HEALTH CARE ETHICS

Task
• A woman is/was suffering from a terminal disease and asked
her loving partner to euthanize her.
Her partner is now being tried for assisted suicide.
• How would legalists, antinomians and situationists judge the
partners actions and decide whether the action should be
punished or not?
Situation Ethics
• Situation ethics is sensitive to variety and complexity. It uses
principles to illuminate the situation, but not to direct the
action.
• Fletcher divides his principles into two categories.
• The four working principles and
• The six fundamental principles
Strengths of Situation Ethics
• Christian system consistent with the teaching of Jesus.
• Flexible relativist system it enables people to make tough
decisions.
• It emphasizes love (agape) surely everyone agrees that’s a good
thing.
• It avoids conflicts of duty, as one experiences in absolutist
systems. Where moral rules collide,
Situation ethics gives a way of resolving the conflict of love.
Weaknesses of Situation Ethics:
• Christian system atheists and those of other faiths might not
want to follow the example of Jesus.
• Unprincipled relativist system it could allow for almost any
action.
• Love is very subjective. People naturally will disagree about
what loving behaviour is.
• It is difficult to predict the future results of actions making
consequentialist decisions based on love is unreliable.
• Utilitarianism is a moral theory that advocates actions that
promote overall happiness or pleasure and rejects actions that
cause unhappiness or harm.
• A utilitarian philosophy, when directed to making social,
economic, or political decisions, aims for the betterment of
society.
• There are two types of utilitarians--rule utilitarians and
act utilitarians--and both strive to maximize the utility of
actions for the good of humankind. They only differ in the way
they approach this task.
• Kant's theory:
• Kant's theory is an example of a deontological moral
theory–according to these theories, the rightness or wrongness
of actions does not depend on their consequences but on
whether they fulfill our duty. 
• Kant believed that there was a supreme principle of morality,
and he referred to it as The Categorical Imperative.
• His ethical view is sometimes called deontologism for its
emphasis on duty or obligation i.e., deontos in Greek.
• Kantian ethics refers to a deontological ethical
theory developed by the German philosopher
Immanuel Kant. ... Central to Kant's construction of the moral
law is the categorical imperative ( meaning accdg. To the
dictionary---Categorical statement is a clear statement that
something is definitely true), which acts on all people,
regardless of their interests or desires. 
• Kant formulated the categorical imperative in various ways.
 
• Others regard it as a form of intuitionism precisely because of
its claim that morality is exclusively within the human
personality; what is morally right or wrong is solely a matter of
intent, motive and will. Intuition here means internal motive
or intention; hence means it is a motivist theory, too.
• There are several ways of approaching Kant’s ethics, depending
upon the context within which one may set about dealing with
it.
• One may even use Kant’s ethical arguments to establish the
existence of God.
Let’s begin with this question:
• “What makes an act moral as distinguished from a non-moral
one? That is, what is the difference between a person who acts
morally and one who does not?
• Kant maintains that one acts morally (i.e., performs a moral
act) if and only if one does whatever one is obliged to do.
• But what is that act which an individual is obliged to do?
• It is one that is performed or done from a sense of duty or
obligation.
• Thus, what makes an act moral is its being done out of duty, as
distinguished from acts done for other reason.
• Anyone, for example, who does something merely because one
feels like doing it (e.g., out of inclination) is not acting morally,
is not a moral person, nor he/she performing a moral act.
• Likewise, a doctor who performs his/her job out of the mere
desire to do so, or inclines towards it rather than something
else, is not acting morally or doing a distinguish moral act. It is
only when a doctor recognizes the duty to cure a patient that
he/she is genuinely a moral person, acting morally, and doing a
distinctively moral act. Duty in this context is that which an
individual ought to do, despite the inclination to do otherwise.
Hence, doing one’s duty is doing what one is obliged to do.
That is why duty is also known as obligation.
• Act done in accord with duty and act done from a
sense of duty (Kant 1949; Popkin and Stroll
1967:38-40).
• Kant makes a distinction these two acts.
• A doctor, for example who performs his/her medical functions
merely out of desire to do so or out of fear of being accused of
negligence is acting in accord with duty. Hence, such acts are
non-moral, i.e., they have no moral significance.
• Doctors act from a sense of duty if they recognize that there is
a special obligation to their patients because of their
relationship with them. Physicians who understand the nature
of such an obligation and act upon it accordingly are indeed
moral persons or ethical individuals; otherwise, they are not.
• Thus, for Kant, the essence of morality is to be found in the
motive from which an act is done.
• In other words , the rightness or wrongness of an action is
determined by the motive from which it is being carried out,
regardless of the consequences which doing so or not doing so
will produce.
• The motive here refers to the duty that one ought to
perform---it is what makes the act morally good.
• A person who does such an act is a person of good will, Kant’s
view.
• A good person is a moral one who acts from a respect for duty,
and one who acts from a sense of duty is also a person of good
will.
• But how can one know one’s duty in a given situation, so that
one may act accordingly? Is there a test for determining what
one’s duty will be under a particular set of circumstances?
Kant answers in the affirmative:
• To be able to determine whether or not one acts from a sense

