HEALTH CARE ETHICS (BIOETHICS) – NCM_108

HUMAN SEXUALITY AND ITS MORAL

EVALUATION WHAT DOES THE DEFINITION OF
• Human sexuality is defined as the totality of MARRIAGE IMPLY
experiences, systems, attributes, .and behavior that • That marriage as a permanent union implies that it is
characterize the sexual sensation, reproduction, and indissoluble, hence there is no divorce in the
intimacy of Homo sapiens (Grebe and Drea, 2018). Philippines because the law provides that marriage is
• To be able to morally evaluate sufficiently and a special permanent contract.
appropriately the issues concerning human sexuality, • That the union is between a man and a woman,
there is a need for the students of health care ethics means same sex marriage is not recognized by the
to understand different perspectives on sexuality and law in the Philippines.
related concepts such as marriage and procreation. • That the union is entered for the establishment of
• Catholic Morality on sexuality : According to the conjugal and family life, means that the purpose of
Philippine Statistics Authority (PSA) from the 2015 marriage seeks conjugality and procreativeness.
Census of the population, almost four fifths (79.5 % or • That marriage is the foundation of the family. Since
80, 304, 061 persons) of the total population of 8.6 the family is the foundation of the society, the stability
million reported Roman Catholic as their religious and status of marriage profoundly affects how the
affiliation. (In 2010, the corresponding figure was 80.6 family and society is thriving. Therefore, the
% or 74,407,708 persons.) This is followed by Islam breakdown in marriage threatens the family and
with 6% of the total population and Iglesia ni Cristo consequently, the integrity of the society.
with 2.6 share.
ISSUES ON SEX OUTSIDE MARRIAGE
FREEDOM, RESPONSIBILITY AND SEX
AND HOMOSEXUALITY
• Suffice to say that sexuality is also not just mere
psychological mechanisms or cultural constructs. • Chapter 3 of the Family Code of the Philippines
• All of sexual life is accompanied by responsibility. stipulates the reasons that renders marriage void
• Responsibility also means accepting sexuality for from the beginning, as if the marriage did not take
what it is and what it involves in terms of meaning and place and hence is annulled.
consequences. • Under Article 35.4, those bigamous or polygamous
marriages not failing under article 41 is one of the
THE SEXUAL REVOLUTION
reasons that a marriage is void from the beginning.
• The best illustration of social change is the sexual
Article 45 of the Family Code further stipulates that a marriage
revolution that occurred during the 20th century. In
may be annulled for any of causes mentioned below that are
1900 only 6 percent of unmarried teenage girl
existing at the time of the marriage:
engaged in premarital sex; By 2002 a large majority
1. Marriage for those 18 years of age or over but below
(roughly 75 percent) had experienced this. (Scholarly:
21 and the marriage was solemnizedj without the
commons et al., n.d.) This is said to be caused by the
consent of the parents, guardian or person having the
contraception revolution. Both the technology for
parental authority over those who are married, unless
contraception and education about its practice
such arty freely cohabited with the other and both
changed dramatically over the course of the last
lived together as husband and wife.
century.
2. Either party was of unsound mind, unless after
FUNDAMENTALS OF MARRIAGE coming to reason, freely cohabited with the other as
• Article 1 of the Family Code of the Philippines defined husband and wife.
marriage as: "a special contract of permanent union 3. Consent was obtained by fraud, unless afterwards,
between a man and a woman entered into in with full knowledge of the facts constituting the fraud,
accordance with law for the establishment of conjugal freely cohabited with the other as husband and wife.
and family life. It is the foundation of the family and 4. Consent was obtained by force, intimidation or undue
an inviolable social institution whose nature, influence.
consequences, and incidents are governed by law 5. Physically incapable of consummating the marriage
and not subject to stipulation, except that marriage with the other, and such incapacity continues and
settlements may fix the property relations during the appears to be incurable
marriage within the limits provided by this Code
 HEALTH CARE ETHICS (BIOETHICS) – NCM_108

