1.
(to safeguard against the tension of integrity)
AUTONOMY
• Derived from the Greek words ‘auto’ meaning ‘self’ and
‘nomos’ meaning ‘rule’. Thus, autonomy means self-law or
law to oneself. The original usage then of autonomy is to
mean ‘self -rule’ or ‘self- governance’ of independent city-
states.
CAPACITIES FOR SELF- GOVERNANCE:
- (moral reflection) the issue and what the situation is all
about and to reason out and give one’s opinion.
- (effective deliberation) by weighing the pros and cons of
the issue.
- (free choice) basic to making an independent choice is
one’s capacity to make decisions.
PRACTICAL IMPLICATION OF RESPECT FOR AUTONOMY IN
MEDICAL PRACTICE
1. Right of the patient, that is, right to self-determination
which is guaranteed by the patient’s bill of rights.
2. Informed consent
3. Actual directive
4. Advance directive/Living will
5. Refusal of treatment
INFORMED CONSENT
• is also known as enlightened
consent, to mean, any prior substantial or therapeutic and
research participation, patient must have a full information of
what procedure is all about, objective, need and advantage.
• It is also a form of invitation to a patient to
participate in his health care decisions.
INFORMED CONSENT MAYBE EXPRESSED INTO TWO
SETTINGS:
1. Therapeutic setting
2. Research setting
ELEMENTS OF INFORMED CONSENT: THRESHOLD ELEMENTS
1. Disclosure/Information
2. Competence/comprehension
3. Voluntariness
• The extent of information given to the patient by the
physician/nurse relating to the medical procedure.
• The expenses to be incurred, likewise is decisive
whether or not consent is to be given by the patient for
medical procedure.
• The patient’s level of education greatly affects one’s
own decision and the level of emotion to the extent
relevantly possible.
• The health care provider can appropriately assess
the accessibility of the language that will understand by
patient. Patient can finally render an intelligent decision.
• This element of informed consent is customarily
understood as free and willfully given by the patient. The
issue at hand is
that the patient must be given sufficient time and ample
space. THE TWO FUNCTION OF INFORMED CONSENT
2. (to be involved in the health care decision making)
TWO BASIC OF OBTAINING CONSENT
1. (it is often use upon admission of patient into the
hospital, another used it maybe dream necessary for
other procedure likely surgery)
2. ( it usually comes the comes in the form of an implied
consent like when a patient seeks consultation with is
physician)
SIGNIFICANCE AND JUSTIFICATION OF INFORMED CONSENT
1. Patient of an opportunity to be an informed participant in
health decision.
2. It is also a legal document and as a form of an assurance
of safety for the and for healthcare professionals (ex:
invasive procedure such as: surgery, anaesthesia and
others)
3. A form of protocol of the research process because most
researches involve patient’s lives.
4. It emphasizes honesty trait of the professional to carry in
their very selves an honest character when asking patient
to sign informed or enlightened consent.
5. It reduces risks and avoids unfair treatment and
exploitation by the professional and it is also regulatory
and institutional control.
6. It also protects the autonomous choice, by which the
claim of patient’s right to autonomy was promoted.
Barriers to informed consent vis-à- vis nursing intervention
1. Language: the nurse can use intermediary such as a
translator to translate information to language that can
be understood by the patient.
2. Cultural differences: the nurse can use intermediary or let
patient meet other persons who underwent the same
medical procedure or treatment of the same culture
background as the patient.
3. Physical impairment/illiteracy: the nurse can show
pictures, videos, literature and other related teaching aid.
4. Incompetence: the nurse help to ensure that decision
made by the person responsible for the patient is for
letters benefit and well-being.
• General it is ethical as well as legal responsibility of the
nurse to overcome these barriers and everything in her
capacity to ensure that the patient sufficiently gets all the
needed information to make an informed decision.
ACTUAL DIRECTIVE AND ADVANCE DIRECTIVE
• The right to self-determination originated from the
principle of autonomy which entails every individual to
informed consent including the right of person of legal age
and sound mind to voluntarily refuse a diagnosis.
• is an instruction that was given on the very moment
that is being done by any person with a normal condition.
