Chapter IV: THE CALLING OF THE HEALTH CARE PROVIDER

What is a Health Care Profession?

A health care profession is a profession or an occupation that may operate within all branches of
health care, including medicine, surgery, dentistry, midwifery, pharmacy, psychology, nursing or
allied health professions. A health professional may also be a public/ community health expert
working for the common good of the society.

Client:

Comes from the Latin word, clinare, which means ‘to lean’
Defined as ‘one who is the recipient of a professional service’

Patient:

Comes from the Latin word, pallor, which means ‘to suffer’
Defined as ‘one who suffers’

Based on the word roots and definitions, some may feel that the term ‘patient’ indicates a
hierarchical relationship, where the term ‘client’ signifies a more collaborative relationship. It’s
interesting the that many authors, clinician and non-clinician, use the terms interchangeably or even
simultaneously. For example, ‘patient or client selfreport measures’ or ‘patient/client safely’ is often
found in the literature.

Difference between Client and Patient

As nouns the difference between client and patent…

Is that a client is a customer, a buyer or receiver of goods or services while patient is a person or
animal who receives treatment from a doctor or other medically educated person

Michael Shevell, MD, suggest that those who use the term client “seek to convey a nonmedical,
humanistic, less acute care model of orientation to healthcare delivery that is thought to be more
empowering to the actual recipient of healthcare

The term patient implies “passivity <objectivity of an action> that removes responsibility
<bearing,enduring>…” and “can be construed as stigmatizing as its usage may enhance perceived
disability and impairment.

Health Care Provider

A health care provider is a person or company that provides a health care service to you. In other
words, your health care provider takes care of you. The term ‘health care provider’ is sometimes
incorrectly used to refer to a health insurance plan, but health insurance is different from health
care.’
Social Health Insurance Program

Philippine Health Insurance Corporation

The Philippine Health Insurance /PhilHealth/ is a government owned and controlled corporation
<GOCC> founded on Feb. 5,1995. It’s main goal is to ensure the health of every Filipino through social
health insurance regardless of social status: poor, rich, young, old, sick, healthy, working, or jobless.
Nevertheless, this social insurance program provides a means for the healthy to pay for the care of
the sick and for those who can afford medical care to subsidize those cannot.

The National Health Insurance Program was established to provide health insurance coverage and
ensure affordable, acceptable, available, and accessible health care services of all citizens of the
Philippines. PhilHealth is a tax-attempt Government Corporation attached to the Department of
Health for policy coordination and guidance.

Health Care Provider-Client Relationship

A patient-physician relationship exists when a physician serves a patient’s medical needs. Generally,
the relationship is entered into by mutual consent between physician and patient <or surrogate>

A primary care provider <PCP> is a health care practitioner who sees people that have common
medical problems. This person is most often a doctor. However, a PCP may be a physician assistant
or a nurse practitioner. Your PCP is often involved in your care for a long time.

When we think of people who work in healthcare, we tend to think of people who are caring, kind,
and patient.

Six Qualities of truly great Health Care Provider and Community Care Professionals

1. Passion for the Job

2. Good Communication Skills
3. Ability to Multi-task
4. Fit and Active
5. Good problem-solving skills
6. Empathy and Compassion

The Roles, Duties, and Responsibilities of a Good Health Care to the Client, Society, and as a Profession

Health providers play numerous roles in the overall wellbeing of their patients, in addition to
providing assistance with physical needs, health care providers offer advice and direction for illness
prevention and injury.

Evaluation

Many health care providers are involved in the evaluation of disease and injury. From the paramedic
who responds to the call for help, to the lab technician who verifies the results of a blood test, every
provider along the way works to find the cause of a patient’s condition. Nurses often take patient
histories to look for clues as to the causes of the current condition, while the doctor diagnose
disease and injury. X-ray technicians, mental health professionals and specialists often collaborate to
make assessments.

