THEORIES AND PRINCIPLES OF HEALTH

ETHICS

I. THEORIES AND PRINCIPLES OF HEALTH

Ethics- is a philosophical and practical
ETHICS
science that deals with the study of the
morality of human acts or human conduct. A. Ethical Theories

• Ethics as a science- comprises data on

the morality of human acts that are put
1. Deontology
together and arranged in order along
with the causes and reasons by which • Deontological (Duty- Oriented)
said data are held to be factual Theories- Greek word “deon”,
thereby making a systematized body of obligation, duty, and “logos” meaning
knowledge. “science”. Is the normative ethical
• Human acts with reference to right and theory that the morality of an action
wrong should be based on whether that
action itself is right or wrong under a
Morality- quality of human acts where the acts
series of rules rather than based on the
could be good or right, evil or wrong.
consequences of the action. Concept
What makes good, good? was introduced by Immanuel Kant.

•An act is good when it is in Example: Killing someone is wrong, even if it

agreement or conformity with the was in self-defense.
dictates of right reason
What makes evil, evil? • Duty is the basis of all moral action.
Some acts are obligatory (duty-bound)
•An act is evil when it is not in regardless of their consequences.
agreement and conformity with
and is in transgression of the How do we know what our duty is? One
dictates of right reason. possible answer to the question can be found
What makes reason right? in classical deontological theory that derives
from religious ethics. According to this view, it
• Reason is considered right when it is is Gods command that determine our moral
conformity with the truth- which duties. If, for example, Gods commands “thou
must be objective in its sense. The shall not kill, thou shall not steal, then conduct
truth is not that which is acceptable that accords with this command is morally
only to some but not to others. What praiseworthy (right and justified).
is true for you may not be true for
me or vice versa. Rather the truth is 2. Utilitarianism
universally acceptable to all human
persons regardless of time, space • Based on Jeremy Bentham and John
Stuart Mill an English philosopher
and culture since its capability of
describes that utilitarianism seek
being recognized is anchored upon
pleasure, avoid pain and you do things
the intrinsic demand of human that are more beneficial to the greater
nature which is the same among all majority.
men. • Actions are to be judged by their
Bioethics- a science that deals with the study consequences.
of the morality of human conduct concerning • General welfare of people as a whole
human life in all its aspects from the moment rather than individuals.
of its conception to its natural end. • Promotes universal point of view, that
one person interests cannot count as
Health ethics- a science that deals with the being superior to the interests of
study of morality of human conduct another, just because they are
concerning health and health care. personal interest. (I cannot claim that
 my interest is more deserving than your uses communication skills, speech, signals,
interests are, just because they are my writing and behaviour during patient
interests) assessment as well as the planning,
implementing and evaluating of nursing care.
B. Virtue Ethics Communicate with patients, families, groups
and members of the health care team. Good
1. Virtues/Ethics in Nursing in oral and written forms of communication as
well as in techniques of therapeutic
Virtues- refer to specific character traits. communication.
Examples: Honest, courage, kindness,
respectfulness, f. Teaching- most important role of a nurse is to
compassion, fairness. assist patients and their families with receiving
information necessary for maintaining
Virtue Ethics- It is in the heart and personality patient’s optimal health. A nurse provides
of the agent and in their character. patients and families with information based
Emphasizes being a certain kind of person on their assessed learning needs, their abilities,
who will no doubt manifest their being in learning preference and other readiness to
actions or non-action. learn.
The question is “What sort of person should I
become?” g. Critical Thinking- nurses constantly involved
Aim to cultivate in gifted people their in making accurate and appropriate clinical
potential intellectual and moral qualities. decisions. Able to think critically and can
The Nightingale Pledge: Promise, purity, faith, make decisions when patients present
love, loyalty, devotion, temperance, problems in which there may not be clear,
trustworthiness. textbook solutions. It involves an active and
Good Character: is cornerstone of good organized cognitive
nursing. Nurse will act according to principle. process.

2. Core Values of a Professional Nurse h. Psychomotor Skills- are the physical side of
the nursing profession. Good motor skills can
a. Empathy and Caring perform the physical tasks of nursing with
speed and finesse. Can use equipment
Empathy- nurses ability to understand, be properly.
aware of, be sensitive to and vicariously Fundamental of nursing is the “ laying on of
experience the feelings, thoughts and hands” to provide comfort, and the use of
experience of the patients and their family. specific skills to accomplish client assessment
and to provide and evaluate nursing care.
Caring- involves the planning and provision of
culturally sensitive and appropriate care. i. Ethical and Legal Consideration- a nurse
Caring, promoting health, healing and hope plans, provides and evaluates nursing care
in response to the human condition. guided by specific ethical and legal
boundaries.
b. Integrity- respecting the dignity of a normal Code of Ethics- for nurses provides the ideal
and wholeness of every person without framework for safe and correct practices and
condition or limitation. behaviour. Ethical Behaviour also involves
accountability, responsibility, confidentiality,
c. Diversity- affirming the uniqueness and truthfulness, fidelity and justice.
differences among persons, ideas, values and
ethnics. j. Professionalism- involves the characteristics
of a nurse that reflects his or her professional
d. Excellence- co-creating and implementing status.
transformation and strategies with daring
ingenuity. Professionals- are knowledgeable in their
subject matter, conscientious in their actions
e. Communication- the exchange of and responsible for themselves and others.
thoughts, messages or information vital Nurses enhance their professionalism by
importance to the nursing process. A Nurse
understanding history, educational choice, any form of advance payment
professional organization and standards. for treatment.

2. Right to Informed Consent.

C. Ethical Principles
• The patient has a right to a clear,
1. AUTONOMY- Greek word “autos” (Self) and truthful
“nomos” (Governance/Rule) Latin for “Self and substantial explanation, i
Rule” n a
• Having the right to choose/Decide for manner and language unders
himself; An individual has the right to tandable to the patient, of all
determine for himself proposed procedures,
whether diagnostic, preventive,
• Corollary Principles- Honesty in our curative, rehabilitative or
dealings with others and obligation to therapeutic,
keep promises. • wherein the person who will
perform the said procedure shall
The Rights of the Patients provide his name and
credentials to the patient, po
1. Right to Appropriate Medical Care and ssibilities of any risk of mortality
Humane Treatment. or serious side effects, problems
related to recuperation, and
• Every person has a right to probability of
health and medical care success and reasonable risks i
corresponding to his state of nvolved: Provided, That the p
health, without any atient will not be subjected to
discrimination and within the any procedure without his
limits of the resources, written informed consent,
manpower and competence except in the following cases:
available for health and
medical care at the relevant a) in emergency cases, when the patient is at
time. imminent risk of physical injury, decline
• The patient has the right to of death if treatment is withheld or postponed.
appropriate health and medical In such cases, the physician can perform any
care of good quality. diagnostic or treatment procedure as good
• In the course of such, his human practice of medicine dictates without such
dignity, convictions, integrity, consent;
individual needs and culture b) when the health of the population is
shall be respected. dependent on the adoption of a mass health
• If any person cannot program to control epidemic;
immediately be given treatment c) when the law makes it compulsory for
that is medically necessary he everyone to submit a procedure;
shall, depending on his state of d) When the patient is either a minor, or
health, either be directed to legally incompetent, in which case. a third
wait for care, or be referred or party consent Is required;
sent for treatment elsewhere, e) when disclosure of material information
where the appropriate care can to patient will jeopardize the success of
be provided. treatment, in which case, third party
• If the patient has to wait for disclosure and consent shall be in order;
care, he shall be informed of the f) When the patient waives his right in writing.
reason for the delay.
• Patients in emergency shall be • Informed consent shall be obtained
extended immediate medical from a patient concerned if he is of
care and treatment without any legal age and of sound mind. In case
deposit, pledge, mortgage or the patient is incapable of giving
consent and a third
 party consent is required. the follow of the patient without his consent,
ing persons, in the order of priority s except:
tated hereunder, may give consent:
a) when such disclosure will benefit
i. spouse; public health and safety;
ii. son or daughter of legal age;
iii. either parent; b) when it is in the interest of justice and upon
iv. brother or sister of legal age, or the order of a competent court; and
v. guardian
c) when the patients waives in writing the
• If a patient is a minor, consent shall confidential nature of such information;
be ottained from his parents or legal
guardian. If next of kin, parents or legal d) when it
guardians refuse to give consent to a is needed for continued medical treatmen
medical or t or advancement of medical science
surgical procedure necessary to save subject to de-identification of patient and
the life or limb of a minor or a patient shared medical confidentiality for those who
incapable of giving consent, courts, have access to the information.
upon the petition of the physician or
any person interested in the welfare of • Informing the spouse or the family to
the patient, in a summary proceeding, the first degree of the patient's medical
may issue an order giving consent. condition may be allowed; Provided
That the patient of legal age shall have
3. Right to Privacy and Confidentiality. the right to choose on whom to inform.
In case the patient is not of legal age or
• The privacy of the patients must is mentally incapacitated, such
be assured at all stages of his information shall be given to
treatment. The patient has the the parents, legal guardian or his next
right to be free from of kin.
unwarranted public exposure,
except in the following cases: 4. Right to Information.

a) when his mental or physical condition is in • In the course of

controversy and the appropriate court, in its his/her treatment and hospital
discretion, order him to submit to a physical or care, the patient or his/her legal
mental examination by a physician; guardian has a right to be
informed of the result of the
b) when the public health and safety so evaluation of the nature and
demand; and extent of his/her disease, any
other additional or
c) when the patient waives this right in further contemplated medical
writing. treatment on surgical procedure
or procedures, including any other
• The patient has the right to demand additional medicines to be
that all information, administered and their generic
communication and records counterpart including the possible
pertaining to his care be treated as complications and other
confidential. pertinent facts, statistics or
• Any health care provider or practitioner studies, regarding his/her illness
involved in the treatment of a patient • The patient or his legal guardian
and all those who have legitimate has the right to examine and be
access to the patient's record is not given an itemized bill of the
authorized to divulge any information hospital and medical services
to a third party who has no rendered in the facility or by his/her
concern with the care and welfare physician and other health care
providers, regardless of the
 manner and source of payment. serve him as well as the facility
He is entitled to a thorough except when he is under the
explanation of such bill. care of a service facility or when
• The patient or his/her legal public health and safety so
guardian has the right to be demands or when the patient
informed by the physician or expressly waives this right in
his/her delegate of his/her writing.
continuing health care • The patient has the right to
requirements following discharge, discuss his condition with a
including instructions about home consultant specialist, at the
medications, diet, physical activity patient's request and
and all other pertinent information expense. He also has the right
to promote health and well-being. to seek for a second opinion
• At the end of his/her and subsequent opinions, if
confinement, the patient is appropriate, from another
entitled to a brief, written health
summary of care provider/practitioner.
the course of his/her illness
which shall include at least 6. Right to Self-Determination.
the history, physical examination,
diagnosis, medications, surgical • The patient has the right to avail
procedure, ancillary and himself/herself of any
laboratory procedures, and the recommended diagnostic
plan of further treatment, and and treatment procedures.
which shall be provided by the Any person of legal age and of
attending physician. sound mind may make an
• He/she is likewise entitled to the advance written directive for
explanation of, and to view, the physicians to administer terminal
contents of medical record of care when he/she suffers from
his/her confinement but with the the terminal phase of a terminal
presence of illness: Provided That
his/her attending physician or in
the absence of the attending a) he is informed of the medical
physician, the hospital's consequences of his choice;
representative.
• Notwithstanding b) he releases those involved in his care from
that he/she may not be any obligation relative to the consequences
able to settle his accounts by of his decision;
reason of financial incapacity,
he/she is entitled to reproduction, c) his decision will not prejudice public health
at his/her expense, the and safety.
pertinent part or parts of
the medical record the purpos 7. Right to Religious Belief.
e or purposes of which he
shall indicate in • The patient has the right to
his/her written request for reprod refuse medical treatment or
uction.The patient shall procedures which may be
likewise be contrary to his religious beliefs,
entitled to medical certifICate, subject to the limitations
free of charge, with respect to described in the preceding
his/her previous confinement. subsection: Provided, That such
a right shall not be imposed by
5. The Right to Choose Health Care parents upon their children who
Provider and Facility. have not reached the legal age
in a life threatening situation as
• The patient is free to choose the determined by the attending
health care provider to
 physician or the medical • No patient shall be detained against
director of the facility. his/her will in any health care institution
on the sole basis of his failure
7. Right to Medical Records. to fully settle his financial obligations
. However, he/she shall only be
• The patient is entitled to a allowed to leave the hospital provided
summary of his medical history appropriate arrangements have been
and condition. made to settle the unpaid bills:
• He has the right to view the Provided. further, That unpaid bills of
contents of his medical records, patients shall be considered as loss
except psychiatric notes and income by the hospital and health care
other incriminatory information provider/practitioner and shall
obtained about third parties, be deducted from gross income as
with the attending physician income loss only on that particular year.
explaining contents thereof.
• At his expense and upon 9. Right to Refuse Participation In Medical
discharge of the patient, he Research.
may obtain from the health care
institution a reproduction of the • The patient has the right to be
same record whether or not he advised if the health care
has fully settled his financial provider plans to involve him in
obligation with the physician or medical research, including but
institution concerned. not
• The health care institution shall limited to human experimenta
safeguard the confidentiality tion which may be performed
of the medical records and to only with the written informed
likewise ensure the integrity and consent of the patient:Provided,
authenticity of the medical That, an institutional review
records. board or ethical review board in
• The health care institution shall accordance with the guidelines
issue a medical certificate to set in the Declaration of Helsinki
the patient upon request. Any be established for research
other document that the patient involving human
may require for insurance claims experimentation: Provided,
shall also be made available to further, Provided, fUrthermore,
him within forty-fIVe (45) days That the patient involved in the
from request. human experimentation shall
be made aware of the
8. Right to Leave. provisions of the Declaration of
Helsinki and its respective
• The patient has the right to guidelines.
leave hospital or any other
health care institution regardless 10. RIght to Correspondence and to
of his physical condition: Receive Visitors.
Provided That
• The patient has the right
a) he/she is informed of the medical to communicate with relatives
consequences of his/her decision and other persons and to
receive visitors subject to
b) helshe releases those involved in his/her reasonable limits prescribed by
care from any obligation relative to the the rules and regulations of the
consequences of his decision; health care institution.

