PRINCIPLES OF

BIOETHICS
 PRINCIPLES OF BIOETHICS

Principle of Principles of Ordinary

Stewardship and the A C and Extraordinary
Role of Nurses as Means
Stewards.

Principle of Totality Principle of

and its Integrity. B D Personalized
Sexuality
PRINCIPLES OF
BIOETHICS
A. Principle of
This Stewardship
principle is grounded in the presupposition
that God has absolute Dominion over creation,
and that, insofar as human beings are made in
God’s image and likeness, we have been given a
Iimited dominion over creation and are
responsible for its care.
Stewardship in Nursing
Stewardship in nursing involves valuing and
respecting patients' priorities and self-
determination. Nurses become stewards or
teachers to patients who may not have the
expertise or experience in the disease process,
but who understand the consequences of their
illness.
 Future nurse leaders or stewards will be directly centered on working with
nurse practitioners and nurse educators to transform the practice
environments in which they work. The intended outcome is to make practice
environments more positive, healthy, and engaging. Areas for dialogue may
be within:

 patient-population
centeredness  increased respect for the
contributions made by
professional nurses
 safety for patients and
healthcare personnel  clarification of the caring
work of the nurse
 the needs of an ageing
workforce  enhancement of the
collaborative practice of the
• increased autonomy for multidisciplinary healthcare
advanced nurse practitioners team
 Personal Stewardship {Stewardship of
PRINCIPLES OF BIOETHICS
 Self} To meet the domains of stewardship in
health care and the nursing profession, it is
crucial that nurse leaders engage with the
development of self.
Social Stewardship
 Social stewardship is closely related to
the objectives of human development,
social development, and human security.
In addition to the responsible use of
natural resources, it includes long-term
efforts to enhance social stability.
Ecological Stewardship
 Ecological or environmental stewardship
means acting as a steward, or caretaker, of
the environment. Stewards can be
government bodies, community groups,
corporations, or individuals. An ecosystem is
comprised of the dynamic interaction of the
living (biotic) and non-living (abiotic) aspects
 PRINCIPLES OF
BIOETHICS
Restoration and Protection
 The most straightforward form of environmental
stewardship is in ecological protection and restoration.
Conserving and restoring parcels of land is hugely
helpful for local ecological processes. Governments and
organizations can buy public land for conservation, or
sign agreements with private landowners to ensure the
protection of private lands.
Everyday Choices
 Anybody can practice environmental stewardship by
making everyday choices that benefit the environment.
For example, choosing to reuse or recycle rather than
throw something away. Even better is making
environmentally ethical choices as a consumer by
not buying unneeded objects that will be wasted.
This is the key idea of the phrase reduce, reuse, recycle.
 PRINCIPLES OF
Other examples BIOETHICS
of everyday choices in ecological stewardship include:

 Saving energy and water by replacing inefficient appliances,

turning off lights and electronic appliances when not in use,
keeping heat or air conditioning off or on low, or taking shorter
showers.
 Choosing to walk, bike, carpool, or use public transportation, when
possible, to reduce carbon emissions from burning gasoline.
 Using reusable grocery and fruit/vegetable bags rather than single-
use plastic.
 Fixing old electronics rather than upgrading to a new phone or
computer to reduce e-waste.
 Practicing a vegan, vegetarian, or meat-reduced diet makes an
impact on land use, water use, and carbon emissions.
 Composting food scraps in the kitchen or garden is helpful in
creating healthy soil from organic matter.
 Donating to accredited environmental organizations to support
land acquisition, conservation, and revitalization.
 Donating and buying objects such as clothing from thrift stores also
helps keep items out of landfills.
 PRINCIPLES OF BIOETHICS
Community Awareness
 Environmental stewardship can also be achieved by raising
community awareness. This could include actions of local
groups or individuals educating others about
environmental matters or encouraging them to take action
on environmental issues.
Biomedical Stewardship
 Biomedical stewardship is reflected in the utmost care in
the proper disposal of contaminated body secretions and
excretions, equipment, and articles. Amputated body parts
(e.g., extremities) need to have death certificates and be
buried in government-approved institutions.
 PRINCIPLES OF BIOETHICS
B. Principle of Totality and Its Integrity
 These principles dictate that the well-being of the
whole person must be taken into account in deciding
about any therapeutic intervention or use of
technology. Therapeutic procedures that are likely to
cause harm or undesirable side effects can be
justified only by a proportionate benefit to the
patient.
 Totality refers to the duty to preserve intact the
physical component of the integrated bodily and
spiritual nature of human life, whereby every part of
the human body “exists for the sake of the whole as
the imperfect for the sake of the perfect” (St. Thomas
Aquinas, Summa Theologica II, Article11.
 PRINCIPLES OF BIOETHICS
Integrity
 Refers to each individual's duty to Justifiable
"preserve a view of the whole human Removing part of the body for
person in which the values of the the purpose of improving the
intellect, will, conscience and function of the body part e.g.,
fraternity are pre-eminent.“ amputation of gangrenous foot,
a) To promote human dignity in tooth extraction (for better
the community, every person functioning).
must develop, use, care for, and
persevere all of his or her Matter of life and death,
natural physical and psychic
mastectomy, organ donation.
functions in such a way that
lower functions are never
Non-Justifiable
Removal of the uterus
sacrificed except for the better
functioning of the whole person (hysterectomy because you don't
and even then, with an effort to want to have a child, cosmetic
compensate for this sacrifice. reason, or addiction for vanity
b) the basic capacities that define purposes.
human personhood are never
sacrificed unless this is
necessary to preserve life.
 PRINCIPLES OF BIOETHICS
Principle of totality and integrity:
it states that all decisions in medical ethics must prioritize the
good of the entire person (physical, psychological, and spiritual
factors).
the principle of totality is used as an ethical guideline by
healthcare institutions.
in the human person, the part exists for the whole, and
therefore, the good of the part is subordinated to the good of
the whole.