Treatment

Health care providers deliver necessary treatment through a variety of venues. Pharmacists fill the
medication orders given by the treating physician who diagnoses the patient and prescribes a
treatment plan. Physical therapists work with patient’s physical rehabilitation, while psychologists
and psychiatrists treat emotional and mental disorders.

Care

Short- and long-term care are provided by a host of health care providers from doctors and nurses to
nurses’ aides and personal care assistants. Health care providers may become an integral part of an
ailing person’s life and present for most activities. Health care workers specializing in hospice care
attend to the needs of the dying, while those involved in midwifery accompany women through the
childbirth process.

Prevention

Health care providers take on the role of educators as well as healers. Dentists train patients on how
to brush and floss daily to prevent tooth decay and gum disease. Physical therapists provide patients
with exercise plans and tools to avoid further injuries. Nutritionists help patients form healthy eating
patterns and counsellors give patients an outlet for their emotional issues to prevent breakdowns.

Administration

An entire cadre of health care professionals operates the facilities that offer other health care
services to the community. They employ administrators, billing clerks, receptionists, and managers to
keep the operations running for the medical staff and their patients. Health care providers in
administration make sure that laws and guidelines are followed and insurance policies are met to pay
for patient care. They keep important medical records and protect patient privacy.

Virtues, Vices, and Habit of a Health Care Provider

Fidelity: Health care providers must be faithful to the promises they made as professionals to provide
competent, quality care to their patients.

Honesty: Honesty is important in all careers, but it is especially crucial for people with nursing jobs, as
they are frequently required to handle sensitive materials, deal with patients in difficult situations
and rely closely on their co-workers.

Integrity: The quality of being honest and having strong moral principles and following your moral
convictions and doing the right thing in all circumstances

Humility: A modest or low view of one’s own importance; the quality of being humble or humbleness
How to develop humility?

 Spend time listening to others

 Practice mindfulness, and focus on the present
 Be grateful for what you have
 Ask for help when you need it
 Seek feedback from others on a regular basis
 Review your actions against the language of pride

Respect: is a way of treating or thinking about something or someone. You show respect by being
polite and kind.

How do you show respect in health care? Top Ten Ways

 Listen to understand
 Keep your promises
 Be encouraging
 Connect with others
 Express gratitude
 Share information
 Speak up
 Walk in their shoes

Courage: enables us to do the right thing for the people we care for, to speak up when we have
concerns and to have the personal strength and vision to innovate and to embrace new ways of
working. A commitment to our patients and populations is a cornerstone of what we do.

Compassion: Sympathetic pity and concern for the sufferings or misfortunes of others. When or if
someone shows kindness, caring, and a willingness to help others.

The Difference Between Compassion and Empathy

Compassion is the ability to feel for another living being. Empathy is the ability to not only
understand another’s feelings, but also to become one with that person’s distress to put
yourself in their shoes and imagine what they’re going through in that situation.

Prudence: right reason in acting

Prudent nurse: a nurse that uses good judgement in providing nursing care according to
accepted standards and that another nurse with similar education and experience in similar
circumstances would provide

Fraud: Health care fraud is a crime. It’s committed when a dishonest provider or consumer
intentionally submits or causes someone else to submit false or misleading information for use in
determining the amount of health care benefits payable.

Ten Common Health Care Provider “Fraud Schemes”

 Billing for services not rendered

 Billing for a non-covered service asa covered service
  Misrepresenting dates of services
 Misrepresenting locations of service
 Misrepresenting provider of service
 Waiving of deductibles and/or co-payments
 Incorrect reporting of diagnoses or procedures <includes unbundling>
 Overutilization of services
 False or unnecessary issuance of prescription drugs
 Idk

Pride: is associated with falseness, blindness, conceit, and arrogance while on the other it side is
associated with elation, self-confidence, productivity, creativity, and altruism. Pride can also have a
negative meaning and refer to exceedingly high self-regard. For example, you might have too much
pride to ask for help when you need it.

