Lesson 5: Principles

of Bioethics
Introduction:

Ethics refers to standard of conduct, derived

from principles of right and wrong. We must be able to distinguish right from wrong, good from evil, and
propriety from impropriety – at times difficult. We must commit ourselves to do what is right, good and
proper.

Bioethics is the study of the ethical issues emerging from advance in biology and medicine. It is a branch
of ethics, which is the interdisciplinary study of problems created by biological and medical progress
(micro and macrosocial level), and its impact in society and value system, both for now and for the
future.

Birth of Bioethics

Bioethics was preceded by medical ethics, which focused primarily on issues arising out of the physician
– patient relationship. The ancient Hippocratic Literature (which includes but is not limited to the
Hippocratic Oath) enjoins doctors to use their knowledge and powers to benefit the sick, to heal and not
to harm, to preserve life, and to keep in the strictest confidence information that ought not to be spread
about (though precisely what must be kept confidential is not detailed).

Objective:

1. Display communication skills with client and/or support system base on trust, respect and shared
decision making using appropriate communication/interpersonal techniques/strategies.

At the start of this lesson, you are to take pre – assessment test to see how much background
information and knowledge you have.
This lesson is self – instructional. You can read, analyze concepts and ideas presented and relied on
them. The activities and self – check questions will help you assess how you progress as you go through
the module.
The answers to the self – check questions and activities may be self – evaluated by your facilitator if
you so desire. These will be part of your formative evaluation. Do not write your answers in the module.
Your answers should be written in separate sheet.
The answer to self – check questions and activities are found at the end of the lessons. The post –
assessment will be given in a separate booklet upon completion of the module. It will serve as the
summative evaluation of your performance.
Remember, you are to work on this module independently. I shall not be around to supervise you as
you go through each lesson. It is expected that you will make the most this module
and grow professionally in your desire to become a competent Nurse, determined to make a difference.

Pre - Assessment Test

Multiple Choice: Directions: Read the sentences carefully. Choose the best answer. Write the letter of you
choice.
1. This principle requires that the gifts of human life and its natural environment be used with
profound respect for their intrinsic ends.
a. Principle of double effect c. Principle of Totality
b. Principle of Stewardship d. Principle of Cooperation
 2. This principle advocates maintaining the wholeness of the body but it extended to allow for
removal of a part of the body, if it is done in the interest of or the benefit of the whole person.
a. Principle of Stewardship c. Principle of Cooperation
b. Principle of Totality d. Principle of Solidarity
3. Means reasonable hope of benefit/success; not overly burdensome; does not present an
excessive risk and are financially manageable
a. Ordinary Means c. Principle of Totality
b. Extraordinary Means d. Principle of Stewardship
4. It is a complex aspect of our personality and self. One sexuality is defined by sexual thoughts,
desires and longings, erotic fantasies, turn – ons and experience.
a. Ordinary Means c. Sexuality
b. Extraordinary Means d. Principle of Stewardship
5. This element of human character often leads to a loss of human dignity and am inability to
pursue the truly fulfilling goals of human life.
a. Ordinary Means c. Sexuality
b. Extraordinary Means d. Personalized Sexuality

Pls. Read

1.Principle of Stewardship and Role of Nurses as

Stewards
 This principle is grounded in the presupposition that God has
Absolute Dominion over creation and as human beings are made
in God’s image and likeness (Imago Dei), we have been given a
limited dominion over creation and are responsible for its care.
 The principle requires that the gifts of human life and its
natural environment be used with profound respect for
their intrinsic ends.
 Human life comes from God
 We have the responsibility to protect and defend it
 We have the obligation to seek appropriate medical care to
ensure proper functioning

Example:

 The concept of stewardship has been applied in

diverse realms, including with respect to
environment, economics, health, property,
information and religion and is linked to the
concept of sustainability.

2.Principle of totality and its integrity

 “According to the Philosopher Thomas Aquinas, all 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.
 Based on Natural Law
 We have the duty to preserve ourselves
 However, a single part may be sacrificed if the loss is necessary for the good of the whole
person.
 It refers to the 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 whole as the
imperfect for the sake of the perfect” (St. Thomas Aquinas, Summa Theologica II, Question 65,
Article 1 ),
 These principles dictate that the well - being of the whole person must be taken into account in
deciding about any therapeutic intervention or use of technology.

Totality – Application in Health Care

Example:
Under the principle of Totality, organ donations are allowed if the organ donation would save another
from a serious physical threat, if the donation does not diminish the functional integrity of the person and
if the organ donation was an act of charity with free and informed consent from the donor.

This principle advocates maintaining the wholeness of the body but is extended to allow for removal of a
part of the body. If it is done in the interest of or the benefit of the whole person.
Example:
This would permit the amputation of an extremity in order to save the rest of the body. In addition, to
the assumed need for totality in the resurrection of the body, the principle of totality includes the
charitable donation and mutilation of the body.

3.Principle of Ordinary and Extraordinary Means

 Withholding or Withdrawing Treatments

Ethical Perspective

o When are we morally obliged to start or to continue a treatment?

o When are we morally obliged to refuse or discontinue a treatment (even if this would lead to
death)?
o What are the ethical principle?
o Principle of Ordinary and Extraordinary Means
- Ordinary Means - Ordinary Means reasonable hope of benefit/success; not overly
burdensome; does not present an excessive risk and are financially manageable.
Francisco De Vitoria (1486 -1546)
“If a sick man can take food or nourishment with a certain hope of life, he is required
to take food as he would be required to give it to one who is sick. However, if the
depression of spirits is so severe and there is present grave consternation in the
appretitive power so that only with the greatest effort and as though through torture
can the sick man take food, this is to be reckoned as an impossibility and therefore,
he is excused, at least from mortal sin.
(cited in Clark, 2006 p. 50)
Domingo Soto (1494 – 1560)
Amputation/mutilation
… no one can be forced to bear the tremendous pain in the amputation of a member
or in an incision into the body because no one is held to preserve his life with such
torture.
 (cited in Cronin, 1989)
Juan De Logo (1583 – 1660)
Reasonable hope of benefit
Patient’s perspective

