PRELIM NOTES 2ND SEMESTER

BIOETHICS LEC 1

Ethics

- A philosophical and practical science that deals with the study of the morality of human acts or human
conduct.
- The science of human acts with reference to right and wrong.
- Study of the rectitude of human conduct
- The scientific inquiry into the principles of morality

Biology

- Derived from the Greek word “Bios” means “life”

- Concerned with the study of life and living organisms, including their structure, function, growth,
evolution, distribution, and taxonomy.

BIOETHICS

- The term was first used by the biologist VAN RENSSELAER POTTER
➢ Refers to a new field devoted to human survival and an improved quality of life.
- A science that deals with the study of the morality of human conduct concerning human life in al aspects
from the moment of its conception to its natural end.

a. Health Ethics
- A science that deals with the study of the morality of
human conduct concerning health and health care.
- Is employed to regulate human conduct in the practice of
health care so that good may be done and evil may be
avoided thereby ensuring that the purpose of health care,
which delves into alleviation of suffering, prevention of
sickness and promotion of health, is being met in the light of
the fundamental principles of morality.
b. Professional Ethics
- Encompass the personal, organizational and corporate standards of behavior expected of
professionals
- How the use of this knowledge should be governed when providing a service to the public
- Professionals are capable of making judgments, applying their skills and reaching informed decisions
in situations that the general public cannot.
o One of the earliest example is the HIPPOCRATIC OATH to which medical doctors still
adheres to this day.

Morality

- Quality of human acts

- Acts could be good or right, evil or wrong.
- This quality indicates and determines whether the kind of human act that is performed is good or bad.
ETHICS MORALITY
Pertains to the knowledge of what to study about- Pertains to the application of this knowledge in the
that- is the goodness or evilness of human act performance of human act.
Indicates the “theory” Is the flesh
Indicates the “practice”
Learning about the morality of a human conduct. Provide ways in practicing what is learned.

Morality of human act

Human Act

- An act that proceeds from the deliberate free will of man

- The act that is done advertently or knowingly done by the agent
- Requires the use of both the rational faculties of knowing (intellect) and willing (free will)
- 3 elements of human act
1. Knowledge – means the act is done in the light of the agent’s knowing faculty. He is aware and
conscious of what he is doing. He knows what he is performing means.
2. Freedom (free act) - means that the act is performed in accordance with and not against the
will. The will to choose to do or not to do an act.
3. Voluntariness – means that the act is done by the agent is intentional. Voluntarily performs
the act. A voluntary act is willed act, an act that is willfully done. It proceeds from the
employment of knowledge and freedom.

Health care Practice is a human act because of the three constitutive elements at work.

The prevention, treatment, and management of illness and the preservation of mental and physical well-being
through the services of the health care practitioners are acts of knowingly, freely, and voluntarily done.

Act of Man

- An act that does not proceed from the deliberate free will of man. Does not require the employment of
the rational faculties of intellect and free will.
- Acts beyond one’s consciousness; not dependent on the intellect and the will
- Essential Qualities of Acts of Man:
➢ Done without knowledge
➢ Without consent
➢ Involuntarily
- Acts of man can become human acts when he employs his intellect and will in performing the act.
- Actions done within the influence of purely bodily functions

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DETERMINNATS OF THE MORALITY OF HUMAN ACT

The Act Itself – It is the primary determinant of morality.

Either:
* Intrinsically good act
* Intrinsically evil act
What Act is Governed by the Norm of Morality?

Morality – is the measure of relation between the human act performed and its norm according to the dictates of
right reason, human nature and ultimately God’s Eternal Law.
Indifferent Act – which is neither in agreement nor in disagreement with right reason, human nature and God. It
is “silent” in terms of its relation with them. It can be considered a human act in as much as it is deliberately,
freely, and voluntarily done.
Moral Principles in the Judgment of Morality

Moral Principles Governing the Motive of the Agent

1. A good act which is done for a good motive becomes doubly good.
- The goodness doubled because the act takes on a new goodness from a good motive. And if the
good act is done out of several good motives, a new goodness is taken from each of them

2. An evil act which is done for an evil motive becomes doubly evil.
- the evil becomes doubled because it takes on a new malice of evil from an evil motive. And if
the evil act is done out of several motives, a new malice of evil is given birth by each of them

3. A good act which is done for an evil motive becomes evil.

- It goes to show that evil motives are strong enough to affect the goodness of an act. The good
act turns out to be entirely evil if the evil motive is the only and very reason for which the
act is done, and if the evil of said motive is grave though it is not the entire motive of the
act. On the other hand, the good act turns out to be partially evil if the evil motive is not
the whole reason in the performance of said act & if the motive is not gravely evil.

