BIOETHICS AND ITS

APPLICATION IN VARIOUS
HEALTH CARE SITUATIONS
Sexuality and Human Reproduction
1. Human Sexuality and its Moral Evaluation
• Human sexuality is the way people experience and express themselves sexually.
• This involves biological, erotic, physical, emotional, social, or spiritual feelingsand
behaviors.
• Because it is a broad term, which has varied over time, it lacks a precise definition.
• The biological and physical aspects of sexuality largely concern the human
reproductive functions, including the human sexual response cycle.
• Someone's sexual orientation is their pattern of sexual interest in the opposite or
same sex.
• Physical and emotional aspects of sexuality include bonds between individuals that
are expressed through profound feelings or physical manifestations of love, trust,
and care.
• Social aspects deal with the effects of human society on one's sexuality, while
spirituality concerns an individual's spiritual connection with others.
• Sexuality also affects and is affected by cultural, political, legal,
philosophical, moral, ethical, and religious aspects of life.
Legal Issues on Human Sexuality
• Globally, laws regulate human sexuality in several ways, including
criminalizing particular sexual behaviors, granting individuals the privacy
or autonomy to make their own sexual decisions, protecting individuals with
regard to equality and non-discrimination, recognizing and protecting other
individual rights, as well as legislating matters regarding marriage and the
family, and creating laws protecting individuals from violence, harassment,
and persecution.
• Issues regarding human sexuality and human sexual orientation have come
to the forefront in Western law in the latter half of the twentieth century, as
part of the gay liberation movement's encouragement of LGBT individuals
to "come out of the closet" and engaging with the legal system, primarily
through courts. Therefore, many issues regarding human sexuality and the
law are found in the opinions of the courts.
2. Marriage
• WHAT IS MARRIAGE?
• Under the Family Code of the Philippines (FC), marriage is defined as a
special contact of permanent union between a man and a woman
entered into in accordance with law for the establishment of conjugal
and family life. It is the foundation of the family and inviolable social
institution whose nature, consequences, and incidents are governed by
law and not subject to stipulation, except that marriage settlements
may fix the property relations during the marriage within the limits
provided by the FC.
Essential requisites and formal requisites
• Essential requisites:
 Legal capacity of the contracting parties who must be a male and a female; and
 Consent freely given in the presence of the solemnizing officer.
• Formal requisites:
 Authority of the solemnizing officer;
 A valid marriage license except in marriage of exceptional circumstances; and
 A marriage ceremony which takes place with the appearance of the contracting parties before
the solemnizing officer and their personal declaration that they take each other as husband and
wife in the presence of not less than 2 witnesses of legal age.
• Parental consent is necessary when the contracting parties are between the
ages of 18-21 years of age, in addition to the other requirements.
• Generally, divorce is not allowed in the Philippines except in cases wherein
divorce is validly obtained abroad by a foreign spouse capacitating him or
her to remarry, the Filipino spouse shall have capacity to remarry under the
Philippine law.
RIGHTS AND OBLIGATIONS BETWEEN HUSBAND AND WIFE
• PERSONAL OBLIGATIONS OFTHE SPOUSESTO EACH
OTHER
• Live together;
• To observe mutual love, respect and fidelity; and
• To render mutual help and support.
3. Issues on Artificial Reproduction, its Morality
and Ethico-Moral Responsibility of Nurses
Artificial insemination (AI)
• is the deliberate introduction of sperm into a
female's cervix or uterine cavity for the purpose of achieving
a pregnancy through in vivo fertilization by means other
than sexual intercourse.
• If the procedure is successful, the woman will conceive and carry
a baby to term in the normal manner. A pregnancy resulting from
artificial insemination is no different from a pregnancy achieved
by sexual intercourse.
The beneficiaries of artificial insemination
• are women who desire to give birth to their own child who may
be single, women who are in a lesbian relationship
• women who are in a heterosexual relationship but with a male
partner who is infertile or who has a physical impairment which
prevents full intercourse from taking place.
