PART 1.

OVERVIEW OF BIOETHICS

INTRODUCTION
Why Study Law and Ethics?
Two Important Reasons:
1. To help us function at the highest possible professional level, providing competent, compassionate health
care to patient
2. To help us avoid legal entanglements that can threaten our ability to earn a living as a successful
healthcare practitioner
We live in a litigious (prone to engage in lawsuit) society, where patients, relatives, and others are
inclined to sue health care practitioners, health care facilities, manufacturers of medical equipment and
products, and others when medical outcomes are not acceptable.

Knowledge on Law and Ethics Can Help us Gain Perspective in the following areas:
1. The rights, responsibilities, and concerns of Health care consumers
2. The legal and ethical issues facing society, patients, and health care practitioners as the world
changes
3. The impact of rising costs on the laws and ethics of health care delivery

Court Cases Illustrate Risk of Litigation

When a lawsuit is brought, the trial court or a higher court must first decide if the plaintiff has a legal
reason to sue, or if the defendant is liable. When a court has ruled out that there is a standing (reason) to
sue and that defendant can be held liable, the case may proceed to resolution.
Often once liability and a standing to sue have been established, the two sides agree on an out-of-
court settlement.
***lawsuit – refers to any action, complaint, charge, case or legal proceeding brought before the court of
law, tribunal or quasi-judicial body, in w/c the party commencing the case seeks a legal remedy
***plaintiff – the person bringing charges in a lawsuit
***defendant – The person or party against whom criminal or civil charges are brought in a lawsuit
***precedent – decisions made by judges in the various courts that become rule of law and apply to future
cases, even though they were not enacted by a legislature; also known as case law
***summary judgment – decision made by a court in a lawsuit in response to a motion that pleads
there is no basis for trial
ETHICS
➢ Greek: ethicos = “custom” or “character”
➢ Defined as the philosophical science that deals with the morality of human conduct
➢ Establishes the standards or norms of human acts; Determines human acts as good or bad and right
or wrong
➢ Science of GOOD and BAD or RIGHT and WRONG actions
➢ *Morality of human acts-refers to the goodness/badness, rightness or the wrongness of human
acts; Morality = Latin: mos or moris
➢ One must apply theories of ethics for one to actually live a good and MORAL life. When one does
this, one is already in the ambiance of morality = praxis of theory; MORALITY = Applied Ethics
o Ethics provides the theories and the principles
o Morality actualizes these theories and principles
➢ POSTULATES in ETHICS (presumed to be true):
o Existence of God
o Existence of Intellect and Free Will
o Spirituality and Immortality of Human Soul

HUMANS
➢ The only qualified MORAL AGENTS
➢ It is rationality that makes every human being a unique class of animal
➢ The human person’s perceptual knowledge helps him/her draw judgments as he/she compares
ideas so that eventually he/she engages in what is called reasoning
➢ The human person, therefore, does not just perceive things but also analyzes, criticizes, or in a
word INTELLECTUALLIZES things.
➢ INTELLECT and WILL
o Human person’s INTELLECT enables him/her to search for TRUTH;
o Human person’s WILL enables him/her to choose for one which is deemed good.
o If a person possesses the TRUTH, he/she can apply what she knows WISDOM, while his/her
exercise of good makes him/her VIRTUOUS (virtue = Roman: vir = “man”)
➢ Polarity in Morality – When a person exercises his/her freedom to choose between good and bad
or right or wrong actions

BIOLOGY
➢ Generally understood as the natural science that deals with the issue of life
➢ It has an intrinsic role to protect and safeguard the welfare of all living species

BIOETHICS
➢ Etymology: bio (life), ethos (ethics)
➢ Begins from the womb (conception) and ends to the tomb (death)
➢ Daniel Callahan – first to introduce the term bioethics in 1969, when he, together with Willard
Gaylin, founded the Hastings Center
➢ Van Rensselaer Potter (Dr. Potter) – popularized the term in 1970; he is an oncologist as the
University of Wisconsin
➢ Meanings:
o Discipline that deals with the ethical implications of biological research
o Study of ethical issues that emanate from the changes and developments in the life science
technologies
o Branch of ethics that deals with the life sciences and their impact in society
o Brach of ethics that analyzes moral values in the context of biomedical sciences
o Branch of ethics of biological science and medicine
o Systematic study of the human conduct in the areas of life sciences and healthcare
o Study of the moral problems in medicine and biological technology
o Result of the COLLECTIVE EFFORTS in philosophy, theology, law, and medicine as it
confronts the complex crisscrossing and intertwining of science and technology ambit of
human life
HIPPOCRATIC OATH and MEDICAL TECHNOLOGY CODE OF ETHICS
Hippocratic Oath
➢ written by the Greek physician, Hippocrates
➢ Father of Modern Medicine, because his works in medicine lived on as they were thoroughly
studied until the 19th century, he was aided by:
o Aristotle – made a detailed anatomical research on the difference between animals and humans
o Herophilus – renowned physician who conducted the first-ever public dissection
o Erasistramus – first physician to show expertise in physiology of the brain, arteries, and veins
➢ Modern Version was written by Louis Lasagna (Dr. Lasagna) in 1964, worked as the Academic
Dean of the School of Medicine at Tufts University

