2. SUBJECT PROPER:PRELIM
CONTENT: Theories and Principles of Health
Ethics
1.Ethical Theories
2.Virtue Ethics
3.Ethical Principles
4.Other Relevant Ethical
Principles
5.Principles of Bioethics
3. The Health Care Ethics: Overview of the
Basics
Ahmed Bait Amer Sultan Qaboose University Hospital, Muscat, Oman
The First Question We Have to Answer Is What Is Ethics?
Ethics has a long history in Western philosophy. The
word “ethics” comes from the Greek word Ēthika, which
is an adjective that itself derives from ēthos, the
Greek word for character. For Aristotle, character is
of central importance to ethics, and one cannot have a
good character without having formed good ethoi or
habits. So ethics is Greek for customs, and morality
comes from mores, which is Latin for customs.
4. What Then, Is Ethics?
• Ethics is a branch of philosophy that seeks to
determine how human actions may be judged right
or wrong. When the study of the ethics is
applied to a professional field, it becomes
necessary to discuss not only basic ethical
positions, but also the nature of the
profession and the conditions under which that
profession operates.
11. 2.Teleology
• teleology, (from Greek telos, “end,” and logos, “reason”),
explanation by reference to some purpose, end, goal, or
function.
• It is also called consequentialism, as it focuses on the
consequences of actions, not the intentions or rules.
12. Teleology
“the best way to understand why things are the
way they are is to understand what purpose they
were designed to serve.”
-Aristotle
13. 3.Utilitarianism
• Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes.
It is a form of consequentialism.
• Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for
the greatest number. It is the only moral framework that can be used to justify military force or
war. It is also the most common approach to moral reasoning used in business because of the way in
which it accounts for costs and benefits.
• For example, assume a hospital has four people whose lives depend upon receiving organ
transplants: a heart, lungs, a kidney, and a liver. If a healthy person wanders into the hospital, his
organs could be harvested to save four lives at the expense of one life. This would arguably produce
the greatest good for the greatest number. But few would consider it an acceptable course of action,
let alone the most ethical one.
14. 3.Utilitarianism
“any action should cause the
greatest happiness for the greatest
number, and the end result is what
should determine the moral worth
of the initial action.”
17. Virtue Ethics and Nursing
Practice
Derek Sellman PhD, RN
• Virtue ethics is an approach that focuses on
character with the assumption that a person of
good character will tend to behave in ways that
are consistent with their character. A virtue
ethics for nursing is therefore concerned with
the character of individual nurses and seeks
ways to enable nurses to develop character
traits appropriate for actions that enhance
wellbeing.
18. Virtue Ethics and Nursing
Practice
• Virtue ethics is the term given to an approach that has a focus on
character. More specifically, it focuses on the character of the actor or
agent. Hence virtue ethics is sometimes referred to as agent-based
ethics.
• So the deontologist may ask, ‘which duty takes precedence in this
situation?’; the utilitarian may ask ‘what action will lead to the best
consequence?’ In contrast, guidance for action in agent-based ethics
requires the agent to seek to become a certain sort of person, a person
with the virtues to lead them to act in ways that the virtuous person
would act. So, the virtue ethicist might ask ‘if I act in such and such a
way, would I be acting in a way that was virtuous?’ The assumption here is
that by becoming, for example, a just, courageous, and honest person, the
individual will tend towards acting in just, courageous, and honest ways
out of habit or inclination. This is to say that the just, courageous, and
honest person will act in ways that reflect their character.
19. Core Values of a Professional Nurse
•1. Compassion
• Compassion encompasses empathy, caring, and the promotion
of each patient’s dignity.
• Be sensitive to the needs of your patients and your
patients' families.
• “Nurses get burned out and suffer from compassion
fatigue, however, we need to remember that even though we
have seen something a thousand times, this is probably
their first. Treat every patient like they were your
family member, and treat their guests like they were your
own," Matthew Thomson, a CCRN with more than 10 years of
experience in the nursing field.
20. Core Values of a Professional Nurse
•2. Trustworthiness
• Nurses are among the most trusted groups of people
• Trustworthiness is vital to your integrity and ethical behavior
•3. Humility
• Nursing is one of the most rewarding, fulfilling career paths.As a nurse,
you have a wealth of medical knowledge and skills.Humility should be your
companion.
• Thomson advises nurses to remain humble. Ask questions or ask for help
when needed.
• “Whether you're a nurse graduate or a nurse with 30 years of experience,
we can all improve on our skills and knowledge,” Thomson explains. “Keep
an open mind and open heart. Your patients will reap the benefits.”
21. Core Values of a Professional
Nurse
• 4. Accountability
• Take ownership of your practice, including every mistake, error in judgment, or
failure to communicate
• “Practice a mental exercise where you assume every problem is 100 percent your own
fault. How did you contribute to a problem? What could you have done better? How
can you improve next time? It forces you to take an active role in your life and
keeps you from blaming others," explains Thomson.
• 5. Curiosity
• Nursing knowledge encompasses all the theories, philosophies, research, and
practice wisdom of the nursing profession.You should never stop learning
• As Thomson points out, “Graduation is only the beginning of a nurse’s education.
Curiosity and an insatiable desire to learn what separates mediocre nurses from
great ones.”
23. Ethical Principles:Autonomy
Autonomy ;
• freewill in such a manner it uses the person's
ability to be rational.
• AUTONOMY IN NURSING PRACTICE
Nurses who practice with autonomy typically have
more confidence and freedom to make critical
patient care decisions.