Preparations
• Timing is critical, as the window and opportunity for fertilization is little more than
twelve hours from the release of the ovum. To increase the chance of success, the
woman's menstrual cycle is closely observed, often using ovulation kits, ultrasounds or
blood tests, such as basal body temperature tests over, noting the color and texture of
the vaginal mucus, and the softness of the nose of her cervix. To improve the success
rate of AI, drugs to create a stimulated cycle may be used, but the use of such drugs
also results in an increased chance of a multiple birth.
• Pre- and post-concentration of motile sperm is counted. Sperm from a sperm bank
will be frozen and quarantined for a period, and the donor will be tested before and
after production of the sample to ensure that he does not carry a transmissible
disease. For fresh shipping, a semen extender is used.
• If sperm is provided by a private donor, either directly or through a sperm agency, it is
usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm
provided in this way may be given directly to the recipient woman or her partner, or it
may be transported in specially insulated containers. Some donors have their own
freezing apparatus to freeze and store their sperm.
Techniques
• The human female reproductive system.The cervix is part of the uterus.The
cervical canal connects the interiors of the uterus and vagina.
• Semen used is used either fresh, raw, or frozen. Where donor sperm is
supplied by a sperm bank, it will always be quarantined and frozen, and will
need to be thawed before use. The sperm is ideally donated after 2-3 days of
abstinence, without lubrication as the lubricant can inhibit the sperm
motility [9].When an ovum is released, semen is introduced into the
woman's vagina, uterus or cervix, depending on the method being used.
• Sperm is occasionally inserted twice within a 'treatment cycle'.
In-vitro Fertilization

• In vitro fertilization (IVF) is a complex series of procedures used to help with

fertility or prevent genetic problems and assist with the conception of a
child.
• During IVF, mature eggs are collected (retrieved) from ovaries and fertilized
by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are
transferred to a uterus. One full cycle of IVF takes about three weeks.
Sometimes these steps are split into different parts and the process can
take longer.
IVF can also be done if you have certain health conditions. IVF may be an option if you
or your partner has:

• Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it

difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available
for fertilization.
• Endometriosis. Endometriosis occurs when the uterine tissue implants and grows
outside of the uterus — often affecting the function of the ovaries, uterus and
fallopian tubes.
• Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are
common in women in their 30s and 40s. Fibroids can interfere with implantation of
the fertilized egg.
• Previous tubal sterilization or removal. If you've had tubal ligation — a type of
sterilization in which your fallopian tubes are cut or blocked to permanently
prevent pregnancy — and want to conceive, IVF may be an alternative to tubal
ligation reversal.
• Impaired sperm production or function. Below-average sperm
concentration, weak movement of sperm (poor mobility), or abnormalities
in sperm size and shape can make it difficult for sperm to fertilize an egg. If
semen abnormalities are found, your partner might need to see a specialist
to determine if there are correctable problems or underlying health
concerns.
• Unexplained infertility. Unexplained infertility means no cause of infertility
has been found despite evaluation for common causes.
• A genetic disorder. If you or your partner is at risk of passing on a genetic
disorder to your child, you may be candidates for preimplantation genetic
testing — a procedure that involves IVF. After the eggs are harvested and
fertilized, they're screened for certain genetic problems, although not all
genetic problems can be found. Embryos that don't contain identified
problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions. If you're about
to start cancer treatment — such as radiation or chemotherapy — that could
harm your fertility, IVF for fertility preservation may be an option. Women
can have eggs harvested from their ovaries and frozen in an unfertilized
state for later use. Or the eggs can be fertilized and frozen as embryos for
future use.
Risks of IVF include:
• Multiple births. IVF increases the risk of multiple births if more than one embryo is
transferred to your uterus. A pregnancy with multiple fetuses carries a higher risk
of early labor and low birth weight than pregnancy with a single fetus does.
• Premature delivery and low birth weight. Research suggests that IVF slightly
increases the risk that the baby will be born early or with a low birth weight.
• Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as
human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian
hyperstimulation syndrome, in which your ovaries become swollen and painful.
• Symptoms typically last a week and include mild abdominal pain, bloating, nausea,
vomiting and diarrhea. If you become pregnant, however, your symptoms might
last several weeks. Rarely, it's possible to develop a more severe form of ovarian
hyperstimulation syndrome that can also cause rapid weight gain and shortness of
breath.