6. Either party was afflicted with a sexually- 'female' identity at birth, but their true gender identity
transmissible disease found to be serious and is male;
appears to be incurable. • Non-binary (NB) is a term that describes people
7. It would be useful to read the Family Code of Ethics on whose gender identity does not fit into the male
the grounds for annulment to fully understand such /female gender binary structure.
grounds. METHODS OF CONTRAPTION
Article 55 of the family code stipulates that a petition for legal 1. Folk methods
separation may be filed under these circumstances: 2. Pre coital/ post coital douche using vinegar
1. Repeated physical violence or grossly abusive 3. Prolonged lactation
conduct 4. Coitus interruptus and coitus reservatus
2. Physical violence or moral pressure to compel the 5. Mechanical methods
petitioner to change religious or political affiliation. 6. condom and diaphragm
3. Corruption or inducement to engage in prostitution, 7. Chemical Methods
or connivance in the corruption and inducement. 8. Vaginal suppository,vaginal tablets, vaginal jellies,
4. Imprisonment of more than six years, even if creams and foams
pardoned. 9. Hormonal Methods
5. Drug addiction or habitual alcoholism 10. Contraceptive pills, injections and implants
6. Lesbianism or homosexuality
MORALITY OF CONTRAPTION
7. Bigamous marriage, whether in the Philippines or
• Central to the morality of contraception is the answer
abroad
8. Sexual infidelity or perversion to the profound question-"when does life begins"-
9. Attempt against the life of the petitioner which is often the topic of ethical debates. As it is
mentioned in the anthropological presuppositions on
10. Abandonment of petitioner by respondent without
justifiable cause for more than one year. sexuality in the early part of the chapter is the
11. Note: Please read related articles in the family code usefulness of understanding the nature of the human
person in his bodily dimension.
to further understand related matters regarding the
• In answering the question when does life begin, comes
legal separation.
to mind the question whether the terms "zygote",
ON HOMOSEXUALITY "pre-embryo", "embryo" and "fetus" really indicate
• Semantically, homosexuality (a noun) is the condition
ISSUES ON ARTIFICIAL
or the quality of being homosexual. A homosexual
(adjective) is either a male or a female. (Homosexual REPRODUCTION, ITS MORALITY, AND
I Etymology, Origin and Meaning of Homosexual by ETHICOMORAL RESPONSIBILITY OF
Etymonline, n.d.)
NURSES
• Sexual inversion was a term used in 1883 to refer to
biological successive stages of the development of a
homosexuality which later became inversion in 1895;
human being or not.
unnatural love was used between 18th-19th century.
1. Artificial Insemination - is a less radical and sophisticated
It is said to have originated in Italian psychology.
procedure to facilitate conception in an unnatural way.
(Homosexual, Adj. and n. : Oxford English Dictionary.
A. Artificial insemination is the introduction of sperm from a
• Lesbian refers to women who only feel sexual-
man into a woman by laboratory methods in the attempt to
affective attraction to other women
bring about a conception in the woman's womb, thus making
• Gay refers to men who only feel sexual-affective
the marital act of husband and wife insignificant causally in the
attraction to other men, and bisexual refers to people
bringing about of the conception.
who feel sexual-affective attraction to people of the
2. In-vitro fertilization: In vitro (in glass) human fertilization is
same or different genders to themselves.
facilitating conception of a human person outside the body of
• A transgender person (often abbreviated as trans) is
a woman.
someone whose gender identity differs from the sex
A. This conception takes place in a laboratory container—a
they were assigned at birth: trans women were
glass vessel or suchlike—using eggs taken from a woman's
assigned a 'male' identity at birth, but their true
body and sperm from a man's.
gender identity is female; trans men were assigned a
 HEALTH CARE ETHICS (BIOETHICS) – NCM_108