AMERICAN BIOETHICS CENTER

➢ Hastings Center
➢ Kennedy Institute of Ethics at Georgetown University
➢ Society for Health and Human Values

SOME PHILIPPINE BIOETHICS CENTER

➢ Catholic Bishops’ Conference of the Philippines (CBCP)
➢ UST Bioethics Department
➢ UP College of Medicine Bioethics Department
➢ FEU Bioethics Department

HEALTHCARE ETHICS
➢ Domain in the practice of healthcare profession that sets the standards or guidelines relative to
studies, inquiries, and decisions on the part of healthcare professionals in relation to the delivery of
healthcare
➢ Deals and treats ethical issues such as withdrawal of life-support system, testing of diseases, access
to healthcare services, brain death, clinical death, suicide, euthanasia, vices and virtues, conscience,
law, and the like.

PROFESSIONAL ETHICS
➢ Pertains to the normative moral system that injuncts a kind of behavior that is expected of a
professional

THEORIES OF BIOETHICS
✓ Utilitarianism
- Jeremy Bentham and John Stuart Mill
- Morality of action is judged solely on its end result
- This theory asserts that all ethical decisions should entail a balancing of the costs and benefits
of an action with an eye towards maximizing overall “happiness”
- Rule Utilitarian
Operates on precedent; General rule serves the greater good, they advocate that such a rule
should be adhered to regardless of individual consequences
- Act Utilitarian
More pragmatic; Advocates maximizing of the “good” in each separate situation; Does not
adhere to strict rules of general good
✓ Deontology
- Immanuel Kant
- This theory advocates that actions are morally right if they are consistent with a
predetermined moral rule
- Principle of Universality: “Act only on the maxim whereby you can at the same time will that
it should become a universal law.”
✓ Principle Theory
- Beauchamp and Childress
- Principlism, Advocated the use of 4 basic considerations in ethical deliberation: respect for
autonomy, beneficence, nonmaleficence, and justice
- Each consideration is prima facie binding but may be overridden by another conflicting
consideration for good reason; Allows clinician to exercise more discretion in decision making
than in more stringent philosophical models of utilitarian thought and deontology.
✓ Virtue Ethics
- Embodied in Hippocratic Oath
- Aristotle and Plato
- Emphasizes the pursuit of virtuous characteristics by health care providers, Integrity, fidelity,
respect, sympathy, fairness, skill, wisdom, and knowledge are characteristics to be aspired to
by providers that guide appropriate behavior.
PART 2. THE HUMAN PERSON

