Bioethics 1

1 D. Accept responsibility for their actions

Values freely chosen, enduring beliefs or attitudes about the worth of person, object, idea or action important because they influence decisions and actions heavily influenced by socio-cultural environment o cultural, ethnic, religious groups, family, peer Conscience practical judgment of reason upon individual act as either good and to be performed or as evil and to be avoided “To follow one’s conscience “ To follow feelings or emotions To follow law or custom Blind obedience to the inspiration of God Follow personal freedom and autonomy “ The capacity to make practical judgments in matters involving ethical issues” Involves reasoning about moral principles Must be rooted in reality and truth and not on mere will or desire or blind choice Sound, true and certain conscience- own perception, sound education, understanding of natural law, traditional wisdom, teachings of family and Church, experience Conscience can be in error as when one misunderstands principles, misjudges facts or is led by misguided affections One is culpable of an erroneous decision of conscience only within one’s capability and freedom to prevent the error. CONSCIENCE FORMATION • • • • •

Diligently learning the laws of moral life Seeking expert advice on difficult cases Asking God for light through prayer Removing the obstacles to right judgment Personal examination of conscience “ My conscience is my guide” “ What I don’t know can’t hurt me” “ It is God’s will”

Principle of Well-Formed Conscience -To attain the true goals of human life by responsible actions, in every free decision involving an ethical question, people are morally obliged to do the following: A. Informed themselves as fully as practically possible about the facts and the ethical norms B. Form a morally certain judgment of conscience on the basis of this information C. Act according to this well formed conscience

B Principle of Moral Discernment I To make a conscientious ethical decision, O one must do the following: 1. Proceed on the basis of a fundamental E commitment to God and to human persons T (including oneself) according to their GodH given and graced human nature 2. Among possible actions that might seem to be I means of fulfilling that commitment, exclude any that are contradictory to it ( intrinsically C evil) S 3. Also consider how one’s own motives and other circumstances may contribute to or nullify the effectiveness of these other possible actions as means to fulfill one’s fundamental commitment 4. 4. Among the possible means not excluded or nullified, select one by which one is most likely to fulfill that commitment and act on it

Conscience Formation • Making moral decisions demand mature responsibility • A fully mature and responsible conscience should be free, correct, clear and certain • Discerning what is right and what is wrong • We must follow our decision only after we have done our best to search for the truth regarding the issues facing us

I N N U R S I N G P

Qualities of Conscience R A. Personal freedom - Free A - Unfree- impeded by some obstacles such as C fear and anger B. Objective Value T - correct- subjective conforms to the objective I moral values C - Objective- norms of morality - Erroneous- lack of conformity to the objective E norms of morality - Culpable- one is in error and therefore responsible - Inculpable- has erred in good faith C. Moral attitude - Lax- careless in its effort to seek the truth -

Strict- follow to the letter

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Scrupulous- tends to judge sin to be present when there is none

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Pharisaical- judgmental towards other

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Clear

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Callous- worst type- no sensitivity to sin

D. Degree of certitude

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Perplexed- wrong if you don’t do; wrong if you did

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Doubtful- lack of sufficient evidence

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Probable- made a decision already but still admitting the possibility that the opposite is true

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Certain

ETHICS The study of good conduct, character, and motive. A method of inquiry that assists people to understand the morality of human behavior Greek word “ethikos” or “ethos” meaning CUSTOM/CHARACTER/BEHAVIOR Latin word “mos” or “moris” meaning morals Practical Science of the morality of human conduct Practical because it: o - implies direction o - presents the reason which show these data to be true o - moral because it is related to the dictates of reason (how it should be) o - human conduct because it deals with human activity and how one should act 1. General ethics Presents truths about human acts – general principles of morality 2.

Special ethics   

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-applied ethics - applies the principles of General ethics Individual- God, self, fellowmen Social- family, State, world

Professional ethics

Code of Ethics a formal statement of the group’s ideals & values that is 1. Is shared by members of the group 2. Reflects their moral judgment overtime 3. Serves as a standard for their professional actions Nursing Ethics – Ethical issues that occur in nursing practice As the basis for professional code of ethics, ethical theories attempt to provide

