Ethical Decision Making in Various Bioethical Issues (Sexuality and Human Reproduction).pdf

Ethical Decision Making in Various Bioethical Issues (Sexuality and Human Reproduction) ETHICAL DECISION MAKING IN VARIOUS BIOETHICAL ISSUES Health care delivery system has undergone notable changes during the last few decades that includes increased client participation, shorter hospital stays and...

Ethical Decision Making in Various Bioethical Issues (Sexuality and Human Reproduction) ETHICAL DECISION MAKING IN VARIOUS BIOETHICAL ISSUES Health care delivery system has undergone notable changes during the last few decades that includes increased client participation, shorter hospital stays and restructuring services (outpatient clinics, shortstay units, long-term care and in home-care). The dynamic changes contributed to the development of new clinical environment and expanded practice. At present, nurses frequently encounter difficult situations involving decisions about the best course of action. Furthermore, nurses are obligated to provide not only expanding nursing care but also ethical and legal client care that demonstrates respect for others. Consequently, nurses confront not only the expanding role and ever-changing clinical environment but also various ethical or moral problems and concerns. What are these moral or ethical problems that nurses are facing? Jameton (1984) described 3 different types of moral problems: Moral uncertainty The nurse identifies a moral problem but is unsure of the morally correct action. -Internal struggle and conflict within oneself Moral distress - Feeling unable to act on what you believe is right due to external barriers (e.g., policies, time constraints, supervision). Moral distress is the physical or emotional anguish that is experienced when we are prevented from following the course of action that we believe is right. We may be prevented from doing what we think is right by facility policy or procedure, influence from the patient and/or family, direction from a supervisor, or limited time. When the nurses are unable to follow their moral beliefs because of institutional or other restriction. The distress occurs when the nurse violates a personal moral value and fails to fulfill perceived responsibility. Moral distress also happen when two or more mutually exclusive moral claims clearly apply and both seem to have equal weight. Moral distress represent practical, rather than ethical dilemmas. Moral outrage - feeling angry about others' wrong actions that you cannot correct. The nurse knows the morally correct action and feels a responsibility to the patient, but institutional or other restraints make it nearly impossible to follow through with appropriate action. How do the nurse handle those moral or ethical concerns/problems?  Nurses are able to deal with the mentioned concerns if she has moral courage and has a well-developed ethical decision making skills. ON MORAL COURAGE Moral courage can be defined as taking action to do what is right in spite of possible repercussions. Moral courage is easily practiced if the individual has personal integrity (adherence to moral principles or values) and moral imagination (a sense of the variety of possibilities and moral consequences of their decisions, the ability to imagine a wide range of possible issues, consequences, and solutions” ), a heightened sense of moral integrity. (Werhane, 1998:76) ON MORAL INTEGRITY This heightened sense of moral integrity is facilitated through moral discernment and conscience formation. Principle of Moral Discernment moral conviction determine one's behavior and ultimately one's life. To make a conscientious ethical decision one must do the following: Proceed on the basis of a fundamental commitment to God and to human persons (including oneself) according to their God-given and graced human nature Exclude any that are contradictory to it (or those that are intrinsically evil) Consider how one’s own motives and other circumstances may contribute to or nullify the effectiveness of these other possible actions as means to fulfill one’s fundamental commitment. Among the possible means not excluded or nullified, select one by which one is most likely to fulfill that commitment and act on it. ON DECISION- MAKING The process follows a similar pattern in most circumstances, including gathering data, comparing options, using some criteria for weighing the merit of each option, and making a choice. Also, the evaluation of outcomes provides more data regarding the rightness of the choice. Ethical decision-making particularly is imperative to arrive at an ethical action or intervention. Ethical decision-making would require an ethical judgment and such judgment needs a basis. A specific reference point, criteria or. condition so we can examine, evaluate then judge and consequently act ethically.  