Organ Donation: Scrutinizing Republic Act 7170 PDF

Organ Donation: Scrutinizing Republic Act 7170 ANALEIN E. VILLAREAL,. RN, MAN At the end of this lesson, student will be able to: 1. Understand RA 7170 , its purpose and importance; 2. Identify the requirements for organ donation by living and deceased donors under the law. 3. Discuss the ethical and practical considerations in implementing organ donation practices. 4. Identify the role of nurses and healthcare providers in advocating for and facilitating organ donation. Definition: Republic Act 7170, also known as the Organ Donation Act of 1991, is a Philippine law that provides the legal basis for the donation of human organs and tissues. It allows individuals to donate parts of their bodies, either during their lifetime or after death, for medical and scientific purposes. OVERVIEW  Organ donation in the Philippines is governed by Republic Act 7170, also known as the Organ Donation Act of 1991. This act provides the legal framework for the donation of human organs and tissues, either during life or after death, to save lives or improve health. Importance of ethical and legal frameworks in healthcare  Ethical and legal frameworks provide the foundation for ensuring that organ donation practices are fair, transparent, and respectful of individuals' rights. Republic Act 7170 (Organ Donation Act of 1991) plays a critical role in guiding healthcare professionals and institutions in navigating the complexities of organ donation. Protection of Donors and Recipients  Legal provisions ensure that organ donation is conducted with informed consent, safeguarding donors from coercion or exploitation.  Recipientsare assured of ethical allocation practices, prioritizing medical necessity and fairness. Promotion of Trust  Ethical practices build public trust in the healthcare system by demonstrating commitment to transparency, accountability, and respect for individual rights.  Trust encourages more people to consider organ donation. Respect for Autonomy  RA 7170 emphasizes the importance of informed consent, enabling individuals to make voluntary decisions about organ donation.  Families are involved in decision- making processes, especially in cases of deceased donation. Prevention of Exploitation and Abuse  The law prohibits illegal practices such as organ trafficking, ensuring that organ donation remains a noble and altruistic act.  Ethical guidelines protect vulnerable populations from being targeted for organ harvesting. Guidance for Ethical Dilemmas A standardized legal and ethical approach ensures consistency in how organ donation is managed across healthcare institutions.  Thisuniformity reduces disparities and promotes equitable access to transplantation services. Encouragement of Ethical Advocacy  Nursesand other healthcare professionals can confidently educate and advocate for organ donation, knowing their actions are supported by clear ethical and legal standards. Legal Framework  RA 7170 allows Filipinos to donate their organs or tissues voluntarily.  It specifies requirements for consent, with provisions for both living and deceased donors. Republic Act 7170 (Organ Donation Act of 1991)  Definition and purpose  Key provisions:  - Who can donate organs  - Consent and authorization processes  - Role of the next-of-kin  Requirements for living and deceased donors  Prohibited acts and penalties Purpose of RA 7170: 1. To Save and Improve Lives 2. To Promote Voluntary Donation 3. To Ensure Ethical and Legal Compliance 4. To Encourage Medical and Scientific Research 5. To respect Wishes of Donors 6. To Protect the Rights of Next-of-Kin. Who Can Donate Organs Under RA 7170?  Under Republic Act 7170 (Organ Donation Act of 1991), individuals eligible to donate organs are categorized into living donors and deceased donors. COMPARISON  1. Living Donors  2. Deceased Donors  Criteria for Deceased Donors:  Criteria for Living Donors: Must have been declared legally dead Must be of legal age (18 years or older). based on either: Must have the capacity to give Cardiac death: Irreversible cessation informed consent, which means they of heart and respiratory functions. fully understand the risks and benefits of Brain death: Irreversible cessation of the procedure. all brain activity, certified by authorized medical professionals. Must not be under any form of coercion or undue pressure to donate. Consent must have been provided through: The donation must not jeopardize the A signed donor card or will during donor's life or health, as assessed by a the donor's lifetime. medical professional. Authorization from the next-of-kin if no prior consent was documented. COMPARISON  Commonly Donated  Commonly Donated Organs or Tissues: Organs or Tissues: Kidneys: A healthy Organs: Heart, lungs, individual can donate liver, kidneys, pancreas. one kidney. Tissues: Corneas, skin, Part of the liver or lung: bones, and blood As these organs can vessels. regenerate or function with reduced size. Special Considerations: Minors: Generally cannot donate organs unless under exceptional circumstances, such as donation to an immediate family member, and with parental or legal guardian consent. Medical Screening: All donors (living or deceased) must undergo medical evaluation to ensure that their organs are suitable for transplantation and free of infectious diseases. Ethical and Legal Safeguards: The law ensures that all donations are voluntary, ethical, and free from financial transactions or coercion. This protects the rights and dignity of both donors and recipients. Prohibited Acts 1. Commercialization of Organ Donation  Selling or purchasing human organs or tissues for transplantation or other purposes.  Offeringfinancial or material incentives in exchange for organ donation. 2. Coercion or Exploitation  Forcing or pressuring individuals to donate organs against their will. Prohibited Acts  Targeting vulnerable populations, such as minors or economically disadvantaged individuals, for organ harvesting. 3. Unauthorized Removal of Organs  Removing organs from a deceased person without proper consent from the individual or the next-of-kin.  Violatingthe guidelines for determining brain death or cardiac death. Prohibited Acts 4. Illegal Handling of Donated Organs  Mishandling or misusing donated organs or tissues for purposes other than those specified by the donor or their family.  Improper storage, transport, or disposal of organs. 5. Misrepresentation or Forgery  Falsifying documents, such as consent forms or death certificates, to facilitate organ donation.  Misrepresenting the donor's intent or eligibility. Penalties  Violators of RA 7170 face legal consequences, which may include: 1. Imprisonment - Depending on the gravity of the offense, imprisonment may range from a few years to life imprisonment. 2. Fines -Financial penalties may be imposed in addition to or in lieu of imprisonment, often ranging from tens of thousands to hundreds of thousands of pesos. Penalties 1. Revocation of Professional Licenses -Healthcare professionals involved in illegal activities may face suspension or permanent revocation of their licenses. 2. Institutional Sanctions -Hospitals or medical facilities involved in prohibited practices may face closure, fines, or loss of accreditation. Ethical Considerations  Principles of beneficence, non-maleficence, autonomy, and justice  Ethical dilemmas in organ donation  Role of informed consent Ethical Considerations in Organ Donation  Organ donation is a life-saving act that involves complex ethical considerations. Healthcare providers must navigate these challenges while respecting the rights, values, and dignity of both donors and recipients. Here are the key ethical principles and considerations relevant to organ donation, especially under the framework of Republic Act 7170: AUTONOMY Respecting the individual’s right to make informed decisions about donating their organs. Ensuring donors or their families understand the implications of their consent. Beneficence Acting in the best interest of the recipient by providing organs to save or improve their lives. Non-Maleficence Ensuring that organ donation causes no undue harm to the donor, especially for living donors. Non-Maleficence Ensuring that organ donation causes no undue harm to the donor, especially for living donors. Justice Ensuring fair and equitable allocation of organs to recipients based on medical need, urgency, and compatibility, not social or economic status. Informed Consent Ensuring donors or their families are fully informed about: The purpose of organ donation. Risks and benefits (for living donors). The final use of donated organs or tissues. Consent must be free from coercion, financial incentives, or undue pressure. Cultural and Religious Sensitivities  Many Filipinos hold cultural or religious beliefs that may affect their willingness to donate organs. Healthcare providers should address these concerns with respect and sensitivity while providing accurate information. Allocation of Resources Ethical frameworks guide the allocation of limited organ resources to ensure fairness and avoid discrimination. Policies must prevent favoritism or corruption in the selection of transplant recipients. Handling Ethical Dilemmas Addressing family conflicts when the wishes of the deceased donor are unclear. Deciding between living donors and deceased donors in urgent cases. Resolving cases of brain death when families refuse to accept medical findings. Transparency and Accountability Transparency in the organ donation and transplantation process is critical for maintaining public trust. Healthcare institutions must adhere to legal and ethical guidelines, documenting every step of the process. Preventing Exploitation Safeguarding against the exploitation of vulnerable individuals, such as minors, the poor, or uneducated populations. Strictly prohibiting organ trafficking and commercialization. Practical Considerations  Current organ donation practices in the Philippines  Challenges and barriers:  - Cultural beliefs  - Lack of awareness  - Logistics  Success stories and statistics Role of Nurses and Healthcare Providers Nurses serve as advocates, educators, and facilitators in the organ donation process. They must balance the needs and emotions of donors, families, and recipients while upholding ethical standards. Role of Nurses and Healthcare Providers  Nursesand physicians must advocate for donation, educate families, and support them during decision-making.  