c) hislher decision will not prejudice public 11. Right to Express Grievances.
health and safety.
 • The patient has the right ✓ Providers will work to understand
to express complaints and the patient’s health care goals
grievances about the care and personal values
and services received without
fear of discrimination or reprisal Informed Consent or Enlightened Consent
and to know about the
disposition of such complaints. • Autonomy and Respect for person.
Such a system shall afford all • Any procedure to be done on a person
parties concerned with the may only be administered with his free
opportunity to settle amicably and Informed consent. This gives valid
all grievances. permission for others to act in certain
specific ways.
12. Right to be Informed of His Rights and
Obligations as a Patient. Informed Consent therefore has 2 main
functions:
• Every person has the right to
be informed of his rights and a. Protective- to safeguard against intrusion of
obligations as a patient. integrity.
• It shall be the duty of health b. Participative- to be involved in medical
care institutions to inform of their decision making.
rights as well as of the institution's
rules and regulations that apply Shift from the Paternalism of “Doctor knows
to the conduct of the patient best and decides” to “Patient knows best and
while in the care of such decides.”
institution.
Nursing Responsibilities:
• Witness the signing of the
Patient’s Bill of Rights consent.
✓ High quality hospital care • Make sure the patient
✓ A patient can expect to be understands the procedure
treated with respect regardless to be performed.
of race, sex, gender, color, The ability to give informed consent depends
religion, age, marital status, on:
sexual orientation, disability or Adequate disclosure of
other state or condition information;
✓ A patient may choose who Legally, adequate disclosure includes
she/he spends time with during information concerning the following:
the course of care • Diagnosis:
✓ Appropriate pain management • Nature and
will be provided to the patient purpose of
✓ Patients are to be free from treatment;
restraints and seclusion unless • Risks of treatment;
completely medically necessary • Treatment
✓ Providers will disclose and alternative
discuss patient’s condition and
provide information about Patient freedom of choice;
relevant medical decisions Patient comprehension of
✓ Providers will understand who is information;
to make decisions for the patient And patient capacity for
if she/he is unable to decision making.
✓ Patients can expect access to
their medical records at will By meeting these above requirements, three
✓ Providers will work to obtain necessary conditions are satisfied:
information from patients about 1. That the individual’s decision is voluntary
their condition and personal 2. That this decision is made with an
state appropriate understanding of the
circumstances;
3. And that the patient’s choice is deliberate *Vicarious Consent- For incompetent or
in so far as the patient has carefully incapacitated individuals, this right and duty
considered all of the expected benefits, of the patient to give consent is to be
burdens, risks and reasonable alternatives. exercised on her behalf by a surrogate. This is
regulated by individual state and federal laws,
following various standards of surrogate
decision making, including substituted
Proxy Consent/Legally Acceptable judgment and best interests.
Representative
• This is done when the patient is not Legally Authorized Representative (LAR): An
capable of giving informed consent individual or judicial, or other body authorized
(unconscious, insane or minor) and under applicable law to grant permission on
legitimately represented by a behalf of a prospective participant in
competent surrogate who acts on his research activities. Surrogate consent was
behalf. previously referred to as “proxy consent”.
• The patient’s family or guardian or
representative provides it. This is Proxy Privacy- A state of being private, withdraw
Consent. Decisions by proxy should be from public view or company. Privacy is
based on what the patient would have justified by the principle of Autonomy. Rights
chosen had he been competent or if to privacy are valid claims against
the patient’s preferences are not unauthorized access that have their basis in
known, based on the patient’s interest. the right to authorize or decline access. These
• Proxy Consent is the process by which rights are justified by rights of Autonomous
people with the legal right to consent choice expressed in the principle for
to medical treatment for themselves or autonomy. In this respect, the justification of
for a minor or a ward delegate that the right to privacy is parallel to the justification
right to another person. of the right to give an Informed Consent.
Latin “ privatus” Patient’s right.
There are three fundamental constraints on
this delegation: Invasion of Privacy – If a patient is exposed to
1. The person making the delegation must the public personally or thru pictures or
have the right to consent. recording, the person responsible for his/ her
2. The person must be legally and medically exposure can be held liable if the patient has
competent to delegate the right to consent. not given his authority for the exposure.
3. The right to consent must be delegated to a Unauthorized exposure even after death may
legally and medically competent adult. constitute Invasion of Privacy.

Depending on the circumstances consent Privacy is a client's right to have control over
may take 2 other forms. their personal information and be free from
being observed by others not involved in their
*Presumed- In cases where individuals are care, while confidentiality refers to a client's
brought to the hospital in an unconscious right to have their information kept secret.
state or with no decision making capacity, Privacy concerns people, whereas
that the procedures to be performed are confidentiality concerns data.
necessary and can’t be postponed until the
person has regained consciousness or 2. CONFIDENTIALITY
decision making capacity. Latin word “confidere” means to trust. Relates
Example: An almost unconscious and to matters of professional ethics. It protects the
unmanageable patient who is gasping and client/patient from the unauthorized
panting for breath because of severe gunshot disclosures of any sort by the professionals
wounds is reasonable judged to be without the informed consent of the client. The
consenting to immediate oxygenation purpose of confidentiality is to safeguard the
inhalation, surgery and other necessary clients right with sanctions for violations of
medical intervention geared towards the confidentiality. Clients must be able to assume
sustenance of life. that their private communications with the
obligation not to divulge information without
the client knowledge and authorization unless Conceal the truth when:
it is in the client interest to do so. *You have no right to disclose the truth
*The person has no right to know the truth
2 General Situations that may give rise to Example: A suspiciously looking individual
exceptions exist: inquires at the nurses station about the
• Concern safety of other location of a patient who turns out to be his
specific person, the target of assassination.
determining factor in
justifying breaking Considerations in concealing truth when:
confidentiality is whether *It must not injure the right of another person
there is good reason to to know the truth
believe, specific *There must be a good reason for concealing
individual are placed in the truth
serious danger *The intention for concealing the truth must be
depending on the good
medical information at
hand.
• Concern for Public 4. FIDELITY
Welfare in most cases of - It’s keeping one’s promises. The nurse must
limited confidentiality. be faithful and true to their professional
The health care promises and responsibilities by providing high
practitioner is required to quality, safe in a competent manner.
report in certain
communicable infectious Example: A nurse who told their patient they
diseases to the public are coming back in 30 minutes to check on
health authorities the duty their pain, would either come back, or
to protect. delegate somebody else to come back if they
are tied up.
3. VERACITY/TRUTH
– means to tell the truth, to never lie to patients 5. JUSTICE
or give them knowingly false reassurance. - Latin word “justitia” – “jus” From “ justus”
means lawful and rightful. Nurses practicing
Example: If a patient was starting justice do not provide care to patients
chemotherapy and asked about the side differently based on their race, gender
effects, a nurse would be honest about the identity, sexual orientation or religion.
side effects they could expect with
chemotherapy. Example: If you are taking care of multiple
patients, you would not provide better care
based on wealth and fame of a person.
Thoughts corresponds to action
“ We should declare what we think and not Fairness; Equal distribution of resources
lie”.
*Lying – intention of deceiving “Giving each one what is his due”
*Lie - “intrinsically evil and can never be JUSTICE = EQUITY
considered lawful” EQUITY vs UNIFORMITY
*Truth – Concealing the truth when: Preferential option for the poor
Mental Reservation- act of the mind limiting X- has a right to his due
the spoken phrase. Y- has the obligation not to deprive X of his
Not bearing the full sense of the phrase. due.
Example: Supposed to know but not to tell Justice also means to treat equals equally
like- Cancer patient. X and Y are equal: X and Y should have equal
benefits/burdens
2. Mental Evasion- limiting the right of the
patient to know about his condition. Avoid in However, problems may arise when
answering questions. Never, tell a lie but tell extraordinary situation occurs such as
them with Mental Reservation and Evasion calamity, epidemics causing difficulties out of
scarcity of health care resources and health
care providers and out of voluminous number treatment has greatest probability
of patients and distribution of health care of medical success.
burdens. b) The principle of immediate
usefulness- gives priority to
4 Different Types of Justice candidate who is of greatest
immediate service to the larger
• Commutative Justice- refers to that group under the circumstances.
which is owed between individuals. To c) The principle of conservation- gives
give to each person that to which he or priority to those candidates who
she is entitled, according to rules of the require proportionally smaller
price system, means to give him or her amount of resources and therefore
that to which he or she is entitled, if the more lives will be saved.
price context complies with its own d) The parental role principle- gives
rules. priority to those who have largest
responsibility to dependents.
Example: in conducting business transactions. Example: The father with dependent children
If I injure my neighbor by driving my would be given priority over a bachelor with
automobile carelessly and he suffers a no dependents.
fracture of the leg, I must recompense him e.) The principle of general social value- gives
with money. priority to those believed to have the greatest
general social worth thus leading to the good
• Contributive Justice- which refers to of society.
what individuals owe to society for the Example: The municipal or city mayor has
common good . Justice is achieved not a right to medical treatment deemed greater
when benefits are received, but rather than an ordinary citizen
when there is both the duty and
opportunity for everyone to contribute
labor and decision making. The 2. Egalitarian Alternative- represent
contribution a person makes to his or maintaining or restoring the equality of the
her society. person in need.

