Bachelor of Science in Nursing 2YA
ETIC111: BSN 2ND YEAR 1ST SEMESTER FINAL 2021
Coverage for Final:
• Autonomy and Beneficence
• Non-maleficence and Justice
• Some Ethical Issues
- Care at the Beginning of Life
- Care at the Promotion of Life
- Care at the End of Life
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AUTONOMY & BENEFICENCE
Autonomy
Derived from the Greek words ‘auto’ meaning ‘self’ and
‘nomos’ meaning ‘rule’. Thus, autonomy means self-law or
law to oneself. The original usage then of autonomy is to mean
‘self-rule’ or ‘self-governance’ of independent city-states
Capacities for Self-Governance:
• To Understand (moral reflection) the issue and what the
situation is all about and to reason out and give one’s
opinion/
• To Deliberate (effective deliberation) by weighing the
pros and cons of the issue.
• To Make an Independent choice (free choice) basic to
making an independent choice is one’s capacity to make
decisions.
Practical Implication of respect for Autonomy in medical
practice
Right of the patient, that is, right to self-determination which
is guaranteed by the patient’s bill of rights.
Informed consent
Actual directive
Advance directive/Living will
Refusal of treatment
Informed Consent
Informed consent is also known as enlightened consent, to
mean, any prior substantial or therapeutic and research
participation, patient must have a full information of what
procedure is all about, objective, need and advantage.
It is also a form of invitation to a patient to participate in his
health care decisions.
Two Settings:
• Therapeutic setting
• Research setting
Elements of informed consent: Threshold elements
Disclosure/Information
Competence/comprehension
Voluntariness
Disclosure/Information
The extent of information given to the patient by the
physician/nurse relating to the medical procedure.
The expenses to be incurred, likewise is decisive whether
consent is to be given by the patient for medical procedure
Competence/comprehension
The patient’s level of education greatly affects one’s own
decision and the level of emotion to the extent relevantly
possible.
The health care provider can appropriately assess the
accessibility of the language that will understood by patient.
- Patient can finally render an intelligent decision
Voluntariness
- This element of informed consent is customarily understood as
free and willfully given by the patient. The issue at hand is that
the patient must be given sufficient time and ample space
The Two function of informed consent
• Projective (to safeguard against the tension of integrity)
• Participative (to be involved in the health care decision
making)
Two basics of obtaining consent
1) Written consent (it is often use upon admission of patient into
the hospital, another used it maybe dream necessary for other
procedure likely surgery)
2) Verbal consent (it usually comes the comes in the form of an
implied consent like when a patient seeks consultation with is
physician)
Significance and justification of informed consent
1) Patient of an opportunity to be an informed participant in
health decision.
2) it is also a legal document and as a form of an assurance of
safety for the and for healthcare professionals (ex: invasive
procedure such as: surgery, anesthesia, and others)
3) A form of protocol of the research process because most
research involve patient’s lives.
4) It emphasizes honesty trait of the professional to carry in their
very selves an honest character when asking patient to sign
informed or enlightened consent.
5) It reduces risks and avoids unfair treatment and exploitation by
the professional and it is also regulatory and institutional
control.
6) It also protects the autonomous choice, by which the claim of
patient’s right to autonomy was promoted.
Barriers to informed consent vis-à-vis nursing intervention
• Language: the nurse can use intermediary such as a translator
to translate information to language that can be understood by
the patient.
• Cultural differences: the nurse can use intermediary or let
patient meet other persons who underwent the same medical
procedure or treatment of the same culture background as the
patient.
• Physical impairment/illiteracy: the nurse can show pictures,
videos, literature, and other related teaching aid.
• Incompetence: the nurse help to ensure that decision made by
the person responsible for the patient is for letters benefit and
wellbeing.
• General it is ethical as well as legal responsibility of the nurse
to overcome these barriers and everything in her capacity to
ensure that the patient sufficiently gets all the needed
information to make an informed decision.
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Actual directive and advance directive
The right to self-determination originated from the principle of
autonomy which entails every individual to informed consent
including the right of person of legal age and sound mind to
voluntarily refuse a diagnosis.
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Actual directive is an instruction that was given on the very
moment that is being done by any person with a normal
condition.