The Ethical Decision-making Process is the process of choosing the best alternative for achieving the best results or outcomes in compliance with individual and social values, morals, and regulations. Making good ethical decisions to solve Ethical Dilemmas requires a trained sensitivity to ethical issues and a practiced method for exploring the ethical aspects of a decision. Having a method for ethical decision-making is absolutely essential. The ethical decision-making process provides a method for nurses to answer key questions about ethical dilemmas and to organize their thinking in a more logical and sequential manner just like the nursing process. The process of making ethical decisions requires: Commitment: The desire to do the right thing regardless of the cost Consciousness: The awareness to act consistently and apply moral convictions to daily behavior Competency: The ability to collect and evaluate information, develop alternatives, and foresee potential consequences and risks Possible outcomes: Good decisions are both ethical and effective: Ethical decisionsgenerate and sustain trust; demonstrate respect, responsibility, fairness and caring; and are consistent with good citizenship. Effective decisionsare effective if they accomplish what we want to be accomplished and if they advance our purposes. Consequences of unethical behaviors: Criminal charges and/or fines; Lawsuits; Ruined careers; Injured organization reputation; Wasted time; Low morale; Recruiting difficulties; Oppressive legislation; Fraud and scandal What influence ethical decision-making? Oxford University (2005) identified individual and situational influences which eventually help a nurse become more self-aware as to the influences that shape his or her moral stand, ethical judgment, and ethical decisions. Individual Influence on Ethical decision making Age and gender National and cultural characteristics Education and Employment Psychological factors  Cognitive moral development Locus of control Personal integrity Moral imagination Situational Influence on Ethical decision making Issue-related - Moral intensity, Moral framing Context-related – Rewards, Authority, Bureaucracy, Work roles, Organizational culture, National context BIOETHICAL ISSUES: SEXUALITY AND HUMAN REPRODUCTION Nurses are trained in the areas of human sexuality, maternal and child nursing, and family health nursing to assist individual patients and the family to thrive and manage health concerns. However, some concerns may put the nurse in a much challenging situation as the patient and the family face issues with ethical dimension. Human Sexuality and its’ Ethical Evaluation Human sexuality is defined as the totality of experiences, systems, attributes, and behavior that characterize the sexual sensation, reproduction, and intimacy of Homo sapiens (Grebe and Drea, 2018). To be able to ethically evaluate sufficiently and appropriately the issues concerning human sexuality, there is a need for the students of health care ethics to understand different perspectives on sexuality and related concepts such as marriage and procreation. Anthropological Perspective of Sexuality and Procreation In sexual ethics, it is useful to understand the relationship between the person and sex that mirrors the relationship between the person and the body. The differentiation and complementarity of the sexes is discerned in the biological design of the body. The body is contained in an essentially uniform structure that exhibits a series of differentiating factors imprinted on the entire basic personality. These differentiating factors are: The chromosomal factors (presence of X or Y in the last chromosome pair)  The neuroendocrine factors are linked to the last chromosomal pair of X or Y and are marked by major differences in the gonads. (ovaries for women- internal, and testicles for men – external) Differentiation continues with the ducts (Wolffian ducts in men, Mullerian ducts in women) This is followed by the emergence of phenotypic sex characteristics or the so-called primary and secondary sex characteristics. The human body is then marked as a whole in its morphology, the voice, movement, sensorial and perceptive traits by sexual differentiation in its fundamentally identical and homogenous structure. Being sexed differently is therefore an original fact with men endowed with masculinity and women endowed with femininity by virtue of the sex differentiation described. Being sexed enables man and woman to acquire a unique personality in a different dimension expressed “in and by” the design of their bodies. This expression of the body carries the richness and vitality of the entire being – the spirit that animates the body – which is believed to have been created in the image and likeness of the Creator. Sexuality marks the entire person. That the person does not merely have a