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Isip, Erwin Gabriel C.

BS MD: 3Y1-1

I. Basic Ethical Principles - Ethical principles provide a generalized framework within which ethical dilemmas may be
analyzed, these principles can provide guidance in resolving ethical issues that codes of ethics may not necessarily
provide. If basic moral teachings dont always provide obvious answers in the most unusual medical cases, they at least
orient us toward making ethical decisions based on a clear set of values.
a) Stewardship
This principle is grounded in the presupposition that God has absolute Dominion over creation, and that, insofar as human
beings are made in Gods image and likeness (Imago Dei), we have been given a limited dominion over creation and are
responsible for its care. The principle requires that the gifts of human life and its natural environment be used with profound
respect for their intrinsic ends. Accordingly, simply because something can be done does not necessarily mean that it should
be done (the fallacy of the technological imperative). As applied to Catholic-sponsored health care, the principle of
stewardship includes but is not reducible to concern for scarce resources; rather, it also implies a responsibility to see that
the mission of Catholic health care is carried out as ministry with its commitment to human dignity and the common good.
b) Totality
These principles dictate that the well-being of the whole person must be considered in deciding about any therapeutic
intervention or use of technology. Integrity refers to everyones duty to preserve a view of the whole human person in which
the values of the intellect, will, conscience, and fraternity are pre-eminent. 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.
c) Double Effect
An action that is good that has two effects--an intended and otherwise not reasonably attainable good effect, and an
unintended yet foreseen evil effectis licit, provided there is a due proportion between the intended good and the permitted
evil. When there is a clash between the two universal norms of "do good" and "avoid evil," the question arises as to whether
the obligation to avoid evil requires one to abstain from good action to prevent a foreseen but merely permitted concomitant
evil effect. The answer is that one need not always abstain from a good action that has foreseen bad effects, depending on
certain moral criteria identified in the principle of double effect.
1. The object of the act must not be intrinsically contradictory to one's fundamental commitment to God and neighbor
(including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not
be intrinsically evil).
2. The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects
as far as possible, that is, one must only indirectly intend the harm.
3. The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other
means of achieving those effects are available.
4. The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate
5. The beneficial effects must follow from the action at least as immediately as dote harmful effects.

d) Cooperation
Along with the principles of double effect and toleration, the principles of cooperation were developed in the Catholic moral
tradition as a way of helping individuals discern how to properly avoid, limit, or distance themselves from evil (especially
intrinsic evil) to avoid a worse evil or to achieve an important good. In more recent years, the principles of cooperation have
been applied to organizations or corporate persons (the implication being that organizations, like individual persons, are
moral agents). Like the principle of double effect and some other moral principles, the principles of cooperation are a
constellation of moral criteria:

1. Formal Cooperation.
Formal cooperation occurs when a person or organization freely participates in the action(s) of a principal agent, or shares
in the agents intention, either for its own sake or to some other goal. Implicit formal cooperation occurs when, even though
the cooperator denies intending the object of the principal agent, the cooperating person or organization participates in the
action directly and in such a way that it could not be done without this participation. Formal cooperation in intrinsically evil
actions, either explicitly or implicitly, is morally illicit.

2. Immediate Material Cooperation.

Immediate material cooperation occurs when the cooperator participates in circumstances that are essential to the
commission of an act, such that the act could not occur without this participation. Immediate material cooperation in
intrinsically evil actions is morally illicit. There has been in the tradition a debate about the permissibility of immediate
cooperation in immoral acts under "duress." When individuals are forced under duress (e.g., at gunpoint) to cooperate in
the intrinsically evil action of another, they act with diminished freedom. Following Church teaching, the matter of their action
remains objectively evil, but they do not intend this object with true freedom. In such cases, the matter remains objectively
evil as such, but the subjective culpability of the cooperator is diminished. Very recently, the Vatican has rejected the
arguments of those who would apply this concept of duress to Catholic organizations to justify their immediate material
involvement in certain objectionable actions.

II. Major Bioethical Principles

1. Respect for a Person
Respect for persons is the concept that all people deserve the right to fully exercise their autonomy. Any notion of moral
decision making assumes that rational agents are involved in making informed and voluntary decisions. In health care
decisions, our respect for the autonomy of the patient would, in common parlance, mean that the patient has the capacity
to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary
act. This principle is the basis for the practice of informed consent.

2. Importance of free & informed consent

The concept of consent arises from the ethical principle of patient autonomy and basic human rights. Patient's has all the
freedom to decide what should or should not happen to his/her body and to gather information before undergoing a
test/procedure/surgery. No one else has the right to coerce the patient to act in a way. Even a doctor can only act as a
facilitator in patient's decision making. Personal liberty of action in which the individual determines his/her own course of
action in accordance with a plan chosen by him/herself; self-determination. Implies independence and self-reliance, freedom
of choice, and ability to make decisions.
a) Patients right to information
The basis of this code is the Hippocratic Oath by which physicians are obliged to act always for the benefit of their patients.
The right to information can be understood as the updating of a partial aspect of this obligation. Citizens' interest in receiving
information on their own conditions arose from the demands of groups of AIDS patients, and was later extended to all layers
of society. The right to information is dealt with in a similar way in all the codes. The Catalan case can serve as an example:
Art. 22 Doctors are obliged to give patients as much information as possible on their state of health, the steps taken in the
diagnosis, the complementary investigations and the treatments. The information must be given in an understandable way
and exercising caution.
b) Proxy Consent
Whenever possible, informed consent on the part of the subject is ethically and legally necessary for every medical treatment
and research project. Sometimes, however, the subject is not able to give consent. For example, an aged person in a coma,
a two-month old child, or a fetus in the womb cannot perform the rational act necessary for informed consent even though
he or she may require some medical treatment. In such cases, another person is called upon to offer consent: this is called
proxy or vicarious consent. Proxy consent is not a subspecies of informed consent, rather it is a substitute for informed
consent and is sought when acquiring informed consent is impossible. For the ethical and legal use of proxy consent, two
conditions must be present: (1) the patient or research subject cannot offer informed consent; (2) the person offering the
consent ought to determine what the incompetent person would have decided where he or she able to make the ethical
decision. Decisions of proxy consent should be made in view of the good of the individual patient, not for the higher good
of society, nor for a class good, because this would amount to manipulation of the person. When deciding upon the treatment
for a comatose person dying of cancer, for example, the proxy must seek to determine what the patient would decide if able
to make the decision. What would benefit people other than the patient should not be considered unless it can be assumed
reasonably that this would have been the consideration of the person who is the patient.

3. Principles of Justice

Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "Giving toeach that which is his due."
This implies the fair distribution of goods in society and requires that we look at the role of entitlement. The question of
distributive justice also seems to hinge on thefact that some goods and services are in short supply, there is not enough to
go around, thussome
fair means of allocating scarce resources must be determined.