Facilitate timely communication between donor families, transplant teams, and recipients. Public Awareness and Education Efforts: Educating communities about the benefits of organ donation and addressing misconceptions. Encouraging individuals to register as donors and communicate their wishes to families. Challenges: Overcoming cultural and religious barriers to organ donation acceptance. Encouragement for Ethical Advocacy in Nursing on Organ Donation  Nurses play a pivotal role in advocating for ethical practices in organ donation. As frontline healthcare providers, nurses interact closely with patients, families, and the wider healthcare team, making them essential in promoting awareness, ensuring informed decision-making, and upholding ethical standards. 1. Promoting Education and Awareness 2. Facilitating Informed Consent 3. Supporting Families Through Ethical Dilemmas 4. Ensuring Non-Exploitation in Organ Donation 5. Empowering Patient Autonomy 6. Leading by Example in Ethical Decision- Making Empowering Nurses as Ethical Advocates  Ethical advocacy in organ donation not only saves lives but also upholds the dignity of the donor, recipient, and their families. Nurses, as compassionate and knowledgeable healthcare professionals, are in a prime position to champion ethical practices. By fostering an environment of respect, education, and transparency, nurses can lead efforts to enhance public trust in organ donation programs and ensure ethical standards are met across the healthcare system. MAJOR BIOETHICAL PRINCIPLES PRESENTED BY: ANALEIN E. VILLAREAL, RN, MAN Introduction: In health care delivery, the major purpose might be the pursuit of health, with the prevention of death and the alleviation of suffering as secondary goals. Ethical principles have been developed to allow health professionals to determine right and wrong in regard to value issues involving these goals. OBJECTIVES: At the end of the lesson, students will be able to: 1. Distinguish the principles of autonomy, beneficence, nonmaleficence, and justice; 2. Determine how the major principles in bioethics affects patient care. 3. Identify the moral issues and principles involved when presented with an ethical situation FOUR MAJOR BIOETHICAL PRINCIPLES The Principle of Respect for Autonomy The Principle of 3 of which are: Non-Maleficence FIDELITY, VERACITY, AND AVOIDANCE OF KILLING The Principle of The Principle of Beneficence Justice The Principle of The term “ Autonomy” comes from Greek words autos, which means “self”, and nomos, “rule or governance,” thus, the idea of self-rule, self-governance, or self-determination applies or extends Respect for to individuals. The principle of respect for autonomy means acknowledgement of the person’s right to hold views and opinions, Autonomy to make decisions and choices, and to take action based on personal values, virtues, traditions, and beliefs. This autonomy gives rise to the notion of informed consent. The choice includes the right to refuse intervention or recommendation about care, and to choose from available alternatives. It implies recognition of the individual’s worth with the capacity to develop oneself. Under the Ross ethics, the concept of non- maleficence was discussed briefly in relation to duties. As principle, it requires health care professionals to act in such a manner as to avoid causing harm The to patients. It includes deliberate harm, risk of harm, and Principle of other harms that may happen during a procedure. It prohibits experimental research that assumes Non- negative impact on participants, and the performance of unnecessary procedures for economic gain or self-interest. Maleficence The Concept of Non-Maleficence may be summed up by the quotation as follows: “Do not do to others what you would not wish done to yourself” -Confucius “Do not do to others that which would cause you pain if done to you” -Mahabharata The Principle of Justice The Principle of The term justice is associated with the concepts of fairness, rightfulness, reward Beneficence or punishment, and equity. The principle requires social benefits, like The term “Beneficence” comes from the health care services, and social burdens, Latin word bene, which means “well” or like payment of taxes, be distributed in “good”, and facere, “to do or make” which accordance with the demand of justice. means doing what is good. It implies a sense of duty to treat all people without bias to age, socio- The Principle of Beneficence has three major economic status, race, or gender. It components, namely: applies community extension of 1. Do or promote good necessary treatment to all or to those in need, even though they may not have 2. Prevent harm the means to pay for such treatment. 3. Remove evil or harm The principle of justice may be concluded by saying that goes: It is associated with the concept or virtues of kindness, benevolence, altruism or “Justice delayed is Justice denied.” humanitarianism Beneficence and a Higher Moral Burden Beneficence represents a level of altruism that is absent from simply refraining from harm. The ethics principle of having to engage in altruistic or beneficent acts means that we are morally obligated to take positive and direct steps to help others. Relative to ethics theories, the underlying principle of CONSEQUENTIALISM, THE GREATEST GOOD FOR THE GREATEST NUMBER, is itself a statement of beneficence. Beneficence and a Higher Moral Burden For example, acts of kindness and courtesy not expected by typical strangers are required of healthcare workers. For example, failure to open a door to help someone in a wheelchair may be discourteous in most settings of perhaps even rude. H o w e v e r, i f h e a l t h c a r e p e r s o n n e l t a k e t h i s a c t i o n , i t i s unprofessional and may result in disciplinary action. Acting with kindness, compassion and understanding, even under extremely stressful circumstances, is part of the description of professionalism in healthcare. In addition, active beneficence requires a balance between beneficence and clinical decision-making for the best patient care. Beneficence is a fundamental principle of healthcare. The motivation for most people who want to be a healthcare professional is helping people. In health care, everyone is involved in the provision of care, including clinicians, administrators, and support personnel, are expected to act with beneficence. EXAMPLES OF NURSING BENEFICENCE Resuscitating s victim of drowning Providing pain medication as soon as possible to an injured patient in the emergency room. Lifting side rails on a patient’s hospital bed to prevent falls. Providing psychosocial support to an anxious patient. JUSTICE Morrison and Furlong (2019) assert the following statements on justice: Justice is the principle that governs social fairness. It involves determining whether someone should receive or is entitled to receive resource. Justice means fairness. When nurses care for a g r o u p o f p a t i e n t s , c a r e m u s t b e g i v e n e q u i t a b l y, fairly and justly to each individual. A nurse cannot play favorites or compromise care because of personal opinions or beliefs. Usually comes in 2 major categories: procedural and distributive. PROCEDURAL JUSTICE Can be defined as due process. For example, in the legal system, we speak of being equal before the law as part of procedural justice. In the legal sense, then, procedural justice or due process means that when you get your turn, you receive the same treatment as everyone else. One can apply this concept to health care. For example, when you were waiting to see your primary care physician, did you receive the same attention and care as the person who preceded you? DISTRIBUTIVE JUSTICE The concept of distributive justice relates to determining what is fair when decision makers are determining how to divide burdens and benefits. I n a d d i t i o n , d i s t r i b u t i v e j u s t i c e r e f e r s t o f a i r, equitable, and appropriate distribution/ allocation of responsibilities, or share of rights and roles. Examples: A physician has to decide how much time to spend with each patient. Nurse managers have to effectively allocate too few nurses to too many patients. It’s application and implication to health care profession in relation to the client or patients’ well- being in the Philippine context may be considered as the following: Slow and delayed enactment and implementation of the Cheaper Medicine Act (R.A. No. 9052)have denied the p o o r a n d t h e n e e d y a f fo r d a b l e m e d i c i n e a g g ra v a t e d t h e i r p l i g h t t o t h e e x t e n t o f l o s s o f l i fe. Sick people are denied access to quality treatment in p r i v a t