BIOETHICS

DE LA SALLE HEALTH SCIENCES INSTITUTE

COLLEGE OF MEDICINE
FIRST YEAR LEVEL
 BIOETHICS 1
The course involves the study of the fundamental
concepts of general ethics and the foundations of
Bioethics. Here, students are made aware of their
moral responsibilities as Christians as they exercise
their profession. It is emphasized that as medical
students, they should know where decisions are
based in order to be ethical and Christian-oriented
physicians. The course also includes related values
and virtues that are necessary for the enhancement
of morality in the practice of medicine.
 ELGA
The expected lasallian graduate’s attributes (ELGA) are:
• Ethically competent
• Ethically efficient
• Imbued with the spirit of faith
• Virtuous
• Reveres life: promotes and defends life
• Respectful towards the human person
• Compassionate and safe physician
• Ethically responsive
• Just
• Responsible for oneself and responsible to others/patients
• Respectful to human rights
• Effective communicator
 INTRO TO BIOETHICS
OBJECTIVES

1. To define the different ethical sciences

2. To identify the similarities of the ethical
sciences
3. To differentiate the ethical sciences from
one another
4. To determine the scope of Bioethics
 ETHICS

That branch of philosophy that

studies and draws conclusions of the
degree of goodness and badness of
human actions and conduct in
relation to the purposes of human
living.
 CHRISTIAN ETHICS

That branch of theology which studies,

in the light of human reason and of
Christian Faith, the guidelines man
must follow to attain his final goal.
 BIOETHICS

Is the systematic study of human

conduct in the areas of life sciences
and of health care, insofar as that
conduct is examined from the view
point of moral values and principles
 GENERAL
SUBJECT OBJECT JUDGMENT

G
H O
ETHICS U O
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M U D
A M N
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N A E
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N S
I
P S
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CHRISTIAN R C O
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ETHICS S T R
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N B
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BIOETHICS
 GENERAL PA R T I C U LA R
SUBJECT OBJECT JUDGMENT SUBJECT OBJECT END BASIS

HUMAN HUMAN UPRIGHT- HUMAN

G ACT NESS REASON
PERSON
H O
ETHICS U O
H
M U D
A M N
S
N A E
C
N S
I
P S HUMAN MAN’S HUMAN
E
E A PERSON AS RESPONSE ULTIMATE
N REASON
CHRISTIAN R C O RELATED TO GOD’S GOAL/END AND
C
ETHICS S T R TO GOD CALL/WILL FAITH
E
O S
N B
A
D RIGHT
N DECISION
MEDICAL
E OR HUMAN
PHYSICIAN DECISION
S RIGHT REASON
AND OF
S DECISION AND/OR
BIOETHICS PATIENT BOTH THE
AS RELATED PHYSICIAN WITH THE FAITH OR
TO GOD AND THE ULTIMATE RELIGIOUS
PATIENT END IN VIEW BELIEF
 Bioethics goes beyond ethical issues in medicine
to include ethical issues in:

• Public health
• Population concerns
• Genetics
• Environmental health
• Reproductive practice and technologies
• Animal health and welfare and the like
 ISSUE AREAS IN BIOETHICS
1. The rights and duties of patients and health
professionals.

2. The rights and duties of research subjects

and researchers;

3. The formulation of public policy, guidelines

for clinical care and biomedical research.
 WHY IS THERE A NEED TO STUDY
BIOETHICS?
1. there is a physician-patient relationship
2. the physician is a healer of another’s body
3. the physician does not have a total right
and/or obligation over the patient
4. the physician must be guided by principles
5. the physician must be able to decide on
certain actions/procedures without prejudice
to the patient
 HUMAN ACTS
OBJECTIVES:
1. To define human act
2. To differentiate human act from act of man
3. To analyze the nature of the human act
4. Describe the kinds of voluntary acts
5. To describe the effects of voluntary acts
6. Indentify the impairments of human acts or to
voluntariness
7. To judge the imputability of a human act
 HUMAN ACTS

Actions that proceed from

insight into the purpose of
one’s doing and from consent
of free will
 Knowledge
Intellectual
Constituent Attention

Judgment

Perf./ Imperf.
(Actions)
Actual/Virtual

HUMAN
ACTS
Positive/Negative
(Effects)
Direct/Indirect

Volitive Quest for Good

Constituent
Choice
 VOLUNTARY ACT
• perfect – an act performed with full knowledge
and full consent of the will

• imperfect – knowledge and/or consent are not

full or lacking

• actual – the act that proceeds from the present

deliberation of the will

• virtual – the act is placed by a previous

deliberation that still persists in its effect
 EFFECT OF THE VOLUNTARY ACT

• Positive – the effect comes from an action that

is done (committed)
• Negative – the effect comes from an action that
is not done (omitted)