Conditions for Principle of Totality:

1.that the organ, by its deterioration in function, may cause
damage to the whole organism or at least pose a serious threat
to it.
2.that there is no other way than taking the indicated action
against it or obtaining the desired good result.
3.that the damage being avoided to the whole is proportional to
that which is caused by the mutilation or incapacitation of the
 PRINCIPLES OF BIOETHICS
Ethico-Moral Responsibility of Nurses in Surgery
 Each Registered Nurse (RN) has an ethical and moral responsibility to represent the
patient's interests, show humility, respect and protect patient autonomy, and preserve
patient dignity (International Council for Nurses, 2013).
 PRINCIPLES OF BIOETHICS
Ethico-Moral Responsibility of Nurses in Surgery
 Ensure that the Patient is not Exposed to Risks
 To protect the patient's body
 Systematically plan and organize work in the
surgical team.
 Confirm the patient as a person
 To feel in and be responsive to the situation
 To care for the patient
 To preserve the patient's dignity
 Preservation of Bodily Functional Integrity

Key Elements Are Significant To Every Person Of

Any Gender As Well As Among The Old And
The Dying:
a. Freedom of movement
b. Security of Persons
c. Reproductive and sexual rights
d. Women's health
 PRINCIPLES OF BIOETHICS
Issues in Organ Donation FROM THE PATIENT’S
 ThePERSPECTIVE
Ethics of the Donor as a Patient
• When is it ethical to ― The ethics of the living human donor are
donate an organ? strongly influenced by the question of
• When is it obligatory to whether the donation involves a
donate an organ? renewable resource, such as blood or
• Is it ever ethical to sell bone marrow, or paired nonrenewable
organs, such as the corneas or the
an organ? kidneys, or nonpaired nonrenewable
• Is it always ethical for organs, such as the heart or the liver.
the patient to accept ― Today there are few ethical problems
an organ? with the donation of a renewable
• What are the medical resource such as blood since there are
no real dangers to the donor and few to
criteria for the the recipient if the blood has properly‘
allocation of organs? screened for such things as HIV. On the
• What should society other hand, any medical procedure
pay for in the area of involves some risk, even if minimal, and
expense, such as discomfort and time.
transplants?
PRINCIPLES OF BIOETHICS
The Living Donor of Nonrenewable Paired Organs
 The only nonrenewable paired organs that can be donated are
our corneas, lungs, and kidneys.
 There can be no proportional reason for risking harm if a harm-
free or less risky alternative is available.
 In the case of transplants, the less risky alternative of cadaver
donations can raise ethical questions about donations inter
vivos.
The Ethics of the Recipient as Patient