- Advance directive, on the other hand, is an issue given in
anticipation of what a person might think would happen
relative to his/her health condition.
• Biological parents of the patient
• the oldest child of the patient if of legal age
• legally adapting parents of the patient
• nearest kin
• municipal health officer of the place where the hospital is
located/medical director
Two forms advance directive
1) Living Will (instructional directive)
- A will by which any competent adult give direction and
instruction for future care in the event that the patient
involve can no longer make due to terminal or severe
illness or an impending death
2) Medical Power of Attorney (Health care proxy)
- A probable patient can name a person trusted so as to act
in their behalf as an agent/proxy in making health care
decisions in an event of incapacity.
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Practical Implication/issues of limiting Autonomy
Paternalism (Parentalism)
Paternalism (Parentalism) comes from the Latin word ‘pater’
to mean father. The conflict between respect for autonomy and
the desire to help the patient (beneficence) brings the problem
into forefront of paternalism.
Paternalism describe as ‘the principle and practice of paternal
administration; government as by a father; the claim or attempt
to supply needs or to regulate the life of a nation or
community in the same way a father does to the children.
Two important features of Paternalism: That the father acts
beneficently, namely, in accordance with the conception of the
interest of his children and he makes all or at least some of the
decisions relating to his children’s welfare, rather then letting
them make those decision.
In medicine, Paternalism is applied when health care givers
such as doctor, nurses and the like, assumed the authority to
make decision for and in behalf of the patient without their
consent or knowledge.
Placebo
(Latin for "I shall please") is a pharmacologically inert
substance (such as saline solution or a starch tablet) that seems
to produce an effect similar to what would be expected of a
pharmacologically active substance (such as an antibiotic)
The Placebo Effect
The placebo effect consists of several different effects woven
together, and the methods of placebo administration may be as
important as the administration itself
a simulated or otherwise medically ineffectual treatment for a
disease or other medical condition intended to deceive the
recipient. Sometimes patients given a placebo treatment will
have a perceived or actual improvement in a medical condition,
a phenomenon commonly called the placebo effect or placebo
response.
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Resuscitation
A form of medical intervention done in a series of steps
directed to sustain adequate circulation of oxygenated blood to
vital organs while an effective heartbeat was restored.
Do not Attempt Resuscitate (DNAR) or commonly known as
Do not Resuscitate (DNR) a request to forego resuscitation
maneuvers.
Indications for DNR orders
When the patient condition is terminal, and death is immanent
so that life support only prolongs the dying process.
When the patient is irreversibly comatose or in persistent
vegetative state and there is no hope of improvement.
When the burden of treatment far outweighs the benefit
(adapted from the Southeast Asia Center of Bioethics).
The following are reasons for DNR orders, these were taken
from different sources gathered:
• No medical benefit
• Poor quality of life before CPR
• Poor prognosis
• Severe brain damage
• Extreme suffering or disability in a chronically or
terminally ill patient
• Request by a patient or family member
• Enormous cost and personnel commitment as opposed to
the low probability of patient recovery
• By not administering any cardiopulmonary in the event of
cardiac arrest
• We are letting the person go in peace and dignity.
Beneficence
Etymologically, comes from the two Latin words:
• “bonus” where bene was taken to mean “good”
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“fic” where fiche was taken to mean “to act or do”.
It refers to “action done for the good of the others”.
In the language of medicine, this principle highlights the duty
of health provider to do good and take positive steps, such as
prevention and removal of harm to the patient.
Beauchamp, Childress & Psyche believed that it could be seen
through associated acts of kindness, charity, humanity,
altruism & love.
Beneficence was often thought to broadly include all form of
actions. (Benevolence & Provenance, intended to benefit other
persons.
So, beneficence refers to an action done benefit others.
• Benevolence – refers to the character, trait or virtue of
being disposes to act for the benefit of others.
• Provenance – is the attentiveness dictated by kindness to
anticipate what one needs since each one of us, has that
inner goodness that pushes us to alleviate the pain and
discomfort to others.
Therefore, Beneficence goes hand in hand with benevolence
and provenance.
Obligatory and Ideal Beneficence
Some ethnical theories like Utilitarianism are based on the
principle of beneficence. This means, that goodness and kinddeed form the substratum of the Utilitarian Theory.