a system of principles and rules for resolving ethical dilemmas

B I O Nursing Code of Ethics - The “Code of Ethics for Nurses” BON E Resolution 220 series 2004- provides guidance for carrying out nursing responsibilities consistent with T the ethical obligations of the profession H I 1. Provides guidelines for safe and compassionate care C 2. Guarantees the public that nurse adheres to S standards of professional practice e.g. International Council of Nurses Code of Ethics Four fundamental responsibilities 1. to promote health 2. to prevent illness 3. to restore health 4. to alleviate suffering 4 elements (outlines standards of ethical conduct) 1. nurses and people 2. nurses and practice 3. nurses and the profession 4. nurses and co- workers ETHICS COMMITEE Issues of patient care that presents as ethical dilemmas The institution’s ability to protect the rights and interests of clients in general The development of institutional policies and educational programs on ethical issues Professional Code of Ethics Nurses have a contract with society to behave in accordance with rules dictated by society and the nursing profession Nurse practice Acts vs. Code of ethics Delineates nursing’s moral ideals, provides guidelines for ethically principled behavior and holds nurses morally accountable for their actions ETHICAL CONCERNS IN HEALTHCARE  CONFIDENTIALITY OF RECORDS  RIGHT TO PRIVACY  RIGHT TO INFORMATION  COMPETENT CONSENT TO TREATMENT  RIGHT TO REFUSE TREATMENT  TERMINATION OF TREATMENT  Human cloning  Research  Organ transplants Virtue ethics • Character ethics

I N N U R S I N G P R A C T I C E

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Human traits of compassion, courage, wisdom… exhibited by people in concrete situations • Claims of virtue ethics: 1. An action is right if and only if it is what the agent with a virtuous character would do in the circumstances 2. Goodness is prior to rightness- person matters before the action 3. The virtues are irreducibly plural intrinsic goods- virtues cannot be reduced to just one value but various virtues are necessary for good actions 4. Some intrinsic goods are agent relativeevery action depends on the person 5. Acting rightly does not require we maximize the good- good is not enough- “excellence” is needed

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Values are freely chosen, cherished and consistently incorporated into one’s behavior B Values are shaped by culture, ethnicity, family, I environment and education O Value awareness Congruence between your values/ health E institution KEY CONCEPTS All human interactions are value based Nurses must clarify and respect the values of others and examine their own values Values are enhanced and refined by experiences that cultivate values development such as interactions with people of differing values and viewpoints and experiences that I challenge one’s way of thinking

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watch your THOUGHTS, they become WORDS watch your WORDS, they become ACTIONS watch your ACTIONS, they become HABITS watch your HABITS, they become CHARACTER watch your CHARACTER, it becomes your destiny Morals 

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fundamental standards of right or wrong that an individual learns and internalizes usually during early stages of childhood development reflects what is done in a situation refers to human conduct itself application of ethics Based on norms of conduct about right or wrong Society’s moral codes guide what people ought to do Professional codes such as the code of ethics for nurses, communicate the goals and ideals of the profession

VALUES AND VALUES CLARIFICATION  Ethical problems results from changes in society, advances in technology and the nurse’s conflicting loyalties and obligations  Nurse’s ethical decisions will be influenced by their moral theories and principles, levels of cognitive development and personal and professional values  The goal of ethical reasoning is to reach a mutual, peaceful agreement that is in the best interests of the patient  All Human beings have needs  Anything that fulfills a need is a VALUE  Values give direction and meaning to life and guide a person’s behavior

T H I C S

N U R S I N G P

Bioethics – Ethics as applied to human life or health; R e.g. decisions about euthanasia; abortion A bios (life) + ethikos (behavior) C a systemic study of human behavior, T specifically in the fields of life sciences and health care as examined in the light of I moral values and principles (M.T. Reich) Why do we have to study Bioethics?

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The following changes gave rise to the need of bioethics: 1. because of perennial issues, dilemmas & problems 2. because of legal dimension 3. Emergence of ethical practice in health care 4. to provide awareness to the health team of the do’s and don’ts of nursing practice 5. To enrich one’s competence by understanding that the patient is a person and holistic individual 6. To make clear to us why one act is better than the other 7. Enable us to live and have an orderly social way of life 8. Scientific Advances 9. Inequalities in socio-economic, educational and political positions 10. Finitude of resources

4 11. Changes in the doctor-patient relationships 12. Rampant unethical behavior ETHICAL THEORIES 1. Deontology 2. Teleology 1. Deontology Greek word “deontos’= duty an action is right when it conforms to laws or rules APPLICATION OF DEONTOLOGY TO HEALTH CARE 

The RN is duty – bound to act under moral rules that establish the right or wrong: o duty to honor a patient’s autonomy o duty to promote good & well being o duty to keep promise & confidentiality

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Nurses have a contact with society to behave in accordance with rules dictated by society and the nursing profession

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“The Code of Ethics for nurses” BON Resolution 220 series 2004 provides guidance for carrying out nursing responsibilities consistent with the ethical obligations of the profession