Example: The church encourages EVERYONE a) The principle of saving no one- gives
TO PARTICIPATE in the economic, political, priority to no one because not all
and cultural life of society. It is the duty of all can be saved. If there is no enough
citizens to contribute to the BETTERMENT OF resources for all who need them,
THEIR COUNTRY. then no one should receive any.
b) The principle of medical neediness-
• Legal Justice- which refers to rights and gives priority to the candidates with
responsibilities of citizens to obey and the most pressing medical needs.
respect the rights of all the laws devised Example: Patients who are the most seriously ill
to protect peace and social order. The are the ones who benefit from the limited
rule of law, not the rule of any health care resources.
individual. All men are equal before the c) The principle of general neediness-
law and the law applies equally to all. gives priority to the most helpless or
The restoration of fairness in the eyes of general neediest in attempt to bring
the law. them as nearly as possible to the
level of well.being equal enjoyed by
Distributive justice- which refers to what others.
society owes to its individual members. Example: The poorest candidate would
Example: the just allocation of resources. receive the available resources.
2 alternatives: d.) The principle of first come, first serve basis-
1. Utilitarian Alternatives- maximizing gives priority to those who arrives first.
strategies to achieve the greatest amount of e. ) Principle of random selection- gives
good or minimizing strategies to reduce the priority to those selected by chance or
amount of potential harm. random. The candidate chosen in a lottery
a) The medical success principle- receives the resource.
gives priority to those for whom
 ❖ “Do not inflect harm’’ means to do No,
Creating a health care policy helps decide to prevent, to remove or not to risk
how limited resources are to be distributed. It harm.
should consider the principles of equality ❖ Do not kill, do not cause pain or
(distributive justice), social justice and suffering, do not incapacitate others,
solidarity. The policy should state in clear terms do not deprive others of goods of life
the criteria for consideration, rank ordering,
etc. and this should be made public. The
process must be just, though sometimes X- has a right Not to be harmed;
outcomes do not appear Just. Y- has an obligation, Not to harm X
Harm maybe physical, mental, psychological,
6. BENEFICENCE- Latin “bene” means good; social, financial, spiritual etc.
“facere” means to do; Beneficentia
Example: Hippocratic Oath-“ I will never use
✓ Practice of doing acts of goodness, treatment to injure or wrong the sick”
kindness and charity; suggests acts of Preventing a patient from taking a harmful
Mercy and Charity. medication
A nurse would perform multiple checks before
✓ Is the positive pole of non – administering medication to avoid a
maleficence. It means to do good, to dangerous medication error.
provide a benefit. A surgeon might decide not to perform a high
risk surgery on an elderly patient if the
✓ Performing a deed that benefits potential complications are too risky.
someone.

Other Relevant Ethical Principles

“Do good and do no harm”
1. Principle of Double Effect- is a set of ethical
Action that brings the most benefits and the criteria which Christian philosophers, and
least burden to those affected, this is the some others have advocated for evaluating
Principle of Utility. the permission of acting when one’s otherwise
legitimate act (for example, relieving a
X- has a duty to benefit Y provided Y- is at terminally ill patient’s pain) may also cause an
significant risk effect one would otherwise be obliged to
X’s action is needed; X’s action is likely to avoid (Sedation and a slightly shortened life).
succeed;
There is No significant risk for X. The benefit to An action done with two results: good or bad
Y outweighs any harm for X.
4 Conditions of Double Effect:

Example: Do overtime, during emergency, • The act must be good in itself

Stay and help or No help at all. • The intention must be good
Transporting a sick or injured person to and • Proportion of graveness must
from the hospital be weighed (the good must
Helping a patient to get out of bed outweigh the bad effects)
Providing personal protective measures for • Good effects must follow
health care workers to prevent HIV exposure from the action as
and provide counseling regarding HIV immediately as do the
exposure harmful effects

The intended effect of care must be positive.

Any harmful effects of care should be
7. NON- MALEFICENCE - Make sure patient is predicted but not intended. Harmful effects of
safe and not harmed care should not be used as a way to achieve
beneficial results.
❖ Refraining from doing something that
harms or injures someone.
Example: In cases when saving the life of a Definition: Formal cooperation occurs when
pregnant women causes the death of her an individual or entity directly participates in
unborn child-performing an abortion when and shares the intention of an action that is
the pregnancy would risk killing the mother. morally problematic. One intends the evil, the
other person does.Explicit intention and
2. The Principle of Legitimate Cooperation – willingness for the evil act.
an application of the principle of double
effect to situations involving cooperation with Example: A medical professional actively
someone else action. Cooperation is working assists in performing an abortion procedure
with another in the performance of an action. with the shared intention of terminating a
pregnancy.
-to assist in performing an evil act.
: Paying a hired killer to kill someone.
Cooperation comes from the Latin word cum
which means with,' and operari which means :The relative did not kill the baby but ordering
'to work.' this he was intending for the nurse to commit
this crime.
There are human actions whose
performance is possible and feasible :If the parents or partner of a woman wants
because of people working together with her to have an abortion they are formally
specific functions to play. cooperating with the abortion.

The magnitude and essentiality of the • Material Cooperation:

function played indicate the degree of Definition: An act other than the evil act itself
cooperation in the performance of an act. but facilitates and contributes to its
The lesser the magnitude and essentiality of achievement. Material cooperation involves
the function shared, the lesser the indirect participation in actions that may
cooperation. have morally questionable aspects, but the
individual or entity does not share the
There is no question of morality if the action intention of the morally problematic action.
performed is good.
Example: A nurse assisting a doctor to
Moral question comes in when the act is perform an abortion (she herself does not kill
contrary to the dictates of right reason and the fetus but helps the doctor to kill the child),
moral law. In the discussion of morality, the
principle of cooperation pertains to the evil of The closer the material cooperation to the
an action shared together by individuals in immoral action, the more difficult it is to justify.
the achievement of an evil practice whose
Note: If there is a reason sufficiently grave,
culpability may vary according to the gravity
material cooperation may be morally
of the act partaken.
excused.
Example: Ethical dilemmas arise when
someone else is doing what we consider to be
wrong, and they ask us to help them Or a Direct and Indirect Cooperation
Supervisor (boss) ask one to do something
• Direct Cooperation- direct
which is against one conscience
participation in the performance of evil
(Do not make yourself an accomplice in act.
another person’s sin, accept human Example: The surgeon and the assistant
authorities but obedience to God comes surgeon who directly take part in the removal
before obedience on human beings) of the uterus for the sole purpose of
contraception.
Various degrees of Cooperation
• Indirect Cooperation- act that is not
Formal and material cooperation intimately connected with the
performance of an evil act.
• Formal Cooperation:
Example: a janitor disposing of fetal remains • Supports a balance
after the abortion. between collective
responsibility for public
3. Principle of Common Good and Subsidiary health and individual
autonomy in medical
1. Common Good:
decision-making.
• Definition: The common good
Every task of society should be assigned to
refers to the overall well-being
the smallest possible group that perform it.
of society, where individuals
Only if the smaller group is unable to resolve
and groups work together to
the problem itself should a group at a higher
achieve conditions that enable
level assume responsibility. This idea is
everyone to flourish.
summed up in the principle of subsidiarity.
• Application in Bioethics:
Example: if a family is experiencing problems,
• Emphasizes the the state can intervene only if the family or the
importance of health parents are overburdened and cannot
policies, medical resolve them. It helps to avoid too much
practices, and research centralization. Being able to help oneself is an
contributing to the well- important component of the dignity of the
being of the entire human person.
community.

• Encourages equitable
Example: In an effort to control the apparent
access to healthcare
rapid population growth in the country, the
services and resources.
State formulates a program on responsible
• Calls for the promotion of parenthood which redounds to the
health and prevention of enactment of a law mandating every family
harm on a societal level. to just limit the number of its offspring only to
one or two under pain of penalty. And so, the
2. Subsidiarity:
State through the Department of Health
• Definition: Subsidiarity is the conducts contraceptive programs and
principle that matters should be distributes various forms of contraceptive
handled by the smallest, lowest, methods to ensure the State directed number
or least centralized competent of children every family ought to raise.
authority capable of addressing
Analysis: The State arrogates to itself the
them effectively.
function that can efficiently be done by and
• Application in Bioethics: incumbent upon every family in determining
how many children to raise. A law mandating
• Encourages decision-
every family, under pain penalty, to just limit its
making at the most local
number of children to one or two is a clear
or individual level
violation and usurpation of the innate right of
possible, respecting
the family to raise as many children as it can
autonomy and avoiding
according to its capacity and decision. In the
unnecessary
first place, it is the family who should
centralization of control.
determine and decide on its internal and
• Acknowledges the exclusive affairs, one of which is the decision
importance of on the number of children it would want to
community and have. Thus, the State does is destructive of the
individual involvement in small but basic unit of society, plainly against
healthcare decisions. the principle of subsidiarity.
In the context of bioethics, these principles • Application in Healthcare:
often guide discussions on issues such as:
• Emphasizes the
• Access to Healthcare: Common good responsible use of
emphasizes equitable distribution of healthcare resources,
healthcare resources, while subsidiarity including financial,
supports local solutions and human, and
community involvement in addressing environmental resources.
healthcare disparities.
• Encourages a focus on
• Medical Research: Both principles can the common good and
guide ethical considerations in the well-being of patients
research, emphasizing the need for and communities.
research to contribute to the well-
• Recognizes the
being of society (common good) and
importance of
ensuring that decisions are made at
sustainability in
the appropriate level of authority,
healthcare practices.
avoiding unnecessary centralization
(subsidiarity). 2. Role of Nurses as Stewards:
• End-of-Life Care: Discussions about • Resource Management (a series
end-of-life care often involve of processes and techniques
balancing the common good by used to ensure you have all the
providing compassionate and just necessary resources to
care for individuals while respecting complete a project or meet
their autonomy and making decisions business objectives. It also
at the most local and personal level focuses on making the most
possible. efficient use of those resources
by eliminating waste for more
Principles of Bioethics
profits and a high return on
1. Principle of Stewardship: investment (ROI).):

• Definition: ones responsibility to • Nurses play a crucial role

take care of, nurture and in managing healthcare
cultivate what has been resources efficiently,
entrusted to him including time,
medications, equipment,
• Stewardship is the responsible
and personnel.
management and care of
resources, recognizing the need • They work to minimize
to use, preserve, and allocate waste, promote cost-
resources ethically and effective care, and
sustainably for the benefit of ensure that resources are
present and future generations. allocated where they
can have the most
• Steward- May be characterized
significant positive
as a person who preserves and
impact on patient
promote intrinsic value of a
outcomes.
situation, as well as engage
others in solutions and actions. • Advocacy (are people who
Means keeper; Responsible for speak on behalf of those whose
the care of the body of oneself voices aren’t heard) for
and of others. Patients:

• Accountability- related to both Example: Nurses can act as mediators

responsibility and answerability. between patients and doctors who may have
overlooked certain patient needs or solutions. (example: advocating for the use of green
For example, if a patient receives an cleaning products, encouraging public
inaccurate diagnosis, unsafe transportation or carpooling, and supporting
accommodation, or unclear instructions for waste reduction and recycling efforts)
self-care, the nurse must alert the doctor or
medical facility and communicate the issue.
• Ethical Decision-Making:
• Nurses act as advocates
for their patients, ensuring • Nurses are often faced
that they receive with ethical dilemmas in
appropriate and timely patient care.
care while respecting Stewardship guides
their autonomy and nurses to make ethical
preferences. decisions that consider
the best use of resources
• Stewardship in nursing
while prioritizing patient
involves balancing the
well-being and dignity.
individual needs of
patients with the broader • Quality Improvement:
considerations of
resource allocation for • Nurses contribute to the
the greater good. continuous improvement
of healthcare quality by
• Education and Prevention: participating in initiatives
that enhance patient
• Nurses contribute to
outcomes, safety, and
stewardship by
overall efficiency.
educating patients
about preventive Case Example: Marissa, 16 years old, is on her
measures and health gestational embryonic stage. Her pregnancy
promotion, which can is caused by a gang rape. It is an unwanted
help reduce the burden pregnancy. A certain school of medicine is
on healthcare resources looking for some specimen for embryonic
in the long run. stem cell research which will be paid for
• They play a role in anyway. Marissa notices it and submits the
preventing illness and embryo in her womb for said research.
complications through Analysis:
patient education and
proactive healthcare A human life on its embryonic stage is a gift
practices. from the Creator that needs to be nurtured,
taken care of and given the opportunity to
reach maturity stage towards birth. Yet, the
• Environmental Considerations: mother to whom it has been entrusted submits
it for destruction. And the institution supposed
• Stewardship in nursing to sustain and promote life in all its stages
also extends to destroys it under the guise of medical
environmental technology research advancement. It is an
responsibility, as enormous violation of the principle of
healthcare activities can stewardship.
have ecological impacts.
Nurses may be involved in 2. Principle of Totality:
practices that promote • Definition: The principle of
environmental totality refers to the ethical
sustainability within consideration of the whole
healthcare settings.
 person rather than focusing physical, mental, and
solely on individual parts or social well-being.
specific aspects of a person's
• Promotes the idea that
health. It emphasizes that the
medical interventions
well-being of the entire
should aim at enhancing
individual, including physical,
the overall quality of life
psychological, social, and
for the patient.
spiritual dimensions, should be
taken into account when Case Example: A patient is admitted with a
making medical decisions. gangrenous leg. The attending doctor reasons
out, based on scientific medical basis, that
• The whole implies the existence
there is no other way by which the patient can
of its parts. The existence of parts
be saved but to amputate the gangrenous
indicates the existence of the
part of the patient's body. Is it morally
whole. Their mode of existence
and functions contribute to the permissible for the doctor to do the
whole and vice versa. amputation?

