BIOETHICS AND HEALTH CARE FOR PASTORAL CARE

FINALS
 ALLOCATION OF RESOURCES

PRINCIPLE
Allocation of resources must be done in an ethical manner. The criteria for allocation must be made
known to all, and the needs of the poor and the powerless must be respected.

LEVELS OF ALLOCATION OF RESOURCES

MICRO LEVEL
Allocation of resources between individuals or a triage.

MACRO LEVEL
Allocation of resources between various groups.

MICRO-LEVEL
TRIAGE METHOD
French word meaning to pick or sort according to quality. It is any situation where individuals must be
selected for immediate treatment because limited resources dictate that not all can be given equal care.

TRIAGE APPLICATION IN EMERGENCY SITUATIONS (WAR)

 Who is in greatest need of treatment?
 Who will benefit most from the treatment?

TRIAGE HIERARCHY
 The wounded who will die unless treated, but who will probably survive if treated
 The dying whose need is great, but who will benefit least from treatment and who should be made
comfortable and left to die.
 The wounded who will survive without treatment because their need is little and who can be left to
care for themselves.

TRIAGE IN NON-EMERGENCY SITUATIONS

 Assessment of Needs
 Random Selection or Lottery
 Those closest to us who are in need

MACRO-LEVEL
Priority should be given to that kind of preventive medicine or treatment of acute diseases that will raise
the standards of general health, especially for the young over elaborate treatments for the aged and the
seriously handicapped.

Problems Encountered
No priorities for the expenditure of funds. Thus, the more dramatic and colorful programs, such as
transplant and dialysis receive more funds, while the more basic preventive programs, such as pre-
natal care and vaccinations receive insufficient support.

International
Because of the crisis of population and hunger, industrial countries are faced with the hard choice of
continuing to send medical aid and food to developing countries which will only increase their
overpopulation than even more people will starve than are starving now.
Modern countries have introduced modern technology into developing countries not only for
humanitarian reasons but to further their policies of political and economic imperialism.

FUNDAMENTAL PRINCIPLE
Equal justice for all the members of the world community, even the least privileged. If resources are
scarce, they must be assigned first to those who can use them best and most justly for the good of all.
 BIOETHICS MEDICINE AND TECHNOLOGY (Patients’ Rights)

MORAL RIGHTS
Social ethics tradition shows to fundamental orientation to rights: Traditional and Contemporary

TRADITIONAL ORIENTATION
A set of mutually binding obligations upon members of a community which allows them to achieve their
personal good while simultaneously achieving the common good of society. Defining one’s relationship
with the community gives them entitlement.

CONTEMPORARY ORIENTATION
They are entitlements to individual goods which the community may not take away. They are defenses
against society.

LEGAL RIGHTS
DEFINITION: They are claims to whose fulfillment one is entitled by law. They are rights that are written
into law by the community. They specify one’s claims on society, what society owes one, and defines the
limitations there may be on rights.

RIGHTS OF PATIENTS
 The Right to Information
 The Right to Refuse Treatment
 The Right to Privacy
 Hospital Records
 Voluntary Participation in Research

Information
If one is ignorant, one cannot exercise options, cannot make plans, and cannot assume control. Access
and possession of information are the bases for exercising autonomy, and if the patient is denied these,
he or she will be a victim of paternalism.

Refusing Treatment
If one has the right to give informed consent to treatment, by implication one has the right to refuse
treatment. Again such refusal is an exercise of autonomy and a means whereby the patient exercises the
right of self-determination.

Privacy
Confidentiality and the protection of information gained during the professional-client interchange are
extremely important. If confidentiality cannot be assured, people may not seek help, the basis of trusting
relationship destroyed and jeopardized.

Hospital Records
The right to access one’s records. One cannot exercise autonomy if one does not have knowledge.
Another problem involves who else can see the records.

Voluntary Participation
Ensuring potential subjects are recruited and adequately informed before being enrolled in research
protocols. The main issue is the protection of the subject. The right of consent is seen as a median
between the social desire to protect individuals and the needs of science.
 CONSCIENCE
A judgment of the practical reason on the morality of a concrete action commanding to do what is good
and to avoid what is evil.

Levels of Conscience

Three levels are distinguished

 Level of instinct
 Moral Level
 Religious Level

LEVEL OF INSTINCT
 LAW
It is pre-conscience. The law comes from without, from pressure of reality, and especially of society,
which means of taboos, controls the impulses of the primitive drives in man experienced as alien and
hostile.
 CONCEPT OF SIN
It is experienced as a material transgression of some prohibition or taboo.
 CONCEPT OF GUILT
Spontaneous anxiety of being threatened by a mysterious power for having strayed beyond safe
boundaries.
 CONTRITION becomes the instinctive urge to escape retribution and it looks for magical rites and
formulae to placate the angered power.

