BIOETHICS MIDTERM REVIEWER
Human conduct – deliberate, free and how one
Course Unit 1
Introduction to Bioethics
BIOETHICS - is a field of study concerned with
the ETHICS and philosophical implications of
certain biological and medical procedures,
technologies, and treatments, as organ
transplants, genetic engineering, and care of the
terminally ill.
- A science that deals with the study
of the morality of human conduct concerning
human life in all its aspects from the moment of
its conception to its natural end.
HEALTHCARE ETHICS - is the field of applied
ethics that is concerned with the vast array of
moral decision-making situations that arise in
the practice of medicine in addition to the
procedures and the policies that are designed to
guide such practice. Health ethics is employed
to regulate human conduct in the practice of
health care so that the good may be done and
evil may be avoided thereby ensuring the
purpose of health care.
NURSING ETHICS - can be defined broadly as
the examination of all kinds of ethical and
bioethical issues from the perspective of nursing
theory and practice which, in turn, rest on the
agreed core concepts of nursing, namely:
person, culture, care, health, healing,
environment and nursing itself.
PROFESSIONAL ETHICS - Is the division of ethics
that relates to professional behavior.
ETHICS
It is a PRACTICAL science of morality of human
conduct that implies direction;
Science – deals with complete and systematic
body of factual and empirical data and
reasoning;
Moral – dictates of reason on how things should
be.
person SHOULD ACT.
Ethics - concerns the needs and values of
human persons in all matters of human concern
including HEALTH; nothing is more human and
personal than HEALTH; Ethics is concern with
the study of social morality and philosophical
reflection on its norms and practices; Moral
issues deals with respect for life, freedom, love,
issues that provokes conscience; issues that
responds to ought, should, right, wrong, good,
bad and complicated.
The Human Being
The PERSON
- (Biblical) Created in the image and likeness of
God; differing from animals due to possession of
spiritual intelligence and free will;
- God produces the human body through the
cooperation of human parents; the creation of
the human soul is direct act of God;
- Each person is unique and irreplaceable; and
are called not only to maturity but to eternal
life.
HUMAN ACTS & ACTS OF MAN
- Human act is an act which proceeds from the
deliberate free will of man. Man knows what he
is doing and freely chooses to do what he does;
- Not all acts are Human Acts; for an act to be
human it must have:
- KNOWLEDGE and FREEDOM HUMAN ACTS &
ACTS OF MAN
KNOWLEDGE - of what it is about and what it
means
- facts, information, and skills acquired by a
person through experience or education; the
theoretical or practical understanding of a
subject:
- awareness or familiarity gained by experience
of a fact or situation
FREEDOM – to do or leave it undone without
coercion or constraint;
- it implies voluntariness which is to rationally
choose by deliberate will the object
- an idea of reason that serves an indispensable
practical function. Without the assumption of
freedom, reason cannot act.
CONSCIENCE – spiritual discernment;
- The capacity to make practical judgement in
matters involving ethical issues;
- It is person’s most secret sanctuary where
he/she is alone with God;
- Hence the more a correct conscience prevails
the more do persons and groups turn aside
from blind choice and try to be guided by the
objective standards of moral conduct (SVC
1965)
Ethical Philosophers/Bioethicists
Immanuel Kant (1724-1804)
 A German philosopher
 was an opponent of utilitarianism
 Our emotional preferences which provides us
with values, must be checked against certain
rational standards of a PURELY formal kind;
 Supreme principle of morality referred to as
The Categorical Imperative (CI);
 Any choices we make must be such that we
would be willing for everyone else to make the
same choices (universality).
John Bordley Rawl
 Born: February 21, 1921
 an American moral and political
philosopher;
 Professorship at Harvard University, University
of Oxford;
 His magnum opus, A Theory of Justice (1971
 According to English philosopher Jonathan
Wolff, John Rawls was the most important
political philosopher of the 20th century
 Social Contract as a solution to Distributive
Justice (the socially just distribution of goods in
a society);
 Resultant theory known as "Justice as
Fairness”:
1. Society should be structured so that the
greatest possible amount of liberty is given to its
members;
2. Inequalities either social or economic
are only to be allowed only if the worst will
result under an equal distribution;
3. Finally, if there is such a beneficial
inequality, this inequality should not make it
harder for those without resources to occupy
positions of power, for instance public
office.
St. Thomas Aquinas
 Born 1225; Sicily, Italy
 Proclaimed Doctor of the Catholic Church
 Joined the Dominican Order
 (Order of Preachers – OP)
 Thomas's ethics - "first principles of action.“
 Summa theologiae , he wrote:
 Virtue denotes a certain perfection of a
power;
 Now a thing's perfection is considered chiefly
in regard to its end;
 But the end of power is act. Wherefore power
is said to be perfect, according as it is
determinate to its act.[82]
St. Thomas Four Cardinal Virtues
1. Prudence
2. Temperance
3. Justice
4. Fortitude
 The object of the theological virtues is GOD
Himself, Who is the last end of all, as
surpassing the knowledge of our reason;
On the other hand, the object of the intellectual
and moral virtues is something comprehensible
to human reason. Wherefore the theological
virtues are specifically distinct from the moral
and intellectual virtues.
William David Ross
• Born: April 15, 1877; Thurso, Scotland
• Scottish philosopher
• Education: University of Edinburgh
• The moral order...is just as much part of the
fundamental nature of the universe (and...of
any possible universe in which there are moral
agents at all) as is the spatial or numerical
structure expressed in the axioms of geometry
or arithmetic
• "moral intuitionist" theory,
• According to W. D. Ross (1877-1971), there are
several prima facie duties that we can use
to determine what, concretely, we ought to do.
• A prima facie duty is a duty that is binding
(obligatory)
• "Unless stronger moral considerations
outweigh, one ought to keep a promise made."
Course Unit 2
Theories and Principles of Health Care Ethics
Moral philosophy is the branch of philosophy
that examines beliefs and assumptions about
certain human values. Ethics is the practical
application of moral philosophy; that is, given
the moral context of good or bad,
right or wrong, “What should I do in this
situation?” The philosopher reveals an
integrated global vision in which elements, like
pieces of a puzzle, have a logical fit. By
developing theories of ethics, the philosopher
hopes to explain values and behavior related to
cultural and moral norms. Each theory is based
upon the particular viewpoint of the individual
philosopher, and maintains, within itself,
philosophical consistency.
1. Deontology- Deontological theories of ethics
are based upon the rationalist view that the
rightness or wrongness of an act depends upon
the nature of the act, rather than its
consequences. The term deontology is taken
from the Greek word for duty. Occasionally,
deontology is called formalism; some
writers refer to this type of ethical theory as
Kantianism. Kantianism is based upon the
writings of the German philosopher Immanuel
Kant, who shaped many deontological
formulations.
 Act only according to that maxim by which
you can at the same time will that it should
become a universal law.
 Act so that you treat humanity, whether in
your own person or that of another, always as
an end and never as a means only.
Deontology also implies that ethics are derived
from fulfilling duties. One must act for the sake
of duty or obligation. Most professional codes of
ethics are based upon Kantian principles.
