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Bachelor of Science in Nursing 2YC NCMA218: BSN 2ND YEAR SUMMER MIDTERM 2022 Coverage for Midterm: Modules 1-9 Bioethics Introduction to Bioethics...

Bachelor of Science in Nursing 2YC NCMA218: BSN 2ND YEAR SUMMER MIDTERM 2022 Coverage for Midterm: Modules 1-9 Bioethics Introduction to Bioethics Samuel Gorovitz Theories and principles of health ethics and virtue ethics - An interdisciplinary field that examines the moral dimension in nursing of decision making in health care and life sciences. (to the Ethical Principles and Relevant Principles in Health Care point that some hospital come up to a point ethics committee, Principle of stewardship. that will resolve ethical issues with regards to health issues) Principle of Totality and Integrity. - Critical examination of decision making in health relate Principle of Ordinary and Extraordinary Means. context and in context involving biological science. Principle of Personalized Sexuality - He observes the issues that a healthcare worker encounters. Human Sexuality and its moral obligation and Marriage Issues on artificial reproduction and its morality. Morality Practice of Healthcare ethics on abortion and rape - Interdisciplinary field of study and practice that seeks Dignity of Death and Dying, Advance Directives and Do specifically, to understand the values undergirding making not resuscitate (DNR) decision and action in: 1. Health care INTRODUCTION TO BIOETHICS - Ex. The nurse and the doctor with the patient. A patient Discussed by Prof. Ma. Diosul Roque is supposed to undergo a certain procedure that will help Right & Wrong to identify what the real problem is or a patient who will - Some persons keep on doing wrong things because of: have a surgery. They will benefit from doing wrong things. (They are more - Scenario: a diabetic person who will be amputated concerned with the outcome) because if not his blood will be poisoned but he refused Satisfaction and pleasure. (The heart dictates the mind, ex. kase sabi niya binigyan siya ni Lord ng kumpletong Diabetic persons, they keep on eating what is bad from katawan at gusto niyang ma-meet si Lord ng buo siya. them to satisfy their self). - As a nurse we do not outright the patient’s refusal. Let’s The truth hurts and most people doesn’t like to be corrected continue to encourage the patient but we will encourage because of their pride and ego. (They want to keep their the patient after the doctor talks to him/her. We will use pride intact and cannot admit that they are wrong. The pride the doctor’s information to explain in the simplest dictates to continue what they do and what they wanted to manner to the patient at dadagdagan lang natin ito. do) Kausapin din ntin mga kamag anak nila to encourage the Beliefs and experiences (dahil maganda ung nagging patient not to refuse. Wag natin agad tanggapin na nag outcome nung wrong doing mo u continue to do it) re-refuse ang patient. If ever ayaw talaga niya document Human are naturally sinners, we have limitations and it in the patients chart and make the patient sign a weaknesses like adam and eve when temptations and waiver. problems come natutukso tayo at nadadaig. 2. Health research Circumstances the person may in could drive or pushes him - To come up with the new knowledge and intervention. to do something wrong instead of choosing the right way. - Effectiveness of new drug. Experimental (gagamitan ng (because of his way of thinking na tama un para sa kanya, to gamot) and controlled group (gagamitan ng ibang also have some acceptance kaya gagawa ka ng storya) substance). Ethics in here is how do we choose who will Environment he/she grew up with could influence his action belong in the experimental or controlled group. Ensuring that participants will be given voluntarily consent. Ethics Nabigyan dapat sila ng tamang information kunng bakit - Also called moral philosophy sila kasama dun sa research. - The discipline concerned with what is morally good and bad 3. Health policy and morally right and wrong. - Like privileges of Philhealth. - The term is also applied to any system or theory of moral - You pay for your Philhealth and yet old people just values or principles. benefit from it. - Moral issues - To provide guidance in action when this values conflicts. deals with respect for life (ex. abortion), freedom (from - Can be defined broadly as the examination of all kinds of anything but let us know that everything has a limitation), ethical and bioethical issues from the perspective of nursing love (what is acceptable to the society), issues that theory and practice which, in turn, rest on the agreed core provokes conscience (we cannot decide whether to accept concepts of nursing, namely: person, culture, care, health, it or not); issues that responds to ought, should, right, healing, environment and nursing itself. wrong, good, bad and complicated The Human Being Man - Is defined as bio psycho socio-cultural and spiritual well-being. J.A.K.E 1 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 - Biological - as nurses we are doing interventions to regain the turn aside from blind choice and try to be guided by the balance or homeostasis in the body for its proper functioning. objective standards of moral conduct (svc 1965). - Psychological – we should understand that a person is a thinking/ mental person that is aware of what is happening to ETHICAL PHILOSOPHERS/ BIOETHICISTS him/her. Discussed by Prof. Ma. Diosul Roque - Social being – no matter what the person is in he/she should not Immanuel kant be left alone. The more difficult a person is the more we should - His moral philosophy is a philosophy of freedom. Without realize that the patient is a lonely patient. He/she is shouting human freedom, thought kant, moral appraisal and moral because it is her way to draw attention. responsibility would be impossible. (kailangan rin nakakaranas - Cultural being – the patient and the nurse has own culture that ng kalayaan ung tao at dito natin masusukat kung ano ung mga could have a clash of culture but being a nurse, you should behaviors nila kung ano ang dapat at hindi dpt gawin) understand a patient. - The categorical imperative (CI); - Spiritual being – kahit na dumating na siya sa acceptance of Categorical- thoughts that do not accept exemption dying meron pa rin syang pinang hahawakan. Scenario: ung Imperative- denotes command (order, urgency to conform doctor pinapaalis ung statue ni mama mary kaso as a nurse u on what should be) derived from principle (pure reason than should stand from your decision na wag alisin kase alam mo at experience) mas kilala mo ung patient mo na un na lang ang nakakapag o Ex. Honesty is what is morally right at kung apply ito sa CI palakas sa kanya. wala dapat tayong palusot or sasabihing exemption sa The person pagiging honest, when u make a lie it’s a lie and whatever Biblical created in the image and likeness of God; differing that lie is whether it is small or big or white lie it is still a lie. from animals due to possession of spiritual intelligence and free o Stealing have 2 kinds of theft and robbery. Theft is stealing will; (because animals have instinct to survive, they fight other something from a person without his knowledge hindi niya animals but humans have intellect and will we know what is namalayan at hindi mo rin siya ginawan ng dahas. Robbery right from what is wrong) is stealing from a person with his knowledge using threat or God produces the human body through the cooperation of force. human parents; the creation of the human soul is a direct act of - Moral applies to all for all times. God; (we are products of pro-creation and when we are made - Kant's moral philosophy is a deontological normative theory, God put life into our soul.) which is to say he rejects the utilitarian idea that the rightness Each person is unique and irreplaceable; and are called not only of an action is a function of how fruitful its outcome is. (hindi to maturity but to eternal life tumitingin sa outcome kundi sa action mismo even fruitful un Human acts and acts of man outcome kung mali pamamaraan mo mali pa din un) He says - Not all acts are human acts; for an act to be human it must that the motive (or means), and not consequence (or end), of an have: knowledge and freedom action determines its moral value. - Human acts – is an act which proceeds from deliberate free will John Bordley Rawl of man. Man knows what he is doing and freely chooses to do - Resultant theory known as "justice as fairness”: what he does; (pinagiisipan at pinag dedesisyunan. Gising ka, 1. Society should be structured so that the greatest possible alam mo at may kalayaan ka para gawin ang isang bagay at amount of liberty is given to its members; pinili mong gawin un ng walang nag banta it is considered as 2. Inequalities either