I. The Human Dignity

o The state of being worthy of honor and respect
o State of righteousness, integrity, and virtue in human beings
II. The Acts of Human
o Actions that proceed from the deliberate free will of man; Refer to any activity performed by man
o Latin maxim: Agere sequitur esse; English: “a thing acts according to its nature”
o Humans are RESPONSIBLE for their actions
o THREE-FOLD ELEMENT:
✓ KNOWLEDGE
▪ The agent has intellectual knowledge of the act. In performing an act with knowledge,
the agent has the awareness about the means to employ as he/she performs an act.
✓ FREEDOM
▪ The agent is not forced to do or not do a particular action. A human act is an act which
is determined solely by the will.
✓ VOLUNTARINESS
▪ Requires the presence of the two other constituents, knowledge and freedom
▪ A voluntary act is a willful act
▪ Voluntary act = Human act; Essentially the product of the will acted upon in the light
of freedom and intellectual knowledge
o NORMS of HUMAN ACTS:
✓ LAW
▪ Defined as the rule of action or a principle of conduct which directs things toward a
definite goal
▪ Guiding principle of man’s reason, and only can direct human actions toward their proper
goal
▪ BRANCHES OF LAW IN ACCORDANCE TO THE CONTEXT OF PHILIPPINE LEGAL
SYSTEM (De Belen):
o Constitutional Law – branch of the science of law which treats of the nature of
constitutions, their adoptions and amendments, their construction and
interpretation, and of the validity of legal enactments as tested by the criterion of
their conformity of the law of the land
o Criminal Law – Branch of law which defines crimes, treats of their nature and
provides for their punishment
▪ Useful pieces of evidence for criminal offenses resulting in injuries
or death of patients:
- Body
- Objects on or with the body
- Injuries sustained
- Tissues and Body Fluids
- Other Medical Evidence or Findings
▪ Revised Penal Code (RPC)/ RA 3815 An Act Revising the Penal Code
and Other Penal Laws (December 8, 1930) – principal legal document in
the study of criminal law
o Civil Law
▪ Branch of law that pertains to the organization of the family and the
regulation of property
▪ Civil Code of the Philippines/ New Civil Code/ RA 386 (August 30,
1950) – contracts, personal and family relations, property issues, and other
civil relations, and damages in case of breach of contract and
negligence
o Administrative Law
▪ branch of law w/c deals with the activities or functions of executive or
administrative agencies such as the “departments”, “bureaus”, “boards”,
“commissions” or all other offices under the administrative supervision of the
Office of the President
 o Labor Law
▪ branch of law that governs and regulates the relationship of employers and
employees
▪ Labor Code of the Philippines/PD 442/(May 1, 1974)
- Book III Conditions of Employment (Art.82-90)
- Art. 83 Normal Work Hours – Normal work of an employee shall not
exceed 8 hours.
o Civil Service Law
▪ Branch of law w/c deals with the civil service in all branches, subdivisions,
instrumentalities, and agencies of the government, including government-
owned or controlled corporations with an original charter
▪ Civil Service Commission – Created by PD 110 dated January 26, 1973
o Remedial Law
▪ Branch of law that deals with the rules concerning pleadings, practices and
procedures in all courts in the Philippines
o Commercial Law
▪ Branch of private law that provides for the rules that govern the rights,
obligations, and relations of persons engaged in commerce or trade, and
necessarily includes the purchase, sale, exchange, traffic, and distribution of
goods, commodities, production, services or property, tangible or intangible,
including the instrumentalities and agencies by which they are promoted and
the means and appliances by which they are carried out
o Case Law
▪ Body of the prevailing jurisprudence or decisions of the Supreme Court
interpreting the laws or the Constitution or applying them to certain sets of
facts or actual cases and controversies
▪ CASE LAW in MEDICAL NEGLIGENCE (Criminal, Civil, Administrative)
o CRIMINAL
If crime is punished by:
- RPC -> felony
- Special law -> offense
- Ordinance -> infraction
THREE CLASSES OF CRIME IN THE PHILIPPINE CRIMINAL JUSTICE SYSTEM
o Criminal Negligence – committed by means of fault (culpa)
▪ Two Types:
o Reckless Imprudence
o Simple Imprudence or Negligence
o Mala in se - Crime Committed By Deceit (dolo)
o Mala prohibita – Crime Punished by Special Law
▪ INTENTIONAL CRIMES BY PHYSICIANS
- Abortion
- Perjury or False Testimony
- Issuance of False Certificates
- Simulation of Birth, Concealment of One Child for Another and
- Concealment or Abandonment of a Legitimate Child
▪ INTENTIONAL CRIMES BY ANY PERSON
o MUTILATION – or maiming; act of physical injury that degrades the
appearance or function of the human body
- Female Genital Mutilation
- Castration
o KILLING
▪ Abortion – may be intentional or unintentional
▪ Suicide – Intentional killing of oneself
▪ Medicide – Suicide accomplished w/ the aid of physician
▪ Infanticide – Killing of any child less than three days old, whether the killer
is the parent or grandparent, or any relative of the child, even a stranger
(parricide if killer is parent/ascendant; murder if committed by stranger)
▪ Murder-Suicide – Suicide committed immediately after one or more
murders
 ▪ Capital Punishment – Judicial killing of a human being for odious crimes
▪ Euthanasia – also mercy killing; killing of any being for compassionate
reasons
▪ Genocide – systematic extermination of an entire national, racial, religious,
