Bioethics Midterms Outline PDF

BIOETHICS THE PHILOSOPHY OF SEXUALITY EXPLORES MA. LORAINE D. PONCEJA – BSN 3C THESE TOPICS BOTH CONCEPTUALLY AND NORMATIVELY...

BIOETHICS THE PHILOSOPHY OF SEXUALITY EXPLORES MA. LORAINE D. PONCEJA – BSN 3C THESE TOPICS BOTH CONCEPTUALLY AND NORMATIVELY BIOETHICS AND ITS APPLICATION IN CONCEPTUAL ANALYSIS VARIOUS HEALTH CARE SITUATIONS  is carried out in the philosophy of sexuality in order to clarify the fundamental notions of sexual TOPIC OUTLINE desire and sexual activity. Conceptual analysis is A. Sexuality and Human Reproduction also carried out in attempting to arrive at 1. Human Sexuality and its Moral Evaluation satisfactory definitions of adultery, prostitution, 2. Marriage rape, pornography, and so forth.  Fundamentals of Marriage NORMATIVE PHILOSOPHY  Issues on Sex outside Marriage and  of sexuality inquiries about the value of sexual Homosexuality activity and sexual pleasure and of the various  Issues on Contraception, its Morality and forms they take. Thus, the philosophy of Ethico-Moral responsibility of Nurses sexuality is concerned with the perennial questions of sexual morality and constitutes a A. Sexuality and Human Reproduction large branch of applied ethics. 1. Human Sexuality and its Moral Evaluation SEX vs GENDER HUMAN SEXUALITY Sex – refers to the biological differences between males  It is the total of our physical, emotional, and and females, such as the genitalia and genetic differences. spiritual responses, thoughts, and feelings. Sexuality is more about who we are than about Gender – describes psychological (gender identity) and what we do. sociological (gender role) representations of biological  Human sexuality is the expression of sexual sex. sensation and related intimacy between human  Cisgender – individuals’ gender identities beings. correspond with their birth sexes. 5 COMPONENTS OF HUMAN SEXUALITY  Transgender – individuals’ gender identities do not correspond with their birth sexes. SENSUALITY  Awareness, acceptance of, and comfort with one's SEXUAL ORIENTATION own body; physiological and psychological  refers to a person’s sexual attraction to others. enjoyment of one's own body and the bodies of Sexual orientation may include attraction to the others. same gender (homosexuality), a gender different than your own (heterosexuality), both men and INTIMACY women (bisexuality), all genders (pansexual), or  The ability and need to experience emotional neither (asexuality). closeness to another human being and have it returned. SEXUAL BEHAVIOR  is a manner in which humans experience and IDENTITY express their sexuality.  The development of a sense of who one is sexually, including a sense of maleness and SEXUAL FANTASIES femaleness.  any mental imagery that is sexually arousing. (e.g., replacement fantasy). SEXUALIZATION  The use of sexuality to influence, control or TYPES OF SEXUAL BEHAVIOR manipulate others. Masturbation – physical stimulation of the body for sexual pleasure. Empirical evidence links masturbation to SEXUAL HEALTH AND REPRODUCTION increased levels of sexual and marital satisfaction, and  Attitudes and behaviors related to producing physical and psychological health. children and health consequences of sexual behavior. Coital Sex – is the term for vaginal-penile intercourse. Oral sex – sexual activity in which the genitals of one MORALLY SUPEREROGATORY partner are stimulated by the mouth of the other.  ‘Supererogatory’ designates any action which is Cunnilingus oral stimulation of the female’s external sex deemed morally good, but which carries or organs and fellatio oral stimulation of the male’s external implies no obligation to act. Supererogatory sex organs. actions are also known as altruistic actions.  Example: one person’s agreeing to have sexual Anal sex – sexual activity involving penetration of the relations with another person when the former anus. Anal sex is not exclusively a “homosexual has no sexual desire of his or her own but does behavior.” want to please the latter might be an act of supererogation. SEXUAL CONSENT  Sexual consent refers to the voluntary, MORALLY WRONG conscious, and empathic participation in a sexual  Morally wrong acts are morally prohibited, act, which can be withdrawn at any time morally impermissible, acts one ought not to do, (Jozkowski & Peterson, 2013). It is the baseline and acts one has a duty to refrain from doing. for what are considered normal acceptable and  Example: rape and incest are commonly thought healthy behaviors; whereas nonconsensual sex to be morally wrong. — i.e., forced, pressured or unconscious participation— is unacceptable and unhealthy. A. Sexuality and Human Reproduction  Kristen Jozkowski and her colleagues (2014) 2. Marriage found that females tend to use verbal strategies of Humankind’s most basic and oldest social unit is the consent, whereas males tend to rely on nonverbal Family. It is a social institution primarily established by indications of consent. society to ensure its continuity and to regulate the sexual  “The universal principles of pleasure, sexual behavior of its members. behaviors, and consent are intertwined. Consent is the foundation on which sexual activity needs Light and Keller (1985) – marriage is a socially to be built. Understanding and practicing recognized union between two or more individuals that empathic consent requires sexual literacy and an typically involves sexual and economic rights and duties. ability to effectively communicate desires and limits, as well as to respect others’ parameters.” Bronislaw Malinowski – marriage is a contract for the production and maintenance of children. MORAL EVALUATION Sexual acts can be distinguished as: According to the Executive Order No 209 or the Family Code of the Philippines – marriage is a special MORALLY OBLIGATORY contract of permanent union between a man and a woman  Morally obligatory acts are morally right acts one entered in accordance with law for the establishment of ought to do, one is morally prohibited from not conjugal and family life. It is the foundation of the family doing them, they are moral duties, they are acts and