24. Ethical Principles:Autonomy
Patient rights are the legal and ethical entitlements of
people who
receive health care services.
Patient's Bill of Rights
Senate Bill No. 1534 PATIENTS' BILL OF RIGHTS AND
RESPONSIBILITIES ACT
Every patient in the Philippines has the following rights that they can demand from
healthcare providers in the country:
Informed Consent
Proxy Consent/ Legally
Acceptable Representative
Confidentiality and Privacy
25. Ethical Principles:Autonomy
1. Right to Appropriate Medical Care and
Humane Treatment.
Every person has a right to health and medical care
corresponding to his state of health, without any
discrimination and within the limits of the resources,
manpower and competence available for health and medical
care at the relevant time.
26. Ethical Principles:Autonomy
2. Right to Informed Consent. - The patient has a right to a clear,
truthful and substantial explanation, in a manner and language
understandable to the patient, of all proposed procedures. That the patient
will not be subjected to any procedure without his written informed
consent, except in the following cases:
a)in emergency cases
b) when the health of the population is dependent on the adoption of a mass
health program to control epidemic.
c) when the law makes it compulsory for everyone to submit a procedure.
d) When the patient is either a minor, or legally incompetent, in which
case. a third party consent Is required;
e) when disclosure of material information to patient will jeopardize the
success of treatment, in which case, third party disclosure and consent
shall be in order;
f) When the patient waives his right in writing
27. Ethical Principles:Autonomy
Informed consent shall be obtained from a patient concerned if he is of legal age
and of sound mind. In case the patient is incapable of giving consent and a third
party consent is required. the following persons, in the order of priority stated
hereunder, may give consent:
i. spouse;
ii. son or daughter of legal age;
iii. either parent;
iv. brother or sister of legal age, or
v. guardian
If a patient is a minor, consent shall be obtained from his parents or legal
guardian. If next of kin, parents or legal guardians refuse to give consent to a
medical or surgical procedure necessary to save the life or limb of a minor or a
patient incapable of giving consent, courts, upon the petition of the physician or
any person interested in the welfare of the patient, in a summary proceeding, may
issue an order giving consent.
28. Ethical Principles:Autonomy
• 3. Right to Privacy and Confidentiality- The privacy of the
patients must be assured at all stages of his
treatment. The patient has the right to be free from
unwarranted public exposure, except in the following
cases:
• a) when his mental or physical condition is in
controversy and the appropriate court, in its
discretion, order him to submit to a physical or mental
examination by a physician;
• b) when the public health and safety so demand; and
• c) when the patient waives this right in writing.
29. Ethical Principles:Autonomy
• 4. Right to Religious Belief. - The patient has the right to refuse medical
treatment or procedures which may be contrary to his religious beliefs,
subject to the limitations described in the preceding subsection:
Provided, That such a right shall not be imposed by parents upon their
children who have not reached the legal age in a life threatening
situation as determined by the attending physician or the medical director
of the facility.
• 5. Right to Leave. - The patient has the right to leave hospital or any
other health care institution regardless of his physical condition:
Provided. That
• a) he/she is informed of the medical consequences of his/her decision
• b) he/she releases those involved in his/her care from any obligation
relative to the consequences of his decision;
• c) his/her decision will not prejudice public health and safety.
30. Ethical Principles:Confidentiality
reference:EducationalCareerArticles
• Confidentiality is an important ethical principle in
nursing. It is an important legal and medical
obligation that all health professionals are supposed
to obey. Matters regarding patients should not be
disclosed to others at any cost. Confidentiality, trust
and privacy are three principles that are intertwined;
if there is no privacy and trust, there is no room for
confidentiality.
• The simplest definition of confidentiality is
maintaining privacy. Nurses are bound by their
professional code of ethics and federal regulation to
refrain from discussing or sharing personal information
related to their patients without permission.
31. Ethical Principles:Confidentiality
• The list below shows examples of entities and
individuals that routinely share information to
provide treatment, testing and financial
services:
•Physicians
•Nurses
•Laboratories
•Administrators
•Insurance Companies
•Occupational and Vocational Therapists
32. Ethical Principles:Confidentiality
• What is Confidentiality Breaching
Breaching confidentiality occurs when nurses share information about patients with
people that do not have a “need to know” status covered under the patient’s written
authorization. Unless otherwise instructed to do so, nurses cannot discuss patient
care or diagnosis with family, friends, co-workers, other nurses, insurance
providers or financial aid organizations. Even casual conversation that might reveal
private information is precluded.
In addition, sharing is not just talking to unauthorized people, but includes every
form of media and conversation. This includes paper, vocal and digital channels:
•Verbal conversation
•Written conversation
•Fax
•Email
•Text
•Voice mail messages
33. Ethical Principles:Veracity
• Veracity is sometimes viewed as one of
the most difficult ethical principles in
nursing to uphold. The principle of
veracity requires nurses to be completely
honest with patients. It means telling
the truth, even if the truth may cause
the patient distress.
34. Ethical Principles:Veracity
reference:Nsgprocessorg
• For Example:
Mr. Douglas has congestive heart failure and lung cancer that has
metastasized to his spine. The doctor came to his room to explain the
severity of his condition and told Mr. Douglas they had tried all
possible treatments and his life expectancy is less than six months. The
doctor recommends hospice at home.