• Direct – the effect is intended in itself

• Indirect – the effect is not intended but merely
permitted as the inevitable result of an object
directly willed
 Knowledge
I Invincible
Ignorance
Intellectual Vincible
Constituent Attention M Inattention
Judgment Error
P
Perf./ Imperf.
(Actions) A
Actual/Virtual

HUMAN
I
ACTS
R
Positive/Negative
Direct/Indirect
(Effects) M
E
N
Volitive Quest for Good
Constituent T
Choice
S
 IGNORANCE
• Invincible Ignorance – one is not able to dispel/remove the
ignorance by a reasonable diligence
• Vincible Ignorance – the ignorance can be removed by
reasonable diligence but it is not removed due to negligence or
bad will

Principles:
1. Invincible Ignorance takes away or prevents the human act from
being voluntary in regard to that which is not known. So, a
human act coming from invincible ignorance is not voluntary in
its cause.
2. Vincible Ignorance does not take away the voluntariness but
diminishes voluntariness
 INATTENTION

• an actual, momentary privation of knowledge

Principles:
1. if a person does not attend at all to what he is
doing, he does not accomplish a human act.

2. if a person is only half-attending to what he is

doing, he performs an imperfect human act.
 ERROR
1. the origin of error may be traced from:
– deficient education
– influence of bad company
– misleading mass media

2. man is challenged to overcome the errors and search for the

truth.

3. man must be able to reach views based on sound reasons.

4. man, as an individual, must fight against errors, and the

community must help one another to resist error.
 I Invincible
Knowledge Ignorance
Intellectual Vincible
Constituent Attention M Inattention
Judgment Error
P
Perf./ Imperf.
(Actions) A
Actual/Virtual
I
HUMAN Passion/ Antecedent
ACTS R Concupiscence
Consequent
Positive/Negative
(Effects) M
Direct/Indirect Fear
E
N Violence

Volitive Quest for Good

Constituent T Dispositions/Habits
Choice
S
 PASSION OR CONCUPISCENCE
• a movement of the sensitive appetite which is produced
by good or evil apprehended by the imagination

Concept:
• there is no connotation of evil
• God has endowed man with these appetites which
pervade his whole sensitive life
• they are instruments for the self-preservation of the
individual and the whole human race
• passions become evil only if their force is not controlled
by reason
• man has the urgent duty to check his sensitive appetites
 PASSION OR CONCUPISCENCE
Division:

• antecedent – precedes the action of the will

and at the same time induces the will to
consent

• consequent - follows the free determination

of the will and is either freely admitted and
consented to or deliberately aroused
 PASSION OR CONCUPISCENCE

Principles:
1. antecedent passions always lessen voluntariness and
sometimes preclude it completely because it hinders
the reflection of reason and weakens its attention, at
the same time, it strongly entices one to action and
entices the will to consent. The more intensive
concupiscence is, the weaker the intellect and will
become.
2. consequent passions are either good or bad because
they are either freely admitted and consented to or
deliberately aroused. They are voluntary in
themselves.
 FEAR
• the shrinking back of the mind on account of an
impending evil

Concept:
• this kind of fear is intellectual fear as distinguished
from the fear arising from the senses which is one of
the passions
• intellectual fear does not generally escape the control
of the mind and will
• generally it leaves the person free
• the evil that causes the fear may threaten the affected
person or those associated with him
 FEAR
Principles:
1. fear does not destroy the voluntary character of an
action but it usually lessens the merit or guilt
2. even though an action done out of fear has an
involuntary aspect, it holds that a person does so by a
decision of his will and therefore performs a human
act.
3. grave fear – caused by a grave evil which one cannot
easily escape from – usually excuses from the
obligations of divine or human laws. The reason for this
is that moral impossibility excuses from the compliance
with such laws.
 VIOLENCE
• a compulsive influence brought to bear upon
one against his will by some extrinsic agent

Concept:
• violence is not caused by moral force but only
by the compulsive force of some physical or
psychic agent
• while internal resistance of the will is essential
for violence, external resistance is not always
called for
 VIOLENCE
Division:
• absolute – if the will dissents totally and resists as best
it can and is meaningful
• relative – if the will dissents only partially or weakly
and is perhaps deficient in its external resistance, too

Principles:
• absolute violence excludes any voluntariness.
• relative violence does not impair voluntariness
completely but lessens it
 DISPOSITIONS AND HABITS
1. Disposition – an inclination that one has to
certain ways of action and conduct which
have their roots in one’s character an
inherited propensities

2. Habit –the facility or easiness and readiness

of acting in a certain manner acquired by
repeated acts
 DISPOSITIONS AND HABITS
Principles:
1. a deliberately admitted habit does not
lessen voluntariness, and actions resulting
there from are voluntary at least in their
cause; person is responsible if he consents
by free decision to the habit.

