PREVALENCE OF

BIOETHICAL ISSUES

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 OBJECTIVES
Discuss the prevalence of the bioethical issues and its
01 implication in the nursing practice.

02 Identify the different bioethical issues and concerns.

03 Appreciate the role of the nurse in the delivery of safe,

effective and efficient care to patients
 BEGINNING OF HUMAN LIFE
When does human life , or personhood begin?
ART 41 OF THE CIVIL CODE
 “For civil purposes, the fetus is considered born if
it is alive at the time it is completely delivered
from the mother’s womb.
 However if the fetus had an intra-uterine life of
less than seven months, it is not deemed born if it
dies within 24 hours after its complete delivery
from the maternal womb.”

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ART. 42 OF THE CIVIL CODE
 “Civil personality is extinguished by death. The
effect of death upon the rights and obligations of
the deceased is determined by law, by contract
and by will.”
 P.D. 603
 Issue of human personhood is determined at
fertilization or conception.
 Why should the beginning of human life need to
be determined?
– Because of the serious moral problem that
pertains to abortion.

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 THEORIES OF THE BEGINNING OF
EXISTENCE OF HUMAN LIFE
NEUROLOGICAL THEORY
 Based on the capabilities and functions of
electroencephalogram (EEG)
 EEG recognizes the life of a fetus at approximately
24-27 weeks
 According to HAROLD MOROWITZ and JAMES
TREFIL, that very moment when a developing
fetus starts to manifest an EEG pattern indicates
the beginning of human life
 Human life begins from 4 – 6 months after
gestation
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BIOLOGICAL INDEPENDENCE THEORY
 Founded on viability and depends on the maturation
of the lungs of the growing fetus.
 Based on this theory, not until the fetus has acquired
matured lungs that can strongly allow it to be viable,
or exist outside the uterus, only then can it be said to
have started to live, or have enjoyed the status of
human life.
METABOLIC THEORY
 Advocates that there is no such thing as fertilization
 Believe that the concept of fertilization is only
concocted by both physicians & biologists only for
academic purposes.
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EMBRYOLOGICAL THEORY
 Believes that beginning of human life happens at
gastrulation

Gastrulation – the process in which a gastrula (an

embryo in an early stage of development)
differentiates into two cell layers; approximately
starts at the third week of pregnancy

 Advocates that from 12 to 14 days after fertilization,

the embryo is intrinsically capable of splitting into
identical twins
 Maintains that the embryo is credited of being a
human being; however it is not a person yet
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SELF-CONSCIOUSNESS THEORY
 Human life begins when the child earns
consciousness of his/her very self
 Proposed by MICHAEL TOOLEY, argues that only
when the child attains consciousness can he/she
be ascribed as a person

GENETIC THEORY
 Fertilization or conception marks the beginning of
humanness and personhood
 Considers the conceptus a person

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 CURRENT REPRODUCTIVE
TECHNOLOGY
SEX SELECTION
Three ways:
(1) pre-implantation method
- Sperm Sorting and Pre-Implantation Genetic
Diagnosis / Embryo Screening
(2) post-implantation method
- Amniocentesis / ultrasound machines
(3) post-birth method
- sex-selective infanticide
- sex-selective abandonment
- sex-selective adoption 9
 CONTRACEPTION
 Oral contraceptive pill
 Made up of hormones similar to those found in a woman’s
body.
 Intra-uterine system (Mirena)
 Guarantees straight long 5 yrs. Of contraception.
 Contraceptive patch
 Looks like a square band-aid.
 Must be worn at all times for 3 wks.
 Uses estrogen & progesterone
 Intra-uterine device
 Usually made up of copper which is inserted into the
uterus.
 Injection or injectable contraceptive
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 Vasectomy / male sterilization
 Diaphragm
 Cervical cap
 Vaginal contraceptive ring
 Emergency contraception
 Outercourse / non-vaginal sex
 Rhythm method
 Calendar-based method
 Body temperature method
 Billing’s method
 Woman has to monitor the discharges during
ovulation.
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 CONTRACEPTION
 Male condom
 Female condom
 Contraceptive sponge
 Withdrawal or coitus interruptus
 Tubal ligation / female sterilization

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 Controversial Choices

• The value of self-determination is cited to support 2

decisions that have been the focus of much controversy
for many years:
– Abortion
– Active euthanasia

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 Controversial Choices
• Nurses need to be very clear about their own
values regarding each of theses issues, and
find a balance between personal values &
professional obligations to patients and
families.
• Nurses must sort out their own beliefs about
what is right and wrong
– so that they can differentiate between tasks & roles
that are consistent with their ethical stance and
those that are not.
– Make responsible practice decisions accordingly.