e h o s p i t a l s d u e t o f i n a n c i a l c a p a c i t y t o p a y. The massive out-flux of Filipino doctors and nurses to foreign countries may deny necessary healthcare services to patients. Any Question, Clarification, Reaction? T H A N K YO U BASIC ETHICAL PRINCIPLES ANALEIN E. VILLAREAL,RN, MAN OBJECTIVES Define the principles and its importance Determine how the basic principles in ethics are applicable in the practice of nursing; and Identify the moral issues and principles involved when presented with an ethical situation A principle is a truth that is a foundation for other truths. It is conceived as an agreement of thought and reality, an eventual verification (of hypothesis, theory, or doctrine), and consistency of thought with itself. Law and Moral Ethics are principles. Legal and Ethical principles are basic truths that guide decision analysis and decision-making. Like nurses, knowledge of and interest in legal and ethical truths are indispensable conditions in the practice of their profession. THIS CHAPTER LIMITS ITS PRESENTATION TO AND/OR DISCUSSION ON THE FOLLOWING BASIC ETHICAL PRINCIPLES: 1. Stewardship 7. Fidelity 2. Totality 8. Utility 3. Double Effect 9. Paternalism 4. Solidarity 10. Casuistry 5. Cooperation 11. Respect 6. Communitarianism 12.Veracity 1. PRINCIPLE OF STEWARDSHIP A steward or stewardess is a person appointed in the place or stead of another. He/she takes charge of representing and protecting another’s interest, and sees to it that the service is to carried out faithfully. This management and supervision for others is stewardship. 1. PRINCIPLE OF STEWARDSHIP By virtue of their chosen profession, the healthcare providers, like nurses, are charged by society as stewards in the health care services. They are called and mandated to take care of or look after the well-being of the sick, disabled, and other people suffering from physical and psychological infirmities. 2. PRINCIPLE OF TOTALITY The term “ totality” connotes wholeness, completeness, or entirety. The principle of totality applies to any entity that is made up of parts that together constitute as a whole. But the whole is greater than any of its parts. 2. PRINCIPLE OF TOTALITY These principles dictate that the well-being of the whole person must be taken into account in deciding about any therapeutic intervention or use of technology. As applied to the human person, his/her whole physical body is more important and valuable than any of its part. It may be ethical and legal to sacrifice a part of one’s body for the good of his/her whole body. On this basis, a cancerous leg may be amputated, or breast be operated. Removal of either part does not reduce the integrity of the human person. But to reduce or remove a part from the whole unnecessarily or out of vanity, will be contrary to moral integrity or integrity of creation. 3. PRINCIPLE OF DOUBLE EFFECT The principle contemplates on two effects or outcomes arising from the performance of an action. The first or primary effect results from the agent’s intent, desire wish or will, while the secondary effect is only allowed, tolerated, or permitted. Moreover, the principle distinguishes performance of a good act that has both good and evil effects, from performance of an evil act so that good effect may result therefrom. THERE ARE FOUR (4) CONDITIONS OR ELEMENTS TO CONSIDER OR FULFILL BEFORE AN ACTION WITH DOUBLE EFFECT IS JUSTIFIED, NAMELY: The action done must be morally good, or at least morally indifferent or neutral The good effect must come directly from the action itself, and is not coming from or following as a consequence of secondary evil effect The good effect must be intended or willed and the evil/harm merely tolerated or allowed, with sufficient reason The good must outweigh or at least be equivalent in importance to the evil effect 4. THE PRINCIPLE OF SOLIDARITY To be solid means to be firmly united. It follows that solidarity implies unity or fellowship, arising from common responsibility and interest. Sense of solidarity or unity characterizes quality standing of any profession like nursing. 4. THE PRINCIPLE OF SOLIDARITY a socio-ethical and political concept which states that it is fair and just that benefits and obligations are justly shared between members of the society. Agreement between and support for the members of a group. the responsibility for the healthcare of a person (unit) shared as a whole (entirety) by that person and a nurse or a nursing team. 4. THE PRINCIPLE OF SOLIDARITY emphasizes the idea that solidarity helps to: ✓foster respect and avoid discrimination, ✓promote cohesion in health communities, ✓increase individual responsibility and a spirit of service, ✓stimulate motivation, ✓improve communication, ✓create an engaging workplace, and ✓ develop leadership. 5. THE PRINCIPLE OF COOPERATION To cooperate means to work together, to unite in producing a result, or desire, intend, or wish in a common thing. Cooperation, then implies that one works with others in the performance of an act to accomplish a goal. “The end will not justify the means” 6. PRINCIPLE OF COMMUNITARIANISM Aims to preserve the balance between individual rights and social responsibilities, the moral integrity of a caring society, and the unique character of mutual trust between patients and healthcare personnel. Individuals do not exist apart from society, and communities have a moral value that is independent of individuals. views that emphasize character and virtue of the community. 7. PRINCIPLE OF FIDELITY acting with integrity and trustworthiness but also, in a professional context, nurses are expected to act in the best interest of their patients or clients. includes creating and maintaining trust in relationships. consistent with fulfilling the expectation that nurses will fulfill their professional obligations to provide safe, ethical, and competent care. 8. PRINCIPLE OF UTILITY the moral course is one that maximizes value over disvalue and seeks the greatest benefit for the greatest number. In this framework, harm to some individuals may be acceptable for an overall net benefit to the group at large. if you could sacrifice your life to save the lives of several other people then, other things being equal. invites us to consider the immediate and the less immediate consequences of our actions. Given its insistence on summing the benefits and harms of all people, utilitarianism asks us to look beyond self-interest to consider impartially the interests of all persons affected by our actions. 9. PRINCIPLE OF PATERNALISM The belief that one should, on the basis of doing good for the patient, limit the patient’s personal autonomy. In the best sense, it is a conflict between the basic principle of autonomy and beneficence Healthcare Professionals makes healthcare decisions without a patient's consent. patients are not always capable of making their own healthcare decisions, as in cases of disability or illness. 10. PRINCIPLE OF CASUISTRY a case-based method of reasoning. aims at discovering what actions are good, wherever they occur. a method of case reasoning especially useful in treating cases that involve moral dilemmas. the basis of case law in common law, and the standard form of reasoning applied in common law. the casuist might conclude that a person is wrong to lie in legal testimony under oath, but might argue that lying actually is the best moral choice if the lie saves a life (Thomas Sanchez and others thus theorized a doctrine of mental reservation). For the casuist, the circumstances of a case are essential for evaluating the proper response. 11. PRINCIPLE OF RESPECT the intentional act of showing consideration for another person's interests and well-being. Nurses recognize another human-being as someone with their own likes and dislikes, thoughts and ideas, and values and morals. has been part of the foundation of excellent nursing care. “A fundamental principle that underlies all nursing practice is respect for the inherent worth, dignity, and human rights of every individual“ ask a patient how they would like to be addressed and explain to patients who we are and what we plan to do, 12. PRINCIPLE OF VERACITY Binds both the healthcare practitioner and the patient in an association of truth. Patient must tell the truth in order that appropriate care can be provided. The health practitioner needs to disclose factual information so that the patient can exercise personal autonomy. a nurse's obligation to tell the truth is part of accountability. if a patient was starting chemotherapy and asked about the side effects, a nurse practicing veracity would be honest about the side effects they could expect with chemotherapy. to tell the truth—to never lie to patients or give them knowingly false reassurance, which is also lying. VERACITY IS NECESSARY IN PROFESSIONAL-PATIENT RELATIONSHIP FOR 3 REASONS, NAMELY: 1. The obligation of veracity is based on respect owed to others Example: In asking patients their consent for any deemed necessary procedure or intervention, the validity of the consent depends on the thorough information, full disclosure, and enlightenment given to the patient regarding the procedure or intervention to be done. 2. Veracity has a strong association with obligations of fidelity and promise-keeping. Example: When we communicate with others (e.g., patients, families, significant others, communities), we implicitly promise that we will speak truthfully and that we will not deceive our listeners. VERACITY IS NECESSARY IN PROFESSIONAL-PATIENT RELATIONSHIP FOR 3 REASONS, NAMELY: 3. relationship of trust between persons are necessary for successful intervention and cooperation Example:Relationships between health care professionals and their patients and between researchers and their subjects ultimately depend on trust and adherence to the rules of veracity. These are all necessary to foster trust. ANY QUESTIONS, REACTION OR CLARIFICATION? THANK YOU AND GOD BLESS! DIGNITY IN DEATH AND DYING ANALEIN E.VILLAREAL, RN,MAN AT THE END OF THIS LESSON, STUDENTS WILL BE ABLE TO: 1. Discuss death, its characteristics, and definition from medical and legal perspective, 2. Compare the various types of euthanasia and its ethical implications; 3. Determine the morality of suicide; 4. Critique the practicality and morality of using stem cell technology; 5. Contrast the organ procurement in terms of a utilitarian, deontology and virtue ethics approach WHAT IS DEATH? Death is the irreversible cessation of life, marking the end of an organism's biological functions. It has profound medical, legal, ethical, and philosophical implications. WHAT IS DEATH? Death is defined from various points of view: 1. PHYSIOLOGICAL DEFINITION: A person is dead when the heart has stopped beating. Often referred to as the traditional understanding of death. 