BIOETHICS

(Greek: bios, meaning life; ethicos, pertains to ethos, translated

as “custom” or “character” meaning, behavior.) viewed as a
living study of the conduct of human life.

Prepared by:
Walbert F. Delos Santos, RN.MN
NATURE AND CONCEPT OF BIOETHICS
— Ethics in general terms is the philosophic sciences, that deal with human
acts. This definition however, is too broad and essentially incomplete
because it doesn’t really deal with all human acts, but only those which are
voluntary, proceeding from deliberation, and ordered toward some
important goal or purpose. There are many human acts which do not
concern ethics because they are involuntary, do not involve moral concerns
or do not have significant consequences. Ethics could be defined in a
special manner, as the science which deals with those acts proceed from
the deliberative will of man, especially as they are ordered to the ultimate
end of man, ethics, as we understand it, has for its primarily concern the
ultimate end of man and the principles of ethics to be discovered are of
concern only as they apply toward that ultimate end. In another practical
way, the science of ethics can be considered to be foundation for the art of
living well.
— The method used in the science of ethics is human reason based on human
experiences. Through the use of rational faculty of man, the basic
principles of ethics are derived from ordinary experiences and applied to
the multiplicity of human act which can be performed. Ethics does not
result in a set of specific rules of human behavior, but in general principles
to be applied in practical situation. Ethics therefore, does not deal in
matters of “absolute truth”. First, the subject matter of ethics is variable,
since it consists of free human acts. Second the universal principles of
ethics have an element of uncertainty about them. The reason for this
element of uncertainty is because the general principles, when applied to a
specific human acts, must take into consideration the circumstances
surrounding the act. As these become more complicated, there may be
more and more uncertainty in evaluating the morality of act. It might be
nice if every human act came in simple, uncomplicated package, but
reality teaches us that this seldom so.
Ethics deals with deliberate and voluntary human acts that are
ordered toward some ultimate end. The matter of the ultimate end
becomes important because it is the goal or purpose toward which
all human acts, in the long run, are directed. Furthermore, it is the
ultimate end which must direct us in the art of living well. We have
lived well if the ultimate end has been attained.

We are dealing with human actions because it is only through our

actions or activities that we can live well. Living well, is not, in
other words, a state of affairs, it involves a series or set of actions.
We are virtually forced to admit that there must be at least one thing
which must willed form itself. Alone and not for anything else.
There must be at least one thing which is an end and which never is
means. It is called the “ultimate end”. This will be the end toward
which all of us strive. This will be the end which is the final reason
why we act all. If there is at least one end for everything that we do
and for the sake of which we will do everything else, it would seem
that this end would be the most important one to us. We are now
faced with the following question; Is there such an end as the
“ultimate end” for all our actions?
 WH A T IS E T H IC S ?

ETHICS- A study of morality’s effect on conduct; the study of moral

standards and how they affect conduct.
It is also a branch of philosophy concerned with judgments about right
and wrong; goodness and badness.
It covers related concepts such as virtue, vice, duty and obligation.
A major branch of philosophy, encompassing proper conduct and good
living.
Morality- refers to a “sense of rightness and wrongness of an act.”
WH A T IS B IO L O G Y ?

The study of life.

Branch of natural science which studies living organism
and how they interact with each other and their
environment.
First used by a French naturalist jean-baptise lamarck.
According to him it examine structure, function, growth,
origin, evolution, and classification of living things.
WH A T IS B IO E T H IC S ?

Bioethics is derived from two words “bio”, life or having

to do with living things, and “ethics”, conduct or
behavior, or characteristics of rational animal. Therefore,
it may be viewed as a living study of the conduct of
human life.

