3.04 Medical Ethics Trans - Human Acts

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27 Nov 2015 Dr. EUSTAQUIA T. ACEVEDO | Human Act

Introduction • A person is not responsible for an act over which he has no
Human Act control, unless he deliberately surrenders such control by
• actus humanus running into conditions and circumstances which rob him of
• a conscious and free exercise of one’s faculties liberty.
• involves biological, psychological, social and spiritual dimensions o rape, surgery with no prior free and informed
• An outward expression of a person’s choice consent
• An act which proceeds from the deliberate free will of man Two Forms of Freedom
• planned or desired 1. Basic Freedom
• exacts responsibility • aka freedom of self determination
• also called as “personal act” • Persons decide about their beings as persons – who they want
to be.
Act of Man 2. Freedom of Choice
• actus hominis • about their concrete actions what they are doing to realize
• comprises all spontaneous biological and sensual process their being
o e.g. breathing, sleeping, etc. • Freedom of Will in Holy Scripture
• performed without intervention of intellect & free will o freedom to do what is good and to avoid what is evil
o e.g. reflex actions and conditioned responses done o Gen. 3: Sir 15: 14
without knowledge and consent of the will § freedom to keep the ten commandments
• forced acts o Is: 19; Jer 11: 6-8 Ezek 18: 21-28
o coercion § freedom to remain faithful to the Lord
• no element of knowledge (e.g. somnambulism), freedom (e.g. all • Theological Reflection
acts of human infants) and voluntariness (e.g. the act of digesting) o Freedom is the ability to direct oneself abidingly
• an act of man can turn out to be a human act. towards what is good.
o e.g. the act of overhearing o For his self-determination, the person is responsible
before God.
Two Principles Constituting Human Act o This freedom is not a settled possession of man from
1. Intellectual constituent the beginning, but must be gained thru steady effort
• the will can decide for something and seek it only if it is known and always be confirmed again.
o It is not primarily a right but a duty.
• Human act is voluntary only if its different elements are

sufficiently known.
3. Voluntariness
2. Volitive constituent
• every voluntary act includes: • Execution
a. formal element of every desire - necessary • person is not responsible for an act which he does not will,
element, the quest for good unless he wills to give up his self-control
b. material element - free element, the choice of • A voluntary agent is one who is able to will or has power of
the concrete object in which the good is free choice.
sought. • does not necessarily imply freedom
• A person is not responsible for an act over which he has no
Essential Elements of a Human Act control, unless he deliberately surrenders such control by into
1. Knowledge conditions and circumstances which rob him of liberty.
• What it is about and what it means
• Advertence Division of Voluntary Act
• a person is not responsible for an act done in ignorance, unless a. Perfect and Imperfect Voluntary Act
the ignorance is the person’s own fault, and is therefore • Perfect voluntary act
willed. o performed with full attention and consent of the
• Vincible ignorance will
o he has knowledge that he is in ignorance and ought Example of Perfect Voluntary Act
to dispel it. The doctor does the act of diagnosing a patient using
• Nihil volitum quid prius in intellectum auscultation, palpation, inspection and appropriate laboratory
o What is in the will is first in the intellect tests and their results. He ascertains the diagnosis of the patient
and gives medications leading to the immediate recovery of the
2. Freedom said patient.
• Volition
o Implies voluntariness which is to rationally choose Analysis:
by deliberate will the object
The example shows that the doctor has full knowledge

Transcriber: mtagrz Page 1 of 5


3.04 MEDICAL ETHICS
Dr. Eustaquia T. Acevedo | Human Act

of what he is doing and what it means – indicative of the different Example of Indirect Voluntary Act
steps he does that he is able to ascertain the sickness and the John, a staff-nurse does the act of injecting an injectable
necessary medications leading to the immediate recovery of the antipyretic substance into the buttock of a febrile four-year old
patient. boy in order to normalize his temperature. Nevertheless, the
It can rightfully be presumed that the doctor also has injection happens to hit the sciatic nerve of the little boy resulting
the full intention of doing the acts of diagnosing and treating in to a sort of paralysis.
which the power of his will to intend said acts is employed
without any defect whatsoever. Analysis:
Hence, the act is a perfectly involuntary act. The act of injecting is an act directly willed and intended
by the agent.
The act of hitting the sciatic nerve resulting to the boy’s
• Imperfect voluntary act paralysis is an effect that is not directly intended by the agent
o attention or consent is imperfect proceeding, however, from the act of injecting as the cause which
o affected by obstacles of human act (e.g. fear) is directly willed.
Furthermore, the possibility of hitting the sciatic nerve
Example of Imperfect Voluntary Act
is always foreseen considering the tenderness of the buttocks of
Ms. Castro, a staff nurse working in a private hospital is
pediatric patients to which a health care practitioner, befitting his
asked by Dr. Que, the medical director, to assist in the
knowledge and profession, must be sensitive and attentive.
performance of tubal ligation for conception prevention. Knowing
Hence, the act is indirectly voluntary.
it is morally obnoxious, Ms. Castro has inner sense of objection.

