INTRODUCTION TO BIOETHICS

Human Existence
• Born without his knowledge and usually dies against his will (Fromm, 1967)
• At moment of birth, one begins to suffer and continues to suffer until he dies
• Being born is a tragic fate -> one can feel an apparent absurdity in one's existence
• Every individual realizes life is a disturbing question rather than an answer in itself
• Life poses a big problem and demands a corresponding answer
• Leads individuals to search for the ultimate meaning of life

Philosophy
• Ceaseless, intellectual quest for the existential import of life
• Search for meaning

Search for Meaning

Problems of:
• Reasoning (logical)
• Morality (ethical)
• Truth (epistemological)
• God (theological)
• Art and Beauty (aesthetical)
• Cosmological (universe)
• Scientific (science)

Ethics
• Refers to the individual’s search for meaning
• Also known as moral philosophy

Morality
• Refers to the area of right and wrong in the theory and practice of human behavior
• Studies if human acts are good or bad (right or wrong)

Moral Philosophy
• Practical and normative science
• Based on reason
• Studies human acts
• Provides norms for goodness and badness

Moral Philosophy as a Practical Science

• Systematized body of knowledge that can be used, practiced, and applied to human action
• Considers usefulness, practicality, and application of human knowledge to one’s experience
• Distinguished from theoretical knowledgeàinterested only in truth for truth’s sake
• Not on the bearing on action and experience
Moral Philosophy as Normative Science
• Establishes norms or standards for the direction and regulation of human actions

Big Questions in Ethics

• How can one determine whether one is acting rightly or wrongly?
• Is there a norm of good and evil?

Basis on Reason
Ethics is Based on Reason
• All proofs of ethical science must find their source in the native power of reason alone
• Investigates facts, analyzes them, and draws practical applications to particular actions
• Does not rely on divine revelation
- Knowledge revealed to man by God
- Cannot be fully understood
- But need to be accepted as true (because God says so)
- God cannot deceive nor be deceived by us

This Separates Ethics from Religion

• Religion -> no morality without God
• Ethics -> morality remains possible without God
- Non-believers can still be good
- Believers can still be bad

Human Acts vs Acts of Man

Human Acts
• Acts -> deeds
• Done with intellectual deliberation and freedom
• Personal responsibility presupposes knowledge and volition
- Acts of irrational animals and the insane are devoid of moral significance
- Amoral beings performing non- moral acts
• Done with knowledge and full consent of the will
• One knows what one is doing and does it freely and willingly

Acts of Man
• Performed in the absence of either or both of the two conditions (of the human act)
- Knowledge
- Free will
Case Example: Rape
• Rapist knows what he is doing and does it with volition
• Quality of the act (rape) changes if the rapist is an idiot or insane
• Rape victim suffers from an act of man (insane/idiot) unless predisposed himself/herself in a
sexually provocative manner -> becomes voluntary
• Rape victim suffers from an act of man (insane/idiot)
 - unless predisposed himself/herself in a sexually provocative manner -> becomes
voluntary
• Rapist is held morally responsible for the sexual assault (rape victim is not)

Ignorance
• Absence of knowledge in an individual who is supposed to know
• Should a person be held responsible morally for an act performed in ignorance?
• Types:
- Vincible – can be overcome by exerting some effort
- Invincible – cannot be removed even if there was extra effort

Case Example: Absence

• Student doesn’t know about a test to be given tomorrow.
• Absent previous meeting but did not contact classmates.
• Absent previous meeting but could not contact classmates in any possible way.

Health Ethics
• Science that deals with the study of the morality of human conduct concerning health and
health care

Biology
• Study of life
• Science that employs the scientific method to study living things

Bioethics
• Ethics of life (or medical care)
• Division of ethics that relates to the human life or the ethics of the life sciences and health
care, both delivery and research

Scope of Bioethics
• Initial Stage:
- Ethical problems associated with medical practice
• Later Stage:
- Expanded to include social issues related to health, animal welfare, and environmental
concerns

Stages of Human Issues and Queries

• Beginning of life - contraception, and family planning
• Middle of life – genetic engineering and abortion
• End of life – death and euthanasia

Evolution of Bioethical Studies

• even the most primitive tribes have a code (or set of unwritten rules) in relation to one another
• human beings are social individuals who live with other individuals
- Family, Cave, and State