Nurses’ codes of ethics stress both the
importance of fulfilling duties that are
inherently owed to patients and the importance
of preserving the dignity and autonomy of each
individual patient. For example, section 1.2 of
the ANA Code of Ethics for Nurses (Appendix A)
notes that, “The nurse establishes relationships
and delivers nursing services with respect for
patient needs and values, and without
prejudice.” This statement presumes that
the nurse has a duty to respect and care for the
patient in terms of the patient’s own needs and
values. It demonstrates the principles of respect
for person, beneficence, and autonomy. These
principles are so pervasive in the profession that
they often go unnoticed. When you maintain
confidentiality, when you advocate for a patient,
when you keep your promises, when you tell
the truth, and when you practice with expert
skill, you are utilizing deontic principles.
2. Utilitarianism- Utilitarianism is a pivotal form
of moral philosophy for health care delivery.
Sometimes called consequentialism,
utilitarianism is a type of teleological theory.
Telos comes from the ancient Greek language
and literally means end: Utilitarianism is the
moral theory that holds that an action can be
considered good or bad in relation to its end
result. Utilitarianism is an important ethical
philosophy that has its basis in naturalism.
According to the utilitarian school of thought,
the right action is that which has the greatest
utility or usefulness. No action is, in itself, either
good or bad. Utilitarian hold that the only
factors that make actions good or bad are the
outcomes, or end results, that are derived from
them.
 The end justifies the means
Utilitarianism is widely used in the health care
system. It is the basis for many policy-level
decisions about the distribution of health care
services and can be integral to medical
emergency triage decisions. Policy makers
attempt to wisely appropriate public funds. The
debates about funding are often in the news
and include topics on a variety of public
programs, such as Medicare, Medicaid,
managed care, family planning, pediatric
services, mental health, and others. As these
programs focus on delivering cost-effective
health care to large numbers of people, they
serve very specific narrow populations (denying
resources to others) and provide or deny very
specific services—all based upon utilitarian
principles. In emergency situations such as war
or natural disasters, utilitarianism may become
the default method of making these types of
decisions.
3. Consequentialism/Teleology -
Consequentialist moral theories evaluate the
morality of actions in terms of progress toward
a goal or end. The consequences of the action
are what matter, not their intent. This is in
contrast to previously noted theories (e.g.,
deontology, virtue ethics, and natural law) that
consider intent. Consequentialism is sometimes
called teleology, using the Greek term telos,
which refers to “ends.” Thus, one finds that the
goal of consequentialism is often stated as the
greatest good for the greatest number.
Virtue Ethics in Nursing
Virtue ethics, sometimes called character ethics,
represents the idea that individuals’ actions are
based upon a certain degree of innate moral
virtue. First noted in the writings of Plato,
Aristotle, and early Christian thinkers, there has
been a contemporary resurgence of interest in
virtue ethics. Western moralism emerged with
the idea of the cardinal virtues of wisdom,
courage, temperance, justice, generosity, faith,
hope, and charity (Kitwood, 1990). Modern and
contemporary writers also include such virtues
as honesty, compassion, caring, responsibility,
integrity, discernment, trustworthiness, and
prudence. Though nearly absent in nursing
ethics texts in the past 20 years, virtue ethics is
re-emerging as an important framework for
examining moral behavior.
Focal Virtues
In the discussion of virtue as related to
biomedical ethics, Beauchamp and Childress
(2008) define character as being made up of a
set of stable traits that affect a person’s
judgment and action. Like Aristotle, these
authors suggest that although people have
different character traits, all have the capacity to
learn or cultivate those that are important to
morality. Beauchamp and Childress propose
that there are four focal virtues that are more
pivotal than others in characterizing a virtuous
person: compassion, discernment,
trustworthiness, and integrity.
Virtue Ethics in Nursing
How does the concept of virtue or character
ethics fit with nursing as a principled
profession? It is likely that principled behavior,
while not the sole domain of a good moral
character, is more likely to occur in the
presence of one. Certainly, Florence Nightingale
thought virtue was an important trait of the
good nurse. Nightingale learned Greek as a
child. She was inspired by Plato and translated
parts of Phaedo, Crito, and Apology. Nightingale
was intrigued by Plato’s description of elite
people with rare gifts who command many
kinds of knowledge. The characteristics, or
virtues, of these people resonated with
Nightingale and were reflected in her writings
throughout her life (Dossey, 2000). She believed
that one of the aims of philosophy was to
cultivate in gifted people their potential
intellectual and moral qualities. The Nightingale
Pledge, composed by Lystra Gretter in 1893 and
traditionally recited by graduating nurses,
implies virtue of character as nurses promise
purity, faith, loyalty, devotion, trustworthiness,
and temperance. It is reasonable to say that
good character is the cornerstone of good
nursing, and that the nurse with virtue will act
according to principle. If Aristotle was correct in
his belief that virtue can be practiced and
learned, then we can learn, through practice,
those acts that, by their doing, create a virtuous
person.
Core Values of a Professional Nurse
Nursing is a caring profession. Caring
encompasses empathy for and connection with
people. Teaching and role-modeling caring is a
nursing curriculum challenge. Caring is best
demonstrated by a nurse's ability to
embody the five core values of professional
nursing. Core nursing values essential to
baccalaureate education include human dignity,
integrity, autonomy, altruism, and social justice.
The caring professional nurse integrates these
values in clinical practice. Strategies for
integrating and teaching core values are
outlined and outcomes of value-based nursing
education are described. Carefully integrated
values education ensures that the legacy of
caring behavior embodied by nurses is
strengthened for the future nursing workforce.
Course Unit 3
Ethical Principles
Ethical issues are commonly examined in terms
of a number of ethical principles Ethical
principles are basic and obvious moral truths
that guide deliberation and action. Major ethical
theories utilize many of the same principles,
though either the emphasis or meaning may be
somewhat different in each. For example,
respect for autonomy is a dominant principle in
deontological theory but is less important in
utilitarian theory. It is vital for nurses to
understand ethical principles and be adept at
applying them in a meaningful and consistent
manner.
A. Respect for persons
All of the principles discussed in this module
presuppose that nurses have respect for the
value and uniqueness of persons. Occasionally
viewed as an ethical principle in its own right,
respect for persons implies that 1 considers
others to be worthy of high regard. Certainly,
genuine regard and respect for others is the
moving force behind all caring professions.
Codes of nursing ethics explicitly state that
respect for persons is a cornerstone of
professional ethics. Discussion of the ethical
principles in this chapter is based upon the
belief that nurses value the principle of respect
for persons.
B. Autonomy
As you would expect, the ethical principle of
respect for autonomy denotes the ethical
obligation to honor the autonomy of other
persons. The word autonomy literally means
self-governing. Autonomy denotes having the
freedom to make choices about issues that
affect one’s life, free from lies, restraint, or
coercion. Respect for autonomy is closely linked
to the notion of respect for persons, and is an
important principle in cultures where all
individuals are considered unique and valuable
members of society.
Implied in the concept of autonomy are four
basic elements.
1. Autonomous person is respected
2. Autonomous person must be able to
determine personal goals
3. Autonomous person has the capacity to
determine personal goals
4. Autonomous person has the freedom to act
upon choices.
Patient’s bill of rights.