an inviolable social institution. that are required. In general, something is “right” if it is morally obligatory. MARRIAGE  Example: a spouse might have a moral obligation Marriage, also called as matrimony or wedlock, is a to engage in sex with the other spouse. legally and socially sanctioned union, usually between a man and a woman, that is regulated by laws, rules, MORALLY PERMISSIBLE customs, beliefs, and attitudes that prescribe the rights and  Permitted means behavior that is within the duties of the partners and accords status to their offspring bounds of the moral system. It is morally (if any). It is another human construction to ensure the permitted to act in any way that does not cause continuity of the family and the eventual perpetuation of others unjustified harms. In short, “permitted” is the human species. the lowest bar for moral behavior. Anything that is not morally forbidden is permitted. BASIC FORMS OF MARRIAGE  Example: It might be morally permissible for Monogamy – an ideal, widespread, and rational type of married couples to employ contraception while marriage. It refers to marriage with one woman at a time. engaging in coitus. Polygamy or Plural Marriage – refers to the marriage of more than one mate at a given time. The practice of Polygamy is also commonly found in sub- 5. Trust – is an indispensable ingredient in building Saharan Africa, where 11% of the population lives in and maintaining a healthy marriage. It is one of arrangements that include more than one spouse. the most important elements of a relationship, and a crucial element of any lifetime commitment. THREE FORMS OF POLYGAMY Without trust, the quality of the relationship will 1. Polygyny – a type of marriage in which a man deteriorate. marries more than one wife at a time (e.g., 6. Intimacy – In marriage, intimacy is an essential Muslims). From Neoclassical Greek word poly- part to keep the relationship strong. It involves "many", and gyne "woman" or "wife", is the most feelings of emotional closeness and common and accepted form of polygamy, connectedness with another person. entailing the marriage of a man with several women. TYPES OF INTIMACY 2. Polyandry – a type of marriage in which a Emotional Intimacy – involves opening up to deeper woman marries several men at a time. This is the authentic feelings by sharing emotions verbally or opposite of polygyny. From Greek: poly-, "many" nonverbally. and andry from the word anēr or adros, "man") 3. Endogamy or Group Marriage – a type of Intellectual Intimacy – a cerebral connection often marriage in which a group of men marry a group obtained through thoughtful conversations such sharing of women at a time. It is common in many whatever you are thinking and your skills. It could be cultures and ethnic groups. The Urapmin, which sharing your hopes, dreams, fears, and experiences. is a small tribe in Papua New Guinea, practice strict endogamy. Physical Intimacy – is about touch and closeness between bodies. In a romantic relationship, it might A. FUNDAMENTALS OF MARRIAGE include holding hands, cuddling, kissing, and sex. 1. Connection – a relationship in which a person, thing, or idea is linked or associated with Sexual Intimacy – when people engage in sensual or something else. In marriage, connection means a sexual activities. It consists of exploring and sharing bond that holds partners together in a relationship sexuality together — sharing fantasies, foreplay, roleplay, and it is one of the most important strengths for mutual masturbation, or non-genital, sensual touch. couples to have. Without this, relationships or marriage can easily drift apart. A strong Spiritual Intimacy – entails sharing a spiritual or connection often serves as a foundation upon religious connection. which other elements are built. 2. Commitment – the state or quality of being Sexual ethics is the study of human sexuality and sexual dedicated to something. Commitment in marriage behavior. In a word, it seeks to understand and evaluate means that both parties are willing to do whatever the moral conduct of relationships and sexual activities it takes to make the marriage work. It means both from a philosophical perspective. have to find ways to compromise to make the relationship successful. ISSUES ON SEX OUTSIDE MARRIAGE AND 3. Giving – the act of presenting something HOMOSEXUALITY voluntarily and without expecting any These issues include: compensation. It is the tangible show of  Pre-marital Sex commitment, of choice, of a deeper attachment  Adultery and Concubinage than mere friendship.  Cohabitation 4. Respect – may best be defined as the way you  Prostitution show true appreciation for another person. Respect is an action, not just a feeling. It’s a 1. Pre-marital sex — is any sexual activity with an declaration of value for someone. Respect is opposite sex partner or with same sex partner shown in marriage not because one person is before he/she has started a marriage life. The term more superior than the other, but because each is usually used to refer to intercourse before a person recognizes the value of the other. It marriage. Sexual activities among young people eliminates fear of being different, upholds have been increasing worldwide. healthy boundaries in the relationship, and Disadvantages: strengthens the relationship.  STDs  Having a physical relation with someone leads to greater emotional connect   Having multiple partners before marriage results Queer – re-appropriated (in recent years) by lesbian, gay, in a need for variety bisexual, and transgender (LGBT) persons and others to  Risk of pregnancy denote a general self-identification as non-heterosexual or  Adoption non-cisgender.  