Other Relevant Ethical Principles
always be bad and good effect.
PRINCIPLE OF DOUBLE EFFECT
 is used to determine when an action which
has two effects, one good and one evil, may
still be chosen without sin.
 Thomas Aquinas (1225-1274) – This principle
is attributed to St. Thomas Aquinas, who used
it to show that killing in self-defense is
justified in Summa Theologica (II-II, Qu. 64,
Art.7)
What if an action has two outcomes, one good, one
bad?
To make such a determination, one must analyze an
action on the basis of four conditions; all of which
must be met for the action to be morally justifiable.
The conditions of the principle of double effect are the
following.
Conditions:
1. The action intended, in and of self must be
good or at least morally indifferent or neutral.
2. The evil effect must not be directly intended
but morally allowed only as a regrettable side
issue (side effect).
3. The evil effect must not be the means by
which the good effect is achieved.
4. The good effect must outweigh the evil effect
or at least proportional.
NOTE:
 All the above conditions have to be FULFILLED
in order for an act to be morally justified and
permissible.
 If ONE of the conditions is NOT MET, the
entire act is deemed morally objectionable,
and thus should not be performed.
Example:
We want to do the right thing, but something bad can
also happen. We respect human life for the moment
of conception, and no way that we will violate it, but
imagine a pregnant women going to his physician and
finds out she has a UTERINE CANCER or cancer of the
womb and if this cancer will not be removed, she is
going to die, but if the cancer is removed or the uterus
will be removed the baby will die. So what are we
going to do, we are in dilemma?
The church can help them to have a decision called
the PRINCIPLE OF DOUBLE EFFECT that when we are
in the situation that no matter what we do, there will
1. The action intended, in and of self must be
good or at least morally indifferent or neutral.
- We can remove the uterus because all we
wanted to do is remove the cancer.
2. The evil effect must not be directly intended
but morally allowed only as a regrettable side
issue (side effect).
- That is not to lead to the death of the
child, we foresee that the child will die but
that is not what we intend to do.
3. The evil effect must not be the means by
which the good effect is achieved.
- The good thing of removing the cancer of
the uterus is not brought about by the
death of the child. It is a good act of
removing the can which leads to the
unintentionally death of the child.
4. The good effect must outweigh the evil effect
or at least proportional.
- We have a proportion in doing this, we
have two lives, therefore, if there is no
other way of resolving this.
We can control the love and goodness we put into
every action. The principle of double effect should not
be seen as a get-out-of-jail-free card or a way to justify
our dicey actions but rather a protection and a guide
allowing us to live the gospel with conviction and love
even when faced with difficult moral situations.
PRINCIPLE OF LEGITIMATE
COOPERATION
To achieve a well-formed conscience, one should
always judge it unethical to cooperate formally with
an immoral act (that is, directly to intend the evil act
itself), but one may sometimes judge it to be an
ethical duty to cooperate materially with an immoral
act (that is, only indirectly intend its harmful
consequences) when only in this way can a greater
harm be prevented, provided:
 That the cooperation is not immediate and  
 That the degree of cooperation and the danger
of scandal are taken into account
Types of Cooperation:
1. Formal cooperation - occurs when a person or
organization freely participates in the actions
of a principal agent. 
 2. Immediate material cooperation - occurs
when the cooperator participates in
circumstances that are essential to the
commission of an act, such the act could not
occur without this participation.
3. Mediate material cooperation - occurs when
the cooperator participates in circumstances
that are not essential to the commission of
the action, such that the action could occur
even without cooperation. 
PRINCIPLE OF COMMON GOOD AND
SUBSIDIARITY
Principle of Common Good
Common Good stems from:
4. Dignity
1. Unity
2. Equality
Common good is referred to as the social and
community dimension of the moral good. 
On Healthcare: Nursing and the Common Good
 The literature examining the relationship of
the common good to nursing and other health
professions mainly cites the common good as
an impetus for action.
 Nursing is viewed as promoting the common
good.
 In addition to development of nursing as a
discrete profession reflects societal
recognition that the constellation of services
provided by nurses is supportive of the
common good.
 Nursing also addresses the need to balance
the preservation of individual dignity and
respect against societal integrity. 
 The “added value” of the common good to
existing nursing concepts may be illustrated by
examining instances of ethical misconduct in
clinical research and the evolution of the
health care delivery system.
Subsidiarity  
 It is a principle of social doctrine that all social
bodies exist for the sake of the individual so
that what individuals are able to do, society
should not take over, and what small societies
can do, larger societies should not take over. 
 It is in relation of individual and group lower
and higher subordinate and superior.
 The principle of subsidiarity reminds us that
larger institutions in society should not
overwhelm or interfere with smaller or local
institutions, yet larger institutions have
essential responsibilities when the more local
institutions cannot adequately protect human
dignity, meet human needs, and advance
coming good. 
Applications of Subsidiarity 
 If a man can do it, a woman can do it.
 Kung kaya ni mister, kaya ni misis
 The postion of the roman catholic church is
that parents should have maximum
reasonable amount of authority over and
responsibility for, the raising of their children. 
Principle Of Bioethics
PRINCIPLE OF STEWARDSHIP AND ROLE
OF NURSES AS STEWARDS
Stewardship - refers to the expression of one's
responsibility to take care, nurture, and cultivate the
earth has been entrusted to him. 
In the context of the Principles of Stewardship,
humans must respect the sanctity of life and the
world. Therefore, any act that would defile the
blessedness of life and the world is deemed against
the principle of stewardship
Stewardship in nursing
 involves valuing and respecting patients’
priorities and self-determination.
 Nurses becomes stewards or teachers to
patients who may not have the expertise or
experience in the disease process, but who
understand the consequences of the illness.
Social Role
 Health care has been identified as Canadians'
number one public priority - and nurses play a
central role in delivering health care.
Nurses advocate for health promotion,
educate patients and the public on the
prevention of illness and injury, provide care
and assist in cure, participate in rehabilitation,
and provide support. 
 No other health care professional has such a
broad and far-reaching role.
 Nurses help families learn to become healthy
by helping them understand the range of
 emotional, physical, mental and cultural
experiences they encounter during health and
illness. Nurses help people and their families
cope with illness, deal with it, and if necessary
live with it, so that other parts of their lives
can continue.
 Nurses do more than care for individuals. They