given sex but is truly a complete man and a complete woman who are sexually differentiated by design but whose endowments of complimentary traits can harmoniously fulfill coexistence in the world –the man and the woman, though diversified or not identical, but the complementarity and capacity for reciprocity reveal an equal nature of personal dignity. This does not mean however that the corporality is only sexuality since the body also has other functions and dimensions. But a person is more than one’s body, more than the sum of its parts, more than one’s sex. Human sexuality, therefore, cannot be reduced to a thing or an object. The mentality of “sexuality without risks and without regrets” sums up the philosophy of sexuality as consumption. Human sexuality, rather, is the structural conformation of the person that expresses a unique personality, hence, such structural expression warrants respect and acceptance. Sexuality has a role in how a person reveals himself to others. Treating sexuality as a mere object and thing to be manipulated and changed will have a profound effect on the whole person and others to which he is revealing himself. Other Perspectives on Sexuality Catholic Morality on Sexual Ethics can be summarized in the following: Sexuality must be used in keeping with its human teleology.  The conjugal act has inseparable and integrated unitive, and procreative dimensions. Unitive – love-giving: signifies, expresses and incarnates the mutual love between husband and wife; authentic total self-giving. Procreative – life-giving; inherent orientation to the transmission of life. On the contribution of Sigmund Freud to the concept of Sexuality: The contributions of Sigmund Freud were fundamental in affirming sexuality as a dimension of the whole person and its importance in the individual’s process of maturation and socialization. It can be deduced from Freud’s theory that sexuality expresses itself and by its dynamics is linked to the depths of the subconscious, and structures personality. Freud proposed sublimation as a mechanism that inhibits instinctual forces. Nonetheless, the pansexualitys and deterministic understanding of the person took its cue from Freud which includes: Sex is everything, sex takes orders from no one, and psychological disturbances and sufferings of the person are due to sexual repression. Other contributions to the liberalization of sexuality and its detachment from the procreative responsibilities Sexological therapy by the American sexologists William Masters and Virginia Johnson whose theories were taken up by Helen Singer Kaplan and Robin Skynner. They conducted a study of the neurophysiological reactions in men and women during sexual intercourse which apparently reduced the unitive gesture of sex- of authentic self- giving- into a complex network of recordable reactions. Measurements of these reactions were provided using scientific instruments, filmed recordings of them were distributed, and viewing them in the laboratory was suggested as a method of “treatment” Phenomenology of Sexual Life A phenomenology of the sexual inclinations and a correct interpretation of its significance are requisites for the metaphysical analysis of love which affirms the value of the person and the communion of the persons. In animal species, the sexual impulse acts as a strong, irrational instinct. In human beings, the sexual impulse has the natural tendency to be transformed into love. The playful components of sexual life that are associated with the sexual impulse, rise to the level of the dignity of the person when the sexual impulse is closely connected with love. Freedom, Responsibility and Sex Beyond psychological and cultural dynamics lies the spirituality of man which is his freedom and responsibility. Sexuality cannot be deprived of this spiritual vitality, cannot be devoid of freedom and responsibility.  Freedom and responsibility enrich sexuality, expressing it in an interpersonal relationship, and consequently in the overall process of personal growth. Sexuality is also not just mere psychological mechanisms or cultural constructs. All of sexual life is accompanied by responsibility. Responsibility also means accepting sexuality for what it is and what it involves in terms of meaning and consequences. The sexual revolution The ideologies of sexual revolution according to Screggia (1992) Libertinism: posits that sexuality is one of the fundamental instincts that govern life hence it must be exempted from moral control. There is one sexuality oriented to pleasure and another sexuality oriented to procreation. Post-Freudian interpretation: asserts it is necessary to satisfy every impulse since sexuality is the fundamental driving force and all of its expression (pansexualism). Failing to do so or repressing those impulses will lead to neuroses. (mental issues) Feminism of