She does the act of assisting out of her apprehension of being
grounded if refusal is made while retaining her inner objection. c. Positive and Negative Voluntary Act
• Positive voluntary act
Analysis: o the will effects something positively by exercising
Notwithstanding the fact that the act is done out of the active influence on the causation of an object
agent’s inner sense of objection because of its moral implication, o e.g. injuring a neighbor by setting his house on fire
and apprehension of being grounded if ever refusal is made, the
act is still voluntary. It is still a product of the will making her Example of Positive Voluntary Act
decide to do the act of assisting. Ms. Castro, a clinical instructor, performs her
However, there is a defect in the agent’s intention responsibility of supervising student-nurses in the hospital under
indicative of her inner sense of objection rendering the act less her tutelage during the tour of duty.
intended.
Hence, the act is imperfectly voluntary. Analysis:
The act of performing her responsibility of supervising

student-nurses during the tour of duty is, in a way, an “act of
b. Direct and Indirect Voluntary Act
commission” – an act committed or done.
• Direct voluntary act
Hence, the act is positively voluntary.
o intended in itself as an end
o e.g. murder for the sake of revenge, murder for

robbery and profit • Negative voluntary act
o the will effects something negatively by voluntary
Example of Direct Voluntary Act
omission of an act which could have averted an evil
John, a staff-nurse does the act of injecting an injectable from another person or helped him to secure a
antipyretic substance into the buttock of a febrile four-year old good.
boy in order to normalize his temperature. After a few minutes, o e.g. not to prevent a fire already started in a
the fever subsides. neighbor’s house

Analysis: Example of Negative Voluntary Act
The act of injecting is an act directly willed by the agent. Cynthia, a second year student-midwife knows that she
The end purpose for which the injection is done is also directly has been assigned at the delivery room today. Yet, she does not
intended, that is to make the fever of the child subside. Hence, go to the D.R. She omits doing the act of going there to report to
the act is directly voluntary. her duty.

Analysis:
• Indirect Voluntary Act The act of refraining from reporting to her duty at the
o not intended but merely permitted as an inevitable D.R. is, in a way, an “act of omission.”
result of an object directly willed.
Hence, the act is negatively voluntary.
o e.g. death of a fetus after removal of a cancerous

