The Four Principles

When it comes to ethics in the healthcare word, we need to know the most important
principles or what we called pillars of ethics. These are based upon basic "Prima Facie"
moral commitments. Provides a simple and culturally neutral approach to ethical issues
in clinical practice. Aids health care workers in indecision making when reflecting on moral
issues that arise in the workplace
• Autonomy
Requires that the patient have autonomy of thought, intention, and action when
making decisions regarding health care procedures. Therefore, the decision-
making process must be free of coercion or coaxing. In order for a patient to make
a fully informed decision, she/he must understand all risks and benefits of the
procedure and the likelihood of success. Because ARTs are highly technical and
may involve high emotions, it is difficult to expect patients to be operating under
fully-informed consent.
• Justice
The idea that the burdens and benefits of new or experimental treatments must be
distributed equally among all groups in society. Requires that procedures uphold
the spirit of existing laws and are fair to all players involved. The health care
provider must consider four main areas when evaluating justice: fair distribution of
scarce resources, competing needs, rights and obligations, and potential conflicts
with established legislation. Reproductive technologies create ethical dilemmas
because treatment is not equally available to all people.
• Beneficence

Requires that the procedure be provided with the intent of doing good for the
patient involved. Demands that health care providers develop and maintain skills
and knowledge, continually update training, consider individual circumstances of
all patients, and strive for net benefit.

• Non-maleficence
Requires that a procedure does not harm the patient involved or others in society.
Infertility specialists operate under the assumption that they are doing no harm or
at least minimizing harm by pursuing the greater good. However, because
assistive reproductive technologies have limited success rates uncertain overall
outcomes, the emotional state of the patient may be impacted negatively. In some
cases, it is difficult for doctors to successfully apply the do no harm principle.
Defining Humanhood and explaining the Human Needs

When things get really tough in life, we have this deep urge to cut everything back to the
bare essentials. Tiny houses, minimalism, less-is-more, back-to-basics - these are all
strategies to make sure that we are getting our most basic needs met on a daily basis
without getting distracted by the shiny objects in life.

• Food - The body needs calories and a variety of nutrients including protein, fat,
and carbohydrates every day to grow, function, and repair. Without food, the body
begins to atrophy.
• Water - Ample hydration allows for the processes of the body to occur. Without
water the body cannot process food or remove wastes.
• Shelter - We require protection from blazing sun, freezing temperatures, wind, and
rain. Without shelter, human skin and organs are damaged from extreme
temperatures
• Sleep - 6–9 hours of sleep every 24 hours allows the brain to process new
knowledge and deal with emotional information. Without ample sleep we cannot
learn new things or get past emotional pain
• Sleep - 6–9 hours of sleep every 24 hours allows the brain to process new
knowledge and deal with emotional information. Without ample sleep we cannot
learn new things or get past emotional pain.
• Others - Adults require connection (physical or emotional) with other humans to
release certain hormones like oxytocin. Human touch is so important that when we
are young, our brains don’t develop correctly without it. Regular connection to
others allows us to maintain a sense of well-being that allows for self-care.
• Novelty - Novelty creates the opportunity to learn and the potential to fail, which
stimulates dopamine release in the brain. Without regular novelty, motivation
wanes and a healthy sense of well-being is lost.

These 6 needs, when met, allow for a person to develop the self-esteem, security,
belonging, actualization, and the other expressions of contentedness that Maslow
described. Maslow’s list came from what he saw in successful and happy people versus
those who were not as contented or accomplished. He was the first to study contented
humans. Prior to Maslow’s work, Psychology focused on people who were described as
mentally ill.
Differentiate Human Acts with Acts of Human
“A human act is one that proceeds from knowledge and free will.” A human act is
something a person does voluntarily; act of free will. Human acts are acting that people
do not do automatically without thinking. An example of one would be a student
going to school daily knowing how important education is to his or her future. While
a human act is something you do voluntarily, acts of man are acts that people
perform without considering the possible effects to his or her life, good or bad. This
is something done involuntarily. An example is blinking our eyes every few seconds
or so.

Differentiate values, morals, and ethics.

What are the differences between values, morals and ethics? They all provide behavioral
rules, after all. It may seem like splitting hairs, but the differences can be important when
persuading others.

• Values - According to the dictionary, values are “things that have an intrinsic
worth in usefulness or importance to the possessor,” or “principles, standards, or
qualities considered worthwhile or desirable.” However, it is important to note that,
although we may tend to think of a value as something good, virtually all values
are morally relative – neutral, really – until they are qualified by asking, “How is it
good?” or “Good to whom?” The “good” can sometimes be just a matter of opinion
or taste, or driven by culture, religion, habit, circumstance, or environment,
etc. Again, almost all values are relative. The exception, of course, is the value
of life. Life is a universal, objective value. We might take this point for granted, but
we all have the life value, or we would not be alive. Life is also a dual value – we
value our own life and the lives of others.

• Morals - are relative values that protect life and are respectful of the dual life
value of self and others. The great moral values, such as truth, freedom, charity,
etc., have one thing in common. When they are functioning correctly, they are life
protecting or life enhancing for all. But they are still relative values. Our relative
moral values must be constantly examined to make sure that they are always
performing their life-protecting mission. Even the Marine Corps core values of
“honor, courage and commitment” require examination in this context. Courage
can become foolish martyrdom, commitment can become irrational fanaticism,
honor can become self-righteousness, conceit, and disrespect for others. Our
enemies have their own standard of honor, they have courage, and they are
surely committed. What sets us apart? Respect for the universal life value sets us
apart from our enemies.

• Ethics - A person who knows the difference between right and wrong and
chooses right is moral. A person whose morality is reflected in his willingness to
 do the right thing – even if it is hard or dangerous – is ethical. Ethics are moral
values in action. Being ethical id an imperative because morality protects life and
is respectful of others – all others. It is a lifestyle that is consistent with mankind’s
universal values as articulated by the American Founding Fathers – human
equality and the inalienable right to life. As warriors it is our duty to be protectors
and defenders of the life value and to perform the unique and difficult mission of
taking the lives of those acting immorally (against life) when necessary to protect
the lives of innocent others.

Virtues of the Health Care Professionals

• Fidelity- Faithful devotion duty.
• Honesty- Essential part of behaving with decency and professional integrity.
• Integrity- It is important in healthcare records and documentation because it
provide accuracy and completeness of work
• Humility- Willingness to assess oneself and one’s limitations, the ability to
acknowledge gaps in one’s knowledge, and openness to new ideas.
• Respect- Being considerate. Discrimination should be avoided, should be
culturally sensitive to the ethnic or racial backgrounds.
• Compassion- Ability of the healthcare practitioner to actively and deeply imagine
the suffering of a patient what he or she is going through.
• Prudence- making the best use of resources to give the best possible quality and
quantity of care for patients.
• Courage- Require a healthcare practitioner to have a strong will to do his tasks.
• Truth- The candid disclosure and discussion of information not only helps patients
to understand and deal with what is happening to them, but also fosters and helps
to maintain trust
• Love- It is needed to be able to have deep communication for the patients.
• Faith – Healthcare Practitioners should balance their care to their patients, having
also spiritual care which involves serving the whole person which means serving
physically, emotionally, socially, and spiritually.
• Hard Work- Requires self-discipline and effort. It is a strong challenge but most of
the time it gives best results.
• Social Justice- Is the equal distribution of resources among the people that need
the resources.
Components of the Therapeutic Interaction
There are many skills to learn when studying to become a nurse. One of the most
important skills is how to create a therapeutic relationship and interaction with patients.
To do this, a nurse must master a few key components
Trust and Respect - As a nurse, you should introduce yourself to your patients and refer
to the patient by name. These seemingly small gestures display an air of friendliness,
caring, and approachability, which can go a long way toward making a patient feel safe.
When you maintain eye contact with a patient, you continue to foster trust and respect as
your relationship progresses. It's also important to respect a patient's boundaries. Some
patients feel comforted when their hand is held or they are offered a hug, while other
patients may find these actions uncomfortable. Always respect differences in personality
and cultures.
Genuine Interest - the patient's life and situation is another way to encourage a
therapeutic nurse-patient relationship. This can be accomplished by taking a few minutes
to build rapport with a patient. It's also supported when you actively listen to a patient. For
example, a nurse might say, 'Jane, you mentioned that you're feeling concerned about
what the lab tests might reveal.' By restating a patient's statement, you reassure her that
her concerns have been heard and that you're interested in her well-being.
Empathy- Another component that is essential to a therapeutic nurse-patient relationship.
When a nurse shows empathy, she demonstrates that she understands a patient's
feelings. To effectively show empathy, a nurse must be able to pick up on verbal and non-
verbal cues shared by the patient. For example, if a patient is pacing the floor after
learning that her cancer has spread, a nurse might say, 'Jane, I see you're tense. How
can I help you?'

