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BIOETHICS
-Circa 1977-present some of the greatest
advances were made
TRADITIONAL ETHICAL THEORIES
DEONTOLOGY
-duty based ethics
-Immanuel
- derives the rightness or
Kant
wrongness of one's
CATEGOR
conduct from the
ICAL
character of the
IMPERATIV
behaviour itself rather
E
than the outcomes of the
-John Rawl
conduct

- judges the morality of

ORIGINAL
an action based on the
POSITION
action's adherence to a
rule or rules
-GOAL: fulfillment of
ones duties or the
carrying out of
obligations without
regard to ones desire
-CONS: suspicious of
desire or happiness as a
guide to moral action
-seeks basis for duties
PRIORI PRINCIPLE
(need to appeal to ones
experience)
CONSEQUENT
-actions are good and
IALISM
bad based upon their
UTILITARIA
consequences
NISM (we
-a morally right act (or
need to
omission) is one that will
take the
produce a good outcome,
actions that
or consequence
generally
-CONS: we only come to
lead to
know the normal effects
happiness
of actions through
or pleasure)
experience
-JOHN
-Choose the action that
STUART
is likely to produce the
MILL &
greatest good for the
JEREMY
greatest number.
BENTHAM
VIRTUE
- describes the character
ETHICS
of a moral agent as a
ARISTOTLE
driving force for ethical
-THOMAS
behavior, rather than
AQUINAS
rules
(deontology), consequent
ialism(which derives
rightness or wrongness
from the outcome of the
act itself rather than
character), or social
context (pragmatic
ethics)
-particular actions are so
variable that they require
a good deal of
judgement, not inflexible
rules

NOTE: The difference between these four

approaches to morality tends to lie more in the
way moral dilemmas are approached than in the
moral conclusions reached. For example, a
consequentialist may argue that lying is wrong
because of the negative consequences produced

by lying though a consequentialist may allow

that certain foreseeable consequences might
make lying acceptable. A deontologist might
argue that lying is always wrong, regardless of
any potential "good" that might come from lying.
A virtue ethicist, however, would focus less on
lying in any particular instance and instead
consider what a decision to tell a lie or not tell a
lie said about one's character and moral behavior.
As such, lying would be made in a case-by-case
basis that would be based on factors such as
personal benefit, group benefit, and intentions (as
to whether they are benevolent or malevolent).
FOUR PRINCIPLE
PRINCIPLISM

CAUSISTRY

COMMUNITARIAN
BIOETHICS

3 APPROACHES
-doing medical ethics is a
balancing 4 principle of
beneficence, non-maleficence,

-case based reasoning

-applying role specific mora
circumstance of a particular ca
-more emphasis on how impo
particular circumstances are fo
resolution of problematic cases
-circumstances make t
(people experience will have
principle or resolution sugges
case it self
-paradigm cases
-method
in
applied
et
jurisprudence
-rule-based reasoning
-offshoot of a larger political
movement
pioneered
by
Macintyre,
Micheal
San
Charles Taylor
-US is a pluralistic society in
values are shared.

CONSCIENCE
Judges the complete act as good or bad
Moral faculty which tells people
subjectively what is good or evil and which
manifest their moral obligation to them
LEVELS OF CONSCIENCE

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LEVEL
1

LEVEL
2

Level
3

-a
characteristic

-A process

-An event

-Basic sense of responsibility

that characterizes the human
person
-General sense of value
-awareness of personal
responsibility; To be
accountable
-First principle of moral
order: DO GOOD AVOID
EVIL
-all humans shares a sense of
goodness and badness of their
deeds
-infallible
- Exercise of moral reasoning
-formation of conscience
-deals with specific perception
values, concrete individual
values.
-it needs to be educated,
formed, guided, directed,
illuminated and assisted
-kneels before truth
-truth is supreme; truth
is the object which is
sought
-Church has the greatest role
as a teacher of moral values
-Led us to analyze and
understand our situation in a
particular way
-fallible/absolute
-Steps:
1. Gather information
2. Form morally certain
judgment
3. Act accordingly
4. Accept responsibility for
action
-Judgment by which we
evaluate a particular action
-defined as an ultimate
practical judgment on the
morality of a concrete action
-commanding to do good and
avoid evil
-infallible (not absolute)
-constitute the final norm by
which a persons action must
be guided.