 Once the recipient has been properly informed by the health care
team, the effects of the transplant on the recipient's quality of life,
family, and society must be taken into consideration.
 If the recipient has a proportionate good to gain, the recipient and
his or her family and physicians must respect the autonomy of the
potential donors.
 Even in life-or-death situations, it is still unethical for would-be
recipients to bribe physicians or for hospitals to give them a
privileged position on the waiting list.
PRINCIPLES OF
BIOETHICS Problems with Donation
Cadaver donations include not only kidneys, skin, bone,
and corneas, but such single organs as the heart, liver,
lung, pancreas, and spleen. The list will undoubtedly
grow as medical techniques advance.
Is There an Obligation to Donate?
Although risking one's life, even laying it down for
another, maybe an altruistic ideal, it is not an obligation.
There is no natural or legal obligation, contractual or
otherwise, to sacrifice an organ for the good of another
person even when the principle of proportionality is
satisfied. One individual is not subordinated to another
individual even in the areas of life and death.
Selling Organs
The first problem that might result from the widespread sale of
organs involves the exploitation of the poor. The second involves a
distribution of organs in accord with the ability to pay, rather than
PRINCIPLES OF BIOETHICS
THE ETHICS OF CADAVER ORGAN DONATION
 The ethics of organ donation after the donor is dead may seem
much simpler than the ethics of donation inter vivos. There are,
however, legal and ethical problems.
 Some Background: Brain Death
 When dealing with a cadaver donation, it is important to harvest and
transplant the organ as quickly as possible. This puts great
importance on the ability of the physician to determine as precisely
as possible the moment of death of the patient. A determination of
death must be made in accordance with accepted medical
standards.
 These criteria call first for the elimination of the possibility of
hypothermia and coma induced by barbiturates and then the
application of the following four tests:
1) unreceptive and unresponsiveness even to intensely painful
stimuli,
2) no movement or breathing during an hour-long period of
observation,
3) no reflexes, and
MEDICAL
INFOGRAPHIC
The Ethics of the Healthcare Team
The following statements of the AMA Council on Ethical and
Judicial Affairs (20 12) present the principal ethical concerns of the
physician and the health care team:
Full discussion of the proposed procedure with the donor and the
recipient or their responsible relatives or representatives is
mandatory.
The physician should ensure that consent to the procedure is fully
informed and voluntary, in accordance with the Council's
guidelines on informed consent.
The physician's interest in advancing scientific knowledge must
always be secondary to his or her concern for the patient.