uterus - Principle of Double Effect

Transcriber: mtagrz Page 2 of 5


3.04 MEDICAL ETHICS
Dr. Eustaquia T. Acevedo | Human Act

Aspects of the Human Act Principles of Ethical Judgment*


1. Agent a. A human act if ethically good when the act itself, the intention
• emphasized by the Virtue Theory, holding that actions are and all circumstances surrounding it are all GOOD
right or wrong depending on what they express about the e.g. act of giving alms to the poor
Agent
2. Acts b. A human act that is good in itself becomes ethically bad when the
• emphasized by the Deontological Theories, that Acts in and of intention or even one of the circumstances is lacking in goodness
themselves, holding that some inherent or intrinsic features e.g. Act of giving alms to the poor for self-enhancement
of actions make them right or wrong, not simply their ends before the public or money is ill-gotten
and their consequences.
3. Ends c. A human act that is indifferent in itself (neither good nor bad)
• Teleological theories emphasize the ends of action. becomes ETHICALLY GOOD when both the intention and all the
4. Consequences circumstances are good.
• Consequentialist theories emphasize the consequences or
effects of action. d. When either the intention or even one of the circumstances lacks
in goodness, the act becomes ETHICALLY BAD
Determinants in the Morality of the Human Act e.g. Act of eating [in the middle of the class that
1. Object of the Act eventually disturbs the lecturer]
• it is the primary and essential element
• the very substance of the act e. When the human act is in itself intrinsically bad, nothing can make
• St. Thomas Aquinas: it ethically good, not even when both the intention and all
o “An object of the act is good when it is in conformity circumstances under which the act is done is good
with reason or when it fulfills or fits the demands of e.g. Euthanasia; abortion
reason. Otherwise, the object of the act is evil.”
• WHAT (nature, means): the agent wants to do to accomplish Good vs. Bad
the act. It is rational: one needs to know what one is doing. • No one willfully performs an act for the sake of evil
o e.g. Operating on a person with tumor • Human act is an act of both the intellect, the object of the which is
truth, and the will, whose object is good
2. Motive of the Agent • When one acts it is always towards the truth and the good
• purpose for which the agent does an act • “Why do human beings do evil to fellow human beings?”
• “what specifically does the agent personally want to • The problem is the perception of what is truth is and what good is.
accomplish?” • “DO GOOD, AVOID EVIL” à First principle of moral order
• WHY (motive): for what reasons why the agent does the act. • It is the process of judgment that makes people, owing to their
o e.g. Injecting a lethal drug to a terminally ill patient individual differences, can differ in arriving at the truth and in the
perception of good.
3. Circumstances
• events, occasions or conditions that make the act concrete Good Act
• WHO: agent who performs the act; special quality; prestige; • That which in agreement with right reason, human rational
rank of person involved. nature, and God
• WHAT: what is the intended object of the act. Evil Act
o e.g. act of returning a wallet, act of surgical • That which is disagreement or in opposition to the said norms
operation Indifferent Act
• BY WHAT MEANS: refers to the various instruments, tools, or • That which is neither in agreement nor in disagreement with
procedures by which an act is done or performed right reason, human nature and God. It is “silent” in terms of
• WHERE: place where the act was done its relation with them.
• WHEN: time when the act was performed • Considered as a human act in as much as it is deliberately,
o e.g. abusing a patient under sedation freely, and voluntarily done.
• HOW: manner or way by which the act was done
• WHY: refers to the motive of the agent The Modifiers of Human Acts / Obstacles of Human Act
I. Intellectual constituent
NOTE: 1. Ignorance
• An act is morally good only if these factors are morally good 2. Error
i.e. in conformity with the order of reason. 3. Inattention
• Both the proximate and ulterior end must be good and the
circumstance must be appropriate. II. Volitive Constituent
• A person’s responsibility for a human act is proportionate to 1. Passion or Concupiscence
2. Fear and Social Pressure
one’s capacity to make a correct judgment and his freedom to
3. Violence
act upon it.
4. Disposition and Habits
• Ignorance and misinformation may cause failure of

understanding.
I. Intellectual Constituent
• External threats, manipulation, and internal fears may restrain
• impairments of required knowledge
one from doing what one sees as right.

Transcriber: mtagrz Page 3 of 5


3.04 MEDICAL ETHICS
Dr. Eustaquia T. Acevedo | Human Act

Ignorance Error
• Absence of intellectual knowledge in man Origin of Errors:
• deficient education
a. Invincible Ignorance • influence of bad company
• absence of knowledge that ought to be present. • reading of misleading books and papers, etc.
(1) It is inculpable – blameless. • one of the greatest hazards to freedom in our times:
(2) Characterized as antecedent because it precedes any o the insidious influence of mass suggestion, which
voluntary act often emanates from:
(3) Imputable: prevents the human act from being voluntary in § organizations like parties
regard to that which is not known. § ideological groups like nationalist and
o What is not known cannot be voluntary and since fundamentalist circles, liberalist
invincible ignorance is not known, is not voluntary. § anti-religious movements or other
powerful associations of citizens
§ far-reaching potency of the mass media:
Example of Invincible Ignorance press, radio and television
A Buddhist medical-technologist has a firm belief and
conviction based on what she knows about Buddhism as the true Inattention
religion. She grows up in a Buddhist environment which is not yet • If a person does not attend at all to what he is doing, he does not
accessed by Catholic evangelization. Unaware of the true faith, accomplish a human act.
• If a person is only half-attending to what he does, the acts he
the medical technologist continues to be working in accordance
performs are only imperfect human acts.
with her faith.


II. Volitive Constituent
Analysis: • Impairment of Free Consent
That the medical-technologist works in accordance with
her Buddhist faith while being unaware of her ignorance about Passion or Concupiscence
the true religion constitutes invincible ignorance that cannot be • has no connotation of evil
dispelled. • instruments for self-preservation of the individual and the human

b. Vincible Ignorance race
• can be removed by reasonable diligence but is not because of • They become destructive and evil only if their force is not
negligence or bad will. controlled by reason
(1) It is culpable.
(2) Consequent ignorance because it is admitted as willed a. Concept and nature:
either directly or indirectly. • Signifies frailty or proneness to evil.
(3) Crass or supine – if no serious effort has been taken to • Bodily appetites or tendencies
remove the ignorance (1) Concupiscible
(4) Affected – if one deliberately wills to remain ignorant • strong sexual desire
Ethical Principle • e.g. Love, joy, hatred, sadness, desire, despair,
aversion or horror
Example of Simple Vincible Ignorance (2) Irascible
A medical student encounters a certain medical term • easily provoked to anger
which he does not know. He asks his classmate about its meaning. • e.g. Anger, courage, daring
But then, his classmate does not also know it and provides no
answer to his query. He can go to the library to scan pages of the b. Division of Concupiscence
medical dictionary or directly ask his clinical instructor about it, (1) Antecedent concupiscence
• spring into action which are unstimulated by any act of
but does not anymore bother to do so.
the will