Members of the Health Care Team

Healthcare is a team effort. Each healthcare provider is like a member of the team with a
special role. Some team members are doctors or technicians who help diagnose disease.
Others are experts who treat disease or care for patients' physical and emotional needs.
In this part of the tutorial you will learn about different types of healthcare providers, their
jobs and role on the healthcare team. You will also learn who the team members are for
patients with different chronic diseases. Healthcare team members we will look at include:

• Doctors - Doctors, or physicians, are key members of the healthcare team. They
have years of education and training. They may be primary care doctors or
specialists.

 Primary care doctors

When patients need medical care, they first go to primary care doctors.
Primary care doctors focus on preventive healthcare. This includes
regular check-ups, disease screening tests, immunizations and health
counseling. Primary care doctors may be family practitioners, internal
medicine or Osteopathic Doctors (OD's). Pediatricians also provide
primary care for babies, children and teenagers. Primary care
pediatricians treat day-to-day illnesses and provide preventive care such
as minor injuries, viral infections, immunizations and check-ups.

 Specialists
Specialists diagnose and treat conditions that require a special area of
knowledge. Patients may see a specialist to diagnose or treat a specific
short-term condition or, if they have a chronic disease, they may see a
 specialist on an ongoing basis. Examples of specialties include:
endocrinology, dermatology and obstetrics.

• Physician Assistants (PA's) - Physician's Assistants are licensed to practice

medicine and are supervised by a doctor. Their training is similar to a doctor's but
they do not complete an internship or residency. Like a medical doctor, a
physician's assistant can perform physical exams, order tests, diagnose illnesses
and prescribe medicine, assist in surgery, provide preventive Healthcare
counseling. Education for PA's includes a 4-year degree plus a 2-year Physician
Assistant program.

• Nurses - Nurses work closely with patients. A nurse’s job duties depend on their
education, area of specialty and work setting. Types of nurses include

 Licensed Practical Nurses (LPN)

Are also called Licensed Vocation Nurses. They train for about one year
at a community college or vocational school and are licensed by their
state.

 Registered Nurses (RN’s)

Aare licensed by their state. They may have completed a diploma
program, an associate’s (2-year) degree or a bachelor’s (4-year) degree.

 Advanced Practice Nurses

Are nurses who have more education and experience than RN’s.
Examples of advanced practice nurses are clinical nurse specialists,
nurse anesthetist, nurse midwife and nurse practitioner.

• Pharmacists - Pharmacists give patients medicines that are prescribed, or

recommended, by a doctor. They tell patients how to use medicines and answer
questions about side effects. Sometimes pharmacists help doctors choose which
medicines to give patients and let doctors know if combinations of medicines may
interact and harm patients.

• Dentists - Dentists diagnose and treat problems with teeth and mouth, along with
giving advice and administering care to help prevent future problems. They teach
patients about brushing, flossing, fluoride, and other aspects of dental care. They
treat tooth decay, fill cavities and replace missing teeth.

• Technologist and Technicians - Technologists and technicians have a technical

role in diagnosing or treating disease. They work in a variety of settings. Examples
of technologists and technicians include:

 Laboratory Technologists
 help providers diagnose and treat disease by analyzing body fluids and
cells. They look for bacteria or parasites, analyze chemicals, match
blood for transfusions, or test for drug levels in the blood to see how a
patient is responding to treatment.

 Radiology Technologists
Also called radiographers, help providers diagnose and treat disease by
taking x-rays. For some procedure’s technologists make a solution that
patients drink to help soft body tissues can be seen. Radiology
technologists are can specialize in computed tomography (CT scans),
Magnetic Resonance Imaging (MRI’s) or mammography.

 Pharmacy Technicians
Help pharmacists prepare prescription medications. They also provide
customer service and perform administrative duties such as take
prescription requests, count pills, label bottles and prepare insurance
forms.

• Therapists and Rehabilitation Specialists - Therapists and rehabilitation

specialists help people recover from physical changes caused by a medical
condition, chronic disease or injury. Types of rehabilitation specialists include
physical therapists, occupational therapists and speech therapists.

 Occupational Therapist
help patients perform tasks needed for every-day living or working. They
work with patients who have physical, mental or developmental
disabilities. This includes stroke patients who have lost function on one
side of their body, heart or lung disease patients with activity or breathing
limitations, or diabetes patients who have had a limb amputated.
Occupational therapists help clients find new ways to dress, cook, eat or
work. They may visit patients in their home or workplace to find adaptive
equipment or teach patients new ways to do things.

 Physical Therapist
Help patients when they have an injury, disability or medical condition
that limits their ability to move or function. Physical therapists test a
patient's strength and ability to move and create a treatment plan. The
goal of treatment is to improve mobility, reduce pain, restore function or
prevent further disability. PT's may treat patients who have had an
amputation, stroke, injury or chronic disease.
  Respiratory Therapists Treat and care for patients with breathing
problems. They work with all types of patients including premature abies,
older people with lung disease, or patients with asthma or emphysema.

 Speech Therapists are also called speech-language pathologists.

They work with patients who have problems related to speech,
communication or swallowing. These problems may be caused by
cancer, stroke or brain injury. Speech therapists tailor care plans to each
patient's needs. If a patient has a problem speaking, the therapist may
teach them to use communication devices, sign language or alternative
ways to communicate. For problems swallowing, they may teach
patients to strengthen muscles or new ways to swallow food and liquids
without choking.

• Emotional, Social and Spiritual Support - The team members provide physical
support. There are many healthcare team members who provide emotional, social
and spiritual support.

 Mental Health Professionals

Mental Health Professionals help with the emotional aspect of living with
a chronic disease.

 Psychiatrists
Are medical doctors (MD's) who diagnose and treat mental, emotional
and behavioral disorders. This includes disorders of the brain, nervous
system and drugs or chemical abuse.

