Unit 2: Bioethics and Its Application in Various Health Care Situations

Unit 2
Bioethics and its Application in Various Health

Care Situations
Prof. Eljohn P. Zulueta, RN, MAN, PhDc

B. Dignity in Death and Dying
1. Euthanasia and Prolongation of Life

Dying with Dignity (slide 1 of 1)
• Movement that promotes the ability to meet death on your own

terms.
• The word “dignity” is derived from the Latin, dignitas, meaning
worthiness and nobility. It may be attributed to a broad range of
things.
• “Dignity” appears to have two words that function as opposites,
“undignified” and “indignity”. One important aspect in these two
words, neither of which seem to function as a pure antonym, is the
sense that they can convey of some type of insult or affront.
Euthanasia (slide 1 of 21)
• Euthanasia comes from the Greek words: Eu (good) and

Thanatosis (death) and it means "Good Death, "Gentle and
Easy Death." This word has come to be used for "mercy killing”.
• It is the act or practice of ending a life of a person either by a lethal
injection or suspension of medical treatment.
• The word "euthanasia" was first used in a medical context by
Francis Bacon in the 17th century, to refer to an easy, painless,
happy death, during which it was a "physician's responsibility to
alleviate the 'physical sufferings' of the body”
• Active euthanasia:
– It is when death is brought by an act. Eg. taking a high dose of
drugs.
– To end a person’s life by the use of drugs, either by oneself or by
the aid of a physician.
• Passive euthanasia:
– When death is brought by an omission eg: When someone lets
the person die, this can be done by withdrawing or withholding
treatment.
• Withdrawing treatment: For example switching off a machine that
keeps the person alive.
• Withholding treatment: For example not carrying out a surgery that will
extend life of the patient for a short time.
• Voluntary euthanasia is committed with the willing or autonomous

cooperation of the subject. This means that the subject is free from
direct or indirect pressure from others.
• Non voluntary euthanasia occurs when the patient is unconscious
or unable to make a meaningful choice between living and dying,
and an appropriate person takes that decision for him/her.
• This is usually called murder, but it is possible to imagine cases
where the killing would count as a favor for the patient.
• Indirect euthanasia:
– This means providing treatments -mainly to reduce pain- that has a
side effect of shortening the patient’s life.
– Since the primary intent wasn’t to kill, it is morally accepted by
some people.
• Assisted suicide:
– This usually refers to cases where the persons who are going to
die need help to kill themselves and ask for it.
– It may be something as simple as getting drugs for the person,
and putting those drugs within their reach.
• Ethical Issues
– Morals
• Refer to an individual’s own principles regarding right and wrong.
– Ethics
• Moral principles or Rules of conduct respect to a particular class of
human particular group or culture.
• The Hippocratic Oath that doctors take states:
“I will give no deadly medicine to any one if asked, nor suggest any such
counsel”
• Do no harm
• Ethical Issues
– Ethics
• Nuremberg Code is a set of research ethics principles for human
experimentation set as a result of the subsequent Nuremberg trials at the
end of the Second World War
• Belmont Report
– Respect for person
– Beneficence
– Justice
• Moral Dilemma
– The question thus becomes: under what conditions is euthanasia
morally acceptable?
– Discussion of particular cases often turns on the type of
euthanasia involved:
• Assisted Suicide
• Voluntary vs Non-voluntary Euthanasia
• Active vs Passive Euthanasia
• Moral Dilemma
– Suppose someone has a terminal cancer and that all
conventional treatments have failed and will die soon.
• Experimental drug
• Some promise
• Very unpleasant side effects
• Few would argue that it is immoral for doctors to accept his wish to refuse
taking part in this experiment and opt for euthanasia
• Moral Dilemma
– Who are these patients?
• The frail aged
• Those with dementia
• Survivors of severe head injury
• Those with serious terminal physical illness
• Those with incurable mental illness
• Severely impaired children and adults
• Moral Dilemma
– Euthanasia fundamentally upsets the balance between doctor
and patient.
• We must consider the advisability of allowing doctors to act in a way
contrary to the rest of society.
• There are serious concerns in removing constraints on the way doctors
can conduct themselves.
• Moral Dilemma
– Legislative support for euthanasia
• Erodes standards of end-of-life care
• Becomes available to a wider group than those with terminal cancer
• Upsets the doctor-patient relationship
– Legislating in favour of euthanasia is no substitute for
• Better care
• Improved pain and symptom management
• Better teamwork
• Better research
• Euthanasia Law
– Legitimacy of Euthanasia Law
• 9 countries have legalized euthanasia or assisted death
– Netherlands
– Belgium
– Colombia
– Luxembourg
– Switzerland
– Germany
– Japan
– Albania
– US (states of Washington, Oregon, Vermont, New Mexico and Montana)
• Arguments for Euthanasia
– In favour
• Freedom of choice
• Dignity
• Painless death
• Saves family's money
• Organs can be put to good use
• Shorten the grief and suffering of the patient's loved ones
– Against
• Professional roles compromised
• Moral religious argument
• Legalizing euthanasia and assisted suicide leads to suicide contagion
• Rejection of the importance and value of human life
• Demeans the sanctity oflife, it is murder and it's only God who can take
away human life
– Against
• It destroys life which has potential that is yet unknown to the patient,
doctor or the family members
• Euthanasia would not only be for people who are "terminally ill”
• It discourages scientists who are looking for a cure for incurable ailments
• Euthanasia and Religion
– Christianity
• Catholicism
– Based on core principles of sanctity of human life, condemns
euthanasia as a "crime against God“
• Protestantism
– Physician assisted dying has obtained greater legal support
– Hinduism
• Helping to end a painful life a person is performing a good deed and so
fulfilling their moral obligations
• Disturbing the timing of the cycle of death and rebirth
– Judaism
• Increasing support for certain passive euthanasia options
– Jainism
• “Sallekhana” is made up of two words sal (meaning 'properly') and
lekhana (meaning to thin out)
• Person is allowed to fast unto death
– Buddhism
• Compassion is used by some Buddhists as a justification for euthanasia
because the person suffering is relieved of pain
• Immoral "to embark on any course of action whose aim is to destroy
human life, irrespective of the quality of the individual's motive"
– Shinto
• Prolongation of life using artificial means is a disgraceful act against life
• 69% of the religious organizations agree with the act of voluntary passive
euthanasia
• 25% supporting voluntary active euthanasia
– Islam
• All human life is sacred because it is given by God, and that God chooses
how long each person lives
• “Do not kill yourselves, Surely, Allâh is Most Merciful to youth”
(Qur'an 4:29)
• “When their time comes they cannot delay it for a single hour nor can they
bring it forward by a single hour” (Qur'an 16:61)
• “And no person can ever die except by Allah's leave and at an appointed
term” (Qur an 3:145)
2. Inviolability of Human Life

