Module 2

Bioethics and Its

Application in Various
Health Care Situations

BIOETHICS AND ITS

APPLICATION IN
VARIOUS HEALTH
CARE SITUATIONS
Introduction
Bioethics is the study of ethical issues that result from technologic and scientific advances, especially as
they are used in biology and medicine. This area of study is also called biomedical ethics because of its
association with medical practice. It is a subdiscipline within the larger discipline of ethics which is the
philosophic study of morality, or what is right and what is wrong. Today more than ever, nurses and their
patients need to keep pace with the technologic changes occurring in health care. The critical choices
that must be made by patients, their families, and members of the health care team are the result of
changes that were not a part of our decision-making in earlier times. This lesson discusses some of the
choices with which nurses and their clients must grapple. It should be read, studied, and discussed within
the framework of the information concerning ethical decision-making that was provided earlier. The
content of the chapter should provide a basis with which you can look at judicial rulings, legal mandates,
and social standards, and how they can be used to assist in resolving concerns that face us in health care
delivery. You have had some experience in looking at what is right or wrong regarding your personal
professional practice. This lesson examines more specifically the issues that apply to the bioethics of
patient care.

At the start of this lesson, you are to take pre – assessment test to see how much background
information and knowledge you have.
This lesson is self – instructional. You can read, analyze concepts and idea presented and relied on
them. The activities and self – check questions will help assess how you progress as you go through the
module.
The answers to the self – check questions and activities may be self – evaluated by your facilitator if
you so desire. These will be part of our formative evaluation. Do not write your answers in the module,
your answers should be written in a separate notebook.
The answer key to self – check questions and activities are found at the end of the lesson. The post –
assessment will be given in a separate booklet upon completion of the module. It will serve as the
summative evaluation of your performance.
Remember, you are to work on this module independently. I shall not be around to supervise you

Objective:
1. Formulate with the client a plan of care to address ethical health concerns, needs, problems and
issues based on priorities.
2. Implement safe and quality interventions with the client to address ethical health concerns,
needs, problems and issues:
- Relate the inviolability of life to ethical death and dying

Pre - Assessment Test

Multiple Choice:
1. A state wherein a human organism has irreversibly lost his/her capacity of consciousness.
a. Brain Death c. Cortical Death
b. Persistent Vegetative State d. Comatose
2. Which of the following describes euthanasia?
a. Is believing that in certain cases there is totally no hope for improvement from an
incapacitating condition.
b. Do not slow down nor speed up the onset of death.
c. Does not intervene with the patient's life.
d. Ending the life of a person to relieve pain or suffering
3. Result of a study showed that there is residual language recognition observed in brain death.
a. False b. True
4. "Death cannot be dignified"
a. Socrates c. Terri Schiavo
b. P.Welby d. Epicurius
5. Only those that are living are the ones who can die?
 a. True b. False
6. The ethical principle of respect for persons is a broader concept than autonomy.
a. True c. False
7. What principle best applies for euthanasia?
a. Beneficence c. Justice
b. Non-maleficence d. Autonomy
8. The following are the most frequent symptoms experienced by the dying older adult. Select all
that apply:
a. Pain c. Respiratory Distress-
b. Euphoria d. Confusion
9. DNR. Select all that apply
a. Do not resuscitate c. Withhold other care
b. No code d. May be indicated in patient’s living will
10. Signed and witnessed documents providing specific instructions for healthcare treatment in the
event that a person is unable to make those decisions personally at the time they are needed.
a. Advanced directives c. Living will
b. Power of attorney d. health document
11. Professional accountability serves for the following purpose except for:
a. To provide basis for ethical decision
b. To respect the decision of the client
c. To maintain standards of health
d. To evaluate new professional practices and reassess existing ones
12. A wrong dose of drug is administered by the nurse. The nurse is responsible to whom?
a. Client c. Society
b. Physician who ordered the drug d. all of these
13. The nurse in a unit is caring for several clients. To distribute nursing care the nurse utilized the
principle of triage due to the limited availability of resources. The nurse is promoting which
ethical principle?
a. Fidelity c. veracity
b. Justice d. confidentiality
14. The client on renal dialysis informs the nurse that he wants to stop the series of dialysis. The
nurse should appropriately do which action in response to the client’s decision?
a. Inform the client that the doctor must decide what to do.
b. Tell the client that he must finish his series of renal dialysis.
c. Respect the client’s decision and provide comfort measures
d. Leave the client and attend other patients
15. The nurse’s obligations to the client least like include:
a. Considers the dignity of clients
b. Retains a commitment of welfare to the client
c. Work toward securing and maintaining conditions of employment that satisfy the goals of
nursing
d. Hold confidential all information about a client learned in a health care setting
16. Before the nurse administered the client’s medication she assessed the client’s needs for drugs,
and followed the “rights” in drug preparation and administration. After the nurse has given the
dose, she evaluated the client’s response to the medication given. The nurse is promoting:
a. Accountability c. Responsibility
b. Autonomy d. veracity
17. Being answerable for one’s own action is assuming:
a. Accountability c. Nonmaleficence
b. Responsibility d. Veracity
18. The execution of duties associated with nurse’s particular role is called:
a. Accountability c. nonmaleficence
b. Responsibility d. veracity
19. Nursing ethics provides the standards for professional behavior and is the study of principles of
right and wrong for nurses. This set of standards states the duties and obligations of nurses to:
a. Client c. community
b. Other health professionals d. all of these
20. Nurse Janine avoids deliberate harm, risk of harm and harm that occurs during her performance
of nursing actions. The nurse is promoting which ethical principle?
a. Autonomy c. beneficence
b. Nonmaleficence d. justice