2. an opposed habit lessens voluntariness and

sometimes precludes it completely.
NORMS OF
MORALITY
Objective Norm – Moral Law

Subjective Norm – Conscience

 MORAL LAW
OBJECTIVES:
• To identify the objective norm of morality
• To define the different laws
• To differentiate the different laws from one another
• To explain the nature of moral law
• To explain the nature of natural law
• To explain the nature of human law
• To determine and justify the obligations towards the laws
• To judge a human action according to the moral law
LAW – ANY DIRECTIVE OR RULE OF ACTIVITY

MORAL LAW - A DIRECTIVE RULE OF

OBLIGATORY, GENERAL, AND STABLE
CHARACTER, ORDERING MAN’S
ACTIVITY TOWARD THE ULTIMATE
END.
DIVISION OF MORAL LAW
(hierarchical order):

Divine Law

Natural Law

Human Law
 Moral Law Includes:
– obligatory demands
– recommendations
– common laws which concern all men or
groups of men
– personal commands which result from an
individual call addressed to an appointed
person
– counsels
– permission
CHARACTERISTICS OF A GENUINE MORAL
LAW: GOOD and HOLY
A genuine moral law must be good and holy
because the moral law MUST GUIDE human
activity to contribute to the REALIZATION OF
THE FINAL GOAL of human history and of
creation and that it should prevent man from
obstructing the attainment of this end.
 CHARACTERISTICS OF A GENUINE
MORAL LAW: GOOD and HOLY

PRINCIPLES:
• a norm which does not contribute to the
final end has no moral force binding the
will.
• a norm which results in the frustration of
the ultimate good is morally evil and its
observance unlawful.
 The Moral Law is based on the ORDER
OF BEING

• Action follows being

1. a thing acts according to its nature.

2. the nature of a thing is the cause,

while the action is the effect.
 The Moral Law is based on the ORDER OF BEING

• Application of this axiom to man’s activity

1. man’s moral obligation must be derived from and measured by
the nature of his being.

2. God is the ultimate norm of moral law since He created

everything.

3. the laws emerging from man’s nature have their origin in the
Creator’s designs.

4. the task of Christian Ethics is to recognize man as he really is in

his true nature and with all his essential relations and to derive
therefrom the moral laws which are to direct his activity.
NATURAL MORAL LAW IS THAT MORAL
ORDER WHICH ARISES FROM THE FULL
REALITY OF HUMAN NATURE AND
WHICH CAN BE RECOGNIZED BY MAN’S
REASON, INDEPENDENT OF POSITIVE
DIVINE REVELATION.
 NATURAL MORAL LAW

“full reality of human nature”

• spiritual – the effects of Christ’s saving work

• comprises all the ends designed in the physical,

psychical and spiritual inclinations and
aspirations of human nature inclusive of the
ultimate end
 NATURAL MORAL LAW
“full reality of human nature”

The ends here refer to existential ends, and these are/include:

1. self-preservation which includes bodily integrity and social respect
2. self-perfection physically and spiritually which includes: a) development of
one’s faculties for the improvement of the conditions of life, and b) provision
for one’s economic welfare by securing the necessary property or income
3. broadening of experience and knowledge
4. procreation and education of children
5. interest in the spiritual and material welfare of one’s fellowmen as human
persons equal in value
6. social organizations to promote common utility which consist in the
maintenance of peace and order and in the opportunity for all to attain full
human existence by sharing proportionately in the welfare of society
7. promotion of cultural progress and creative evolution of the world
8. the knowledge and worship of God and the ultimate fulfillment of man’s
destiny through union with Him
 NATURAL MORAL LAW

“recognized by man’s reason”

the medium is reason alone but this does not

exclude the influence of grace.
 PROPERTIES OF THE NATURAL LAW
1. UNIVERSALITY
– the natural law binds all people at all times in all places
– no one is superior to the guidelines which show man the
way
– no one is beyond good and evil
– no one is free from the obligation of fulfilling the duty to
obey and abide with this law
– the most universal principle of the natural law is: GOOD
MUST BE DONE AND EVIL MUST BE AVOIDED. What is
good and worthy of man’s desire?
The following are guidelines:
1. the golden rule
2. maintain and promote your bodily and mental life.
3. maintain and promote social coexistence
4. give to everyone what is his due
 PROPERTIES OF THE NATURAL LAW

2. IMMUTABILITY

3. INDISPENSABILITY

– no one is dispensed from the natural law from the

side of human authority

– there may be a suspension of the natural law but

such suspension always demands an expressed
positive divine revelation
HUMAN LAW IS AN ORDINANCE OF REASON FOR
THE COMMON GOOD, PROMULGATED BY HIM
WHO HAS THE CARE OF THE COMMUNITY.