After the doctor leaves, Mrs. Douglas questions the nurse stating, "As
soon as we get him home, the hospice people will take good care of
him. He will be better in no time, right?" The nurse understands that
Mrs. Douglas is grasping for hope and wants the nurse to give her
something to cling to. However, the principle of veracity demands the
nurse to explain what the doctor said to Mrs. Douglas without giving
her false hope.
36. Ethical Principles:Fidelity
• For Example:
Mr. Grayson is a patient at an inpatient rehabilitation center
following left knee surgery. Following physical therapy this
morning, Mr. Grayson complained of increased pain and asked
the nurse for pain medication. Nurse Michaels administered
pain-relieving medicine as per the physician's order at 1:20 p.m.
and told Mr. Grayson she would check on him in an hour. At 2:15
p.m., Nurse Michaels returned to Mr. Grayson's room to evaluate
the effectiveness of the pain medication and verify if he requires
any other assistance.
37. Ethical Principles:Justice
• Justice is one of the ethical principles in nursing concerned with
the act of being fair or impartial. Nurses must make impartial
decisions about patient care without showing partiality due to a
patient's age, ethnicity, economic status, religion, or sexual
orientation.
• Applying justice in nursing practice means treating patients
fairly. Fairness means providing the same quality of care for
all patients.
38. Ethical Principles:Justice
• For example:
Nurse Brooks is working in the pediatric clinic. Two families arrived within a few minutes of one
another. One family has a fifteen-month-old son with a severe rash and cough. His parents report
he has had an elevated temperature for the past eight hours. The second family has three children
suspected of being exposed to COVID. None of the children is currently symptomatic. Nurse
Brooks must decide which patient to treat first and what protocol to follow.
Some people may think that fairness would be for Nurse Brooks to see the children potentially
exposed to COVID first. Nurse Brooks understands the importance of preventing the spread of
COVID. However, the three children who may have been exposed are asymptomatic. Therefore,
she takes the family to an isolation room to await triage and the physician. She then takes the
fifteen-month-old patient to an examination room, gets all his vital signs and health history, and
notifies the physician the child is ready to be evaluated.
In this situation, Nurse Brooks understood the importance of reducing the risk of possible
COVID exposure but also realized the children were asymptomatic. Conversely, the fifteen-
month-old patient had a fever, rash, and a cough, which warranted immediate attention.
39. Ethical Principles:Beneficence
• The ethical principle of beneficence is a quality requiring
nurses to act with genuine care, concern, and generosity
regarding the welfare of others, acting with the best interest of
patients in mind, regardless of the nurse's personal opinion or
self-interest.
• “To do Good”
40. Ethical Principles:Beneficence
• For Example:
• Mr. Douglas, whose wife has stage IV breast cancer, just learned his
wife's condition has worsened. She is not responding to verbal
commands and has little response to tactile stimulation. The doctors
have advised Mr. Douglas all they can do for Mrs. Douglas at this
time is to help make her comfortable. Mr. Douglas is visibly shaken.
Nurse Leah demonstrates beneficence when she offers to sit with Mr.
Douglas for a while, holding his hand and letting him talk. At the
appropriate time, Nurse Leah asks Mr. Douglas if there is anyone he
would like for her to call to be with him and his wife, stating she
wants to help as much as possible so he can spend time at his wife’s
bedside.
41. Ethical Principles:Non-Maleficence
Nonmaleficence is one of the ethical principles in nursing that
means to do no harm to others. This principle involves actions
by which a positive effect is intended and expected, and any risk
of harm is outweighed by the likelihood that no harm will come to
the patient or nurse
“do no harm”
42. Ethical Principles:Non-Maleficence
• For Example:
Nurse Adam received an order to administer Sumatriptan to his patient, Mrs. Elliott, for the
treatment of migraines. When Nurse Adam asked Mrs. Elliott if she had ever taken Sumatriptan, she
reported she had never tried the medication and stated, "Let's try it. The only medicine I'm allergic to
is Azulfidine." Nurse Adam recognizes Azulfidine as a sulfa-containing drug and knows that
Sumatriptan also contains sulfa. He asks Mrs. Elliott to describe the type of reaction she has when
taking Azulfidine. Mrs. Elliott reports that when she took Azulfidine, she experienced a severe
sunburn-like rash and tightness in her chest and throat. With this information, Nurse Adam chooses
to hold the Sumatriptan and notify the physician of her sulfa-allergy and request an alternative non-
sulfa-containing medication.
Nurse Adam demonstrated nonmaleficence by acting in the best interest of Mrs. Elliott. With the
knowledge he had of her severe allergic reaction to a sulfa drug previously, had Nurse Adam
administered the new medication, he would be held accountable for any adverse events.
45. Other Relevant Ethical Principles
1.Principle of Double Effect
2.Principle of Legitimate
Cooperation
3.Principle of Common Good and Subsidiarity
46. Principle of Double Effect
Principle of Double Effect is sometimes invoked when an action has two effects (hence
'Double Effect'); one good and the other harmful. The principle allows the action as
morally permissible in those circumstances in which the harmful effect is not intended,
but is a side-effect of the action.
For an action to be ethically legitimate or justified, it must satisfy 4 conditions as required
by the principle.
1.The act must be ethically good or at least indifferent.
Criteria to be considered an act is good:
An act directed toward the right ultimate end.
Choose an effective means to achieve that goal.
The intention should be honest.
47. Principle of Double Effect
2.The agent's intention is to achieve directly the beneficial effect and even if there is a resulting
harmful effect.