A. S
Lesson 6: e
x
SEXUALITY AND u
HUMAN a
l
REPRODUCTION i
t
y
and Human Reproduction
 Human Sexuality and Its Moral Evaluation
AS God’s gift to us, it is the way in which we experience and express ourselves as sexual
beings
 The Sixth Commandment
protects Human Sexuality.
You shall not commit Adultery
prohibits married person from
entering into sexual union with
someone other than their spouse.
It touches on the very nature of human sexuality and the full range of man – woman
relationships.
It protects the family and marriage, with their two ends of procreation and human
completeness.

 The Christian view of sexuality

Our Sexuality is viewed as a fundamental
component of personality, a good thing created
by God, restored by the power of Jesus Christ
and enriched by the saving activity of the Church,
and by which the whole person enters into
communion with others.
Sexuality is not the same as the sex act. All human persons must develop their
God-given gift of sexuality. But some treaty choose, for the sake of the Kingdom,
not to enter into the sex act.
 With Christian view on human sexuality, men and women are:
Of equal personal dignity and human rights
Created through love and for love
Called to mutual gift of self and reciprocity
Different but complimentary
  The different states of life expressing love for men and women are:
Conjugal union of the married
Christian Youth before entering into a definite state of life
The single blessedness chosen by lay faithful
Consecrated celibacy chosen freely for the
sake of the Kingdom

 The sixth commandment “liberates” man

and woman from:
Self - Righteous Decency, consisting of
hypocritical moralizing and misguided taboos
regarding sexuality;
Indecency which exalts casual, spontaneous
sex without commitment or love.
 The Ninth Commandment
You shall not covet your neighbor’s wife, goes
to the interior root and source of the disorders
of the flesh by prohibiting covetousness or evil
desires of the heart.
The Ninth Commandment protects and enjoins
a free, responsible fidelity life – long conjugal
union.
Positively, the Ninth Commandment enjoins
purity of the heart or the virtue of chastity
which signifies the spiritual energy capable of defending love from the perils of
selfishness and aggressiveness
 The church Position in Masturbation,
Homosexuality, Pornography and Prostitution
These realities masturbation and homosexuality
hinder achieving such sexual maturity by turning
away from the self – giving love and service to
life.

Marriage
Nature and Definition

Humankind’s most basic and oldest social unit is the family. It is a social institution primarily
established by society to ensure its continuity and regulate the sexual behavior of its members.
 The family is the primary group where the child is initially socialized and initiated in the ways of life of
his group. The family provides the child’s social, psychological and emotional needs – warmth, intimacy,
affection, love, nurturance, care and security.

The New Family Code of the Philippines, which became effective on August 3, 1998, defines:

Marriage as special contract of permanent union between a man

and woman entered into in accordance with law for the
establishment of conjugal and the family life.