 Psychologists
Deal with mental processes, especially during times of stress. They are
not medical doctors, but have a Doctor of Psychology (PsyD) or a doctor
of philosophy degree (PhD). Most psychologists do not prescribe
medicine, but treat patients with counseling and psychotherapy ("talk"
therapy)

 Social Workers
Social workers in a clinical or hospital setting help patients and families
cope with emotional, physical and financial issues related to an illness.
Depending on a patient's need a social worker may help coordinate
services such as housing, transportation, financial assistance, meals,
long-term care, or hospice care. Social workers may also refer patients
to mental health professionals for emotional or substance abuse
support.
  Clergy
Religion or spirituality can be important for people coping with illness.
Members of the clergy such as priests, ministers and rabbis provide
patients with spiritual support. They may listen to patients, counsel them
on religious or spiritual philosophy. They may also perform religious
sacraments or rites such as special blessings, communion or last rights.

• Administrative and Clerical Staff - Administrative and clerical staff coordinate

and facilitate patient care. They schedule appointments, answer phones, greet
patients, keep medical records, handle medical billing, fill out insurance forms,
arrange for laboratory or other diagnostic services, and handle financial records.
Some job titles of administrative or clerical staff include:

 Clinical Coordinator
 Administrative Medical Assistant
 Medical Records Specialist
 Medical Billing Specialist
 Financial Counselor
 Scheduler

• Volunteers - Volunteers are an important part of the healthcare team. The duties
of volunteers can vary widely. Volunteers may have administrative duties and work
in reception areas or gift shops. In a medical office they may file documents,
answer phones, help with health screening or deliver documents to various parts
of the hospital. "Advanced Volunteers" have special training and may work closely
patients under the supervision of a nurse or doctor.
Euthanasia “To Take Away a Life or Not”

The largest topics affecting individuals on a global scale are typically seen across
headlines of every major news source and spur massive debates and opinionated
arguments. However, one of the most controversial topics facing the health industry is not
being given sufficient attention. Euthanasia and Physician-Assisted Suicide (PAS), is a
growing concern for physicians across the globe and not enough participants are
assisting in the search to come up a conclusion on the topic. The plethora of factors to be
taken into consideration while addressing the issue need to be downsized, and the only
proper way to do so is through in-depth research and analysis on a global scale. Through
religion, pain susceptibility, and societal inhibitions, doctors have been working to come
up with a proper way to decipher a patient’s request or need for euthanasia or PAS.

Ethics have become the protagonist, ahead of medical and law issues, in doctors and
governments studies of euthanasia. Surprisingly enough, studies have shown that the
three major religions (Orthodox, Catholic, and Islamic), share the same view on the
subject of euthanasia. The embodiment of their opposition is to preserve the gift and
holiness of life. This is viewed in all major religions as the most important emphasis of the
debate. Although it may seem broad, the Islamic states have taken the biggest lead in
reprimanding euthanasia. Within these, their legislations state euthanasia to be
considered equally punishable to that of committing murder. This charge of murder varies
throughout countries, ranging from lenient forms of murder considered as ordinary
murder, to potential first-degree murder. Thus, these individuals do not even attempt to
justify the need or possibility of such procedure. Bozidar Banovic and Veljko Turanjanin
conducted a study of 55 Muslim physicians that resulted in 98% of them believing that
euthanasia and PAS is a violation of human dignity and they would not be willing to
provide patients with the opportunity (Banovic and Turanjanin, 2014).

The majority of the countries, which view euthanasia’s punishment to be the same as
murder, are of Islamic beliefs. Nevertheless, Western European countries, focusing on
Benelux countries (Netherlands, Belgium and Luxembourg), fall on the opposite side of
the spectrum. They believe that the matter should be handled subjective to the patient’s
ability to meet a certain criterion. There are specific legal rules and medical procedures
that exist in these countries, that serve as a benchmark in deciding the outcome and
viability of euthanasia and PAS. While it remains true that it is possible for euthanasia to
occur, every case is handled medically and legally in order to determine if the procedure
was properly implemented. A physician must meet all the requirements present in the
legal system, in order to justify the procedure and not be reprimanded. In brief, the
permission of euthanasia is granted when the following criteria are met: request originates
from the patient, intolerable pain is present and no way to be facilitated, patient is aware
of their condition, when there are no other medical alternatives, a colleague is consulted
after proper secondary examination, and that it is performed with necessary care. Only
once these are all properly justified, is a physician performing under the legal guidelines
and practicing appropriately (Banovic and Turanjanin, 2014).

While religion plays a big role in the morality of the issue, there are deeper factors needing
to be addressed that can greatly affect the decision to proceed with euthanasia and PAS.
In the article Assisted Dying, author Ray Tallis presents viable justifications spurring from
the patients point-of-view. These factors are immeasurable through medical or legal
studies, however, create one of the biggest arguments. Patients who are exposed to the
possibility of these procedures have a numbered timeline left in their life. The importance
of their view on this issue should be the forefront of the argument. Professor Rob George
conducted a study in Oregon, where he asked questions various patients who had an
assisted death in the year 2012. His results showed that “49% of people who had an
assisted death in 2012 said they didn’t want to be a burden on family, friends, and
caregivers.” Also, 93% were losing autonomy, 89% were being less able to engage in
activities making life enjoyable, and 72% who had lost dignity (Tallis, 2014). Perhaps the
most bone chilling statement made was “‘Suffering’ is a term that goes far beyond pain
control alone” (Tallis, 2014). This topic cannot be handled solely on the basis of medical
and legal guidelines. An issue involving an individual’s life should never be handled as a
routine procedure, rather, they should be viewed individually and in their own way.

In conclusion, religion, medical procedures, the law, and ethics can all play a role in
deciding the ability to perform such an act. With that being said, one should never discard
each individual’s personal desires. Weighing factors that arise far away from any form of
justification, individuals should have a say in each of their cases. Legal precedence
cannot justify the taking of one’s life, unless they are given the opportunity to say what
they would like to do. There is no possible framework to properly formulate guidelines to
follow, when undergoing a situation where euthanasia is a possibility. An individual is at
will to make the decision themselves, unless they cannot. However, in the cases where
this is not possible, there must be some sort of degree of harmony to set appropriate
limits. The debate will not be satisfied unless there are enough similar characteristics in
each case. To end a global issue, there must be some sort of global consensus.
Abortion “The Freedom to Choose”

“Any law forbidding any incest or rape victim from having an abortion would be denying
that any crime was ever committed.” This statement was taken from Emilie Ailts, a Denver
native rape victim who went public with her rape story after fifteen years of silence (Davis).
Although her statement might not be as credible as those of a politician or psychiatrist,
the emotions behind her words hold have more impact on the female gender. Abortion
has been a controversial issue in the United States for decades. Debaters are intensely
divided into two labeled groups: pro-choice and pro-life. Subtopics such as the
determination of when an unborn fetus can be considered a human and the natural rights
of human beings make the issue confusing and complicated. Because such an issue
deals with such deep moral topics, people are typically intensely polarized to one side of
the issue or the other. To have an abortion is an incredibly emotional and serious decision
that a woman should have the option to make to acknowledge her constitutional right to
life, liberty, and happiness.

The act of ending a pregnancy has been such a controversial topic ever since the late
1800s, and the road to the legalization of abortion has been intense and controversial.
Abortion was prohibited in all fifty states by 1965 with some exceptions due to rape or
incest (Lewis). States began to deal with the issue of abortion individually and several
states allowed abortion due to extreme circumstances. In 1967, Colorado’s Denver
General Hospital created an official Board, which had the ability to approve or deny
applications requesting abortions. This new Board approved more applications than it
rejected and eight times as many abortions were performed compared to previous
records. This encouraged surrounding hospitals to become more lenient concerning
abortions and become more active in their abortion practices (Heller).