Reasons for the necessity of human law

1. to make clear the requirements of the natural law and the
divine positive law for everybody

2. to enforce obedience at least to those demands of the

moral law which are of greater value for the common good.

3. to determine the moral law more precisely when several

possibilities of fulfilling it are open to men.
OBJECT OF THE HUMAN LEGISLATION
The direct object of human law is the common
welfare/good

Human legislation is supposed to create favorable

conditions for man’s life in the religious, cultural, social
and economic aspects.

Human legislation has to safeguard the common good by

protecting the moral culture of the community, its
interior peace, security, social justice, and human rights.
 4 conditions that a regulation may
become the object of a law
1. the content of the law must be morally permitted.
2. the content of the law must be just
– the lawgiver must not go beyond his jurisdiction
– the law must not restrict the rights of the subjects
– the law must distribute burdens and privileges equally and according
to the capacities of the subjects
– new penal laws cannot be extended to past actions

3. the law must be physically and morally possible.

– the law must be within the forces and means of a person
– the command of the law can be done with no great difficulty

4. the law must be useful and of benefit for the common good
 MORAL OBLIGATION TOWARDS THE LAW:
PRINCIPLES:
1. on the nature and gravity of the moral obligation
– just laws bind in conscience by reason of their intrinsic necessity and
justice
– anyone who violates a just law is in conscience bound to submit to a just
punishment
– a punishment is just if it measures up to the importance of the law for the
common welfare

2. on the extent of the moral obligation

– the subject has the moral obligation to acquire by sufficient means a
knowledge of the law
– the subject is obliged to use the ordinary means which are absolutely
necessary for the observance of the law
– the subject is bound to remove or anticipate obstacles which make the
observance of the law proximately impossible, if this can be done without
great inconvenience
 CESSATION
1. of the obligation towards the law:
– when one ceases to be subject of the law
– when one is invincibly ignorant of the law
– when there is a physical impossibility
– when there is a moral impossibility
– a dispensation
– a privilege

2. of the law:
– through the act of a legislator or through contrary customs
– a new law abrogates a former law if it expressly states it, or
if it is directly contrary to the old law
– the purpose of the law ceases to exist
 CONSCIENCE
OBJECTIVES:
• To identify the subjective norm of morality
• To describe what is conscience
• To distinguish the division of conscience
• To identify the kinds of conscience
• To demonstrate the obligation towards
conscience
• To judge a human action according to the
dictate of conscience
 CONSCIENCE

Conscience judges on the morality of

a concrete action commanding to do
what is good and to avoid what is
evil
 1. RIGHT

ANTECEDENT PERFLEXED
VINCIBLE

2. ERRONEOUS LAX
INVINCIBLE
SCRUPULOUS
CONSCIENCE

3. CERTAIN

CONSEQUENT

4. DOUBTFUL
The Concept of Conscience:
• It is not a theoretical or scientific knowledge of moral values
and of good and evil, but
• It shows to man what his nature is and what the divine Spirit
requires of him as his personal obligation and then leads
him to perceive the binding force of these requirements.
• In most cases, the judgment of conscience is not reflexive
but spontaneous. The judgment of conscience is expressly
reflected upon especially in instances of doubt, or of
resistance and disobedience to the dictates of conscience.
• It concerns a person’s concrete action in a concrete
situation.
• It formulates general moral principles concerning the
morality of human actions in the abstract without relation
to the concrete activity of a person here and now.
The Dictate of conscience Contains 2 Elements:

1. the judgment on the morality of a

concrete action which a person intends to
perform or has performed, and

2. the command and obligation that what is

recognized as good must be done and
what is recognized as evil must be
avoided. The obligation is categorical. It is
not only right to follow it, it is obligatory
to do so.
Antecedent Conscience – the judgment on
the morality of an action and the
obligation to perform it or omit it is
passed before the action is done. This
conscience commands, exhorts, permits
or forbids.

Consequent Conscience – evaluates a deed

already done or omitted. This conscience
approves, excuses, reproves or accuses.
Right Conscience – the moral judgment agrees
with the objective norm of morality

Erroneous Conscience – the moral judgment

disagrees with the objective norm of morality.
This can be:

a. vincibly erroneous – it dawns on man that his moral

outlook might not be entirely sound or he is aware
of being careless and irresponsible in his decision

b. invincibly erroneous – the person has no

awareness of the possibility of error
 Other Kinds of Erroneous Conscience:

1. Perplexed – when confronted with two alternative

precepts, it fears sin in whatever choice it makes. This is a
disturbed conscience. There is a disturbance of the capacity
to form a judgment

2. Lax – judges a thing to be lawful when it is actually

unlawful, moral when actually immoral, light or venial sin
when actually serious or mortal sin.