Simone Beauvoir: This posits that a woman must be made capable of planning her own life autonomously and of freeing herself from the trappings of motherhood. How nurses should respond ethically to sexuality issues? - It is important that sexual counseling is structured according to the needs of the individuals. Nurses are responsible for strengthening the sexual health of the individuals they care for, encouraging them to express their sexual problems, identifying the causes of these problems, making appropriate initiatives to resolve these identified problems, and raising their quality of life. (vcili, Funda & Demirel, Gulbahtiyar. (2019). Patient’s Sexual Health and Nursing: A Neglected Area.) Nurses do not impose their own beliefs on sexuality on the patients, instead, a nonjudgmental attitude towards caring is necessary. When a patient requests counseling, the nurse must facilitate this taking into consideration the patient’s autonomy, beliefs, and preferences. On Marriage Fundamentals of Marriage Article 1 of the Family Code of the Philippines defined marriage as: “a special contract of permanent union between a man and a woman entered into in accordance with law for the establishment of conjugal and family life. It is the foundation of the family and an inviolable social institution whose nature, consequences, and incidents are governed by  law and not subject to stipulation, except that marriage settlements may fix the property relations during the marriage within the limits provided by this Code.” (Executive Order No. 209, s. 1987 | Official Gazette of the Republic of the Philippines, n.d.) What does this definition imply? Issues on Sex Outside Marriage and Homosexuality Chapter 3 of the Family Code of the Philippines stipulates the reasons that renders marriage void from the beginning, as if the marriage did not take place and hence is annulled. Under Article 35.4, those bigamous or polygamous marriages not failing under article 41 marriage is void from the beginning if it involves is one of the reasons that a marriage is void from the beginning. bigamy or polygamy, unless certain exceptions marriage is treated as if it never happened. in Article 41 apply. Article 45 of the Family Code further stipulates that a marriage may be annulled for any of causes mentioned below that are existing at the time of the marriage. can be annulled (legally canceled) if specific issues were present at the time of the marriage Marriage for those18 years of age or over but below 21 and the marriage was solemnized without the consent of the parents, guardian or person having the parental authority over those who are married unless such arty freely cohabited with the other and both lived together as husband and wife Ifparents' one partner is between 18 and 21 years old and got married without their or guardians' consent, the marriage can be annulled. However, if they lived together as husband and wife afterward, it may not apply. Either party was of unsound mind, unless after coming to reason, freely cohabited with the other as husband and wife. and If either person was not mentally capable of understanding the marriage later regained their senses but chose to live together afterward, the marriage might not be annulled. Consent was obtained by fraud, unless afterwards, with full knowledge of the facts constituting the fraud, freely cohabited with the other as husband and wife. Consent was obtained by force, intimidation, or undue influence. Physically incapable of consummating the marriage with the other, and such incapacity continues and appears to be incurable Either party was afflicted with a sexually-transmissible disease found to be serious and appears to be incurable. Meanwhile, Article 55 of the family code stipulates that a petition for legal separation may be filed under these circumstances: Repeated physical violence or grossly abusive conduct Physical violence or moral pressure to compel the petitioner to change religious or political affiliation. Corruption or inducement to engage in prostitution, or connivance in the corruption and inducement. Imprisonment of more than six years, even if pardoned. Drug addiction or habitual alcoholism  Lesbianism or homosexuality Bigamous marriage, whether in the Philippines or abroad Sexual infidelity or perversion Attempt against the life of the petitioner Abandonment of petitioner by respondent without justifiable cause for more than one year. Note: Please read related articles in the family code to further understand related matters regarding the legal separation On Homosexuality Semantically, homosexuality (a noun) is the condition or the quality of being homosexual. A homosexual (adjective) is either a male or a female. (Homosexual | Etymology, Origin and Meaning of Homosexual by Etymonline, n.d.) Sexual inversion was a term used in 1883 to refer to homosexuality