Abortion Transvestism – a condition in which a person, usually heterosexual in orientation, is more comfortable sexually 2. Adultery and Concubinage – Adultery is while wearing clothing symbolic of the opposite sex. committed by a married woman and her Transsexualism – differs markedly from the foregoing paramour who knows of her marital status, when by gender dysphoria syndrome, i.e., an anxiety, they engage in sexual intercourse. Concubinage sometimes reaching suicidal depression, as the result of is committed by a married husband by: the obsessive feeling that one's "real" sex is the opposite (a) keeping a mistress in the conjugal dwelling. of one’s phenotypic sex. (b) having sexual intercourse under scandalous Polysexuality – this category refers to people who are circumstances with a woman who is not his attracted to people because of their gender identity, not wife. their sex. Attraction occurs towards groups and (c) cohabiting with her in any other place. collectives with a specific gender identity, regardless of whether they are men or women. 3. Cohabitation — to live together as a couple Homoromantic heterosexuality or homoromantic without being married. homosexuality – while it cannot be considered entirely a Pros: type of sexual orientation, to understand this ▪ Your relationship may be deepened and enriched differentiation it is necessary to consider the difference ▪ The stresses of getting married can be eased between sexual orientation and romantic orientation. ▪ Reducing your expenses can save you more money Although they generally go hand in hand, there are cases Cons: in which people who are sexually attracted to a particular ▪ Cohabitation is not a permanent relationship sex on an affective and romantic level only feel attached ▪ There is always uncertainty with cohabitation to the opposite. ▪ Couples who cohabitate have less fulfilling sexual lives Asexuality – although asexuality is defined by the absence of sexual desire of any kind, this does not mean 4. Prostitution — Is the practice of engaging in that people with this type of sexual orientation cannot relatively indiscriminate sexual activity, in develop romantic attachments. In other words, just general with someone who is not a spouse or a because they are not sexually attracted or interested in the friend, in exchange for immediate payment in sexual aspects does not mean that they cannot fall in love. money or other valuables. Prostitutes may be And such infatuation can occur with people of both the female or male or transgender, and prostitution opposite sex (asexual hetero-romantic) and the same sex may entail heterosexual or homosexual activity, (asexual homo-romantic). but historically most prostitutes have been women and most client’s men. ISSUES ON CONTRACEPTION, ITS MORALITY AND ETHICO-MORAL RESPONSIBILITY OF HOMOSEXUALITY NURSES  It is the same-sex affection of men or women; The expression of the conjugal will of a man and woman attracted to individuals of the same sex. to parenthood is commonly called sexual intercourse or Lesbians – traditionally exclusively referred to women coitus, the celebration of physical, mental, and spiritual who are attracted to other women. intimacy. Gay – exclusively referred to men who are attracted to other men. CONTRACEPTION Bisexual – individuals who are attracted to both men and  Defined as the voluntary prevention and women. contraception by the positive used of artificial Transgender – a term used to describe people whose means which hinder the generative cells from gender identity differs from the sex they were assigned at uniting during sexual act. The moral issue of birth. contraception is concerned with the rightness or Pansexual – individuals whose sexual attraction is wrongness of the use of various methods by limited by either the traditional binary types of male & which contraception can be prevented in the female nor other categories of sex, gender & gender conjugal union. identity.  Contraception is the use of devices, drugs, agents, sexual practices, or surgical procedures to prevent conception or pregnancy.   Helps a woman plan when and if they want to husband in intimate circumstances, consider a have a baby. male physician often as not acceptable, even with  Birth control involves actions, sexual practices, a chaperone. The punishments for adultery or sex and medications to intentionally prevent before marriage in certain countries/cultures can pregnancy be death. These cultural taboos are followed more  3 types of Birth Control: Contraception, closely in some cultures than in others, even if contragestion, chemical/surgical abortion they are of the same religion.  Birth control methods: Coitus interruptus, male,  Christianity – Contraception and abortion are and female condom, spermicides, pills, forbidden in Catholicism. Mica thermic methods contraceptive patch and injection, subdermal of contraception are acceptable. The best course implant. is to ask the patient if there are any special considerations you need to be aware of in view of ISSUES ON CONTRACEPTION their religion or background. This gives you a 1. AGE better picture of what they consider important.  Differing age menarche – different populations tend to have different physical and emotional MORALITY OF CONTRACEPTION maturity. Age at menarche of European children Many thinks contraception is inherently wrong because it is higher than those from the Caribbean or from is unnatural, anti-life, form of abortion, separates sex the Indian subcontinent. from reproduction, leads to “immoral behavior”. It also  Risk takers – Younger people are more likely to brings bad consequences which include health risks, have sex with multiple partners and engage in prevents potential human beings from being conceived, other risk-taking behavior such as drugs and prevents people who might benefit humanity from being alcohol. These factors, with a less than rigorous born and may lead to depopulation. Many believe that it approach to regular pill taking, may result in a is not wrong because of the following: higher rate of pregnancy. a. Human right benefits: “Procreative liberty”  Peer pressure – along with media exposure of b. Health benefits: Prevents conception of unwanted sex, may put some youngsters under pressure to children thus reducing the number of abortions and the experiment with sex before they are ready or use of condoms help prevent STDs and HIV mature enough to do so. c. Family benefits: Prevents the conception of children that a family cannot support 2. CULTURE d. Enables people to avoid having more children than they  Cultural attitudes to premarital sex – In certain want cultures, attitudes are extreme and premarital sex e. Improves marriages is considered a matter of great shame and a loss f. Benefits for the woman of family honor. The consequences of premarital g. Demographic benefits: It enables world population to sex can be so severe in some cultures that it is be controlled and thus protects the environment and essential to ensure that strict confidentiality in reduces poverty relation to these matters is always maintained.  