social or economic are only to be allowed human act. Kapag alam mong hindi siya pwedeng gawin kaso only if the worst will result under an equal distribution; (dpt tinakot ka, pinilit ka at ginawa mo so there is an absence of the equally divided kaso there are limitations of the resources ex. 2 components of human act and this considered act of man) Ung mga ayuda nung pandemic hindi naman lahat nabigyan. - Knowledge and freedom – characteristics of human act that is Meron kaseng equality and equity. Equality lahat pantay pantay different from acts of man. at equity kase binibigyan ka base sa pangangailangan mo lalo na kung limited lang resources pipiliin tlga kung sino lang dpt Knowledge mabigyan) - Of what it is about and what it means: facts, information, 3. If there is such a beneficial inequality, this inequality should and skills acquired by a person through experience or not make it harder for those without resources to occupy education; positions of power, for instance, public office. (even there is - The theoretical or practical understanding of a subject: inequality with resources we should give a fair chance to the awareness or familiarity gained by experience of a fact people to elect them) or situation St. Thomas Aquinas Freedom - St. Thomas four cardinal virtues - To do or leave it undone without coercion or constraint. 1. Prudence - Implies voluntariness which is to rationally choose by - The act of being careful cautious. (Opposite of carelessness) deliberate will the object - First cardinal virtue because it is concerned with the - An idea of reason that serves an indispensable practical intellect (we use our knowledge and wisdom). function. Without the assumption of freedom, reason - We should follow step and procedure para hindi mag kamali. cannot act. (ex. We invert the hot water bag upside down to check for - Conscience - the inner sense of right or wrong that enable leakage and if well sealed and we put this into the foot of individuals to discern moral choices freely. Hence the more a the patient who is feeling cold with a towel or newspaper correct conscience prevails the more do persons and groups J.A.K.E 2 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 but the carelessness in here is that the nurse forgot to ask - You achieve your goals in respective of the means. the patient’s tolerance to the hot water na pwede nmn Utilitarianism palang wala ng towel kahit na we use the towel to prevent - Also called consequentialism, a form of teleological theory the patient from burnt e kung tolerable nmn sa patient ung (telos –end). init khit wag na natin to ilagay. Pwede rin na dpt hininaan - The action is judged as good or bad in relation to consequences. na lang ung aircon or binigyan ng extra cloths. Dapat rin (dapat na achieve natin ung goal at nagging maganda ung educate natin ung patient na kahit tolerable sya sa hot water outcome) eh bawal pa din alisin un towel kase magkakasugat siya - Requires to tell the truth (keep promises, avoid killing, and so dahil diabetic sya) on) in all circumstances - If a nurse left to do something and it caused harm to the - Sacrifices rights of individuals in favor of overall good. patient the nurse involve can be charge of negligence. - Also called consequentialism, a form of teleological theory 2. Justice (telos –end). The action is judged as good or bad in relation to - The second cardinal virtue, because it is concerned with the consequences. will - - act utilitarianism-allows for different, sometimes opposing - The constant and permanent determination to give everyone action in different situation. his or her rightful due. - - rule utilitarianism- suggest that people should act according to - As a nurse what is due to a patient it is a quality care for the the rules that tend to maximize happiness and diminished patient to recover or improve health of the patient. unhappiness - Every man is due. - We should not look at the patient’s status they should be treated fair. 3. Temperance - The restraint of our desires or passions. 4. Fortitude - Allows us to overcome fear and to remain already in our will in the face of obstacle. - Usually equated with the word courage or beyond courage. Theories and Principles of Health Ethics - Ethical theories Virtue Ethics / Character Ethics 1. Deontology - Does not question how we act but instead studies how we are as 2. Teleology people, it is agent centered. (Ito ung nakalakahihan mo na na- 3. Utilitarianism absorb mo na at mag mamanifest na un sa actions mo. A person Deontology is going to be a good person but we don’t question whether he (Deontological Theories: Formalism, Kantianism) is right or wrong) - The rightness and wrongness of an act depends upon the nature - “Is mr. X a good person?” Rather that “is mr. X right or wrong of the act rather than the consequences. (duty oriented, one has to do this thing bcs it is his/her duty). The consequences of - Western moralism cardinal virtues: wisdom, courage, temperance, justice, generosity, faith, hope ,and charity. action is essentially irrelevant (kant) - An act would be either right or wrong not both. - Modern and contemporary writers: honesty, compassion, caring, responsibility, integrity, discernment, trustworthiness, and - Morality – is derived from rationality (pinag-iisipan), not from prudence. (mas nagging madali ang pag galling nila kase experience and obligation is grounded not on the nature of man somebody try to talk to them and give their time to lessen their or circumstances but in pure reason. emotions) - Ex. Ung nurse inassign sa HIV ward so the nurse response - Moral values; truthfulness. Kindness, or honesty. should not refuse kase un ung inassign sa kanya e. Immanuel Kant’s Categorical Imperative - Categorical imperative – moral rules that do not accept exemption (lying, suicide, squandering of talent and helping others) - Practical imperative- act whether your own person or others always as a means not as and end (domination of one person over another is morally wrong, performing of duties owed) Teleology - A theory of ethics (as utilitarianism or ethical egoism) according to which the rightness of an act is determined by its end. - Explain phenomenon by referring to purpose, ends and aims. - Answer the question why? J.A.K.E 3 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 The Golden Mean - Deficiencies in moral integrity may include vices, insenserity, - Practicing moderation, avoiding excess and deficiency and bad faith (aristotle). For him the basic moral question is “one should one be?” Rather than “what should one do?” (ano ka ba dapat? Virtue Ethics in Nursing Hindi ung ano ang dapat mong gawin) - Florence nightingale thought virtue was an important trait of a - A positive will is sometimes necessary ingredients in success. good nurse. Traditionally recited by the graduating nurses, the (p. Foot). nightingale pledge implies virtue of character as nurse promise - “One man may succeed where another man fails not because of purity, faith, loyalty, devotion , trustworthiness and temperance their differences in the previous conduct but because their heart - Good character - is the corner stone of good nursing and the lies in different place, the disposition of the heart is part of the nurse with virtue will act according to principle. virtue. The innermost desire. Virtue must actually engage the - How does the concept of virtue ethics fit with nursing as will. P.foot) principled profession? 4 Focal Virtues (Beauchamp, Childress) Compassion ETHICAL PRINCIPLES (UNIVERSAL PRINCIPLES) - The ability to imagine oneself in the situation of another Discussed by Prof. Ma. Diosul Roque (empathy, extends desire to help other people) Autonomy - Combining attitude of active regard to another’s welfare (gusto - Autos – self mo na mas maging maginhawa ang pt.), with awareness and - Nomos – governance emotional response of deep sympathy, and discomfort and - Autonomy is closely linked to the notion of respect to person misfortune or suffering of another person. (binibigyan natin ung tao ng pag papahalaga or chance to - Internalizes the golden rule decide for himself kase katawan niya un) - Compassion sometimes outweighs technical care - An important principle in culture where individuals are - Be careful that compassion does not impede our ability to make considered unique and valuable member of the society objective decision 4 Basic Element of Autonomy Discernment - The autonomous person is respected. There is uniqueness. - The autonomous person must be able to determine personal - Classical concept of wisdom. (kapag nurse kana dpt matured goals. (Ano ba tlga ung gusto niyang mangyari? Gusto ba tlga thinking kana) nyng gumaling? Give the patient all the information and by that - Rest on sensitive insight involving acute judgment and he/she can use his/her autonomy. Informed consent