2. RELIGIOUS OR PHILOSOPHICAL DEFINITION: Means the separation of soul and body. WHAT IS DEATH? Death is defined from various points of view: 3. BRAIN DEATH DEFINITION: refers to a condition in which the brain is completely destroyed, and in which the cessation of function of all other organs are imminent and inevitable. EEG and ECG can determine the total or irreversible loss of circulatory and respiratory functions. WHAT IS DEATH? Death is defined from various points of view: 3. CELLULAR DEFINITION: refers to the disintegration and breakdown of the metabolic process of the body’s substance. Considers the irreversible loss of neo- cortical activity as the only significant criterion because it renders all capacity for consciousness and social integration impossible. EEG is needed. WHAT IS DEATH? Medical definition of death revolves around the irreversible loss of vital functions & categorized as: 1. CARDIAC DEATH: Defined as the permanent cessation of the heart's ability to pump blood, leading to the loss of oxygen and nutrients to tissues. Historically the standard for determining death. WHAT IS DEATH? Medical definition of death revolves around the irreversible loss of vital functions & categorized as: 1. BRAIN DEATH: Irreversible loss of all brain activity, including the brainstem, which controls basic life functions like breathing and heartbeat. Brain death is considered legal death in many countries, even if other organs are functioning artificially. WHAT IS DEATH? The legal definition of death varies by jurisdiction but often aligns with medical criteria. Key aspects include: Uniform Determination of Death Act (UDDA) (U.S.): Death is legally defined as: Irreversible cessation of circulatory and respiratory functions. Irreversible cessation of all functions of the entire brain, including the brainstem. WHAT IS DEATH? The legal definition of death varies by jurisdiction but often aligns with medical criteria. Key aspects include: Practical Implications: Death must be officially certified for legal matters like inheritance, burial, and cessation of medical treatment. Organ donation relies on precise legal definitions to prevent premature declarations of death. CHARACTERISRTICS OF DEATH? 1. Irreversible Cessation of Vital Functions: Cessation of the heart (cardiac death) and respiration. Loss of brain activity (brain death). 2. Biological Markers: Absence of reflexes (e.g., pupillary reaction to light). Rigor mortis (stiffening of muscles after death). Livor mortis (blood pooling in dependent areas). CHARACTERISRTICS OF DEATH? 3. FINALITY Death is permanent; no medical intervention can reverse it. 4. UNIVERSALITY A natural and inevitable process for all living organisms. 5. Irreversibility: Once diagnosed, death is not reversible, distinguishing it from states like coma or vegetative state. SEVERAL VIEWS OF DEATH NIKOLAI BERDYAEV-a Russian theologian, states that only death can give meaning to life. Without death, life would be meaningless because meaning is bound up with the end. EPICURUS- the Athenean thinker, argues that there is either immortality or there is none. If there is, then humans should be glad there is death, for once they are dead they shall become immortal. SEVERAL VIEWS OF DEATH MARTIN HEIDEGGER- a German existentialist, views death as the completion of life, for unless and until one dies, one’s life is not yet complete, hence, his concept of man as being- towards-death. JOHN, the Evangelist quotes Jesus Christ, saying, “ I am the resurrection and the life; he that believes in me, though he were dead, shall live again; and whoever lives and believes in me shall never die” APPLICATION OF ETHICAL THEORIES NATURAL LAW ETHICS- regards death as a part of nature. It declares that a person is dead once the soul leaves the body. UTILITARIAN PRINCIPLE- the brain death definition seems to be in keeping with the utility precept, if the dying patient is detached from all life- supporting machines. RAWLS’s concept of justice- may also justify the unplugging of life- sustaining machines if and when they are no longer useful to the dying person-at least, in fairness to the patient, so that they will not prolong his/ her suffering. EUTHANASIA Comes from the Greek words ‘eu” (good) and “Thanatos” (death). (mercy killing, assisted suicide) The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma. The practice is illegal in most countries. Is the act or practice of killing or permitting the death of hopelessly sick or injured individuals ( such as persons or domestic animals) in relatively painless way for reasons of mercy ( Merriam Webster) TYPES OF EUTHANASIA Active euthanasia- killing a patient by active means. Passive euthanasia- intentionally letting a patient die by withholding artificial life support such as a ventilator or feeding tube. Involuntary euthanasia- without the consent of the patient. Self-administered euthanasia- the patient administers the means of death Other-administered euthanasia- a person other than the patient administers the means of death. Assisted- the patient administers the means of death but with the assistance of another person, such as the physician. Mercy-killing- usually refers to active, involuntary or nonvoluntary, other administered euthanasia. In other words, someone kills a patient without their explicit consent to end the patient’s suffering. DYSTHANASIA MISTHANASIA A term generally used when a Other term for social person is kept alive artificially, euthanasia. in a condition where It has no relation with the otherwise they cannot survive; search for a good, smooth and sometimes for some sort of painless death. ulterior motive. ORTHOTHANASIA (ART OF DYING WELL) Rejects all forms of misthanasia without, however, failing into the trap of euthanasia or dysthanasia. Seeks to deal with the terminal patient, helping him to face his destiny with greater tranquility, maintaining a distinction between healing and caring, between maintaining life and allowing the person to die, when the time comes. THE MORAL ISSUE OF SUICIDE Ancient Greeks and Romans both defended and condemned suicide depending on the circumstances under which t was committed. Socrates, as recounted by Plato, for instance, taught that an individual was a property of the gods, so self-killing would bring about their anger. Plato cited 3 other exceptions to the prohibition of suicide: (1) any shame of extreme distress and impoverishment, (2) affliction by any extraordinary sorrow, and (3) inevitable turn of fortune. Aristotle, on the other hand, thought of suicide as an act of cowardice and an offense against the state. THE MORAL ISSUE OF SUICIDE Epicurus, in his way, held that if life ceases to be a pleasure or a pleasure one, the recourse for a free individual was to terminate it. Roman stoic philosopher, LUCIUS SENECA, argued eloquently in favor of suicide as an escape from suffering and the decay of old age (which he did at the age of 65, on the imperial command, after he had been accused of participation in a conspiracy to depose Nero , allegedly to succeed him to the throne). MEANING AND CAUSES OF SUICIDE Suicide is the direct and willful destruction of one’s own life. It is direct insofar as the primary object of the act itself is the killing of oneself; it is willful insofar as it is deliberate, voluntary, and intentional; and it is destructive insofar as the means of terminating one’s own life is, more often than not, violent, brutal, or very harsh. Suicide, on the contrary, is usually the destructive and violent termination of one’s life. The individual who commits suicide for non-medical reasons ( e.g., a great loss in a business venture) is solely responsible for his/ her own death. MEANING AND C AUSES OF SUICIDE Other than the religious or cultural causes of suicide, one may cite personal, financial, and social reasons, although, at times, these 3 overlap. The personal reasons may include (1) misfortune and frustration on love or marriage (e.g., desertion by one’s beloved spouse), thus, making one a victim of a broken home or marriage, (2) parental indifference or apathy towards one’s boyfriend or girlfriend; (3) in-law problems, especially if victims live with their parents-in-law; (4) failure in examinations; (5) loss of honor and integrity (e.g., shame and self-pity resulting from pregnancy caused by rape and/ or incest); and (6) a nervous breakdown due to one’s inability to cope with life’s problems (e.g., inability to adjust to new situations and/ or responsibilities. MEANING AND C AUSES OF SUICIDE Financial causes include (1) poverty and impoverishment (e.g., parents and children burn themselves to death because of extreme deprivation), and (2) great loss of money or collapse in a business venture. Social and Political reasons include (1) failed coup d’etat (e.g., many of the coup plotters who failed against Mikhail Gorbachev resorted to suicide ) and (2) protest against man’s inhumanity to man (e.g., the practice of self-immolation among Buddhist monks.) PROS OF SUICIDE View suicide as one’s fear of suffering that is worse than death itself. It is the most excusable incitement to self-killing- MICHEL de MONTAIGNE Suicide is a means of liberating oneself from exploitation and oppression.