Cultural isolation – Some cultures disapprove of ETHICO-MORAL RESPONSIBILITY OF NURSES the education of women. This can result in ON CONTRACEPTION women becoming isolated, particularly when 1. DOING NO HARM – The nurse must prioritize they emigrate with their family to a different the participant’s safety to avoid harm. The venue country with a different primary language. A for the process must be held at a safe environment special need exists for their education about the of their choice. availability of different choices of contraceptive 2. VOLUNTARY PARTICIPATION – It is the methods so that they can be empowered to control role of the nurse to make sure that the participants their fertility according to their needs. must voluntarily participate in the process and should never be coerced to undergo this 3. RELIGION procedure.  Orthodox religions – These include Judaism, 3. INFORMED CONSENT – The nurse must Islam, Hinduism, & Sikhism. Orthodox followers ensure that the patient has read and understood of all these religions tend to: regard sex outside everything before signing the paper. It is also the marriage as taboo, forbid abortion, and regard responsibility of the nurse to ensure that the menses as unclean, extend the taboos against sex informed consent is signed and is witnessed by before marriage to sex outside marriage, i.e., the nurse themselves. adultery, forbid seeing any other man than the 4. CONFIDENTIALITY AND ANONYMITY – It is essential to ensure confidentiality to protect their privacy. The client’s information must be kept confidential in the context of the institution’s protocol unless it is stated or required by law that it requires disclosure. If such information needs to be disclosed as the law suggests, then the client must have the right to know about it. 5. ETHICAL DECISION MAKING – The nurse must be able to identify ethical issues that stem from the issue in order to participate in formal and informal processes that address ethical issues to be evaluated afterwards. Nurses must also recognize that they have both the responsibility and the right to care for the patients as a whole, they must be aware of their own personal values, understanding processes and resources available to utilize for ethical decision making, and the awareness of the constantly changing legal and health policies to be considered in the event of of decision-making process. COMPLICATIONS OF ETHICAL THEORIES/MORALITY  Natural law moralists are divided on the issue of contraception: only rhythm method and abstinence. The neo-scholastic ethicians consider the natural order as designed by God. Majority of the members of this commission took the position that contraception does not conflict with human nature and the natural law if it is practiced promoting responsible parenthood.  Rhythm or safe method is allowed by the encyclical.  Roman Catholic church views voluntary sterilization as intrinsically wrong in so far as it involves the frustration of natural power and function. ISSUES ON ARTIFICIAL REPRODUCTION, ITS HOMOLOGOUS (ARTIFICIAL INSEMINATION MORALITY AND ETHICO-MORAL HOMOLOGOUS—AIH) RESPONSIBILITY OF NURSES  The husband’ s sperm is used Using the husband’ s sperm is by far the most common and creates  Infertility has traditionally been an area of the fewest problems legally, ethically, and medicine in which physicians and health care morally. providers around the world had limited means to help their patients. However, the landscape of this HETEROLOGOUS (ARTIFICIAL field changed dramatically with the INSEMINATION DONOR—AID) announcement of the birth of Louise Brown in  Artificial insemination in which these men is 1978 through in vitro fertilization (IVF). Since obtained from a donor other than the husband or then, assisted reproductive techniques have partner. become more available such that it now accounts for 1% of all live births in the USA. TYPES OF ARTIFICIAL INSEMINATION INFERTILITY INTRACERVICAL INSEMINATION  Infertility is defined by the failure to achieve a  This procedure is typically one of the easiest and pregnancy after 12 months or more of regular least costly of the types of artificial insemination unprotected sexual intercourse. For couples in humans because it most closely mimics hoping to become parents, difficulty conceiving a intercourse. Semen is introduced to the opening baby can be frustrating and unexpected. Many of the cervix by a health professional with a couples who struggle with infertility do end up needleless syringe. After the sperm is introduced having children, sometimes with medical help. to the body, you might wear a conception cap for a few hours. The cap is meant to hold semen ASSISTED REPRODUCTIVE TECHNOLOGY inside the body to raise the chances of successful  Assisted reproductive technology (ART) -all implantation. treatments or procedures that involve the in vitro handling of both human oocytes and sperm or of INTRAUTERINE INSEMINATION embryos for the purpose of establishing a  In Intrauterine Insemination, washed sperm is pregnancy. injected into the uterus with a catheter.  These include: Intrauterine insemination is one of the most  Artificial Insemination efficient types of artificial insemination in  In-Vitro Fertilization (IVF) humans and has some of the highest success rates.  