• However, if its state of condition Analysis:

and continuous existence as A gangrenous leg at the cited case poses a
part pose a threat to do more grave threat to the whole body and to the life
harm than good leading to the of the patient. Besides, there is no other way
destruction of the whole and to address the problem except the necessity
that there is no other means by of amputation. The principle of totality which
which the problem can be is in harmony with right reason is employed
addressed, the principle of mandating that the sick part be removed
totality provides that it be since it serves as a fatal threat and that the
removed and sacrificed for the whole is far more important than the
sake of the whole. Parts are gangrenous leg. Hence, the amputation is
viewed in relation to the whole morally permissible.
so that if any one of them
becomes a menace and
irretrievably injurious, the Principle of Integrity:
importance of the whole • Definition: The principle of
prevails over it. This is to preserve integrity in healthcare
the whole which is far greater emphasizes the importance of
than any of its parts. respecting and preserving the
• Application in Healthcare: wholeness and dignity of the
individual. It involves
• Encourages healthcare maintaining the person's
professionals to view physical and psychological
patients in a integrity, as well as their
comprehensive manner, autonomy and individuality.
addressing not only their
immediate medical • Integrity is being honest even
concerns but also when no one else is looking. It is
considering the broader doing the right thing even when
aspects of their lives. no one is around to see you do
it.
• Supports a patient-
centered approach that • Application in Healthcare:
recognizes the • Calls for healthcare
interconnectedness of practices that respect
the inherent dignity of
 individuals and uphold information, and act as
their rights and advocates to ensure that the
autonomy. patient's autonomy is
respected.
• Encourages the
protection of patients 3. Communication and Collaboration:
from unnecessary harm
• Explanation: Effective
and invasive procedures
communication and
that may compromise
collaboration with the surgical
their physical or
team, including surgeons,
psychological integrity.
anesthesiologists, and other
• Recognizes the healthcare professionals, are
importance of informed essential for patient safety.
consent, allowing
• Application: Nurses must
patients to make
communicate clearly, share
decisions about their
relevant patient information,
care while respecting
and work collaboratively to
their values and beliefs.
ensure a coordinated and safe
Ethico-moral Responsibility of Nurses in surgical experience.
Surgery
4. Patient Safety:
Nurses play a crucial role in the surgical • Explanation: Ensuring a safe
setting, and their ethico-moral responsibilities environment for the patient is a
are significant in ensuring patient safety, well- primary ethico-moral
being, and overall positive outcomes. Here responsibility.
are some key ethico-moral responsibilities of
a nurse in surgery: • Application: This includes
verifying patient identification,
1. Patient Advocacy: confirming the correct surgical
• Explanation: Nurses must site, monitoring vital signs, and
advocate for the best interests advocating for infection
and well-being of the patient prevention protocols to minimize
before, during, and after the risk of harm.
surgery. 5. Confidentiality and Privacy:
• Application: This involves • Explanation: Respecting patient
ensuring that the patient's rights confidentiality and privacy is
are respected, providing clear crucial for maintaining trust and
and accessible information, and ethical standards.
addressing any concerns or
questions the patient may have. • Application: Nurses should
ensure that patient information is
2. Informed Consent: handled with discretion, and
• Explanation: Nurses contribute they must uphold the principles
to the informed consent of confidentiality before, during,
process, ensuring that patients and after surgery.
fully understand the nature of 6. Cultural Sensitivity and Diversity:
the surgery, potential risks,
benefits, and alternatives. • Explanation: Recognizing and
respecting cultural and diversity
• Application: Nurses may witness considerations is essential in
the patient's signature on providing patient-centered
consent forms, clarify care.
 • Application: Nurses should be Sterilization is not identical with impotence.
aware of the patient's cultural Impotence is the inability to engage in sexual
background, beliefs, and intercourse.
preferences, and incorporate
• A method of birth control
these factors into their care to
ensure respect for diversity. • Medical Application: In
healthcare, sterilization
7. Ethical Decision-Making:
procedures may include tubal
• Explanation: Nurses may ligation (for women) or
encounter ethical dilemmas vasectomy (for men), both of
during surgery, requiring sound which are elective surgical
moral judgment and adherence procedures intended to
to ethical principles. permanently prevent
pregnancy. These procedures
• Application: Ethical decision-
are typically undertaken with
making involves considering the
the informed and voluntary
best interests of the patient,
consent of the individual.
respecting autonomy, and
navigating situations where Types of Sterilization
conflicting values may arise.
1. Therapeutic or non-Therapeutic
8. Continuing Education and Professional
Therapeutic Sterilization implies the removal of
Development:
all or part of the reproductive organs to protect
• Explanation: Staying informed the health and the life of the client.
about current surgical practices,
technologies, and ethical Example: A female client who is endangered
guidelines is crucial for providing due to cancer of the uterus or cervix was
high-quality care. submitted for Tah BSO. A total abdominal
hysterectomy (TAH), is the removal of your
• Application: Nurses should uterus (womb) and the cervix through an
engage in ongoing education abdominal incision. 2. Bilateral salpingo-
and training to enhance their oophorectomy (BSO), is the removal of both
knowledge and skills, ensuring your fallopian tubes and ovaries.
that they are well-prepared to
meet the evolving needs of Non therapeutic sterilization, often called
surgical patients. Convenience Sterilization is the purpose of
destroying the removal of all or part of the
reproductive organs for the purpose of
Sterilization/mutilation destroying the reproductive function.

1. Sterilization: • sterilization for a purpose other than

to 'treat some malfunction or
• Definition: Sterilization refers to disease
the process of making an object
or a person incapable of example: vasectomy and Bilateral Tubal
reproducing or producing Ligation (BTL)
offspring. In the context of 2. Voluntary and Involuntary
medical procedures, sterilization
often involves surgical or non- Voluntary Sterilization is a term synonymous
surgical methods to prevent an with non therapeutic and convenience
individual from being able to sterilization.
conceive or impregnate. Involuntary Sterilization is compulsory
sterilization of individual reasons for Eugenic
reasons.
3. Direct or Indirect 2. Mutilation:

Direct Sterilization refers to type of sterilization • Definition: Mutilation involves the

that is directly willed either as an end or a intentional removal or alteration
means. of body parts, often resulting in
disfigurement or impairment of
Example: The willful act of submitting for
function. The term is usually
vasectomy
associated with acts that cause
Indirect Sterilization type of sterilization that is severe harm, and it is often
not willfully employed either as an end or a viewed negatively.
means. • Refers to procedure that
Example: the surgical removal of the ovaries or diminishes or destroys the
testicles sick with cancer. functional integrity.

4. Temporary or Permanent Example: Tonsillectomy, ribs resection,

laryngectomy, se transplant, etc.
Temporary Sterilization refers to type of
sterilization that brings about provisionary and • Medical Context: In a medical
reversible sterility context, the term mutilation is
generally avoided due to its
Example: Oral and hormonal contraceptive negative connotations. Surgical
whose sterilizing effect are momentary. procedures are typically
performed to address medical
Permanent Sterilization type of sterilization that
conditions, improve health, or
creates irreversible and lasting sterility,
enhance well-being, rather than
Example: hysterectomy, oophorectomy, to cause harm. Procedures such
salphingectomy as amputations, which involve
the removal of body parts, are
undertaken with the goal of
4. Medical or Surgical treating diseases, injuries, or
other medical conditions.
Medical Sterilization refers to type of
sterilization that produces medically-sterilizing It's important to note that the ethical
effects such as oral and hormonal implications of medical procedures, including
contraceptive. sterilization and surgeries, depend on factors
such as informed consent, medical necessity,
Example: Oral and hormonal contraceptive and respect for individual autonomy. In
whose sterilizing effect are momentary. medical ethics, the principles of beneficence
Surgical Sterilization refers to a surgical (promoting well-being), autonomy
procedure that sterilizes or renders one unable (respecting individual choices), and non-
to reproduce. maleficence (do no harm) guide the ethical
considerations associated with various
4. Punitive or Eugenic medical interventions.
Punitive Sterilization refers to type of In the context of reproductive choices,
sterilization which is a form of penalty or sterilization procedures are considered ethical
punishment usually ascribed as sex related when performed with the informed and
crimes voluntary consent of individuals seeking the
Eugenic Sterilization refers to a type of procedure. However, ethical concerns may
sterilization that is intended for one whose arise if there is coercion, lack of informed
genetic or eugenic make up is seen to consent, or if the procedure is forced.
produce defective offspring. Types of Mutilation
 Major Mutilation- refers to the ❖ That it can be reasonably forseen that
procedure that destroys the functional the negative effect, the mutilation and
integrity of the human body so that it its consequences, will be
becomes incapacitated of its natural compensated by the positive effect.
function. Plastic Surgery- is a surgical procedure of
fixing, repairing and restoring the damaged,
Example: A woman who submits for
disfigured, and missing parts of the body
hysterectomy for the purpose of avoiding
mainly by means of tissue relocation, or
procreation is incapacitated of her uterine
transplantation. The procedure obviously
function to let implantation occur for normal
constitutes a form of mutilation.
fetal development.
Three reasons taken into consideration for
Minor Mutilation- procedure that
plastic surgery:
diminishes but does not destroy the functional
integrity of the human body. ❖ For the treatment of a physical
pathologic condition (to address a
Example: Tonsillectomy, ribs resection, blood
damages, disfigured, or missing bodily
donation, tooth extraction, circumcision.
part caused by either inborn or
Excision of Healthy Organs is not morally incidental/accidental circumcision)
allowed.
Example: A man who has met an accident
Excision of healthy organs is usually not morally and has suffered a severely serious facial
allowed, it provides no sufficient reason and it deformity and is in need of plastic surgery is
is a form of mutilation that attacks the integrity morally allowed to undergo the procedure)
of human body.