It is the philosophical study of the ethical controversies

brought about by advances in biology and medicine.
Bioethicists are concerned with the ethical questions that
arise in the relationships among life sciences,
biotechnology, medicine, politics, law, and philosophy.
The term Bioethics (Greek bios, life; ethos, behavior) was coined in
1927 by Fritz Jahr, who "anticipated many of the arguments and
discussions now current in biological research involving animals" in
an article about the "bioethical imperative," as he called it, regarding
the scientific use of animals and plants.Lolas, F. (2008). Bioethics
and animal research: A personal perspective and a note on the
contribution of Fritz Jahr. Fritz Jahr's 1927 concept of bioethics.
Kennedy Inst Ethics J, In 1970, the American biochemist Van
Rensselaer Potter also used the term with a broader meaning
including solidarity towards the biosphere, thus generating a "global
ethics," a discipline representing a link between biology, ecology,
medicine and human values in order to attain the survival of both
human beings and other animal species.[1][2]
WH A T IS H E A LT H E T H IC S ?
Study of concepts and principles of health ethics and their implications
to the individual, schools, hospitals, community and society.
It is concerned with the type of conduct or character that is approved or
disapproved of in terms of right and wrong, or good or bad relative to
health-care service.
Presents issues in the health care system that will require the
practitioner a commitment to excellence in clinical practice and
commitment to a set of appropriate moral, ethical and social behavior.
It aims to develop in students an understanding of these important
concepts and principles as well as to provide guidelines in dealing with
ethical issues with emphasis on the role of the health care practitioner
as a patient advocate.
NURSING ETHICS- is concerned with the moral principles of
that govern the conduct of a nurse in his/her relationship with
patients, physicians, colleagues, the nursing profession, and the
community or public.
These Moral Principles guiding a nurse in the practice of his/her
profession are as follows:
a. True concern and devotion to his/her duties for the promotion
of public health and public welfare.
b. In the exercise of his/her profession, a nurse must employ
utmost diligence, skill, and solicitude to conserve human lives.
c. A nurse is morally bound to fulfill his/her civil obligations, to
be a law-abiding citizen, and to contribute his/her knowledge to
promote health; and
d. A nurse must protect and preserve the reputation and dignity
of the profession and that of his/her colleagues.
 WH A T IS P R O F E S S IO N A L E T H IC S ?
This concern one’s conduct of behavior and practice when carrying
out professional work.
Works such as consulting, researching, teaching and writing.
The institutional code of conduct and codes of practice is common
with many professional bodies for their members to observe.
Code can may be considered to be a formalization of experience
into a set of rules.
Any profession needs ethics and morals in the quest for an orderly
progress in the course of practice and maintenance of high
professional standard.
IN THE NURSING PROFESSION, ethics and/or moral values
direct nurses’ conduct, basing on established ethical, moral, and
spiritual principles, rules, and practices that may make their
profession fruitful and beneficial to the public.
PR E VA L E N C E OF BIO E T H IC A L IS S U E S :
1. Abortion
2. Euthanasia
3. Suicide
4. Determination of Death
5. Clinical death and The Determination of Death
6. Biological and Clinical Death
7. In-Vitro fertilization
8. Stem Cell Technology
 ABORTION
Is the termination of pregnancy by the removal or expulsion of an
embryo or fetus from the uterus, resulting from death.
Can occur spontaneously or therapeutically due to complications
during pregnancy..