Surrogate Motherhood This type of insemination is typically the most effective if you’re under the age of 30. ARTIFICIAL INSEMENATION  Artificial insemination is a fertility treatment in INTRAUTERINE TUBOPERITONEAL which sperm is deposited into a female’s INSEMINATION reproductive tract using a syringe or catheter-like  The sperm is injected into the fallopian tubes, and medical device. once the semen is put into your system, your  Sometimes, these sperm are washed (aka cleaned, health practitioner will put a clamp on your cervix concentrated, and prepared) and the woman takes that prevents semen leakage. This option is a medications to increase the odds of pregnancy. great fit for couples with mild male infertility or  Artificial insemination was first developed by a mild endometriosis because it bypasses the Russian man name Ilya Ivanoff in 1899 in organs that are affected. You may be induced into domesticated farm animals. The process was then ovulation for this procedure or any of the other later adapted for human artificial insemination insemination methods because the process with the first reports appearing around in the guarantees that you ’ll release more eggs than 1940s. usual and eggs of better quality.  Today artificial insemination is one of the most common fertility treatments and often the first INTRATUBAL INSEMINATION treatment one will encounter or be suggested by a  In intratubal insemination, sperm is introduced medical provider. solely to the fallopian tubes. Sometimes this procedure is called fallopian tube sperm perfusion. A catheter goes through the cervix and the uterus and puts sperm directly into the  fallopian tubes. An important part of all artificial  The practice of surrogacy, cryopreservation of insemination is monitoring your cycles and embryo’s fertility. With this procedure and with most artificial insemination, you should be sure that ETHICO-MORAL RESPONSIBILITY OF NURSES your health practitioner takes into account the  The nurse practitioner caring for the couple type of cycle you’re on, whether it be your body’s requesting assisted reproduction technique must natural cycle, or a fertility drug induced one. be able to provide comprehensive care as a teacher, counselor, and technician. ARTIFICIAL INSEMINATION RISKS:  The nurse practitioner assesses the couple's Infection. There’s a slight risk of developing an infection emotional status relative to infertility, counsels as a result of the procedure. them if indicated, describes the legal Spotting. Sometimes the process of placing the catheter ramifications of the procedure, performs the in the uterus causes a small amount of vaginal bleeding. insemination, and assists in interviewing donors This doesn’t usually have an effect on the chance of for the program. pregnancy.  Nurses must maintain professionalism in the Multiple pregnancy. Artificial insemination itself isn’t working place and do the duties in a lawful and associated with an increased risk of a multiple pregnancy proper manner by maintaining the workplace — twins, triplets or more. But, when coordinated with ethics. ovulation-inducing medications, the risk of a multiple  Nurses must understand and respect patient pregnancy increases significantly. A multiple pregnancy autonomy and the right to self-determination. has higher risks than a single pregnancy does, including  A nurse is ethically obligated to know and follow early labor and low birth weight. state, federal and facility rules on handling confidential patient information and records. IN-VITRO FERTILIZATION  Ethical nurses believe in social justice and  IVF is a series of procedures used to help with treating patients fairly. fertility or prevent genetic problems and assist with the conception of child. It involves MORALITY OF PROBLEMS RELATED TO DESTRUCTION OF LIFE retrieving mature eggs form a woman's ovaries ABORTION and fertilizing them with a sperm in a laboratory.  Abortion is used in this discussion to refer to IVF is the most effective form of assistive deliberate removal of a fetus from the womb of a reproductive technology. human female, at the request or through the IN-VITRO FERTILIZATION RISKS agency of the mother, so as in fact to result in the  Multiple Pregnancies death of the fetus but with insignificantly small  Premature delivery and low birth weight risk to the life or health of the mother. Abortion  Egg-Retrieval procedure complications is the ending of a pregnancy by removal or  Miscarriage expulsion of an embryo or fetus before it can survive outside the uterus. Abortion that occurs SURROGATE MOTHERHOOD without intervention is known as a miscarriage or  A woman who becomes pregnant by artificial spontaneous abortion. insemination or by implantation of a fertilized egg created by in-vitro fertilization for the METAPHYSICAL AND PHYSICAL STATUS purpose of carrying the fetus to term for the  Metaphysics deals with questions about the intended parents. ultimate nature and categories of reality. The metaphysical status of a being is how it should be The main issues that raise ethical dilemmas following classified with respect to what we take to be the the development of assisted reproduction techniques most basic categories and types of reality and are the following: experience: whether it has subjective existence or  The right to procreate or reproduce is an object only, whether it is a person, whether  The process of in vitro fertilization itself- some it has or is an immaterial soul, etc. “PERSON” belief deems that it is not morally acceptable to  The physical status of a being is the nature of its interfere in the reproduction process physical (and mental) existence. It could be alive,  The moral status of the embryo dead, able to exist on its own, be at a certain stage  The involvement of a third party in the of maturity, be of a particular species, and possess reproductive process by genetical material physical organs and capabilities such as a brain, donation central nervous system, and intelligence. “HUMAN BEING”   Generally human beings are considered persons, PRO-LIFE but there could be persons who are not human  Sometimes the belief is not that the embryo or beings. fetus is a person but that it is a potential person.  