The possibly most important Supreme Court decision regarding abortion, Roe v. Wade,
declared most laws forbidding abortion unconstitutional and officially legalized abortion
(Lewis). The court determined that the right to an abortion fell under a citizen’s right to
privacy (History of U.S. Abortion). Privacy rights contend that the government cannot
enforce a certain moral view and an individual cannot be forced to surrender the freedom
to make decision such as abortion on their own (Sandel 522). The Roe v. Wade decision
also required that late term abortions had to have the statement of a professional physical
that an abortion was needed because of issues with the mother’s health (History of U.S.
Abortion). The decision to officially declare abortion as a citizen’s personal right resulted
in such controversial responses that three abortion clinics were bombed on Christmas
Day of 1984 (Lewis). However, even after such violent acts against abortion, the Roe v.
Wade decision still is in place today.
Following the Roe v. Wade decision, more attempted and successful changes were made
to the legal view of abortion. In 1981, the National Right to Life Committee (a prominent
pro-life organization) tried and failed to pass a law that determined fertilization as the
beginning of a human being’s right to life. In 1992 the Supreme Court laid out a set of
rules for abortion providers to follow (parental consent, etc). The court also changed their
previous decision including abortion under privacy rights and concluded that abortion
should fall under the right to liberty. In 1997, President Clinton officially banned the Partial
Birth Abortion Ban Act, which had previously imposed a jail sentence of at least two years
for women undergoing abortions in their third trimester (History of U.S. Abortion).
Although abortion is currently legal, it is still an extremely controversial and much debated
issue.

The pro-choice standpoint on abortion is to give to all pregnant women the opportunity to
choose whether to terminate or continue their pregnancy. If a woman does decide to
terminate her pregnancy, which is her own private decision, there are two types of
abortion available to her: the abortion pill and an in-clinic abortion. The abortion pill, which
is medically termed “mifepristone,” can be taken up to nine weeks after conception. The
cost varies from three hundred and fifty dollars to six hundred and fifty dollars. The in-
clinic abortion is a medical procedure that ends the pregnancy in the first trimester. There
are two types of in-clinic abortions: aspiration (which is done up to 16 weeks into the
pregnancy and is a minimally invasive procedure) and dilatation and evaluation (which is
done after 16 weeks into the pregnancy and is more intrusive and invasive). The in-clinic
abortions range in cost from three hundred and fifty dollars to nine hundred and fifty
dollars (Methods of Abortion). Both the pill and the in-clinic abortion are effective and
commonly undergone by women receiving an abortion.

Pro-life advocates strongly believe that the abortion of a fetus is the murder of an innocent
human being. Their theory is as follows: it is innately wrong to kill human beings, and
because fetuses are human beings it is innately wrong to destroy fetuses (Warren 5).
Many pro-life supporters consider the unborn fetus as completely human as the mother
that is carrying the child (Wertheimer 72). The area of this statement that pro-choice
supporters disagree with is the assertion that fetuses are human beings. Many pro-choice
advocates define a human being as having one or more of the four qualities:
consciousness, ability to reason, self-motivated activity, or communication (Warren 8). An
unborn fetus in the first and second trimester does not possess any of these qualities.
Other pro-choice supporters contest that when the fetus becomes physically able to live
outside the mother’s womb it is officially a human being because the mother is no longer
responsible for the life of the child (Wertheimer 82). It is incredibly difficult to state a
specific date or stage in the pregnancy determining whether the fetus can be considered
a human being or not because of the varying circumstances of each pregnancy.

Many Catholic pro-life advocates state that the fetus, even the embryo, is so equivalent
to a human being that the unborn and the mother are on the same moral level and the
unborn has just as much right as the mother (Wertheimer 72). Pro-choice advocates
respond by stating that the rights of the mother, an actual person, outweigh those of the
potential human being. The mother has constitutional and moral rights to protect her
health, happiness, freedom, and her life if circumstances get to that intensity (Warren 3).
If a woman is forced to continue a pregnancy that she emotionally does not want, it can
cause extreme emotional and psychological issues during and after the pregnancy is
completed.

The psychological health of the mother is a topic of great importance to pro-choice

supporters. A study was done that discovered that the women who continued with their
unwanted pregnancies sought psychological help after their pregnancy was completed.
The number of women utilizing therapy doubled after continuing their pregnancy. There
was no difference in women who had an abortion and the study reported no psychological
impacts from abortion (Emery). If a woman’s psychiatric health can be negatively
impacted by continuing with an unwanted pregnancy, she should have the right to protect
her emotional health by making the conscious decision to terminate her pregnancy.

Colorado is a focused location for the controversy of abortion due to the high teen
pregnancy rates and the previous very pro-life standpoint of Colorado. With the
introduction of birth control in earlier decades, birth rates decreased significantly.
However, Colorado’s birth rate was one of the states that did not decrease as significantly
as other states. According to the Centers for Disease Control and Prevention, the teen
birthrate increased in more than half of the states (including Colorado) in 2006 (Brown).
Colorado is subjected to controversy due to its known pro-life dominated advocacy while
at the same time acting as home to six well-known abortion clinics. There are abortion
clinics in Boulder, Colorado Springs, and Denver (Colorado Abortion Clinics). These
clinics, like clinics nationwide, have been subjected to pro-life protests and ridicule.

The pro-choice standpoint does not require the entire population to understand a
woman’s decision to terminate a pregnancy… only to allow her the opportunity and to
give her enough free will to make the decision on her own. Incest victim Ginger Smith of
Denver, Colorado, stated that “Any law forbidding incest or rape victims from an abortion
would be denying that any crime was every committed” (Davis). Not all people need to
understand a woman’s decision to have an abortion, but it should be recognized that her
decision is a private and personal one, which was why abortion was considered to fall
under privacy rights. The Supreme Court has stated that, “Few decisions are more private
than a woman’s decision to end her pregnancy. Her right to choose is fundamental”
(Sandal 522).
Contraception, Family Planning and RH Law “Any other way”

Over the years, several bills have been filed in both the Senate and Congress, proposing
a law on “reproductive health”; all provoked the most polarizing public debates. It seems
hard to think as to why some people are still against it when almost the entire world has
been practicing contraception, family planning and such.

This paper will try to examine the real issues involved and why the proposed bill has
divided our country once again. The House Bill No. 5043, more commonly known as the
Reproductive Health Bill of 2008, which is in substitution to House Bill Nos. 17 (Adolescent
Reproductive Health), 812 (Reproductive Health, Responsible Parenthood and
Population Development), 2753 (Women's Right to Know Act) and 3970 (Bill Enhancing
the Philippines’ Labor Dispute Settlement System) was introduced during the first regular
session of the 14th Congress by Honorable(s) Edcel C. Lagman, Janette L. Garin,
Narciso D. Santiago III, Mark Llandro Mendoza, Ana Theresia Hontiveros-Baraquel and
Elandro Jesus F. Madrona.

The bill declares that in accordance with the state policy, it upholds and promotes
responsible parenthood, informed choice, birth spacing and respect for life in conformity
with internationally recognized human rights standards. It shall then uphold the right of
the people, particularly women and their organizations; to effective and reasonable
participation in the bill’s formulation and implementation. This policy is anchored on the
rationale that sustainable human development is better assured with a manageable
population of healthy, educated and productive citizens.

What are guaranteed by the state are the universal access to medically-safe, legal,
affordable and quality reproductive health care services, methods, devices, supplies and
relevant information. It however prioritizes the needs of women and children, among other
underprivileged sectors (Lagman, et.al. 2008).

