OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF MEDICAL LABORATORY SCIENCE
BIOETHICAL ISSUES
Medical Technology Laws and
Bioethics (MTLB211 )
Sherlyn Joy P. Isip, RMT, MSMT
What is a Bioethical Issue?
• a bioethical issue is an ethical dispute that requires the application of
ethical principles for its resolution.
• The resolution of every biological issue calls for complementary
standing of "life" (pro-life) on one hand and "choice" (pro-choice) on the
other.
• Pro-life is a universally accepted principle that every human being
enjoys the right to life. The right to life, being grounded on natural law,
is inherent and, therefore, not a creation of, or dependent upon a
particular law, custom, or belief. It precedes and transcends any
authority or the laws of men. Pro-life argues inviolability of life ad
infinitum.
• Pro-choice attempts to calibrate the extent of respect and protection
due to life. Pro-choice sets boundaries.
• A bioethical issue is different from a legal issue. The bioethical issue
requires the application of ethical principles to a certain ethical inquiry,
while the legal issue is concerned with the interpretation or application
of the law to certain given facts.
ABORTION
• It is the termination of pregnancy by
the removal or expulsion from the
uterus of a fetus or embryo prior to
viability.
• An
abortion
can
occur
spontaneously, in which case it is
usually called a miscarriage, or it can
be purposely induced.
• The term abortion most commonly
refers to the induced abortion of a
human pregnancy.
DIFFERENT METHODS OF
SURGICAL ABORTION
1. SUCTION ABORTION: also called ‘suction
curettage’. Is appropriately done during the 1st
trimester up to 16 weeks so far. The
abortionist begins by dilating the cervix, then
he inserts a suction curette consisting of a
hollow tube with a sharp tip into the cervix
and then into the uterus. The suction machine
tears the developing baby apart, sucks the
pieces through the tube and deposits them
into a bag.
2. DILATION AND CURETTAGE (D&C)
ABORTION: employed during the 1st trimester
of pregnancy. A sharp looped knife or curette
(sharp curettage) is inserted into the uterus to
scrape its walls. Then, the lodging baby is cut
apart and its bodily parts are removed and
checked for completeness.
DIFFERENT METHODS OF
SURGICAL ABORTION
3. DILATION AND EVACUATION
(D&E) ABORTION: commonly used
during the 1st half of second
trimester (13-20 weeks). Usually the
abortionist cuts off one or more of
the baby’s limbs and waits until he or
she bleeds to death before
proceeding with the abortion. In case
of larger babies, big forceps are used
to crush their heads and bodies
inside the uterus. The bodily parts
torn into pieces pass through the
cervix and are removed.
DIFFERENT METHODS OF
SURGICAL ABORTION
4. SALINE ABORTION: also known as
“intra-amniotic injection” or “saline
solution method” utilized during the
2nd trimester and early 3rd trimester.
Withdrawal of 200 milliliters of
amniotic fluid from amniotic sac. The
said fluid is replaced with saline or
urea solution. The baby breathes in
and swallows this concentration and
dies painfully from salt poisoning,
dehydration, brain hemorrhage and
convulsions. While dying, the baby
suffers extreme pain brought about
by the salt solution as it burns off the
outer layer of his/her skin.
DIFFERENT METHODS OF
SURGICAL ABORTION
5. DILATION AND EXTRACTION (D&X) ABORTION: also called “partial-birth
abortion”. This method of abortion is usually intended for a pre-born baby
who has already attained the late 2nd and 3rd trimester of gestational age.
Guided by ultrasound, the abortionist uses forceps to twist one of the baby’s
legs and pull it out through the birth canal and delivers the entire body except
the head. Afterwards, puncturing the back of the baby’s head with a sharp
scissor. Finally, a suction tube is inserted to suck out the brain of the baby
causing the skull to collapse.
DIFFERENT METHODS OF
SURGICAL ABORTION
6. PROSTAGLANDIN ABORTION: performed during late 2nd and 3rd
trimester of gestation. A prostaglandin hormone containing about 8
milliliters is injected into the uterine muscle which contracts to expel the
baby in an artificially-induced and extremely –violent premature labor
that takes about 20 hours.
7. HYSTEROTOMY ABORTION: Caesarian section done during the last
trimester of pregnancy when other types of abortion are dangerous to the
mother. The uterus is surgically opened and the baby is lifted out. The
baby is then either left to die or deliberately killed.
