BioEthics NOM 108N/ WEEK. 1-5/PPT Mrs. Yasmin Umali HUMAN SEXUALITY AND REPRODUCTION SEXUALITY + central aspect of being human throughout life which encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. GENDER IDENTITY Gender identity is inside us; i's how we feel about our ‘own gender. Gender is the way someone identifies Internally and how they choose to express themselves ‘externally GEDER EXPRESSION Gender expression is what's visible about your gender to other people. Gender expression refers to the ways that people present their gender identity to the world. This may be through clothing, haircuts, behaviors, and ther choices. SEX ASSIGNED AT BIRTH The sex (male, female, intersex) assigned to a child at birth, most often based on the childs external anatomy. Also referred to as birth sex, natal sex, biological sex, or sex. PHYSICAL AND EMOTIONAL ATTRACTION Physical altraction refers to the characteristics of a person that might make you physically or sexually attracted to them. Physical atraction can come from a. varity of factors, including someone's gender identity, ‘gender expression, or the sex they were assigned at birth. Emotional attraction relates to the characteristics of @ person that might make you emotionally or romantically attracted to them. 1[Page GENDER ROLES social role encompassing a range of behaviors and attitudes that are generally considered acceptable, appropriate, or desirable for a person based on that person's biological or perceived sex. A guy who is attracted to girls is considered heterosexual while someone who Is attracted to the same sex is called a homosexual. SEXUAL ETHICS ethics concemed with issues from all aspects of human sexuality including human sexual behavior SEXUAL CONSERVATISM ‘group of beliefs that emphasize the acceptance andor affirmation of social and normative conventions regarding sexuality, respect to traditions, and the ‘maintenance of society. + Sox is permissible between a legally married ‘man and woman. © Sexual behavior must have a morally significant goal, such as procreation SEXUAL LIBERISM Group of beliefs that emphasize the acceptance and/or affirmation of individual sexual freedom and respect for fone’s sexual autonomy. Any sexual activity between ‘consenting adults is morally fine ‘SEXUALITY: MORAL THEORIES NATURAL LAW ‘+ moral actions follow the natural course of human nature © procreation is natural and other acts, considered non-procreational are immoral ‘= supports the conventional view KANTIAN ETHICS + the basis of his general conception of morality is that actions are wrong when we treat people disrespecttully as mere objects or instruments. Itis traditional and conservative, UTILITARIANISM ‘+ any sexual act is moral based on the overall {900d it creates for everyone.BioEthics NOM 108N/ WEEK 1-5/ PPT Mrs. Yasmin Umali MORAL ISSUES ON SEXUALITY means of procreation ‘+ sterilization violates the principle of totality ‘and its integrity HOMOSEXUALITY ‘+ sexval interest in and attraction to members of one's own sex ‘= some hold the view that homosexuality is related to a mental disorder ‘= most religions discourage homosexual activities = homosexuality in the Philippines is Increasingly being tolerated + 49% view homosexual relations between consenting adults as morally wrong or ‘unacceptable ARTIFICIAL REPRODUCTION ‘+ creation of new le by other than the natural ‘means available to an organism 1) Atificial Insemination + assisted method of reproduction in which the sperm is provided typically by means of ‘masturbation and is injected into the woman's reproductive tract through a catheter + excludes the marital act from procreation + distorts the meaning and purpose of PRE-MARITAL SEX procreation ‘+ sexual relations between two people prior 2) marriage ‘+ sex before marriage is a sin against the body In-Vitro Fertilization + a medical procedure whereby an egg {ertilized by sperm in a test tube or elsewhere ‘outside the body Sho ete alae ene Caer + thical issues: disposal of spare embryos, — ‘and use of embryonic tissue in medical research 3) Surrogacy =: | Ee ‘© an arrangement, often supported by a legal WD He en ‘agreement, whereby a woman (the surrogate ro eer = i mother) agrees to bear a child for another [en@) = L & pac opr, wl Dame Oe chile’s parent(s) after bith EXTRAMARITAL SEX + Ethical issue ‘© consensual sexual intercourse by a married = social injustice: commoditcation ofthe womb person with someone other than their lawful ot women in ess developed countries spouse = iological connectivity vs contractual agreement (parenthood) CONTRACEPTION ‘© deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse 2[PageBioEthics NOM 108N/ WEEK 1-5/PPT Mrs. Yasmin Umali 4) Abortion ‘= ending of a pregnancy by removal or expulsion of an embryo or fetus types of abortion = spontaneous abortion ~ Induced abortion = motivation = personal - societal - maternal and fetal heath + ethical issues = sanctity of life = autonomy = provife vs pro-choice DIGNITY IN DEATH AND DYING Dying with Dignity. movement that promotes the ability to meet death on your own terms Suicide- assisted suicide, which is also called Physician-assisted suicide, is when a doctor gives a person the means to commit suicide when requested fori. Euthanasia. a doctor is allowed by law to end a person's life by painless means, as long as the patient ‘and their family agrees. © Voluntary: When euthanasia is conducted with consent. Voluntary euthanasia is currently legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of (Oregon and Washington in the U.S. © Non-voluntary: When euthanasia is conducted on a person who Is unable to consent due to thelr current heath condition, In this scenario the decision is made by another appropriate person, on behalf of the patient, based on their quality of life and sulfering ‘+ Involuntary: When euthanasia is performed ‘on a person who would be able to provide Informed consent, but does not, either because they do not want to die, or because they were not asked. This is called murder, as it's often against the patients will. EUTHANASIA- “ MERCY KILLING” {tis the intentional taking of the life of an ailing person, {or any of the following reasons: Incurabilty of illness, Unbearable intensity of physical or emotional pain, unbearable financial burden arising from the illness. 3/Page Types: 1. By Reason of the manner of attaining death * Active or Direct Euthanasia. the active taking Of steps by the physician or the caregiver to ‘end the life of the patient. + Passive or Indirect Euthanasia- the intentional Comission or non-administration of medical treatment to cause or hasten the death of the patient, 2. By reason of patient's consent ‘© Voluntary Euthanasia- the patient consciously and directly requests the health care provider to take the steps to put an endo the patient's, ite. + Involuntary Euthanasia- the act of seeking the death of the patient is without the patient's consent or knowledge. > Argument favoring Euthanasia: compassion for the patient and shortening the period of suffering of the patient > Argument disapproving Euthanasia: It's intrinsically wrong since it rejects lie. PHYSICIAN ASSISTED SUICIDE The pationt requests from the physician to provide the ‘means to end his ite. INVIOLABILITY OF HUMAN LIFE ‘The concept of inviolabilty is an important fle between the ethics of religion and the ethics of law, as each seeks lustifcation for its principles as based on both purity and natural concept, as well as in universality of application In religion and ethics, the inviolabilty or sanctity of ite [sa principle of mplied protection regarding aspects of sentient life that are sald to be holy, sacred, or otherwise of such value that they are not to be violated the phrase sanctity of life refers to the idea that human lite is sacred, holy, and precious, argued mainly by the prolife side political and moral debates over such controversial Issues as abortion contraception ‘euthanasia embryonic stem-cell research, and the right to die in the United States Canada, United Kingdom and other English-speaking countriesBioEthics NCM 108N/ WEEK 1-5/PPT Mrs. Yasmin Umali DYSTHANASH ‘+ Dysthanasia is a term generally used when a person s to be kept alive artificially in a condition where, otherwise, they cannot survive; sometimes for some sort of ulterior {intentionally hiddervtuture) motive. ORTHOTHANASIA: * A normal or natural manner of death and dying. Sometimes used to denote the deliberate stopping artificial or heroic means of maintaining life Passive euthanasia, see there. ADMINISTRATION OF DRUGS TO THE DYING. In Medicine, specifically in end-ot-ite care, palliative sedation is the practice of relieving distress in a terminally ill person in the last hours or days of a dying patient's fe. usually by means of a continuous Intravenous or subcutaneous infusion of a sedative drug, or by means of a specialized catheter designed to provide comfortable and discreet administration of ‘ongoing medications via the rectal route. Palliative sedation is an option of last resort for patients whose symptoms cannot be controlled by any other means. its not a form of euthanasia, as the goal of palliative sedation is to control symptoms, rather than to shorten the patient’ lite ADVANCE DIRECTIVES ‘Sometime generically called “Living Will” + Directive to Physician and Family or Surrogate ‘= Most common. Allows pt to document wishes {or tx or