J. Bentham and W.D. Ross differ in the meaning of
beneficence, yet they employed the term beneficence as a
positive obligation, to others, though some critics denied this
kind of beneficence for he holds that the beneficence is a
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virtuous ideal/acts of charity, thus any person therefore is not
morally deficient if he/she failed to act beneficently.
Beneficence then is sometimes an admirable ideal of action
that exceeds obligation.
Nobody denies that the Beneficent acts is morally meritorious
and therefore, morally praiseworthy away from a personal
obligation.
Example: Donating one’s kidney to a stranger.
- We are not morally required as morality dictates to
perform all possible acts of generosity or charity that will
benefit others. By this,
Ideal Beneficence means going out of one’s way in order to
do good to others, while Beneficence, is merely goodness to
others without going out of one’s way. To sum up, Ideal
Beneficence is benevolent act that involves going out of one’s
way to do good as that of Good Samaritan.
Obligatory Beneficence is a mandatory act to do good and to
give aid to those who are in need.
Practical Applications of the Principle of Beneficence
Protect and defend the right of others
Prevent harm from occurring to others
Remove conditions that will cause harm to others
Help persons with disabilities
Rescue persons in danger
The principle of beneficence is already practice by Filipinos
by showing one’s goodness such as, delicate and generous
hospitality and this is shown in different situations like;
Sharing of goods & Lending of money, materials, equipment
and even human resources like bayanihan.
NON – MALEFICENCE
One’s own obligation to do good in the practice of medicine is
also limited by one’s own obligation to avoid evil/harm. One’s
avoidance of harm on others is embedded into what we call,
the principle of nonmaleficence. In medical ethics it has been
closely associated with the maxim, primum non nocere, which
means, above all (or first) do no harm (Beauchamp and
Childress, 2001).
This maxim expresses an obligation of nonmaleficence in the
Hippocratic tradition, ‘I will use treatment to help the sick
according to my ability and judgment, but I will never use it to
injure or wrong them’. This principle helps in decision-making
about issues that may alter one’s own life, such as on killing
and letting go, withholding and withdrawing treatment, use of
extraordinary and ordinary means/procedures and other issues.
Nonmaleficence comes from a Latin word: ‘non’ to mean
‘not’; ‘malos’ from which ‘male’ is taken to mean ‘bad/evil’
and ‘faceo’ from which ‘fic’ comes which means ‘do/make’.
Thus, the term nonmaleficence means not to make or to do bad
or to make evil things intentionally.
In medicine, nonmaleficence means not to inflict harm which
is not different from ‘not doing evil or bad things. This
principle requires a health care provider to prevent or refrain
from any sort of actions that eventually causes harm to patient
and more importantly when the action is never been justified.
Distinction Between Non-Maleficence and Beneficence
Generally, an obligation of nonmaleficence is more stringent
than obligations of beneficence and in some cases,
nonmaleficence perhaps may override beneficence.
Beauchamp and Childress suggested the following schema to
distinguish the principle of nonmaleficence and beneficence.
But the said authors do not propose a hierarchical order
Instructive Principle
Bioethical Principle
One ought not to inflict evil or harm
Nonmaleficence
One ought to prevent evil or harm
Beneficence
One ought to remove evil or harm
Beneficence
One ought to do or promote good
Beneficence
Examples:
1. Do not kill
2. Do not cause pain or suffering to others
3. Do not cause offense to others
4. Do not incapacitate others
5. Do not deprive others of the goods of life
Criteria on Determining Negligence
1. The professional must have the duty to the affected party 2.
The professional must breach that duty
3. The affected party must experience a harm
4. The harm must be caused by the breach of duty
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Principle of Non-Maleficence
Affirms the need for medical competence
A part of Filipino character through avoidance of
confrontational dialogue that will eventually cause harm to
others
Practical Application/Implication of the Principle of NonMaleficence
Withholding Treatment and Withdrawing Treatment
- are bioethical issues which can be acted upon or justified
by the following conditions:
1. When the case is irreversible any form of treatment will
not benefit the patient
2. When death is immanent or when patient is already dead
Ordinary and Extra-ordinary Treatments
• Ordinary treatment comprises of the provision of necessities
of life that usually pertain to food, normal respiration and
elimination process. Hence like intravenous fluids, nasogastric
tube feedings, indwelling catheters, are some among the many
considered ordinary and necessary measure of treatment and
may be sustained even if the case is irreversible.