Inviolability of Human Life (slide 1 of 9)
• The concept of inviolability is an important tie between the ethics of religion and
the ethics of law, as each seeks justification for its principles as based on both
purity and natural concept, as well as in universality of application.
• In religion and ethics, the inviolability or sanctity of life is a principle of implied
protection regarding aspects of sentient life that are said to be holy, sacred, or
otherwise of such value that they are not to be violated.
• The phrase sanctity of life refers to the idea that human life is sacred, holy, and
precious, argued mainly by the pro-life side in political and moral debates over such
controversial issues as abortion, contraception, euthanasia, embryonic stem-cell
research, and the "right to die" in the United States, Canada, United Kingdom and
other English-speaking countries.
• Life
– As a gift
• A gift from God.
• ‘You have granted me life and steadfast love; and your care has preserved
my spirit’ (Job 10:12)
• Everyone is responsible for his life before God who has given it to him.
• As sacred
• We are created in God’s image and likeness
• God Continues to sustain our life
• It is redeemed by he precious blood of Christ
• Life
– As Inviolable
• Reflection of the absolute inviolability of God, finds its primary and
fundamental expression and preservation of human life.
• We are all called to protect our life and promote its goodness as well as that
of the others.
• Life
“Human life is freely given by God. It is mysterious. It is inviolable. It

is sacred. These indicate that ‘the basis for the extraordinary value
of human life is God. He is the Lord and Giver of life, in whom we
live and move and have our being”.
• We are Stewards Not Owner
– We are stewards of life who must respect and care for our own
lives and the lives of others.
– Life must be protected with the utmost care from the moment of
conception
• Becoming Stewards of Life
– Some of our false beliefs:
– “Buhay ko naman‘to ah, bakit ka nangingialam?”
– “Mind your own business”
– “Bahala ka, hindi naman ako”.
• False beliefs
• Life is your private possession.
• Life of others is apart from ours.
• Whatever happens to us, will not affect others and vice versa.
• The Truths
• Our lives is not our private possession.
• The human sense of solidarity and community.
• We are interdependent.
• Becoming of Ministers Virtue not Vice
• “Love one another as I have loved you”.
• “If we love one another, God dwells in us and His love is brought
to perfection is us”.
• Ways to Remain Steward of Life
• Choose your company
• Curiosity kills the cat.
• Be wary/careful.
• Develop friendship with Jesus. Draw yourself closer to Him.
3. Euthanasia and Suicide

Assisted Suicide (slide 1 of 1)
• Which is also called Physician-assisted Suicide (PAS), is when a
doctor gives a person the means to commit suicide when requested
for.
• Once it is determined that the person's situation qualifies under the
physician-assisted suicide laws for that place, the physician's
assistance is usually limited to writing a prescription for a lethal dose
of drugs.
• In many jurisdictions, helping a person die by suicide is a crime.
• A doctor is allowed by law to end a person's life by a painless means,
as long as the patient and their family agree.
4. Dysthanasia
Dysthanasia (slide 1 of 1)
• A term generally used when a person is seen to be kept alive
artificially in a condition where, otherwise, they cannot survive;
sometimes for some sort of ulterior (intentionally hidden/future)
motive.
• Therapeutic obstinacy practiced with the aim to postpone death.
5. Orthothanasia
Orthothanasia (slide 1 of 1)
• A normal or natural manner of death and dying.
• Sometimes used to denote the deliberate stopping of artificial or
heroic means of maintaining life.
• Art of promoting a humane and correct death.
6. Administration of Drugs to Dying

Administration of Drugs to Dying (slide 1 of 1)
• In medicine, specifically in end-of-life care, palliative sedation is the
practice of relieving distress in a terminaly ill person in the last hours
or days of a dying patient's life, usually by means of a continuous
intravenous or subcutaneous infusion of a sedative drug, or by
means of a specialized catheter designed to provide comfortable and
discreet administration of ongoing medications via the rectal route.
• Palliative sedation is an option of last resort for patients whose
symptoms cannot be controlled by any other means.
• It is not a form of euthanasia, as the goal of palliative sedation is to
control symptoms, rather than to shorten the patient's life.
7. Advance Directives
Advance Directives (slide 1 of 3)
• Advance directives are legal documents that allow you to spell out
your decisions about end-of-life care ahead of time.
• They give you a way to tell your wishes to family, friends, and health
care professionals and to avoid confusion later on.
• Living Will
• A legal document used to state certain future health care
decisions only when a person becomes unable to make the
decisions and choices on their own.
• Durable power of attorney for health care/ Medical power of
attorney
• A legal document in which you name a person to be a proxy
(agent) to make all your health care decisions if you become
unable to do so.
8. Do Not Resuscitate (DNR)

or End of Life Care Plan
DNR or End of Life Care Plan (slide 1 of 2)
• End of life care includes palliative care.
• If you have an illness that can't be cured, based on the
understanding that death is inevitable.
• Palliative care makes you as comfortable as possible, by managing
your pain and other distressing symptoms.
• It also involves psychological, social, and spiritual support for you
and your family or careers.
DNR or End of Life Care Plan (slide 2 of 2)
• When does End-of-Life care begin?
• Having an advanced incurable illness, such as cancer, dementia
or motor neurone disease which are generally frail and have co-
existing conditions to which they are expected to die within 12
months.
• Having an existing conditions if they are at risk of dying from a
sudden crisis in their condition.
• Having a life-threatening acute condition caused by a sudden
catastrophic event, such as an accident or stroke.
Unit 2
Bioethics and its Application in Various Health

