Module 1: Ethics and Bioethics ● ● ● ● Bioethics ○ Bio: biological knowledge, the science of systems of living things ○ Ethics: knowledge of human values Origins ○ Hippocratic Oath, Hippocrates, 5 BC: Do no harm, will not bring death, ○ WWII: Biological weapons Birth of bioethics ○ Van Rensselaer Potter: coined the term “bioethics” in 1970 and called it as the science of survival ○ Andre E. Hellegers: “maieutic” dimension; interdisciplinary methodology Ethical theories ○ Teleological Theories ■ Aka consequentialism ■ Depends on the consequences of the action to be carried out; maximize the good in a situation ■ J. Bentham and J. Stuart Mill called this a maximization of good “utility” -> utilitarianism ○ Authority-based Theories ■ Faith-based (Muslim, Christian, Hindu, Jew) or purely ideological (Marxism, capitalism) ■ Based on what the authority has said ○ Deontological Theories ■ Immanuel Kant ■ “Deon” means duty hence the science of determining our duties ■ What is good leads to the fulfillment of one’s duties and the fulfillment of one’s duties always leads to the good. ○ Egoistic Theories ■ What is right is that which maximizes a person’s self-interest ○ Virtue Ethics ■ Plato and Aristotle ■ Find the proper end for humans and to seek that end (goal); seek perfection or excellence ○ Natural Law ■ What is right is in accord with the providentially order nature of the world ■ Types: ● Divine Law ○ Natural moral law ● Human Laws ○ Canon law ○ Civil law Module 2: Bioethical Principles ● ● ● Autonomy ○ The freedom and ability to act in a self-determined manner ○ Elements ■ Threshold Elements (Preconditions) ● Competence ● Voluntariness ■ Information Elements ● Disclosure ● Recommendation ● Understanding ■ Consent Elements ● Decision ● Authorization ○ Intentional non-disclosure ■ Legal in emergency situations and when patient waives right to be informed ■ Therapeutic privilege, placebos, research integrity ○ RA 10173: Data Privacy Act of 2012 Nonmaleficence ○ “Do no harm” ○ Principle of Double Effect ■ That the action, in itself, be good or at least indifferent. ■ That the good effect cannot be obtained in some equally expeditious and effective way, without the concomitant evil effect ■ That the evil effect be not directly willed, but only permitted. Under no condition can the action be even partially prompted by a desire for the evil effect. Otherwise, the evil effect becomes a direct voluntary ■ That the evil effect be not a means to producing the good effect, because if the evil effect is a means to producing the good effect, then the evil effect, like any other means, is directly willed. ■ That there be due proportion between the good that is intended and the evil that is permitted ○ Cooperation with evil ■ Immediate (direct): coincides in the same act as the one committing the evil act ■ Mediate (indirect): provides the means utilized by another to do evil ■ Proximate: close physical or moral proximity ■ Remote: less physical or moral proximity ■ Positive: voluntary act which contributes to the evil act of another ■ Negative: omission, allowing an evil act ■ Formal: consent to the evil act; always illicit ■ Material: cooperating through a physical act without consenting to it; may or may not be illicit Beneficence ○ Taking actions to benefit and promote the welfare of other people ○ Rule: ■ Protect and defend the rights of others ■ Prevent harm from occurring to others ■ Remove conditions that will cause harm to others ■ ■ ● Help persons with disabilities Rescue persons in danger Justice ○ Fairness, treating people equally and without prejudice, and the equitable distribution of benefits and burdens, including ensuring fairness in biomedical research ○ Human act: from deliberate free will (knowledge, freedom, voluntariness) ○ Act of man: performed indeliberately or w/o free choice ○ Obstacles to voluntariness ■ Ignorance and error ■ Invincible ignorance ■ Vincible ignorance ■ Fear and concupiscence ■ Habit ■ Pathologic obstacles Module 3: Human Dignity and Human Rights ● ● Modern Philosophy ○ Giovanni Pico della Mirandola: an aspect of personal freedom ○ Thomas Hobbes: an embodiment of one’s public worth ○ Immanuel Kant: universal virtue ■ “To treat any other person always at the same time as an end, never merely as a means” Notion of Human Dignity ○ Human dignity has no external equivalent; it is an end in itself ○ A person is dignified as a human being ○ All human beings are equal in dignity ○ Recognition of a person’s dignity presupposes active respect for the person’s human rights, self-esteem, and self-determination ○ Interests and welfare of the individual are considered as prior to the sole interest of society, community, or any particular kind of publicly wholesome activity. ■ Individual should never be sacrificed for the sake of science or for the sake of society Module 4: Harm and Benefits ● ● Benefit ○ Treatment of a disease ○ Protection from onset of a disease ○ Restoring physical function ○ Mental health Harm ○ Physical harm ○ Psychological harm ○ Moral harm ○ Social/economic harm Module 5: Autonomy and Individual Responsibility; Informed Consent ● Autonomy ○ Capacities of self-governance ○ Personal rule of the self ○ Acts intentionally or willfully with adequate understanding and free from control by others Module 6: Privacy and Confidentiality ● ● ● Privacy ○ Right to be free from intrusion from others ○ Includes right to determine which information about them should be disclosed to others Confidentiality ○ An attribute of personal information requiring that it not be disclosed to others without sufficient reason Justified breaches of confidentiality ○ Sharing information for patient care and access to the patient’s chart to provide care ○ Using interpreters ○ Teaching medical students ○ Mandatory reporting of infectious diseases, suspected child abuse ○ Serious dangers to others (controversy if a family member has right to patient’s genetic information) ○ Genetic information ○ With patient or guardian consent ○ Special circumstances of research ■ Implied consent ■ Anonymized data ■ Umbrella consent Module 7: Respect for Human Vulnerability and Personal Integrity ● Vulnerability ○ Aspects ■ Biological or corporeal vulnerability: biological threats and natural man-made threats ■ Social vulnerability: fragility of the human capacity for creating coherence in one’s life and for sharing goods and services ● Social threats (war and crime, prejudice and discrimination, cruelty, and indifference) ● Hospitalization and institutionalization ● Social circumstances and conditions ■ Cultural vulnerability: fragility of particular traditions and conceptions of values that are typical for a community or local cultures ○ Dilemmas of vulnerability ■ Disability ■ Death ■ Depression Module 8: Equality, Justice, and Equity ● ● Equality ○ Means sameness in some respect such as human dignity Justice ○ Signifies fairness ○ Types ■ Distributive ● Each person receives a fair share of public resources ● Concepts ○ ○ ○ ○ ○ ■ ■ ■ ● Authoritarian: what the highest authority decrees is just Libertarian: what an individual decides to do with their property is just Utilitarian: greatest good of the greatest number Egalitarian: when everybody has equal access to the societal resources that they need Restorative or Transformative: justice requires favoring previously disadvantaged individuals or groups Procedural ● Ensuring a fair process of making decisions and settling disputes Retributive ● Ensures punishment of wrongdoers Social ● Combination; individuals and groups receive fair treatment and an equitable share of the benefits of the society Equity ○ Application of fairness ○ What is just and what is equitable are generally the same and both are good, though what is equitable is better ○ A fundamental requirement in terms of justice Module 9: Bioethical Themes Related to Beginning of Life and Procreation ● ● ● ● ● ● ● Human life began when a sperm meets an egg The first visible sign that an egg is fertilized is the human zinc spark Embryos are alive (daw) so they have the same moral status that we have Pregnancy starts at fertilization Abortion and illegal in the ○ Termination of human life in its gestational age; gravely immoral Philippines ○ Terminologies ■ Medical ● Spontaneous: accidental or involuntary ● Induced: therapeutic abortion to eliminate risk to the mother ■ Legal: criminal abortion ■ Ethical ● Direct: directly willed as the principal end ● Indirect: accidental or probable consequence of medical intervention ○ Contraceptives with abortive effects ■ Contraception: prevention of pregnancy by preventing fertilization ● If through prevention of implantation or inducing abortion of implanted ovum → abortion ■ Contraception to delay birth → permitted (discern which is most appropriate) Reproductive technologies ○ Any action which separates procreation from the marital act is ilicit ■ IVF, GIFT (Gamete Intrafallopian Transfer), Modified GIFT, TOT (Tubal Ovum Transfer) ○ LTOT (Lower Tubal Ovum Transfer) is licit since the sexual act still happens ○ Sexual act has 2 inseparable aspects: procreation aspect and unitive aspect ○ As long as the aspects of sexual act are not dissociated, it is licit Eugenics 😖 😡 ○ ● Study of biological heredity, its laws and its transmission, and the influence (beneficent or prejudicial) of external factors (social or circumstantial) to the end that the future generations may be physically and mentally vigorous ○ Those who advocate for eugenics want a superior race ○ Negative eugenics - eliminate those who are not considered perfect Human sexuality ○ Physical: the sexual act and the the pleasure; also called as marital or conjugal act ○ Sexual act: has both unitive and procreative aspect ○ Psychological and emotional: binds couple together ○ Spiritual: there is a nuptial meaning; like a sacrament Module 10: Bodily Integrity ● ● ● Principle of Stewardship: we need to care for our health/body Principle of Totality: if there is danger to itself, the parts can be disposed of for the benefit of the whole ○ Mutilation: the destruction of a member or organ or part of the body, or the suppression of a physical function in such a way that the bodily organism become no longer basically whole ■ Organic or functional ■ Direct or therapeutic ○ Transplants ■ Must not involve direct mutilation or killing ■ The transplanted part must only have therapeutic and never reproductive function ■ Damage must be proportional to the good ■ Reasonable prospects of success ■ Types ● Autotransplant: donor is the patient themselves ● Heterotransplant: donor is animal; from another entity ● Homotransplant: donor is human, alive or dead Secondary Principles ○ Autonomy ■ Actions are autonomous if intentional, has sufficient understanding, and free of internal and external constraints ● If present → spouse, immediate family members, parent will decide ○ Beneficence and non-maleficence: do no harm ○ Justice ■ Decision must not be based on what you think is the worth of the individual but based on medical reasons ○ Fidelity ■ Professional secrecy: confidentiality ● May only be broken if there will be harm to self and others ■ Truth-telling ○ Organ donation ■ Part: any part of the human body ■ Death: the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem ■ Consideration: ● The heart and livers are damaged in about 3-5 minutes ● The kidneys are damaged in about 30 minutes Module 11: Duties Towards the Dying Patient ● ● ● Pain and Death ○ Suppression of consciousness of the dying ■ Direct and indirect ○ Indirect shortening of life ■ Giving anesthesia is not bad in itself (for analgesia) and you did not will for its bad effect (loss of consciousness) ■ Analgesia is, of itself, licit End of life ○ Health outcomes: peaceful death and pain control of the terminally ill ○ Palliative care ■ Treatment of a person with serious illness which does not have an existing cure and the disease process cannot be reversed ■ Includes end of life care but broader Euthanasia ○ “Eu”: good and “thanatos”: death ○ Well death or dying well ○ Intentional killing by act of a dependent human being for his or her alleged benefit ○ Types ■ Voluntary: the person has requested to be killed ■ Non-voluntary: the person made no request and no consent; decision made by other family member ■ Involuntary: the person made an expressed wish to the contrary ○ Assisted suicide ■ Someone provides an individual with information, guidance, and means to take his own life ■ If it is a doctor who helps → “physician-assisted suicide” ○ By action or by omission ■ By action: by performing an action (giving a lethal injection) ■ By omission: by not providing necessary and ordinary care or food and water Module 12: Protection of the environment, the biosphere, and biosphere ● ● ● Environmental ethics ○ The discipline in philosophy that studies the moral relationship of human beings to the environment as well as value and moral status ○ Lynn White: Judeo-Christian thinking ■ Main strands of Judeo-Christian thinking had encouraged the overexploitation of nature by maintaining the superiority of humans over all other forms of life on Earth ○ Paul and Anne Ehrlich: the Population bomb ■ Growth of human population threatened the viability of planetary life-support systems Anthropocentric Environmental Ethics: Human-Centered Ethics ○ Human beings have moral duties only towards one another ○ Human interests prevail over the interests of other species ○ Ethical methodologies: utilitarianism and deontology Non-anthropocentric Environmental Ethics ○ Biocentric: Other living organisms have intrinsic value ■ All life forms are ‘moral patients’ and have intrinsic value → respect all life forms ○ Ecocentric: Ecosystems have intrinsic value ● ● ■ Nature is a ‘moral patient’ ■ All organisms and entities in the ecosphere are equal in intrinsic value Basic Principles of Environmental Ethics ○ Respect for nature: conserve and protect integrity of ecosystem and its biodiversity ○ Environmental justice: environmental benefits and burdens should be equally distributed ○ Intergenerational justice: every generation should leave the following generations an equal opportunity to live a happy life Sustainable development ○ Development that meets the needs of present generations without compromising the ability of future generations to meet their needs ○ 2 qualifications ■ The needs of the poor are central in sustainable development ■ The only constraint on sustainable development is the state of technology and social organization in society