have always have been at the forefront of
change in health care and public health.
Ecological Role
Ecology is the study of the relationships between
living organisms, including humans, and their physical
environment; it seeks to understand the vital
connections between plants and animals and the
world around them.
 The nursing profession is well equipped to
solve the problems of reducing waste within
medical systems.
 The health sector produces a large amount of
waste that leads to environmental problems
such as air pollution and water pollution.
 Nurses have the potential to use their
trustworthy skills to guide the way to more
healthier communities and societies in which
they work.
 the emerging methods of waste
management in healthcare.
 the nurses form the largest group in
the health sector and are
 skilled at informing research and
eliminating waste.
Biomedical Role
 Withholding nutrition can constitute nursing
neglect and expose the nurse to criminal
charge of negligence or conspiracy to commit
suicide.
PRINCIPLE OF TOTALITY AND ITS
INTEGRITY
 Totality – Duty to preserve intact the physical
component of the integrated bodily and
spiritual nature of human life, whereby every
part of the human body “exist for the sake of
the whole as the imperfect for the sake of the
perfect.”
 Integrity – Each individual’s duty to “preserve
a view of the whole human person in which
the values of intellect, will, and conscience are
highly distinguished.”
“All decisions in medical ethics must prioritize the
good of the entire person, including physical,
psychological and spiritual factors.”
“All of the organs and other parts of the body exist for
the sake of the whole person. Because the purpose of
the part is to serve the whole, any action that
damages a part of the body or prevents it from
fulfilling its purpose violates the natural order and is
morally wrong”
Ethico-Moral Responsibility Of Nurses In Surgery
(Perioperative Nurse)
 Working with patients prior to surgery to
complete paperwork, and help answer
questions or calm fears about surgery
 Monitoring a patient’s condition during and
after surgery
 Selecting and passing instruments and
supplies to the surgeon during operation
(sometimes referred to as a scrub nurse)
 Managing the overall nursing care in the
operating room to help maintain a safe and
comfortable environment (sometimes
referred to as a circulating nurse)
 Educating patients on best practices for
recovery, including pain management and
keeping wounds clean
 Cleaning surgical equipment and operating
rooms to maintain a sterile environment
 Obligated morally to respect the dignity and
worth of individual patients.
 Perioperative nursing care must be provided
in a manner that preserves and protects
patient autonomy and human rights.
 Preserve and protect their patients'
autonomy, dignity, and human rights with
specific nursing interventions
 Explain procedures and the OR environment
before initiating actions, and they respect
patients' wishes in regard to advance
directives and end‐of‐life choices. 
 Help patients make choices within their scope
of care as applicable. 
 Provide patients with honest and accurate
answers to their questions, especially related
to perioperative teaching, and formulate
ethical decisions with help from available
resources
 Perioperative nurses provide nursing care
directed to meet the comprehensive needs of
all patients, taking into consideration aspects
of culture, language, perception of pain,
significant others, values, and beliefs
  Nurses provide patients with information and
explain the patient self‐determination act in
instances such as organ procurement, do‐not‐
resuscitate orders, informed consent, and
advance directives. 
 Nurses also impart patient status reports to
the patient's family members if the patient
has indicated it is acceptable to do so
Sterilization and Mutilation
What is Sterilization?
 In microbiology: Sterilization refers to any
process that effectively kills or eliminates
transmissible agents (such as fungi, bacteria,
viruses, spore forms, etc.) from a surface,
equipment, article of food or medication, or
biological culture medium. Sterilization can be
achieved through application of heat,
chemicals, irradiation, high pressure or
filtration.
 As surgical procedure: Sterilization is a
surgical technique leaving a male or female
unable to reproduce. It is a method of birth
control. For years, surgical operations
resulting in permanent sterilization have been
performed for therapeutic purposes, such as
the removal of reproductive organs to halt the
spread of cancer or other pathologic
processes.
Concept of Sterilization:
 Sterilization may pose few problems for those
who are satisfied with the number of children
they have had or who are adults who have
determined that they do not want to have
children
 Full and informed consent is required of the
person being sterilized; however, health care
providers often prefer to obtain assent from
the spouse if the person is married to avoid
subsequent emotional and family problems.
Moral Issues on Sterilization
 The Catholic church has strongly condemned
all artificial methods of Contraception (a
position also held by most Protestant
churches up to 1930, when the Anglican
church voted for change). 
 This includes the contraceptive pill, condoms
and also medical procedures such as
vasectomy and sterilization. In fact, the church
regards contraception as mortally sinful. The
official position is stated in the papal
encyclical Humanae Vitae, issued by Pope Paul
VI in 1968.
Ethical Issues on Sterilization
 The main issues that raise ethical dilemmas
following the development of assisted
reproduction techniques are: the right to
procreate or reproduce; the process of in vitro
fertilization itself — is it morally acceptable to
interfere in the reproduction process?; the
moral status of the embryo; the involvement
of a third party in the reproductive process by
genetic material donation; the practice of
surrogacy; cryopreservation of pre-embryos;
genetic manipulation; experiments on pre-
embryos, etc.. 
 For those who consider life to begin at
conception abortion always equals murder
and is therefore forbidden. Those who believe
in the absolute autonomy of the woman over
her body take the other extreme approach. 
 The development of new effective
contraceptive methods has a profound impact
on women's lives. 
What is Mutilation?
 An act or physical injury that degrades the
appearance or function of any living body,
usually without causing death. 
 It is a medical term that reflects what is done
to the genitalia of girls and women. It is a
cultural reality. Mutilation means the removal
of healthy tissue.
Usage:
1. The term is usually employed to describe the
victims of accidents, torture, physical assault,
or certain premodern forms of punishment.
Mutilation can also refer to forgery of
documents, letters, and brochures, letters of
recommendation and other pieces of
evidence or testimony. 
2. Some ethnic groups practice ritual mutilation. 
3. In some cases, the term may apply to
treatment of dead bodies.
Female Genitalia Mutilation
 Female genital mutilation (FGM) involves the
partial or total removal of external female
genitalia or other injury to the female genital
organs for non-medical reasons. 
  FGM is recognized internationally as a
violation of the human rights of girls and
women  incision); stripping the skin from the shaft of
 The practice also violates a person's rights to
health, security and physical integrity; the
right to be free from torture and cruel,
inhuman or degrading treatment; and the
