Bioethics/

Ethical Principles/
Moral Issues
Philosophy
Which means to pursuit wisdom
GREEK WORDS:
‘’PHILOS’’ – love
‘’SOPHIA’’ – knowledge, wisdom
Ethics
•Greek word: ‘’ethicos’’ – moral duty
•The study of human action or conduct from a moral
perspective as to whether they are good or bad

Bioethics
•Medical ethics, biomedical ethics
•Branch of ethics that is concerned with issues surrounding
health care and biological science
•Challenge arising from modern biological science
 Ethics Morality
The nature of the Fundamental
good convictions of human
The nature of human agent
person Character of moral
Criteria of judgment agent
Use of norms
Situational analysis
Ethical relativism – or moral relativism,
ethics anchored to the norms of a
particular culture

Ethical Pragmatism – theory on

knowledge, truth, and meaning rather
than morality.

Ethical Utilitarianism – rightness or

wrongness of actions is determine dby
their consequences
 Health Care Profession
Is a special calling, a service characterized by a
trusting and caring relationship which cannot be
measured in momentary terms
It is a vocation
Relationship- not a contract, it is a covenant.
 Patient
Every person has an obligation to care for his own health,
therefore he has the right to seek and receive healthcare

A sick individual becomes a patient if:

1. He admits that he is sick
2. That he can no longer take care of himself
 Patient
HCP- protect, give care, and teach how to care for
himself
Patient- accept responsibility for his care,
cooperate by telling the truth and doing best to
follow the instruction.
 Health Care Provider
He is committed to healthcare services
Invested authority but with corresponding responsibilities
to patients his profession, and the society
He must be a patient advocate
Must always be understanding, humane and
compassionate
As an authority- must contribute to knowledge, conduct
himself in an ethical profession always serve as a role
model
Universal Principles of BioMedical
Ethics
1. VERACITY
2. AUTONOMY
3. BENEFICENCE
4. NONMALEFICENCE
5. ROLE FIDELITY
6. CONFIDENTIALITY
7. JUSTICE
VERACITY
Binds the health practitioner and the patient in an
association of truth
PATIENT- tell the truth in order that appropriate
care can be provided
HCP- needs to disclose factual information
 AUTONOMY
Greek ‘’autos’’ – self
‘’nomos’’ – governance
It is the capacity for self determination
Implies that one should be free from coercion in deciding
to act.
Exercised through the process of obtaining informed
consent
 Informed consent
Gives valid permission to others
Any procedure to be done on any person may only be
administered with his free and informed consent
Introduced into patient care as a means of protecting a
patients personal integrity
It means to morally justify the burdens given to them by
their agreement to accept such burdens
 Two main function of
informed consent
1. PROTECTIVE- to safeguard against instruction of integrity
2. PARTICIPATIVE- to be involved in medical decision
making