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 ABORTION
 Any premature expulsion of a human fetus,
whether naturally spontaneous, as in miscarriage,
or artificially induced, as in a surgical or chemical
abortion.
 1973, US Supreme Court handed down a decision
on Roe v. Wade legalizing abortion in all 50 states
during all nine months of pregnancy for any
reasons---medical, social, or otherwise

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 PSYCHOLOGICAL CONSEQUENCES
 Horrible nightmares of children, body parts, blood
 Psychological pain
 Feeling of worthlessness
 Post-Abortion Syndrome (PAS)
- drug and alcohol abuse
- personal relationship disorders
- sexual dysfunction
- repeated abortions
- communication difficulties
- damaged self-esteem
- attempting suicide
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 ABORTION
 The abortion debate sparks passionate, emotion-
laden arguments in political, social, legal, religious,
and moral arenas.
 Issues of self-determination arise regarding the
mother’s right to control her body and her life
(right to choose), in contrast to rights of the
unborn fetus to a chance at life (right to life).
 “Right-to-Life” Camp
Believe that abortion constitutes murder of an
unborn person, suggesting it is a legal as well as
an ethical matter.
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 ABORTION
 “Right-to-Choose” Camp
– The right to privacy regarding health care
decisions includes a woman’s reproductive
choices, implying that governmental regulation is
an infringement on this privacy.
 Values in relation to life are fundamental
considerations in regard to abortion, such as:
– Beliefs about when life begins
– Considerations regarding quality of life for children
who are unwanted.
– Concerns about the mother’s life & health.
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 ABORTION
 Some believe that life starts at conception, while
others hold that life begins only when a fetus is
viable outside the womb.
 Opponents of abortion hold the position that
because a fetus possesses humanity, it must be
accorded all human rights, including the right to life.
 Proponents of abortion argue that based on
autonomy, a woman has a right to her own body, and
that no woman should be forced to bear a child that
she does not want

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EUTHANASIA
“MERCY KILLING”
 EUTHANASIA
 Derived from two Greek words EU, which means
well or good, and THANATOS which means death.

 The act of deliberately ending a life to relieve

suffering in a painless way.

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TYPES OF
EUTHANASIA
TYPES OF EUTHANASIA
1. ACTIVE EUTHANASIA (similar to assisted suicide)
 A person deliberately intervenes to end
someone’s life
 Lethal substances are used to kill a person
– Ex. Sodium thiopental, pancuronium bromide

2. PASSIVE EUTHANASIA
 A person causes death by withdrawing or
withholding a treatment that is necessary to
maintain life
 E.g. avoiding the intake of common treatments
like antibiotics, chemotherapy 23
TYPES OF EUTHANASIA

3. NON-ACTIVE EUTHANASIA
• Life-support systems shall be withdrawn from the
patient.

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FORMS OF EUTHANASIA
1. VOLUNTARY EUTHANASIA
 A person makes a conscious decision to die
painlessly and asks for help to do this

2. INVOLUNTARY EUTHANASIA
 The patient cannot decide for himself/herself to
die painlessly so that another person will decide
for him/her.
– Terminally ill
– Comatose
– Persistent vegetative state (PVS)
– Defective newborns 25
 ARGUMENT
AND ETHICAL CONTRADICTION
ARGUMENT ARGUMENT
Right to Life Right to Die

ETHICAL
CONTRADICTION
ETHICAL Hippocratic Oath
CONTRADICTION states that “to
Doctor-Assisted please no one will I
Suicide prescribe a deadly
drug nor give advice
which may cause his
death.
 QUESTIONS:

1. Must a patient who is suffering from an extremely painful cancer

of the throat and will certainly die several days later be allowed
to die of pain? Or . . .
2. Must he/she, if he/she so desires, be assisted by a doctor to
hasten his/her death?
3. Must the patient be killed painlessly? Or . . .
4. Must he/she rather be allowed to die the natural way?