Pride is feeling a sense of satisfaction from one’s own accomplishments, qualities, or possessions.
Pride can be a good emotion and a positive personality trait. However, it can also be negative,
motivating a person to pursue selfish needs to satisfy their pride.

Three types of pride: dignity, superiority and arrogance, are distinguished, their mental ingredients re
singled out, and two experimental studies are presented showing that they are conveyed by
different combinations of smile, eyebrow and eyelid positions, and head posture.

Greed: A selfish want for something beyond one’s need. Typically, greed is associated with wealth
and power. Greed describes a desire to have or acquire something that is not necessary for their own
survival but also the detrimental of another. In addition, greed usually describes someone that
cannot have enough.

Chapter VII: Basic Ethical Principles

Moral Principles in Health Care

What is a Principle?

 A basic idea or rule that explains or controls how something happens or works
 A basic rule that guides or influences thought or action

What is a Moral Principle?

A moral principle refers to a “fundamental rule of moral law” containing certain truth from which
knowledge of a definite moral action for performance proceeds long with the provision of solution
to a specific moral problem or issue

Moral principles are ideals that we try to follow in our attempt to live right and be good people,
instead of bad. Some common examples of moral principles are honesty, respect, and kindness.

Moral law is a system of guidelines for behaviour. These guidelines may or may not be part of
religion, codified in written form, or legally enforceable. For some people moral law is synonymous
with the commands of a divine being. For others, moral law is a set of universal rules that should
apply to everyone.

The first rule of moral law is to do good and avoid evil.

What do the rules of moral behaviour tell us? “What we ought to do, will tell us what things to do”

The Principle of Stewardship

A biblical world view of stewardship can be consciously defined as:

“Utilizing and managing of resources God provides for the glory of God and the betterment of his
creation. “The central essence of biblical world view of stewardship in everything God brings into the
believer’s life in a manner that honors God.

Stewardship refers to the expression of one’s responsibility to take care of, nurture and cultivate
what has been entrusted to him.

In harmony with his definition, Hugh J. O’Connor says:

Stewardship consists in the practical recognition that man is not the absolute master of himself or
his possessions. He has received every gift and grace from God. Then, he must use them in a
responsible manner to promote the interest of God and to establish His kingdom in the heart of
every man.

By principle, primarily man has to be the steward of the gift of life along with other possessions that
God has shared with him. Since life is a part of God’s creation seen to be very good in its nature. As a
steward, man does not have absolute ownership of his life in the sense that he can do whatever he
wishes without corresponding responsibility before God. He does not go beyond what is mandated
by the principle of stewardship which basically consists of partaking in the creative power of God
whose creation is good. And the goodness it refers is the protection of life, promotion and
development in keeping with its very nature.

In health care practice: Stewardship refers to the execution of responsibility of the health care
practitioners to look after, provide necessary health care services, and promote the health and life of
those entrusted to the care. To be a health care steward is to be just and honest with the exercise of
his duties and obligations to uphold the goodness of human life as God’s creation. And to uphold its
goodness is to treat it with utmost care and protect it from harm meaning:

 To make all health care facilities and technologies serve the well-being of patients and
prevent inflictions of unnecessary pains
 To respect life from the moment of conception until its natural expiration and defend it from
any unnatural proceedings meant to contradict its nature and destroy its dignity

Let us all remember that the tremendous success of the medical science manifested in its modern
aptitude to treat what was previously untreatable, to discover and invent highly sophisticated
medical facilities and state of the art technologies, and to come up with the principle of stewardship
as long as human nature, life and dignity are not at stake.
Finally, to be a health care steward is to recognize his dependency not so much on his capacity but
on God, the giver of that capacity, to be ambassador of service for the sick, and to project the very
image of God with whom he is to make an ultimate account of his stewardship.