must understanding and it eventuates in decisive action. (beauchamp always be based on informed choice) and childress, 1994) - Has the capacity to decide on the plan of action. Understand the - Discernment requires that we continually strive to recognize meaning of choices to be made and deliberate various option and understand important nuances in human behavior. while understanding the implication of possible outcome. - Ex. A discerning nurse will recognize when a patient needs - Groups that are mentally impaired to make inform consent, comfort and reassurance rather than privacy. (dapat may children, fetus, and mentally impaired. (may mga patient na sensitivity ka ex. kung kailangan mong iwan ung patient or hindi magamit ang autonomy dahil mentally impaired, hindi) unconscious, minor children. Emancipated minor doesn’t need Trustworthiness parents’ permission) - Trust is a confident belief in and reliance upon the ability and - Ex. Sterilization should be signed by the couple. But if the moral charater of another person. (dpt mapagkakatiwalaan ung problem is just to remove the problem of the wife because of nurse sa responsibility na ibinigay sa kanya) bleeding and some diseases in her reproduction organ there is - Trust entails a confidence that another will act with right no need for the husband to sign. motives in accord with moral norm (beauchamp and Intrinsic Factors That May Threaten Patient’s Autonomy childress,1994) - Dependent role on health care provider. Patients are asked to - Measured by others’ recognition of nurse’consistency and comply with the rule that requires them to be and act predictability in following the moral norms and reputation that dependently. Upon admission. we have among coworkers - Patient are disrobed, asked personal and private matter, forced - This virtue is important in relationship with patient, physicians to relinquish money and belongings, and expected to remain in and other nurses. bed, that emphasizes the dependency role. Integrity - Placed in a room that is seldom closed. - Moral integrity means soundness, reliability, wholeness, and - Labeled as difficult or non-compliant if they do not follow each integration of moral character. plan. - Continuing to follow moral norms overtime with active fidelity Violations of Patient’s Autonomy to those value judgment and action 1. The nurse falsely assume that the patients have the same values - The person has consistency of conviction, actions, and and goals themselves. (kapag pinangunahan na agad si patient) emotions, and is trustworthy. (nabuo kana nung mga virtues 2. Failure to recognize that individual’s thought process is natin) different. (huwag pilitin si patient to sign) - Integrity will be compromise if the nurse is inconsistent 3. Assumptions about the patient’s knowledge base 4. The work of nursing becomes the focus instead of caring J.A.K.E 4 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 Informed consent patient is non-compliance, it is not just the fault of the pt. but - The process by which patients are informed of the possible also the nurse failed to do. Ex. Papaiwan nung pt. ung gamot outcomes, alternatives and risk of treatments and are required tapos hindi naman iinumin so dpt wag ntin tong gawin we must to give their consent freely. confirm na nainom na nya ung gamot. What u write to the chart - Assures legal protection of patient’s right to personal is what u have really done) autonomy in regard to specific treatment and procedures. - Care of noncompliant patients centers on 2 basic factors - Nursing signature is a sign that he/she is a witness and the - Autonomous participation of the client importance of this is the consent was taken voluntarily and - The nurse and other health care professionals must assess the the patient is mentally competent. Before u sign make sure patients abilities to follow plans of care. (lack of resources, lack the patient is fully alert and awake. of knowledge, lack of support from family members, Paternalism/ Parentalism psychological , and cultural beliefs) - Paternalism – gender biased term that literally means acting in fatherly manner. The traditional view of paternal action Beneficence includes such role behavior as leadership, benevolent decision - The nurse is required to act in ways that benefit patients. making, protection and discipline. - Beneficent act are morally and legally demanded by our - Parentalism – non gender term parallels the meaning of professional role. (do not harm the pt. and do only good to the paternalism pt) - In health care arena parentalism translate to professionals - Nurse action to promote good who restricts others autonomy, to protect that person from Ma’am Roque perceived harm. (ex. Doc. Finds out the patient is terminally - Duty to do acts of kindness and mercy that directly benefit the ill patient and patient looks depressed the doc will hold the patient through health promotions, preventions of results and this is called a benevolent decision) illness/complications, alleviation of suffering or assisting - Parentalism is appropriate when a patient is judged to be towards a peaceful death. incompetent or to have diminished decision-making capacity. 3 major components of the ethical principle of beneficence. - Ex. Restraining a patient may be justified because of the risk 1. Do or promote good of harm. (Ex. A pt. was brought to the ER by a stranger and 2. Prevent harm the pt. is soaked with blood she lost 3 unit of blood so the doc. 3. Remove evil or harm exercise his right to decide to the patient to have blood - The nurse takes appropriate action to safeguard individuals in transfusion huli na nung dumating ung asawa nung pt. at their care are endangered by co-workers or any other person sinabing Jehovah’s witness pala sila) - Ex. Health teaching by educating pt. what to do and not to do. - But the risk of harm is not enough by itself to judge a person Checking the room of the patient. Doing ID before medication is incompetent. (Restraining a patient should be ordered by a to check if the pt. has an allergy if negative pwede i-recheck by doctor if wala doc. look at the hospital policy kung need na doing it on the other arms, skin test should be interpreted by a tlga i-restrict) nurse and confirmed by a doctor. Lahat ng tamang pag iingat ay - Ex. A 94-year-old Virginia Anderson, who is certainly gawin bago mag bigay ng medication. competent, recounts her experience in the hospital. She could not stand a prolonged stay in bed and opted to sit on a chair. Non maleficence This is when the nurse saw her, and immediately tell her that - The principles require us to act in such a manner as to avoid she would be tied up if she will not go back lying-in bed. Ms. causing harm to the patient. This includes deliberate harm, risk Anderson told herself “You just try it.” (we have to instruct of harm and harm that occurs during the performance of the patient to ring the bell to assist him/her by a nurse. Let beneficial act. (Do no harm by making sure that you check the them do what they want u just have to assist them. They want procedure, do no harm by at least checking the medication 3x to be useful as they are even though they are old) while observing for the 10rs. Do no harm by refraining from - Paternalism also evokes negative sentiments among nurses; telling the other nurses about the status of your pt. do no harm autonomy of the patient is violated in the name of by not damaging the reputation of other people) beneficence. Professionals make dangerous assumption that - This prohibits experimental research that assumes negative they are qualified to make health care decisions by virtue of outcome and performance of unnecessary procedure for their knowledge and that knowledge is enough to make economic gain or solely as learning experience. decision for the client - Avoiding harm as a consequence of doing good. The harm - In making decisions all factors; economic, lifestyle, values, must be weighed role, culture, and spiritual belief must be taken into - Ex. Giving immunization, on the other hand while causing pain consideration results in benefit of protecting the child. Ma’am Roque - In situation where distinction is not clear because the harm is - Assuming the authority to make a decision for another equal to the benefit, or the outcome cannot be assured. - Ex. Narcotic analgesia for patient with terminal illness to Noncompliance relieve pain but causes dependence and hasten death when - Denoting unwillingness of the patient to participate in health given in amount required to relieve pain. care activities like taking medications as scheduled, - Ex. Orders of npo for procedures to elderly patient for a series maintaining weight loss diet, regular exercise, quitting smoking. of test up to 6 day This represents failure of the nurse and the patient. (If the J.A.K.E 5 