• Extra ordinary treatment comprises of the use of aggressive
modalities vis-à-vis the capacities of the family or maybe
some family who can very well afford it, continue to give
extra ordinary measure. But this means do not necessarily
offer any benefit to the patient.
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Killing and Letting Die
In ordinary language ‘killing’ is a causal action that
deliberately brings about another’s death
‘Letting die’ is ‘prima facie’ acceptable in medicine under two
conditions:
A medical technology is useless (medically futile) and patients
(or valid surrogate/proxy) have validly refused a medical
technology,
JUSTICE
Justice comes from the Latin word "jus" means "right".
Justice is a concept of moral rightness based ethics, rationality,
law, natural law, religion, equity and fairness, as well as the
administration of the law, taking in to account the inalienable
and inborn rights of all human beings and citizens, the right of
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all people and individuals to equal protection before the law of
their civil rights, without discrimination on the basis of race,
gender, sexual orientation, gender identity, national origin,
color, ethnicity, religion, disability, age, wealth, or other
characteristics, and is further regarded as being inclusive of
social justice.
Formal Principle of Justice
Aristotle in Nichomachean Ethics
• Equals must be treated equally
• Unequal must be treated unequally
Material Principle of Justice
Principle that specifies the relevant characteristics for equal
treatment are called "Material" because they identify the
substantive properties of distribution.
Engelhadrt, Keusch, Wildesand others have suggested the
following material principle of Justice.
• to each person an equal share
• to each person according to need
• to each person according to contribution
• to each person according to free-market exchange
Wildes and others have suggested the following material
principle of Justice
• to each person according to merit
• to each person according to effort
SOME ETHICAL ISSUES
Care at the Beginning of Life
The way life is brought into existence (reproductive
technology) and the way in which the nature of future human
lives are intervened with (like, embryonic stem cell research,
human cell line and commodification) reflect this age of
consumer mentality and market ethics.
Babies have to come at the appropriate time, number and
space. For a service fee, then, sex were selected, genes were
improved. Children therefore were made to satisfy the desire
market (like baby making parent, supplier or baby breaking
experimenters). Though this may sound economically good
yet its not done for the common good.
Commercialization had led to the continued use and abuse of
human life and human person. Issue at the beginning of life is
peculiar because it involves: mother/woman, father/man and
fetus that cannot give consent, has no wishes and cannot
defend itself. Nurses in this regard must be able to inculcate in
the minds of those proxies to act in and for the best interest.
Natural reproduction
The female ovaries expel the mature egg towards the Fallopian
tubes every 28 days.
The male’s testes produce the sperms which are expelled at
ejaculation.
With the conjugal act the perms are deposited in the vaginal
canal. The sperm travel up the uterus into the uterus into the
Fallopian tubes and there fertilize the egg.
The fertilize egg (mean the embryo) travels down to the uterus
where it is implanted, develops, grow (embryo, fetus) after 9
months the baby is born.
Principles
1) Inviolability of Life. All human from the moment of
conception (fertilization) and through all subsequent stages is
sacred. Thus, all have the duty to affirm, respect, love and
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defend it. Violation of this principle occurs like in: abortion, in
vitro-fertilization and stem cell research.
Stewardship. Man msut take care, cultivate, creatures within
the creature’s innate nature and teleology and within man’s
knowledge and understanding. Violations arises in: surgical
sterility, substitution of reproduction, use of hormones, intrauterine devices (IUD) donation of sperm or egg genetic
manipulation.
Double Effect. A foreseen evil effect may be allowed if the
foreseen intended good effect is greater than and does not
result from the evil effect. This is applied into maternal-fetal
conflict, removal of diseased organ like in ectopic pregnancy,
anencephalic ifants.
Nonmaleficence. Do no and risk no harm. This is applied into:
sterilization, hormones psychological harm psychological and
financial effect of new technologies.
Beneficence: do good and provide a benefit. This applies
when removing diseased organs, facilitating pregnancy,
educating on responsible parenthood.
Respect for Person. 1) Not to be denatured/destroyed. Issues/
and violation arises in: artificial methods of reproduction (like:
IVF and AID or AIH), cloning. 2) to be an end and not a
means to an end. This happens in contraceptions,
commodifications of sperm/egg, uterus dysfunction, and
embryonic manipulation.