- JOHN DONNE. BARON de MONTESQUIEU-Justified suicide by saying (1) it is unjust to compel a person to labor for a society he/she no longer consents to be a member of-this justifies the act of terminating one’s own life; (2) the act of suicide does not disturb the order of Providence, nor does any other human act alter the modifications of matter; and (3) though the soul is separated from the body, the order or regularity in the universe never changes. PROS OF SUICIDE DAVID HUME- defended suicide as: (1) The removal of misery makes suicide morally justifiable and permissible; to bear unbearable pain is in no way part of a natural inclination; (2) moral duty is reciprocal; while alive and healthy, it is one’s bounden duty to render service to society, as it protects him/her in return, but when his/her life becomes a liability and a burden to society, his/her withdrawal is not only innocent but laudable; and (3) there is no such thing as order designed by God; man’s life is as disposable as that of an oyster. CONS OF SUICIDE According to JEWISH TRADITION, suicide (1) is a crime which is contrary to the common nature of all animals (e.g., the instinct of survival-animals are naturally inclined to preserve themselves); and (2) the soul is a depositum ( deposited for safekeeping) received from God, so to kill oneself is contrary to the divine will; hence it is a wicked act. ST AUGUSTINE, likewise, contended: (1) suicide is a greater sin than any and all sins that could be allegedly avoided by committing it; (2) self-murder is against the fifth commandment (Thou shall not Kill); (3) suicide deprives one of the opportunity to repent; and (4) it is an ignoble act through which one attempts to escape the ills of life. CONS OF SUICIDE ST. THOMAS AQUINAS himself gave a 3 fold argument regarding suicide: (1) suicide is against the natural law of self-preservation; this is a sort of self- kindness or charity that one owes to oneself ; (2) being a member of a society, a person who kills oneself will deprive the community of his/ her activity- they , likewise, will be greatly affected by his/ her sudden, if not violent, death; and (3) suicide is a usurpation of God’s function- life is God’s gift to man; suicide, thus, involves an arrogant act which one is not at liberty to perform. APPLICATION OF ETHICAL THEORIES NATURAL LAW ETHICS-with its principle of stewardship, consider suicide as self-murder. UTILITARIAN’S PRINCIPLE OF UTILITY seems to be in keeping with the argument that an individual may deliberately terminate his/ her own life if and when suffering becomes too much to bear. Besides, whenever one has become a financial burden and a liability due to a prolonged, incurable disease, then an appeal to the greatest happiness for the greatest number principle becomes justifiable. This is arguable, however. APPLICATION OF ETHICAL THEORIES KANT’S ETHICS- within the context of categorical imperative not using oneself only as a means but always as an end, may be taken as a rejection or prohibition of suicide. On the other hand, advocated of the principle of autonomy and self- regulating will to support and justify their argument that an individual not only has a duty to preserve his/ her l; life, but also to die with dignity if and when the situation warrants such a moral decision. STEM CELL TECHNOLOGY: ETHICAL AND PRACTICAL CONSIDERATIONS Stem cells are special, undifferentiated cells with the unique ability to: 1.Self-Renew: Divide and produce more stem cells. 2.Differentiate: Transform into specialized cell types like muscle cells, nerve cells, or blood cells. Stem Cells play a vital role in growth, development, and tissue repair and are foundational to regenerative medicine and scientific research. TYPES OF STEM CELLS Stem cells are classified based on their source and potential to differentiate into different cell types: 1. Embryonic Stem Cells (ESCs) Source: Derived from early-stage embryos (blastocysts). Potency: Pluripotent – Can become almost any cell type in the body. Applications: Used in regenerative medicine and studying early human development. Ethical Concerns: Involves destruction of embryos, raising moral debates. TYPES OF STEM CELLS 2. Adult Stem Cells (Somatic Stem Cells) Source: Found in specific tissues like bone marrow, skin, or the brain. Potency: Multipotent – Limited to becoming specific types of cells related to their tissue of origin (e.g., hematopoietic stem cells form blood cells). Applications: Used in therapies like bone marrow transplants. Advantages: Avoids ethical concerns associated with embryonic stem cells. TYPES OF STEM CELLS 3. Induced Pluripotent Stem Cells (iPSCs) Source: Created by reprogramming adult cells (e.g., skin or blood cells) to behave like embryonic stem cells. Potency: Pluripotent – Can differentiate into almost any cell type. Applications: Personalized medicine, drug testing, and disease modeling. Advantages: Avoids the use of embryos; ethically acceptable. TYPES OF STEM CELLS 4. Perinatal Stem Cells Source: Found in umbilical cord blood, placental tissue, or amniotic fluid. Potency: Range from multipotent to pluripotent. Applications: Non-invasive collection and potential in regenerative therapies. STEM CELL POTENCY LEVELS Stem cells are also categorized by their potential to differentiate: 1.Totipotent: Can form all cell types, including embryonic and extra-embryonic tissues (e.g., zygote). 2.Pluripotent: Can form nearly all body cell types but not extra- embryonic tissues (e.g., embryonic stem cells). 3.Multipotent: Limited to specific tissue types (e.g., adult stem cells). 4.Unipotent: Can only produce one cell type (e.g., skin stem cells). IMPORTANCE OF STEM CELL TECHNOLOGY IN HEALTHCARE AND BIOETHICS Stem cell technology has revolutionized healthcare and raised important ethical questions. Its applications in regenerative medicine, disease treatment, and research hold immense promise while prompting discussions about its ethical implications. IMPORTANCE IN HEALTHCARE 1. Regenerative Medicine Enables the repair or replacement of damaged tissues and organs (e.g., skin grafts for burns, cartilage repair for arthritis). Potential to grow entire organs for transplantation, reducing the need for donors. 2. Treatment of Chronic Diseases Provides new treatments for conditions like Parkinson’s, Alzheimer’s, diabetes, and spinal cord injuries. Restores lost function by replacing damaged cells with healthy ones. IMPORTANCE IN HEALTHCARE 3. Cancer Treatment Hematopoietic stem cells (from bone marrow or umbilical cord blood) are used in treating blood cancers like leukemia. Advances in understanding cancer stem cells help in targeting tumor growth more effectively. 4. Personalized Medicine iPSCs derived from a patient’s cells allow for tailored treatments, minimizing the risk of immune rejection. Enhances drug testing and development by creating patient-specific IMPORTANCE IN HEALTHCARE 5. Understanding Human Development and Disease Stem cells provide a platform to study early developmental processes and disease mechanisms. Accelerates the discovery of new treatments through advanced disease modeling. IMPORTANCE IN BIOETHICS 1. Ethical Debates on Life and Embryo Use Embryonic Stem Cells (ESCs): Raise questions about the moral status of embryos. Critics argue their destruction equates to ending a potential life, while proponents emphasize their potential to save lives. Sparked discussions on balancing scientific progress with respect for life. IMPORTANCE IN BIOETHICS 1. Ethical Debates on Life and Embryo Use Embryonic Stem Cells (ESCs): Raise questions about the moral status of embryos. Critics argue their destruction equates to ending a potential life, while proponents emphasize their potential to save lives. Sparked discussions on balancing scientific progress with respect for life. IMPORTANCE IN BIOETHICS 2. Informed Consent and Exploitation Risks Ethical concerns about the consent process for donating embryos, eggs, or tissues. Risk of exploiting vulnerable populations in sourcing stem cells, especially in low-income regions. 3. Equity and Access Challenges in ensuring equal access to stem cell therapies, as they are often expensive and experimental. Raises concerns about creating disparities in healthcare between rich and poor. IMPORTANCE IN BIOETHICS 4. Potential for Misuse Fears of "designer babies" or cloning due to misuse of stem cell technology. Calls for strict regulations to prevent unethical practices. 