or ethnic group
▪ Parricide – deemed highest form of destruction of human life. It is
committed when one kills his father, mother, or child, whether legitimate
or illegitimate, or any of ascendants, or descendants, or his spouse
▪ Homicide – act of killing a person; In the absence of any proof as to how
the victim was killed, the crime should be characterized as homicide
- Justifiable homicide
- Excusable homicide
- Criminal homicide – Murder, Manslaughter, Criminally Negligent
Homicide
- Voluntary and Involuntary Manslaughter
▪ Murder – malicious and unlawful killing of a human by another human;
Specific intent crime; person committed an act that was actually intended
to kill or seriously harm another
- First Degree Murder – also called capital murder; most serious form
of murder; involves elements like deliberate planning (defendant
makes a clear-headed decision to kill the victim), premediation
(showing the defendant actually thought about the killing before it
occurred), or malice (requires proof that the defendant did a harmful
act without just cause or legal excuse)
- Second Degree Murder – Killing another with malice (doing a harmful
act without just cause or legal excuse) but WITHOUT premediation or
deliberation
- Felony Murder – killing that happens during the course of the
commission of a felony
▪ Famacide – killing of another’s reputation; slander; defamation; libel
▪ Rape – said to be the most detestable crime; classified into two: (1)
Traditional and (2) Sexual Assault
▪ Sexual Harassment – Committed in the work place, school, or training
environment, by someone who has authority, influence, or moral
ascendancy over the victim; Committed by the former who demands,
requests, or otherwise requires any sexual favor from the latter, regardless
of whether such demand, request, or requirement for submission is
accepted.
o CIVIL
▪ Culpa contractual (breach of contract)
- If a physician was contractually obligated to perform a particular health
service or intervention to a patient and he/she caused the death or injuries to
the latter for doing things other than he/she was contracted to do so; Breach
of contract under New Civil Code of the Philippines in short
▪ Culpa Aquiliana (Quasi-delict)
- In the absence of any contractual relationship, a physician may be liable for
damages or injuries sustained by any person arising from the negligent conduct
of the former; quasi-delict=civil action for damage
▪ LAW CAN BE SYSTEMATICALLY CLASSIFIED FROM FOUR STANDPOINTS
(Babor):
▪ From the Standpoint of Legislator
o Divine Law – authored by God
o Human Law – authored by man
o Civil Law – enacted by the State
o Ecclesiastical Law – enacted by the Church
▪ From the Standpoint of Duration
o Eternal – God’s divine plan for all things and to God’s direction in all things
for their proper order
 oTemporal – promulgated by man pursuant to the fact that all human laws
are temporal in nature
▪ From the Standpoint of the Mode of Promulgation
o Natural – Eternal law apprehended by human reason; made known to man
directly through his/her reason; natural moral law is the application of
the natural law to man in terms of his/her actions
o Positive – Latin: ponere “to place an object down somewhere”; Laws that
are made known or promulgated in terms of writing
o Divine Positive Law – promulgated by special command of God; ex: The
Decalogue or Ten Commandments of God
o Human Positive Law – defined as an ordinance of reason, derived from
the natural law, or making a determinate application of the natural law,
promulgated for the common good by a human agency in charge of society;
ex: Congressional Statutes and Presidential Decrees
- Ecclesiastical
- Civil
▪ From the Standpoint of Prescription
o Affirmative – also called permissive or suppletory law; “bind always, but
not at every moment”
o Negative – mandatory or prohibited laws; “bind always and at every
moment”
✓ CONSCIENCE
▪ Latin: cum alia Scientia: acting with knowledge
▪ Referred to as the judgment of morality (goodness or badness) or acts done or about to
be done
▪ An act of the practical judgment of reason deciding upon an individual action as good
and to be performed or as evil and to be avoided
▪ KINDS OF CONSCIENCE
o Antecedent – draws the judgment before the action is executed; main functions:
to command, to advice, to forbid, to permit
o Consequent – judges only after an act is executed; result is either inner peace or
remorse
o True – judges only after an act is executed; Knowledge + sense of responsibility =
correct conscience
o Erroneous – false conscience; judges things in a distorted or slanted manner;
Considers bad acts as good, and good acts as bad
o Invincible/ Inculpable – doer of act is without fault because he/she does not know
that the acts he/she does is bad/wrong
o Vincible/ Culpable – moral agent has full knowledge that what he/she does is a
wrong act so he is liable
o Certain – subjective certainty on the legality of particular actions to be executed or
not
o Doubtful – moral agent is not sure about the moral judgment
o Scrupulous – sees wrong when actually there is none
o Lax – one that fails to see wrong even when there is actually wrong, opposite of
scrupulous; arrogance and false pride
▪ EDUCATION OF CONSCIENCE
o Steps to be complied with for a health professional to educate his/her conscience:
▪ Overcome ignorance and error by studying and applying laws and regulations
▪ Consulting authorities for conscience clarification
PART 3. THE CALLING OF A HEALTHCARE PROVIDER