The moral rights of a human person: Human The assumption is that a potential person has beings are typically considered to be persons, so actual rights, not just potential rights, and these we may speak of human persons. Apart from include the right to life. having official legal rights granted by  Pro-lifers sometimes also believe that, except in governments, human persons are considered to cases of rape, the mother and father of the embryo have “human rights” which are moral rights, or fetus should be held morally responsible for entitlements to be treated in certain ways. A conceiving the child and bear the consequences human person has rights to life and liberty (the of their actions. The attitude is that if they didn’t right not to be harmed and the right to be free to want a child, they should have taken better pursue one’s own way of life as long as it doesn’t precautions. Killing an innocent embryo or fetus interfere with the liberty of others). is not a proper way to bear that responsibility.  The morality of abortion depends to some extent  Some pro-lifers believe that in certain exceptional on how the embryo or fetus deserves to be treated: cases abortion is morally permissible. Such cases in what sense it is a moral patient, whether it has include situations where it is necessary to abort the moral rights not to be harmed and to pursue a the fetus to save the life of the mother, or where life, what kind of moral consideration it is owed. it is highly likely the mother would die if the fetus We seem to take the moral status of a being to were carried to term. Other more controversial depend on its metaphysical or physical status. cases involve incest and rape. In such cases the interpretation would be that the fetus is not PRO-LIFE vs PRO-CHOICE innocent or that the right to life of the fetus can  The basic pro-life position holds that induced be overridden or outweighed by these other abortions are morally impermissible (morally factors or circumstances. wrong, morally prohibited).  The basic pro-choice position holds that induced PRO-CHOICE abortions are morally permissible (morally  Pro-choicers sometimes assume that the fetus is allowable, not morally wrong). part of the mother’s body, and the mother can do PRO-LIFE PRO-CHOICE what she wants with her body. A zygote is more The simplest line of Most pro-choicers have in like an unfertilized egg cell than an adult, so the reasoning behind the pro- mind other factors such as the zygote should have the same moral status as the life position is something following: egg cell. like the following:  The child is having MORALITY OF RAPE  The embryo or significant potential  Rape is the act of sexual intercourse with an fetus is a person for an impairment or individual without his or her consent, through  Persons have a genetically based force or the threat of force. In many jurisdictions, right to life disorder the crime of rape has been subsumed under that  Therefore, the  An unstable or sexual assault, which also encompasses acts that embryo or fetus unloving home fall short of intercourse. Rape was long has a right to life environment considered to be caused by unbridled sexual  It is wrong to kill  Major disruption of desire, but it is now understood as a pathological a life the pregnant woman’s assertion of a power over a victim.  Therefore, it is life plans wrong to kill an  Financial hardship of SELF-DESTRUCTION/SUICIDE embryo or fetus the pregnant woman  Suicide violates our moral duty to honor the value  Women will die from of human life, regardless of the value anyone closet abortions if places upon that life. driven underground  The basic freedom of MORALITY ON TAKING SOMEONE'S LIFE a woman to determine  Murder is also defined as unlawful, premeditated the course and use of killing of a human being by another. Informally, her own body murder is an unpleasant, troublesome, or dangerous state of affairs; in legal terms, murder  is the killing of a human being with malice and a 2) At the end of natural life (terminal stage). premeditated motive. 3) When a person is severely impaired as a result of brain damage (unforeseen mishap). DIGNITY IN DEATH AND DYING  Movement that promotes the ability to meet death Active/Passive Euthanasia on your own terms. A Active euthanasia: killing a patient by active means. Euthanasia Sometimes called “aggressive” euthanasia. Also called as Assisted Suicide the “mercy killing” drugs - P Passive euthanasia: intentionally letting a patient die INVIOLABILITY OF LIFE (SANCTITY OF LIFE) - Bunot machine  The concept of inviolability is an important tie Voluntary, Non-voluntary, Involuntary Euthanasia between the ethics of religion and the ethics of Y Voluntary – formal request from patient law, as each seeks justification for its principles Nonvoluntary – people who lack ability to decide as based on both purity and natural concept, as I Involuntary – killing against the will of the person well as in universality of application.  In religion and ethics, the inviolability or sanctity Arguments for Euthanasia of life is a principle of implied protection  Shorten Suffering regarding aspects of sentient life that are said to  Autonomy be holy, sacred, or otherwise of such value that  Right to Die with Dignity they are not to be violated.  Beneficence and Nonmaleficence  The phrase sanctity of life refers to the idea that  Possibility of Finding cures human life is sacred, holy, and precious, argued  Interference with God Plan mainly by the pro-life side in political and moral  Killing is incompatible with a Doctor’s/ Nurses debates over such controversial issues as Responsibilities abortion, contraception, euthanasia, embryonic stem-cell research, and the "right to die" in the Wrongfulness of Euthanasia by J. Gay-Williams United States, Canada, United Kingdom, and  Active Euthanasia is always wrong other English-speaking countries. Reasons: Violates the nature and dignity of persons Human Life is sacred; taking a human life is morally Self-interest (possibility of new treatment, family wrong. pressure)  Taking a human life is intrinsically wrong Practical effects (e.g., slippery slope to nonvoluntary  Taking a human life is extrinsically wrong  Taking a human life is directly wrong  Taking a human life is indirectly wrong i euthanasia) Voluntary Active Euthanasia by Dan W. Brock Taking a human life – Death  Defends voluntary active euthanasia Value of individual self-determination or autonomy Views About When Death Happens Value of individual well-being  Loss of the Soul More goals of physicians are consistent with voluntary  Irreversible Loss of Cardiac Function active euthanasia  Irreversible Loss of Pulmonary Function  Whole Brain Death Nurses’ Roles in Euthanasia  Cortical Brain Death (Irreversible Loss of  Nurses are not the one conducting euthanasia, but Consciousness) they are involved in the process which begins when the patient requests for euthanasia and ends EUTHANASIA with providing support to the patient’s relatives  The word “euthanasia” itself comes from the and healthcare colleagues after the act. Greek words “eu” (good) & “thanatos” (death).  