• , on the other hand, is an issue given in anticipation
of what a person might think would happen relative to
his/her health condition.
A. Biological parents of the D. Nearest kin
patient
B. The oldest child of the E. Municipal health officer of the place where
 patient if of legal age the hospital is located/medical director
C. Legally adapting parents
of the patient
TWO FORMS ADVANCE DIRECTIVE
1. (instructional directive) A will by which any
competent adult give direction and instruction for future
care in the event that the patient involve can no longer
make due to terminal or severe illness or an impending
death
2. (Health care proxy). A
probable patient can name a person trusted so as to act
in their behalf as an agent/proxy in making health care
decisions in an event of incapacity.
PRACTICAL IMPLICATION/ISSUES OF LIMITING AUTONOMY
1. (Parentalism)
• Paternalism (Parentalism) comes from the Latin
word ‘pater’ to mean father. The conflict between respect for
autonomy and the desire to help the patient (beneficence)
brings the problem into forefront of paternalism.
• Paternalism describe as ‘the principle and practice of
paternal administration; government as by a father; the claim
or attempt to supply needs or to regulate the life of a nation
or community in the same way a father does to the children.
• Two important features of Paternalism: That the
father acts beneficently, namely, in accordance with the
conception of the interest of his children and he makes all or
at least some of the decisions relating to his children’s
welfare, rather than letting them make those decisions.
• In medicine, Paternalism is applied when health care
givers such as doctor, nurses and the like, assumed the
authority to make decision for and in behalf of the patient
without their consent or knowledge.
• (Latin for "I shall please") is a pharmacologically inert
substance (such as saline solution or a starch tablet) that
seems to produce an effect similar to what would be
expected of a pharmacologically active substance (such as an
antibiotic)
• The placebo effect consists of
several different effects woven together, and the methods of
placebo administration may be as important as the
administration itself • A simulated or otherwise medically
ineffectual treatment for a disease or other medical condition
intended to deceive the recipient. Sometimes patients given a
placebo treatment will have a perceived or actual
improvement in a medical condition, a phenomenon
commonly called the placebo effect or placebo response.
• Resuscitation - A form of medical intervention done
in a series of steps directed to sustain adequate circulation of
oxygenated blood to vital organs while an effective heartbeat
was restored. Do not Attempt Resuscitate (DNAR) or
commonly known as do not Resuscitate (DNR) a request to
forego resuscitation maneuvers.
INDICATIONS FOR DNR ORDERS
1. When the patient condition is terminal and death is
immanent so that life support only prolongs the dying
process.
2. When the patient is irreversibly comatose or in persistent
vegetative state and there is no hope of improvement.
3. When the burden of treatment far outweigh the benefit
(adapted from the Southeast Asia Center of Bioethics).
4. The following are reasons for DNR orders, these were
taken from different sources gathered: no medical
benefit, poor quality of life before CPR, poor prognosis,
severe brain damage, extreme suffering or disability in a
chronically or terminally ill patient, request by the a
patient or family member, enormous cost and personnel
commitment as opposed to the low probability of patient
recovery, by not administering any cardiopulmonary in
the event of cardiac arrest, we are actually letting the
person go in peace and dignity.
BENEFICENCE
• Etymologically, comes from the two Latin words:
➢ “bonus” where was taken to mean “good” ➢
“fic” where was taken to mean “to act or do”.
• It refers to “action done for the good of the others”.
• In the language of medicine, this principle highlights the
duty of health provider to do good and take positive steps,
such as prevention and removal of harm to the patient.
• Beauchamp, Childress & Psyche believed that it could be
seen through associated acts of kindness, charity, humanity,
altruism & love.
• Beneficence was often thought to broadly include all form
of actions. (Benevolence & Provenance, intended to benefit
other persons.
• So, beneficence refers to an action done benefit others.
➢ refers to the character, trait or virtue of being disposes
to act for the benefit of others.
➢ is the attentiveness dictated by kindness to anticipate
what one needs since each one of us, has that inner
goodness that pushes us to alleviate the pain and
discomfort to others.
• Therefore, Beneficence goes hand in hand with benevolence
and provenance.
