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Values
freely chosen, enduring beliefs or
attitudes about the worth of person,
object, idea or action
important because they influence decisions
and actions
heavily influenced by socio-cultural
environment
o cultural, ethnic, religious
groups, family, peer
Conscience
practical judgment of reason upon
individual act as either good and to be
performed or as evil and to be avoided
To follow ones conscience
To follow feelings or emotions
To follow law or custom
Blind obedience to the inspiration of God
Follow personal freedom and autonomy
The capacity to make practical
judgments in matters involving ethical
issues
Involves reasoning about moral principles
Must be rooted in reality and truth and
not on mere will or desire or blind choice
Sound, true and certain conscience- own
perception, sound education,
understanding of natural law, traditional
wisdom, teachings of family and Church,
experience
Conscience can be in error as when one
misunderstands principles, misjudges
facts or is led by misguided affections
One is culpable of an erroneous decision
of conscience only within ones capability
and freedom to prevent the error.

CONSCIENCE FORMATION

Diligently learning the laws of moral life
Seeking expert advice on difficult cases
Asking God for light through prayer
Removing the obstacles to right judgment
Personal examination of conscience
My conscience is my guide
What I dont know cant hurt me
It is Gods will

Principle of Well-Formed Conscience
-To attain the true goals of human life by responsible
actions, in every free decision involving an ethical
question, people are morally obliged to do the
following:

A. Informed themselves as fully as practically
possible about the facts and the ethical norms
B. Form a morally certain judgment of
conscience on the basis of this information
C. Act according to this well formed conscience
D. Accept responsibility for their actions

Principle of Moral Discernment
To make a conscientious ethical decision,
one must do the following:
1. Proceed on the basis of a fundamental
commitment to God and to human persons
(including oneself) according to their God-
given and graced human nature
2. Among possible actions that might seem to be
means of fulfilling that commitment, exclude
any that are contradictory to it ( intrinsically
evil)
3. Also consider how ones own motives and
other circumstances may contribute to or
nullify the effectiveness of these other
possible actions as means to fulfill ones
fundamental commitment
4. 4. Among the possible means not excluded or
nullified, select one by which one is most
likely to fulfill that commitment and act on it

Conscience Formation
Making moral decisions demand mature
responsibility
A fully mature and responsible conscience
should be free, correct, clear and certain
Discerning what is right and what is wrong
We must follow our decision only after we
have done our best to search for the truth
regarding the issues facing us

Qualities of Conscience
A. Personal freedom
- Free
- Unfree- impeded by some obstacles such as
fear and anger
B. Objective Value
- correct- subjective conforms to the objective
moral values
- Objective- norms of morality
- Erroneous- lack of conformity to the objective
norms of morality
- Culpable- one is in error and therefore
responsible
- Inculpable- has erred in good faith

C. Moral attitude
- Lax- careless in its effort to seek the truth
- Strict- follow to the letter
- Scrupulous- tends to judge sin to be present
when there is none
- Pharisaical- judgmental towards other
- Clear
- Callous- worst type- no sensitivity to sin
D. Degree of certitude


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- Perplexed- wrong if you dont do; wrong if
you did
- Doubtful- lack of sufficient evidence
- Probable- made a decision already but still
admitting the possibility that the opposite is
true
- Certain
ETHICS
The study of good conduct, character, and
motive.
A method of inquiry that assists people to
understand the morality of human
behavior
Greek word ethikos or ethos meaning
CUSTOM/CHARACTER/BEHAVIOR
Latin word mos or moris meaning
morals
Practical Science of the morality of human
conduct
Practical because it:
o - implies direction
o - presents the reason which
show these data to be true
o - moral because it is related to
the dictates of reason (how it
should be)
o - human conduct because it
deals with human activity and
how one should act

1. General ethics
- Presents truths about human acts
general principles of morality

2. Special ethics

-applied ethics
- applies the principles of
General ethics
Individual- God, self, fellowmen
Social- family, State, world

3. Professional ethics

Code of Ethics
a formal statement of the groups ideals &
values that is
1. Is shared by members of the group
2. Reflects their moral judgment overtime
3. Serves as a standard for their
professional actions

Nursing Ethics
Ethical issues that occur in nursing practice
As the basis for professional code of
ethics, ethical theories attempt to provide
a system of principles and rules for
resolving ethical dilemmas


Nursing Code of Ethics
- The Code of Ethics for Nurses BON
Resolution 220 series 2004- provides guidance for
carrying out nursing responsibilities consistent with
the ethical obligations of the profession