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 Ma’am Roque knowledge in the practice of my profession” Florence Non-maleficence - do no harm nightingales oath Justice - “Whatever, in connection with my professional practice, or not - The right to be treated justly, fairly, and equally. in connection with it, I see or hear, in the life of men, which - Ex. Fair opportunity rule in terms of distribution of goods ought not to be spoken of abroad, I will not divulge, as and resources. reckoning that all such should be kept secret.” Hippocratic oath Ma’am Roque - Equal access to goods and services. Confidentiality – respect for individual privacy (expose only - Art XIII of the Philippine constitution guarantees that the the part needed) the state shall adopt an integrated and comprehensive A. Protecting the physical privacy of patients approach to health development and shall endevour to B. Consider all information gathered from patients as make essential goods, health and social services available confidential (priviledge communications extends even after to all people at affordable cost. There shall be priority for the patient’s death) the needs of the underprivileged, sick, elderly, and the C. Do not discuss patients with anyone not professionally disabled the women and children. involved in their care. Veracity Confidential information may only be revealed when: 1. Patients themselves permit such revelation (insurance - Truth telling (code for the doc. & the nurse) claim) - Deception is accomplished through non-disclosure (nag aantay 2. Medico-legal case, w/c have to be reported to the local ka ng tamang panahon kung kailan ba dpt sabihin sa pt. inaatay police or NBI (ex. stab wound, gunshot wound, rape, mong maging more stable ang pt.) suicide) - Practice of telling the truth. But, bioethicist disagree on the 3. Communicable disease cases where public safety may be absolute necessity of truth telling in all instance. jeopardized - Truth telling engenders trust, lack of respect. 4. Given to the members of the health team if information is - Patient has the right to obtain complete, current information relevant to his care. concerning diagnosis, treatment and prognosis in terms they Art IV Sec 4 Of The New Philippine Constitution – also states can understand. This position relates to the physician, nurses as that: “the privacy of communication and correspondence shall advocates has the responsibility in assuring patient’s right are be inviable except upon lawful order of the court or when honoured. public safety and order require otherwise” - Binds both the health practitioner and the patient in association Data Privacy Law Republic Act No 10173 – an act protecting of truth individual personal information in information and - The one responsible for deception when unfortunate communications systems in the government and the private consequences occur, can be assumed as the one responsible. On sector creating for this purpose a national privacy commission the other hand when bad consequences occur after we reported and for other purposes. the truth, we can attribute responsibility to unfortunate Arguments in Favor of Maintaining Confidentiality circumstances. The individual’s right to control personal information, and - There is discrepancy between nursing and medical literature in protect privacy. regard to veracity, and disclosure of information involved - The patient has the right to expect that personal information nurses and physician, it is important to understand the medical will not be shared unnecessarily among health care perspective. providers Ma’am Roque - Patient information is not an appropriate topic for elevator - The obligation to tell the truth both on the patient and health and dinner conversation. care provider’s part. - Care must be taken in choosing information to be recorded - Patient’s Part: accurate and complete information about his in patient’s chart, including electronic records complaints, past illness, previous hospitalization, medication, One utility allergies, religious restrictions and other relevant data. - if the patient suspect that health care providers reveal - HC Provider’s Part: diagnosis, plan care, treatment, possible sensitive and personal information indiscriminately, they risks, length of treatment, expenses, options. are reluctant to seek care. This problem was recognize and - Exception to the rule of veracity is Benevolence Deception: the confidentiality is mandated (reproductive health issues, practitioner intentionally withholds information according to aids) his sound judgement when such revelation would cause more Limits of confidentiality harm to an emotionally unstable or depressed person. - Maintaining confidentiality will result in preventable wrongful harm to innocent others. (Mandatory premarital testing for Confidentiality syphilis). Duties of confidentiality is not absolute and may need - Ethical principle that requires non-disclosure of private or to be modified to protect the patient, innocent people and for secret information with which one is entrusted. Support for this public safety. principle is found in codes and oaths of nursing and medicine. - Foreseeability of harm in which confidentiality conflicts with - “I will do all in my power to elevate the standard of my the duty to warn. (Harm principle) profession and will hold in confidence all personal matters - Justice committed to my keeping and all family affairs coming to my J.A.K.E 6 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 - Relates to fair, equitable and appropriate treatment in light of drugs, it's no use saying that my intention was to relieve their what is due or owed to persons, recognizing that giving to some pain. And that applies even if there was no other way of will deny the receipt of others who might otherwise have controlling their pain. received these things. (distributive justice) Principle of Legitimate Cooperation Fidelity - To achieve a well-formed conscience, one should always judge - Concept of faithfulness and practice of keeping promises. (ex. it unethical to cooperate formally with an immoral act (that Ms. Masakit napo balakang ko may gamot po ba dito? Yes, po is, directly to intend the evil act itself) (Para amalinis ang ma’am check ko muna po sa chart balikan ko po kayo. Pero ang konsensya mo dpt lahat ng gusto mong gawin at isagawa ay tagal na hindi pa rin bumabalik si nurse) mga bagay na hindi lalabag sa ethical principle at hindi - Licensure makes nurse a legitimate member of the profession maituturing na immoral act) mandated to uphold the responsibilities inherent in the contract Types of Cooperation of the society. Formal Cooperation - Members are called to be faithful to the society that grants the - Occurs when a person or organization freely participates in right to practice- keep promises in upholding the code of ethics, the actions of a principal agent. Implicit formal cooperation practice within the scope of practice and definition of nursing, occurs when even though the cooperator denies intending the remain competent in practice, abide by the policies, and keep object of the principal agent, the cooperator participates in the promises to individual client. action. Ma’am Roque - Ex. Nag tatrabaho ka sa clinic ng OB gyne tapos may Fidelity kapitbahay kayong OB gyne pero nag aabort, ung nurse sa - The duty to keep one’s word or promise nag aabort na clinic inalok ka na mag refer or sumideline kase - Ex. Make sure to complete contracts mataas sahod so kapag nag comply ka dito kasama kana rin sa Advocacy pumatay dun sa fetus there is acting participation by assisting - To look out or speak up for the rights of others and you are already an accomplice as well as accessory to the - There are times pt. are hesitant to voice out to the doctors crime. Pero kapag hindi ka nag refer or or sumideline binalaan mo lang sila na may nag mamanman na pulis then u Other Principles are facilitating the escape of the crime Principle of Double Effect Immediate Material Cooperation - This doctrine says that if doing something morally good has a - Occurs when the cooperator participates in circumstances that morally bad side effect it's ethically ok to do it providing are essential to the commission of an act, such the act could the bad side-effect wasn't intended. This is true even if you not occur without this participation. A debate on about duress foresaw that the bad effect would probably happen. (may wherein an act was done at gunpoint. intended outcome kaso iba ung nagiging epekto) Mediate Material Cooperation - The principle is used to justify the case where a doctor gives - Occurs when the cooperator participates in circumstances that drugs to a patient to relieve distressing symptoms even though are not essential to the commission of the action, such that the he knows doing this may