THE HEALTHCARE PROFESSION

▪ Loaded with a lot of sensitivities and vulnerabilities since it deals with the highest form of value (life)
▪ This carefully and sympathetically calls to respect both the issues of life and death

THE CLIENT
▪ Justifies the quiddity of the healthcare professional; Summit of the meaning of the healthcare
profession
▪ Without the client, the healthcare provider will lose the very essence of his/her profession
▪ The client is the paramount concern and responsibility of the healthcare provider in the same manner
that the former must also be cooperative, abiding, and respectful to the latter

THE HEALTHCARE PROVIDER

▪ Paramount obligation of the healthcare provider is the life of the client

***MEDICAL CONFIDENTIALITY
- One of the core duties of medical practice; Requires health care providers to keep a patient’s
personal health information private unless consent to release the information is provided by
the patient
***MEDICAL MALPRACTICE
- Professional malpractice is defined as the improper or unethical conduct by a professional,
resulting in harm, injury or death of another person
- Also called Medical negligence – type of lawsuit or claim w/c a victim has available to him/
her as redress for a wrong committed by a medical professional w/c has caused bodily harm
- FOUR ELEMENTS:
• Duty
• Breach
• Injury
• Proximate Causation
PART 4. VIRTUES, VICES, and HABITS of the HEALTHCARE PROVIDER

I. VIRTUES – faculties of the human person to choose what is good against what is deemed to be bad or
evil
➢ Fidelity – Latin: fidelitas “Faihtfulness”; faithfulness to one’s obligations, duties, responsibilities
➢ Honesty – Latin: honestus “honor”; A healthcare provider must be sincere, truthful, straightforward,
decent, comely, tidy, open, upright, virtuous, trustworthy, fair, honorable, creditable, and of good
moral character
➢ Integrity – Latin: enteros “whole”; Integrity can make a human person whole or complete
➢ Humility – restraint upon the arrogance and infinity of the appetite
➢ Respect – regard others with special attention, esteem, and care, or to consider others worthy of
esteem and honor
➢ Compassion – a feeling of deep sympathy and sorrow for someone struck by misfortune,
accompanied by desire to alleviate the suffering
➢ Prudence – defined as an exercise of good judgment, common sense, and caution in the conduct of
practical matters; Overarching virtue that ties together discretion (wise self-restraint), foresight
(ability to foresee the future or what may happen as a result of one’s decision), forethought
(advance rational calculation of future events), and circumspection (moral considerations as effects
of one’s actions).
➢ Courage – is the mean (virtue) between confidence (excess) and fear (deficiency); quality of mind
or spirit that enables a person to face difficulty, danger, and pain without fear; confidence, resolution,
and conscious self-sacrifice for the sake of something greater than one’s own self-interest

II.VICES – considered an immoral, depraved, or degrading act to all the members in a given society; Latin:
vitium “failing or defect”
➢ Fraud – false representation of fact, made with a knowledge of its falsehood, or recklessly, without
belief in its truth, with the intention that it should be acted upon by the complaining party and actually
inducing him to act upon it; Deliberate deceit; trickery; intentional perversion of truth for the purpose
of inducing another in reliance upon it to part with some valuable thing belonging to him, or to
surrender a legal right
➢ Pride – feeling of gratification arising from association with something good or laudable; egoism or
vanity which implies a favorable view of one’s own appearance, advantages, achievements…and often
apply to offensive characteristics
➢ Greed – Latin: avaricia “avarice or covetousness”; qualifies as a sin of excess, like gluttony and lust;
utter display of distasteful behaviors, such as betrayal, bribery, theft, violence, and manipulation of
authority

III.HABIT – defined as a constant, easy way of doing things acquired by the repetition of the same act
➢ Entitative habits – connatural qualities (health, strength, beauty)
➢ Operative habits – habits of acting; tendencies we have developed in ourselves from repeated acts
PART 5 & 6. BASIC ETHICAL PRINCIPLES and MAJOR BIOETHICAL PRINCIPLES
and their APPLICATIONS

I.STEWARDSHIP/ ACCOUNTABILITY
➢ Humans are only mere stewards or caretakers, with the responsibility of protecting and cultivating
spiritual and bodily functions

II. TOTALITY
➢ Pursues the issue of the dignity of the whole person, in essence the integrity of human life
➢ “Do unto others what you want others do unto you”

III. DOUBLE-EFFECT ACT

➢ Indirect voluntariness or voluntary in causa; refers to an act desired not as an end in itself but as a
foreseen effect or consequence of an act

IV. COOPERATION

V. RESPECT FOR AUTONOMY AND PATERNALISM

➢ Principle of autonomy: Anchored on the deontological ethics of Immanuel Kant, specifically on his
principle of humanity that says “act in such a way that your treat humanity, whether in your own
person or in the person of any other, never simply as means, but always as the same time as an
end.”
➢ Respect for Autonomy: Healthcare providers are mandated to respect what their patients want
with themselves; these involve their bodies and health conditions
➢ Paternalism: Interference with a person’s autonomy that must be duly justified meaning there must
be grave and sufficient reason why autonomy of the individual must be restricted.; manner of treating
individuals in the way that a parent treats his/her child