Immanuel Kant It is only through dutiful actions that people have moral worth only reason and not emotion is sufficient to lead a person to moral actions (because rational choice is within one’s control) 2. Teleology - Greek word “teleos” = goal - focuses on the consequences or end product of our actions - The principle of the greatest happiness for the greatest number of people What is best for groups?” We apply the bioethical principle to a particular case

Well known consequentialists Jeremy Bentham John Stuart Mill DIFFERENT ETHICAL PRINCIPLES I. PRINCIPLE OF HUMAN DIGNITY II. PRINCIPLE OF STEWARDSHIP

III. PRINCIPLE OF AUTONOMY B IV. PRINCIPLE OF INFORMED CONSENT V. PRINCIPLE OF CONFIDENTIALITY I VI. PRINCIPLE OF BENEFICENCE O VIII. PRINCIPLE OF NONMALEFICENCE IX. PRINCIPLE OF DOUBLE EFFECT E X. PRINCIPLE OF JUSTICE T XI.PRINCIPLE OF COOPERATION XII PRINCIPLE OF TOTALITY AND INTEGRITYH OF THE HUMAN PERSON I XIII FIDELITY XIV. VERACITY C XV. PROFESSIONAL COMMUNICATION S XVI. ORDINARY AND EXTRAORDINARY MEANS XVII. PRINCIPLE OF SUBSIDIARITY I XVIII. PRINCIPLE OF PERSONALIZED N SEXUALITY I. PRINCIPLE OF HUMAN DIGNITY Basis of Human Dignity • Salvation History

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1. Creation of man 2. Fall of Man 3. Promise of a Savior 4. Preparation for the Coming 5. Fulfillment of the Promise 6. Establishment of the Church 7. Heavenly Kingdom Image and Likeness of God

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Christ redeemed us

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Ultimate destiny to fulfill

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Rational beings

Human rights - needs and values as it relates to other human beings - it is universal - equal among everybody - not a product of human creativity but inherent to us Universal Declaration of Human Rights (1948) – respects the dignity of the human person PERSON a person is a rational, autonomous being with the ability to know universal, objectives moral laws & the freedom to decide to act morally SIGNIFICANCE OF BEING A PERSON • Has an inherent dignity which must be respected - A person should not be destroyed; uniqueness must not be altered; genes cant be manipulated; organs removed without any reason; one cant be cloned

N U R S I N G P R A C T I C E

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Has an ultimate destiny- to live with God

1. 20- 29 years old (intimacy vs

B 2. Rates higher on males than females I 3. Single O 4, unemployed 5. High school level E 6. Drug taking: Poly Drug Use T Comprehensive Dangerous Drug Act of H I Signed: June 7, 2002 Published: June 19, 2002 C Took effect: July 4, 2002 S

isolation) -To fulfill this, one has needs that must be met, resources must help one meet these needs; but he is only a steward • Lives with other persons in the community - Interacts with people; helps them HUMAN DIGNITY All ethical decisions (made by patients and healthcare givers) must aim basically and ultimately at human dignity.

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Composition of the Board  

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They must protect, defend, enhance and enable the person’s worth. They must aim for the maximum and integrated satisfaction of every person’s needs, as an individual and members of his community. Human Dignity Every human being has an inner worth and inherent dignity. These he possesses not because of what he has or what he does but because of what he is: a human person As a human person, he must be respected regardless of the nature of his health problem, social status, competence, past actions Decisions about health must aim at the maximum integrated satisfaction of his needs: biological, psychological, social and spiritual Certain actions may never be done because performing them would constitute a violation against the person’s dignity

Respect for Person  Every human being has an inner worth and inherent dignity. These he possesses not because of what he has or what he does but because of what he is: a human person 

As a human person, he must be respected regardless of the nature of his health problem, social status, competence, past actions

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Certain actions may never be done because performing them would constitute a violation against the person’s dignity

II. PRINCIPLE OF STEWARDSHIP CALL FOR 3 RESPONSIBILITIES 1. Personal 2. Social 3. Ecological Profile of Drug abusers

CHAIRPERSON 2 Permanent Board Members 12 Ex – officio members DO DILG DepE CHED DSW H d D DN DFA DOF NYC PDE D A 2 Regular 2 Permanent Members Consultants IBP NGO NBI PNP s “God is the Lord of Life and of Creation; Persons are Their Custodians.” DIMENSIONS OF STEWARDSHIP HUMAN RECONSTRUCTION - God made human beings free and intelligent- we have the right and obligation to improve ourselves- good stewardship - But we must use it with profound respect for God’s creation especially if it will undermine the very freedom and intelligence given to us by God - Responsible Stewardship of Available Resources - Managing resources with prudence and moderation - Wasting or squandering of scarce resources is a sin - Not to fall into the trap of the technological imperative