shorten the patient's life. action could occur even without cooperation. Factors Involved In The Doctrine Of Double Effect Principle of Common Good and Subsidiarity - The term the "common good" has been used in various contexts - The good result must be achieved independently of the bad to identify actions or outcomes that have some definable one: for the doctrine to apply, the bad result must not be benefit that extends beyond individual gain. (Dictates what will the means of achieving the good one. So if the only way the help the profession to grow) drug relieves the patient's pain is by killing him, the doctrine of double effect doesn't apply. - Nursing is viewed as promoting the common good - The action must be proportional to the cause: if i give a - Nursing also addresses the need to balance the preservation of individual dignity and respect against societal integrity. (hindi patient a dose of drugs so large that it is certain to kill them, dpt tayo gumawa ng bagay na nakakasira) and that is also far greater than the dose needed to control their pain, i can't use the doctrine of double effect to say that what i Therapeutic Privilege did was right. - The action must be appropriate (a): i also have to give the - The legal exception to the rule of informed consent which allows a caregiver to proceed with the care in case of: patient the right medicine. If i give the patient a fatal dose of emergency, incompetence, waiver, implied consent (hinayaan pain-killing drugs, it's no use saying that my intention was to ka nung pt na gawin ung procedure or nag kusa sya gawin). relieve their symptoms of vomiting if the drug doesn't have any effect on vomiting PRINCIPLE USED IN BIOETHICS - The action must be appropriate (b): i also have to give the Discussed by Prof. Ma. Diosul Roque patient the right medicine for their symptoms. If i give the Principle of Stewardship patient a fatal dose of pain-killing drugs, it's no use saying that - Stewardship - The job of supervising or taking care of my intention was to relieve their symptoms of pain if the something, such as an organization or property. (or anything patient wasn't suffering from pain but from breathlessness. that has been given to us or anything precious and something - The patient must be in a terminal condition: if i give the that is entrusted to us could be a person, things, properties or patient a fatal dose of pain-killing drugs and they would have recovered from their disease or injury if i hadn't given them the J.A.K.E 7 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 organization kaya dapat may kaukulang pag iingat at pag and develop because when you do this it will not just aalaga tayo dito para hindi ito masira, masayang at maaabuso) benefit you but will also be extended to our client/patient) - God has the absolute domain over creation. (Everything that b. Social has been given to us, in us or outside of us are absolute - Nurses advocate for the health promotion to educate domain of God) patients and public on the prevention of illness and injury, - Man is made in God’s image and likeness; we have given the provide care and assist in cure, participate in rehabilitation limited dominion over creation and WE are responsible for its and provide support. care. (Everything that you do should always please God) - (This aspect or function of nurses also embodies code of - Two great gifts that a wise and loving God has given to us; ethics. In the nursing law the nurse role is to improve 1) the earth, with all the natural resource (all the things promotion of health, prevention of illness, care of the ill provided from us here on earth is where we get food and towards rehabilitation. Kung hindi man natin maibalik and etc. to sustain our life and for our shelter) sa normal condition ung patient dapat they can still act/be 2) Human nature (our body), with its biological, useful and if they are dying, we should help them through psychological, social and spiritual capacities. (This is like what Virginia said about dying persons. Stages of our ability to relate to other people and exercise our dying are denial, anger, bargaining, depression, and spiritual capacity. Problems are brought upon us by us acceptance, some people stop at a point. A nurse should what we did to our environment just goes back to us. also be a culturally competent they know and understand The earth has to be able to sustain human nature as well as able to adjust and adopt their nursing care however, human nature has affected the earth that is according to the patient they take care of) why the earth cannot able to sustain human nature) - Nurses help families become healthy by helping them - Human creativity should be used to cultivate nature, understand the range of emotional, physical, mental and recognizing our limitation and the risk of destroying these cultural experiences they encounter during health and gifts. (Our brain is able to have higher thinking skills to create. illness. Example technology has good and bad side effects. If human - Nurses help people and their families to cope with their beings used their creativity to make something else, produce, illness and deal with it and if necessary live with it, so that invent, discover it must be for good intent) their normal life can continue. (ex. Pt who are dying, - Gifts of human life and environment MUST be used with according to Watsons nurse should be able to in-still faith profound respect. (ex. Abortion, in-vitro fertilization, and hope specially for those who are feeling hopeless and transgender) faithless about their health status. It is the nurse role to Stewardship in a Health Care Practice find the reason of hopelessness and faithlessness so that - Refers to the expression of one’s (health care practitioners) she may be able to find way by w/c this person can be responsibility to take care, nurture and cultivate what has been addressed) entrusted to him. (Clients were entrusted to health care c. Ecological practitioners they are the consumers of our care and it includes - Nurses can help with waste management. Health care both the well and sick individual) sectors generates tons of waste from the hospitals and - In healthcare practice, STEWARDSHIP refers to the since nurses are the frontlines of care, they can be helpful execution of responsibility of the health care practitioners to in coming up with policies about hospital waste look after, provide necessary health care services, and promote segregation and recycling. Nurses can lead a way for the health and life of those entrusted to their care. communities to have a more sustainable way of living. - {This is also embodied in the PH nursing law RA 9173 – it is - (Nurse should be an advocate regarding ecological safety the duty of the nurse to take care of the patient whether they and a role model. Nurses must be the manifestation of are acting out seemly or independently or even if they are what she advocates. What you talk is how you walk what working as a member of a team. Nursing care starts from the you take is what you do.) womb and even towards the tomb – from a baby has been d. Biomedical conceived (kase kung naaalagaan natin ng maayos ung pag - A nurse should be familiar and well versed with new bubuntis nung nanay maaalagaan din natin ung baby), up to equipment and tools that are being used in the hospital the old age even death because we give postmortem care.} and other clinical setting. (Nurses should know basic Roles Of Nurses As Stewards procedure but nurse should also be able to adopt new a. Personal technology) - The nurse steward ought to structure educational - According to the theory of Locsin, entitled Technological opportunities that encourage nurses to shift their competency as caring in nursing, a nurse can be a steward epistemology of practice to integrating a virtue-based of patients if they know how to use technology to their practical reasoning. (Pursuit of knowledge should not be advantage. for knowledge itself ex. Habang tumataas IQ mo o pinag araalan mo nawawala pag ka virtuous mo.) Principle of Totality and Integrity - (As you go along to the lather of additional knowledge to - The principle of totality states that all decisions in medical expand yourself and improve yourself, enhance yourself ethics must prioritize the good of the entire person, including there, should always be the integration of virtue base physical, psychological and spiritual factors. practical reasoning. It is in-need for nurses to improve - (When we take care of our patient we don’t just look or knowledge what you have learned should be enhanced address to his/her certain physical illness but as a whole, J.A.K.E 8 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 holistically. We should look to other aspect of his/her body on 14) Nurses ethically should support patients in their choices, how