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 EUTHANASIA
 J. GAY – WILLIAMS
 A renowned advocate of the immorality and
the wrongfulness of euthanasia, condemns
euthanasia for the following reasons:
1) It contradicts nature since it is a blatant
violation of the natural inclination to
preserve life.
– All human beings are endowed with a
natural inclination to preserve life.
– All normal human beings have fear of
death.
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 EUTHANASIA
 J. GAY – WILLIAMS
 He condemns euthanasia for the following
reasons:
2) If practiced, euthanasia will bring a lot of
disadvantages because it endangers the
preservation of life inasmuch as it leads to
medical practitioners to be less efficient.
3) Accepting euthanasia as a practice may
result in certain undesirable long-term
consequences.

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 EUTHANASIA
 J. GAY – WILLIAMS
 He claims that “TO SAVE LIVES” is the total
commitment of doctors & nurses, and other
healthcare providers.
Thus, to lose the life of a patient must be for
them a personal failure which is an insult to
their skills and knowledge.
If euthanasia would be practiced, this
predicament will be changed.
Doctors & nurses might not try hard
because patients will be better off dead
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 EUTHANASIA
 Experts like E. J. Hayes, P. J. Hayes, D. E. Kelly
– “Euthanasia is immoral and therefore ought
not be legalized.”
– They based their convictions on the following
grounds:
1) Legalized euthanasia would lessen the
incentive for medical research.
2) It would become possible to arrange for the
death of an enemy, or a wealthy relative.
3) Voluntary euthanasia is but a step removed
from compulsory euthanasia.
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 EUTHANASIA
4) The purpose of the medical profession is to
preserve life not to destroy it.
5) Many patients today surprise the doctor by
recovering; if euthanasia is legalized, they
would be killed.
6) The practice of euthanasia would make the
doctor a man from whom we would wish to
flee in terror when we are seriously ill.

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 SUICIDE
 Derived from the Latin word SUICIDIUM which
means “to kill oneself”.
 The direct killing of oneself on one’s own
authority.
 The intentional killing of one’s own life.
 The agent of death is the person himself.

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 ASSISTED SUICIDE
the act of deliberately assisting or encouraging another
person to kill themselves.

ASSISTED
SUICIDE
 MEDICAL EUTHANASIA
ASSISTED SUICIDE

 Physician directly  The physician provides

commits the act by the medical means
medical means  The physician is
 The physician is necessary, but not
necessary and sufficient sufficient for the act to be
for the act to be completed
completed  The patient needs to do
 The patient's condition the final act
provides the context
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COMMON METHODS:
 Asphyxation
– Deprivation of O2 by hanging oneself
 Toxification
– poisoning
 Blunt force trauma
– Jumping from a building, etc.
 Self-defenestrating
– Making oneself killed by a train, truck, etc.

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COMMON METHODS:
 Exsanguination/Bloodletting
– Slitting one’s wrist, abdomen, etc.
 Drowning
 Electrocution
 Self-immolation
– A deliberate and willing sacrifice of oneself
often by fire.
 Starvation

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CAUSES OF SUICIDE:
 Physical pain, illness
 Anxiety, emotional pressure
 Financial difficulties
 Shame, guilt, depression, desperation
 Psychological disturbance, mental disturbance

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APPLIED ETHICAL THEORIES
Natural Law of Ethics
•Principle of stewardship
•Suicide is a sin

Utilitarian’s Principle
•Whenever one has become a burden
and liability to the greatest number of
people, its justifiable to commit suicide

Kant’s Ethics
•Categorical Imperative
Treat individuals not as means only but
also as ends
•
Principle of autonomy/self-determination
Has the right to decide whether to commit
suicide or not
• Is SUICIDE immoral?

YES
• It is nothing else but tantamount to cowardice.
• It is a total reversion and aversion of sanctity of
the God-given life.
• It is a blatant negation to accept the facts of life
in the name of courage, obligation, respect, love
& gratitude to God and members of human
society.

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 SUICIDE

• It is therefore the paramount duty of the healthcare providers to

keep track of the emotional status and mental directions of their
patients, especially those who are suffering from malignant
diseases, to hold on to their life, no matter what.
• Healthcare providers must always be ready to assist their patients
in their spiritual, physical, emotional, psychological, and mental
turmoils.

