Bioethics and Moral Decisions

Mr. Jhessie L. Abella, RN, RM, MAN

Ethics
Ethics comes from the Greek word Ethos meaning characteristic way of acting and in Latin word Mos, morrs meaning way of acting. Ethics is a study of human acts or conduct from a moral perspective as to whether they are good or they are bad. We commonly associated ethics to customs, morals and etiquette and even used them interchangeably.
Customs are acts approved by a group or society. Etiquette social observance required by good breeding.

Ethics
is a practical and normative science, based on reason,

which studies human acts and provides norms for their goodness or badness Ethics deals with only human acts insofar as they performed with intellectual deliberation and freedom. Ethics is defined as the standards or principles of moral judgment or actions. It provides a methodical system in differentiating right from wrong basing on a certain belief.

Significance in Profession
Ethics reflects the standards that govern a proper conduct in a particular profession. For instance, the nurse on duty knows that she is obligated to act for the good of the client and to prevent any incident to harm the patient. This principle of doing no harm to the client is the intervention of knowing the ethics in nursing.

What is Human Acts and Acts of Man

It is an act performed by a human being when he is responsible, when it is done with full knowledge and consent of will. Actus Humanus Knowledge, Freedom, Actual Choice or Voluntariness Human acts are done with knowledge and full consent of the will. One knows what one is doing and one does it freely and willingly. Acts of human or actus hominis are performed in the absence of either or both of the two conditions.

Elements of Human Acts

Knowledge a person is not responsible for
an act done in ignorance unless the ignorance is vincible

Freedom a person is not responsible for an

act over which he has no control.

Actual Choice a person is not responsible

for an act which he does not will, unless he give up his self control

Should a Person be Held Responsible for an act of performed in IGNORANCE?

Vincible Ignorance Invincible Ignorance

Parts of Ethics

General Ethics deals with the basic principles

which are the morality of human acts.

Social Ethics tackles the basic principles in the

life of man as a member of the society.

Professional Ethics branch of moral science

that treats of the obligations which a member of a profession owes to the public, to his profession and to his clients.

Objectives of Ethics
To make clear to us why one act is better than another. To live an orderly social life. To appraise and criticize intelligently the moral conduct and ethical system. To seek the true value of life.

Bioethics

Bioethics
Is a relatively new term. It began to be discussed in the 1960s when such phrases as medical ethics and biomedical ethics. The term was originally coined in America Bios which means life and ethics. In philosophy it is a branch of ethics that is concerned with issues surrounding health care and the biological sciences. Biotechnology means the used of technology and microorganism and other biological material for technological purposes.

What is the Scope of Bioethics?

Bioethics is the term used to describe the application of ethics to biological sciences, medicine and related fields. It is the philosophical study of the ethical controversies brought about by advances in biology and medicine. It is a systematic study of moral conduct in life sciences and medicines. For M.T. Reich, it is a systematic study of human behavior, specifically, in the fields of life sciences and health care, as examined in the light of moral values and principles. Bioethics is ethics to a special focus on challenges arising from modern biotechnology. Biotechnology is any technology using micro-organism or biological materials for technological purposes (example is modifying things for better quality, cloning).

Importance of BioEthics
To provide awareness to the health team or workers of the dos and donts of medical practice. To enrich ones competence by understanding that the patient is a person and a holistic individual. This field of study was developed in countries that had to face many ethical challenges due to the bioscientific developments, but the same moral problem challenges us even in the Philippines. As medical interventions became more powerful, ethical problems associated to medical and health practices also grow.

NORMS OF HUMAN ACTS

These are directives or guides in making decisions on what we ought to do or to be.

Law an ordinance of reason, promulgated for the

common good by one who has legitimate authority. It is an authoritative order that should be just, honest, possible of fulfillment, useful, to a certain degrees of permanency and promulgated or made known to the subject.

Conscience the practical judgment of reason upon

an individual act as good and to be performed or as evil and to be avoided.

IMPORTANT CLASSES OF LAWS

Eternal Law It is Gods eternal plan and providence for the universe. It is the diverse reason or will commanding the preservation of the natural order of things and forbidding its disturbance. According to St. Thomas, it is the plan flowing from Gods wisdom directing all acts and movements.

Natural Law it is the eternal law as known to human through reason. It is nothing than the rational creatures participation in the eternal law of God and Human comes to the knowledge of this law by natural light of his/her reason. e.g. do good and avoid evil. (St. Thomas)
The reason why it is called Natural is because it is neither communicated in a supernatural way, nor a result of a command of a legislative or authority. The precept of natural law is found and derived for the very nature of human beings.