certain physical illness is affecting his/her other aspects regardless of whether they agree with the patient's decision. psychologically, emotionally and etc.) 15) Nursing assessment and care also applies to situations in Supporting Patients’ Rights and Choices which patients identify advance directive choices or decisions 1) Respect the dignity and worth of individual patients. related to do‐not‐resuscitate orders. It is the nurse's role to 2) Preserves and protects patient autonomy and human rights. ensure that surgical team members are aware of a patient's 3) Be knowledgeable about the moral and legal rights of their wishes in these matters. patients and to protect and support those rights. (Always 16) It is important that all team members and the patient discuss remember that we are advocate of our patient, means we and identify a plan of care before beginning the surgical always have to speak in behalf of our patient who is not procedure. knowledgeable to the things that could affect her health, help patient to speak kase minsan hesitant sila to ask their Ethical Dilemmas concerns) - An ethical dilemma (ethical paradox or moral dilemma) is a 4) Individual rights to self‐ determination in health care should be problem in the decision-making process between two possible overridden temporarily to preserve the life of the community. options, neither of which is absolutely acceptable from an Self‐ Determination Vs. Public Safety ethical perspective (when you decide you look at the pros and - For example, during a bioterrorism attack, victims cons and then you will come up with a good decision. Ex. infected with transmissible organisms (eg, small pox, Umagree na si pt. kaso nung pipirma na sya hesitant sya so covid 19) require infection control measures to ang tagal kaya ung doctor fno-follow up na si nurse kung prevent transmission to others. nasaan na so ano ang dapat gawin? The procedure should be - These infection control measures may require post-phoned) isolation, resulting in restricting a patient's right to - Ethical dilemma when a patient is anxious because he or she freedom of movement to protect others. (Kaya nga does not understand fully what is going to happen in surgery may quarantine or lockdowns) and the nurse is being pressured for a fast turnover time. 5) Supporting patient's participation in decision making, - Nurse is told to get the patient's signature on a consent form. confirming informed consent, and implementing advance Nurses must realize that they are not being asked to provide directive policies (documents that needs to be prepared in informed consent for the patient. (Hindi pwedeng diktahan advance kung sakaling ma-comatose ang pt. like sino ang dpt nung nurse si pt. to say na naipaliwang napo yan pirmahan mag desisyon para sa knya kapag unconciuos na siya at niyo na lang po nag hihintay napo si doc.) specifiy nya kung hanggang saan ang kailangan ibigay sa - The nurse is merely acting as a witness to the identity of the knyang panga-galaga etc. it is a reflection of the wishes of the patient and to the patient's signature on the consent form. patient by the time his/her level of consciousness is affected.) - Once again assess the patient's level of understanding and see 6) Provide patients with honest and accurate answers to their if he or she wishes to further discuss the proposed intervention questions. with the physician. 7) Perioperative nurses should explain the procedures and OR Sterilization environment before initiating actions. Familiarity of the pt. - Refers to any process that eliminates, removes, kills, or with what is in her immediate surroundings also lessens the deactivates all forms of life and other biological agents. (This anxiety. is permanent that he/she will not get any children however, 8) Respect patients' wishes in regard to advance directives and there are people who have undergo this but able to get end‐ of‐life choices. pregnant again) 9) Patients have the right to self‐ determination (ie, the ability to Female Genital Mutilation (FGM) decide for oneself what course of action will be taken in - comprises all procedures that involve partial or total removal various circumstances). of the external female genitalia, or other injury to the female 10) Nurses can empower patients by providing opportunities for genital organs for non-medical reasons. (This is seen from them to make autonomous decisions about their health care. some tribes) 11) When dealing with informed consent, the nurse's role is to Preservation of Bodily Functional Integrity validate that the patient has been given the information and - Principle of integrity – refers to every individual’s duty to understands as much as possible about the surgical preserve the view of the human person in which the intervention. (ano ung mga dapat malaman ng pt. at ano ung order/function of the body and its systems are respected and mga alternative action ng mga doctor na ina-allow nya kapa not duly compromised by medical interventions. (If there are gung procedure does not proceed as planned dpt rin malinaw interventions to be done to the pt’s must be focus in the ang kaisipan ng patient kapag pinapirma o binigyan sya ng problem of functionality. Ex. Organ donor) consent) - Anatomical - material or physical integrity of the body 12) The principle of autonomy provides for patients to make decisions freely, even if those decisions are against medical - Functional - systemic efficiency or functionality of the body advice. (Inform the doc about pts refusal, chart it, and make - This principle dictates that the wellbeing of the whole person patient sign the waiver) must be taken into account in deciding about any therapeutic 13) Even if the surgeon and nurse believe that surgery is in the intervention or use of technology. best interest of the patient, the patient has the right to refuse - Therapeutic procedures that are likely to cause harm or the procedure at any time, regardless of whether he or she undesirable side effects can be justified only by a signed the surgical consent form. proportionate benefit of the patient. J.A.K.E 9 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 - For example: providers kung ano kaya nila magawa like ipinag pasa Dios na If one organ is missing from the person’s body = lack of lang lahat) anatomical integrity - Ordinary means – must be taken to preserve life But if one kidney is healthy, present and functioning well - Ordinary means are those “means of treatment available are = functional integrity is preserved objectively proportionate to the prospects for improvement.” Issues on Organ Donation (Done to sustain the life of the patient) - Organ donation is when a person allows an organ of their own - For example, a feeding tube is an ordinary means of to be removed and transplanted to another person, legally, preserving life either by consent while the donor is alive or dead with the - Extraordinary means – are “medical procedures which no consent of the next of kin longer correspond to the real situation of the patient, either - Donation may be for research or, more commonly, healthy because they are by now disproportionate to any expected transplantable organs and tissues may be donated to be results or because they impose an excessive burden on the transplanted into another person. patient and his family. (Putting all your hopes to a miracle) - Some organs and tissues can be donated by living donors, such - Ordinary means must be taken to preserve life, and as a kidney or part of the liver, part of the pancreas, part of the extraordinary means can be morally refused lungs or part of the intestines, but most donations occur after - Advance directive – voluntarily written document. Patient the donor has died. specifies what type of medical care he/she wants in the future - Common transplantations include kidneys, heart, liver, if he loses his capacity to make decisions. It includes the pancreas, intestines, lungs, bones, bone marrow, skin, and following: corneas. a. Health care proxy – client gives another person the power - RA 7170 – organ donation act of 1991, an act authorizing the to make decisions regarding medical treatment. Must at legacy or donation of all or part of a human body after death least be 18 years old, and of sound mind. His/her power to for specified reason. decide ends when the patient dies. Proxy cannot decide regarding organ donation. (Pero sa property ng Section 3 (Person who may execute a legacy) – any pasyentelike organs hindi na sya pwedeng makialam dito) individual, at least 18 years of age and of a sound mind, b. Living will – a document that provides specific may give by way of legacy, to take effect after his death, instructions about health care decisions. all or part of his body for any purpose specified in section c. Consent – authorizes a person to give a specific 