With the production of informed consent in healthcare,

there has been a shift from the paternalism of ‘’doctor
knows best and decides’’ to ‘’patient knows best and
decides’’
Paternalism
Intentional limitation of the autonomy of
one person by another, in which the person
who limits autonomy appeals to grounds of
benefits to the other person
Proxy Consent
The patient family, or guardian or representatives
provides the informed consent
Decisions by proxy should be based on what thee
patient would have chosen when he been
competent
BENEFICENCE
Traditionally understood as the ‘’first principle of
morality’’
It means ‘’to do good, & to provide a benefits’’
Acts of mercy and charity
It hinge on other duties such as fair play, keeping
promises, role commitments.
NONMALEFICENCE
It means to do no harm (doing no harm/doing no
evil)
‘’primum non nocere’’ – first do no harm.
It makes action almost impossible in a world
where even the best action may have some
harmful results
NONMALEFICENCE
Harm may be:
Physical
Mental
Psychological
Social
Financial
Spiritual
ROLE FIDELITY
Whatever the assigned role, the ethics of
health care require that the practitioner
practice faithfully within the constraint of
the role
CONFIDENTIALITY
Important aspect of trust that the patient place in
health care professionals
If the patient felt that information in regard to his
body or condition was subject of public
conversation
It harms patients, profession, and society, which
depends on the service we provide
JUSTICE
Also termed as fairness
Means to give to each one what he deserves or
what is his due
Distributive justice- principle of equality
distribution of scarce resources
‘’equals must be treated equally and un-equals
must be treated unequally’’
JUSTICE
COMPENSATORY JUSTICE- in which individuals
seek compensation for a wrong that has been
done
RETRIBUTIVE JUSTICE- calls for equal suffering
‘’ an eye for an eye and a tooth for a tooth’’ very
little to do with any form of behaviour suitable for
the health care arena.
ETHICAL
PRINCIPLES
Principle of double effect
When an act is foreseen to have both good and
bad effects
There is a clash between the two universal norms
of ‘’do good’’ and ‘’avoid evil’’
 Cooperation
Is the participation of one agent with another to produce a
particular effect or joint effect
Cooperation may be:
FORMAL- when the secondary agent willingly participates
MATERIAL- when the secondary agent does not willingly participate
IMMEDIATE- when the action of the secondary agent is inherently
bound to the performance of the evil action.
 Totality
It refers to the whole
Every person must develop, use, care for
and preserve all his parts
This principle dictates that the well being of
the whole person must be taken into account
Solidarity
To be one with others
In the provision of healthcare, it is
important for the provider to be in
solidarity with the patient when seeking
always
Stewardship
This means we are responsible for the
bodies, our life, our human nature and
everything in this earth are given by the
dominion over
We should not harm but rather improve
and care for them
 Virtues of health care
provider
Virtues are habits to do what is morally right
They are traits of character that dispose to act accordingly
1. Fidelity- faithfulness. Keep his promises and keep the
patients best interest in mind
2. Honesty- truthfulness, it is telling the patient, the
family, colleagues, and society the truth about an illness
3. Integrity- acting in the same way ones says he should
act
4. Humility- recognizing ones capabilities and limitations.
Accepting deserved praise graciously and denying
undeserved praises
5. Respect- paying attention to others
6. Compassion- is loving kindness, feeling for those who
suffer.
7. Prudence- is foresight. A habitual deliberateness, caution
and circumspection in action consider how diff. options
may affect others before making a decision
8. Courage- one sees as right without undue fear, or
standing up against what one sees as wrong even if it
means standing up alone
9.Pride- is inordinate self-esteem, conceit. It is
behaviour of superiority over others
10. Greed- is inordinate acquisitiveness often for
wealth but also for power or position
 Problems and concerns in the
medical technology practice
NEGLIGENCE- it is a general term that denotes the conduct
of practice is lacking in due care. Carelessness and
deviation from the standard of care that a reasonable
person uses in a particular set of circumstances
MALPRACTICE- it is a professional negligence by act or
omission of a health care provider in which care provided
deviates from the accepted standards of practice in the
medical community. To be liable for malpractice, the
person committing the wrong is a professional
 In order to prove negligence
or malpractice:
A duty has owed- a legal duty exists whenever a hospital or health
care provider undertakes care or treatment of a patient
A duty was breached- the health care provider failed to conform to
the relevant standard of care
The breach causes an injury- the breach of duty was the proximate
cause of injury
Damages- may be economic (lost earning capacity, medical expenses)
and non-economic damages can be physical (loss of vision, organ,
limbs etc.) and psychological (severe pain, emotional distress)
 Moral issues and
ethical considerations
 Stem cells
Stem cells are master cells of the body; cells from which
other cells with specialized functions are created.
Stem cells divide to form more cells called daughter cells.
These cells may become brain cells, blood cells, muscle
cells, or bone cells which can be used to generate and
repair diseased or damaged body tissues
 Sources of stem cells
•EMBRYONIC STEM CELLS- these stem cells come from the
embryos (4-5 days old), called blastocyst, with about 150
cells. This cells have the greatest potential to divide
•ADULT STEM CELLS OR SOMATIC CELLS- these stem cells are
found in bone marrow of adult and in placentas and
umbilical cords of infants. This stem cells have been
successfully used to treat rare genetic diseases
AMNIOTIC FLUID STEM CELLS- the stem cell found
in the amniotic fluid, a fluid that fills the sac that
surrounds and protects a developing fetus in the
uterus; these are sample of cells that are drawn
from pregnant women, such procedure is called
amniocentesis
 Risk of stem cell therapy
It must be certain that stem cells will differentiate the specific cell
type desired
They can be tumour cells and travel to other parts of the body
They also trigger the immune response which the body attack the
stem cells as foreign invaders
They may fail to function normally
They may contain abnormalities due to environmental hazards,
toxins or errors during replication
 Moral implication of stem
cell therapy