Care Situations
Prof. Eljohn P. Zulueta, RN, MAN, PhDc

A. Sexuality and Human Reproduction
1. Human Sexuality and Its Moral Evaluation

Human Sexuality (slide 1 of 4)
• Sexual meaning makes us realize the need for some measure of fullfillment
that only the other can give.
• One has to be free from self-centeredness by opening one to the other
person.
• Giving ang giving of the best, a giving of self.
• Giving until nothing more is to give.
• A happiness that is sought for ourselves alone can never be found. For a
happiness that is diminished by being shared is not big enough to make us
happy.
• Making someone happy.
• Right or Freedom of Sexuality

– Your right to sex involves a duty in others to respect it
– Sex implies moral discipline
“It is better to be a human being dissatisfied

than a pig satisfied”
– John Stuart Miller
• Human Sexuality = Commitment

• Commitment consist of
– Care
– Concern
– Responsibility
– Safeguarding the other’s value
– Responsibility to and for one another
– Humanizing
– Human sex is dehumanizing if and when it destroys a person’s honor, and
becomes a degradation of the other.
• Natural Law
– Human Sexuality is sacred and a God-given Gift.
• Kant
– Act as to reat human as always an end, never as means.
• Rawls
– Justice is fairness.
– Never take advantege of persons for own personal gains and satisfaction.
• Fletcher
– Prostitution out of necessity and survival may be legitimate.
2. Marriage
Marriage (slide 1 of 6)
• According to the book

– Marriage may be defined as ‘formal and durable
sexual union of one or more women to one or more men,
which is conducted within a set of designed rights and duties.
• According to Family code of the Philippines

– Marriage is a special contract of permanent union between a
man and a woman entered into in accordance with law for the
establishment of conjugal and family life.
– It is the foundation of family and an inviolable social institution
whose nature, consequences and incidents are governed by
law and not subject to stipulation, except that marriage within
the limits provided by this codes.
• Importance of Marriage
– To have a permanent relationship with the person you love.
– To beget children and have happy family.
– For economic and social upliftment or insurance.
• Forms of Marriage
– Monogamy
• One-union marriage wherein man marries one woman.
– Bigamy
• As provided by Philippine law, when a man marries more than one
woman at a given time, which is considered a crime.
• Forms of Marriage
– Polygamy
• The practice of marrying multiple spouses.
• Polygyny - a marriage uniting one man to two or several women.
• Polyandry - a marriage uniting one woman to many men.
• Selection of Marriage Partners

– Endogamy
• Requires a person to marry someone from his own locality, from his
own race, social class and religion.
– Exogamy
• Mandates marriage between people of different social categories.
Issues on Sex Outside Marriage (slide 1 of 2)
• Premarital Sex
– Sexual activity practiced by people before they are married.
– Considered a moral issue which was taboo in many cultures
and considered a sin by a number of religions.
– Generally consensual sexual intercourse between two people
not married to each each other.
Issues on Sex Outside Marriage (slide 2 of 2)
• Premarital Sex Should be Discouraged

– Causes one's emotional, social, spiritual and physical being to
become corrupted.
– Premarital pregnancy
– HIV/AIDS, STDs
Issues on Homosexuality (slide 1 of 6)
• What is HOMOSEXUALITY?
– Homosexuality means that men are sexually and emotionally
attracted to men, and women are sexually and emotionally
attracted to women. This is also called same-sex attraction.
– A sexual attraction or sexual relations with persons of the
same sex.
• Heterosexual
– Sexually attracted to people of the opposite sex.
• Homosexual
– Sexually attracted to people of their own sex.
• Bisexual
– Sexually attracted to both men and women.
• Transgender
– People who are born with typical male or female anatomies but
feel as though they’ve been born into the “wrong body”.
• A neurobiologist from Amsterdam University, Dick Swaab

– Pre-birth exposure to both nicotine and amphetamines
increases the chance of lesbian daughters.
– Pregnant women suffering from stress are also more likely to
have homosexual children of both genders because their raised
level of the stress hormone cortisol affects the production of
foetal sex hormones.
• Why HOMOSEXUALiTY is a Social Problem?

– Homosexuals experience abuses.
– We live in a Christian world.
“If there is a man who lies with a male as those who lie with a
woman, both of them have committed a detestable act; they
shall surely be put to death”.
-Lev. 20:13
– Homosexual marriage violates the natural law.
– Homosexuality gives diseases which is difficult to cure.
• Bayot/Bading/Bakla in the Philippines fall into two categories:

– Effeminate gays or effems — they used make-up and dressing
in woman’s cloth. They tend to be concentrated in certain
profession. Eg. parlolista, fashion, modeling, entertainers
– Straight acting gays — these men are not effeminate. They are
found outside of the stereotype gay profession. Sexual
preferences vary with some willing to have sex with other
straight acting gays or men.
– Bisexual (Paminta/Maya) - attracted to both sexes (men and
women).
• Is it possible to legalized same sex marrigein the Philippines?