Magna Carta of Patient’s Rights and Obligations
Act of 2017
1. Right to Good Quality Health Care and
Humane Treatment
2. Right to Dignity
3. Right to be informed of His Rights and
Obligations as a Patient
4. Right to Choose His Physician / Health
Institution
5. Right to Informed Consent
6. Right to Refuse Diagnostic and Medical
Treatment
7. Right to Refuse Participation in Medical
Research
8. Right to Religious Belief and Assistance
9. Right to Privacy and Confidentiality
10. Right to Disclosure of, and Access to.
Information
11. Right to Correspondence and to Receive
Visitors
12. Right to Medical Records
13. Right to Health Education
14. Right to Leave Against Medical Advice
15. Right to Express Grievances
16. Right to Health
17. Right to Access to Quality Public Health Care
18. Right to a Healthy and Safe Workplace
19. Right to Medical Information and Education
Programs
20. Right to Participate in Policy Decisions
21. Right to Access to Health Facilities
22. Right to an Equitable and Economical Use of
Resources
23. Right to Continuing Health Care
24. Right to Be Provided Quality Health Care in
Times of Insolvency
Obligations of Patients
1. Know Rights
2. Provide Adequate, Accurate and Complete
Information
3. Report Unexpected Health Changes
4. Understand the Purpose and Cost of
Treatment
5. Accept the Consequences of Own Informed
Consent
6. Settle Financial Obligations
7. Respect the Rights of Health Care Providers,
Health Care Institutions and Other Patients
8. Obligation to Self
9. Provide Adequate Health Information and
Actively Participate in His/Her Treatment
10. Respect the Right to Privacy of Health Care
Providers and Institutions
11. Exercise Fidelity on Privileged
Communication
12. Respect a Physician's Refusal to Treat Him
13. Respect the Physician's Decision on Medical
Reasons based on his/lier Religious Belief
14. Ensure Integrity and Authenticity of Medical
Records
15. Participate in the Training of Competent
Future Physicians
16. Report Infractions and Exhaust Grievance
Mechanism.
Informed consent
Relates to the process by which the patients are
informed of the possible outcomes,
alternatives, and the risks of treatments, and
are required to give their consent freely. It
assures the legal protection of a patient’s right
to personal autonomy in regard to specific
treatments and procedure that may be complex
or simple. This is usually discussed in relation to
surgery or complex medical procedures.
Common intervention like immunization and
certain methods of contraceptive need
informed consent .This concept means the
patient is given the opportunity to choose a
course from alternative of action-to refuse or to
accept.

Exemption to informed consent.
Emergencies when there is no time to disclose
the information, waivers of patients who do not
want to know their prognosis or risk of
treatment.
Ethical and Legal Elements of informed
Consent.
Ethically valid consent is a process of shared
decision making based upon mutual respect
and participation , not a ritual to be equated
with reciting the contents of a form that details
the risks of particular treatment.
Major legal elements of informed consent;
Information- Includes disclosure and
understanding of the essential information: the
nature of health concern and prognosis if
nothing is done.
Consent- Implies the freedom to accept or
reject it, it means that consent to health care
intervention must be voluntary, without
coercion, force or manipulation from healthcare
provider and family. Coercion and manipulation
may be overt or subtle and may include
threats, rewards, deception, or inducing
excessive fear. The voluntary nature of the
consent does not prohibit the health care
provider from making recommendations or
attempting to persuade patient to accept their
suggestion but must be alert to situation which
persuasion takes on qualities of coercion and
manipulation
Paternalism
A gender biased term that literally means acting
in fatherly manner, that denotes leadership,
benevolent decision making, protection and
discipline. In nursing it carries negative
connotations, particularly related to implied
dominant male and submissive female roles.
Patient’s autonomy was frequently violated in
the name of beneficence. Professionals often
make dangerous assumption that they are
uniquely qualified to make health care decision
by the virtue of their knowledge. This kind of
thinking ignore other factors like economic,
consideration, values, role, culture and spiritual
belief.
Parentalism
Translates to professionals who restricts other
autonomy to protect the person form perceived
or anticipated harm. This is appropriate when
the patient is judged to be incompetent or have
diminished decision making capacity;
unconscious post op patient, older client,
children, and teenagers. We can consider
parentalism as an advocacy if we combine
genuine concern for the patient with well-
founded belief that the patient is unable to
make autonomous decisions.
Noncompliance
Denoting unwillingness of the patient to
participate in health care activities; taking
medications as scheduled, maintaining
therapeutic or weight loss diet, exercising
regularly, and quitting smoking
C. Confidentiality
The terms confidentiality and privacy are
interrelated. Privacy refers to the right of an
individual to control the personal information or
secrets that are disclosed to others. Privacy is a
fundamental right of individuals
(O’Keefe, 2001). The ethical principle of
confidentiality demands nondisclosure of
private or secret information about another
person with which one is entrusted. That is,
confidentiality requires that one maintain the
privacy of another. When the nurse learns
private information about a patient, the nurse
must keep that information confidential, sharing
only that information necessary to provide
patient care (ANA, 2001).
Nursing codes of ethics require that we
maintain the confidentiality of patient
information. According to the ICN Code of Ethics
for Nurses (2006), “The nurse holds in
confidence personal information and uses
judgement in sharing this information.”
Similarly, the ANA Code of Ethics for Nurses
(2001) and the CNA Code of Ethics for
Registered Nurses (2008) direct nurses to
maintain confidentiality. Confidentiality is the
only facet of patient care mentioned in the
Nightingale Pledge. This oath has been recited
for decades by graduating nurses: “I will do all in
my power to elevate the standard of my
profession and will hold in confidence all
personal matters committed to my keeping and
all family affairs coming to my knowledge in the
practice of my profession.”
Course Unit 4
Ethical Principles
Ethical issues are commonly examined in terms
of a number of ethical principles Ethical
principles are basic and obvious moral truths
that guide deliberation and action. Major ethical
theories utilize many of the same principles,
though either the emphasis or meaning may be
somewhat different in each. For example,
respect for autonomy is a dominant principle in
deontological theory but is less important in
utilitarian theory. It is vital for nurses to
understand ethical principles and be adept at
applying them in a meaningful and consistent
manner.
Continuation:
E. Fidelity
The ethical principle of fidelity relates to the
concept of faithfulness and the practice of
keeping promises. Society has granted nurses
the right to practice nursing through the
processes of licensure and certification. “The
authority for the practice of nursing is based on
a social contract that acknowledges professional
rights and responsibilities as well as
mechanisms for public accountability” (ANA,
1995, p. 3). The process of licensure is one that
ensures no other group can practice within the
domain of nursing as defined by society and the
profession. Thus, to accept licensure and
become legitimate members of the profession
mandates that nurses uphold the
responsibilities inherent in the contract with
society. Members are called to be faithful to the
society that grants the right to practice—to keep
the promise of upholding the profession’s code
of ethics, to practice within the established
scope of practice and definition of nursing, to
remain competent in practice, to abide by the
policies of employing institutions, and to keep
promises to individual patients. To be a nurse is
to make these promises. In fulfilling this
contract with society, nurses are responsible to
faithfully and consistently adhere to these basic
principles.
F. Justice
Justice is the ethical principle that relates to fair,
equitable, and appropriate treatment in light of
what is due or owed to persons, recognizing
that giving things to some will deny receipt to
others who might otherwise have received
those things. Within the context of health care
ethics, the most relevant application of the
principle focuses on distribution of goods and
services. This application is called distributive
justice. Unfortunately, there is a finite supply of
goods and services, and it is impossible for all
people to have everything they might want or
need. One of the primary purposes of governing
systems is to formulate and enforce policies that
deal with fair and equitable distribution of
scarce resources.
Decisions about distributive justice are made on
a variety of levels. The government is
responsible for deciding policy about broad
public health access issues, such as children’s
immunization and Medicare for the elderly.