BENEFICENCE: OBLIGATORY AND IDEAL BENEFICENCE
• Some ethnical theories like Utilitarianism are based
on the principle of beneficence. This means, that goodness
and kinddeed form the substratum of the Utilitarian Theory.
• J. Bentham and W.D. Ross differ in the meaning of
beneficence yet they employed the term beneficence as a
positive obligation, to others, though some critics denied this
kind of beneficence for he holds that the beneficence is a
virtuous ideal/acts of charity, thus any person therefore is not
morally deficient if he/she failed to act beneficently.
• Beneficence then is sometimes an admirable ideal of
action that exceeds obligation.
• Nobody denies that the Beneficent acts is morally
meritorious and therefore, morally praiseworthy away from a
personal obligation.
➢ Donating one’s kidney to a stranger.
• We are not morally required as morality dictates to perform
all possible acts of generosity or charity that will benefit
others. By this,
➢ means going out of one’s way in order to
do good to others, while , is merely goodness
to others without going out of one’s way.
• To sum up, Ideal Beneficence is benevolent act that involves
going out of one’s way to do good as that of Good Samaritan.
➢ is a mandatory act to do good and
to give aid to those who are in need.
DISTINCTION BETWEEN NONMALEFICENCE AND
BENEFICENCE
PRACTICAL APPLICATIONS OF THE PRINCIPLE OF
• Generally an obligation of nonmaleficence is more stringent
BENEFICENCE
than obligations of beneficence and in some cases,
• Protect and defend the right of others
nonmaleficence perhaps may override beneficence.
• Prevent harm from occurring to others
Beauchamp and Childress suggested the following schema
• Remove conditions that will cause harm to others to distinguish the principle of nonmaleficence and
• Help persons with disabilities beneficence. But the said authors do not propose a
• Rescue persons in danger hierarchical order.
➢ The principle of beneficence is already practice by Filipinos
EXAMPLES OF NONMALEFICENCE:
by showing one’s goodness such as, delicate and
generous hospitality and this is shown in different 1. Do not kill
situations like; Sharing of goods & Lending of money, 2. Do not cause pain or suffering to others
materials, equipment and even human resources like 3. Do not cause offense to others
bayanihan. 4. Do not incapacitate others
5. Do not deprive others of the goods of life
• One’s own obligation to do good in the practice of medicine CRITERIA ON DETERMINING NEGLIGENCE:
is also limited by one’s own obligation to avoid evil/harm. 1. The professional must have the duty to the affected
One’s avoidance of harm on others is embedded into what party
we call the principle of nonmaleficence. In medical ethics it
2. The professional must breach that duty
has been closely associated with the maxim, primum non
3. The affected party must experience a harm
nocere, which means; above all (or first) do no harm
(Beauchamp and Childress, 2001). This maxim expresses an 4. The harm must be caused by the breach of duty
obligation of nonmaleficence in the Hippocratic tradition, ‘I PRINCIPLE OF NONMALEFICENCE
will use treatment to help the sick according to my ability • Affirms the need for medical competence
and judgment, but I will never use it to injure or wrong • A part of Filipino character through avoidance of
them’. This principle helps in decision-making about issues confrontational dialogue that will eventually cause harm to
that may alter one’s own life, such as on killing and letting others
go, withholding and withdrawing treatment, use of PRACTICAL APPLICATION/IMPLICATION OF THE PRINCIPLE
extraordinary and ordinary means/procedures and other
OF NON-MALEFICENCE
issues.
• Withholding Treatment and Withdrawing Treatment are
• Nonmaleficence comes from Latin words: ‘ to mean
bioethical issues which can be acted upon or justified by the
‘ ;‘ from which ‘ is taken
following conditions:
and ‘ to mean ‘
1. When the case is irreversible any form of treatment
from which ‘ comes which means ‘do/make’. Thus
will not benefit the patient
the term nonmaleficence means not to make or to do bad or
2. When death is immanent or when patient is already
to make evil things intentionally.
dead
• In medicine, means not to inflict harm
➢ Ordinary and Extra-ordinary Treatments
which is not different from ‘not doing evil or bad things’.