I N N U R S I N G P R A C T I C E

Ecological and Biomedical Dimension - Our bodies, our life, our human nature and everything in this earth are gifts we have dominion over. This means we are responsible for them. We should not as faithful stewards, harm but rather improve and care for them. We have to treat them with utmost respect, use originality and creativity to cultivate them, know

6 and respect their limits. We cannot contradict human nature. III. PRINCIPLE OF AUTONOMY Autonomy Greek word “autos” meaning self and “nomos” meaning rule/ governance/ law. self- governing or the ability to govern self is dependent upon many factors such as o sound mind o sound body o full information of the issues o without force or coercion Recognizing patients as persons who are entitled to such basic human rights such as the right to know, privacy and right to receive treatment State of being self-regulating, selfdefining and self-reliant Ability of a person to make their own decisions without interference -

freedom to make choices about issues that affect one’s life

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Respect for persons; unique and valuable members of the society

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Free to choose and implement one’s own decision, free from lies, restraint or coercion

KEY POINTS This principle assumes rational thinking on the part of the individual and may be challenged when the rights of others are infringed upon by the individual

PATERNALISM  Deliberate restriction of people’s autonomy by health care professionals based on the idea that they know what’s best for the clients- can be justifiable at times  Doing good should take precedence over autonomy The doctor can decide: 1. Doctor can act as loco-parentis 2. If it is a matter of life and death 3. Court E.g. Jehovah’s witness 12 years old IV. PRINCIPLE OF INFORMED CONSENT - It is a patient’s right to exercise freedom to make decisions for his/her health. Appropriate and necessary information are

required so that medical protocols and management may be done for his interest.

B I To protect the basic need of every human person for health care and the person’s primary responsibility for O his or her own health, E T (1) no physical or psychological therapy may be administered without the free and informed consent H of the patient, or, I (2) if the patient is incompetent, the person’s C legitimate guardian acting for the patient’s benefit S and, as far as possible, in accordance with the patient’s known and reasonable wishes. ELEMENTS OF INFORMED CONSENT 1. Disclosure 2. Comprehension of information 3. Voluntariness 4. Competence 5. Consent What info you should give to patients? 1. Current Medical status (Diagnosis) 2. Therapy, treatment, procedures available 3. Risks and benefits 4. Prognosis 5. Affordability Who are incompetent? - Comatose - Below 18 yrs old - Mentally incoherent

I N N U R S I N G

P R A Who gives proxy consent? C 1. Durable Power of attorney T 2. Closest of kin Adult- married- spouse, children of major age I Below 18- parents, grandparents C No spouse- siblings, uncles/aunts E Key point  In securing consent, exhaust the vertical line first before the horizontal V. PRINCIPLE OF CONFIDENTIALITY Confidentiality non disclosure of private or secret information with one is entrusted Requires the non-disclosure of private or secret information with which one is entrusted ICN (2000)- “ the nurse holds in confidence personal information and uses judgment in sharing this information” An important component of autonomymaintains dignity and respect for the person

7  Privacy – non exposure of a body part The following are subjects of Confidentiality and should not be revealed to anyone except for graver cause: 1. Private Secrets 2. Contractual Secrets 3. Professional Secrets Privileged Communication a confidential communication that one cannot be forced to divulge  Husband & wife  priest & penitent  doctor & patient  lawyer & client  To qualify for privileged status, communication must generally be made in private setting (that is, in a context where confidentiality could reasonably be expected).  Are there any situations in which a medical professional justified in revealing embarrassing or damaging information about a patient to a third party?           

GRAVE CAUSE abuse (child/ elder abuse) intent to kill self or someone communicable disease statuses require the disclosure of certain happenings e.g. rape, abuse, incest, other crimes Personal decision Reportable cause Legal case

KEY POINTS The public good outweighs the individual’s right to privacy and confidentiality protective privileged ends where the public perils begins duty to warn is the duty to disclose confidential information to protect identifiable victim and warn appropriate authority targeted by threat

VI. PRINCIPLE OF BENEFICENCE Beneficence  Comes from the LT. word “bene” meaning good and “fiche” meaning to act or do.  An act of or goodness, kindness, an action done for the good and benefit of others.