However, some people believe that the term “reproductive health” used in this bill is not
concerned with the safe, licit and natural generation and moral upbringing of any new
human being. They said that instead of its plain meaning “referring to a person’s health
in both body and mind, in the mature and responsible use of his or her reproductive
organs and faculties; its primary concern is the safe, licit and natural generation and
proper upbringing of a new human being (a child)”, it is anchored with the United Nation’s
definition stating that “reproductive rights” refers to what an individual wants to do with his
or her body and sexuality, including but not limited to the ‘right to abortion’ (Tatad, 2008).
Let us now try to examine the two sides of both issue and why only one must prevail. It is
better to take the issue on the population first as the other issues follow after it. The
proponents of the RH Bill of 2008 do not claim that planning is the panacea for poverty.
It simply recognizes the verifiable link between a huge population and poverty. They
argued that based on studies, high fertility rate affects and are affected by poverty.

According to Thomas Malthus, high fertility and poverty are relative with each other. In
the latest data of the National Demographic and Health Survey (2003), it shows that
poverty incidence is less than 10% for a family with one child; but it rises steadily with the
number of children to 57% for a family with nine or more children. Moreover, larger
families make less investment per child in human capital, investments that are crucial in
breaking the chain of intergenerational poverty (Pernia, et al, 2008). Now with the issue
of population control, family planning comes into the scene. Tatad (2008) said that while
National Security Study Memorandum: Implications of Worldwide Population Growth for
U.S. Security and Overseas Interests (NSSM200) did not specify abortion as a preferred
family planning method, the report observed that “no country has reduced its population
growth without resorting to abortion.”

In addition, pushing for only two children per family will make us experience the population
ageing and collapse taking place today in rich countries, and like them, we will also wish
to pay parents to have more children--but unlike them, we will have no money to do so.
Despite the highly orchestrated media hype about “population explosion”, there certainly
is no such thing. Our women are not multiplying like rabbits; “overpopulation” is a myth
(Tatad, 2008). Former Senator Tatad (2008) in his blog also mentioned that there is no
definite statistic on any place’s “carrying capacity” (how many people it can hold or
support). To see if a given territory is sparsely, moderately, or densely populated, the total
population, total land area and population density must be taken into account. In a position
paper of Buenaventura, et al (2008), it was said that according to the data from the
National Statistics Office, the average population growth rate in the period 2000 to 2007
is 2.04 and is decreasing over the years, projecting that the annual population rate for the
period of 2005-2010 is 1.95%.

Another thing is that there could not be overpopulation. Also based from the NSO data,
there are more people in the National Capital Region and other highly urbanized cities
located in the Metro Manila as opposed to the other twelve regions whose growth rates
are below the national figure of 2.04%. Overpopulation cannot be concluded with only few
urbanized and populated cities as the basis. Moreover, the population is not fairly
distributed, creating a congestion of certain places in the country, thus leaving other areas
with few people (Buenaventura, et al, 2008). The problem of poverty is indeed very real
but population control has never been the solution because in the first place (Tatad, 2008)
the real problem is the defective resource allocation and unequal wealth distribution
(Buenaventura, et al, 2008). They believe that family planning then must be left to the
individual families and not the State intervening on it. However, as according to the NSSM
200 report, the Philippines, as one of the thirteen countries tended by it and also a part of
the 47 percent that make up the world population, it must advocate the promotion of
education and contraception and other population control measures (NSSM). Moreover,
the UN Human Development Reports show that countries with higher population growth
invariably score lower in human development.

The Asian Development Bank in 2004 also listed a large population as one of the major
causes of poverty in the country. Th The RH Bill also promotes timed pregnancy which
will ensure that children will be blessings for their parents since their births are planned
and wanted (Lagman, 2008). The Filipino woman's desired number of children is 2.5.
However, the actual fertility rate is 3.5 children or a difference of one child. This difference
is due mainly to the lack of information on and access to family planning services (NSO,
NDHS 2003). Maternal deaths account for 14% of deaths among women.

According to the Commission on Population, ten (10) women die every 24 hours from
pregnancy or childbirth-related complications (Popcorn 2000). It posits a bigger possibility
that the children will be well-taken care of and be brought up properly, send to a good
school, and enjoy their rights. With that as well, there will be fewer instances of abortion
since pregnancies will be according to the preference and want of the couple. It must be
noted however, that the bill does not impose a two-child policy. It only shows the ideal
children approximates desired by women and it being included in the bill is a strong
suggestion for the women/couples (Lagman, 2008).

Another benefit from this bill is the strengthening of the Population Commission. Popcom
shall initiate and sustain an intensified nationwide multimedia campaign to raise the level
of public awareness on the urgent need to protect and promote reproductive health and
rights (Lagman, 2008). In order to control population, the use of contraceptives is
encouraged by the bill. It is stressed out that the bill does not legalize abortion nor does
lead to its legalization. In fact, other Catholic countries have already promoted
contraceptives while criminalizing abortion. Same goes with some Muslim and Buddhist
countries (Lagman, 2008).

Contrary to beliefs, contraceptives have no life-threatening side effects. Medical and

scientific evidence shows that all the possible medical risks connected with
contraceptives are infinitely lower than the risks of an actual pregnancy and everyday
activities. If the bill is passed, it shall form part of the National Drug Formulary considering
that family planning reduces the incidence of maternal and infant mortality as well. The
risk of dying within a year of riding a car is 1 in 5,900. The risk of dying within a year of
using pills is 1 in 200,000. The risk of dying from a vasectomy is 1 in 1 million and the risk
of dying from using an IUD is 1 in 10 million.

The probability of dying from condom use is absolutely zero. But the risk of dying from a
pregnancy is 1 in 10,000 (Lagman, 2008). Through the distribution of contraceptives, the
incidences of HIV cases will also decrease. A national policy, according to GWHAN Chair
Marlon Lacsamana, would stop people in the country who "demonize" condom use. Fifty-
seven new HIV cases were reported in the Philippines in September, bringing the total to
395 new cases this year. Lacsamana in a statement said, "This alarming statistic supports
the call for the immediate passage of the reproductive health bill now being deliberated
in the House of the Representatives," adding, "Moreover, the widespread disinformation,
misinformation and increased efforts to demonize condom use must be disproved with
accurate data” (Harutyunyan, 2008).

The bill however, does not promote contraceptive mentality. It does not prohibit
pregnancy. Its critics are wrong in saying that availability of contraceptives will make
people prefer to have no children at all. Couples will not stop wanting children simply
because contraceptives are available. Contraceptives are used to prevent unwanted
pregnancies but not to stop pregnancies altogether. Again, timed pregnancies are
assured (Lagman, 2008). The Church defends that as according to the Humanae Vitae,
it reaffirmed the Catholic Church's traditional view of marriage and marital relations and
a continued condemnation of artificial birth control. With "Humanae Vitae," Paul VI
reaffirmed the constant and very firm teaching of the Church excluding contraception and
that the teaching had already been proposed infallibly by the ordinary magisterium -- that
is, by the morally unanimous agreement of the bishops of the whole world in communion
with the popes.