Transplant procedures of body organs should be

undertaken:
only by physicians who possess special medical knowledge and
technical competence developed through special training, study,
and laboratory experience and practice, and
in medical institutions with facilities adequate to protect the
PRINCIPLES OF
BIOETHICS
Relationships with Surrogates and Families
 The health care team also has ethical and legal
obligations with regard to the way in which
they approach, or do not approach, the family
for permission to take the cadaver organs for
transplant. When the patient has made her or
his desires clear, they must be respected.
Informed Consent
 The transplant team needs the informed
consent of the recipient and the donor or, in
the absence of an advance directive, of a
surrogate when the donor is incompetent. The
donor and recipient should be told that such
procedures as bone marrow transplants
involve real pain and not merely discomfort.
PRINCIPLES OF BIOETHICS
C. Principles of Ordinary and Extraordinary Means
Taboada (2008) shares the following discussions on the principles of
ordinary and extraordinary means:
a)Nature of the ordinary means.
 In the writings of Francisco de Vitoria (1946. Cited in Taboada, P.,
2008), the explicit recognition of the requisites deemed as the
foundation of the moral obligatory nature of 'ordinary' means of
preserving life:
1) the hope of a reasonable benefit or the scientific-technical
'usefulness' of the measure (understood as the recuperation of
health or the prevention of an avoidable death).
2) the absence of a physical or moral impossibility in its utilization on
the part of the individual.
Tradition holds that both conditions must be met simultaneously for a
means defined as 'ordinary' and — therefore — morally obligatory.
Thus, among the examples utilized to describe the nature of 'ordinary
means' are:
o "the hope of beneficial results" ;
o "common means";
o "in accordance with the proportion of one's state in life"
 PRINCIPLES OF BIOETHICS
b. Nature of the ‘extraordinary means’ and causes of moral impossibility
 Among the expressions that have been utilized to designate the
causes of the impossibility are as follows:
o "Ultimate effort" and "extremely difficult means"
o "Certain torment" and "enormous pain";
o "Extraordinary cost", "valuable means" and "exquisite means";
o "Severe horror".
Ordinary and Extraordinary Means
 These two terms refer to the means to preserve life.
 Ordinary means are obligations whereas, extraordinary means are
optional and may be chosen with the hope of healing a person or may
not be chosen because they may produce no benefit.
Ordinary means or proportionate means include the following:
 medicines, treatments, and operations that offer a reasonable hope
of benefit f‹ the patient and can be obtained without excessive
expense, pain, or other inconveniences.
 proportionate means are those that in the judgment of the patient
offer a reasonable hope of benefit and do not entail an excessive
burden or impose excessive expertise on the family or the
community.
PRINCIPLES OF BIOETHICS
ORDINARY TREATMENT
Is often used to describe those means of prolonging
life that are available, offer reasonable hope, and do
not cause unbearable pain and suffering.
EXTRAORDINARY TREATMENT
Is used to describe those means or measures that are
not usually available, do not offer a reasonable hope of
benefit, and cause unbearable pain and suffering.
A treatment or life-sustaining measures can be
extraordinary because:
• Too painful, frightening, hazardous, or disruptive
for the patient
• It is financially too burdensome for the patient,
family, and hospital.
• Treatment can be extraordinary because it is
simply futile.
D. Principle of Personalized Sexuality
A. Sexuality and Human Reproduction PRINCIPLES OF
1. Human Sexuality and its Moral Evaluation BIOETHICS
2. Marriage
 Fundamentals of Marriage
 Issues of sex Outside Marriage and Homosexuality
 Issues on Contraception, its Morality, and Ethico-Moral
Responsibilities of Nurses
3. Issues on Artificial Reproduction, its Morality, and Ethico-Moral
Responsibilities of Nurses
 Artificial Insemination
 In-Vitro Fertilization
 Surrogate Motherhood
4. Morality of Abortion, Rape and Other Problems Related to
Destruction of Life
B. Dignity in Death and Dying
1. Euthanasia and Prolongation of Life 6. Administration of Drugs
to
2. Inviolability of Human Life the Dying
3. Euthanasia and Suicide 7. Advance
Directives
4. Dysthanasia 8. DNR and End-of Life
 SEXUALITY AND HUMAN REPRODUCTION
“You and I are persons. More specifically, we are human persons—
persons who are members of the species Homo sapiens. But what
does it mean to say that someone is a person? And what is the
significance of being human?”
—David DeGrazia, Human Identity and Bioethics
Human sexuality
(2005)
The totality of experiences, systems, attributes, and behavior that
characterize the sexual sensation, reproduction, and intimacy of homo
sapiens ( Grebe & Drea, 2018).
Different Perspective on Sexuality and Related Concepts:
1.Anthropological Perspective of Sexuality and Procreation
 The body is contained in an essentially uniform structure that
exhibits a series of differentiating factors imprinted on the entire
basic personality.
 These differentiating factors are:
• The chromosomal factors (presence of X and Y in the last
chromosome pair
• The neuroendocrine factors that are linked to the last
chromosomal pair of X or Y and are marked by major differences
in the gonads (ovaries for women and testicles for men-external)
SEXUALITY AND HUMAN REPRODUTION
 PRINCIPLES OF
SEXUALITY BIOETHICS
AND HUMAN REPRODUCTION
 These differentiating factors are:
• Differentiation continues with the ducts (Wolffian ducts in men,
Mullerian ducts in women)
• The human body is then marked as a whole in its morphology, in
the voice, in its movement, sensorial and perceptive traits by
sexual differentiation in its fundamentally identical and
homogenous structure
2. Other Perspectives on Sexuality
 Catholic Morality on Sexuality
• Arise not only from the Holy Book (Bible) but also on the
Doctrines that are laid out by the Magisterium on matters of
Catholic Faith who are vested with the authority of true
interpretation of the Holy Book’s content.
 Other doctrinal developments in sexual ethics
• Teachings of the Popes
• Magisterium of the Vatican Council II
• Encyclical Humanae Vitae by Paul VI
• Apostolic exhortation
• The Apostolic Letter
 PRINCIPLES OF
SEXUALITY BIOETHICS
AND HUMAN REPRODUCTION
 These differentiating factors are:
• Differentiation continues with the ducts (Wolffian ducts in men,
Mullerian ducts in women)
• The human body is then marked as a whole in its morphology, in
the voice, in its movement, sensorial and perceptive traits by
sexual differentiation in its fundamentally identical and
homogenous structure
2. Other Perspectives on Sexuality
 Catholic Morality on Sexuality
• Arise not only from the Holy Book (Bible) but also on the
Doctrines that are laid out by the Magisterium on matters of
Catholic Faith who are vested with the authority of true
interpretation of the Holy Book’s content.
 Other doctrinal developments in sexual ethics
• Teachings of the Popes
• Magisterium of the Vatican Council II
• Encyclical Humanae Vitae by Paul VI
• Apostolic exhortation
• The Apostolic Letter
 PRINCIPLES OF
SEXUALITY BIOETHICS
AND HUMAN REPRODUCTION
 The ideologies of sexual revolution according to Screggia (1992):
• Libertinism
• Post-Freudian interpretation
• Feminism of Simone Beauvoir

MARRIAGE
Fundamentals Of Marriage
“A special contract of permanent union between a man and a
woman entered into in accordance with the law for the
establishment of conjugal and family life. It is the foundation of
the family and an inviolable social institution whose nature
consequences, and incidents are governed by law and not subject
to stipulation, except that marriage settlements may fix the
property relations during the marriage within the limits provided
by this code.”
- Article I of the Family Code of the Philippines
 What does the definition of marriage imply
MARRRIAGE That marriage as a permanent union implies that it is
indissoluble, hence there is no divorce in the Philippines
because the law provides that marriage is a special
permanent contract.
That the union is between a man and a woman, means
same-sex marriage is not recognized in the Philippines.
That the union is entered for the establishment of
conjugal and family life, means that the purpose of
marriage seeks conjugality and procreativeness.
That marriage is the foundation of the family. Since the
family is the foundation of society, the stability and
status of marriage profoundly affect how the family and
society are thriving. Therefore, the breakdown in
marriage threatens the family and consequently, the
integrity of the society.
The nature, consequences, and incidents of violations
towards the marriage as an inviolable institution are
governed by the law.