Hospitals and other organizations formulate
policy on an institutional level and deal with
issues such as how decisions will be made
concerning who will occupy intensive care beds
and which types of patients will be accepted in
emergency rooms. Nurses and other health care
providers frequently make decisions of
distributive justice on an individual basis. For
example, having assessed the needs of patients,
nurses decide how best to allocate their time (a
scarce resource).
There are three basic areas of health care that
are relevant to questions of distributive justice.
First, what percentage of our resources is it
reasonable to spend on health care? Second,
recognizing that health care resources are
limited, which aspects of health care should
receive the most resources? Third, which
patients should have access to the limited
health care staff, equipment, and so forth
(Jameton, 1984)? In making decisions of
distributive justice, one must ask the question,
“Who is entitled to these goods or services?”
Philosophers have suggested a number of
different ways to choose among people.
G. Beneficence
The principle of beneficence means to do good.
It requires nurses to act in ways that benefit
patients. Beneficent acts are morally and legally
demanded by the professional role (Beauchamp
& Walters, 2007). The objective of beneficence
provides nursing’s context and justification. It
lays the groundwork for the trust that society
places in the nursing profession, and the trust
that individuals place in particular nurses or
health care agencies. Perhaps this principle
seems straightforward, but it is actually very
complex. As we think about beneficence, certain
questions arise: How do we define beneficence
—what is good? Should we determine what is
good by subjective, or by
objective, means? When people disagree about
what is good, whose opinion counts? Is
beneficence an absolute obligation and, if so,
how far does our obligation extend? Does the
trend toward unbridled patient autonomy
outweigh obligations of beneficence? Veatch
(2002) asks whether the goal is really to
promote the total well-being of the patient or to
promote only the medical well-being of the
patient. We must keep these questions in mind
as we practice.
The ethical principle of beneficence has three
major components: do or promote good,
prevent harm, and remove evil or harm.
Beneficence requires that we do or promote
good (Beauchamp & Childress, 2008). Even with
the recognition that good might be defined in a
number of ways, it seems safe to assume that
the intention of nurses in general is to do good.
Questions arise when those involved in a
situation cannot decide what is good. For
example, consider the case of a patient who is
in the process of a lingering, painful, terminal
illness. There are those who believe that life is
sacred and should be preserved at all costs.
Others believe that a natural and peaceful
death is preferable to an extended life of pain
and dependence. The definition of good in any
particular case will determine, at least in part,
the action that is to be taken. The principle of
beneficence also requires us to prevent or
remove harm (Beauchamp & Childress, 2008). In
fact, some believe that doing no harm, and
preventing or removing harm, is more
imperative than doing good. All codes of nursing
ethics require us to prevent or remove harm.
For example, the International Council of Nurses
(ICN) Code of Ethics for Nurses (2006) says, “The
nurse takes appropriate action to safeguard
individuals, families and communities when
their care is endangered by a co-worker or any
other person.” Similarly, the Canadian Nurses
Association (CNA) Code of Ethics for Registered
Nurses (2008) says, “Nurses question and
intervene to address unsafe, non-
compassionate, unethical or incompetent
practice or conditions that interfere with their
ability to provide safe, compassionate,
competent and ethical care to those to whom
they are providing care, and they support those
who do the same”
H. Non Maleficence
The principle of nonmaleficence is related to
beneficence. Whereas beneficence requires us
to prevent or remove harm, nonmaleficence
requires us to avoid actually causing harm.
Included in this principle are deliberate harm,
risk of harm, and harm that occurs during the
performance of beneficial acts. Most ethicists
today tend toward the Hippocratic tradition that
says to first do no harm (the principle of
nonmaleficence), placing this principle above all
others. It is obvious that we must not commit
acts that cause deliberate harm. This principle
prohibits, for example, experimental research
when it is fairly certain that participants will be
harmed, and the performance of unnecessary
procedures for economic gain or solely as a
learning experience.
Non maleficence also means avoiding harm as a
consequence of doing good. In such cases, the
harm must be weighed against the expected
benefit. For example, sticking a child with a
needle for the purpose of causing pain is always
bad—there is no benefit. Giving an
immunization, on the other hand, while causing
similar pain, results in the benefit of protecting
the child from serious disease. The harm caused
by the pain of the injection is easily outweighed
by the benefit of the vaccine. In day-to-day
practice, we encounter many situations in which
the distinction is less clear, either because the
harm may appear to be equal to the benefit
gained, because the outcome of a particular
therapy cannot be assured, or as a result of
conflicting beliefs and values. For example,
consider analgesia for patients with painful
terminal illness. Narcotic analgesia may be the
only type of medication that will relieve very
severe pain. This medication, however, may
result in dependence and can hasten death
when given in amounts required to relieve pain.
Principle of double effect
The first principle that proposes to distinguish
between a good and an evil is the theory of
double effect. Derived from Summa Theologica,
the principle has four key points:
 The act must be good, or at least morally
neutral, independent of its consequences.
 The agent intends only the good effects, not
the bad effect.
 The bad effect must not be a means to the
good effect. If the good effect were to be the
causal result of the bad effect, the agent would
intend the bad effect in pursuit of the good
effect
 The good effect must outweigh the bad effect.
The theory of double effect has use in medical
ethics when dealing with abortion, euthanasia,
and other decisions where there is a conflict
between a good and an evil. For example, under
this view, abortion is an evil, but saving the life
of a mother is a good. Under this view,
euthanasia is an evil, but relieving pain by the
use of morphine is a good. If the person dies
and the death was not intended, then is it
acceptable? Major issues arise in the application
of the theory concerning how to determine a
person’s intent.
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
 Formal cooperation - occurs when a person or
organization freely participates in the actions of
a principal agent. Implicit formal cooperation
occurs when even though the cooperator denies
intending the object of the principal agent, the
cooperator participates in the action.
 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. A debate on
about duress wherein an act was done at gun
point.
 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
The Common Good
The term the "common good" has been used in
various contexts to identify actions or outcomes
that have some definable benefit that extends
beyond individual gain. The common good has
been addressed in professional literature
pertaining to ethics, political action, the
environment, nursing, and health care.
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; literature exploring the
common good as a concept of use to nursing
and health care is very limited. However,
nursing is viewed as promoting the common
good. 8 In addition, the development of nursing
as a discrete profession reflects societal
recognition that the constellation of services
provided by nurses is supportive of the common
good. Although nursing literature does not
address the common good from a theological
perspective, it clearly addresses related
concepts such as concern for the whole
person in the community and outcomes
associated with the common good, such as
distributive justice. 9 Consistent with the
Catholic perspective of the common good, 10
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.
Course Unit 5
Principle of Stewardship
Requires us to appreciate 2 great gifts that a
wise and loving God has given; the earth,
with all the natural resource and out own
human nature, with its biological, psychological,
social and spiritual capacities. This principle is
grounded in the presupposition that God has
the absolute domain over creation and that in
so far as man are made in God’s image and
likeness, we have given the limited dominion
over creation and are responsible for care.
Gifts of human life and environment be used
with profound respect. Human creativity should
be used to cultivate nature, recognizing our
limitation and the risk of destroying these gifts.
The principles of stewardship includes but not
reducible to concern scarce resources.