– YES
• Retired Supreme Court Associate Justice Jose Vitug believes that “same sex
marriage in the country still has a long way to go”.
– NO
• Article 1 of the Family Code of the Philippines which states that "marriage is a special
contract of permanent union between a man and a woman entered into in
accordance with the law for the establishment of conjugal and family life”.
• According to a professor from Ateneo de Manila (and now also Dean of FEU Institute
of Law) Mel Sta. Maria in her book on the Family Code: "Marriage is a union founded
on the distinction of sex. The law likewise provides that the contracting parties must
be a natural born male and natural born a female." (Melencio Sta. Maria, Persons
and Family Relations, p. 110, 4th Ed.).
LGBT, RODRIGODUTERTE
DUTERTE ON SAME SEX
MARRIAGE: ‘BASTA KALIPAY SA
TAO, OK KO’
MAY 17, 2012 DURIANBURGDAVAO
According to theAtoni Bay cable television program on Skycable
hosted by radio journalist Leo Villareal @utertesaid he would support any move to allow
gay marriage.
“I look at them as human beings and not on their gender,”

he said. “If people want same sex marriage, gay
marriages, it is their choice.”
“If there is a law (allowing same-sex unions), I will

support and go for it”.
Issues on Contraception (slide 1 of 3)
• Contraception
– Voluntary prevention of conception
– Uses artificial means that prevents the union of sperm and egg
– Synonymous with Family planning
– Planned parenthood
– Responsible parenthood
– Birth control
Issues on Contraception (slide 2 of 3)
• Sterilization
– Positive use of artificial methods
– Cutting off the sexual capacity in a man or woman
– Usually done surgically
– Types according to willingness:
• Voluntary
• Involuntary
– Types according to purpose or ends:
• Therapeutic
• Contraceptive
• Eugenic - reduce human suffering by “breeding out” disease, disabilities, undesirable characteristics.
• Social
• Punitive - corrective, disciplinary, punishment
3. Issues on Artificial Reproduction, its Morality

and Ethico-moral Responsibility of Nurses
Artificial Insemination (slide 1 of 7)
• Consists of depositing a man’s semen in the vagina, cervical

canal or uterus, through the use of instruments (e.g. syringe) to
bring about conception unattained or unattainable by sexual
intercourse.
• The process can either be:

– Intravaginal
• Placing the semen in the vaginal vault
– lntracervical
• In the cervical cavity
– lntrauterine
• Inside the uterus itself
• Methods of Extraction:
– Masturbation
– After a short period of abstinence from ejaculation 3 to 12 days
– Condomistic intercourse
– Coitus interruptus
– Anal massage of the prostate gland
– Direct puncture of the epididymis (excretory duct of the testicle)
• Types:
– Homologous or Artificial Insemination by Husband (AIH)
• Collecting the husband's sperm and injecting it into his wife's
reproductive tract via the vagina at the appropriate stage of the
menstrual cycle period.
• DIY
– Heterologous or Artificial Insemination by Donor (AID)
• Semen from other person other than husband
• Reasons why couple seek Insemination by Husband (AIH)

– The husband may be fertile but unable to participate in normal
sexual relations (impotent)
– The husband may have a low sperm count (oligospermia) or no
sperm in the semen (azoospermia)
– The husband may use AIH as precautionary measure eg. spinal
injury.
– Vasectomy
– Physiologic obstructions of genital organs of wife
• Reasons why couple seek Insemination by Donor (AID)

– The husband might be carrying a genetic disease that he does
not want to pass on to his child eg. cleft lip, hemophilia
– He may be sterile as a result of a disease or accident.
– When there is some concern over the antibody reaction from
the mother when, for example, the husband is Rh positive and
the mother is Rh negative.
• Application of ethical theories
– Natural law ethics/Roman Catholic
• Immoral
– Situational ethics
• Moral
• Our right to overcome childlessness
– Utilitarianism
• Moral since it produces more happiness
– Pragmatism
• Moral since it is practical, beneficial and useful and workable
– Immanual Kant
• Principle of autonomy
• It is moral only if and only if the couple it is voluntary and mutually agreed.
In Vitro Fertilization (slide 1 of 3)
• Eggs removed from a woman and fertilized in a laboratory dish

(by husband or another man)
• Embryos implanted in a woman (donor or other woman), where
egg brought to term
• Extra, or spare, embryos
• Implantation process may fail and be repeated
• Freezing of embryos
• Rating them for quality
• Discarding those that hold genetic defects
• Thawing them and disposing of them
– What happens to excess embryos can be a moral dilemma and
controversial
• Women could postpone pregnancy without risking infertility or

diseases of pregnancy
• Identifying genetic abnormalities
• Embryonic tissue in medical research
– Embryo: mitochondria, cytoplasm, DNA of mother and father
Surrogacy (slide 1 of 2)
• When a woman agrees to carry a baby to term and give it up to

another set of parents to raise
• Sometimes done for money, sometimes as a favor
– Pregnancy a deeply personal experience that should never be
undergone for the sake of others
– Very reason surrogacy supreme gift to another
Surrogacy (slide 2 of 2)
• Kantians: surrogacy problematic since birth mother is being used

as incubator and not regarded as a rational actor
• Utilitarians: faced with very complicated utility calculations
• Well-accepted practice in spite of misgivings of some people
4. Morality of Abortion, Rape and other Problems

Related to Destruction of Life.
The Abortion Issue (slide 1 of 4)
• Abortion statistics
– More than half of American women receiving abortions are in
their 20s
– 17 percent of all U.S. abortions are teenagers
– 60 percent of women already have a child
– 37 percent have two or more children
– No racial or ethnic group makes up a majority of women having
abortions
– Continues...
• Abortion statistics (continued)

– 70 percent of women reported religious affiliation
– 40 percent of women with family incomes below federal poverty
level
– 10 percent occur in second trimester
– 90 percent in first twelve weeks of pregnancy
– 60 percent occur in first eight weeks
• Abortion is a very common experience for women

• 2012: 1.31 million abortions in United States
• Reasons diverse and complex
• Experience of abortion real, immediate, personal
• Americans evenly divided between pro-choice/pro-life positions
• Pro-choice advocates favor intact dilation and evacuation

• Pro-life advocates use term partial birth abortion
• Fewer than a thousand third-trimester abortions performed each
year
The Legal Debate (slide 1 of 5)
• 1973: In Roe v. Wade, Supreme Court, legalized a woman’s right

to have an abortion
– Right not considered to be unrestricted
– Balanced the interests of the woman and the state
– Term person used only postnatally
– 28th week: allowed state to shift to protection of fetus
• 1976: Danforth v. Planned Parenthood of Central Missouri