Simply, the good effect must be "primus in intentione". Thus, the unforeseen harmful effect,
though necessary, is not the direct intention sought but only as a side effect of an action.If
that which is directly intended is wrong, then the act is wrong.
3.The beneficial effect must happen first or at least at the same time as the harmful
effect.The good effect should never be a result of the bad effect.
If evil happens first before the good, then it could be understood as using evil means to achieve
the good.
4.The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects.
The beneficial effect of an act must be greater in value or at least equal to the harmful
effect.
48. Principle of Double Effect
• Chemotherapy
• Administering Vaccine
• In war (bomb)
• Self-Defense
49. The Principle of Legitimate
Cooperation
• To achieve a well-formed conscience, one should always judge it unethical to
cooperate formally with an immoral act;
• But one may sometimes judge it to be an ethical duty to cooperate materially
with an immoral act (that is, only indirectly intend its harmful effect) when
only in this way can greater harm be prevented, provided:
• 1.That cooperation is not immediate; and The degree of cooperation and the
danger of the scandal are taken into account.
• 2.Material cooperation is when one is identified to act but not to the purpose
of it.
• This kind of cooperation is not immediate and is more remote from doing the
evil involved.This is done to prove that one truly avoids formal cooperation.
50. Principle of Common Good and Subsidiarity
PRINCIPLE OF SUBSIDIARITY - means that what an individual, lower or
smaller group can achieve within his/her or its capacity should not be
should not be taken away and transmitted to the custody and
and performance of a higher or bigger group.
For Example:
• Doctor prescribed a medication but the nurse found out that the
that the patient has an allergy related to the medicine thus the
thus the nurse has the knowledge for patient’s welfare and later on
and later on informed the Doctor.
52. PRINCIPLES OF BIOETHICS:
Principle of Stewardship and Role of Nurses as
Stewards.
Stewardship - refers to the expression of one's responsibility to take care nurture and
cultivate the has been entrusted to him.
For Example: Someone gave you a plant
Healthcare practice stewardship - refers to the execution of responsibility of the
healthcare practitioner to look after, furnish fundamental health care services, and
promote the health and life of those entrusted to their care.
Stewards as well practicing nurses who are looking for to preserve and promote value at a
point of provider may have an effect on managers in their decisions about who ought to
get hold of what provider and how, and therefore impact change in healthcare
organizations. Nurse leaders are to have interaction others and work collaboratively to
establish and acquire a vision and motive that impacts the well-being of a system or
organization as an alternative than promote their self-interest.
Leaders are either:
Oriented to self - reflects the value of individualism (leaders perceive themselves as
the decision maker and others as implementers.)
Oriented to the company or system - displays the value of collectivism holds as their
precedence the well-being of the agency exhibit respect to all its members.
53. PRINCIPLES OF BIOETHICS:
Principle of Stewardship and Role of
Nurses as Stewards
The steward to self -to reach the realms of health and nursing stewardship, it is important that
nurse leaders participate in self-development. Succession of preparing to grow and cultivate and
a new generation of innovative nurse leaders could be the only way to do this.In order to meet
the idea of Lifelong Learning Nurse Leaders or stewards, mentors and personal trainers would need
to be used to assist them in developing abilities and improving skills.Healthy nurse leaders will
thus become visible and sound role.
1 Personal Virtue Ethics of Stewardship
Mcintyre, a communitarian theorist, believes that an individual is a conceptual self that seeks
meaning or good for itself through the perception of everyday experiences.Virtues are important
because they influence interpretation decisions on what is important in experience. A virtue is
characterized as a quality in which a person can move towards the accomplishment of a specific
human goal.
Character or reputation is established as virtues are typically practiced. In creating a
character, a person acts without determining the proper outcome of his or her actions, rather
than acting in the expectation that the action is worthwhile.
It can be claimed that personality influences the protection and promotion of what is obiectively
important in one's experience as a result of perceptual decision.
54. PRINCIPLES OF BIOETHICS:
Principle of Stewardship and Role of Nurses as
Stewards
• Virtue Ethics in Personal Stewardship
A nurse who demonstrates stewardship at the point of
delivery in compliance with Mcintyre's Theory of Ethics
would make it easier for nurses to explain their common
ethical goals within professional frameworks such as the
Nurses Association Code of Ethics.
As a result, stewards and nurses will maintain and
encourage what is fundamentally important in patient
care. It may also be argued that, in order to enable
nurses' discernment of embedded values, nurses will
progressively balance self-interest with service to
others.
55. PRINCIPLES OF BIOETHICS:
Principle of Stewardship and Role of
Nurses as Stewards
2.Social Virtue Ethics of Stewardship
Social role of nurses as stewards.
Health care has been listed as the number one public priority in
Philippines-and nurses play a vital role in the healthcare system. Nurses
advocate for health promotion educating patients and the public on disease
and injury prevention, providing treatment and helping to restore health,
and providing support. No other health care provider has such a wide and
far-reaching role to play.
Nurses help families learn to be healthy by helping to understand the
variety of emotional physical, mental and cultural interactions they
encounter during health and illness.Nurses do far more than care for
people. They always have always been at the forefront of innovation in
healthcare and public health.
56. PRINCIPLES OF BIOETHICS:
Principle of Stewardship and Role of Nurses as
Stewards
3. Ecological Virtue Ethics of Stewardship
Ecological role of nurses in stewardship
The nursing profession is well equipped to solve the problems of reducing waste
within medical systems.The health sector produces a large amount of waste that
leads to environmental problems such as air pollution and water pollution.By
uniting and engaging workers through shared governance, nursing frameworks will
decrease and overhead costs associated with waste management.