MORAL LEVEL
 LAW
It is the function of self-development corresponding to the aspirations of the inner self appearing as
absolute demand or moral obligation. Conscience is the power of discovering what will promote
authentic self-realization.
 CONCEPT OF SIN
When one freely acts against the dictates of reason.
 CONTRITION
Acknowledgment and regret for the deliberate deviation together with the active will for amendment.

RELIGIOUS LEVEL
 LAW
The invitation beyond the growth of one’s individual being towards a long self-donation, entailing a higher
and deeper self-realization. Obligation becomes vocation.
 CONSCIENCE
Love itself as the power of discovering what can promote union with God and neighbor.
 SIN
The refusal to love, to be for the other.
 CONTRITION
The awareness of the infidelity to love with a confident appeal to the loving mercy of God.
DIVISION OF CONSCIENCE
 Right or Erroneous (Lax or Scrupulous)
 Certain, Doubtful and Perplexed

RIGHT
It is when conscience is in conformity with reality. It is an agreement with the objective norms of morality.

CERTAIN
It is when conscience passes judgment without any fear of error. For moral certainty it suffices that all
reasonable fear be excluded.
 Binding Force
A certain conscience must always be obeyed when it commands or forbids. It may always be followed
when it permits something. Conscience is that appropriate faculty of man which tells him his moral
duties.

DOUBTFUL
If conscience is in the state of uncertainty as to the lawfulness of an action whether it suspends its
judgment or whether it inclines to one side but with the fear that the contrary might be equally true.
 Binding Force
In practical doubt about the lawfulness of an action one may never act. The action must be postponed until
certainty can be reached.

ATTAINING PRACTICAL CERTAINTY

DIRECTLY
Solving the doubt through reflection on the case in the light of general principles through consultation
with experts, books, etc.
INDIRECTLY
Through reflex principles.

REFLEX PRINCIPLES
Rules of prudence which do not solve a doubt concerning the existence of a law, moral principle or fact
by extrinsic or intrinsic evidence but only indicate where, in cases of unsolvable doubt, the greater right
is usually to be found and the lesser evil to be feared.
 In doubt, the condition of the possessor is the better.
 In doubt, favor the accused.
 Crime is not presumed it is proven.
 In doubt, presumption stands on the side of the superior
 In doubt, stand for the validity of the act.
 In doubt, amplify the favorable, restrict the unfavorable.
 In doubt, presumption stand for the usual and the ordinary.
 A dubious law does not bind.

PERPLEXED
A type of conscience confronted with two alternatives and fears sin in whatever choice it takes.
 Binding Force
In a perplexed conscience, one postpones decision until perplexity is removed. If not, one must choose
the lesser evil. If it becomes difficult which is the lesser evil, one may choose any.
ERRONEOUS
An erroneous conscience can be:
 Lax Conscience
On insufficient grounds is inclined to judge a thing lawful when it is not; something light when it is grave.

SCRUPULOUS CONSCIENCE
 Due to temporary crises in life
 Compensatory Scrupulosity
 Obsessive-Compulsive Scrupulosity

Conscience feels guilty due to the following:

 Traumatic Experience in Life
 Period of Puberty
 Menopausal Stage in Women

COMPENSATORY
Easily bothered and scandalized by the little faults and mistakes others commit. Indicates a fundamental
lack of generosity in oneself.

OBSESSIVE-COMPULSIVE TYPE
Consists of disturbance and inhibition of psychic development, resulting from a person’s inability to
integrate certain basic drives and values of life into the structure of his personality obstructed by
unconscious factors built up in early childhood.

CAUSES OF OBSESSIVE-COMPULSIVE
 Inconsistent and unilateral moral and spiritual education
 The infantile past (over perfectionistic, too demanding, sternly rigid parents)
 Rigorism of educators

CORPORATE DIMENSION
It is partnership in discerning the will of God. Though each person is ultimately responsible for his
decisions and actions, still he must act in solidarity with his brethren. Moral doctrine is largely the tested
wisdom and experience of the whole community.
 DEATH AND MEDICAL PRACTICE

Why is it important to know the time of death?

We are morally obliged to treat and care anybody who is apparently human, even in the fetal state, as a
human person with rights until we are sure that the body has become disorganized that it no longer
retains its human unity.

CRITERIA ESTABLISHED TO DETERMINE THE PERSON IS DEAD

CLINICAL DEATH
 The absence of breathing and blood circulation marks death. The irreversible loss of heart and
lung function is seen as indicative of death.
 In turn, the lack of oxygen as a result of no blood flow will lead to the permanent loss of brain stem
function.

BRAIN STEM DEATH

 Irreversible cessation of the function of the brain and the loss of capacity for consciousness or for
ventilation.
 The brain stem is the lower part of the brain that is connected to the spinal cord. The brain stem is
responsible for regulating most of the automatic functions of the body that are essential for life
like breathing, heartbeat, blood pressure and swallowing.
 The brain stem also relays all information to and from the brain to the rest of the body, and plays
an important role in the brain core’s function such as consciousness, awareness and movement.