right to life, in instances when the procedure
results in death.
Types of Female Genitalia Mutilation:
 Type 1 (Clitoridectomy): this is the partial or
total removal of the clitoral glans, and/or the
prepuce/ clitoral hood.
 Type 2 (Excision): this is the partial or total
removal of the clitoral glans and the labia
minora, with or without removal of the labia
majora.   Part can be understood as the
 Type 3 (Infibulation): Also known as
infibulation, this is the narrowing of the
vaginal opening through the creation of a
covering seal.
 Type 4: This includes all other harmful
procedures to the female genitalia for non-
medical purposes.
Male Genitalia Mutilation
 Male genital mutilation (MGM), sometimes
known as "male circumcision," refers to any
treatment that involves the partial or
complete removal of the external male
genitalia or any harm to the male genital
organs for cultural, religious, or other non-
therapeutic reasons.
Types of Male Genitalia Mutilation:
 Type 1: excision or injury of part or all of the
skin and specialized mucosal tissues of the
penis including the prepuce and frenulum
(circumcision, dorsal slit without closure). 
 Type 2: excision or injury to the glans
(glandectomy) and/or penis shaft,
(penectomy) along with Type I MGM.  charity is proportionate to the good resulting
 Type 3: excision or destruction of the testes
(castration, orchidectomy) with or without
MGM.  5. The recipients for the scarce organs are
 Type 4: unclassified: includes pricking,
piercing or incision of the prepuce, glans,
scrotum or other genital tissue; cutting and
suturing of the prepuce over the glans
(infibulation); slitting open the urethra along
the ventral surface of the penis (sub-incision);
slitting open the foreskin along its dorsal
severing the frenulum; surface (super-
the penis; introducing corrosive or scalding
substances onto the genital area.
Moral Issues on Mutilation
Theory: The principle of totality presupposes that
“parts exist for the whole ... The good of the part is
subordinated to the good of the whole; the whole is
the determining factor for the part and can dispose of
its own interest.” The main notions on which the
principle grounds itself are “the whole, the part, and
their mutual relationships.” Regarding the part,
Aristotle explains it in the following manner:
 A part denotes any portion of a
quantum into which it can "be
divided" remains always a part of it. 
constituent element of a dividable
kind "apart from the quantity."
 Whole, which includes a part, can be
divided 
 Finally, the constituent "elements in
the definition which explain a thing
are also parts of the whole."
Preservation of Bodily Functional Integrity
 Functional Integrity refers to the ability of the
body to function in a healthy manner.
 Concern with the moral obligation to preserve
bodily and functional integrity. 
Issues on Organ Donation
Transplanting organs from one living person to
another is also ethically acceptable provided that the
following criteria are met:
1. There is serious need on the part of the
recipient that cannot be fulfilled in any other
way.
2. The functional integrity of the donor as a
human person will not be impaired, even
though anatomical integrity may suffer.
3. The risk taken by the donor as an act of
for the recipient.
4. The donor’s consent is free and informed
selected justly.
Who can be a donor?
1. Living Donor
2. Cadaver Donor
Criteria for becoming an organ donor:
1. Organs can be donated only after a person
has been declared brain dead while his vital
organs are being maintained on a machine.
2. Organ donors can be anyone up to age 75.
How does one become a cadaver organ donor?
1. The prospective organ donor should tell to his
family his wishes and in the event of death,
permission by his family/next of kin.
2. He must also a sign a donor card or express
his intentions in their driver’s license.
Although these are both considered legal
documents, his family’s permission of
donation must still be obtained.
Can human organs be bought or sold?
 DOH ISSUED THE ADMINISTRATIVE ORDER
NO. 124, SERIES OF 2002  what is the correct course of action to take.
3 Types Of Living Donations Matching Donors To
Recipients
1. Directed Donation – Donor specifically
chooses who will receive the transplant.
2. Non-Directed Donation – Donor is neither
related to not known by the person in need.
3. Paired Donations (Kidney Only) – Involves at
least two pairs of living kidney donors and
transplant candidates who do not have
matching blood types.
RA 7170 ORGAN DONATION ACT OF 1991 Ethical
Consideration in Living Donation
1. The demand for solid organs far exceeds the
number of organs available from deceased
donors.
 Identify relatives or others who would be
willing to donate the needed organ or partial
organ directly.
2. Organ donation by living donors clearly saves
lives, improves transplantation outcomes
under some circumstances, and reduces
recipient’s waiting times.
3. The transplantation of organs from living
donors seems to violate the traditional first
rule of medicine primum non nocere (above all
do no harm)
PRINCIPLE OF ORDINARY AND
EXTRAORDINARY MEANS
Ordinary Means
All medical, treatments, and operations that offer
reasonable hope of benefit:
 Obtained without excessive expense
 Without excessive pain
 Without other inconvenience
Given to the patient for the hope of improvement and
may be called appropriate.
According to John Paul II, the following are ordinary
means:
1. Nutrition
2. Hydration 
3. Cleanliness
4. Warmth
If the treatment does not offer reasonable hope, is
excessively expensive, or is inconvenient, then it
would be classified as an extraordinary intervention
and would only be optional and not be morally
obligatory—a conclusion which can give peace of
mind to the family who may be facing a dilemma as to
Extraordinary Means
All medicines, treatments, and operations that cannot
be obtained or used without:
 Excessive expense
 Excessive pain
 Excessive inconvenience
If used, would not offer reasonable hope of benefit
 “medical procedures which no longer
correspond to the real situation of the patient,
either because they are by now
disproportionate to any expected results or
because they impose an excessive burden on
the patient and his family.”
 What is “ordinary” for one patient would be
“extraordinary” for another.
How can we know when a treatment is Ordinary
(morally obligatory) or Extraordinary (optional)?
The Church gives us helpful advice: “by studying the
type of treatment to be used, its degree of complexity
or risk, its cost and the possibilities of using it, and
comparing these elements with the result that can be
expected, taking into account the state of the sick
person and his or her physical and moral resources”
(Sacred Congregation for the Doctrine of the Faith
1980, part IV).5
“the treatment is ordinary, but the family could not
afford it.
Ordinary (or extraordinary) is not simply a technical
explanation of the complexity of a treatment, but
rather a description of the overall set of circumstances
including the treatment proposed, the burden
imposed, the degree of success, pain incurred, as well
as the financial situation of the patient and family.
If the family cannot afford it, then the treatment is
not ordinary but extraordinary
human dignity and an inability to pursue the truly
fulfilling goals of human life.
The Gift of Sexuality
 Must be used in keeping with its intrinsic,
invisible, specifically human teleology.
 Must be a loving, bodily, pleasurable
expression of the complementary, permanent
self-giving of a man and a woman to each
other.