STAGES IN DEVELOPMENT OF CONSCIENCE

AUTHORITARIAN CONSCIENCE
conscience in childhood; mustconscience
MATURE (ADULT) CONSCIENCE ought
conscience; no longer sustained by fear
of punishment and mental limitation;
originate from the conviction of the inner
value of the moral obligation from the
inner law of mans nature and divine
calling as spelled out in the center of the
human person which is true self; personal
responsibility

SIX STAGES OF MORAL DEVELOPMENT

(KOHLBERG):
LEVEL 1:
PRECONVENTIONAL STAGE

STAGE 1: Obedience and

Punishment Orientation

STAGE 2: Naively Egoist

Orientation

LEVEL 2: CONVENTIONAL STAGE

STAGE 3: Good boy orie

STAGE 4: Authority and

order

STAGE 5: Contractual
Legalistic orientation

STAGE 6: Conscience of
principle orientation

DIVISION OF CONSCIENCE
I.
ANTECEDENT OR CONSEQUENT
ANTEDECENT Before the action;
judgment on the morality of an action
and the obligation to perform or omit is
passed before the action is translated to
reality; commands, forbids, permits,
exhorts
CONSEQUENT After the action;
evaluates deed done; approves,
excuses, reproves, accuses
II.

CERTAIN OR DOUBTFUL
CERTAIN CONSCIENCE - Judgment
without fear or error; all reasonably fear
be excluded; must always be obeyed
when it commands or forbids; wide
moral certainty is sufficient
(accompanied by slight yet negligible
fear of error because the possibility of
error is of little probability; example:
assumption that physician will act
responsibly)
DOUBTFUL CONSCIENCE Uncertain
concerning the morality of an action;
suspends judgment; passes judgment
with reasonable fear for erring.

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III.

RIGHT OR ERRONEOUS
ERRONEOUS CONSCIENCE
A. INVINCIBLY ERRONEOUS
CONSCIENCE inculpable (guiltless);
person has no awareness of the
possibility error; honest mistake
B. VINCIBLY ERRONEOUS
CONSCIENCE Culpable; with some
good will its errors could be corrected;
full accountability; cannot be followed
as a legitimate rule of action
C. LAX CONSCIENCE judges
something sinful to be lawful; does not
face up the gravity of the moral
situation; needs to reform their state of
mind; a wrongful act becomes normal
D. PERPLEXED CONSCIENCE
confronted with 2 alternative precepts;
fear sin in whatever choice it makes;
choose the lesser evil
E. SCRUPULOUS CONSCIENCE
constant dread of sin where there is
none; very strong super ego; OCD

MORALITY OF HUMAN ACTS

HUMAN ACT outward expression of a persons
choice
- proceed from insight into the
nature and purpose of ones doing and from
consent free will
- Needs 2 constituent: knowledge
(intellectual constituent) & free-will (freedom
from external or internal compulsion)
ACT OF MAN
- performed without
intervention of intellect and free will

DIVISION OF THE VOLUNTARY ACT AND

EFFECT
I. VOLUNTARY ACT
A. PERFECTLY VOLUNTARY performed
with full attention (knowledge) and full
consent (free will)
B. IMPERFECTLY VOLUNTARY attention
or consent of will is both imperfect
II.

VOLUNTARY EFFECT
A. DIRECTLY VOLUNTARY It is intended
in itself as an end; example: murder for
the sake of revenge
B. INDIRECTLY VOLUNTARY results are
not intended; inevitable result of an
object direct willed; example:
medications side effect
C. POSITIVELY VOLUNTARY Exercising
active influence on the causation of an
object; caused intentionally