Aspects of Marriage
First, Legal Point of View
 Posts that Marriage is a Contract.
Second, Religious Point of View
 Posts that Marriage a Sacrament.
“What God has put together let no man put asunder”.

The Meaning of Marriage and the Family Issue

a. The most traditional social norm
o Views marriage as a sacred phenomenon;
That is, the family and the marriage are divine and holly institutions created and maintained by God or
some supreme being greater than human beings.

Traditional Family Norms Non - Traditional Alternatives

1. Legally Married Singlehood never married
Non married cohabitation
2. Married Once Remarriage, multiple marriages
3. Heterosexual Marriage Same sex marriage
4. Endogamous Marriage Interfaith marriage, inter racial marriage
5. Two adult households Communal living
6. Children Voluntary childless
7. Two parents living together Single parents, joint custody, step families
8. Parent as key source of: Education, School, Churches, Government Police, Clubs and
Religion, Protection and Recreation Professional sport
9. Until Death Until Divorce of Separation
10. Male as Provider Female as provider
Dual Careers
Commuter marriages
11. Male as “head” or Authority Female as “head”
Androgynous Relationships
12. Self supporting Independent Welfare
Social Security
13. Premarital Chastity Pre or non marital intercourse
14. Marital Exclusivity Extra marital relationships
Sexually open marriages
Intimate Friendships
b. A Second Traditional Norm

o Views the meaning of marriage and family as centering primarily on Social Obligations

c. A Third
 o Meaning of marriage suggest that families and the marital relationship exist for the Individual.

Important Legal Matters on Marriage

A. Essential Requisites for Marriages

Family Code of the Philippines provides:

Art. 2: No Marriage shall be valid:

 Unless these essential requisites are present:

 Legal capacity of the contracting parties (18 y/o or upwards), who must be a male and female
and
 Consent freely given in the presence of the solemnizing officer

B. Formal requisites of marriage

Art. 3. The formal Requisites of marriages are:

 Authority of solemnizing officer;

 A valid marriages license except in cases provided in chapter 2 of this title and
 A marriage ceremony which takes place with the appearance of the contracting parties before the
solemnizing officer and their personal declaration that they take each other as husband and wife
in the presence of not less than two witnesses of legal age.

Art 4. The absence of any of the essential or formal requisites shall render the marriages
“void ab initio” (void from the beginning) except as stated in Article 35 (a)

C. Annulment of a marriage
Annulment
- Refers to hr legal process of filing a petition in the appropriate court seeking a judicial
declaration of making a marriage null and void ab initio or from the beginning as if no marriage
took place.

Art 45. Enumerates the grounds for annulment of marriage as follows:

 One of the contracting parties is 18 years of age or over but below 21 and without parental
consent
 Either party was of unsound mind
 Consent of either party was obtained by fraud, force and intimidation
 Either party was physically incapable of consummating the marriage with the other
 Either the was afflicted with a sexually transmissible disease found to be serious and incurable.

D. Legal separation
Legal Separation – refers to the legal process of filling a petition in the appropriate court seeking
a judicial declaration of legal separation for married couples.

Art. 55. A petition for legal separation may be filed on any of the following grounds.

 Repeated physical violence or grossly abusive conduct directed against the petitioner
 Physical violence or moral pressure to compel the petitioner, apolitical affiliation

Norms of Marriage on the Selection of Potential Marriage Partners

 1. Endogamy – is a rule that requires a person to marry someone from within his or her own group
– tribe, nationality, religion, race community or any other social grouping.
2. Exogamy – is a rule that requires a person to marry someone from outside his/her own group.
3. Sororate – prescribes that a widower marry the sister or nearest kin of the decease wife.
4. Levirate – prescribes that widows marry the brother nearest kin of the deceased husband.