– Statutory provision required a woman to receive her husband’s,
or if a minor, her parent’s or guardian’s, permission prior to
having abortion
– Court held requirements were unconstitutional
• 1976: Hyde amendment restricted availability of Medicare funding

for abortions
– Modified to allow funding in which mother’s life threatened by
carrying fetus full term or in cases of incest or rape
– It does primarily affect poor women
• Webster v. Reproductive Health Services

– Court held that a state could ban public employees and public
health facilities from performing or assisting in performing
nontherapeutic abortions
• State legislatures in Northeast and West Coast have consistently

supported abortion rights
• Legislatures in a number of states have passed restrictive laws
designed to stop or slow process
• Main framework of Roe v. Wade still in place and is the law of the
land
The Moral Issues
• Personhood
• Sanctity of life
• Quality of life
• Autonomy
• Mercy
• Freedom
• Social stability
The Two Positions
• Pro-life: anti-abortion, believes abortion is murder and should be

stopped
• Pro-choice: believes decision to abort is one of personal liberty
and should be legal
Sanctity of Life Argument
• Fetus is a live human

• Killing him or her is wrong
• Allow for a few exceptions
• Human life sacred on basis of divine mandate, unalienable natural
or human rights, or common collective decision
• Genetic code argument
The Facts of Fetal Development (slide 1 of 2)
• Conceptus: union of sperm and egg

• Zygote: full genetic code will determine sex, hair color, skin color,
and other attributes
• Embryo: zygote settles into uterine wall
• 8 weeks: entity is a fetus
• Second trimester: fetus will have begun to move (quickening)
The Facts of Fetal Development (slide 2 of 2)
• 5th month: neurologically, fetus can feel pain

• 6th month: fetus period of potential viability
• Third trimester: fetus develops minimal consciousness
• Birth occurs after nine months
• Infant completely dependent on mother
Killing and Self-Defense
• If someone is about to kill you, and the only way to save yourself
is to kill the other person first, then killing is permissible
• Doctrine of double effect: distinguish intended effect of an action
from other, unintended effects
“Human” or “Person”?
• Traits Central to Personhood

– Member of the moral community
– Consciousness of objects and events
– Ability to feel pain
– Reasoning
– Self-motivated activity
– Capacity to communicate
– Concept of the self
The Viability Argument
– Viability: characteristic of biological independence

– Some argue a fetus has standing only when it becomes viable
outside the mother
– Some philosophers believe there is more to the abortion
question than the issue of personhood
Women’s Liberty and the Priority of Life Plan
(slide 1 of 3)
• Pro-choice: crucial a woman have control over her life plan in the
way a man has control
• Pro-life: root of abortion problem is modern attitude toward sex
• Differing ideas concerning sexuality, one’s religious beliefs, or
deeply held moral beliefs
(slide 2 of 3)
• Pro-choice advocates worry about:
– The “backstreet abortion” if abortion is made illegal
– The quality of women’s lives if denied basic autonomy of
reproductive self-control
(slide 3 of 3)
• Pro-life theorist:
– Will see the social problem as another manifestation of rampant
immorality of modern age
– Considers element of autonomy in reproduction a matter of
“convenience” than a life plan
Traditionalism vs. Modernism
• Pro-life Activists
– Tend to be more traditional and religious
– Sex should be reserved for marriage
• Pro-choice Activists
– Tend to be less traditional and religious
– More career oriented with higher incomes
– Sex is a natural expression of oneself
Abortion and the Freedom of Religion
(slide 1 of 2)
• Pro-life Theorists
– Reject the idea their views on abortion are the result of their
religious views
– They are result of basic moral reasoning
– Freedom of religion is not absolute
Abortion and the Freedom of Religion
(slide 2 of 2)
• Pro-choice Theorists
– Reflect one’s most deeply held beliefs
– Even if views are not religious in the partisan sense, they are
equally profound
– Best solution: tolerance
The Environmental Perspective
• See humans as members of a biotic community

• Duty to maintain a balance of numbers with other members of that
community
• Maintain and perhaps encourage use of abortion as a tool to
control world population
• Aggressive attitude toward family planning
The Family Planning Perspective
• Asks why we should favor accidental babies over planned babies

• People should have the right to choose at what point they will
have their children
• Pro-life perspective: family planning example of decadent culture
of permissiveness
Conclusion (slide 1 of 2)
• Abortion issue not a health issue but a social issue that takes
place in the health care arena
• Abortion, in most instances, is legal (US)
• One’s attitude toward abortion is intense, close, and personal
Conclusion (slide 2 of 2)
• Abortion requires we review our moral intuitions

• Perhaps missing in abortion debate is level of tolerance and
civility that considers opposing view to be wrong but rational
Rape (slide 1 of 6)
• Rape is forced, unlawful sexual intercourse.

• Without the victim’s “Consent”.
• It can happen to both men and women of any age.
Rape (slide 2 of 6)
• Sexual harassment vs Rape