4. An evil act which is done for a good motive does not become good.
- To say that a good motive makes an evil act good is to disregard the fact that the performance
of a human act proceeds from the deliberate will and not from the motive. It is the will that
determines an act which it freely chooses to do, whether good or evil. And if it chooses to do
evil, the act done is evil.
-
5. An indifferent act which is done for a good motive becomes good.
- A good motive qualifies the act as good

6. An indifferent act which is done for an evil motive becomes evil

- The evil motive qualifies the act as evil

What makes a good, good? - when it is in agreement or conformity with the dictates of right reason. To
Christians, an act is good when it is in agreement or conformity not only with the dictates of right reason but
also with God’s Moral Law exemplified by Christ.

What makes evil, evil? - when it is not in agreement & conformity with & in transgression not only of the
dictates of right reason but also of God’s Moral Law & Gospel value exemplified by Christ .

What makes the reason right? - When it is in conformity with the truth- which must be objective in its sense.
Moral Principles Governing the Circumstances of the Act

1. Circumstances can make an indifferent act good or evil.

- The moral quality of an indifferent act making it good or evil is derived from the circumstances
surrounding it.
- Example: Marivic, a patient’s watcher, is singing. She sings in the middle of the night inside the
hospital.
Analysis: The act of singing is an indifferent act. The singing is done involving two specific
circumstances, namely time (at the middle of the night-wherein people are asleep) and place
(inside the hospital- where tranquility should be the usual therapeutic atmosphere) ‘Furthermore,
it may involve circumstances of person referring to the patients who, in their pathological
condition, are in need most of due rest and sleep. Hence, by reason of said circumstances, the act
becomes evil-against charity (manifested in the disturbances the act of singing creates)

PRINCIPLE OF DOUBLE EFFECT

- The principle holds that such an action should be performed only if the intention is
to bring about the good effect and the bad effect will be an unintended or indirect
consequence.
More specifically, four conditions must be satisfied:
1. The action itself must be morally indifferent or morally good.
2. The bad effect must not be the means by which the good effect is
achieved.
3. The motive must be the achievement of the good effect only.
4. The good effect must be at least equivalent in importance to the bad
effect.

2. Circumstances can make a good act evil.

- A good act is tainted with evil malice taken from the circumstances under which it is performed
making it evil.

Example: A single, medical-technologist falls in love. She is loving a good-looking

resident-physician who happens to be a married man already

Analysis: An act of loving is, of course, a good act. It turns out to be bad because of the
circumstances of person referring to the married resident.

3. Circumstances can never make evil act good.

- No circumstance can ever justify the performance of an evil act for it is in itself, fundamentally,
not in keeping with the order of right reason and God’s Eternal Law.

Example: Telling of untruth or a lie to the inquisitive terminally ill-patient about his real
pathological condition in an intention to spare him from a possible stressful state.

Analysis: The act of telling untruth or lie is evil for it is against the virtue of truth. The
circumstances of motive in performing the act that is to spare the patient from stressful state
which is a good act of charity does not take away the evil of the act. Hence, the act remains
evil.
 4. Circumstances can make good or evil acts better or worse.
- An act may have an increased goodness or evil by reasons of circumstances without its species or
nature being altered.

Example: A newly-hired staff-nurse starts her tour of duty by providing nursing care to her
patients to the best of her ability as she has been nurturing the thought of serving them deep
within her heart since college.

Analysis: The act of providing nursing care is a good act of service. Its goodness increase by
reason of the circumstance of time as the nurse nurtured the thought of serving the patients
for quite a long period of time leaving the species of the act unaltered

5. Circumstances can cause new goodness in a good act and new malice in an evil act.
- They can add a specifically new moral character of goodness or evil to an already good or evil
act so that its nature may change from simple to complex one.