of duty in a particular situation, one must judge his action in

the light of how it would appear if it were to become a
universal precept or code of behavior.
• In other words one must test the act’s universalizability by
means of the categorical imperative, the kernels of Kant’s ethic
theory.
Example:
One must ask oneself:
• Do I want every pregnant woman, without, exception, whether
she be my sister, mother or daughter, who is in a situation
similar to mine, to abort her deformed fetus? If I say “yes” to
this question without any mental ulterior reservation at all, then
I know that it is my duty to abort my malformed fetus: but if I
say “no” and give certain exceptions and rationalization for
other cases, then I know that it is my duty not to expel my
unborn child, deformed though it may be.
• Kant expresses the principle of humanity (PH) as follows: “
Act in such a way that you treat humanity,
whether in your own person or in the person of any other,
never merely as a
means, but always at the same time as an end.”
• Kantian ethics refers to a deontological ethical theory
 developed by the German philosopher Immanuel Kant. The
theory is stated as: "It is impossible to think of anything at
all in the world, or indeed even beyond it, that could be
considered good without limitation except a good will."
• The theory was developed as a result of 
Enlightenment rationalism, and states that an action can only
be good if its maxim—the principle behind it—is duty to 
the moral law, and arises from a sense of duty in the actor.
Kantian ethics: (From Wikipedia, the free encyclopedia)
• Kant formulated the categorical imperative in various ways.
His principle of universalizability requires that, for an action
to be permissible, it must be possible to apply it to all people
without a contradiction occurring.

• Kant's formulation of humanity, the second section of the

Categorical Imperative, states that as an end in itself humans
are required never to treat others merely as a means to an end
, but always as ends in themselves.
• The formulation of autonomy concludes that rational agents are
bound to the moral law by their own will, while Kant's concept
of the Kingdom of Ends requires that people act as if the
principles of their actions establish a law for a hypothetical
kingdom.

• Kant also distinguished between perfect and imperfect duties.

 a.) A perfect duty, such as the duty not to lie, always
holds true;
 b.) an imperfect duty, such as the duty to give to
charity, can be made flexible and applied in
particular time and place.
• That I should not harm or inflict injury upon others.
• That I should show love and compassion occasionally to
others, based on my own choice
 
Ross’s Ethics:
• William David Ross (b 1877), a British Aristotelian scholar
and moral philosopher, presented a rule-deontological theory
in his book, (Oxford, 1938) (Ross 1930, 1939; Munson 1979;
Pahl: 36-42; Beauchamp and Childress: 35-47, 45-46).
Though influenced by rule utilitarianism, Ross has rejected the
utilitarian precept that an action is validated as right by its
consequences.
• The outcomes of an act, however beneficial and pleasant they
may be for many individuals, may not determine its rightness.
And though he was deontologist himself like Kant, Ross
considers the latter’s absolute principles to be rigid.
• He perceives that not only do such principles fail to
demonstrate sensitivity with regard to the complexities of
actual situations, but they also conflict with one another in
some instances.
• Is it morally justified, for example, to lie to (or withhold the
truth from) from someone who has no right to know about it?
• Does a questioner have the right to know the truth which is not
due him?
• One can discern from these questions Ross’s apparent trouble
with Kant’s absolutism.
 