PROPERTIES OF NATURAL LAW

Universality the natural moral law binds every person at all times and in all places or its basis is the very nature of human. One cannot remain ignorant of the natural law, at least not of its basic precepts. However, human beings do not possess the knowledge of this law, in a fully developed form from the beginning. She or he must develop it just as the development of other forms of knowledge. E.g. respect for life

PROPERTIES OF NATURAL LAW

Immutability as soon as the human being has the capacity of using his/her reason, certain fundamental norms will become self-evident to humans. These fundamental norms are imprinted in human nature, so that they exist as long as human nature exists. The genuine commands and prohibitions of natural law cannot be changed.

PROPERTIES OF NATURAL LAW

Indispensability no one is dispended or excused in the observance of the natural law. Why? Because, the origin of natural law is God. Natural law is identical to Gods will. Evidently, human has no authority over a law of this status. This means that if there is dispensation of this law, there is a violation in Gods Law.

Types of Natural Law

Affirmative Law Negative Law Divine Negative Law Human Positive Law Law of Charity

Evolutionary Phase of Bioethical Studies

Even the most primitive tribes anthropologies tell us have some code or set of unwritten precepts. Basic human situations bring with them certain rights and obligations which are needed not only to maintain peaceful and well ordered relations but also for their survival

Evolutionary Phase of Bioethical Studies

Medical ethics is the oldest form of bioethical exploration. Percival Ethics (1803) AMA Code of Ethics (1847) Research Ethics Nuremburg Code 1947 Public Policy is the third stage in the development of bioethical inquiry. This phase refers to the peoples efforts or involvement in formulating public guidelines .

Patients Bill of Rights

The patient has the right to considerate and respectful care irrespective of socio-economic status. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. H has the right to know by name or in person, the medical team responsible in coordinating his care.

Patients Bill of Rights

The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. The patient has the right to refuse treatment/life giving measures, to the extent permitted by law, and to be informed of the medical consequences of his action. The patient has the right to every consideration of his privacy concerning his own medical care program.

Patients Bill of Rights

The patient has the right to expect that all communications and records pertaining to his care should be treated as confidential. The patient has the right that within its capacity, a hospital must make reasonable response to the request of patient for services. The hospital must provide evaluation, service and/or referral as indicated by the urgency of care. When medically permissible a patient may be transferred to another facility only after he has received complete information concerning the needs and alternatives to such transfer.

Patients Bill of Rights

The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. The patient has the right to obtain as to the existence of any professional relationship among individuals, by name who are treating him. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project.

Patients Bill of Rights

The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby he is informed by his physician or a delegate of the physician of the patients continuing health care requirements following discharge. The patient has the right to examine and receive an explanation of his bill regardless of source of payment. The patient has the right to know what hospital rules and regulation apply to his conduct as a patient.

Dying Persons Bill of Rights

I have the right to be treated as a living human being until I die. I have the right to maintain a sense of hopefulness however changing its focus may be. I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this might be. I have the right to express my feelings and emotions about my approaching death in my own way. I have the right to participate in decisions concerning my care.

Dying Persons Bill of Rights

I have the right to expect continuing medical and nursing attention even though cure goals must be changed to comfort goals. I have the right not to die alone. I have the right to be free from pain. I have the right to have my question answered honestly. I have the right not to be deceived.

Dying Persons Bill of Rights

I have the right to have help from and for my family in accepting my death. I have the right to die in peace and dignity. I have the right to retain my individuality and not be judged for my decisions which may be contrary to beliefs of others. I have the right to discuss and engage my religious and/or spiritual experiences, whatever these may mean to others. I have the right to expect that the sanctity of the human body will be respected after death. I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.

Dominant Themes in Bioethical Study

Principle of Beneficence Traditionally understood as the "first principle" of morality, the dictum "do good and avoid evil" lends some moral content to this principle. Beneficence is action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others.

Dominant Themes in Bioethical Study

Non-maleficence: Definition: Non-maleficence means to do no harm.. Nurses must refrain from providing ineffective treatments or acting with malice toward patients.

Dominant Themes in Bioethical Study

Principle of Autonomy is the moral right to choose ones own plan of life. Autonomy is based on respect for person.