Forms of marriage

1. Monogamy – marriage between one man and one woman

2. Polygamy or plural Marriage

Has three forms:

3. Polygamy – one husband and one or more wives

4. Polyandry – one wife and two or more husbands
5. Group marriage – two or more husbands and two or more wives

Why people marry

 Love compatibility
 Economic security unhappy home situation
 Emotional security money
 Parent’s wishes companionship
 Escape from loneliness adventure
 Common interest sex and sexual attraction
 Parenthood death of a former spouse
 Physical attraction acceptance responsibility

Family
Planning

Family Planning as the process by which responsible and mature couples, if they wish, determine by
themselves the timing, proper spacing and numbers of children born to them. Family planning involves
three main aspects:
 Responsible Parenthood
 Proper spacing of children
 Birth control
 Contraception means prevention of unwanted pregnancy.
 Responsible parenthood means responsible procreation and socialization of children.
 As responsible parents, married couples are prepared for the responsibility of rearing a child who
can be properly fed, clothed and educated

Norms of Family Planning

o Sociological Norms
- Married couples arrive at an intelligent decision in the number of children they could provide with
quality life.
o Medical Norms
- Contraceptives work to prevent the meeting of egg and sperm. Family planning involves the prevention
of unwanted births by contraceptive techniques or reducing the length of exposure to pregnancy.
o Legal – Judicial Norms
Government support of family planning is reflected in Article XV.
Sec. 10 of the Philippine Constitution to achieve and maintain population levels.
o Ecclesiastical Norms
All the major religions of the world believe in the guiding principle that a couple has a right to limit family
size. The
Roman Catholic Church is not against family planning but categorically condemns the use of artificial
methods as they are against the natural laws.
o Psychological Norms
Family planning has a psychological bearing on problems which confront the young today brought about
by their development stage and the sexual revolution in the present times.

1. Chemical Methods
a. Pill or oral contraceptives
b. Morning After Pill
- Emergency birth control – anti abortion and pro life groups insist that the pill previously
marketed here under the brand Postinor – is an abortifacient because as many of them believe, a
fertilized egg is already considered a life form.
c. Implants
The rods released low doses of hormones to suppress ovulation and cause a thickening of the
cervical mucus so that sperm cannot penetrate.

2. Sterilization or Surgical Method

a. Tubal Ligation
Female sterilization involves tying, cutting or searing the two fallopian tubes or oviducts via survey so
that the passageway to the uterus is blocked.
b. Vasectomy
Male sterilization involves tying, cutting or searing the two vas deferens, the tubes which carry
sperm from the testes to the penis, to prevent the sperm from mixing with the seminal fluid.

3. Mechanical Barrier Methods

The barrier methods of contraception put a physical barrier between sperm and egg, so that two
cannot meet.
a. Male condom
b. Female condom
c. diaphragm/Cervical Cup
It prevents the sperm in the vagina from entering the uterus and reaching the egg
beyond.it is usually fitted 2 or 3 hours before intercourse and removed several hours
afterwards.
d. Sponge
It must be moistened and inserted before intercourse and left in place from up to six
hours afterward. It works like the diaphragm and the cervical cap. Its function is to block
the entry of the sperm into the womb.

4. Natural Family Planning Method

Natural Family Planning also called fertility Awareness, refers to methods for planning and
preventing pregnancies by observation of the naturally occurring signs and symptoms of the
fertile and infertile phases of the menstrual cycle. Intercourse is avoided during the fertile phase
 if pregnancy is not desired. The natural methods rely on timing rather than that artificial aids or
surgery.
A. The rhythm or calendar method
B. Cervical mucus method
C. Symptothermal Method
D. Withdrawal or coitus Interruptus
E. Prolonged lactation or lactation amenorrhea (LAM)

Issues on Contraception, its Morality and Ethico – Moral Responsibility of Nurse

Definition:
The deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of
sexual intercourse.
Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation,
fertilization, and implantation. There are different kinds of its birth control that act at different points in
the process.

So, how does it become a moral issue?