Nurses have the potential to use their trustworthy skills to guide the way to
more healthier communities and societies in which they work.
the emerging methods of waste management in healthcare.the nurses form the
largest group in the health sector and are skilled at informing research and
eliminating waste.
• Example:Color-Coded Trashbins and Checking of Expired Supplies
57. PRINCIPLES OF BIOETHICS:
Principle of Stewardship and Role of Nurses as Stewards
• Biomedical Virtue Ethics of Stewardship
• Bioethics (Greek words bios means life and ethos means
behavior) is a branch of applied ethics that refers the
discipline dealing with the ethical consequences of
biological science and application particularly in
medicine. It includes questions related to the
beginning and end of human life.
• Example: 5R in Administering Medication
58. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• Ethico-moral Responsibility of Nurses in Surgery
• Sterilization/ Mutilation
• Preservation of Body
• Functional Integrity
• Issues on Organ Donation
59. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• Principle of totality and its integrity implies that all
decisions in the field of medical ethics must
give priority to the welfare of the whole
person, considering physical and spiritual
factors. This principle was derived from the
works of St. Thomas Aquinas, a medieval
philosopher who synthesizes Aristotle’s
philosophy with theology. The principle of
totality is being used as an ethical standard
by Catholic health institutions.
60. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• According to the philosopher Thomas Aquinas, all
organs as well as other parts of the body exist
for the sake of the whole individual. Because the
intent of the part is to serve the whole, any
intervention that damages or prevents a part of
the body from achieving its objectives, infringes
the natural order and is morally wrong. This is
called the principle of totality. However, a
single part may be chosen to sacrifice if the loss
is essential for the benefit of the whole person.
• For instance, the principle of totality would
justify the amputation of a gangrene limb because
the person could perish if the gangrene spreads
61. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• A. Ethico-moral Responsibility of Nurses in Surgery
Codes of ethics for the nursing profession tend to
concentrate on professional conduct and to ensure that
decision-making is as patient-driven as possible.
Respect for other people
The nurse must respect the dignity and value of patients and
colleagues and treat all persons equally regardless of
personal characteristics or health problem. Related to this
is the obligation to always respect the patient's right to
self-determination in medical care.
62. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• Commitment to Patient One of the key ethical duties of the
nurse is to collaborate with the patient in order to provide
treatment that will optimize the physical, mental and social well-
being of the patient. The nurse is also responsible for preserving
and facilitating patient safety and rights, in particular in terms
of maintaining the highest standards of privacy and
confidentiality in compliance with the law.
• Honesty and Self-Integrity Nurses also have an ethical
responsibility to be honest with patients and colleagues, and to
maintain self-integrity and high personal moral standards. By the
same token, nurses have a personal responsibility to maintain
professional competence and strive towards personal and
professional growth so as to provide the best possible care to
patients.
63. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
Professional Responsibilities
The nurse also has a variety of ethical obligations
related to the nursing profession and its
specialization. A central obligation is always to aim to
change both the health care system and the conditions of
workers in order to optimize the efficiency of health
care delivery.
64. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
B. Sterilization
Sterilization may be described as any medical or surgical
intervention which renders a patient woman or a man incapable of
procreation naturally or operationally temporarily or permanently
Classifications:
Sterilization may be classified according to different methods
employed. These include both surgical and non-surgical methods.
The surgical methods were the earliest employed. They involve the
inhibition of the reproductive organs male or female by operating
on any of the various parts.
65. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
For example, the surgical method used in females includes:
Oophorectomy or removal of the ovaries that produce germ cells.
Salpingectomy ligation or destruction of the fallopian tubes
Hysterectomy or removals of the uterus.
TAHBSO-Total abdominal hysterectomy bilateral salpingo oophorectomy
For men:
Castration or removal of the testicles.
Vasectomy or ligation or removal of the vas deferens
Emasculation or suppression of the male genital organ
66. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• Some of these interventions are brutal and outdated.
However, tubal ligation and vasectomy are still common
today. Four chosen birth control programs are
considered in developing countries. These methods have
limited adverse effects. Even after depletion of
reproductive ability, they do not affect sexual
appetite.
• The non-surgical approach involves preventing the
maturation of the ovum through the use of
pharmacological agents.
• A different classification is used from a legal point
of view.
67. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
The reasons for sterilization, rather than the procedure, are considered.
Sterilization is classified as:
Eugenic sterilization-to prevent the birth of a deficient or deceased
offspring. The law of eugenic sterilization had first been approved in
Indiana USA in 1907. Many who suffer from presenile dementia epilepsy and
manic-depressive disorder become eligible for this form of sterilization.
Therapeutic sterilization: the removal of a defective reproductive organ
that endangers the health of the patient. This is exemplified by the
removal of the cancerous uterus.
Contraceptive sterilization: whether organic or mechanical, it consists of
suppressing ovulation in a female that makes her sterile.
68. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
Ethical evaluation
Before we discuss various ethical problems related to sterilization, it is important
to differentiate between direct and indirect sterilization.
a. Indirect or therapeutic sterilization is what is not itself sought.It is the
result of a therapeutic treatment of a deceased organ demanded by the health or life
of the person. The treatment is not geared towards sterilization, but sterility is
the product of comprehensive removal of pathological tissues.The morality of these
actions is based on the concept of totality, inasmuch as greater good.
b. Direct sterilization by its very nature has only one immediate effect: rendering
procreation impossible. This involves so-called preventive sterilization. Pregnancy,
according to its proponents, can aggravate some of the diseases
Sterilization is immoral, despite good intentions to avoid potential pregnancy-
related illnesses.Obstetrics has advanced so much today that these severe issues of
high-risk pregnancy are well handled in modern hospitals.
69. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
C. Preservation of Bodily Functional Integrity.
The human body is an integral part of the human
being and thus deserving of human dignity. It
must be kept whole. No body part should be
removed mutilated or incapacitated unless doing
so is appropriate for the wellbeing of a more
important body part or the body as a whole. An
unessential or redundant body part can be
removed for the benefit of person.
70. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
Human nature is a convergence of body and spirit. These two dimensions can never be
separated. The human body retains the dignity of the individual being. To decapitate
the body or otherwise, human dignity is violated by treating the human being as a
machine or as an object to be used and discarded.
There is no morality whatsoever involved in cutting down the mere anatomical
completeness of the body.
It is immoral to lessen the functional perfection and comprehensiveness of the body
when such a factor is not needed for the sustainability of the health and life of
the whole body.
Since the whole is greater and more important than any of its parts, it is morally
permissible to reduce the functional completeness of the body when it is the only
efficient way of ensuring a person's health or life.
The principle of totality validates a series of surgical procedures done in daily
clinical practice. Particular operations to not in present moral problems if
surgical ablation involves these diseased organs such as the appendix, gallbladder,
kidneys, lungs, and other organs. Difficulties are encountered in cases of cosmetic
71. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
D. Organ transplants and donation
Transplant can be defined as the transfer of an organ or a
major or minor portion of the tissue from one area of the
body to another or from one organism to another. It should be
noted that the development and advancement of the
transplantation technique is part of the medicine during 20th
century.In clinical practice alongside blood transfusion, the
foregoing have been ordinary: Corneal transplant, bone
transplant, skin grafting, heart valve transplant and other
transplants. The first successful kidney transplant between
monozygotic twins was performed in 1954. Since then,
thousands of patients have survived by kidney transplants all
over the world. Several other transplants have indeed been
performed, including heart transplantation, liver
transplantation, lung, pancreas, and so on.
72. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
Terminology transplants can be classified as:
1. Auto transplant autografts or autoplastic grafts): the donor and the
recipient are the same person. The transition is from one
part of the body to another, like a piece of the skin or
bone.
2. Heterologous transplants: the donor and the recipient are two
separate people. In certain situations, the donor is an
animal, more often it is just any human being. The latter
is often referred to as homo transplantation (homograft)
homoplastic grafts or homologous transplantation. Within
the subtype of human to human organ transplantation, there
are two possibilities from either living the person or from
a dead body.
73. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• Ethical evaluation
Auto transplantation is generally considered to be lawful for the same purpose
as ordinary surgery. Hetero transplants involving animal donors are now deemed
to be legal.
~ Likewise, the transplantation of organs collected from cadavers is legal if
it is carried out in compliance with civil law. Natural law forbids the
handling of a human cadaver literally as a product or as an animal. If there is
no law on transplantation, the donor's permission must be obtained before he or
she dies; otherwise, the family must give the authorization.
~ Homologous transplants between two living individuals became the subject of
many arguments between the ethicist and the moralist. Some have dismissed this
as a form of mutilation. However, these transplants are today justified by the
so-called Principle of Finality: "A healthy individual may willingly donate any
part of his body that is not essential to his life without contradicting nature
for the benefit of a sick neighbor." Done out of kindness, which is often the
case, his gestures are not only validated, and therefore also meritorious.
Organ donation is fostered among Christians today as a way to imitate Jesus
Christ, who gave his life for many. (Mark 10:45 a.m.)
74. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• Certain requirements govern transplants between two living people,
which tend to be completely rational. In order to make it moral,
the following requirements are needed
• On the part of the donor: That the organ is purely nonessential to
life, that the donation is willing, not forced or pressured even
by family, that it is done for noble reasons and that the donor
clearly understands the risk involved.
• On the part of the recipient: That the transplant is absolutely
important for his or her wellbeing.
• On the part of the procedure: that the procedure has a fair chance of
success and that the gain to the recipient and the expense to the
donor is proportionate.
75. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
Criteria on donation
• There have been a lot of discussions in the past about organ donation. The medical
requirements for patients eligible for organ donation must be strictly observed once a
diagnosis of death has been identified.
• Relevant requirements are further suggested for potential kidney donors, the most often
transplanted organs. The specifications shall include:
• 18-55 years of age, for example, and
• No current nephropathy, malignant phase (except for brain tumors), diabetes mellitus
communicable or infectious disease with serum-positive hepatitis syphilis.
• Key legal issues concerning transplantation:
• Confirmation of the exact date of death of the donor before continuing with the
extraction of organs and The legal existence of the cadaver: who has the authority or
control over it, who may decide ond its use for medicinal research purposes, etc.
76. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
Principles of ordinary and extraordinary means
• Ordinary measures are those that are based on medications or
services that are readily available and can be administered without
incurring significant discomfort, expense or other inconvenience, but
which offer the patient in question a reasonable hope for an
effective improvement in his or her health.