Violations:
Actions performed that constrain a persons capacity to make a decision. Ex. Not telling a patient the risks involved in an intervention recommended and therefore preventing him for properly weighing risks and benefits

Non-Violations:
A person expresses his autonomous wish to waive consent or delegate authority to others. Ex. A patient explicitly tell his physician to do whatever you think is best, and not expect to be asked permission for every procedure done.

Role of the Health Professionals

Provide information necessary to weigh risks and benefits State own conviction and clearly explain the reason for this opinion Dont exercise coercion, manipulation, undue influence, or irrational persuasion Respect the patients autonomous choice

 Withdraw from the case and help the patient find another health professional who might be more successful in these situations when the health professional feels it is impossible to help the patient.

Principle of Justice

Justice, also termed fairness, means to give to each one what he deserves or what is his due.

Role of the Health Professional

Give each patient what is due: available care he needs, information and confidentiality. Provide equal health care to all patients without discrimination.

 Work toward just health care policies such as the delivery of minimum health care to all according to their needs.

Avoid giving undue burden to individuals: abusing the poor by using them as learning materials

Ethical Theories
Level of Moral Development
Preconvention dos and donts

Stage of Reasoning
Stage 1: (Punishment and Obedience Orientation). Right is obedience to power and avoidance of punishment. (I must follow the rules otherwise I will be punished). Stage 2: Instrumental Relativist Orientation. Right is taking responsibility and leaving others to be responsible for themselves. (I must follow the rules for the reward and favor it gives).

Approximate Age <11

Conventional

Stage 3: Good-Boy-Nice Girl Orientation. Right is being considerate: adolescence uphold the values of other adolescents and adults rules of society. (I and adulthood must follow the rules so I will be accepted) Stage 4: Society-Maintaining Orientation. Right is being good, with the values and norms of family and society at large.(I must follow rules so there is order in the society).

Postconventional

Stage 5: Social Contract Reorientation. Right is finding inner universal rights balance between self-rights and societal rules a social contract.(I must follow rules as there are reasonable laws for it). Stage 6: Universal Ethical Principle orientation. Right is based on a higher order of applying principles to all human-kind; being nonjudgmental and respecting all human life.(I must follow rules because my conscience tells me).

after 20

TELEOLOGICAL
This describes an ethical theory which judges the rightness of an action in terms of an external goal or purpose. Teleological moral systems are characterized primarily by a focus on the consequences which any action might have (for that reason, they are often referred to as consequent list moral systems, and both terms are used here). Thus, in order to make correct moral choices, we have to have some understanding of what will result from our choices. When we make choices which result in the correct consequences, then we are acting morally; when we make choices which result in the incorrect consequences, then we are acting immorally

Teleological
Greek word: telos - end or purpose. It stresses the endresult or consequence of an act. Utilitarianism (Jeremy Bentham, John Stuart Mill) The Principle of Utility Actions are good insofar as they tend to promote happiness, bad when they tend to promote unhappiness. The Principle of the Greatest Happiness An action is good (right) insofar as it produces the greatest happiness for the greatest number of people, bad(wrong) insofar as it produces more harm for the greatest number of individual. 6/18/2013 50

Deontology
Deontological moral systems are characterized primarily by a focus upon adherence to independent moral rules or duties. Thus, in order to make the correct moral choices, we simply have to understand what our moral duties are and what correct rules exist which regulate those duties. When we follow our duty, we are behaving morally. When we fail to follow our duty, we are behaving immorally.

a. Acts done in accord with duty b. Acts done from a sense of duty c. Categorical Imperatives:

1. Act only on that maxim which you can at the same time will to become a universal law. 2. Always act so as to treat humanity, either yourself or others, as an end and never as only a means.

Types of Duties: 1. Perfect duty that we must observe, irrespective of time and place, and circumstance. 2. Imperfect duty- we observe only on some occasions.

Utilitarianism
Utilitarianism is a theory in normative ethics holding that the proper course of action is the one that maximizes overall "happiness".

The END do not justify the MEANS The goodness of the intention then reflects the balance of the good and evil of these consequences

Act-Utilitarian vs. Rule-Utilitarian

Act-utilitarian choose an act that
could/would bring more benefits for a greater number of people. Ex. Giving of goods to the typhoon victims

Rule-utilitarian formulate a rule or policy

that governs certain actions that could/would bring benefits to many. Ex. Killing innocent people is immoral.

Types of Prima Facie Duties

1. 2. 3. 4. 5. 6. 7.