Characteristics of Marital Love (Pope Paul VI, Humanae

vitae,9)
 PRINCIPLES OF BIOETHICS
Issues on Sex Outside Marriage and Homosexuality
 The Family Code of the Philippines (Chapter 3) stipulates the reason
that renders marriage void from the beginning, as if the marriage did
not take place and hence is annulled.
 Those bigamous or polygamous marriages not falling under Article 41
are one of the reasons that a marriage is void from the beginning
(Article 35.4).
 Article 45 further stipulates that a marriage may be annulled for any
of the causes mentioned below that are existing at the time of
marriage:
 Marriage for those 18 years old or over but below 21 and the
marriage was solemnized without the consent of the parents,
guardian, or person having the parental authority over those who
are married unless such party cohabited with the other and both
lived together as husband and wife.
 Either party is of unsound mind, unless after coming to reason,
freely cohabited with the other as husband and wife.
 Consent was obtained by fraud, unless afterward, with the full
knowledge of the facts constituting the fraud, freely cohabited
 PRINCIPLES OF
BIOETHICS
Physically incapable of consummating the marriage with the
other, and such incapacity is continuous and appears to be
incurable.
 Either party is afflicted with STD found to be serious and
appears to be incurable.
 Article 55 stipulates that a petition for legal separation may be
filed under these circumstances:
o Repeated grossly violent or grossly abusive conduct.
o Physical violence or moral pressure to compel the petitioner
to change or political affiliation.
o Corruption or inducement to engage in prostitution, or
connivance in the corruption and inducement.
o Imprisonment of more than 6 years or even pardoned.
o Drug addiction or habitual alcoholism.
o Lesbianism or homosexuality.
o Bigamous marriage, whether in the Philippines or abroad.
o Sexual infidelity or perversion.
o Attempt against the life of the petitioner.
o Abandonment of petitioner by respondent without justifiable
PRINCIPLES OF
BIOETHICS
HOMOSEXUALITY
Is the condition or quality of being homosexual. Is either a
male or a female (Homosexual Etymology, Origin and Meaning
of Homosexual, by Etymoline, n.d.)
Terms used in place of homosexual:
o Sexual inversion (1883)
o Inversion (1895)
o Unnatural Love (between 18th-19th century)
o Originated in Italian psychology.
In the field of psychology and psychoanalysis, homosexuality
is characterized by sexual, or romantic desire, attachment, or
sexual activity with people of the same sex (Oxford English
Dictionary).
In the present context, monosexuality has evolved into the
LGBT movement. LGBT stands for the collective lesbian, gay,
bisexual, and transgender people.
PRINCIPLES OF
BIOETHICS Morality of Contraception
Central to the morality of contraception is the answer to the profound
question –” when does life begin”- which is often the topic of debates.
In answering the question of when life begins, comes to mind the
question of whether the terms “zygote”, “pre-embryo” and “fetus”
really indicate successive stages of the development of a human
being or not.

ISSUES ON ARTIFICIAL REPRODUCTION, ITS MORALITY, AND

ETHICO-MORAL RESPONSIBILITY OF NURSES
1.Artificial Insemination is a less radical and sophisticated procedure
to facilitate contraception unnaturally.
 Is the introduction of sperm from a man into a woman by
laboratory methods in an attempt to bring about a conception
in a woman’s womb, thus making the marital act of husband
and wife insignificant casually in the bringing about of the
conception.
2.In Vitro Fertilization: In Vitro (in glass) human fertilization facilitates
the conception of a human person outside the body of the woman.
 This conception takes place in a laboratory container – a glass
PRINCIPLES OF
BIOETHICS ISSUES ON CONTRACEPTION, ITS MORALITY, AND ETHICO-
MORAL RESPONSIBILITY OF NURSES

Contraception
In the past decades people believed that the population was out
of control resulting in poverty and suffering of the human
species. Efforts to control the population were sought.