On moral issue
1. Those who say contraception is morally wrong do so far a variety of reasons
 Contraception is inherently wrong:
 Contraception is unnatural
 Contraception is anti – life
 Contraception is a form of abortion
 Contraception separates sex from reproduction
3. Contraception is unnatural…
 The natural consequence of having sexual intercourse is conceiving a child. It is wrong to
interfere with this. Therefore, birth control is intrinsically wrong.
 This argument depends on two other ideas:
 It is wrong to interfere with the natural order of the universe
 Human beings interfere with the natural order of the universe all the time.
4. Contraception is Anti – life
 The argument is based on the premise that life is a good thing of this view argue that
contraception is morally wrong because:
 Life is a fundamental good – it is a good thing
 Those who use contraception are engaged in an intentionally life act because they intend
to prevent a new life coming into being.
5. Contraception is a form of abortion…
 Some birth control technique can operate by preventing the implantation and
development of a fertilized egg. Those opposed to such methods say that this amounts
to an abortion and that if abortion is wrong then those forms of contraception must also
be wrong.
 The forms of contraception included in this objection are:
 Some birth control pills
 Most modern birth control pills
 The “morning after pill”
 The IUD
6. Contraception separates sex from reproduction
 Contraception makes it easier for people to have sex outside marriage. This is certainly
true, since sexual intercourse without contraception carries a significant risk or
conceiving a child, which most of those having sex outside marriage would regard as a
deterrent.
  People think separating sex from marriage is wrong because:
 It makes immoral behavior less risky
 It undermine public morality by making it more likely that people will have sex outside
marriage
 It weakens the family

Is the Pope catholic?

“Abortion is not a lesser evil, it is a crime. Avoiding a pregnancy is not an absolute evil”
- Pope Francis

Issues on Artificial
Reproduction: Its Morality
and Ethico – Moral
Responsibility of Nurses

Artificial insemination
- Depositing a man’s semen in the vagina, cervical canal or uterus, through the use of
instruments to bring about conception without sexual intercourse.
- How is it done?
 Intravaginal
 Intracervical
 Intrauterine
Methods of Extraction:
 Masturbation
 Condomistic Intercourse
 Coitus Interruptus
 Anal massage of the prostate gland
 Direct puncture of the epididymis

Two Types of Artificial Insemination

1. Homologous Insemination (AIH)
a. Semen is from the husband
2 Methods
 Do It Yourself
 Homologous IVF and ET
 Homologous in vitro and embryo

2. Heterologous Insemination (AID)

a. Semen from other person other than husband
 Heterologous Artificial Insemination

Justifications of AIH

o Husband is impotent.
o Anatomical defects
 o Oligospermia/azoospermia
o Spinal injury
o Vasectomy
o Physiologic obstruction of genital organs of wife

Application of Ethical Theories

o Natural Law Ethics/Roman Catholic
 Immoral
o Situational Ethics
 Moral
 Our right to overcome childlessness
o Utilitarianism
 Moral since it produces more happiness
o Pragmatism
 Moral since it is practical, beneficial and useful and workable
o Immanuel Kant
 Principle of Autonomy
 It is moral only if and only if the couple it is voluntary and mutually agreed

In Vitro Fertilization

DEFINITION
In Vitro Fertilization
Refers to the union between egg cell and sperm outside body in a culture vessel involving their collection
and fusion under appropriate conditions in vitro to give rise to zygotes which are cultured in virto to
obtain young embryos.

Infertility is a common and serious problem in reproduction now – a – days. Animal culture and tissue
techniques provide a solution to this problem through the techniques of IVF and Embryo transfer (ET).

The implantation of young embryos developed in vitro or obtained from the uterus of females into the
womb of selected females is termed as Embryo Transplantation or Embryo Transfer.

Steps involved
 Collection of oocytes
 Collection of sperms
 IVF of the oocytes
 Implantation of the resulting zygotes in the uterus

Collected from females desirable of having baby.

Cannot be collected from females with non-functional ovaries
Can be collected during a natural or induced menstrual cycle
Time for this is determined by monitoring rise in the level of Leuteinizing Hormone (LH) in urine
or blood

Techniques
 The patient is orally administered with Valium before embryo transfer.
 The whole process is negotiated through cervical canal.

Steps Involved:
 The patient is placed in lithotomy (knee chest) position.
 A sterile bivalve speculum is inserted to visualize the cervix.
  The cervical canal and uterine cavity are aligned.
 The embryo is drawn into a Teflon catheter in tissue culture medium. Teflon is used due to its
low adhesiveness.
 The catheter is inserted into the uterine cavity just short of the fundus.
 The embryo is gently inserted in culture medium and the catheter and cannula are gently
withdrawn.
 Catheter is examined under the microscope to ensure that the embryo has been expelled.

Steps involved in Embryo Transfer

 The babies produced using these approaches are called Test Tube Babies.
 The first test tube baby was born on July 24, 1978 and was named Louise Joy Brown.
 The Nobel Prize of Medicine for the year 2010 was awarded to Robert G. Edwards for this
outstanding invention.