• Miscarriage. The rate of miscarriage for women who conceive using IVF with
fresh embryos is similar to that of women who conceive naturally — about
15% to 25% — but the rate increases with maternal age.
• Egg-retrieval procedure complications. Use of an aspirating needle to
collect eggs could possibly cause bleeding, infection or damage to the
bowel, bladder or a blood vessel. Risks are also associated with sedation and
general anesthesia, if used.
• Ectopic pregnancy. About 2% to 5% of women who use IVF will have an
ectopic pregnancy — when the fertilized egg implants outside the uterus,
usually in a fallopian tube. The fertilized egg can't survive outside the uterus,
and there's no way to continue the pregnancy.
• Birth defects. The age of the mother is the primary risk factor in the
development of birth defects, no matter how the child is conceived. More
research is needed to determine whether babies conceived using IVF might
be at increased risk of certain birth defects.
• Cancer. Although some early studies suggested there may be a link between
certain medications used to stimulate egg growth and the development of a
specific type of ovarian tumor, more-recent studies do not support these
findings. There does not appear to be a significantly increased risk of breast,
endometrial, cervical or ovarian cancer after IVF.
• Stress. Use of IVF can be financially, physically and emotionally draining.
Support from counselors, family and friends can help you and your partner
through the ups and downs of infertility treatment.
The chances of giving birth to a healthy baby after using IVF depend on
various factors, including:

• Maternal age. The younger you are, the more likely you are to get pregnant
and give birth to a healthy baby using your own eggs during IVF. Women age
41 and older are often counseled to consider using donor eggs during IVF to
increase the chances of success.
• Embryo status. Transfer of embryos that are more developed is associated
with higher pregnancy rates compared with less-developed embryos (day
two or three). However, not all embryos survive the development process.
Talk with your doctor or other care provider about your specific situation.
• Reproductive history. Women who've previously given birth are more likely
to be able to get pregnant using IVF than are women who've never given
birth. Success rates are lower for women who've previously used IVF
multiple times but didn't get pregnant.
• Cause of infertility. Having a normal supply of eggs increases your chances
of being able to get pregnant using IVF. Women who have severe
endometriosis are less likely to be able to get pregnant using IVF than are
women who have unexplained infertility.
• Lifestyle factors. Women who smoke typically have fewer eggs retrieved
during IVF and may miscarry more often. Smoking can lower a woman's
chance of success using IVF by 50%. Obesity can decrease your chancesof
getting pregnant and having a baby. Use of alcohol, recreational drugs,
excessive caffeine and certain medications also can be harmful.
There are several moral issues with in vitro.
• First of all, the child is created outside the womb by human devices as a
sperm and a harvested egg are combined.
• Second, many children (embryos) are created and some are frozen for later
use while several are placed in the mother's womb. The survival for these
embryos is low, sometimes quoted around 25%. So in essence, multiple
children are created, knowing that most of them will not live. Some
physicians only place 2-3 embryos in the mother, hoping that one or all of
them will survive. Other physicians place more embryos in the mother, and
if too many live, they then abort the "extras" and leave a more
"manageable" number of embryos in the womb.
• The frozen embryos have an uncertain fate. Some of them remain frozen
for an inestimable period of time, children that have been created and then
frozen! Does it seem right to create life and then leave it? Some of the
frozen embryos may be thawed later for a repeat cycle of IVF, and most do
not survive. In some cases embryos are donated to other couples or some
may be donated for research (i.e.: killing them in the name of scientific
study).
• The overall problem with IVF is that it destroys life as it creates
life. Meaning, the chance of one child surviving carries with it the necessity
of many other children (embryos) having been created and then dying. So
for the one surviving child, many other children have been given life
(combining sperm and egg) with the knowledge that most of them won't
make it.
Surrogate Motherhood
What Is a Surrogate Mother?
There are two kinds:
• Traditional surrogate. It's a woman who gets artificially inseminated with the
father's sperm. She then carries the baby and delivers it for you and your partnerto
raise.
A traditional surrogate is the baby's biological mother. That's because it washer
egg that was fertilized by the father's sperm. Donor sperm can also be used.