Assisted reproduction
The right to procreate is limited by man’s nature. Artificial
methods that help the conjugal act and ultimately reproduction
are praiseworthy.
Like, the use of folic acid, sex education, fertility awareness
and planning, fertility drugs or hormones, viagra (for sexual
dysfunction) microsurgery to correct reproductive organ
defects, delivery with forceps, these assisted reproductions
abide with the bioethical principles.
Artificial insemination by AIH/AID including zygote
implantation into fallopian tube (ZIFT), intracytoplamic sperm
injection (ICSI) replace the conjugal act and are illicit.
In-vitro fertilization and embryonic transfer (IVF-ET)
In IVF-ET the gametes are separately harvested, in number of
eggs are fertilized in ‘Patri Dish’ some zygotes are implanted
into the mother, and unwanted embryo may be removed. This
is not in conformity with the following principles:
a) Inviolability of Life (some unwanted zygote are allowed
to die)
b) Stewardship (the procedure is artificial and it substitutes
the conjugal act)
c) Nonmaleficence (the baby may develop the ‘genealogical
bewilderment syndrome’, also, if sperm is from a donor,
the unknown biological lineage may lead to incest or
inherited diseases. Mothers are psychologically harm by
series of unsuccessful attempt)
d) Justice (if private funds are used the prohibitive cost
limits availability to the rich. If public funds are used,
more essential needs are abandoned)
e) Respect for Person (the human body, the uterus, sperm
egg becomes commodities trafficked, transferred or sold;
the baby is not a gift but a product of other’s will to be
disposed of as desired (the unused embryo; ‘take home’
baby in term of wasted babies are often not shared with
parents)
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Cloning
the reproduction of a genetic copy of another human being
either through ‘splitting’ of the embryo’s cell or through
somatic cell nuclear transfer. The latter, involved the removal
of the nucleus from the unfertilized female egg and its
replacement by the nucleus of a cell taken from donor.
Embryos are cloned either to provide human embryonic stem
cells (ES cells) as precursors for differentiated cells to treat
diseased (mean therapeutic cloning) or to produce a new
individual by implanting it in a woman’s uterus (mean
reproductive cloning). Now, harvesting of human ES cells
requires destruction of the embryo. Cloning violates:
f) Inviolability of Life (embryo are destroyed in the
therapeutic cloning)
g) Stewardship (the process is artificial)
h) Nonmaleficence (the psychological and physical risks to
mother and child. In accdition the concept of the ‘family’
is perhaps destroyed)
i) Respect for Person (denatured and destroyed by
stockbreeding with no uniqueness ans individuality;
parents were reduced to a mere provider of human
‘materials’, like, sperm, egg and uterus)
Human Embryonic stem cells (Human ES cells)
the production of human embryos/the use of surplus embryos
from IVF or aborted embryos or frozen embryos.
The isolation of the inner cell mass (ICM) which is cultured
and subcultured to form colonies then cell lines must be done
early in the embryonic life and destroyed the embryo
(nonmaleficence).
This intentional killing is morally illicit. Thought the end may
be praiseworthy as in a regenerative medicine, it cannot justify
the means (double effect). To use commercially available or
supplied ES cells obtained from them is proximate material
cooperation with scandal in the act of embryo destruction
(respect for person and nonmaleficence).
Prevention of reproduction
There are two ways by which reproduction may be prevented
it is through contraceptive and abortive. There are some
obvious reasons why other people choose this methods, one is
space pregnancy, health, economics, unreadiness, no desire to
be obligated to try to have children and others.
Contraception
any action which in anticipation of the conjugal act (castration,
tube ligation, vasectomy, oral or parental hormones to prevent
ovulation) or in its accomplishment (like, spermatocides in
creams, jellies, foams or suppositories, coitus interuptus,
condoms, diaphragm, hormones which thicken cervical
muscus) or in the development of its natural consequences
(like IUD, abortion, fetal reduction) whether as an end or
means, prevents the creation of new life (anti-life).