D. NEGATIVELY VOLUNTARY voluntary

omission of an act which could have
averted an evil from another person;
permitted
OBSTACLES OF HUMAN ACT
A. IMPAIRMENT OF REQUIRED KNOWLEDGE
1. IGNORANCE
a. INVINCIBLE IGNORANCE cannot be
corrected by reasonable diligence;
prevents the act from being voluntary in
regard to that which is not known.
b. VINCIBLE could be corrected by
reasonable diligence; possibility of
solving the doubt by means of inquiry
2. ERROR deficient education, influence of
bad company, reading misleading papers;
overcome by sound reason
3. INATTENTION actual and momentary
privation of knowledge
B. IMPAIRMENT OF FREE CONSENT
1. PASSION/CONSCUPISCENCE hinders
reflection; weakens attention; feelings
2. FEAR & SOCIAL PRESSURE moral force
against will; lessens guilt as well as its
merit
3. VIOLENCE compulsive force by intrinsic
agent
4. DISPOSITION AND HABIT incline man
to certain ways of reaction conduct; habits
weakens the intellect and will in concrete
situation
CASE 1: A first year med student who always
receives excellent grades gets a GWA of 77% and
she commits suicide.
- Human act; imperfectly voluntary;
impairment of free will;
passion(overwhelming emotion:
depression)
CASE 2: A resident assists in fallopian tube
ligation on a single prostitute because he may
lose his job if he refuses to assist (Under natural
law ethics it is immoral; supposing that the
physician believes in the natural law ethics)
-

Human act; imperfectly voluntary;

impairment of freewill; pressure (pressure
of losing his job)

CASE 3: Maria salivates and feels like eating

whenever she sees a beautifully decorated cake
- Act of man; spontaneous biological
SOURCES DEFINING MORALITY OF HUMAN
ACT
OBJECT

-action

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-primary source for judgment

on4:
theRemoval
morality of
act
CASE
of an
a pregnant
cancerous uterus
-can be morally good, evil
or the
indifferent
when
treat is the best recommended
-morally evil: presupposes
the existence
of spread of cancer.
treatment
to avoid
of action w/c on account-Action:
on their object
are considered
absolutely
and
Removal
of (a pregnant
cancerous)
uterus
intrinsically evil)
= Good
INTENTION
CIRCUMSTANCES

I.

-Intention: to avoid spread of cancer = good

-Goal
-Circumstances: pregnant cancerous uterus
-the end or the reason for w/c
the agent undertaken an act
=Proportionate
-situation
-Circumstances: Best recommended treatment
-particulars of the concrete
human
act which
are not necessarily
-Non
violation
of Principle
of Double Effect
connected with its object
-who? What? When? Why? How? What means?

FOUR PRINCIPLES
BENEFICENCE
Obligation to do good
Latin word: Bene good
Always goes along with non maleficence
NONMALIFICENCE
We ought not to inflict evil or harm; do no
harm

PRINCIPLE OF LEGITIMATE COOPERATION

-Act is performed by more than one person

1. FORMAL COOPERATION person is mainly

responsible for performing the evil action;
advises, encourage, or counsels the person
principally responsible for the evil action
II.
2. MATERIAL COOPERATION One becomes

involved in an action without the same

intention of the evil doer
a. IMMEDIATE ones action contributes to
PRINCIPLE OF DOUBLE EFFECT
the active performance of the evil action
Provides that a person may perform an act
so that the evil action could not be done
which has risks or evil effect. Four
without his help; example: Nurse who
conditions:
assisted the doctor perform abortion
1. The action itself is good or indifferent
b. MEDIATE Ones cooperation is not
2. The good effect and not the evil effect is the one directly intended by the
agent in the performance of the evil
needed
3. The good effect is not produced by means of evil effect. Good effect must follow the action at
action but may assist in the performance
least as immediately as the harmful effect
4. Theres a proportionate reason for permitting the foreseen evil to occur of an action; example: the pt who
undergone abortion was transferred to
ward, and the nurse is attending to her
CASE 1: Giving sedative or analgesic to alleviate
needs, making sure that she is
pain to a dying patient even if it may shorten the
comfortable(but she has no intention in
patients life
participating in the abortion procedure)
-Action: Giving sedative/analgesic = Good
-Intention: To alleviate pain = Good
III.
AUTONOMY
-Circumstances: dying patient = Proportionate