withdrawal, also commonly known as “Living Wilr 4|Page Medical Power of Attorney + Allows the pt to designate another person as their decision maker (Out of Hospital Do-Not-Resuscitate Order. + Allows competent adults to refuse life sustaining procedures when out of the hospital setting. Can include not wanting to be taken to ER, let me sit here and die. Declaration of Mental Health Treatment + Allows a court to determine incapacity and allows the pt to refuse Not same as DNR (do not resuscitate) ‘+ These are written during hospitalization after the doc and the pt (or pt surrogate) decide to withdrawal life sustaining treatments, Advanced Directives + are documents that state in wring the pts wishes for healthcare interventions it they should become incapacitated OTHER CONTINGENCIES ‘+ Directives unavailable / never done ‘= Autonomy versus “best interest” of clients ‘+ Substituted judgment- Legal standard that presumes the surrogate is capable of making decisions for that pt ‘+ Dementia clients Dementia diagnosis doesn't necessarily mean the pt is incapable of making their own decisions. Esp inthe first {ew stages of dementia. Ptis very alert and very aware and very much can make that decision for themselves. END OF LIFE CARE PLAN OR DNR End of life care includes palliative care. i you have an iiiness that cant be cured, based on the understanding that death is inevitable. palliative care makes you as Comfortable as possible, by managing your pain and other distressing symptoms. It also involves psychological, social and spiritualsupport for patients and their families. WHEN DOES END OF LIFE CARE BEGIN? + have an advanced incurable illness, such as ‘cancer, dementia or motor neurone disease are generally frail and have co-existing conditions that mean they are expected to die within 12 monthsBioEthics NOM 108N/ WEEK 1-5/PPT Mrs. Yasmin Ural = have existing conditions if they are at risk of dying from a sudden criss in their condition * have a life-threatening acute condition caused by a sudden catastrophic event, such as an accident or stroke NURSING ROLES AND RESPONSIBILITIES ‘+ treat people compassionately listen to people ‘communicate clearly and sensitively identity and meet the communication needs of each individual * acknowledge pain and distress and take action ‘+ recognise when someone may be entering the last few days and hours of life ‘= involve people in decisions about their care ‘and respect their wishes ‘© the person who is reaching the end of life and those important to them up to date with any cchanges in condition © document a summary of conversations and decisions + seek further advice ‘+ Look after yourself and your colleagues and ‘se0k suppor if you need it ‘= Learning from complaints = Care of the person ‘The process of making ethical decisions requires: Commitment: The desire to do the right thing regardless of the cost Consciousness: The awareness to act consistently ‘and apply moral convictions to daily behavior Competency: The abilty to collect and evaluate information, develop alternatives, and foresee potential consequences and risks Good decisions are both ethical and effective: + Ethical decisions generate and sustain trust; demonstrate respect, responsiblity, falrness ‘and caring; and are consistent with good citizenship. These behaviors provide a foundation for making better decisions by setting the ground rules for our behavior. + Effective decisions are effective if they accomplish what we want accomplished and it they advance our purposes. The key to S|Page ‘making effective decisions is to think about choices in terms of their ability to accomplish ‘our most important goals. This means we have to understand the difference between \mediate and short-term goals and longer- range goals. Ethical Decision Making Process 1. Identtying the problem + Describe the moral problem + Rights, obligations, and positions of key stakeholders identified + Whatis in contict? ‘+ Gather more information it needed 2. Planning + Decide who are the key decision makers. + Identity all possible courses of action © Compare and select which one is best. 3. Implementing Legal requirements + Provide support to stakeholders during implementation, DECISION MAKING MODEL To make ethical decisions when acting as a client advocate, the use of a decision making madelis helpful in determining how to make ethical decisions with respect to issues that arise in acting as an advocate for the client. Five step process: 1. Assessing the situation 2. Diagnosing or identifying the moral problem 3, Setting moral goals and planning an appropriate ‘moral course of action 4, Implementing the moral plan of action 5. Evaluating the moral outcomes of the action implemented