1

D. Accept responsibility for their actions

Values freely chosen, enduring beliefs
B
or attitudes about the worth of Principle of Moral Discernment I
To make a conscientious ethical
person, object, idea or action decision, O
important because they influence one must do the following:
decisions and actions 1. Proceed on the basis of a fundamental
heavily influenced by socio- E
cultural environment commitment to God and to human persons
T
(including
God- given oneself) according
and graced human to nature
their

o cultural, ethnic,
religious
groups, family,
Conscien peer
ce
practical judgment of reason
upon individual act as either
good and to be performed or as
evil and to be avoided
To follow ones
conscience To follow
feelings or emotions To
follow law or custom
Blind obedience to the inspiration
of God Follow personal freedom
and autonomy
The capacity to make
practical judgments in matters
involving ethical issues
Involves reasoning about moral
principles Must be rooted in reality
and truth and not on mere will or
desire or blind choice
Sound, true and certain
conscience- own perception,
sound education, understanding
of natural law, traditional wisdom,
teachings of family and Church,
experience
Conscience can be in error as
when one misunderstands
principles, misjudges facts or is
led by misguided affections
One is culpable of an erroneous
decision of conscience only within
ones capability and freedom to
prevent the error.
2. H
Among possible actions that might seem to
be
I of fulfilling that commitment,
means
exclude
any that are contradictory to it
( intrinsically C
Personal examination of
conscience My conscience
is my guide
What I dont know cant hurt
me It is Gods will
Principle of Well-Formed Conscience
-To attain the true goals of human life by
responsible actions, in every free decision
involving an ethical question, people are morally
obliged to do the following:
A. Informed themselves as fully as practically
possible about the facts and the ethical
norms
B. Form a morally certain judgment of
conscience on the basis of this
information
C. Act according to this well formed
conscience

CONSCIENCE FORMATION

Diligently learning the laws of moral

life
Seeking expert advice on difficult
cases
Asking God for light through prayer
Removing the obstacles to right
judgment
 2
evil) P
Qualities of Conscience
A. Personal freedom R
S3. Also consider how ones own - Free A
motives and - Unfree- impeded by some obstacles
other circumstances may such as C
contribute to or nullify the fear and anger
effectiveness of these other
B. Objective Value T
N
Ifulfill
possible actions as means to
ones
- correct- subjective conforms to the
objective I
fundamental commitment moral values
4. 4. Among the possible means - Objective- norms of morality C
not excluded or nullified, select - Erroneous- lack of conformity to theN
one by which one is most likely objective
to fulfill that commitment and E
norms of morality
act on it - Culpable- one is in error and
U therefore responsible
Conscience Formation - Inculpable- has erred in good faith R
Making
demand moral
mature decisions
responsibility C. Moral attitude
- Lax- careless in its effort to seek the
S truth
A fully mature and responsible
conscience - Strict- follow to the letter
I hould be free, correct, clear and
s
certain - Scrupulous- tends to judge sin to be
Discerning what is right and what is present when there is none
wrong
N - Pharisaical- judgmental towards other
We must follow our decision only after
- Clear
we
G
have done our best to search for the
- Callous- worst type- no sensitivity to
truth sin
regarding the issues facing us
D. Degree of certitude
 - Perplexed- wrong if you dont do; 3.Serves as a standard for their
wrong if you did professional actions

- Doubtful- lack of sufficient evidence Nursing Ethics

Ethical issues that occur in nursing
- Probable- made a decision already practice As the basis for professional
but still admitting the possibility that code of
the opposite is true ethics, ethical theories attempt to
provide
- Certain

ETHICS
The study of good conduct,
character, and motive.
A method of inquiry that assists
people to understand the morality
of human behavior
Greek word ethikos or ethos
meaning
CUSTOM/CHARACTER/BEHAVIOR
Latin word mos or moris
meaning morals
Practical Science of the morality of
human conduct
Practical because it:
o - implies direction
o - presents the reason
which show these data to
be true
o - moral because it is related
to the dictates of reason
(how it should be)
o - human conduct because
it deals with human
activity and how one
should act

1. General ethics

- Presents truths about human

acts general principles of morality

2. Special ethics

-applied ethics
- applies the
principles of General
ethics
Individual- God, self,
fellowmen
Social- family, State, world

3. Professional ethics

Code of Ethics
a formal statement of the groups
ideals & values that is
1. Is shared by members of
the group
2.Reflects their moral judgment
overtime
 a
forsystem of principles
resolving and rules
ethical dilemmas 1. nurses and
B people R
I 2. nurses and
Nursing Code of Ethics practice S
3.nurses and the profession
4.nurses and co- workers I
O N
- The Code of Ethics for Nurses BON ETHICS COMMITEE
Issues of patient care that presents G as
ethical dilemmas
E
Resolution 220 series 2004- provides The institutions ability to protect the
guidance for T
carrying out nursing responsibilities
P
consistent with the ethical obligations of rights and interests of clients in general
the profession R
The development
policies
ethical of institutional
and educational programs on
H
A
1. issues C
Provides guidelines for safe and Professional Code of Ethics