Human Beings are Social Individuals

• Family
- member lives, plays, and eats with other members
• Cave
- dweller who lives, grows, and hunts other animals with other dwellers
• State
- citizen who exists, works, and associates with other citizens

Purpose of the Code of Behavior

• certain situations bring rights and obligations (toward each other)
• needed to maintain peaceful and well-ordered relations among the members of the group
• for own survival
• system members are supposed to treat themselves and relate to each other (known as group
morality)
- without which, group will perish

Perforce of Morality
• grows out of human relationships for the sake of survival
• holds true for different relationships
- physician-patient, teacher- student, labor-management (employer-employee) relations

Evolution of Bioethical Studies

1. Medical Ethics
• Oldest phase of bioethical exploration
• Formulation of ethical norms for the conduct of healthcare professionals in the treatment of
patients
• based on the physician-patient relationship (no different from other human relationships which
involve duties and rights)
• respect for these rights and acting by one’s duties --> good for both parties (detrimental if any
infractions are committed)

Can We Date Our Patients?

Hippocratic Oath
• I swear by Apollo the Healer, by Aesculapius, by Health and all the powers of healing and to
call witness all the gods and goddesses that I may keep this oath and promise to the best of my
ability and judgment.
• I will pay the same respect to my master in the science as to my parents and share my life with
him and pay all my debts to him. I will regard his sons as my brothers and teach them the
science, if they desire to learn it, without fee or contract.
• I will hand on precepts, lectures and all other learning to my sons, to those of my master and
to those pupils duly appointed and sworn and to none other.
• I will use my power to help the sick to the best of my ability and judgment. I will abstain from
harming or wrong doing any man by it. I will not give a fatal draught to anyone if I am asked, nor
will I suggest any such thing.
• Neither will I give a woman means to procure an abortion. I will be chaste and religious in my
life and in my practice. I will not cut, even for the stone, but I will leave such procedures to the
practitioners of that craft. Whenever I go into a house I will go to help the sick and never with the
intention of doing harm or injury.
• I will not abuse my position to indulge in sexual contacts with the bodies of women or of men
whether they be freemen or slaves.
• Whatever I see or hear, whether professionally or privately which ought not to be divulged I will
keep secret and tell no one. If therefore, I observe this oath and do not violate it, may I prosper
both in my life and in my profession, earning good repute among all men for all time.
• If I transgress and foreswear this oath, may my lot be otherwise.
• No prescription of fatal drugs
• Rule out any form of abortifacient
• No sexual relations between doctors and patients
• Moral significance of confidentiality or medical secrecy

2. Research Ethics
• Second phase of bioethical studies
• Use of humans as experimental specimens (biomedical research
- Prisoners, poor patients, children, fetuses, non-consenting concentration camp prisoners
for the production of “super offspring” (Nazis, 1945)
• led to the concept of informed consent

Friedrich Nietsche (Third Reich Era)

• “superman” philosopher who strengthened Hitler’s conviction of the super race (“Aryans”)
• “will to power” driving force in humans (or self-determination)
• progress is achieved not be alleviation of the poor (but my cultivating the superior race of
humans)

Sterilization is Liberation (Not a Punishment)

• Eugenics (racial improvement and planned breeding) poster in 1930s
• handicapped children
• “Who would want to be responsible for this?”

Nuremberg Code (1947)

• Humanize the cruel and barbaric nature of experiments
• Considers experiment’s subject’s consent (informed choice/decision)
• Contributions:
- Respect of patient’s rights through informed consent
- Right of patients to decline (not submit himself to any healthcare procedure)
 1. The voluntary consent of the human subject is absolutely essential.
- should have legal capacity to give consent; exercise free power of choice, without the
intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior
form of constraint or coercion; and should have sufficient knowledge and comprehension
of the elements of the subject matter involved as to enable him to make an
understanding and enlightened decision.
- This latter element requires that before the acceptance of an affirmative decision by the
experimental subject there should be made known to him the nature, duration, and
purpose of the experiment; the method and means by which it is to be conducted; all
inconveniences and hazards reasonably to be expected; and the effects upon his health
or person which may possibly come from his participation in the experiment.
- The duty and responsibility for ascertaining the quality of the consent rests upon each
individual who initiates, directs, or engages in the experiment. It is a personal duty and
responsibility which may not be delegated to another with impunity.