B. The living human embryo of the conception is then SUMMARY OF ROE V. WADE
transferred from the laboratory container into the body of a • Spontaneous abortion - that occurring naturally.
woman for gestation until normal birth. • Therapeutic abortion - that induced for medical
C. All techniques of in vitro fertilization proceed as if the human considerations.
embryo were a mass of cells to be used, selected and • Threatened abortion - a condition in which vaginal
discarded. bleeding is less than in inevitable abortion and the
INDUCED ABORTION TECHNIQUES cervix is not dilated, and abortion may or may not
3. Surrogate Motherhood - Is to facilitate conception through a occur.
third-party reproduction in which a woman consents to carry • Abortion by dilatation and curettage (7- 12wks AOG)
a pregnancy for intended parent(s) who cannot conceive for • Abortion by CS or abdominal Hysterectomy
medical reasons or those who are a gay couple. • Abortion by Suction (before 3-4months or 12-16wks)
A. There are two forms of surrogacy: traditional surrogacy and • Via Intra- amniotic infiltration (before 3-4months or
gestational surrogacy. 12-16weeks)
raditional surrogacy uses the surrogate mother's egg for • Via injection of Prostaglandin RU 486 -Contraceptive
conception. pill associated with Prostaglandin
Gestational surrogacy is performed by transferring embryos ARGUMENTS: CONTRA-ABORTION
made through IVF with eggs from the intended mother or a
1. Not firmly a choice between a mother only or to the
donor.
child only but must center onsaving both lives.
B. The advent of IVF has assisted gestational surrogacy.
2. The ethical choice can be guided by the principle of
However, pregnancy and gestation involve psychological
Double Effect,
burden and health risks for the surrogate mother.
3. Unselfish love and solitude to an innocent creature is
C. The legal procedures for parenthood following surrogacy are
upheld
complicated due to the typical legal assumption that a woman
4. Recognition of the complementary roles between
giving birth to a child is the legitimate mother of the child.
man woman
ABORTION 5. The offspring gas genetic code totally different from
• Abortion is the expulsion from the uterus of the the cells of the parents.
products of conception before the fetus is viable. It is ARGUMENTS: PRO ABORTION
the premature stoppage of a natural or a pathological
1. To safeguard the life of the mother
process.
2. Abortion as an expression of woman’s sexual
TYPES OF ABORTION:
freedom
1. Complete Abortion - one in which all the products of
3. The fetus is not a human person
conception are expelled from the uterus and identified.
2. Habitual Abortion - spontaneous abortion occurring in three RAPE
or more successive pregnancies, at about the same level of • Rape is an unlawful activity with sexual intercourse
development. carried out forcibly or under threat
3. Incomplete Abortion - that with retention of parts of the • of injury against tt person's will or with a person who
products of conception. is beneath a certain age or incapable of N'll CMIn•llt
4. Induced Abortion - that brought on intentionally by because of mental illness, mental deficiency,
medication or instrumentation intoxication, unconsciousness, or decept ion. (Rape
TYPES OF ABORTION I)difinition Meaning - Merriam-Webster, n.d.)
• Inevitable abortion - a condition in which vaginal • Euthanasia: This is assisted suicide (predominantly)
bleeding has been profuse and the cervix has become of people who are suffering usually from a long
dilated, and abortion will invariably occur. terminal illness and want to expedite inevitable
• Infected abortion - that associated with infection of death. A more exhaustive discussion is shared under
the genital tract. issues on death and dying.
• Missed abortion - retention in the uterus of an abortus • Sterilization: Many people who have had undesirable
that has been dead for at least eight weeks. traits like mental illness, alcoholism, mental or
• Septic abortion - that associated with serious physical defects and genetic disorders were sterilized
infection of the uterus leading to generalized infection. in the 20th century. Against their will. This was
completely legal in the States for a time.
 HEALTH CARE ETHICS (BIOETHICS) – NCM_108