Duty of fidelity Duty of reparation Duty of gratitude Duty of Justice Duty of beneficence Duty of self-improvement Duty of non-maleficence

Rawls Theory
Synthesis of utilitarianism and deontological views

1.Theory of Justice
a. b. c. Every individual is inviolable- not even a general welfare of society can override and supersede it. Erroneous theory is tolerable in the absence of a good one. Individual liberty should be restricted in order to maintain equality of opportunities.

2. Principles of Justice

a. Equal access to the basic human rights and liberties. b. Fair equality of opportunity and the equal distribution of socio-economic inequalities.

Rawls Theory
3. Justice in Human Relations

Four Types of Duties: a. Fairness in our dealings with others. b. Fidelity c. Respect for persons d. Beneficence

Situation Ethics
Situation ethics is advocated by Joseph Fletcher . This ethical theory states that the moral norm depends upon a given situation, but whatever this situation may be, one must always act in the BioethicsProf. Chris Pelias 60 name of Christian love.

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Six Propositions
1. Love is intrinsically good. 2. Love is the ultimate norm of Christian decisions. 3. Love and justice are the same, for justice is love distributed. 4. Love wills the neighbour's good whether we like him or not. 5. Only the end justifies the means: nothing else. 6. Decisions ought to be made situationally, not prescriptively.

Thomistic Ethics
It is attributed to St. Thomas Aquinas, one of the founders of the Catholic Church, a scholar, and a religious saint. Aquinas looks at morality from the vantage point of the natural law. Morality has to obey the natural law, which governs moral reasoning (synderesis). Natural law is the order and harmony of things. For everything has a place in this world.

Mans Three-fold Natural Inclination

1. Self-preservation not to kill ourselves and put ourselves in danger. 2. Just dealings with others to treat others with the same dignity and respect that we accord ourselves. 3. Propagation of our species reproductive organs are by their very nature designed to reproduce and to perpetuate the human specie.

 "Everyone is responsible for his life before God who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of." "Suicide contradicts the natural inclination of the human being to preserve and perpetuate his life. It is gravely contrary to the just love of self. It likewise offends love of neighbor because it unjustly breaks the ties of solidarity with family, nation, and other human societies to which we continue to have obligations. Suicide is contrary to love for the living God.

 "If suicide is committed with the intention of setting an example, especially to the young, it also takes on the gravity of scandal." "Voluntary co-operation in suicide is contrary to the moral law." "Grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide." "We should not despair of the eternal salvation of persons who have taken their own lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives."

The Moral Issues of Abortion

Abortion in the Philippines

Unplanned pregnancies on the rise

December 8, 2011, 3:50am MANILA, Philippines "I'm pregnant! are two words any parent would dread hearing from their teenage daughter. The truth however is appalling: teenagers are having sex. Based on a survey by the National Statistical Coordination Board (NSCB) 23 percent or five million Filipino adolescents aged 15-24 have already engaged in premarital sex; the direct result of which are an increase in the incidences of sexually transmitted diseases (STDs) and unplanned pregnancies that lead to abortion. According to a World Health Organization (WHO) study, one third of teen pregnancies worldwide result in abortion. In the Philippines where abortion is illegal, the numbers are unspeakable: 64,000 abortions annually, based on a study by the World Bank in 2010. The harsh realities on unwanted pregnancies are shocking. The burden is on young women who have to face social stigmas that can have harmful psychological and social impact. Educating the young on pressing issues on sexual health is imperative, says Isa Marfori, brand manager for leading condom brand Durex.

Unplanned pregnancies on the rise

December 8, 2011, 3:50am MANILA, Philippines "I'm pregnant! are two words any parent would dread hearing from their teenage daughter. The truth however is appalling: teenagers are having sex. Based on a survey by the National Statistical Coordination Board (NSCB) 23 percent or five million Filipino adolescents aged 15-24 have already engaged in premarital sex; the direct result of which are an increase in the incidences of sexually transmitted diseases (STDs) and unplanned pregnancies that lead to abortion. According to a World Health Organization (WHO) study, one third of teen pregnancies worldwide result in abortion. In the Philippines where abortion is illegal, the numbers are unspeakable: 64,000 abortions annually, based on a study by the World Bank in 2010. The harsh realities on unwanted pregnancies are shocking. The burden is on young women who have to face social stigmas that can have harmful psychological and social impact. Educating the young on pressing issues on sexual health is imperative, says Isa Marfori, brand manager for leading condom brand Durex.