➢ LIBERTY-LIMITING PRINCIPLES by Mappes and De Grazia:

a) Harm principle: The liberty of a person can be justifiably restrained to deter the person from
harming others
b) Offense principle: The liberty of a person can be justifiably restrained to prevent the person
from hurting or offending others
c) Principle of paternalism: The liberty of a person can be justifiably restrained to prevent the
person from harming himself/herself
d) Principle of legal moralism: The liberty of a person can be justifiably restrained to prevent the
person from acting immorally
e) Principle of extreme paternalism: The liberty of a person can be justifiably restrained to
benefit himself/ herself
f) Social welfare principle: The liberty of a person can be justifiably restrained to benefit others

➢ Rights of the Patient

a) Right to medical treatment
b) Right to information
c) Right to choices
d) Right to privacy
e) Right to complaint
f) Right to health education
g) Right to a healthy and safe environment

➢ DECISION MAKING
✓ Decision Making Capacity – evaluation of such capacity is a decision-specific determination
that focuses on the patient’s ability to understand and communicate a rational decision
o Key considerations in assessment of decision-making capacity:
▪ Ability to express a choice
▪ Ability to understand relevant information
 ▪ Ability to appreciate the significance of the information and its
consequences
▪ Ability to manipulate information
✓ Competence – Determined by a court of law and uses issues of capacity in evaluating the
legal ability to contract, write wills, or conduct one’s affair
✓ Patients with Decision-Making Capacity
o “Every human being of adult years and sound mind has a right to determine what shall
be done with his own body: and a surgeon who performs an operation without his
patient’s consent commits an assault for which he is liable” - Justice Cardoza 1914
o INFORMED CONSENT – requires patient’s authorization of a medical intervention or
involvement in research. Requires THREE BASIC ELEMENTS:
▪ Disclosure of information
▪ Comprehension
▪ Voluntariness
✓ Patients Who Lose Capacity
o Living wills
o Powers of Attorney
o Surrogate Decision Makers
✓ Patients Who Never Had Capacity to Make Medical Decisions
o Mentally Retarded Adults
o Pediatric Patients

VI. BENEFICENCE
➢ Broad term applied to the range of cluster of duties that require abstentation from harm and positive
assistance
➢ FOUR ELEMENTS that help express the substance of the PRINCIPLE OF BENEFICENCE
(William Frankena):
o One ought not to inflict evil or harm
o One ought to prevent evil or harm
o One ought to remove evil or harm
o One ought to do or promote good

VII. NONMALEFICENCE
➢ Understood as the overriding principle through which everyone is required to undertake the caring
of the patient; Capsulized in the phrase “Do not harm”
➢ Loaded with multifarious implications in the healthcare profession, like avoiding negligent and
harmful care, and with decisions that pertain to withdrawing or continuing medication to the patient
➢ Beneficence and Nonmaleficence are correlative principles. Together with principles of autonomy,
these required justified intervention in the context of paternalism.

VIII. JUSTICE
➢ Rendering of what is due or merited
➢ Habit that enables one to give each and every human person his/her due or his/her own right
➢ Latin: jus “right”
 ➢ TWO KINDS OF JUSTICE:
o General Legal Justice – refers to a human’s wishes and proper actions in consonance with the
common good
• Equity – kind of general legal justice by w/c a human person judges, wills, and does what
is right to others, not necessarily from moral law, but from civil law
• Common legal justice – human person shows proclivity to will and do something for the
good of others in accordance with the moral law or with the prescription of civil law
o Particular justice – Justice between persons; Pertains to wishing and doing what is right in
relation to another person who is accounted as an individual with an inherent right to his/her own
private good
• Distributive – person’s will to share the goods w/c belong to a community or to
individuals who are part of his/her community; Sharing of the wealth of nation, including
natural resources and food, with the indigents and the disadvantaged, or the fair,
equitable, appropriate distribution in society determined by justified norms and structure
of distribution as part of the terms of social cooperation;
• Example of distributive justice: The Philippine government and its agency, Philippine
Charity Sweepstakes Office
• Commutative – Deals with fairness of exchange; Exists in the relationship between
individuals or between entities, like nations or corporations

IX. CASUISTRY (CASE-BASED REASONING)

➢ Application of general ethical principles to particular cases of conscience or conduct
➢ Rule of precedence becomes a potent source making a sound decision in healthcare practice
➢ Uses history, past paradigmatic cases, and factual circumstances to determine appropriate decision
making; Favors analogy over deductive reasoning
➢ Example: In cases of patient in a PVS (Persistent Vegetable State), pertains that person’s brain
is extremely damaged that it cannot exhibit any sense of awareness or maintain any reaction to
external stimuli. In this condition, the physician and the patient’s relatives will undoubtedly be thrown
into a quandary of what to do with the patient.

