ETHICS

• MORAL PHILOSOPHY DEONTOLOGICAL THEORY

• Derived from the Greek word ETHOS, This type of theory claims that there are features
which means CUSTOM or CHARACTER within the actions themselves which determine
• Philosophical science that deals with whether or not they are right.
morality of human conduct These features define the extent to which the
• Systematically establishes the standards or actions conform with recognized moral duties.
norms of human acts Deontological theories do not consider
• Determines human acts as good or bad and consequences to be important when determining
right or wrong whether or not an action is ethical.
• Provides the principles on the morality of It doesn’t matter if the drunk driver made it
human acts. home safely.

Immanuel Kant's ethical theory is deontological.

4 Major areas of Study: He claims that actions are only morally right
when they are done out of duty.
• Descriptive ethics He sees moral duties as unchanging laws

–
for human conduct.
this is the division of philosophical Always act out of duty, in accordance with a
or general ethics that involves the good will
observation of the moral decision- I.e. One does the right thing
making process with the goal of because one recognizes that it is the
describing the phenomenon. right thing to do, not because it
– Describes the nature, essence or
pleases you to do it or will promote
good consequences.).
substance of reality.

– reports what people believe, how the TELEOLOGICAL THEORY

This describes an ethical theory which judges the
y reason, and how they act.
rightness of an action in terms of an external goal
or purpose.
• Normative Philosophy According to a teleological theory, consequences

–
always play some part, be it small or large, in the
concerned with criteria of what is determination of what one should or should not do.
morally right and wrong. Theory of morality that derives duty or moral
– It includes the formulation
obligation from what is good or desirable as an end
to be achieved.
of moral rules that have
direct implications for what human
actions, institutions, and ways of life
should be like.
• Practical Philosophy

– 3 types of normative theories:

– A division in philosophy which
reflects on truth with due recourse of
• virtue theories, deontological action.
(moral obligation) theories,
and teleological theories
– the attempt to work out the implicatio
nsof
general theories for specific forms of
VIRTUE-BASED THEORY conduct and moral judgment;
Virtue based theories focus on the character of the formerly called applied ethics.
person.
According to virtue based theories, ethics is about
what sort of person one should strive to become.
The qualities that one should develop in oneself are
called virtues (ex. honesty, fairness, kindness, • Critical Philosophy (Epistemology)
faithfulness, generosity, prudence, integrity,
bravery, etc.). – is the study of the nature and scope
of knowledge and justified belief.

– It analyzes the nature of knowledge

and how it relates to similar notions
For example: such as truth, belief and justification.
Aristotle claimed that in order to become an honest
person, one should tell the truth. (Aristotle) Eventually it
– asks questions like: "What is
knowledge?", "How is knowledge
becomes a habit. acquired?", "What do people
One learns how to tell the truth appropriately, know?", "What are the necessary
without being brutally honest all of the time or lying and sufficient conditions of
whenever it is easier to do so. knowledge?"
It is a learning process that continues throughout
your life.
 MORALITY BIOLOGY
• Derived from the Latin word MOS or MORIS • Natural science that deals with the issue of
• Applied Ethics life
• Actualizes/ applies the theories and • Important in bioethics because it deals with
principles provided by ethics the multifarious (DIVERSE) dimensions and
domains of all life forms.
Postulates in Ethics
(Presumed to be true) BIOETHICS
•
• The existence of God.
This term was introduced by DANIEL
CALLAHAN in 1969, together with
• The existence of intellect and free will.
WILLARD GAYLIN when they founded the
HASTINGS CENTER
• The spirituality and immortality of the • Popularized by VAN RENSSELAER
POTTER in 1970
human soul.
Moral Assumptions • BIOETHICS
•
• As a rational and free grade of animal, man
A discipline that deals with the ethical
implications of biological research.
knows that there are actions that are right • The study of ethical issues that emanate
or wrong, and good or bad. from the changes and developments in the
• Man knows that there are actions that he is
•
life science technologies.
A branch of ethics that deals with the life
not obliged to do.
sciences and their impact in society.
• Man knows that he is responsible for his • A branch of ethics that analyzes moral
actions. values in the context of biomedical