Excision of Healthy Organs is sometimes ❖ For aesthetic consideration (to

morally allowed. transform a physical look and feature or
to improve beauty and physically
Excision of a healthy organ is sometimes pleasing qualities)
morally allowed. There are cases when the The morality of aesthetic surgery designed to
continued existence and attachment of a change or improve physical attributes is
health organ to the human body may determined by motive and circumstances
stimulate further progression and surrounding the act.
advancement of certain disease that beserts 3 conditions required to exist so that the
another organ thereby posing a grave serious performance of plastic surgery to a patient
danger to the health and life of the patient. who is in need of aesthetic transformation may
The said cases may constitute be morally justified, to wit:
exception to the general rule so that the ❖ The motive must, in the first
removal of a healthy and non-pathologic place be good
organ can morally be permitted in an effort to ❖ The preservation and
treat and prevent furtherance of disease in protection of the patients
another organ. health from any remarkable
Three conditions that need to be satisfactorily risks and danger must be
fulfilled so that surgical removal of a healthy ensured along with the
organ can be morally allowed, to wit: procedure
❖ The reason sufficiently grave
❖ The preservation of functioning of a should exist proportionate to
particular organ provokes a serious the gravity of the procedure
damage or constitutes a threat to the involved.
complete organism (whole body)
❖ Damage cannot be avoided, or at Example: A pediatric nurse whose big nose
least notably diminished, except by the serves as an object of fear among her
amputation (for mutilation) in question pediatric patients and is found counter
and that its efficacy is well assured.
therapeutic thereby prejudicing both her 5) The recipients for the scarce organs are
nursing profession and employment may in selected justly.
good conscience, seek for aesthetic surgery.
Who can be a donor?
❖ For psychological reason (To treat or 1. Living donor
tackle a certain psychological problem
associated with some distorted 2. Cadaver donor
physical attributes) What are the criteria for becoming an organ
donor?
Example: if a distorted physical state creates
psychological problem and disturbance such 1. Organs can be donated only after a person
as inferiority and insecurity complexes, has been declared brain dead while his vital
neurotic personality and plastic surgery is seen organs are being maintained on a beathing
as a sure means of getting rid of said machine
problems) 2. Organ donors can be anyone including
Preservation of Bodily Functional Integrity newborns up to age 75.
The functional integrity of the person may be How does one become a cadaver organ
sacrificed to maintain the health or life of the donor?
person when no one other normally
permissible means is available. The principle of 1. The prospective organ donor should tell to
totality is based on the natural law which says his family wishes and in the event of his death,
that life is to be preserved and maintained. permission by his family /net of kin

Artificial means of preservation comprise the 2. He must also sign a donor card or express his
application of simple heat or cold, powders intentions in their driver`s license. Although
such as a sawdust bed mixed with zinc these are both considered legal documents,
sulphate, evisceration combined with his family`s permission for donation must still be
immersion, drying, local incision and obtained.
immersion, arterial injections, cavity injections.
Furthermore, simple immersion in alcohol,
brine etc., and sole arterial injection, which Organ Donation Act of 1991 RA 7170 (Ethical
can be combined with cavity treatment and/ considerations in living donation)
or immersion were used.
1. The demand for solid organs far exceeds
Issues on Organ Donation the number of organs available from
deceased donors.
Organ Donation – Transplanting organs from
one living person to another is also ethically • Identify relatives or others who would
acceptable provided that the following be willing to donate the needed organ
criteria are met: or partial organ directly
2. Organ donation by living donors clearly
1.) There is serious need on the part of the
save lives, improves transplantation outcomes
recipient that cannot be fulfilled in any other
under some circumstances, and reduces
way
recipients waiting times.
2.) The functional integrity of the donor as a
3. The transplantation or organs from living
human person will not be impaired, even
donors seems to violate traditional first rule of
though anatomical integrity may suffer
medicine primum non nocere (above all do
3.) The risk taken by the donor as an act of no harm)
charity is proportionate to the good resulting
3 types of living donations matching donors to
for the recipient
recipients
4.) The donor`s consent is free and informed
There are three categories of living donations:
1. Directed Donations: donor specifically each other which is open to fruition
chooses who will receive the transplant in the perpetuation and expansion
of this personal communion through
2. Non-Directed Donation: donor is neither
the family they responsibly beget
related to not known by the person in need.
and educate.
3. Paired Donations (Kidney only): involves at Basic concepts /values recognized in
least two pairs of living kidney donors and sexuality
transplant candidates who do not have
• Sex is a search for sensual pleasure
matching blood type.
& satisfaction, releasing physical &
psychic tensions
• Sexuality- =male and female =
Principle of Ordinary and Extraordinary Means genitals (with natural tendencies)
Ordinary Means – are those that are based on • Sex is a search for the
medication or treatment which is directly contemplation of the human
available and can be applied without person through an intimate
incurring severe pain, costs or other personal union of love expressed by
inconveniences, but which give the patient in bodily union. Sex is a necessary for
question justified hope for a commensurate the procreation of children.
improvement in his health. (Cost is low and
benefit is high) The principle of personalized sexuality in
nursing ethics recognizes that each individual
Extraordinary Means – are medical has unique sexual preferences, needs, and
procedures which no longer correspond to identities. It emphasizes the importance of
real situation of the patient, either because respecting and supporting patients' sexual
they are by now disproportionate to any autonomy, privacy, and dignity.
expected results or because they impose an
excessive burden on the patient and his This principle can be applied in nursing ethics:
family. (Cost is high and benefit is low) 1). Informed Consent: Nurses should ensure
that patients have the necessary information
to make informed decisions about their
Example: On day one of a sickness, a family sexual health and well-being. This includes
could have funds to pay for a ventilator (so it discussing risks, benefits, and alternatives to
could be “ordinary”); but on day 10 their funds various sexual practices or interventions.
may be exhausted and thus the same
treatment (a ventilator) can become 2). Non-Discrimination: Nurses should provide
extraordinary. care without discrimination based on sexual
orientation, gender identity, or any other
Example: A baby is born with spina bifida and
aspect of a patient's sexual identity. They
in addition the baby has no kidneys, a rare
should create a safe and inclusive
and fetal condition for which there is no
environment where patients feel comfortable
treatment. No surgery was done for the spina
discussing their sexual concerns.
bifida.

Ordinary care becomes extraordinary care 3). Confidentiality: Nurses should maintain
because the fatal kidney condition makes strict confidentiality regarding patients'
useless. The Baby will die regardless of sexual health information. This includes
treatment. protecting their privacy and not disclosing
any sensitive information without their
Principle of Personalized Sexuality
explicit consent.
• It must be a loving, bodily,
pleasurable expression of the 4). Cultural Sensitivity: Nurses should be
complementary, permanent self- aware of and respect diverse cultural
giving of a man and a woman to beliefs and practices related to sexuality.
They should provide care that is sensitive to are consistent with the fundamental
patients' cultural backgrounds and values, commitment of Christians to love of God and
ensuring that their sexual needs and love of neighbor. Such relationships may
preferences are understood and respected. signify the union between Christ and the
Church.
5).Advocacy: Nurses should advocate for
patients' rights to access appropriate sexual
health services and resources. This may involve MARRIAGE
addressing barriers to care, promoting sexual
health education, and supporting patients in - A legally and socially sanctioned
making informed decisions about their sexual union, usually between a man and a
health woman, that is regulated by laws, rules,
Human sexuality and its Moral Evaluation customs, beliefs, and attitudes that
prescribe the rights and duties of the
- It is the total of our physical, emotional partners and accords status to their
and spiritual responses, thoughts and offspring (if any).
feelings. Sexuality is more about who - Marriage is also called matrimony or
we are than about what we do. wedlock. It is a culturally recognised
- union between people called spouses,
5 Components of Human Sexuality that establishes rights and obligations
• Sensuality- Awareness, acceptance of and between them and their children and
comfort with one's own body; physiological between them and their in-laws.
and psychological enjoyment of one's own Basic Social and Personal Functions:
body and the bodies of others
• Intimacy- The ability and need to • sexual gratification and regulation
experience emotional closeness to another • division of labor between the sexes,
human being and have it returned.
Human sexuality and its moral evaluation • economic production and consumption,
• Identity- The development of a sense of who • satisfaction of personal needs for affection,
one is sexually, including a sense of maleness status, and companionship
and femaleness
• Sexualization- The use of sexuality to
influence, control or manipulate others.
FUNDAMENTALS OF MARRIAGE
• Sexual Health and Reproduction- Attitudes
and behaviors related to producing children 1. Love/Commitment - Marriage is a decision
and health consequences of sexual behavior. to be committed through the ups and downs,
The human desires and activities that involve the good and the bad. When things are going
the search for and attainment of sexual well, commitment is easy. But true love is
pleasure or satisfaction and, on the other displayed by remaining committed even
hand, to the human desires and activities that through trials of life.
involve the creation of new human beings. For
2. Sexual faithfulness - Includes your eyes,
it is a natural feature of human beings that
mind, heart and soul. When we devote our
certain sorts of behaviors and certain bodily
minds to sexual fantasies about another
organs are and can be employed either for
person, we sacrifice sexual faithfulness to our
pleasure or for reproduction, or for both. Moral
spouse. It requires self-discipline and an
qualities of a relationship are more primary for
awareness of the consequences.
evaluating any relationship than is the sexual
orientation of the persons involved. Intimate 3. Communication - they certainly discuss kid’s
same-sex relationships may have these schedule, grocery list, and utility bills but they
necessary qualities. Heterosexual ones may don’t stop here. They also communicate
not. What matters are mutual responsibility, hopes, dreams fears and anxieties. They don’t
commitment, fidelity, forgiveness and just discuss the changes that are taking place
generativity. Relationships with these qualities
in the kids life they also discuss changes that heterosexual has long been considered
are taking place in their own hearts and souls. "normal" in our society. However, being
heterosexual is only one sexual orientation.
4. Selfishness – Although it will never show up
Other people are gay, or homosexual.
on any survey, more marriage are broken up
by selfishness than any other reason. Surveys Issues on Contraception, its Morality and
blame it on finance, lack of commitment, Ethico-Moral Responsibility of Nurses
infidelity or incompatibility but the root cause
The main issues that raise ethical dilemmas
for most of these reason is selfishness
following the development of assisted
5. Humility- An essential building block of a reproduction techniques are:
healthy marriage is the ability to admit that
• The right to procreate or reproduce
you are not perfect , that you will make
• The process of in vitro fertilization itself-
mistakes and that you will need forgiveness.
is it morally acceptable to interfere in
6. Patience/Forgiveness- Because no one is the reproduction process?
perfect, patience and forgiveness is always • The moral status of the embryo
required in a relationship. • The involvement of a third party in the
reproductive process by genetical
7. Time- Relationship don’t work without time
material donation
investment.
• The practice of surrogacy,
8. Honesty and Trust- Honesty and trust cryopreservation of embryo’s
become the foundation for everything in a • Assisted reproduction can raise
successful marriage. complicated ethical changes for the
individuals involved health care
PREMARITAL SEX professionals and the greater society.
Is a sexual activity practiced by people before One ethical dilemma associated with
they are married. ARTs involve:
The politics of embryo’s and what to do with
Was considered a moral issue which was unused embryos. For both clinical reasons,
taboo in many cultures and considered a sin clinics are reluctant to dispose of embryos
by a number of religions. without a couple’s consent.
HOMOSEXUALITY Third-party reproduction, in which another
person enters into the baby-making mix also
Romantic attraction, sexual attraction, or involves risks and raises many important
sexual behavior between members of the ethical concerns.
same sex or gender. As a sexual orientation
homosexuality is an enduring pattern in CONTRACEPTION
emotional, romantic and or sexual attractions
to people of the same sex. Contraception refers to a direct and positive
method of preventing conception before,
Bisexuality
during or after the act of sexual intercourse.
Bisexuality is romantic attraction, sexual
attraction, or sexual behaviour toward both Direct Method
males and females, or to more than one sex or
gender. It may also be defined as romantic or Contraception is directly willed either as an
sexual attraction to people of any sex or end of the means or a means to attain
gender identity, which is also known as pan another end.
sexuality.
Example: Rowena, a married woman, does
Heterosexual
not want to conceive a child. So, she takes
A heterosexual person is attracted to people "oral contraceptives. "It is obvious that
of the opposite sex. Boys who like girls and Rowena's means to attain her end of
women who like men are heterosexual. Being preventing conception is to take a
contraceptive pill, and as such, the act is • The Mini-Pill. This contains only the
directly willed. It is distinct from an indirect act progestin which is taken continuously.
which is not willfully employed as a means or
an end of thwarting conception. Mode of Action