1. Provides guidelines for safe and
compassionate care
2. Guarantees the public that nurse adheres to
standards of professional practice

e.g. International Council of Nurses Code of Ethics
Four fundamental responsibilities
1. to promote health
2. to prevent illness
3. to restore health
4. to alleviate suffering
4 elements (outlines standards of ethical
conduct)
1. nurses and people
2. nurses and practice
3. nurses and the profession
4. nurses and co- workers

ETHICS COMMITEE
Issues of patient care that presents as
ethical dilemmas
The institutions ability to protect the
rights and interests of clients in general
The development of institutional policies
and educational programs on ethical
issues

Professional Code of Ethics
Nurses have a contract with society to
behave in accordance with rules dictated
by society and the nursing profession

Nurse practice Acts vs. Code of ethics
Delineates nursings moral ideals,
provides guidelines for ethically
principled behavior and holds nurses
morally accountable for their actions

ETHICAL CONCERNS IN HEALTHCARE
CONFIDENTIALITY OF RECORDS
RIGHT TO PRIVACY
RIGHT TO INFORMATION
COMPETENT CONSENT TO TREATMENT
RIGHT TO REFUSE TREATMENT
TERMINATION OF TREATMENT
Human cloning
Research
Organ transplants

Virtue ethics
Character ethics


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Human traits of compassion, courage,
wisdom exhibited by people in concrete
situations
Claims of virtue ethics:
1. An action is right if and only if it is what the
agent with a virtuous character would do in the
circumstances
2. Goodness is prior to rightness- person
matters before the action
3. The virtues are irreducibly plural intrinsic
goods- virtues cannot be reduced to just one value
but various virtues are necessary for good actions
4. Some intrinsic goods are agent relative-
every action depends on the person
5. Acting rightly does not require we
maximize the good- good is not enough- excellence
is needed

watch your THOUGHTS, they become
WORDS
watch your WORDS, they become
ACTIONS
watch your ACTIONS, they become
HABITS
watch your HABITS, they become
CHARACTER
watch your CHARACTER, it becomes your
destiny

Morals
fundamental standards of right or
wrong that an individual learns and
internalizes usually during early stages of
childhood development
reflects what is done in a situation
refers to human conduct itself application of
ethics
Based on norms of conduct about right or
wrong
Societys moral codes guide what people
ought to do
Professional codes such as the code of ethics
for nurses, communicate the goals and ideals
of the profession

VALUES AND VALUES CLARIFICATION
Ethical problems results from changes in
society, advances in technology and the
nurses conflicting loyalties and obligations
Nurses ethical decisions will be influenced by
their moral theories and principles, levels of
cognitive development and personal and
professional values
The goal of ethical reasoning is to reach a
mutual, peaceful agreement that is in the best
interests of the patient
All Human beings have needs
Anything that fulfills a need is a VALUE
Values give direction and meaning to life and
guide a persons behavior
Values are freely chosen, cherished and
consistently incorporated into ones behavior
Values are shaped by culture, ethnicity, family,
environment and education
Value awareness
Congruence between your values/ health
institution

KEY CONCEPTS
All human interactions are value based
Nurses must clarify and respect the values of
others and examine their own values
Values are enhanced and refined by
experiences that cultivate values development
such as interactions with people of differing
values and viewpoints and experiences that
challenge ones way of thinking



Bioethics
Ethics as applied to human life or health;
e.g. decisions about euthanasia; abortion
bios (life) + ethikos (behavior)
a systemic study of human behavior,
specifically in the fields of life sciences
and health care as examined in the light of
moral values and principles (M.T. Reich)

Why do we have to study Bioethics?

The following changes gave rise to the need of
bioethics:
1. because of perennial issues, dilemmas &
problems
2. because of legal dimension
3. Emergence of ethical practice in health care
4. to provide awareness to the health team of
the dos and donts of nursing practice
5. To enrich ones competence by
understanding that the patient is a person and holistic
individual
6. To make clear to us why one act is better
than the other
7. Enable us to live and have an orderly social
way of life
8. Scientific Advances
9. Inequalities in socio-economic, educational
and political positions
10. Finitude of resources


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11. Changes in the doctor-patient
relationships
12. Rampant unethical behavior

ETHICAL THEORIES
1. Deontology
2. Teleology

1. Deontology
Greek word deontos= duty
an action is right when it conforms to laws
or rules

APPLICATION OF DEONTOLOGY TO HEALTH
CARE

The RN is duty bound to act under moral
rules that establish the right or wrong:
o duty to honor a patients
autonomy
o duty to promote good & well being
o duty to keep promise &
confidentiality

Nurses have a contact with society to
behave in accordance with rules dictated
by society and the nursing profession

The Code of Ethics for nurses BON
Resolution 220 series 2004 provides
guidance for carrying out nursing
responsibilities consistent with the ethical
obligations of the profession