Criteria for Diagnosis

 Apnaeic coma of known etiology.
 Absence of cranial nerve reflexes (pupillary (II, III, corneal III, V…)
 Absence of motor response to painful stimuli within cranial distribution.
 Absence of spontaneous respiration with permissive hypercapnia.
 Tests should be performed on two separate occasions by two medical practitioners.

TOTAL OR WHOLE BRAIN DEATH

It is the irreversible end of all brain activity (including involuntary activity necessary to sustain life) due
to total necrosis of the cerebral neurons following the loss of brain oxygenation.

BRAIN DEATH: NEO-CORTICAL

Irreversible cessation of the function of the cerebral cortex, thus the disappearance of that which makes
a living being a living human being.

HARVARD CRITERIA FOR BRAIN DEATH

 Absence of DTRs
 Absence of Corneal Reflexes
 Negative Calone Testing
 Flat EEG
 No Sedatives
 Hypothermia or Metabloic Problems
PHILIPPINE CRITERIA FOR BRAIN DEATH
Irreversible cessation of respiratory functions; or irreversible cessation of all the functions of the
entire brain including the brainstem.

Recognition of Irreversibility
 Upon evaluation the cause of coma is established and is sufficient to account for the loss of brain
function.
 The cessation of all brain functions persists for at least twenty-four (24) hours of observation
and therapy.

Criteria for the Cessation of Brain Functions

 Irreversible coma; no spontaneous respiration and no response to apnea test for six (6) minutes;
absence of the following brainstem reflexes: pupillary, corneal and caloric tests.

ETHICAL EVALUATION
 The traditional cardiovascular clinical signs are basic and sufficient and should be retained.
 The new brain criteria should be employed only when such signs cannot be used because the
dying person depends on a respirator or other forms of artificial maintenance.
 The new brain death criteria have to be ascertained by well-trained professional. Although brain
death is a sufficient criterion for human death, partial brain death is not a sufficient criterion.
 ETHICAL GUIDELINES IN MEDICAL PRACTICE
 OB-Gynecology Guidelines
 Pediatric Policy
 Organ Donation and Transplants Guidelines
 Guidelines on Withholding or Withdrawing Life Sustaining Treatment
 Guidelines on Referrals
 Guidelines for Research Proposals

OBSTETRICS AND GENECOLOGY GUIDELINES

Preamble
 The human person, God’s image, possesses unique dignity and inviolable rights. His life is sacred
and must be respected from the moment of conception to natural death.
 Human sexuality is an essential component of the nature of the human person. Its end is love, as
giving and receiving. Human sexuality is expressed uniquely in the language of conjugal love,
through which man and woman, equal in dignity relate with each other.
 The union between husband and wife is made sacred in the sacrament of marriage which for
Christians imitate the love of Christ for his Church. This union involves a mutual personal
commitment for each other, manifested through the conjugal act.
 Each and every marriage act must remain open to the transmission of life. The Church promotes
responsible parent-hood, through which husband and wife recognize fully their own duties
toward God, themselves, the family and society in a correct hierarchy of values.
 Responsible parenthood and motherhood may lead the parents to limit, for, serious motives (HV
16) the number of children. Only natural family planning is morally acceptable.

OB-GYNE GUIDELINES
 No action or means intended to render procreation impossible is permitted.
 Assisted reproductive technologies that facilitate conception within marriage are allowed
provided that these procedures respect the unitive and procreative aspects of the conjugal act
and do not replace or substitute the conjugal act itself.

Abortion, that is, a directly intended termination of pregnancy before the age of viability is always
immoral. Likewise, a directly intended destruction of a viable fetus (late abortion) is immoral. An aborted
embryo or fetus should be respected as a deceased human person.

Direct sterilization, whether permanent or temporary, for men and women is immoral. Procedures that
result in sterilization may be permitted provided they are immediately directed to the cure or alleviation
of a present serious pathologic condition, are not directly contraceptive, and a simpler treatment is not
reasonably available.

Maternal-fetal conflicts include medical or surgical complications necessitating invasive diagnostic

therapeutic procedures during pregnancy that may adversely either the mother or the fetus. In every
case, initial consideration should be directed towards saving both lives.

In ectopic pregnancy, the dangerously part of the mother may be removed even though fetal death is
foreseen, provided that the operation is not just a separation of the embryo or fetus from its site or direct
abortion.
 When the uterus is dangerously pathological, a hysterectomy is permitted.
A caesarian section to remove a viable fetus is permitted, even with risk to the life of a mother, if needed
for successful delivery, or with the risk for the fetus if needed for the safety of the mother.

Postmortem caesarian section should be done when the fetus is likely to be viable, at 24 weeks or more.
The same guideline applies to cases of dying mother where early delivery improves fetal survival.

In risk assessment, the physician should provide the patient with accurate objective observations of her
disorder and known data regarding quantifying benefits and risks as accurately as possible. This
information must be communicated in a manner culturally acceptable and appropriate to the patient.