The Principle of Totality

A simple expression of the principle of totality means, “the parts of the physical entity, as parts, are
ordained to the good of the physical whole. This means that the principle of totality aims at the
subordination of a part to the good of the whole

According to the philosopher Thomas Aquinas, all of the organs and other parts of the body exist for
the sake of the whole person. Because the purpose of the part is to serve the whole, any action that
damages a part of the body prevents it from fulfilling its purpose violates the natural order and is
morally wrong. This is called the “principle of totality”

However, a single part may be sacrificed if the loss is necessary for the good of the whole person. For
example, the principle of totality would justify the amputation of a gangrenous limb, because the
person could die if the gangrene spread.

The principle of totality states that all decisions in medical ethics must prioritize the good of the
entire person, including physical, psychological and spiritual factors. The principle of totality is used
as an ethical guideline by Catholic healthcare institutions.

From the medial perspective, the principle of totality would mean that “all the parts of the human
body, as parts, are meant to exist and function for the good of the whole body, and are thus
naturally subordinated to the good of the whole body. The term “totality” points to the duty to
preserve intact the physical component of that integrated whole.

The Principle of Double Effect

The doctrine of double effect in Ethics. This doctrine says that if doing something morally good has a
morally side effect wasn’t intended. This is true if you foresaw that the bad effect would probably
happen.

The doctrine or principle of “double effect” is often invoked to explain the permissibility of an action
that causes a serious harm, such as the death of a human being, as a side effect of promoting some
good end. According to the principle of double effect, sometimes it is permissible to cause harm as a
side effect <or double effect> of bringing about a good result even though it would not be
permissible to cause such a harm as a means to bringing about the same good end.

In some cases, the principle of totality cannot resolve a question of medical ethics on its own,
because some medical decisions have both good effects and bad effects on the patient. For instance,
the medicine that treats the patient’s symptoms may also have unpleasant or even dangerous side
effects. To resolve these situations, Aquinas applies the principle of double effect. According to this
principle, an action with both good and bad results maybe undertaken on four conditions.

1. The action must be morally good or neutral in itself. Providing medicine to a sick patient
meets this requirement
 2. The bad results cannot be the means for achieving the good results. In this case, negative
side effects don’t cause the medicine to work more effectively.
3. The motivation for carrying out the action must be solely to achieve the good results.
Doctors prescribe medicine to help their patients, not to expose them to side effects.
4. The good result must be at least as significant as the bad. So prescribing medication with side
effects is acceptable if the health benefits to the patient will be at least as significant as the
harm from the side effects.

The Principle of Cooperation

Cooperation comes from the Latin word “cum” which means ‘with’, and “operari” which means to
‘to work’. Meaning cooperation is working with another in the performance of an action. There are
human actions whose performance is possible and feasible because of people working together with
specific functions to play. The magnitude and essentiality of the function played indicate the degree
of cooperation in the performance of an act. The lesser the magnitude and essentiality of the
function shared, the lesser the cooperation. There will be no question of morality if the action
performed is good.

Moral questions come in when the act is contrary to the dictates of right reason and moral law. In
the discussion of morality, the principle of cooperation pertains to the evil of an action shared
together by individuals in the achievement of an evil practice whose culpability may vary according
to the gravity of the act partaken.

Various degrees of cooperation:

1. Formal and Material

Formal cooperation consists of an explicit intention and willingness for the evil act. In such a
case, the person has formally cooperated and categorically wills and intends the evil action.
Example: A hospital director who wills and intend the evil act of contraception/sterilization
by means of hysterectomy at the request of an interested part, by arranging with the OR
team as the operation and its schedule.
Material cooperation consists of an act other than the evil act itself but facilitates and
contributes to its achievement. The one materially cooperating may provide means apart
from the evil act itself which is used to carry out the performance of an evil act.
Example: The scrub nurse who assists by giving the gynaecologist-surgeon all the necessary
instruments in the performance of hysterectomy. Take note the giving of instruments is
distinct from the act of removing the uterus and yet the scrub nurse facilitates and
contributes to the performance of the procedure
2. Direct and Indirect Cooperation
Direct cooperation consists of direct participation in the performance of an evil act. The one
directly cooperating gets involved by openly and straightfowardly taking part in the practice
of an evil action
Example: The surgeon and assistant surgeon who directly take part in the removal of the
uterus for the sole purpose of contraception. Direct cooperation may also constitutes a
formal cooperation and both a conspicuously immoral.
 Indirect Cooperation consist of an act that is not intimately connected with the performance
of an evil act as in formal or direct cooperation but whose effect may have an indirect
bearing upon it.
Example: The janitor who cleans up the operating room that eventually serves as the venue
where the immoral surgical procedure takes place. Depending on its bearing upon the evil
act and the intention of the one indirectly cooperating, indirect cooperation may incur a
lesser culpability or can be excuse from accurate moral judgement.
3. Proximate and Remote Cooperation
Proximate cooperation consists of an act that is intimately linked with the performance of an
evil action due to its close bearing.
Example: The OR nurse who takes the role of a scrub nurse in the immoral operation, in a
way, proximate cooperation constitutes material cooperation but if a sufficiently graver
reason exist, proximate cooperation may be morally excuse.
Remote cooperation consists of an act with a distant bearing upon connection with the
execution of an evil act.
Example: A medical technologist who performs extraction of some blood samples for
laboratory examinations preceding the evil surgical procedure. Subject to accurate moral
analysis, the one remotely cooperating may have a lesser accountability or be excused as the
case may be.

Moral Rules Governing Cooperation

1. No one should formally and directly cooperate in the performance of an evil act. This kind of
cooperation is never allowed for it consist blatantly of willful, intentional, and direct
partaking in an immoral action.
2. If a reason sufficiently graver exist, material cooperation in the performance of an evil action
may be morally excused. No medical condition is a sufficient reason for the performance of
an immoral operation. However, if certain circumstances may exist, which would constitute a
sufficient reason for material cooperation such as the fact that refusal will result to dismissal.
3. If the material cooperation is proximate, a reason sufficiently graver should exist so as to be
morally excused without which evil is incurred. What makes a reason sufficiently grave differs
from one case to another depending on the closeness of the desired cooperation to an evil
action. Since proximate cooperation consist in performing an act that is too close to the evil
action, a reason sufficiently graver should be present in order that said cooperation may be
morally tolerated.
Example: In the case of an OR nurse who is compelled, under pain of dismissal, to assist as a
scrub nurse in hysterectomy for the sole purpose of contraception/sterilization gives her
proximate cooperation because of two sufficiently graver reasons, namely:
a. She is the only breadwinner in her family with two brothers and one sister whom she is
sending to school and the loss of her job if ever refusal is made means loss not only of
her subsistence but also that of her family and her siblings’ education.
b. It is extremely difficult to find another job from which she can earn a living for herself and
her family. In which case, the OR nurse may be morally excused for her material
proximate cooperation. However, if she will only be reprimanded, and not dismissed,
 then her material proximate cooperation is not justified because a reprimanded does not
constitute a reason sufficiently graver for such cooperation.

The Principle of Solidarity

It translates into the willingness to give oneself for the good of one’s neighbour, beyond any
individual or particular interest <altruism>

The principle of solidarity requires that men and women of our day cultivate a greater awareness
that they are debtors of the society of which they have become part.

Solidarity is a personal value, which expresses the purest manifestations of men and women as social
beings. In a collectively or social group, solidarity is the capacity of performing as a whole in a group.

Solidarity refers to a union of interests, purposes or sympathies among members of a group.

What is the Use of Solidarity in Philosophy and Bioethics

Early ancient philosophers such as Socrates and Aristotle discuss solidarity as a virtue ethics
framework because in order to live a good life one must perform actions and behave in a way that is
in solidarity within the community.

Solidarity is a unifying opinion, feeling, purpose or interest among a group of people. An example of
solidarity is a protest with a clear goal like the “EDSA revolution” <People Power Revolution> in1986
that toppled the regime of dictatorship of Pres. Ferdinand Marcos which eventually restored
democracy in the country.