• The central court decision that created current • Euthanasia is illegal in the Philippines
abortion law in the U.S. is Roe • Dysthanasia is a term generally used when a person
• v. Wade. is kept alive artificially, in a condition where otherwise
• In this 1973 decision, the Supreme Court ruled they cannot survive; sometimes for some sort of
that women has a constitutional right to abortion, ulterior motive. Dysthanasia occurs when a person
and that this right was based on an implied right to
personal privacy from the Ninth and Fourteenth ADMINISTRATION OF DRUGS TO THE
Amendments. DYING
• In Roe v. Wade the Court said that a fetus is not a who is dying has their biological life extended through
person but "potential life," and thus does not have technological means without regard to the person's
constitutional rights of its own. quality of life. Technologies such as an implantable
• The Court also set up a framework in which the cardioverter defibrillator and artificial ventilation can
woman's right to abortion and the state's right to extend the dying proccess. In -some cases,
protect potential life shift: cardiopulmonary resuscitation can be considered a
• during the first trimester of pregnancy, a woman's form of dysthanasia
privacy right is strongest and the state may not • Orthothanasia (art of dying well) rejects all forms of
regulate abortion for any reason; misthanasia without, however, falling into the trap of
• during the second trimester, the state may regulate euthanasia or dysthanasia. Orthothanasia seeks to
abortion only to protect the health of the woman;
CHAPTER 3.2 DIGNITY IN DEATH AND EUTHANASIA AND SUICIDE
DYING deal with the terminal patient, helping him to face his
• The word "euthanasia" itself comes from the Greek destiny with greater tranquility, maintaining a
words "eu" (good) and "thanatos" (death). The idea is distinction between healing and caring, between
that instead of condemning someone to a slow, maintaining life and allowing the person to die, when
painful, or undignified death, euthanasia would allow the time comes.
the patient to experience a relatively "good death." FEEDING AND HYDRATION
• Euthanasia (mercy killing, assisted suicide). The • Suicide: is the intentional termination of one's own life.
painless killing of a patient suffering rom an incurable This definition will include all those cases in which a
and painful disease or in an irreversible coma. The person wants to kill himself or herself, whether the
practice is illegal in most 'countries (Oxford person does this by omitting something (passive
Languages). suicide) or by doing something (active suicide).
TYPES OF EUTHANASIA • Are nutrition and hydration medically indicated for
• Involuntary euthanasia: without the consent of the terminal patients?
patient, for example, if the patient is unconscious and • There are several methods of intravenous nutrition
his or her wishes are unknown.. Some ethicists and hydration. There are also two methods of feeding
distinguish between "involuntary" (against the and hydration by inserting tubes into the intestinal
patient's wishes) and "nonvoluntary" (without the tract. We are dealing with medical procedures, not
patient's consent ut wishes are unknown) forms. with simple tasks of everyday living. The question,
• Mercy-killing: The term "mercy-killing" usually refers then, is whether these procedures are medically
to active, involuntary or nonvoluntary, other- indicated. That is, do they do more harm than good
administered euthanasia. In other words, someone for the
kills a patient without their explicit consent to end the PHYSICIAN INITIATIVES
patient's suffering.
• patient? In treating a terminally ill or irreversibly
• Physician-assisted suicide: The phrase "physician-
comatose patient, the physician should determine
assisted suicide* refers to active, voluntary, assisted
whether the benefits of treatment outweigh its
euthanasia where a physician assists the patient. A
burdens. At all times, the dignity of the i patient should
physician provides the patient with a means, such as
be maintained.
sufficient medication, for the patient to kill him or
• Under certain circumstances, it may be appropriate
herself.
for a physician to take the initiative in discussing
 HEALTH CARE ETHICS (BIOETHICS) – NCM_108

termination of care for the patient. The physician is Biological Life

obligated to inform the patient clearly and completely • Living things
about his condition in order to obtain consent for • Cardiopulmonary function
treatment. This should include an accurate
BIOLOGICAL AND BIOGRAPHICAL LIFE
description of the burdens and benefits of continued
Biographical Life
treatment and the odds of success. At times, this
• Human life captured in weddings, memories,
means the physician must tell the patient when it is
likely that the patient will die no matter what is done. relationships
• Separates human life from other life forms
Also, the physician is obligated to provide treatment
• Makes us uniquely human
that does not harm the patient.
• Care for the Dying and Pain Control BRAIN DEATH
• The use of such terminology as DNR, no code, or slow • Unreceptivity and unresponsiveness
code, all of which stress omitting a treatment, might • No movements or breathing
lead to the impression that there is no need to care • No reflexes
for the dying. This is an impression often reinforced by • Flat EEG of confirmatory value
the physician's declaration, "There is no more that we • Patient is deceased
can do." On the contrary, as death approaches and
PERSISTENT VEGETABLE STATES
the technical devices of medically intensive care
become useless, there is need for humanly intensive (PVS) (SLIDE 1 OF 2)
care. The dying patient needs the supportand comfort 1. No recognizable cognitive function
of staff, family, and friends. Limits on 2. Characterized by permanent eyes-open state of
• visits should be removed. After proper preparation, unconsciousness
even children should be allowed to visit (Jordan, 1987) 3. Patient is not comatose
ETHICAL PROBLEMS OF DEATH AND 4. Patient is awake but unaware
DYING 5. Irreversible loss of all neocortical function