Rule and moral properties:
• Despite Kant’s absolutism, however, Ross has perceived that
ethical significance of rules in the medical context, although
moral rules should not be so absolute and inflexible, that there
are no exceptions whatsoever (Pahl, 1981; Munson 1079).
• Moral rules serves as moral guidelines in such a way that they
must be adjusted or modified, if not set aside in some
situations, depending upon our perception of what is right and
good.
• Consider, for example, the predicament of whether or not
should lie to a terminally ill patient about his/her condition.
• Knowing that it would cause him/her useless anguish and
apprehensions, should we tell the patient the truth?
• Are we not violating the patient’s trust in us to act morally, and
to speak the truth, should we withhold it and lie to her?
• In the light of these problems, Ross has recognized that there
are exceptions for every rule, and in some situations the latter
must be set aside.
• Absolute rules are often insensitive to the consequences of an
act; at times, not only are they in conflict with one another but
they are also inflexible that they become irrelevant to ever-
changing situations.
• “Always tell the truth,” But suppose the truth kills patient,
or at least hasten his death?
• Right and good are distinct, modefinable and irreducible
objective qualities, in Ross’s view, Rightness belongs to acts,
independent of motives: hence we speak of right acts.
• Moral goodness belongs to motives; hence we speak of good
motives. For Ross, an act is that which is done, while an
action is the doing of an act.
• Thus, the doing (that is the carrying out or execution) of a right
act can be the result of a morally bad motive or inversely, the
doing of a wrong act can originate from a good motive.
• For Ross then, rightness and goodness are the only two moral
properties. Neither can be explained nor replaced by other
properties.
• When we say an act is right, rightness is a moral property of
that act. But is not identical with the act per se, precisely
because as pointed out earlier, a right act can originate from a
morally bad motive. In considering the rightness of an act,
as well as the goodness of a motive, we also have to
determine, the nonmoral properties or circumstances
surrounding the act as such.
• Upon seeing a physician giving someone an injection, for
instance, I have to determine what the injections is and why he
is injecting and why the physician is giving the injection (these
are the nonmoral properties, the circumstances).
• Once an individual has determined these nonmoral properties,
then he/she can say he is performing a right or a wrong act. If
he is injecting the right drug (what) to cure the patient’s illness
(why) because it is his duty as a physician to do so (why he is
doing it)), then his act (injecting the patient) is right.
• But suppose the physician is deliberately injecting the wrong
drug in order to kill the patient, because the latter happens to be
his mortal enemy? Here it comes increasingly clear why Ross
claims that rightness, as the moral property of an act, is not
identical with the act itself (act of injecting).
• If it were, then all physician’s acts of injecting people (either
with the wrong drug or with a bad motive, or both) would be
right.
• Prima facie is defined as something that has been proven or
assumed to be true unless there is evidence presented to the
contrary.
• Actual Duty and Prima Facie duty:
• If and when moral rules come into conflict in particular
situation, how are we to determine which one applies?
• To resolve this question, Ross makes a distinction between an
actual duty and a prima facie duty . (Pahl, 1981). The former
is one’s real duty in a given situation. It is the action one ought
to choose from among many other actions.
• The latter (which in Latins means “as first view,” or so far as it
appears) is one that directs or commands what one ought to
perform when other relevant factors are not taken into account.
More often than not, there are several prima facie duties in a
particular circumstances.
Let us illustrate:
• I have promised to lend money to a friend in dire need. It is
thus my prima facie duty to hand over the money on the day
agreed upon. But suppose, for instance, that before I do so, I
find that I need the money because my mother has suffered
from an attack of chronic asthma, and needs to be hospitalized.
According to Ross, “Do whichever act is more of a duty,
“In other words, my actual duty in the situation is determined
by an examination of the weight of both prima facie duties in
conflict. Which one is stronger of then two?
• Here one can see that the prima facie duty of promise-keeping
(as I have done for my friend) is not absolute , for it can be
overridden by a stronger prima facie duty under some
conditions ( such as my duty to an ailing mother in serious
condition).
• Sir David Ross offers us two principles by which to resolve
cases of conflicting duties.
1.) Act in accordance with the stronger, more stringent or
more sever prima facie duty.
2. ) Act in accordance with the prima facie duty, which has
aa
greater balance of rightness over wrongness compared
to other prima facie duties.
• How am I to determine my actual duty in a given
situation when there are conflicting prima facie
duties?
• If a terminally patient asks “Am I going to die?” I have a prima
facie duty to tell him the truth. But I also have a prima facie
duty to give him comfort, peace of mind and to spare him from
needless suffering.
Ross holds that:
a.) one and only one of these two prima facie duties is
my actual duty
b.) I know each of them to be a prima facie duty
c.) I can only have an opinion (a personal conviction or
perception to the best of my knowledge) about which is
more of a duty” (more crucial, more serious) and there-
fore, my actual duty.
• So, if I can save a person from killing himself by lying to him,
then, my prima facie duty to lie in order to save him is my
actual duty; my prima facie duty to lie is more stringent than
my prima facie duty to tell him the truth and allow him to kill
himself.
• The problem with Ross’s twofold principle is that he does not
tell us how we can determine when one particular prima facie
duty is “more stringent” than another; nor does he give us a
rule for settling the greater balance of prima facie rightness
over wrongness between two conflicting duties.
• For Ross, we have to rely on our moral intuition (hence, his
view is also known as intuitionism) as the ultimate guide in
particular cases.
What to do then in such a situation would be:
• Learn and discern the facts in the case;
• Consider the possible consequences of our actions
• Reflect on our prima facie duties;
• Decide on the best course of action under the circumstances.
 