• Gestational surrogates. A technique called "in vitro fertilization" (IVF) now makes
it possible to gather eggs from the mother, fertilize them with sperm from the
father, and place the embryo into the uterus of a gestational surrogate.
The surrogate then carries the baby until birth. She doesn't have any genetic ties
to the child because it wasn't her egg that was used.
A gestational surrogate is called the "birth mother." The biological mother,
though, is still the woman whose egg was fertilized.
 The Ethical Issues that are Pertinent in the
Surrogacy Process
• While there are many religious organizations that frown upon the process of
surrogacy, this concept is oftentimes the only option for some individuals to start a
family. It is for this reason that some highly controversial and key ethical issues be
addressed
• Attachment with the Gestational Mother – In a surrogate situation, the gestational
mother is the woman who carries the baby to term. This can be a very taxing
process both physically and emotionally – and unique in that after the surrogate
mother physically carries the baby throughout the pregnancy, she needs to
physically and emotionally detach herself from the child once it is born.
• Involvement with the Gestational Mother – Because the gestational mother will
not likely be the child's primary caretaker, there could be legal questions that arise
in terms of what – if any – involvement she will have with the child once born.
• Identity of the Child – There are also ethical considerations that are brought to
mind in terms of informing the child of his or her surrogate mother, as doing so
may have an effect on the child's self-identity.
• In addition to the above issues, there is also the factor of surrogate mother
compensation. It is typically expected that the intended parents of the child will
reimburse the surrogate mother for her medical and other related expenses. This
can include a dollar amount for her hospitalization as well as incidentals such as her
maternity clothing, meals, and other similar costs that she may be out during her
time of pregnancy.
• There are also surrogate situations where the individual or couple who are the
intended parents will pay a fee to the surrogate mother for carrying their baby.
With this in mind, it is thought by some that surrogacy could be thought of as being
a luxury that is only available to the wealthy – and in some cases it could even be
thought of as pregnancy-for-hire.
• In any case, however, the process that allows for a loving individual or parents to
have a child of their own can allow intended parents to follow through on their
intentions of starting a family, regardless of any medical or other factors that
would otherwise prevent them from being able to do so.
4. Morality of Abortion, Rape and other
Problems Related to Destruction of Life
Abortion
• For centuries Western culture in general and Christians in particular have
held to a view of the sanctity of human life.
• In our society today this view is beginning to erode into a quality-of-life
standard.
• Where once we saw the disabled, the retarded, and the unborn as having a
special place in God’s world, now we have moved into a position of judging
on the quality of human life.
• No longer is life as such seen as sacred and worthy to be saved.
• Now it is seen as something to be judged and evaluated.
• If we arbitrarily feel that life is not worth living, then it is advisable to
terminate it.
Definition of Terms
Abortion
• Is the premature termination of pregnancy
prior to birth
• Spontaneous abortion/miscarriage
• Induced abortion is caused by thewoman
herself or by another, usually a medical
doctor
QuestionS to ponder
• “When does human life begin?”
• “At what point is it to be valued and protected
to the same extent as the lives of human
beings who already have been born?”
• Conflict between the positions for and against
centers on so-called absolute rights
When does human life begin?
• “Is abortion the taking of human life?”
• Daniel Callahan (well-known Catholic
theologian) said:
• Life is present from the conception but allows for
the possibility that there may be later different
point at which such life can be considered as
man.
• Human life in potentiality is existent in various
stages of development during the nine months of
gestation
When does human life begin?
• Point of argument on abortion
• Fetus is not an actual human life in the womb
after the 12th week, when the brain structure is
essentially complete and a fetal
electrocardiogram through the pregnant woman
can pick up heart activity.
• When the child breathes on its own, are the
only points at which human life begins
• Human being able to survive without life support of
some kind.
• If they cannot breathe for themselves or eat and
drink on their own they are not actually human
beings.
• Once born-they are considered as human.
Question to ponder
• “At what point in development of the
conceptus to be valued to the extent that
terminating its life would be equivalent to
terminating the life of people who are
already born?”
• GENETIC VIEW – human life is to be
valued from conception onward.