Immanuel Kant
It is only through dutiful actions that
people have moral worth
only reason and not emotion is sufficient
to lead a person to moral actions (because
rational choice is within ones control)


2. Teleology
- Greek word teleos = goal
- focuses on the consequences or end product
of our actions
- The principle of the greatest happiness for
the greatest number of people

What is best for groups?
We apply the bioethical principle to a
particular case


Well known consequentialists
Jeremy Bentham
John Stuart Mill

DIFFERENT ETHICAL PRINCIPLES
I. PRINCIPLE OF HUMAN DIGNITY
II. PRINCIPLE OF STEWARDSHIP
III. PRINCIPLE OF AUTONOMY
IV. PRINCIPLE OF INFORMED CONSENT
V. PRINCIPLE OF CONFIDENTIALITY
VI. PRINCIPLE OF BENEFICENCE
VIII. PRINCIPLE OF NONMALEFICENCE
IX. PRINCIPLE OF DOUBLE EFFECT
X. PRINCIPLE OF JUSTICE
XI.PRINCIPLE OF COOPERATION
XII PRINCIPLE OF TOTALITY AND INTEGRITY
OF THE HUMAN PERSON
XIII FIDELITY
XIV. VERACITY
XV. PROFESSIONAL COMMUNICATION
XVI. ORDINARY AND EXTRAORDINARY
MEANS
XVII. PRINCIPLE OF SUBSIDIARITY
XVIII. PRINCIPLE OF PERSONALIZED
SEXUALITY
I. PRINCIPLE OF HUMAN DIGNITY

Basis of Human Dignity
Salvation History
1. Creation of man
2. Fall of Man
3. Promise of a Savior
4. Preparation for the Coming
5. Fulfillment of the Promise
6. Establishment of the Church
7. Heavenly Kingdom
Image and Likeness of God
Christ redeemed us
Ultimate destiny to fulfill
Rational beings

Human rights
- needs and values as it relates to other
human beings
- it is universal
- equal among everybody
- not a product of human creativity but
inherent to us

Universal Declaration of Human Rights (1948)
respects the dignity of the human person

PERSON
a person is a rational, autonomous being
with the ability to know universal,
objectives moral laws & the freedom to
decide to act morally

SIGNIFICANCE OF BEING A PERSON
Has an inherent dignity which must be
respected
- A person should not be destroyed; uniqueness must
not be altered; genes cant be manipulated; organs
removed without any reason; one cant be cloned


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Has an ultimate destiny- to live with God
-To fulfill this, one has needs that must be met,
resources must help one meet these needs; but he is
only a steward
Lives with other persons in the community
- Interacts with people; helps them

HUMAN DIGNITY
All ethical decisions (made by patients
and healthcare givers) must aim
basically and ultimately at human
dignity.

They must protect, defend, enhance and
enable the persons worth.
They must aim for the maximum and
integrated satisfaction of every persons
needs, as an individual and members of his
community.
Human Dignity
Every human being has an inner worth and
inherent dignity. These he possesses not
because of what he has or what he does but
because of what he is: a human person
As a human person, he must be respected
regardless of the nature of his health problem,
social status, competence, past actions
Decisions about health must aim at the
maximum integrated satisfaction of his needs:
biological, psychological, social and spiritual
Certain actions may never be done because
performing them would constitute a violation
against the persons dignity

Respect for Person
Every human being has an inner worth
and inherent dignity. These he possesses
not because of what he has or what he
does but because of what he is: a human
person

As a human person, he must be respected
regardless of the nature of his health
problem, social status, competence, past
actions

Certain actions may never be done
because performing them would
constitute a violation against the persons
dignity


II. PRINCIPLE OF STEWARDSHIP

CALL FOR 3 RESPONSIBILITIES
1. Personal
2. Social
3. Ecological

Profile of Drug abusers
1. 20- 29 years old (intimacy vs
isolation)
2. Rates higher on males than females
3. Single
4, unemployed
5. High school level
6. Drug taking: Poly Drug Use

Comprehensive Dangerous Drug Act of
2004
Signed: June 7, 2002
Published: June 19, 2002
Took effect: July 4, 2002

Composition of the Board

CHAIRPERSON
2 Permanent Board Members
12 Ex officio members
DO
H
DILG DepE
d
CHED DSW
D
DN
D
DFA DOF NYC PDE
A
2 Regular
Members
2 Permanent
Consultants
IBP NGO
s
NBI PNP

God is the Lord of Life and of Creation; Persons
are Their Custodians.