2 kinds of abortion:
1. Spontaneous abortion such as miscarriage.
2. Therapeutic abortion such as
Induced/Medical/Elective/Intentional/Criminal.
D&X- a mechanical method of abortion designed to kill the pre-
born child after the period of viability. Also called ‘partial-birth
abortion’.
TH E R E ARE 5 TYPES O F A B O R T IO N S :
threatened, incomplete, inevitable, complete, missed.
these are the medical terms for abortion. the above are not
medically induced. they are basically various types of miscarriages
that occur due to various reasons, some of which include genetic
defects, cervical incompetency, previous miscarriages, etc. they are
natural.
the 6th type is MTP or medical termination of pregnancy, which we
commonly associate with the term abortion. This is medically
induced. The two ways of performing MTP is either medically (the
patient is given two tablets, and this induces the fetus to get aborted)
or surgically (dilatation and curettage being the most common
method)
 EUTHANASIA
Greek term “Thanatos”
The act of practice of permitting the death of hopelessly
sick or injured individuals in a relatively painless way for
reasons of mercy.
It is commonly called merciful killing to relieve
suffering.
 PASSIVE EUTHANESIA
Hastening the death of a person by altering some form of support and
letting nature take its course is known as passive euthanasia. Examples
include such things as turning off respirators, halting medications,
discontinuing food and water so as to allowing a person to dehydrate or
starve to death, or failure to resuscitate.
Passive euthanasia also includes giving a patient large doses of morphine
to control pain, in spite of the likelihood that the painkiller will suppress
respiration and cause death earlier than it otherwise would have happened.
Such doses of painkillers have a dual effect of relieving pain and
hastening death. Administering such medication is regarded as ethical in
most political jurisdictions and by most medical societies.
These procedures are performed on terminally ill, suffering persons so
that natural death will occur sooner. They are also commonly performed
on persons in a persistent vegetative state; for example, individuals with
massive brain damage or in a coma from which they likely will not regain
consciousness.
 ACTIVE EUTHANASIA
Far more controversial, active euthanasia involves causing the death of a
person through a direct action, in response to a request from that person. A
well-known example of active euthanasia was the death of a terminally ill
Michigan patient on September 17, 1998. On that date, Dr. Jack Kevorkian
videotaped himself administering a lethal medication to Thomas Youk, a
52-year-old Michigan man with amyotrophic lateral sclerosis. CBS
broadcast the videotape on 60 Minutes less than a week later. Authorities
subsequently charged Kevorkian with first-degree premeditated murder,
criminal assistance of a suicide, and delivery of a controlled substance for
administering lethal medication to a terminally ill man. There was no
dispute that the dose was administered at the request of Mr. Youk, nor any
dispute that Mr. Youk was terminally ill. A jury found Kevorkian guilty of
second-degree murder in 1999. He was sent to prison.
 SUICIDE
Intentional self-inflicted death.
A uniquely human acts, suicide occurs in all cultures.
People who attempt or complete suicide usually suffer
from extreme emotional pain and distress and feels
unable to cope with their problems.
Severe depression and feels hopelessness about the
future.
 DETERMINATION OF DEATH
The uniform determination of death act(UDDA) is a draft state law that was
approved for the US in 1981 by the national conference of commissioners on
uniform state laws
Cooperated by the American medical association, American bar association
and the president's commission on medical ethics.
The act is intended “to provide a comprehensive and medically sound basis
for determining death in all situations.”
DEATH- is determined when an individual has sustained irreversible
cessation of circulatory and Respiratory function, or irreversible cessation of
all functions of the entire brain including the brain stem(Legally Death).
CLINICAL DEATH- It is the popular term for cessation of blood circulation
and breathing. It occurs when the heart stops beating in a regular rhythm, a
condition also called as cardiac arrest. During clinical death, all tissues and
organs in the body steadily accumulate a type of injury called ISCHEMIC
INJURY.
BIOLOGICAL DEATH- Irreversible cessation of all body functions or
orgasmic functioning and human death as the irreversible loss of personhood.
 CLINICAL DEATH
It is a popular term for cessation of blood circulation and breathing.
Occurs when the heart stop breathing in a regular rhythm, a
condition called cardiac arrest.
Meaning the clinical appearance of death.
It is a medical condition that precedes death rather than actually
being dead.
Instead of death, cardiac arrest came to be called “Clinical Death”,
meaning the clinical appearance of death. At the onset of clinical
death, consciousness is lost within several seconds. Measurable
brain activity stops within 20 to 40 seconds, irregular gasping may
occur during this early period, and is sometimes mistaken by
rescuers as a sign that CPR is not necessary.
 CL IN IC A L D E AT H A N D D E T E R M IN AT IO N O F
D E AT H
Historically death is believe to be an event. But it is actually a
process rather than an event.
It is a process which divide a fine line between life and death
It also depends on factors beyond the presence or absence of vital
signs.
It is neither necessary nor sufficient for a determination of legal death.
 IN VITRO FERTILIZATION
In vitro fertilization: IVF, a laboratory procedure in which sperm are
placed with an unfertilized egg in a Petri dish to achieve fertilization.
The embryo is then transferred into the uterus to begin a pregnancy or
cryopreserved (frozen) for future use. IVF was originally devised to
permit women with damaged or absent Fallopian tubes to have a baby.
Normally a mature egg is released from the ovary (ovulated), then
enters the Fallopian tube, and waits in the neck of the tube for a sperm
to fertilize it. With defective Fallopian tubes, this is not possible. The
first IVF baby, Louise Joy Brown, was born in England in 1978.
In vitro fertilization literally means "fertilization in glass." A child born
by in vitro fertilization is inaccurately known a "test tube baby."
In-Vitro Fertilization – the process involves hormonally
controlling/correcting the ovulatory process, removing the
ova(egg) from the woman’s ovaries thru a clinical procedure or
process(follicle aspiration) and letting the egg(zygote), is then
transferred to the patient’s uterus with the sperm for fertilization.
 STEM CELL TECHNOLOGY
A technology developed with the used of multi potent stem cells.
In addition to the benefits from the ethical perspective, this method
has the advantage that it uses readily- available skin cells as the
starting material. It is not subject to supply constraints of existing
sources of embryonic material. This new and unlimited source of
Stem Cell Lines could be use to produce differentiated cell lines for a
variety of targets.
It is developed in US aimed at the production, expansion, and
differentiation of multipotent stem cells. The program is known as the
Revivicor program, which involves the differentiation of
skinfibroblast cells, thus bypassing the need for creating and then
destroying human embryo or fetal tissues.
 TH E HU M A N PE R S O N