• comprises of the provision of
This principle requires a health care provider to prevent or
necessities of life that usually pertain to food, normal
refrain from any sort of actions that eventually causes harm
respiration and elimination process. Hence like intravenous
to patient and more importantly when the action is never
fluids, nasogastric tube feedings, indwelling catheters, are
been justified.
some among the many considered ordinary and necessary
measure of treatment and may be sustained even if the case
is irreversible.
• comprises of the use of
aggressive modalities vis-à-vis the capacities of the family or
maybe some family who can very well afford it, continue to
give extra ordinary measure. But this means do not
necessarily offer any benefit to the patient.
KILLING AND LETTING DIE
• In ordinary language ‘killing’ is a causal action that
deliberately brings about another’s death
• ‘Letting die’ is ‘prima facie’ acceptable in medicine
under two conditions:
1. a medical technology is useless (medically futile) and
2. patients (or valid surrogate/proxy) have validly refused a
medical technology
SOME ETHICAL ISSUES
CARE AT THE BEGINNING OF LIFE The way
life is brought into
existence
(reproductive technology) and the way in which the
nature of future human lives are intervened with (like,
embryonic stem cell research, human cell line and
commodification) reflect this age of consumer mentality
and market ethics. Babies have to come at the
appropriate time, number and space. For a service fee,
then, sex were selected, genes were improved. Children
therefore were made to satisfy the desire market (like
baby making parent, supplier or baby breaking
experimenters). Though this may sound economically
good yet its not done for the common good.
Commercialization had led to the continued use and
abuse of human life and human person. Issue at the
beginning of life is peculiar because it involves:
mother/woman, father/man and fetus that cannot give
consent, has no wishes and cannot defend itself. Nurses
in this regard must be able to inculcate in the minds of
those proxies to act in and for the best interest.
Natural reproduction
The female ovaries expel the mature egg
towards the Fallopian tubes every 28 days. The male’s
testes produce the sperms which are expelled at
ejaculation. With the conjugal act the perms are
deposited in the vaginal canal. The sperm travel up the
uterus into the uterus into the Fallopian tubes and there
fertilize the egg. The fertilize egg (mean the embryo)
travels down to the uterus where it is implanted,
develops, grow (embryo, fetus) after 9 months the baby
is born.
Principles
The principles involved and promoted in the reproductive
issue are:
1. Inviolability of Life. All human from the moment
of conception (fertilization) and through all
subsequent stages is sacred. Thus, all have the
duty to affirm, respect, love and defend it.
Violation of this principle occurs like in: abortion,
in vitro-fertilization and stem cell research.
2. Stewardship. Man msut take care, cultivate,
creatures within the creature’s innate nature and
teleology and within man’s knowledge and
understanding. Violations arises in: surgical
sterility, substitution of reproduction, use of
hormones, intra-uterine devices (IUD) donation
of sperm or egg genetic manipulation.
3. Double Effect. A foreseen evil effect may be
allowed if the foreseen intended good effect is
greater than and does not result from the evil
effect. This is applied into maternal-fetal conflict,
removal of diseased organ like in ectopic
pregnancy, anencephalic ifants.
4. Nonmaleficence. Do no and risk no harm. This
is applied into: sterilization, hormones
psychological harm psychological and financial
effect of new technologies.
5. Beneficence: do good and provide a benefit.
This applies when removing diseased organs,
facilitating pregnancy, educating on responsible
parenthood.
6. Respect for Person. 1) Not to be
denatured/destroyed. Issues/ and violation
arises in: artificial methods of reproduction (like:
IVF and AID or AIH), cloning. 2) to be an end
and not a means to an end. This happens in
contraceptions, commodifications of sperm/egg,
uterus dysfunction, and embryonic manipulation.
Assisted reproduction
The right to procreate is limited by man’s nature.
Artificial methods that help the conjugal act and
ultimately reproduction are praiseworthy. Like, the use of
folic acid, sex education, fertility awareness and
planning, fertility drugs or hormones, viagra (for sexual
dysfunction) microsurgery to correct reproductive organ
defects, delivery with forceps, these assisted
reproduction abide with the bioethical principles.