6 hereof. treatment/care. Absence of this makes the members of the Section 4 (person who may execute donation) – ex. health team liable for criminal, civil and administrative namatay na ung pt tapos wala syang nagawang living will offense. so eto ung mga pwedeng mag decide para sa katawan niya: Principle of Personalized Sexuality 1. Spouse - Sex – is a social necessity for the procreation of children and 2. Son or daughter of legal age their education in the family so as to expand the human 3. Either parent community and guarantee its future beyond the death of 4. Brother or sister of legal age or individual members. Teaches that God created persons as male 5. Guardian over the person of the decedent at the time and female and blessed their sexuality as a great and good gift. of his death Section 6 (person who may become legatees or donees) – HUMAN SEXUALIY AND ITS MORAL OBLIGATION AND The following perosns amy become legatees or donees of MARRIAGE human bodies or parts thereof for any of the purposes Discussed by Prof. Ma. Diosul Roque stated hereunder: Human Sexuality and its Moral Evaluation A. Any hospital, physician, or surgeon – for medical or - Human sexuality - refers to people’s sexual interest in and dental education, research, advancement of medical attraction to others, as well as their capacity to have erotic or dental science, therapy or transplantation. experiences and responses. B. Any accredited medical or dental school, college or - People’s sexual orientation - is their emotional and sexual university – for education, research, advancement of attraction to particular sexes or genders, which often shapes medical or dental science or therapy their sexuality. C. Any organ bank storage facility – for medical or dental education for research, therapy or - Sexuality - may be experienced and expressed in a variety of ways, including thoughts, fantasies, desires, beliefs, attitudes, transplantation and values, behaviors, practices, roles, and relationships. D. Any specified individual – for therapy or transplantation needed by him. Moral evaluation - Christian ethics has centered its consideration of human Principle of Ordinary and Extraordinary Measures sexuality in committed monogamous lifelong heterosexual Christian marriage. (Anything that does not fall in this - Ordinary measures – are those that are based on medication or standard is already a violation?) treatment which is directly available and can be applied without incurring severe pain, costs or other inconveniences (It - Marriage is seen biblically and theologically, to signify is based from the pt if he/she will allow ordinary measure Christ's union with the Church. (Paano kung may couple na should be done or it will be based from the health care kuntento na lang as a couple?) J.A.K.E 10 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 - In Christian marriage sexuality is only good insofar as it is Fundamentals of marriage open to PROCREATION. Husband – A married man considered in relation to his spouse. - Sexuality is both a good in itself and a means of achieving Wife – A married woman considered in relation to her spouse other goods and purposes, including for example such things Marriage License – A license that a couple must obtain before as commitment, fidelity, mutual joy, and comfort. getting married - The basic criteria for evaluating any relationship have to do Personal obligation of the spouse to each other with the extent to which key relational components are present Live together; and expressed in ways appropriate to the particular To observe mutual love, respect, and fidelity; and relationship. To render mutual help and support. - Mutual regard, respect, and truthfulness are minimums for any Issues on sex outside marriage relationship. Premarital sex - Relationships that are more than fleeting ought also to involve - is a sexual activity that is practiced by people before they responsibility, loyalty, accountability, attentiveness, and are married. availability. - Historically, premarital sex has been considered a moral - Long-enduring relationships require commitment, fidelity, issue that is taboo in many cultures and it is also reciprocity, forgiveness, and generativity. (As a couple they considered a sin by a number of religions, but since the should develop as individual and there should be 1 to sexual revolution of the 1960s, it has become accepted by contribute to the growth of the other. Each one should express certain liberal movements, especially in Western belief in each other’s capability and they grow together) countries. Extra Marital Sex Marriage - occurs when a married person engages in sexual activity - Defined differently and by different entities, based on cultural, with someone other than their spouse. religious and personal factors. - Where extramarital sexual relations do breach a sexual - A commonly accepted and encompassing definition of norm, it may be referred to as adultery or non-monogamy marriage is the following: A formal union and social and legal (sexual acts between a married person and a person other contract between two individuals that unites their lives legally, than the spouse), fornication (sexual acts between economically, and emotionally. Legal contract between two unmarried people), philandry, or infidelity. individual who both sign a marriage contract and a tested and - These terms imply moral or religious consequences, witnessed by ninong’s and ninang’s. marriage units the life of whether in civil law or religious law Extra-Marital two couple of two different individual and they live together Adultery and Concubinage legally as well as live together economically meaning they - Philippines' law criminalizes adultery and concubinage. share their resources of each other and unites their lives Both are deemed “crimes against chastity” emotionally. - Under the Revised Penal Code of the Philippines and are - The contractual marriage agreement usually implies that the treated as sexual infidelity in the Family Code. couple has legal obligations to each other throughout their - The law discriminates against wives. The crime of lives or until they decide to divorce. adultery can be committed only by a wife and her - Being married also gives legitimacy to sexual relations within paramour. the marriage. - The husband need only prove that his wife had sexual - Traditionally, marriage is often viewed as having a key role in intercourse with a man other than him. the preservation of morals and civilization. (Marriage is a Methods of Contraception decision therefore it needs a commitment of both person that Folk methods: Precoital/Poscoital Douche Prolonged were united by marriage.) Lactation Withdrawal- coitus interruptos, coitus reservatus Marriage as a Moral Act Mechanical methods: condom Diaphragm Sponge - Marriage is sacred and was ordained of God from before the Chemical methods: Vaginal suppositories and tablets Vaginal foundation of the world thus, it affirmed the divine origins of jellies, creams, and foams marriage: Hormonal methods: Contraceptive pills Injections and a. Commitment implants b. Respect Abortifacients: Intrauterine Device DES (diethylstilbestrol c. Fidelity Prostaglandin Anti pregnancy vaccine Low-dose of d. Understanding contraceptive pills e. Loyalty Surgical methods: Tubal ligation Vasectomy Hysterectomy f. Sacrifice Natural or behavioral methods: Rhythm or calendar method - The sacred nature of marriage was closely linked to the power Temperature method Ovulation (Mucus) Method Sympto- of procreation. thermal method Sex relations during menstruation - Marriage is a vital institution for rearing children and teaching Morals of Contraception them to become responsible adults. Many believe that personhood begins at fertilization, when the - Under the Family Code of the Philippines (FC), marriage is genes from two parent cells combine to create a unique defined as a special contract of permanent union between a genome (Gilbert, Tyler, & Zackin, 2005). man and a woman entered into in accordance with law for the establishment of conjugal and family life. J.A.K.E 11 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 The moral issue of contraception is concerned with the Wife’s anatomical problem rightness or wrongness of the use of various methods by which o Beneficiaries of artificial insemination: contraception can be prevented in the conjugal union of the - women who desire to give birth to their own child sperm and egg thus prevented the born of a fetus. who may be in a lesbian relationship If personhood begins with God’s thought of a person, using - single women contraception therefore would seem to go against God’s will. - women who are in a heterosexual relationship but (Gerber 2013) with a male partner who suffers from male infertility On this view, it interferes with God’s plan for that