Role of nurses as stewards
Personal - Although the nurse steward ought to
structure educational opportunities that
encourage nurses to shift their epistemology of
practice, integrating a virtue-based practical
reasoning, a gap remains to be filled by the
steward’s theoretical lens. MacIntyre’s theory of
virtue ethics, which is founded in Aristotle’s
concept of phronesis, provides such a lens. This
theory extends understanding of virtue-based
practical reasoning, due to its explanation of
how character qualities - or self-identity -
influence practical reasoning, specifically how a
moral insight may be evoked through a critical
appraisal of situations generating conflict and
ambiguity. The nature of lived experiences may
be appraised through drawing on experience,
understanding and values, as well as a
continuous dialogue between the experience
and theory and practice. This theory finds itself
dual premised: it embraces a form of realism,
specifically, that human experience and
sensitivity can yield a knowledge of moral reality
whose properties exist outside subjective
awareness; and secondly, it is grounded in a
teleological form of understanding that accepts
the end’s or goal’s primacy.

Social- Nurses advocate for the health
promotion educate patients and public on the
prevention of illness and injury, provide care
and assist in cure, participate in rehabilitation
and provide support. Nurses help families
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 to cope with their illness and deal
with it and if necessary live with it, so that their
normal life can continue.
Ecological – Nurses can help with waste
management. Health care sectors generates
tons of waste from the hospitals and since
nurses are the frontlines of care, they can be
helpful in coming up with policies about
hospital waste segregation and recycling. Nurses
can lead a way for communities to have a more
sustainable way of living.
Biomedical – Over the past decades, the nursing
profession has faced a tremendous
advancement in technology and medical
practice, a nurse should be familiar and well
versed with new equipment and tools that are
being used in the hospital and other clinical
setting. According to the theory of Locsin,
entitled Technological competency as caring in
nursing, a nurse can be a steward of patients if
they know how to use technology to their
advantage.
Principle of Totality and Its Integrity
The principle of totality states that all decisions
in medical ethics must prioritize the good of the
entire person, including physical, psychological
and spiritual factors. The principle of totality is
used as an ethical guideline by Catholic
healthcare institutions.
Ethico-moral responsibility of nurses in surgery
Though often difficult, ethical decision making is
necessary when caring for surgical patients.
Perioperative nurses have to recognize ethical
dilemmas and be prepared to take action based
on the ethical code outlined in the American
Nurses Association's (ANA's) Code of Ethics for
Nurses with Interpretive Statements.
Perioperative nurses often find ethical decisions
difficult to make, but necessary when caring for
surgical patients in practice. Perioperative
nurses need to be able to recognize ethical
dilemmas and take appropriate action as
warranted. They are responsible for nursing
decisions that are not only clinically and
technically sound but also morally appropriate
and suitable for the specific problems of the
particular patient being treated. The technical
or medical aspects of nursing practice answer
the question, “What can be done for the
patient?” The moral component involves
the patient's wishes and answers the question,
“What ought to be done for the patient?”
SUPPORTING PATIENT RIGHTS AND CHOICES
Perioperative nurses are 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.
Nurses have an obligation to be knowledgeable
about the moral and legal rights of their
patients and to protect and support those
rights. Health care does not occur in a vacuum,
so perioperative nurses must take into account
both individual rights and interdependence
in decision making. By doing so, nurses can
recognize situations in which individual rights to
self‐determination in health care temporarily
should be overridden to preserve the life of the
human community. For example, during a
bioterrorism attack, victims infected with
transmissible organisms (eg, small pox) require
infection control measures to prevent
transmission to others. These infection control
measures may require isolation, resulting in
restricting a patient's right to freedom of
movement to protect others. Perioperative
nurses preserve and protect their patients'
autonomy, dignity, and human rights with
specific nursing interventions, including
supporting a patient's participation in decision
making, confirming informed consent, and
implementing facility advance directive
policies.7 Perioperative nurses explain
procedures and the OR environment
before initiating actions, and they respect
patients' wishes in regard to advance directives
and end‐ of‐life choices. Perioperative nurses
help patients make choices within their scope of
care as applicable. They also provide patients
with honest and accurate answers to their
questions, especially related to perioperative
teaching, and formulate ethical decisions with
help from available resources (eg, ethics
committee, counselors, ethicists). Patients have
the right to self‐ determination (ie, the ability to
decide for oneself what course of action will be
taken in various circumstances). The nurse, as a
moral agent for the patient, must be ready and
able to advocate for the patient's rights and
needs whenever necessary while providing care.
Assuming such a stance involves acting on
ethical principles and values. Nurses must be
prepared to identify advocacy issues and take
action on them as needed. The nurse‐patient
relationship not only allows the nurse to
support the patient, but it also supports the
nurse. Nurses can empower patients by
providing opportunities for them to make
autonomous decisions about their health care.
They can support patient empowerment
through education about appropriate
administrative protocols (eg, patients' rights,
hospital policies, procedures) that best meet
individual patient's needs. When dealing with
informed consent, the nurse's role is to validate
that the patient has been given the information
and understands as much as is possible about
the surgical intervention. The nurse's
assessment includes determining whether the
patient has any additional questions that might
require another discussion with the physician.
The nurse also assesses the level of decision
making the patient is able to demonstrate. The
principle of autonomy provides for patients
to make decisions freely, even if those decisions
are against medical advice. The criterion that
must be met is that the patient is an adult who
is capable of making decisions and has been
given the information necessary to make an
autonomous choice. Even if a surgeon and nurse
believe that surgery is in the best interest of the
patient, the patient has the right to refuse the
procedure at any time, regardless of whether he
or she signed a surgical consent form. Nurses
ethically should support patients in their
choices, regardless of whether they agree with
the patient's decision. Nursing assessment and
care also applies to situations in which patients
identify advance directive choices or decisions
related to do‐not‐resuscitate orders. It is the
nurse's role to ensure that surgical team
members are aware of a patient's wishes in
these matters. It is important that all team
members and the patient discuss and identify a
plan of care before beginning the surgical
procedure.
ETHICAL DILEMMAS
Perioperative nurses often are faced with an
ethical dilemma when a patient is anxious
because he or she does not understand fully
what is going to happen in surgery and the
nurse is being pressured for a fast turnover
time. The nurse is faced with conflicting
expectations (ie, the patient's emotional needs,
expectations to be efficient). Nurses following
the ethical principles of compassion and respect
would place a patient's emotional needs above
expediting the surgical schedule. In addition,
there may be times when a perioperative nurse
is told to get the patient's signature on a
consent form. Nurses must realize that they are
not being asked to provide informed consent for
the patient. In cases such as these, the nurse
merely is acting as a witness to the identity of
the patient and to the patient's signature on the
consent form. If a nurse is present at the time
the patient signs the consent, it is a good
opportunity to once again assess the patient's
level of understanding and see if he or she
wishes to further discuss the proposed
intervention with the physician.

Sterilization and Mutilation
Sterilization refers to any process that
eliminates, removes, kills, or deactivates all
forms of life and other biological agents.
Female genital mutilation (FGM) comprises all
procedures that involve partial or total removal
of the external female genitalia, or other injury
to the female genital organs for non-medical
reasons.
Preservation of bodily functional integrity
Principle of integrity refers to every individual’s
duty to preserve the view of the human person
in which the order/function of the body and its
systems are respected and not duly
compromised by medical interventions.
Anatomical- material or physical integrity of the
body
Functional- systemic efficiency or functionality
of the body
These principle dictates that the well-being of
the whole person must be taken into account in
deciding about any therapeutic intervention or
use of technology. Therapeutic procedures that
are likely to cause harm or undesirable side
effects can be justified only by a proportionate
benefit of the patient.