3. Scrupulous – judges something to be sinful when actually it

is not, or something to be grievous or moral when actually
light or venial
Certain Conscience - passes judgment
without fear or error

Doubtful Conscience - uncertain

concerning the morality of an action
WE MUST HAVE A RIGHT AND DELICATE
(SENSITIVE) CONSCIENCE PRESERVING
OURSELVES INTACT WITH CLEAR AND
VIGILANT DISCERNMENT OF THE GOOD
AND EVIL.
 The VINCIBLY ERRONEOUS CONSCIENCE

Before a person with this kind of conscience may

act:

1. he must remove his erroneous state by

searching the truth; if this is not possible
because he is unable to do so,

2. He must postpone the action; if the action

cannot be postponed,

3. He must follow the safer line of action.

 THE PERPLEXED CONSCIENCE
The line of actions to be taken is:
1. if the decision can be delayed, postpone the action to
obtain information and deliberate; if the decision cannot
be postponed,
2. One must choose what appears to be the lesser evil; if
still this is impossible to settle/do,
3. Either of the alternatives may be done

Principles:
1. If this line of action is observed, there is no formal sin
because it is impossible for the person to escape both
alternatives of the perplexing situation;
2. If this line of action is not observed, the person may be
guilty of formal sin because nothing was done to correct
the error.
 The DOUBTFUL CONSCIENCE
the line of actions to be done:

1. the action must be postponed until

certainty is reached; If the doubt cannot be
solved directly,

2. one may make a presumption

PRESUMPTION - a conjecture where the

GREATER RIGHT COMMONLY LIES and the
lesser injustice is to be feared
 REFLEX PRINCIPLES WHERE PRESUMPTION
STANDS
1. In doubt, presumption stands on the
side of the superior.

2. In doubt, stand for the validity of the

act.

3. In doubt, amplify the favorable and

restrict the unfavorable.

4. In doubt, presumption stands for the

usual and the ordinary.
 BINDING FORCE OF CONSCIENCE
1. MUST BE OBEYED:
• Certain
• Invicibly Erroneous
• Right
• Unaware Lax

2. MUST NOT BE OBEYED:

• Aware Lax

3. MUST NOT BE OBEYED UNTIL SOME CLARIFICATION

IS OBTAINED, BUT ONE MAY ACT IF CLARIFICATION
CANNOT BE OBTAINED AND THE DECISION HAS TO
BE MAKE IMMEDIATELY:
• Vincibly Erroneous
• Perplexed
• Doubtful
 FREEDOM OF CONSCIENCE
- There is a strict obligation to follow one’s
certain conscience; correspondingly, one has
the right to act according to one’s conscience.

- The restrictions of the freedom of conscience

is when it happens that the dictate of
conscience runs in conflict with the demands
of the common welfare.
 SOURCES OF MORALITY
OBJECTIVES:
1. To explain the meaning of “sources of
morality”
2. To enumerate the sources of morality
3. To explain each of the sources of morality
4. To determine how the elements affect the
morality of a human act
5. To judge a human act according to the
sources of morality
 SOURCES OF MORALITY

Sources defining the morality of human acts -

these are the elements in the human act which
determine its morality. These elements are
called sources of the morality of human acts
because the human act derives its morality from
their agreement or disagreement with the moral
norm.
These sources are:

OBJECT

CIRCUMSTANCES

INTENTION
 OBJECT
Object of the human act is the effect which an
action primarily and directly causes. It is always
and necessarily the result of the act,
independent of the circumstances or of the
intention. It is generally regarded as the primary
source for the judgment on the morality of an
act.
 Effect of the Human Act is:
1. the physical, biological changes which an act brings about;
2. The impact of the act on rights and claims of persons,
whether of other persons or of the agent himself, and the
changes the act brings about in this sphere.

To determine the OBJECT of a specific action:

1. look into the matter the act is concerned with and the
existing rights and claims of persons to this matter;
2. Define the changes which are to be brought about
primarily and directly.
 CIRCUMSTANCES

These are the particulars of the concrete human act which are not
necessarily connected with its object,

These CIRCUMSTANCES are:

WHO
WHAT
WHERE
WITH WHAT MEANS
WHY
HOW
WHEN

The CIRCUMSTANCES can alter the morality of human acts for better or
for worse. They can influence the morality of a human act.
 INTENTION / END

This is the reason for which the agent undertakes

an act. The agent performs the action for the
sake of this end/intention which he expects to
achieve.