Together, they had taught for many centuries that using contraceptives always is grave
matter. Their manner of teaching implied that what they taught was a truth to be held
definitively. Thus, the teaching on contraception met the conditions for infallible teaching,
without a solemn definition, articulated by Vatican II in "Lumen Gentium," 25 (Grisez,
2003). But then Humanae Vitae is not an infallible doctrine. After Pope John VI ordered
a committee to research on this matter, the Papal Commission on Birth Control, voting 69
to 10, strongly recommended that the Church change its teaching on contraception as it
concluded that “the regulation of conception appears necessary for many couples who
wish to achieve a responsible, open and reasonable parenthood in today’s
circumstances” (Lagman, 2008). Five days after the issuance of the encyclical, a
statement against it was signed by 87 Catholic theologians. It asserted that “Catholics
may dissent from … noninfallible Church doctrine” and that “Catholic spouses could
responsibly decide in some circumstances to use artificial contraception” (Lagman, 2008).
Critics of the bill are also stressing that we are not a welfare state, taxpayers have no duty
to provide contraceptives to try and cure pregnancy, which is not a disease. Access to
contraceptives is free and unrestricted long before despite the WHO cancer-research
finding that oral contraceptives cause breast, liver and cervical cancer, none of these
items have been banned by law. This bill will eventually lead to the legalization of abortion.
Church:

The reproductive bill allows or even prescribes the use of birth control methods which
have the effect of blocking a fertilized zygote from being implanted in the uterus or of
expelling a fertilized zygote before implantation. The widespread use of contraceptives
would lead to conjugal infidelity and the general lowering of morality (Tatad, 2008). When
it comes with sex education, age-appropriate RH education promotes correct sexual
values. It will not only instill consciousness of freedom of choice but also responsible
exercise of one’s rights.

The UN and countries which have youth sexuality education document its beneficial
results: understanding of proper sexual values is promoted; early initiation into sexual
relations is delayed; abstinence before marriage is encouraged; multiple-sex partners is
avoided; and spread of sexually transmitted diseases is prevented (Lagman, 2008). But
the critics of the bill imply that sex education is a matter closely related to religious
morality. Our constitution allows the teaching of religion to children in public schools, but
it requires that it be done only with the written consent of parents. As for sex education in
private schools, any law on this should respect academic freedom which is also protected
by the Constitution (Tatad, 2008).

I think everyone will agree with me that both sides have their own share of rights and
wrongs. It is nice to see as well that people are truly engage with this which only goes to
show that as citizens of this country, we are all concern for what is best for it. But then, I
believe that what is best is for our lawmakers to pass the RH Bill which is long overdue.
The bill is, in fact, “pro-life,” “pro-women,” and “propoor” (Lagman, 2008). It promotes
quality not only for the parents but also especially to the future generation of our country.
It also protects women’s rights and the health projects will surely benefit the
underprivileged. The bill is national in scope, comprehensive, rights-based and provides
adequate funding to the population program. It promotes information on and access to
both natural and modern family planning methods, which are medically safe and legally
permissible. The bill will promote sustainable human development. The UN stated in 2002
that “family planning and reproductive health are essential to reducing poverty.
Genetic Engineering and Modification

A broadly accepted view in today’s world is that the human organism becomes a person
at the moment of birth. A competing position is that personhood begins at the moment of
conception. Adopting this latter view weighs against selective pregnancy reduction and
research on embryos and might require that all embryos be implanted. The Catholic
Church is the major proponent of the view that the life of a new human being begins at
the moment the ovum is fertilized. According to Catholic teaching, viewing a human
individual as a person dictates recognition of the rights of the pre-embryo as a person.

Is a pre-embryo a person from the moment the ovum is fertilized? According to Thomas
Shannon (1997), the answer is no. He states that not until totipotency gives way to
specialized cellular development, which occurs approximately 3 weeks after formation of
the zygote, can we correctly speak of the pre-embryo as an individual. Before this time,
the pre-embryo is not an individual and, therefore, cannot be a person. Although science
cannot provide a concept of personhood, it appears, in this context, to have provided a
necessary condition for human individuality without which personhood is not possible.
However, Shannon acknowledges that the biology of the pre-embryo will eventuate in an
individual who is a person.

Focusing on the argument from totipotency results in the conclusion that human
individuality and, therefore, human personhood does not begin until some weeks after the
ovum is fertilized. If we emphasize the fact that the fertilized ovum normally will develop
into a person, then the argument from potentiality may lead us to conclude, along with the
Catholic Church, that the embryo is a person from the moment of conception. Because
the existence of personhood bars us from abusing or killing a person, the logical
conclusion is that pregnancy reduction and embryo research are immoral. The Church
would like us to believe that personhood occurs at the moment of conception, and
Shannon would like us to believe that prior to 3 weeks’ gestation, the pre-embryo falls
short of being a person.

As already noted, personhood is a social construct based on community needs and

interests as well as on biology. These needs and values find their expression in the way
we see things. For example, one person looking at the softly rolling hills of California might
react by “seeing” God as the invisible landscape architect who made the beautiful
placements of the live oak trees, while another might “see” these placements as the effect
of soil conditions, wind, and rain. William Werpehowski “sees” the human face in the pre-
embryo when he says,“ Following fertilization, the human zygote is a genetically unique,
individual human organism that in its immediate appearance displays to us the human
countenance.” However, many do not “see” a human countenance in the pre-embryo. For
them, personhood is conferred on human organisms with whom human interactions are
possible or occur. We can cuddle a baby; we cannot cuddle a zygote. We coo at an infant
and he or she responds by smiling; zygotes do not smile. An infant grasps a proffered
finger; a zygote cannot. Babies have personalities and embryos do not. That is why
babies are persons and embryos are not. Prima Facie Demands

Nevertheless, some have argued that although a pre-embryo is not a person, it does have
special status and, therefore, is to be treated with special respect. Richard McCormick
cites these considerations to support his belief that “the potential of the pre-embryo for
person-hood makes powerful prima facie demands on us not to interfere with that
potential.”

A prima facie demand is one that cannot be interfered with unless it is overridden or
trumped by more powerful ethical considerations. However, identification of a more
powerful ethical consideration is determined partly by the perceived otologic status of the
pre-embryo. As McCormick has pointed out, there is broad moral and legal recognition
that the pre-embryo is too primitive to have any interests or rights. Thus, its use in
research or its elimination in pregnancy reduction, which either directly or indirectly
satisfies the needs or interests of human beings, is a more powerful ethical consideration
than treating the pre-embryo with special respect. Indeed, unless the pre-embryo is
viewed as having rights from the moment of conception, interference in its development
to benefit persons is warranted ethically. Unfortunately, any discussion about the special
status of or special respect for the pre-embryo, which may have symbolic value, does not
contribute to resolving the question of whether its destruction is a wrong.
Genital Mutilation

FGM is a global threat to the public health of women, and thus requires a culturally
sensitive acknowledgement, not only by national and local governments, but also by
Western societies in which the practice is often dismissed as harmful and disempowering.
Rothstein (2002) posits that “the existence of a public threat demands a public response,
and in a representative political system it is the government that is authorized to act on
behalf of the public” (146).

However, public approval for a harm reduction approach, particularly in Western

countries, which tend to set the international precedent, will be difficult to attain. Thus, it
becomes imperative that these societies are well informed about the principles of harm
reduction and fully understand that symbolic circumcision is the best possible alternative
to FGM at this time. Furthermore, it is critical to understand that many women want these
interventions and are justified in their volitions, as the alternative leaves them to the harms
of traditional practices. Galeotti (2007) speaks to the Western cultural hegemony that
seems to dictate these policies, and argues that just because a culture is different does
not mean it is suspicious. She questions, “why, then, should we want only women of alien
cultures to conform to high standards of autonomy?