8. INTER-CARDIAC INJECTION ABORTION: it is employed during about
sixteen weeks. An amount of potassium chloride or some other fluid is
injected to the baby’s heart with the aid of ultrasound imagery, causing
the baby to have an immediate heart attack. After a period of days, the
dead baby is delivered.
ABORTION
PRO
• A woman has the right to decide
what she can and can't do with
her body.
• The fetus exists inside a woman's
body.
• A woman has the right to decide
whether the fetus remains in her
body.
• Therefore, a pregnant woman
has the right to abort the fetus.
ANTI
• Deliberately killing innocent
human beings is wrong.
• A fetus is an innocent human
being.
• Abortion is the deliberate killing
of a fetus.
• Therefore, abortion is the
deliberate killing of an innocent
human being.
• Therefore, abortion is wrong.
SURROGACY
• Is the process of assisting the reproduction of
parents who are unable to conceive or bear
children. In most cases, surrogacy is carried out
by gestational women or gestational surrogates
who are willing to carry and deliver a child for
another person or another couple.
Issues brought about by surrogacy:
• the rights of the children borne out of
surrogacy
• the ethical and practical complications of the
commercialization of women's bodies
• the exploitation of poor and low-income
women desperate for money
• the moral and ethical consequences of
transforming a normal biological function of a
woman's body into a commercial transaction.
CONTRACEPTION
• Birth control, also known as
contraception
and
fertility
control, refers to methods or
devices
used
to
prevent
pregnancy.
• Planning and provision of birth
control is called family planning.
• Safe sex, such as the use of male
or female condoms, can also help
prevent transmission of sexually
transmitted diseases.
FAMILY PLANNING
• In its broadest sense, it is a
program crafted to promote
responsible parenthood.
• In its strict sense, it refers to a
program which enables couple,
and individuals to decide freely
and responsibly the number and
spacing of their children and to
have the information and means
to carry out their decisions, and
to have informed choice and
access to a full range of safe, legal
and effective family planning
methods, techniques and devices.
FAMILY PLANNING
Characteristics of a valid Family Planning:
• It must be voluntary.
• No life must be destroyed.
• Public welfare must be amply protected.
• For married couples, sexual relationship must not be impaired.
Issues:
• Does it provide equality to protection of life both for the mother and the
unborn child from conception?
• Does the use of contraceptives promote abortion?
FAMILY PLANNING
ANTI
PRO
• It facilitates responsible parenthood.
• Helps couples and parents achieve
their desired family size.
• Reduce incidence
pregnancy.
of
teenage
• Enable government to achieve a
balanced distribution.
• Basis: Pro-choice
• This will play into the hands of
pro-abortion camp.
• As cheap condoms fail, there will
be an increase in unwanted
pregnancies among the poor.
• Rapid growth of population does
not correspond to the increase in
food production.
• Basis: Pro-natural procreation
STERILIZATION
• A surgical technique leaving a male or female unable to reproduce.
• It is a method of birth control.
Common sterilization methods include:
Vasectomy in males: the vasa deferentia the tubes which connect, the
testicles to the prostate are cut and closed. This prevents sperm produced in
the testicles to enter the ejaculated semen which is mostly produced in the
seminal vesicles and prostate.
Tubal ligation in females: known popularly as" having one's tubes tied". The
fallopian tubes, which allow the sperm to fertilize the ovum and would carry
the fertilized ovum to the uterus, are closed. This generally involves a
general anesthetic and laparotomy or laparoscopic approach to cut, clip or
cauterize the fallopian tubes.
STERILIZATION
Other procedure that result in sterility:
Hysterectomy in females: the uterus is surgically removed, permanently
preventing pregnancy and some diseases, such as uterine cancer.
Castration in males: the testicles are surgically removed. This is
frequently used for the sterilization of animals, with added effects such as
docility, greatly reduced sexual behavior, and faster weight gain (which is
desirable in some cases, for example to accelerate meat production).
STERILIZATION
Moral Issues on Sterilization
• The Catholic church has strongly condemned all artificial methods of
Contraception (apposition also held by most Protestant churches up to
1930, when the Anglican church voted for change).
• This includes the contraceptive pill, condoms and also medical
procedures such as vasectomy and sterilization. In fact, the church
regards contraception as mortally sinful. The official position is stated in
the papal encyclical Humanae Vitae issued by Pope Paul VI in 1968.
HUMAN CLONING
• Cloning is the process of
extracting the DNA out of a
donor's cell and implanting this
genetic code in another cell in
order to grow a being with
identical genes, thus virtually
duplicating the donor. The term
"clone" refers to the new being
that has identical genes to the
donor.