VIII. PRINCIPLE OF NONMALEFICENCE

it is related to the following human rights B  Right not to be killed  Right not to have bodily injury or I pain inflicted to oneself  Right not to have one’s confidence O revealed to others E

Violations of nonmaleficence 1. Physically harming a person as in suicide, abortion, infanticide, torture and violence 2. Exposing a person to physical harm as in subjecting a person to unnecessary treatment or to dangerous procedure without a commensurate important goal. 3. Harming a person’s reputation, honor, property or interests as by revealing confidential information KEYPOINTS 1. BOTH the principles of BENEFICENCE and NONMALEFICENCE focus on doing good to others. 2. BOTH principles attuned to ALTRUISM (doing good) IX. PRINCIPLE OF DOUBLE EFFECT From a common cause – an action- two effect are produced:  A good effect and an evil effect Determinants of the Morality of Human Act  The ACT itself  The INTENTION  CIRCUMSTANCES

T H I C S I N N U R S I N G

P R No amount of good intention or difficult circumstance A can make a wrong action correct. C T Basic Axioms of Morality  Majority opinion is not the norm of I morality C  Widespread custom or the conventional E wisdom is not the norm of morality   

A good end does not justify an evil means If an act is evil by its nature, nothing can make it good We cannot allow our emotions to warp our moral judgment

Principle of Double Effect  Act itself must be morally good or at least indifferent.  The motive behind the act must be to achieve the good effect never the evil effect, even though it is foreseen and permitted  The good effect of the act must precede the evil effect or at least simultaneous with it.  The good effect must be sufficiently desirable to outweigh the evil effect.

8 Considerations 1. INTENTION is focused on the Beneficial Effect 2. INTENTION must be good 3. B.E = H.E. or if possible BE > HE> 4. ORDER OF TIME  BE must come  BE comes simultaneously with the HE X. PRINCIPLE OF JUSTICE

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IMPLICATIONS OF THE PRINCIPLES OF JUSTICE 1. each individual should receive what is due to right such as a. Life b. Information needed for decision making c. Confidentiality of private information 2. benefits should be justly distributed among individuals such as a. minimum health care b. equal opportunities for scarce resources 3. each individual should share in the burden of health and science such as a. caring for his own health b. caring for the health of others c. participating in health/science progress VIOLATIONS OF THE PRINCIPLES OF JUSTICE 1. Denying/ withholding a benefit to which a person has a right 2. Distributing a minimum health benefit unequally 3. Imposing an unfair burden on an individual NON VIOLATIONS OF THE PRINCIPLES OF JUSTICE 1, the patient chooses to give up what is due 2. unjust outcome results or just process Distributive Justice  the aspects of justice that pertains to a fair scheme of distributing a society’s benefits and burdens to its members PROBLEMS OF DISTRIBUTIVE JUSTICE a. macro-allocation b. meso – allocation c. micro- allocation A. Utilitarian alternatives  promotes the highest good that is possible in every situation (the greates good for the greatest number) 

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Principle of Immediate Usefulness o gives priority to the candidate who is at greater immediate service to the larger group under the circumstances Medical Success Principle

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give priority to those whom B treatment has the highest probability of success I Principle of Conservation o gives priority to those candidates O who requires proportionally E smaller amount of resources and T therefore more lives would be saved H Parental Role Principle I o gives priority to those who have C the largest responsibilities to dependents S Principle of General Social Value o gives priority to those believed to have the greatest general social I worth thus leading to the good of N society

B. Egalitarian Alternatives - restoring the equality of the persons N in need U  Principle of Saving No One R = gives priority to no one because not all S can be saved  Principle of medical Neediness I = with the most pressing medical N needs  Principle of General Neediness G = gives priority to the most helpless or generally neediest in an attempt to bring them as nearly as possible to a level of P well being equal to that enjoyed by others. R  Principle of Queuing the line = gives priority to those who arrived A first C  Principle of Random Selection = gives priority to those selected by T chance or random I XI.PRINCIPLE OF COOPERATION COOPERATION  Working with another in the performance of an action. Types of cooperation:

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I. FORMAL COOPERATION - Cooperator wills the evil either by an explicit act of will or actual sharing in the evil act itself - Formal cooperation in evil is never allowed.  Identification with the “purpose”  Directly intend the evil action  Legitimate cooperation A nurse must never formally cooperate in immorality either by explicitly willing the evil or by directly sharing in the immoral act. II. MATERIAL COOPERATION

9 -Cooperator performs an act which in itself is not wrong though it is used by the principal agent to help commit the evil action -It consists in performing morally indifferent actions which make the operation possible.  You cooperate in the act but not in purpose  indirectly intend the evil action