•
sciences.
Man knows that those actions are • A branch of the ethics of biological science
considered wrong are punishable and that and medicine.
those actions that are right are rewardable. • A systematic study of the human conduct in
the areas of the life sciences and
Humans: The Sole Moral Agents healthcare.
It is their being rational that makes humans • It belongs to the auspices of medical ethics
humans. and is loosely anchored in the avenues of
The human person’s perceptual knowledge helps life sciences.
him/her draw judgements as he/she compares • The study of the moral problems in
ideas. medicine and biological technology.
The human person, therefore, does not just
perceive things but also analyzes, assesses, BIOETHICS
criticizes, or intellectualizing things. PREVAILING ISSUES SURROUNDING
Intellect Compared with Will THE AUSPICES OF BIOETHICS:
What does intellect do?
• Human life
It knows.
• Health
Acts as the thinking faculty of the human
person. • Research
Enables him/her to search for truth • Science
What about the will? • Technology
It chooses. • Philosophy, theology, law and medicine
It implements what it has chosen.
Enables him/her to choose which is good. HEALTHCARE ETHICS
• A domain in the practice of the healthcare
Concrete Basis of Morality profession that sets the standards or
Morality becomes vivid when one encounters a guidelines relative to studies, inquiries, and
moral experience. decisions on the part of healthcare
This moral experience leads him/her to a moral professionals in relation to the delivery of
problem. healthcare.
The human person is duty-bound to face his/her • Deals with ethical issues such as: life-
obligation. support system, testing of diseases, access
Ex. to healthcare services, brain death, clinical
Should a person who has no money, steal? death, suicide, euthanasia, vices and
Should a person who has no answer in an virtues, conscience and law.
exam, cheat?
PROFESSIONAL ETHICS
• The normative moral system that injuncts a
kind of behavior that is expected of a
professional.
• NOT ONLY OF AN INDIVIDUAL BUT
ALSO AS A GROUP.
CASE STUDY PREVALENCE OF BIOETHICAL ISSUES
Not My Job BEGINNING OF HUMAN LIFE
Barbara Gonzales is a special procedures
nurse at a medium-sized community hospital. She When does human life , or personhood begin?
enjoys her position as it allows her to spend ART 41 OF THE CIVIL CODE
additional time with the patients who have come in • “For civil purposes, the fetus is considered
for cardiac stress tests. In fact, she enjoys almost born if it is alive at the time it is completely
all aspects of her job with the exception of dealing delivered from the mother’s womb.
with Dr. Jones, who is invariably late for procedure • However if the fetus had an intra-uterine life
appointments. Barbara understands that physicians of less than seven months, it is not deemed
have full schedules and often must take additional born if it dies within 24 hours after its
time with some patients, which makes them late for complete delivery from the maternal womb.”
all other appointments that day. ART. 42 OF THE CIVIL CODE
However, in this case, it is not a professional issue • “Civil personality is extinguished by death.
that is causing the problem but rather a personal The effect of death upon the rights and
one. It is widely known among staff that he is obligations of the deceased is determined
having an affair with a nurse from the critical care by law, by contract and by will.”
unit and spends time talking with the nurse while on • P.D. 603
the job. Barbara does not care who Dr. Jones is • Issue of human personhood is determined
having an affair with and feels it is not her business at fertilization or conception.
to judge. However , she resents being brought into • Why should the beginning of human life
the matter, as the doctor directed her to tell his need to be determined?
waiting patients that he is being held up in an Because of the serious moral problem that
emergency. pertains to abortion.
• Is Nurse Barbara making a big deal over a
small matter?
• Does she have a duty to cover for her THEORIES OF THE BEGINNING OF EXISTENCE
colleague? OF HUMAN LIFE
• How would you address this issue? NEUROLOGICAL THEORY
• What best serves the patients? • Based on the capabilities and functions of
electroencephalogram (EEG)
• EEG recognizes the life of a fetus at
NIGHTINGALE’S PLEDGE approximately 24-27 weeks
• According to HAROLD MOROWITZ and
was composed in 1893 by Lystra E. Gretter JAMES TREFIL, that very moment when a
and a Committee for the Farrand Training developing fetus starts to manifest an EEG
School for Nurses, Detroit. It was called the pattern indicates the beginning of human life
Florence Nightingale Pledge as a token of • Human life begins from 4 – 6 months after
esteem for the founder of modern nursing. gestation
It was first administered to the 1893
graduating class of the Farrand Training BIOLOGICAL INDEPENDENCE THEORY
School, Harper Hospital, Detroit, Michigan. It • Founded on viability and depends on the
is as follows: maturation of the lungs of the growing fetus.
• Based on this theory, not until the fetus has
acquired matured lungs that can strongly
allow it to be viable, or exist outside the
uterus, only then can it be said to have
started to live, or have enjoyed the status of
human life.