I T Nurses have a contract with

compassionate care society to I
behave in accordance with rules
C dictated
C
by society and the nursing profession
2.Guarantees the public that nurse
adheres to E
S
standards of professional practice Nurse practice Acts vs. Code of ethics
Delineates nursings moral ideals,
e.g. provides guidelines for ethically
principled behavior and holds
International Council of Nurses Code nurses morally accountable for
of Ethics their actions

ETHICAL CONCERNS IN HEALTHCARE

FourI fundamental responsibilities CONFIDENTIALITY OF RECORDS
1. to RIGHT TO PRIVACY
promote health N RIGHT TO INFORMATION
2.to prevent illness COMPETENT CONSENT TO TREATMENT
3.to restore health RIGHT TO REFUSE TREATMENT
4. to TERMINATION OF TREATMENT
alleviate suffering N Human cloning
4 elements (outlines standards of Research
ethical Organ transplants

Virtue ethics
U
conduct) Character ethics
 Human traits of compassion,
courage, wisdom exhibited by Values are freely
consistently chosen, cherished
incorporated into ones and
people in concrete situations behavior B
Claims of virtue ethics:
Values are shaped by culture,
1. An action is right if ethnicity, family, I
environment and education
and only if it is what the agent
Value awareness O
with a virtuous character would do
in the circumstances Congruence between your values/
2.Goodness is prior to rightness- person health E
matters before the action
institution
3.The virtues are irreducibly plural intrinsic T
goods- virtues cannot be reduced to just KEY CONCEPTS H
one value but various virtues are necessary All human interactions are value
for good actions
based
4.Some intrinsic goods are agent relative- I
every action depends on the person Nurses
values must
values of clarify
others andand respect
examine theown
their
5.Acting rightly does not require we maximize C
the good- good is not enough- excellence Values are enhanced and refined by
is needed
experiences that cultivate values
S
development
such as interactions with people of
differing values and viewpoints and
experiences that
challenge ones way of thinking I
N
watch your THOUGHTS, they become
WORDS
watch your WORDS, they become N
ACTIONS U
watch your ACTIONS, they become R
HABITS
watch your HABITS, they become S
CHARACTER I
watch your CHARACTER, it becomes your N
destiny
G
Morals
fundamental standards of right or wrong The goal of ethical reasoning is to reach a
that an individual learns and mutual, peaceful agreement that is in the
internalizes usually during early best interests of the patient
stages of childhood development All Human beings have needs
reflects what is done in a situation Anything that fulfills a need is a VALUE
refers to human conduct itself application of Values give direction and meaning to life
ethics and guide a persons behavior
Based on norms of conduct about right or
wrong
Societys moral codes guide what people
ought to do
Professional codes such as the code of ethics
for nurses, communicate the goals
and ideals of the profession