X. COMMUNITARIANISM
➢ Emphasizes the interest of communities and societies over those of the individual
➢ In Communitarianism, the following points have to be emphasized:
o Individual rights are coupled with communal responsibility
o Communal good is more important than individual good
o There should be balance between the welfare of the community and that of the individual
o Solutions to important questions necessitate a distributed communal deliberation or
understanding
PART 7 & 8. APPLIED HEALTH ETHICS AND ANALYSIS OF BIOETHICAL ISSUES

I. Beginning of Human Life

➢ When does human life, or personhood begin? – There is no exact answer scientifically, theologically,
or philosophically.
➢ Why do we need to determine the beginning of human life? Answer: Issue of Abortion
➢ THEORIES AND CONCEPTS ABOUT LIFE’s ORIGIN:
1. Neurological Theory
- Based on the notion of the capabilities and function of a gadget called
electroencephalogram (EEG), a medical test used to determine the brainwaves of the
human being; EEG was invented by a German psychiatrist and physiologist Hans
Berger
- Fetus considered to have life when brain waves are duly captured by EEG; EEG can
recognize life of a fetus approximately in a span of 24-27 weeks after gestation (period
required for the formation of synapses for the neural activity to be detectable);
***modern technology is still not capable of performing EEG in utero
- Harold Morowitz and James Trefil (1992) – “Beginning of human life is the very
moment when a developing fetus starts to manifest an EEG pattern that correlates to
that of a mature brain indicates the indelible mark of the beginning of human life.”
- Maturation of cerebral cortex is indispensable in this theory since it is the one
through which the fetus does its electrical activity
- Human life begins from four to six months gestation
2. Biological Independence
- Founded on the notion of viability; Depends on the maturation of lungs of the growing
fetus
- Viability of human fetus increases significantly beyond 24 weeks after gestation as
the lungs of the fetus develop progressively towards a saccular stage (stage of lung
development of the fetus wherein the lung volume increases significantly to form a
saccule/ subdivision of the saccules into alveoli
3. Metabolic
- Advocates the idea that there is no such thing as fertilization (moment of fusion of the
ovum and the sperm cell that leads to the formation of the so-called new reality or
term zygote)
- Fertilization cannot be exactly determined inasmuch as it is, a process that requires
20 to 22 hours between the duration when the sperm cell has successfully penetrated
the outmost layers of the egg cell that results in the formation of a diploid cell – the
cell or organism that have two sets of chromosomes
- Proponents of this theory do not accept the agreed 14th day approximation of the
complete fertilization that leads to the formation of an embryo
4. Embryological
- Beginning of human life happens at gastrulation, not at fertilization
- Gastrulation = Greek: Gaster = stomach or gut; is the process in w/c a gastrula (an
embryo in an early stage of development during which the blastula differentiates into
two cell layers and the central cavity becomes the archenteron
o Blastula – an early developmental stage of an animal which is consisted of a
single spherical layer of cells enclosing a hollow or central cavity
o Archenteron
- Introduced in 1891 by Ernst Heinrich Philipp August Haeckel
5. Consciousness of the Self
- Human life begins when the child earns consciousness of his/her very self
- Proponent Michael Tooley: “Only when the child attains self-consciousness, or to the
least gains consciousness, can he/she be ascribed of personhood, or to have begun to
live a human life.
- Allows infanticide – killing of a less than three days old child, Art.255, Revised Penal
Code
6. Genetic
- Fertilization or conception occurs the moment the sperm cell fuses with the egg cell
 - Support in consonance with the teachings of the Catholic Church
- Fertilization is a process that occurs over a period of 12-24 hours after the actual
combination of the sperm and the egg. The sperm will penetrate into the egg by
passing through the egg’s corona radiata and zona fellucida, the egg will close
itself, making a stern order that there will be no other sperm that will be
accommodated inside.
- Experts claim that approximately, it takes 10 hours for the sperm to take a successful
journey from the cervix to the fallopian tube, specifically at the middle part (or the
ampulla), where it usually meets the egg

II. Current Reproductive Technologies

II.A. Sex Selection
- Done in three ways:
1. Pre-Implantation Method
1.A. SPERM SORTING – means of sex selection through which the X and Y chromosomes
of the spermatozoa and the X chromosomes in the oocytes (eggs do not contain Y
chromosome) are dissected, or separated into X (female) and Y (male) chromosomes
based on the variance of DNA content. This process is made possible through a process
called flow cytometry wherein the respective X and Y chromosomes are identified by the
use of a fluorescent dye called Hoechst 33342.
1.B PGD or PRE-IMPLANTATION GENETIC DIAGNOSIS or EMBRYO SCREENING –
Primordial purpose is to screen the anatomical, physiological, or genetical conditions of
the embryo. The most fit or healthiest embryo that bears the sex that is preferred by the
couple will be used to impregnate the wife.
2. Post-Implantation Method – used prenatal diagnosis w/c is done by the use of
amniocentesis and/or ultrasound machines for purposes of determining the sex of
the offspring (Couples would resort to abortion in case the sex of the fetus is not the one
they want)
3. Post-Birth Method – uses sex-selective infanticide, sex-selective abandonment,
sex-selective adoption