What care would be necessary?

A caring doctor can give very helpful advice
about the treatment required. At times the family may Generally Recognized Values:
feel pressure to do everything possible to keep their
1. Sex is a search for sensual pleasure and
loved ones alive but our heart needs to be guided also
satisfaction, releasing physical and psychic
by our head. The family should avoid the temptation
tensions.
to subsequently change that decision in moments of
2. Sex is a search for the completion of the
medical crisis except for valid, serious, and medically
human person through an intimate personal
justifiable reasons, not merely misplaced emotional
union of love expresses by bodily union.
ones. Overly aggressive and futile treatment should
3. Sex is a social necessity for the procreation of
never be employed just to try to meet unrealistic
children and their education in the family so
demands.
as to expand the human community and
Avoid Euthanasia guarantee is future beyond the death of
 The Catechism of the Catholic Church states,  individual members.
 direct euthanasia consists in putting an end to 4. Sex is a symbolic (sacramental) mystery,
the lives of handicapped, sick, or dying somehow revealing the cosmic order:
persons. Thus an act or omission which, of
For Secular Humanis, Reasonable Uses of Sex
itself or by intention, causes death in order to
eliminate suffering constitutes a murder 1. Use sex purely for sake of pleasure apart from
gravely contrary to the dignity of the human any relation to love or family
person and the respect due to the living God, 2. Use it to reproduce without any reference to
his Creator. The error of judgment into which pleasure or love.
one can fall in good faith does not change the 3. Expression of unselfish love, but without any
nature of this murderous act, which must relation to marriage or family.
always be forbidden and excluded. (Catechism
2 Norms of Sexual Morality
1997, n. 2277)
1. Laws or social attitudes that hinder human
freedom to achieve these values in ways the
PRINCIPLE OF PERSONALIZED individual's desires are unjust and oppressive.
SEXUALITY 2. Sexual behavior, at least among consenting
adults, is entirely a private matter to be
Sexuality – A complex aspect for our personality and
determined by personal choice, free from any
self. Our sexuality is defined by sexual thoughts,
moral guilt.
desires and longings, erotic fantasies, turns-ons and
experiences.