VALUES AND VALUES CLARIFICATION

Ethical problems results from
changes in society, advances in
technology and the nurses
conflicting loyalties and obligations
Nurses ethical decisions will be
influenced by their moral theories and
principles, levels of cognitive
development and personal and
professional values
Bioethics Why do we have to study Bioethics? E
The following changes gave rise to
P the need of bioethics:
1.because of perennial issues, dilemmas &
Ethics as applied to human life or
problems
health; 2.because of legal dimension
3.Emergence of ethical practice in health
R care
e.g. 4.to provide awareness to the health team of
the dos and donts of nursing practice
decisions about euthanasia; abortion
5.To enrich ones competence by
understanding that the patient is a person
A
bios (life) + ethikos (behavior)
and holistic individual
6.To make clear to us why one act is better
than the other
C
a systemicspecifically
behavior, study of human
in the
fields of life sciences 7.Enable us to live and have an orderly social
way of life
T 8.Scientific Advances
and health care as examined in the
9.Inequalities in socio-economic, educational
light of
I
moral values and principles (M.T. and political positions
Reich) 10. Finitude of resources
C
 11. Changes in the doctor- III. PRINCIPLE OF AUTONOMY
patient relationships IV. PRIN
12. Rampant unethical
CIPLE OF INFORMED CONSENT B
behavior
V. PRINCIPLE OF CONFIDENTIALITY I
VI. PRINCIPLE OF BENEFICENCE
ETHICAL THEORIES VIII. PRIN
CIPLE OF NONMALEFICENCE O
1.Deontology
2.Teleology
IX. PRINCIPLE OF DOUBLE EFFECT E
X. PRINCIPLE OF JUSTICE
1. Deontology XI. PRINCIPLE OF COOPERATION T
XII PRINCIPLE OF TOTALITY AND
INTEGRITYH I
Greek word deontos= duty OF THE HUMAN PERSON
XIII FIDELITY
an action is right when it conforms
to laws or rules
XIV. VER
ACITY C
XV. PROFESSIONAL COMMUNICATION
APPLICATION OF DEONTOLOGY TO XVI. ORDINARY AND S
HEALTH CARE EXTRAORDINARY MEANS
XVII. PRI
NCIPLE OF SUBSIDIARITY
XVIII. I
PRINCIPLE OF PERSONALIZED
The RN is duty bound to act under N
SEXUALITY
moral
rules that establish the right or I. PRINCIPLE OF HUMAN DIGNITY
wrong:
Basis of Human Dignity
N
o duty to honor a
patients autonomy Salvation History U
o duty to promote good & well
being
1. Crea
o duty to keep tion of man
R
promise &
confidentiality 2. Fall
of Man S
3.Promise of a Savior
Nurses have a contact with
4.Preparation for the Coming I
society to behave in accordance
with rules dictated by society and 5. Fulfillment of the
the nursing profession Promise N
6. Establishment of the
The Code of Ethics for nurses Church
BON Resolution 220 series 2004 7.Heavenly KingdomG
provides guidance for carrying out Image and Likeness of God
nursing responsibilities consistent P
with the ethical obligations of the Christ redeemed us
profession R
Ultimate destiny to fulfill A
Immanuel Kant Rational beings C
It is only through dutiful
actions that people have moral
T
worth Human rights I
only reason and not emotion is - nee
sufficient to lead a person to moral ds and values as it relates to other
actions (because rational choice is human beings C
within ones control) -it is universal E
- equal among everybody
- not a product of human creativity but
2. Teleology inherent to us
- Greek word teleos =
goal Universal Declaration of Human Rights
- focuses on the consequences or end product (1948)
of our actions respects the dignity of the human person
- The principle of the greatest happiness for
the greatest number of people
What is best for groups?
We apply the bioethical
principle to a particular case
Well known consequentialists
Jeremy
Bentham John
Stuart Mill
PERSO a person is a rational,
N autonomous being with the ability
to know universal, objectives
moral laws & the freedom to
decide to act morally
SIGNIFICANCE OF BEING A PERSON
Has an inherent dignity which
must be respected

DIFFERENT ETHICAL - A person should not be destroyed;

PRINCIPLES uniqueness must not be altered; genes cant
I. PRINCIPLE OF HUMAN be manipulated; organs removed without
DIGNITY any reason; one cant be cloned
II. PRINCIPLE OF
STEWARDSHIP
 Has an ultimate destiny- to live with isolatio 1.20- 29 years old (intimacy
God n) vs
B
-To fulfill this, one has needs that must be 2. Rates higher on males
met, resources must help one meet these than females I
needs; but he is 3.Single

only a steward 4, unemployed O

Lives with other persons in the 5. High
community
school level E
- Interacts with people; helps them 6. Drug
200
4 taking: Poly Drug Use
HUMAN DIGNITY T
Comprehensive Dangerous Drug Act of
All ethical decisions (made by
patients and healthcare H
givers) must aim basically
and ultimately at human Signed: June 7, 2002
I
dignity. Published: June 19, 2002

They must protect, defend,

C
Took effect: July 4, 2002
enhance and enable the persons S
worth. Composition of the Board
They must aim for the maximum IN
and integrated satisfaction of every CHAIRPERSON
persons needs, as an individual 2 Permanent Board Members
and members of his community. 12 Ex officio members
Human Dignity D DIL Dep CHED DS
N
Every human being has an inner O G E W
worth and inherent dignity. These he DH DFA d
DOF NYC D
PD U
possesses not because of what he N E
has or what he does but because of D
2 2 A R
what he is: a human person Regular Permanen
As a human person, he must be Member
IBP NGO tNBI PNP
respected regardless of the nature of s S
his health problem, I
N
social status, competence, past Certain actions may never be done
actions because performing them would
Decisions about health must aim at constitute a violation against the
the maximum integrated satisfaction persons dignity
of his needs: biological, psychological,
social and spiritual
Certain actions may never be done II. PRINCIPLE OF STEWARDSHIP
because performing them would
constitute a violation against the
CALL FOR 3 RESPONSIBILITIES
persons dignity
1. Personal
2.Social
Respect for Person
3.Ecological Profile of
Every human being has an inner
worth and inherent dignity. These Drug abusers
he possesses not because of what
he has or what he does but
because of what he is: a human
person

As a human person, he must be

respected regardless of the nature
of his health problem, social
status, competence, past actions
God is the Lord of Life and of Creation; - Responsible Stewardship of Available
Persons E
Resources
- Managing resources with
G prudence and moderation
are Their Custodians.
- Wasting or squandering of
DIMENSIONS OF STEWARDSHIP P scarce resources is a sin
HUMAN RECONSTRUCTION - Not to fall into the trap
- God made human beings free and of the technological R
intelligent- we have the right and imperative