Advance Directives PERSISTENT VEGETABLE STATES

• Advance directives include living wills, health care (PVS) (SLIDE 2 OF 2)
proxies, and durable powers of attorney for health
1. Brain stem functions remain
care (Blais and Haves. 1011). They are based on values
2. Patients can breathe on their own
of informed consent, patient autonomy over end-of-
3. Elicitable reflexes, spontaneous respirations, and
life decisions, truth telling, arid control over the dying
reactions to external stimuli
process.
4. Recovery rather remote
• Living wills represent written documents that direct
treatment in accordance with a patient's wishes in ORDINARY AND EXTRAORDINARY
the event of terminal illness or condition. With this CARE
document a patient is able to declare which medical • Ordinary means are all medicines, treatments, and
procedures he or she wants or does not want when
operations that offer a reasonable hope of benefit
terminally ill or in a persistent vegetative state. Living
and that can be obtained without excessive
wills are often difficult to interpret and not clinically
expense, pain, or other inconvenience.
specific in unforeseen circumstances. Thus you are
required to know how your state interprets living wills • Extraordinary means are all medicines, treatments,
and under which circumstances a nurse implements and operations that cannot be obtained or used
them (Guido, 2014). without excessive expense, pain, or other
ETHICAL CONCERNS IN END-OF-LIFE inconvenience or that, il used, would not offer a
reasonable hope of benefit.
CARE
PERSONHOOD
•
1. One who could be said to have interests
DECISIONS AT THE END OF LIFE 2. One who has cognitive awareness
• 3. One who is capable of relationships
 HEALTH CARE ETHICS (BIOETHICS) – NCM_108

4. One who has a sense of futurity • Distinctions between withholding and withdrawing
1990 Patient Self-Determination Act (PSDA) ADVANCED DIRECTIVES (SLIDE 1 OF 3)
DO NOT RESUSCITATE (DNR) care are legally irrelevant
GUIDELINES 1. DR orders should be documented in the written medical
• Federal law regarding advanced directives record.
• To make people aware of their rights 2. DR orders should specify the exact nature of the treatments
Joint Commission to be withheld.
• Developed standards for the documentation of 3. Patients, when they are able, should participate in DR
patients’ wishes regarding advanced-directives decisions. Their involvement and wishes should be
• No uniformity in laws on living wills and surrogate ADVANCED DIRECTIVES (SLIDE 2 OF 3)
decision makers
documented in the medical record.
• Many authorities recommend use of durable power of
4. Decisions to withho CPR should be discussed with the health
attorney over a living will
care team.
ADVANCED DIRECTIVES (SLIDE 3 OF 3) 5. DR status should be reviewed on a regular basis.
Supreme Court BABY DOE (SLIDE 1 OF 2)
• Upheld concept that competent individuals could
Baby Doe Regulations
refuse life-sustaining treatment
• Consider withholding of medical care for
• Made no legal distinction between tube feeding and
handicapped infants, neglect
other life-sustaining measures
Exceptions
PROXY DECISION-MAKING • When infant chronically and irreversibly comatose
STANDARDS (SLIDE 1 OF 2) • When treatment would only prolong dying
• Courts have not made their decisions on basis of • When treatment would be futile, or inhumane
personhood criteria BABY DOE (SLIDE 2 OF 2)
• Courts created standards for allowance of decisions
• Translated into the language of personhood:
by proxy • Infant who has no present or future potential for self-
PROXY DECISION-MAKING awareness or relationships can be said to have no
STANDARDS (SLIDE 2 OF 2) interests at all
Best-interest Standard • Incomprehensible to provide life-extending care
• Takes into account tangible factors as harms and ORGAN DONATION (SLIDE 1 OF 3)
benefits, physical and fiscal risks Advances in technique and immunosuppressive drugs have
Substituted-judgment Standard made it possible to transplant:
• Decision about treatment or nontreatment must 1. Hearts
remain that of the patient 2. Lungs
• Based on principle of autonomy 3. Kidneys
INFORMED NONCONSENT 4. Livers
(SLIDE 1 OF 2) 5. Bone marrow
• Acuity of patient is irrelevant to the allowance of 6. Skin
treatment refusal 7. Corneas
• Patient’s own perceived view of her quality of life and 8. Pancreases
treatment requirements necessary to preserve it are ORGAN DONATION (SLIDE 2 OF 3)
of paramount importance 1. Survival and success rate progressively improving
INFORMED NONCONSENT 2. Shortage of supply
3. Uniform Anatomical Gift Act
(SLIDE 2 OF 2)
4. Purely voluntary decision
• There is no meaningful legal distinction between
5. Organs may be donated by those close to individual
mechanical life support and nasogastric feeding; both
are invasive
ORGAN DONATION (SLIDE 3 OF 3)
 HEALTH CARE ETHICS (BIOETHICS) – NCM_108