Solidarity is a tool for reducing inequality and social injustice in the world. Example are the programs
of United Nations for human development, economics, industry, and health.

Solidarity leads to the sustainable development of peoples. For this reason, it is essential that it be
used for the benefits it can offer to a particular cause. Solidarity can be cultivated through education,
as children or adults.

Examples Where the Principle of Solidarity Applies

 A father decides where his family with young kids will go on holidays <even though not all
the kids like the destination>
 A municipality decides a name for a new street <even though some homeowners don’t like
that name>
 A professional body decides what fees every member must pay to practice their respective
professions.
 A country decides how much money will be spent on health care <even though some citizens
think that more money should be spent on wind turbines>
The Principle of Beneficence

Inscribed in the natural law, the principle of beneficence provides that good must be done either to
oneself for to others: This fundamental moral principle binds and urges everyone to do what is good
and perform for good as a moral obligation.

It mandates the right of every human person to the preservation of life, promotion of quality life,
physical integrity, and health.

When applied to clinical practice involving health care, this principle as mandated both by natural law
and the nature of their profession. Health care practitioners have the primary obligation to ensure
that good is done to their patients and clients. Their fundamental functions of preventing and
treating sickness, alleviating suffering, and promoting health are services in accordance with the said
principle provided they are in the order of right reason and God’s Eternal Law.

In the health care milieu, patients are in need most of what is good for them. All the necessary and
proper means of care should be given in an effort to serve not only the biological and pathological
needs of the patients but also their psychological and spiritual longings.

In other words, the good that should be done by the health care provider does not stop of the
provision of biological and pathological care such as giving appropriate nourishment and needed
fluids, providing air passage, administering medications, application of necessary medical equipment
and the like.. But rather, this type of health care should also be meant to cater the patient’s
psychological and spiritual needs, which are essential and these includes counselling, therapeutic
communication, touch and presence , calling the pries for the administration of the Sacraments of
Confession, anointing of the sick, and the Holy Viaticum for Catholics, and the like.

Even in situations when biological and pathological care seems to be contraindicated in some specific
cases or situation, the psychological and spiritual care should still be done for the good of the
patients. Non-performance or omission of any of the stated necessary means of care constitutes
violation of the principle of beneficence along with the negligence to duty, sense of responsibility,
and others in deprivation of the provision of what ought to be done.

Serving or doing service to our patients and clients can be the “greatest kind of good or goodness”
that health care provider can ever provide pursuant to the principle of beneficence.

The Principle of Respect for Persons

The principle of respect for persons affirms the primary importance of allowing the individual to
exercise their moral right of self-determination. To violate their ability to be self-determining is to
treat them as less than persons. In doing so we deprive them of their essential dignity.

Respect for persons is one of the fundamental principles in research: It is the recognition of a person
as an autonomous, unique, and free individual. It also means that we recognize that each person has
the right and capacity to make her or his own decisions. Respecting a person ensures that dignity is
valued.
Individuals should be empowered to make free decisions and be given all the information needed to
make good decisions. To conduct a research project when some of the potential participants do not
have the right or the capacity to make a decision is a violation of research ethics and basic human
rights.

The Principle of Justice

The principle of justice states that there should be an element of fairness in all medical decisions:
fairness in decisions that burdens and benefits, as well as equal distribution of scarce resources and
new treatments, and for medical practitioners to uphold applicable laws and legislation when
making choices.

The principle of justice could be described as the moral obligation to act on the basis of fair
adjudication between competing claims. As such, it is linked to fairness, entitlement, and equality. In
health care ethics, this can be subdivided into three categories:

1. Fair distribution of scare resources <distributive justice>

2. Respect for people’s rights <rights-based justice>
3. Respect for morally acceptable laws <legal justice>

The Principle of Non-Maleficence

The principle of non-maleficence provides that evil or harm should not be inflicted on oneself or on
others. This fundamental moral principle binds and urges everyone to avoid inflicting harm as a moral
obligation. It man dates the right not to be killed, right to not have bodily injury, or pain inflicted in
oneself, and right not to have one’s confidence revealed to others.