Ross has listed down SEVEN (7) types of Prima facie
duties:
• 1) Duty of fidelity
We should be faithful to our duties, obligations, vows, or
pledges; this likewise refers to one’s loyalty to a worthy cause,
telling the truth as the situation demands it, keeping actual and
implicit promises, and not representing fiction as truth.
Treachery, deception, hypocrisy, trickery, double-dealing,
insincerity, betrayal, lying duplicity cunning or craftiness are
infractions against the duty of fidelity.
•  
2) Duty of Reparation
• A Filipino saying underscores the great significance of
this duty: “Kung nakagawa ka ng masama, gumawa
ka naman ng mabuti,” So we have a duty to make amends
for injury that we have inflicted on others. This is an act of
making amends righting the wrong s we have done to others.
Asking for the other person’s forgiveness is insufficient. We
have to do that person good to atone for our wrongdoings.
It is easy to say I am sorry,” or “Please, forgive me for what I’ve
done.” This duty further enjoins us to do good or make up for or
repair the damage done; hence it is also known as the duty of
compensation. You should not only say, “I’m really sorry for
what I did to you,” but you should translate your words into good
deeds as well.
3.) Duty of Gratitude
• We have a duty to appreciate and recognize the services others
have done for us, which may either a favor, kindness, good
fortune, a great help, or saving one’s life. The cultural grip of
one’s duty of gratitude to one’s parents among Filipinos is very
evident. In fact, this is an essential element of their value
system, their philosophy of life, by which they gauge the
rightness or wrongness of their moral decisions.
 4.) Duty of Justice
Ross stresses the proper distribution of social benefits and
burdens. Not only should we enjoy social benefits with others,
but we should also equally share with them the burdens of
social living. The duty of justice demands fairness for everyone.
Equitable distribution of medical resources must be observed as
 5.) Duty of Beneficence
This type of duty enjoins us not only to bring about what is
good for others but also to help them better their conditions with
respect to virtue, intelligence, or comfort. We should contribute
in whatever small way we can to their health and well-being. Our
duty to confer benefits and to prevent and far as availability
and/or scarcity will allow. The distribution of pleasure or
benefits that are not in keeping with the merit of the people
involved must be prevented.
 to prevent and remove harm is important in biomedical and
behavioral contexts. Equally important is the duty to balance
the
good that our decision may yield against the harm that may
result from doing or not doing what we honestly believe to be
beneficial to the patient. In short, this duty requires the
provision of benefits and balancing of benefits and harm for all
people concerned in a give circumstance.
 6.) Duty of Self-improvement
• As we have duty to help others better themselves, so we also
have a duty to improve and develop ourselves with respect to
virtue, intelligence, and happiness. This type of duty should go
hand-in-hand with other duties, for unless one performs or
carries out one’s duty to oneself, the fulfillment of one’s other
duties should be less effective.
• Having done my duty of self-improvement---morally,
intellectually, and physically---I would be in a better position to
fulfill my duties to others. On Kantian precept, I should treat
• myself also as an end and never only as means for the benefit
of others. In other words, I must be just to myself too, by
extending to myself what I wish to extend to others.
It is a matter of fair play to improve oneself in order to be
able to help improve the lot of others. You will notice here that
the effective and fruitful fulfillment of our other duties
revolves,
to a large extent,, around our duty of self- improvement merit.
By way of implication, we ought to improve ourselves so as to
be able to cultivate others. The duty of self-improvement, there-
 therefore, augers well for the carrying out of other duties.
Anyone who is remiss in his duty of self-improvement would
not be as morally, intellectually, and physically ready to fulfill
other obligations as an individual who has undergone the rigors
and severity of self-cultivation or self-improvement.