In risk acceptability, the physician must respect the right of the patient to make her own decision. The
family may be given the same information as the patient and be involved in the decision-making process.
 The physician has the right to withdraw from the case if what is decided by the patient, or the
family, as the case may be – is contrary to his or her own personal or institution’s values.
 In an emergency (when consultation with the patient or relative is not possible), the physician
should serve as a surrogate decision maker and exercise his or her own therapeutic privilege.
 However, a patient’s specific request not to involve her family in spite of the physician’s effort to
persuade her should be respected.

Pre-natal diagnosis is permitted provided: parents give informed consent, the procedure does not
involve great risks to unborn baby or the mother, and it may provide helpful information for better care.

 It is not permitted when requested with the intention of a possible abortion or whatever other
reason.
 Catholic health care providers should be ready to offer counseling for those who are seeking
abortion.
 GUIDELINES ON WITHOLDING LIFE SUSTAINING TREATMENT

Purpose of Policy
 To ensure that every DNR sustaining treatment decision is made through a medically responsible
and ethical process that protects the right of patients and families.
 To educate health care givers caring for the terminally ill patients regarding the ethical,
emotional, legal and spiritual consideration involved in DNR orders.

DNR Guidelines
A physician may not initiate DNR in the following situations:
 When the patient’s condition is terminal and death is so imminent so that life support only
prolongs the dying process.
 When the patient is irreversibly comatose or in persistent vegetative state and there is no hope of
improvement.
 When the burden of treatment far outweighs the benefits.

CARDIO-PULMONARY RESUSCITATION (CPR)

When potential benefit is uncertain, cardiopulmonary resuscitation (CPR) must be provided until futility
of treatment is established.

PROCEDURAL GUIDELINES
Palliative Treatments
DNR orders include only resuscitative measures and should not influence other palliative treatment that
may be appropriate for the patient.

PHYSICIAN’S RESPONSIBILITIES
 To ascertain that the patient is terminally ill, that death is imminent, that CPR is not beneficial or
too burdensome.
 To indicate palliative measures appropriate to the case.
 To coordinate communications among all those involved in the DNR orders.
 Discuss the issues including the consequences of the DNR orders/withdrawal to the patient if he
is mentally competent or to the guardian.
 Enter the DNR orders including its justification in the patient’s medical record.
 Monitor the patient’s condition and revoke DNR orders if the patient’s condition improves.
 In the event that the decision to withdraw life sustaining treatment has been agreed upon and no
member of the team wants to unplug the respirator, the attending physician who ordered its
withdrawal has the primary responsibility to do it.

DECISION MAKING
 The attending physician, after conferring with the other members of the team, should make the
decision that CPR or life support is not medically indicated.
 He should convey the decision to the patient and/or the family.
 The DNR decision should be made by the patient (and family) if he is competent.

WITH ADVANCE DIRECTIVES

If an advance directive made by a competent patient in consultation with his family is available it should
be usually respected.
NO ADVANCE DIRECTIVES
If no advance directive is available, the DNR/withholding and withdrawal of life support decision must be
made by the patient’s family in the order of priority.

NO RELATIVES
 If the patient is abandoned by relatives or appears to have no relatives, the decision must be
referred to proper medical authorities.
 If the patient does not satisfy the medical indications for a DNR, the order should not be given even
if the family members or legal guardian request for it.

PROCEDURAL DIAGREEMENTS
If a member of the team disagrees with the decision and in conscience cannot follow the orders, he/she
may beg off and the attending physician should respect his/her decision.

PEDIATRIC PATIENTS
In newborn pediatric patients, DNR orders must be given with utmost precautions, following pediatric
policy.

Care and Comfort

A DNR order is not abandonment of the patient. It is a re-direction of care towards alleviating suffering
and ensuring maintenance of personal hygiene and dignity. Ordinary supportive measures and palliative
care including food and water, should be given until the patient dies.

Pastoral and Spiritual Care

 Praying for the patient should be encouraged at all times especially when the patient appears to
be dying. The patient/family should be encouraged to seek for spiritual care including the
Sacraments of the Anointing of the Sick, Penance and Eucharist.
 In case of non-Catholics, the patient/family should be advised to call for their pastor or other
religious ministers of the Christian congregation or religion to which they belong.

Discharge of Patient
If the family of the terminally ill patient desires to bring the patient home, he/she should be allowed to go
home.
 ISSUES ON DEATH AND DYING

DEATH SITUATION ISSUES

 Truth Telling to The Terminally-Ill and Dying Person
 Prolongation of Life
 Letting Die
 The Care of the Corpse or Cadaver

Truth-Telling to The Terminally-Ill and Dying Person

 The Duty to Tell
The dying and more generally in fatal pathology, anyone with incurable disease have the right to
be told the truth.

 What to Tell
They should be told the following:
Whatever information is necessary to help them understand their condition and the opportunity
to discuss such condition with the family and health providers.

Appropriate medical information that would make it possible to address the morally legitimate
choices available to them.
The needed spiritual support.

 When to Tell
Telling a patient something takes place over a span of time. The role of the hospital chaplain is very
important. His mission calls upon him the privileged role of preparing the disposition of the
patient.