For example:
If one person is missing from the person’s body
= lack of anatomical integrity
But is one kidney is healthy, present and
functioning well =functional integrity is
preserved
Issues on Organ Donation
Organ donation is when a person allows an
organ of their own to be removed and
transplanted to another person, legally, either
by consent while the donor is alive or dead with
the assent of the next of kin. Donation may be
for research or, more commonly, healthy
transplantable organs and tissues may be
donated to be transplanted into another
person.
Common transplantations include kidneys,
heart, liver, pancreas, intestines, lungs, bones,
bone marrow, skin, and corneas. Some organs
and tissues can be donated by living donors,
such as a kidney or part of the liver, part of the
pancreas, part of the lungs or part of the
intestines, but most donations occur after the
donor has died.
Principle of ordinary and extraordinary
measures
Ordinary measures are those that are based on
medication or treatment which is directly
available and can be applied without incurring
severe pain, costs or other inconveniences, but
which give the patient in question justified hope
for a commensurate improvement in his health.
Principle of Personalized Sexuality
Sex is a social necessity for the procreation of
children and their education in the family so as
to expand the human community and guarantee
its future beyond the death of individual
members. Teaches that God created persons as
male and female and blessed their sexuality as a
great and good gift.
Course Unit 6
Bioethics and Its Application in Various Health
Care Situations
Human Sexuality and its moral evaluation
Human sexuality refers to people’s sexual
interest in and attraction to others, as well as
their capacity to have erotic experiences and
responses. People’s sexual orientation is their
emotional and sexual attraction to particular
sexes or genders, which often shapes their
sexuality. Sexuality may be experienced and
expressed in a variety of ways, including
thoughts, fantasies, desires, beliefs, attitudes,
values, behaviors, practices, roles, and
relationships.

HUMAN SEXUALITY
 Human sexuality is the capacity to have erotic
experiences and responses.
 A person's sexual orientation may influence
their sexual interest and attraction for another
person.
 Sexuality is a multidimensional phenomenon
that includes feelings, attitudes, and actions. It
has both biologic and cultural components. It
encompasses and gives direction to a person’s
physical, emotional, social, and intellectual
responses throughout life.
 Sexuality may be experienced and expressed
in a variety of ways, including through thoughts,
fantasies, desires, beliefs, attitudes, values,
behaviors, practices, roles and relationships,
which may manifest by way of biological,
physical, emotional, or spiritual
aspects.
TYPES OF SEXUAL ORIENTATION:
 Heterosexual: attracted to individuals of the
opposite sex (straight) A person who finds
sexual fulfillment with a member of the
opposite gender.
 Homosexual: attracted to individuals of the
same sex. A person who finds sexual fulfillment
with a member of his or her own sex. Many
homosexual men prefer to use the term “gay.”
“Lesbian” refers to a homosexual woman. More
recent terms are “men who have sex with men”
(abbreviated as “MWM”) and “women who
have sex with women” (WWW)
 Bisexual: attracted to both sexes. People are
said to be bisexual if they achieve sexual
satisfaction from both homosexual and
heterosexual relationships.
 Queer: attracted to the same or both sexes
and/or transgendered individuals
 Asexual: not experiencing sexual attractions
 Transexuality: molded to be the opposite sex.
A transsexual or transgender person is an
individual who, although of one biologic gender,
feels as if he or she is of the opposite gender.
Such people may have sex change operations so
that they appear cosmetically as the gender
they feel that they are.
Moral issues and the public aspect of human
sexuality
1. Rape, child molestation and sadism
considered harmful to the public and controlled
by law
2. Pornography, homosexuality, sex outside
marriage, prostitution, masturbation, and
‘unnatural’ or ‘perverted’ sex are all activities
considered by some to be against public
interest.
3. Premarital Sex -is sexual activity practiced by
persons who are unmarried. Historically,
premarital sex was considered a moral issue
which was taboo in many cultures and
considered a sin by a number of religions, but
since about the 1960s, it has become more
widely accepted, especially in Western
countries.
4. Same-Sex Marriage - (also known as gay
marriage) is marriage between two people of
the same sex. Legal recognition of same-sex
marriage or the possibility to perform a same-
sex marriage is sometimes referred to as
marriage equality or equal marriage,
particularly by supporters.
5. Masturbation -is the sexual stimulation of
one's own genitals for sexual arousalor other
sexual pleasure, usually to the point of orgasm.
6. Pornography -is the portrayal of sexual
subject matter for the purpose of sexual
arousal. Pornography may be presented in a
variety of media, including books, magazines,
postcards, photographs, sculpture, drawing,
painting, animation, sound recording, film,
video, and video games.
7. Prostitution -is the business or practice of
engaging in sexual relations in exchange for
payment or some other benefit. Prostitution is
sometimes described as commercial sex.
Marriage
Marriage is defined differently, and by different
entities, based on cultural, religious, and
personal factors.
A commonly accepted and encompassing
definition of marriage is the following: a formal
union and social and legal contract between two
individuals that unites their lives legally,
economically, and emotionally. The contractual
marriage agreement usually implies that the
couple has legal obligations to each other
throughout their lives or until they decide to
divorce. Being married also gives legitimacy to
sexual relations within the marriage.
Traditionally, marriage is often viewed as
having a key role in the preservation of morals
and civilization.
Fundamentals of marriage
Husband - A married man considered in relation
to his spouse.
Wife - A married woman considered in relation
to her spouse
Marriage License - A license that a couple must
obtain before getting married
• Monogamy - one man, one woman. All 1st
world countries are monogamous.
• Polygamy - more than one wife or
husband. Example: Islam & Fundamental
Mormons
• Bigamy – Marrying another person while
still married to someone else. It is against the
law.
• Serial Monogamy or Modified Polygamy –
Succession of marriages over time. Typical of
US marriages.
Issues on sex outside marriage
Premarital sex- Premarital sex is sexual activity
which is practiced by people before they are
married. Historically, premarital sex has been
considered a moral issue which is taboo in
many cultures and it is also considered a sin by a
number of religions, but since the sexual
revolution of the 1960s, it has become accepted
by certain liberal movements, especially
in Western countries.
Extra Marital Sex- occurs when a married
person engages in sexual activity with someone
other than their spouse. Where extramarital
sexual relations do breach a sexual norm, it may
be referred to as adultery or non-monogamy
(sexual acts between a married person and a
person other than the spouse), fornication
(sexual acts between unmarried people),
philandery, or infidelity. These terms imply
moral or religious consequences, whether in
civil law or religious law.
Adultery and Concubinage
Philippines' law criminalizes adultery and
concubinage. Both are deemed “crimes against
chastity” under the Revised Penal Code of the
Philippines and are treated as sexual infidelity in
the Family Code.
The law discriminates against wives. The crime
of adultery can be committed only by a wife and
her paramour. The husband need only prove
that his wife had sexual intercourse with a man
other than him.
The crime of concubinage can be committed
only by a husband and his concubine, but it
requires that the wife must prove that her
husband has kept a mistress in the conjugal
dwelling, or has had sexual intercourse under
“scandalous circumstances” or lived together
with his mistress in any other place.
The penalties are also quite different. For
adultery the guilty wife and her paramour may
be imprisoned for up to 6 years.
For concubinage, the husband may be
imprisoned for up to 4 years and 1 day, while his
concubine may be merely “banished” but may
not be imprisoned.
