of thousands of creatures whit their natural
habitat because of human activity. Economic development could not justify such resource
depletion. In the past, the damage was minimal but today, with the powerful technologies,
the damage is very huge. Hence, human being must take responsibility in order to stop this
damage while continuing the desired development. this means a sustainable idea of
development should take part. The act of taking responsible towards nature starts with
awareness. Thus in early 60’s, environmentalist Movement was started. Almost a decade, the
knowledge of the necessity of a radical cultural change led to the birth of a new discipline,
Bioethical which united the world of science and in particular the world of biological and
ecological knowledge with the world of ethics and human values.
Consequently, the concern of bioethics is not purely on science and technology but
includes every living existence. It so happened that humans are gifted with intellect which
made him more accountable to himself, to other human beings, and to the non-humans.
Bioethical Principles
One of the characteristics of a democratic and civilized society the ability is to have
guiding principles that will unite every citizen in addressing different issues met by the
society. These principles serve as the standards which guides every factual opinion,
statement, or decision in order to meet the welfare of the common people. Further, these
principles respect the dignity, ensure justice, maintain secrecy, promote truthfulness, observe
faithfulness and safeguard the wholeness of every individual who is involved in any bioethical
issue in the society.
Autonomy

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Landline No. (082) 291 1882

Accredited by ACSCU-ACI
Freedom is one of the possessions that lower animals do not enjoy. It makes life more
productive and meaningful. The respect of freedom shows respect for the dignity of every
free individual. The absence or the manipulation of freedom in whatever method disrespects
the very nature of the reason possessing the freedom. The worst is the violation of the
freedom of a particular free person is a violation of the freedom of the entire humanity which
is characterized as free. Hence, to avoid committing such universal crime, we must learn to
respect the autonomy of others.
Etymology, autonomy comes from the Greek terms “autos” means self. And “namos”
means governance. “in short, autonomy simply means self-governance. In the context of
bioethics, self-governance means a form of liberty where the individual is free to choose and
implement one’s own decision without deceit and coercion. The principle of autonomy
emphasizes how dignified every human being involved in particular situation. The respect of
autonomy means respect of the dignity of the person. However, there are few things to
remember to make sure that this first principle is surely observed. First, the person involved
must be properly informed. Without adequate information, honest and responsible decision
cannot be achieved. Second, the person involved must the capability to understand and
decide. The absence of intellectual competence makes the practice of autonomy impossible.
Third, the respect of autonomy involves everybody including the minors, the sick and the
dying represented by their legal and rightful guardians. Failure to truly follow the guides
above may lead the involved person to an involuntary decision. The two examples below
portray two sides of the principle. The first example is concrete observance of the first
principle while the second one is a clear manipulation of it.
First example
A male retiree is suffering from severe diabetes. After a series of medical check0ups,
the doctor found out that the patient is in a critical condition. In order to prevent the damage
from spreading to the vital parts of the patient, the affected part of the body must be
removed. In that case, the patient needs to undergo a right leg amputation. All stakeholders
gathered together to discuss the scenario. The doctors involved informed the patient and the
relatives regarding the diagnosis and the prognosis. After a through analysis of the doctor’s
information and recommendation, the patient finally decides not to undergo surgical
amputation. The patient appreciated the efforts of the medical practitioners in informing him;
however, he chose to enjoy the remaining days of his life with complete legs.
Second Example
Mr. Salde Alde, as street sweeper residing at Bolton Isla and a father of 6 kids
approached by a friend, an “organ broker”. Alde was convinced by his friend to sell one of his
kidneys in order to have some money for his family’s need such as tuition fee for his kids,
bills, and small savings for the rainy days. In Alde’s economic situation, the offer was too
lavish to turn down but he worried about the physical effect of the operation. However, the
“organ broker” promised that no physical side effect would be experienced after the removal
of one kidney. It is the same as normal, in fact there is a possibility that the kidney will grow
again and return to its normal condition, the broker said. Hence, without proper information
and clear understanding of the process and the effect, Mr. Alde sold his kidney. Few months
after the operation, Alde suffered different illnesses. It was found out by the doctor that the

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Juan dela Cruz Street, Toril, Davao City
Landline No. (082) 291 1882

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cause of his frequent illnesses was the removal of his kidney. His body was not fit to undergo
any internal operation. Though Mr. Alde personally decided to sell his kidney, the decision
was irrelevant because he was not fully knowledgeable of his physical condition and fully
aware of the process and the adverse physical effect.