The INTENTION/END can modify the morality of

an act in similar ways as circumstances do.
 VIRTUE
OBJECTIVES:
1. To define virtue
2. To explain the concept of virtue
3. To specify the fundamental requirements for virtue
4. To define, enumerate and explain the meaning of the
requirements of the theological virtues
5. To define, enumerate and explain the meaning and
requirements of the cardinal virtues
6. To apply the concept of virtue in medical practice
7. To enumerate and explain the meaning of the virtues of a
physician
 VIRTUE

A habit that gives both the

inclination and the power to do
readily what is morally good.
Inclination to the moral value and to
love it
very essential and
indispensable element
of virtue

Power is the dominion over one’s spiritual

and sensual drives and passions
1. moral knowledge
- some insight and knowledge of the
value it endeavors to realize
- education, instructions, formation

2. prudence
- cautious deliberation
- to look carefully into the concrete
circumstances
3. love of moral value
- the beauty and goodness of the
moral value must be deeply sensed
and truly loved
- deepening and faithful pursuance of
the right fundamental option

4. dominion over the passions

- moderating restraint
  Faith
 Hope
 Charity

Theological Virtue - God is the

immediate object
is the most exalted, the most
fundamental and universal of all virtues
- can co-exist with:
failures that result from weaknesses: wrong
attitudes which result from deficient insight
into the real demands of the moral value

- cannot co-exist with:

bad habit;
fully deliberate adherence to a serious vice
CARDINAL VIRTUES - considered as “hinges” on
which the whole moral life turns

PRUDENCE - disposes a man to discern correctly what

measures he must take to realize the exigencies of a
virtue in concrete circumstances

JUSTICE - to give what is due

FORTITUDE - courage to stand/defend what one believes

TEMPERANCE - gentleness; benevolence; moderation

Virtue as lived morality or a lived dimension of morality,
refers to a gathering of personal motives, feelings and
dispositions for a consistent lived expression of a
virtue.

“Becoming A Good Doctor”

by James F. Drane
p. 157

Virtue is the personal appropriation of values made with

the help of reason
Ibid., p. 164
Connected with diagnosis and prognosis

- it is the character trait which disposes the

doctor to carry out beneficent acts

- It refers to the commitment or will to carry out

medical acts according to the highest ethical
standards

- It refers to wishing a patient well or being

disposed to attend to the patient’s needs
Connected with medical communication

- it is the disposition to tell the truth, not only

once but several times over;

- The habit of telling the truth even when it is not

convenient or does not serve a personal
convenience;

- It disposes the doctor to prepare patients for full

participation in decision-making regarding their
own lives
Connected with decision-making

- it is the trained attitude or disposition to

reverence those free acts by which patients
carry out their best interests

- It disposes the doctor to handle differences

with the patient with sensitivity, avoiding
deceit or manipulation
Connected with inevitability of feelings; affective dimension
- there is pleasure in one another’s company, confidences
are shared, and there is an exchange of benefits;
- Feelings are shared and intimacies revealed appropriate
only within this relationship
Affectionate relationship - controlling personal hostility
Understanding - looking beyond the patient’s acts, words
and behavior and seeing the interior world of thoughts
and feelings
Forgiving
Connected with the idea that doctors are priests

- Reflection on the awesome dimensions of his work

- Recognition of what is “transcendent” in the patient (the mystery of

life)

- Commitment to serving patients struggling with life’s meaning

- Treating the patient as Christ would

- “Other” - directed; the “other” is the patient

- It keeps doctors from confusing themselves with God, and from

falling into the temptation of moral self-righteousness

- It is the reality of God that keeps creatures aware of “their place”.

FUNDAMENTAL
BIOETHICAL
PRINCIPLES
1. Sanctity and Inviolability of Life
2. Human Dignity
3. Autonomy
4. Stewardship and Accountability
5. Totality
 SANCTITY AND INVIOLABILITY OF
HUMAN LIFE
OBJECTIVES:
1. To explain the meaning of the principle of sanctity and
inviolability of human life
2. To evaluate the bases for this principle
3. To formulate the general rule system bearing on the
sanctity and inviolability of human life
4. To apply the principle in given cases or situations
5. To judge violation or non-violation of the principle in
given cases.
 SANCTITY OF LIFE