Example: A certain medical practitioner performs an act of contraception to a patient. He does

it by way of oophorectomy

Analysis: Contraception is an evil act of frustrating the natural process of conception. It takes
on a new evil malice from the circumstance of the manner of removing the ovary which is a
permanent form of sterilization and an act of mutilation that is against bodily integrity thereby
changing the nature of the act from simple to complex species.

6. A gravely evil circumstance destroys the entire goodness of an objectively good act.

Example: A male medical director in a private hospital elevates a female nurse-supervisor to a

position of chief nurse in a premeditated intention to establish illicit sexual intimacy with her.

Analysis: The act of promotion of the nurse-supervisor to the position of chief nurse is a good
act. However, the circumstances of the motive of the agent (the medical director) is to
establish illicit sexual intimacy with her which is gravely evil. The said circumstances vitiate the
entire goodness of the act.

7. A not so gravely evil circumstance does not destroy the entire goodness of an objectively good act.
Example: Before reporting to hospital duty, a staff – nurse prays to God to make her an
instrument of healing to her patients. She does it carelessly and lazily.

Analysis: An act of prayer is an objectively good act of religion. The circumstance of manner of
praying carelessly and lazily is slightly evil which injuries but does not totally destroy the
goodness of the act of prayer
CONDITIONS AFFECTING THE MORALITY OF HUMAN ACT

1. Ignorance – the absence or lack of knowledge of the existence of a certain law.

Two kinds of Ignorance
a. Invincible Ignorance – cannot be dispelled because it is not within the capacity of the agent to
do so and obtain knowledge.
b. Vincible Ignorance – can be dispelled because it is within the capacity of the agent to do so and
obtain knowledge if sufficient and diligent efforts are exerted.
2. Concupiscence – the rebellion of the passions against reason. It is the revolt of the sense faculties of man
against the dominion of his faculty of reason. All men perceive this revolt within themselves.
Two types:
a. Antecedent – pertains to the occurrence of passion prior to the act of the will and is not
therefore willfully fostered.
b. Consequent – pertains to the occurrence of passions as deliberately fostered by the will.
3. Fear – an agitation of the mind brought about by the apprehension of an impending evil.
Types:
a. Light fear – the evil threatening is present but the slight or serious but remote
b. Grave fear – present when the evil threatening is considered serious
c. Intrinsic Fear – the agitation of the mind which arises because of a disposition within one’s own
mind or body
d. Extrinsic Fear – agitation of the mind which arises from something outside oneself. Under this
heading comes necessary extrinsic fear.

4. Violence – external force applied by a free cause for the purpose of compelling a person to perform an
act against his will
Types:
a. Perfect Violence – is that which the victim gives complete resistance to the application of
external force.
o Physical Perfect Violence – in which the victim uses every possible means of resisting at
the command of his will.
o Morally Perfect Violence – in which the victim makes use of all powers of resistance
that can be employed
b. Imperfect Violence – in which sufficient resistance is not exerted despite the opportunity and
capacity to terminate the violence.

PREVALENCE OF BIOETHICAL ISSUE

1. Abortion
- refers to the expulsion of human fetus before the period of viability
- takes place intentionally or unintentionally, deliberately or accidentally.

3 classification of the expulsion of human fetus

▪ Direct abortion – intentionally or deliberately done, the termination of pregnancy constitutes

direct abortion
▪ Indirect abortion – unintentionally, the fetus is aborted indirectly
▪ Spontaneous – if it accidentally occurs, the expulsion of fetus makeup spontaneous abortion
Common Cause of Induced Abortion

The report contains stories and posted staggering statistics on the Philippines, including:

• 36 in every 1,000 Filipino girls aged 15 to 19 already gave birth between 2004 and 2020
• 6 percent of women experienced intimate-partner violence in the past 12 months according to 2017 data
• 71 in every 1,000 women aged 15 to49 went through an unintended pregnancy between 2015 and
2019.
• The Philippines ranks 56th among 150 countries for the number of unintended pregnancies at 71 per
1,000 women annually
• 51% of all pregnancies are unintended which is almost the same as the global average