Elements of Ordinary Means

1. Reasonable proportionate hope of benefit/success
2. Common diligence
3. Proportionate – physical/social/financial
4. Not unreasonably demanding

Elements of Extraordinary Means

1. “Certain Impossibility” – physical or a moral
2. Great effort – excessive
3. Pain
4. Exquisite and extraordinarily expensive
5. Severe dread or revulsion

Development (Gerald Kelly)

 Ordinary means – “all medicines, treatments and operations, which offer a reasonable hope of
benefit for the patient and which can be obtained and used without excessive expense, pain or
other inconvenience.”
 Extraordinary means – “all medicines, treatments and operation, which cannot be obtained or
used without excessive expense, pain, or other inconvenience, or which, if used, would not offer
a reasonable hope of benefit” (Kelly 1957 p 129)

Situation
Susan is a 45 years old mother of two young boys. She recently noticed a small lump in her right
breast. She ignored it for a while, thinking that it was probably a cyst. However, after some
encouragement from her friends, she decided to see her GP. The GP referred her for a mammogram,
which confirmed that the lump was abnormal and warranted further investigation. The results of a
biopsy confirmed that it was a malignant tumor.
Surgery was recommended. Although it was not be a mastectomy but rather a lympectomy.
Susan was still very concerned about the scarring afterwards. She was a model when she was in her
20s.
The surgery was a success. But it was discovered that many of her lymph nodes were involved. Her
consultant immediately referred her to the consultant oncologist to discuss a programme of
chemotherapy.
Susan is not quite adamant that she does not want to undergo chemo. She feels that this is too
much to endure. Her aunt – who die some years ago from cancer – also had chemo and had a
particularly difficult time with it. Up to now, Susan has gone private and paid for consultant’s fees to
ensure she did not have to wait long for treatment. However, she is not willing to spend more money
on consultant’s fees. She is a great believer in the body’s natural healing powers and is happy to take
any natural remedies to help her.
She also believes that the health care team are not being completing honest with her, they speak
in the language of “outcomes” and “survival rates”. She thinks it is all for nothing.

4.Principle of Personalized Sexuality

Sexuality
- Sexuality is a complex aspect of our personality and self. One sexuality is defined by sexual
thoughts, desires and longings, erotic fantasies, turn – ons and experience.
 Personalized Sexuality
- Is based on 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 human dignity and am inability to
pursue the truly fulfilling goals of human life.
As the image of God, man is created for love.
Genesis 1-3
Teaches that God created persons as male and female and blessed their sexuality as a great and
good gift.

The Gift of Sexuality

o Must be used in keeping with its intrinsic, individualistic, indivisible, specially human
teleology.
o Must be a loving, bodily, pleasurable expression of the complementary, permanent self
giving of a man and a woman to each other.

Generally Recognized Values

1. Sex is a search for sensual pleasure and satisfaction, releasing physical and psychic tension.
2. Sex is a search for the completion of the human person through an intimate personal union
of love expressed by bodily union.
3. Sex is a social necessity for the procreation of children and their education in the family as
to expand the human community and guarantee its future beyond the death of individual
members.
4. Sex is a symbolic (sacramental) mystery, somehow revealing the cosmic order.

For Secular Humanists, reasonable uses of Sex

 Use Sex purely for the sake of pleasure apart from any relation to love or family.
 Use it to reproduce (make test-tube babies) without any reference to pleasure or love.
 Expression of unselfish love, but without any relation to marriage or family.
Sex = Symbolic Mystery
↓
Love and Ecstasy

2 Norms of Sexual Morality

1. Laws or social attitude that hinder human freedom to achieve these values in ways the
individual desires are unjust and oppressive.
2. Sexual behavior at least among consenting adults, is entirely a private matter to be
determined by personal choice free from any moral guilt

Multiple Choice: Directions: Read the sentences carefully. Choose the best answer. Write the
letter of your choice.
1. This principle requires that the gifts of human life and its natural environment be used with
profound respect for their intrinsic ends.
a. Principle of double effect c. Principle of Totality
b. Principle of Stewardship d. Principle of Cooperation
2. This principle advocates maintaining the wholeness of the body but it extended to allow for
removal of a part of the body, if it is done in the interest of or the benefit of the whole person.
a. Principle of Stewardship c. Principle of Cooperation
b. Principle of Totality d. Principle of Solidarity
3. Means reasonable hope of benefit/success; not overly burdensome; does not present an
excessive risk and are financially manageable
a. Ordinary Means c. Principle of Totality
b. Extraordinary Means d. Principle of Stewardship
4. It is a complex aspect of our personality and self. One sexuality is defined by sexual thoughts,
desires and longings, erotic fantasies, turn – ons and experience.
a. Ordinary Means c. Sexuality
b. Extraordinary Means d. Principle of Stewardship
5. This element of human character often leads to a loss of human dignity and am inability to
Self Assessment

Before you end this lesson, evaluate your current competency by answering the checklist that follow. Put
a check (/) mark to best describe your current level of mastery of each list of competency.

Competency I can do I can do this but I I am learning how I can not

this very need to learn to do this do this yes
well more and improve (Apprentice) (Novice)
(expert) (Practitioner)
1. Define Principle of
Totality
2. Define Principle of
Stewardship
3. Define ordinary and
extraordinary means

References:
1. Raymond S. Edge, J. Randall Groves (2019) Ethics of Health Care Fourth Edition. Philippines