The laws work to the great disadvantage of
women. There is no divorce in the Philippines
and abandoned wives are often accused of
adultery in order to force them to agree to their
husband's petitions to nullify the marriage. The
Philippine Commission on Women reports that,
“In many cases, women who are faced by these
threats are forced to forego legitimate custodial
claims of their children while some are forced to
give up their claims over conjugal properties,
assets and the like.”
Contraception
Methods of Contraception
1. Folk methods Precoital/Poscoital Douche
Prolonged Lactation Withdrawal- coitus
interruptos, coitus reservatus
2. Mechanical methods condom Diaphragm
Sponge
3. Chemical methods Vaginal suppositories and
tablets Vaginal jellies, creams, and foams
4. Hormonal methods Contraceptive pills
Injections and implants
5. Abortifacients Intrauterine Device DES
( diethylstilbestrol Prostaglandin Antipregnancy
vaccine Low-dose of contraceptive pills
6. Surgical methods Tubal ligation Vasectomy
Hysterectomy
7. Natural or behavioral methods Rhythm or
calendar method Temperature method
Ovulation (Mucus) Method Sympto-thermal
method Sex relations during menstruation
The controversy questions around are
1. Whether individuals have a right to control
parenthood?
2. Which type of contraceptive method is best?
3. Who should practice contraceptives?
4 .At what age contraception would be used?
Age of consent
•Children who are under the age of eighteen
years may be sexually active and require health
care because of pregnancy or sexually
transmitted diseases.
•Some students ask the physician or school
nurse for birth control devices.
Application of ethical theories
Natural law ethics had two division
● Only rhythm method and abstinence
● Voluntary sterilization as WRONG
Utilitarianism
● Justify contraception and sterilization for the
greatest happiness and benefits
Pragmatism
● Contraception and sterilization is practical,
useful, and beneficial.
Course Unit 7
Artificial Insemination
Artificial insemination (AI) consist of depositing
a man’s semen in the vagina, cervical canal or
uterus through the use of instruments to bring
about conception unattained or unattainable by
sexual intercourse.
2 types of artificial insemination
1. Homologous insemination or artificial
insemination by husband (AIH)
2. Heterologous insemination or artificial
insemination by donor
Justification for AIH
A. Husband;s impotence
B. Anatomical defects of a husband’s urethra
C. Oligospermia
D. Spinal injury
E. Underwent vasectomy
F. Anatomical problem of the wife
Justification for AID
A. Azoospermia
B. Husband is carrier of a hereditary disease
C. Wife’s oocytes are defective
D. Wife’s anatomical problem
In Vitro Fertilization
• In vitro fertilization and embryo transplant
(IVF-ET)
• One or more eggs are surgically removed from
a woman’s ovary, fertilized with her husband’s
sperm in a laboratory dish and developed in the
dish for a few days after which tiny embryo is
transferred into the woman’s uterus in the hope
that pregnancy will proceed normally.
• There is complete separation of unitive and
procreative concepts
• It does not show the burden of the procedure
such as expenses, emotional frustrations, child
defects, other serious problems;
• It promotes the wrong attitude of the child
being a product and not a gift
Fundamental ethical concern
• Any intervention in the reproductive process is
that the child be brought into existence by the
NATURAL love act of married couple.
Other ethical issues
• Bypassing the natural method of conception;
• The creation of life in the laboratory;
• Fertilization of more embryos than will be
needed;
• Discarding of excess embryos;
• Unnatural environment for embryos;
• Use of untested technology;
• Not affordable for many;
• Misallocation of medical resources
• Creation of embryos, then freezing them, and
keeping them "in limbo“;
• Exposure of embryos to unnatural substances;
• Destruction of embryos in research;
• Potential to create, select and modify
embryos;
• Facilitation of the idea that embryos are
commodities;
• Financial rewards for IVF doctors dissuade
them from recommending other methods to
couples;
• Infertility is treated as a disease and not as a
symptom of underlying medical problems.
Surrogate Motherhood
SURROGACY
A surrogacy arrangement or surrogacy
agreement is the carrying of a pregnancy for
intended parents.
SURROGATE
A surrogate is a substitute or deputy for another
person in a specific role and may refer to:
Surrogate pregnancy is a type of pregnancy in
which a woman carries and gives birth to a baby
for a person who is not able to have children.
Sexual surrogate, sometimes referred to as
surrogate partners, are practitioners trained in
addressing issues of intimacy and sexuality. A
surrogate partner works in collaboration with a
therapist to meet the goals of their client.
Surrogate marriage, describes the
arrangement where a woman is infertile or dies
young and her family substitutes another
woman to bear children for the husband.
Surrogate Mothers
A surrogate mother is a woman who agrees
to carry a pregnancy to term for a subfertile
couple.
The surrogate may provide the ova and be
impregnated by the man’s sperm. In other
instances, the ova and sperm both may be
donated by the subfertile couple, or donor ova
and sperm may be used.
Surrogate mothers are often friends or family
members who assume the role out of friendship
or compassion, or they can be referred to the
couple through an agency or attorney and
receive monetary reimbursement for their
expenses.
TYPES OF SURROGACY
1. Gestational surrogacy - the child is not
biologically related to the surrogate mother,
who is often referred to as a gestational carrier.
Instead, the embryo is created via in vitro
fertilization (IVF), using the eggs and sperm of
the intended parents or donors, and is then
transferred to the surrogate This form of
surrogacy is sometimes also called “host
surrogacy” or “full surrogacy.” In most cases, at
least one intended parent is genetically related
to the child, and the surrogate is not.
This makes gestational surrogacy less legally
complicated than other forms of surrogacy
because stepparent or second-parent adoption
is not required.
How does gestational surrogacy work?
Intended parents may locate a surrogacy
opportunity on their own and pursue an
independent surrogacy with an attorney
specializing in assisted reproductive law.
Once a match has been identified, the surrogate
and intended parents will each work with an
attorney to discuss each party’s legal risks and
responsibilities, as well as surrogate
compensation.
Once everyone is in agreement and the
contracts are signed, a fertility clinic will handle
the IVF and embryo transfer process. An embryo
will be created and transferred to the surrogate
using one of the following:
1. The eggs and sperm of the intended parents,
in which case both intended parents will be
genetically related to their child
2. A donated egg fertilized with sperm from the
intended father, in which case the intended
father
will be genetically related to the child
3. The intended mother’s egg fertilized with
donor sperm, in which case the intended
mother will be genetically related to the child
4. A donor embryo or an embryo created using
donor eggs and donor sperm, in which case
neither intended parent will be genetically
related to the child From there, the surrogate
will carry the baby as if it were any other
pregnancy, and the intended parents will
welcome their child and have full legal custody
when he or she is born.
Pros and Cons of Gestational Surrogacy
Pros
Gestational surrogacy permits infertile
couples, single parents and members of
the LGBT community to complete their
families.
Gestational surrogacy consents intended
parents to maintain a genetic link to their
child.
Surrogacy gives proposed parents the
opportunity to create a meaningful relationship
with their surrogate.
Cons
Surrogacy is generally a legally complex
and costly process.
Gestational surrogacy requires intended
parents to abandon some control as
someone else carries the pregnancy for
them.
If the proposed mother is using her own
eggs in the surrogacy process, she will
have to undergo fertility treatments and
other medical procedures.