 How to Tell the Terminally-Ill and Dying Person

It should be done prudently and compassionately. One should always develop the virtue of
truthfulness and veracity.

Advantage of Telling the Truth

 Understanding their condition and the opportunity to discuss them with family members
 Addressing the morally legitimate choices available to them
 Preparing them for death

PROLONGATION OF LIFE
The Problem
The problem lies in continuing or discontinuing medical treatment. It could also lie in the withholding or
withdrawal of life support measures.

Means of Prolonging Life

ORDINARY MEANS
 Medical
They stand for accepted medical procedures or interventions that are
 Scientifically Verified
 Statistically Successful
 Readily Available
Ethical
Ordinary proportionate means are those that preserve life or health which do not involve serious burden
(including psychological burden) and are genuinely beneficial.

EXTRAORDINARY MEANS
 Medical
They refer to medical procedures and interventions which are still in the experimental stage
 Ethical
Those that are disproportionately burdensome or useless or become so in the course of
treatment.

Useless
Ineffective and futile with no real hope for the patient’s benefit
Burdensome
Causes precarious prolongation of life and deliberate consideration of burden to others like cost factor
or excessive expenses
Excessive
It would depend upon a particular case or the subjective qualities of the patient (religious outlook,
tolerance of pain, etc…) as evaluated in the light of objective factors such as proximity to the time of death,
or degree of alertness and consciousness.

HOW TO DETERMINE TREATMENT FOR A TERMINALLY ILL PERSON?

Questions to be Asked
 Will the intervention offer reasonable benefits?
 Is the intervention futile?
 Is the intervention overly burdensome?

INTERVENTION TREATMENT
 Reasonable Benefit  Given or Obligatory
 Does Not Offer Reasonable Benefits  Optional
 Futile  Should Not Be Offered By The Physician
 Burdensome (Financial, Psychological,  Optional
Emotional, etc.)

CASE OF PVS (PERSISTENT VEGETATIVE STATE)

Aggressive treatment may not be morally advisable. In the context of scarcity of health resources futile
treatment might be unjust and immoral.

CASE OF DOUBTFUL TREATMENT

If treatment is doubtful or uncertain the best interest principle should be invoked: treatment if it has
potential benefit. It is ethical to err on the side of life.

CASE OF IMMINENT DEATH

One can in conscience refuse forms of treatment that would only secure a precarious prolongation of life
as long as the normal care due the sick is not interrupted.
LETTING DIE
Letting die can be viewed from the following perspectives:
 Common Sense
 Consequentialist
 Vitalist

COMMON SENSE VIEW

Deliberately killing people is deliberately evil whatever is the circumstances, ulterior motive or
consequences. It is letting nature take its course.

CONSEQUENTIALIST VIEW
All matters are consequences. If a person dies because we kill them or just because we sit by and let
them die, the result is the same.

VITALIST VIEW
We have the absolute duty to save as many lives as possible for as long as possible. Letting a person dies
when some intervention might save her is just as wicked as killing.

OTHER PERSPECTIVES
 Euthanasia
 Dysthanasia
 Ortothanasia

EUTHANASIA
Literally means easy death or happy death. It is an action or omission which of itself or by intention
causes death in order that all suffering may in this way be eliminated.

Functional Characteristics
 Confronts life
 Advanced death
 Favors death
 Shortens life
 Reduces life
 Kills

Ethical Evaluation
 True health care should never condone or participate in euthanasia or assisted suicide in any way.
Dying patients who request should receive loving care, psychological and spiritual support and
appropriate remedies for pain.
 The use of painkillers to alleviate the sufferings of the dying even at the risk of shortening their
days can be morally in conformity with human dignity if death is not willed either as an end or a
means, but only foreseen as inevitable.
 PEDIATRIC POLICY GUIDELINES
PREAMBLE
Human life, a gift from God is sacred. It must be respected at all times from the moment of conception to
natural death. Children are also a gift from God.

Parents have the natural right and duty over their children which includes caring, rearing, and making
decisions for them. There is a presumption that parents act in the best interest of their children;
decisions, however, have to be discussed with the medical team to ensure protection for these
vulnerable members of society.

Ethical Guidelines in Pediatrics

 Informed Consent
 Privacy and Confidentiality
 Child Abuse and Violence
 Withholding and Withdrawing Life Sustaining Treatment
 Determination of Death

INFORMED CONSENT
Diagnostic and Therapeutic Procedures
 Each available medical procedure should be considered from the child’s perspective in light of the
overall benefit that it may offer and the burdens that it may entail.
 The free and informed consent of the patient’s surrogate is required for all medical procedures
and treatments except in an emergency situation when the child is left alone in the hospital and
consent cannot be obtained. It requires the patient’s surrogate to receive full and adequate
information about the essential nature of every procedure.
 The well-being of the child must be taken into account in deciding about any use of technology or
therapeutic intervention. Procedures that may cause harm or undesirable side effects can be
justified only by the proportionate benefit to the patient.
 The capacity for decision making is developmental. The surrogate and the physicians should
involve the child/adolescent to the extent of the child’s adolescent ability to understand and
decide. The preferences and values of the patient should be considered.
 Respect for religious beliefs of patient/ family should be considered in the decision making
process.