Artificial insemination by AIH/AID including
zygote implantation into fallopian tube
(ZIFT), intracytoplamic sperm injection (ICSI)
replace the conjugal act and are illicit.
1. In-vitro fertilization and embryonic transfer
(IVF-ET). In IVF-ET the gametes are separately
harvested, in number of eggs are fertilized in
‘Patri Dish’ some zygotes are implanted into the
mother, and unwanted embryo may be removed.
 This is not in conformity with the following
principles:
a) Inviolability of Life (some unwanted
zygote are allowed to die)
b) Stewardship (the procedure is artificial
and it substitutes the conjugal act)
c) Nonmaleficence (the baby may develop
the ‘genealogical bewilderment
syndrome’, also, if sperm is from a
donor, the unknown biological lineage
may lead to incest or inherited diseases.
Mothers are psychologically harm by
series of unsuccessful attempt)
d) Justice (if private funds are used the
prohibitive cost limits availability to the
rich. If public funds are used, more
essential needs are abandoned)
e) Respect for Person (the human body,
the uterus, sperm egg becomes
commodities trafficked, transferred or
sold; the baby is not a gift but a product
of other’s will to be disposed of as
desired (the unused embryo; ‘take
home’ baby in term of wasted babies are
often not shared with parents)
2. Cloning it is the reproduction of a genetic copy
of another human being either through ‘splitting’
of the embryo’s cell or through somatic cell
nuclear transfer. The latter, involved the removal
of the nucleus from the unfertilized female egg
and its replacement by the nucleus of a cell
taken from donor.
Embryos are cloned either to provide human
embryonic stem cells (ES cells) as precursors for
differentiated cells to treat diseased (mean therapeutic
cloning) or to produce a new individual by implanting it in
a woman’s uterus (mean reproductive cloning). Now,
harvesting of human ES cells requires destruction of the
embryo. Cloning violates:
a) Inviolability of Life (embryo are
destroyed in the therapeutic cloning)
b) Stewardship (the process is artificial)
c) Nonmaleficence(the psychological and
physical risks to mother and child. In
accdition the concept of the ‘family’ is
perhaps destroyed)
d) Respect for Person (denatured and
destroyed by stockbreeding with no
uniqueness ans individuality; parents
were reduced to a mere providers of
human ‘materials’, like, sperm, egg and
uterus)
3. Human Embryonic stem cells (Human ES
cells) it is the production of human embryos/the
use of surplus embryos from IVF or aborted
embryos or frozen embryos. The isolation of the
inner cell mass (ICM) which is cultured and
subcultured to form colonies then cell lines must
be done early in the embryonic life and
destroyed the embryo (nonmaleficence). This
intentional killing is morally illicit. Thought the
end may be praiseworthy as in a regenerative
medicine, it cannot justify the means (double
effect). To use commercially available or
supplied ES cells obtained from them is
proximate material cooperation with scandal in
the act of embryo destruction (respect for person
and nonmaleficence).
Prevention of reproduction
There are two ways by which reproduction may be
prevented it is through contraceptive and abortive.
There are some obvious reasons why other people
choose this methods, one is space pregnancy,
health, economics, unreadiness, no desire to be
obligated to try to have children and others.
1. Contraception is any action which in anticipation of
the conjugal act (castration, tube ligation,
vasectomy, oral or parental hormones to prevent
ovulation) or in its accomplishment (like,
spermatocides in creams, jellies, foams or
suppositories, coitus interuptus, condoms,
diaphragm, hormones which thicken cervical
muscus) or in the development of its natural
consequences (like IUD, abortion, fetal reduction)
whether as an end or means, prevents the creation
of new life (anti-life). contraceptives treat fertility as
a negative value that should be suppressed. It
vilates or it is nonconformity to:
a) inviolability of life (drugs and devices that
inhibit fertilized ovum transport to and
implantation in the uterus or its development
are abortificient. They kill the fetus.
b) Stewardship (it promotes hedonistic
mentality with refusal to accept the
reproductive responsibility of sexual or to
recognize a new human being. (perhaps as
god is the final Creator)
c) Nonmaleficence (castration removes a
healthy organ, tubal occlusion or ligation and
vasectomy prevents a healthy function. IUD
promotes infection as well. Contraception as
well promotes a premarital sex, extramarital
sex, or homosexuality.