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KEY POINTS: 1. Formal cooperation is always immoral 2. Immediate material cooperation is likewise immoral 3. Mediate material cooperation may be moral Sample Case Scenario “Angelica attempted abortion because her boyfriend Derek does not want to marry her and he bought Cytotec and bottled herbal medications from Quiapo and suggested that she removed the baby. In her attempt she was bleeding profusely and her relatives, unaware of her intention, rushed her to the hospital. The doctors completed the procedure even if there is  FHT. 1. Angelica- formal cooperation; intends to terminate pregnancy and the evil action 2. Derek: formal cooperation; intends evil action, advices to abort the baby, bought abortifacients such as bottled herbal medications and Cytotec 3. Relatives: material cooperation: not included in the evil plan, rushes to the hospital unaware 4. Doctors: formal cooperation; intends evil action by the expulsion and aborting the fetus even though there is a FHT 5. The janitor in paternal leave: knows what’s happening in the hospital: material cooperation: because even though he is aware on what the institution is doing, he remains quiet and doesn’t do anything to stop the evil action 6. Nurse on duty during the procedure, nursing aide and janitor on duty: formal cooperation: knows the evil action, didn’t do anything to save the baby, present on the time of abortion and condone the evil act. XII PRINCIPLE OF TOTALITY AND INTEGRITY OF THE HUMAN PERSON Totality and Integrity  to promote human dignity in community every person must develop, use, care for and persevere all of his or her natural physical and psychic functions in such a way that

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In the human person, the part exists for the whole, and therefore, the good of the part is subordinated to the good of the whole.

A. LOWER FUNCTIONS are never sacrifices except for the better functioning of the whole person and even then with an effort to compensate for this sacrifice.

B I O E T H I C S I N

N U Justifiable R  removing part of the body for the purpose of improving the function of the body part S - e.g amputation of gangrenous foot, tooth I extraction (for better functioning) N B. THE BASIC CAPACITIES G That define human personhood are never sacrificed unless this is necessary to preserve life Non justifiable – TAHBSO because you don’t want to have a child, cosmetic reason addiction for vanity purposes Justifiable – matter of life and death, mastectomy, organ donation

P R A C T I C E

KEY POINTS  A person may will to dispose of his body and to destine it to ends that are useful, morally irreproachable and even noble, among them the desire to aid the sick and suffering. One may make a decision of this nature with respect to his own body with full realization of the reverence which is due it … This decision should not be condemned but positively justified. ORGAN DONATION Transplanting organs from one living person to another is also ethically acceptable provided that the following criteria are met: 1. There is serious need on the part of the recipient that cannot be fulfilled in any other way. 2. The functional integrity of the donor as a human person will not be impaired, even though anatomical integrity may suffer.

10 3. The risk taken by the donor as an act of charity is proportionate to the good resulting for the recipient. 4. The donor’s consent is free and informed. 5. The recipients for the scarce organs are selected justly.

CAN HUMAN ORGANS BE BOUGHT OR SOLD?  NO, In order to manage and regulate the act of organ donation as well a the conduct of non related kidney transplantation, DOH issued the Administrative Order No. 124, series of 2002

WHAT ARE THE BENEFITS OF ORGAN DONATION? 1. Save lives 2. Improves quality of life 3. Cost effective

WHO CAN BE A DONOR? 1. Living donor 2. Cadaver donor

National Policy on Kidney Transplantation from living Non – Related Donors  this order sets the guidelines and ethical principles in conducting kidney transplantation from LNRD’s which will stop profiteering, remove brokers and make sure donations are not organized commercial effort

B I O E T H I C S I N

ORGAN DONATION ACT OF 1991 RA 7170 WHO CAN BE A LIVING DONOR? 1. Healthy person age 18-60 years old, whose blood type and HLA tissue typing are compatible with the recipient 2. The donation must be a voluntary act 3. A related donor is a blood relative; parent, offspring, sibling, half-sibling, aunt, uncle or cousin CAN NON RELATED INDIVIDUALS DONATE ORGANS? 1. If a blood relative is unable to donate a spouse or an “emotionally related” person may be considered. 2. In these cases, careful consideration is given to such factors as the motives, long term emotional bonds, and psychological implications for both donor and recipient ORGANS THAN CAN BE DONATED ARE:  Heart, liver, kidneys, lungs, pancreas, corneas, intestines WHAT ARE THE CRITERIA FOR BECOMING AN ORGAN DONOR 1. Organs can be donated only after a person has been declared brain dead while his vital organs are being maintained on a breathing machine 2. Organ donors can be anyone including newborns up to age 75 IS BRAIN DEATH THE SAME AS COMA OR VEGETATIVE STATE 1. No, a person in a coma or vegetative state still has some brain activity and therefore is not considered brain dead. HOW DOES ONE BECOME A CADAVER ORGAN DONOR? 1. The prospective organ donor should tell to his family wishes and in the event of his death, permission by his family/ next of kin 2. He must also sign a donor card or express his intentions in their driver’s license. Although these are both considered legal documents, his family’s permission for donation must still be obtained.