RESEARCH
 Free and informed consent is necessary especially if risks and the child’s vulnerability are
involved.
 In non-therapeutic research only minimal risk to the child is allowed.
 All research should be approved by the department’s bioethics committee.

PRIVACY AND CONFIDENTIALITY

 Every child’s privacy and confidentiality must be respected at all times.
 Presentation in teaching sessions may be allowed only if it is likely to benefit the child or in cases
where there is no likely benefit to the child, will be of benefit to others.
 In both cases (as stated above) free and informed consent must be obtained and precautions must
be taken to preserve the dignity of the child.
 PRINCIPLE OF DOUBLE EFFECT
 A set of criteria for evaluating the permissibility of acting when one’s otherwise legitimate act will
also cause an effect one would normally be obliged to avoid.
 The principle originated from St. Thomas Aquinas treatment of homicidal-self-defense.

PRINCIPLES
 To form a good conscience when an act is foreseen to have both ethically and beneficial and
physically harmful effects, the following should be met:
 The action itself must be good or at least indifferent.
 The intention of the agent must be honest, that is, to achieve the beneficial effects and as far as
possible to avoid the harmful effects.
 The good effect must come first, or if not, simultaneous.
 There has to be a grave reason in performing the action.

Examples
MEDICINE
 A vaccine manufacturer typically knows that while a vaccine will save many lives, a few people
may die from the side-effects of vaccination. The manufacture of a drug is in itself morally
neutral. Lives are saved as a result of the vaccine, not as a result of the deaths due to side-
effects. The bad effects (deaths due to side effects) does not further any goals for the
manufacturer, and hence is not intended as a means to an end. Finally, the number of lives saved
is much greater than the number lost, so the proportionality condition is satisfied.
 If a woman who is pregnant is found to have a cancerous uterus, a surgeon could remove the
cancerous uterus in order to save the woman’s life. The surgeon would realize that removing the
gravid uterus will result in the death of the fetus, but this effect is beyond the intention of the
woman and the surgeon.

PALLIATIVE CARE
The administration of high dosage of opioids is sometimes allowed for the relief of pain in cases of
terminal illness, even when this can cause death as a side effect. This concept is different from
deliberate euthanasia for relief of pain. In addition, opioids have a very wide safety margin when used
appropriately and in the context of pain relief that is adjusted to the individual patient. In like manner,
sedatives are not lethal when used only to relieve distress at the lowest dose to avoid dangerous
adverse effects.
 PRINCIPLE OF GROWTH THROUGH SUFFERING
PRINCIPLE
Suffering and even bodily death when endured with courage can and should be used to promote personal
growth in both private and communal living.

There are two things to be addressed in sickness:

 Pain
 Suffering

The principle of growth through suffering can be well understood by trying to study the nature of two
things:
 Health
 Sickness

UNDERSTANDING SUFFERING
It is an individual’s affective experience of unpleasantness and aversion associated with harm or threat
of harm.

SUFFERING AND HEALTH CARE

In health care, it is viewed as a state of severe distress associated with events that threaten the
intactness or the integrity of the human person as a result of a sickness or a disease.
Thus medicine makes a distinction between pain and suffering and most attention goes to the treatment
of pain. Nevertheless, pain relief itself lacks adequate attention from the medical community.

Christian View of Suffering

 Suffering and death is evil because it is the result of sin.
 It is a liberating and grace-filled experience if proper motivation is present.
 Suffering and death joined to the suffering of Christ, represent not dissolution but growth, not
punishment but fulfilment, not sadness but joy.

Redemptive Suffering
It is the belief that human suffering, when accepted and offered up in union with the Passion of Christ, can
remit the just punishment for one’s sins and the sins of others.

UNDERSTANDING HEALTH
Etymological Definition
From the Anglo-Saxon word, it means not only healing but also holiness and wholeness. The root of the
word denotes completeness.

PHYSIOLOGICAL MODEL
It is the state of being in which an individual does the best with the capacities he has, and acts in ways that
maximizes his capacities.

Concerns itself with the standard physiological parameters, that is, what is usual and average:
 Vital signs
 Presence of various chemicals in the blood
 Electro-neurological readings
 Gross anatomy and histology
Problems Encountered
The universal definition of human health is impossible and that only a range of usual values can be
achieved. What is identifiably healthy for one individual does not necessarily indicate a state of health for
another person.

FUNCTION MODEL
 It is the optimal functioning of the human body. This implies that each organ and organ system are
functioning well and together form a single life process; the diverse functions are harmoniously
interrelated yet differentiated phases.
 In view of this concept of human functioning, human health means not only the capacity of the
organism to maintain itself in its environment but also to create function within itself involving an
ever expanding culture.