which later became inversion in 1895; unnatural love was used between 18th-19th It is said to have originated in Italian psychology. (Homosexual, Adj. and n. : Oxford English Dictionary, n.d.) In the field of Psychology ad Psychoanalysis, homosexuality is characterized by sexual or romantic , desire, attraction or sexual activity with people of the same sex. (Homosexual, Adj. and n. : Oxford English Dictionary, n.d.) In the present context, homosexuality has evolved to the LGBT movement. LGBT stands for the collective of lesbian, gay, bisexual, and transgender people. Other initialism emerged such as LGBTIAQ which refers to lesbian, gay, bisexual, transgender, intersex, asexual, aromantic and queer people). LGBTIAQ is sometimes replaced with LGBT+ to explicitly refer to other groups. (Medina-Martínez et al., 2021) How do healthcare providers ethically respond to issues of marriage and homosexuality? Healthcare practitioners guided by the ethical principle of respect for persons, are to carry out without judgment the case-and-age-appropriate interventions to address the health disparities identified. Supportive, non-judgmental, and respectful dealing with people going through those issues is imperative as they navigate through the challenges of their personhood and be given their inherent right to authentic human dignity and respect. As much as a society protects the integrity of marriage as the foundation of the family, there is also a need to assist every person who faces and experiences these threatening issues of marriage and family life like homosexuality. Issues on Contraception and its Morality In the past decades, people believed that the population or the number of people cohabiting the earth is out of control resulting in poverty and suffering of the human species. Hence, efforts to control the population were sought. Methods to control conception are: Methods of Contraception Folk methods - Pre-coital/ post-coital douche using vinegar, Prolonged lactation, Coitus interruptus, and coitus reservatus Mechanical methods – condom and diaphragm Chemical Methods – Vaginal suppository, vaginal tablets, vaginal jellies, creams and foams Hormonal Methods- Contraceptive pills, injections, and implants Morality of Contraception Central to the morality of contraception is the answer to the profound question-“when does life begin”- which is often the topic of ethical debates. In answering the question of when life begins, comes to mind the question whether the terms “zygote”, “pre-embryo”, “embryo” and “fetus” really indicate biological successive stages of the development of a human being or not. If one rejects recognition of such terms as stages in the development of the human being, one is bound to accept any acts that do not render respect to such biological stages of human development. When one accepts a zygote, embryo, or fetus as biological stages of human development, then one is bound to render respect to such stages the way respect for the dignity of persons is rendered to a grown human person. Issues on Artificial Reproduction and its Morality Artificial Insemination is a less radical and sophisticated procedure to facilitate conception in an unnatural way. Artificial insemination is the introduction of sperm from a man into a woman by laboratory methods in the attempt to bring about a conception in the woman’s womb, thus making the marital act of husband and wife insignificant causally in the bringing about of the conception. In-vitro fertilization: In vitro (in glass) human fertilization is facilitating conception of a human person outside the body of a woman.  This conception takes place in a laboratory container—a glass vessel or suchlike—using eggs taken from a woman’s body and sperm from a man’s. The living human embryo of the conception is then transferred from the laboratory container into the body of a woman for gestation until normal birth. All techniques of in vitro fertilization proceed as if the human embryo were a mass of cells to be used, selected and discarded. Surrogate Motherhood - is to facilitate conception through a third-party reproduction in which a woman consents to carry a pregnancy for intended parent(s) who cannot conceive for medical reasons or those who are a gay couple. There are two forms of surrogacy: traditional surrogacy and gestational surrogacy. Traditional surrogacy uses the surrogate mother’s egg for conception. Gestational surrogacy is performed by transferring embryos made through IVF with eggs from the intended mother or a donor. The advent of IVF has assisted gestational surrogacy. However, pregnancy and gestation involve psychological burdens and health risks for the surrogate mother. The legal procedures for parenthood following surrogacy are complicated due to the typical legal assumption that a woman giving birth to a child is the legitimate mother of