Success Rate
 IVF success rates are the percentage of all IVF procedures which result in a favorable outcome,
which implies Pregnancy Rate (Number of confirmed pregnancies) or Live Birth Rate (Number of
Live Births)
 Due to advancement in reproductive technology, the IVF success rates are substantially better
today than they were just a few years ago.

Factors Affecting Success Rate

Maternal Age
Duration of fertility or sub fertility
FSH
Number of oocytes
Tobacco smoking
High body mass index
Alcohol/caffeine intake

Ethical Issues

 Laboratory mix – ups (misidentified gametes, transfer of wrong embryos) have occurred, leading
to legal action against the IVF provider and complex paternity suits.

An example: A case of a woman in California who received the embryo of another couple and was
notified of this mistake after the birth of her son. This has led to many authorities and individual clinics
implementing procedures to minimize the risk of such mix ups.

 The Catholic Church opposes all kinds of in vitro fertilization because, as with contraception, it
separates the procreative purpose of the marriage act from its unitive purpose, i.e. to produce a
new life.
 Another concern is that people will screen in or out for particular traits.
A deaf British couple have petitioned to create a deaf baby using IVF. Medical Ethicists are
against this form of Pre Implantation Genetic screening or diagnosis as intentionally culling out
blind or deaf embryos might prevent considerable future suffering, while a policy that allowed
dear or blind parents to select for such traits intentionally would be fair more troublesome.

Surrogate Motherhood

Definition of Surrogate Motherhood

  A woman who agrees to become pregnant for the purpose of gestating and giving birth to a child
for others to raise.
 Allow the infertile couples having the children who have genetic linkage with them.

Conflicts of Surrogate Motherhood

The idea of surrogate motherhood is morally wrong.

 Violates the ethics
 Degrade the role and value of mother
 Put the unborn children into the dangerous circumstance.

Ethic Perspective
 The ruined family moral principles.
Vatican has issued a statement rejecting surrogate motherhood.

Role and Value of Mother

- New Definition of Mother
 Genetic Mother – provides the ovum
 Gestational Mother – carries the pregnancy.
 Social Mother – brings up the child

The Uncertain Environment for Children

 Surrogate Motherhood lacks of the consideration of the children
- The safety and welfare of the children?
the risk of abandoning the children?
The child has serious disabilities?

Ethical and Moral Issues

 Children are not elegant little presents we can wrap up with a bow and send out of the door.
 Surrogacy destroys the sanctity of marriage.
 Destroys the spiritual connection the parents and child
 Bring the child and mother bearing it to be objects of negotiation and purchase.
 Turns women into reproductive machines.
 May lead to confused parent – child relationship
 Ultimately damages the institution of family
 Only poor women are happy to help – economical reason
 Involvement of the third party “reproductive prostitution”

Lesson 7:
Dignity in
Death and
Learning Outline:
1. Euthanasia and Prolongation of Life
Dying
2. Inviolability of Human Life
3. Dysthanasia
4. Orthothanasia
 5. Administration of Drugs to the Dying
6. Advance Directives
7. End of Life Care Plan or DNR
8. Nursing Roles and Responsibilities
9. Ethical Decision Making Process

Dying with Dignity – movement that promotes the ability to meet death on your own terms.

Suicide: Assisted suicide, which is also called physician – assisted suicide, is when a doctor gives a person
the means to commit suicide when required for:

Euthanasia: A doctor is allowed by law to end person’s life by a painless means, as long as the patient
and their family agree.

1. Euthanasia:

Voluntary – when euthanasia is conducted with consent. Voluntary euthanasia is currently legal in
Belgium, Luxemberg, The Netherlands, Switzerland and the states of Oregon and Washington in US.

Non – voluntary – when euthanasia is conducted on a person who is unable to consent due to their
current health condition. In this scenario the decision is made by another appropriate person, on behalf
of the patient, based on their quality of life and suffering.

Involuntary – when euthanasia is performed on a person who would be able to provide informed
consent, but does not, either because they do no want to die, or because they were not asked. This is
called murder as it’s against the patient’s will.