COMMON CAUSE OF MISCARRIAGE:

• Chromosomal abnormalities. (most common)

• Infection
• Trauma
• Abnormalities of fetus
• Vascular disease (Lupus)
• Advanced maternal age
• Diabetes
• Previous history of miscarriage
• Hormonal problems

ARTICLE 2 OF 1987 PHILIPPINES CONSTITUTION: SECTION 12

- The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic
autonomous social institution". It shall equally protect the life of the mother and the life of the unborn
from conception.

- The act is criminalized by the Revised Penal Code of the Philippines, which was enacted in 1930 and
remains in effect today. Articles 256, 258 and 259 of the Code mandate imprisonment for the woman
who undergoes the abortion, as well as for any person who assists in the procedure, even if they are the
woman's parents, a physician or midwife. Article 258 further imposes a higher prison term on the woman
or her parents if the abortion is undertaken "in order to conceal (the woman's) dishonor".

- There is no law in the Philippines that expressly authorizes abortions in order to save the woman's life;
and the general provisions which do penalize abortion make no qualifications if the woman's life is
endangered. It may be argued that an abortion to save the mother's life could be classified as a justifying
circumstance (Duress as opposed to self-defense) that would bar criminal prosecution under the Revised
Penal Code. However, this has yet to be adjudicated by the Philippine Supreme Court.

- Proposals to liberalize Philippine abortion laws have been opposed by the Catholic Church, and its
opposition has considerable influence in the predominantly Catholic country. However, the constitutionality
of abortion restrictions has yet to be challenged before the Philippines Supreme Court.
Is Abortion Moral?

▪ As long as it is direct – that is, it is performed deliberately and willfully, abortion is immoral.
▪ It is against the order of right reason which dictates, regardless of religious beliefs and social orientation,
that innocent life must not be taken directly, deliberately, and willfully for whatever reasons.

Against Natural Law:

- It is against the order of right which dictates, regardless of religious beliefs & social orientation, that
innocent life must not be taken directly, deliberately & willfully for whatever reasons. Moreover, the
provision of the Commandment: “thou shall not Kill” necessarily includes the prohibition of all forms of
unjust killing of any human being of whatever age & stage of human development

Canonical Penalty for Abortion

- Citing the specific provisions embodied in Canon Law pertaining to the penalty incurred in the
performance of abortion: the Church attaches the canonical penalty of excommunication - latae
sententiae.

SCOPE OF PENALTY
- Extends to those who provide assistance in any form Without which abortion would not be made
possible.
• The abortionist, nurse, & other health care worker who providers assist & help during the
procedure
• includes the boyfriend, or husband who encourages woman go to abortionist
• the parent who pushes they’re to abortionist
• a friend or anybody who counsels & give advice

When is abortion Morally Permissible?

- Abortion is morally justifiable when it is indirect- that-is when it is not willfully employed as an end or a
means. Indirect abortion is the foreseen but unintended loss of the fetus following upon medical
procedure necessary to preserve the life or health of the mother

When does human life begin to exist?

- During fertilization approach and segmentation approach

Pointers for a Health Care Practitioner

1. Abortion willed as an end or a means of another end is direct and thus, immoral. This includes therapeutic
abortion as the case maybe. A cooperation without which direct abortion cannot come to its completion is
an ample ground for automatic excommunication. The sin of abortion is reserved for absolution to the
bishop or a priest delegated by him

2. Abortion which is not directly willed as an end or means and which is merely seen and tolerated as evil
effect is indirect and thus, morally permissible under the principle of double effect

3. In case of spontaneous-inevitable abortion, if it is medically indicated that the fetus is dead, it is morally
licit to remove it; if the fetus is viable and the mother is in danger of death, termination of pregnancy for
premature delivery is medically incurring no moral objection; if the fetus is not viable, direct removal of
which constitutes direct abortion rendering the procedure immoral; if the mother is in danger of death, the
 principle of double effect has to be invoked so that the procedure constitutes indirect abortion which is
morally allowed