the child. Therefore, a surrogate mother is required to formally abandon parental authority, and the intended parent(s) then adopt the child born. (Ishii, 2018) How do healthcare providers ethically respond to issues on Artificial Reproduction? The ethicality of artificial insemination, IVF, and surrogacy can be discerned by analyzing the applicable ethical principle such as respect for the dignity of the person, beneficence, non- maleficence, justice, and autonomy. Healthcare practitioners, the nurse most importantly, is to assist the person who is facing issues with artificial reproduction in a non-judgmental manner, offering information when necessary and facilitating decision-making on the part of the patient through such information. Moreover, the nurse is to highly advocate for the autonomy or freedom of choice of the patient as a manifestation of respecting his dignity as a person. ABORTION, RAPE AND OTHER PROBLEMS RELATED TO DESTRUCTION OF LIFE ABORTION Abortion is the expulsion from the uterus of the products of conception before the fetus is viable. It is the premature stoppage of a natural or a pathological process. TYPES OF ABORTION: Complete Abortion - one in which all the products of conception are expelled from the uterus and identified. Habitual Abortion - spontaneous abortion occurring in three or more successive pregnancies, at about the same level of development. Incomplete Abortion - that with retention of parts of the products of conception. Induced Abortion - that brought on intentionally by medication or instrumentation Inevitable abortion - a condition in which vaginal bleeding has been profuse and the cervix has become dilated, and abortion will invariably occur. Infected abortion - associated with infection of the genital tract. Missed abortion - retention in the uterus of an abortus that has been dead for at least eight weeks. Septic abortion - associated with a serious infection of the uterus leading to generalized infection. Spontaneous abortion - occurring naturally. Therapeutic abortion - induced for medical considerations. Threatened abortion - a condition in which vaginal bleeding is less than inevitable abortion and the cervix is not dilated, and abortion may or may not occur. Induced Abortion Techniques: Abortion by dilatation and curettage (7- 12wks AOG) Abortion by CS or abdominal Hysterectomy Abortion by Suction (before 3-4months or 12-16wks) Via Intra- amniotic infiltration (before 3-4months or 12-16weeks) Via injection of Prostaglandin RU 486 –Contraceptive pill associated with Prostaglandin LEGAL, MORAL & ETHICAL CONSIDERATIONS Article II, Section 12 of the 1986 Constitution provides that “The state recognizes the sanctity of life and shall protect and strengthen the family as the basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception.” ARGUMENTS: CONTRA-ABORTION Not firmly a choice between a mother only or the child only but must center on saving both lives.  The ethical choice can be guided by the principle of Double Effect, Unselfish love and solitude to an innocent creature are upheld Recognition of the complementary roles between men and women The offspring has a genetic code totally different from the cells of the parents ARGUMENTS: PRO-ABORTION To safeguard the life of the mother Abortion as a woman’s right Abortion is an expression of a woman’s sexual freedom The fetus is not a human person RAPE Rape is an unlawful activity with sexual intercourse carried out forcibly or under threat of injury against a person’s will or with a person who is beneath a certain age or incapable of valid consent because of mental illness, mental deficiency, intoxication, unconsciousness, or deception. (Rape Definition & Meaning - Merriam-Webster, n.d.) Other Related Problems to the Destruction of Life 1.Human Population Control: Eugenics The term eugenics was coined by the Scientist Francis Galton (1822 - 1911). It literally means (eu)good (genos)birth. Francis Galton was the cousin of Charles Darwin who wrote the evolutionary books Origin of the Species and The Descent of Man. Galton coined the phrase from studying Darwin's works. There are two sides to Eugenics Negative Eugenics-the study of or belief in the possibility of improving the qualities of the human species or a human population, especially by such means as discouraging reproduction by persons having genetic defects or presumed to have inheritable undesirable traits. Positive Eugenics-encouraging reproduction by persons presumed to have inheritable desirable traits. How Eugenics has Manifested Itself Throughout History Abortion: This form of human population control is at an all-time high now since the 1973 court decision of Roe v. Wade.  50 million babies have been murdered since then. As one looks closer at this issue, it is startling to see how the largest abortion provider in the US has targeted poor