Interpreted as to mean that each

individual, regardless of the state of
health, is not to be used as means, and
is to be treated with dignity because he
is valuable.
 SANCTITY OF LIFE
• Life is holy because God is the origin of life and the
ultimate guarantor of the sanctity of human life;
• Because man’s life comes from God he belongs
directly and exclusively to Him;
• One must respect one’s own life and the life of
others not only because of this;
• Because of man’s eternal destiny
HUMAN LIFE
- the fundamental ethical value

MORAL INTEGRITY
- the absolute ethical value
 General Rule System Bearing on the
Sanctity of Life
1. Survival and integrity of the human species – man ought to
work towards his own survival
2. Survival and integrity of family lineage
3. Integrity of bodily life – the basic right to life
4. Integrity of personal, mental and emotional individuality –
the right to be oneself
5. Integrity of personal bodily individuality – integrity of the
human body
CONCLUSION: Man’s life is holy because it comes
from God and has an eternal
destiny.
 INVIOLABILITY OF LIFE

Because life is holy it cannot be violated

 HUMAN DIGNITY
OBJECTIVES:
1. To explain the meaning of the principle of human dignity
2. To evaluate the bases for this principle
3. Co-relate this principle with sanctity and inviolability of life
4. To determine the scope of reference of human dignity
5. To explain respect for human dignity in the dimensions of
personhood
6. To apply the principle in given cases/situations
7. To judge the violation or non-violation of the principle in given
cases.
 HUMAN DIGNITY
The dignity of the human person is the STRUCTURAL
NUCLEUS OF ETHICS

• In the sense that moral life is basically the

actualization of what it means to be a person
in relation to other persons and sentient
beings.

• RESPECT for the dignity of all persons and

each person is the necessary condition for all
morally good attitudes and acts.
 BASES OF THE DIGNITY OF THE HUMAN
PERSON
1. Every human person is crated in His image and likeness.

2. Every human person is endowed with intelligence to know and a

free will to decide/choose.

3. The creation of the human soul is a direct action of God.

4. Every human person is called into existence in relation to God.

5. Each human person is unique and irreplaceable.

6. Each human person is called to maturity and eternal life.

SCOPE OF REFERENCE OF HUMAN DIGNITY

Respect for the dignity of the human person should be:

1. Concrete
1. Universal
1. Egalitarian
1. Absolute
1. Partisan in favor of those who suffer from dehumanizing
situations
 Respect for the dignity of the human
person should be:

CONCRETE

In the sense that it refers not to abstract

human nature, but to concrete and actual
human beings immersed in complexed and
conflictive historical realities
 Respect for the dignity of the human
person should be:

UNIVERSAL

In that it applies to all persons, going beyond

geographical and political boundaries
 Respect for the dignity of the human
person should be:

EGALITARIAN

In that it affirms the equality of all human

persons in dignity, rejecting all discrimination,
whether this be based on race, religion, sex,
ideology, generation, social class or any other
arbitrary criterion
 Respect for the dignity of the human
person should be:
ABSOLUTE

Because it is inherent in human persons precisely as

persons, and not for what they possess, nor for what
they can give, nor for their physical, intellectual and
social capabilities, but for what they are --- persons

The human person is valuable most of all because he

is a person; he is an end in himself and should never
be used or manipulated as a mere means for another
end
 Respect for the dignity of the human
person should be:

PARTISAN IN FAVOR OF THOSE WHO

SUFFER FROM DEHUMANIZING SITUATIONS

- in the sense that it has a preferential option in practice

in favor of the liberation of those human beings whose
humanity has been disfigured by dehumanizing
situations – the oppressed, the destitute and other
marginalized persons
 Human dignity
• entails respecting the human person in all
the concrete dimensions of his personhood:
1. his / her corporeity

1. his / her social nature

1. his / her reason and liberty

 CORPOREITY
Human beings exist corporeally. The biological
bodies and the bases for their human
consciousness, and thus for their personhood,
and so participate in the dignity of the human
person
 Social Nature
Human persons are by nature social; they live together
and interact with other persons in society.

Within society, the rights and responsibilities of persons

should be recognized, and as persons they should be
active participants in social and cultural life in a relation
of equality with other persons.
 REASON AND LIBERTY
Human persons are characterized by reason and liberty, and are
thus called to realize themselves responsibly as persons.

They should be active and responsible subjects of their own

lives.

Consequently, they have a right to access to information that

affects them.