A Ecological and Biomedical Dimension

obligation to improve ourselves- - Our bodies, our life, our
good human nature and C
stewardship everything in this earth are
- But we must use it with profound gifts we have dominion over.
respect T This means we are
for Gods creation especially if it responsible for them. We
will should not as faithful
stewards, harm but rather
I improve and care for them.
undermine
and the very freedom
God intelligence given to us by We have to treat them with
C utmost respect, use
originality and creativity to
cultivate them, know
 and respect their limits. We
cannot contradict human E.g. Jehovahs witness 12 years old
nature.
IV. PRINCIPLE OF INFORMED CONSENT
III. PRINCIPLE OF AUTONOMY - It is a patients right to exercise freedom
to make decisions for his/her health.
Autonomy Appropriate and necessary information
Greek word autos meaning self are
and nomos meaning rule/
governance/ law.
self- governing or the ability to
govern self is dependent upon
many factors such as
o sound mind
o sound body
o full information of the
issues
o without force or coercion
- Recognizing patients as persons who are
entitled to such basic human rights such as
the right to know, privacy and right to
receive treatment
- State of being self-regulating, self- defining
and self-reliant

- Ability of a person to make their own

decisions without interference

- freedom to make choices about issues that

affect ones life

- Respect for persons; unique and valuable

members of the society

- Free to choose and implement ones own

decision, free from lies, restraint or
coercion

KEY POINTS
This principle assumes rational thinking on
the part of the individual and may be
challenged when the rights of others are
infringed upon by the individual

PATERNALISM
Deliberate restriction of peoples
autonomy by health care professionals
based on the idea that they know
whats best for the clients- can be
justifiable at times
Doing good should take
precedence over autonomy

The doctor can decide:

1. Doctor can act as loco-parentis

2. If it is a matter of life and death

3. Court
 required so that medical
may beprotocols
and management
his interest. done for 5. Affor
B dability
G
I
Who are incompetent?
To protect
person for the basic
health need
care andofthe
every human
persons
primary responsibility for O - C
his or her own health,
o
m
E
a
(1) no physical or psychological therapy
may be t
T administered without the free and o
informed consent H of the patient, or,
s
e
I
(2)
if the patient is incompetent, the persons - Below 18 yrs old P
C - M
e
legitimate guardian acting for the patients n
benefit St
al
and, as far as possible, in ly
in
accordance with the patients c
o
known and reasonable wishes. h
e
r
I e
ELEMENTS OF INFORMED CONSENT n
t
1.
Disclosure R
N A
2.Comprehension of information Who gives proxy consent? C
1. Durable Power of attorney
3.Voluntariness
2. Closest of kin T
4.
Competence Adult- married- spouse, children of major
age I
N Below 18- parents, grandparents
C
No spouse- siblings, uncles/aunts
5. E
Consent Key point
In securing consent, exhaust the vertical
line first before the horizontal
U
What info you should give to patients? V. PRINCIPLE OF

R CONFIDENTIALITY
1. Confidentiality
Current Medical status (Diagnosis) non disclosure of private or secret
information with one is
S entrusted
2.Therapy, treatment, procedures
available Requires the non-disclosure of I
3.Risks and benefits private or secret information with
4. which one is entrusted
Prognosis ICN (2000)- the nurse holds in
confidence personal information
N and uses judgment in sharing this
information
An important component of
autonomy- maintains dignity and
respect for the person
 VI. PRINCIPLE OF BENEFICENCE
Privacy non exposure of a body part
Beneficence
The following are subjects of Confidentiality Comes from the LT. word bene
and should not be revealed to anyone except meaning good and fiche meaning to
for graver cause: act or do.
1.Private Secrets An act of or goodness, kindness, an
2.Contractual Secrets action done for the good and benefit of
3.Professional Secrets others.

Privileged Communication
a confidential communication that
one
cannot be forced to divulge
Husband & wife
priest & penitent
doctor & patient
lawyer & client
To qualify for privileged status,
communication must generally be
made in private setting (that is, in a
context where confidentiality could
reasonably be expected).
Are there any situations in which a
medical professional justified in
revealing embarrassing or
damaging information about a
patient to a third party?

GRAVE CAUSE
abuse (child/ elder abuse)
intent to kill self or
someone
communicable disease
statuses require the
disclosure of certain
happenings e.g. rape,
abuse, incest, other
crimes
Personal decision
Reportable cause
Legal case