• Extraordinary measures are those focused on medicine or therapy
that cannot be used without incurring serious discomfort, expense or
other inconvenience. However, their application would not give the
patient a fair chance for a significant change in his health
77. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• The principle of personalized sexuality
The gift of sexuality must be used in accordance with human teleology. Personalized
sexuality is based on the concept of sexuality as one of the essential
characteristics of an individual and must be established in a way that is compatible
with the enhancement of human dignity.
The Catholic Church is fascinated with sexual morality. The explanation for the
emphasis on sexual morality in the teaching of the Church is that this aspect of
human character too frequently leads to a lack of integrity and an unwillingness to
fulfill the real purpose of human life.
In the Jewish Christian tradition, which is based on the first chapters of the
genesis of human sexuality, the family is often seen as the basic community in which
we are born and educated and on which the larger society is founded. Sexuality is
also not just a private matter, although it includes the most personal of
relationships. It also affects the general good of society and acquires its public
support and protection at the heart of the social organization.
78. PRINCIPLES OF BIOETHICS:
Principle of Totality and its
Integrity
• The principle of personalized sexuality can be described as follows. The
gift of human sexuality must be used in marriage, in accordance with its
inherent indivisible, explicitly human teleology, as a caring, physical,
satisfying expression of a man's and a woman's complementary, permanent
self-giving to one another, which is also a fruitful perpetuation and
extension of that personal communion through the family they engender and
teach.
Norms of sexuality
• Laws or social attitudes that impede human freedom to accomplish these
values in the way that individual desires are unjust and oppressive.
• Sexual behavior, at least among responsible adults, is essentially a
private matter to be decided by personal choice, free from any moral
guilt.
80. 1.Sexuality and Human
Reproduction
1 A. Human Sexuality and its Moral Evaluation
1 B. Marriage
• Fundamentals of Marriage Issues on Sex Outside Marriage and Homosexuality
• Issues on Contraception, its Morality, and Ethico-moral Responsibility of Nurses
1 C. Issues on Artificial Reproduction, its Morality and Ethico-moral
Responsibility of Nurses
• Artificial Insemination
• In-vitro Fertilization
• Surrogate Motherhood
1 D. Morality of Abortion, Rape and other Problems Related to Destruction of Life
83. 1 A. Human Sexuality and its Moral
Evaluation
Don Lucas and Jennifer FoxNorthwest Vista College
• Sexuality is one of the fundamental drives behind
everyone’s feelings, thoughts, and behaviors. It defines
the means of biological reproduction, describes
psychological and sociological representations of self,
and orients a person’s attraction to others. Further, it
shapes the brain and body to be pleasure-seeking. Yet,
as important as sexuality is to being human, it is often
viewed as a taboo topic for personal or scientific
inquiry.
84. 1 A. Human Sexuality and its Moral
Evaluation
• Sex makes the world go around: It makes babies bond, children
giggle, adolescents flirt, and adults have babies. It is addressed
in the holy books of the world’s great religions, and it infiltrates
every part of society. It influences the way we dress, joke, and
talk. In many ways, sex defines who we are. It is so important,
the eminent neuropsychologist Karl Pribram described sex
as one of four basic human drive states. Drive states motivate us
to accomplish goals. They are linked to our survival. According
to Pribram, feeding, fighting, fleeing, and sex are the four drives
behind every thought, feeling, and behavior.
85. 1 A. Human Sexuality and its Moral
Evaluation
What is the good of human sexuality? What is good
human sexuality? What is the point of sex?
DO YOU BELIEVE THAT…
• HUMAN SEXUALITY= COMMITMENT?
• ONE HAS THE RIGHT OR FREEDOM OF
SEXUALITY?
86. 1 A. Human Sexuality and its Moral
Evaluation
• Sexual meaning makes us realize the need for some measure of fulfillment
that only the other can give.
• One has to be free from self-centeredness by opening one to the other
person.
• Giving and giving of the best, a giving of self. Giving until nothing more is to
give
• A happiness that is sought for ourselves alone can never be found. For a
happiness that is diminished by being shared is not big enough to make us
happy.
• Making someone happy
87. 1 A. Human Sexuality and its Moral
Evaluation
Your right to sex involves a duty in
others to respect it.
Sex implies moral discipline.
Commitment consist of Care
,Concern and responsibility
88. 1 A. Human Sexuality and its Moral
Evaluation
Safeguarding the other's value
Responsibility to and for one another
Humanizing
Human sex is dehumanizing if and when it destroys a
person's honor, and becomes a degradation of the other
89. 1 A. Human Sexuality and its Moral
Evaluation
• Natural Law
HS is sacred and a God-given Gift
• Rawls
Never take advantage of persons for own personal
gains and satisfaction
90. 1 A. Human Sexuality and its Moral
Evaluation
“It is better to be a human
being dissatisfied than a pig
satisfied“
-John Stuart Miller
91. 1 B. Marriage
• Fundamentals of Marriage Issues on Sex Outside
Marriage and Homosexuality
• Issues on Contraception, its Morality, and Ethico-
moral Responsibility of Nurses
92. Fundamentals of Marriage Issues on Sex Outside
Marriage and Homosexuality
Marriage has become an increasingly important topic in
academic and policy research. A burgeoning literature
suggests that marriage may have a wide range of benefits,
including improvements in individuals' economic well-being,
mental and physical health, and the well-being of their
children.