a. The Human Acts

b. Voluntary Acts
c. The Modifiers of the Voluntary Acts
d. The Morality of Passion
e. Passion, Freedom, Responsibility
 TH E HU M A N AC T S
1. THREE CONSTITUENTS OF THE HUMAN ACTS - knowledge,
freedom, and voluntariness are the necessary conditions of man’s moral actions.
Morality – is based on the freedom 0f the will and freedom presupposes
rational knowledge. As volition precedes human actions, knowledge precedes
volition( the power of using one’s will)

2. A HUMAN ACT - three (3) essential elements required:

a. knowing and deliberate act. Knowledge is awareness or consciousness of the

conditions and implications of our actions.
b. free. freedom is the power to choose between two or more course of action
without being force to take one or the other by anything except our own will.
c. voluntary act. Voluntariness is a formal quality of human acts whereby any
action or omission results from the principles within the agent, and from some
knowledge which the agent possesses of the end.
2. HUMAN ACTS AND ACTS OF MAN-
- human acts are those acts which proceed from man as a rational
being. They are the very means man possesses in order to arrive to
his moral perfection.
- man is man by his intellect and by his rational will. Only man is
responsible for his actions; man alone is aware of what he is doing
and is free to act or not to act.

 Only acts performed with knowledge and freedom are properly human
and consequently moral, for only then
are they either good or evil.
 Actions which happen in the body or through the body without the
awareness of the mind or the control of the will are not human acts but
merely acts of man.
3. Division of Human Acts – There are different kinds
of human acts:
a. Elicited and commanded acts – elicited acts are those
produced directly by the will; they begin and end in this
faculty without transcending to other faculties, as the act of
love, hate, or desire. Commanded acts are completed through
other internal or external powers of man under the control of
the will, as the act of thinking (internal), and the acts of
walking, talking, writing (external).
b. Internal and External Acts – the first are performed by the
internal faculties of the soul, as the acts of thinking and
loving. The latter are properly called actions and are
produced by different organs and senses of the body under
the command of the will.
c. Good, Bad, and indifferent Act are: those acts which agree,
disagree, or stand in no positive relation, respectively, with the
dictates of right reason or the rules of morality.
d. Natural and Supernatural acts are those which proceed from the
natural powers of human nature alone or from the supernatural
aids given to man such as the sacraments, grace, faith, etc.
e. Valid and invalid acts. The valid acts possess all the moral
requirements to produce proper or several of the required moral
conditions. The invalid acts lack one or several of the required
moral conditions.
4. Analysis of the Human Act – the psychological process
involved in the different steps towards the completion of the
moral or human act was carefully analyzed by St. Thomas
Aquinas. Six of these steps emanate from the formal
causality of the intellect; the other six, from the formal
causality of the will.
The Seven (7) Steps are the following:
a. Volition which is a mere desire or inclination of the will towards any
good object known by the intellect.
b. Intention which is the active desire for a particular good after the
intellect has “convinced” the will that this particular good should be
obtained through a personal action.
c. Deliberation or counsel which sets in motion a series of thoughts and
judgments concerning the most suitable means toward the
attainment of the desired good or end.
d. Consent which is a definite decision as to what means should one
used. The will is finally attracted to the result of the process of
counselling.
 e. Choice or election by which the agent actively commits
himself to follow the last particular judgment accepts by
choice the particular means proposed in order to get that
desired good.
f. Command. The intellect points out and the will moves
together executive power of man, internal and external, to
act and get the intended object. To command is primarily
an act of the intellect, but it must be supported by or
founded on a previous act of the will, by virtue of which
reason moves through command of the will to the
command of the act.
g. Enjoyment of fruition which consist in the actual attainment
of the desired good. “Sensible fruit is what is looked for in
the final stage of a tree, and it is perceived with some
sweetness.
5. Freedom and Morality – Some philosophers teach that
man is not free but determined by heredity, economic
factors, environment, character, temperament, etc. They
say that all these factors so intrinsically affect human life
and determine human conduct that man has little
freedom, if any.
 II. THE VOLUNTARY ACT
1. Nature of the voluntary Act - A voluntary act is defined as
the act which proceeds from an intrinsic principle with
knowledge of the end.