Veracity
The second principle is anchored on the principle of autonomy. It binds both parties in
the agreement. Proper observance of veracity makes each representative in the discussion
confident to achieve the necessary agreement. To ensure that both parties may exercise truly
their autonomy, truthfulness is indispensably required. The decision that is generated from
misinformation or the manipulation of the truth is weak. The deceived party may sooner
react and hold back the decision given. The other party which manipulated the discussion
cannot be trusted in any dialogue anymore. The manipulation of the truth in any dialogue
which is described as strategic action in Habermas language is failure. A clear compliance of
this principle is stated in the first example under principle of autonomy. The disclosure of the
whole truth concerning the condition of the client, though sometimes deplorable, is helpful in
the stake holders’ decisions.
Any medical practitioner who is proven guilty of violating the principle of veracity
jeopardizes the whole medical practice. Medical clients will doubt the information provided
by the doctor to the point of restraining themselves form going to the hospital. Those who
are honestly practicing their profession as health care providers will suffer the same
stereotyping. In the part of the patient, truth-telling is necessary institution which engages in
dialogue.
Beneficence/ Non-Maleficence
In the world of medicine, these principles play a vital role. These principles are the
core of medical practice. This is the reason why all medical institutions aim to promote and
save life above all other considerations. On the other hand, the principle of beneficence
suggests that every action must produce a good or beneficial effect to the doer of the action.
On the other hand, non-maleficence on stands in the opposite side. It promotes the
avoidance if not removal of a harmful way of treating the patient/client. This principle is
likened to the concept of Ahimsa (do no harm) in the Buddhist tradition. There are many
situations wherein painful and harmful effects cannot be avoided when providing the
medication. In this case, the beneficial effect must supersede the pain felt by the medication.
In this case, the beneficial effect must supersede the pain felt by the patient. For example:
Erna is a sixty-five-year-old woman who has cancer of the bladder. During the curse of her
therapy, she sustains radiator burns in some parts of her body. The physician orders frequent
medical douches and wound irrigations. This treatment makes the patients suffers the pain.
Though painful, it is the only way to keep the wound from going severe. Besides, the pain
brought by the wound is just a by-product of a higher goal, which is to remove the cancer
cells in order to save her life.
These two principles are highlighted in the Hippocratic Oath which is still observed and
promised by the physician nowadays. Beneficence is the affirmative description of the oath

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while non-maleficence is the negative form. Confidentiality is an important aspect of the trust
that the patient gives to the health care providers. If the patient feels that the information
about his/her condition is subject to public conversation, a great barrier between the
practitioner and the patient will exist. It would even question the integrity of the hospital
institution. For example: the fear of disclosure lead minors with sexually transmitted diseases
to suffer without care knowing that the system required the health care system to notify their
patients.

Role Fidelity
Nowadays, public and private institutions function with the aid of mission and vision
to clearly see the direction of the operation. The assurance of meeting the target of the
institution is determined by the compliance of the principle patterned from the mission and
vision. In addition to the principle, each member/employee should be given the appropriate
job description to keep one’s action on the direction situated by the institution. Faithful
observance of the job description or the role set for a particular profession is what we call
role fidelity.
In the realm of bioethics specifically biomedical practice, role fidelity is simply defined
as performing the given task with full compliance of the prescribed scope of practice provided
by the medical institution. This principle requires the practitioners overlap the principle upon
exercising their function.
For example:
Daryn is a 24-year-old nurse practitioner who works in the evening shift. One of her
patients, a man almost at the same age named Albert is in the hospital for almost a month.
She knows Albert because they were coming from the same high school. She kept on visiting
him during her vacant and talked to him about high school days. Daryns feels that Albert is
feeling some affection toward her but she keeps their relationships friendly and professional.
On his last day in the hospital, she hugs and says good luck to him. This simple scenario
caught the attention of the hospital director. Daryn’s attention was called and reminded her
not to engage a deeper communication to any of the patient because she might overlap the
scope of her practice. Though there was no clear violation of the principle role fidelity, the
action of the nurse must be corrected because it might give wrong impression to the other
clients/patients.
This principle is applicable in every workplace and profession. Maintaining
professionalism in the work place is easy to do when everyone functions according to the
given job description. But sometimes part of being a Filipino is to take part other’s life most
especially if we feel that our colleague is need of help. Others are authentic in their intention
to help while others are simply gathering personal information for fun. Whatever is our
intention, we must always be objective in our action. If we are not asked to help, it is better to
hold back because we might contribute to the dilemma. If our colleague is involved in an issue
which is detrimental to the institution or it endangers and affects the work of our colleague, it
is then, our responsibility to take part. Such responsibility is coming from the fact that we