N MUTILATION  Destruction of member, organ or part of U the body (organic) or the suppression of a physical function (functional) in such a R way that the organism becomes no longer S basically whole I Types -direct- willed in itself, as end or as means, N intended and caused G -indirect ( therapeutic)- caused by the exigencies of the health or survival of the patient; at times willed as means, at others tolerated as an P unavoidable side effect R STERILIZATION A • A medical or surgical intervention which C causes a patient, incapacity of generation T • Therapeutic- inevitably required for the I survival and health of a person- sexual organs- integrating parts which must yield to C E the good of the whole; •

licit if:

- Sickness is grave, certainly diagnosed and definitive that it offsets the evils of sterilization - It is necessary because it is the only possible effective remedy - Exclusively curative- intention is important •

Direct sterilization- the immediate effect is to render procreation impossible

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Types:

- eugenics- seeking to avoid the transmission of hereditary defects - hedonistic- evade the complications & responsibilities of procreation without giving up the sexual pleasure - demographic- to control the birthrate

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- preventive- render pregnancy impossible which might aggravate sickness that already exist XIII. FIDELITY  faithfulness, promises and loyalty  Obligation of an individual to be faithful to commitments to him/herself and also to others  Main support for the concept of accountability  Keeping information confidential and maintaining privacy and trust XIV. VERACITY  truthfulness, document accurately  Duty to tell the truth  Fundamental to the development and continuance of trust among human beings- truth telling, integrity and honesty Truth telling  Definition: a nursing intervention from the Nursing Interventions Classification (NIC) defined as the use of whole truth, partial truth, or decision delay to promote the patient’s self determination and well being. XV. PROFESSIONAL COMMUNICATION  what, when, where, how XVI. ORDINARY AND EXTRAORDINARY MEANS Ordinary means or Proportionate means:  Not only food, drink and rest but also medicines, treatments and operations which offer a reasonable hope of benefit for the patient and which can be obtained without excessive expense, pain or other inconveniences  Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.  A person has an obligation to use ordinary or proportionate means of preserving his or her life. (NCCB, Ethical and Religious Directives, 1995) Extra ordinary means or Disproportionate means  When the means used do not offer a reasonable hope of any notable benefit to the patient  Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

A person may forego extraordinary or disproportionate means of preserving life. B (NCCB, Ethical and Religious Directives, I 1995)

Euthanasia  confronts life  advances & favors death  helps to die  shortens, reduces life  KILLS  

O E T H I C S

Passive Euthanasia – refraining of any medical treatment aimed at retarding death Active Euthanasia – terminating a person’s life I in a painless way, at his request & with the N intention to prevent person from suffering.

Dysthanasia  confronts death  delays death making dying difficult  prolongs, extends, lengthens life  does not allow to die, stops death Orthothanasia  neither advances nor delays death  it helps while dying  neither shortens nor lengthen life  neither confronts life nor fights for it  DOES NOT KILL.. IT ALLOWS TO DIE  death in its due time  normal process of death  letting the incurably diseased person “die his own death’ while making no extra efforts to prolong his life.

N U R S I N G

P R A C T Criteria for CESSATION OF BRAIN FUNCTION include I  irreversible coma  no spontaneous respiration and no C response to apnea test for 6minutes E  absence of the following brain stem   

reflexes: pupillary, corneal, gag and caloric test Death & Advance refusals of Treatment Apparent Death – the cessation of life as indicated by the absence of all vital functions Legal Death – the total absence of activity in the brain and central nervous system, the cardiovascular system, & the respiratory system as observed and declared by a physician.