2. Inviolability of Life

 The concept of inviolability is an important tie between the ethics of religion and the ethics of
law, as each seeks justification for its principles as based on both purity and natural concept as
well as in universality of application.
 In religion and ethics, the inviolability or sanctity of life is a principle of implied protection
regarding aspects of sentient life that are said to be holy sacred or otherwise of such value that
they are not to be violated.
 The phrase sanctity of life refers to the idea that human life is sacred, holy and precious, argued
mainly by the pro life side in political and moral debates over such controversial issues as
abortion, contraception, euthanasia, embryonic, stem – cell research and the “right to die” in the
United States, Canada, United Kingdom and other English speaking countries.

3. Orthothanasia

 A normal or natural manner of death and dying.

 Sometimes used to denote the deliberate stopping of artificial or heroic means of maintaining life
Passive euthanasia see there

4. Dysthanasia
 Dysthanasia is a term generally used when a person is seen to be kept alive artificially in a
condition where, otherwise they cannot survive sometimes for some sort of ulterior (intentionally
hidden/future) motive

5. Administration of drugs to the dying

 Medicine, specifically in end of life care, palliative sedation is the practice of relieving distress in a
terminally ill person in the last hours or days of a dying patient’s life usually by means of a
continuous intravenous or subcutaneous infusion of a sedative drug or by means of a specialized
catheter designed to provide comfortable and discreet administration of ongoing medications via
the rectal route.
 Palliative sedation is an option of last resort for patients whose symptoms cannot be controlled
by any other areas.
 It’s not a form of euthanasia, as the goal of palliative sedation is to control symptoms rather than
to shorten the patient’s life.

6. Advance Directives
 Are legal documents that allow you to spell out your decisions about end of life care ahead of
time. They give you a way to tell your wishes to family, friends and health care professionals and
to avoid confusion later on.
 Living Will - The living will is a legal document used to state certain future health care decisions
only when a person becomes unable to make the decisions and choices on their own.
 Durable Power of Attorney for health care/Municipal Power of Attorney
 A durable power of attorney for health care, is a legal document in which you name a person to
be a proxy (agent) to make all your health care decisions if you become unable to do so.

7. End of Life Care Plan or DNR

 End of life care includes palliative care. If you have an illness that can’t be cured, based on
understanding that death is inevitable. Palliative care makes you as comfortable as possible, by
managing pain and other distressing symptoms.
 It also involves psychological, social and spiritual support for you and your family or careers.
 When does end of Life Can Begin?
o Have an advanced incurable illness, such as cancer, dementia, or motor neuron disease are
generally frail and have no co-existing conditions that mean they are expected to die within 12
months
o Have existing conditions if they are at risk of dying from a sudden crisis in their condition
o Have a life- threatening acute condition caused by sudden catastrophic event, such as an
accident or stroke.

Lesson 8: Roles and

Responsibilities

  Treat people
compassionately
 Listen to people
 Communicate clearly and sensitively
 Identify and meet the communication needs of each individual
 Acknowledge pain and distress and take action
 Recognize when someone may be entering the last few days and hours of life
 Involve people in decisions about their care
  Keep the person who is reaching the end of their life and those important to them up to date
with any changes in condition
 Document a summary of conversations and decisions
 Seek further advice if needed
 Learning from complaints
 Care of the person

Lesson 9: Ethical
Decision Making
Process

 Choose among alternatives in a manner consistent with ethical principles. In making

ethical decisions, it is necessary to perceive and eliminate unethical options and select
the best ethical alternatives.

The Process of Making Ethical Decisions Requires:

 Commitment: The desire to do the right thing regardless of the cost.
 Consciousness: The awareness to act consistently and apply moral convictions to daily
behavior.
 Competency: The ability to collect and evaluates information develop alternatives and
foresee potential consequences and risk.

Good decisions are both Ethical and Effective:

 Ethical Decisions: generate and sustain trust; demonstrate respect, responsibility, fairness and
caring and are consistent with good citizenship. These behaviors provide a foundation for making
better decisions by setting the ground rules for our behavior.
 Effective Decisions: are effective if they accomplish what we want accomplished and if they
advance our purposes. The key to making effective decisions to think about choices in terms of
their ability to accomplish our most important goals. This means we have to understand the
difference between immediate and short term goals and longer range goals.