Example: Elaine takes the prescribed - The pill suppresses ovulation, the
medication for direct motive of healing process by which the ovum is
endometriosis whose inevitable evil side effect produced.
is sterility. This can be done under the principle - It thickens the cervical mucus
of double effect. making it not capable of Being
penetrated by the sperm.
Positive Method - It alters the endometrium so that
the uterus becomes not
By a positive method is meant the means used receptive or "inhospitable" to the
is deliberately arbitrary and determinate, and fertilized egg. In which case, the
as such, is not a part of the natural processes pill prevents implantation and
of sexual system, causing frustration of the can be construed as
generative faculty for conception. Example: abortifacient. Abortifacient
The use of condom is an arbitrary and refers to that which is used at
determinate means of preventing sperms from early gestational age upon
entering the vaginal canal to unite with the fertilization directed towards
egg. It is not a part of the natural design of the termination of pregnancy.
generative structure. It is different from the
negative method or means in which there is Potential Side Effects
nothing that is arbitrarily done to suppress the
generative power or faculty so that the • Nausea and vomiting,
process goes on as naturally designed. headache, and weight gain or
Example: Rhythm method is a form of periodic loss
abstinence which does not employ any • Hypertension and impaired
positive meaning to thwart conception. vision
• Increased risk of stroke or heart
Before, During, and After Sexual Intercourse attack
• Possible link to cancer of
Contraception can be done based on the reproductive organs and of the
nature and functions of its different methods breast
before, during, or after the act of sexual • Increased risk of gall bladder
intercourse in an effort to preclude the disease and liver tumors
possibility of conception. • Difficulty in conceiving after its
Take note that the term contraception is use is discontinued
defined here in reference to its artificiality and • Reduced bleed levels of
being unnatural. It is specifically called essential vitamins
artificial contraception. • Development of depressive
personality changes
Different Methods of Contraception
Norplant
The Pill
Two Kinds of Pill Two Kinds of Norplant
• The Combined Pill. This contains two
female hormones: the 1) estrogen and Norplant is a series of six rubber "rods" or
2) progestin. capsules that are implanted under the skin in
the inside portion of a woman's upper arm.
The contraceptive effects can last for five - Prolonged and unpredictable
years. delay in the occurrence of
fertility period
Norplant 2 differs in the number and size of the - Mild deterioration of
rods whose contraceptive effects can last carbohydrate tolerance
even for seven years. Decrease in breast milk
production Depression and
Mode of Action reduction of libido

• It suppresses ovulation in only Condoms

about 50 percent of cycles
Progestin causes thickening of A condom is a thin rubber or latex sheath worn
the cervical mucus making it over an erect penis before the intercourse
difficult for the sperm to go takes place. It is stored in a cool, dry place in
through. order to prevent the deterioration of rubber. It
• It may also induce early also has limited "shelf life"as it may corrode
abortion. It alters the lining of the over some time.
uterus barring the fertilized egg
from implanting itself. Mode of Action

Potential side Effects - It traps the ejaculated sperm at

the tip thereby preventing it
- Severe lower abdominal pain from coursing through the
- Prolonged or heavy vaginal vaginal canal towards the
bleeding; or amenorrhea as fallopian tube where the ovum
experienced by more than two- is.
thirds of all users
- Arm pain and infection, Potential Side Effects
migraine, headache or blurred
- vision - Effective only 84 to 85 percent
- Changes in lipid metabolism of the time, at best chance of
pregnancy over one year of use
Contraceptive Injections is one in six).
- Pregnancy rate of 18.4 percent
Depo-Provera (Medroxy-progesterone among women less than
acetate commonly known as "couple's eighteen vears of age, among
choice,is iniected every three to six months. unmarried minority women, the
failure rate of condom use is
Mode of Action even higher-5ome 36 percent.
- It may not be as effective as it is
• It prevents pregnancy by believed to be preventive of
inhibiting ovulation. HIV-AIDS transmission. Human
• It prevents implantation since immunodeficiency virus is 500
the normal functioning of times smaller than a human
endometrium is altered. Hence, spermatozoon. Since condoms
it has an abortifacient action. fail from 12 to 44 percent of the
time in preventing pregnancy,
Potential Side Effects they may even be less effective
in the prevention of AIDS virus
- Major disturbance of menstrual transmission.
pattern Condoms have flaws or holes. The average
hole-size is five microns. A sperm is only 2.5
microns smaller than the size of the hole of a - If ever human sperm survives to
condom. unite with the ovum and
conception occurs, greater
Intra-uterine Device (I.U.D.) incidence of congenital
disorders among children
Intra-uterine device (IUD) is a plastic device conceived during the use of
placed in the uterus through the cervical spermicides includes Down's
canal which may contain trace metals or Syndrome, limb reduction
hormones to increase efficacy. malformation. malignant
neoplasms (cancerous tissue
Mode of Action growths) and severe
hypospadias.
- preventing implantation. - Increased chance of vaginal
- It may also interfere with tubal infections because the
function and prevent the absorption of spermicides alters
passage of ovum or sperms vagina's normal chemical
favoring the development of environment.
ectopic pregnancy.
- Diaphragm
Potential Side Effects
- It may create chronic A diaphragm is a flexible metal ring covered
inflammation of the with rubber in the shape of a shallow dome.
endometrium. Mode of Action
- Occasional perforation of uterus
or cervix requiring surgery - It is placed in the vagina to
- Pelvic inflammation that can encircle the cervix completely
cause sterility and to prevent the sperm from
- Anemia due to excessive entering the uterine cavity.
menstrual bleeding - It is usually utilized with
- Embedding, migration, or spermicidal jelly or cream
fragmentation of the IUD applied to the side of dome
- Spotting or prolongation of facing the cervix.
menstrual flow
Potential Side Effects
Spermicides
- Local skin irritation caused by
Spermicides are available in many forms sensitivity or allergy
including cream. jellies, suppositories, aerosol
foam, and foam tablets. Is Contraception Moral?

Mode of Action Since time immemorial, the Church has

strongly and forcefully maintained-amidst
- Spermicides form a chemical vehement criticisms from different sectors in
barrier at the opening to the the society-that contraception, in its various
uterus that prevents the sperm unnatural methods, runs counter to the true
from reaching the egg. standards of moral conduct in marital
- They also damage and even
destroy sperm cells. Natural Family Planning

Potential Side Effects Natural Family Planning refers to the

observance of the natural cycles of
menstruation characterized by avoidance of
sexual intercourse during the woman's fertile
period and limiting of said intercourse within However, the rhythm method has been
the period of non-fertility. It is commonly called discarded recently by the Department of
periodic abstinence. Now, there are two Health (DOH) as a form of natural family
important elements that need to be paid planning because it is not scientifically
attention to: accurate and reliable.
(1) avoiding marital act when the wife is fertile
and Basal Body Temperature Method is a method
(2) limiting it within her infertile period. of family planning in which the post-ovulatory
infertile phase of the menstrual cycle is
Different Methods of Natural Family Planning identified by a temperature shift in the basal
body temperature curve.
The different methods of natural family
planning indicate when the woman's infertile Basal body temperature (BBT) refers to a rise in
period and fertile period fall so that marital act body temperature of o.4 to 1.0°c following
can be conjugally decided upon in moments ovulation, The temperature shift is caused by
suited to the establishment of proper spacing progesterone, It drops again before menses of
of children. continues to elevate if pregnancy occurs.103
When the temperature rises to such a degree,
Rhythm Method is also called Calendar it indicates that ovulation is about to occur
Method, It is an old method of family planning Thus, at this moment, marital act is avoided.
in which the time of the fertile phase is
predicted by calculations based on calendar Sympto-Thermal Method is a method of family
records of past menstrual cycles. planning that combines observations of basal
body temperature (BBT) and cervical mucus,
Approximate Patterns of Menstrual Cycle and as an optional cross-check, adds an
examination of the cervical os (mouth of the
1. Conception is seldom possible from 20 to 24 cervix) as well. During fertile times, the os
days before the next menstruation opens, the cervix rises, and its tip becomes
2. Conception is possible from 12 to 19 days softer. Some women also experience regular
before the next menstruation. episodes of mittelschmerz or pain associated
3. Conception is impossible during the l1 days with ovulation. During infertile times, the os
before the next menstruation. closes, the cervix descends, and the tip
becomes firmer.
This method is quite easy to learn and employ. Some sympto-thermal applications add
All that has to be done is for a wife to simply calendar (rhythm) method calculations in
keep a menstrual calendar for several cycles estimating the end of the relatively infertile
noting when menstruation usually begins and phase. This is done so as to determine whether
ends. She then determines the longest and the fertile period begins which signals
shortest cycles, and applies the 'minus 10, avoidance of marital act, and then, to
minus 20' rule, which means she uses the recognize the infertile period that welcomes a
shortest cycle to find the first fertile day by marital intercourse.
subtracting 20 days from its length, and uses
the longest cycle to find the last fertile day by Billings Ovulation Method is a method of family
subtracting 10 days from its length. planning using the basic infertile pattern (BIP)
to mean the physiological manifestation of
For example, if the longest cycle has been 30 relative ovarian inactivity before the
days,and the shortest cycle 25 days, the first beginning of follicular maturation. The basic
fertile day will be day 5, and the last fertile day infertile pattern can be either dryness or a
will be day 20.102 This means that abstinence constant, unchanging discharge that remains
from marital act during said number of days the same day after day, or a combination of
has to be observed so as to avoid procreation. the two.106 When the said pattern is found out
to be present, it is "safe"for husband and wife 98% effective according to the World Health
to engage in marital intercourse for no Organization.
fertilization will occur.
The observance of natural family planning is
Moreover, in this method, the vaginal mucus is likely to give couples a sense of dignity as
detected as a reliable barometer of hormonal husband and wife sharing and facing, in their
changes which take place during the marital bond, the "ups and downs" of their
ovulation period so as to preclude any marital conjugal love including the practice of
act. discipline periodic abstinence from marital
intercourse may entail. Rather than engaging
1.The menstrual period at the start of each in the routinary, dull experience of intercourse,
cycle is considered to be fertile. The reason for spouses are motivated with joyful anticipation
viewing the time of menstruation as fertile is of renewing their genital relations after a
that if a woman should have an unusually or period of abstinence (thereby being) inspired
unexpectedly short cycle such that the to more vibrant, exciting and creative acts of
ovulation process were to begin toward the love.
end of menstruation, she would have no
warning of this fact since the presence of the Is Natural Family Planning (NFP)Moral?
menstrual flow would make it difficult for her to
examine her vaginal mucus. Thus, as a Natural family planning does not directly and
precaution, women are advised to regard the positively interfere with the natural processes
menstrual period as fertile. of the generative mechanism. It is even in
accordance with the natural rhythm of how
2. After menstruation, the absence of any the sexual system is structured. The whole
vaginal discharge of mucus is noticeable, and menstrual cycle of the woman expresses itself
the woman experiences a definite sensation in the rhythm of fertility and infertility periods.
of dryness, During days of dryness, the woman
is infertile. Pointers for a Health Care Practitioner
The following pointers are hereby given for
3. At the end of this period of dryness, cervical reflection and appropriate action:
mucus begins to be discharged from the
vagina. At first, this mucus is a kind of cloudy, 1. With the knowledge of the morality of
sticky discharge, but it gradually becomes a contraception, be honest enough to tell your
clear, egg-white, stretchy and lubricative clients who are asking for it about its adverse
substance. It indicates the process of effects and the moral questions it foments
ovulation. The "peak" or main sign of ovulation while respecting their freedom of conscience.
is the last day on which this clear and stretchy
mucus is present. The woman's period of 2. While couples are allowed not to intend to
fertility, however, is defined as starting with the procreate in each marital act, they are not
first day of the cloudy mucus discharge and allowed to frustrate by an action before,
continuing up until three days after the peak during or after the marital act, the procreative
symptom of ovulation. aspect of the marital act.