Nurses should be open-minded and non-  “Direct intentional killing of a person as part of judgmental to accept the euthanasia request as the medical care being offered.” nurses’ professional attitude could discourage  “The practice of intentionally ending a life in patient from euthanasia. order to relieve pain and suffering”  Nurses assist in preparing medication including  AIM: let patients die with dignity. sedative agent, analgesic agent, and euthanasic & label them properly. Three Occasions when we question about Euthanasia 1) At the beginning of life (at birth).  PAS PROLONGATION OF LIFE Physician-Assisted Suicide The equal value of All Human Life Suicide carried out with the assistance of a physician  “Every innocent human being is absolutely equal whose role is to typically provide a lethal dose of a drug to all others.” at the explicit, voluntary request of a mentally competent patient considered to be incurable. The Issue in the Sanctity of Life  Does it require us to put an equal effort into Considerations: prolonging all human life, irrespective of its  Patient must request the assistance freely and quality? frequently after careful consideration.  Physician may act on request only if the patient is Ordinary vs Extraordinary Means terminally ill, with hope of improvement and in These two expressions are used to clarify the moral status severe pain. of any medical treatment or its suspension.  Physician must consult with another physician Ordinary – morally obligatory. We have to do this: “of and file a coroner (an official who examines a preserving life are all medicines, treatments, and person’s cause of death). operations, which offer a reasonable hope of benefit for the patient, and which can be obtained without excessive Arguments for Physician-Assisted Suicide expense, pain, and other inconveniences.”  We need it Extraordinary – morally optional. We can consider where we’d like to go: “of preserving life are all those  We want it  We can control it 33W's medicines, treatments, and operations which cannot be obtained without excessive expense, pain, or other Arguments against Physician-Assisted Suicide inconvenience, or which, if used, would not offer a  Alternative treatments are available reasonable hope of benefit.  There is no ‘right’ to be killed and the slippery slope of assisted suicide is real Ordinary Means  We could never truly control it  Comfort measures  The assumption that patients should have a right F  Fluids to die would impose on doc tors a duty to kill N  Nutrition ORTHOTHANASIA Extraordinary Means D Dysthanasia – “Faulty or imperfect death”; generally  CPR understood as the undue prolongation of life. GetaSteine i  Tube feedings j Orthothanasia – “Correct dying”; allowing a person to  Chemotherapy die a dignified and natural death.  Mechanical breathings  Respirator Three possibilities of orthothanasia (allowing-to-die) 1. When treatment to prolong life is useless or futile to the Does this distinguish permissible from impermissible patient. euthanasia? 2. When prolongation of life is excessively burdensome  The “intentional termination of human life” is for the patient and the family. always morally impermissible (this includes both 3. When the patient needs painkillers active euthanasia as well as withholding or withdrawing “ordinary means” of prolonging ADMINISTRATION OF DRUGS TO THE DYING life), but it is sometimes morally permissible to In medicine, specifically, in end-of-life care, palliative cause a patient’s death by withholding or sedation is the practice of relieving distress in a terminally withdrawing “extraordinary means” of ill person in the last hours or days of a dying patient's life, prolonging life. usually by means of a continuous intravenous or subcutaneous infusion of a sedative drug. or by means of SUICIDE a specialized catheter designed to provide comfortable A person has committed suicide when: and discreet administration of ongoing medications via  Person brings about his/her own death the rectal route.  Others do not coerce him/her to do the action  Palliative sedation is an option of last resort for  Death is caused by condition arranged by the patients whose symptoms cannot be controlled by ↳ person for the purpose of bringing about his/her any other means. death. treatment   It is not a form of euthanasia, as the goal of own knowledge of legal matter and finances, palliative sedation is to control symptoms, rather therefore leaving room for possible errors. than to shorten the patient's life. Surrogate Decision Maker GOALS OF PALLIATIVE CARE  A surrogate decision maker is a agent who makes ❖ Provide relief from symptoms a choices for a patient when the person is unable ❖ Regard dying as a normal process to make them for themselves.  