Contraceptives treat fertility as a negative value that should be
suppressed. It vilates or it is nonconformity to:
a) Inviolability of life (drugs and devices that inhibit
fertilized ovum transport to and implantation in the uterus
or its development are abortificient. They kill the fetus.
b) Stewardship (it promotes hedonistic mentality with
refusal to accept the reproductive responsibility of sexual
or to recognize a new human being. (perhaps as god is the
final Creator)
c) Nonmaleficence (castration removes a healthy organ,
tubal occlusion or ligation and vasectomy prevents a
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healthy function. IUD promotes infection as well.
Contraception as well promotes a premarital sex,
extramarital sex, or homosexuality.
d) Respect for person. (to have one spouse use the other
spouse as a means for one’s satisfaction or pleasure is a
sign of disrespect)
Abortion
the process of deliberately terminating pregnancy with the
resulting death of an entity or it is a process of deliberately
terminating pregnancy at any stage of its development. Types
of abortion:
• Direct abortion or induced: it a kind of abortion with the
intentional of immediate purpose of ending or destroying
the fetus at any stage of after its conception.
• Indirect abortion is a process of terminating pregnancy
directly in which the moral object of the action is the
therapy of the mother and the death of the fetus is a side
effect that is inevitably unavoidable effect. Ex., removal
of pathological tube containing a fertilized ovum in an
ectopic pregnancy, removal of the cancerus gravid uterus.
This act is justified by the principle of double effect.
Obviously direct abortion violates the principles of natural
reproduction.
Abortion is done through:
a) Injection with concentration saline (salt) (it is an
injection of a concentrated saline solution into the their
mothers womb. It burns their skin off them while were
still alive the babies breathe it in and swallow it, frying
their insides. Some of babies were born alive despite this
torture and are then ‘disposed of’)
b) Dilation and evacuation dilation (this is characterized
by using a suction tube to remove the fetus and placenta)
c) Hysterotomy (abortion by caesarian surgery)
d) Vacuum aspiration (is a method by suctioning of the
lining of the uterus through the use of a thin and flexible
tube inserted through the opening of the cervix)
Care at the Promotion of Life: Organ Transplantation and
Donor
- Advance in surgery and introduction of new drugs have led to
the steady growth of organ transplantation and donation. The
removal of the organ from one being and its implantation into
another has saved lives or made lives better. Unfortunately,
organs are scarce resource.
- Thus, many who need new organs die while on the waiting
lists. This lack of organs has led to abuses such as robbing,
maiming, or even killing of donors, commercialization of
organs by health care givers, middlemen or institutions and
coercion exploitation of disadvantaged donors or needy
recipients. It is in the abuse that violation occurs.
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Terms to consider
Organ donation means the giving of tissue/organ/body by a
person to another person or to an institution
Donor the given who may be a cadaver (with an assumptive
document by the donor when still alive or by proxy) or a living
person (either by relatives, non-relative)
Vendor is a person who exchange their organ for money
Recipient the receiver of the organ given by the donor or
institution; a recipient who pay the organ is a buyer
Organ transplantation means the transfer or the planting
across of organ from donor/vendor to recipient/buyer
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Xenotransplantation is the planting of an organ from animal
organ to human beings.
Allotransplantation it is the transplantation of the organ from
one body to another body of the same species.
Organ donor
Our main concern is to care life that is the life of the donor.
The principle stewardship and nonmaleficence state that man
must take care of his body and do no harm to it. If the donor is
the cadaver, harvesting an organ will do no harm. If the donor
is living, taking away a healthy organ is not taking care one’s
body: no life is saved, no health is restored.
Removal of organ may even be mutilation. However, a very
proportionate reason and a meritorious act my override the
rule of stewardship and nonmaleficence.
The rule of unselfish love, solidarity love of neighbor,
beneficence, and charity these may supercede the rules of
stewardship and nonmaleficence.