2. The experiment should be such as to yield fruitful results for the good of society,
unprocurable by other methods or means of study, and not random and unnecessary in
nature.
3. The experiment should be so designed and based on the results of animal
experimentation and a knowledge of the natural history of the disease or other problem
under study that the anticipated results will justify the performance of the experiment.
4. The experiment should be so conducted as to avoid all unnecessary physical and mental
suffering and injury.
5. No experiment should be conducted where there is an a priori reason to believe that
death or disabling injury will occur; except, perhaps, in those experiments where the
experimental physicians also serve as subjects.
6. The degree of risk to be taken should never exceed that determined by the humanitarian
importance of the problem to be solved by the experiment.
7. Proper preparations should be made and adequate facilities provided to protect the
experimental subject against even remote possibilities of injury, disability, or death.
8. The experiment should be conducted only by scientifically qualified persons. The highest
degree of skill and care should be required through all stages of the experiment of those
who conduct or engage in the experiment.
9. During the course of the experiment the human subject should be at liberty to bring the
experiment to an end if he has reached the physical or mental state where continuation
of the experiment seems to him to be impossible.
10. During the course of the experiment the scientist in charge must be prepared to
terminate the experiment at any stage, if he has probable cause to believe, in the
exercise of the good faith, superior skill and careful judgment required of him that a
continuation of the experiment is likely to result in injury, disability, or death to the
experimental subject.

3. Public Policy
• Emphasizes participatory aspect of decision-making in a democratic setup with regards to
formulation of public policies
• Consulting people, seeking expert opinions, and public discussion is encouraged
• after proposals become law, are further subjected to analysis and evaluation by experts (for
final amendments)
• family planning, abortion, divorce, use of life support machines, drug testing on humans

Theories of Health Ethics

• Types:
- Teleological
- Deontological
- Utilitarinism
- Thomistic

Teleological Ethics
• Comes from the Greek “teleos” (end or purpose)
• Stresses the end-result, goal, or consequence as the final determining factors of its rightness
and wrongness
• Consequential ethics

Deontological Ethics
• Comes from the Greek “deontos” (discourse, duty, or obligation)
• Stresses duty as the norm of moral action
• Duty ethics

Utilitarianism
• An action or practice is right if it leads to the greatest possible balance of good consequences
in the world as a whole
• Four (4) Conditions:
- Principle of Utility (maximize the good)
- Theory of Value (standard of goodness)
- Consequentialism (whatever its precise value theory)
- Impartiality (universalism)

Thomistic Ethics
• Originated from St. Thomas Aquinas (1225-1274)
• Christian/Roman Catholic Ethics
• Natural Law Ethics
• Scholastic Ethics
• Synderesis
- Inherent capacity of every individual, lettered or unlettered, to distinguish the good from
the bad
 - Voice of right reason (or conscience)
• Man’s Threefold Natural Inclination
- Self-preservation
- Just dealings with others
- Propagation of our species

Determinants of Moral Action

• Object
• Circumstance
• Purpose (or End)

The Object
• That which the will intends directly and primarily
• Could be a thing or a procedure

The Circumstance
• Conditions which, when superadded to the nature of the moral act, affects its morality
• Mitigating or aggravating circumstances

The Purpose
• consider the end (of the means)
• understand the purpose of the
doer (or the agent)
• also affects goodness and badness of an action (or decision) in a number of ways

Case Scenarios
• Clinical Decision-Making
• Patient Confidentiality
• Time Management and Learning Opportunities

Case Scenario #1
• A nursing student is assisting in the care of a patient with a complicated medical condition. The
student notices a potential error in the patient's medication administration that could have
serious consequences if left uncorrected.
What Should You Do?
Case Scenario #2
• During a clinical training session, a nursing student overhears a conversation between
healthcare professionals discussing a patient's sensitive information without proper consent or
in a public area where others can hear.
What Should You Do?

Case Scenario #3
• A nursing student has multiple responsibilities, including attending lectures, clinical rotations,
and studying for exams. The student must prioritize between attending an essential lecture to
gain valuable knowledge or joining a clinical training session that provides hands-on experience.
What Should You Do?