A voluntary act is different:

a. From what is merely willed and cannot be controlled by
the will, as good as bad whatever.
b. From what is violent or artificial because these acts are
caused by some external gents.
c. From what is natural, because nature acts are without
knowledge of the end.
2. Classification of Voluntary Acts
a. Free or necessary, according as one cane or cannot abstain from it. The
contemplation of God is a necessary voluntary act for the blesses in heaven
since they look at Him knowingly and gladly and cannot separate their
knowledge and love from that infinite being which makes them blessed.
b. Perfect voluntary act is the act performed with complete knowledge and full
consent. Otherwise, it is an imperfect voluntary act.
c. Directly voluntary or voluntary itself is an act which is willed as end in itself.
Example: A person drinks either because he likes liquor or because he wants
to quarrel with somebody.
d. Indirect voluntary or voluntary in its cause, is an act which is desired not as an
end in itself but a foreseen effect or sequence of the act.
e. The explicit or expressed voluntary act happens when the consent to an action
is externally manifested by words or by signs. The consent in a tacit voluntary
act is given by silence. “Silence means consent.”
f. The pure or simple voluntary act is that which is willed with full consent and
without dislike. Mixed or conditional voluntary act results when the act to be
performed is wiled under certain conditions but at the same time is likeable
under other conditions
g. Actual, virtual, habitual and interpretative voluntaries or
intention.

1. Actual intentions- is that which is present ‘here and now’ before the mind
while performing in action.
2. A virtual intention- is that which was made at some former time and still
influences the act which is now being performed.
3. Habitual intention- is the retention in the unconscious mind of a intention
made at some former time and which, although actually forgotten, has never
been retracted. It is different from a habit or custom.
4. Interpretative intention- is the result of interpreting the intention of one who is
not present or of one who does not have the power of judgment to make a
decision by himself.
 III. THE MODIFIERS OF THE VOLUNTARY ACT
The modifiers or conditions are factors that affect the morality of human acts.
These intervening factors may influence the will’s judgment and the reason’s
decision-making processes as to the degree of moral responsibility, liability,
or accountability of the agent/doer.
Since knowledge and freedom admit various degrees it follows that moral
responsibility is in proportion to the degree of knowledge and freedom. The
greater the knowledge and freedom, the greater the voluntariness and moral
responsibility involved, and conversely. Hence, in order to determine the
moral responsibility of human actions, we must study the various degrees of
ignorance.
 There are five (5) modifiers or conditions, namely:
1. Ignorance
2. Fear
3. Concupiscence
4. Violence
5. habit
1. Ignorance – In ethics, ignorance is lack of the knowledge
which man should have of his moral duties. The want or
absence of knowledge, that is, a person is unaware or
uninformed of a fact, law, or penalty. Like a child’s ignorance
of the lawyer’s duties is only a negative ignorance for it is
absolutely involuntary.
Implications- agent/doer is liable for acts out of conquerable,
consequent ignorance, but not answerable due to
unconquerable, antecedent, and concomitant ignorance.
a. Invincible Ignorance is that which cannot be overcome either because
a person does not realize his own state of ignorance, or because it is
almost impossible for him to acquire the proper knowledge of the
matter. It is by no human effort can ignorance be dispelled, it is called
physically invincible. If ignorance cannot be overcome by ordinary
diligence and reasonable efforts, it is called morally invincible
ignorance.
FIRST PRINCIPLE:
• Invincible ignorance makes an act involuntary. nothing is willed except that which
is known and knowledge here is beyond the person’s power or at least very
difficult to attain.

b. Vincible ignorance is that which can be removed by ordinary efforts.