HUMAN CLONING
Arguments in favor of Reproductive Cloning:
• Reproductive cloning can provide genetically related children for people
who cannot be helped by other fertility treatments (i.e., who do not
produce eggs or sperm).
• Reproductive cloning would allow lesbians to have a child without
having to use donor sperm, and gay men to have a child that does not
have genes derived from an egg donor (though, of course, a surrogate
would have to carry the pregnancy).
• Reproductive cloning could allow parents of a child who has died to seek
redress for their loss.
• Cloning is a reproductive right and should be allowed once it is judged
to be no less safe than natural reproduction.
HUMAN CLONING
Arguments against Reproductive Cloning:
• Reproductive cloning would foster an understanding of children, and of people in
general, as objects that can be designed and manufactured to possess specific
characteristics.
• Reproductive cloning would diminish the sense of uniqueness of an individual. It
would violate deeply and widely held convictions concerning human individuality
and freedom and could lead to ad evaluation of clones in comparison with nonclones.
• Cloned children would unavoidably be raised in the shadow of their nuclear donor,
in a way that would strongly tend to constrain individual psychological and social
development.
• Reproductive cloning is inherently unsafe. At least 95% of mammalian cloning
experiments have resulted in failures in the form of miscarriages, stillbirths, and lifethreatening anomalies; some experts believe no clones are fully healthy. The
technique could not be developed in humans without putting the physical safety of
the clones and the women who bear them at grave risk.
• If reproductive cloning is permitted to happen and becomes accepted, it is difficult
to see how any other dangerous applications of genetic engineering technology
could be prescribed.
HUMAN CLONING
PRO
• Genetic cloning are more openly for
therapeutic cloning.
• Cloning is a reproductive right and
should be allowed once it is judged to
be no less safe than natural
reproduction.
• Human society can accept or reject
any proposed technology on its own
merits.
• Basis: Pro choice
ANTI
• It is an acceptable norm that life
begins at conception and that life
cannot be created artificially but
from the unity of a man and
female.
• Hence, once the embryo exists it
must be treated as a person.
• Therefore, destroying embryos and
using them only for the purpose of
research is not morally right as it
constitutes intentional destruction
of life.
• Basis: Pro Life and Religious views
EUGENICS
• Works on the possibility of creating a
superior human society and race by
promoting
the
reproduction
of
populations with positive or desirable
traits while controlling and prohibiting
the reproduction of populations with
negative or undesirable traits.
Issues concerning eugenics:
• include the loss of genetic diversity
• culturally-accepted improvement of
the gene that may lead to
extinction
• increased vulnerability to disease
• reduced ability to adapt to
environmental change
MUTILATION
• Mutilation or maiming is an act or physical
injury that degrades the appearance or
function of the (human)body, usually
without causing death.
• The term is usually used to describe the
victims of accidents, torture, physical assault,
or certain premodern forms of punishment.
Moral Issues on Mutilation
• A diseased part is harmful to the whole body.
• Another question pertains to "the
predicament of a person who was ordered by
a tyrant to cut off his own hand.”
• Another case is "the necessity to amputate
an extremity."
ORGAN DONATION
• Is the process of surgically removing a tissue
or organ from one person (tissue or organ
donor) and transplanting it to another
person (tissue or organ recipient).
Issues involving organ donation:
• the ethics on organ procurement
• ethics of allocation
• fundamental morality of organ transplants
• possibility of undue influence and coercion
• altruism or commercial dealing
• widening gap between organ supply and
organ demand
• the use of living donors as sources of organs
SUICIDE
• Suicide is the act of intentionally
causing one’s own death.
• Suicide is often committed out of
despair, the cause of which can be
attributed to a mental disorder such
as depression, bipolar disorder,
schizophrenia, alcoholism, or drug
abuse.
• Stress factors such as financial
difficulties or troubles with
interpersonal relationships often
play a significant role.
EUTHANASIA
• Comes from the Greek word, “thanatus” which means "easy or happy
death".
• Implicit in this etymological meaning is the outright rejection and
avoidance of the opposite: "a difficult or sorrowful death,” so that the
condition of a dying person which is characterized by intense pain and
suffering can be a reason to opt for a willful maneuvering that which
paves the way to an “easy death”.
• “Easy death”: earlier death that is intentionally caused in order to get
rid of a “difficult death”
• Sacred Congregation for the Doctrine of the Faith states:
“By Euthanasia is understood an action or omission which, of itself by
intention causes death, in order that all suffering may in this way be
eliminated.”