II.B. In Vitro Fertilization

- An example of ART
- An artificial process through which the egg cells are fertilized by the sperm outside of the
woman’s reproductive tract
- Term in vitro der. From Latin in glass; Historically refers to glass containers like beakers,
test tubes, and petri dishes which are used during experimentations conducted for the
purpose of fertilizing the egg and sperm, thus the colloquial term “test tube baby”
- Related methods:
• Transvaginal Ovum Retrieval (TVOR)
• Assisted Zona Hatching (AZH)

III.C. Artificial Insemination

- One example of ART (Assisted Reproductive Technology)
- An act through which the sperm is placed into a female’s uterus, or the intrauterine method,
by the use of artificial means rather than by conjugal act or sexual intercourse which is
understood as the natural means of copulation
- The WIFE is the one INCAPABLE of reproduction
- Two processes:
• Homologous or Artificial Insemination from the Husband (AIH)
- accepted by some theologians as a justifiable act
• Heterologous or Artificial Insemination from a Donor (AID)

III. Contraception
• Catholic Church’s teaching: “Whenever couples engage in sexual intercourse, they must have in mind
• the holy intention and knowledge that the conjugal act is always directed towards PROCREATION.”
• ***Research on RH Law
• Various Kinds of Contraceptive Methods:
• Oral Contraceptive Pill
 o Intra-Uterine System (or Mirena)
o Contraceptive Patch
o Intrauterine Device (IUD)
o Injection or Injectable Contraceptive
o Male and Female Condom
o Contraceptive Sponge
o Coitus Interruptus (Withdrawal)
o Tubal Ligation or Female Sterilization
o Vasectomy or Male Sterilization
o Diaphragm
o Cervical Cap
o Vaginal Contraceptive Ring (Nuva Ring)
o Emergency Contraception (“Morning after Pill”
o Outercourse or Non-vaginal Sex
o Rhythm Method – the only method commended by the Catholic Church

IV.MATERNAL-FETAL RELATIONSHIP
Mothers must be cooperative enough to the healthcare workers in submitting for treatments for their fetus.
Through fetal surgery, some FETAL ABNORMALITIES can be treated, such as follows:
1. Myelomeningocele or spina bifida
2. Congenital Diaphragmatic Hernia
3. Urinary Tract Infection
4. Congenital Cystic Adenomatoid Malformation of the Lungs
5. Sacrococcygeal Teratoma
*Open Fetal Surgery – akin to a normal caesarian section performed under general anesthesia, except
that the fetus remains dependent on the placenta and is returned to the uterus to finish gestation.
Healthcare providers who happen to assist during this type of surgery have nothing to fear or worry relative
to any aspect of moral uneasiness in relation to such operation.

V. Death
• Medical: Permanent Cessation of all bodily functions/ vital functions. Heart, lungs, Brain stop working.
• Legal: Cessation of life as indicated by the absence of blood circulation, respiration, pulse, and other
vital function
• Legal and Medical: Irreversible Cessation of all of the following:
o EEG Assessed Flat-Lined total cerebral function
o Spontaneous Function of the respiratory system
o Spontaneous Function of the circulatory system

VI.STEM CELL TECHNOLOGY

• Argument: “Are pre-implantation embryos human beings?”
• Stem Cell – a cell that has the viability to divide or self-replicate for indefinite periods – often
thought the life of the organism; Stem cells have the potential to develop into mature cells that have
the characteristic shapes and specialized functions, such as heart cells, skin cells, and nerve cells
(NIH)
• CLASSIFICATION of STEM CELLS
o Totipotent
o Multipotent
o Pluripotent
• Pre-Implantation Embryos/ Surplus Embryos
o Developed from the first week after conception w/c further develops into three distinct
phases: zygote, morula, blastocyst

VII.ORGAN TRANSPLANTATION/ORGAN DONATION

• An organ transplant is the moving of a whole or partial organ from one body to another for the
purpose of replacing the recipient’s damaged or failing organ with a working one from the donor.
• Two Kinds of Organ Transplantation:
o Inter vivos – transplant done among the living
o Postmortem – donations given after the death of the donor
• RA 7170, Organ Donation Act of 1992
References:
• Medical Jurisprudence (1st edition) by Rustico T.De Belen, 2009.
• Bioethics: A Guide to Healthcare Providers (2nd edition) by Dr. Eddie R. Babor, LLB, 2010.
• Introduction to Law and Ethics
• Principles of Bioethics by Mareiniss and Casarett