Personalized Sexuality – Is based on the

understanding of sexuality as one of the basic traits of
the human person and must be developed in ways
consistent with enhancing human dignity. This
element of human character often leads to a loss of
  Intimacy – The ability and need to experience
emotional closeness to another human being
and have it returned.
 Identity – The development of a sense of who
one is sexually, including a sense of maleness
and femaleness 
 Sexualization- The use of sexuality to
influence, control or manipulate others. 
 Sexual Health and Reproduction- Attitudes
and behaviors related to producing children
and health consequences of sexual behavior.

Bioethics and its Application in

Various Health Care Situations
SEXUALITY AND HUMAN
REPRODUCTION
Human Sexuality and its Moral Evaluation

What is Human Sexuality?

 It is the total of our physical, emotional and
spiritual responses, thoughts and feelings.
Sexuality is more about who we are than
about what we do.
Sexual Expression: Behavior of how someone releases
Biologic Gender – A term used to denote a person’s sexual desires and achieves sexual fulfillment.
chromosomal sex: male (XY) or female (XX)
1. Bisexuality – Sexual attraction to and activity
Gender Identity – The inner sense a person has of with both genders
being male/ female, which may be the same as or 2. Heterosexuality – Male-female sexual
different from biologic gender. relationships
3. Homosexuality – Sexual attraction to a member
Development of Gender Identity of the same gender
4. Transvestism – Obsession with wearing clothing
1. Infancy – Gender identity is established early in of the opposite gender
life. 
2. Preschool – distinguish between males and Types of Sexual Expression
females   Celibacy
3. School-age – imitating adult roles (gender  Masturbation
roles)   Erotic stimulation 
4. Adolescent- establishment of sense on identity   Fetishism 
5. Young adult – choose way(s) on expressing  Transvestism 
sexuality   Voyeurism 
6. Middle-age adult – achieved a degree of  Sadomasochism 
stability   Exhibitionist 
7. Older adult - enjoys active sexual relationship  Pedophiles 
 Zoophilia
Components of Human Sexuality

 Sensuality – Awareness, acceptance of and

comfort with one's own body; physiological
and psychological enjoyment of one's own
body and the bodies of others 