Why should we accept the self- abrogative conduct of would-be starlets while questioning
the choices of lucid, adult African women?” (102). By placing the issue within a framework
that Westerners can relate to and question, Galeotti forms a culturally acceptable and
reasonable argument. Western societies and governments should view harm reduction
as a steppingstone to eventual eradication, not a legitimization of a disempowering
tradition. In constructing ethical arguments, it is critical to approach issues from a
universal, not relativistic perspective. Harm reduction fits this criterion, by applying
practices that aim to increase the quality of life for all women, in a cultural context. In
applying cultural awareness but maintaining moral standards, it is possible to ethically
implement harm reduction programs in the case of female circumcision.

CONCLUSION AND RECOMMENDATIONS Complete eradication of FGM is an ideal,

but unrealistic goal for the near future. One organization, TOSTAN, a Senegalese
nonprofit centered on community-based empowerment and education for women, has
been successful in decreasing the FGM practice in communities. Although this program
was successful in decreasing FGM rates, prevalence continued to stay extremely high
(79 percent) for daughters over the age of five at the end of the study (Diop and Askew
2009). Lack of countrywide initiatives like TOSTAN, as well as long-term analysis and
resources with which to implement these initiatives, suggest that complete eradication is
not possible at this time.

As previously discussed, blanket bans of FGM serve to further disempower women and
elevate their health risks. Careful ethical reasoning has demonstrated that symbolic
female circumcision is the least harmful and most culturally appropriate alternative at this
time. Below, policy and practice recommendations based on the ethical analysis will
illuminate critical aspects of implementing a harm reduction agenda. Female Circumcision
| 104 The Michigan Journal of Public Affairs – Volume 10, Spring 2013 Gerald R. Ford
School of Public Policy, University of Michigan mjpa.umich.edu In establishing effective
harm reduction programs, it is crucial to work with the communities in which FGM is
common, in order to ensure acceptance of its implementation. Macklin (1999) posits that
in order to make effective and ethical change, forming alliances with the people within
these communities is a critical step. Further, harm reduction must respect transparency
and confidentiality in order to maintain public trust (Kleinig 2008). In doing so, health
programs will reach more women and be more effective in achieving their objectives. In
addition to community-based work, the importance of access to information in harm
reduction programs is essential. The association between lack of education and FGM has
been established (Karmaker et al. 2010).

Further, Reymond et al. (1997) suggest that most women who want to end FGM do not
have enough resources or knowledge to convince men or other community members that
it is extremely harmful. Mackie (2003) echoes this sentiment, arguing that increasing
education could influence peoples’ decisions to not get circumcised. Information may
come in the form of pamphlets, group discussions, or small-scale social marketing
campaigns. A review of anti-FGM educational interventions among the Maasai in
Tanzania suggests that the best campaigns were those that addressed and framed the
issue within the changing local community, rather than positioning themselves as
“opposite” or “outside” traditional practices (Winterbottom, Koomen, and Burford 2009).

The dissemination of information in these communities is paramount, and doing so in a

culturally sensitive manner will help to not only bolster harm reduction programs, but also
to improve education about the harms of FGM. Although community-based participatory
programs are essential in changing any health behavior, they are not as effective on a
broader scale without the implementation of effective national and international policies
to guide the practice. In the United Kingdom and Australia, effective policy approaches
have centered on the establishment of supportive health services in addition to
community education initiatives (Karmaker et al. 2010). Therefore, the formation of
culturally sensitive and uniform training programs for healthcare workers is necessary.
Medical professionals, such as community nurses and midwives, are critical actors in
harm reduction implementation, as their actions can directly ensure that women and girls
are not subjected to traditional mutilation. A study of the Yoruba in Nigeria found that
among mothers of non-circumcised daughters, twofifths attributed their decision to
abstain to the influence of a doctor or nurse, as opposed to 2 percent who made this
choice based on recommendations from religious leaders (Caldwell et al. 2000).

Therefore, policy should allow for a medical education in which physicians and nurses,
as well as community health workers, are taught the harms of FGM and the appropriate
use and implementation of symbolic female circumcision. This will allow women access
to a safe and legal female circumcision from trained health care providers, should they
choose this practice. Setting a firm policy agenda, which compliments educational
campaigns with clear standards for medical personnel, will help to establish medicalized
female circumcision as an ethical, viable, and realistic alternative to FGM. The ability to
access these services without legal or social repercussions will aid in to empowering
women and health professionals in the communities who previously had little or no choice
surrounding this procedure. Internationally, a harm reduction policy approach will be
beneficial in setting standards for practices in countries where FGM is widespread.
Namely, international Female Circumcision | 105 The Michigan Journal of Public Affairs
– Volume 10, Spring 2013 Gerald R. Ford School of Public Policy, University of Michigan
mjpa.umich.edu organizations should recognize that symbolic female circumcision is a
viable interim solution, and that harm reduction practices are acceptable as long as they
are safe and legal, and also address women’s needs.

The WHO argues that medicalized circumcision “tends to obscure its human rights aspect
and could hinder the development of long-term solutions” (WHO 2013a). However,
international policymakers must consider the evidence: FGM is an extremely prevalent
practice that is not only detrimental physically but reinforces a lesser place in society for
women and girls. Social justice demands that policies should reduce inequalities and that
programs must work to ensure the health and safety of the most vulnerable (Gostin and
Powers 2006).

Thus, international organizations have an imperative to instate policies that allow for the
implementation of medicalized female circumcision as a harm reducing solution. Further,
international regulations should recognize the need for a culturally sensitive approach,
and establish directives to allow for the foundation of safe and legal clinics where this is
possible. International support of female circumcision as an appropriate practice will
legitimize national efforts and aid in establishing effective and educational clinics in
communities where change can begin to occur.
Female genital mutilation is a harmful practice; subjecting women to any sort of physical
pain, especially one that is lasting and impairing, is unacceptable and must be addressed.
Due to the deep cultural rootedness of the matter, however, it becomes clear that
symbolic female circumcision is the most ethically and culturally appropriate intermediate
practice. When implemented the right way, symbolic female circumcision can make a
difference in the lives of millions of women and girls who would normally face an elevated
and long-term health risk.

It is critical to understand the ethical imperatives that suggest this kind of approach, as
well as to ensure that harm reduction programs are implemented with the full support of
the community. In order to fully support the health of women and girls, harm reduction
policy is the most ethical and promising approach. Female Circumcision.
Plastic Surgery

According to Catholics Rev. Nurya Love Parish, there are two competing ethical values
that must be weighed in this instance. On one hand, there is the value of honesty, which
would indicate that keeping one’s wrinkles is virtuous. On the other hand is the value
of beauty, which would indicate that removing one’s wrinkles is virtuous. Those who
value honesty over beauty would probably say that such surgery is unethical. Those
who value beauty over honesty would probably say the surgery is ethical. There is no
clear choice in these circumstances.

Sandra Nikkel the Grand Rapids East Classis and Pastor of the multicultural Ministry
at Eastern Avenue Christian Reformed Church. However, there is one additional
consideration: the relative worth of such surgery in a world where innocent people
suffer needlessly. The ethical value here is clear: it is foolish to spend money on an
unnecessary surgery given that the alternative is to provide life for another human soul.
The most ethical thing to do is to provide for the poor with the funds you would
otherwise spend on the surgery and let your wrinkles be a mark of your wisdom.