In health care practice, it is also the primary obligation of health care providers to make sure that
there is no harm exacted on their patients in whatever form.

Anything that harms the person and human dignity in all the aspect of his existence is a lucid
transgression of the principle of non-maleficence. It includes the physical, intellectual, economic,
social, psychological, moral and spiritual aspects that should not be subjected to harmful experience.

According to ewannnnnnnnnnnnnnnnn…………………

Both the principle of beneficence and non-maleficence advocate high regard and respect for
humanlife and dignity. These two principles can go altogetherin the performance of health care
services. It emphasizes the need to do good by giving all the necessary meansof care to patients sa
that no harm may be inflicted onthem.
The Principle of Double Effect

In one’s clinical practice, there may be situations in whichhealth care practice provides jealpful
outcome along with harmful consequences deemed inevitable. There are times an act is done with
two effects, one is good and the other is evil. In which case, health care practitionershouldbe careful
so as not to violate the principle of non-maleficence by applying the priniciple of double effect.

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.

Four Conditions of the Principle of Double Effect

1. The act must be good in itself, or at least, morally indifferent.

Being the primary 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 indicates the fact that the good effect is the one directly being willed and not the evil effect
in the performance of an act. The good effect is the very purpose for which the evil act is
done as such, it is produced not by the evil effect but by the act itself. I fact, the good effect
comes ahead of the evil effect. If it is not possible for the good effect to happen first, at least,
both effects occur concomitantly.
3. There must be sufficient reason for the performance of an act in its attainment of the good
effect.
When does a sufficient reason exist? As determined by the nature of an act and its
circumstances, sufficient reason exist when there is no other means by which the desired
good effect can be achieved. It also exist when the desire for the good 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/her intention? By directly willing to obtain the good effect
and not the evil effect the act. This can be proven when the evil effect just follows after the
good effect is achieved.

When can the Principle of Double Effect “Not be Invoked”?

What the four conditions are when not satisfactorily met

1. When the act by its nature is evil.

When the act performed 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 the 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 effect is 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 or evil effect can create or may be greater than the
good effect.
4. When the motive of the agent is not honest.
This means that the main motive behind the performance of an evil act is the occurrence of
the evil effect for being ahead of the good effect.

The Principle of Indirect Voluntary Act

Aside from an act with two effects – one is good as directly intended and the other is evil, as
intended and the third act that is directly intended with an evil effect that is not directly
intended through foreseen or foreseeable. Sometimes, in the performance of human act
which is a willed act as freely determined by the will, an evil effect sprouts which is not that
directly willed. That is why in situation like this, we often hear remarks like this: “sorry, I did
not truly mean it” or : sorry, it was not intended” are at once addressed by the offender who
perform the act with an evil effect which he does not directly intend, to the other person
who suffers from the said effect. This is what “Indirect Voluntariness of an Act” is all about.
The question is: Is there a moral culpability in act that is directly willed but whose evil effect is
nor directly willed by the agent? When does the evil effect that is not directly meant become
imputable to the agent?

The Three Conditions of Indirect Voluntary Act that will Make the Agent Culpable and
Responsible
1. The evil effect must be foreseen or foreseeable in the performance of the act at least in a
general ways.
Knowledge and perhaps common sense will give us the capacity to foresee that an evil
effect though, indirectly willed may happen as it proceeds from a human act that is to be
performed,
2. There must be freedom to choose not to do the act which is the cause of the evil act. As
we previously learned, a free act is elicited by the will having the power to choose to do
or not to do it. True, as many seemed, freedom cannot be exercised if there is no light of
knowledge in the intellect. To foresee an evil effect means the light of knowledge is
anyhow at play so that the agent can exercise his freedom to withhold the performance
of an act from which the said effect stems.
3. Ewan……………