• not intended by the person (act of man).
Analysis:

The agent, obviously, has the capacity to dispel his
Ethical Principle
ignorance and obtain knowledge about the medical term, thereby
Antecedent passion always lessens voluntariness and sometimes
constituting vincible ignorance. precludes it completely. Agent is not responsible.
He exerts a certain effort by asking his classmate about
the meaning of the term but not sufficiently enough to eliminate (2) Consequent concupiscence
his ignorance and get knowledge, thereby constituting simple • the will, directly or indirectly, stirs them up or fosters them.
vincible ignorance. • first risen spontaneously, but afterwards the will accepts and
fosters it by free decision.
a. Invincible Ignorance

• destroys voluntariness and relieves the agent of responsibility
Ethical Principle
b. Vincible Ignorance
Consequent passion does not give rise to lessened voluntariness and is
• lessens but does not remove voluntariness and responsibility
therefore good or bad. Agent is responsible.

Transcriber: mtagrz Page 4 of 5


3.04 MEDICAL ETHICS
Dr. Eustaquia T. Acevedo | Human Act

Fear and Social Pressure 2. An indifferent act is made good or evil by circumstances When the
• The shrinking back of the mind on account of an impending evil. object is morally indifferent, the morality of the act is determined
• The agitation of mind (ranging from slight disturbance to actual primarily by the intention and/or by the circumstances. When both the
panic) brought about by apprehension of impending evil intention and the circumstances are good, an indifferent act becomes
• actions may proceed from fear as their cause, or may be done with ETHICALLY GOOD.
fear as an accompanying circumstances e.g. Act of eating

Divisions: 3. The principal end or intention of the subject can convert an act whose
(1) slight or grave evil object is indifferent into a good or bad act. An act which is good in its
(2) unjustly and justly object can become more good or less good, even bad; and a bad act can
become worse or better, but never good.
Ethical Principle
1. Fear does not destroy the voluntary character of an action; but it 4. The circumstances cannot convert a good act into something bad or
usually lessens its guilt as well as its merit. vice-versa.
2. Grave fear usually excuses from the obligations of positive
ecclesiastical or civil law and of affirmative natural law. 5. For an act to be good, its object, end and circumstances have to be
good.

Violence 6. When the act is in itself intrinsically bad, nothing can make it ethically
• A compulsive influence by an external force compelling a person to good, not even when both the intention and all the circumstances under
perform an act against his will. which the act is done is good.
e.g. Euthanasia, abortion
Rules Applying to the Influence of Violence on Imputability
Responsibility
1) Absolute violence excludes any voluntariness from the forced action.
• Man is accountable to God for his human acts
2) Relative violence does not impair voluntariness completely but
lessens it. • Human acts are imputable and hence the agent is responsible,
accountable, answerable for them.
Disposition and Habits
References
• Lasting readiness and facility, born of frequently repeated acts for
acting in a certain manner. 1. Ethics of Health Care - Ashley & O’Rourke
2. Moral Philosophy - Archimedes C. Articulo
• e.g. A man who always endeavored to speak the truth has the habit
3. Florentino T. Timbreza - Bioethics & Moral Decisions
of truthfulness, and it goes against his habit.
4. Medical Ethics - Robert Veatch

5. Health Ethics - Concepts and Moral Issue 1st edition
Ethical Principle
6. Educational Publishing House Research Staff
Habit does not take away voluntariness; acts done from habit are
7. Ethics and Life
voluntary and the person is responsible for it.
8. Michael A. Monge - Ethical Practice in Health and Disease, 1991


The Morality of Human Acts

According to Church teachings, actions that are intrinsically

evil are evil no matter who performs them and what the circumstances

are because, as Pope John Paul II has said, they “are by their nature”

incapable of being ordered “to God, because they radically contradict

the good of the person made in His image.”



Intrinsically Evil Acts

1) Whatever is hostile to life itself, such as any kind of homicide,

genocide, abortion, euthanasia and voluntary suicide

2) Whatever violates the integrity of the human person, such as
mutilation, physical or mental torture and attempts to coerce the spirit

3) Whatever is offensive to human dignity such as subhuman living
conditions, arbitrary imprisonment, deportation, slavery, prostitution
and trafficking in women and children.

Moral Principles of Human Act: (Based on the Determinants)
• Morality of the human act refers to the conformity or disagreement
of the human act with the moral norms.

1. The object is the primary and essential element of the morality of an
act.

Transcriber: mtagrz Page 5 of 5

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