DIMENSIONS OF STEWARDSHIP
HUMAN RECONSTRUCTION
- God made human beings free and
intelligent- we have the right and
obligation to improve ourselves- good
stewardship
- But we must use it with profound respect
for Gods creation especially if it will
undermine the very freedom and
intelligence given to us by God
- Responsible Stewardship of Available
Resources
- Managing resources with prudence and
moderation
- Wasting or squandering of scarce
resources is a sin
- Not to fall into the trap of the
technological imperative

Ecological and Biomedical Dimension
- Our bodies, our life, our human
nature and everything in this earth
are gifts we have dominion over.
This means we are responsible for
them. We should not as faithful
stewards, harm but rather
improve and care for them. We
have to treat them with utmost
respect, use originality and
creativity to cultivate them, know


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and respect their limits. We
cannot contradict human nature.

III. PRINCIPLE OF AUTONOMY

Autonomy
Greek word autos meaning self and
nomos meaning rule/ governance/ law.
self- governing or the ability to govern
self is dependent upon many factors such
as
o sound mind
o sound body
o full information of the issues
o without force or coercion
- Recognizing patients as persons who
are entitled to such basic human rights such as the
right to know, privacy and right to receive treatment
- State of being self-regulating, self-
defining and self-reliant

- Ability of a person to make their own
decisions without interference

- freedom to make choices about issues
that affect ones life
- Respect for persons; unique and
valuable members of the society
- Free to choose and implement ones
own decision, free from lies, restraint or
coercion
KEY POINTS
This principle assumes rational thinking on the part
of the individual and may be challenged when the
rights of others are infringed upon by the individual


PATERNALISM
Deliberate restriction of peoples autonomy
by health care professionals based on the idea
that they know whats best for the clients- can
be justifiable at times
Doing good should take precedence over
autonomy

The doctor can decide:
1. Doctor can act as loco-parentis
2. If it is a matter of life and death
3. Court
E.g. Jehovahs witness 12 years old

IV. PRINCIPLE OF INFORMED CONSENT
- It is a patients right to exercise freedom to
make decisions for his/her health.
Appropriate and necessary information are
required so that medical protocols and
management may be done for his interest.

To protect the basic need of every human person for
health care and the persons primary responsibility for
his or her own health,

(1) no physical or psychological therapy may be
administered without the free and informed consent
of the patient, or,

(2) if the patient is incompetent, the persons
legitimate guardian acting for the patients benefit
and, as far as possible, in accordance with the
patients known and reasonable wishes.

ELEMENTS OF INFORMED CONSENT
1. Disclosure
2. Comprehension of information
3. Voluntariness
4. Competence
5. Consent

What info you should give to patients?
1. Current Medical status (Diagnosis)
2. Therapy, treatment, procedures available
3. Risks and benefits
4. Prognosis
5. Affordability

Who are incompetent?
- Comatose
- Below 18 yrs old
- Mentally incoherent

Who gives proxy consent?
1. Durable Power of attorney
2. Closest of kin
Adult- married- spouse, children of major age
Below 18- parents, grandparents
No spouse- siblings, uncles/aunts

Key point
In securing consent, exhaust the vertical line first
before the horizontal

V. PRINCIPLE OF CONFIDENTIALITY

Confidentiality
non disclosure of private or secret
information with one is entrusted
Requires the non-disclosure of private or
secret information with which one is
entrusted
ICN (2000)- the nurse holds in
confidence personal information and uses
judgment in sharing this information
An important component of autonomy-
maintains dignity and respect for the
person


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Privacy non exposure of a body part

The following are subjects of Confidentiality and should
not be revealed to anyone except for graver cause:
1. Private Secrets
2. Contractual Secrets
3. Professional Secrets

Privileged Communication
a confidential communication that one
cannot be forced to divulge
Husband & wife
priest & penitent
doctor & patient
lawyer & client
To qualify for privileged status,
communication must generally be made in
private setting (that is, in a context where
confidentiality could reasonably be
expected).
Are there any situations in which a
medical professional justified in revealing
embarrassing or damaging information
about a patient to a third party?

GRAVE CAUSE
abuse (child/ elder abuse)
intent to kill self or someone
communicable disease
statuses require the disclosure
of certain happenings e.g. rape,
abuse, incest, other crimes
Personal decision
Reportable cause
Legal case


KEY POINTS
The public good outweighs the
individuals right to privacy and
confidentiality
protective privileged ends where
the public perils begins
duty to warn is the duty to
disclose confidential information
to protect identifiable victim and
warn appropriate authority
targeted by threat


VI. PRINCIPLE OF BENEFICENCE

Beneficence
Comes from the LT. word bene meaning
good and fiche meaning to act or do.
An act of or goodness, kindness, an action
done for the good and benefit of others.