– In Sexual harassment, the victims are physically harmed which
showcases male dominance, whereas,
– In rape, the victim’s are ravished like an animal for the
fulfillment of desire and lust of another.
Rape (slide 3 of 6])
• Types of Rape
– Acquaintance Rape / Date Rape
– Spousal Rape
– Gang Rape
– Minor Rape
– College Campus Rape
– Statutory Rape
– Prison Rape
– War Rape
– Rape Within the Military
– Corrective Rape
Rape (slide 4 of 6)
• Types of Rape
– Acquaintance Rape / Date Rape
• When the victim & the rapist know each other.
• eg. rapes of co-workers, schoolmates, friends
– Spousal/Marital/Wife/Husband Rape
• Rape between a married or a de facto couple (who are behaving like a couple but not married)
– Gang Rape
• When a group of people participate in the rape of a single victim.
– Minor Rape
• When a child is raped by an adult.
• eg. parent or close relatives, school teachers, religious authorities, or therapists.
Rape (slide 5 of 6)
• Types of Rape
– College Campus Rape
• When Rape is done inside college premises by college aged men and women.
– Statutory Rape
• Adults engaging in consensual sexual relations with sexually mature minors under the age of
consent.
– Prison Rape
• Rapes which happen in prison, mainly homosexual, (since prisons are separated by sex). Attacker is
most commonly another inmate, but prison guards may also be involved, primarily in female prisons.
– War Rape
• During war, rape is often used as means of psychological warfare iin order to humiliate the enemy
and undermine their morale.
Rape (slide 6 of 6)
• Types of Rape
– Rape within the Military
• When men & women are sexually harassed in the military..
– Corrective Rape
• Whereby men rape lesbian women, purportedly as a means of “curing” the woman of her sexual
orientation.
Ethics and Nursing Research
1
Overview
• Synonyms
• Examples of Un-ethical Research
• Development Of Ethical Codes And Guidelines
• Elements Of Informed Consent
• Documentation Of Informed Consent
• The Nurse Researcher As A Patient Advocate
• Clinical Trials
• Vulnerable Research Subjects
• Assent
• Guidelines for Critiquing the Ethical Aspects of a
Study
2
Synonyms:
belief
conventionalities
conduct
criteria
conscience
decency
convention
natural law
ethos
moral code
goodness
principles
honesty
right and wrong
honor standards
ideal the Golden Rule
imperative rules of conduct
integrity practice
morality standard
mores
nature
3
Post World War II Research- Ethics?
• How long does it take for body
parts to freeze when people • They were trying to
are kept naked outdoors in determine the most
subfreezing temperatures? effective means of
treating German Air
• What signs and symptoms are Force pilots who had
seen when people are kept in been exposed to
tanks of ice water for 3 hours? cold conditions
• These questions were asked • The so-called
by so-called researchers in subjects for these
Germany in the early 1940s experiments were
prisoners in the
German
concentration camps
4
• During 1942 and 1943, • Many nurses
prisoners’ wounds were participated in
deliberately infected with these unethical
bacteria experiments;
• Infection was aggravated by others found ways
the forcing of wood shavings to avoid
and ground glass into the participation, such
wounds as becoming
• Sulfanilamide was then given pregnant or asking
to these prisoners to for transfers to
determine the effectiveness of other assignments
this drug (Bonifazi, 2004)
• Some subjects died and others
suffered serious injury
5
• Between June and • One purpose of this
September 1944, study was to determine if
photographs from live
photographs and body
human beings could be
measurements were used to predict skeletal
taken of 112 Jewish size
prisoners • The skeleton collection
• Then they were killed, was to be displayed at
and their skeletons the Reich University of
were defleshed. Strasbourg (Nuremberg
Military Tribunals, 1949)
6
Conspiracy Between US Government Leaders And The
Japanese
Shearer (1982) revealed some of these horrible
experiments:
• Infecting women prisoners with syphilis,
having them impregnated by male prisoners,
then dissecting the live babies and mothers
• Draining the blood from prisoner’s veins and
substituting horse blood
• Exploding gas gangrene bombs next to
prisoners tied to stakes
• Vivisecting prisoners to compile data on the
human endurance of pain
The book is titled The Truth About Until 731
7
Examples Of Research Carried Out In US
• This unethical
• One of the most widely known unethical studies study became
was started in Macon County, Alabama, in 1932 by common
the U.S. Public Health Service. knowledge 40
• The study was titled “Tuskegee Study of Untreated years after it was
Syphilis in the Negro Male” begun
• Of the 600 black male subjects, 399 had syphilis • On May 16,
1997, President
• The subjects with active disease were given no Bill Clinton made
treatment. a public apology
• They were given free medical exams, free meals, on behalf of the
and burial expenses (Centers for Disease Control nation
and Prevention, 2006).
• Even after penicillin was accepted as the treatment
of choice for syphilis in 1945, subjects were still
given no treatment.
8
Ethics?
• It is common knowledge that smallpox is no longer a threat to
the world.
• Few people remember, or even know, that Edward Jenner
deliberately exposed an 8-years-old child to cowpox to try out
his new vaccine for smallpox (Hayter, 1979).
sienna jurado 9
• From 1963 – 1966, a group of children
diagnosed with MR were deliberately exposed
to infectious hepatitis in Willowbrook State
Hospital (Staten Island, NY)
• The children were deliberately injected with

the hepatitis virus and treated with gamma
globulin
10
Health Research In US
• In July 1963 doctors at the Jewish Chronic
Disease Hospital in Brooklyn, New York,
injected live, cancer cells into 22 elderly
patients
• The study was designed to measure

patients’ ability to reject foreign cells
• The patients were told that they were

being given skin tests (Katz, 1972)
11
• In Los Angeles, California, between, 1989 and
1991 approximately 900 children who were
mostly black of Hispanic, were given an
experimental measles vaccine called EZ (“Measles
Mistake,” 1996)
• The researchers never told the parents about the
experiment because the vaccine was unlicensed
• Kaiser Permanente and the Centers for Disease
Control and Prevention (CDC) sponsors of the
study, said the drug was safe but agreed that they
should have notified parents about the status of
the drug
12
• A similar situation • Parents were never
occurred in 1991 at the told their children
Standing Rock Sioux were part of a
Reservation in the research project and
Dakotas (“Parents Say that the vaccine had
Government Quiet,” not been approved at
1996) that time
• A group of American • The study was
Indian children were sponsored by the CDC
given a vaccine for and the Indian Health
hepatitis A Services
13
• In 2005 it was revealed that government funded researchers
tested experimental AIDS drugs on hundreds of foster children
without providing these children with an independent advocate
(Solomon, 2005)
• These children, who were mostly poor or from minority groups,

received cutting-edge treatments at the government’s expenses
• In some cases, their lives were extended
• However, many children experienced side effects, such as rashes,

vomiting, and sharp drops in infection-fighting blood cells
• They had no advocate to weigh the advantages and

disadvantages of their participation in research
14
• 2007 : newly discovered documents revealed that
Indian soldiers were deliberately exposed to mustard
gas during WW II to test their reaction to chemical
• Documents in Britain’s National Archives describe

the experiments carried out at a remote British base
(Pakistan)
• Troops marched into the gas chambers; usually