Meaning of Sex in the Individual
 Sexual meaning permeates our physical
proximity to one another and makes us more
aware of our individual existence. We become
more aware of ourselves and explore
ourselves through this sexual meaning.
 In other words, the entire being of a human is
exposed in the life of sex. In sexual meaning,
we know that we are alone and separate
powerless and ignorant, strong and poor,
empty and homeless, inadequate and
incomplete.
 Sexual meaning consequently makes us realize
that there is a need for some measure of
accomplishment that only the other can give.
In other words, we come to know more about
our true self We become conscious of
ourselves 
 According to the author of the genesis after
Adam and Eve, ate the forbidden fruit that the
truth was revealed, as their eyes were open,
and they became aware of themselves as both
male and female.
One inhumanity to another
 Undoubtedly, there are aspects of sex that
suppress and kill equality. In other words, sex
may become an obstacle to an individual's
ability to become completely human. 
For example, if sex becomes a degradation of one's
identity, it no longer plays the humanizing role that it
should play in one's life. And if sexuality is no longer
accompanied by a profound respect for human dignity
and moral integrity, it will become inhumanity to one
another.  Orientation or Gender Identity or Expression
 In this case, an individual is dehumanized and
depersonalized. He or she is reduced to a
simple object or play unit, manipulable and
accessible at anytime and anywhere. A trim
and insensitive human abuse, "the use of man
by man”. In this sense, we have what we call
sexual alienation — sex alienates us from our
ability to become fully human. A person
becomes a slave to sex, which in turn
becomes the master of a person.
Humanizing and Dehumanizing
 We may gather from this that human sexuality
can be either humanizing or dehumanizing.
Humanizing as it helps one to understand
oneself as much as it takes the other to
fulfillment. They both achieve reciprocal self-
fulfillment and unitive self- fulfillment. 
 Sexual love is humanizing if it is taken as a sort
of personal engagement and responsibility to
challenge one's loyalty with love. Authentic
mutual, unitive self- realization is thus made
possible by and through responsible sexuality.
 Human sex, on the other hand, is
dehumanizing if and when it damages the
dignity of an individual and becomes a
humiliation of the other. Dehumanizing
sexually entails using the other as a tool to
one's own end.
 Sexual
Orientation and
Gender Identity
Expression
(SOGIE) Equality
Bill
Sexual Orientation and Gender Identity Expression
(SOGIE) Equality Bill
 House Bill No. 4982 or  “An Act Prohibiting
Discrimination on the Basis of Sexual
(Sogie) and Providing Penalties Therefor”
The Purpose:
 The SOGIE Equality Bill is meant to fulfill the
rights set forth in the 1987 constitution,
 particularly the equal protection clause. It
recognizes the LGBTQ+ as equals and ensures
that their rights are protected in as much as
everyone’s is. The bill also acknowledges the
Philippines duties under international law
particularly the Universal Declaration of
Human Rights and the International Covenant
on Civil and Political Rights. It thus recognizes
the non-discrimination of the LGBTQ+ as both
a national and international duty.
Human Sexuality and its Moral Evaluation
 The human desires and activities that involve
the search for and attainment of sexual
pleasure or satisfaction and, on the other
hand, to the human desires and activities that
involve the creation of new human beings. For
it is a natural feature of human beings that
certain sorts of behaviors and certain bodily
organs are and can be employed either for
pleasure or for reproduction, or for both.
 Moral qualities of a relationship are more
primary for evaluating any relationship than is
the sexual orientation of the persons involved.
Intimate same-sex relationships may have
these necessary qualities. Heterosexual ones
may not. What matters are mutual
responsibility, commitment, fidelity,
forgiveness and generativity. Relationships
with these qualities are consistent with the
fundamental commitment of Christians to
love of God and love of neighbor. Such
relationships may signify the union between
Christ and the Church.
Marriage
Marriage is defined differently, and by different
entities, based on cultural, religious, and personal
factors.
 a formal union and social and legal contract
between two individuals that unites their lives
legally, economically, and emotionally.  used of artificial means which hinder the
 Being married also gives legitimacy to sexual
relations within the marriage.  act.
Marriage is another human construction to ensure the
continuity of the family and the eventual perpetuation
of the human specie.
The New Family Code of the Philippines, which
became effective on August 3,1998, defines Marriage
as a special contract of permanent union between a
man and a woman entered into in accordance with
law for the establishment of conjugal and the family
life.
Aspects of Marriage
 First, the Legal point of view: posits that
marriage is a contract.
 Second, religious point of view: What God
has put together let no man put asunder.
Forms of Marriage
 Monogamy – Marriage between one man and
one woman.
 Polygamy
a. Polygyny – one husband and two or
more wives.
b. Polyandry – one wife and two or more
husbands.
c. Group marriage – two or more
husbands and two or more wives.
Issues on Sex Outside Marriage and Homosexuality
1. Filipinos remain a morally conservative
2. Most religions tend to disapprove of
extramarital and premarital sex.
3. Kant thinks that sex is morally permissible
within the context of a heterosexual, lifelong,
an monogamous marriage.
4. St. Aquinas and other Natural Law theorists
would say that our sexual faculties have one
true end — procreation.
Issues on contraception, its morality, and Ethico-
Moral Responsibility of Nurses
The expression of the conjugal will of a man and
woman to parenthood is commonly called sexual
intercourse or coitus, the celebration of physical,
mental and spiritual intimacy. 
What is Conception?
 Contraception is thus defined as the voluntary
prevention and contraception by the positive
generative cells from uniting during sexual
 
 The moral issue of contraception is concerned
with the rightness or wrongness of the use of
various methods by which CONTRACEPTION
can be PREVENTED in the conjugal union. 
Methods of Contraception:
1. Folk Methods
 Precoital /postcoital douche 
  Prolonged lactation   According to Fletcher, (the one who founded
 Withdrawal ethics) that to be artificial or against nature if
2. Mechanical Methods often the highest good, in terms of moral
 Condom  values. 
 Diaphragm 
 Sponge Ethico-Moral Responsibility of Nurses on
3. Chemical Methods Contraception
 Vaginal suppositories and tablets 
 Vaginal jellies, creams and foams  Important considerations for nursing relate to
4. Hormonal Methods  attitudes, values , communication, and
 Contraceptive pills maintaining human focus care. 
 Injection and implants   Fostering good communication.
5. Surgical Methods   Encouraging clients to make decision. 
 Tubal ligation   Avoiding judgement about the rightness and
 Vasectomy  the wrongness of the decision based on
 Hysterectomy personal values and accepting decisions even
6. Abortifacients  if they are different. 
 Intrauterine device   Remember that the client is the ultimate
 Diethylstilbestrol 
decision maker. 
 Prostaglandins 
 Self awareness related to values, beliefs and
 Anti-pregnancy vaccine 
reactions. 
 Low dose type of contraceptive pills
7. Natural or behavioral Methods  Listen to their fears and concerns. 
 Rhythm or calendar method  Raising awareness among women about all
 Temperature method  the methods of contraception and to address
 Ovulation method their questions, can expel myths and help to
 Sympto-thermal method  reduce the large numbers of unintended
 Sex relation during menstruation  pregnancies
Applications of Ethical Theories/Morality  Nurses should ensure that they work within
 Natural law moralists are divided on the issue the limits of their competence and are aware
of contraception: only rhythm method and of how and where to refer women for
abstinence. specialist support, if required. 
 The neo-scholastic ethicians consider the  This goes hand in hand with respecting the
natural order as designed by God. Majority of autonomy of the patient: the nurse must
the members of this commission took the respect the patient's right to make their own
position that contraception does not conflict decisions, which means the doctor together
with human nature and the natural law if it is with the nurse should provide the method the
practiced to promote responsible patient prefers unless there is a medical
parenthood.  reason not to do so. 
 Rhythm or safe method is allowed by the  Nurses have an obligation to maintain patient
encyclinical.  confidentiality.
 Roman Catholic church views voluntary
sterilization as intrinsically wrong in so far as it Issues on Artificial Reproduction, its Morality and
involves the frustration of natural power and Ethico-Moral of Nurses
function. Artificial Insemination
 Utilitarianism with its principle of utility, may
justify contraception and sterilization in terms Introduction of sperm into the female’s vaginal vault,
of the great happiness and benefits that they uterus or cervix for the purpose of achieving
will ultimately bring forth. pregnancy other than sexual intercourse
 Pragmatism may likewise consider the
Two Processes:
practically, usefulness and benefits and that
the practice of contraception can provide for 1. Homologous or AI from husband (AIH) – the
couples who want to limit the number of sperm used in artificial insemination comes
children that they can support and educate.  from the husband of a woman
 2. Heterologous or AI from a Donor (AID) – the  AIH and AID promote more good than
sperm used is not from the source of the harm, more happiness than unhappiness,
husband but from a donor more pleasure than pain for a childless
couple
Issues:
 Therefore, it is being advocated
 Only AIH is acceptable
 AID is considered as “permitted” adultery 4. Pragmatism ethics
 Health care provider should not support AID  AI is the most practical, beneficial and
useful technique to be undertaken by
Justification of AIH: spouses w/ reproductive problems
 Husband’s impotence
 Anatomical defects of urethra 5. Kant’s Ethics
 Deficient sperm count (oligospermia)  AI should be agreed upon by both spouses
 Some type of spinal injury and other physical and none of the spouses should be used
problem that hinders normal intercourse only as means to an end
 Vasectomy
 Physiological obstruction which the sperm
cannot reach the ovum
 In Vitro
Justification for AID: Fertilization