4. Finally, from the fourth day after the peak 3.Actively take part in the education of your
symptom until the start of the next menstrual clients along natural family planning with its
cycle, a period of infertility occurs. different methods. There is no moral objection
as long as they are motivated with valid
The methods of natural family planning are reasons stipulated in the chapter in order to
easy to be understood, particularly when the give proper upbringing and education to their
assistance of health care practitioners and children.
technically knowledgeable NFP educators is
sought. The ovulation billings method is, so far,
4. The married couples fruitfully exercise their the uterine cavity as in intrauterine
procreative power, they come to enjoy a insemination for fertilization or conception.
certain special participation in God's own
Applicability of Artificial insemination
creative work. This is a dignifying task that
needs to be inculcated in one's mind and Artificial insemination can be sought because
heart through family planning seminars. of the following factors:
Artificial Insemination
• Impotency, male sterility, and other
• refers to an assisted method of male factor infertility
reproduction in which the sperm is • Couples with immunological
provided typically by means of irregularities
masturbation and is injected into the • Women's infertility accompanied with
woman's reproductive tract through a endometriosis indicating the abnormal
catheter. It is an old form of fertilizing a presence of endometrial tissue in
woman other than by a naturally fertile locations such as vagina, cervix,
intercourse. fallopian tubes, and others;
How is Artificial Insemination Performed? anovulatory infertility referring to
irregularity or cessation of ovulation;
Techniques of the Procedure
and cervical and unexplained infertility.
Below are the techniques and steps by which • The procedure may also be of help to
the woman is fertilized via artificial women who are ovulating on their own
insemination: as compared to those who are just
medically stimulated to ovulate.
1. A medication is administered to activate
The very goal of artificial insemination is to
egg development. This is to ensure egg
fertilize a woman for procreation.
production for fertilization. Meaning, the A.I.
takes place concomitant with the process of Categories of A.I.
ovulation.
Artificial insemination can be basically
2. The semen is obtained by means of categorized into:
masturbation after a designated few days of
1.Homologous Insemination. This is commonly
refraining from ejaculation.This is to ensure
called artificial insemination by the husband.
adequate sperm production for
In case of the wife's problem of not being
concentration-in an effort to determine the
fertilized via the natural intercourse, due
density of sperm cells expressed in numbers,
perhaps, to some abnormalities in her
their morphology (referring to the)
reproductive system, endocrine-related
percentages of normal and abnormal forms,
discrepancies, emotional stress and the like,
and their motility (referring to the) percentage
the husband produces his gametes by the
(of cells) moving actively for insemination.
usual means of masturbation, and submits for
3. The seminal processing follows which is sperm processing whose germ cell is
characterized by washing and purification of eventually inseminated. This category of A.I. is
the semen specimen at the laboratory. During also preferred when, under natural
the process, the male germ cell is segregated intercourse, the sperm cannot get in touch
from the rest of the seminal fluid and is near the cervix as in the case of epispadias or
concentrated in a small volume deemed to hypospadias. If the husband has oligospermia
be the highly motile or the most active sperm indicative of low sperm count-his masturbated
cell. Depending on the technique used, semen is "centrifuged to increase (its)
seminal processing takes about 30 minutes to concentration"199 for possible attempt of
one hour. insemination.

4. The purified and segregated male germ cell 2. Heterologous Insemination. This is also
is finally inseminated or injected either into the called artificial
cervix as in cervical insemination or high into
insemination of donor. In case of the and share understanding. These sexual
husband's inability to reproduce which may expressions (to communicate and relate
be caused by azoospermia (complete inherently necessitate gratification and
absence of sperm cells in the scams), satisfaction that may culminate in the total
oligospermia, or even any relative male factor self-giving and mutual loving towards human
sterility or infertility, a third party who serves as fulfillment in life. In fact, flowing from the said
donor (other than the husband) produces meaning, the genitality or physicality of the
sperm to be injected into the body of the marital act is intrinsically symbolic of the joy of
husband's wife. In like manner, a woman other self-giving and mutual love involving the
than the wife may donate her ova or the use whole person of both husband and wife.
of her uterus for insemination by the sperm of
Now, masturbation, being the means
a husband whose wife is unable to reproduce.
employed to obtain the semen in the case of
Moreover, a man who wants to marry despite
artificial insemination, entails the use of a
the problem of impotency may see artificial
sexual faculty that is obviously, in and of itself,
insemination by donor as a means to foster his
designed to be devoid, negative, and
fatherhood.
frustrative of the joy of self-giving and mutual
3. Artificial Insemination outside Marriage. The love unselfishly shared by the couple for
procedure simply takes place between the human fulfillment in the celebration of the
unmarried man and woman who may not marital sexual act. In which case,
regard marriage act as the only licit means of masturbation is a dissociation from the innate
transmitting life. meaning of human sexuality.

Is Artificial Insemination Moral? In terms of its purpose, sexuality as an

expression of mutual loving and sharing
Artificial insemination is intrinsically evil on the
intimately demonstrated in marital sexual
following grounds:
union is designed for the procreation of
Transgression of the will of God Expressed in offspring as its fruit. In fact, the purpose
the Law of Nature (procreation) is attained through the
celebration of its meaning as naturally devised
The defiance of the law of nature takes variety in the sexual system of the couple so that the
of forms, namely: meaning and purpose of sexuality are
A. Arbitrary Exclusion of the Marital Act from inherently deemed inseparable.
Procreation. Nevertheless, in the case of masturbation in
The naturally devised means of transmitting life reference to artificial insemination, the
embedded within the reproductive faculty of procedure is geared towards procreation as if
both husband and wife is no other than the it seems to be not frustrative of the purpose of
marital act. Now, by artificial insemination, the sexuality. But then, looking critically at
said act is deliberately and arbitrarily masturbation whose ejaculate is meant for
excluded from procreation and replaced with insemination, the meaning of sexuality that
a medically framed means, that, the insertion naturally results to the attainment of its
of a thin and soft catheter containing sperm purpose is arbitrarily made absent. In which
into the wife is reproductive tract-a procedure case, masturbation singles out the procreative
enormously Contrary to nature as purpose apart from that through which it
recognizable to the faculty of reason. occurs in accordance with nature thereby
distorting the manner it is attained.
B. Distortion of the Meaning and Purpose of
Sexuality. Any deliberate use of a sexual faculty that
arbitrarily omits, diverts, and excludes its
The meaning and purpose of sexuality are meaning from the achievement of its purpose,
deeply inscribed within its natural expressions. as in masturbation, is a distortion of the same.
In terms of its meaning, sexuality is in and of
itself, expressive of an action to communicate In Vitro-fertilization
and relate in an atmosphere of unselfishness
 - is a process of fertilization where an egg less than 30 minutes but may take up to an
is combined with the sperm outside the hour.
body, in vitro. The process involves
5. Immediately after the retrieval, eggs are
monitoring and stimulating a woman’s
mixed with some donated sperm in the
ovulatory process, removing an ovum
laboratory. Retrieved eggs are placed in a
or ova from the woman’s ovaries and
Petri dish filled with a nutrient solution and
letting sperm fertilize them in a liquid in
exposed (them) for half a day to (some) drops
the laboratory.
of sperm.
- The union between the sperm and egg
cells takes place in a test tube so the 6. If the eggs are fertilized, they are kept in the
baby conceived this way called test clinic under observation to ensure optimal
tube baby. growth. At times, there may be a need to wait
What is the Procedure of In Vitro Fertilization for about five days until the embryo reaches a
steps of the Procedure more advanced blastocyst stage-a stage
where it divides into several cells
Below are the chronological steps by which
the eggs are procured, placed in the test-tube 7.Once they are ready, one or more embyos
or glass dish and mixed with some sperm cells, will be transferred into the uterus of a woman
stimulated chemically to fertilize therein, and for gestational development. During this
eventually implanted into the uterus as the procedure, the woman receives
case maybe. progesterone to prepare her uterine lining for
implantation of the embryo. The doctor inserts
1. Hormones are injected to enable the
a flexible tube o catheter into the vagina
woman to produce multiple eggs. Then, a
passing through the cervix towards the uterus
medication is given designed to ripen the
where the said embryos are implanted. The
developing eggs marking the process of
procedure is obviously easier and quicker than
ovulation.
egg retrieval.
2. The woman is tested to determine whether
Hence, test-tube conception pertains to a
she is ready for egg retrieval. Timing is
medical procedure in which mature egg cells
important; the eggs must be retrieved just
are removed from a woman, fertilized with
before they emerge from the follicles in the
male sperm outside the body (in the test-
ovaries. If the eggs are taken out too early or
tube), and inserted into the uterus...for normal
too late, they will not develop normally. The
gestation.219 Take note that the fertilized egg
doctor may employ blood tests or an
can be transferred to the same woman who
ultrasound to ensure that the harvest of the
donates the said egg or to another woman
eggs is at the right stage of development.
who may have the problem of infertility.
3. Instructions are given the night before and
The First Test-Tube Baby
the day of the procedure. Oftentimes, the
woman receives pain reliever, or is given the On July 25,1978,Louise Brown, the first baby
choice to be mildly sedated, or even to be conceived in a Petri dish, was born. Dr. (R.G.)
under full/general anesthesia in preparation Edwards and Dr.(Patrick) Steptoe220 of Britain
for the procedure. were the medical scientists who produced
Louise through in vitro fertilization.
4. Then, a healthy egg from the woman is
obtained (procedure proper). Under general Applicability of I.V.F.
anesthesia, the doctor proceeds with
laparoscopy. A laparoscope is inserted (a In vitro fertilization applies to the following:
camera with a miniature flashlight on its head) • Women or wives whose fallopian tubes
into an incision near the woman's navel.(The are obstructed and rendered unable
doctor) locates a ripe egg that is about to be to accommodate the natural passage
released from the follicle and extracts it with of the sperm and its union with the egg
an aspirating tube (guided by the • Men or husbands who are suffering
ultrasound).216 The procedure usually takes from low sperm count
 • Couples who are infertile four, or five up to seven fetuses may be
• Scientific experimentation and crowding the uterus. If said pregnancies are
biological research out of which left untouched, the patient may have
potential therapy for specific and premature deliveries resulting to some still-
various diseases can be formulated births and the development of brain damage
Technical Problem of I.V.F. in others, along with the risk in the mother's life.
In addendum, the condition of the babies
Despite reported success of in vitro fertilization,
necessitates intensive pediatric care entailing
the fact cannot be denied that largely
a lot of expenses that may be to0 burdening.
numerous embryos are wasted. In the
implantation of in vitro embryos, a chance for Thus, in order to determine favorable
pregnancy is notably slim. In fact, Drs. prognosis and establish babies' healthy
Edwards and Steptoe discarded 99.5 percent conditions, some of them that maybe found
of the ova fertilized in their laboratory over a weaker than others are discarded or simply
period of 12 years. They had failed in their first aborted. The act is deemed favorable to those
200 attempts at transferring the embryo to the found without any defects so that they may
uterus. very well be taken care of and their health
may be ensured for successful birth and
(On the other hand),...the donor woman
existence onwards. The process is called
routinely receives fertility drugs to make her
pregnancy reduction or reduction procedure.
produce several eggs during ovulation..
Doctors fertilize these multiple eggs with The method is that under scan control, a 20-
sperm, then, transfer them to the receiving gauge needle was placed directly into the
woman's uterus. Despite using multiple eggs, fetal heart. After the injection of potassium
the average probability of pregnancy per in chloride (causing heart attack), the heart was
vitro cycle is only about 10-15 percent. monitored visually (by scan for asystole. In
other words, it was watched until stopped
One of the possible causes of the problem is
beating. 224
that "in vitro embryo develops at a slower rate
than the embryo in vivo (i.e. within the body), The procedure is rationalized by the
and hence, the growth of the in vitro zygote performing doctors and by the submitting
embryo) and the development of the patients considering the health and financial
endometrial tissue are not perfectly risk and burden delivery of 5 or 7 babies may
Synchronized. This goes to show that just as it bring about.
may be difficult to make the embryo adapt to
Experimentation and Research
the unique reproductive system of a strange
mother, so also it may be difficult to make the In many I.V.F. clinics, lots of embryos are just
reproductive system compensate the arrival stored and frozen for whatever purpose they
of a "strange embryo" which has not been may be deemed to serve according to the
conceived inside that system. wish of doctors, couples seeking fertility, and
scientists in search of amazing medical
Relevant Issues
breakthroughs. If there are couples who come
Fundamental issues surrounding I.V.F. are and express their desire to have children
strenuously pressing, and demanding that through in vitro fertilization, embryos are
they be seen with the eyes of right reason and implanted. If medical scientists want to
heart of good will, to wit: conduct biological research and
experimentation, then embryos are subjected
Pregnancy Reduction
to such.
Due to the great number of failures, women
But, if other embryos do not meet biological
seeking pregnancy by means of in vitro
standards set by the clinic (for having unsound
fertilization receive multiple embryos to ensure
condition), or are considered surplus, then
its occurrence. If in case all are successfully
they are merely destroyed. However, for those
implanted, multiple pregnancies occur. Four,
to be destroyed, a strong reason is contended
or five up to seven embryos who turn out to be
that they just be submitted for embryonic stem Different types of Surgical Abortion
cell research. After all, their stem cells will be
1. Suction Abortion- also called suction
used for experimentation for stem cell
curettage. Done during first trimester up to 16
transplant to replace defective and
weeks. Begins by dilating the cervix the,
damaged cells of patients.
suction curette is inserted into the cervix to the
Furthermore, there are embryos produced in uterus. Suction machine tears the developing
vitro for the exclusive purpose of making them body parts of fetus and sucks the pieces
biological materials for experimentation and through the tube and deposits into the bag.
stem cell research. In effect, they are
2.Dilation and Curettage (D&CI Abortion, This
produced to be destroyed, By their stem cells,
method of abortion is most often employed
the said embryos will be of help in the
also during the first trimester of pregnancy, A
treatment of medical problems and
sharp looped knife or curette (sharp
pathologic conditions of many.
curettage) is inserted into the uterus to scrape
its walls. Then, the lodging baby is cut apart
and its bodily parts are removed and checked
SURROGATE MOTHERHOOD
for completeness.
Practice in which woman bears in child for a
Unlike other abortion methods, D&C has an
couple unable to produce children in a usual
alternative and entirely legitimate use.
way, usually because the wife is interfile or
Physicians often perform curettage after a
otherwise unable to undergo pregnancy. In so
miscarriage to ensure that the uterus is clean
called traditional surrogacy, the surrogate
thereby avoiding the infection that may result
mother is impregnated through artificial
from the retention of necrotic or decaying
insemination with the sperm of the husband.
tissue either from the baby or from the
Morality of abortion placenta, or from other uterine conditions or
disorders.
Abortion is the expulsion of human fetus
before the period of viability 3.Dilation and Evacuation (D&E) Abortion. This
method of abortion is most commonly used
Period of viability refers to the stage of during the first half of the second trimester 13
gestation when the human fetus can survive to 20 weeks, but is employed up to about 28
outside the uterus with r without assistance. weeks of gestation. Usually, the abortionist
Different types of Abortion cuts off one or more of the baby's limbs and
waits until he or she bleeds to death before
1. Complete Abortion- when all the contents proceeding with the abortion. In case of larger
of the uterus (fetus and placenta) have been babies, big forceps are used to crush their
expelled from the uterus. heads and bodies inside the uterus. The bodily
2. Incomplete Abortion- parts of the fetus and parts torn into pieces pass through the cervix
placenta remain within the uterus and are removed.