potential o In Vitro Fertilization human being. - In vitro fertilization and embryo transplant (IVF-ET) Contraception leads to "immoral behavior" - One or more eggs are surgically removed from a Contraception makes it easier for people to have sex outside woman’s ovary, fertilized with her husband’s sperm marriage in a laboratory dish and developed in the dish for a Contraception leads to widespread sexual immorality few days after which tiny embryo is transferred into Contraception allows people (even married people) to have the woman’s uterus in the hope that pregnancy will sex purely for enjoyment proceed normally. Ethico-Moral Responsibility of Nurses in Contraception - There is complete separation of unitive and Primary Concern - Welfare of the patient and respecting the procreative concepts autonomy of the patient. - It does not show the burden of the procedure such as Secondary Concern - Make sure the patient gets all the expenses, emotional frustrations, child defects, other information and advice that they need to be able to choose serious problems; wisely. - It promotes the wrong attitude of the child being a Patient needs to know: reliability of the method, ease of use of product and not a gift the method, potential side effects, and health risks. o Vivo fertilization - Fertilization of a ripe egg within the Help the patient weigh the advantages and disadvantages. uterus of a fertile donor female. Usually, the doctor does this but if the patient will ask you, o Vitro fertilization - a process of fertilization where an egg you also have to know is combined with sperm outside the body. In vitro("in Health care practitioners should respect also the confidentiality glass") of a patient. o Reasons why a woman would use artificial insemination: The problem here is when teenagers ask for contraceptive help - A woman's immune system may be rejecting her and make it clear that they do not want their parents to know partner's sperm as invading molecules. about it. - Women who have issues with the cervix: What to do? Encourage the minors to inform their parents and Cervical scarring explore the reasons the patient does not want to do so. Cervical blockage from endometriosis Thick cervical mucus may also benefit from artificial insemination since the sperm must pass ISSUES ON ARTIFICIAL REPRODUCTION AND ITS through the cervix to result in fertilization. MORALITY & MORALITY ON ABORTION AND RAPE Discussed by Prof. Ma. Diosul Roque Artificial insemination (AI) - consists of depositing a man’s semen in the vagina, cervical canal or uterus through the use of instruments to bring about conception unattained or unattainable by sexual intercourse. 2 types of Insemination 1. Natural - a man and a woman have sexual intercourse in order to start a family. 2. Artificial - the deliberate introduction of sperm into a female's uterus or cervix through in vivo fertilization. 1. Homologous insemination or artificial insemination by husband (AIH) Husband’s impotence Anatomical defects of a husband’s urethra Oligospermia Spinal injury Underwent vasectomy Artificial Insemination Procedure Anatomical problem of the wife Step 1: The physical exam 2. Heterologous insemination or artificial insemination by - To begin the artificial insemination procedure, both you and donor (AID) your male partner (or your potential donor) will have a Azoospermia complete physical examination, including blood testing. Husband is carrier of a hereditary disease Wife’s oocytes are defective J.A.K.E 12 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 Step 2: Fertility drugs and monitoring - Such a relationship of domination is, in itself, contrary to the - While not required, your doctor may prescribe fertility drugs dignity and equality that must be common to parents and like Clomid or gonadotropins/injectables before the artificial children'" insemination procedure. Combining hormone treatments with IUI seems to give infertile couples a better chance at Fundamental Ethical Concern pregnancy. - Any intervention in the reproductive process is that the child Step 3: Preparing the sperm be brought into existence by the NATURAL love act of - If you are undergoing IUI the sperm sample will undergo a married couple special washing and processing procedure. After a semen - Other ethical issues: sample is obtained, the sperm are washed and concentrated Bypassing the natural method of conception; down to maximize the chances of conceptio. During this The creation of life in the laboratory; washing and processing phase, potentially toxic chemicals Fertilization of more embryos than will be needed; are removed, along nwith a seminal plasma shell that Discarding of excess embryos; surrounds each sperm cell. Unnatural environment for embryos; Step 4: Insertion of the sperm Use of untested technology; - The artificial insemination procedure is quick and usually Not affordable for many; painless. When the procedure begins, you will lie down as Misallocation of medical resources you normally would for a pelvic exam. A speculum will be Creation of embryos, then freezing them, and keeping inserted and the sperm sample will be prepared for insertion. them "in limbo“; The sperm is placed all the way into the uterine cavity with Exposure of embryos to unnatural substances; a thin catheter and syringe. Destruction of embryos in research; Step 5: Rest Potential to create, select and modify embryos; - After the artificial insemination procedure, a cervical cap or Facilitation of the idea that embryos are commodities; sponge is placed into the vagina to keep the sperm near the cervix. This sponge or cap can be removed several hours Financial rewards for IVF doctors dissuade them from after the procedure is over. recommending other methods to couples; Types of Artificial Insemination Infertility is treated as a disease and not as a symptom of Intracervical insemination (ICI) underlying medical problems. - The easiest and most common insemination technique Surrogacy - Involves injection of unwashed or raw semen into the cervix - “Surrogate” means substitute with a needleless syringe. - Came from the Latin word surrogatus which translates to "in - When performed at home without the presence of a place of another." ϖ professional this procedure is sometimes referred to as - A biomedical technique whereby a fertilized ovum is intravaginal insemination (IVI) implanted to the uterus of another woman who will carry the Intrauterine insemination (IUI) baby to term either as a favor or for free - A more efficient method of artificial insemination - In such cases, a woman who can produce normal ova, but - Involves injection of washed sperm into the uterus with a whose health would be endangered by pregnancy, can have catheter. her ovum fertilized by her husband's semen either in vitro or in - Normally requires a medical practitioner to perform the vivo. After 3 to 5 days of growth the embryo could be procedure. transferred to the uterus of a healthy woman who would carry Intrauterine tuboperitoneal insemination (IUTPI) it to term. - Involves injection of washed sperm into both the uterus and Gestational Surrogacy fallopian tubes. - With this type of surrogacy, the surrogate's eggs are not used Intratubal insemination (ITI) at all; therefore, the child will not be related to the surrogate - Involves injection of washed sperm into the fallopian tube. biologically. - The embryo is created by using both the biological father's Morality in Christianity sperm and the biological mother's egg through a process called - An Anglican writer says that, "To achieve union but not in vitro fertilization. children by means of contraceptives and to achieve children - The woman who carries the baby is the gestational surrogate but not union by means of artificial insemination are both or gestational carrier. equally wrong.” - Pros and Cons of Gestational Surrogacy: - According to the Catechism of the Catholic Church, artificial Pros: insemination "dissociates the sexual act from the procreative - Gestational surrogacy permits infertile couples, single act. The act which brings the child into existence is no longer parents and members of the LGBT community to an act by two persons giving themselves to one another, but complete their families. one that 'entrusts the life and identity of the embryo into the - Gestational surrogacy consents intended parents to power of doctors and biologists and establishes the domination maintain a genetic link to their child. of technology over the origin and destiny of the human person. - Surrogacy gives proposed parents the opportunity to create a meaningful relationship with their surrogate. J.A.K.E 13 of 16  BIOETHICS – BSN 2ND YEAR SUMMER MIDTERM 2022 Cons: Common Problems of Surrogacy - Surrogacy is generally a legally complex and costly - Legal Issues process. - Surrogate’s refusal to give the