wears masks but 1 occasion masks were not used to
determine the effect of gas on their eyes
• Clinical Nurse Specialist “A Case of Scientific
Misconduct” (Patricia O’Malley, 2009) describes
shredding a manuscript she had written and then
tossing it in the trash can. She discovered that
several published papers she had used as
references had been retracted
• Because of falsified data
• Discussed a relabeled agent and multimodal
analgesia that she believed would have
implications for CNS practice
Development Of Ethical Codes And Guidelines
• The biblical Ten Commandments are an example of
a code of conduct that has endured through the
centuries
• The present ethical standards used in nursing

research, and in research conducted by other
disciplines, are based on the guidelines developed
after World War-II
• The 1947 Nuremberg Code resulted from the

revelations of unethical human behavior that
occurred during the war
17
• The Nuremberg Code is the most important
document in the history of the ethics of
medical research.1-6 The Code was
formulated 50 years ago, in August 1947, in
Nuremberg, Germany, by American judges
sitting in judgment of Nazi doctors accused of
conducting murderous and torturous human
experiments in the concentration camps (the
so-called Doctors' Trial).7
• It served as a blueprint for today's principles
that ensure the rights of subjects in medical
research. Because of its link with the horrors
of World War II and the use of prisoners in
Nazi concentration camps for medical
experimentation, debate continues today
about the authority of the Code, its
applicability to modern medical research, and
even its authorship.
Nuremberg Code
This code is concerned with several criteria for
research including the following.
1. Researcher must inform subjects about

the study
2. Research must be for the good of society
3. Research must be based on animal
experiments, if possible
4. Researcher must try to avoid Injury to
research subjects
5. Researcher must be qualified to conduct
research
6. Subjects or the researcher can stop the
study if problems occur
20
The Belmont Report
• In 1978 The National Commission for the

protection of Human Subjects of
Biomedical and Behavioral Research was
formed
• The goals of this commission were to:

(a) identify basic ethical principles that
should guide the conduct of research
involving human subjects and
(b) develop guidelines based on principles
that had been identified.
21
The Belmont Report
• “Ethical Principles and Guidelines for the
Protection of Human Subjects of Research”
The Belmont Report
• The report published by this commission in

1979 was titled “The Belmont Report”
• Three basic principles related to research
subjects were identified
1. Respect for Persons – research subjects

should have autonomy and self
determination
2. Beneficence – research subjects should be
protected from harm
3. Justice – research subjects should receive
fair treatment
23
General Guidelines For Research
• The U.S. Department of Health, Education
and Welfare (HEW) (now the Department
of Health and Human Services, DHHS)
published general guidelines for research
in 1981
• The federal government guidelines

resulted in the creation of institutional
review boards (IRBs)
• These review boards are given various

names
24
Declaration of Helsinki
• The World Medical Association has developed
the Declaration of Helsinki as a statement of
ethical principles to provide guidance to
physicians and other participants in medical
research involving human subjects. ... It is the
duty of the physician to promote and
safeguard the health of the people.
Why was the Declaration of
Helsinki created?
• The DoH was first adopted at the 1964 WMA
General Assembly in Helsinki. Its purpose was
to provide guidance to physicians engaged in
clinical research and its main focus was the
responsibilities of researchers for the
protection of research subjects.
What is the Helsinki protocol?
• The Declaration of Helsinki (DoH, Finnish:
Helsingin julistus, Swedish:
Helsingforsdeklarationen) is a set of ethical
principles regarding human experimentation
developed for the medical community by the
World Medical Association (WMA). It is widely
regarded as the cornerstone document on
human research ethics.
Research Guidelines For Nurses
• In 1968 the American Nurses Association Research and
Studies Commission published a set of guidelines for
nursing research
• These guidelines were revised in 1975 and 1985 and are

titled Human Rights Guidelines for Nurses in Clinical and
Other Research
• The American Nurses Association published another set of

guidelines in 1995
• This document is titled Ethical Guidelines in the Conduct,

Dissemination, and Implementation of Nursing
Research (Silva, 1995)
28
Elements Of Informed Consent
• The principal means for
ensuring that the rights of
research subjects are
protected is through
informed consent
• Informed consent concern

subjects’ participation in
research in which they have
full understanding of the
study before the study begins
29
Major Elements Of Informed Consent
• Researcher is
identified and
credentials presented
30
• Subject selection
process is described
• How they were chosen

to participate
• Information should be
provided
• Meet the criteria to be
eligible
31
• Purpose of study is
described
• Clearly stated
• Subjects’ preferred
language
• Printed material at
subjects’ reading level
32
• Study procedures are

discussed
• Fully explained
• Inform when and where
the study will take place
• Informed consent (e.g.
experimental studies)
33
• Potential risks are

described.
• Inform possible
discomforts
• Discuss possible
invasion of privacy
34
• Potential benefits are

described
35
• Compensation, if any,
is discussed
36
• Alternative
procedures, if any, are
disclosed
37
• Anonymity or
confidentiality is
assured
Anonymity (no one can

identify the subjects in
the study)
Confidentiality (the
researcher will protect
the subjects’ identities)
s 38
• Right to refuse to
participate or to
withdraw from study
without penalty is
assured
• Voluntary participation
39
• Offer to answer all

questions is made
40
• Means of obtaining
study results is
presented
41
Documentation Of Informed Consent
• The researcher
must document
that informed
consent was
obtained.
42
The Nurse Researcher As A Patient Advocate
• The nurse researcher has the responsibility
to protect the privacy and the dignity of the
people involved in the research
• The researcher has an obligation to refrain

from conducting such research study
involving undue physical risks, psychological
risks, or both
• The nurse researcher must assume

responsibility for study conditions
43
Clinical trials
• Clinical trials are research
studies conducted to evaluate
new treatments, new drugs,
and new or improved medical
equipment
• Nurses should be able to

answer patients’ questions
about research studies,
particularly clinical trials (Habel,
2005)
44
Vulnerable Research Subjects
• Certain special groups of people are
considered particularly vulnerable
research subjects because they are
either unable to give informed
consent or because the likelihood of
coercion to participate is strong
• Special precautions must be taken to

ensure that the study has a low risk
potential for these vulnerable
people
45
Vulnerable Research Subjects
These groups include:
• Children
• Geriatric clients
• Prisoners
• People with AIDS
• Homeless
• Unconscious
• Sedated patients
46
Assent
• When children are younger than 7 years,
parental consent is sufficient
• If a child is older than 7 years, not only

must the parent consent to the child’s
participation but the child must also
agree to be in the study by giving assent
to participate in a study
• Assent means that an underage child or

adolescent freely chooses to participate
in a study
47
Guidelines for Critiquing the Ethical Aspects of a Study
1. Was the study approved by an Institutional