Liberty of human persons must be respected as long as its

exercise does not violate/injure the rights of other persons.
 AUTONOMY
OBJECTIVES:
1. To explain the meaning of the principle of autonomy
2. To describe the assets of autonomy
3. To identify the role of the health professional in helping the
patient make an autonomous choice
4. To co-relate this principle with the principle of stewardship
5. To apply the principle in given cases/situations
6. To judge the violations and no-violation of the principle in
given cases.
 AUTONOMY

One has the moral right to choose and

follow one’s own plan of life
 IMPLICATIONS OF AUTONOMY
1. This does not mean absolute freedom to do anything as one
wishes;

2. To act morally, man still has to follow the guidelines of moral law
and conscience;

3. One has a right to determine what will be done to him;

4. One has a duty not to constrain another’s autonomous choices

and actions;

5. Human beings should be treated with dignity;

6. Human beings should be allowed to make decisions for

themselves.
 POSITIVE ASSETS OF AUTONOMY
1. Autonomy enhances a person’s worth and
self-image

2. It protects a person from being used or

abused by others

3. In health care it develops a mature

therapeutic alliance between health care
professional and patient.
 VIOLATIONS OF THE PRINCIPLE OF
AUTONOMY

Actions performed that constrain a person’s

capacity to make a decision;

Actions performed that constrain a person’s

capacity to act according to his decision
 NON-VIOLATIONS OF THE PRINCIPLE OF
AUTONOMY

 When a person expresses his autonomous wish to

waive consent or delegate authority to others. The
physician’s delegated prerogative refers to the
authority of a physician over his patient as an
authority delegated to him by the patient

 When respecting a person’s autonomy competes

with other moral principles
THE ROLE OF THE HEALTH PROFESSIONAL
The health professional should help the patient make his/her
autonomous choice and act on it by:
providing him/her with the information necessary to weigh
the reason for his/her opinion;
stating his/her own convictions and clearly explaining the
reason for this opinion;
not exercising coercion, manipulation, undue influence, or
irrational persuasions;
respecting the patient’s autonomous choice;
withdrawing from the case and helping the patient find
another health professional who might be more successful in
these particular situations when the health professional
thinks it is impossible to help the patient.
 STEWARDSHIP/ACCOUNTABILITY

Man is not the independent lord of his life but

only a steward subject to the sovereignty of
God, and he is responsible for it because he is
accountable to God. Man’s bodily life is
entrusted to his freedom
 STEWARDHIP AND ACCOUNTABILITY

OBJECTIVES:
1. To explain the meaning the principle of stewardship and
accountability
2. To analyze man’s responsibility
3. To detect dangers and risks
4. To distinguish different kinds of prerogatives
5. To determine the moral obligations in prerogatives
6. To co-relate this principle with human dignity
7. To apply the principle in given cases/situations
8. To judge the violation and non-violation of the principle in a
given case
 STEWARDSHIP
 Man is accountable in the way he uses his autonomy/freedom
and in the way he respects and maintains his own (and that of
others’) dignity.

 (Prudent) stewardship means seeing that the powers

entrusted to people are gifts and that the true meaning of
these powers is to be found in respecting the dignity of
everyone and everything.

 Man must use his freedom responsibly, in conformity with the

ends which are set forth by the inclination of his own nature
as a rational being.
 DANGERS AND RISKS
Earthly life lies constantly exposed to many dangers. But
human life is altogether impossible without a free risk of
bodily loss in the quest for life’s meaning. Excessive concern
about bodily risks is not acceptable.

It is a matter of weighing values or ideals, and a question of

prudence;

The expected benefit must be proportionate to the risk. The

greater the love with which man risks his life, and the higher
the service rendered for the common good or for a particular
fellowman, the purer is the witness to faith, hope and love,
and so the more justifiable the risk.
 Absolute Prerogative
- One is said to have ABSOLUTE PREROGATIVE in
a thing when it is essentially subordinated to
one’s final end, and has become the object of
one’s lawful rights.
 Prerogative “for use”
- That restricted power which a man has,
whereby he has some right to use the thing,
but with certain restriction, which are
imposed by the higher rights of others.
 Delegated Prerogative
• Is the authority or power given by the patient
to his doctor by virtue of the patient’s right
and obligation as an individual to preserve his
health and bodily integrity.
 Prerogative in Human Life
1. Man has, at most, only a “prerogative for
use” over human life

2. Absolute prerogative in human life is an

exclusively divine prerogative
 TOTALITY
OBJECTIVES:
1. To explain the meaning of the principle of totality
2. To determine the scope of the principle
3. To co-relate this principle with the principles of the
human dignity, stewardship and autonomy
4. To apply this principle to given cases/situation
5. To judge the violations and non-violations of this
principle in a given case
 PRINCIPLE OF TOTALITY

The principle states that all the parts of the

human body as parts, are meant to exist and
function for the good of the whole body, and are
thus naturally subordinated to the good of the
whole body
 Implications of the
Principle of Totality
When some part or function becomes
detrimental to the good of the whole body, it
is in accord with right order to remove such a
part or to suppress its function;

Justified mutilation is limited or has

restrictions