METABOLIC THEORY
• Advocates that there is no such thing as
fertilization
• Believe that the concept of fertilization is
only concocted by both physicians &
biologists only for academic purposes.

EMBRYOLOGICAL THEORY
• Believes that beginning of human life
happens at gastrulation

Gastrulation – the process in which a

gastrula (an embryo in an early stage of
development) differentiates into two cell layers;
approximately starts at the third week of pregnancy
 • Advocates that from 12 to 14 days after CONTRACEPTION
fertilization, the embryo is intrinsically • Male condom
capable of splitting into identical twins • Female condom
• Maintains that the embryo is credited of • Contraceptive sponge
being a human being; however it is not a • Withdrawal or coitus interruptus
person yet • Tubal ligation / female sterilization

SELF-CONSCIOUSNESS THEORY Controversial Choices

• Human life begins when the child earns The value of self-determination is cited to support 2
consciousness of his/her very self decisions that have been the focus of much
• Proposed by MICHAEL TOOLEY, argues controversy for many years:
that only when the child attains Abortion
consciousness can he/she be ascribed as a Active euthanasia
person
Nurses need to be very clear about their own
GENETIC THEORY values regarding each of theses issues, and find a
• Fertilization or conception marks the balance between personal values & professional
beginning of humanness and personhood obligations to patients and families.
• Considers the conceptus a person Nurses must sort out their own beliefs about what is
right and wrong
CURRENT REPRODUCTIVE TECHNOLOGY so that they can differentiate between tasks
SEX SELECTION & roles that are consistent with their ethical
Three ways: stance and those that are not.
(1) pre-implantation method Make responsible practice decisions
o Sperm Sorting and Pre-Implantation accordingly.
Genetic Diagnosis / Embryo
Screening ABORTION
(2) post-implantation method • Any premature expulsion of a human fetus,
- Amniocentesis / ultrasound machines whether naturally spontaneous, as in
(3) post-birth method miscarriage, or artificially induced, as in a
- sex-selective infanticide surgical or chemical abortion.
- sex-selective abandonment • 1973, US Supreme Court handed down a
- sex-selective adoption decision on Roe v. Wade legalizing abortion
in all 50 states during all nine months of
pregnancy for any reasons---medical,
social, or otherwise
CONTRACEPTION
o Oral contraceptive pill
- Made up of hormones similar to those
found in a woman’s body. PSYCHOLOGICAL CONSEQUENCES
o Intra-uterine system (Mirena) • Horrible nightmares of children, body parts,
- Guarantees straight long 5 yrs. Of blood
contraception. • Psychological pain
o Contraceptive patch • Feeling of worthlessness
- Looks like a square band-aid. • Post-Abortion Syndrome (PAS)
- Must be worn at all times for 3 wks. - drug and alcohol abuse
- Uses estrogen & progesterone - personal relationship disorders
o Intra-uterine device - sexual dysfunction
- Usually made up of copper which is - repeated abortions
inserted into the uterus. - communication difficulties
- damaged self-esteem
• Injection or injectable contraceptive - attempting suicide
• Vasectomy / male sterilization
• Diaphragm ▪The abortion debate sparks passionate, emotion-
• Cervical cap laden arguments in political, social, legal, religious,
• Vaginal contraceptive ring and moral arenas.
• Emergency contraception ▪Issues of self-determination arise regarding the
• Outercourse / non-vaginal sex mother’s right to control her body and her life (right
• Rhythm method to choose), in contrast to rights of the unborn fetus
• Calendar-based method to a chance at life (right to life).
• Body temperature method ▪“Right-to-Life” Camp
• Billing’s method ➢Believe that abortion constitutes murder of
- Woman has to monitor the discharges an unborn person, suggesting it is a legal as
during ovulation. well as an ethical matter.
▪“Right-to-Choose” Camp
The right to privacy regarding health care ARGUMENT
decisions includes a woman’s reproductive AND ETHICAL CONTRADICTION
choices, implying that governmental QUESTIONS:
regulation is an infringement on this privacy. • Must a patient who is suffering from an
extremely painful cancer of the throat and
▪Values in relation to life are fundamental will certainly die several days later be
considerations in regard to abortion, such as: allowed to die of pain? Or . . .
Beliefs about when life begins • Must he/she, if he/she so desires, be
Considerations regarding quality of life for assisted by a doctor to hasten his/her
children who are unwanted. death?
Concerns about the mother’s life & health. • Must the patient be killed painlessly? Or . .
.
ABORTION • Must he/she rather be allowed to die the