Fred Wooden, the senior pastor of Fountain Street Church also reacted about the new
trend of removing wrinkles via cosmetic surgery has left many people disappointed or
at least dissatisfied. Trying to cheat the aging process does not always rend the
expected results. Aging is a natural part of life and accepting it speaks of a well
emotionally adjusted life. An emotionally healthy person will receive aging as a part of
one of the stages of life that we are designed to go through. There is so much to learn
from it that I believe that if we spend our efforts trying to stop or slow down the aging
process we might miss the lessons that this golden age is designed to teach us. This
is why I think that cosmetic surgery is unethical. I think one would benefit more from
learning to live a life with wrinkles to the fullest than trying to look 20 years younger. I
personally find that adjusting to the new wrinkles that appear on my face or m y hands
allows me to take a step back and think about how far I've come. It gives me an
opportunity to show gratitude for the many things I've overcome and for the things I
have learned. This allows me to live life more wisely and more fully, especially as I
meditate on the lessons that I have learned through the years and I remember that life
is short and that I need to live it wisely.
Abortion

Abortion is the ending of pregnancy due to removing an embryo or fetus before it can
survive outside the uterus. An abortion that occurs spontaneously is also known as a
miscarriage. When deliberate steps are taken to end a pregnancy, it is called an induced
abortion, or less frequently an "induced miscarriage". The word abortion is often used to
mean only induced abortions. A similar procedure after the fetus could potentially survive
outside the womb is known as a "late termination of pregnancy" or less accurately as a
"late term abortion".

In G10 Countries, abortion is becoming legal due to the increase of population. Let’s take
an example United States of America have at least one abortion clinic. However,
individual states can regulate or limit the use of abortion or create a “Trigger laws”. Which
would make abortion illegal within the first and second trimester.

Meanwhile here in the Philippines there are a lot of women undergo Abortion illegally.
The act is a criminalized by the Philippine Law. Articles 256, 258, and 259 of the Revised
Penal Code of the Philippines mandate imprisonments for women who undergo abortion,
as well for any person who assists the procedure.

There are factors affecting the rise of abortion which is poverty, unlettered, and
environmental influences. Healthcare providers, should educate the downsides and
consequences of abortion. As a nurse and a pro-life advocate, we are not only giving care
to people who seek for assistance with their health issues. We are also a life counselor,
which we tell them that life is gift from God and abortion is a mortal sin.
Euthanasia

In current usage, euthanasia has been defined as the "painless inducement of a quick
death". However, it is argued that this approach fails to properly define euthanasia, as it
leaves open a number of possible actions which would meet the requirements of the
definition, but would not be seen as euthanasia. In particular, these include situations
where a person kills another, painlessly, but for no reason beyond that of personal gain;
or accidental deaths that are quick and painless, but not intentional.

Another approach incorporates the notion of suffering into the definition. The definition
offered by the Oxford English Dictionary incorporates suffering as a necessary condition,
with "the painless killing of a patient suffering from an incurable and painful disease or in
an irreversible coma".

It’s 21st century, Euthanasia of humans have met limited success in Western countries.
As of March 2018, active human euthanasia is legal in the Netherlands, Belgium,
Colombia, Luxembourg, and Canada. Assisted suicide is legal in Switzerland, Germany,
the Netherlands, and in the US states of Washington, Oregon, Colorado, Hawaii,
Vermont, Montana, Washington DC, and California. A law legalizing euthanasia in the
Australian state of Victoria will come into effect in mid-2019.

Although, it’s legal in other countries. Euthanasia is illegal in the Philippines. In 1997,
the Philippine Senate considered passing a bill legalizing passive euthanasia. The bill met
strong opposition from the country's Catholic Church. If legalized the Philippines would
have been the first country to legalize euthanasia. Under current laws, doctors assisting
a patient to die can be imprisoned and charged with malpractice. As we know our country
Philippines belongs to the third world country factors affecting its issue are same with
abortion which are poverty, unlettered, and environmental influences.

As nurse we investigate what are the motives of the family or patient why he/she would
like to do euthanasia. Educate the law of taking one’s life this includes values, morals,
ethics. However, we encounter patients who are terminal ill and would no longer want to
continue with the treatment. By this we can refer it to the patients attending physician so
they can choose whether to extubating or DNR would be the option these are the only
way to take someone’s life legally. Since, I am a pro-life advocate sometimes we can’t
ease the pain of seeing someone who is suffering from pain or terminal stage disease,
especially if one of your family members involve. Ending a is life comparing apples to
apples its should be justifiable.
Blood Transfusion

Generally, the process of receiving blood or blood products into one's circulation
intravenously. Transfusions are used for various medical conditions to replace lost
components of the blood.

Globally Blood transfusion saves lives and improves health, but many patients requiring
transfusion do not have timely access to safe blood. The need for blood transfusion may
arise at any time in both urban and rural areas. The unavailability of blood has led to
deaths and many patients suffering from ill-health. An adequate and reliable supply of
safe blood can be assured by a stable base of regular, voluntary, unpaid blood donors.
Regular, voluntary, unpaid blood donors are also the safest group of donors as the
prevalence of bloodborne infections is lowest among these donors.

However, there is a religion that does not believe in blood transfusion. Jehovah’s
Witnesses, blood transfusion is a big issue to them instead of the medical one. They
believe avoiding taking blood transfusion will show being obedience to God and also
respect him as a life giver. They choose to die instead of getting a blood transfusion.

We healthcare providers should take in consideration in respecting their religious practice.

However, we should at least offer them the solution.
In-vitro Fertilization
IVF is the most effective form of assisted reproductive technology. The procedure can be
done using your own eggs and your partner's sperm. Or IVF may involve eggs, sperm or
embryos from a known or anonymous donor. In some cases, a gestational carrier a
woman who has an embryo implanted in her uterus might be used.

Globally the average age of women and men getting married and having their first child
is increasing. This trend has increased the number of women seeking the IVF treatment.
Moreover, to focus on their career, many women freeze their eggs to have the child at a
later.
Their government funding to encourage egg/sperm freezing to bring down the chances
of multiple pregnancies, technological advancements that enable pre-identification of the
genetic disorder, and various industrial revolutions are expected to boom the market
growth. IVF in the Philippines is legal and there are no laws barring from doing the
procedure. There are few clinics offer the service. However, the Catholic church is against
it because it affects the human dignity and disrespecting the beautiful sexual union of two
people. To add up the possible complications that may affect the outcome result of IVF.
I understand the stand of the Catholic church, but as a healthcare provider I see no
problem with in vitro fertilization when used to circumvent the inability to create children.
Likewise, using selective breeding to reduce the chances of disease is also a very noble
thing to do. One could argue that it would be immoral to not perform such actions if one
has the means to do so. The initial differences between natural fertilization and in vitro
fertilization are minimal at best. Embryos are normally created in the uterus of a female
after a sporadic chain of events involving the interaction of sperm with eggs. In contract,
IVF is very much the same process of sperm/egg interaction but the physician simply
chooses what sperm gets to interact with which egg.
Within these confines, most major religions and ideologies accept IVF as an acceptable
form of procreation because the sanctity of the embryo is still protected. The actual
process of human creation is still innately natural. The problems really arise from the
preparation required in vitro fertilization. Since in vitro fertilization is expensive, time-
consuming, and physically arduous to a female, multiple eggs have to be removed to
ensure successful fertilization in the fewest number of procedures. Since this guarantees
that there will be more than embryo that will form, there is an issue of what to do with the
"other" embryos that aren't deemed fit to be implanted into the uterus of the female.
This is where I see John Singer's logic most fitting. In the 14 days of fertilization, embryos
are not susceptible to pain because their cells are undifferentiated. Until the embryo
reaches a point of consciousness (not to be mistaken with self-consciousness because
some animals exhibit that characteristic and unjustifiably are made to suffer in scientific
research), there is really nothing we can do to the embryo which causes harm to it. And
hence, why I believe it is moral to discard the embryos that will not be used