A surrogate must follow the religious and moral ❖ Affirm life and neither hasten nor postpone death beliefs when making a choice for the patient. ❖ Support holistic patient care and enhance quality of life  Substituted judgement is a form of surrogate ❖ Offer support to patients to live as actively as possible decision making where the surrogate attempts to until death establish what decision the patient would have ❖ Offer support to the family made if the patient were competent to do so. ADVANCE DIRECTIVES Guardianship and Health Care Proxy  Advance directives are legal documents that state  Guardianship is a process where the court system the patient’s wishes when the patient becomes declares a patient incompetent for decision unable to speak for themselves. making and a legal guardian is appointed for  Are created ahead of any medical incapacitation managing financial, medical, and living in order to ensure that the patient has the ability decisions. to make their own decisions when they are unable  Health Care Proxy is an appointed person to make to do so. health treatment decisions if the said person is unable to do so for themselves. Types of Advanced Directives  Living Will Legal Rights of The Patient  Durable Power of Attorney  The “Patients Self-Determination Act of 1990”  Surrogate Decision Maker protects the patients right to create an advanced  Guardianship and Health Care Proxy directive and the right to make healthcare decisions including right to accept or refuse Living Will certain treatments.  A living will is a legal document that discloses a  “Health care institutions certified by Medicare person's individual needs and requests when and/or Medicaid must take steps to educate all unable to make competent decisions on their own. adult patients and the larger community on their  Living will should be validated by two witnesses right to accept or refuse medical care. This law that are not related to the patient. also directs facilities to inquire on admission  Decisions that a living will can address are: whether a patient has made an advance directive, ❏ Life – support treatments such as mechanical maintain policies and procedures on advance ventilation, cardiopulmonary resuscitation (CPR) and life directives, and provide this information to sustaining medications. patients upon admission. Organizations must ❏ Nutrition and hydration – feeding tubes & artificial comply with the PSDA in order to receive nutrition reimbursement through the Medicare and ❏ Guardianship or decision maker appointment Medicaid programs.” ❏ Dialysis and organ donation Ethical Issues with Advanced Directives  Determining that a patient is incompetent to make Durable Power of Attorney personal decisions is one of the first issues when  A durable power of attorney is a legal device that addressing advance directives. Courts and permits one individual, known as a “principle”, to medical personnel can assist in the determination give to another person called the “attorney-in- of competency to make decisions. fact”, the authority to act on his or her behalf.  Ensuring that the patient has made their wishes  The attorney-in-fact that is appointed is giving known and that others are supportive of the the responsibility to take care of banking, legal patient’s choices is a second ethical hurdle when and real estate decision making for a specified making life choices. Making sure that when the amount of time that may be for a lifetime if patient becomes unable to make choices the needed. advanced directive will be followed is a top  Issues with a durable power of attorney is the priority. appointed “attorney-in-fact is limited by their   When families do not agree with the decisions D DEPRESSION – The inevitability of the news eventually that the patient or proxy have made related to (and not before time) sinks in and the person reluctantly health care needs can pose a large problem for accepts that it is going to happen. both the patient, healthcare providers and other family members. A ACCEPTANCE – Restful time, but not necessarily happy. Often begin putting their life in order, sorting out DNR OR END OF LIFE CARE PLAN wills and helping others to accept the inevitability. END OF LIFE CARE FEARS OF DYING PERSON  End of life care refers to health care, not only of patients in the final hours or days of their lives, FEAR OF LONELINESS but more broadly care of all those with a terminal  Distancing by support people and caregivers can illness or terminal disease condition that has occur become advanced, progressive and incurable.  Debilitation, pain, and incapacitation  Hospital, a place that can be very lonely GOALS FOR END-OF-LIFE CARE  Fear of dying alone  Control symptoms  Identify client needs FEAR OF SORROW  Promote meaningful interactions between the  Sadness client and significant others  Letting go of hopes, dreams, the future  Facilitate a peaceful death  Awareness of own mortality  Grief about future losses INDICATIONS OF DEATH  Anticipatory grief that involves mourning, coping  Total lack of response to external stimuli skills  No muscular movement, especially breathing  Grief related to diagnosis that has a long-term  No reflexes effect on the body such as cancer  Flat encephalogram  Patient may feel well at time of diagnosis IMPORTANCE OF CARE OF A DYING PATIENT FEAR OF THE UNKNOWN  Care of the whole person  Death is an unknown state  Support meaningful living  What will happen after death?  Supports the family to cope with loss and grief  What will happen to loved ones, those left behind  Respect personal, cultural, and religious values  Value ethical principles LOSS OF SELF CONCEPT AND BODY INTEGRITY GRIEF AND LOSS  Mutilation via therapy and body image changes Loss – something of value is gone  Loss of role or status Grief – total response to emotional experience related to  Loss of standard of living loss Bereavement – subjective response to by loved ones FEAR OF SUFFERING AND PAIN Mourning – Behavioral response  May be many different types of pain or suffering such as physical, emotional, social, or spiritual in STAGES OF GRIEVING nature D DENIAL – Grief is an overwhelming emotion. It’s not  Altered relationships with others unusual to respond to the strong and often sudden feelings  Anxiety related to the disease and consequences by pretending the loss or change isn’t happening. of the disease A ANGER – Where denial may be considered a coping mechanism, anger is a masking effect. Anger is hiding many of the emotions and pain that you carry. B BARGAINING – In the bargaining stage of grief, you may find yourself creating a lot of “what if” and “if only” statements. A line of defense against the emotion of grief. It helps you postpone the sadness, confusion or hurt.