KEY
POINTS
The public good outweighs
the individuals right to
privacy and confidentiality
protective privileged ends
where the public perils
begins
duty to warn is the duty to
disclose confidential
information to protect
identifiable victim and warn
appropriate authority
targeted by threat
 it is related to the following human (doing good)
rights IX. PRINCIPLE OF DOUBLE EFFECT R
Right not to be killed B S
Right not to have bodily From a common cause an action- two
injury or I effect are I
pain inflicted to
oneself produced:
Right not to have ones A good effect and an evil effect N
confidence
O G
Determinants of the Morality of Human Act
revealed to others E The ACT itself
Violations of nonmaleficence The INTENTION P
CIRCUMSTANCES R
T No amount of good intention or difficult
1. P circumstanceA can make a wrong action
correct.
hysically harming a person as in
suicide,
C
H Basic Axioms of Morality T
abortion, infanticide, torture and violence Majority opinion is not the norm of I
morality
C
I Widespread custom
conventional or the
2.Exposing aaperson
persontotophysical harm as in of morality wisdom is not the norm
subjecting
treatment or
C to
unnecessary E
A good end does not justify an evil
dangerous procedure without a
means
commensurate If an act is evil by its nature,
nothing can make it good
S
important goal.
We cannot allow our emotions to
warp our moral judgment
3.Harming a persons reputation, honor,
property or interests as by revealing
confidential Principle of Double Effect
Act itself must be morally good or
I information at least indifferent.
N The motive behind the act
KEYPOINTS must be to achieve the good
1.BOTH the principles of BENEFICENCE effect never the evil effect,
and NONMALEFICENCE focus on doing even though it is foreseen and N
good to others. permitted
2. B The good effect of the act must
OTH principles attuned to ALTRUISM precede the evil effect or at least
simultaneous with it.
U The good effect must be
sufficiently desirable to
outweigh the evil effect.

VIII. PRINCIPLE OF NONMALEFICENCE

 Considerations
1.INTENTION is focused on the
Beneficial Effect
2.INTENTION must be good
3.B.E = H.E. or if possible BE > HE>
4.ORDER OF TIME
BE must come
BE comes simultaneously with
the HE
PRINCIPLE OF JUSTICE
IMPLICATIONS OF THE PRINCIPLES OF
JUSTICE
c.micro- allocation
A. Utilitarian alternatives
promotes the highest good that is
possible in every situation (the greates
good for the greatest number)
Principle of Immediate Usefulness
o gives priority to the candidate
who is at greater immediate
service to the larger group
under the circumstances
Medical Success Principle

1. each individual should receive what

is due to right such as
a. Life
b. Information needed for decision
making
c. Confidentiality of private information

2. benefits should be justly

distributed among individuals
such as
a. minimum health care
b. equal opportunities for scarce
resources
3. each individual should share in
the burden of health and science
such as
a. caring for his own health
b. caring for the health of others
c. participating in health/science
progress

VIOLATIONS OF THE PRINCIPLES OF

JUSTICE

1.Denying/ withholding a benefit to which a

person has a right
2.Distributing a minimum health benefit
unequally
3.Imposing an unfair burden on an individual

NON VIOLATIONS OF THE PRINCIPLES OF

JUSTICE

1, the patient chooses to give up what is due

2.unjust outcome results or just
process

Distributive Justice
the aspects of justice that pertains
to a fair scheme of distributing a
societys benefits and burdens to
its members

PROBLEMS OF DISTRIBUTIVE
JUSTICE
a. macro-allocation
b. meso allocation
 o give
whom priority to those
treatment has the needs N
highest
B Principle of General Neediness G
probability of success
= gives priority to the most
helpless or
I of Conservation
Principle
generally neediest in an attempt to
bring them as nearly as possible to a
o gives priority to those level of
candidates O R
P well being equal to that enjoyed
by others.
who requires
Principle of Queuing the line
proportionally
= gives priority to those who
arrived A
E first
smaller amount of C
resources and Principle of Random Selection T
therefore more lives = gives priority to those selected
would be by T
saved
chance or random I
H XI.
PRI
Parental Role Principle
o gives priority to those who
NI
C
have I
P
the largest responsibilities L
E
to O
F
C
O
C O
P
dependents E
R
A
T
S of General Social
Principle O
I
Value N
o gives priority to those
believed to have the
greatest general social C
I worth thus leading to
the good of
society
E
COOPERATION
Working with another in the
N performance of an action.
Types of cooperation:
B. Egalitarian Alternatives
- restoring the equality of the N
persons I.FORMAL COOPERATION
- Cooperator wills the evil either by an
in need
explicit act of will or actual sharing in
the evil act itself
U - Formal cooperation in evil is never
Principle of Saving No One allowed. R
= gives priority
because to no
not all can beone
saved Identification with the purpose
Directly intend the evil action
S Legitimate cooperation
Principle of medical Neediness
I = with the most pressing
A nurse must never formally cooperate in
medical immorality either by explicitly willing the evil
or by directly sharing in the immoral act.