3. Early abortion- abortion within the first Sometimes, when the fetal tissues are much
trimester of pregnancy, includes the more cohesive and difficult to tear apart
embryonic stage from the moment of because of older gestational age, a long
conception. curved Mayo scissors maybe necessary to
decapitate and dismember the human fetus.
4. Habitual abortion-miscarriage occurring in
three or more consecutive pregnancies. 4. Saline Abortion. This method of abortion is
also known as intra-amniotic injection 'or
5. Threatened Abortion- vaginal bleeding and 'saline solution method' utilized during the
prognosis is doubtful for it may or may not second trimester and early third trimester. The
redound to inevitable abortion procedure begins at the withdrawal of about
200 milliliters of amniotic fluid from the
6. Inevitable Abortion-
amniotic sac. Then, the said fluid is replaced
with saline or urea solution. The baby breathes scissor is removed and a suction tube is
in and swallows this concentration and dies inserted to suck out the brains of the baby
painfully over a period of hours from salt causing the skull to collapse. The dead baby
poisoning, dehydration, brain hemorrhage, is then removed.
and convulsions. While dying, the baby suffers
6. Prostaglandin Abortion. This method of
extreme pain brought about by the salt
abortion is performed during the late second
solution as it burns off the outer layer of his/her
trimester and third trimester of gestation. A
skin.
prostaglandin hormone containing about
The baby is delivered from 24 to 48 hours after eight milliliters is injected into the uterine
his/ her death. The skin of the baby is either muscle which contracts to expel the baby in
completely burned or turned a cherry-red an artificially-induced and extremely-violent
color. That is why, such a baby is referred to as premature labor that takes about 20 hours.
'candy-apple baby'. Many mothers who
Abortion Moral?
underwent saline abortions said they felt that
their baby's movement within their womb As long as it is direct-that is, it is performed
increased to a desperate frenzy as his /her skin deliberately and willfully, abortion is immoral.
and mucous membranes are scalded Indeed, Employed as an end or a means of another
the baby aborted this way dies in end, abortion is directly willed and, as such, is
unspeakable agony. imputable to the agent.
Nevertheless, this method has become less Against Natural Law
popular due to possible harm to the mother
caused by accidental injection of the saline Abortion is a blatant transgression of natural
solution into her blood vessel. law that is inscribed both in the hearts of men
and in the Decalogue (Ten Commandments).
5. Dillation and Extraction (D&X) Abortion. This
method of abortion is usually intended for a It is against the order of right reason which
pre-born baby who has already attained the dictates, regardless of religious beliefs and
late second and third trimester of gestational social orientations, that innocent life must not
age. Thus, it is used even during the period of be taken directly, deliberately, and willfully for
viability, say, seventh or eighth month. That is whatever reasons. Moreover, the provision of
why it is also called partial-birth abortion'. the Commandment:"Thou shall not kill"
Since the baby's muscles and cartilage have Deuteronomy 5:17) necessarily includes the
already toughened to the point where it is prohibition of all forms of unjust killing of any
virtually not possible to tear or chop him/her human being of whatever age and stage of
apart without harming the mother, the D&X human development.
method, much more harsh than that used
among twenty-week-old fetuses, is suitably
employed. Scope of the Penalty

Guided by ultrasound, the abortionist uses The scope of excommunication-latae

forceps to twist one of the baby's legs and pull sententiae, extends to those who provide
it out through the birth canal. The ripping of assistance in any form without which abortion
muscles and breaking of bones cause the would not be made possible. It necessarily
baby unspeakable agony, for even pro- includes the abortionist, the nurse, and other
abortionists acknowledge that seven-month health care providers who assist and help
and eight-month old pre-born babies during the procedure. It also includes the
definitely feel a sense of pain. Then, the boyfriend or husband who encourages the
abortionist delivers the baby's entire body woman to go to an abortionist, the parents
except the head. Afterwards, he punctures the who push their daughter to submit for
back of the baby's head with sharp scissor and abortion, a friend who counsels and advises
spreads the blades-tearing a massive hole in that abortion is an alternative and anybody
the soft part of the baby's skull. Finally, the who, in one way or another, provides a way
for the realization of abortion.
Accomplices, even though not mentioned in be directly killed as a form of treatment in an
the law or precept, incur the same penalty effort to save the mother. In which case, the
(excommunication latae sententiae), if principle of double effect does not apply
without their assistance., the crime would not since the evil effect (death of the fetus)
have been committed. The point is clear those directly proceeds from the act itself (the direct
who are included in the said penalty are the taking of the baby's life) and that the
individuals whose help or aid contributes and
Pointers for a Health Care Practitioner
paves the way to the commission of abortion
and without which abortion may not have The following pointers are given for
been realized. information, guidance and observance:
They are reinstated to the membership in the 1.Abortion willed as an end or a means of
Church after a sincere repentance and another end is direct and thus, immoral. This
atonement for their sins absolved only by the includes therapeutic abortion as the case
bishop or a priest delegated by the bishop in may be. A cooperation without which direct
the Sacrament of Reconciliation. abortion cannot come to its completion is an
ample ground for automatic
When is Abortion Morally Permissible?
excommunication. The sin of abortion is
Abortion is morally justifiable when it is indirect- reserved for absolution to the bishop or a priest
that is-when it is not willfully employed as an delegated by him.
end or a means. Indirect abortion is the
2. Abortion which is not directly willed as an
foreseen (at least with probability) but
end or means and which is merely seen and
unintended loss of the fetus following upon a
tolerated as evil effect is indirect and thus,
medical (or surgical) procedure necessary to
morally permissible under the principle of
preserve the life or health of the mother.
double effect.
It is usually done under the principle of double
3. In case of spontaneous-inevitable abortion,
effect with corresponding conditions to fulfill.
if it is medically indicated that the fetus is
In which case, there is no direct taking of the
dead, it is morally licit to remove it; if the fetus
baby's life. In fact, the very act performed is
is viable and the mother is in danger of death,
not abortion per se but the treatment of a
termination of pregnancy for premature
pathologic condition of the mother. For
delivery is medically advisable incurring no
example, the case of ectopic pregnancy in
moral objection; if the fetus is not viable, direct
which the fetus is located along the fallopian
removal of which constitutes direct abortion
tube demands immediate surgical
rendering the procedure immoral; if the
intervention so as to avoid tubal rupture that
mother is in danger of death, the principle of
may endanger the life of the mother along
double effect has to be invoked so that the
with that of the fetus. At this juncture, what is
procedure constitutes indirect abortion which
removed is not the fetus per se but the
is morally allowed.
inflamed fallopian tube. The removal of the
sick fallopian tube is the means directly done 4. In case of abruptio placentae, if the
at the procedure which is good whose directly placenta is completely detached causing the
willed end or effect is to save the mother death of the fetus and that hemorrhage
which is also good. The inevitable death of the follows, removal of the fetus is, of course
fetus which is lodging along the removed tube morally licit; if the placenta is not yet
is not even employed, here, as a form of completely detached and that the non-
treatment but as a foreseen evil effect that just viable fetus is still alive, removal of said fetus
simultaneously occurs with the good effect. may constitute direct abortion which is not
Hence, the procedure indicates indirect morally permissible; again, in which case, the
abortion which is morally permissible. principle of double effect has to be
employed.
Take note that the procedure cited is different
from the so-called therapeutic(direct) 5.Responsibility must be taken to dispel any
abortion which provides that the fetus has to vincible ignorance and to obtain knowledge
about surrounding issues and moral principles
relative to the removal of the fetus for the sake
of the mother's health so as to establish clear
and certain conscience in whatever
procedure and or cooperation to be
employed. This can be done by means of
reading books in health ethics and morality,
consultation with moral authorities, and others.

MORALITY OF RAPE

Rape act of sexual intercourse with an

individual without his or her consent, through
force or the threat of force. In many
jurisdictions, the crime of rape has been
subsumed under that sexual assault, which
also encompasses acts that fall short of
intercourse. Rape was long considered to be
caused by unbridled sexual desire but it is now
understood as a pathological assertion of a
power over a victim. A gestation that is
caused by rape or incest cannot justify any
procurement of abortion. The innocent life
should not suffer punishment for the crime
committed by the perpetrator.