7.) Duty of Nonmaleficence

• Ross views “not injuring others” as synonymous with
• maleficence (Beauchamp and Childress: 97-131).
• We ought to avoid inflicting evil, injury or harm upon others as
we would avoid doing so to ourselves.
• We ought to prevent evil or harm, which encompasses pain,
suffering, disability, and death. For instance, we have a duty
not to push someone who cannot swim into deep water.
• Culpable negligence, which includes the failure the failure to
guard against risks of harm to others and to oneself, is an
infraction of this duty.
• A physician who assumes the treatment and care of a patient,
yet lacks the qualifications of his profession, and does not
possess the skill, care, and diligence required for treating
such patient, would actually be exposing this patient to
danger.
Some health care professionals might also appeal to
the duty of nonmaleficence in justifying their position that
we would be doing a terminal patient suffering from
uncontrollable and unbearable pain more good than harm
by unplugging the artificial respirator sustaining his life.
 The Filipino version of this type of duty is expressed by the
moral maxim: “Ang masakit sa iyo ay huwag mong gawin sa
kapwa mo.” If you prick yourself with a pin and it hurts, then it
is your duty not to do this to others.
If you bump your head against the wall and it hurts, then it is
your duty not to bump another person’s head in such manner. It
is as simple as that, although it is easier said than done. For just
as the path towards evil is paved with so many good intentions,
so may moral decisions be made to appear legitimate by so many
ulterior motives.
•
• In the Medical Context
• Ross’s ethics encourages us to show discernment and
sensitivity with regard to the unique aspects of varying
situations before making a moral decisions (Munson 1979;
Pahl: 41-42). It urges us to be judicious, prudent, and flexible
in the light of the facts at hand then explore the possible
consequences of our decisions. Our moral guide should be not
what is useful, but what is right. His list of prima facie duties
may serve as moral guidelines for health care professionals,
including researchers. Such as a list of health personnel
• responsible for patient care responsible to reflect on these
duties and to choose the one that best applies to a particular
situation. Not only must we consider the possible
consequences of our moral decisions (a utilitarian precept),
but we must also recognize the duties (the Kantian principle)
that would justify our moral actions or judgments. In effect,
Ross has attempted a synthesis of the consequence-aspect of
utilitarianism and the duty-aspect of Kant’s ethics.
• Difficulties
• Finally, as pointed out earlier, Ross after giving us a twofold
Principle by which to resolve conflicting prima facie duties,
does not tell us how to determine which duty, between two
prima facie duties in conflict, is more stringent than the other;
and which duty, among a cornucopia of prima facie duties,
has the greatest balance of rightness over wrongness.
Ultimately, we rely upon our own intuition, our own
subjective perception of what and how things ought to be.
•  
• Additional Moral Principles:
• The PRINCIPLE of DOUBLE EFFECT:
• For an act to be good, it must be good in all its moral
determinants. A defect in any one of them renders the act evil
and is morally prohibited. Not infrequently, a single act done
produces two or more effects. A good act may have several
good effects and is worthy of being performed thereby
increasing its goodness or even adding new goodness. An evil
act may also have several evil effects and is unworthy of being
chosen. Besides, it may intensify its evil or even add new evil
 malice. Now, there are times an act is done with two
effects, one is good and the other is evil. The question
is: is it morally permissible to do such an act---with
both good and evil effects?
• The answer is, yes, provided the Principle of Double
Effect is invoked whose conditions must be satisfactorily
fulfilled.
 