II. MATERIAL COOPERATION

 -Cooperator performs an act which in
itself is not wrong though it is used by B
the principal agent to help commit the I
evil action O
-It consists in performing morally
indifferent actions which make the
operation possible.
E
You cooperate in the act but T
not in purpose
H
indirectly intend the evil action
I
KEY POINTS: In the human person, the part exists
1. Formal cooperation is always immoral for C the whole, and therefore, the
good of the S part is subordinated to
2. Immediate material cooperation is the good of the
whole.
likewise immoral
I
3. Mediate material cooperation may be A. LO
moral WER FUNCTIONS are never sacrifices

Sample Case Scenario except

N
for the better functioning of the whole person
Angelica attempted abortion because her and
boyfriend Derek does not want to marry her even then with an effort to compensate for this
and he bought Cytotec and bottled herbal
sacrifice. N
medications from Quiapo and suggested that
U
she removed the baby. In her attempt she
was bleeding profusely and her relatives,
Justifiable R
unaware of her intention, rushed her to the purpose
removingofpart
improving
of thethe function
body of
for the
the body part S
hospital.
The doctorsFHT.
completed the procedure even if there is
- e.g amputation of gangrenous I
foot, tooth baby, present on the time of abortion
1.Angelica- formal cooperation; and condone the evil act.
intends to terminate pregnancy and
the evil action XII PRINCIPLE OF TOTALITY AND INTEGRITY
2.Derek: formal cooperation; OF THE HUMAN PERSON
intends evil action, advices to
abort the baby, bought Totality and Integrity
abortifacients such as bottled to promote human dignity in
herbal medications and Cytotec
community every person must
3.Relatives: material
develop, use, care for and persevere
cooperation: not included in the
all of his or her natural physical and
evil plan, rushes to the hospital
psychic functions in such a way that
unaware
4.Doctors: formal cooperation; intends
evil action by the expulsion and
aborting the fetus even though there
is a FHT
5.The janitor in paternal leave:
knows whats happening in the
hospital: material cooperation:
because even though he is aware on
what the institution is doing, he
remains quiet and doesnt do anything
to stop the evil action
6. Nurse on duty during
the procedure, nursing aide
and janitor on duty: formal
cooperation: knows the evil action,
didnt do anything to save the
 extraction (for better functioning) useful, morally

E irreproachable and even noble, among

them the
N desire to aid the sick and suffering. One
B. THE BASIC CAPACITIES
may make a decision of this nature with
G respect to his own body with full
- That define human personhood
are never realization of the reverence which is due it
sacrificed unless this is necessary to This decision should not be condemned
preserve life
but positively justified.
P
Non
dontjustifiable
want to TAHBSO because you ORGAN DONATION
- Transplanting organs from one living
R have
for
a child, cosmetic reason addiction
vanity purposes person to another is also ethically
A acceptable provided that the following
C criteria are met:
Justifiable matter of life and death,
mastectomy,
organ donation 1.There is serious need on the part of the
recipient that cannot be fulfilled in any
T other way.
I
KEY POINTS 2.The functional integrity of the donor as a
A person may will to dispose of his human person will not be impaired, even C
body and to destine it to ends that are though anatomical integrity may suffer.

3.The risk taken by the donor as an act of
charity is proportionate to the good
resulting for the recipient.
4.The donors consent is free and informed.
5.The recipients for the scarce organs are
selected justly.
WHAT ARE THE BENEFITS OF ORGAN
DONATION?
1.Save lives
2.Improves quality of life
3.Cost effective
WHO CAN BE A DONOR?
1.Living donor
2.Cadaver donor
WHO CAN BE A LIVING DONOR?
1.Healthy person age 18-60 years old,
whose blood type and HLA tissue typing are
compatible with the recipient
2. The donation must be a voluntary act
3.A related donor is a blood relative;
parent,
offspring, sibling, half-sibling, aunt, uncle
or cousin
CAN NON RELATED INDIVIDUALS
DONATE
ORGANS?
1.If a blood relative is unable to donate a
spouse or an emotionally related person
may be considered.
2.In these cases, careful consideration is
given to such factors as the motives,
long term emotional bonds, and
psychological implications for both
donor and recipient
ORGANS THAN CAN BE DONATED
ARE:
Heart, liver, kidneys, lungs,
pancreas, corneas, intestines
WHAT ARE THE CRITERIA FOR
BECOMING AN ORGAN DONOR
1. Organs can be donated
only after a person has been
declared brain dead while his
vital organs are being maintained
on a breathing machine
10
CAN HUMAN ORGANS BE BOUGHT OR SOLD?
B
NO, In order to manage and regulate
the I
act of organ donation as well a the
conduct of non related kidney O
transplantation, DOH issued the E
Administrative Order No. 124, series of
2002 T
H
National Policy on Kidney Transplantation
from I
living Non Related Donors
this order sets the guidelines and ethical
C
principles in conducting kidney
S
transplantation from LNRDs which will
stop profiteering, remove brokers
and
make sure donations are not
organized I
commercial effort
N
ORGAN DONATION ACT OF 1991 RA 7170
MUTILATION N
Destruction of member, organ or part
of
U the body (organic) or the R
suppression of a physical function
(functional) in such a
way that the organism becomes no
longer S
Type
basically whole
s I
-direct- willed in itself, as end or as
N
means,
2.Organ donors can be anyone including
newborns up to age 75
IS BRAIN DEATH THE SAME AS COMA
OR VEGETATIVE STATE
1. No, a person in a coma or vegetative state
still has some brain activity and therefore is not
considered brain dead.
HOW DOES ONE BECOME A CADAVER
ORGAN DONOR?
1.The prospective organ donor should tell to
his family wishes and in the event of his
death, permission by his family/ next of kin
2.He must also sign a donor card or express his
intentions in their drivers license. Although these
are both considered legal documents, his familys
permission for donation must still be obtained.
 11
intended and caused organs- integrating parts which must yield
to C
G
-indirect ( therapeutic)- caused by the good of the whole; E
the
exigencies of the health or survival of the licit if:
patient; at times willed as means, at
others tolerated as an - Sickness is grave, certainly diagnosed and
definitive that it offsets the evils of
P sterilization
unavoidable side effect - It is necessary because it is the only possible
R effective remedy
STERILIZATION - Exclusively curative- intention is important