5. Advocacy for Ethical Alternatives Development of Induced Pluripotent Stem Cells (iPSCs) has provided an ethically acceptable alternative to embryonic stem cells, aligning scientific innovation with moral standards. PRACTICAL BENEFITS Medical Applications: Offers potential cures for previously untreatable diseases like Parkinson's, diabetes, and spinal cord injuries. Revolutionizes organ transplantation through organoid growth. Research Benefits: Provides insights into early human development. Aids in drug testing and reducing animal experimentation. SUCCESS STORIES Treatment of Spinal Cord Injuries Case: Kristin MacDonald (California, USA) Kristin, a former TV producer, was partially paralyzed due to a spinal cord injury. Breakthrough: She participated in a clinical trial where embryonic stem cells were used to repair her damaged spinal cord. Result: She regained some sensation and motor function in her lower body, improving her quality of life. Significance: This marked a significant step in developing therapies for spinal cord injuries. SUCCESS STORIES Curing Blood Disorders Case: Success in Treating Sickle Cell Disease In 2019,Victoria Gray, a woman with sickle cell disease, became the first U.S. patient treated with CRISPR-edited stem cells. Breakthrough: Her bone marrow stem cells were edited to produce healthy hemoglobin, correcting the genetic defect. Result:Victoria no longer experiences the severe pain crises associated with the disease. Significance: Showcases the power of gene editing combined with stem cell therapy. SUCCESS STORIES Regenerating Damaged Corneas Case: Holoclar Therapy (Europe) Holoclar is a stem cell-based treatment used to restore vision in patients with severe corneal damage due to burns. Breakthrough: Limbal stem cells (from the patient's own eye) are grown in a lab and transplanted to the damaged cornea. Result: Thousands of patients have regained vision. Significance: It is one of the first stem cell therapies to receive regulatory approval in Europe. SUCCESS STORIES Restoring Skin After Severe Burns Case: Hassan, a Syrian Boy with Epidermolysis Bullosa (Germany, 2015) Hassan suffered from a life-threatening genetic skin condition causing fragile skin. Breakthrough: Doctors used genetically modified skin stem cells to grow new, healthy skin in the lab. Result: Over 80% of his skin was replaced, and he returned to normal activities. Significance: Demonstrates the potential of gene therapy and stem cells in treating rare genetic disorders. SUCCESS STORIES Organoid Development for Research Breakthrough: Mini-Brains and Mini-Organs Scientists have successfully grown brain organoids from stem cells to study neurological disorders like Alzheimer’s and autism. Result: These organoids mimic real brain tissue, allowing for better drug testing and understanding of diseases. Significance: Reduces the need for animal testing and accelerates research into complex conditions. CHALLENGES High cost and technological complexity. Difficulty in scaling therapies for widespread use. Immune rejection concerns for certain therapies. MORAL AND ETHICAL CONSIDERATIONS Moral Perspectives 1.Pro-Stem Cell Argument: 1.Potential to save lives and improve the quality of life. 2.Emphasis on the moral obligation to reduce suffering. 2.Ethical Concerns: 1.Destruction of embryos in embryonic stem cell research raises questions about the beginning of life. 2.Exploitation risks in sourcing stem cells, particularly in developing countries. 3.Accessibility issues may exacerbate healthcare inequities. MORAL AND ETHICAL CONSIDERATIONS Alternatives: 1.Induced pluripotent stem cells (iPSCs) provide a more ethical and practical option. 2.Shift towards adult stem cells and non-embryonic sources. ORGAN PROCUREMENT AND UTILITARIANISM Utilitarianism is an ethical theory that advocates for actions that maximize overall happiness and minimize suffering for the greatest number of people. When applied to organ procurement, the utilitarian perspective evaluates the practices based on their outcomes in terms of overall benefits and harms. ORGAN PROCUREMENT AND UTILITARIIANISM MAXIMIZING LIVES SAVED: Utilitarianism supports organ procurement methods that save the most lives, prioritizing efficiency in obtaining and allocating organs. Optimizing Resource Use: Efforts are justified if they enhance the use of available resources (e.g., organs that would otherwise go unused). Focus on Outcomes: The process itself (whether invasive or controversial) may be ethically permissible as long as it contributes to the greater good by improving survival rates and reducing suffering. EXAMPLES OF ORGAN PROCUREMENT PRACTICES A. Opt-In System (Voluntary Consent) Individuals register as organ donors during their lifetime. B. Opt-Out System (Presumed Consent) Everyone is considered a donor unless they explicitly refuse. C. Organ Markets (Monetary Incentives) Allow individuals to sell their organs. D. Mandatory Donation at Death Organs are automatically harvested upon death unless medically unviable. ETHICAL CONSIDERATIONS Equity Utilitarian approaches risk prioritizing societal benefit over individual rights, potentially disadvantaging marginalized groups. Consent and Autonomy Maximizing societal welfare must be balanced against respecting individual freedoms and beliefs. Trust in Healthcare Any utilitarian approach must account for the impact on public trust, as a breakdown in trust could lead to reduced participation in organ donation programs. CONCLUSION: From a utilitarian perspective, organ procurement should aim to save the maximum number of lives while minimizing societal harm. While practices like presumed consent or regulated markets align with utilitarian principles, they must be implemented carefully to respect autonomy, ensure fairness, and maintain public trust. Balancing efficiency with ethical concerns is essential to create a system that serves the greater good effectively. ORGAN PROCUREMENT AND DEONTOLOGY FRAMEWORK CORE PRINCIPLE: Moral actions are based on adherence to rules, duties, and rights, irrespective of the outcomes. Approach to Organ Procurement: Respect for individual autonomy and the inherent dignity of donors is paramount. Donors must provide explicit and informed consent. Practices like presumed consent or incentivized donation might be rejected as they could infringe on individual rights. Ethical focus is on the process, ensuring that organ procurement aligns with moral duties (e.g., respecting the dead, transparency with families). CONCLUSION emphasizes moral duties and respect for individuals’ rights, such as informed consent and the dignity of donors. It provides a framework for upholding ethical principles but may struggle with dilemmas where strict adherence to rules limits the ability to save lives. ORGAN PROCUREMENT AND VIRTUE ETHICS APPROACH CORE PRINCIPLE: Focus on cultivating moral character and acting in accordance with virtues such as compassion, generosity, and justice. APPROACH TO ORGAN PROCUREMENT: The emphasis is on the moral character of the individuals and institutions involved. Ethical organ procurement practices are guided by virtues like empathy (toward donors and recipients), fairness (in allocation), and respect (for donors' and families' decisions). Encourages voluntary organ donation as an act of altruism and generosity, fostering a culture of caring and solidarity in society. APPROACH TO ORGAN PROCUREMENT: Decision-making processes aim to embody virtues by ensuring transparency, fairness, and respect for all stakeholders, including honoring the donor’s wishes. Advocates for practices that reflect the moral excellence of society, such as ensuring equity in access to transplantation for marginalized groups. CONCLUSION emphasizes the cultivation of altruism, compassion, and justice, promoting a culture of voluntary organ donation. While it fosters a morally virtuous society, it may lack clear rules for addressing contentious issues. CONTRASTING THE THREE APPROACHES Aspect Utilitarianism Deontology Virtue Ethics Maximizing overall Following moral duties Cultivating virtuous Focus outcomes and rules character View of Intrinsic dignity with Individual embodying Means to increase utility inviolable rights altruism and care Donor Decision Basis Consequences of actions Adherence to moral rules Acting in alignment with virtues Strengths Pragmatic, outcome- Respects autonomy and Fosters moral oriented individual rights excellence and community Can justify morally Can be rigid or overly Lacks clear guidance Weaknesses dubious means rule-bound for complex cases Bioethics and Its Application in Various Health Care Situations ANALEIN E.VILLAREAL, RN,MAN Objectives: At the end of this lecture, the student will: SEXUALITY 1. Develop an understanding of the descriptive and normative AND HUMAN ethics with regards to human sexuality, marriage and REPRODUCTION procreation. 2. Enable to recognize the ethical dimension of the issue and subsequently frame the ethical dilemma that the family is facing. Human Sexuality and its Moral Evaluation Human Sexuality is defined as the totality of experiences, systems, attributes, behavior that characterize the sexual sensation, reproduction, and intimacy of Homo sapiens. (Grebe and Drea, 2018) To be able to morally 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. 