d) Respect for person. (to have one spouse
use the other spouse as a means for one’s
satisfaction or pleasure is a sign of
disrespect)
2. Abortion is the process of deliberately terminating
pregnancy with the resulting death of an entity or it is
 a process of deliberately terminating pregnancy at
any stage of its development. Types of abortion:
a) direct abortion or induced: it a kind of
abortion with the intentional of immediate
purpose of ending or destroying the fetus at
any stage of after its conception.
b) Indirect abortion is a process of terminating
pregnancy directly in which the moral object
of the action is the therapy of the mother and
the death of the fetus is a side effect that is
inevitably unavoidable effect. Ex., removal
of pathological tube containing a fertilized
ovum in an ectopic pregnancy, removal of
the cancerus gravid uterus. This act is
justified by the principle of double effect.
Obviously direct abortion violates the
principles of natural reproduction.
Abortion is done through:
1) injection with concentration saline (salt) (it
is an injection of a concentrated saline solution
into the their mothers womb. It burns their skin
off them while were still alive the babies breathe
it in and swallow it, frying their insides. Some of
babies were born alive despite this torture and
are then ‘disposed of’) 2) dilation and
Evacuation Dilation (this is characterized by
using a suction tube to remove the fetus and
placenta)
3) Hysterotomy (abortion by
caesarian surgery)
4) Vacuum aspiration (is a
method by suctioning of the lining of the
uterus through the use of a thin and
flexible tube inserted through the
opening of the cervix)
CARE AT THE PROMOTION OF LIFE: ORGAN
TRANSPLANTATION AND DONATION
Advance in surgery and introduction of new drugs have
led to the steady growth of organ transplantation and
donation. The removal of the organ from one being and
its implantation into another has saved lives or made
lives better. Unfortunately organs are scarce resource.
Thus, many who need new organs die while on the
waiting lists. This lack of organs has led to abuses such
as robbing, maiming, or even killing of donors,
commercialization of organs by health care givers,
middle men or institutions and coercion exploitation of
disadvantaged donors or needy recipients. It is in the
abuse that violation occurs.
Terms to consider:
Organ donation means the giving of tissue/organ/body
by a person to another person or to an institution
Donor the given who may be a cadaver (with an
assumptive document by the donor when still alive or by
proxy) or a living person (either by relatives, non-relative)
Vendor is a person who exchange their organ for money
Recipient the receiver of the organ given by the donor
or institution; a recipient who pay the organ is a buyer
Organ transplantation means the transfer or the
planting across of organ from donor/vendor to
recipient/buyer
Xenotransplantation is the planting of an organ from
animal organ to human beings.
Allotransplantation it is the transplantation of the organ
from one body to another body of the same species.
Organ donor
Our main concern is to care life that is the life of
the donor. The principle stewardship and
nonmaleficence state that man must take care of his
body and do no harm to it. If the donor is the cadaver,
harvesting an organ will do no harm. If the donor is
living, taking away a healthy organ is not taking care
one’s body: no life is saved, no health is restored.
Removal o organ may even be mutilation. However, a
very proportionate reason and a meritorious act my
override the rule of stewardship and nonmaleficence.
The rule of unselfish love, solidarity love of neighbor,
beneficence, and charity these may supercede the rules
of stewardship and nonmaleficence.
In such a case it is praiseworthy, for it takes what it
means to belong to a human society that we are fulfilling
our duty to one another (deontological duty) and to
contribute to the goal of medicine (healing). By this it
makes the giver a better person. Still in spite of its
meritorious promise there are some requirement before
an organ may be considered moral/bioethically
acceptable:
1) the harm and risk must be minimal and
proportionate to the benefits to be derived.