Post Assessment Test

Multiple Choice: Choose the best answer.

1. A state wherein a human organism has irreversibly lost his/her capacity of consciousness.
a. Brain Death c. Cortical Death
b. Persistent Vegetative State d. Comatose
2. Which of the following describes euthanasia?
a. Is believing that in certain cases there is totally no hope for improvement from an incapacitating
condition.
b. Do not slow down nor speed up the onset of death.
c. Does not intervene with the patient's life.
d. Ending the life of a person to relieve pain or suffering
3. Result of a study showed that there is residual language recognition observed in brain death.
a. False b. True
4. "Death cannot be dignified"
a. Socrates c. Terri Schiavo
b. P.Welby d. Epicurius
5. Only those that are living are the ones who can die?
a. True b. False
6. The ethical principle of respect for persons is a broader concept than autonomy
a. True c. False
7. What principle best applies for euthanasia?
a. Beneficence c. Justice
b. Non-maleficence d. Autonomy
8. The following are the most frequent symptoms experienced by the dying older adult. Select all that
apply:
a. Pain c. Respiratory Distress-
b. Euphoria d. Confusion
9. DNR. Select all that apply
a. Do not resuscitate c. Withhold other care
b. No code d. May be indicated in patient’s living will
10. Signed and witnessed documents providing specific instructions for healthcare treatment in the event
that a person is unable to make those decisions personally at the time they are needed.
a. Advanced directives c. Living will
b. Power of attorney d. health document
11. Professional accountability serves for the following purpose except for:
a. To provide basis for ethical decision
b. To respect the decision of the client
c. To maintain standards of health
d. To evaluate new professional practices and reassess existing ones
12. A wrong dose of drug is administered by the nurse. The nurse is responsible to whom?
a. Client c. Society
b. Physician who ordered the drug d. all of these
13. The nurse in a unit is caring for several clients. To distribute nursing care the nurse utilized the
principle of triage due to the limited availability of resources. The nurse is promoting which ethical
principle?
a. Fidelity c. veracity
b. Justice d. confidentiality
14. The client on renal dialysis informs the nurse that he wants to stop the series of dialysis. The nurse
should appropriately do which action in response to the client’s decision?
a. Inform the client that the doctor must decide what to do.
b. Tell the client that he must finish his series of renal dialysis.
c. Respect the client’s decision and provide comfort measures
d. Leave the client and attend other patients
15. The nurse’s obligations to the client least like include:
a. Considers the dignity of clients
b. Retains a commitment of welfare to the client
c. Work toward securing and maintaining conditions of employment that satisfy the goals of nursing
d. Hold confidential all information about a client learned in a health care setting
16.Before the nurse administered the client’s medication she assessed the client’s needs for drugs, and
followed the “rights” in drug preparation and administration. After the nurse has given the dose, she
evaluated the client’s response to the medication given. The nurse is promoting:
a. Accountability c. Responsibility
b. Autonomy d. veracity
17. Being answerable for one’s own action is assuming:
a. Accountability c. Nonmaleficence
b. Responsibility d. Veracity
18. The execution of duties associated with nurse’s particular role is called:
a. Accountability c. nonmaleficence
b. Responsibility d. veracity
19. Nursing ethics provides the standards for professional behavior and is the study of principles of right
and wrong for nurses. This set of standards states the duties and obligations of nurses to:
a. Client c. community
b. Other health professionals d. all of these
20. Nurse Janine avoids deliberate harm, risk of harm and harm that occurs during her performance of
nursing actions. The nurse is promoting which ethical principle?
a. Autonomy c. beneficence
b. Nonmaleficence d. justice

Self – Assessment

Before you end this lesson, evaluate your current competency by answering the checklist
that follow. Put a check (/) mark to best describe you current level of mastery of each list of
competency.

Competency I can do I can do this but I I am learning I can

this very need to learn more how to do this not do
well and Improve (Apprentice) this yet
(Expert) (Practitioner) (Novice)

Understand the importance

of sexuality and human
production
Define Euthanasia
Define Advance Directives

References:
1. Harold W. Baillie, John F. Mcceehan, Thomas M. Garrett, Rosellen M. Garrett 2018, Health Care
Ethics Sixth Edition, Mind Mover Publishing House, Inc. Manila