Latin: auto self

-Possible Effect: May shorten the life of the patient
Obligation to respect the decision
-Non Violation of Principle Double effect
making capacity of autonomous person
Why? To dignify human
CASE 2: Giving morphine overdose to kill the
Concept of independence
suffering of terminally ill patient upon his request.
-Action: Giving of morphine overdose = Bad
Gave birth to : INFORMED CONSENT
-Intention: to kill = Bad
Autonomy vs. Nonmaleficence =
-Circumstances: Suffering terminally ill patient =
NONMALEFICENCE
not proportionate
Your right is limited by the right of other
-Circumstances: upon patients request
people
-Violation of Principle double effect
IV.
JUSTICE
CASE 3: Performing an abortion to unmarried
Giving what is due
rape victim to prevent psychological trauma
Obligation of fairness in distribution of
-Action: Performing an abortion = Bad
benefits and risk
-Intention: Prevent psychological trauma = Good
-Circumstances: Unmarried rape victim = Not
MIDTERM TOPICS:
Proportionate
-Violation of Principle of double effect
TRUTH TELLING & CONFIDENTIALITY

Patients right to the Truth

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Patient-physician relationship basis for medical

practice
INFORMED CONSENT
Rights moral & inviolable power vested in the
patient as a person in do, hold or demand
something as his own
Duty moral obligation to do or omit something
in favour of another according to the demands of
strict justice
TYPES OF PATIENTS RIGHTS
Right of Self Determination (Principle of
Autonomy) moral right to determine what is
good for himself
1. Right to informed consent receive all
necessary info
Informed Consent willing and
uncoerced acceptance of a medical
intervention by a patient after adequate
disclosure by the health professional;
knowledge of information about the
consent to a particular form of medical
treatment before it is administered
2. Right to informed decision
Informed Decision necessary info and
decision of a medical treatment before it is
administered
3. Right to informed choice
Informed Choice necessary info a
patient should know about a medical
treatment or experiment so that moral
choice can be made
4. Right to refusal of treatment
ELEMENTS OF INFORMED CONSENT
a. Disclosure content of what a patient is
told or informed about during the consent
negotiation
General Standards of Adequate Disclosure:
1. Professional Practice Standard
necessary info to disclose
2. Reasonable Person Standard patientcentered
3. Subjective Standard what the patient
needs to know
Necessary Items to Disclose:
1. Current medical status, treatment
2. Procedure, medication
3. Alternative treatment
4. Risks and benefits
5. Opportunity to ask questions
6. Right to withdraw (research)
7. Professional opinion
Situation When Telling Part of the Truth or
Delaying is Allowed:
1. Physicians therapeutic privilege

Research
o Randomized clinical trials
o Research in psychosis
o Placebo
b. Comprehension if it is understood
c. Voluntariness
d. Competence capacity to make a
decision
Limits of Patients Rights:
1. Do not include the right to die
2. Moribund condition
3. Not absolute
Methods of Obtaining Informed Consent
1. Written
2. Verbal
Emergency Situations: Consent not
Required
1. Comatose/obtunded patients
2. Blind/illiterate patients
3. Underage/unable to understand the
circumstance
4. Language-barrier patients
Implied/presumed Consent
Surrogate Consent

ALLOCATION OF SCARCE RESOURCES

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HUMAN SEXUALITY
ABORTION
Abortion expulsion of a non-violable fetus
before the 28th week of gestation
Forms:
(Medical Standpoint)
1. Spontaneous, accidental or involuntary
abortion
- No moral problem
2. Induced abortion
3. Therapeutic Abortion aims to eliminate a
real or presumed risk for the mother
precipitated by pregnancy
(Legal Standpoint)
1. Criminal Abortion
(Moral Standpoint)
1. Direct
- Principal end
- Includes all types of abortion
- Sought as an end or as a means to an end
2. Indirect
- Not wanted nor sought directly

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Consequence of an operation intended to

cure a gynaecological lesion, independent
of pregnancy

Techniques of Induced Abortion

1. By dilatation & curettage abortive
techniques of long standing; utilizing a carved
blade introduced though the vagina into a
previously dilated cervix until it reaches the
endometrial wall; endometrium is scraped
carefully until all fetal remain and placental
tissues are remived
2. By caesarean section or by abdominal
hysterectomy
3. By suction technique
4. Via intra-amniotic infiltration carries a risk of
uterine perforation
5. Via intravenous infusion of prostaglandin
GENETICS
DEATH & DYING
AIDS
PSYCHIATRY

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