Review Board (IRB)?
2. Was informed consent obtained from the

subjects?
3. Is there information about provisions for

anonymity or confidentiality?
4. Were vulnerable subjects used?
5. Does it appear that subjects might have been

coerced into acting as subjects?
48
Guidelines for Critiquing the Ethical Aspects of a Study
6. Is it evident that the benefits of
participation in the study outweighed the
risks involved?
7. Were subjects provided the opportunity

to ask questions about the study and told
how to contact the researcher if other
questions arose?
8. Were the subjects told how they could

get the results of the study?
49
LETTER OF REQUEST TO CONDUCT THE STUDY
Dr. ________________
Chief of Hospital
Riyadh Care Hospital
Riyadh, KSA
Thru: ________________
Chief Nurse, RCH
Sir/Madam:
The undersigned is a nursing student of Al Farabi College and is currently working on a
research study entitled “Perceptions of Staff Nurses on the Use of Health Informatics Towards
Efficient Nursing Care in Riyadh Care Hospital”. The study will provide an evaluation of the
efficiency of health informatics in providing care to clients and will also identify the problems
encountered by nurses as well. The findings will serve as bases in the formulation of intervention
programs designed to maintain a productive output and improve performance towards nursing
practice.
In this connection, the researcher would like to request approval from your office to
administer the questionnaires to selected staff nurses, n different wards. Rest assured that the
responses will be dealt with strict confidentiality.
Your approval of this request will be very vital to the success of the study.
Thank you very much and more power!
Respectfully yours,
Ms. Zohour Abdi

Researcher
LETER OF REQUEST AND QUESTIONNAIRE
FOR RESPONDENT NURSES
Dear Staff Nurse:
The undersigned is a student of Al Farabi College who would like to conduct a study entitled “Perceptions of
Staff Nurses on the Use of Health Informatics Towards Efficient Nursing care in Riyadh care Hospital”.
The study requires the collection of data from nursing staff , since they are in the best position to
evaluate the efficiency of health informatics in provision of nursing care.
Please provide your honest and accurate answer to every question in this questionnaire. The results
obtained will be treated confidentially.
Your cooperation will be highly appreciated.
Very truly yours,
Mr. Mohammad Abdullah

Researcher
Nieswiadomy, Rose Mary. Foundations of Nursing Research
REFERENCE
52
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Unit 2: Bioethics and Its Application in Various Health Care Situations

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Unit 2

Bioethics and its Application in Various Health

Prof. Eljohn P. Zulueta, RN, MAN, PhDc

1. Euthanasia and Prolongation of Life

• Movement that promotes the ability to meet death on your own

• Euthanasia comes from the Greek words: Eu (good) and

• Voluntary euthanasia is committed with the willing or autonomous

2. Inviolability of Human Life

“Human life is freely given by God. It is mysterious. It is inviolable. It

3. Euthanasia and Suicide

6. Administration of Drugs to Dying

8. Do Not Resuscitate (DNR)

Bioethics and its Application in Various Health

Prof. Eljohn P. Zulueta, RN, MAN, PhDc

1. Human Sexuality and Its Moral Evaluation

• Right or Freedom of Sexuality

“It is better to be a human being dissatisfied

• Human Sexuality = Commitment

• According to the book

• According to Family code of the Philippines

• Selection of Marriage Partners

• Premarital Sex Should be Discouraged

• A neurobiologist from Amsterdam University, Dick Swaab

• Why HOMOSEXUALiTY is a Social Problem?

• Bayot/Bading/Bakla in the Philippines fall into two categories:

• Is it possible to legalized same sex marrigein the Philippines?

“I look at them as human beings and not on their gender,”

“If there is a law (allowing same-sex unions), I will

3. Issues on Artificial Reproduction, its Morality

• Consists of depositing a man’s semen in the vagina, cervical

• The process can either be:

• Reasons why couple seek Insemination by Husband (AIH)

• Reasons why couple seek Insemination by Donor (AID)

• Eggs removed from a woman and fertilized in a laboratory dish

• Women could postpone pregnancy without risking infertility or

• When a woman agrees to carry a baby to term and give it up to

• Kantians: surrogacy problematic since birth mother is being used

4. Morality of Abortion, Rape and other Problems

• Abortion statistics (continued)

• Abortion is a very common experience for women

• Pro-choice advocates favor intact dilation and evacuation

• 1973: In Roe v. Wade, Supreme Court, legalized a woman’s right

• 1976: Danforth v. Planned Parenthood of Central Missouri

• 1976: Hyde amendment restricted availability of Medicare funding

• Webster v. Reproductive Health Services

• State legislatures in Northeast and West Coast have consistently

• Pro-life: anti-abortion, believes abortion is murder and should be

• Fetus is a live human

• Conceptus: union of sperm and egg

• 5th month: neurologically, fetus can feel pain

• Traits Central to Personhood

– Viability: characteristic of biological independence

• See humans as members of a biotic community

• Asks why we should favor accidental babies over planned babies

• Abortion requires we review our moral intuitions

• Rape is forced, unlawful sexual intercourse.

• Sexual harassment vs Rape

• The children were deliberately injected with

• The study was designed to measure

• The patients were told that they were

• These children, who were mostly poor or from minority groups,

• In some cases, their lives were extended