Things need to be considered:
a. accurate definition of death must be
followed and observed
b. the dying cannot be killed
c. the organ to be removed must not be a
necessary condition for life or for
personal procreation, like, brain and
gonads
d. an part of the body that can easily be
regenerated can be given such as
blood, hair, bone marrow
 e. a second kidney or a portion of the liver
these are nor necessary for the personal
or procreational identity
2) the donor must be care for before, during and
after the donation. This includes the following
consideration:
a. proper screening
b. standard of health care
c. reimbursement of medical expenses
d. disability and livelihood lost (burial
expenses of the cadaver)
e. prevention of discrimination in job
f. prevention in community acceptance
3) the intrinsic worth and dignity of the donor must
be respected. The following must observed:
a. free and informed consent must be
given
b. information given should include
process of matching, the chance of
success of the transplant and
permission to refuse
c. financial need and ignorance make te
marginalized vulnerable to exploitation
4) in case of cadaver, consideration must be
observed:
a. consent for the donation must be given
or obtained specially person that met an
accident
Organ Recipient
Stewardship dictates that in case of serious illness man
has the right and the obligation to take necessary
measures to promote life and health. A new organ may
preserve life of the person. To the extent that if it is
available one has a right to and obligation to get it.
Some bioethical consideration are required for it to be
morally and bioethally accepted:
1) respect for autonomy must be allow the recipient to
choose how to get an organ. It requires:
a. to give free and informed consent 2) there must
be justice in allocation. Justice as equal benefits for
everyone in need would dictate giving nothing to anyone
and letting everyone die. It is pointless and harms all..
the following must be consider:
a. the criterion for judging equality is based on the
chance of success
b. the ability to pay the costs of the transplant and
the expensive anti-rejection medication
determines success and access
c. given the case that both are capable to spend
has success and access, the first come first
serve must be serve.
What the nurse can do, they must contribute on the
communal dialogue and public education must be given,
so that the main goal of organ transplantation shift back
to its true nature of:
a. commodities to self love
b. commercialization to charity
c. potential donors must be protected against
harm, thus become an advocate of the donors
d. educating donors that selling organ is not
encourage
e. nurse should address the underlying poverty,
ignorance and vulnerability of people that sells
their organs; organs ‘should not be for sale’
CARE AT THE END OF LIFE: EUTHANASIA AND
PHYSICIAN ASSISTED SUICIDE
One’s values regarding life and death are reflected in
how one dealt with the dying. If one cannot bear to see
suffering, then one resorts to an “advance” death, such
in euthanasia, suicide, or physician assisted suicide. If
one sees life as the highest value with death as a form of
human defeat, or if one is overly influenced by available
new technology and biological idolatry then one does
everything to prolong life beyond one’s one time and this
is known as dysthanasia. On the other hand, if one sees
death as the culmination of a good life, to be valued only
until its natural end, one looks for a good death this is
orthothanasia.
Before proceeding to the types of death, it is important
to determine first signs of the moment of death, signs of
death and when to pronounce that a person is dead.
Moment of death
1. Inevitable and critical moment when
organism ceases to function as
specified, unified, homeostatic system
and becomes disorganized into a mere
collection of heterogeneous chemical
substance. To know that body is
disorganized we must at least become
sure of three things:
a. that the body does not now
exhibit specific human
behavior
b. the body does not function
humanly in the future
c. the body has no more radical
capacity for human functions
due to its lost of basic
structure required for human
unity
The third reason is necessary due to the fact
that medical experience had shown that persons who
are in coma nevertheless have sometimes recovered full
human consciousness. Such resuscitation is possible,
however, after true human death some cells or even
organs of the human body for a time by artificial
respirator, continue to exhibit some life functions but
these functions are not those of human organism but
simply a residual life at level of organization similar to a
plant or animal. Thus, the essential point of determining
human death is not to decide whether any life is present,
but whether human life in the most radical sense of a
unified human person is still present.
2. life force of cell is no longer united to the
matter with which it was at any times
united.
3. religious orientation, the separation of
the body and the soul (medically, it is
understood as, body’s lack of sensation
and self-movement.
4. the lose of touch irrevocably with a
person who previously was able to
communicate and to share our human
community of thought, of love, of
freedom and or creativity.
Signs of death
1. human organism is irreversibly
dysfunctional and dead
2. less conclusive, absence of breathing
and heartbeat
Now, the signs are not a guaranteed bases and
signs of death due to some technological advancement
that is perfected to aid the lungs and heart to functions
artificially as in resuscitation. Such mechanism of
resuscitation restored back and sends blood through the
body, even if after the unity of the body cease to exist.