Methods to Control Contraception are:

Methods of Contraception
 Folk methods
 Mechanical methods
 Chemical methods
 Hormonal Methods
PRINCIPLES OF
BIOETHICS ISSUES ON ARTIFICIAL REPRODUCTION, ITS MORALITY, AND
ETHICO-MORAL RESPONSIBILITY OF NURSES
 The living human embryo of the conception is then transferred
from the laboratory container into the body of a woman for
gestation until normal birth.
 All techniques of fertilization proceed as if the human embryo
were a mass of cells to be used, selected, and discarded.
3.Surrogate Motherhood - is to facilitate contraception through a
third-party reproduction in which the woman in which the woman
consents to carry a pregnancy for the intended parents who cannot
conceive for medical reasons or those who are gay couples.
 There are 2 forms of surrogacy
o Traditional Surrogacy
o Gestational Surrogacy
 The Advent of IVF has assisted gestational surrogacy. However,
pregnancy and gestation involve psychological burdens and
risks for the surrogate mother.
 The legal procedures for parenthood following surrogacy are
complicated due to the typical legal assumption that a woman
giving birth to a child is the legitimate mother of the child.
 PRINCIPLES OF BIOETHICS
Issues of Life, Death & Dying
Ethical dilemmas faced in healthcare settings often relate to
issues of & attitudes toward living and dying. Important
questions that are deliberated by those involved include “When
does life begin?”, “When does life end?”, “How can we be sure
that someone has died?” & “Who decides?”
Issues of Life
Technology has stretched the boundaries & clouded the waters
surrounding life’s beginning and ending. Perspectives vary from
the belief that life begins at conception to the view that it
begins when an infant can survive outside the womb.
Technology makes this discussion even more complex and raises
questions such as “What happens if conception cannot take
place ‘naturally’ and artificial processes are employed either in
vivo or in vitro?” & “Is the laboratory embryo a life?”
Benefits & Challenges of Technology
New interventions have saved lives, improved quality of life,
alleviated suffering, and significantly decreased the incidence of
some diseases. Before the advent of many modern health-
related technologies, people experienced illness and death as an
 PRINCIPLES OF BIOETHICS
QUALITY OF LIFE
A subjective appraisal of factors that make life worth living
& contribute to a positive experience of living, means
different things to different people. Quality of life is a
personal perspective that is determined by each individual.
Recognizing this, we should not judge the quality of
another’s life based on our values. If judgments are made
about a person’s worth & quality of life based on factors
such as contributions to society, age, mental capacity, or
ability to function, discrimination against those who are
judged to have less quality of life may easily follow.
The Metaphysics of Quality has much more to say
about ethics
“It says that even at the most fundamental level of the
universe, static patterns of value and moral judgment are
identical. The 'Laws of Nature' are moral laws . . . When
inorganic patterns of reality create life the Metaphysics of
Quality postulates that they've done so because it's 'better'
and that this definition of 'betterness'—this beginning
response to dynamic Quality—is an elementary unit of ethics
 PRINCIPLES OF
The Beginning of Life
BIOETHICS
Both the Catholic Church and the Philippine
Constitution recognize the sacredness of life from
the time of conception. From fertilization through
fetal life, until birth, the human being must be
protected. Equally important is the respect for the
dignity of parents and newborns expressed in the
method of new life created. A child must be the
fruit of the conjugal union between husband and
wife.
Artificial methods of reproduction that assist the
conjugal act are praiseworthy procedures to help
“infertile” couples. Those that substitute or
replace it are not acceptable.
Caring for the pregnant patient is unique.
Treating the mother automatically treats the child
and vice versa so that when decisions are made,
the health and welfare of one must be mutually
balanced by the health and welfare of the other.
(A Handbook in Bioethics; Rosario Angeles Tan
 PRINCIPLES OF
BIOETHICS
Genetic Engineering
Genetic-is the science that deals with the interaction of the
genes in producing similarities & differences between individuals
related.
 Engineering is the art & science that is concerned with the
practical application of knowledge, as in the design, construction
& operation of rocks, bridges, buildings, etc.
Kinds of Genetic Engineering:
•Embryo Transfer (ET)
•Surrogate Motherhood
•Genetic Testing
•Prenatal diagnosis
•Genetic Screening
•Genetic Intervention Techniques:
 Genetic control
 Genetic therapy
 Genetic surgery
Sperm & Zygote Banking (SZB)
This is the freezing & preservation of sperm at low PRINCIPLES
temperatures which is technically known as
“cryopreservation”.
OF
Justification of SZB: BIOETHICS
To overcome infertility among humans.
To serve as “fertility insurance”, while hoping to retain
their fertility in the future & for future use.
To use sperm deposits for research on genetic diseases &
reproductive process
For further studies sex selection for eugenic reasons.
Couples where both partners are carriers of complementing
recessive genes could prevent the birth of a potentially
afflicted child by substituting their sperm or egg to those of
a donor known to be free of such genes or simply requesting
a defective free zygote.
Superior human beings could be bred by mating eggs &
sperm from donors possessing certain desirable traits;
frozen sperms & eggs would permit a high degree of
selectivity among donors to assure such preferred matching.
This preferential breeding of so-called superior individuals
should be done to improve the genetic stock of the human
PRINCIPLES OF BIOETHICS
Sex Prediction & Selection of Offspring
 The advancement of science gives us karyotyping as
another means of determining the sex of a child by its
chromosomes, with amniocentesis as a means. If the Y
bodies show up under the fluorescent microscope, it
denoted maleness: if not, it is a female baby.
Sex Change Operations
A transsexual: is an individual who is either
male or female but has a strong psychological
desire to belong to the opposite sex.
Transsexual could be helped by surgical
operation transforming them, at least externally,
into the desired thus enabling them to live
either as male or female-this constitutes the
very justification of the procedure.
Moral Issue/Justification. True for a
hermaphrodite, who has both male & female
 PRINCIPLES OF BIOETHICS
CLONING
Came from the Greek word “twig”. It is a technological process
whereby an identical duplicate of an organism is produced by
replacing the nucleus of an infertilized ovum oocyte with the
nucleus or a body or the organism.
Moral justifications for cloning
1.Great way to perpetuate genius
2.Improve the human race
3.Prevent genetic disease in a selected posterity
4.Provide a genotype of one’s spouse living or dead, of a
deceased parent, or of some other departed loved one.
5.Provide a form of immortality for donors
6.Determine the sex of future children
7.Increase scientific knowledge about human reproduction
8.Provide or produce soldiers & servant classes of people
9.Can exchange body parts & can enhance social communion
PRINCIPLES OF
BIOETHICS ISSUES ON ARTIFICIAL REPRODUCTION, ITS MORALITY, AND
ETHICO-MORAL RESPONSIBILITY OF NURSES
 Therefore, a surrogate mother is required to formally abandon
parental authority, and the intended parents then adopt the
child born.