Direct sterilization- the immediate

A
A medical or surgical intervention effect is to render procreation
which impossible C
causes a patient, incapacity of
generation
Types:
T
Therapeutic- inevitably required - eugenics- seeking to avoid the transmission
for the of hereditary defects
- hedonistic- evade the complications &
responsibilities of procreation without
I and health of a person- sexual
survival giving up the sexual pleasure
- demographic- to control the birthrate
 - preventive- render pregnancy
impossible which might aggravate A person may forego
disproportionate extraordinary
means or
of preserving
life.B
sickness that already exist
Extra ordinary means or Disproportionate means
XIII. FIDELITY When the means used do not offer a
faithfulness, promises and loyalty reasonable hope of any notable benefit
Obligation of an individual to be to the patient
faithful to commitments to Disproportionate means are those that
him/herself and also to others in the patients judgment do not offer a
Main support for the reasonable hope of benefit or entail an
excessive burden, or impose excessive
concept of accountability
expense on the family or the
Keeping information
community.
confidential and maintaining
privacy and trust

XIV. VERACITY
truthfulness, document accurately
Duty to tell the truth
Fundamental to the
development and continuance
of trust among human
beings- truth telling, integrity and
honesty
Truth telling
Definition: a nursing intervention
from the Nursing Interventions
Classification (NIC) defined as the
use of whole truth, partial truth, or
decision delay to promote the
patients self determination and
well being.

XV. PROFESSIONAL COMMUNICATION

what, when, where, how

XVI. ORDINARY AND EXTRAORDINARY

MEANS

Ordinary means or Proportionate means:

Not only food, drink and rest but
also medicines, treatments and
operations which offer a
reasonable hope of benefit for
the patient and which can be
obtained without excessive
expense, pain or other
inconveniences
Proportionate means are those that
in the judgment of the patient offer
a reasonable hope of benefit and
do not entail an excessive burden
or impose excessive expense on
the family or the community.
A person has an obligation to use
ordinary or proportionate means of
preserving his or her life.
(NCCB, Ethical and Religious
Directives, 1995)
 (NCCB, Ethical and Religious Directives, Orthothanasia I
I neither advances nor delays death
N
1995) it helps while dying
O neither shortens nor lengthen life G
E neither confronts life nor fights for it
Euthanasia DOES NOT KILL.. IT ALLOWS TO DIE
confronts life death in its due time P
T
advances & favors death normal process of death R
H letting the incurably diseased person
helps to die die
A
his owntodeath
efforts while
prolong his making
life. no extra
I
shortens, reduces life
C
KILLS T
C Criteria for CESSATION OF BRAIN
FUNCTION include
S irreversible coma I
Passive Euthanasia refraining of no spontaneous respiration and no C
any medical
response to apnea test for 6minutes
treatment aimed at retarding death
absence of the following brain E
Active Euthanasia terminating a stem reflexes: pupillary,
persons life I corneal, gag and caloric test
in a painless way, at his request &
with the
Death & Advance refusals of TreatmentN
Apparent Death the cessation of
intention to prevent person from
life as indicated by the absence
suffering. of all vital functions
Legal Death the total absence of
Dysthanasia activity in the brain and central
nervous system, the
cardiovascular system, & the
confronts death N respiratory system as observed
delays death making dying difficult and declared by a physician.
U
HARVARD CRITERIA
prolongs, extends, lengthens life
1. UNRECEPTIVE, UNRSPONSIVE
R
does not allow to die, stops death 2. ABSENCE OF SPONTANEOUS
MOVTS AND BREATHING
S
3. ABSENT REFLEXES, FIXED, DILATED
PUPILS
 4. PERSISTENT ISOELECTRIC EEG The gift of sexuality must be used in
keeping with intrinsic, indivisible,
5. IN THE ABSENCE OF INTOXICATION specifically human teleology. It must be
OR HYPOTHERMIA, THESE FINDINGS a loving, pleasurable, expression of the
PERSIST OVER 24 HRS complementary, permanent self giving
of a man and a woman to each other
Irreversibility is recognized when
which is open to fruition in the
evaluation discloses that:
The cause of coma is established and is perpetuation and expansion of this
sufficient to account for the loss of brain personal communion through the family
functions they responsibly beget and educate
The possibility of recovery of any brain
function is excluded
The cessation of all brain functions persist
for at least 24hours of observation and
therapy