Abortion

Abortion
expulsion of the fetus before it is viable; may be spontaneous or induced the most common bleeding disorder of early pregnancy Occur in 15-20% of recognized pregnancy

Age of Viability

Types of ABORTION
Natural Abortion
Threatened Abortion Imminent Abortion Complete Abortion Incomplete Abortion Missed Abortion Habitual Abortion

Direct or Intentional Therapeutic Abortion Eugenic Abortiion

The Moral Issues of ABORTION

Theory of Immediate Hominization Theory of Delayed Hominization

The Moral Issues of ABORTION

Theory of Delayed Hominization
Implantation takes place six to seven days after conception. Unity and Uniqueness it happens between 2 to 4 weeks after conception. Looks Human views that ensoulment occurs during the 5th and 6th week of fetal development. Electrical Activity about 8 weeks of pregnancy Quickening abput 10th to 12th wek Viability fetus is viable at about 28th weeks Birth

Techniques of Induced Abortion

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What are the EFFECTS of ABORTION

Moral Issue of Euthanasia

The act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy

ACTIVE AND PASSIVE EUTHANASIA

Active Euthanasia or Positive Passive Euthanasia or Negative

Activity
A physicist who had done research on x-rays for thirty years was suffering terribly from skin cancer. Part of his jaw, his upper lips, nose and left hand were lost; growths had been removed from his right and two fingers from his right hands. He was blind and in constant and excruciating pain. Only surgery and continued suffering awaited the patient who the doctors felt had about a year to live. For months he pleaded with his three younger brother to put an end to his life. Eventually, the youngest, a man of 36 took a pistol and after an afternoon and early evening wandering and drinking in local bars, returned to the hospital during visiting hours and shoot his brother to death. What specific type of euthanasia was performed in thi case? Explain your answer. If you were the younger brother or sister, would you have done the same thing? Would you approve of the means employed or would you have preferre3d a more subtle, nonviolent and painless method? Justify your position.

The most realistic, beneficial and useful thing to do in a situation where recovery is nil, is to offer one's healthy organ to people who can still benefit from them. Why render them useless and allow them to die with the patient if others can still use then to continue living?

The Moral Issue of Suicide

The word suicide comes from two Latin roots, sui (of oneself) and cidium (killing or slaying).i People have committed suicide in an endless variety of ways, including swallowing poisonous spiders, power-drilling holes in their heads, sticking hot pokers down their throats, choking on underwear, injecting peanut butter into their veins, crushing their necks in vices, and hurling themselves into vats of beer.b In China, someone takes his or her own life on average every two minutes. China accounts for nearly a quarter of the global total of suicides with between 250,000 and 300,000 suicides a year.b Among famous figures who committed suicide: Sigmund Freud, Cleopatra, Mark Antony, Brutus, Judas Iscariot, Hannibal, Nero, Virginia Wolf, Adolf Hitler, Ernest Hemmingway, Sylvia Plath, Vincent van Gogh, Jack London, Dylan Thomas, Judy Garland, Rudolph Hess, Pontius Pilate, Socrates, and possibly Tchaikovsky, Elvis Presley, and Marilyn Monroe.i It is more likely someone will die from suicide than from homicide. For every two people killed by homicide, three people die of suicide.b

The Moral Issue of Suicide

The suicide rate in the United States has been climbing steadily since 1999In America, someone attempts suicide once every minute, and someone completes a suicide once every 17 minutes. Throughout the world, approximately 2,000 people kill themselves each day.b Suicide is the 8th leading cause of death in the United States.b The most common types of suicide include copycat, euthanasia, familicide, forced, honor, Internet, martyrdom, ritual, attack, and cop suicides.b The acne medication isotretinoin (Acutane) has been linked to a possible increase risk of suicide. The FDA requires Acutane to include a label warning that the product may be linked to suicide, depression, and psychosis.b The spring months of March, April, and May have consistently shown to have the highest suicide rate, 4-6% higher than the average for the rest of the year. Christmas season is actually below average. Some studies suggest greater seasonality in suicides in rural rather than urban areas.g

The Moral Issue of Suicide

10. Drowning 9. Electric Shock 8. Exsanguinations 7. Jumping 6. Suffocation 5. Carbon Monoxide Inhalation 4. Poisoning 3. Hanging 2. Drug / Alcohol Overdose 1. Gun Shot

Moral Issues of Contraception and Sterilization

Contraception is defined as the
voluntary prevention of conception by the positive use of artificial means which hinders the generative cell from uniting during sexual act.

Sterilization

is defined as the mutilation of sexual power of man of man or women so as to render conception impossible.