▪Some believe that life starts at conception, while natural way?
others hold that life begins only when a fetus is
viable outside the womb. ▪J. GAY – WILLIAMS
▪Opponents of abortion hold the position that ▪A renowned advocate of the immorality
because a fetus possesses humanity, it must be and the wrongfulness of euthanasia,
accorded all human rights, including the right to life. condemns euthanasia for the following
▪Proponents of abortion argue that based on reasons:
autonomy, a woman has a right to her own body, • It contradicts nature since it
and that no woman should be forced to bear a child is a blatant violation of the
that she does not want natural inclination to
preserve life.
EUTHANASIA –All human beings are
▪Derived from two Greek words EU, which means endowed with a natural
well or good, and THANATOS which means death. inclination to preserve life.
–All normal human beings have fear of death.
▪The act of deliberately ending a life to relieve ▪He condemns euthanasia for the following
suffering in a painless way. reasons:
• If practiced, euthanasia will
bring a lot of disadvantages
TYPES OF EUTHANASIA because it endangers the
preservation of life
1. ACTIVE EUTHANASIA (similar to assisted inasmuch as it leads to
suicide) medical practitioners to be
▪A person deliberately intervenes to end less efficient.
someone’s life • Accepting euthanasia as a
▪Lethal substances are used to kill a person practice may result in
Ex. Sodium thiopental, pancuronium certain undesirable long-
bromide term consequences.
▪He claims that “TO SAVE LIVES” is the
2. PASSIVE EUTHANASIA total commitment of doctors & nurses, and
▪A person causes death by withdrawing or other healthcare providers.
withholding a treatment that is necessary to −Thus, to lose the life of a patient
maintain life must be for them a personal failure
▪E.g. avoiding the intake of common treatments like which is an insult to their skills and
antibiotics, chemotherapy knowledge.
−If euthanasia would be practiced,
3. NON-ACTIVE EUTHANASIA
this predicament will be changed.
Life-support systems shall be withdrawn from the
−Doctors & nurses might not try hard
patient.
because patients will be better off
dead
FORMS OF EUTHANASIA
▪Experts like E. J. Hayes, P. J. Hayes, D. E.
1. VOLUNTARY EUTHANASIA
Kelly
▪A person makes a conscious decision to die
–“Euthanasia is immoral and therefore
painlessly and asks for help to do this
ought not be legalized.”
–They based their convictions on the
2. INVOLUNTARY EUTHANASIA
following grounds:
▪The patient cannot decide for himself/herself to die
• Legalized euthanasia would lessen
painlessly so that another person will decide for
the incentive for medical research.
him/her.
• It would become possible to
Terminally ill
arrange for the death of an enemy,
Comatose
or a wealthy relative.
Persistent vegetative state (PVS)
Defective newborns
•Voluntary euthanasia is but a step removed from •It is a blatant negation to accept the facts of life in
compulsory euthanasia. the name of courage, obligation, respect, love &
• The purpose of the medical gratitude to God and members of human society.
profession is to preserve life not to
destroy it. It is therefore the paramount duty of the healthcare
• Many patients today surprise the providers to keep track of the emotional status and
doctor by recovering; if euthanasia mental directions of their patients, especially those
is legalized, they would be killed. who are suffering from malignant diseases, to hold
• The practice of euthanasia would on to their life, no matter what.
make the doctor a man from whom Healthcare providers must always be ready to
we would wish to flee in terror when assist their patients in their spiritual, physical,
we are seriously ill. emotional, psychological, and mental
turmoils.
SUICIDE
▪Derived from the Latin word SUICIDIUM which DANGERS OF LEGAL EUTHANASIA AND
means “to kill oneself”. ASSISTED SUICIDE
▪The direct killing of oneself on one’s own authority. • Safeguards don’t prevent abuse of euthanasia
▪The intentional killing of one’s own life. laws
▪The agent of death is the person himself. • Doctors killing people becomes normalised
• It compromises palliative and hospice care
MEDICAL EUTHANASIA • People will die because of mistaken diagnosis or
prognosis
 Physician directly commits the act by medical • Euthanasia and assisted suicide don't guarantee
means a dignified death
 The physician is necessary and sufficient for • Euthanasia and assisted suicide are the ultimate
the act to be completed tools for elder abuse
 The patient's condition provides the context
DEATH
ASSISTED SUICIDE CHARACTERISTICS OF DEATH:
• It is ineffable.
 The physician provides the medical means – Incapable of being expressed in