Husband is sterile
Husband is carrier of a hereditary disease  In Vitro
Fertilization
 Wife’s oocyte is defective
 Wife’s fallopian tube is severely damage by
gonorrhea In Vitro Fertilization

 In vitro fertilization (IVF) is a complex series of

procedures used to help with fertility or
prevent genetic problems and assist with the
Application of Ethical Theories: conception of a child. 
 During IVF, mature eggs are collected
1. Natural Law Ethics
(retrieved) from ovaries and fertilized by
 Considers AI to be Immoral. Since the child
sperm in a lab. Then the fertilized egg
is not the fruit of conjugal act or an
(embryo) or eggs (embryos) are transferred to
expression of personal love
a uterus. 
 Transfer procreation in the laboratory. AI
 One full cycle of IVF takes about three weeks. 
splits the sexual unity of husband & wife in
 The procedure can be done using a couple's
marriage into laboratory, conjugal love is
own eggs and sperm. Or IVF may involve eggs,
completely lost
sperm or embryos from a known or
 Contrary to the unity of marriage, to the
anonymous donor.
dignity of a couple, to vocation proper to
 The first step in IVF is taking fertility
parents, and the child’s right to be
medications for several months to help your
conceived in this world in marriage and
ovaries produce several eggs that are mature
from marriage
and ready for fertilization. This is called
ovulation induction.
2. Situational Ethics
 Once your ovaries have produced enough
 Endorse AI as right to overcome
mature eggs, your doctor removes the eggs
childlessness.
from your body (this is called egg retrieval).
 Parenthood is not a matter of biological
 You’ll get medicine to help you be relaxed and
reproduction, rather accepting the
comfortable during the procedure. Using an
responsibility of caring and rearing a child
ultrasound to see inside your body, the doctor
puts a thin, hollow tube through your vagina
3. Utilitarianism
and into the ovary and follicles that hold your
 eggs. The needle is connected to a suction
device that gently pulls the eggs out of each
follicle.
 About 3-5 days after the egg retrieval, 1 or
more embryos are put into your uterus (this is
called embryo transfer).  They then carry the baby and deliver it for you
Why is it done?
 Fallopian tube damage or blockage
 Ovulation disorders.
 Endometriosis
 Previous tubal sterilization or removal.
 Impaired sperm production or function.
 A genetic disorder.
 Unexplained infertility.   donor), fertilize them with sperm from the
Side effects of IVF
Like all medications and medical procedures, IVF has
some risks and possible side effects. These include:
 bloating
 cramping
 breast tenderness
 mood swings
 headaches
 bruising from shots
 allergic reaction to medicines
 bleeding
 infection
IVF can also be difficult emotionally, both for the
person having the procedures and for their partner
and/or family. Many people doing IVF treatments
struggle with depression and anxiety throughout the
process.
Issues, its Morality and Ethico-Moral of Nurses
The main issues that raise ethical dilemmas following
the development of assisted reproduction techniques
are: 
Surrogate Motherhood
There are two kinds:
1. Traditional surrogate. It's a woman who gets
artificially inseminated with the father's sperm.
and your partner to raise. A traditional
surrogate is the baby's biological mother. That's
because it was their egg that was fertilized by
the father's sperm. Donor sperm can also be
used.
2. Gestational surrogates. A technique called "in
vitro fertilization" (IVF) now makes it possible
to gather eggs from the mother (or an egg
father (or a sperm donor), and place the
embryo into the uterus of a gestational
surrogate. The surrogate then carries the baby
until birth. They don't have any genetic ties to
the child because it wasn't their egg that was
used.
Moral and Ethical Objection of IVF
1. Sanctity of life. – Human life has immeasurable
value in all its forms, including the earliest
stages beginning with fertilization. Embryos
should never be treated carelessly or
destroyed. Unfortunately, some IVF practices
create numerous embryos that are likely to die
or be frozen for an indefinite period.
2. Meaning of marriage.  – What are the
consequences to the God-designed marital
union if sperm from a third party is used, or if
the baby is carried by a surrogate? Modern
science can overstep its boundaries if it creates
artificial divisions between sex, conception,
and childbirth.