1. Anthropological Perspective of Sexuality and Procreation -In sexual ethics, it is useful to understand the relationship of the person and sex that mirrors the relationship between the person and 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: -chromosomal factors: X or Y in the last chromosome pair -ovaries for women-internal and testicles for men-external -Wolffian ducts in men, Mullerian ducts in women -primary and secondary characteristics -voice, movement, sensorial and homogenous structure. Other Perspectives on Sexuality Catholic Morality on sexual ethics arise not only from the Holy Book but also on the doctrines that are laid out by the Magisterium on matters of Catholic Faith who are vested with the authority of the true interpretation of the Holy Book’s content. Can be summarized in the following: -Sexuality must be used in keeping with its human teleology. -The conjugal act has been inseparable and integrated unitive and procreative dimensions. -Unitive- long-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. Accdg. to Leo Screggia: - The sexual inclination of the human person is connected with love and cannot be reduced to a biological, psychological or physiological impulse. - Human love always develops through voluntary acts performed by the person who is able to make a free gift of self. - A sexed relation is between persons of different sex without any genital or physical involvement. - The genital sexual relationship involves all the components of the person in reciprocal personal donation or self-giving. - The personalist vision asserts through that a genital sexual relationship is not necessary for a person’s fulfillment. Sigmund Freud on the concept of Sexuality: The contributions 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. Freud proposed sublimation as a mechanism that inhibits instinctual forces. Nonetheless, the pansexualistic 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. Spousal love is both self-giving and self-fulfilling, because the mutual belonging person is guaranteed only by a free choice of mutual donation. 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. -Animal: sexual impulse acts as a strong, irrational instinct. -Human: sexual impulse has the natural tendency to be transformed into love. Through sexual impulse alone, one would say “I desire you because you are good for me”. But when this impulse is transformed into the benevolence of love, one is bound to say “I desire you as a good”, “I desire your good”, “I desire what is good for you”. Freedom, Responsibility and Sex Beyond psychological and cultural dynamics lies to spirituality of man which is his freedom and responsibility. Freedom and responsibility enrich sexuality, expressing it in an interpersonal relationship, and consequently in the overall process of personal growth. All of sexual life is accompanied by responsibility. Responsibility also means accepting sexuality for what it involves in terms of meaning and consequences. The Sexual Revolution The sexual revolution In 1900 only 6 percent of unmarried teenage girl engaged in premarital sex. By 2002 a large majority roughly 75 percent had experience this. 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. 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. Marriage Article 1 of the Family Code of the Philippines Marriage is 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. Fundamentals of Marriage -There is no divorce in the Philippines because the law provides that marriage is a special permanent contract. -same sex marriage is not recognized by the Philippine Law -Since the family is the foundation of the society, the stability and status of marriage profoundly affects how the family and society is thriving. Therefore, the breakdown in marriage threatens the family and consequently, the integrity of the society. The nature, consequences, and incidents of violations towards marriage as an inviolable institution is governed by the law. Characteristics of Marital Love Human- flesh & spirit, more than emotion, act of the will, grows in daily life; union of hearts. Total- special form of friendship, share everything, unselfish, receives all & gives all. Faithful- shows faithfulness of God to His people, I will not abandon you, forsake you. Exclusive- gift to one person to the exclusion of all others, you and you alone. Fruitful- love goes beyond couple, destined to raise up new life, children supreme gift of marriage. 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. formal requisites of marriage: (1) Authority of the solemnizing officer; (2) A valid marriage license (3) A marriage ceremony which takes place with the appearance of the contracting parties before the solemnizing officer and their personal declaration that they take each other as husband and wife in the presence of not less than two witnesses of legal age. Under Art 35.4, those bigamous or polygamous marriages not failing under article 41 is one of the reasons that a marriage is void from the beginning. Article 45 of the Family Code further stipulates that a marriage may be annulled for an of causes mentioned below that are existing at the time of the marriage: Marriage for those 18 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. Either party was of unsound mind, unless after coming to reason, freely cohabited with the other as husband and wife. Consent was obtained by fraud, unless afterwards, with full knowledge of the facts 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. Art. 36. A marriage contracted by any party who, at the time of the celebration, was psychologically incapacitated to comply with the essential marital obligations of marriage, shall likewise be void even if such incapacity becomes manifest only after its solemnization. CHI MING TSOI vs. COURT OF APPEALS and GINA LAO- TSOI (G.R. No. 119190 January 16, 1997) Chi Ming Tsoi and Gina Lao-Tsoi married on May 22, 1988 at the Manila Cathedral Intramuros Manila. After the celebration thereof and wedding reception, the newlyweds proceeded to the house of husband-defendant’s mother. Contrary to her expectations, instead of consummating their marriage, husband-defendant just went to bed, slept on one side, then turned his back and went to sleep. The newlyweds failed to consummate their marriage even on the succeeding nights. The couple slept together in the same room and on the same bed for almost ten (10) months but there was no attempt of sexual intercourse between them. She claims that she did not even see her husband’s private parts nor did he see hers. On January 20, 1989, they submitted themselves for medical examinations to Dr. Eufamio Macalalag, urologist at the Chinese General Hospital. The results of said physical examination showed that she is healthy, normal and still a virgin, while that of her husband’s examination was kept confidential. Medications were only prescribed for her husband but the same was also kept confidential. No treatment was given to her, but for her husband, he was asked by the doctor to return but he failed to do so. Frustrated, the wife filed a case in the Regional Trial Court of Quezon City in order to annul their marriage. Husband-defendant does not want his marriage annulled since he loves her wife very much, he has no defect on his part, and there is still chance of reconciliation. However, husband- defendant claims that if their marriage shall be annulled by reason of psychological incapacity, the fault lies with his wife. The husband-defendant admitted that since their marriage on May 22, 1988, until their separation on March 15, 1989, there was no sexual contact between them. But, the reason for this, according to the defendant, was that every time he wants to have sexual intercourse with his wife, she always avoided him and whenever he caresses her private parts, she always removed his hands. The defendant claims, that he forced his wife to have sex with him only once but he did not continue because she was shaking and she did not like it. So he stopped. In another physical examination by Dr. Sergio Alteza, Jr., which was submitted in a Medical Report, results showed that there is no evidence of impotency of husband-defendant Whether or not the refusal of a couple to have sexual intercourse with each other constitutes psychological incapacity. Yes, the refusal of a couple to have sexual intercourse with each other constitutes psychological incapacity. The Court provides that one of the essential marital obligations under the Family Code is “To procreate children based on the universal principle that procreation of children through sexual cooperation is the basic end of marriage.” Constant non- fulfillment of this obligation will finally destroy the integrity or wholeness of the marriage. In this case, the Court ruled that the senseless and protracted refusal of one of the parties to fulfill the above marital obligation is equivalent to psychological incapacity. The Court further quoted, “If a spouse, although physically capable but simply refuses to perform his or her essential marriage obligations, and the refusal is senseless and constant, Catholic marriage tribunals attribute the causes to psychological incapacity than to stubborn refusal. Senseless and protracted refusal is equivalent to psychological incapacity. Thus, the prolonged refusal of a spouse to have sexual intercourse with his or her spouse is considered a sign of psychological incapacity.” While the law provides that the husband and the wife are obliged to live together, observe mutual love, respect and fidelity (Art. 68, Family Code), the sanction therefor is actually the “spontaneous, mutual affection between husband and wife and not any legal mandate or court order” (Cuaderno vs. Cuaderno 120 Phil. 1298). Love is useless unless it is shared with another. Indeed, no man is an island, the cruelest act of a partner in marriage is to say “I could not have cared less.” -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 6 years, even 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. On Homosexuality Semantically, homosexuality (a noun) is the condition of the quality of being homosexual. A homosexual (adjective) is either a male or a female. In the field of Psychology and Psychoanalysis, homosexuality is characterized by sexual or romantic, desire, attraction, or sexual activity with people of the same sex. In the present context, homosexuality has evolved to the LGBT movement. LGBT stands for the collective of lesbians, gay, bisexual, and transgender people. -Lesbian refers to women who only feel sexual-affective attraction to other women. Homosexuality and related gender issues exposes a person to a profound moral struggles. In the same manner that these issues threaten the integrity of family life and marriage, it likewise threaten the psychological and moral integrity of the person and ultimately their physicality. Hence, a supportive, non- judgmental and respectful dealings 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. Issues on Contraception, It’s Morality, and Ethico-moral Responsibility of Nurses On Contraception Methods of Contraception: Folk Methods -Pre coital/ post coital douche using vinegar and brine -Prolonged lactation -Coitus interruptus and Coitus reservatus Mechanical Methods -Condoms and diaphragm Chemical Methods -Vaginal Suppository, vaginal tables, vaginal jellies, creams and foams Hormonal Methods -Pills, injections, implants Morality of Contraception When does life begins? A zygote, embryo, fetus and a full grown human person whether an infant or an elderly carry the same genetic information that marks his entire personality and physicality. The genetic information coming from the last pair of X & Y chromosomes are entirely different from that of the parents though was informed through the chromosomes of both parents. Since genetic information of the new zygote being different from that of the parents, imply that the newly-formed zygote carries the genetic information of a whole new person distinct from that of the parents. Issues on Artificial Reproduction, its Morality, and Ethico-moral Responsibility of Nurses 1. Artificial Insemination Less radical and sophisticated procedure to facilitate conception in an unnatural way. -the introduction of sperm from a man into a woman by laboratory methods in attempt to bring about conception in the woman’s womb, thus making the marital act of husband and wife insignificant causally in the bringin about the conception. In-vitro Fertilization: in vitro (in glass) -facilitating conception of a human person outside the body of a woman. -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 a carry pregnancy for intended parent(s) who cannot conceive for medical reason or those who are gay people. 2 forms of surrogacy 1. Traditional surrogacy uses the surrogate mother’s egg for conception. 2. Gestational surrogacy is performed by transferring embryos made through IVF with eggs from the intended mother or a donor. However, pregnancy and gestation involve psychological burden and health risks for the surrogate mother. The legal procedures for a parenthood following surrogacy are complicated due to the typical legal assumption that a woman giving birth to a child is a legitimate mother of the child. Therefore, a surrogate mother is required to formally abandon parental authority, for the intended parents to adopt the child born. Healthcare practitioners, the nurse most importantly, is to assist the person who is facing issues on artificial reproduction in a non-judgmental manner, offering information which is 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 patients as a manifestation of respecting his dignity as a person. MORALITY OF ABORTION, RAPE AND OTHER PROBLEMS RELATED TO DESTRUCTION OF LIFE At the end of this lesson, student will able to : Analyze and evaluate the ethical dimensions of issues in terms of intention, action, consequences and appropriate or applicable ethical principles. Identify and Discuss Problems Related to the Destruction of Life. Understand the History and Ethical Implications of Eugenics. TYPES OF ABORTION: 1. 1. Complete Abortion ABORTION 2. 3. 2. Habitual Abortion 3. Incomplete Abortion -is the expulsion 4. 4. Induced Abortion 5. Inevitable abortion from the uterus of 5. 6. Infected abortion the products of 6. 7. 7. Missed abortion conception before 8. 8. Septic abortion the fetus is viable. 9. 9. Spontaneous abortion 10. 10. Therapeutic abortion 11. 11. Threatened abortion ❖ Complete Abortion- one in which all the products of conception before are expelled from the uterus and identified. ❖ Habitual Abortion-spontaneous abortion occurring in 3 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- that associated with infection of the genital tracts. ❖ Missed abortion- retention in the uterus of an abortus that has been dead for at least 8weeks.. ❖ Septic abortion- that associated with serious infection of the uterus leading to generalized infection. ❖ Spontaneous abortion- that occurring naturally. ❖ Therapeutic abortion- that induced for medical considerations. ❖ Threatened abortion- a condition in which vaginal bleeding is less than in inevitable abortion and the cervix is not dilated, and abortion may or may not occur. Induced Abortion Techniques: Abortion by dilatation and curettage (7-12 wks AOG) Abortion by CS or abdominal hysterectomy Abortion by Suction (before 3-4 months or 12-16 wks) Via Intra amniotic infiltration ( before 3-4 months or 12-16 wks) Via injection of Prostaglandin RU 486- Contraceptive pill associated with prostaglandin LEGAL, MORAL & ETHICAL CONSIDERATIONS Article II, Section12 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 PRO-ABORTION Not firmly a choice between a mother To safeguard the life of the mother. only or to the child only but must center Abortion as a woman’s right on saving both lives. Abortion as an expression of The ethical choice can be guided by the woman’s sexual freedom principle of Double effect, The fetus is not a human person. Unselfish love and solitude to an innocent creature is upheld. Recognition of the complementary roles between man & woman. The offspring has genetic code totally different from the cells of the parents. RAPE -is an unlawful activity with sexual intercourse carried out forcibly or under threat of injury against person’s will or with a person who is beneath a certain age or incapable of valid consent because of mental llness, mental deficiency, intoxication, unconsciousness, or deception. ( Merriam Webster) OTHER RELATED PROBLEMS TO THE DESTRUCTION OF LIFE HUMAN POPULATION CONTROL: EUGENICS ○ EUGENICS- was coined by the Scientist Francis Galton (1822-1911). Literally means (eu) good (genos) birth. ○ 2 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 vs. Wade. GENOCIDE: The deliberate killing of a large number of people from a particular nation or ethnic group with the aim of destroying that nation or group. EUTHANASIA: This is assisted suicide (predominantly) of people who are suffering usually from long terminal illness & want to expedite inevitable death. 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 States for a time HOW EUGENICS HAS MANIFESTED ITSELF THROUGHTOUT HISTORY ANTI MISCEGENATION: Banning of inter racial marriage. Negative EUGENISTS ON EVOLUTION: believe that helping the poor is setting back 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. The phenomenon of DEMOGRAPHIC WINTER: A number of social trends of the post- war era have converged to create a perfect demographic storm which is the demographic winter. Men and women are delaying marriage, making it less likely to haver more than 1 or 2 children. In the West, almost 1 in 2 marriages ends 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. The rise of the graying population, often called by the name demographic winter, is a cause of a manifold of social and economic concerns. CASE SCENARIO: ROE V. WADE The decision involved the case of a woman named Norma Mc Corvey- known in her lawsuit under the pseudonym “ Jane Roe” – who in 1969 became pregnant with her 3rd child. McCorvey wanted an abortion, but she lived in Texas, where abortion was illegal except when necessary to save the mother’s life. She was referred to lawyers Sarah Weddington and Linda Coffee, who filed a lawsuit on her behalf in US federal court against her local district attorney, Henry Wade, alleging that Texas’s abortion laws were unconstitutional. A 3 judge panel of the US District Court for the Northern District of Texas heard the case and ruled in her favor. Texas then appealed this ruling directly to the US Supreme Court, which, agreed to hear the case.-410 US 113 (1973) SUMMARY OF ROE V. WADE The central court decision that created current abortion law in the US is Roe v Wade, In this 1973 decision, the supreme court ruled that women had a constitutional right to abortion , and that this right was based on an implied right to personal privacy emanating from the ninth and fourteenth amendments. In Roe v. Wade the court said that a fetus is not a person but “potential life” and thus does not have constitutional rights of its own. The court also set up a framework in which the woman’s right to abortion and the state’s right to protect potential life shift: During the first trimester of pregnancy, a woman’s privacy right is strongest and the state may not regulate abortion for any reason; During the second trimester, the state may regulate abortion only to protect the health of the woman; During the third trimester, the state may regulate or prohibit abortion to promote its interest in the potential life of the fetus, except where abortion is necessary to preserve the woman’s life or health.

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