WORLD HEALTH ORGANIZATION

 Health is a state of complete physical, mental, and social well-being and not merely the absence
of disease or infirmity.
 Thus, it means optimal functioning of the human body to meet biological, psychological and
spiritual needs. Even though physicians specialize in biological and psychological functions, they
must never neglect or ignore the ethical and spiritual needs of their patient.

ILLNESS AND DISEASES

Broadly defined denote the opposite of health defined as optimal functioning. However, there are two
concepts of a disease namely:
 Ontological
 Physiological

ONTOLOGICAL
 Regards disease as separate entities (devils, contagions, morbid matters, bacteria, genetic
defects, neuroses, psychoses) that can be classified and named like plants and animals.
 It supports the theory that the organism constantly fights to throw off such diseases as alien
invaders which disturbs its homeostasis.
 Those who think in these terms tend to diagnose disease as clearly classified and labeled entities
and to treat them by seeking specific remedies (such as drugs or surgical procedures).

Death
 A homeostatic environment is one that maintains itself perpetually when not disturbed. The
human organism is an open system in constant interaction with the environment. The organism is
homeostatic but there are limits to its power of self-maintenance.
 Consequently, when the environment is altered beyond a certain normal range, the organism is
unable to survive. Thus, when the oxygen content of air, temperature, or the number of bacteria in
the environment changes markedly, the organism undergoes stress, disorganization and finally
death.

PHYSIOLOGICAL
 If the organism were functioning properly, it would resist such bacteria. Hence, classifying
disease is dangerous because disease is essentially the condition of an individual who is
internally maladjusted.
  Advocates of this position therefore tend to emphasize regimen or life style and to use drugs and
surgery secondarily to assist in the adjustment of the individual organism.

Death
Death is always the result of a disease. Physiologically speaking, the organism seems to be made to live
forever, always recovering from any malfunction. Hence, death is due to injuries done to the organism
from the environment, not from any intrinsic tendency.

HEALTH AND DISEASE

Mechanistic Theory
They are more comfortable with anatomy or structure than with function or process. They tend to reduce
process to quantitative measurements of results. Their diagnoses tend toward ontological views.

Organismic Theory
 The person is a dynamic system that does not only include a detailed analysis of the interacting
parts, but that the relationships among the parts are real, just as scientifically observable and
intelligible as the parts which are interrelated.
 The parts themselves cannot be observed or understood in isolation, but only in the context of the
system in which they exist. The eye or kidney, the cell and even the macro-molecular gene cannot
be understood except in the context of the whole organism.
 Medical specialization, therefore, can never be separated from a medical understanding of the
whole person, nor can health or disease be defined except in terms of the whole and its part. This
theory has been central to Western medicine.
 PRINCIPLE OF PERSONALIZED SEXUALITY

RATIONALE FOR SEXUALITY

 In creation, God wanted man to participate in his life. His degree of participation is by giving life and
giving love.
 “If you are to give life, it must be because of love. If you give love, you must be open to life.” –
Humanae Vitae
 Such participation becomes possible through the creation of the male and female.
 Thus, the way a male gives life and love is different from that of the female. This is what human
sexuality is all about.
 That is the reason why the male and female are different from one another biologically and
psychologically.

Why in marriage?
 Stability
 Permanency
 Exclusivity
Marriage is a stable, permanent, and exclusive situation wherein a man and a woman promises to fulfill
the plan of God to give life and love.

FIVE VALUES OF MARITAL SEXUAL ACTIVITY

 Sexual activity is a search for sensual pleasure and satisfaction releasing physical and psychic
tensions.
 More profoundly and personally, sexual activity is a search for the completion of the human
person through an intimate and personal union of love, expressed in and through the mutual gift
of the lover’s bodies. It is also the mutual complementing of the male and female so that each
achieves a more integral humanity.
 More broadly, sexual activity is a social necessity for the procreation of children and their
education in a stable family so as to expand the human community and guarantee its future
beyond the death of the individual members.
 Still more broadly, our sexuality opens us up, married or single, to all the human relationships of
friendship, sympathy, cooperation, compassion and reconciliation that constitute the network of
human society.
 Symbolically, sexual activity is a sacramental mystery, somehow revealing the cosmic order and
our human destiny, because it stands for the creative love of God for his creatures and their loving
response to him.

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

Intrinsic Teleology of Human Sexuality

MAN’S INTRINSIC TELEOLOGY
Based on intrinsic teleology God wants man to participate in his life through our basic capacities:
 Giving Life
 Giving Love
INDIVISIBLE PRINCIPLES
They are indivisible principles: “if one has to give life it must be because of love; if one is to love one must
always be open to life”.

HUMAN SEXUALITY
A manifestation of human teleology. It is for this reason that male and female are different. What makes
a male or a female such is human sexuality for a definite purpose.

Psychological Differences
 Emotion Modest
 Body Modest
 General
 Specific
 Passionate
 Romantic
 Sporadic
 Lingering

PURPOSE OF HUMAN SEXUALITY

The function of the male in giving life and giving love is different from that of the female. This is called
complementariness.