✓ Age limit 
✓ the process of in vitro fertilization itself-is it morally
acceptable to interfere in the reproduction process?  Ethico-Moral Responsibility of Nurses
✓ the involvement of a third party in the reproductive  Regardless of technology , important
process by genetic material donation;  considerations for nursing relate to attitudes
✓Single women and same-sex couples and values , communication, and maintaining
✓ Egg sharing human focus care
✓ Surrogacy  Self awareness related to values, beliefs and
✓ Commercialization of IVF reactions
✓ Meaning of Marriage  Fostering good communication, encouraging
other to make decision, avoiding judgement
about the rightness and the wrongness of the
 decision based on personal values and
accepting decisions even if they are different
from what the nurse would do.
 Nurse who cannot reconcile with a particular
situation need to take the necessary step to
remove themselves from the situation so as
not to compromise patient care or personal
integrity, and in doing it is essential to avoid
abandoning the patient giving them the
assurance that somebody will provide the
needed care.   Removal of a fetus is due to secondary
 Nurses should determine who is involved in
the decision making and how the nurse fits in
the scenario; an advocate to the physician,
 Know what the physician had informed them
and assess their understanding  pregnancy
 Listen to their fears and concerns 
 The patient and the surrogate is the ultimate
decision maker.
Morality of Abortion, Rape and Other Problems
Related to Destruction of Life
Abortion
 Termination of pregnancy, spontaneously or
by induction.
 The expulsion of a living fetus from the
mother’s womb before it is viable.
1. Natural Abortion
 Also known as “Spontaneous” or
“Accidental”, “Miscarriage”,
“Unintentional”
 Expulsion of the fetus through natural or
accidental causes.
 It assumes a moral bearing only if it is a
voluntary cause.
2. Direct Or Intentional Abortion
 Deliberately induced expulsion of a living
fetus before it has become viable.
 This can be done with jogging, horseback
riding and aerobic exercises which causes
the inflammation of uterine wall thereby
inducing abortion
3. Therapeutic Abortion
 Deliberately induced expulsion of the
fetus in order to save the mother’s life.
 Perform by the doctor when the life of
the mother is in danger of death.
4. Eugenic Abortion
 Recommended when there is defect
found in developing fetus.
 It’s better for a child not to be born than
for it to live miserable life
 It is termed eugenic because it is meant
to get rid of the babies and thus
preventing them contaminating the
human species.
5. Indirect Abortion
effects of a legitimate or licit action.
 This is an instance of a double effect
principle.
 Example: woman who has asymptomatic
ENSOULMENT
PHENOMENON
Ensoulment Phenomenon
 Occurs from the moment of Conception – to
expel or abort is to commit murder
 Occurs not from the moment of conception –
abortion before implantation is morally licit.
 Immediate Hominization – human people
exist immediately upon conception.
 Delayed Animation – upholds that ensoulment
occurs later but not from the moment of
conception.
Three Viewpoints of Abortion
1. CONSERVATIVE – abortion is never permissible
2. LIBERAL – abortion is always permissible
3. MODERATE OR INTERMEDIATE – permissible
up to a certain age of fetal development
Positions
1. Pro-Life: Disapproving abortion
2. Pro-Choice: approving views on abortion
Justification of Abortion
1.  Personal Reasons
 Freedom of choice
 Liberates decision
 Safeguards mother 
 Protects reputation
 2. Social Reasons 3. Confidentiality – we need to maintain
 Support pro-choice position anonymity of the client’s and keep records
 Alleviated economic, sociological or confidential.
demographic problem
 
3. Fetal Reasons  
 Prevents birth or terribly malformed or
defective children

Application of Ethical Theories

1. AUTONOMY 
 the mother has the freedom to decide
on her own body
2. BENEFICENCE 
 based on the obligation to the
pregnant woman to protect her life or
her health.
3. DOUBLE-EFFECT 
  can also applied on this issue.

Sexual Assaults

 crime against persons

 difficult and sensitive topic to discuss.
 most of the time young girls are the victims.

 Rape

 is forced, unlawful sexual intercourse without

the victim’s “Consent”
 it can happen to both men and women of any
age.
 Types of Rape:
1. ACQUAINTANCE RAPE – when the victim
and the rapist know each other
2. SPOUSAL RAPE – between married
couple
3. GANG RAPE – when the posal is being
raped by a group of people
4. MINOR RAPE -occurs when a child is
raped by an adult.
5. COLLEGE CAMPUS RAPE – when the
rape is done inside the college premises
or by a college man or woman.
6. STATUTORY RAPE – when adults
engaging in consensual sexual relations
with sexual mature minors under the
age of consent.

Ethical Application

1. Kant’s Ethics – deemed immoral by Kant’s

standards as they dehumanize the victim
2. Utilitarian Approach – rape is never moral