TYPES OF EUTHANASIA
Euthanasia by Commission
Euthanasia by Omission
• Active euthanasia
• Passive euthanasia
• Positive act of causing death
• Negative act of causing death
• a measure necessary to end the
life of a suffering person is
directly used
• a measure necessary to sustain
the life of a suffering person is
omitted, withheld or withdrawn
• Example: a lethal dose is injected
into the terminally ill patient to
cause immediate death
• Example: food and water are
withdrawn to bring about the
earlier death of a terminally ill
patient
CATEGORIES OF EUTHANASIA
Voluntary Euthanasia
• measure of causing the death of the
patient at his willful consent for request
• the consent or request can be verbally
expressed, written in the patient's advance
directive as in a living will or durable
power of attorney, or given by mere
gesture in case of inability to speak and
manage oneself.
• usually done by means of a positive act
either by the health care personnel as in
direct employment of a lethal measure or
by the patient himself as in assisted
suicide. In assisted suicide, technically, the
patient administers the fatal means made
available by the health care team.
CATEGORIES OF EUTHANASIA
Non-Voluntary Euthanasia
• indicates the measure of causing the
death of the patient who is unable to
express his will and make his intentions
known as in unconscious or comatose
state
• the decision to end the patient's life is
made either by the watchers of the
patient, the health care team, or the
society
Involuntary Euthanasia
• indicates the measure of causing the
death of the patient in defiance of his
expressed will and/or against his consent
EUTHANASIA
Argument for Euthanasia
Argument Against Euthanasia
• That people should have
freedom of choice, including the
right to control their own body
and life.
• That these practices can never be
justified for religious reasons, for
example many people believe that
only God has the right to end a
human life.
• Prolonging the life of a person
under vegetative state is a futility
and more of a punishment of
agony rather than a treatment.
• Euthanasia or assist in a suicide
would
be
a
violation
of
fundamental medical ethics. A
doctor must always bear in mind
the obligation of preserving human
life from conception.
PERSISTENT VEGETATIVE STATE
• A condition in which a medical patient
is completely unresponsive to
psychological and physical stimuli and
displays no sign of higher brain
function, being kept alive only by
medical intervention.
• A vegetative state is called "persistent"
if it lasts for more than four weeks.
Issues:
• Withholding and withdrawing of life
support is morally wrong?
• Under what circumstance do we
consider a person dead?
• How, empirically, does one measure
the irreversible loss of whatever
functions have been determined to be
essential for life?
WITHDRAWAL OF LIFE SUPPORT
PRO
ANTI
• Keeping someone alive under
vegetative condition is not the
purpose of medicine or the proper
goal for human existence.
• Hence, continuance of Life Support
is morally optional and may be
withdrawn.
• The morally appropriate foregoing
or withholding of Life Support in
PVS is not abandoning that person.
Rather, it is accepting the fact that
the person has come to the end of
his or her pilgrimage and should
not be impeded from taking the
final step.
• Patient who is suffering PVS, in the
viewpoint
of
medicine,
is
considered alive.
• Being a living individual under PVS,
life support is morally obligatory
and must maintained in all PVS.
• Withdrawal of Life Support is
"euthanasia by omission which by
its very nature and intention brings
about death with the purpose
eliminating all pain.
CRYONICS
• Is reversing the process of death, such that
it involves the process of preserving legally
dead human (or animal) body or only its
head in extremely cold temperatures with
the aim of reviving it in the future when
appropriate scientific and medical advances
become available. It is regarded as a type of
conservative medicine which aims to stop
body functions indefinitely and preserve the
cell structure and body chemistry by cooling
the body at very low temperatures.
Issues concerning cryonics:
• the person's rights when a person who is
considered dead is revived in the future
• resource allocation
• rights and dignity of the health care team
member who does not agree with cryonics
• potential possibility of unnecessary suffering
on the part of a family to move on and accept
death because of cryonics
• unexpected harm or consequences that
cryonics may cause once the cryopreserved
body or body part is revived
REFERENCES
• Paunil-Ciabal, Laura Evelyn (2003). Ethics for the Health Professionals.
• De Guzman, Agnes (2012). Lecture notes in Bioethics. Our Lady of
Fatima University.
• Romael Meng G. Binarao, J.D., RMT (2021). Recitals is Medical
Technology and Bioethics
• Gamaliel Issamar S. De Vera, MSMT et. al, (2023). Medical technology
Laws and Bioethics A Work Textbook