When hardly any effort has been used to dispel ignorance, it is called
crass or supine ignorance.
SECOND PRINCIPLE:
• Vincible ignorance does not destroy, but it does lessen the voluntariness
and responsibility of an act, in as much as the effects of that ignorance
are not clearly perceived and are not willed by the person who does not
possess direct and perfect voluntariness.
c. Affected ignorance occurs when a person positively wants to be ignorant in order to
plead innocent to a charge of guilt

THIRD PRINCIPLE:
Affected or pretended ignorance does not excuse a person from his bad actions;
on the contrary, it actually increases malice.
2. FEAR- the apprehension of pending harm or danger which disturbs
the human mind.
IMPLICATION- Act is done from or out of fear is not one’s own act, thus,
involuntary, while acts done with fear are voluntary.

3. PASSION or CONCUPISCENCE - Passions are strong tendencies towards the

possession of something good or towards the avoidance of something evil.
Passions also receive other names such as emotions, affections, feelings,
sentiments, desires, although each name properly connotes a different meaning.
a. Love – is a tendency towards a desirable good, either present or absent.
b. Hatred – is the aversion for a sensible evil, either present or absent.
c. Desire – is a tendency towards a sensible good that is absent.
d. Horror – is a turning away from a sensible evil that is absent or foreseeable in the future.
e. Delight – is a joy produced by the presence and possession of the desired good.
f. Sadness – is sorrowful experience produced by the presence of evil.
g. Hope – is the reaching out towards a future good whose attainment is possible.
h. Despair – is the turning away from a good that is impossible to attain.
i. Bravery – is the courage to attack an evil that is possible to conquer.
j. Fear – is a state of anguish resulting from the thought that a threatening evil cannot be possibly
overcome
k. Anger – is state of displeasure excited by a feeling of having been insulted or by a desire to avenge
an injury.
4. VIOLENCE- Unjust or unwanted exercise of force, usually with
the accompaniment of vehemence, outrage, or fury. It is an
external force which one inflicts upon another to perform an
act against his/her will.
IMPLICATION- Acts resulting from violence are involuntary
acts, thus, not responsible.
5. HABIT- A disposition or a condition of the body or mind acquired
by custom or a usual repetition of the same act. It is an
inclination to do the same action with less resistance and
increased facility of performance.
IMPLICATION:
Voluntariness remains and acts done by the influence of habit
are imputable to the agent.
Acts are involuntary out of ignorance of the existence of the
habit.
Evil habit acquired voluntarily, but agent shows effort to dispel
it, the act done out such habit is involuntary.
 THE MORALITY OF PASSIONS
Passions are either good or evil, but indifferent. Passions are provided by
nature to spur and to strengthen the will, they may be used by man for good
or for bad purposes.

1. Passions may be called good hence, ordered by the rational will to

help man in the practice of virtue, or in the attainment of that which
is morally good.
2. Passions may arise spontaneously before the previous judgment of
reason and before the will can control the psychological situation.
3. Passions may be deliberately aroused by the will in order to ensure a
more prompt and willing operation. By continuously imagining and
brooding over an insult received from an enemy, a person may build
himself up to a such a state of frenzy that he finally attacks and kills
his enemy.
 PASSIONS, FREEDOM AND
RESPONSIBILITY
FIRST PRINCIPLE: Antecedent passions may completely destroy freedom and
consequently, moral responsibility, when they suddenly arise and impel us to act before
any control of the will is possible.
SECOND PRINCIPLE: Antecedent passions do not always destroy freedom for
passions seldom escape the control of reason. Although men frequently act under the
influences of one passion or another, still they remain masters of their actions which are
considered free and voluntary responsible and imputable to them.
THIRD PRINCIPLE: Antecedent passions lessen freedom and diminish the
responsibility of human actions because they tend to bind the judgment of the intellect
and to block the freedom of the will. Passions make an act more voluntary, more
intensively willed and desired, but the act s less free, for it is less controlled and
deliberate; it is less of human act and more of an act of man.
FOURTH PRINCIPLE: Consequent passions do not lessen voluntariness but may
increase it, because these passions are deliberately excited and they are voluntary in
themselves. A person willing to raise funds for a charitable institution may deliberately
pay close attention to the patients’ distress and sufferings so that the pity provoked in
himself and others may remove any reluctance to be generous.
THE END!