VIII. PRINCIPLE OF NONMALEFICENCE
it is related to the following human rights
Right not to be killed
Right not to have bodily injury or
pain inflicted to oneself
Right not to have ones confidence
revealed to others

Violations of nonmaleficence
1. Physically harming a person as in suicide,
abortion, infanticide, torture and violence
2. Exposing a person to physical harm as in
subjecting a person to unnecessary treatment or to
dangerous procedure without a commensurate
important goal.
3. Harming a persons reputation, honor,
property or interests as by revealing confidential
information

KEYPOINTS
1. BOTH the principles of BENEFICENCE and
NONMALEFICENCE focus on doing good to others.
2. BOTH principles attuned to ALTRUISM
(doing good)
IX. PRINCIPLE OF DOUBLE EFFECT

From a common cause an action- two effect are
produced:
A good effect and an evil effect

Determinants of the Morality of Human Act
The ACT itself
The INTENTION
CIRCUMSTANCES

No amount of good intention or difficult circumstance
can make a wrong action correct.

Basic Axioms of Morality
Majority opinion is not the norm of
morality
Widespread custom or the conventional
wisdom is not the norm of morality
A good end does not justify an evil means
If an act is evil by its nature, nothing can
make it good
We cannot allow our emotions to warp
our moral judgment

Principle of Double Effect
Act itself must be morally good or at least
indifferent.
The motive behind the act must be to
achieve the good effect never the evil
effect, even though it is foreseen and
permitted
The good effect of the act must precede
the evil effect or at least simultaneous
with it.
The good effect must be sufficiently
desirable to outweigh the evil effect.




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Considerations
1. INTENTION is focused on the Beneficial Effect
2. INTENTION must be good
3. B.E = H.E. or if possible BE > HE>
4. ORDER OF TIME
BE must come
BE comes simultaneously with the HE

X. PRINCIPLE OF JUSTICE

IMPLICATIONS OF THE PRINCIPLES OF JUSTICE

1. each individual should receive what is due to right
such as
a. Life
b. Information needed for decision making
c. Confidentiality of private information

2. benefits should be justly distributed among
individuals such as
a. minimum health care
b. equal opportunities for scarce resources
3. each individual should share in the burden of
health and science such as
a. caring for his own health
b. caring for the health of others
c. participating in health/science progress

VIOLATIONS OF THE PRINCIPLES OF JUSTICE

1. Denying/ withholding a benefit to which a person
has a right
2. Distributing a minimum health benefit unequally
3. Imposing an unfair burden on an individual

NON VIOLATIONS OF THE PRINCIPLES OF JUSTICE

1, the patient chooses to give up what is due
2. unjust outcome results or just process

Distributive Justice
the aspects of justice that pertains to a fair
scheme of distributing a societys benefits
and burdens to its members

PROBLEMS OF DISTRIBUTIVE JUSTICE
a. macro-allocation
b. meso allocation
c. micro- allocation

A. Utilitarian alternatives
promotes the highest good that is possible
in every situation (the greates good for the
greatest number)

Principle of Immediate Usefulness
o gives priority to the candidate
who is at greater immediate
service to the larger group under
the circumstances
Medical Success Principle
o give priority to those whom
treatment has the highest
probability of success
Principle of Conservation
o gives priority to those candidates
who requires proportionally
smaller amount of resources and
therefore more lives would be
saved
Parental Role Principle
o gives priority to those who have
the largest responsibilities to
dependents
Principle of General Social Value
o gives priority to those believed to
have the greatest general social
worth thus leading to the good of
society

B. Egalitarian Alternatives
- restoring the equality of the persons
in need
Principle of Saving No One
= gives priority to no one because not all
can be saved
Principle of medical Neediness
= with the most pressing medical
needs
Principle of General Neediness
= gives priority to the most helpless or
generally neediest in an attempt to bring
them as nearly as possible to a level of
well being equal to that enjoyed by others.
Principle of Queuing the line
= gives priority to those who arrived
first
Principle of Random Selection
= gives priority to those selected by
chance or random

XI.PRINCIPLE OF COOPERATION

COOPERATION
Working with another in the performance
of an action.
Types of cooperation:

I. FORMAL COOPERATION
- Cooperator wills the evil either by an
explicit act of will or actual sharing in the evil
act itself
- Formal cooperation in evil is never allowed.
Identification with the purpose
Directly intend the evil action
Legitimate cooperation

A nurse must never formally cooperate in immorality
either by explicitly willing the evil or by directly sharing
in the immoral act.