4. In case of abruption placenta, if the placenta is completely detached causing the death of the fetus and
that hemorrhage, follow removal of the fetus is of course morally licit.; if the placenta is not yet
completely detached and that non-viable fetus is still alive, removal of said fetus may constitute direct
abortion which is not morally permissible; again, in which the case, the principle of double effect has to be
employed

5. Responsibility must be taken to dispel any vincible ignorance and to obtain knowledge about surrounding
issues and moral principles relative to the removal of the fetus for the sake of the mother’s health so as
to establish clear and certain conscience in whatever procedure and or cooperation to be employed. This can
be done by means of reading books in health ethics and morality, consultation with moral authorities and
others

EUTHANASIA

- Greek word “thanatus” means “easy or happy death”

- “Easy death” in this context means, earlier death that is intentionally caused in order to get rid of a
“difficult death

Types of Euthanasia

1. Euthanasia by commission
- Active euthanasia
- the positive act of causing death that is geared towards termination of pain and suffering. By
positive act means a measure necessary to end the life of a suffering person is directly used.
2. Euthanasia by Omission
- passive euthanasia
- the negative act of causing death that is geared towards termination of pain and suffering. By
Negative act is meant a measure necessary to sustain the life of a suffering person is omitted.

Categories of Euthanasia

1. Voluntary Euthanasia
- indicates the measure of causing the death of the patient at his willful consent or request.
- Can be verbally expressed, written in the patient’s advance directive as in a living will or
durable power of attorney, or given by mere gesture in case of inability to speak and manage
oneself.
- Assisted suicide - technically the patient administers the fatal means made available by the
health care team
2. Non –Voluntary Euthanasia
- indicates the measure of causing the death of the patient who is unable to express his will and
make his intentions known as in unconscious or comatose state.
- the decision to end the patient’s life is made either by the watchers of the patient, the
health care team or the society
3. Involuntary Euthanasia - indicates the measure of causing the death of the patient in defiance of his
expressed will and or against his consent
Conditions of the Option for Euthanasia

1. When the patient is terminally ill or incurably sick

- If their medical and pathologic condition is indicative of a hopeless cause which the science of
medicine deems to have nothing to do, then they can be given the option to get rid of their
dreaded situation by their hastened death
2. When the patient experiences unbearable suffering
- Health care practitioners are duty-bound not only to promote health but also to alleviate pain
& suffering. But when the pain & suffering are considered to be intolerably burdening, the
alleviation of pain & suffering may also take the form of causing earlier death
3. When the patient makes a voluntary decision
- But when the patient makes a decision to submit for the termination of his life due to terminal
illness or unbearable pain, nobody can hinder. His decision has to be respected and carried out
accordingly in observance of the so-called principle of autonomy in which the patient has the
inherent right to make a choice without having to be interfered with
4. When the patient’s life is deemed to be not anymore “worth-living
- But, when the patient’s condition irreversibly deteriorates to the point of existing as a mere
biological organism in his vegetative existence, with no retrievable consciousness and no sense of
self, and the like, he can be considered to be devoid of qualities proper to a human person
whose life is no longer “worth-Living” thus, euthanasia is opted.

An Act of Mercy
- The strongest argument for the recourse to euthanasia is its being perceived as an act of mercy.
- The mercy, in this case, apparently manifests itself in a motive to put an end to the terminal pain &
misery of the person. That is why it is commonly called “mercy-killing”. The patient’s death is seen as
the only remedy to the problem.

Analysis
The main point of justifying the procedure resides in the argument that there is no violation of the life principle
because in most cases, the people killed are not fully alive as human beings; rather they are merely existing as an
organism-network of organs and cells. It is an act of mercy, a proponent of mercy killing might argue, to end the
life of those people who although, not “brain-dead”, have suffered 80% brain damage. They will have a plantlike
existence, exhibiting no personality or real human consciousness whatsoever, therefore it is an act of mercy to end
their existence.

Is Euthanasia Moral?
Violation of the Natural Law and Decalogue

- Euthanasia, by consent or request from a suffering patient invoking the so called principle of autonomy,
does not eliminate in one way or another the evil attributed to killing