and minority groups. Most abortion clinics are found in poor, black or hispanic areas. Planned Parenthood's agenda (an organization founded by a supporter of eugenics) is an agenda of genocide. Human Population Control: Eugenics How Eugenics has Manifested Itself Throughout History Genocide: There are some graphic and disturbing examples of Genocide that have occurred in the 20th century alone. - to kill people for the sake of the community - intentional and systematic killing of a group of people because of their race, ethnicity, religion, or nationality This Nazi war devoured millions of mentally and physically handicapped people, homosexuals, Jews, Slavs, Gypsies and so many other groups of people all because they were considered undesirables who were taking up space and food from the superior white race who were deemed to be those deserving of life. Under Communism, 158 million (approx.) people were murdered. Communism is an atheistic worldview that wants to further the great experiment of causing one great race of mankind to dominate the world and bring the human race to its glorious heights. Communists idealize the strong and independent worker. How Eugenics has Manifested Itself Throughout History Euthanasia: This is assisted suicide (predominantly) of people who are suffering usually from a long terminal illness and want to expedite inevitable death. A more exhaustive discussion is shared under issues on death and dying. Sterilization: Many people who have had undesirable traits like mental illness, alcoholism, mental or physical defects and genetic disorders were sterilized in the 20th century. Against their will. This was completely legal in the States for a time. prevents a person from being able to have children Anti-miscegenation: The Darwinists and the eugenicists pushed for the banning of interracial marriage and got it into law. It was illegal in the USA to marry or have sexual relations with someone of a different ethnicity from the 17th century until as recently as 1967. laws or beliefs that prohibit or discourage marriage or relationships between people of different races. Negative eugenicists on Evolution: Evolution is an ideology based on 'survival of the fittest.' Negative eugenicists (possibly the positive ones as well) believe that helping the poor and feeding the hungry and providing health care for the sick and treating mental illness is setting back the 'natural' process of survival of the fittest. They dislike these acts of mercy since it is sustaining the lives of the poor and sick. people who believe in improving the human population by discouraging or preventing those The phenomenon of DEMOGRAPHIC WINTER: they consider "unfit" from having children Demographic winter was called the plague of the century - (Demographic Winter: The Plague of the Century - Washington Times, n.d.) decline in birth rates and the aging population, leading to various social and economic problems  The rise of the graying population, often called by the name demographic winter, is a cause of manifold social and economic concerns. Men and women are delaying marriage, making it less likely to have more than one or two children. In the West, almost one in two marriages end in divorce. The children of divorce are less likely to marry and form families themselves. More married women are putting off having children for careers. After 35, it becomes progressively harder for women to conceive. Demographic winter was called the plague of the century - (Demographic Winter: The Plague of the Century - Washington Times, n.d.) ALFI (ALLiance for the FAMILY Foundation Philippines, Inc. (ALFI) elaborated on this through the following explanations: The fall in fertility is an observed phenomenon in both rich and poor countries and in the majority of cases fertility has fallen below the accepted 2.1 replacement rate indicative of the inability of the population to replace itself. When developed countries imposed their population control programs on poor countries, they also fell prey to the lures of enjoying a “safe and satisfying sex life” free from the responsibilities of children. Global trends indicate that fertility reduction accompanied by increased life expectancy have produced aging populations all over the world. This is evidenced by the increase in the percentage of 60 years and over in the latest UN projections. How do nurses respond to issues about life? Nurses are advocates of patients and hence are advocates of human life. - Nurses ascribe to the universal ethical principles in dealing with ethical issues concerning the beginning of life while at the same time focusing on the unique needs and concerns of the patients with a nonjudgmental attitude. As needed, the nurse must be able to discern and ethically evaluate the intent, the action itself, and the circumstances and effects of the action in question.