II. MATERIAL COOPERATION


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-Cooperator performs an act which in itself is
not wrong though it is used by the principal
agent to help commit the evil action
-It consists in performing morally indifferent
actions which make the operation possible.
You cooperate in the act but not in
purpose
indirectly intend the evil action

KEY POINTS:
1. Formal cooperation is always immoral
2. Immediate material cooperation is likewise
immoral
3. Mediate material cooperation may be moral
Sample Case Scenario

Angelica attempted abortion because her boyfriend
Derek does not want to marry her and he bought
Cytotec and bottled herbal medications from Quiapo
and suggested that she removed the baby. In her
attempt she was bleeding profusely and her relatives,
unaware of her intention, rushed her to the hospital.
The doctors completed the procedure even if there is
FHT.

1. Angelica- formal cooperation; intends to
terminate pregnancy and the evil action
2. Derek: formal cooperation; intends evil
action, advices to abort the baby, bought
abortifacients such as bottled herbal
medications and Cytotec
3. Relatives: material cooperation: not
included in the evil plan, rushes to the
hospital unaware
4. Doctors: formal cooperation; intends evil
action by the expulsion and aborting the fetus
even though there is a FHT
5. The janitor in paternal leave: knows
whats happening in the hospital: material
cooperation: because even though he is aware
on what the institution is doing, he remains
quiet and doesnt do anything to stop the evil
action
6. Nurse on duty during the procedure,
nursing aide and janitor on duty: formal
cooperation: knows the evil action, didnt do
anything to save the baby, present on the time
of abortion and condone the evil act.

XII PRINCIPLE OF TOTALITY AND INTEGRITY OF
THE HUMAN PERSON

Totality and Integrity
to promote human dignity in community
every person must develop, use, care for
and persevere all of his or her natural
physical and psychic functions in such a
way that

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.


A. LOWER FUNCTIONS are never sacrifices except
for the better functioning of the whole person and
even then with an effort to compensate for this
sacrifice.

Justifiable
removing part of the body for the purpose
of improving the function of the body part
- e.g amputation of gangrenous foot, tooth
extraction (for better functioning)

B. THE BASIC CAPACITIES
- That define human personhood are never
sacrificed unless this is necessary to preserve life

Non justifiable TAHBSO because you dont want to
have a child, cosmetic reason addiction for vanity
purposes

Justifiable matter of life and death, mastectomy,
organ donation

KEY POINTS
A person may will to dispose of his body and to
destine it to ends that are useful, morally
irreproachable and even noble, among them the
desire to aid the sick and suffering. One may make
a decision of this nature with respect to his own
body with full realization of the reverence which
is due it This decision should not be condemned
but positively justified.

ORGAN DONATION
- Transplanting organs from one living person
to another is also ethically acceptable provided that
the following criteria are met:

1. There is serious need on the part of the recipient
that cannot be fulfilled in any other way.

2. The functional integrity of the donor as a human
person will not be impaired, even though anatomical
integrity may suffer.






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3. The risk taken by the donor as an act of charity is
proportionate to the good resulting for the recipient.

4. The donors consent is free and informed.
5. The recipients for the scarce organs are selected
justly.


WHAT ARE THE BENEFITS OF ORGAN DONATION?

1. Save lives
2. Improves quality of life
3. Cost effective


WHO CAN BE A DONOR?
1. Living donor
2. Cadaver donor

WHO CAN BE A LIVING DONOR?
1. Healthy person age 18-60 years old, whose blood
type and HLA tissue typing are compatible with the
recipient
2. The donation must be a voluntary act
3. A related donor is a blood relative; parent,
offspring, sibling, half-sibling, aunt, uncle or cousin

CAN NON RELATED INDIVIDUALS DONATE
ORGANS?
1. If a blood relative is unable to donate a spouse or
an emotionally related person may be considered.
2. In these cases, careful consideration is given to
such factors as the motives, long term emotional
bonds, and psychological implications for both
donor and recipient

ORGANS THAN CAN BE DONATED ARE:
Heart, liver, kidneys, lungs, pancreas,
corneas, intestines

WHAT ARE THE CRITERIA FOR BECOMING AN
ORGAN DONOR
1. Organs can be donated only after a person has been
declared brain dead while his vital organs are being
maintained on a breathing machine
2. Organ donors can be anyone including newborns
up to age 75

IS BRAIN DEATH THE SAME AS COMA OR
VEGETATIVE STATE
1. No, a person in a coma or vegetative state still has
some brain activity and therefore is not considered
brain dead.

HOW DOES ONE BECOME A CADAVER ORGAN
DONOR?
1. The prospective organ donor should tell to his
family wishes and in the event of his death,
permission by his family/ next of kin
2. He must also sign a donor card or express his
intentions in their drivers license. Although these are
both considered legal documents, his familys
permission for donation must still be obtained.