MORALITY OF ABORTION, RAPE, AND OTHER PROBLEMS

RELATED TO THE DESTRUCTION OF LIFE
ABORTION
The expulsion from the uterus the products of conception before the
fetus is viable. It is the premature stoppage of a natural or a
pathological process.
The morality of artificial insemination, IVF, and surrogacy can be
discerned by analyzing the applicable ethical principles such as
respect for the dignity of the person, beneficence, non-maleficence,
justice, and autonomy.
Healthcare practitioners, the nurse most importantly, assist the
patient who is facing issues with artificial reproduction in a
nonjudgemental manner, offering information when necessary and
facilitating decision-making on the part of the patient through such
 PRINCIPLES OF BIOETHICS
Types of Abortion
1.Spontaneous abortion
a. Threatened
b. Imminent
c. Complete
d. Incomplete
e. Missed
f. Habitual Moral & Ethical Point of View
2.Induced abortion Induced abortion The direct & voluntary killing of an
innocent human being is always gravely
Induced Abortion Techniques:
immoral, even when it is performed as a
1.Dilatation & Curettage
means to a good end. Life is sacred from
2.Abdominal Caesarian section/abdominal
the very first moment of conception.
hysterectomy
3.Suction Techniques
4.Intra-amniotic Infiltration
5.IV Injection of Prostaglandin
6.RU-486 contraceptive pill
 PRINCIPLES OF
BIOETHICS
Effects of Abortion:
Physical
Psychological
Habitual miscarriage, stillbirth
Guilt, suicidal tendencies,
Ectopic pregnancy

LEGAL, MORAL AND ETHICAL CONSIDERATIONS:

Article II, Section 12 of the 1986 Constitution provides that,
“ The state recognizes the sanctity of life and shall protect
and strengthen the family as the basic autonomous social
institution. It shall equally protect the life of the mother and
the life of the unborn from conception”.
ARGUMENTS: CONTRA ABORTION
Not firmly a choice between a mother only or to the child
only but must center on saving both lives.
The ethical choice can be guided by the principle of Double
Effect
Unselfish love and solitude to an innocent creature is upheld
PRINCIPLES OF
BIOETHICS ARGUMENTS: PRO-ABORTION
To safeguard the life of the mother
Abortion as a woman’s right
Abortion as an expression of a woman’s sexual freedom
The fetus is not a human person

RAPE
An unlawful activity with sexual intercourse carried out forcibly or under
threat or injury against a person’s will or with a person who is beneath a
certain age or incapable of valid consent because of mental illness,
mental deficiency, intoxication, unconsciousness, or deception.