Pre-Requisites for the Fullness of Giving Life and Love

 Stability
 Permanency
 Exclusiveness

MARRIAGE
A permanent, stable, and exclusive situation wherein a man and a woman commit themselves to give life
according to God’s plan.

SEXUAL INTERCOURSE
Where the unitive and procreative acts take place. In marriage, it is one of the highest expression of love
and of giving life.
 STEWARDSHIP AND BEGINNING OF LIFE ISSUES

Principle of Stewardship and Creativity

 The gifts of multi-dimensional human nature and its natural environment should be used with
profound respect for its intrinsic teleology, and especially the gift of human creativity should be
used to cultivate nature and environment.
 All of these should be done with a care set by the limits of actual knowledge and the risk of
destroying these gifts.

Principle of Stewardship
The principle requires us to appreciate two gifts of God:
 EARTH with all its natural resources
 HUMAN NATURE with its biological, psychological, ethical and spiritual capacities.

THE EARTH
 Our earthly environment is a marvelously balanced ecological system without which human life
could never have evolved.
 Although we certainly have a need and a right to cultivate and perfect our earthly home, to till and
irrigate its soil, to build cities, and to use its raw materials for the wonderful devices of modern
technology, we should not do this ruthlessly but must take the utmost care to conserve our
system.

HUMAN NATURE
Our bodies and minds are wonderfully constructed. We have the need and right to improve our bodies
and to develop medical technologies that prevent and remedy the defects to which they are liable. They
have natural teleologies.

HUMAN CREATIVITY
 Because our greatest gifts are our intelligence and freedom stewardship should be creative as in
the use of science and technology.
 What is to be avoided is the technological imperative: “If it can be done, then we should do it”.

CREATIVE TECHNOLOGIES AND STEWARDSHIP

 Science and technology must be for the service of the human person. The rapid development of
technological discoveries gives greater urgency to this need to respect the criteria on human life.
Science without conscience can lead to man’s ruin.
 Advances in technology have made it possible to procreate apart from sexual relations. But what
is technically possible is not for that very reason admissible. These methods are:
o Cloning
o IVF
o Artificial Insemination
CLONING
Involves taking the DNA from a mature, fully differentiated adult cell and placing it into an unfertilized egg
cell from which the nucleus has been removed and fusing them together by an electrical simulation. The
new cell begins to divide, grow and produces.

ANIMALS
Justifiable, provided that the research is directed toward good purposes, is carried out with concern for
the protection of the animal and the integrity of various species, and is performed only under strict ethical
guidelines.

HUMAN BEINGS
Attempts or hypotheses for obtaining a human being without any connection with sexuality through “twin
fission” cloning or partogenesis are to be considered contrary to the moral law since they are in
opposition to the dignity of man.

IN-VITRO FERTILIZATION
 Production of babies in the laboratory together with embryo transfer (ET). Involves bringing
together in a dish containing a nutrient solution an egg cell from a woman and a sperm cell from a
man.
 Once fertilization occurs, the tiny human embryo is transferred into a woman’s uterus and is
expected to develop throughout normal pregnancy, although studies have shown the success
rate of babies born to about 25% only.
NEGATIVE ASPECTS
Such procedures include experimentation on and destruction of human embryos, freezing of embryos
for later implantation, genetic manipulation of human gametes with animals, and surrogate motherhood.

ARTICIAL INSEMINATION
Any attempt to fertilize a female by a means which is a substitute for natural intercourse. They can be
categorized into:
 AIH (married)
 AID (donor)

 It is lawful to use scientific methods to promote fertilization once natural intercourse has taken
place. This is referred to as “assisted insemination” to stress the connection to the natural act of
marriage.
 It is never lawful for any reason to obtain sperm by means of masturbation. The seed can be
obtained by collecting semen with a perforated Silastic sheath that is used during marital
intercourse.
 Artificial insemination with the use of sperm or ovum even with the consent of the husband and
wife is unethical. Only marriage partners have mutual rights over bodies for the procreation of
new life, and these rights are exclusive, non-transferable.

ETHICAL EVALUATION
 Human procreation must take place in marriage. The procreation of a new person, whereby the
man and woman collaborate power of the Creator, must be the fruit and the sign of mutual self-
giving, love and fidelity of spouses.
 Using the sperm or ovum of a third party is not acceptable, because it constitutes a violation of the
reciprocal commitment of the spouses. Moreover, this form of generation violates the rights of
the child to a filial relationship to its parents.
 The generation of a new person should occur only through a act of intercourse performed
between the husband and the wife, in an act that is per se suitable for the generation of children,
to which marriage is ordered by its very nature.
 The fertilization of the new human person must not occur as the result of the technical process
that substitutes for the marital act because it separates the procreative and the unitive aspects of
marriage.
 Methods of human generation that occur outside the marital act are unethical because they result
in the destruction of fertilized ova, and because they bring about the generation outside the
method in accord with natural law and God’s design.