93. Fundamentals of Marriage Issues on Sex
Outside Marriage and Homosexuality
HEALTH ADVANTAGES OF MARRIAGE
There is fascinating and compelling research suggesting that married people enjoy deter neatch than single
people. For example, as compared with those who are single, those who are married tend to
• Live longer
• have fewer strokes and heart attacks
• have a lower chance of becoming depressed
• less likely to have advanced cancer at the time of diagnosis and more likely to survive cancer for a
longer period of time
This doesn't mean that just being married automatically provides these health
benefits.People in stressful, unhappy marriages may be worse than a single person who is
surrounded by supportive and caring friends, family, and loved ones. Interestingly, many of
these health benefits are more pronounced for married men than for married women.
94. Fundamentals of Marriage Issues on Sex
Outside Marriage and Homosexuality
• BEHAVIOR IMPROVES WITH MARRIAGE
Married people may take fewer risks, eat better, and maintain healthier
lifestyles, on average, compared with single people. There is also evidence
that married people tend to keep regular doctors appointments and follow
doctors recommendations more often than single person.
• MENTAL HEALTH IS BETTER WHEN YOU'RE MARRIED
Poor social supports (as might be more likely for those who are single) have
been strongly linked with higher rates of depression. loneliness. and
socialisolation. which have in turn been associated with poorer health
outcomes
95. Issues on Sex Outside Marriage and
Homosexuality
ISSUES ON SEX OUTSIDE MARRIAGE AND
HOMOSEXUALITY
Sexual behaviors of adolescents and youth are categorized as
one of the main health priorities of a society because of
high prevalence of human immunodeficiency acquired
immunodeficiency syndrome (HIV/AIDS), sexually
transmitted infections and unwanted pregnancies.
96. Issues on Sex Outside Marriage and
Homosexuality
PREMARITAL SEXUAL RELATIONSHIPS: EXPLANATION OF THE ACTIONS AND FUNCTIONS OF FAMILY
A study conducted by: Mahnaz Noroozi. Fariba Taleghani, Effat Sadat Merghati-khoei. Mahgol Tavakoli,
and Ali Gholami.
RESULTS showed that live main concepts are involved in the formation of seyna relations hefore
marriage, including:
• Parents child-rearing practices
• Parents interactions
• Children's economic support
• Religious beliefs
• Sexual awareness
CONCLUSIONS Based on the prominent role of the family in shaping sexual relations before marriage, it
is necessary to educate and support families and also revise the neglected aspects.
97. Issues on Sex Outside Marriage and
Homosexuality
PROBLEMS ON SEX OUTSIDE MARRIAGE
• We would have few abortions or unwanted pregnancies
• We would have few sexually transmitted infections
• We would have few teenage pregnancies
• we would have few divorces due to mistrust caused by previous sexual relationships
• We would have fewer children who grow up with single mothers
• Premarital sex also creates spiritual problems in relation to a person's relationship with
God. it one is not repentant, a person can distance himself from God simply because of
guilt and shame.
98. Issues on Sex Outside Marriage and
Homosexuality
Note
Too often people focus on the "enjoyment" and
"pleasurable" part of sex without understanding the other
aspects of sex. such as procreation, the Biblical guidelines
and also the negative etfects o having sex outside of
marriage.
99. Issues on Sex Outside Marriage and
Homosexuality
HEALTH CARE PROBLEMS
• Depression and suicide
• substance misuse
• Prostitution
• Cervical cancer
• Breast and endometria cancer
• Sexually transmitted diseases
• eating disorder
• Anal cancer
100. Issues on Sex Outside Marriage and
Homosexuality
ETHICO-MORAL RESPONSIBILTY OF NURSES ON HOMOSEXUALITY
• Health care professionals should create a safe, nonjudgmental environment for battered
patients-such as posting sticker-notices to indicate safe zones for the lesbian, gay, bisexual,
and transgender population and take an active role in stopping the perpetration antigay
sentiment among colleagues. In addition, professionals should be aware of community support
systems within schools and workplace.
• Health care professionals should take a detailed sexual history, including the number and sex
of previous partners, specific activities engaged in, and the use of preventive measures such as
condoms, gloves, and dental dams. Practitioners should educate their lesbian and bisexual
female patients on the risks of sexually transmitted diseases and the proper use of protective
barriers.Community outreach is needed to educate people on their health risks, the need for
screening and preventive measures.
101. Issues on Sex Outside Marriage and
Homosexuality
Sexual Infidelity widespread but also widely condemned.sexual activity
that one has with someone while being in a monogamous relationship with someone else.
• REASONS
Relationship dissatisfaction. sexual dissatisfaction
in the primary relationship, opportunity, curiosity, desire for excitement, having a more permissive attitude
towards infidelity and wanting to get even with a spouse (Blow and Hartnett 20051)
'For fun', 'for intellectual sharing', 'to feel young',
'for novelty and change and enhancement of confidence and sell-esteem (Glass and Wright 1992)
• Sexual infidelity is wrong because: it breaks a commitment to be sexually exclusive,
which has special significance in the relationship it deceives.
102. ACTIVITY:
1.Is sex before marriage right or wrong?
2.Does the fact that society has normalize
premarital sex mean that sex before
marriage is a good thing?
3.What does the bible say about sex before
marriage?
104. 2. Dignity in Death and Dying
a. Euthanasia and Prolongation of Life
b. Inviolability of Human Life
c. Euthanasia and Suicide
d. Dysthanasia
e. Orthothanasia
f. Administration of Drugs to the Dying
g. Advance Directives
h. DR or End of Life Care Plan