In such a case it is praiseworthy, for it takes what it means to
belong to a human society that we are fulfilling our duty to
one another (deontological duty) and to contribute to the goal
of medicine (healing). By this it makes the giver a better
person. Still in spite of its meritorious promise there are some
requirement before an organ may be considered
moral/bioethically acceptable:
The harm and risk must be minimal and proportionate to
the benefits to be derived. Things need to be considered:
a) Accurate definition of death must be followed and
observed
b) The dying cannot be killed
c) The organ to be removed must not be a necessary
condition for life or for personal procreation, like, brain
and gonads
d) An part of the body that can easily be regenerated can be
given such as blood, hair, bone marrow
e) A second kidney or a portion of the liver these are nor
necessary for the personal or procreational identity
The donor must be care for before, during and after the
donation. This includes the following consideration:
a) Proper screening
b) Standard of health care
c) Reimbursement of medical expenses
d) Disability and livelihood lost (burial expenses of the
cadaver)
e) Prevention of discrimination in job
f) Prevention in community acceptance
The intrinsic worth and dignity of the donor must be
respected. The following must observe:
a) Free and informed consent must be given
b) Information given should include process of matching, the
chance of success of the transplant and permission to
refuse
c) Financial need and ignorance make te marginalized
vulnerable to exploitation
In case of cadaver, consideration must be observed:
a) consent for the donation must be given or obtained
specially person that met an accident
Organ Recipient
Stewardship dictates that in case of serious illness man has the
right and the obligation to take necessary measures to promote
life and health.
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A new organ may preserve life of the person. To the extent
that if it is available one has a right to and obligation to get it.
Some bioethical consideration are required for it to be morally
and bioethally accepted:
1) respect for autonomy must be allow the recipient to
choose how to get an organ. It requires: to give free and
informed consent
2) there must be justice in allocation. Justice as equal
benefits for everyone in need would dictate giving nothing
to anyone and letting everyone die. It is pointless and
harms all.. the following must be consider:
a) The criterion for judging equality is based on the
chance of success
b) The ability to pay the costs of the transplant and the
expensive anti-rejection medication determines
success and access
c) Given the case that both are capable to spend has
success and access, the first come first serve must be
serve.
What the nurse can do, they must contribute on the communal
dialogue and public education must be given, so that the main
goal of organ transplantation shift back to its true nature of:
a. commodities to self love
a) Commercialization to charity
b) Potential donors must be protected against harm, thus
become an advocate of the donors
c) Educating donors that selling organ is not encourage
d) Nurse should address the underlying poverty, ignorance
and vulnerability of people that sells their organs; organs
‘should not be for sale’
Care at the End of Life: Euthanasia and Physician Assisted
Suicide
One’s values regarding life and death are reflected in how one
dealt with the dying. If one cannot bear to see suffering, then
one resorts to an “advance” death, such in euthanasia, suicide,
or physician assisted suicide.
If one sees life as the highest value with death as a form of
human defeat, or if one is overly influenced by available new
technology and biological idolatry then one does everything to
prolong life beyond one’s one time and this is known as
dysthanasia.
On the other hand, if one sees death as the culmination of a
good life, to be valued only until its natural end, one looks for
a good death this is orthothanasia.
Before proceeding to the types of death, it is important to
determine first signs of the moment of death, signs of death
and when to pronounce that a person is dead.
Moment of death
1) Inevitable and critical moment when organism ceases to
function as specified, unified, homeostatic system and
becomes disorganized into a mere collection of heterogeneous
chemical substance. To know that body is disorganized we
must at least become sure of three things:
a) That the body does not now exhibit specific human
behavior
b) The body does not function humanly in the future
c) The body has no more radical capacity for human
functions due to its lost of basic structure required for
human unity
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ETHICS – BSN 2ND YEAR 1ST SEMESTER FINAL 2021
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2)
3)
4)
1)
2)
The third reason is necessary since medical experience
had shown that persons who are in coma nevertheless
have sometimes recovered full human consciousness.
Such resuscitation is possible, however, after true human
death some cells or even organs of the human body for a
time by artificial respirator, continue to exhibit some life
functions but these functions are not those of human
organism but simply a residual life at level of
organization like a plant or animal. Thus, the essential
point of determining human death is not to decide
whether any life is present, but whether human life in the
most radical sense of a unified human person is still
present.
Life force of cell is no longer united to the matter with which
it was at any times united.
Religious orientation, the separation of the body and the soul
(medically, it is understood as, body’s lack of sensation and
self-movement.
The lose of touch irrevocably with a person who previously
was able to communicate and to share our human community
of thought, of love, of freedom and or creativity.