HARVARD CRITERIA 1. UNRECEPTIVE, UNRSPONSIVE 2. ABSENCE OF SPONTANEOUS MOVTS AND BREATHING 3. ABSENT REFLEXES, FIXED, DILATED PUPILS

12 4. PERSISTENT ISOELECTRIC EEG 5. IN THE ABSENCE OF INTOXICATION OR HYPOTHERMIA, THESE FINDINGS PERSIST OVER 24 HRS Irreversibility is recognized when evaluation discloses that: The cause of coma is established and is sufficient to account for the loss of brain functions The possibility of recovery of any brain function is excluded The cessation of all brain functions persist for at least 24hours of observation and therapy Nurse’s role & responsibilities  Advance Directives o an advance declaration by a person of treatment preferences if he or she is unable to communicate his or her wishes.  Living Will  Durable power of attorney for health  Health care proxy Do not resuscitate orders 1. Specify the exact nature of the treatment to be withdrawn or withheld. 2. DOCUMENT the exact justification for the decision 3. Recognize that the DNR does not mean that the patient may be medically or emotionally abandoned. XVII. PRINCIPLE OF SUBSIDIARITY Human communities exist only to promote and share the common good among all their members “from each according to ability, to each according to need” in such a way that: 1. Decision making rests vertically first with the person then with the lower social levels and horizontally with the functional social levels 2. The higher social needs intervene only to supply the lower units what they cannot achieve by themselves while at the same time working to make it easier for lower units and individuals to satisfy these needs by their own efforts. XVIII. PRINCIPLE OF PERSONALIZED SEXUALITY 

The gift of sexuality must be used in keeping with intrinsic, indivisible, specifically human teleology. It must be a loving, pleasurable, expression of the complementary, permanent self giving of a man and a woman to each other which is open to fruition in the perpetuation and expansion of this personal communion through the family they responsibly beget and educate

BASIC CONCEPTS/VALUES RECOGNIZED IN SEXUALITY  sex is a search for sensual pleasure & satisfaction, releasing physical & psychic tensions  sexuality = male and female = genitals (with natural tendencies)  sex is a search for the completion of the human person through an intimate personal union of love expressed by bodily union  sex is a social necessarily for the procreation of children  sex is symbolic mystery, somehow revealing the cosmic order

B I O E T H I C S I

Key points: N  Sex is not always a proof of love, although often is demanded as such  There is inseparable connection established by N God, which man in his own initiative may not break, between the (1) unitive significance U and the (2) procreative significance, both R inherent to marriage act. S  any use of sex outside marriage is ethically wrong because I  N 1. It is selfish pursuit of pleasure apart from love G = masturbation, prostitution, casual or promiscuous relations 2. It expresses love, but not a committed love P involving true self –giving R = adultery or premarital sex A 3. It is committed but practiced in a way contradictory to it natural fulfillment in the C family T = use of artificial contraceptive methods, relations of committed homosexuals I CHARACTERISTICS OF MARRIED LOVE 1. HUMAN 2. TOTAL 3. FAITHFUL & EXCLUSIVE 4. FRUITFUL Abortion  The spontaneous or induced termination of pregnancy before the fetus has developed to the stage of viability. TYPES OF ABORTION 1. SPONTANEOUS 2. INDUCED INDUCED ABORTION TECHNIQUES 1. Abortion by dilatation and curettage (712wks AOG) 2. Abortion by CS or abdominal Hysterectomy 3. Abortion by Suction (before 3-4months or 12-16wks)

C E

13 4. Via Intra- amniotic infiltration (before 34months or 1216weeks) 5. Via injection of Prostaglandin RU 486 –Contraceptive pill associated with Prostaglandin ARGUMENTS: CONTRA-ABORTION 1. Not firmly a choice between a mother only or to the child only but must center on saving both lives. 2. Unselfish love and solitude to an innocent creature 3. Complementary roles between man and woman 4. It has genetic code totally different from the cells of the parents ARGUMENTS: PRO – ABORTION 1. To safeguard the life of the mother 2. Abortion as a woman’s right 3. Abortion as an expression of woman’s sexual freedom 4. The fetus is not a human LEGAL, MORAL & ETHICAL CONSIDERATIONS Article 2, Sec 12 of the 1986 Const. -provides that the state recognizes and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception 3 TYPES OF ART 1. IVF- IN VITRO FERTILIZATION 2. GIFT – Gamete Intra- fallopian Transfer 3. ZIFT – Zygote Intra- Fallopian Transfer METHODS OF CONTRACEPTION 1. Folk methods - Pre coital/ post coital douche using vinegar - Prolonged lactation - Coitus interruptus and coitus reservatus 2. Mechanical methods - condom and diaphragm 3. Chemical Methods - Vaginal suppository, vaginal tablets, vaginal jellies, creams and foams 4. Hormonal Methods - Contraceptive pills, injections and implants

B I O E T H I C S I N N U R S I N G P R A C T I C E