• THE STRONG PROCHOICE POSITION –
human life does not have the value until
birth
Arguments against abortion
• THE GENETIC VIEW OF THE
BEGINNING OF HUMAN LIFE
• Human life starts at conception (the
chromosomes from the sperm and ovum are
united) then a human being exists that must
be valued in the same way as if “he or she”
were already born.
• Safest position to hold: by valuing a
conceptus as a human from conception
onward we are ensuring that we do not act
immorally or irreverently toward human life,
especially innocent, unborn life
• THE SANCTITY OF LIFE ARGUMENT
• Every unborn, innocent child must be regarded
as human person with all the rights of a human
person from the moment of conception onward
• The conceptus not only has the right to life, but
also that his/her right is absolute
• Absoluteoverrides all other rights that might
come into conflict with it
• Eg. A woman’s right to determine the course of
her own procreative life or even her right to
decide between her own life and the life of her
conceptus if her pregnancy is complicated in
some way.
• THE
DANGERS OF ABORTION TO THE
MOTHERS LIFE
• Abortion procedures are dangerous to the
mother’s well-being, life and future pro-
creativity
TWO ASPECTS OF DANGERS
• MEDICAL DANGERS – abortion methods used
DILATATION AND CURETTAGE (D &C)
The woman’s cervix is dilated, and sharp currette, a kind of
scalper is used to scrape the entire uterine cavity.
This method is usually used up to the 12th week of
pregnancy
• POTENTIAL DANGERS:
Perforation of the uterine wall by the sharp instrument
Infection
• UTERINE ASPIRATION
Suction machine (aspirator), which consists of a
plastic instrument at the end of the hose is used
to “aspirate” or suction off, the conceptus and
other related materials
Less chance of uterine perforation
Usually done prior to the 12th week of
pregnancy
• HYSTERECTOMY
•After 12th week of pregnancy, a miniature
caesarian section can be performed
•There is a greater danger involved in major
surgery, because once a caesarian operation
has been performed, any baby a woman have in
the future may also be delivered in the future
may also be deliveerd by caesarian section.
• SALINE ABORTION
 Performed during late pregnancies (after 12th week)
Procedure :
Needle is inserted through the abdominal wall into
the amniotic sac, where the conceptus is floating.
Some of the amniotic fluid is drawn off and replaced
by a glucose, saline or prostaglandin solution. Within
24 hours the woman goes into labor and usually
delivers a dead fetus.
Complications may arise especially during delivery
of fetus where doctor is not usually present.
Can cause psychological problems because the
woman has to go through labor just as if she were
having a baby, yet the result is a dead fetus.
•SELF-INDUCED ABORTION
The most dangerous of all abortions
because they are not done under
medical supervision
Complications:
Infections and hemorrhage – both
can kill the fetus and the mother
Argument:
• Discouraged women from
performing self-induced abortions
POTENTIAL DANGERS (IN GENERAL)
• Abortion increases a woman’s chances of having
miscarriages in later pregnancies (especially for
young girls who have had an abortion)
• Repeated abortion increases the level of danger
• CONCLUSION (PRO-LIFE PROPONENTS)
Pregnancy and childbirth are normal functions of a
woman’s body and that an artificial interruption of
these functions can cause medical problems that
make such procedures hazardous to women.
PSYCHOLOGICAL DANGERS
• It is psychologically destructive to a woman to
authorize the “killing of her baby”.
(Pro-life) A woman who has committed such terrible act
has to live with a great deal of guilt
 Emotional scars will never be eradicated from the psyche
.
RESPONSIBILITY FOR SEXUAL ACTIVITIES
• Whenever women engage in sexual acts with men,
whether contraceptives are used or not, they must
realize that pregnancy may ensure.
• They must accept the responsibility with them and they
cannot sacrifice an innocent human life because of the
failure of a contraceptive device.
• A woman is responsible for not getting pregnant, there
are many methods she can use to avoid pregnancy. If it
does occur , it is her responsibility to go through with it
and gave birth to her child.
RAPE AND INCEST
• If women do become pregnant after rape or incest, the
destruction of human life is still not justified. Women go
through with the pregnancies and, if they do not want the
children because of the circumstances of their
conception, they should put them up for adoption or place
them in government-run institutions.
• In any case, innocent, unborn conceptuses should not
have to pay with their lives for the sins or crimes of
others.