Signs of death
Human organism is irreversibly dysfunctional and dead
Less conclusive, absence of breathing and heartbeat
Now, the signs are not a guaranteed bases and signs of death
due to some technological advancement that is perfected to aid
the lungs and heart to functions artificially as in resuscitation.
Such mechanism of resuscitation restored back and sends
blood through the body, even if after the unity of the body
cease to exist. Be that as it may, it does not lead to a
conclusion that an individual organ simulates unity, unity or
organism is no longer present because the organs would cease
to exist right away if the mechanism is removed. Thus, an
artificial sustained heart and lung activity is not a proof that
human life still remains. That is why as long as this heart and
lung is sustained by mechanical device that runs it artificially
the traditional bases of death is impossible to verify. Thus, we
ask the question? What then is the basis or are there other
clinical signs that can be used not to constitute a new
definition of death rather as an alternative, complementary
ways the same essential fact, namely, the irreversible cessation
of spontaneous heart and lung functions.
- Aside from the new technology used, another reason is the
possible organ transplant of heart and kidney. It is said to be
that the success of transplanting of heart will likely to be very
successful if the organs to harvested from a body through
which blood is circulating. Hence, surgeons, kept the body
alive in the respirator. So then, how is it possible to be sure
that the donor is in fact dead?
Signs of a dead person
1) Cardiovascular clinical signs (this is used when the person is
not attach to respirator. Thus, reliance on technology must be
moderated rather than encourage)
2) The new clinical sign must be ascertained by the well-trained
professionals (basis must be properly observed. That is for no
less than 24 hours when it uses the eeg or
electroencephalogram as it is done in the usa: harvard criteria
for brain death of 1968, this is used to person who is under a
hypothermia and drug-induced coma. But today, short
intervals is now allowed within 6 hours, and the eeg is being
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replaced by an angiogram it is an apparatus to test the blood
flow in the cerebellum of the patient)
Types of Death
Euthanasia
An action/omission which of itself or by intention causes
death, in order that suffering may be eliminated. It
procures/imposes death before one’s time.
Euthanasia is popular for a variety of reasons:
a) Utility: the economic constraints from the escalating
health costs for the growing elderly population especially
chronically ill, disabled.
b) Hedonism: when quality of life is poor or life is a
burdensome and useless then the person can be killed.
Since patient who see themselves as a burden to others are
guilty to be alive.
c) Autonomy: a request for an early death may be an attempt
of the patient to regain control: even if it be only in
deciding when to die, it is practicing the “right to die”
Types of Euthanasia:
a) Voluntary and involuntary (patient’s initiative)
b) Active and passive (healthcare provider’s initiative)
Human life must be promoted because we are as stewards of it.
Filipinos have seen that disabled newborn as “good luck” and
caring a sick person is a privilege. In solidarity, one can’t
abandoned, replaced, worst of all, kill another person. May it
be in the name of economy, practicality, compassion or
autonomy. procuring death is a perversion of a diseased
society made worse if done by a family or healthcare provider.
It is then a betrayal of the trust and respect that health care
providers are known as healers. It harms the victim and at the
same the survivors in the spirit of oneness to the one that
passway.
Dysthanasia
the delaying or postponing death beyond its natural time by all
means available.
Dysthanasia is popular for the following reasons:
a) Doctor’s training (reasons: treating is more comfortable
than not treating, doctor’s felt guilty to abstain, death of
patient is seen as a failure of management)
b) Technologic imperative (reasons: advances and success
pushes the doctor to use everything, that is, malignant
over-diagnosis and over-treatment. It is also biology
rather then personhood is the object of medical attention)
c) Ignorance (reasons: proxy’s are unaware of the distinction
between killing and letting die; lack of information with
regard on prognosis pain high quality of end of life care,
the best place to die)
d) Hospital culture (reasons: rights of patients are considered
as preference rather than directives)
e) Fear (reasons: doctor’s worry about on the accusation of
legal liability and malpractice if everything were not
done)
f) Philippine culture (to add in the filipino hospital context)
(reasons: the filipino non-confrontational attitude makes
all concern hesitate to hear ‘badnews’, instead the ‘status
quo’ is the main focus)
Living should not be a penalty to be prolonged at all cost. To
cause suffering unnecessarily in unworthy of trust and respect
the healthcare provider has. Priority of using the last moment
of life must be given to finish one’s own responsibilities to
others.
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