Be that as it may, it does not lead to a conclusion that an
individual organ simulates unity, unity or organism is no
longer present because the organs would cease to exist
right away if the mechanism is removed. Thus, an
artificial sustained heart and lung activity is not a proof
that human life still remains. That is why as long as this
heart and lung is sustained by mechanical device that
runs it artificially the traditional bases of death is
impossible to verify. Thus, we ask the question? What
then is the basis or are there other clinical signs that can
be used not to constitute a new definition of death rather
as an alternative, complementary ways the same
essential fact, namely, the irreversible cessation of
spontaneous heart and lung functions.
Aside from the new technology used, another
reason is the possible organ transplant of heart and
kidney. It is said to be that the success of transplanting
of heart will likely to be very successful if the organs to
harvested from a body through which blood is circulating.
Hence, surgeons, kept the body alive in the respirator.
So then, how is it possible to be sure that the donor is in
fact dead?
Signs of a dead person
1. cardiovascular clinical signs (this is used when
the person is not attach to respirator. Thus,
reliance on technology must be moderated
rather than encourage)
2. the new clinical sign must be ascertained by the
well-trained professionals (basis must be
properly observed. That is for no less than 24
hours when it uses the EEG or
electroencephalogram as it is done in the USA:
Harvard Criteria for Brain Death of 1968, this is
used to person who is under a hypothermia and
drug-induced coma. But today, short intervals is
now allowed within 6 hours, and the EEG is
being replaced by an Angiogram it is
an apparatus to test the blood flow in the
cerebellum of the patient)
Types of Death
1. Euthanasia means an action/omission which of
itself or by intention causes death, in order that
suffering may be eliminated. It procures/imposes
death before one’s time.
Euthanasia is popular for a variety of reasons:
a. Utility: the economic constraints from the
escalating health costs for the growing elderly
population especially chronically ill, disabled.
b. Hedonism: when quality of life is poor or life is a
burdensome and useless then the person can be
killed. Since patient who see themselves as a
burden to others are guilty to be alive.
c. Autonomy: a request for an early death may be
an attempt of the patient to regain control: even
if it be only in deciding when to die, it is
practicing the “right to die”
Types of Euthanasia:
a. Voluntary and involuntary (patient’s initiative)
b. Active and passive (healthcare provider’s
initiative)
Human life must be promoted because we are
as stewards of it. Filipinos have seen that disabled
newborn as “good luck” and caring a sick person is a
privilege. In solidarity, one can’t abandoned, replaced,
worst of all, kill another person. May it be in the name of
economy, practicality, compassion or autonomy.
procuring death is a perversion of a diseased society
made worse if done by a family or healthcare provider. It
is then a betrayal of the trust and respect that health
care providers are known as healers. It harms the victim
and at the same the survivors in the spirit of oneness to
the one that passway.

2. Dysthanasia is the delaying or postponing death

beyond its natural time by all means available.

Dysthanasia is popular for the following reasons:

a. doctor’s training (reasons: treating is more

comfortable than not treating, doctor’s felt guilty
to abstain, death of patient is seen as a failure of
management)
b. technologic imperative (reasons: advances and
success pushes the doctor to use everything,
that is, malignant over-diagnosis and over-
treatment. It is also biology rather then
personhood is the object of medical attention)
c. ignorance (reasons: proxy’s are unaware of the
distinction between killing and letting die; lack of
information with regard on prognosis pain high
quality of end of life care, the best place to die)
d. hospital culture (reasons: rights of patients are
considered as preference rather than directives)
e. fear (reasons: doctor’s worry about on the
accusation of legal liability and malpractice if
everything were not done)
f. Philippine culture (to add in the Filipino hospital
context) (reasons: the Filipino nonconfrontational
attitude makes all concern hesitate to hear
‘badnews’, instead the ‘status
quo’ is the main focus)

Living should not be a penalty to be prolonged at

all cost. To cause suffering unnecessarily in unworthy of
trust and respect the healthcare provider has. Priority of
using the last moment of life must be given to finish
one’s own responsibilities to others.