PRINCIPLE OF LEGITIMATE COOPERATION
• To achieve a well-formed conscience, one
should always judge it unethical to cooperate
formally with an immoral act (that is, directly
to intend the evil act itself), but one may
sometimes judge it to be an ethical duty to
cooperate materially with an immoral act
(that is, only indirectly intend its harmful
consequences) when only in this way can a
greater harm be prevented, provided:
✓ that the cooperation is not immediate
and
✓ that the degree of cooperation and
the danger of scandal are taken into
account
TYPES OF COOPERATION
1. Formal Cooperation
- Identification with the purpose
- Directly intend the evil action
- The object of the act or motive of the agent
is evil in nature
- Illicit and absolute evil
- Anyone involved is formally cooperating in
an evil act
- Ex. Bank robbery, abortion
✓ Does the act
✓ Agrees
✓ Advice
✓ Counsel
✓ Condone (justify/ forgive)
Example: Cecile wanted to abort her baby before
leaving for abroad and her friend agrees and advises
her to take Mifeprex (common abortion pills). After
aborting her baby, she tells her mother about it and
forgives her.
2. Material Cooperation
- You cooperated in the act but not in the
purpose
- Indirectly intend the evil action
a. Immediate
- If one cooperates in an evil act by
performing something that is essential for
the performance of the evil action.
- Case to case basis if licit or not
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- Example: A robber pointed a gun at your
head and ordered you to drive the car and
assist in loading the stolen object
b. Mediate
- if one cooperates in an accidental or non-
essential manner in the evil action
- Licit and there is no ethical justification
- Example: Selling weapons that are later
used for homicide
CRITERIA FOR JUDGING THE MORALITY OF
COOPERATION
1. Every cooperation which directly influences
the evil intention of the person with whom
one cooperates, is always illicit.
o It is a scandal to incite others to do
evil and should never be done
2. Formal cooperation is always illicit.
o The reason: cooperation not only
affects the evil act but it also affects
the will intention by approving the
mode of action
3. Simple material cooperation is also illicit.
One must not help anyone to do evil.
o Nevertheless, in certain specific
circumstances it may be licit to
cooperate materially in order to
obtain the necessary good or to avoid
a more serious harm
o Example: Even if the robbers pointed
a gun at your head, you should have
not helped them but only if they
already harmed you in a way so that
the evil act will not be complete. One
solution could be just giving the car to
the robbers or calling the police while
driving.
EXAMPLE OF CASES
1. General Hospital vs Abortion Clinic
- GH: Only those who were involved in
completing the abortion procedure is formally
cooperating
- AC: All employees are formally cooperating
because even from the start they have the
knowledge that is an abortion clinic
2. RH law
- Nurses who advises patient to use
contraceptives are formally cooperating
 - Patient who accepted contraceptives but did
not use it are in material cooperation
3. Abortion
✓ Mother
✓ OB
✓ Anesthesiologist
✓ Cardiologist
✓ Scrub nurse
✓ Nurse aid
✓ Administrator
✓ Janitor
CASE
An unmarried woman attempted abortion because
her boyfriend did not want to marry her. In her
attempt she was bleeding profusely, and her
relatives rushed her to the hospital. The doctors
completed the procedure.
- Not ethical
- Unmarried woman: Formal Cooperation
- Boyfriend: Immediate Material Cooperation
- Doctors: Material Cooperation and licit
because they did complete the abortion itself
however their goal was to save the woman’s
life
PRINCIPLE OF AUTONOMY
• The right of the patient to accept or refuse
the physician’s treatment. His option to
choose is based on respect of his free will.
• Assumes rational thinking on the part of the
individual and may be challenged when the
rights of others are infringed upon by the
individual
AUTONOMY
- Recognizing patients as persons who are
entitled to such basic human rights such as
the right to know, privacy and right to receive
treatment
- Ability of a person to make their own
decisions without interference
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
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- Doing good should take precedence over
autonomy
- Example: When the patient is going on a
hunger strike because he wants to die, the
doctor can intervene by putting on an IV fluid
on the patient
WHAT INFORMATION YOU SHOULD GIVE TO
THE PATIENT
a. Diagnosis
b. Prognosis
c. Treatment
d. Affordability
ESSENTIAL ELEMENTS
1. The relationship of physician and patient is
governed by a moral contract.
2. The doctor promises to treat his patient
“according to his best judgment.”
3. The doctor should fully inform his patient and
defer to the latter’s option to accept or reject the
proposed plans of management.
4. When the patient is incompetent, proxy consent
should be sought.
- Incompetent patient:
✓ Mentally incapacitated or Mentally Ill
✓ Under 18 years of age
✓ Comatose
5. Autonomy is never absolute.
6. Patient’s autonomy should be respected unless
his actions constitutes an evil act
- Example: Hunger strike
GIVES PROXY CONSENT
a. Power of attorney → advance directives
b. Closest of kin
✓ Adult (married) → spouse, children of
major age
✓ Below 18 → parents, grandparents
✓ No spouse → siblings, uncles/aunts
NO PROXY PRESENT
a. The doctor can decide if it is a matter of life
and death
b. Doctor can act as loco parentis
c. Court can also decide
- Example: Jehovah’s witness 12 years old
PRINCIPLE OF INFORMED CONSENT ✓ If it is an emergency, the doctor can
• It is a patient’s right to exercise freedom to decide if there are no relatives around
make decisions for his/her health.
Appropriate and necessary information are
required so that medical protocols and
management may be done for his interest.
• To protect the basic need of every human
person for health care and the person’s
primary responsibility for his or her own
health,
✓ no physical or psychological therapy
may be administered without the free
and informed consent of the patient,
or,
✓ if the patient is incompetent, the
person’s legitimate guardian acting
for the patient’s benefit and, as far as
possible, in accordance with the
patient’s known and reasonable
wishes.
• Last for 24 hours
• If there is a delay after 24 hours, another
consent is needed

ASSENT
- The expression of approval or agreement.
- Applies in children
- Example: In giving vaccines, the child
expressed that he did not want any injections,
paternalism is applied because it is the
greater good for the child

ELEMENTS OF INFORMED CONSENT

1. Disclosure – openness without any
reservations
2. Understanding – there should be feedback
3. Voluntariness – without any force
4. Competence
5. Consent

CONSENT
• In securing consent:
✓ Exhaust the vertical line first before the
lateral
Husband

Parents Siblings

Children
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