Nurses role & responsibilities

Advance Directives
o an advance declaration by a
person of treatment
preferences if he or she is
unable to communicate his
or her wishes.
Living Will
Durable power of attorney for
health
Health care proxy

Do not resuscitate orders

1. Specify the exact nature of
the treatment to be
withdrawn or withheld.
2.DOCUMENT the exact justification for the
decision
3. Recognize that the DNR does not
mean that the patient may be medically
or emotionally abandoned.
XVII. PRINCIPLE OF SUBSIDIARITY
Human communities exist only to promote
and share the common good among all their
members from each according to ability, to
each according to need in such a way that:
1. Decision making rests vertically first
with the person then with the lower
social levels and horizontally with the
functional social levels

2. The higher social needs intervene only

to supply the lower units what they
cannot achieve by themselves while at
the same time working to make it
easier for lower units and individuals
to satisfy these needs by their own
efforts.

XVIII. PRINCIPLE OF PERSONALIZED

SEXUALITY
BASIC CONCEPTS/VALUES
RECOGNIZED IN SEXUALITY

wrong because I
B 1.It is selfish pursuit of pleasure apart from
sex is a search for sensual pleasure
N
&
I love G
= masturbation, prostitution, casual
satisfaction,
psychic releasing physical &
tensions or
promiscuous relations
O
sexuality = male and female = 2.It expresses love, but not a committed
genitals love P
E involving true self giving
= adultery or premarital sex R
(with natural tendencies)
3.It is committed but practiced in a wayT
sex is a search for human
completion of the
the person A
through an intimate
H contradictory to it natural fulfillment in the
personal union of love
family
I
C
expressed by bodily
union = use of artificial contraceptive T
sex is a social necessarily for the methods, relations of committed
C homosexuals I
procreation of children
CHARACTERISTICS OF MARRIED LOVE C
1. HUM
S
sex is symbolic mystery, somehow AN E
revealing the cosmic order 2. TOTAL
I 3. FAITHFUL & EXCLUSIVE
Key points: 4. FRUITFUL
Sex is not always a proof of N
love, although often is Abortion
demanded as such The spontaneous or induced
termination of pregnancy before
There is inseparable
established by connection
God, which man in the fetus has developed to the
his own N
initiative may
between the (1) unitive not break, stage of viability.
significance U
and the (2) procreative
TYPES OF ABORTION
significance, both 1.SPONTANEOUS
2.INDUCED
iR
nherent to marriage act.
any use of sex outside marriage is INDUCED ABORTION TECHNIQUES
1.Abortion by dilatation and curettage (7-
ethically 12wks AOG)
2. Abortion by CS or
S abdominal Hysterectomy
3.Abortion by Suction (before 3-4months or
12-16wks)
 4.Via Intra- amniotic infiltration (before 3-
4months or 12- B
16weeks)
5. Via injection of Prostaglandin I
RU 486 Contraceptive pill associated O
with E
Prostaglandin
T
ARGUMENTS: CONTRA-ABORTION H
1. Not firmly a choice between a mother only
or to the child only but must center on saving both I
lives. C
2. Unselfish love and solitude to an innocent
creature S
3. Complementary roles between man and
woman
4. It has genetic code totally different from the I
cells of the parents N
ARGUMENTS: PRO ABORTION
1. To
safeguard the life of the mother N
2. Abor
tion as a womans right
3.Abortion as an expression of womans U
sexual freedom R
4. The
fetus is not a human S
LEGAL, MORAL & ETHICAL CONSIDERATIONS I
N
Article 2, Sec 12 of the 1986 Const.
-provides that the state recognizes G
and strengthen the family as a basic
autonomous social
institution. It shall equally protect the life of the
mother and the life of the unborn from conception P
R
3 TYPES OF ART
1. IVF- IN VITRO FERTILIZATION A
2. GIF
T Gamete Intra- fallopian Transfer C
3. ZIF
T Zygote Intra- Fallopian Transfer T
METHODS OF CONTRACEPTION I
C
1. Folk methods
- Pre coital/ post coital douche using vinegar E
- Prolonged lactation
- Coitus interruptus and coitus reservatus

2. Mechanical methods
- condom and diaphragm

3. Chemical Methods
- Vaginal suppository, vaginal tablets,
vaginal jellies, creams and foams

4. Hormonal Methods
- Contraceptive pills, injections and implants