 
• The Four Conditions:
• 1.) The act must be good in itself, or at least,
morally Indifferent. Being morally determinant, the
act by its very nature must be good. Its goodness
proceeds from within itself. If it is not possible to be
good, the act must not be evil in itself. At least, it is
morally indifferent.
• 2.) The good effect must directly proceed from the
act itself and not from the evil effect. At the very
least, both effects must occur simultaneously. It indi-
 
 dicates the fact that the good effect is the one that is
being
is being directly willed and not the evil effect in the
performance of an act. The good effect is the is the very
purpose for which the act is done, and as such, it is
produced not by the evil effect but by the act itself. In fact, it
comes ahead of the evil effect.
Evil effect must not be directly intended or willed. It
can and should never be employed either as an end or a means
as it remains evil. That is why, evil effect does not precede the
good effect. It just occurs after the good
 effect takes place as the inevitable side effect. If it is not
possible for the good effect to happen first, at least, both
effects occur concomitantly.
3.) There must be sufficient reasons for the performance
of an act in its attainment of the good effect. When
does sufficiency of reason exist? As determined by the nature
of the act and its circumstances, sufficiency of reason exists
when there is no other means by which the desired good
effect can be achieved. It also exists when the desire for the
good effect is as equally important as to
 permit the occurrence of the evil effect.
4.) The motive of the agent must be holy and
honest.
How can the agent be honest in his intention? Bu
directly willing to obtain the good effect and not the
evil effect of the act. This can be proven when the
evil effect just follows after the good effect.

 
• When Can the Principle of Double Effect not be
Invoked?
• When the four conditions are not satisfactorily met, to
wit:
• 1.) When the act by its nature is evil. It is blatantly
contrary to the dictates of right reason to perform
an evil act no matter what the circumstances are.
• 2.) When the good effect directly proceeds from
the evil effect and not from he act itself.
 It means that the evil effect is the one that directly
proceeds from the act itself and, as such, is directly
willed. And the good effect just occurs after the evil
effect takes place. In which case, the evil effects
employed as a means of producing the good effect
which just turns out to be the side-effect.
• 3.) When there is no sufficient reason for the
performance of an act with two effects, one-
good, the other evil. It proceeds from the fact that
there are still other alternatives by which the good
 effect can be obtained and that the desired good effect is
not as equally important as to permit the evil effect.
Furthermore, the destruction the evil effect can create may be
greater than the good effect.
 Case Example:
A female patient is admitted and diagnosed to have a
carcinoma of the uterus. Her condition necessitates immediate
hysterectomy, non-removal of which endangers her life.
Hysterectomy takes away the organ in which the fetus normally
develops and from which menstruation occurs thereby destroying
 the reproductive faculty of the patient. Obviously, the
surgical procedure produces two effects, one is the removal of the
uterine cancer thereby saving the patient as the good effect, and
the other is the patient’s inability to get pregnant as the evil effect.
In which case, is hysterectomy morally justified?

ANALYSIS:
• 1.) The act of removing fatally pathologic organ is good
and in accordance with the dictates of right reason fulfilling
the first condition.
• The good effect which is the patient’s being saved comes not
directly from the evil effect which is the inability of the patient
to reproduce but from the removal of a fatally pathologic
organ. In which case, to save the patient by the act of
removing the sick organ is the one directly intended and that the
patient’s inability to get pregnant just follows only as an
inevitable effect.. Thus, the second condition is fulfilled.
 3.) Obviously, there is a sufficient reason for the removal
of the fatally pathologic organ so as to achieve the good the
good effect deemed equally important as to allow
the occurrence of the evil effect thereby fulfilling the third
condition.
4.) Because the direct intention is to save the patient’s
life and that the evil effect only follows, the honest
motive behind is established-meeting the fourth
condition.
 
 Since the four conditions are satisfactorily fulfilled the
principle of double effect is very well employed rendering
hysterectomy morally fulfilled.
• Regarding the case cited in the principle of non-
maleficence,
• The four conditions of the principle o double effect are
also adequately carried out:
1.) Applying antisepsis to injuries is a good act which
fulfills the first condition.
• 2.) The good effect which is the thwarting of infection
does not proceed from pain which is, in this case, the
evil effect but from the act of putting antisepsis. It
serves the second condition.

• 3.) Being effective in warding off infection, antisepsis

is a sufficient reason for its application to come up with
the good effect. In fact, it is even far greater than the
evil effect of pain. It meets the third condition.
•  
• 4.) The attending nurse certainly does not intend to inflict
pain but to directly obtain the good effect thereby
achieving the fourth condition.

• Therefore, the application of antisepsis is moral. By the

principle of double effect, violation of the principle of non-
maleficence is averted.