CAN HUMAN ORGANS BE BOUGHT OR SOLD?
NO, In order to manage and regulate the
act of organ donation as well a the
conduct of non related kidney
transplantation, DOH issued the
Administrative Order No. 124, series of
2002

National Policy on Kidney Transplantation from
living Non Related Donors
this order sets the guidelines and ethical
principles in conducting kidney
transplantation from LNRDs which will
stop profiteering, remove brokers and
make sure donations are not organized
commercial effort

ORGAN DONATION ACT OF 1991 RA 7170

MUTILATION
Destruction of member, organ or part of
the body (organic) or the suppression of a
physical function (functional) in such a
way that the organism becomes no longer
basically whole
Types
-direct- willed in itself, as end or as means,
intended and caused
-indirect ( therapeutic)- caused by the
exigencies of the health or survival of the patient; at
times willed as means, at others tolerated as an
unavoidable side effect

STERILIZATION
A medical or surgical intervention which
causes a patient, incapacity of generation
Therapeutic- inevitably required for the
survival and health of a person- sexual
organs- integrating parts which must yield to
the good of the whole;
licit if:
- Sickness is grave, certainly diagnosed and
definitive that it offsets the evils of sterilization
- It is necessary because it is the only possible
effective remedy
- Exclusively curative- intention is important

Direct sterilization- the immediate effect is
to render procreation impossible
Types:
- eugenics- seeking to avoid the transmission
of hereditary defects
- hedonistic- evade the complications &
responsibilities of procreation without giving up the
sexual pleasure
- demographic- to control the birthrate


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- preventive- render pregnancy impossible
which might aggravate sickness that already exist

XIII. FIDELITY
faithfulness, promises and loyalty
Obligation of an individual to be faithful to
commitments to him/herself and also to
others
Main support for the concept of
accountability
Keeping information confidential and
maintaining privacy and trust

XIV. VERACITY
truthfulness, document accurately
Duty to tell the truth
Fundamental to the development and
continuance of trust among human
beings- truth telling, integrity and honesty
Truth telling
Definition: a nursing intervention from
the Nursing Interventions Classification
(NIC) defined as the use of whole truth,
partial truth, or decision delay to promote
the patients self determination and well
being.

XV. PROFESSIONAL COMMUNICATION
what, when, where, how

XVI. ORDINARY AND EXTRAORDINARY MEANS

Ordinary means or Proportionate means:
Not only food, drink and rest but also
medicines, treatments and operations
which offer a reasonable hope of
benefit for the patient and which 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
expense on the family or the community.
A person has an obligation to use ordinary
or proportionate means of preserving his
or her life.
(NCCB, Ethical and Religious Directives,
1995)


Extra ordinary means or Disproportionate means
When the means used do not offer a
reasonable hope of any notable benefit to
the patient
Disproportionate means are those that in
the patients judgment do not offer a
reasonable hope of benefit or entail an
excessive burden, or impose excessive
expense on the family or the community.
A person may forego extraordinary or
disproportionate means of preserving life.
(NCCB, Ethical and Religious Directives,
1995)


Euthanasia
confronts life
advances & favors death
helps to die
shortens, reduces life
KILLS

Passive Euthanasia refraining of any medical
treatment aimed at retarding death
Active Euthanasia terminating a persons life
in a painless way, at his request & with the
intention to prevent person from suffering.

Dysthanasia
confronts death
delays death making dying difficult
prolongs, extends, lengthens life
does not allow to die, stops death

Orthothanasia
neither advances nor delays death
it helps while dying
neither shortens nor lengthen life
neither confronts life nor fights for it
DOES NOT KILL.. IT ALLOWS TO DIE
death in its due time
normal process of death
letting the incurably diseased person die
his own death while making no extra
efforts to prolong his life.

Criteria for CESSATION OF BRAIN FUNCTION include
irreversible coma
no spontaneous respiration and no
response to apnea test for 6minutes
absence of the following brain stem
reflexes: pupillary, corneal, gag and
caloric test
Death & Advance refusals of Treatment
Apparent Death the cessation of life as
indicated by the absence of all vital
functions
Legal Death the total absence of activity
in the brain and central nervous system,
the cardiovascular system, & the
respiratory system as observed and
declared by a physician.