2. Traditional surrogacy - the surrogate mother
uses her own egg and is artificially inseminated
using sperm from the intended father or a
donor. The surrogate carries and delivers the
baby, and then, because she is the child’s
biological mother, must relinquish her parental
rights so that the child can be raised by the
intended parents.
Traditional surrogacy is sometimes also called
partial surrogacy or genetic surrogacy because
of the surrogate’s biological link to the child she
carries.
How Does Traditional Surrogacy Work?
• First, the intended parents will not need to
identify an egg donor because the surrogate’s
eggs will be used instead. This means the family
only needs to be matched to a surrogate who is
willing to complete a traditional surrogacy.
• Once the intended parents have found a
traditional surrogate they would like to work
with, legal contracts must be drafted and
signed.
• Traditional surrogacy uses intrauterine
insemination (IUI) to artificially inseminate the
surrogate mother using the intended father’s
sperm. IUI is less complicated, less expensive
and involves fewer medical procedures than IVF,
and this process can be repeated several
times until a pregnancy is achieved.
• From there, the surrogate will carry the baby
as if it were any other pregnancy. When the
baby is born, the surrogate will be the biological
mother and therefore has parental rights.
Pros and Cons of Traditional Surrogacy
Pros
Traditional surrogacy is usually less
expensive than gestational surrogacy.
Intended mothers do not need to undergo
medical procedures because their eggs will not
be harvested to create the embryo.
Intended mothers do not have the option of
being biologically related to their children in
traditional surrogacy.
Cons
A traditional surrogate is the biological
mother of her child, meaning she has
parental rights and the power to change
her mind and keep the baby. The intended
parents would then need to go to court to gain
custody of the child.
In some cases, intended parents will need
to complete a stepparent adoption to both
be recognized as the child’s legal parents.
ROLE OF MOTHER
New definition of a Mother
• Genetic mother - a woman whose
contribution to the child was the ovum, and
hence genes.
• Gestational mother - a woman whose uterus
was used for the nurturing and development of
an embryo into a baby.
• Social mother - a woman who rears the baby
after birth.
2 types of surrogacy arrangements
• Altruistic surrogacy - In this type of surrogacy,
the surrogate mother is not paid for her
'service'. She 'offers her womb' as an act of
'altruism'. Often there will be a pre-established
bond between the surrogate mother and the
expecting couple. Typically, the surrogate
mother is a friend or a relative.
• Commercial surrogacy - In commercial
surrogacy the surrogate mother receives
compensation for carrying the child. Often there
will be a mediating party, a surrogacy agency
that deals with all the practical arrangements
for the commissioning couple: finding a suitable
surrogate mother and dealing with all the
paperwork etc.
CONFLICTS OF SURROGATE MOTHERHOOD
• The idea of surrogate motherhood is morally
wrong
• Degrade the role and value of mother
• Put the unborn children into dangerous
circumstance.
ETHICAL ISSUES
• What if the surrogate decides to maintain her
privacy?
• What if the surrogate and the spouse violate
the abstention clause?
• What if the surrogate decides to keep the
baby?
• What if the surrogate with genetic ties
demands to visit her child?
• Is handing over a child after delivery for a fee
baby-selling?
• Do women participate in surrogacy to save
their marriage?
Abortion
What is Abortion?
Abortion (from Latin abortāre, from aboriri to
miscarry, from ab — wrongly, badly) has been
defined simply by the Collins Australian
Dictionary as the ‘premature termination of a
pregnancy by either spontaneous or induced
expulsion of a nonviable fetus from a uterus’.
Value-neutral (objective) definitions:
Opposed to abortion - ‘artificially causing the
miscarriage of an unborn child’, or ‘killing an
innocent human being’.
Support abortion - ‘terminating pregnancy’ or
‘ridding the products of unwanted/unviable
conception’.
Is Abortion Morally Permissible?
Anthropological studies suggest that abortion
has been widely practised across cultures and
throughout human history:
Chinese, Egyptian and Greek text - describes
abortion techniques
Muslim culture - permit abortion, so long as it is
procured while ‘the embryo is unformed in
human shape’.
Japan - did not introduce anti-abortion laws
until the Meiji Restoration (1869–1912).
Philippine Law on Abortion
● According to Article 2, Section 12 of the 1986
Philippine Constitution “The state recognizes
the sanctity of life and shall protect and
strengthen the family as a basic autonomous
social institution.
It shall equally protect the life of the mother
and the life of the unborn from conception.”
Revised Penal Code of the Philippines (enacted
in 1930 and remains in effect today.) Articles
256, 258 and 259 of the Code mandate
imprisonment for the woman who undergoes
the abortion, as well as for any person who
assists in the procedure, even if they be the
woman's parents, a physician or midwife.
Types of Abortion
● Natural/Spontaneous or Accidental Abortion
- The removal of the product of conception
through natural or accidental causes.
● Direct or Intentional Abortion - planned
removal of the product of conception before it
has become viable or survived.
● Therapeutic Abortion - planned removal of a
living fetus inorder to save the mother from
death or harm caused by medical problems.
● Eugenic/Selective or Abortion on Fetal
Indications - this is done once they discovered
that the fetus has anatomical defects and
cannot live outside the utero once delivered.
● Indirect Abortion - the fetus will be removed
as a secondary effect of a procedure done to
save the life of the mother.
Viewpoints on Abortion
● Conservative Viewpoint
It declares that abortion is never permissible, or
at most, is permissible if and only it is required
to save the pregnant woman’s life, as in the case
of the removal of a cancerous uterus or the
removal of the fallopian tube, or a part of it,
because of ectopic pregnancy. (Edge, R. S. and
Groves, J. R. 2018)
● Liberal Viewpoint
States that abortion is always permissible,
whatever the state of fetal development may
be. If women are truly to be liberated, this view
contends, they must ultimately have full
freedom to control their own reproductive
capacities. “The fetus has no ontological status;
it is neither an individual, human, nor a person,
but only a tissue in a woman’s uterus; therefore,
it possesses no rights and no moral status.”
(Edge, R. S. and Groves, J. R. 2018)
● The moderate or intermediate Viewpoint
It holds that abortion is morally permissible up
to certain stage of fetal development, or for
some limited set of reasons sufficient to justify
the taking of life in this or that special
circumstances. As far as the moderates are
concerned, the fetus obtains ontological status
at quickening or viability. (Edge, R. S. and
Groves, J. R. 2018)

Methods of Abortion
1. PLANTS AND PLANT PREPARATIONS
 Ruta chalepensis/graveolens
 Lycopodium saururus),
 Parsley (Petroselinum hortense),
2. PHYSICAL METHODS
 Massage and abdominal pressure are applied
by the hilot
3. INSERTION OF CATHETERS
4. DILATION AND CURETTAGE- Usually, this is
performed for pregnant women who had
already been bleeding, in which case it is called
completion curettage.
5. DRUGS These include medicines such as
 quinine, an anti-malarial;
 methylergometrin, a uterine stimulant
 methotrexate, an anti-cancer drug.
 Misoprostol (Cytotec)
6. SALT POISONING
○ A needle is inserted through the mother’s
abdomen and 50-250 ml of amniotic fluid is
withdrawn and replaced with a solution of
concentrated salt.
7. HYSTEROTOMY
○ is a form of abortion in which the uterus is
opened through an abdominal incision and the
fetus is removed, similar to a caesarean section,
but requiring a smaller incision. (Abortion.
(2007). MSN Encarta. Retrieved July 1, 2007.
Archived 2009-10-31)