OTHER RELATED PROBLEMS TO THE DESTRUCTION OF LIFE

1.Human Population Control: Eugenics
 Literally means (eu) good (genos) birth.
Two sides of Eugenics:
o Negative Eugenics
o Positive Eugenics
PRINCIPLES
OF
BIOETHICS
PRINCIPLES OF
BIOETHICS
Advance Directive
An advance directive is a written document completed by a
competent person that aims to guide medical treatment after the
person becomes incompetent. There are two types:
o instruction directives, which focus on the types of life-sustaining
treatment that the person would want under various clinical
situations, and
o proxy directives, which focus on who the person would want to
make health care decisions if the person were unable to do so.

SUICIDE
Latin suicidium, from sui caedere, to kill oneself) is the
intentional taking of one's own life; willful destruction of
oneself.
Suicide may occur for a number of reasons, including
depression, shame, guilt, desperation, physical pain, emotional
pressure, anxiety, financial difficulties, or other undesirable
situations.
ETHICAL AND LEGAL ISSUES OF SUICIDE
 Nonmaleficence is the ethical principle addressing the
Duty to fulfill regarding suicide
Confidentiality is the ethical duty to fulfill the promise that client
information received during therapy will not be disclosed without
authorization. As such, it follows that breaching confidentiality can
result in “harm” to the counseling relationship and subsequently the
client.
Negligence results from some type of wrongful action committed by
one person, which results in “injury” to another person. As a general
legal principle, a court must find the following four to be true:
1) A duty was owed by the counselor to the client
2) The duty owed was breached
3) There is a sufficient legal causal connection between the
breach of duty and the client’s injury
4) Some injuries or damages were suffered by the client

The following are considered reasonable duties for counselors in

terms of suicide prevention (Remley & Herlihy, 2001)
Counselors must know how to make assessments of a client’s risk for
suicide and must be able to defend their decisions
When a decision is made that the client is a danger to self,
counselors must take whatever steps are necessary to prevent the
harm
PRINCIPLES OF BIOETHICS
Prevention & Intervention
It is typically best practice to make parents/guardians aware of
suicide risk for their children. Technically, the professional
counselor’s legal liability ends when parents have been notified
that their child is at risk for suicide and prevention actions
have been recommended (Remley & Sparkman, 1993).

DETERMINATION OF DEATH
 In all situations where there is any possibility that life exists,
every effort should be made to resuscitate the patient.
The paramedic should be cognizant of the following facts:
o Persons in V-fib, PEA, and asystole can potentially be
resuscitated.
o Very often the reported "DOWN TIME" is an inaccurate
parameter of resuscitation potential, as the patient may
have been in bradycardia or simply unconscious for a
period of time, yet still perfusing blood to the brain.
o Pupil size and response to light can be inaccurate as
medications taken orally or directly in the eyes can affect
them. Pupils can fixate after one or two minutes of global
PRINCIPLES OF
BIOETHICS BIOLOGICAL AND CLINICAL DEATH
Physical death is the cessation of normal body functions,
the irreversible loss of both components of consciousness,
arousal, and awareness. In legal terms defined as "brain
death", i.e., loss of higher cortical functions.
Biologically, death can occur to wholes, to parts, or to
both. For example, it is possible for individual cells and
even organs to die, and yet for the organism as a whole to
continue to live; many individual cells live for only a short
time, and so most of an organism's cells are continually
dying and being replaced by new ones.

Death is the irreversible ending of life

When organisms die most of their cells live for some time
afterward. Organs can be removed for transplantation
Irreversibility is often cited as a key criterion of death. By
definition, a dead organism cannot be brought back to life;
if it were to be, that would indicate that it had never been
dead. Biochemically, it is unrealistic to think that death
 PRINCIPLES OF BIOETHICS
Respect for the person & Scientific Research
Research for experimentation on a human being cannot legitimize
acts that are in themselves contrary to the dignity of a person or a
moral law. The subject’s potential consent does not justify such
acts. Organ transplants are not morally acceptable if the donor to
those who legitimately speak for him has not given their informed
consent. It is morally inadmissible directly to bring about the
disabling mutilation or death of a human being, even in order to
delay the death of other people.
Respect for health
Life & physical health are precious gifts entrusted to us by God.
We must take reasonable care of them, taking into account the
needs of the other & the common good. Concern for the health of
its citizens requires that society help with the attainment of living
conditions that allow them to grow & reach maturity: food &
clothing, housing, health care, basic education, employment &
social assistance.
Respect for Bodily Integrity
Kidnapping & hostage taking are morally wrong. Terrorism is
gravely against justice & charity. Torture is contrary to respect for
MEDICAL INFOGRAPHIC