 The physician is necessary, but not sufficient words; complex in nature;
for the act to be completed mysterious
 The patient needs to do the final act • It is inescapable.
Everybody dies
COMMON METHODS: • It is beyond experience.
▪Asphyxation One can never have a chance to have a
Deprivation of O2 by hanging oneself taste of death and later share her
▪Toxification encounter with it.
poisoning • It is personal.
▪Blunt force trauma There is no such thing as “untimely death”.
Jumping from a building, etc.
▪Self-defenestrating • It is ontological.
Making oneself killed by a train, truck, etc. – Intrinsically embedded in us at the
▪Exsanguination/Bloodletting very moment when we earned the
Slitting one’s wrist, abdomen, etc. breath of life.
▪Drowning – “As soon as man comes to life, he is
▪Electrocution at once old enough to die”.
▪Self-immolation • It is the grand equalizer.
A deliberate and willing sacrifice of oneself It is never choosy of who it seeks to take.
often by fire. Death takes anybody in a designated
▪Starvation moment as it strikes.
CAUSES OF SUICIDE: DEFINITION OF DEATH
▪Physical pain, illness MEDICAL DEFINITION
▪Anxiety, emotional pressure ▪Death is the permanent cessation of all bodily
▪Financial difficulties functions.
▪Shame, guilt, depression, desperation
▪Psychological disturbance, mental disturbance LEGAL DEFINITION
▪Death is the cessation of life as indicated by the
absence of blood circulation, respiration, pulse and
APPLIED ETHICAL THEORIES other vital functions.
▪The dead person is fit to be buried.
•Is SUICIDE immoral?
•It is nothing else but tantamount to cowardice. LEGAL AND MEDICAL PURPOSES DEFINITION
•It is a total reversion and aversion of sanctity of the ▪Death is the irreversible cessation of all the
God-given life. following:
 (1) EEG assessed flat-lined total cerebral Neural stem cells found in the
function nervous system.
(2) Spontaneous function of the respiratory Their supply in the human body is so limited as
system compared to the stem cells found in the embryos.
(3) Spontaneous function of the circulatory
system Embryonic Stem Cell
The most undifferentiated stem cell is the zygote,
embryo, or the fertilized egg.
UNIFORM DETERMINATION OF DEATH ACT Removal of cell from the human embryo was
(UDDA) initiated in August 09, 2001.
DEFINITION 3 Kinds of Stem Cells:
▪An individual who has sustained either (1) Totipotent
irreversible cessation of circulatory and respiratory Multipotent
functions; or (2) irreversible cessation of all Pluripotent
functions of the entire brain, including the brain, is
dead. A determination of death must be made in • Totipotent stem cells
accordance with accepted medical standards. Have the total potential to develop into
different types of cell.
BRAIN DEATH • Multipotent stem cells
• Patient shows total unreceptivity or Are those whose potentiality to develop into
unawareness to all external stimuli and is other cell types are minimal or
unresponsive to painful stimuli. limited in numbers.
• All spontaneous muscular movement and • Pluripotent stem cells
respirations are gone. Can develop into any cell type except in the
• The pupils loss reflexes and are dilated potentiality to develop as a fetus.
and fixed.
• Still breathe with the help of a ventilator. Only the Totipotent stem cells have the intrinsic
• Legally dead potency to become a zygote or an embryo.
Scientists extract Pluripotent stem cells from
Clinical death human embryos to come to terms with cure or
A medical condition that precedes death rather than healing of various diseases.
being actually dead. Embryos used for this purpose are those
Cardiac arrest that are considered extra or surplus which
are generated from experiments outside the
STEM CELL TECNOLOGY womb of the mother.
STEM CELL
▪A cell that has the ability to divide or self replicate New Method:
for indefinite periods---often throughout the life of In 2006, scientists discovered the
an organism. production of induced pluripotent stem cells
▪Stem cells have the potential to develop into (iPS) by using skin cells.
mature cells that have the characteristic shapes This method allows doctors to create stem
and specialized functions. cells with a specific patient’s genetic code,
eliminating the risk that the body would
2 PRINCIPAL CHARACTERISTICS OF STEM reject transplanted tissues or organs.
CELLS

• They are unspecialized cells that renew

themselves for long periods through cell
division;
• They can be induced to become cells of
the heart muscle, or the insulin-producing
cells in the pancreas.

Stem cells are primitive cells.

They can develop into:
Blood
Bones
Nerve cells
Liver cells
Heart tissues
Brain cells

There are several kinds of stem cells in the human

body.
Example:
Hematopoietic stem cells found in
the bone marrow