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belong to one institution. Whatever happens to him/her in line with his/her work, it will affect
me and the entire force. Our action must also objective. We must first talk to the concerned
colleague and if there is a need to inform the immediate superior, we do so. Sometimes, it is
also good to put the grievance in a written form to make it formal. Gossiping, back fighting
and other forms of irrational moves will neither help the concerned person nor institution.
Justice
The discussion on justice has been a hot topic in the realm of academic discourses. Many
thinkers attempted to expound the meaning of justice. Most of us conceived justice as
retribute. It means that the justice is observe when justice is served. Plunderer legislators
were imprisoned, murderer former governor was incarcerated and criminals sent to prison.
When criminals are not punished, we complain of the unjust practice.
However, justice not only retribute but also distributive. The later form of justice is
referring to how goods and services, power and wealth, burden and accountability are
shared. Distributive justice is concerned with the fair and proper distributions of public
benefits and burdens among members of a community. This has been an issue that thinkers
from the past up to the present time are trying to contemplate and elaborate to acquire a
distinctive description of justice. To understand more about distributive justice, let us try to
study the historical development of such concept.
In the ancient times, justice was viewed according to merit. Plato, in The Republic,
clearly described justice according to the role played by every citizen in the society. The merit
has been given to the individual according to the individuals share to the society. Further,
another form of justice, which is determined by utility, is promoted by consequentialist. The
famous proponents in this view were Jeremy Bentham and John Stuart Mill. The former
suggests that an action is good if it produces happiness to the greatest number of people. The
later, Bentham’s successor, carefully developed the doctrine into an ethical way. The
formulation of the doctrine is: an act according to the rule so that such action may produce
good for the greatest number of people. Nevertheless, this concept of justice is limited only
to the majority. The minority, which is oftentimes the victim of injustices, is forgotten and
neglected. Added to that, selective justice is not necessarily of justice because it only
considers some citizens in the society and not everybody. Selective justice is non-distributive
justice.
Another view of justice is equality. This is very famous in every democratic society.
John Rawls is considered the most widely-read proponent of this view. Justice as equality can
be explained using two principles; 1) principle of liberty and 2) difference principle. The first
principle means that each citizen has the right to enjoy every opportunity the society has
provided. Whenever some members in the society are constrained by their economic
capability, it is the responsibility of the government and the affluent citizens to lift-up their
lives. Equality in this case simply means that every citizen must have the opportunity to live in
the society according to the standard of living. The government is a tool to make this
opportunity possible together with the help of the affluent member of the society. However,
this situation might force the affluent citizen to help the underprivileged. This will resort to
paying high taxes for the rich on order to subsidize the poor. Is this not an infringement of
personal liberty? To justify the first principle, Rawls pointed out the difference principle. The

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second principle suggests that an inequality in the distribution of wealth or income. Is unjust
whenever it does not benefit the poorest members of the society. Inequality is permissible
only if the practice is in favor to the less privilege in the society. Hence, inequality to the
affluent citizen for the benefit of the unprivileged. Is justifiable. The second principle is also
supported by the concept of reciprocity. The idea of reciprocity reminds everybody that those
who benefited much from the system and the policy should reciprocate it. Hence, true
community will be achieved and sustained.

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