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DANGERS OF LEGAL EUTHANASIA AND
ASSISTED SUICIDE
• Safeguards don’t prevent abuse of euthanasia laws
• Doctors killing people becomes normalised
• It compromises palliative and hospice care
• People will die because of mistaken diagnosis or
prognosis
• Euthanasia and assisted suicide don't guarantee a
dignified death
• Euthanasia and assisted suicide are the ultimate
tools for elder abuse
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 DEATH
CHARACTERISTICS OF DEATH:
1. It is ineffable.
– Incapable of being expressed in words;
complex in nature; mysterious
2. It is inescapable.
– Everybody dies
3. It is beyond experience.
– One can never have a chance to have a taste of
death and later share her encounter with it.
4. It is personal.
– There is no such thing as “untimely death”.
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 DEATH
CHARACTERISTICS OF DEATH:
5. It is ontological.
– Intrinsically embedded in us at the very
moment when we earned the breath of life.
– “As soon as man comes to life, he is at once
old enough to die”.
6. It is the grand equalizer.
– It is never choosy of who it seeks to take.
– Death takes anybody in a designated moment
as it strikes.
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 DEFINITION OF DEATH
MEDICAL DEFINITION
 Death is the permanent cessation of all bodily
functions.

LEGAL DEFINITION
 Death is the cessation of life as indicated by the
absence of blood circulation, respiration, pulse
and other vital functions.
 The dead person is fit to be buried.

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LEGAL AND MEDICAL PURPOSES DEFINITION
 Death is the irreversible cessation of all the
following:
(1) EEG assessed flat-lined total cerebral function
(2) Spontaneous function of the respiratory
system
(3) Spontaneous function of the circulatory
system

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UNIFORM DETERMINATION OF DEATH ACT (UDDA)
DEFINITION
 An individual who has sustained either (1)
irreversible cessation of circulatory and
respiratory functions; or (2) irreversible cessation
of all functions of the entire brain, including the
brain, is dead. A determination of death must be
made in accordance with accepted medical
standards.

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BRAIN DEATH
1. Patient shows total unreceptivity or
unawareness to all external stimuli and is
unresponsive to painful stimuli.
2. All spontaneous muscular movement and
respirations are gone.
3. The pupils loss reflexes and are dilated and
fixed.
4. Still breathe with the help of a ventilator.
5. Legally dead
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Clinical death

• A medical condition that precedes death rather than being

actually dead.
– Cardiac arrest

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 STEM CELL TECNOLOGY
STEM CELL
 A cell that has the ability to divide or self replicate
for indefinite periods---often throughout the life
of an organism.
 Stem cells have the potential to develop into
mature cells that have the characteristic shapes
and specialized functions.

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 STEM CELL TECNOLOGY
2 PRINCIPAL CHARACTERISTICS OF STEM
CELLS

1) They are unspecialized cells that renew

themselves for long periods through cell
division;
2) They can be induced to become cells of the
heart muscle, or the insulin-producing cells in
the pancreas.

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 STEM CELL TECNOLOGY
Stem cells are primitive cells.
• They can develop into:
– Blood
– Bones
– Nerve cells
– Liver cells
– Heart tissues
– Brain cells

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 STEM CELL TECNOLOGY
• There are several kinds of stem cells in the
human body.
– Example:
• Hematopoietic stem cells found in the bone
marrow
• Neural stem cells found in the nervous
system.
• Their supply in the human body is so limited as
compared to the stem cells found in the
embryos.

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Embryonic Stem Cell

• The most undifferentiated stem cell is the zygote, embryo, or

the fertilized egg.
• Removal of cell from the human embryo was initiated in
August 09, 2001.
• 3 Kinds of Stem Cells:
– Totipotent
– Multipotent
– Pluripotent
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Embryonic Stem Cell
1. Totipotent stem cells
– Have the total potential to develop into
different types of cell.
2. Multipotent stem cells
– Are those whose potentiality to develop
into other cell types are minimal or limited
in numbers.
3. Pluripotent stem cells
– Can develop into any cell type except in
the potentiality to develop as a fetus.
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Embryonic Stem Cell
• Only the Totipotent stem cells have the
intrinsic potency to become a zygote or an
embryo.
• Scientists extract Pluripotent stem cells from
human embryos to come to terms with cure
or healing of various diseases.
– Embryos used for this purpose are those
that are considered extra or surplus which
are generated from experiments outside
the womb of the mother.
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Embryonic Stem Cell
• New Method:
– In 2006, scientists discovered the production
of induced pluripotent stem cells (iPS) by
using skin cells.
– This method allows doctors to create stem
cells with a specific patient’s genetic code,
eliminating the risk that the body would
reject transplanted tissues or organs.

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END