HARVARD CRITERIA
1. UNRECEPTIVE, UNRSPONSIVE
2. ABSENCE OF SPONTANEOUS MOVTS AND
BREATHING
3. ABSENT REFLEXES, FIXED, DILATED PUPILS


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4. PERSISTENT ISOELECTRIC EEG
5. IN THE ABSENCE OF INTOXICATION OR
HYPOTHERMIA, THESE FINDINGS PERSIST
OVER 24 HRS
Irreversibility is recognized when evaluation
discloses that:
The cause of coma is established and is sufficient to
account for the loss of brain functions
The possibility of recovery of any brain function is
excluded
The cessation of all brain functions persist for at least
24hours of observation and therapy

Nurses role & responsibilities
Advance Directives
o an advance declaration by a
person of treatment preferences if
he or she is unable to
communicate his or her wishes.
Living Will
Durable power of attorney for health
Health care proxy

Do not resuscitate orders
1. Specify the exact nature of the treatment to be
withdrawn or withheld.
2. DOCUMENT the exact justification for the decision
3. Recognize that the DNR does not mean that the
patient may be medically or emotionally
abandoned.
XVII. PRINCIPLE OF SUBSIDIARITY
Human communities exist only to promote and share
the common good among all their members from
each according to ability, to each according to need
in such a way that:
1. Decision making rests vertically first with the
person then with the lower social levels and
horizontally with the functional social levels
2. The higher social needs intervene only to
supply the lower units what they cannot
achieve by themselves while at the same time
working to make it easier for lower units and
individuals to satisfy these needs by their own
efforts.
XVIII. PRINCIPLE OF PERSONALIZED SEXUALITY
The gift of sexuality must be used in
keeping with intrinsic, indivisible,
specifically human teleology. It must be a
loving, pleasurable, expression of the
complementary, permanent self giving of
a man and a woman to each other which is
open to fruition in the perpetuation and
expansion of this personal communion
through the family they responsibly beget
and educate
BASIC CONCEPTS/VALUES RECOGNIZED IN
SEXUALITY
sex is a search for sensual pleasure &
satisfaction, releasing physical & psychic
tensions
sexuality = male and female = genitals
(with natural tendencies)
sex is a search for the completion of the
human person through an intimate
personal union of love expressed by
bodily union
sex is a social necessarily for the
procreation of children
sex is symbolic mystery, somehow
revealing the cosmic order

Key points:
Sex is not always a proof of love, although
often is demanded as such
There is inseparable connection established by
God, which man in his own initiative may not
break, between the (1) unitive significance
and the (2) procreative significance, both
inherent to marriage act.
any use of sex outside marriage is ethically
wrong because

1. It is selfish pursuit of pleasure apart from
love
= masturbation, prostitution, casual or
promiscuous relations
2. It expresses love, but not a committed love
involving true self giving
= adultery or premarital sex
3. It is committed but practiced in a way
contradictory to it natural fulfillment in the
family
= use of artificial contraceptive
methods, relations of committed homosexuals

CHARACTERISTICS OF MARRIED LOVE
1. HUMAN
2. TOTAL
3. FAITHFUL & EXCLUSIVE
4. FRUITFUL

Abortion
The spontaneous or induced termination
of pregnancy before the fetus has
developed to the stage of viability.

TYPES OF ABORTION
1. SPONTANEOUS
2. INDUCED

INDUCED ABORTION TECHNIQUES
1. Abortion by dilatation and curettage (7-
12wks AOG)
2. Abortion by CS or abdominal
Hysterectomy
3. Abortion by Suction (before 3-4months or
12-16wks)


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4. Via Intra- amniotic infiltration (before 3-
4months or 12-
16weeks)
5. Via injection of Prostaglandin
RU 486 Contraceptive pill associated
with
Prostaglandin

ARGUMENTS: CONTRA-ABORTION
1. Not firmly a choice between a mother only
or to the child only but must center on saving both
lives.
2. Unselfish love and solitude to an innocent
creature
3. Complementary roles between man and
woman
4. It has genetic code totally different from the
cells of the parents

ARGUMENTS: PRO ABORTION
1. To safeguard the life of the mother
2. Abortion as a womans right
3. Abortion as an expression of womans
sexual freedom
4. The fetus is not a human

LEGAL, MORAL & ETHICAL CONSIDERATIONS

Article 2, Sec 12 of the 1986 Const.
-provides that the state recognizes and
strengthen the family as a basic autonomous social
institution. It shall equally protect the life of the
mother and the life of the unborn from conception

3 TYPES OF ART
1. IVF- IN VITRO FERTILIZATION
2. GIFT Gamete Intra- fallopian Transfer
3. ZIFT Zygote Intra- Fallopian Transfer

METHODS OF CONTRACEPTION

1. Folk methods
- Pre coital/ post coital douche using vinegar
- Prolonged lactation
- Coitus interruptus and coitus reservatus

2. Mechanical methods
- condom and diaphragm

3. Chemical Methods
- Vaginal suppository, vaginal tablets, vaginal
jellies, creams and foams

4. Hormonal Methods
- Contraceptive pills, injections and implants