These stem cells coming from embryos is a person, creating and

killing embryos for instrumental use is seriously and morally wrong
Some consider that creation of early embryo as a cluster of cells or as
human tissue is lacking in moral status
 Euthanasia
Greek word- ‘’eu’’ easy
‘’thanatos’’ death
•Refers to the practice of ending a life in a manner which relieves
pain and suffering.
•Easy death which also called mercy killing
•It is carried out for someone who is terminally ill and suffering from
prolonged and unbearable pain
 Types of Euthanasia
Euthanasia by commission
-The active euthanasia
-Refers to the ‘’positive’’ act of causing death that is geared
towards termination of pain and suffering
•Euthanasia by omission
-The passive euthanasia
-Refers to the ‘’ negative’’ act of causing death that is
geared towards termination of pain and suffering
 Classification of euthanasia
Voluntary euthanasia- euthanasia conducted with the consent of the
patient is termed voluntary euthanasia. Voluntary euthanasia is legal
in Belgium, Luxembourg, Netherlands, Switzerland and the U.S..
Assisted suicide is used
Non-voluntary euthanasia- euthanasia conducted where the consent
of the patient is unavailable. Ex. Is child euthanasia
Involuntary euthanasia- conducted against the will of the patient
Passive euthanasia- entails the withholding of
common treatment such as antibiotics, necessary
for the continuance of life
Active euthanasia- entails the use of lethal
substances or that which forces to kill and is the
most controversial means
Death- to be able to determine the exact
point in time when a person is dead
Several definitions of death
-Physiological def.- a person is dead when the heart stop beating
-Religious def.- death means separation of body and soul
-Brain death definition- a condition where brain is completely
destroyed
-Cellular def.- disintegration and breakdown of the metabolic process
 Moral implication of
euthanasia

Religious opponents of euthanasia, they believe

that life is given by GOD, and only GOD should
decide when to end ones life
Genetic Engineering
Controversial ethical issue because it
involves genetic manipulations that are
perceived to be against moral standards
set by the society.
Genetic screening-screen, choose,
select the genes for proper detection of
genetic disease
Genetic Engineering

Genetic interventions – genetic control,

therapy and surgery (control bad genes)
 Cloning

It is the creation of a genetic copy of a sequence of DNA or the

entire genome. Refers to as Somatic Cell Nuclear Transfer (SCNT)
From oocyte they can make an embryo.
Dolly, the sheep was the first mammal to be cloned
 Possible uses of cloning
Therapeutic cloning- cloning for therapy will be the most
promising application of the SCNT.
Reproductive cloning- cloning for creating human embryo
with the intentions of gestating them in full-grown human
beings.
 Moral implication of cloning
Embryos for cloning are created for instrumental use only; they are
treated as a mere clone, which means, it is incompatible with a
respectful attitude toward embryo
Embryos resulting from SCNT do not have the same moral status
given to normal embryo
One ethical concern is the exploitation of women. They become
objects of commercialization of oocytes
 Contraception
Also known as birth control
Can be obtain by the use of devices,
sexual practices, or medications to reduce
pregnancy
 Three main routes to prevent
pregnancy
Contraception- the prevention of fertilization of ovum by
the sperm cells
Contragestion- the prevention of implantation of the
blastocyst
Abortion- the chemical or surgical induction of the
developing embryo or fetus
Moral implication of
contraception
Contraception is not only a moral issue; it is also a
religious issue.
Moral philosophers are concerned with ordinary
and natural experiences of all human beings
In vitro fertilization
AKA Laboratory fertilization
Controversial to some religions as it appears
as a deviation of the natural process of
fertilization.
 Organ transplant and blood
donation

An organ transplant is the ‘’ moving of

an organ from one body to another’’
 Reasons for donation and its
ethical issues
Living related donors- donation of organ among family
members
‘’paired exchange’’- a technique of matching willing donors
to compatible recipients
Good Samaritan- ‘’altruistic’’ is giving a donation to
someone not well-known to the donor
Compensated donation- donors get money or other
compensation in exchange for their organs
Allocation of donated organs- deceased family
member requests an organ be given to a specific donor
Forced donation- varies authorities harvest organs
from those who are deemed undesirable, such as the
prison population
Thank you!!
Good luck!
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