• Need to obtain family consent in time of grief and • Health care practitioner deliberately hastens death of
stress major barrier to organ procurementq a patient
ARGUMENTS FOR AND AGAINST • Practice prohibited under homicide laws
• “Consent and humanitarian motive” is never a
EUTHANASIA (SLIDE 1 OF 2)
defense under the law for murder
• Volunteerism and public education have not provided Arguments For:
ARGUMENTS FOR AND AGAINST • Concern and compassion for those painfully and/or
terminally ill
EUTHANASIA (SLIDE 1 OF 2)
• Duty-oriented: extension of personal autonomy—to
adequate supplies of donated organs live our life according to our own vision, unrestricted
• See Table 9-1: Options for Increasing the Supply of by views of others
Salvageable Organs
• 2016: Oregon and four other states allow physician- LEGAL AND SOCIAL STANDING OF
aid-in dying (PAD)
EUTHANASIA (SLIDE 1 OF 3)
• No clear consensus for legalizing euthanasia
Passive Euthanasia LEGAL AND SOCIAL STANDING OF
• Doing nothing to preserve life
EUTHANASIA (SLIDE 2 OF 3)
Active Euthanasia
• Requires actions that speed process of dying Arguments Against:
Involuntary Euthanasia • Religious grounds: our lives are not ours but gifts from
• Ignores individual’s autonomous rights God; to take our life is to destroy what belongs to God
• Could bring about death of unwilling victim • How does one decide euthanasia is appropriate for
another?
LEGAL AND SOCIAL STANDING OF
THE HOSPICE ALTERNATIVE
EUTHANASIA (SLIDE 3 OF 3)
Hospice Programs
A person has committed suicide when:
• Provide palliative care, abatement of pain, and an
• That person brings about his or her own death
environment that encourages dignity
• Others do not coerce him or her to do the action
• Do not cure or treat intensively
• Death caused by conditions arranged by person for
• Ceased to be a place and have become a concept
purpose of bringing about his or her death
• Philosophy: dying is a natural part of life
WORLD STATUS OF EUTHANASIA
CONCLUSION (SLIDE 1 OF 2)
(SLIDE 1 OF 2)
• Traditional definition of death is one died when heart
• Netherlands: first modern industrialized nation to
and lung function ceased
fully sanction physician assisted suicide
• Due to advancements, we have been able to fend off
• German-speaking nations: law allows assisted
brain death
suicide as long as drug is taken without any help
• In many instances, we have reached a cultural, legal,
• Switzerland: allows physician assisted suicide as long
and ethical consensus on decisions of withholding and
as there are no “self-seeking motives”
withdrawing of care
WORLD STATUS OF EUTHANASIA
CONCLUSION (SLIDE 2 OF 2)
(SLIDE 2 OF 2)
Euthanasia divided into two groupings
• Belgium: second Western nation to legalize • Passive euthanasia: process of doing nothing to
physician-assisted suicide; policies less stringent prolong life or fend off death
Netherlands • Active euthanasia: active participation of ending life;
• United States: doctors allowed to prescribe lethal forbidden by codes of ethical conduct in U.S.
doses of drugs to terminally ill patients to “aid in
dying” in five states; active euthanasia is illegal
MERCY KILLING